Emergency Decompression of Orbital Emphysema, a Sight-Saving Tool in a Patient With Precious Eye.

A woman, 19 years old, with a history of falling from a height with resulting zygomatico-maxillar complex fracture on the right side, a mandibular fracture on the left side for which she underwent repair with plate insertion, and traumatic optic atrophy in her right eye, presented 9 months later with eye facial swelling, proptosis, and acute rapid loss of vision in the left eye. The diagnosis was done immediately aided by radiology assistance and a decision was taken to admit the patient to undergo urgent decompression to save the vision and the patient did recover well. This case presented here and the associated literature review focus on severe orbital emphysema with compressive optic neuropathy and orbital compartment syndrome as a morbidity that can exist with delayed presentation after trauma and not elicited by sneezing or forced blowing, as well as the drastic importance of brisk intervention, to save vision and prevent visual complications if left untreated.

Primary prevention implantable cardioverter-defibrillator use in non-ischemic dilated cardiomyopathy based on arrhythmic risk stratification and left ventricular reverse remodeling prediction.

Sudden cardiac death (SCD) and significant ventricular arrhythmias in patients with dilated cardiomyopathy (DCM) have been markedly reduced over the last couple of decades as a result of the advances in pharmacological and non-pharmacological treatment. Primary prevention implantable cardioverter-defibrillator (ICD) plays an important role in the treatment of patients at risk of SCD caused by ventricular arrhythmias. However, the arrhythmic risk stratification in patients with DCM remains extremely challenging, and the decision for primary prevention ICD implantation based on left ventricular ejection fraction (LVEF) solely appears to be insufficient. This review provides an update on current evidence for primary prevention ICD implantation, arrhythmic risk stratification, and left ventricular reverse remodeling (LVRR) prediction in patients with DCM in addition to most recent guideline recommendations for primary prevention ICD implantation in DCM patients and a proposed multiparametric algorithm based on arrhythmic risk stratification and left ventricular reverse remodeling (LVRR) prediction to better identify patients who are likely to benefit from primary prevention ICD.

Role of oesophageal cooling in the prevention of oesophageal injury in atrial fibrillation catheter ablation: a systematic review and meta-analysis of randomized controlled trials.

AIMS: To evaluate the efficacy of oesophageal cooling in the prevention of oesophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation. METHODS AND RESULTS: Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of oesophageal cooling compared with control in the prevention of oesophageal injury during AF catheter ablation. The study primary outcome was the incidence of any oesophageal injury. The meta-analysis included 4 RCTs with a total of 294 patients. There was no difference in the incidence of any oesophageal injury between oesophageal cooling and control [15% vs. 19%; relative risk (RR) 0.86; 95% confidence interval (CI) 0.31-2.41]. Compared with control, oesophageal cooling showed lower risk of severe oesophageal injury (1.5% vs. 9%; RR 0.21; 95% CI 0.05-0.80). There were no significant differences among the two groups in mild to moderate oesophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28-4.23), procedure duration [standardized mean difference (SMD) -0.03; 95% CI -0.36-0.30], posterior wall radiofrequency (RF) time (SMD 0.27; 95% CI -0.04-0.58), total RF time (SMD -0.50; 95% CI -1.15-0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02-36.34), and ablation index (SMD 0.16; 95% CI -0.33-0.66). CONCLUSION: Among patients undergoing AF catheter ablation, oesophageal cooling did not reduce the overall risk of any oesophageal injury compared with control. Oesophageal cooling might shift the severity of oesophageal injuries to less severe injuries. Further studies should evaluate the long-term effects after oesophageal cooling during AF catheter ablation.

Transoral Endoscopic-Assisted Reduction and Internal Fixation of Mandibular Condylar Fractures in Children.

PURPOSE: Extraoral approaches for open reduction and fixation of condylar fractures in children are associated with serious risks of complications, including facial nerve injury, facial scarring, parotid fistula, and auriculotemporal nerve injury. The purpose of this study was to retrospectively evaluate the outcomes of transoral endoscopic-assisted open reduction and internal fixation of condylar fractures and hardware removal in pediatric patients. MATERIAL AND METHODS: This study was designed as a retrospective case series. The study included pediatric patients admitted with condylar fractures that were indicated for treatment with open reduction and internal fixation. The patients were clinically and radiographically evaluated with regard to occlusion, mouth opening, lateral and protrusive movement of the mandible, pain, chewing and speech difficulties, and bone healing at the fracture site. Computed tomography images were used to assess the reduction of the fractured segment, the stability of fixation and progress of healing of the condylar fracture at follow-up visits. The same surgical treatment approach was applied to all patients. The data from the study were analyzed for a single group without any comparison to other groups. RESULTS: The technique was used for the treatment of 14 condylar fractures in 12 patients between the ages of 3 to 11 years. A total of 28 transoral endoscopic-assisted approaches to the condylar region either for reduction and internal fixation or hardware removal were applied. The mean operating time was 53.1 (±11.3) minutes for the fracture repair and 20 (±2.6) minutes for hardware removal, respectively. The mean follow-up time of the patients was 17.8 (±2.7) months (median: 18) months. All patients regained stable occlusion, satisfactory mandibular motion, stable fixation, and complete bone healing at the fracture site at the end of their follow-up period. There was no transient of permanent facial nerve or trigeminal nerve injury in any of the patients. CONCLUSIONS: Endoscopically assisted transoral approach is a reliable technique for reduction and internal fixation of condylar fracture and hardware removal in pediatric patients. The serious risks of extraoral approaches including facial nerve injury, facial scar, and parotid fistula can be eliminated by using this technique.

Identifying the Best Reduction Point for Zygomatic Arch Fractures Using Surface Markers.

This study aimed to describe a straightforward and efficient surgical technique for identifying the ideal point of reduction in isolated zygomatic arch fractures using preoperative radiopaque markers. In addition, a retrospective review of patient outcomes associated with this technique was conducted. The collected data encompassed demographics, injury side, mechanism of injury, time of injury, and classification of the isolated arch fracture. Measured outcomes included radiographic anatomic reduction, clinical facial symmetry, surgical operating time, and maximum interincisal mouth opening. Descriptive statistics were computed for each study variable. A total of 12 patients (10 males and 2 females) with an average age of 39.25 years (range: 26-60 y) were included in the study. The mechanisms of injury comprised road traffic accidents (6 patients, 50%), sports-related injuries (2 patients, 16.7%), occupational injuries (2 patients, 16.7%), and falls (2 patients, 16.7%). On average, patients presented 3 days after the injury (range: 1-14 d). The fracture classification according to Reyes and colleagues categorized 10 patients (83.3%) as type 4 and 2 patients (16.7%) as type 2. Coronoid impingement was observed in half of the patients (50%). The average surgical time was 15.4 minutes (range: 12-19 min). All patients exhibited optimal radiographic anatomic reduction, clinical facial symmetry, and maximum interincisal opening. In conclusion, this study demonstrates that the described technique is a simple and effective method for identifying the optimal reduction point in isolated zygomatic arch fractures.

Use of a Continuous Glucose Monitoring System in High-Risk Hospitalized Noncritically Ill Patients With Diabetes After Cardiac Surgery and During Their Transition of Care From the Intensive Care Unit During COVID-19: A Pilot Study.

OBJECTIVE: Continuous glucose monitoring (CGM) has demonstrated benefits in managing inpatient diabetes. We initiated this single-arm pilot feasibility study during the COVID-19 pandemic in 11 patients with diabetes to determine the feasibility and accuracy of real-time CGM in patients who underwent cardiac surgery and whose care was being transitioned from the intensive care unit. METHODS: A Clarke error grid analysis was used to compare CGM and point-of-care measurements. The mean absolute relative difference (MARD) of the paired measurements was calculated to assess the accuracy of CGM for glucose measurements during the first 24 hours on CGM, the remaining time on CGM, and for different chronic kidney disease (CKD) strata. RESULTS: Overall MARD between point-of-care and CGM measurements was 14.80%. MARD for patients without CKD IV and V with an estimated glomerular filtration rate (eGFR) of ≥20 mL/min/1.73 m2 was 12.13%. Overall, 97% of the CGM values were within the no-risk zone of the Clarke error grid analysis. For the first 24 hours, a sensitivity analysis of the overall MARD for all patients and those with an eGFR of ≥20 mL/min/1.73 m2 was 15.42% ± 14.44% and 12.80% ± 7.85%, respectively. Beyond the first 24 hours, overall MARD for all patients and those with an eGFR of ≥20 mL/min/1.73 m2 was 14.54% ± 13.21% and 11.86% ± 7.64%, respectively. CONCLUSION: CGM has shown great promise in optimizing inpatient diabetes management in the noncritical care setting and after the transition of care from the intensive care unit with high clinical reliability and accuracy. More studies are needed to further assess CGM in patients with advanced CKD.

Implications of an Anatomical Variation of the Infraorbital Nerve in Orbital Floor Reconstruction.

ABSTRACT: Fractures involving the orbital floor such as blow-out fractures may cause damage to the infraorbital nerve (ION). The integrity and course of the nerve should be evaluated preoperatively in order to prevent from such nerve injuries. The anatomy of the ION can show variations in significant number of patients, which should be taken into account in treatment planning. In this report, the authors present a patient with an isolated fracture of the orbital floor, who had abnormal anatomy of his both IONs. Our treatment approach for this patient is presented along with relevant literature findings.

Echocardiography, lung ultrasound, and cardiac magnetic resonance findings in COVID-19: A systematic review.

BACKGROUND: The manifestations of COVID-19 as outlined by imaging modalities such as echocardiography, lung ultrasound (LUS), and cardiac magnetic resonance (CMR) imaging are not fully described. METHODS: We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, CMR, and pulmonary manifestations using LUS. We queried PubMed, EMBASE, and Web of Science for relevant articles. Original studies and case series were included. RESULTS: This review describes the most common abnormalities encountered on echocardiography, LUS, and CMR in patients infected with COVID-19.

Performance Evaluation of Triple-Frequency GPS/Galileo Techniques for Precise Static and Kinematic Applications.

The objective of this research was to develop new precise point positioning (PPP) processing models using triple-frequency GPS/Galileo observations. Different triple-frequency PPP models were developed including undifferenced, between-satellite single-difference (BSSD) and semi-decoupled PPP models. Additionally, a dual-frequency ionosphere-free undifferenced PPP model was developed. The performance of our developed PPP models was evaluated for both static and kinematic applications. To validate the proposed PPP models for static applications, triple-frequency GPS/Galileo observations spanning three successive days from eight globally distributed reference stations were acquired. Then, the observations were processed using the four static PPP solutions. It is found that the 3D positioning accuracy of the triple-frequency semi-decoupled, BSSD and undifferenced PPP models is enhanced after 10 min by about 50, 41 and 29%, respectively, compared with the dual-frequency undifferenced PPP model. After 20 min of processing, improvements in the 3D positioning accuracy by 40, 31 and 21% are obtained for the triple-frequency semi-decoupled, BSSD and undifferenced PPP models, respectively, with respect to the dual-frequency PPP model. The 3D positioning accuracy is also improved after 60 min, compared with the dual-frequency solution, by 40, 40 and 35% for the triple-frequency semi-decoupled, BSSD and undifferenced PPP solutions, respectively. For kinematic application validation, a vehicle trajectory was carried out. The collected triple-frequency GPS/Galileo observations were processed using the four kinematic PPP solutions. It is shown that the triple-frequency semi-decupled, BSSD and undifferenced PPP solutions enhance the 3D positioning accuracy by 31, 23 and 10%, respectively, in comparison with the dual-frequency undifferenced PPP solutions.

Molecular characterisation of rabies virus detected in livestock animals in the southern part of Egypt during 2018 and 2019.

Brain samples were collected from 33 animals of different species, including buffalo, cattle, dog, donkey, fox and wolf, that had been suspected to be infected by rabies virus (RABV) in different geographical regions of Aswan and Luxor governorates in Egypt. The samples were submitted for histopathological examination and the presence of the nucleic acid and antigens of RABV was tested by RT-PCR and indirect fluorescent antibody technique (IFAT), respectively. Sixteen samples were found positive by all the three examinations. Three samples were selected for further study from animals in which the highest virus loads were detected. The partial sequence of the RABV N gene was determined and analysed from the samples of a buffalo, a cow and a donkey. The viruses in the samples were found to share 95-98% and 95-97% nucleotide and amino acid sequence identities, respectively. In comparison to reference sequences, a few amino acid substitutions occurred in the N protein antigenic sites I and IV in the immunodominant epitopes of the viruses detected in the cow and the donkey but not in the one from the buffalo. The phylogenetic analysis revealed that the RABVs sequenced from the samples belonged to genotype 1, Africa-4 clade, and formed two distinct sub-clades within the Egyptian clade. These findings indicate the circulation of RABV among livestock animals in the southern part of Egypt and raise public health concerns. The amino acid changes detected in this work may contribute to the antigenic diversification of RABVs.

Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta-analysis.

BACKGROUND: This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability. METHODS: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. RESULTS: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), -3.89, 95% CI -6.14, -1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: -3.33, 95% CI -4.71, -1.95, P < .001. CONCLUSION: LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

Endoscopically Assisted Transoral Gap Arthroplasty of the Temporomandibular Joint Ankylosis in a Pediatric Patient.

Surgical management of temporomandibular joint (TMJ) ankylosis in children is often challenging and may result in various complications such as facial nerve injury and visible scar. In this clinical report, the authors present minimally invasive management of a 9-year-old boy with bilateral post-traumatic TMJ ankylosis. The ankylotic TMJs were addressed and gap arthoplasties were performed by endoscopically assisted transoral approach. The risk of facial nerve injury is minimized and facial scar was prevented by avoiding extraoral incision. Mandibular movements in 3 directions were satisfactory at 3rd postoperative month.

Molecular typing and evaluation of Sidr honey inhibitory effect on virulence genes of MRSA strains isolated from catfish in Egypt.

Fish represent a worldwide significant source of animal protein. In order to investigate the prevalence of MRSA in catfish as well as the inhibitory effect of Sidr honey on virulence genes of MRSA, fish were collected from Bahr Elbaker canal at Sharkia Governorate, Egypt. Swab samples were collected under complete aseptic conditions from internal organs (pancreas, liver, kidney and intestine), gills and skin then subjected to bacteriological examination. A total of 70 S. aureus strains were isolated from catfish, out of them 15 (21.42%) strains were identified as MRSA as a first record in Egypt. PCR was used for detection of meca, coa and spa genes in the isolated MRSA strains before and after the exposure to sidr honey. Before exposure to sider honey, all the selected MRSA strains showed positive results for meca, coa and spa genes with specific amplicon size of 310 bp, 430 bp and 226 bp, respectively. After exposure to sidr honey, MRSA strains showed inhibition of coa and spa genes, but has no effect on meca gene. In addition, scanning electron microscopy was used for detection of the morphological characters of MRSA strains before and after treatment with sidr honey. After exposure of MRSA strains to 30% (w/v) Sidr honey for 48 hours, cells surfaces were observable irregular with the appearance of cell debris. In conclusion, MRSA strains could be isolated from fresh water catfish in Egypt which may be attributed to the contamination of water and fish food. Sider honey showed a significant inhibitory effect on the growth of isolated MRSA strains. Moreover, it could inhibit spa and coa genes. SEM is a valuable tool revealing the abnormal morphological changes that take place in MRSA strains after exposure to Sidr honey.

Transoral endoscopic assisted reduction and internal fixation of mandibular condylar neck fractures with short condylar segment.

This study aimed to assess the reliability and safety of transoral endoscopic-assisted reduction internal fixation (TERIF) for treating short-segment condylar neck fractures (CNF), including hardware removal. Patients with displaced CNF and short condylar segments treated using TERIF were included in the study. Clinical evaluation covered dental occlusion, range of mouth opening, deviation during mouth opening, protrusion, laterotrusion, pain, and chewing. Radiological evaluation was used to assess fracture displacement, angulation, head dislocation, postoperative reduction, fixation stability, and bone healing. The same technique was used to treat 15 patients with 18 CNF and short condylar segments. Hardware removal was performed for nine fractures in eight patients after fracture healing using the same approach. All patients regained satisfactory, pain-free mouth opening with no deviation and complete bone healing. Computed tomographic images displayed adequate reduction and stable fixation during the follow-up period for all patients. No temporary or permanent facial nerve impairment occurred in any of the patients. TERIF is a reliable and safe treatment for CNF with short condylar segments, even in the presence of head dislocation, medial override, and malunited fractures; hardware can be safely removed after healing using the same approach.

Late Frontal Bone Reconstruction Using Three-Dimensional Printed Models for Titanium Mesh Customization: A Case Series.

BACKGROUND: The convex frontal bone is covered by thin skin, rendering its reconstruction cosmetically challenging. Customized alloplastic implants provide better contouring than autologous bone, yet their high cost and availability limit their application. We assess customized titanium mesh implants precontoured using patient-specific three-dimensional (3D) printed models for late frontal cranioplasty. METHODS: We retrospectively analyzed the prospectively collected cases of unilateral frontal titanium mesh cranioplasty with 3D printing-assisted preplanning from 2017 to 2019. We used two 3D-printed patient-specific skull models for preoperative planning: a mirrored normal model for implant contouring and a defect model for edge trimming and fixation planning. The endoscope was used in 4 cases for percutaneous mesh fixation. We documented postoperative complications. We assessed the reconstruction symmetry clinically, and radiologically on postoperative computed tomography. RESULTS: Fifteen patients were included. The duration after previous surgery ranged from 8 to 24 months. Four patients developed complications, which were managed conservatively. Favorable cosmetic outcomes were achieved in all patients. CONCLUSIONS: Precontouring of titanium mesh implants using in-house 3D-printed models could optimize cosmetic and surgical outcomes in late frontal cranioplasty. Preoperative planning could permit minimal access surgery, which could be aided by the endoscope in select cases.

Contemporary Use of Coronary Physiology in Cardiology.

Coronary angiography has a limited ability to predict the functional significance of intermediate coronary lesions. Hence, physiological assessment of coronary lesions, via fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), has been introduced to determine their functional significance. An accumulating body of evidence has consolidated the role of physiology-guided revascularization, particularly among patients with stable ischemic heart disease. The use of FFR or iFR to guide decision-making in patients with stable ischemic heart disease and intermediate coronary lesions received a class I recommendation from major societal guidelines. Nevertheless, the role of coronary physiology testing is less clear among certain patients' groups, including patients with serial coronary lesions, acute coronary syndromes, aortic stenosis, heart failure, as well as post-percutaneous coronary interventions. In this review, we aimed to discuss the utility and clinical evidence of coronary physiology (mainly FFR and iFR), with emphasis on those specific patient groups.

New perspectives on contrast-induced nephropathy during coronary interventions.

Tweetable abstract To reduce contrast-induced nephropathy as a complication of percutaneous coronary intervention, several thresholds have been proposed, including maximum contrast dose, contrast volume/estimated glomerular filtration rate, revised maximal contrast dose and zero-contrast percutaneous coronary intervention in select patients.

To reduce contrast-induced nephropathy as a complication of percutaneous coronary intervention, several thresholds have been proposed, including maximum contrast dose, contrast volume/estimated glomerular filtration rate, revised maximal contrast dose and zero-contrast percutaneous coronary intervention in select patients.

Meta-Analysis Comparing Outcomes With Bifurcation Percutaneous Coronary Intervention Techniques.

There have been mixed results regarding the efficacy and safety of various percutaneous coronary intervention bifurcation techniques. An electronic search of Medline, Scopus, and Cochrane databases was performed for randomized controlled trials that compared the outcomes of any bifurcation techniques. We conducted a pairwise meta-analysis comparing the 1-stent versus 2-stent bifurcation approach, and a network meta-analysis comparing the different bifurcation techniques. The primary outcome was major adverse cardiac events (MACEs). The analysis included 22 randomized trials with 6,359 patients. At a weighted follow-up of 25.9 months, there was no difference in MACE between 1-stent versus 2-stent approaches (risk ratio [RR] 1.20, 95% confidence interval [CI] 0.92 to 1.56). Exploratory analysis suggested a higher risk of MACE with a 1-stent approach in studies using second-generation drug-eluting stents, if side branch lesion length ≥10 mm, and when final kissing balloon was used. There was no difference between 1-stent versus 2-stent approaches in all-cause mortality (RR 0.95, 95% CI 0.69 to 1.30), cardiovascular mortality (RR 1.07, 95% CI 0.68 to 1.68), target vessel revascularization (TVR) (RR 1.22, 95% CI 0.90 to 1.65), myocardial infarction (MI) (RR 1.04, 95% CI 0.69 to 1.56) or stent thrombosis (RR 1.10, 95% CI 0.68 to 1.78). Network meta-analysis demonstrated that double kissing crush technique was associated with lower MACE, MI, TVR, and target lesion revascularization, whereas culotte technique was associated with higher rates of stent thrombosis. In this meta-analysis of randomized trials, we found no difference between 1-stent versus 2-stent bifurcation percutaneous coronary intervention approaches in the risk of MACE during long-term follow-up. Among the various bifurcation techniques, double kissing crush technique was associated with lower rates of MACE, target lesion revascularization, TVR, and MI.

Coexistence of bla NDM-5 and tet(X4) in international high-risk Escherichia coli clone ST648 of human origin in China.

The emergence of pathogens is conferring resistance to last-resort therapies such as tigecycline, colistin, and carbapenems, limiting the therapeutic options, and raising concerns about the emergence of new "superbugs." This study reports the first incident of a bla NDM-5 and tet(X4) co-harboring Escherichia coli with resistance to carbapenem and tigecycline recovered as the causative agent of a urinary tract infection in a 94-year-old patient. The E. coli strain ECCL209 carries multiple resistance genes [i.e., bla TEM-1B , bla NDM-5, bla CMY-2, aadA22, florR, erm(B), mph(A), erm(42), lnuG, qnrS1, and sul2] and exhibits resistance to almost all clinically used antibiotics. MLST analysis found that the strain belongs to ST648, considered a worldwide high-risk pandemic clone. Moreover, multiple plasmid incompatibility types were detected, i.e., IncHI1A, IncHI1B, IncFII, IncFIA, IncFIB, IncQ1, Col, and IncX4. Genetic analysis revealed that bla NDM-5 and tet(X4) genes were localized on two hybrid plasmids with multiple replicons. Continuous monitoring studies are suggested to quantify the antimicrobial resistance and assess the dissemination of such superbugs into a human healthcare setting.

Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia.

BACKGROUND: There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia. METHODS: We queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia. RESULTS: The analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64). CONCLUSION: In this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.