Sex differences in clinical and angiographic characteristics in spontaneous coronary artery dissection.

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome, mostly in women; however, differences between the sexes should be investigated. Materials & methods: Hundred consecutive patients affected by SCAD were identified; coronary lesions were classified according to the most recent classification and clinical and angiographic data of men and women were compared. Results: Men were significantly younger than women, with more cardiovascular risk factors. Lesions were prevalently classified as type 2A, type 2B or type 1; an angiographic pattern compatible with the presence of an intimal tear (types 1 and 1/2) was more represented in males. Conclusion: Sex-related differences in clinical and angiographic characteristics could help in shedding light on mechanisms that contribute to SCAD.

[Risk assessment and early predictors of survival after out-of-hospital cardiac arrest in the province of Trento, Italy]. / La valutazione del rischio e predittori precoci di sopravvivenza dopo arresto cardiaco extraospedaliero in provincia di Trento.

BACKGROUND: Early prognostication of patients experiencing out-of-hospital cardiac arrest (OHCA) remains difficult, with no recommended risk assessment tool. The aim of this study was to determine and assess the association between available variables with survival at discharge of patients with OHCA in our regional reality. METHODS: We conducted a retrospective observational study in a single-center cohort of 236 consecutive patients with OHCA and return of spontaneous circulation admitted to the S. Chiara Hospital (Trento, Italy) from 2012 to 2015. We applied a backward stepwise multivariable logistic regression performed on 26 variables significantly related to outcome to identify predictors. The final model was evaluated for discrimination with area under the curve (AUC) of a receiver operating characteristic curve and for calibration with Hosmer-Lemeshow test and with calibration belt. RESULTS: We identified four independent factors predictive of outcome: age, arterial blood pH, coronary angiography execution and intervention of helicopter. The final model presented good discrimination with an average AUC of 0.78 (95% confidence interval 0.72-0.84) and was well calibrated, as confirmed by the Hosmer-Lemeshow test (p=0.45) and the calibration belt plot (p=0.597). CONCLUSIONS: Age, arterial blood pH, coronary angiography execution and intervention of helicopter were variables predictive of outcome. Identified predictors are in agreement with the literature and relate to local reality. Accurate prognostic assessment would facilitate an earlier identification of patients who may benefit from intensive advanced post-resuscitation care.

ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks.

Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects.

[ANMCO/SIT Consensus document: Telemedicine and the emergency/urgency care network]. / Documento di consenso ANMCO/SIT: La telemedicina e la rete dell'emergenza-urgenza.

Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyze the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education and legal aspects.