50. Primary PCI for STEMI patients at KACC: Has patient’s access and hospital outcome improved over the last 5 years?

Primary PCI (pPCI) is Class1 indication to treat patients (pts) with S-T elevation Myocardial Infarction (STEMI). In 2010, 56% of STEMI pts presented to KACC were treated with pPCI with hospital mortality of 2.3% compared to 11.3% for those who did not qualify mainly due to late presentation. We aim to compare pts access, reason for no access to pPCI and hospital outcome 5 yrs on. Data from 2010 at KACC showed relatively low access to pPCI for STEMI pts primarily due to late presentation and initial thrombolysis. We believe that pts access to pPCI would have improved over the last 5 years due to improved public awareness and expanding evidenced-based health provision. This is a retrospective study to analyze and compare data for STEMI pts during 2010 (G1 = 223 pts) and those treated between August 2014 and August 2015 (G2 = 288 pts). We compared demographic and baseline characteristics, pts access, reason for no access and hospital mortality for the two groups. We used student-t test to compare continuous variables and Chi-square test to compare categorical onesOf the 288 pts in G2, 247 pts (85%) were males with average age of 57 yrs. 49% were diabetics, 48% hypertensive, 48% were smokers and 27% were obese. These were not different in G1. Of G2, 164 pts (57%) only had access to pPCI compared to 56% in G1 (p = 0.536-NS). In G2, the main reasons for no pPCI was late presentation in 47% vs 53% in G1; P = 0.34-NS and 27% due to thrombolysis vs 17% in G1 (p = 0.11NS). Hospital mortality in G2 was 4% in those treated with pPCI compared to 2.3% in G1 (P = 0.522-NS). Mortality In pts who did not receive pPCI in G2 was 8% compared to 11.3% in G1 (p = 0.49-NS). Females in G2 has about 3 times higher mortality. Compared to 2010, pts treated for STEMI in the last 12 months at KACC still have same, relatively low access to pPCI due mainly to persistent pattern of late presentation and prior thrombolysis which reflect apparent lack of direct access to hospitals with pPCI facilities. This seemingly relates to both lack of public awareness and health provision factors in pPCI organizations. Hospital mortality rate for pts treated with pPCI remained low during the two era while pts who did not qualify for pPCI showed a trend towards improved survival

The Genome Sequence of Taurine Cattle:A Window to Ruminant Biology and Evolution

To understand the biology and evolution of ruminants, the cattle genome was sequenced to about sevenfold coverage. The cattle genome contains a minimum of 22,000 genes, with a core set of 14,345 orthologs shared among seven mammalian species of which 1217 are absent or undetected in noneutherian (marsupial or monotreme) genomes. Cattle-specific evolutionary breakpoint regions in chromosomes have a higher density of segmental duplications, enrichment of repetitive elements, and species-specific variations in genes associated with lactation and immune responsiveness. Genes involved in metabolism are generally highly conserved, although five metabolic genes are deleted or extensively diverged from their human orthologs. The cattle genome sequence thus provides a resource for understanding mammalian evolution and accelerating livestock genetic improvement for milk and meat production.Fil: Bovine Genome Sequencing and Analysis Consortium. Bovine Genome Sequencing And Analysis Consortium; Estados UnidosFil: Amadio, Ariel Fernando. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Santa Fe. Estación Experimental Agropecuaria Rafaela; ArgentinaFil: Poli, Mario Andres. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Genética; Argentin

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p<0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p<0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM