Risultati per: Follow-up dopo colonscopia e polipectomia

Circulation, Volume 148, Issue Suppl_1, Page A16300-A16300, November 6, 2023. Background:Genetic factors are known to affect cardiovascular and coronary heart death. The more deaths occur during the longer follow-up period in a longitudinal study. However, it is unclear whether follow-up lengths affect genetic influences on the mortality from total cardiovascular (CVD) and coronary heart diseases (CHD).Objective:To determine genetic influences on the mortality from CVD and CHD over various years of follow-up in the 45-year longitudinal National Heart, Lung, and Blood Institute (NHLBI) Twin Study.Method:A total of 1024 middle-aged, white male, veteran twins (512 pairs), including 253 monozygotic and 261 dizygotic twin pairs, were initially enrolled during 1969-1973 and then followed up on vital status and causes of death through December 31, 2015. Tetrachoric correlation coefficients were estimated for CHD and CVD death at 20, 30, and 45 years of follow-up, respectively. Genetic and environmental influences on the death were quantified using the best-fitting structural equation model selected with the smallest Akaike’s Information Criterion value and the parsimony rule.Results:The age at death ranged from 43.9 to 97.3 years over a 45-year follow-up. Tetrachoric correlation coefficients in dizygotic twins were less than half of that in monozygotic twins over 20, 30, and 45 years of follow-up for CVD but over 20 and 30 years for CHD, respectively. Dominant genetic factors explained 40% (95% CI 5% ~ 68%), 39 % (16% ~ 59%), and 24% (4% ~ 43%) of variation in CVD death over 20, 30, and 45 years of follow-up, respectively, while the remaining variation in CVD death was explained by unique environmental factors during each follow-up period. For CHD death, unique environmental factors explained all variation over 20 and 45 years of follow-up. By contrast, dominant genetic factors explained 26% (95% CI -6% ~ 53%) variation in CHD death over 30 years of follow-up while the remaining variation was explained by unique environmental factors.Conclusion:Dominant genetic factors consistently influence cardiovascular mortality over 20 to 45 years of follow-up, implying a twin study of cardiovascular death can control for genetic confounding during this period.

Circulation, Volume 148, Issue Suppl_1, Page A15085-A15085, November 6, 2023. Introduction:To compare the effectiveness of transcatheter vs surgical aortic valve implantation on mid-term composite of death for any cause or stroke within high, intermediate and low-risk profiles.Methods:We performed a systematic review of the literature between 2007 and 2023 including randomized controlled trials comparing a composite of all-cause mortality or stroke of transcatheter vs surgical aortic valve replacement. Hazard ratios (HRs) and restricted mean survival time (RMST) differences within high, intermediate and low-risk profiles were estimated by reconstructing time-to-event data from Kaplan-Meier curves.Results:Seven trials were included (8418 participants). The incidence of composite endpoint increases concordantly with higher risk profiles for both treatments. A time variant effect unites all the risk profiles with transcathteter superior to surgery early and a trend toward HR reversal after 24 months, also supported by an cumulative additional time-to-event of 0.57 months at 3 years driven by high risk (95%CI 0.19 – 0.9) that is reabsorbed at 60 months, The benefit of transcatheter approach increased over time till 5 years in high risk, while intermediate and low risk showed a similar quadratic association (a parameter -0.0004, 95%CI -0.0008 – 0, p-value 0.05; b parameter 0.029, 95%CI 0.012 – 0.046, p-value 0.001), with a smaller increase of the transcatheter that is reabsorbed after a nadir at 36 months.Conclusions:There is a different trend of benefit of transcatheter approach within risks. TAVI maintains a benefit over surgery at 5-years in high risk, while its advantage is smaller and runs out at 5 years in the low-mid risk groups.

Circulation, Volume 148, Issue Suppl_1, Page A15793-A15793, November 6, 2023. Introduction:Cardiac rehabilitation (CR) is a cornerstone of secondary prevention for cardiovascular disease (CVD). CR participation is associated with improvements in secondary CVD risk factor management. However, it is unclear if CR participation is associated with maintained improvements in CVD risk factor management following CR completion.Purpose:The aim of this study was to assess the impact of CR participation on CVD risk factor management at 1 and 3 years following CR completion.Methods:This retrospective study analyzed 911 patients (73% male) enrolled in the CR program at Mayo Clinic from 2013 to 2020. Patient demographics, clinical characteristics, and CVD risk factor management were examined pre and post CR as part of clinical practice and assessed passively at 1 and 3 years following CR. Secondary prevention CVD risk factor goals included total cholesterol (40 mg/dL), LDL cholesterol (

Circulation, Volume 148, Issue Suppl_1, Page A17666-A17666, November 6, 2023. Background:Mitral valve prolapse (MVP) is a common condition that exhibits a benign course. Conversely, a small subset of patients experiences life-threatening arrhythmias and sudden cardiac death (SCD). Multiple risk factors have been proposed for arrhythmia in MVP; however, few have been validated as independent predictors of hard arrhythmic events on longitudinal follow-up.Methods:A prospective cohort of 550 consecutive patients with MVP underwent comprehensive clinical assessment and late gadolinium enhancement (LGE) cardiac magnetic resonance. Patients were longitudinally followed for a composite outcome of SCD, aborted SCD, sustained or symptomatic ventricular tachycardia (VT) requiring implantable cardiac defibrillator (ICD) placement, or ventricular ablation. In a multivariable cox regression analysis, we adjusted for female sex, LGE, MVP leaflet involvement, mitral annular disjunction (MAD), and mitral regurgitation (MR) severity.Results:The cohort median age was 62 (IQR 51-71) years, comprising 50% women. Over a mean follow-up of 4.3 years, 44 patients (mean age 62.5 years ±10) met the composite outcome, of which n=33 (75%) were women. Myocardial fibrosis (LGE) was present in 61% of the outcome group (n=27). LGE (HR 3.52 [95%CI, 1.87-6.63],P

Circulation, Volume 148, Issue Suppl_1, Page A17714-A17714, November 6, 2023. Introduction:Percutaneous coronary intervention (PCI) for ischemic heart disease is common and stent selection. Bare metal stents (BMS) or drug-eluting stents (DES) impact outcomes. Colchicine has been shown to reduce cardiac events. The long-term efficacy of BMS plus colchicine (BMS+C) vs DES in terms of major adverse cardiovascular events (MACE) is unknown. We presented preliminary results at AHA 2022, we are reporting extended follow-up.Hypothesis:PCI with BMS+C have similar MACE compared to DES-treated patients (pts).Methods:Multicenter, randomized clinical trial (RCT) enrolled PCI pts from February 2020 to April 2022, randomly assigned to BMS+C or DES and followed at 1, 6, 12 months, and then annually until 5 years. BMS+C received 0.5 mg oral colchicine BID for 3 months. Primary endpoint (EP) compared cost and incidence of MACE, a composite of death, myocardial infarction, stroke, or ischemic-driven target vessel revascularization. Due to the cost difference between devices a non-inferiority 15% threshold level was estimated. Secondary EP included individual components of primary EP and overall costs. Drug tolerance was analyzed. Baseline and 1-month C-Reactive Protein (CRP) levels were assessed and a delta difference was compared. An IRB and local authorities approved the protocol (NCT04382443).Results:We included 205 pts in each arm. Baseline characteristics were similar, Acute Coronary Syndromes was 78% vs 74.6% (p=0.24). Syntax Score was 22.2+/-11.4 vs 21.1+/- 9.4, respectively (p=0.49). Follow-up was 25 +/- 5 months. Primary and secondary EP are presented in the table. 5% of BMS+C pts withdraw from the drug due to side effects. Delta CRP between groups showed 5.4 +/- 6.4 vs 1.6 +/- 1.7, BMS vs DES, p

Circulation, Volume 148, Issue Suppl_1, Page A15693-A15693, November 6, 2023. Background:Insufficient sleep is a worldwide public health problem with potential cardiovascular consequences. Therefore, strategies aiming at improving sleep patterns are highly desired. Cross-sectional studies showed that weekend sleep extension (catch-up sleep) is associated with better glucose metabolism and cognitive function profiles, but longitudinal studies are lacking.Hypothesis:Catch-up sleep may have protective effects on subclinical atherosclerosis.Methods:In this prospective cohort study, we performed a 7-days wrist actigraphy for monitoring sleep duration and a sleep study to detect sleep apnea. Catch-up-sleep was measured by calculating weekend sleep duration (Friday-Saturday nights) minus weekday sleep duration (Sunday-Thursday nights). Coronary artery calcium, CAC (64-slice multi-detector computed tomography) was measured at two different time points throughout the study (baseline, between 2010-2014, and follow-up, between 2016-2018). Incidence of subclinical atherosclerosis was defined as baseline CAC=0 followed by CAC >0 at a 5-year follow-up visit. The association of incident CAC outcome was assessed using logistic regression adjusting for age, sex, race, body mass index, hypertension, diabetes mellitus, smoking, low- and high-density lipoprotein, use of statin, sleep apnea and interscan period). Analysis of incidence was Inverse probability censoring weighted.Results:We analyzed 1,832 participants with available CAC scores at baseline (age: 48.8±8.0years; 57.8% women; 32.1% with sleep apnea). The mean sleep duration was 6.6±1.0 hours. Catch-up-sleep >90 minutes was observed in 28.0%. Incidence of CAC was 27/141 (19.1%) among subjects with catch-up-sleep >90 minutes and 326/1029 (31.7%) among those with catch-up-sleep ≤90 minutes (P90 minutes (OR=0.62; 95% CI 0.52-0.74).Conclusion:Catch-up sleep is independently associated with a lower incidence of CAC. These results underscore that catch-up sleep may mitigate the adverse cardiovascular effects of weekdays sleep restrictions frequently observed in our Society.

Circulation, Volume 148, Issue Suppl_1, Page A17536-A17536, November 6, 2023. Background:The impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real-world patients is understudied.Objectives:to identify predictors of low adherence and discontinuation to statin therapy within 6 months after STEMI and to estimate their impact on cardiovascular outcomes at one year follow-up.Methods:We evaluated real-world adherence to statin therapy by comparing the number of bought tablets to the expected ones at 1 year follow-up through pharmacy registries. A total of 6043 STEMI patients admitted from 2012 to 2017 were enrolled in the FAST STEMI registry and followed up for 4,7±1,6 years; 299 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events, and ischemic stroke. The compliance cut-off chosen was 80% as mainly reported in literature.Results:From a total of 5744 patients, 418 (7,2%) patients interrupted statin therapy within 6 months after STEMI. After univariate and multivariate analysis age over 75 years old, known ischemic cardiopathy and female gender resulted as predictors of therapy discontinuation. Statin discontinuation within 6 months showed an increase of both cardiovascular (5% vs 1.7%; HR 2.23; 95%CI 1.37-3.65; p=0,001) and all-cause mortality (14.8% vs 5.1%, HR 2.32; 95%CI 1.73-3.11; p80%) reduced ischemic stroke incidence (1% vs 2.5%, p=0.001) and both cardiovascular and all-cause death (0.1% vs 4.6%; 0.3% vs 13.4%; p

Circulation, Volume 148, Issue Suppl_1, Page A321-A321, November 6, 2023. Background:The efficacy of mechanical ventilation during CPR with the combination of active compression-decompression, an impedance threshold device, and head-up positioning, collectively termed automated head-up (AHUP)-CPR, is unknown.Hypothesis:Hemodynamic and ventilatory parameters will be similar with manual bag ventilation (MBV) versus automated bag ventilation (ABV) during AHUP-CPR in a porcine model of cardiac arrest.Aim:Assess the proof-of-concept that ABV is safe and effective during AHUP-CPR.Methods:Nine male and female swine (~40 kg) were anesthetized and ventilated. VF was induced and left untreated for 8 min. AHUP-CPR was performed at 105 compressions/min for 7 min using MBV, followed by 6 min using an automated mechanical bag compressor to deliver 10ml/kg of tidal volume (TV) over 1 sec at 10 breaths/min. Pigs were randomized during ABV to a synchronized (Sync) breath delivered at the start of decompression or an asynchronous (Async) breath. Cerebral perfusion pressure, coronary perfusion pressure, end-tidal CO2, intracranial pressure, esophageal intrathoracic pressure, peak airway pressure (PAP), inspiratory and expiratory TVs as well as arterial blood gases were continuously measured. Values (mean ± SD) were compared by paired and unpaired student’s t-tests with a Bonferroni correction.Results:Parameters during the last minute of MBV and ABV are summarized in the table. No significant differences were observed in hemodynamic and ventilatory parameters, except for PAP and pO2 values which were significantly lower with MBV. No significant differences were also observed between the Sync and Async ABV modes.Conclusion:Manual and mechanical ventilation resulted in overall similar physiological effects. The clinical relevance of the observed significant differences in PAP and pO2 is unclear. Additional studies are warranted to further assess the safety and effectiveness of mechanical ventilation during AHUP-CPR.

Circulation, Volume 148, Issue Suppl_1, Page A13569-A13569, November 6, 2023. Introduction:Heart failure (HF) poses a global health burden, with about 26 million people affected and an estimated health expenditure of US$31 billion worldwide . The outcome of HF patients with reduced ejection fraction (HFrEF) has improved significantly due to the availability of evidence-based therapies. Still, the readmission rates, and subsequent mortality, have remained unchanged in the last two decades. Despite immense positive evidence, < 25% of patients with HFrEF are on the appropriate target doses of medical therapy.Objectives:Impact of intense versus routine outpatient follow-up on clinical outcomes and patient satisfaction in Acute decompensated heart failure (ADHF) patients over a 3-month follow-up.METHODS: This is a prospective open-label randomized study analyzing readmission rates and achieving target doses of GDMT.Results:A total of 226 subjects (Intense smartphone application-based follow-up -112) (routine outpatient follow-up -114) were enrolled in the study. The mean age was 53 and 54 years in intense follow-up and routine follow up, respectively. Both study arms were well-matched and randomized. There was a significant reduction in rehospitalization rate in the intense follow-up arm (28 vs. 57) p - 0.005. Subjects on smartphone application-based follow-up had better drug compliance and a rapid escalation of GDMT to reach target doses.Number of patients on target dose of GDMT at three monthsConclusion:Intense smartphone application based follow-up was feasible and safe for ADHF patients. The incidence of 30-day and three months readmissions improved. They also showed improved BP, HR, and NT Pro-BNP levels. Drug dosages were up-titrated periodically in these subsets of patients based on their cardiac function and laboratory parameters. Newer apps should be designed to incorporate artificial intelligence (AI) with features more likely to improve key patient-reported and clinical outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A14919-A14919, November 6, 2023. Introduction:The occurrence of myocardial injury during acute COVID-19 is well known however, its persistence and impact over a longer period of time is unclear.Hypothesis:We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricle (RV) longitudinal and free wall strain using speckle tracking echocardiography (STE) in COVID-19 recovered patients.Methods:A total of 189 subjects following recovery from COVID-19 infection and with a normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers and detailed echocardiographic evaluation including STE were done for all. All these patients were followed-up for a period of one year with repeat echocardiography done at six months and one-year.Results:Of the 189 subjects, 176 (93.1%) were symptomatic and categorized as mild [n = 91 (51.8%)], moderate [n = 65 (36.9%)] or severe [n = 20 (11.3%)] illness. Subclinical LV and right ventricle (RV) dysfunction were seen in 58 (30.7%) and 25 (13.2%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -21.4 ± 3.1 %; moderate: -18.8 ± 4.8%; severe: -16.3 ± 2.7%; P < 0.0001). RV longitudinal strain was significantly lower in patients recovered from severe COVID (mild: -22.9 ± 1.7, moderate: -21.8 ± 1.5, severe: -17.9 ± 1.6; P < 0.0001). There was a significant improvement in LVGLS (baseline: -19.1± 5.7, one-year: -19.9±4.6; P < 0.0001) and RVFWS (baseline: -23.5±6.3; one-year: -23.7 ± 5.8; P=0.03) however, RVLS improved though not significant (baseline: -21.4±5.7; one-year: -21.6 ± 5.2; P=.156) over a one-year follow-up period. Of the 58 subjects with baseline reduced LVGLS, over a one-year follow-up, 22 (11.6%) had persistently reduced LVGLS.Conclusions:Subclinical LV dysfunction was seen in one third of recovered COVID-19 patients which improved over a one-year follow-up. A fraction of subjects had persistently reduced LVGLS even at one year which suggests need for closer follow-up among them to elucidate long-term cardiovascular outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A14254-A14254, November 6, 2023. Introduction:Myocarditis is a common acquired cardiac disorder that may lead to persistent scar. Current guidelines recommend follow up cardiac MRI (CMR) in 3-6 months for athletes. Data supporting this recommendation is unfortunately very limited.Aim:The aim of this study was to evaluate the demographic and clinical variables of patients diagnosed with myocarditis. Clinical data for those who had a follow up CMR was also evaluated separately.Methodology:Patients who had a cardiac MRI (CMR) organised between July 2019 till December 2022 because of a MINOCA/Myocarditis hospital admission were retrospectively reviewed. Those with a myocarditis diagnosis were included. An athlete was defined as an individual who engaged in >4 hours of physical activity weekly or underwent organized sport.Results:105 patients were included (mean age 35.4±15.6 years, 83.8% male). 34.3% were athletes. 12.4% had possible acute myocarditis, 10.5% had likely myocarditis and 77.1% had confirmed myocarditis on cardiac MRI (median 4 days from presentation). ECG was abnormal in 60.0%. 8.6% had arrhythmias. Echocardiography was abnormal in 26.7%. CMR revealed 15.2% reduced LV EF, 57.1% regional wall motion abnormalities, 5.7% reduced RV EF, 25.7% pericardial effusion, 84.5% myocardial oedema. Most (88.5%) had late gadolinium enhancement (LGE). 56.2% were started on anti-heart failure medical therapy.29.5% had a CMR repeated (interval between scans 14.7±14.2 months). 77.4% showed persistent LGE, less pronounced in most (71.0%). Diffuse LGE at baseline was the only predictor for persistent scar (p=0.004). Scar persisted equally in athletes and non-athletes (p=0.666). Clinical variables were similar in both.At follow-up (24.6±15.3 months), 8.6% had adverse outcomes. The event rate was similar in athletes and non-athletes. A low LV EF on CMR (p=0.011) and abnormal ECHO (p=0.027) were the only variables that could predict outcome.Conclusion:LGE after myocarditis persists in 77.4% of cases, albeit better. No variable could predict the persistence of LGE in this cohort. Athletes and non-athletes had a similar clinical course, suggesting that repeat CMR in non-athletes is reasonable. The diagnostic utility of repeat CMR after myocarditis remains questionable.

Circulation, Volume 148, Issue Suppl_1, Page A14087-A14087, November 6, 2023. Background:Physical activity (PA) reduces cardiovascular disease (CVD) risk; those living in lower-resourced neighborhoods have higher CVD risk in part due to limited PA access. Monocyte subsets (classical, intermediate, and non-classical) with their platelet aggregates (PlAgg) are key in CVD, but less is known about relationships between PA and monocytes. We investigated associations between PA and monocyte subsets with PlAgg in African American (AA) women at risk for CVD living in resource-limited Washington, DC areas.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged PA intervention. Baseline PA was measured as daily step counts using a FitBit Charge 2. Monocyte subsets and PlAgg were measured in fasting blood samples by flow cytometry. Multivariable linear regression was used to determine relationships between PA and monocytes adjusting for BMI and ASCVD 10-year risk score. We examined neighborhood deprivation index (NDI), a 2018 Census-tract based measure of neighborhood socioeconomic deprivation, as a moderator of associations between PA and monocytes.Results:The study cohort was a sample of AA women with overweight/obesity enrolled in Step It Up (N=106, age=57±12 y, BMI=34.8±6.3kg/m2). Higher baseline PA associated with monocyte subsets, but not overall monocyte presence (Table). Furthermore, higher baseline PA negatively associated with PlAgg on all monocytes. PA and monocyte subsets were most associated among those residing in higher deprivation neighborhoods (Table).Conclusion:Baseline PA was associated with monocyte subsets and lower monocyte-PlAgg formation among AA women living in lower-resourced conditions. Future work should examine the relationship between PA changes and changes in monocyte subsets in community engaged PA interventions like Step It Up, particularly among those residing in limited resource communities.

Circulation, Volume 148, Issue Suppl_1, Page A15223-A15223, November 6, 2023. Introduction:Short-term cardiac monitors (STMs) are increasingly used in the work-up of cryptogenic stroke patients before proceeding to long-term continuous monitoring for atrial fibrillation (AF) with insertable cardiac monitors (ICM). However, the rate of ICM placement after STM is only 4-5% based on large real-world studies. The impact of patient fall-out after STM on clinical/economic outcomes is unknown.Research Question:The objective of this analysis was to project the risk of additional ischemic strokes and stroke-related costs with varying rates of patient loss to follow-up (LTFU) after 48-hour, 14-day or 30-day monitors, compared to an approach of continuous ICM monitoring post-stroke.Methods:A previously published Markov model based on the CRYSTAL-AF trial was utilized to project lifetime ischemic strokes after various monitoring strategies, from a US payer perspective. Patient characteristics and AF detection rates were based on CRYSTAL-AF: diagnostic yield with the initial STMs were 0.8% for 48-hr, 3.1% for 14-day and 6.8% for 30-day monitors. AF detection resulted in a change from aspirin to DOAC, with subsequent risks of ischemic strokes and associated costs (including acute + post-acute care) modeled based on published literature.Results:Increasing rates of patient LTFU after STM were associated with higher projected additional secondary strokes compared to an immediate ICM approach, across all 3 STM types (figure). In the scenario based on real-world data (95% LTFU), a range of 62-68 additional strokes are projected per 1,000 patients, with associated stroke costs of $4,928-$5,449/patient when averaged across the population.Conclusions:Loss of patient follow-up after STM in real-world CS patients is projected to lead to substantial secondary stroke burden due to undetected AF, compared to continuous monitoring with ICM. Future work could focus on optimizing stroke pathways to ensure timely and continued access to monitoring.

Circulation, Volume 148, Issue Suppl_1, Page A17940-A17940, November 6, 2023. Background:Heart failure with a preserved ejection fraction (HFpEF) is prevalent and has few evidence-based therapies. In a trial of HFpEF patients with specialized pacemakers, an accelerated personalized pacing rate averaging 75 bpm (myPACE) improved quality of life, NT-proBNP, physical activity, and atrial fibrillation burden compared with the standard lower rate setting of 60bpm (usual care). The one-year myPACE trial was not powered for clinical outcomes, but most patients elected to remain on their assigned treatment.Methods:The myPACE study was a single-center, blinded, randomized controlled trial that enrolled patients from June 2019 to November 2020. In this per-protocol analysis of clinical events over a 3-year follow-up, we included trial participants who remained on their assigned heart rate after study completion. The outcome of this analysis is a composite of the first clinical event (urgent visit or hospitalization for heart failure or atrial fibrillation, unstable angina or myocardial infarction, stroke, and death). Events were obtained by chart review and adjudicated by two blinded investigators. A Kaplan-Meier event-free survival plot and a log-rank test evaluated differences between the two treatment arms.Results:Of the 100 myPACE trial participants, most (40/48 myPACE and 48/52 usual care) remained on their assigned heart rate over a median (IQR) of 3.3 (2.6, 3.7) years after enrollment. The median (IQR) age was 75(69-80), and 45% were female. Accelerated personalized pacing was associated with reduced adverse clinical outcomes by about 60 percent. The Kaplan-Meier event-free survival plot for the composite of clinical events is shown in the Figure.Conclusions:In a per-protocol clinical event analysis of the extended myPACE study, those who continued the myPACE accelerated pacing protocol had fewer adverse clinical events than those with a lower rate setting of 60 bpm.

Circulation, Volume 148, Issue Suppl_1, Page A11932-A11932, November 6, 2023. Introduction:Readmission after acute myocardial Infarction is a challenge in health care. Guidelines recommend early follow-up as those who do not have established follow-up are 10 times more likely to be re-hospitalized. This allows for close review of cardiac symptoms and medications. While there is substantive data about early follow up in the obstructive ST-Segment Elevation Myocardial Infarction (STE-Obstructive) populations improving readmission rates, there are minimal guidelines regarding follow up for STE-MINOCA patients.Hypothesis:Does time to post-discharge outpatient care impact rate of readmission between STE-Obstructive and STE-MINOCA patients?Methods:A single center, retrospective cohort study analyzed demographics and discharge pathways of patients meeting STEMI criteria who underwent coronary angiography. Discharge medications, follow up appointment, and readmissions were examined. Simple and multiple logistic regression analyses were used to explore the association between discharge pathways and clinical factors in two STEMI populations.Results:377 of 433 patients survived discharge with a median age of 59. Of those who survived, 63.9% were male, 44.3% Black, 30.2% Hispanic, and 82.7% had government-issued insurance. STE-Obstructive patients had significantly higher rates of follow up (p=0.0006) and earlier than STE-MINOCA patients (p=0.052) (Table 1). Despite differences in follow up, readmissions for cardiovascular issues were not significantly different between the STE-MINOCA and STE-Obstructive patients. Of note 64% of STE-MINOCA patients who were readmitted did not have follow up prior to readmission.Conclusions:STE-MINOCA patients had longer time to follow up and less follow up than STE-Obstructive patients. Readmission rates between the two groups were similar. Further studies are required to explore the role of earlier follow up in STE-MINOCA clinical trajectory.

Circulation, Volume 148, Issue Suppl_1, Page A320-A320, November 6, 2023. Background:Rapid Basic Life Support (BLS) treatment with controlled sequential elevation of the head and thorax, active compression-decompression CPR, and an impedance threshold device, collectively termed automated Head Up Position (AHUP)-CPR, is associated with better outcomes versus conventional CPR (C-CPR) in animal models and human observational studies.Hypothesis:Rapid AHUP-CPR should improve survival and neurological function vs rapid C-CPR followed by delayed AHUP-CPR.Aim:Determine if AHUP-CPR should be initiated as a BLS or ALS intervention.Methods:Male and female farm pigs (n=22) weighing~40kg were anesthetized and ventilated. Central venous and aortic pressures, as well as end-tidal CO2 (ETCO2) and cerebral oximetry (rSO2) were measured continuously. After 15 min of untreated VF, pigs were randomized to either rapid AHUP-CPR for 25 min or 10 min of C-CPR followed by 15 min of AHUP-CPR. Pigs received intravenous epinephrine and amiodarone after 24 min of CPR and were defibrillated 60 sec later. For the primary endpoint, 24-hour neurologic function, a veterinarian blinded to the CPR intervention assessed pigs using a Neurological Deficit Score (0 = normal and 260 = worst deficit score or death). Secondary outcomes included 24-hour survival rates and hemodynamic parameters. Data were expressed as mean ± SD. Statistical significance was determined by log-rank, Mann-Whitney-U and unpaired t-tests.Results:Sustained return of spontaneous circulation was achieved in 10/11 pigs with rapid AHUP-CPR vs 6/11 with delayed AHUP-CPR and cumulative 24-hour survival rates were 45.5% (5/11) vs 9.1% (1/11), respectively (p=0.01). Neurological Deficit Scores were 202.7 ± 80.3 with rapid AHUP-CPR vs 259.1 ± 3.0 with delayed AHUP-CPR group (p=0.04). Ten minutes after initiating CPR, ETCO2 (mmHg) was 45.0 ± 3.8 vs 26.9 ± 5.4 (p