Performance analysis of a STEMI network: prognostic impact of the type of first medical contact facility

Prognosis in ST-elevation myocardial infarction (STEMI) is determined by delay in primary percutaneous coronary intervention (PPCI). The impact of first medical contact (FMC) facility type on reperfusion delays and mortality remains controversial.We performed a prospective registry of primary coronary intervention (PCI)-treated STEMI patients (2010-2020) in the Codi Infart STEMI network. We analyzed 1-year all-cause mortality depending on the FMC facility type: emergency medical service (EMS), community hospital (CH), PCI hospital (PCI-H), or primary care center (PCC).We included 18?332 patients (EMS 34.3%; CH 33.5%; PCI-H 12.3%; PCC 20.0%). Patients with Killip-Kimball classes III-IV were: EMS 8.43%, CH 5.54%, PCI-H 7.51%, PCC 3.76% (P?<?.001). All comorbidities and first medical assistance complications were more frequent in the EMS and PCI-H groups (P?<?.05) and were less frequent in the PCC group (P?<?.05 for most variables). The PCI-H group had the shortest FMC-to-PCI delay (median 82?minutes); the EMS group achieved the shortest total ischemic time (median 151?minutes); CH had the longest reperfusion delays (P?<?.001). In an adjusted logistic regression model, the PCI-H and CH groups were associated with higher 1-year mortality, OR, 1.22 (95%CI, 1.00-1.48; P?=?.048), and OR, 1.17 (95%CI 1.02-1.36; P?=?.030), respectively, while the PCC group was associated with lower 1-year mortality than the EMS group, OR,?0.71 (95%CI 0.58-0.86; P?<?.001).FMC with PCI-H and CH was associated with higher adjusted 1-year mortality than FMC with EMS. The PCC group had a much lower intrinsic risk and was associated with better outcomes despite longer revascularization delays.Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals with Prediabetes: A Multi-Cohort Study

Objectives: To describe the epidemiology and prognostic value of the coronary artery calcium (CAC) among individuals with prediabetes. Research Design and Methods: We pooled participants free of clinical ASCVD from 4 prospective cohorts Multi-Ethnic Study of Atherosclerosis (MESA), Heinz-Nixdorf Recall Study (HNR), Framingham Heart Study (FHS) and Jackson Heart Study (JHS). Two definitions were used for prediabetes: inclusive (fasting plasma glucose [FPG] ≥100-<126 mg/dL and hemoglobin A1c [HbA1c] ≥5.7-<6.5%, if available, among participants not taking glucose-lowering medications) and restrictive (FPG ≥110-<126 mg/dL and HbA1c ≥5.7-<6.5%, if available). Results: The study included 13,376 participants (mean age 58 years, 54% women, 57% White, 27% Black). The proportion with CAC≥100 was 17%, 22%, and 37% among those with euglycemia, prediabetes, and diabetes, respectively. Over a median (25th – 75th percentile) follow up time of 14.6 (7.8-16.4) years, individuals with prediabetes and CAC≥100 had higher unadjusted 10-year incidence of ASCVD (13.4%) than the overall group of those with diabetes (10.6%). In adjusted analyses, using the inclusive definition of prediabetes, compared to individuals with euglycemia the hazard ratio (HR) (95% confidence interval) for ASCVD was 0.79 (0.62, 1.01) for prediabetes and CAC=0, 0.70 (0.54, 0.89) for prediabetes and CAC 1-99, 1.54 (1.27, 1.88) for prediabetes and CAC≥100; and 1.64 (1.39, 1.93) for diabetes. Using the restrictive definition, the HR for ASCVD was 1.63 (1.29, 2.06) for prediabetes and CAC≥100. Conclusions: CAC≥100 is frequent among individuals with prediabetes, and identifies a high ASCVD risk subgroup in which the adjusted ASCVD risk is similar to people with diabetes.</p