INTRODUCTION:The Extracorporeal Membrane Oxygenation (ECMO) service at the Shaare Zedek Medical Center was established in 2015. In 2017, the first patient underwent emergent ECMO cannulation during extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest . AIMS:To describe outcomes of ECPR at Shaare Zedek Medical Center. METHODS:A retrospective analysis of all patients who underwent ECPR. RESULTS:Between the years 2017 and 2024, a total of 108 patients underwent ECPR. Of these, in 62 cases it was due to out-of-hospital cardiac arrest (OHCA), and in 46 cases it was due to in-hospital cardiac arrest (IHCA). The median age was 56 (42-64) years, and 26% of patients were female. The most common diagnosis was acute coronary syndrome. The median duration of ECMO was 3 (1-6) days, and after one week, 75% of patients were either weaned off the device or had died. Of the entire cohort, 24 (22%), in the OHCA cohort 9/62 (15%) and in the IHCA cohort 15/46 (33%) survived, with a statistically significant difference noted between groups (p=0.025). Initial pH values were higher and lactate values lower in survivors vs non-survivors (p=0.015 and p=0.018, respectively). CONCLUSIONS:ECMO-facilitated resuscitations for refractory cardiac arrest at Shaare Zedek Medical Center have steadily increased over time. However, better characterization of patient variables associated with survival in this severe condition is still necessary.

Objective:To assess how inclusion criteria from major randomized controlled trials (RCTs) of extracorporeal cardiopulmonary resuscitation (ECPR) apply within a cannulated ECPR cohort and to benchmark observed outcomes against published trial results. Methods:We conducted a single-center retrospective cohort study at a 1,000-bed tertiary medical center of adults who underwent ECPR for out of hospital cardiac arrest. Inclusion criteria from the ARREST, PRAGUE, and INCEPTION trials were retrospectively applied. Analyses were restricted to cannulated patients, with survival evaluated overall and stratified by trial eligibility, and descriptively compared with published RCT outcomes. Results:Sixty-six patients underwent ECPR, including 25 (38%) with a non-shockable initial rhythm. Overall survival to hospital discharge was 14% (9/66; 95% CI 6.4-24.3%), with favorable neurological outcome in 5/9 survivors. Survival was numerically higher among patients meeting trial inclusion criteria, but differences were not statistically significant. Survival was comparable to PRAGUE and INCEPTION and lower than ARREST. Conclusions:Within this program level, cannulated ECPR cohort, RCT-derived inclusion criteria did not clearly distinguish survivors from non-survivors, and survival occurred among patients not meeting one or more trial eligibility thresholds. Rigid application of trial criteria at the point of cannulation may therefore exclude some patients with potential for meaningful recovery.

As the population ages, non–ST-segment elevation myocardial infarction (NSTEMI) in the oldest-old poses unique management challenges, yet this group remains underrepresented in clinical trials. Hence, the present study sought to evaluate clinical outcomes and the effectiveness of coronary intervention in patients aged ≥ 85 years with NSTEMI admitted to the intensive coronary care unit (ICCU) of a tertiary center within an unselected, contemporary cohort. All consecutive patients aged ≥ 60 years admitted to the ICCU with a diagnosis of NSTEMI between July 2019 and June 2024 were included. Patients were stratified into two groups according to age (60–84 years and ≥ 85 years). The primary outcome was all-cause mortality at 45 days, 6 months, and long-term follow-up. Multivariable Cox proportional hazards models were used to identify independent predictors of mortality. To address potential confounding by indication, propensity scores for receiving percutaneous coronary intervention (PCI) were estimated, and inverse probability of treatment weighting (IPTW) was applied within each age group. A total of 967 patients were enrolled, with a mean age of 73.6 ± 8.9 years; 137 (14

Background:Immature platelet fraction (IPF) reflects thrombopoietic activity and platelet reactivity and has been associated with adverse cardiovascular outcomes. However, its prognostic value in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction has not been systematically evaluated. Methods:We analyzed 1,713 consecutive PPCI patients from a prospective single-center registry (July 2019-April 2026). Patients were stratified into IPF tertiles: low (≤3.0%), mid (3.0-5.1%), and high (>5.1%). The primary endpoint was long-term all-cause mortality, estimated using the Kaplan-Meier method and compared by the log-rank test. All effect estimates were derived from multivariable Cox proportional hazards regression adjusted for age, ejection fraction, sex, hypertension, diabetes mellitus, chronic renal failure, and prior coronary artery disease. Prespecified sensitivity analyses comprised a 3-year truncated analysis and a postdischarge landmark analysis. Results:Among 1,713 PPCI patients (median age: 64 years, 20.9% female), median IPF was 4.2%. Over a median potential follow-up of 3.0 years, 233 deaths (13.6%) occurred. Kaplan-Meier estimated 3-year all-cause mortality increased stepwise across tertiles: 9.1, 10.2, and 18.2% in the low, mid, and high IPF groups, respectively (log-rank p < 0.001). In-hospital mortality showed a nonsignificant trend (2.1, 2.6, and 3.9%; p = 0.157). On multivariable Cox regression, IPF as a continuous variable was not independently associated with long-term mortality (hazard ratios [HR]: 1.039 per 1% increase, 95% confidence intervals [CI]: 0.998-1.081, p = 0.066), whereas the high IPF tertile was independently associated with a 51% higher hazard of death compared with the low tertile (HR: 1.51, 95% CI: 1.08-2.12, p = 0.017). The association persisted in the 3-year truncated analysis (HR: 1.78, 95% CI: 1.23-2.58, p = 0.002) and in the postdischarge landmark analysis (HR: 1.52, 95% CI: 1.04-2.21, p = 0.03). Conclusion:High admission IPF (>5.1%) was independently associated with increased long-term mortality after PPCI. Because IPF is automatically reported as part of the admission complete blood count at no additional cost, it may help identify patients who warrant closer postdischarge surveillance. However, external validation in independent cohorts is required before IPF can be incorporated into routine risk stratification.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and is increasingly recognized as a major contributor to cardiovascular morbidity and mortality. Beyond liver involvement, MASLD represents a systemic metabolic disorder closely linked to cardiovascular disease (CVD), the leading cause of death in affected patients. This association persists independently of traditional cardiometabolic risk factors and is driven by multiple mechanisms, including insulin resistance, chronic low-grade inflammation, atherogenic dyslipidemia, endothelial dysfunction, and prothrombotic states. Disease severity, particularly liver fibrosis, appears to further increase cardiovascular risk. This review summarizes current evidence on the epidemiological and pathophysiological links between MASLD and CVD, including its role in atherosclerosis, coronary artery disease, and heart failure. Clinical implications for cardiovascular risk stratification, screening, and multidisciplinary management are also discussed, highlighting the need for integrated strategies to reduce both hepatic and cardiovascular complications.

INTRODUCTION:Immature platelet fraction (IPF), a population of young platelets with distinct histological and functional characteristics, is associated with adverse outcomes in several cardiovascular diseases. However, data on the role of IPF in acute pulmonary embolism (PE) is limited. The objective of this study was to evaluate the prognostic significance of IPF levels in patients with acute PE. METHODS:All patients admitted to a tertiary care center's intensive cardiovascular care unit (ICCU) with confirmed diagnosis of acute PE from July 2019 to July 2024 were included. IPF measurement was carried out using an autoanalyzer (Sysmex XN-2000). The correlation between IPF level and outcome of all-cause mortality was assessed. RESULTS:A total of 166 patients were included. Mean age of 65.0 years (±17.3), of whom 92 (55.4%) were male. The overall one-year mortality rate was 9.0% (15 patients), while the 30-day mortality rate was 4.8% (8 patients). Multivariate logistic regression analysis demonstrated that elevated IPF levels were independently associated with increased 30-day mortality (OR 1.36; 95% CI 1.06-1.80, p = .017) and one-year mortality (OR 1.23; 95% CI 1.02-1.5, p = .03). CONCLUSIONS:Elevated IPF levels are independently associated with increased 30-day and one-year mortality in patients with acute PE. These findings highlight the potential of IPF as a prognostic marker for short-term outcomes in this patient population.

Background:Ethnic disparities in cardiovascular health are well recognized worldwide, including in Israel, where Jewish and Arab populations differ in cardiovascular risk profiles and life expectancy. However, data regarding outcomes among critically ill cardiac patients treated in the standardized environment of an intensive cardiac care unit (ICCU) remain limited. This study compared demographic characteristics, comorbidities, clinical presentation, and outcomes between Arab and Jewish patients admitted to a tertiary ICCU. Methods:We conducted a prospective single-center cohort study including all consecutive patients admitted to the ICCU between July 2019 and December 2025. Patients were stratified by ethnicity (Jewish vs. Arab). The primary endpoint was long-term all-cause mortality. Multivariable Cox regression analysis adjusted for baseline characteristics and index diagnosis. Results:The cohort included 7,026 patients: 5,615 (79.9%) Jewish and 1,411 (20.1%) Arab. Arab patients were approximately 10 years younger [59.5 (SD 14.9) vs. 69.5 (SD 15.7) years; p < 0.001], more often male (77.6% vs. 66.0%; p < 0.001), and had a higher prevalence of diabetes mellitus, smoking, dyslipidemia, prior coronary artery disease, and prior coronary artery bypass grafting (all p < 0.001). They more frequently presented with ST-elevation myocardial infarction (34.4% vs. 26.7%; p < 0.001) and stent thrombosis (1.8% vs. 0.7%; p < 0.001). Arab ethnicity was independently associated with higher long-term mortality (adjusted HR 1.31, 95% CI 1.09-1.57; p = 0.004). Conclusions:Despite being younger, Arab patients had a higher burden of cardiovascular risk factors and a 31% increased risk of long-term mortality, highlighting the need for intensified primary and secondary prevention and cardiovascular risk reduction strategies.

INTRODUCTION:This is a summary of a few of the recent innovations in cardiology that affect our practice. In the area of cardiac intensive care, recent developments included the use of AI algorithms to improve multi-modality monitoring, thus improving patient safety. The use of robots in Coronary Care Units (CCUs) and the extensive use of mechanical support are also some of the major breakthroughs in intensive care cardiology. The area of cardiac interventions is characterized by procedures performed in octogenarians and nonagenarians, including coronary interventions in heavily calcified coronary arteries, and valvular interventions of various kinds. In the field of arrhythmia, there was a recent entrance of new energies for ablation, especially the pulsed field ablation, based on non-thermal electroporation, that is less destructive to the surrounding tissue and is therefore safer to the patient. Another breakthrough is the wide adoption of conduction system pacing which paces the heart in a physiological mode that decreases the long-term damage of pacing to the function of the heart. Another new trend in pacing is the use of small leadless pacemakers that are implanted directly into the heart by an interventional technique via the femoral vein. Innovations in imaging include the increased use of 3-dimensional echocardiography as well as strain echocardiography that increases sensitivity to specific conditions such as drug effects and cardiomyopathy. The new photon counting CT technology improved the quality of CT imaging considerably. Heart failure treatment has improved significantly over recent years, with special emphasis on the use of mechanical support for bridging and destination treatments. This is just a partial list of the great advances that have happened in the field of cardiology.

Introduction Not applicable. Material and methods Not applicable. Results Not applicable. Conclusions Not applicable.

Coronary artery calcium visible on routine, low-dose, non-contrast, chest computed tomography (CT) scans provides clinically relevant information about cardiovascular risk, without additional radiation exposure or cost. Mandatory systematic reporting of coronary artery calcium findings, supported by artificial intelligence and standardized workflows, could transform and elevate an often-overlooked, incidental finding into a practical tool in preventive cardiovascular care.

Clinical features associated with sustained ventricular arrhythmias (sVA) during acute myocarditis (AM) are poorly defined. Identify simple clinical characteristics of arrhythmogenic AM patients who develop sVA during acute-phase hospitalization. Case-control study of AM patients hospitalized in two tertiary centers from 2000 to 2020. Patients with documented sVA during AM hospitalization (cases) were compared with AM patients without VA (controls). Patients with history of myocardial infarction, heart failure or VA were excluded. Univariate and multivariable analyses were used to evaluate clinical parameters associated with occurrence of sVA during AM hospitalization. Study included 41 cases with sVA and 137 controls without any VA during AM hospitalization period. VAs included monomorphic VT and polymorphic VT/VF in 24/41 (58.5

Aims:Patients with cancer have an increased risk of cardiovascular (CV) events, although there is limited data on future trends in cancer prevalence amongst patients with an acute cardiovascular admission. The aim of this study was to evaluate trends in cancer prevalence among CV admissions with an attempt to predict future cancer and CV co-morbidity over the next 20 years. Methods and results:The analysis included all hospital admissions with a primary CV diagnosis from the US National Inpatient Sample (NIS), from 2016 to 2020. The sample was stratified by specific CV admission and by cancer status and type. The chi-square and the Kruskal-Wallis tests were used to compare categorical and continuous data, respectively, across the years. A Poisson regression model was used to predict the prevalence of overall and specific cancer types through 2040, based on the 5-year baseline period. Among 4.79 million CV admissions from 2016 to 2020, there was a significant increase in cancer prevalence from 4.8% to 5.4% (P < 0.001). This upward trend was observed across all CV diagnoses. Predictive modelling estimates that cancer prevalence in CV inpatients will increase from a 4.8% baseline in 2016 to 11.9% by 2040, with the most pronounced rate of growth seen in liver (IRR 1.069; P < 0.001), breast (IRR 1.056; P < 0.001), and renal cancer (IRR 1.055; P < 0.001). Nevertheless, haematological and lung cancers show the highest prevalence, both at baseline and in 2040. Conclusion:The prevalence of cancer among patients hospitalized with CV disease is predicted to increase 2.48-fold by 2040. This trend highlights the importance of integrated cardio-oncology and multidisciplinary care models.

Background: Pericardial effusion has a broad differential diagnosis, whereas bacterial pericarditis is rare. Despite this, routine culturing of pericardial fluid is frequently performed, and its diagnostic yield remains uncertain. Methods: We conducted a retrospective study of all pericardial fluid cultures obtained at a tertiary medical center between January 2016 and May 2024. Cultures were classified as true positive if a recognized bacterial pathogen was isolated or if it was deemed clinically pathogenic by an infectious disease’s specialist at the medical record. Contaminants were defined according to CDC criteria. Clinical, laboratory, and imaging variables were analyzed using univariate testing and multivariable logistic regression. Results: Among 198 eligible pericardial fluid cultures, 8 (4%) yielded true bacterial pathogens, whereas 43 (23%) grew contaminants and 147 (73%) remained sterile. Thus, contaminant growth occurred more than five times as frequently as that of true pathogens. The most frequent pathogens were Staphylococcus aureus and Streptococcus species. No demographic features, presenting symptoms, or imaging findings were associated with culture positivity. In multivariable analysis, concurrent bacteremia (odds ratio [OR] 17.49; p = 0.002) and higher peripheral neutrophil percentage (OR 1.20; p = 0.012) independently predicted bacterial pericarditis. In models incorporating pericardial fluid cell counts, a lower mononuclear cell percentage was also independently associated with infection (OR 0.91; p = 0.03). Conclusions: Bacterial pericarditis is uncommon, and routine pericardial fluid cultures, of all pericardial fluid specimens, have a low diagnostic yield with substantial contamination. Laboratory markers, particularly bacteremia and neutrophilia, may help identify patients most likely to benefit from culture. A selective, laboratory-guided approach may improve diagnostic efficiency and reduce unnecessary testing.

Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet–anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care.

Background:Hemoglobin A1c (HbA1c) is a well-established marker for long-term glycemic control and a diagnostic tool for diabetes mellitus (DM). The relationship between HbA1c levels and prognosis among acute coronary syndrome (ACS) patients is not well described. The aim of the current study was to assess HbA1c levels as an independent predictor of mortality in patients with ACS admitted to contemporary intensive cardiovascular care unit (ICCU). Methods:A retrospective single center study included all patients admitted to the ICCU between July 2019 and December 2024 with ACS. Patients were categorized by HbA1c levels into three groups: non-DM (<5.7%), pre-DM (5.7-6.4%), and DM (≥6.5%). Demographics, clinical characteristics, in-hospital complications, and long-term (up to 60 months) mortality were analyzed. Results:A total of 2,772 patients were admitted with a diagnosis of ACS and had HbA1c levels recorded at admission. Among them, 41.4% were non-diabetic, 29.1% had pre-diabetes, and 29.5% had diabetes. In-hospital mortality showed a gradual increase across these groups: 2.0% in non-diabetics, 1.6% in pre-diabetics, and 2.9% in diabetics (p = 0.294). Long-term mortality rose significantly with higher HbA1c categories, reaching 11.4%, 14.7%, and 18.1%, respectively (p<0.001). Multivariate analysis confirmed DM as an independent predictor of mortality (HR 1.635, 95% CI: 1.280-2.08, p<0.001). Conclusions:Over half of patients admitted with an ACS have evidence of dysglycemia. Both pre-DM and DM groups were associated with increased long-term mortality in ACS patients. The findings highlight the need for greater recognition and management, especially of pre-DM ACS patients in acute cardiovascular care.

Background/Objectives: Existing data regarding the kinetics of cardiac troponin I (cTnI) are limited. The aim of the current study was to evaluate the kinetics of highly sensitive (hs) cTnI following acute myocardial infarction (MI) in a large-scale, real-world cohort. Methods: A prospective observational cohort study included all consecutive patients admitted to the intensive cardiovascular care unit (ICCU) with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) who underwent percutaneous coronary intervention (PCI) between January 2020 and April 2024. Hs-cTnI concentrations were measured at the time of presentation and daily thereafter. Results: A total of 1174 STEMI patients [191 females (16.3%)] with a mean age of 63 years and 767 NSTEMI patients [137 females (17.9%)] with a mean age of 66.7 years were enrolled. The average hs-cTnI peak levels were 77,937.99 ng/L and 24,804.73 ng/L for STEMI and NSTEMI patients, respectively. A single peak of hs-cTnI was observed in 83% and 78% of STEMI and NSTEMI patients, respectively, while two peaks were observed in 11% and 19% and three or more peaks were observed in 6% and 3% of STEMI and NSTEMI patients, respectively. A higher number of peaks was associated with a lower ejection fraction and more in-hospital complications. Additionally, a higher number of peaks correlated with a higher in-hospital mortality rate among NSTEMI patients. Conclusions: Most STEMI and NSTEMI patients displayed a monophasic kinetic pattern of hs-cTnI peak levels. However, a greater number of hs-cTnI peaks was linked to a higher incidence of clinical complications, lower ejection fraction, and increased mortality.

Pulmonary embolism (PE) is a life-threatening condition often treated with unfractionated heparin (UFH) in intermediate high-risk patients. Activated Partial Thromboplastin Time (aPTT) is used to monitor UFH efficacy. We sought to evaluate the correlation between time in therapeutic range (TTR) and prognosis in patients with pulmonary embolism treated with unfractionated heparin. A prospective cohort study included 203 patients admitted to a tertiary care center between July 2019 and August 2024 with a confirmed diagnosis of intermediate risk PE treated with UFH. TTR was calculated based on aPTT values during the first 72 h of hospitalization. The correlation between TTR and mortality rates was assessed. Out of the 203 patients, 116 (57

Background: High-sensitivity cardiac troponin (hs-cTn) is useful for detecting acute myocardial infarction, but chronic hemodialysis patients often have elevated baseline levels that exceed the upper reference limit (URL). This study aimed to determine whether hs-cTnI levels in asymptomatic hemodialysis patients exceed the URL established for the general population, evaluate the impact of high-flux hemodialysis on hs-cTnI concentrations, and examine associations between hs-cTnI levels and subsequent hospitalization or mortality. Methods: A prospective, single-center cohort study was conducted at a tertiary care center from August 2023 to July 2024. Blood samples for hs-cTnI were collected from asymptomatic hemodialysis patients aged ≥ 40 years, measured before and after dialysis within one month. Patients were followed for up to 12 months. Results: Fifty-six patients were enrolled. The mean hs-cTnI levels were 28.4 ng/L pre-dialysis and 27.9 ng/L post-dialysis, with ranges of <6–223 ng/L and <6–187 ng/L, respectively. The mean hs-cTnI delta between pre- and post-dialysis was −0.5 ng/L, with 52% showing a negative delta, 30% no change, and 18% a positive delta. No association was found between baseline hs-cTnI levels and mortality or hospitalization during follow-up. Conclusions: Most asymptomatic hemodialysis patients had hs-cTnI levels in the “gray zone”, thus neither confirming nor excluding acute myocardial infarction. Dialysis did not significantly affect hs-cTnI levels, and elevated baseline hs-cTnI was not linked to increased mortality or hospitalization over 12 months.

Background: Takotsubo syndrome (TS) mimics acute coronary syndrome in 1% to 3% of patients presenting with chest pain, ECG changes and echocardiographic transient apical wall hypokinesia. Objectives: This study aimed to validate a previously developed scoring system on a larger cohort size. Methods: Patients admitted to an intensive cardiovascular care unit were divided into three groups: (a) patients diagnosed with TS, (b) females with anterior MI, and (c) other all-comer STEMIs. A 10-point scoring system was used: stressful events (three points), female gender (two points), no history of diabetes mellitus (two points), estimated left ventricular ejection fraction (LVEF) ≤40% on admission echocardiography (one point), positive troponin on admission (one point), and no smoking (one point). A t-test was applied to the three study groups,sensitivity and specificity testing was performed using the ROC curve method. Results: A total of 1150 patients were included in our study: 54 with TS, 97 females with anterior MI and 999 other all-comer STEMIs. Patients in the TS group were predominantly females with a higher rate of stressful events prior to admission, lower rates of diabetes mellitus and smoking, and lower LVEF% systolic function compared to the STEMI cohort. In a multivariate logistic regression analysis, the average TS scoring system was significantly higher in the TS group compared with the anterior STEMI and all-comer STEMI groups (8.3 vs. 5.7 vs. 3.83, p < 0.001, respectively) with an AUC of 0.83 for TS score ≥8. Conclusions: The 10-point TS scoring system is an easy, reliable, and useful diagnostic tool that might help in distinguishing patients with TS and ACS.

Chronic kidney disease (CKD) is a well-documented risk factor for major adverse cardiac events and bleeding events. The optimal antiplatelet strategy for patients with CKD remains unclear, especially patients with glomerular filtration rate (GFR) < 30 ml/min. We aim to compare clinical outcomes of patients with acute coronary syndrome (ACS) and CKD treated with ticagrelor or prasugrel vs. clopidogrel. Patients were collected from the acute coronary syndrome Israeli survey (ACSIS). Patients were divided into 2 groups: ST-segment myocardial infarction (STEMI) and non-STEMI. Each group was further divided based on the GFR value (<30 ml/min or ≥ 30 ml/min). Mortality, bleeding, repeat revascularization, and re-hospitalization at 30-day and 1-year were evaluated. A total of 5,442 patients were included in the final analysis. There were no significant differences regarding baseline characteristics between both groups of ACS patients. In patients with STEMI and GFR < 30 ml/min, re-hospitalization (32