Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry

The so-called \"smoking paradox\", conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history

Ice formation modelling around the coils of an ice storage tank

This paper aims to develop a dynamic model of the charging process of a commercial ice-storage tank. Firstly, three different 1st order and 2nd order numerical schemes have been compared to solve the transport equation of the heat transfer fluid. Euler s method has finally been chosen as the mass flow rate can vary throughout the charging and it avoids the oscillations which are introduced by Lax-Wendroff s and MacCormack s method. Secondly, the heat transfer outside the coils is analyzed. The numerical complications involved in the creation of the first ice layer around the tubes are discussed and an electrical resistance model is introduced to avoid this problem. The model results have provided a very good agreement with experimental measurements of charging tests which have been performed on a CALMAC ICEBANK tank with a capacity of 172 kWh. The model helps to predict the final part of the latent heat transfer process, where the thermal power is decreased due to the contact between the ice layers around adjacent tubes of the tank.Biosca Taronger, J.; Payá Herrero, J.; López Navarro, A.; Corberán Salvador, JM. (2012). Ice formation modelling around the coils of an ice storage tank. Journal of Physics: Conference Series. 395:12133-12142. doi:10.1088/1742-6596/395/1/012133S1213312142395Zalba, B., Marı́n, J. M., Cabeza, L. F., & Mehling, H. (2003). Review on thermal energy storage with phase change: materials, heat transfer analysis and applications. Applied Thermal Engineering, 23(3), 251-283. doi:10.1016/s1359-4311(02)00192-8Gebhart, B., & Mollendorf, J. C. (1978). Buoyancy-induced flows in water under conditions in which density extrema may arise. Journal of Fluid Mechanics, 89(4), 673-707. doi:10.1017/s0022112078002803Chen, S.-L., & Lee, T.-S. (1998). A study of supercooling phenomenon and freezing probability of water inside horizontal cylinders. International Journal of Heat and Mass Transfer, 41(4-5), 769-783. doi:10.1016/s0017-9310(97)00134-

Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry

Background: Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods: In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results: A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion: This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020)

Gender Difference in the Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry

Background. Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry. Methods. This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March–June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality. Results. We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825–0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31–2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96–1.34], p = 0.12). Conclusions. The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655

Unfractionated heparin-clopidogrel combination in ST-elevation myocardial infarction not receiving reperfusion therapy

Objective: We sought explore the relative benefits of unfractionated heparin (UFH) compared with enoxaparin, alone or in combination with clopidogrel, in ST-segment elevation myocardial infarction (STEMI) patients not undergoing reperfusion therapy. Methods: This is a propensity score study from The International Survey on Acute Coronary Syndromes in Transition Countries (ISACS-TC/NCT01218776) on patients admitted between October 2010eJune 2013. There were a total of 1175 STEMI patients who did not receive mechanical or pharmacological reperfusion. Of these, 1063 were eligible for the aim of the study, being treated with UFH (522/1175; 44.4%) or enoxaparin (541/1175; 46%). Clopidogrel in combination with UFH or enoxaparin was given to 751 (63.9%) patients. The primary endpoint was in-hospital mortality. Secondary endpoints were intracranial hemorrhages, and clinically relevant bleedings. Results: After adjustment for any confounders, UFH was associated with a lower risk of in-hospital mortality in clopidogrel users (multivariate adjusted regression analysis: odds ratio [OR]: 0.62, 95% Confidence Interval [CI] 0.41e0.94) as compared with clopidogrel non-users (OR: 0.94, 95% CI 0.55e1.60). The observed effect was not associated with combined enoxaparin and clopidogrel therapy. Major bleeding events were comparable in the enoxaparin group and UFH group (0.4% and 1.5% respectively, p ¼ 0.06). The risk of major hemorrhage was nearly similar with combined UFH-clopidogrel therapy (1.4%) as compared with UFH alone (1.9%), p ¼ 0.67. Conclusion: UFH e Clopidogrel combination was associated with a large mortality reduction in STEMI patients not undergoing reperfusion therapy and did not significantly increase the risk of major bleeding

High rates of 30-day mortality in younger women presenting with STEMI: the ISACS Study

Introduction: Previous works have shown that women hospitalized with STEMI have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary PCI. Purpose: We sought 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. Methods: From January 2010 to January 2016, a total of 8834 patients have been 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). Logistic regression model was adjusted to covariates significantly different between groups in univariate analysis. The endpoint was 30-day mortality after STEMI. Results: There were 2657 women and 6177 men. Women were older than man, with a higher prevalence of risk factors and comorbidities. Fewer women than men presented within 2 hours from symptom onset (p<0.001). They presented more (p<0.001) Killip class 652 than men A significantly (p<0.001) lower proportion of women was treated with acute medications, secondary prevention therapies and primary PCI. Thirty day mortality was significantly higher for women than for men (11.6% versus 5.9%, p<0.001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% versus 3.3%, p<0.001). A significant interaction was found between sex and age. Women under 60 had higher early mortality risk than men of the same group (OR: 1.78, 95% CI: 1.04\u20133.05, p=0.03) after adjusting for age, comorbidities and treatment variables. Women aged 60\u201374 had the same risk of men (OR: 1.38, 95% CI: 0.95\u20131.99 p=0.08). The same results applied to women aged over 75 (OR: 1.06, 95% CI: 0.74\u20131.52, p=0.71). Conclusions: Younger age is associated with higher short term mortality rate in women with STEMI even after adjustment for medications, primary PCI and other coexisting comorbidities. This difference was no longer observed in older wome