Background Timely revascularization with percutaneous coronary intervention ( PCI ) reduces death following myocardial infarction. We evaluated if a sex gap in symptom-to-door ( STD ), ...door-to-balloon ( DTB ), and door-to- PCI time persists in contemporary patients, and its impact on mortality. Methods and Results From 2013 to 2016 the Victorian Cardiac Outcomes Registry prospectively recruited 13 451 patients (22.5% female) from 30 centers with ST-segment-elevation myocardial infarction ( STEMI , 47.8%) or non-ST-segment-elevation myocardial infarction (NSTEMI) (52.2%) who underwent PCI . Adjusted log-transformed STD and DTB time in the STEMI cohort and STD and door-to- PCI time in the NSTEMI cohort were analyzed using linear regression. Logistic regression was used to determine independent predictors of 30-day mortality. In STEMI patients, women had longer log- STD time (adjusted geometric mean ratio 1.20, 95% CI 1.12-1.28, P<0.001), log- DTB time (adjusted geometric mean ratio 1.12, 95% CI 1.05-1.20, P=0.001), and 30-day mortality (9.3% versus 6.5%, P=0.005) than men. Womens' adjusted geometric mean STD and DTB times were 28.8 and 7.7 minutes longer, respectively, than were mens' times. Women with NSTEMI had no difference in adjusted STD , door-to- PCI time, or early (<24 hours) versus late revascularization, compared with men. Female sex independently predicted a higher 30-day mortality (odds ratio 1.67, 95% CI 1.11-2.49, P=0.01) in STEMI but not in NSTEMI. Conclusions Women with STEMI have significant delays in presentation and revascularization with a higher 30-day mortality compared with men. The delay in STD time was 4-fold the delay in DTB time. Women with NSTEMI had no delay in presentation or revascularization, with mortality comparable to men. Public awareness campaigns are needed to address women's recognition and early action for STEMI .
Background Takotsubo syndrome (TS) is a potentially life-threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, ...management, and outcome remain incompletely understood. Our aim was to assess the relative short-term mortality risk of TS, ST-segment-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) and to identify predictors of in-hospital complications and poor prognosis in patients with TS. Methods and Results This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 2.5%), STEMI (N=48 493 41.2%), or NSTEMI (N=66 329 56.3%) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all-cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30-day mortality risks lower than STEMI (adjusted hazard ratio adjHR, 0.60; 95% CI, 0.48-0.76;
<0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14-3.41;
<0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91-1.76;
=0.16) but a lower risk of cardiogenic shock (adjHR, 0.55; 95% CI, 0.34-0.89;
=0.02). The relative 30-day mortality risk for TS versus STEMI and NSTEMI was higher for smokers than nonsmokers (adjusted
interaction STEMI=0.01 and
interaction NSTEMI=0.01). Conclusions The 30-day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.
As the IEEE says on this link https://www.ieee.org/membership_services/membership/fellows/index.html: "IEEE Fellow is a distinction reserved for select IEEE members whose extraordinary ...accomplishments in any of the IEEE fields of interest are deemed fitting of this prestigious grade elevation." Fellow nominees must be a Senior Member of the IEEE.
Background ST-segment-elevation myocardial infarction is associated with an intense acute inflammatory response and risk of heart failure. We tested whether interleukin-1 blockade with anakinra ...significantly reduced the area under the curve for hsCRP (high sensitivity C-reactive protein) levels during the first 14 days in patients with ST-segment-elevation myocardial infarction (VCUART3 Virginia Commonwealth University Anakinra Remodeling Trial 3). Methods and Results We conducted a randomized, placebo-controlled, double-blind, clinical trial in 99 patients with ST-segment-elevation myocardial infarction in which patients were assigned to 2 weeks treatment with anakinra once daily (N=33), anakinra twice daily (N=31), or placebo (N=35). hsCRP area under the curve was significantly lower in patients receiving anakinra versus placebo (median, 67 interquartile range, 39-120 versus 214 interquartile range, 131-394 mg·day/L;
<0.001), without significant differences between the anakinra arms. No significant differences were found between anakinra and placebo groups in the interval changes in left ventricular end-systolic volume (median, 1.4 interquartile range, -9.8 to 9.8 versus -3.9 interquartile range, -15.4 to 1.4 mL;
=0.21) or left ventricular ejection fraction (median, 3.9% interquartile range, -1.6% to 10.2% versus 2.7% interquartile range, -1.8% to 9.3%;
=0.61) at 12 months. The incidence of death or new-onset heart failure or of death and hospitalization for heart failure was significantly lower with anakinra versus placebo (9.4% versus 25.7%
=0.046 and 0% versus 11.4%
=0.011, respectively), without difference between the anakinra arms. The incidence of serious infection was not different between anakinra and placebo groups (14% versus 14%;
=0.98). Injection site reactions occurred more frequently in patients receiving anakinra (22%) versus placebo (3%;
=0.016). Conclusions In patients presenting with ST-segment-elevation myocardial infarction, interleukin-1 blockade with anakinra significantly reduces the systemic inflammatory response compared with placebo. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01950299.
Quantifying rates of climate change in mountain regions is of considerable interest, not least because mountains are viewed as climate “hotspots” where change can anticipate or amplify what is ...occurring elsewhere. Accelerating mountain climate change has extensive environmental impacts, including depletion of snow/ice reserves, critical for the world's water supply. Whilst the concept of elevation‐dependent warming (EDW), whereby warming rates are stratified by elevation, is widely accepted, no consistent EDW profile at the global scale has been identified. Past assessments have also neglected elevation‐dependent changes in precipitation. In this comprehensive analysis, both in situ station temperature and precipitation data from mountain regions, and global gridded data sets (observations, reanalyses, and model hindcasts) are employed to examine the elevation dependency of temperature and precipitation changes since 1900. In situ observations in paired studies (using adjacent stations) show a tendency toward enhanced warming at higher elevations. However, when all mountain/lowland studies are pooled into two groups, no systematic difference in high versus low elevation group warming rates is found. Precipitation changes based on station data are inconsistent with no systematic contrast between mountain and lowland precipitation trends. Gridded data sets (CRU, GISTEMP, GPCC, ERA5, and CMIP5) show increased warming rates at higher elevations in some regions, but on a global scale there is no universal amplification of warming in mountains. Increases in mountain precipitation are weaker than for low elevations worldwide, meaning reduced elevation‐dependency of precipitation, especially in midlatitudes. Agreement on elevation‐dependent changes between gridded data sets is weak for temperature but stronger for precipitation.
Plain Language SummaryMountains cover a large part of the Earth's surface and harbor distinct ecosystems, hold most of snow and ice outside the polar regions, and provide water for billions of people. This research looks at recent climate changes in mountains and compares them with simultaneous changes in lowland regions using weather station data, large global data sets, and climate models. We examine changes since 1900, but also concentrate on the last 40 years since this is when many changes have started to accelerate. Nearly all regions of the globe are getting warmer. When we make local comparisons, mountain sites are usually warming faster than lower areas nearby. However, when we average data from all global mountains and compare them with those from all lowland areas, there is no significant difference. Rainfall/snowfall on the other hand is decreasing in some areas, and increasing in others. In nearly all cases the strongest increase is occurring in the lowland areas, with increases in the mountains being more subdued (if at all). One consequence of our findings is that stores of mountain snow and ice may decline even faster than previously assumed due to the combination of enhanced mountain warming and reduced elevation dependency of rainfall/snowfall.
Key PointsUsing station and gridded data sets, we compare global precipitation and temperature trends by elevationLocal comparisons of paired stations and regional comparisons using gridded data often show faster mountain than lowland warmingPrecipitation differences between mountains and adjacent lowlands are reducing, often driven by stronger precipitation increase in lowlands
ABSTRACT
The Tibetan Plateau (TP) affects its surroundings significantly through thermal and dynamic processes. Reductions in near‐surface wind speed (Ws) have been observed from ground measurements ...but how the trends of Ws vary with the elevation is less clear. Trends of Ws with respect to elevation were investigated using long‐term daily records taken from 1970 to 2012 of Ws and maximum (Tmax), minimum (Tmin), and mean (Tmean) air temperatures from 139 stations over and around the TP. The major findings are as follows. (1) Pronounced reductions in Ws can be observed in all seasons and annually across the TP. Spring demonstrates the most prominent weakening. The rate of reductions in Ws was amplified with elevation, and higher‐elevation environments experienced greater changes in Ws than lower‐elevation areas. Elevation‐dependent reductions in Ws have intensified from 1970 to 2012. (2) Statistically significant negative correlations between Ws and corresponding near‐surface temperatures were detected. We suggested that the elevation‐dependent warming and thereby the increased surface roughness at higher‐elevation environments may contribute to the elevation‐dependent reductions in Ws over and around the TP. More detailed mechanisms causing this pattern are to be further explored.
BACKGROUND:ST-segment–elevation myocardial infarction (STEMI) and non–ST-segment–elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little ...information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015.
METHODS:We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France.
RESULTS:From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention.
CONCLUSIONS:Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010.
IMPORTANCE: Previous works have shown that women hospitalized with ST-segment elevation myocardial infarction (STEMI) have higher short-term mortality rates than men. However, it is unclear if these ...differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI). OBJECTIVE: To investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications, and primary PCI in this excess of risk. DESIGN, SETTING, AND PARTICIPANTS: From January 2010 to January 2016, a total of 8834 patients were hospitalized and received medical treatment for STEMI in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776). EXPOSURES: Demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI. MAIN OUTCOMES AND MEASURES: Adjusted 30-day mortality rates estimated using inverse probability of treatment weighted (IPTW) logistic regression models. RESULTS: There were 2657 women with a mean (SD) age of 66.1 (11.6) years and 6177 men with a mean (SD) age of 59.9 (11.7) years included in the study. Thirty-day mortality was significantly higher for women than for men (11.6% vs 6.0%, P < .001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% vs 3.3%, P < .001). After multivariable adjustment for comorbidities and treatment covariates, women under 60 had higher early mortality risk than men of the same age category (OR, 1.88; 95% CI, 1.04-3.26; P = .02). The risk in the subgroups aged 60 to 74 years and over 75 years was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P = .19 and OR, 1.17; 95% CI, 0.80-1.73; P = .40; respectively). After IPTW adjustment for baseline clinical covariates, the relationship among sex, age category, and 30-day mortality was similar (OR, 1.56 95% CI, 1.05-2.3; OR, 1.49 95% CI, 1.15-1.92; and OR, 1.21 95% CI, 0.93-1.57; respectively). CONCLUSIONS AND RELEVANCE: Younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities. This difference declines after age 60 and is no longer observed in oldest women.
ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical ...professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients.
This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol on the treatment and prognosis of STEMI patients in China.
Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients.
The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center’s modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable.
There were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.
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