BACKGROUND:The optimal transfusion strategy in patients with acute myocardial infarction (AMI) and anemia may be influenced by sex differences in pathophysiology and cardiovascular outcomes. The Myocardial Ischemia and Transfusion trial (MINT) randomized patients with AMI and anemia to restrictive or liberal transfusion thresholds, but sex-stratified outcomes remain undefined. The objective was to evaluate whether the clinical effect of restrictive versus liberal red blood cell transfusion strategies differs by sex in patients hospitalized with AMI and anemia. METHODS:In this prespecified secondary analysis of the MINT trial, we examined outcomes by sex and transfusion strategy. The primary outcome was 30-day composite death or MI. Secondary outcomes included heart failure, stroke, cardiac death, and 180-day mortality. Adjusted relative risks (RRs) and hazard ratios (HRs) were estimated accounting for sex differences at baseline. Interactions between sex and transfusion effects were assessed. RESULTS:There were 3504 study participants, of whom 1593 (45.4%) were women. Women received fewer transfusions on average. Primary outcome occurred in 15.7% of women and 15.7% of men and occurred in 16.5% of women and 17.1% of men in the restrictive arm, versus 14.9% and 14.2% in the liberal arm, respectively. Women had a lower mortality between 30 and 180 days (11.0% versus 13.5%; P=0.04). There were no statistically significant interactions between sex and transfusion strategy for the primary outcome (interaction P=0.60). For 30-day cardiac death, a higher RR in men was observed in the restrictive transfusion arm (RR, 2.34; 95% CI, 1.48-3.70; interaction P=0.05). CONCLUSIONS:For MINT patients with anemia and AMI, women comprised nearly half of the study population, and randomization to a restrictive or liberal transfusion strategy resulted in comparable outcomes in women and men. These findings support sex-neutral transfusion thresholds. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02981407.

BACKGROUND:Cardiovascular disease remains the leading cause of mortality worldwide, with acute myocardial infarction (AMI) contributing to over 100,000 deaths annually in the United States. Accurate risk stratification for in-hospital mortality is essential for guiding clinical decisions, improving outcomes, and optimizing hospital resources. However, existing models often rely on limited predictor sets, outdated data, and linear methods that may not reflect current clinical practice. OBJECTIVE:To develop and validate a contemporary in-hospital mortality risk model for AMI patients, incorporating clinical, demographic, and social determinants of health, and to compare performance against the legacy ACTION Registry-GWTG model. METHODS:We utilized data from the American Heart Association (AHA) Get with The Guidelines-Coronary Artery Disease (GWTG-CAD) Registry. Patients with AMI admitted between October 1, 2019, and December 31, 2022 (201,191 patients from 605 hospitals) were used to develop the in-hospital mortality prediction model. A total number of 70,302 patients admitted in 2023 served as an independent validation cohort. We incorporated 27 predictors and benchmarked against the legacy ACTION Registry-GWTG model. Subgroup and sensitivity analyses assessed model performance across sex, race/ethnicity, ST-elevation myocardial infarction status, and time period. RESULTS:The Light Gradient Boosting Machine (LightGBM)-based GWTG-CAD model achieved the highest discrimination (area under the receiver operating characteristic curve [AUROC] 0.874, 95% confidence intervals, 0.867-0.880) and superior calibration across subgroups, outperforming the ACTION Registry-GWTG model (AUROC 0.859, 95% confidence intervals, 0.852-0.867). Comorbidities, transportation method, and community-level socioeconomic factors contributed meaningful predictive value beyond traditional predictors. The generalized linear mixed model (AUROC 0.865) provided interpretable odds ratios and calibrated probability estimates suitable for risk-adjusted benchmarking and quality improvement. CONCLUSION:The GWTG-CAD model suite advances AMI mortality prediction through 2 complementary approaches: the LightGBM model offers superior discrimination for identifying high-risk patients across diverse subgroups, while the generalized linear mixed model provides a transparent tool for institutional benchmarking and quality improvement. Broader external validation is needed before clinical deployment.

Over 40% of patients are discharged to post-acute care services which serve predominantly older adults with cardiovascular or cerebrovascular disease and substantial age-related complexity. Post-acute care settings are often siloed from the broader healthcare system, creating care gaps, suboptimal outcomes, and higher-than-average readmission rates. As value-based care models increasingly emphasize holistic, equitable care for an aging population, post-acute care represents a major opportunity for improvement, including the use of preventive strategies and standardized, evidence-based processes. Certification programs in post-acute care could strengthen patient and family engagement in prevention and wellness, integrate routine geriatric assessments, and promote consistent application of personalized clinical practice guidelines following cardiovascular events and stroke. The American Heart Association (AHA)/American Stroke Association (ASA) is well suited to lead this effort, with a strong history of building registries, accreditation frameworks, and recognition programs that elevate guideline-recommended heart and stroke care. Leveraging new tools and data systems, the AHA/ASA is generating the evidence needed to support widespread post-acute care certification, with the goal of improving care quality and long-term outcomes for patients transitioning from acute hospitalization.

Previous studies about the COVID-19 pandemic on STEMI patient outcomes have conflicting results. It remains unclear if this may be attributed to regional differences and/or differences during COVID-19 wave periods. Using the American Heart Association Get With The Guidelines–Coronary Artery Disease registry data, we evaluated (1) time metrics related to STEMI system goals and (2) regional variation in STEMI incidence and in-hospital mortality during pandemic wave time periods. The study included all patients 18–100 years old admitted with STEMI (n = 72,516) to 1 of 435 American Heart Association Get With The Guidelines–Coronary Artery Disease hospitals (1 October 2019–31 December 2021). Of these, 70.8% were male and 73.0% non-Hispanic White, with a median age of 63 (IQR 18) years. Compared to pre-pandemic time frames, patients with STEMI had a higher risk profile, delayed time to treatment, were treated with fibrinolytic therapy or primary PCI, and were transferred for primary PCI at similar rates, and had higher adjusted in-hospital mortality (during the second wave in the South and Midwest). Preservation of STEMI systems of care resulted in an overall lower in-hospital mortality rate than predicted, although opportunities exist to improve treatment delays. Regional differences in mortality rates require further study.

Background: The past two decades have witnessed reductions in time to diagnosis and reperfusion therapy in patients with ST elevation myocardial infarction (STEMI), largely through improvements in STEMI systems of care. While studies have demonstrated important benefits of timely coronary reperfusion in STEMI patients, those with non-system reasons for delay (NSD) are often excluded from these analyses, limiting insights into the overall quality of care for these patients. Methods: We analyzed the NSD in patients with STEMI undergoing primary PCI who were enrolled in the GWTD-CAD registry from January 1st, 2019, to December 31st, 2021. We examined the patient-level characteristics and outcomes for patients with and without reported NSD. We performed multivariable logistic regression models to examine the association between NSD and in-hospital mortality, adjusting for patient demographics, clinical variables, and social factors. We then categorized hospitals into four groups based on proportion of STEMI patients with NSD and examined the hospital-level characteristics across the quartiles. We further grouped hospitals by quality metric achievement of timely coronary reperfusion and examined the rates of NSD and treatment times for each category of achievement of the quality metric. Results: 74,372 patients were included in the study. 17,741 (23.9%) patients were reported to have NSD. Patients with NSD were older, and more likely to be female, of Black race, and have significant comorbidities including higher rates of cardiac arrest, heart failure and cardiogenic shock on presentation. In-hospital mortality rate was significantly higher in patients with NSD (15.4% vs 2.7%), (Adjusted OR 2.78, [95% CI:2.54-3.04]). Although high-achieving hospitals (those meeting the metrics ≥75%) excluded more patients, they consistently maintained shorter treatment times, even when NSD patients were included in the analysis. Conclusion: NSD in STEMI care is prevalent and linked to higher in-hospital mortality. While concerns about selective case exclusion exist, high-achieving hospitals consistently demonstrated excellent time-to-treatment even when patients with NSD are included ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This is not a prospective study ### Funding Statement The Get With The Guidelines®?Coronary Artery Disease (GWTG-CAD) program is provided by the American Heart Association. GWTG-CAD is sponsored, in part, by Novartis, Novo Nordisk and Bayer. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Because data were used primarily at the local site for quality improvement, each participating hospital received either human research approval to enroll cases without individual patient consent under the common rule, or a waiver of authorization and exemption from subsequent review by their institutional review board (IRB). Advarra, the IRB for the American Heart Association, determined that this study is exempt from IRB oversight. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The Precision Medicine Platform is a cloud-based system that allows researchers to collaborate and analyze large datasets from any computer in the world using a secure environment and the power of machine learning. Within the research interface, users have access to assorted datasets, including the industry-changing Get With The Guidelines® registry data to accelerate findings into impactful discoveries. Researchers must have an approved research proposal to access Get With The Guidelines® registry data.

In 1924, the founders of the American Heart Association (AHA) envisioned an international society focused on the heart and aimed at facilitating research, disseminating information, increasing public awareness, and developing public health policy related to heart disease. This presidential advisory provides a comprehensive review of the past century of cardiovascular and stroke science, with a focus on the AHA's contributions, as well as informed speculation about the future of cardiovascular science into the next century of the organization's history. The AHA is a leader in fundamental, translational, clinical, and population science, and it promotes the concept of the "learning health system," in which a continuous cycle of evidence-based practice leads to practice-based evidence, permitting an iterative refinement in clinical evidence and care. This advisory presents the AHA's journey over the past century from instituting professional membership to establishing extraordinary research funding programs; translating evidence to practice through clinical practice guidelines; affecting systems of care through quality programs, certification, and implementation; leading important advocacy efforts at the federal, state and local levels; and building global coalitions around cardiovascular and stroke science and public health. Recognizing an exciting potential future for science and medicine, the advisory offers a vision for even greater impact for the AHA's second century in its continued mission to be a relentless force for longer, healthier lives.

COVID‐19 has disrupted the care of all patients, and little is known about its impact on the utilization and short‐term mortality of percutaneous coronary intervention (PCI) patients, particularly nonemergency patients.

The importance of early revascularization in the setting of ST-segment elevation myocardial infarction (STEMI) has become a pillar of contemporary cardiology practice. With the landmark results of the GISSI (Gruppo Italiano per lo Stustudy showing an 18% risk reduction in 21-day mortality after STEMI with streptokinase administration compared with medical therapy alone1 and the DANAMI-2 (Danish Multicenter Randomized Study plasty in Acute Myocardial Infarction) study showing the superiority of primary percutaneous coronary intervention (PCI) over fibrinolytic therapy,2 a host of process measures developed soon thereafter to ensure that STEMI patients receive timely reperfusion. Not surprisingly, as time to revascularization (most commonly measured as "door-to-balloon" time) decreased, in-hospital mortality decreased as well.3 Nevertheless, despite the implementation of more standardized care processes as well as major advancements in the field of interventional cardiology devices, techniques, and pharmacology over the past decade, recent studies have suggested that

Objective To compare outcomes in women undergoing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. Design This retrospective, propensity-score matched cohort study from the New York State cardiac registry (2012-2018) included all women with multivessel coronary artery disease undergoing PCI with everolimus-eluting stents (EES) and CABG surgery. The primary outcome was all-cause mortality. The key secondary outcome was major adverse cardiac events, defined as the composite of all-cause mortality, myocardial infarction, and stroke. Results PCI with EES was associated with a higher 6-year risk of mortality (25.75% vs 23.57%; adjusted hazard ratio [AHR], 1.29; 95% confidence interval [CI], 1.14-1.45). PCI also was associated with a higher rate of the composite outcome of death, myocardial infarction, and stroke (36.58% vs 32.89%; AHR, 1.28; 95% CI, 1.17-1.41), as well as myocardial infarction (14.94% vs 9.12%; AHR, 1.84; 95% CI, 1.56-2.17), but not stroke (7.07% vs 7.62%; AHR, 0.83; 95% CI, 0.67-1.03). Repeat revascularization rates also were higher for women undergoing PCI (21.53% vs 11.57%; AHR, 1.88; 95% CI, 1.63-2.17). There was no difference in mortality between the 2 interventions when PCI patients received complete revascularization or had noncomplex lesions and for women without diabetes. Conclusions For women with multivessel coronary artery disease, CABG surgery is associated with lower 6-year mortality, myocardial infarction, and repeat revascularization rates compared to PCI with EES.

BACKGROUND There is very little information about the use of ad hoc percutaneous coronary intervention (PCI) in stable patients with multivessel (MV) disease or unprotected left main (LM) disease patients for whom a heart team approach is recommended.OBJECTIVE To identify the extent of ad hoc PCI utilization for patients with multivessel disease or left main disease, and to explore the inter-hospital variation in ad hoc PCI utilization for those patients.METHODS New York State's cardiac registries were used to examine the use and variation in use of ad hoc PCI for MV/ LM disease as a percentage of all MV/LM PCIs and revascularizations (PCIs plus coronary artery bypass graft procedures) during 2018 to 2019 in New York. RESULTS After exclusions, 6,425 of the 8,196 stable PCI patients with MV/LM disease (78.4%) underwent ad hoc PCI, ranging from 58.7% for patients with unprotected LM disease to 85.4% for patients with 2-vessel proximal left anterior descending (PLAD) disease. Ad hoc PCIs comprised 35.1% of all revascularizations, ranging from 11.5% for patients with unprotected LM disease to 63.9% for patients with 2-vessel PLAD disease. The risk-adjusted utilization of ad hoc PCI as a percentage of all re-vascularizations varied widely among hospitals (eg, from 15% in the first quartile to 46% in the last quartile for 3-vessel disease).CONCLUSIONS Ad hoc PCIs occur frequently even among patients with MV/LM disease. This is particularly true among patients with 2-vessel PLAD disease. The frequency of ad hoc PCIs is lower but still high among patients with diabetes and low ejection fraction and higher in hospitals without surgery on-site (SOS). Given the magnitude of hospital-and physician-level variation in the use of ad hoc PCIs for such patients, consideration should be given to a systems approach to achieving heart team consultation and shared decision making that is consistent for SOS and non-SOS hospitals. (J Am Coll Cardiol Intv 2023;16:1733-1742) (c) 2023 by the American College of Cardiology Foundation.

•A total of 2121 (1.55%) patients who underwent PCI died within 30 days; 34% were after discharge.•Hospital mortality outliers were all different.•Including deaths after discharge has a large effect on hospital quality assessment.

HomeCirculation: Cardiovascular InterventionsVol. 16, No. 6Enhancing Regional ST-Segment–Elevation Myocardial Infarction Care: A Shock to the System No AccessEditorialRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessEditorialRequest AccessFull TextEnhancing Regional ST-Segment–Elevation Myocardial Infarction Care: A Shock to the System Nir Ayalon and Alice K. Jacobs Nir AyalonNir Ayalon https://orcid.org/0000-0002-0480-1249 Evans Department of Medicine, Section of Cardiology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, MA. Search for more papers by this author and Alice K. JacobsAlice K. Jacobs Correspondence to: Alice K. Jacobs, MD, Evans Department of Medicine, Section of Cardiology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 720 Harrison Ave, Boston, MA 02118. Email E-mail Address: [email protected] https://orcid.org/0000-0002-2428-2458 Evans Department of Medicine, Section of Cardiology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, MA. Search for more papers by this author Originally published20 Jun 2023https://doi.org/10.1161/CIRCINTERVENTIONS.123.013177Circulation: Cardiovascular Interventions. 2023;16This article is a commentary on the followingReperfusion Delays and Outcomes Among Patients With ST-Segment–Elevation Myocardial Infarction With and Without Cardiogenic ShockFootnotesFor Disclosures, see page 359.The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to: Alice K. Jacobs, MD, Evans Department of Medicine, Section of Cardiology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, 720 Harrison Ave, Boston, MA 02118. Email alice.jacobs@bmc.orgReferences1. Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2023 update: a report from the American Heart Association.Circulation. 2023; 147:e93–e621. doi: 10.1161/CIR.0000000000001123LinkGoogle Scholar2. Reynolds K, Go AS, Leong TK, Boudreau DM, Cassidy-Bushrow AE, Fortmann SP, Goldberg RJ, Gurwitz JH, Magid DJ, Margolis KL, et al. Trends in incidence of hospitalized acute myocardial infarction in the Cardiovascular Research Network (CVRN).Am J Med. 2017; 130:317–327. doi: 10.1016/j.amjmed.2016.09.014CrossrefMedlineGoogle Scholar3. McNamara RL, Kennedy KF, Cohen DJ, Diercks DB, Moscucci M, Ramee S, Wang TY, Connolly T, Spertus JA. Predicting in-hospital mortality in patients with acute myocardial infarction.J Am Coll Cardiol. 2016; 68:626–635. doi: 10.1016/j.jacc.2016.05.049CrossrefMedlineGoogle Scholar4. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, et al; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association.Circulation. 2017; 136:e232–e268. doi: 10.1161/CIR.0000000000000525LinkGoogle Scholar5. Kochan A, Lee T, Moghaddam N, Milley G, Singer J, Cairns JA, Wong GC, Jentzer JC, Van Diepen S, Alviar C, et al. Reperfusion delays and outcomes among patients with ST-segment–elevation myocardial infarction with and without cardiogenic shock.Circ Cardiovasc Interv. 2023; 16:e012810. doi: 10.1161/CIRCINTERVENTIONS.122.012810LinkGoogle Scholar6. Jollis JG, Granger CB, Zegre-Hemsey JK, Henry TD, Goyal A, Tamis-Holland JE, Roettig ML, Ali MJ, French WJ, Poudel R, et al. Treatment time and in-hospital mortality among patients with ST-segment elevation myocardial infarction, 2018-2021.JAMA. 2022; 328:2033–2040. doi: 10.1001/jama.2022.20149CrossrefMedlineGoogle Scholar7. Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ, Krumholz HM; National Cardiovascular Data Registry. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study.BMJ. 2009; 338:b1807. doi: 10.1136/bmj.b1807CrossrefMedlineGoogle Scholar8. Wong GC, Welsford M, Ainsworth C, Abuzeid W, Fordyce CB, Greene J, Huynh T, Lambert L, Le May M, Lutchmedial S, et al; Members of the Secondary Panel. 2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the acute management of ST-elevation myocardial infarction: focused update on regionalization and reperfusion.Can J Cardiol. 2019; 35:107–132. doi: 10.1016/j.cjca.2018.11.031CrossrefMedlineGoogle Scholar9. Nallamothu BK, Normand SL, Wang Y, Hofer TP, Brush JE, Messenger JC, Bradley EH, Rumsfeld JS, Krumholz HM. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study.Lancet. 2015; 385:1114–1122. doi: 10.1016/S0140-6736(14)61932-2CrossrefMedlineGoogle Scholar10. Papolos AI, Kenigsberg BB, Berg DD, Alviar CL, Bohula E, Burke JA, Carnicelli AP, Chaudhry SP, Drakos S, Gerber DA, et al; Critical Care Cardiology Trials Network Investigators. Management and outcomes of cardiogenic shock in cardiac ICUs with versus without shock teams.J Am Coll Cardiol. 2021; 78:1309–1317. doi: 10.1016/j.jacc.2021.07.044CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesReperfusion Delays and Outcomes Among Patients With ST-Segment–Elevation Myocardial Infarction With and Without Cardiogenic ShockAndrew Kochan, et al. Circulation: Cardiovascular Interventions. 2023;16 June 2023Vol 16, Issue 6 Advertisement Article Information Metrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.123.013177PMID: 37339238 Manuscript receivedMay 15, 2023Manuscript acceptedMay 23, 2023Originally publishedJune 20, 2023 KeywordsEditorialsreperfusionshock, cardiogenicST-segment–elevation myocardial infarctiontriagePDF download Advertisement Subjects Catheter-Based Coronary and Valvular Interventions Heart Failure

Risk models and risk scores derived from those models require periodic updating to account for changes in procedural performance, patient mix, and new risk factors added to existing systems. No risk model or risk score exists for predicting in-hospital/30-day mortality for percutaneous coronary interventions (PCIs) using contemporary data. This study develops an updated risk model and simplified risk score for in-hospital/30-day mortality following PCI. To accomplish this, New York's Percutaneous Coronary Intervention Reporting System was used to develop a logistic regression model and a simplified risk score model for predicting in-hospital/30-day mortality and to validate both models based on New York data from the previous year. A total of 54,770 PCI patients from 2019 were used to develop the models. Twelve different risk factors and 27 risk factor categories were used in the models. Both models displayed excellent discrimination for the development and validation samples (range from 0.894 to 0.896) and acceptable calibration, but the full logistic model had superior calibration, particularly among higher-risk patients. In conclusion, both the PCI risk model and its simplified risk score model provide excellent discrimination and although the full risk model requires the use of a hand-held device for estimating individual patient risk, it provides somewhat better calibration, especially among higher-risk patients.

BACKGROUND:Systems of care have been developed across the United States to standardize care processes and improve outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). The effect of contemporary STEMI systems of care on racial and ethnic disparities in achievement of time-to-treatment goals and mortality in STEMI is uncertain. METHODS:We analyzed 178 062 patients with STEMI (52 293 women and 125 769 men) enrolled in the American Heart Association Get With The Guidelines-Coronary Artery Disease registry between January 1, 2015, and December 31, 2021. Patients were stratified into and outcomes compared among 3 racial and ethnic groups: non-Hispanic White, Hispanic White, and Black. The primary outcomes were the proportions of patients achieving the following STEMI process metrics: prehospital ECG obtained by emergency medical services; hospital arrival to ECG obtained within 10 minutes for patients not transported by emergency medical services; arrival-to-percutaneous coronary intervention time within 90 minutes; and first medical contact-to-device time within 90 minutes. A secondary outcome was in-hospital mortality. Analyses were performed separately in women and men, and all outcomes were adjusted for age, comorbidities, acuity of presentation, insurance status, and socioeconomic status measured by social vulnerability index based on patients' county of residence. RESULTS:Compared with non-Hispanic White patients with STEMI, Hispanic White patients and Black patients had lower odds of receiving a prehospital ECG and achieving targets for door-to-ECG, door-to-device, and first medical contact-to-device times. These racial disparities in treatment goals were observed in both women and men, and persisted in most cases after multivariable adjustment. Compared with non-Hispanic White women, Hispanic White women had higher adjusted in-hospital mortality (odds ratio, 1.39 [95% CI, 1.12-1.72]), whereas Black women did not (odds ratio, 0.88 [95% CI, 0.74-1.03]). Compared with non-Hispanic White men, adjusted in-hospital mortality was similar in Hispanic White men (odds ratio, 0.99 [95% CI, 0.82-1.18]) and Black men (odds ratio, 0.96 [95% CI, 0.85-1.09]). CONCLUSIONS:Race- or ethnicity-based disparities persist in STEMI process metrics in both women and men, and mortality differences are observed in Hispanic White compared with non-Hispanic White women. Further research is essential to evolve systems of care to mitigate racial differences in STEMI outcomes.

The evidence on recurrent pregnancy-related pericarditis is limited, and management strategies are based on case reports and expert opinion. We describe a patient with myopericarditis complicated by cardiac tamponade presenting shortly after her first pregnancy, which was then complicated by refractory recurrent pericarditis. She was treated with standard first line therapies, such as NSAIDs, corticosteroids, and colchicine, and eventually initiated on the purine analog, azathioprine. Out of fear of teratogenicity, she self-discontinued her maintenance medications and thereafter, her course was complicated by a recurrent flare of pericarditis during a subsequent pregnancy. Our case illustrates the significant burden on our patient due to the incessant nature of her disease and on the providers due to the therapeutic dilemmas associated with family planning and pregnancy. Further data is required on this unique clinical scenario, and patient-centered management by a multidisciplinary team is critical.

The American Heart Association Mission: Lifeline program objectives are to improve the quality of care and outcomes for patients with ST-segment-elevation myocardial infarction. Every minute of delay in treatment adversely affects 1-year mortality. Transfer of patients safely and timely to hospitals with primary percutaneous coronary intervention capability is needed to improve outcomes. But treatment times continue to show delays, especially during interhospital transfers. A simple 3-step process of an interhospital "Call 9-1-1" protocol may expedite this process. This STAT TRANSFER process uses a systems approach that considers diverse ways in which patients access care, how EMS responds and determines destinations, how referring hospital transfers are performed, urban and rural differences, and how receiving hospitals prepare for an incoming patient with ST-segment-elevation myocardial infarction. This initiative suggests a strategy to reduce variability in interhospital transfer times using a STAT TRANSFER and a Call 9-1-1 process in a system of care that involves all stakeholders.

Introduction: Timely treatment of ST elevation myocardial infarction [STEMI] requires ongoing coordinated care between emergency departments, paramedics, and primary percutaneous coronary (PCI) intervention facilities. Methods: To provide a current view and a national benchmark, we examined 121,576 patient records submitted by 648 hospitals participating the GWTG-CAD registry from Q2 2018 through Q3 2021 [median age 63, women 29%, Black 11%, Hispanic 8%, admission cardiac arrest 5%, shock 7%, heart failure 7%, Covid 0.2%, presentation EMS 47%, walk in 27%, transfer 22%] Results: Reperfusion method for all patients included primary PCI 87%, fibrinolysis 5%, and no reperfusion 8% [increasing from 7 to 9% during the study period]. Median time from symptom onset to reperfusion was shortest for EMS patients 148 minutes, followed by walk-in 195 minutes, ground transferred 238 minutes, and air transferred 247 minutes. Process times did not improve during the study period. First medical contact to device times increased by 5 minutes for EMS and ground transferred patients in Q2 2020 corresponding with the pandemic onset, and adjusted mortality was significantly higher in the final 3 quarters compared to Q2 2018 [OR, 95% CI 1.28(1.07-1.53); 1.35(1.13-1.61); 1.23(1.03-1.48)]. Patients treated within guideline goals had significantly lower mortality [Figure]. Conclusions: These data reaffirm the association between process times and lower mortality for STEMI patients. They also identify concerning trends and opportunities for improved care. Increasing delays in treatment, particularly for hospital transfer, greater numbers of untreated patients, and increased risk-adjusted in-hospital mortality all provide strong impetus for renewed focus on STEMI systems. Regional collaborative efforts led by coordinators and informed by a common data system have the potential to reverse these trends and improve survival.

The relation between operator volume and mortality of primary percutaneous coronary intervention (PPCI) procedures for ST-elevation myocardial infarction has not been studied comprehensively. This study included patients who underwent PPCI between 2010 and 2017 in all nonfederal hospitals approved to perform PCI in New York State. We compared risk-adjusted in-hospital/30-day mortality for radial access (RA) and femoral access (FA) and the relation between risk-adjusted mortality and procedure volume for each access site. In 44,540 patients in the study period, the use of RA rose from 8% in 2,010% to 43% in 2017 (p <0.0001). There was no significant change in PPCI risk-adjusted mortality during the period (p=0.27 for trend). RA was associated with lower mortality when imposing operator exclusion criteria used in recent trials. There was a significant operator inverse volume-mortality relation for FA procedures but not for RA procedures. FA procedures performed by lower volume FA operators (lowest quartile) were associated with higher risk-adjusted mortality compared with RA procedures (3.71% vs 3.06%, p = 0.01) or compared with FA procedures performed by higher volume FA operators (3.71% vs 3.16%, p = 0.01). In conclusion, in patients with ST-elevation myocardial infarction referred for primary PCI in New York State, there was a significant uptake in the use of RA along with relatively constant in-hospital/30-day mortality. There was a significant inverse operator volume-mortality relation for FA procedures accompanied by higher mortality for FA procedures performed by low volume FA operators than for all other primary PCI procedures. In conclusion, this information underscores the need for operators to remain vigilant in maintaining FA skills and monitoring FA outcomes.