Mortality after admission for acute myocardial infarction in Aboriginal and non-Aboriginal people in New South Wales, Australia: a multilevel data linkage study

Background - Heart disease is a leading cause of the gap in burden of disease between Aboriginal and non-Aboriginal Australians. Our study investigated short- and long-term mortality after admission for Aboriginal and non-Aboriginal people admitted with acute myocardial infarction (AMI) to public hospitals in New South Wales, Australia, and examined the impact of the hospital of admission on outcomes. Methods - Admission records were linked to mortality records for 60047 patients aged 25–84 years admitted with a diagnosis of AMI between July 2001 and December 2008. Multilevel logistic regression was used to estimate adjusted odds ratios (AOR) for 30- and 365-day all-cause mortality. Results - Aboriginal patients admitted with an AMI were younger than non-Aboriginal patients, and more likely to be admitted to lower volume, remote hospitals without on-site angiography. Adjusting for age, sex, year and hospital, Aboriginal patients had a similar 30-day mortality risk to non-Aboriginal patients (AOR: 1.07; 95% CI 0.83-1.37) but a higher risk of dying within 365 days (AOR: 1.34; 95% CI 1.10-1.63). The latter difference did not persist after adjustment for comorbid conditions (AOR: 1.12; 95% CI 0.91-1.38). Patients admitted to more remote hospitals, those with lower patient volume and those without on-site angiography had increased risk of short and long-term mortality regardless of Aboriginal status. Conclusions - Improving access to larger hospitals and those with specialist cardiac facilities could improve outcomes following AMI for all patients. However, major efforts to boost primary and secondary prevention of AMI are required to reduce the mortality gap between Aboriginal and non-Aboriginal people

4D quantitative coronary artery motion analysis : a novel method for culprit lesion prediction

This study aims to determine if measuring four-dimensional quantitative coronary artery motion (QCAM) and change in tortuosity (∆T) on invasive biplane coronary angiogram is predictive of the location of culprit lesions responsible for myocardial infarctions. Invasive coronary angiograms have no current clinical application for the prediction of future coronary events. Previous studies have shown promise in demonstrating the effects of coronary artery motion on plaque formation and location, but this has yet to fully translate into a directed diagnostic method. QCAM and ΔT were calculated with CAAS QCA4D prototype software (Pie Medical Imaging, the Netherlands) for sections of the culprit coronary artery using biplane coronary angiograms of fourteen patients undergoing percutaneous coronary intervention for myocardial infarction. Prediction of the artery section containing the culprit lesion was performed using one sample t-testing, generalised linear latent and mixed statistical modelling with grouping by patient, and logistic regression modelling. QCAM was a significant predictor of the location of culprit lesions (p = 0.047). ΔT was not a significant predictor of the location of culprit lesions (p=0.49). QCAM has a role in predicting the location of culprit lesions, and may allow for targeted local therapy to prevent future events

High rate of persistent symptoms up to 4 months after community and hospital-managed SARS-CoV-2 infection

Recovery after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains uncertain. A considerable proportion of patients experience persistent symptoms after SARS-CoV-2 infection which impacts health-related quality of life and physical function