Twin peaks of in-hospital mortality among patients with STEMI across five phases of COVID-19 outbreak in China:a nation-wide study

Lockdown and re-opening may become cyclical due to the recurrent waves of the COVID-19 epidemic.Few studies have examined temporal trends and determinants of in-hospital mortality among patients with ST-segment elevation myocardial infarction(STEMI),a life-threatening condition that requires emergency medical care.Using nation-wide data before,during and after the Wuhan lockdown,we aimed to depict temporal patterns and major determinants of STEMI in-hospital mortality in China across five time periods of the COVID-19 epidemic.We analyzed the data of 283,661 STEMI patients who were admitted to 4,487 chest-pain-centers across China,from January 1,2019 to May 31,2020.Compared with the period before the lockdown,STEMI in-hospital mortality increased by 25%(OR 1.25,95%CI 1.16–1.34)during Early Lockdown,by 12%(OR 1.12,95%CI 1.03–1.22)during Later Lockdown,by 35%(OR 1.35,95%CI 1.21–1.50)during Early Lift,and returned to pre-COVID risk(OR 1.04,95%CI 0.95–1.14)during Later Lift.For each time-period,we observed a clear mortality gradient by timing and types of revascularization procedure.In conclusion,the COVID-19 epidemic had a significant adverse impact on STEMI in-hospital mortality,with bimodal peaks during early lockdown and early lift periods and clear mortality gradients by timing and types of revascularization procedure,independent of the time periods.

Acquired Cardiomyopathy Caused by Cardiac Tsc1 Deficiency

Cardiomyopathies are myocardial disorders with enlarged, thick, or rigid cardiac muscles. Because no effective treatment is available to prevent the deterioration of the myocardium function, the prognosis of cardiomyopathy is usually poor. Cardiomyopathies can be inherited or acquired. A number of genes associated with inherited cardiomyopathy, such as the genes encoding for sarcomeric, cytoskeletal,

Long-term Management of Patients with Myocardial Infarction:An Updated Review

The outcomes of patients with myocardial infarction(MI)have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention,and the majority of MI patients subsequently enter a chronic stable phase.Therefore,the long-term management of patients with MI has become a core issue in daily clinical practice for cardiologists.The long-term incidence of adverse events can be further reduced using newly developed medications and therapies ranging from lipid-lowering agents(eg,proprotein convertase subtilisin/kexin type 9 inhibitors)to anti-thrombotic treatments(eg,shortened dual anti-platelet therapy).However,a considerable number of patients still experience adverse events,as some residual risk can remain despite intensive secondary prevention,such as continuously elevated cholesterol levels,chronic cardiovascular inflammation,and rapid atherosclerosis progression due to increased plaque instability.Therefore,the present review sought to summarize and discuss recent advances in several key aspects regarding the long-term management of MI patients,with the expectation of clarifying the available treatment strategies for various clinical scenarios,examining the gaps between trial evidence and clinical practice,and providing possible directions for future research.