Introducing Virtual Reality in a STEMI Coronary Syndrome Course: Qualitative Evaluation with Nurses and Doctors.

In the increasing number of medical education topics taught with virtual reality (VR), the prehospital management of ST-segment elevation myocardial infarction (STEMI) had not been considered. This article proposes an implemented VR system for STEMI training and introduces it in an institutional course addressed to emergency nurses and case manager (CM) doctors. The system comprises three different applications to, respectively, allow (a) the course instructor to control the conditions of the virtual patient, (b) the CM to communicate with the nurse in the virtual field and receive from him/her the patient's parameters and electrocardiogram, and (c) the nurse to interact with the patient in the immersive VR scenario.

Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization.

Unlabelled: Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity.

Objectives: To test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added.

Response to a massive SARS-CoV-2 infection in a nursing home transformed into a caring center.

Background: The best policy to follow when nursing homes are massively hit by SARS-CoV2 is unclear.

Aim: To describe COVID-19 containment in a nursing home transformed into a caring center.

Methods: Physicians and nurses were recruited.

Detection of severe acute respiratory syndrome coronavirus 2 in nasopharynx according to clinical phenotype of affected patients.

Objectives: Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the upper respiratory tract is extremely variable, but its relation to disease severity is unknown. We investigated this relation in the 530 000 inhabitants of the northeastern Italian province of Udine.

Methods: We analysed real-time RT-PCR tests for SARS-CoV-2 in upper respiratory specimens conducted at the Virology Laboratory of the University Hospital of Udine, Italy (which serves the whole province) from 1 March to 30 April 2020 Specimens were from positive individuals in four groups characterized by different disease severity (critically ill patients admitted to intensive care units, patients admitted to infectious disease units, symptomatic patients visiting the emergency department and not hospitalized, and asymptomatic individuals tested during contact tracing or screening activities).

Epidemiology and mortality in an Italian region after the adoption of the universal definition of myocardial infarction.

Aims: The aim of the study is to validate at the biochemical level (presence of myocardial damage) the discharge diagnosis code ICD-9-CM 410.x1, and to compare the acute myocardial infarction (AMI) epidemiology based on pure administrative data with the epidemiology based on troponin and clinical data.

Methods: The health-related administrative databases of the Italian Region Friuli Venezia Giulia were used as the source of information.

Fifteen-Year Trends of Cardiogenic Shock and Mortality in Patients with Diabetes and Acute Coronary Syndromes.

Purpose: Our study was intended to examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus.

Methods: We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units.

Results: Of 28,225 participants, 8521 (30.

Trends in management and outcome of patients with non-ST elevation acute coronary syndromes and peripheral arterial disease.

Objective: Patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS) and peripheral arterial disease (PAD) present a worse prognosis compared to those without PAD. We sought to describe contemporary trends of in-hospital management and outcome of patients admitted for NSTE-ACS with associated PAD.

Methods: We analyzed data from 6 Italian nationwide registries, conducted between 2001 and 2014, including consecutive NSTE-ACS patients.

Recent trends in management and outcome of patients with acute coronary syndromes and atrial fibrillation.

Aims: To describe the clinical characteristics, contemporary trends of in-hospital management and outcome of patients admitted for an acute coronary syndrome (ACS) with associated atrial fibrillation (AF).

Methods: We analyzed data from four Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive ACS patients.

Results: Out of 16,803 ACS patients, 1019 (6.

Contemporary Trends and Age-Specific Sex Differences in Management and Outcome for Patients With ST-Segment Elevation Myocardial Infarction.

Background: Age- and sex-specific differences exist in the treatment and outcome of ST-elevation myocardial infarction (STEMI). We sought to describe age- and sex-matched contemporary trends of in-hospital management and outcome of patients with STEMI.

Methods And Results: We analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI.

Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.

Aims: Despite advances in the management of patients with acute coronary syndrome (ACS), cardiogenic shock (CS) remains the leading cause of death in these patients. We describe the evolution of clinical characteristics, in-hospital management, and outcome of patients with CS complicating ACS.

Methods And Results: We analysed data from five Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with ACS.

A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units.

Objective: To describe the evolution of clinical characteristics, in-hospital management and early outcome of elderly patients with non-ST elevation myocardial infarction (NSTEMI).

Methods: We analysed data from five consecutive Italian nationwide registries, conducted between 2001 and 2010, including patients with acute coronary syndromes admitted to cardiac care units (CCUs).

Results: Of 10 983 patients with NSTEMI enrolled in the 5 surveys, 4350 (39.

Vitamin K antagonists in patients with nonvalvular atrial fibrillation: appropriateness and quality of treatment in an Italian cohort.

Background: Vitamin K antagonists (VKA) are highly recommended in patients with atrial fibrillation for their efficacy in preventing stroke. However, there is a lack of data on oral anticoagulation (OAC) with VKA overall treatment (i.e.

Infarct-like acute myocarditis: relation between electrocardiographic findings and myocardial damage as assessed by cardiac magnetic resonance imaging.

Background: Acute myocarditis (AM) may occasionally have an infarct-like presentation. The aim of the present study was to investigate the relation between electrocardiographic (ECG) findings in this group of patients and myocardial damage assessed by cardiac magnetic resonance imaging (MRI) with the late gadolinium enhancement (LGE) technique.

Hypothesis: Myocardial damage may be associated with ECG changes in infarct-like AM.

Chronic aspirin and statin therapy in patients with impaired renal function and acute coronary syndromes: results from the IN-ACS Outcome Registry.

Background: The cardioprotective role that statin and aspirin has appears to be reduced in patients with chronic kidney disease (CKD). This analysis aims to evaluate the impact of statin and aspirin on the outcome of patients with CKD and acute coronary syndrome (ACS).

Methods: All patients who were enrolled in the IN-ACS Outcome registry, diagnosed with CKD, were included in our analysis.

Clinical epidemiology, management and outcome of acute coronary syndromes in the Italian network on acute coronary syndromes (IN-ACS Outcome study).

Background: The Italian network on acute coronary syndromes outcome (IN-ACS Outcome) study is a nationwide observational, multicenter study with the aim to describe clinical epidemiology, management, 30-days and one-year outcomes of ACS in Italy.

Methods: All consecutive patients admitted for ACS to 38 hospitals, between December 2005 and February 2007, were enrolled in the study. Patient in-hospital details and follow-up data at 30-days and one-year were collected using a web-based CRF and stored in a central database.

Predictive value of cardiac troponin-I compared to creatine kinase-myocardial band for the assessment of infarct size as measured by cardiac magnetic resonance.

Background: The estimation of infarct size by biochemical myocardial necrosis markers is used in current clinical practice, rather than the more expensive and not always available imaging techniques. However, for this purpose, the peak value of serum biomarkers can overestimate the necrotic area, especially after reperfusion.

Objective: We investigated whether late release cardiac troponin I (cTnI) values could predict more precisely infarct volume measured by delayed-enhancement cardiac magnetic resonance (DE-CMR) in patients with acute myocardial infarction [ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI)] independently of reperfusion (spontaneous and provoked).

An imbalanced OPG/TRAIL ratio is associated to severe acute myocardial infarction.

Background: This study was designed to evaluate the biological significance of simultaneous changes in the circulating levels of osteoprotegerin (OPG) and TNF-related apoptosis inducing ligand (TRAIL) in patients with coronary artery disease (CAD), and, in particular, with acute myocardial infarction (AMI).

Methods: Total levels of OPG and TRAIL were measured by ELISA in patients with AMI (n=113), unstable angina (UA, n=21) and healthy controls (n=120).

Results: Since OPG was elevated during the acute phase (first 12-24-48h) after AMI and in patients with UA with respect to healthy controls, while TRAIL was decreased in acute AMI patients, CAD patients were characterized by an increased OPG/TRAIL ratio.

The acute myocardial infarction with ST segment elevation Udine registry (Come-to-Udine): predictors of 3 years mortality.

Background: Percutaneous coronary intervention (PCI) is considered the best treatment for acute myocardial infarction with ST segment elevation (STEMI), but it is difficult to deliver.

Objectives: To report on long-term mortality predictors in a registry based on a 'hub and spoke' model, according to the initial strategy: thrombolysis followed or not by PCI, invasive strategy followed or not by primary PCI and no reperfusion.

Methods And Results: From May 2001 to June 2003, 514 patients (mean age 67 +/- 12) with STEMI onset less than 12 h (<24 h if pain ongoing) were enrolled, 34% transferred from spoke centers.

Modalities of treatment and 30-day outcomes of unselected patients older than 75 years with acute ST-elevation myocardial infarction: data from the BLITZ study.

Background: The optimal treatment strategy for elderly patients presenting with ST-elevation myocardial infarction is still controversial and few investigations have studied this high-risk population in a community setting.

Methods: We analyzed data from the BLITZ survey on patients with any acute myocardial infarction admitted to the Italian Coronary Care Unit (CCU) network, in order to assess current treatment strategies among unselected patients older than 75 years presenting with ST-elevation myocardial infarction. We also evaluated the 30-day rates of major adverse cardiovascular events (death/re-myocardial infarction/stroke) relative to different treatment strategies.

In-hospital outcome of patients with acute coronary syndrome: relationship with inflammation and remodeling markers.

Objectives And Methods: The present study was designed to evaluate the role of some inflammation [interleukin (IL)-1beta, soluble IL-1 receptor, IL-1 receptor antagonist (IL-1RA), high-sensitivity C-reactive protein (hsCRP) and fibrinogen], and remodeling markers [matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2] in patients with acute coronary syndrome (ACS; 40 patients), or chronic stable angina (CSA; 40 patients) compared to age- and sex-matched healthy controls (20 subjects).

Results: IL-1RA, hsCRP, fibrinogen, MMP-9, and TIMP-1 plasma levels were significantly higher in patients than in controls, whereas soluble IL-1 receptor had an opposite pattern. Among patients with ACS, hsCRP plasma levels were higher in patients with non-ST segment elevation myocardial infarction (NSTEMI) than in those with unstable angina (UA).

[Technical equipment of modern coronary care units: ventricular assist devices].

Intra-aortic balloon counterpulsation (IABP) is sometimes used in critically ill patients with cardiac disease. By increasing diastolic arterial pressure and decreasing systolic pressure, it reduces left ventricular afterload. IABP may be beneficial in subjects with cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, or advanced heart failure or those who undergo high-risk surgical or percutaneous revascularization, but the evidence to support its use in these patient subsets is largely observational.