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Aims - The objective of our study is to compare pharmaco-invasive strategy (PhIS) in terms of safety and efficacy, with primary percutaneous coronary intervention (pPCI) strategy as standard therapy for STEMI patients from remote areas. Background - At present, primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy for STEMI patients. However, despite pPCI being the gold standard, it is not always achievable due to variables such as lack of cardiac catheterization services and delays in the first medical contact-to-balloon time. Methods - This observational study is based on a prospective analysis of a cohort of 157 patients with ST-elevation myocardial infarction, over nine months, at Elias University Hospital (EUH). The study assessed the safety and efficacy of a sequence of fibrinolytic therapy in the first contact hospital before being referred to our center for PCI (PhIS, 35 patients, 22.29%) versus angioplasty alone (pPCI, 122 patients, 77.70%) during hospitalization. The primary outcomes studied were in-hospital death, and major adverse cardiac events (MACE), while secondary outcomes were the length of in-hospital stay, and the safety of the procedure. Results - The median reperfusion time was lower for the PhIS group compared to the primary PCI group (4 hours, IQR:6.25 vs 7 hours, IQR:12.38, p<0.05). The left ventricular systolic function (%) on arrival at EUH was higher in the PhIS group compared with the PCI alone group (46.55; 95%CI 42.42-49.15 vs 41.73; 95%CI 39.91-43.34; p=0.04). The mean number of diseased vessels, including the culprit-lesion, were similar in the two groups (2.84 vs 2.82, p=0.09). The in-hospital mortality rate was lower in the PhIS group than in the primary PCI group (1 patient; 2.9% vs 18 patients; 14.80%; p=0.05), while the number of in-hospital major adverse cardiac events (MACE) was not significantly different (17.10% vs 26.20%; p=0.27). There was no difference of the median length of hospitalization (6 days, IQR:2 vs 5 days, IQR:3; p=0.67) for the PhIS, and primary PCI groups, respectively. The safety endpoints of the procedures were similar in the two groups. Conclusions - Pharmaco-invasive strategy (PhIS) had clinical and procedural outcomes (in-hospital MACE, length of in-hospital stay) similar to primary percutaneous coronary intervention (pPCI), in case of long distances to catheterization laboratories. Efficient thrombolysis makes PhIS a viable alternative in saving lives with a lower rate of in-hospital death than pPCI. Performed thrombolysis in a local non-PCI center and referral of the STEMI patients to a 24/7 catheterization laboratory may be a good option for areas where the infrastructure of such facilities is weak. [ABSTRACT FROM AUTHOR]

Aim: The body mass index (BMI), the most used anthropometric index of obesity, has an important limitation, not taking into consideration the distribution of body fat. We developed a new simple index: the waist-corrected BMI (wBMI), calculated as waist circumference (WC) × BMI. The study aim was to assess the role of wBMI, compared to BMI, WC, and Waist-to-Height Ratio (WHtR) in predicting abnormal cardiac geometry, insulin resistance, increased arterial stiffness, and dyslipidemia. Methods: This was a cross-sectional study that included 805 patients referred to our Department of Preventive Cardiology for risk factors evaluation and treatment. Eleven echographic and laboratory parameters were determined, and receiver operating characteristic (ROC) curves were derived. Areas under ROC curves (AUC) were used to assess the accuracy of the four indexes to identify unfavorable characteristics. Results: There were 29% overweight, 59% obese, and 77% hypertensive patients. Of 11 echographic and laboratory parameters, wBMI, BMI, WHtR, and WC had the largest AUC for identifying 3, 1, 6, and 1 parameters, respectively, but with overlapping 95% confidence intervals. wBMI had the largest AUC for increased arterial stiffness and insulin resistance; also, it was superior to BMI for increased left atrial volume, relative wall thickness, and triglyceride level. Conclusions: In a large population with a high prevalence of obesity and hypertension, all four indexes were associated with unfavorable characteristics. wBMI has the theoretical advantage of taking into account simultaneously the global fat mass and distribution and might be useful for a better cardiovascular risk assessment. [ABSTRACT FROM AUTHOR]

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