• Heart attack
• Hospital closures
• Mortality
• Patient outcomes
• Travel time

• Humans
• Male
• Italy/epidemiology
• Female
• Budgets
• Hospital Mortality/trends
• Aged
• Health Facility Closure/economics
• Health Facility Closure/statistics & numerical data
• Length of Stay/statistics & numerical data
• Middle Aged
• Patient Readmission/statistics & numerical data
• Myocardial Infarction/mortality

• Longitudinal strain
• Myocardial infarction
• Quantitative microvascular perfusion

• Humans
• ST Elevation Myocardial Infarction/physiopathology
• ST Elevation Myocardial Infarction/diagnostic imaging
• ST Elevation Myocardial Infarction/therapy
• Male
• Female
• Middle Aged
• Retrospective Studies
• Microcirculation
• Percutaneous Coronary Intervention/adverse effects
• Aged
• Coronary Circulation
• Predictive Value of Tests
• Myocardial Perfusion Imaging/methods
• Treatment Outcome
• Time Factors
• Echocardiography
• Ventricular Function, Left

• 24ZYQA029 the Central Guidance Fund for Local Science and Technology Development Reserve Project
• 19SYPYB-2 In-Hospital Cultivation Fund of Gansu Provincial Hospital
• SKLRD-OP-202504 the State Key Laboratory of Respiratory Disease-Open Project
• JCYJ20210324122410028 Shenzhen Science and Technology Program

• COVID-19
• COVID-19 testing
• Delayed care COVID-19 vaccine
• Discrimination
• Health care utilization

• 2 P30 AG015272 NIA NIH HHS

• Antithrombotic therapy
• MACE
• Major adverse cardiovascular events
• ST-elevation myocardial infarction
• STEMI

• PCI
• STEMI
• system delay
• time-to-treatment

• furin
• proprotein convertase subtilisin/kexin type 3
• protein modification
• cardiovascular diseases

• cardiac rehabilitation (cr)
• improved quality of life (qol)
• positive outcome
• post myocardial infarction (mi)
• reduced mortality and hospital readmission

• Humans
• Female
• Middle Aged
• ST Elevation Myocardial Infarction/epidemiology
• ST Elevation Myocardial Infarction/therapy
• Medically Uninsured
• Emergency Service, Hospital
• Insurance Coverage
• California/epidemiology

• R21 HL140382 NHLBI NIH HHS
• R01 HL114822 NHLBI NIH HHS
• R01 HL134182 NHLBI NIH HHS
• UL1 RR024975 NCRR NIH HHS
• UL1 TR000445 NCATS NIH HHS

• ACS
• COVID
• In-hospital delay
• Mortality

• acute coronary syndrome
• air transport
• helicopter emergency medical service

• Adult
• Female
• Humans
• Middle Aged
• Aged
• Aged, 80 and over
• Croatia/epidemiology
• Air Ambulances
• Emergency Medical Services
• Aircraft
• Hospitals, University
• Retrospective Studies

How to deal with large thrombus burdens of culprit’s blood vessel remains a great challenge in the treatment of acute myocardial infarction.

A 32-year-old Chinese man was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed that the distal end of a tortuous left circumflex was completely occluded by a large amount of thrombus. Cutted balloon-directed intracoronary artery retrograde thrombolysis (ICART) with urokinase led to the restoration of coronary blood flow. Because there was no obvious plaque rupture or artery stenosis in the coronary artery, it was only dilated, and no stent was implanted.

Cutted balloon-directed ICART can be performed effectively and safely in some STEMI patients with tortuous coronary vessels and large thrombus. (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).

Following acute myocardial infarction (MI), irreversible damage to the myocardium can only be reduced by shortening the duration between symptom onset and revascularization. While systemic hypothermia has shown promising results in slowing pre-revascularization myocardial damage, it is resource intensive and not conducive to prehospital initiation. We hypothesized that topical neck cooling (NC), an easily implemented therapy for en route transfer to definitive therapy, could similarly attenuate myocardial ischemia-reperfusion injury (IRI).

Using an in vivo mouse model of myocardial IRI, moderate systemic hypothermia or NC was applied following left coronary artery (LCA) occlusion and subsequent reperfusion, at early, late, and post-reperfusion intervals. Vagotomy was performed after late NC in an additional group. Hearts were harvested to measure infarct size.

Both hypothermia treatments equally attenuated myocardial infarct size by 60% compared to control. The infarct-sparing effect of NC was temperature-dependent and timing-dependent. Vagotomy at the gastroesophageal junction abolished the infarct-sparing effect of late NC. Cardiac perfusate isolated following ischemia had significantly reduced cardiac troponin T, HMGB1, cell-free DNA, and interferon α and β levels after NC.

Topical neck cooling attenuates myocardial IRI in a vagus nerve-dependent manner, with an effect comparable to that of systemic hypothermia. NC attenuated infarct size when applied during ischemia, with earlier initiation resulting in superior infarct sparing. This novel therapy exerts a cardioprotective effect without requiring significant change in core temperature and may be a promising practical strategy to attenuate myocardial damage while patients await definitive revascularization.

• National Institutes of Health
• Commonwealth Health Research Board
• University of Virginia

• AMI - acute myocardial infarction/STEMI
• CS - shock
• ECMO/IABP/Tandem/Impella
• MCS - mechanical circulatory support
• META - meta-analysis
• PCIC - percutaneous coronary intervention
• PPCI - primary PCI
• cardiogenic
• complex PCI

Acute coronary syndrome is a major cause of morbidity and mortality all over the world. Timely intervention in ST-elevation myocardial infarction (STEMI) in the form of primary angioplasty is the gold standard of treatment to reduce mortality and morbidity. “Time is muscle” is the phrase to impress upon the importance of time in treating patients with STEMI. Traditional treatment target included “door to balloon time” of 90 min or less. This “door to balloon time” is now rephrased as the “wire crossing time” (WCT). The European Society of Cardiology (ESC) updated its guidelines further, reducing the target of wire crossing time to 60 min.

The present study is a brief report on the door to wire crossing time status in one of the tertiary care centers of a nonmetro city. Retrospective analysis of case records was done for 79 patients admitted with acute MI who underwent primary angioplasty between November 2018 and June 2019 (pre-corrective action group). Various reasons for the delay, right from the time of the patient reaching the emergency room (ER) to the time of wire crossing, were analysed and measures were taken to reduce the delay. The post-corrective action group comprised 77 patients. The major causes of a prolonged WCT in our setup were delayed diagnosis of STEMI in ER, delay in giving consent by the patient’s relatives, financial issues, and availability of cath lab technicians during the off-duty hour. The delay in WCT in our center was 121 min. Remedial actions were taken to mitigate the problems at each step, which resulted in a reduction of delay by 20 min, i.e., to 101 min leading to a significant difference in the outcome in view of morbidity and mortality.

(1) Background: While an artificial intelligence (AI)-based, cardiologist-level, deep-learning model for detecting acute myocardial infarction (AMI), based on a 12-lead electrocardiogram (ECG), has been established to have extraordinary capabilities, its real-world performance and clinical applications are currently unknown. (2) Methods and Results: To set up an artificial intelligence-based alarm strategy (AI-S) for detecting AMI, we assembled a strategy development cohort including 25,002 visits from August 2019 to April 2020 and a prospective validation cohort including 14,296 visits from May to August 2020 at an emergency department. The components of AI-S consisted of chest pain symptoms, a 12-lead ECG, and high-sensitivity troponin I. The primary endpoint was to assess the performance of AI-S in the prospective validation cohort by evaluating F-measure, precision, and recall. The secondary endpoint was to evaluate the impact on door-to-balloon (DtoB) time before and after AI-S implementation in STEMI patients treated with primary percutaneous coronary intervention (PPCI). Patients with STEMI were alerted precisely by AI-S (F-measure = 0.932, precision of 93.2%, recall of 93.2%). Strikingly, in comparison with pre-AI-S (N = 57) and post-AI-S (N = 32) implantation in STEMI protocol, the median ECG-to-cardiac catheterization laboratory activation (EtoCCLA) time was significantly reduced from 6.0 (IQR, 5.0–8.0 min) to 4.0 min (IQR, 3.0–5.0 min) (p < 0.01). The median DtoB time was shortened from 69 (IQR, 61.0–82.0 min) to 61 min (IQR, 56.8–73.2 min) (p = 0.037). (3) Conclusions: AI-S offers front-line physicians a timely and reliable diagnostic decision-support system, thereby significantly reducing EtoCCLA and DtoB time, and facilitating the PPCI process. Nevertheless, large-scale, multi-institute, prospective, or randomized control studies are necessary to further confirm its real-world performance.

• acute myocardial infarction
• alarm system
• artificial intelligence
• deep learning
• electrocardiogram

Early diagnosis and treatment of a patient displaying symptoms of myocardial ischemia is paramount in preventing detrimental tissue damage, arrhythmias, and death. Patient-related hospital delay is the greatest considerable cause of total delay in treatment for acute myocardial infarction.

To identify patient characteristics contributing to prehospital delay and ultimately developing health interventions to prevent future delay and improve health outcomes.

A retrospective chart review of 287 patients diagnosed with ST-elevation myocardial infarction (STEMI) was evaluated to examine correlates of patient-related delays to care.

Stepwise logistic regression modeling with forward selection (likelihood ratio) was performed to identify predictors of first medical contact (FMC) within 120 minutes of symptom onset and door-to-balloon (DTB) time within 90 minutes. Distance from the hospital, being unmarried, self-medicating, disability, and hemodynamic stability emerged as variables that were found to be predictive of FMC within the first 120 minutes after symptom onset. Similarly, patient characteristics of gender and disability and having an initial nondiagnostic electrocardiogram emerged as significant predictors of DTB within 90 minutes.

Individual attention to high-risk patients and public education campaigns using printed materials, public lectures, and entertainment mediums are likely needed to disseminate information to improve prevention strategies. Future research should focus on identifying the strengths of prehospital predictors and finding other variables that can be established as forecasters of delay. Interventions to enhance survival in acute STEMI should continue as to provide substantial advances in overall health outcomes.

• Acute Coronary Syndrome/diagnosis
• Acute Coronary Syndrome/mortality
• Acute Coronary Syndrome/therapy
• Aged
• COVID-19
• Female
• Hospital Mortality/trends
• Humans
• India
• Male
• Middle Aged
• Patient Acceptance of Health Care
• Patient Admission/trends
• Percutaneous Coronary Intervention/mortality
• Percutaneous Coronary Intervention/trends
• Practice Patterns, Physicians'/trends
• Retrospective Studies
• Thrombolytic Therapy/mortality
• Thrombolytic Therapy/trends
• Time Factors
• Time-to-Treatment/trends
• Treatment Outcome

• coronary artery disease
• gender differences
• mixed methods
• patient perspective
• risk perception

• Aged
• Coronary Angiography
• Coronary Artery Disease/diagnosis
• Coronary Artery Disease/epidemiology
• Female
• Heart
• Humans
• Male
• Middle Aged
• Risk Assessment
• Risk Factors
• Sex Factors

• acute myocardial infarction
• cardiac mortality
• direct admission
• percutaneous coronary intervention
• percutaneous coronary intervention–capable hospital

• Aged
• Female
• Follow-Up Studies
• Hospitals/statistics & numerical data
• Humans
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction/mortality
• Non-ST Elevated Myocardial Infarction/surgery
• Patient Admission/statistics & numerical data
• Patient Transfer/statistics & numerical data
• Percutaneous Coronary Intervention/statistics & numerical data
• Registries/statistics & numerical data
• Risk Factors
• ST Elevation Myocardial Infarction/mortality
• ST Elevation Myocardial Infarction/surgery
• Time Factors
• Time-to-Treatment/statistics & numerical data
• Treatment Outcome

• acute coronary syndrome
• prehospital delay
• emergency medical services
• symptoms

• Acute Coronary Syndrome/diagnosis
• Acute Coronary Syndrome/epidemiology
• Acute Coronary Syndrome/therapy
• Aged
• Chest Pain/diagnosis
• Chest Pain/epidemiology
• Chest Pain/etiology
• Electrocardiography
• Emergency Service, Hospital
• Fatigue
• Female
• Humans
• Male
• Middle Aged

• F31 NR018589 NINR NIH HHS
• R21 HL140277 NHLBI NIH HHS

• Angioplasty
• Cardiac arrest
• Cardiogenic shock
• Myocardial infarction
• Registry

The coronavirus disease-2019 (COVID-19) pandemic has caused an enormous strain on healthcare systems and society on a global scale. We report a new phenomenon of medical care avoidance among patients with acute coronary syndrome, which is due to concerns about contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during hospital stay, ultimately leading to dire clinical outcomes. (Level of Difficulty: Beginner.)

• COVID-19, coronavirus disease-2019
• ECG, electrocardiography
• EMS, emergency medical services
• ICU, intensive care unit
• LAD, left anterior descending artery
• LV, left ventricular
• MI, myocardial infarction
• PCI, percutaneous coronary intervention
• SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
• STEMI, ST-segment elevation myocardial infarction
• acute coronary syndrome
• complication
• myocardial infarction

• PPCI
• STEMI
• fibrinolysis
• infarct size
• mild hypothermia

• Coronary artery disease
• Percutaneous coronary intervention

• Korean Society of Cardiology
• Korean Society of Interventional Cardiology

• ST-segment elevation myocardial infarction
• Selvester QRS score
• conservative treatment
• in-hospital mortality
• primary PCI strategy

• ST elevation myocardial infarction
• Therapeutic thrombolysis
• Thrombus
• Urokinase

Background: Various systems have employed with the objective to reduce the time from emergency medical services contact to balloon inflammation for ST-elevation myocardial infraction (STEMI) patients. The WCACG message system was used to an alternative communication platform to improve confirmation of the diagnosis and movement to treatment, resulted in shorten the door-to-balloon (D-to-B) time for STEMI patients.

Methods: We collected 366 STEMI patients admitted at the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Department of Cardiology, during the period from June 2013 to October 2015. The patients were divided into two groups one underwent the current GC processes and the other group was handled using WCACG system. We compared between two groups with several indicators including D-to-B time, duration of hospitalization, associated costs, and incidence of adverse cardiovascular events.

Results: The results show that the new method with WCACG system significantly reduced the average D-to-B time (from 100.42 ± 25.14 mins to 79.81 ± 20.51 mins, P < 0.05) compared to the GC processes, and also reduced the duration, costs and undesirable cardiac incidence during hospitalization.

Conclusions: The modified WCACG process is an applicable system to save pieces of time and efficiently integrate the opinions of experts in emergency.

• Mortality
• Myocardial infarction
• Reperfusion time

• Aged
• Brazil
• Cardiac Catheterization
• Emergency Medical Services/statistics & numerical data
• Female
• Hospitals, Teaching
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Myocardial Reperfusion
• ST Elevation Myocardial Infarction/therapy
• Time-to-Treatment

• Photoplethysmography
• classification
• feature extraction
• myocardial infarction
• second derivative

• acute myocardial infarction
• systems of care
• emergency department
• insurance

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Emergency Service, Hospital
• Female
• Humans
• Insurance Coverage/statistics & numerical data
• Insurance, Health/statistics & numerical data
• Logistic Models
• Male
• Medicaid
• Medically Uninsured/statistics & numerical data
• Medicare
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Patient Transfer/statistics & numerical data
• Risk Factors
• ST Elevation Myocardial Infarction
• United States
• Young Adult

• K12 HL109019 NHLBI NIH HHS
• K23 GM110469 NIGMS NIH HHS
• K23 HL127130 NHLBI NIH HHS

• Aged
• Cicatrix/diagnostic imaging
• Cicatrix/physiopathology
• Echocardiography
• Female
• Heart Ventricles/diagnostic imaging
• Heart Ventricles/physiopathology
• Humans
• Magnetic Resonance Imaging
• Magnetic Resonance Imaging, Cine
• Male
• Middle Aged
• Percutaneous Coronary Intervention
• Randomized Controlled Trials as Topic
• ST Elevation Myocardial Infarction/physiopathology
• ST Elevation Myocardial Infarction/surgery
• Stroke Volume
• Ventricular Dysfunction, Right/diagnostic imaging
• Ventricular Dysfunction, Right/physiopathology
• Ventricular Function, Right

• Distance
• Heart attack
• Quality of care
• Regionalization
• Spatial sorting

• Delivery of Health Care
• Geography
• Health Facility Closure
• Humans
• Myocardial Infarction/mortality
• Quality of Health Care
• Sweden/epidemiology

• Antiplatelet therapies
• Antithrombotic therapies
• Coronary thrombectomy
• Fibrinolysis
• Primary percutaneous coronary intervention
• ST-segment myocardial infarction
• STEMI receiving center

The Third Universal Definition of Myocardial Infarction (MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient’s plasma of cardiac troponin (cTn) with at least one cTn measurement greater than the 99^th percentile of the upper normal reference limit during: (1) symptoms of myocardial ischemia; (2) new significant electrocardiogram (ECG) ST-segment/T-wave changes or left bundle branch block; (3) the development of pathological ECG Q waves; (4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or (5) identification of intracoronary thrombus by angiography or autopsy. Myocardial infarction, when diagnosed, is now classified into five types. Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI. However, high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis. The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated, especially if the initial ECG is not diagnostic of MI.

There have been significant advances in adjunctive pharmacotherapy, procedural techniques and stent technology in the treatment of patients with MIs. The routine use of antiplatelet agents such as clopidogrel, prasugrel or ticagrelor, in addition to aspirin, reduces patient morbidity and mortality. Percutaneous coronary intervention (PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI. Drug eluting coronary stents are safe and beneficial with primary coronary intervention. Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein IIb/IIIa receptor antagonists and is associated with a significant reduction in bleeding. The intra-coronary use of a glycoprotein IIb/IIIa antagonist can reduce infarct size. Pre- and post-conditioning techniques can provide additional cardioprotection. However, the incidence and mortality due to MI continues to be high despite all these recent advances. The initial ten year experience with autologous human bone marrow mononuclear cells (BMCs) in patients with MI showed modest but significant increases in left ventricular (LV) ejection fraction, decreases in LV end-systolic volume and reductions in MI size. These studies established that the intramyocardial or intracoronary administration of stem cells is safe. However, many of these studies consisted of small numbers of patients who were not randomized to BMCs or placebo. The recent LateTime, Time, and Swiss Multicenter Trials in patients with MI did not demonstrate significant improvement in patient LV ejection fraction with BMCs in comparison with placebo. Possible explanations include the early use of PCI in these patients, heterogeneous BMC populations which died prematurely from patients with chronic ischemic disease, red blood cell contamination which decreases BMC renewal, and heparin which decreases BMC migration. In contrast, cardiac stem cells from the right atrial appendage and ventricular septum and apex in the SCIPIO and CADUCEUS Trials appear to reduce patient MI size and increase viable myocardium. Additional clinical studies with cardiac stem cells are in progress.

• Myocardial necrosis
• Type 1-5 myocardial infarctions
• Troponin assays
• Percutaneous coronary intervention
• Fibrinolytic therapy
• Thienopyridines
• Cardioprotection
• Bone marrow stem cells
• Cardiac stem cells

To evaluate the relationship between system delay and 30-day and long-term mortality in patients with anterior versus non-anterior ST-elevation myocardial infarction (STEMI).

We conducted a prospective observational cohort study. Patients with STEMI who were transported to the Isala Hospital, Zwolle, and underwent primary percutaneous coronary intervention (pPCI) from 2005 until 2010 were included. These patients were divided into quartiles of system delay (time from first medical contact until reperfusion therapy): Q1–Q4.

In total, 3041 patients were included in our study. 41% (n=1253) of the patients had an anterior myocardial infarction (MI) and 59% of the patients (n=1788) had a non-anterior MI. Only in patients with an anterior MI, prolonged system delay was associated with a higher mortality (30-day Q1: 2.6%, Q2: 3.1%, Q3: 6.8%, Q4: 7.4%, p=0.001; long-term Q1: 12.8%, Q2: 13.7%, Q3: 24.1%, Q4: 22.6%, p<0.001). After multivariable adjustment, prolonged system delay was associated with a higher 30-day and long-term mortality in patients with an anterior MI (30 day Q2: HR 1.18, 95% CI (0.46 to 3.00), Q3: HR 2.45, 95% CI (1.07 to 5.63), Q4: HR 2.25, 95% CI (0.97 to 5.25)); long-term Q2: HR 1.09, 95% CI (0.71 to 1.68), Q3: HR 1.68, 95% CI (1.13 to 2.49), Q4: HR 1.55, 95% CI (1.03 to 2.33)), but not in patients with a non-anterior MI.

Prolonged system delay significantly increased short-term as well as long-term mortality in patients with an anterior MI. This effect was not demonstrated in patients with a non-anterior MI. Therefore, it is of the greatest importance to minimise system delay in patients who present with an anterior MI.

• Mortality

• humans
• emergency medical services
• thrombolytic therapy
• thrombolytic therapy/adverse effects
• thrombolytic therapy/mortality
• fibrinolytic agents
• fibrinolytic agents/administration & dosage
• fibrinolytic agents/adverse effects
• hemorrhage
• hemorrhage/chemically induced
• myocardial infarction
• myocardial infarction/drug therapy
• myocardial infarction/mortality
• randomized controlled trials as topic
• time‐to‐treatment

• Emergency Medical Services
• Fibrinolytic Agents/administration & dosage
• Fibrinolytic Agents/adverse effects
• Hemorrhage/chemically induced
• Humans
• Myocardial Infarction/drug therapy
• Myocardial Infarction/mortality
• Randomized Controlled Trials as Topic
• Thrombolytic Therapy/adverse effects
• Thrombolytic Therapy/mortality
• Time-to-Treatment

• Door to Reperfusion Time
• ECG
• Health Care delivery
• Primary PCI
• STEMI

• Antiplatelet therapies
• Antithrombotic therapies
• Coronary thrombectomy
• Fibrinolysis
• Primary percutaneous coronary intervention
• ST-segment myocardial infarction
• STEMI receiving center

• Advance Care Planning
• Diagnostic Imaging/methods
• Electrocardiography
• Evidence-Based Medicine/methods
• Global Health
• Humans
• Incidence
• Myocardial Infarction/diagnosis
• Myocardial Infarction/epidemiology
• Myocardial Infarction/therapy
• Myocardial Revascularization/methods
• Survival Rate/trends

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expeditiously and by experienced operators. In spite of excellent clinical results this technique is associated with longer delays than thrombolysis and this fact may nullify the benefit of selecting this therapeutic option. Several strategies have been proposed to decrease the temporal delays to deliver PPCI. Among them, prehospital diagnosis and direct transfer to the cath lab, by-passing the emergency department of hospitals, has emerged as an attractive way of diminishing delays. The purpose of this review is to address the effect of direct transfer on time delays and clinical events of patients with STEMI treated by PPCI.

• Primary angioplasty
• Direct transfer
• ST-segment elevation myocardial infarction network
• Primary percutaneous coronary intervention
• Myocardial infarction

• Japan earthquake disaster
• ST-elevation myocardial infarction
• Tsunami
• mortality
• percutaneous coronary intervention