ST-SEGMENT-ELEVATION MYOCARDIAL INFARCTION in COVID-19

Introduction: The Severe Acute Respiratory Syndrome Coronavirus-2 have been associated with cardiovascular adverse events including acute myocardial infarction due to a prothrombotic and hypercoagulable status, and endothelial dysfunction. Case report: We report the case of a 62-year-old women, admitted to the hospital via the emergency room for acute chest pain and dyspnea. A nasopharyngeal swab was positive for COVID19 real-time reverse transcriptase-polymerase chain reaction 11 day ago. On admission, she was hypotensive with systolic blood pressure measering 87 mmHg and tachycardic with 117 beats/min, oxygen saturation (SO2) was 94%. An 18-lead ECG revealed an infero-postero-lateral ST-elevation myocardial infarction with right ventricular involvement and a seconddegree- Mobitz Type 1 atrioventricular block. The coronary angiography from the right femoral artery showed acute thrombotic occlusion of the first diagonal branch with TIMI 0 flow and acute thrombotic occlusion of proximal right coronary artery with TIMI 0 flow. The most likely diagnosis was myocardial infarction secondary to a non-atherosclerotic coronary occlusion. The angioplasy was performed with dilatations with a semi compliant balloon, bailout implant of BMS, manual thrombus aspiration and intracoronary injection of tirofiban in the right coronary artery. The myocardial revascularization was ineffective. The patient developed significant severe hemodynamic instability and cardiac arrest for pulseless electric activity after 24 hours. Conclusion(s): The COVID-19 outbreak implies deep changes in the clinical profile and therapeutic management of STEMI patients who underwent PCI. At present, the natural history of coronary embolism is not well understood;however, the cardiac mortality rate are hight. This suggests these patients require further study to identify the natural history of the condition and to optimize management to improve outcome.

Post-Covid Myocarditis Simulating Acute Coronary Syndrome

Background: Acute myocarditis corresponds to an acute inflammation of the myocardium whose origin is most often viral. Several viruses can be incriminated to note the parvovirus B19, the virus herpes of the group 6 and to a lesser degree the virus of the hepatitis C (VHC) [18,19]. Since 2019 and with the discovery of SARS COV2 some cases of myocarditis associated with covid have been noted, this last association is rare and is present in only 5% of cases [8]. The diagnosis of myocarditis is sometimes difficult and can lead to confusion with acute coronary syndrome, especially in cases of ST-segment elevation on the EKG, hence the interest of magnetic resonance imaging, which has made it possible in recent years to reduce the rate of unnecessary coronary angiography, especially in the case of young subjects with no cardiovascular risk factors. in this context we report the case of a 33 year old patient with no cardiovascular risk factors and no medical or surgical antecedents who was admitted to the emergency department for the management of acute chest pain related to acute post-covid myocarditis, the patient was initially admitted to the cardiology intensive care unit where he was put in condition and under analgesic treatment and under therapeutic protocal of covid 19 and under anticoagulation based on low molecular weight heparin at preventive dose with a good clinical evolution he was transferred thereafter to the clinical cardiology then declared outgoing under treatment of covid 19 with an appointment of control in 1 month.

Acute Pancreatitis Following a Lower Extremity Angioplasty

Introduction: Acute pancreatitis affects a significant population globally. Usual etiologies are gallstones, alcohol, hypertriglyceridemia, medications;less frequent are trauma, hypercalcemia, infections, toxins, ischemia, anatomic anomalies, vasculitis, and idiopathic. Pancreatitis post coronary intervention is an uncommon cause with only 19 published cases in the last two decades. Being cognizant of this etiology is important given the increasing number of patients undergoing angiography. Case Description/Methods: An 81-year-old female with hypertension, diabetes, peripheral arterial disease, prior cholecystectomy underwent left lower extremity angioplasty at an outside center. Within a few hours, she started having severe epigastric pain radiating to her back, nausea, vomiting and loose bloody stool. She presented to the emergency department 24 hours after symptom onset. Epigastric tenderness was present on exam. Labs revealed leukocytosis (24,450/muL), elevated lipase (1410 U/L), elevated creatinine (1.3 mg/dL), lactate (3.1 mmol/L), calcium 9.4 mg/dL and triglycerides 161 mg/dL. Incidentally, found to be positive for COVID-19. Normal common bile duct diameter seen on sonogram. CT angiogram of the abdomen/pelvis showed acute pancreatitis, duodenal and central small bowel enteritis (Figure). She was not on any medications known to cause pancreatitis and denied alcohol use. Patient improved with analgesics and intravenous fluids. She had no recurrence of bloody stools and hemoglobin remained stable. On day 4, she was able to tolerate a regular diet, and leukocyte count and creatinine normalized. Patient did not have any COVID respiratory symptoms, and was discharged. Discussion(s): Given the temporal association to angioplasty and no other identifiable cause, acute pancreatitis was presumed to be due to the contrast used during angioplasty. Other possibilities included cholesterol embolism but no peripheral signs of cholesterol embolism were seen. Patient was an asymptomatic COVID-19 case. Although, there are case series of pancreatitis due to COVID, those were found in very sick symptomatic patients. On review of literature, cholesterol embolism was identified as a definite cause only on autopsy or laparotomy (Table). Other possible mechanisms are: high viscosity of the contrast media leading to ischemia and necrosis, contrast causing NF-kB activation followed by epithelial damage, and vasospasm. Pancreatitis after coronary angiography is rare, nonetheless, an important differential especially if there is a temporal relationship.

Coronary artery bypass grafting after iatrogenic coronary artery dissection: A single center eight years' experience

Background: Iatrogenic coronary artery dissection during diagnostic or therapeutic catheterization is a rare and mortal complication that may result in a newly developed myocardial infarction. In this study, we aimed to share the results of CABG treatment of patients with iatrogenic coronary artery dissection after coronary angiography (CAG) in our clinic. Method(s): All patients who underwent CAG or percutaneous coronary intervention (PCI) in our hospital between January 2014 and December 2021 were analyzed retrospectively and patients who underwent CABG after iatrogenic coronary artery dissection were included in the study. The dissection classification was achived according to the National Heart, Lung and Blood Institute (NHLBI) classification. Result(s): During the eight years, CAG was applied to 20,398 patients and PCI to 9583 patients. Needed to treat CABG in iatrogenic coronary artery dissection developed in 17 of the patients (0.06%). LMCA was dissected in 6 (35.3%) patients and LAD in 6 (35.3%), CX in 2 (11.8%) and RCA dissection in 3 (17.6%). 3 patients (17.6%) had an intubation time longer than 48 hours. One of them has recently had a COVID infection. Another was suffering from pulmonary edema. The other patient died on the 4th postoperative day due to low cardiac output. The length of stay in the intensive care unit was 2 (min: 1 - max: 13) days. The hospital stay was 6 (min: 4 - max: 20) days. Conclusion(s): The development of a critical clinical condition prior to surgery is strongly associated with a higher probability of early and late postoperative death. For this reason, it is clear that the treatments applied at every stage of the pre-, per-, and postoperative period are the most important determinants of the results.Copyright © 2023, CKS.

Post-infectious acute myocardial infarction following COVID-19 infection in a young patient

It is now widely known that COVID-19 can also cause various extrapulmonary manifestations. Possible mechanisms of cardiovascular damage include direct myocardial damage due to hypercoagulability caused by systemic inflammation, which may also lead to destabilisation of coronary plaques. We present a case of a 30-year-old young man following asymptomatic COVID-19 infection, who was admitted to the emergency room of the Grande Ospedale Metropolitano di Reggio Calabria, Italy, with typical chest pain. The patient had no cardiovascular disease, cardiovascular risk factors including no family history of cardiovascular disease. Urgent coronary angiography showed critical stenosis of the middle-proximal portion of the left anterior descending artery (80%) with ulcerated plaque appearance. Regardless of cardiovascular risk factors, our case report emphasises the need to determine COVID-19 status in all patients with acute myocardial infarction during this pandemic.Copyright © 2023, CKS.

The Coronavirus Double Threat: A Rare Presentation of Chest Pain in a Young Female.

Severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) led to global coronavirus disease 2019 (COVID-19) pandemic. The virus affects the respiratory system predominantly and has resulted in multiorgan complications. Myocarditis, acute coronary syndrome (ACS), cardiogenic shock, and sudden cardiac death were common cardiac manifestations of COVID-19. Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease that is previously reported in patients with COVID-19. SCAD usually occurs in a middle-aged woman with few or without any cardiovascular risk factors. The gold standard for its diagnosis is coronary angiography. The SCAD treatment recommendations depend on the hemodynamic status: conservative therapy in hemodynamically stable SCAD patients and urgent revascularization in hemodynamically unstable SCAD patients. The exact pathophysiology of COVID-19 associated with SCAD is unknown. It is considered a combination of systemic inflammatory response and localized vascular inflammation. The case reported is of COVID-19-associated SCAD in a patient with no history of cardiovascular disease later complicated by the transient ischemic attack (TIA) and left ventricular (LV) thrombus.

In-hospital outcomes of ST elevation myocardial infarction in post-COVID-19 patients.

Aim. To study clinical and anamnestic data, as well as inhospital outcomes in patients with ST elevation myocardial infarction (STEMI) with prior coronavirus disease 2019 (COVID-19) compared with previously uninfected STEMI patients. Material and methods. This prospective study included 181 patients treated for STEMI. The patients were divided into 2 groups, depending on the anti-SARS-CoV-2 IgG titer as follows: the main group included 62 seropositive patients, while the control group - 119 seronegative patients without prior COVID-19. Anamnesis, clinical and paraclinical examination, including electrocardiography, echocardiography, coronary angiography, were performed. Mortality and incidence of STEMI complications at the hospital stage were analyzed. Results. The mean age of the patients was 62,6+/-12,3 years. The vast majority were men (69,1% (n=125)). The median time from the onset of COVID-19 manifestations to STEMI was 60,00 [45,00;83,00] days. According to, the patients of both groups were comparable the severity of circulatory failure (p>0,05). Coronary angiography found that in patients of the main group, Thrombolysis In Myocardial Infarction (TIMI) score of 0-1 in the infarct-related artery was recorded much less frequently (62,9% (n=39) vs, 77,3% (n=92), p=0,0397). Patients of the main group demonstrated a lower concentration of leukocytes (9,30*109/l [7,80;11,40] vs 10,70*109/l [8,40;14,00], p=0,0065), higher levels of C-reactive protein (21,5 mg/L [9,1;55,8] vs 10,2 mg/L [5,1;20,5], p=0,0002) and troponin I (9,6 ng/mL [2,2;26,0] vs 7,6 ng/mL [2,2;11,5], p=0,0486). Lethal outcome was recorded in 6,5% (n=4) of cases in the main group and 8,4% (n=10) in the control group (p=0,6409). Both groups were comparable in terms of the incidence of complications (recurrent myocardial infarction, ventricular fibrillation, complete atrioventricular block, stroke, gastrointestinal bleeding) during hospitalization (p>0,05). Conclusion. Patients with STEMI after COVID-19, despite a more burdened history and higher levels of C-reactive protein and troponin I, compared with STEMI patients without COVID-19, did not differ significantly in clinical status, morbidity, and inhospital mortality.Copyright © 2023, Silicea-Poligraf. All rights reserved.

Complete Atrioventricular Block in COVID-19-Related Myocarditis: A Case Report

Myocarditis accompanied by a high-grade atrioventricular (AV) block is a rare manifestation of COVID-19 infection. A 53-year-old woman presented with an episode of syncope, dyspnea, dry cough, and fever. On physical examination, the patient had high blood pressure and bradycardia. Her electrocardiography displayed a complete AV block with a junctional escape rhythm. Laboratory investigations revealed leukocytosis, elevated D-dimer, a positive SARS-CoV-2 nasopharyngeal swab, and a significant elevation in troponin. No reversible cause of the AV block was found, and the complete AV block persisted after the complete treatment of COVID-19. A His bundle permanent pacemaker was then implanted. An endomyocardial biopsy demonstrated endomyocardial tissue with focal hemorrhage, fatty infiltration in the endocardium, and active chronic inflammation, supporting the diagnosis of myocarditis. Several hypotheses of complete heart block in COVID-19 infection have been proposed, including direct myocardial injury and enhanced inflammatory response. A persistent total AV block following complete COVID-19 treatment is an indication for permanent pacemaker implantation.Copyright © 2023, Iranian Heart Association. All rights reserved.

Remote Clinical Quality Management of Endovascular Care

To assess the effectiveness of remote clinical quality management of endovascular Aim care. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008-2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019-2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The Methods system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019-2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p<=0.005. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In April-December 2020 it increased up to 71.6% (p<0.001). The frequency of performing Results PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005). Remote clinical management based on telemedicine and mentoring process Conclusion technologies contributes to improving the quality of endovascular care in MI.Copyright © 2021 Angles. All rights reserved.

Impact of early readmission to the cardiac ICUon in-hospital mortality and hospital length of stay in 30,942 cardiac patients

Background: The need for cardiac intensive care unit (ICU) beds remains high in order to monitor and treat emergency patients with severe cardiovascular diseases, particularly during the COVID-19 pandemic. Therefore, timely discharge strategies from the cardiac ICU to peripheral wards are crucial to meet the increasing demand for cardiac ICU beds. Early patient transfer from ICU to the peripheral ward may result in worsening of the patient's clinical condition and outcome with readmission to the ICU, while late transfer may require prolonged expert care and generate unwanted costs. Purpose(s): To investigate whether unplanned readmission of cardiac patients to the cardiac ICU within 72 hours after the index ICU stay is associated with increased mortality risk (primary outcome) and prolonged total hospital length of stay (LOS) (secondary outcome), as well as to identify predictors of ICU readmission in cardiac patients. Method(s): Adult patients who were admitted to the cardiac ICU due to a primary cardiac admission diagnosis at a tertiary care center between 2003 and 2021 were included. Outcomes were analysed with multivariable regression models adjusted for 26 a priori defined variables on patient demographics, underlying comorbidity levels, ICU procedures and administered ICU drugs. Result(s): 30,942 cardiac patients were included, out of whom 1,499 patients (4.84%) were readmitted to the cardiac ICU within 72 hours. 1,023 (68.2%) of readmitted patients were male. Compared to non-readmitted patients, readmitted patients were older, had more underlying comorbidities (Charlson Index), had more severe disease courses (SOFA score, TISS, APACHE II score and SAPS), as well as required more frequently vasopressor therapy, renal replacement therapy and coronary angiographies (Table 1). Readmission to the cardiac ICU was associated with higher in-hospital mortality risk (Odds Ratio 7.52, 95% Confidence Interval (CI) 4.15-12.27, P<0.001) and prolonged hospital LOS (Incidence Rate Ratio 1.56, 95% CI 1.15-1.58, P<0.001). Patients who were readmitted to the ICU had been discharged 18% earlier during the index ICU stay compared to non-readmitted patients (P<0.001). Of note, readmitted and nonreadmitted patients had similar vital parameters at time of ICU discharge after their index ICU stay. During the index ICU stay, non-readmitted patients were prescribed more beta blockers (65.3% vs. 45.8%), ACE inhibitors (37.0% vs. 27.2%) and blood transfusions (10.7% vs. 7.7%). Conclusion(s): Early readmission to the cardiac ICU was associated with increased in-hospital mortality and prolonged hospitalisation. Readmitted patients had been discharged earlier from their index ICU stay and required more comprehensive critical care. ICU discharge strategies should optimally be based on objective patient assessments to facilitate patient safety and shorten hospital length of stay. Artificial intelligence-based algorithms may support clinicians with safe ICU discharge. (Table Presented).

Multivessel Epicardial Coronary Artery Thrombosis after Heart Transplantation

Introduction: Although cardiac allograft vasculopathy (CAV) remains one of the leading causes of graft failure after heart transplantation (HTx), simultaneous thrombosis of multiple epicardial coronary arteries (CA) is an uncommon finding. Case Report: A 43-year-old male patient with non-ischemic dilated cardiomyopathy underwent successful HTx in 2019. The first two years after HTx were uneventful, surveillance endomyocardial biopsies (EMB) did not reveal any rejection episodes, coronary CTA revealed only minimal non-calcified CA plaques. The patient was admitted to hospital due to fever and chest pain in 2021. Immunosuppressive therapy consisted of tacrolimus, mycophenolate-mofetil and methylprednisolone. ECG verified sinus rhythm. Laboratory test revealed elevated hsTroponin T, NT-proBNP and CRP levels. Cytomegalovirus, SARS-CoV-2-virus and hemoculture testing was negative. Several high-titre donor-specific HLA class I and II antibodies (DSAs;including complement-binding DQ7) could have been detected since 2020. Echocardiography confirmed mildly decreased left ventricular systolic function and apical hypokinesis. EMB verified mild cellular and antibody-mediated rejection (ABMR) according to ISHLT grading criteria. Cardiac MRI revealed inferobasal and apical myocardial infarction (MI);thus, an urgent coronary angiography was performed. This confirmed thrombotic occlusions in all three main epicardial CAs and in first diagonal CA. As revascularization was not feasible, antithrombotic therapy with acetylsalicylic acid, clopidogrel and enoxaparin was started for secondary prevention. Tests for immune system disorders, thrombophilia and cancer were negative. Patient suddenly died ten days after admission. Necropsy revealed intimal proliferation in all three main epicardial CAs, endothelitis, thrombosis, chronic pericoronary fat inflammation, fat necrosis, and subacute MI. CA vasculitis owing to persistent high-titre DSAs, chronic ABMR and acute cellular and antibody-mediated rejection led to multivessel CA thrombosis and acute multiple MI. ABMR after HTx may be underdiagnosed with traditional pathological methods. Pathologies affecting coronary vasculature of HTx patients with DSAs, unique manifestations of CAV lesions and occlusive thrombosis of non-stenotic, non-atherosclerotic lesions should be emphasized.Copyright © 2023

Takostubo syndrome during the COVID-19 pandemic: A single center experience

Background: Takotsubo syndrome (TTS) is a major psychosomatic cardiovascular disease. It has been suggested that in the current pandemic of coronavirus disease 2019 (COVID-19), the psychological, mental and physical consequences of the restrictive measures taken to combat the pandemic, is likely to make individuals more vulnerable to TTS. Purpose(s): In our study, we investigated whether TTS incidence has increased during the COVID-19 era in a major tertiary hospital in Athens. Method(s): The study population included 316 consecutive patients admitted to the Coronary Care Unit (CCU) of our hospital throughout the 16 months (March 2020-June 2021) pandemic COVID-19 with the initial diagnosis of acute coronary syndrome (ACS). For comparison 342 patients with ACS admitted to CCU during the 16 months period preceding the COVID- 19 pandemic (November 2018-February 2020) were analyzed. All ACS patients underwent coronary angiography within 48 hours of admission. A prerequisite for admission to CCU of all ACS patients during the pandemic period was a negative reverse transcription-polymerase chain reaction test for COVID-19. Result(s): The vast majority (95%) of TTS patients were women and the mean age was 71.1+/-15.4 years. There was a significant increase in the incidence of TTS during the 16 months COVID-19 period (6.3%, i.e., 20 TSS among 316 ACS patients) compared with the corresponding incidence of TTS 16 months prior the pandemic (2.6%, i.e., 9 TTS among 342 ACS patients) [Figure 1]. The incidence rate ratio comparing the TTS cases of COVID-19 pandemic period to the pre-pandemic period was 2.22 (95% CI: 0.97-5.54, p=0.021). Conclusion(s): COVID-19 pandemic was associated with a significant increase in the incidence of TTSprobably due to the additional psychological burden imposed by the pandemic. (Figure Presented).

COVID-19 and Spontaneous Coronary Artery Dissection: Association or Causality

Clinical Information Patient Initials or Identifier Number: JS Relevant Clinical History and Physical Exam: A 55-year old woman was brought to emergency department complaining of sudden onset squeezing chest pain radiating to her arm and jaw and associated with giddiness. She had flu like illness a day prior to her presentation associated with malaise, arthralgia and dry cough. She had history of hypertension. Physical examination revealed dual heart sounds and clear lung fields to auscultation. Relevant Test Results Prior to Catheterization: Electrocardiogram (ECG) showed normal sinus rhythm and the cardiac enzymes were elevated;high sensitivity troponin-I, 23000 ng/L (range0-10 ng/L). RNA PCR was positive for SARS-CoV-2 (COVID-19). D-Dimer was 303microgram/L (normal <500). Transthoracic echocardiogram showed severe hypokinesis of the mid inferolateral wall with left ventricular ejection fraction (LVEF) 52%. Chest X-ray showed no focal consolidation. [Formula presented] [Formula presented] Relevant Catheterization Findings: Invasive coronary angiogram showed tortuous coronary arteries with abrupt narrowing of mid- distal Ramus Intermiedius and discrete lesion of mid PDA. SCAD (spontaneous Coronary dissection) of Ramus Intermedius and mid PDA (posterior descending artery) was suspected, and patient was treated conservatively. Repeat coronary angiography, few months later showed complete resolution of SCAD with normal appearance of affected vessels. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: After obtaining an informed consent right Radial access was achieved with 6F Terumo sheath using over the wire technique. 1% lignocaine was used as local anaesthetic. 5F JL 3.5 (Judkin's) and JR 4 catheters were used to engage left main stem (LMS) and right coronary artery (RCA) and selective coronary angiography was performed. No percutaneous coronary intervention was performed. After the procedure hemoband (TR band) was applied to access site. Patient remained hemodyanamically stable throughout the procedure. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): SCAD is a potential cause of type II myocardial infarction in patients with COVID-19, but more studies are needed to establish causality. Infection-related SCAD may occur at any time during index events and could be difficult to diagnose. Conservative management seems like a safe strategy.Copyright © 2023

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study.

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

Specific characteristics of STEMI in COVID-19 patients and their practical implications: A systematic review

Introduction: STEMI is one of the cardiac emergencies whose management has been mostly challenged by the COVID-19 pandemic. Patients presenting with the "lethal combo" of STEMI and concomitant SARS-CoV- 2 infection have faced dramatic issues related to need for self-isolation, systemic inflammation with multi-organ disease, and difficulties to obtain timely diagnosis and treatment. Method(s):We performed a systematic search of three electronic databases from February 1st 2020 to January 31st 2022. We included all studies reporting crude rates of in-hospital outcomes of STEMI patients with concomitant COVID-19. Result(s): A total of 9 observational studies were identified, mainly conducted during the first wave of the pandemic. STEMI patients with COVID -19 were more likely Afro-American and displayed higher rates of hypertension and diabetes with lower smoking prevalence. Associated comorbidities, including coronary artery disease, prior stroke and chronic kidney disease were also more common in those with SARS-CoV-2 infection. At coronary angiography, a higher thrombus burden in COVID-19 positive STEMI patients was highlighted, with up to 10-fold higher rates of stent thrombosis and greater need for glycoprotein IIb/IIa inhibitors and aspiration thrombectomy;this was not always associated with prolonged times from symptom onset to hospital admission and door-to-balloon. COVID-19 positive STEMI patients were less likely to receive coronary angiography and primary PCI, and more likely to be treated with fibrinolytics only. At the same time, patients with Covid-19 were more prone to present MINOCA. In-hospital mortality ranged from 15% to 40%, with consistent variability across different studies and subjects who tested positive for SARS-CoV- 2 did also present higher rates of cardiogenic shock, cardiac arrest, prolonged ICU stay, mechanical ventilation, major bleeding, and stroke. Conclusion(s): The coexistence of STEMI and COVID-19 was associated with increased in-hospital mortality and poor short-term prognosis. This was not entirely attributable to logistic issues determining delayed coronary revascularization, since patients' specific clinical and angiographic characteristics, including higher burden of cardiovascular risk factors and greater coronary thrombogenicity might have substantially contributed to this trend. (Figure Presented).

Myocardial infarction with non-obstructive coronary arteries (MINOCA) complicating myocarditis

Myocarditis can lead to myocardial infarction in the absence of coronary artery obstruction. We report a case of probable myocarditis, complicated by myocardial infarction with non-obstructive coronary arteries. A 19-year-old man presented with chest pain typical of myocarditis. He was a smoker but was otherwise well. Electrocardiogram revealed diffuse ST-elevation and echocardiography revealed a thin, akinetic apex. Troponin-T levels on admission were raised leading to an initial diagnosis of myocarditis being made. However, late gadolinium enhancement study on cardiac magnetic resonance imaging demonstrated transmural enhancement typical of ischaemia. Coronary angiogram was normal, leading to a likely diagnosis of myocardial infarction with non-obstructive coronary arteries. It is important to highlight that coronary assessment remains important when working up for myocarditis, as myocardial infarction with non-obstructive coronary arteries can often complicate myocarditis in cases of normal angiography. Another important lesson was on how cardiac magnetic resonance imaging provided vital evidence to support underlying ischaemia despite normal coronary angiogram, leading to a diagnosis of myocardial infarction with non-obstructive coronary arteries. Myocardial infarction with non-obstructive coronary arteries remains a broad 'umbrella' term and cardiac magnetic resonance imaging, as well as more invasive coronary imaging techniques during angiography, can further assist in its diagnosis. Our case provides a reminder that myocardial infarction with non-obstructive coronary arteries, although increasingly recognised, remains under-diagnosed and can often overlap with peri-myocarditis, highlighting the need to employ multi-modality imaging in guiding management.Copyright © The Author(s) 2021.

Successful Use of Biventricular Assist Devices in Fulminant Myocarditis

Background Fulminant myocarditis can cause biventricular dysfunction with a mortality rate over 40%. We report a case with severe biventricular failure due to fulminant myocarditis that was successfully supported by left and right ventricular assist devices. Case A 65-year-old woman presented with chest pain, abdominal pain and diarrhea. She was hypotensive and labs revealed elevated troponin-T of 13.5 ng/mL and lactate of 4.3 mmol/L. She was positive for COVID by antigen testing. She was started on multiple vasopressor infusions and admitted to the intensive care unit. Echocardiogram revealed a severely reduced left ventricular ejection fraction of 15% and severe global hypokinesis. The following day, she developed a wide complex tachycardia that was refractory to amiodarone, lidocaine and multiple defibrillation attempts. She was transferred emergently to the cardiac cath lab where coronary angiography revealed an isolated 70% stenosis of the distal left circumflex artery. A Swan-Ganz catheter was placed that yielded a cardiac index by Fick of 1.2 L/min/m2, systemic vascular resistance of 1270 dynesseccm-5 and mixed venous oxygen saturation of 35%. Decision was made to emergently insert an Impella CP device. That evening, she developed complete heart block and transvenous pacing wire was inserted. Due to frequent suction alarms, decision was made to insert ProtekDuo device, which resulted in hemodynamic stabilization. A temporary coronary sinus pacing lead for atrial capture was inserted to improve atrioventricular synchrony. After several days of monitoring, repeat echocardiogram showed complete recovery of biventricular function and Impella CP and ProtekDuo devices were removed. Decision-making The decision of early implantation of ProtekDuo device was made to provide adequate blood flow to the left ventricular assist device for hemodynamic support. In addition, increased atrioventricular synchrony via insertion of temporary coronary sinus pacing wire improved cardiac output. Conclusion Fulminant myocarditis involving biventricular dysfunction can be supported by the use of simultaneous left and right ventricular assist devices.Copyright © 2023 American College of Cardiology Foundation

The SWISS PCI Survey - coronary and structural heart interventions in Switzerland 2020

For almost 35 years, the Swissworking Group for interventional Cardiology of the Swiss Society of Cardiology has evaluated and assessed the invasive diagnostic and therapeutic heart interventions performed annually in Switzerland.the aim of this survey, which was completed by 36 centres using a standardised questionnaire, was to report the data for the year 2020. Overall, 53,088 coronary angiographies with 48.8% subsequent percutaneous coronary interventions, i.e., 8.6% less than in 2019, were performed. regarding structural interventions, there were 1790 transcatheter aortic valve implantations, with a decrease of 6.4% compared with 2019.this decrease was most likely due to the coronavirus disease (COvid-19) pandemic and its consequences on the Swiss healthcare system.Copyright © 2021 Edizioni Minerva Medica.

SAME DAY DISCHARGE VIA A DEDICATED RADIAL LOUNGE-RESULTS of 1-YEAR EXPERIENCE during the COVID-19 PANDEMIC

Background: Same day discharge (SDD) is a validated option for selected patients (pts) undergoing coronary angiography (CAG) and percutaneous coronary interventions (PCI). We analyzed how the COVID-19 pandemic influenced patients' admissions to and discharges from our SDD radial lounge. We focused on safety and complications. Method(s): In 2021, 817 pts (age 65+/-11 years, 28% female) were admitted to the lounge. CAG was performed in 729 pts, and 176 (24%) underwent ad hoc PCI. Furthermore, 88 pts were admitted for implantable device replacement procedures. Result(s): Out of 729 transradial CAGs 621 were performed by using the proximal radial approach (PRA) and 108 (15%) via the distal radial approach (DRA). Ninety % of all these procedures (n = 655) were performed from the nondominant left hand. PRA was associated with one radial artery occlusion (RAO) and longer compression time (92+/-24 min vs 75+/-26 min, p <0.05). In the PRA group 23 postprocedural local hematomas <5 cm (3%) and 17 hematomas <10 cm (2%) were observed but did not require specific treatment. DRA was associated with only 4 super-ficial hematomas <2 cm and no RAO. No other relevant complications occurred in the rest of pts. Ninety % of all pts (n = 732) were discharged home on the same day (<=6 hours after procedures) and none of them was readmitted within the next 24 hours. The remaining 10% of the patients (n = 85) were hospitalized after CAG and PCI, mostly because of severe coronary artery disease findings. Conclusion(s): During COVID-19 pandemic, CAG and PCI together with device replacement procedures in our SDD program were associated with a one-year saving of more than 700 overnight stays, minimal complications and 0,1% RAO rate. Supported by the Charles University Research program "Cooperatio-Cardiovascular Science" and by MH CZ-DRO (Faculty Hospital in Pilsen-FNPl, 00669806).

ESC Asia 2022 with APSC and AFC

The proceedings contain 138 papers. The topics discussed include: cardiovascular profile and electrocardiographic findings of hospitalized adult patients during the surge of delta and omicron variants of COVID-19 in a COVID-19 tertiary referral center;abnormal left atrial strain is associated with eventual diagnosis of atrial fibrillation in patients with embolic stroke of undetermined source;sex differences in the evaluation and outcomes of multi-ethnic Asian patients undergoing stress echocardiography;intraventricular pressure gradient: a novel color M-mode echocardiographic-derived imaging modality to assess and predict the alterations following acute myocardial infarction;nationwide trends of gatekeeper to invasive coronary angiography in suspected coronary artery disease;change in minimum indexed left atrial volume predicts incident heart failure: the multi-ethnic study of atherosclerosis;and the diagnostic utility of cardiac imaging (echocardiogram and cardiac MRI) in COVID 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia.