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Background: Cardiogenic shock (CS) is still the leading cause of in-hospital mortality in patients presenting with acute myocardial infarction (AMI). Aim: To investigate the epidemiological and clinical characteristics of a series of patients hospitalized for AMI complicated by CS and to determine the in-hospital mortality. Methods: We retrospectively analysed 70 patients affected by AMI complicated by CS admitted to cardiology department of the military hospital between October 2005 and April 2015. Results: A total of 70 patients were included in the study, 56 (80%) patients were male. The mean age was 63±10 years. Diabetes mellitus (62%) and hypertension (50%) were the predominant risk factors. On admission, 41% of patients were in left ventricular failure and 59% in shock. The mean LVEF was 49±14.4%. Thrombolysis was performed in 51% of patients. Seventy-two (72%) of patients underwent angiography and 56.6% had percutaneous coronary intervention (PCI). Of these, 27% were taken for primary PCI and 73% had rescue PCI. Revascularization was complete in 37% of cases. The success rate of PCI was 85%. The average of hospital stay was 7±8 days. Patients revealed a mortality rate of 47%, occurring on average in the 6th day of hospitalization. We found that renal failure (p=0.014), late onset of shock (p=0.031), hyperglycemia (p=0.014), leukocytosis (p=0.02), use of vasopressors (p=0.003), and the anterior territory of MI (p=0.003) were significantly predictive of hospital mortality. Conclusion: Despite significant advances in the treatment of myocardial infarction, the in-hospital mortality of patients in CS complicating MI remains high. Renal failure, late onset of shock, hyperglycemia and the anterior territory of MI were the major predictive of hospital mortality. A multidisciplinary approach including medical actors and pre-hospital centers specialized in the treatment of this condition is actually necessary.

OBJECTIVES: To assess clinical and coronary angiographic characteristics, previous medical history, and clinical course, by age group, in older adults after myocardial infarction who underwent primary percutaneous coronary intervention (pPCI). METHODS: Single-center, cohort study that enrolled all patients with ST-segment elevation myocardial infarction who underwent pPCI at a specialized cardiology reference center in the South of Brazil. Older adults were defined as age ≥60 years, as set out in Brazilian legislation. Patients in the following age groups were compared: 60 to 64 years, 65 to 69 years, 70 to 74 years, 75 to 79 years, and ≥80 years. Patients' clinical course was assessed at initial hospital admissions and after 2 years of clinical follow-up. Data were analyzed using SPSS 19, and significance was established at p <0.05. RESULTS: From December 2015 to December 2018, a total of 636 patients were enrolled consecutively. Angiographic success rates were around 90% in all age groups. There were no differences in medications used, except for glycoprotein IIb/IIIa inhibitors, which were more frequently used in patients of lower age groups. Older patients had more in-hospital acute renal failure and higher in-hospital mortality. Predictors of mortality were age over 75, chronic renal failure, need for ventilatory support, severe arrhythmia, and sepsis. CONCLUSIONS: pPCI in older adult patients is a safe procedure with a high success rate.

Diabetes Ketoacidosis in association with acute myocardial infarction is quite frequent but is also associated with higher morbidity and mortality. These two can trigger each other, different hypothesis have been proposed to explain this phenomenon but still it is difficult to know which one appears first. We report a referred case to our centre with acute Myocardial Infarction and diabetic ketoacidosis promptly initiated treatment of diabetic ketoacidosis along with primary PCI. Keywords: Cardiogenic shock; diabetic ketoacidosis; metabolic acidosis; myocardial Infarction

Background In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. Methods In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. Results At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. Conclusions Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those who underwent immediate multivessel PCI. (Funded by the European Union 7th Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549 .).

After litigation against the tobacco industry ended in a settlement, the Texas legislature funded pilot projects to reduce tobacco use in selected areas of the state. Subsequent telephone surveys showed that well-funded activities were successful in reducing population rates of self-reported cigarette smoking. We present evidence that the reduction in smoking promptly led to lower rates of death from acute myocardial infarctions.

The UK government is considering establishing a national primary angioplasty service for patients with acute myocardial infarction. David Smith and Kevin Channer debate whether moving away from first line thrombolysis is appropriate or practical

The UK government is considering establishing a national primary angioplasty service for patients with acute myocardial infarction. David Smith and Kevin Channer debate whether moving away from first line thrombolysis is appropriate or practical

In this paper, a theoretical and applied understanding is brought to the study of acute myocardial infarction [AMI] care‐seeking behavior. The time between the onset of an AMI and the initiation of definitive medical care is presently the single most important factor impeding reduced mortality and improved morbidity from thrombolytic therapy. It is suggested that the acknowledged, yet relatively neglected, area of emotional response is a key element in understanding why individuals may delay seeking definitive health care services following the onset of AMI symptoms. Emotionally significant dimensions of the care‐seeking process and a model for intervention to reduce morbidity and mortality are presented.

Conventional cardiovascular risk factors (CVRF) are accepted to identify asymptomatic individuals with high risk of acute myocardial infarction (AMI). However, AMI affects many patients previously classified at low risk. New biomarkers are needed to improve risk prediction. We propose to evaluate the NLRP3-inflammasome complex as a potential CVR indicator in healthy males and post-AMI patients and compare both groups by known CVRFs. We included 109 men with no history of cardiovascular disease (controls) and 150 AMI patients attending a cardiac rehabilitation program. AMI patients had higher mean of BMI and waist circumference than the controls. However, high percentages of the controls had a high BMI and a waist circumference >95 cm. The controls also had higher systolic blood pressure (P>0.001), total and LDLcholesterol, dietary nutrient and calorific intake. Fuster BEWAT Score (FBS) correlated more closely than Framingham risk score (FRS) with most CVRF, groups. However, only the FBS showed a correlation with inflammasome cytokine IL-1β. Several conventional CVRFs were significantly better in AMI patients; however, this group also had higher mRNA expression of the inflammasome gene NLRP3 and lower expression of the autophagy gene MAP-LC3. The controls had high levels of CVRF, probably reflecting unhealthy lifestyle. FBS reflects the efficiency of strategies to induce lifestyle changes such as cardiac rehabilitation programs, and could provide a sensitive evaluation cardiovascular risk. These results lead to the hypothesis that NLRP3- inflammasome and associated IL-1β release have potential as CVR biomarkers, particularly in post-AMI patients with otherwise low risk scores. ; Andalusian regional government (Grupo de Investigacion Junta de Andalucia) CTS113 Consejeria de Salud de la Junta de Andalucia: PI-0036-2014

<i>Background:</i> Alcohol consumption has been causally related to the incidence of coronary heart disease, but the role of alcohol before the event has not been explored in depth. This study tested the hypothesis that heavy drinking (binge drinking) increases the risk of subsequent acute myocardial infarctions (AMI), whereas light to moderate drinking occasions decrease the risk. <i>Methods:</i> Case-crossover design of 250 incident AMI cases in Switzerland, with main hypotheses tested by conditional logistic regression. <i>Results:</i> Alcohol consumption 12 h before the event significantly increased the risk of AMI (OR 3.1; 95% CI 1.4–6.9). Separately, the effects of moderate and binge drinking before the event on AMI were of similar size but did not reach significance. In addition, AMI patients showed more binge drinking than comparable control subjects from the Swiss general population. <i>Conclusions:</i> We found no evidence that alcohol consumption before the event had protective effects on AMI. Instead, alcohol consumption increased the risk.