AIMS: The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1-70.1%) for timely reperfusion. CONCLUSIONS: The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

• MeSH
• ST Elevation Myocardial Infarction * therapy   MeSH
• Cardiology * MeSH
• Percutaneous Coronary Intervention * MeSH
• Humans MeSH
• Hospitals MeSH
• Prospective Studies MeSH
• Registries MeSH
• Myocardial Reperfusion MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

Cangrelor je jediným nitrožilním inhibitorem destičkového receptoru pro adenosindifosfát typu P2Y12 s klinicky prokázanou účinností pro snížení ischemických komplikací koronární angioplastiky (percutaneous coronary intervention, PCI). Přestože doporučenou indikací pro jeho použití je každá PCI u pacientů neléčených perorálními inhibitory P2Y12, v klinické praxi je používán dominantně pro rizikové výkony při akutním koronárním syndromu. Hlavní výhodou jeho podání při léčbě infarktu myokardu PCI je jeho rychlý a dobře předvídatelný protidestičkový účinek, nicméně experimentální studie ukazují navíc významný vliv cangreloru na ochranu myokardu před reperfuzním poškozením. Slibné teoretické výhody cangreloru pro použití při léčbě infarktu myokardu čekají na potvrzení v klinických studiích.

Cangrelor is the only intravenous platelet P2Y12 receptor inhibitor that has proven clinical efficacy in reducing coronary angioplasty (percutaneous coronary intervention, PCI) - related ischemic complications. Despite being recommended to all P2Y12-naive patients, cangrelor is preferentially used in routine clinical practice for high-risk PCI's in acute coronary syndrome. The fast and predictable antiplatelet action creates the optimal conditions for PCI treatment of myocardial infarction, but in addition, cangrelor offers a cardioprotective effect against reperfusion injury in many animal models. The promising position of cangrelor in treating myocardial infarction needs to be confirmed by large randomized clinical trials.

• Keywords
• Kangrelor,
• MeSH
• Adenosine Monophosphate analogs & derivatives   MeSH
• Purinergic P2Y Receptor Antagonists * pharmacology   therapeutic use   MeSH
• Myocardial Infarction * drug therapy   MeSH
• Platelet Aggregation Inhibitors pharmacology   therapeutic use   MeSH
• Percutaneous Coronary Intervention methods   MeSH
• Humans MeSH
• Myocardial Reperfusion methods   MeSH
• Myocardial Reperfusion Injury prevention & control   MeSH
• Ticagrelor therapeutic use   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study. METHODS: STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission. RESULTS: Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51-0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33-0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084-0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect. CONCLUSIONS: This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.

• MeSH
• Antihypertensive Agents therapeutic use   MeSH
• COVID-19 mortality   therapy   MeSH
• COVID-19 Drug Treatment MeSH
• Hospitalization MeSH
• ST Elevation Myocardial Infarction mortality   therapy   MeSH
• Percutaneous Coronary Intervention MeSH
• Middle Aged MeSH
• Humans MeSH
• Pandemics MeSH
• Prognosis MeSH
• Registries MeSH
• Renin-Angiotensin System MeSH
• Myocardial Reperfusion * MeSH
• SARS-CoV-2 * MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

Základem léčby akutního koronárního syndromu je dnes včasná reperfuze. Po úspěšné reperfuzi musí následovat režimová opatření doplněná účinnou farmakoterapií, která má za úkol zabránit remodelaci levé komory, restenóze koronární tepny, retrombóze a arytmiím. K tomuto slouží 4 lékové skupiny – blokátory systému renin-angiotenzin-aldosteron, betablokátory, antiagregancia a hypolipidemika. V českém registru po infarktu myokardu (FARIM) dostávalo ACE-inhibitory (ACE-i) nebo sartany (ARB) 90 % nemocných, betablokátory (BB) 86 % a statiny dokonce 92 % sledovaných. Nedostatečné bylo v některých případech dávkování, především statinů a ACE inhibitorů (sartanů), vysoké dávky mělo jen 25 % pacientů.

Early reperfusion is the basic treatment of acute coronary syndrome. Regime recommen-dation and pharmacotherapy must followin order to prevent remodelation of left ventricle, restenosis, rethrombosis and arrhythmias. Four basic drug groups are usedrenin angiotensin aldosteron blockers, betablockers, antiagregation and lipid lowering drugs. The use of these drugs in the Czechregistry FARIM was: ACE-inhibitors (ACE-i) or sartans 90 % of patients, betablockers (BB) 86 % and statins 92 %. But the doses were frequently insufficient. High dose of ACE inhibitors (sartans) and statins received only 25% of the patients.

• MeSH
• Acute Coronary Syndrome diet therapy   drug therapy   prevention & control   MeSH
• Adrenergic beta-Antagonists administration & dosage   adverse effects   therapeutic use   MeSH
• Angiotensin II Type 1 Receptor Blockers administration & dosage   adverse effects   therapeutic use   MeSH
• Drug Therapy * methods   trends   utilization   MeSH
• Myocardial Infarction * diet therapy   drug therapy   surgery   MeSH
• Angiotensin-Converting Enzyme Inhibitors administration & dosage   adverse effects   therapeutic use   MeSH
• Platelet Aggregation Inhibitors administration & dosage   adverse effects   therapeutic use   MeSH
• Humans MeSH
• Meta-Analysis as Topic MeSH
• Ventricular Remodeling physiology   drug effects   MeSH
• Renin-Angiotensin System physiology   drug effects   MeSH
• Myocardial Reperfusion * methods   trends   utilization   MeSH
• Arrhythmias, Cardiac drug therapy   prevention & control   MeSH
• Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage   adverse effects   therapeutic use   MeSH
• Statistics as Topic MeSH
• Healthy Lifestyle MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

• MeSH
• Denervation MeSH
• Stellate Ganglion MeSH
• Counterpulsation methods   MeSH
• Coronary Disease * therapy   MeSH
• Angiogenesis Inducing Agents MeSH
• Humans MeSH
• Myocardium MeSH
• Myocardial Reperfusion MeSH
• Myocardial Revascularization * methods   MeSH
• Severity of Illness Index MeSH
• Transcutaneous Electric Nerve Stimulation methods   MeSH
• Transmyocardial Laser Revascularization MeSH
• Check Tag
• Humans MeSH

• MeSH
• Anticoagulants administration & dosage   therapeutic use   MeSH
• Fibrinolytic Agents administration & dosage   therapeutic use   MeSH
• ST Elevation Myocardial Infarction * diagnostic imaging   pathology   therapy   MeSH
• Platelet Aggregation Inhibitors administration & dosage   therapeutic use   MeSH
• Percutaneous Coronary Intervention MeSH
• Humans MeSH
• Myocardial Reperfusion methods   MeSH
• Practice Guidelines as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• Keywords
• kardioprotektivní intervence, mitochondrial permeability transition pore,
• MeSH
• Adaptation, Biological MeSH
• Hypoxia MeSH
• Ion Transport MeSH
• Myocardial Ischemia * pathology   MeSH
• Ischemic Postconditioning MeSH
• Ischemia MeSH
• KATP Channels physiology   MeSH
• Humans MeSH
• Membrane Potential, Mitochondrial MeSH
• Mitogen-Activated Protein Kinases MeSH
• Disease Resistance physiology   MeSH
• Nitric Oxide MeSH
• Ischemic Preconditioning MeSH
• Reactive Oxygen Species adverse effects   MeSH
• Myocardial Reperfusion MeSH
• Signal Transduction MeSH
• Mitochondria, Heart * enzymology   physiology   drug effects   ultrastructure   MeSH
• Calcium physiology   MeSH
• Infant Health MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Ischemicko-reperfuzní procesy provázející akutní koronární syndromy jsou provázeny významnou aktivací imunitního systému. Molekula CD163 patří mezi významné molekuly scavengerového systému, které se podílejí na eliminaci hemoglobin-haptoglobinového komplexu a mají tak potenciál snížit produkci reaktivních kyslíkových radikálů. Cílem studie bylo sledovat změny hladin sCD163 v průběhu 96 hodin akutního koronárního syndromu léčeného direktní perkutánní intervencí. V souboru 29 pacientů (25 mužů, 4 žen) průměrného věku 64,55 let ± 7,55 let byly stanoveny hladiny sCD163 v době přijetí, následně za 24 a 96 hodin. Studie prokázala významné zvýšení hladiny sCD163 již v čase přijetí a v dalších měřeních se dále zvyšovala [čas 0 hod: 1770,5 (1451; 2096,25) vs. 1178 (1078; 1265) μg/l, p < 0,001, 24 hod.: 2063 (1589; 2453) vs. 1178 (1078; 1265) μg/l, p < 0,001, 96 hod: 2116 (1924; 2458) vs. 1178 (1078; 1265) μg/l, p < 0,001]. Analýza vztahu k funkci levé komory (ejekční frakci) prokázala statisticky významnou asociaci ve všech sledovaných obdobích. Studie ukázala na potenciální význam sCD163 pro stratifikaci rizika těchto nemocných.

Background: The ischemia/reperfusion process in the course of acute coronary syndrome with ST-segment elevation is associatedwith significant increase of immune system activation. CD163 molecule belongs to important parts of the scavenger system,which helps to eliminate hemoglobin-haptoglobin complex and has the potential to suppress reactive oxygen radicals production. Aim: The aim of our study was to assess sCD163 level in the course of STEMI.Patients and method: Plasma sDC163 level was assessed in a group of 29 patients (25 males, 4 females) of average age 64.5 let± 7.5 yrs. at the time of admission, at 24 hours and at 96 hours. Results: The plasma sCD163 level was increasing during the time of observation [0h: 1770.5 (1451; 2096.25) μg/L vs. 1178 (1078;1265) μg/L, p < 0.001, 24h: 2063 (1589; 2453) vs. 1178 (1078;1265) μg/L, p < 0.001, 96h: 2116 (1924; 2458) vs. 1178 (1078; 1265) μg/L, p < 0.001]. Plasma sCD163 level was associated with leftventricle ejection fraction. Conclusion: The study showed a potential significance of sCD163 assessment as a prognostic marker.

• MeSH
• Biomarkers blood   MeSH
• Antigens, CD * blood   MeSH
• Immunity, Humoral MeSH
• ST Elevation Myocardial Infarction * MeSH
• Middle Aged MeSH
• Humans MeSH
• Myocardial Reperfusion MeSH
• Receptors, Scavenger MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Myocardial Infarction diagnosis   surgery   complications   MeSH
• Shock, Cardiogenic mortality   prevention & control   MeSH
• Cardiac Imaging Techniques methods   instrumentation   MeSH
• Humans MeSH
• Mitral Valve Insufficiency etiology   surgery   MeSH
• Heart Rupture, Post-Infarction surgery   radiography   ultrasonography   MeSH
• Myocardial Reperfusion methods   adverse effects   MeSH
• Check Tag
• Humans MeSH

Řízená reperfuze s cílem snížit ischemicko-reperfuzní posškození, kdy se pomocí manžety tonometru vyvolá ischemie tkání vzdálených od myokardu u pacientů se STEMI směrovanými k reperfuzní léčbě, snižuje morbiditu a mortalitu. Je to jednoduchá technika proveditelná jak v sanitním voze tak na urgentním příjmu, zatímco je pacient připravován k perkutánní koronární intervenci; snižuje riziko akutního poškození ledvin, signifikantně snižuje rozsah poškození myokardu při infarktu a snižuje riziko srdečního selhání a dysrytmií během intervence i po ní. Tyto účinky přetrvávají ještě delší dobu po zákroku a u pacientů je nižší pravděpodobnost další koronární nebo mozkové příhody v následujících měsících až letech. Kromě snížené mortality a lepší kvality života přináší metoda i měřitelné snížení nákladů vynaložených na zdravotní péči.

EMS of Central Bohemian Region had introduced the board portable ultrasonography devices for use in daily practice in the prehospital emergency care. The devices used are compact ultrasonographs GE-VScan with dual sector/linear probe. The devices were placed at EMS district stations. This article describes the scheme of training, possibilities of practical use for diagnostics and therapeutical procedures in EMS practice. We use modified emergency protocols FATE, FEEL, BLUE and FAST. The author describes individual clinical training in hospitals under supervision of clinical specialists which is provided after initial traininng. The first experience during 3 and half months´s praktice since start of this project are also described. Based on the ultrasound examination therapeutical management had been changed in 5 cases and once the difficult i.v. ultrasound guided access was in the field.

• MeSH
• Myocardial Infarction surgery   MeSH
• Ischemic Preconditioning, Myocardial * methods   MeSH
• Percutaneous Coronary Intervention MeSH
• Humans MeSH
• Postoperative Complications prevention & control   MeSH
• Myocardial Reperfusion methods   MeSH
• Myocardial Reperfusion Injury prevention & control   MeSH
• Emergency Medical Services methods   MeSH
• Check Tag
• Humans MeSH