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The COVID-19 pandemic presents several challenges for managing patients with acute coronary syndrome (ACS). Modified treatment algorithms have been proposed for the pandemic. We assessed new algorithms proposed by The European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Acute Cardiovascular Care Association (ACCA) on patients with ACS admitted to the hospital during the COVID-19 pandemic. The COVID-19 period group (CPG) consisted of patients admitted into a high-volume centre in Prague between 1 February 2020 and 30 May 2020 (n = 181). The reference group (RG) included patients who had been admitted between 1 October 2018 and 31 January 2020 (n = 834). The proportions of patients with different types of ACS admitted before and during the pandemic did not differ significantly: in all ACS patients, KILLIP III-IV class was present in 13.9% in RG and in 9.4% of patients in CPG (p = 0.082). In NSTE-ACS patients, the ejection fraction was lower in the CPG than in the RG (44.7% vs. 50.7%, respectively, p &lt, 0.001). The time from symptom onset to first medical contact did not differ between CPG and RG patients in the respective NSTE-ACS and STEMI groups. The time to early invasive treatment in NSTE-ACS patients and the time to reperfusion in STEMI patients were not significantly different between the RG and the CPG. In-hospital mortality did not differ between the groups in NSTE-ACS patients (odds ratio in the CPG 0.853, 95% confidence interval (CI) 0.247 to 2.951, p = 0.960) nor in STEMI patients (odds ratio in CPG 1.248, 95% CI 0.566 to 2.749, p = 0.735). Modified treatment strategies for ACS during the COVID-19 pandemic did not cause treatment delays. Hospital mortality did not differ.

Uvod: Mechanicka trombektomie (MT) se ukazala být ucinnou lecebnou metodou u pacientů s akutni ischemickou cevni mozkovou přihodou (iCMP) vzniklou uzavěrem proximalniho useku velkých mozkových tepen. Cilem teto studie bylo porovnat zavažnost neurologickeho deficitu pacientů, kteři podstoupili MT v zavislosti na jejich zakladnich klinických charakteristikach.Metody: Prospektivni observacni monocentrický registr pacientů lecených mechanickou trombektomii pro akutni iCMP. Stupeň neurologickeho deficitu byl kvantifikovan pomoci modifikovane Rankinovy skaly (mRS 0-6) s odstupem tři měsiců od vzniku iCMP. Dle zavažnosti neurologickeho postiženi byli pacienti rozděleni do dvou skupin - mRS 0-2 vs. mRS 3-6.Výsledky: Celkem bylo do registru zařazeno 111 pacientů (průměrný věk 65,9 roku, muži 55 %). Klinicky přizniveho výsledku (mRS ≤ 2 za tři měsice) bylo dosaženo v 39,8 % (44 pacientů). Tito pacienti (mRS ≤ 2) byli v porovnani s druhou, klinicky horsi skupinou (mRS 3-6) mladsi (61 let vs. 70 let, p < 0,01), měli větsi zastoupeni aktivnich kuřaků (45,5 % vs. 25,4 %, p < 0,002) a mensi prevalenci fibrilace sini (25 % vs. 53,7 %, p < 0,001). Mezi skupinami nebyly výrazne rozdily v zastoupeni jednotlivých pohlavi (muži 50 % vs. 58 %, p = 0,27), v hodnotě indexu tělesne hmotnosti (27,8 vs. 29,2, p = 0,21), v prevalenci arterialni hypertenze (70,5 % vs. 77,6 %, p = 0,26), diabetes mellitus (15,9 % vs. 25,4 %, p = 0,15), chronicke renalni insuficience (11,4 % vs. 22,4 %, p = 0,08) a ani v hodnotě NIHSS (National Institute of Health Stroke Scale) při přijmu (15 vs. 18, p = 0,69).Zavěr: Mechanicka trombektomie dosahuje lepsich klinických výsledků u mladsich pacientů, u kuřaků a u pacientů s iCMP, ktera nebyla způsobena embolizaci při fibrilaci sini.

Purpose Identification of clinical and laboratory predictors related to Infectious Complications (ICs) in patients after Out-of-Hospital Cardiac Arrest (OHCA). Methods Patients, aged > 18, after an OHCA between 9/2013 and 11/2015, surviving > 24 h, were studied. Results Study group consisted of 42 patients (mean age 63.4 years, 88.1% men). Forty percent of patients had IC; lower respiratory tract infections were most common (87.5% of cases). ICs were more common in patients receiving Targeted Temperature Management (50% vs. 10%; p = 0.032). Antibiotics were used in 85.7% of patients. The mean time to therapy initiation was 9.6 (SD 7.1) hours after admission. The mean course of treatment was 9.0 (SD 6.2) days. Fifty-three percent of patients receiving early antibiotic treatment didn't have IC. Initial antibiotic therapy was changed more often in patients with IC (75% vs. 38.9%; p = 0.045). C-Reactive Protein, Procalcitonin, Troponin and White Blood Cell count values were higher in patients with IC. Conclusion Early initiated antibiotic treatment is overused in patients after OHCA. This practice is associated with necessitating antibiotic change in the majority of patients with IC. Assessment of clinical and laboratory parameters in the first days after OHCA increases the likelihood of appropriate ATB therapy.

Survivors after cardiac arrest (CA) due to AMI undergo PCI and then receive dual antiplatelet therapy. Mild therapeutic hypothermia (MTH) is recommended for unconscious patients after CA to improve neurological outcomes. MTH can attenuate the effectiveness of P2Y12 inhibitors by reducing gastrointestinal absorption and metabolic activation. The combined effect of these conditions on the efficacy of P2Y12 inhibitors is unknown. We compared the antiplatelet efficacies of new P2Y12 inhibitors in AMI patients after CA treated with MTH. Forty patients after CA for AMI treated with MTH and received one P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) were enrolled in a prospective observational single-center study. Platelet inhibition was measured by VASP (PRI) on days 1, 2, and 3 after drug administration. In-hospital clinical data and 1-year survival data were obtained. The proportion of patients with ineffective platelet inhibition (PRI > 50 %, high on-treatment platelet reactivity) for clopidogrel, prasugrel, and ticagrelor was 77 vs. 19 vs. 1 % on day 1; 77 vs. 17 vs. 0 % on day 2; and 85 vs. 6 vs. 0 % on day 3 (P < 0.001). The platelet inhibition was significantly worse in clopidogrel group than in prasugrel or ticagrelor group. Prasugrel and ticagrelor are very effective for platelet inhibition in patients treated with MTH after CA due to AMI, but clopidogrel is not. Using prasugrel or ticagrelor seems to be a more suitable option in this high-risk group of acute patients.

AIMS The aim of this study was to evaluate the role of direct catheter-based thrombectomy (d-CBT, without thrombolysis) and the feasibility and safety of d-CBT performed in an interventional cardiology centre. METHODS AND RESULTS This single-centre, prospective observational registry based on the pre-specified protocol included three months of follow-up. The decision to perform acute stroke intervention was made by a neurologist based on the clinical and imaging findings. Inclusion criteria were moderate-to-severe acute ischaemic stroke (NIHSS ≥6)

Background Survival rates and outcomes after out-of-hospital cardiac arrest (OHCA) remain low despite investments of time and money. The goal of this analysis was to identify variables related to survival of patients transferred to our coronary care unit (CCU) after an OHCA. Methods 102 consecutive OHCA patients, mean age 64.6 (SD 13.3), 70.6% men, between January, 2011 and December, 2013, who were transferred to our tertiary care CCU, were studied. Results Cardiac-cause OHCA was present in 84 patients (82.4%). Of these 60.7% had an acute coronary syndrome (ACS) – STEMI 35.7%; NSTEMI 23.8%. Coronary angiography was performed in 73 (71.6%) patients – 81% with cardiac- and 31.3% (5/16) with a non-cardiac cause. Percutaneous coronary intervention (PCI) was performed in 50 patients (68.5%), 49 with cardiac-cause, and succeeded in 92%. In-hospital mortality was 38.2%, one-year mortality was 51.5%. In-hospital and one-year mortality were related to age (p = 0.002 resp. p = 0.001), first ECG rhythm (p = 0.001, resp. p = 0.005), history of coronary artery disease (RR 2.1; p = 0.026 resp. RR 1.71; p = 0.029), and history of arrhythmia (supraventricular tachyarrhythmia, bradyarrhythmia) (RR 2.74; p = 0.003 resp. RR 2.3; p = 0.001). One-year mortality was also related to a history of diabetes mellitus (RR 1.89; p = 0.006). Conclusion Cardiac-cause was the most common cause of OHCA. Acute coronary syndrome was present in more than half of the cases. Availability of interventional facilities was a crucial factor in OHCA management. A history of coronary artery disease, diabetes mellitus, and arrhythmia were associated with worse survival.