Primary angioplasty vs. early fibrinolysis: the role of reperfusion delay

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Sex difference in the impact of delay to reperfusion on coronary blood flow and outcomes in ST-segment elevation myocardial infarction

Background: Delay from symptom onset to reperfusion by primary percutaneous coronary intervention (PCI) is longer in women and has been linked to increased mortality and worse clinical outcome. The mechanism underlying this association is still unclear. Purpose: We sought to investigate the impact of delay from symptom onset to hospital presentation on sex difference in TIMI flow grades and 30-day mortality after primary PCI for STEMI. Methods: The current study evaluated 2596 patients with STEMI who underwent primary PCI within 12 hours from symptom onset and had a stent implantation between 2010 and 2016 in the ISACS-TC registry (ClinicalTrials.gov, NCT01218776). Main outcomes measures were adjusted 30-day mortality rates and suboptimal post-PCI TIMI (Thrombolysis In Myocardial Infarction) flow (grades 642) estimated using inverse probability of treatment weighted (IPTW) models. Time from symptom onset to hospital presentation was classified as <2 hours, <6 hours, and <12 hours Results: Early reperfusion (<2 hours) was not associated with significant sex differences in the rates of mortality and final flow post-PCI TIMI flow (grades 642). Sex differences in outcomes differed if analyzing patients with 652-hour delay. Mortality rates were 4.0% for women versus 2.1% for men with an OR of 1.94 (95% CI: 1.09 to 3.47) in patients with <6 hours delay, and 4.6% for women versus 2.3% for men with an OR of 2.02 (95% CI: 1.24 to 3.27) in patients with <12 hours delay. The odds of TIMI 642 in women versus men were 1.40 (95% CI: 0.85 to 2.31) in patients with <6 hours delay, and 1.49 (95% CI: 0.99 to 2.24) in patients with <12 hours delay. Conclusions: Longer delays to reperfusion are associated with sex differences in the rates of 30-day mortality and worse outcome in women. Women are more vulnerable to prolonged untreated ischemia. This effect appears not to be mediated by less successful reperfusion

European study on the attitude of psychiatrists towards their patients

INTRODUCTION: Many people think that people with mental disorders might be dangerous or unpredictable. These patients face various sources of disadvantages and experience discrimination in job interviews, in education, and housing. Mental health-related stigma occurs not only within the public community, it is a growing issue among professionals as well. Our study is the first that investigates the stigmatising attitude of psychiatrists across Europe. OBJECTIVES: We designed a cross-sectional, observational, multi-centre, international study of 33 European countries to investigate the attitude towards patients among medical specialists and trainees in the field of general adult and child and adolescent psychiatry. METHODS: An internet-based, anonymous survey will measure the stigmatising attitude by using the local version of the Opening Minds Stigma Scale for Health Care Providers. Data gathering started in July this year and will continue until December 2020. RESULTS: This study will be the first to describe the stigmatising attitude of psychiatric practitioners across Europe from their perspectives. CONCLUSIONS: The study will contribute to knowledge of gaps in stigmatising attitude towards people with mental health problems and will provide with new directions in anti-stigma interventions. DISCLOSURE: No significant relationships

EAPCI Core Curriculum for Percutaneous Cardiovascular Interventions (2020): Committee for Education and Training European Association of Percutaneous Cardiovascular Interventions (EAPCI). A branch of the European Society of Cardiology.

The proposed 2020 Core Curriculum for Percutaneous Cardiovascular Interventions aims to provide an updated European consensus that defines the level of experience and knowledge in the field of Percutaneous Cardiovascular Intervention (PCI). It promotes homogenous education and training programmes among countries, and is the cornerstone of the new EAPCI certification, designed to support the recognition of competencies at the European level and the free movement of certified specialists in the European Community. It is based on a thorough review of the ESC guidelines and of the EAPCI Textbook in Percutaneous Interventional Cardiovascular Medicine. The structure of the current Core Curriculum evolved from previous EAPCI Core Curriuclum and from the "2013 core curriculum of the general cardiologist" to follow the current ESC recommendations for Core Curriculums. In most subject areas, there was a wide - if not unanimous - consensus among the task force members on the training required for the interventional cardiologist of the future. The document recommends that acquisition of competence in Interventional Cardiology requires at least 2 years of postgraduate training, in addition to 4 years devoted to cardiology. The first part of the curriculum covers general aspects of training and is followed by a comprehensive description of the specific components in 54 chapters. Each of the chapters includes statements of the objectives, and is further subdivided into the required knowledge, skills, behaviours, and attitudes

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. Methods and results Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (inhospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, prehospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. Conclusion The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality