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A decade ago women with ST-elevation myocardial infarction (STEMI) were significantly older than men, with more comorbidities, less likely treated by primary percutaneous coronary intervention (PPCI) and their prognosis was worse. The progress in treatment led to increased survival after STEMI. Our aim was to evaluate the possible current differences between the genders in treatments, mortality and the changes in women over time in STEMI population. We retrospectively evaluated 307 STEMI patients (224 men, 83 women), admitted between October 1, 2011 and December 31, 2012 and a historic group of 523 STEMI patients from 2008 to 2009 (361 men, 162 women). Reperfusion strategy was PPCI, combined with aspirin and clopidogrel or prasugrel or ticagrelor and a heparin with glycoprotein receptor IIb/IIIa antagonist or bivalirudin. Between the genders and in women over time we compared clinical data, the use and time to PPCI, in-hospital complications, 30-day and 6-month mortality. STEMI patients in recent years were treated by PPCI in 94.5 %. Their 30-day mortality was 10.4 % and 6-month mortality 14.7 %. Between the genders we observed mostly nonsignificant differences (age, comorbidities, treatments, in-hospital complications, 30-day and 6-month mortality). Over the last years in women mean age significantly decreased, the use of PPCI significantly increased, the incidence of heart failure and bleedings decreased significantly, but mortalities nonsignificantly. Women still account for 1/4 of STEMI population, but the gap between the genders in presentation, treatments and outcome in STEMI population is decreasing.

In patients with refractory cardiac arrest presumably from acute coronary occlusion, primary percutaneous coronary intervention (PPCI) may provide an opportunity for revascularisation and, subsequently, return of spontaneous circulation. We present our experience from a 24/7 primary percutaneous coronary intervention centre serving a population of approximately 800,000 individuals. A retrospective analysis was performed in patients with cardiac arrest treated from July 2011 to January 2014. Inclusion criteria were cardiac arrest and emergency coronary angiography performed during on-going external cardiopulmonary resuscitation (CPR). Course of treatment was analysed to outline the reasons for poor survival. Eight patients met the inclusion criteria; six (75 %) were male, and the mean age was 63 ± 16 years. Revascularisation under continuous cardiopulmonary resuscitation was achieved in all eight patients. Sustained return of spontaneous circulation was achieved in two patients (25 %). Both patients had poor neurological outcome (cerebral performance category 4), and both died within 3 months. We identified total duration of cardiopulmonary resuscitation (90.5 ± 33.3 min), lack of prehospital mechanical cardiopulmonary resuscitation devices and lack of extra-corporeal life support devices as the most likely reasons contributing to poor survival.

In normal circumstances central venous to arterial pCO(2) difference is approximately 1 kPa (7.5 mmHg). In shock states it is usually increased. We sought to evaluate the agreement between admission central venous to arterial pCO(2) difference and mortality in patients with acute myocardial infarction and cardiogenic shock. We hypothesized that patients with higher central venous to arterial pCO(2) difference on admission would have higher mortality. We retrospectively included 30 patients with acute myocardial infarction and cardiogenic shock (mean age 67 ± 10 years, 73 % men), of which 20 (67 %) died. Nonsignificant differences between survivors and nonsurvivors were observed in age, gender, admission mean blood pressure, heart rate, lactate, hemoglobin, peak troponin I, cardiopulmonary resuscitation, use of therapeutic hypothermia, vasopressors, inotropes, intraaortic balloon pump, and mechanical ventilation. A significant difference between survivors and nonsurvivors was observed in admission central venous to arterial pCO(2) difference (1.35 ± 0.49 kPa vs. 0.83 ± 0.36 kPa, p = 0.003). In patients with admission central venous oxygen saturation over 70 %, we observed a significant difference in central venous to arterial pCO(2) difference between survivors and nonsurvivors (1.33 ± 0.51 kPa vs. 0.7 ± 0.3 kPa, p = 0.003) and a nonsignificant difference between survivors and nonsurvivors in patients with admission central venous oxygen saturation under 70 % (1.38 ± 0.53 kPa vs. 1.25 ± 0.33 kPa, p = 0.37). Patients with decreased central venous to arterial pCO(2) difference on admission seem to be at increased risk of dying even with admission central venous oxygen saturation over 70 %.