Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

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Plasma Chemerin Levels Are Increased in ST Elevation Myocardial Infarction Patients with High Thrombus Burden

Cardiology Research and Practice ◽

10.1155/2018/5812704 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Ahmet Hakan Ateş ◽

Uğur Arslan ◽

Aytekin Aksakal ◽

Ahmet Yanık ◽

Metin Özdemir ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Intervention ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction ◽

Reactive Protein ◽

Creatine Kinase Mb ◽

St Elevation

Objective. To investigate plasma chemerin levels in ST elevation myocardial infarction (STEMI) patients and find out possible relationships between plasma chemerin levels and angiographic characteristics. Patients and Methods. Ninety-seven consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention (PCI) with coronary stents were enrolled, and 30 age- and sex-matched patients with stable angina pectoris who underwent coronary angiography formed the control group. Angiographic characteristics of the patients including thrombolysis in myocardial infarction (TIMI) thrombus and Gensini scores were noted. Blood samples were taken to detect several biochemical markers including plasma chemerin levels at the admission to hospital. Results. Serum chemerin and C-reactive protein (CRP) levels were significantly increased in patients with STEMI. Among STEMI patients, serum chemerin levels were significantly higher in patients with high thrombus burden (581.5 ± 173.7 versus 451.3 ± 101.2 mg/dL, p<0.001). CRP levels and peak creatine kinase-MB (CK-MB) levels were higher, and left ventricular ejection fraction and post-PCI TIMI flow were lower in patients with high thrombus burden. After multivariate analysis, serum chemerin levels were also higher in patients with high thrombus grade (odds ratio: 1.009 (1.005–1.014), p<0.001). Besides, serum chemerin levels were also found to be significantly correlated with CRP r=0.47,p<0.001 and peak CK-MB r=0.376,p<0.001 levels. Conclusions. Results from our study have demonstrated for the first time that chemerin levels were higher in STEMI patients with greater thrombus burden and higher level of inflammation.

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Impact of collateralisation to a concomitant chronic total occlusion in patients with ST-elevation myocardial infarction: a subanalysis of the EXPLORE randomised controlled trial

Open Heart ◽

10.1136/openhrt-2018-000810 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000810 ◽

Cited By ~ 2

Author(s):

Ivo M van Dongen ◽

Joëlle Elias ◽

K Gert van Houwelingen ◽

Pierfrancesco Agostoni ◽

Bimmer E P M Claessen ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Decision Making ◽

Controlled Trial ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Significant Difference ◽

St Elevation ◽

The Impact

ObjectiveThe impact on cardiac function of collaterals towards a concomitant chronic total coronary occlusion (CTO) in patients with ST-elevation myocardial infarction (STEMI) has not been investigated yet. Therefore, we have evaluated the impact of well-developed collaterals compared with poorly developed collaterals to a concomitant CTO in STEMI.Methods and resultsIn the EXPLORE trial, patients with STEMI and a concomitant CTO were randomised to either CTO percutaneous coronary intervention (PCI) or no-CTO PCI. Collateral grades were scored angiographically using the Rentrop grade classification. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) at 4 months were measured using cardiac magnetic resonance imaging. Well-developed collaterals (Rentrop grades 2–3) to the CTO were present in 162 (54%) patients; these patients had a significantly higher LVEF at 4 months (46.2±11.4% vs 42.1±12.7%, p=0.004) as well as a trend for a lower LVEDV (208.2±55.7 mL vs 222.6±68.5 mL, p=0.054) when compared with patients with poorly developed collaterals to the CTO. There was no significant difference in the total amount of scar in the two groups. Event rates were statistically comparable between patients with well-developed collaterals and poorly developed collaterals to the CTO at long-term follow-up.ConclusionsIn patients with STEMI and a concomitant CTO, the presence of well-developed collaterals to a concomitant CTO is associated with a better LVEF at 4 months. However, this effect on LVEF did not translate into improvement in clinical outcome. Therefore, the presence of well-developed collaterals is important, but should not solely guide in the clinical decision-making process regarding any additional revascularisation of a concomitant CTO in patients with STEMI.Clinical trial registrationNTR1108.

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114 Impact of left ventricular ejection fraction on procedural and long-term outcomes of bifurcation percutaneous coronary intervention

European Heart Journal Supplements ◽

10.1093/eurheartj/suab134.020 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Guglielmo Gallone ◽

Francesc Bruno ◽

Ovidio De Filippo ◽

Enrico Cerrato ◽

Saverio Muscoli ◽

...

Keyword(s):

Ejection Fraction ◽

Systolic Function ◽

Coronary Intervention ◽

Left Ventricular ◽

Doppler Imaging ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

All Cause Mortality ◽

The Impact

Abstract Aims Longitudinal systolic function may integrate information on aortic stenosis (AS) natural history and cardiac comorbidities with potential prognostic implications. We explored the impact of tissue Doppler imaging (TDI)-derived longitudinal systolic function defined by the peak systolic average of lateral and septal mitral annular velocities (average S’) among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). Methods and results 297 unselected patients with severe AS undergoing TAVI from January 2017 to December 2018 at three European centres, with available average S′ at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12–18) follow-up, 36 (12.1%) patients died. Average S′ was associated with all-cause mortality (per 1 cm/s decrease: HR: 1.29, 95% CI: 1.03–1.60, P = 0.025), with a best cut-off of 6.5 cm/s. Patients with average S′ <6.5 cm/s (55.2% of the study population) presented characteristics of more advanced left ventricular remodelling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, P = 0.007) also when adjusted for in-study outcome predictors (adj-HR: 3.33, 95% CI: 1.25–8.90, P = 0.016). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without left ventricular hypertrophy. Conclusions Longitudinal systolic function assessed by average S’ is independently associated with long-term all-cause mortality among unselected patients with symptomatic severe AS undergoing TAVI. In this population, an average S′ below 6.5 cm/s best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification.

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Abstract 656: Impact of Percutaneous Coronary Intervention on Ventricular Function in Potential Candidates for Prophylactic Implantable Defibrillators

Circulation ◽

10.1161/circ.118.suppl_18.s_595 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ravi K Ramana ◽

Robert S Dieter ◽

Joseph Cytron ◽

Nishath Quader ◽

David Homan ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Clinical Indication ◽

Ventricular Ejection Fraction ◽

Clinical Variables ◽

Percutaneous Coronary ◽

St Elevation

While left ventricular ejection fraction (LVEF) may improve in some pts with ischemic cardiomyopathy (ICM) following percutaneous coronary intervention (PCI), there are limited data with respect to the frequency and clinical predictors of this finding in pts who are candidates for subsequent placement of an implantable defibrillator (ICD). We retrospectively identified 105 consecutive pts with an initial LVEF <35% who underwent PCI and had follow-up echocardiographic assessment at least one mo (median 5.2 mo) later. No pt had a history of syncope or sustained ventricular arrhythmias. The indication for PCI was ST-elevation myocardial infarction (STEMI) in 17 patients (16.2%), non-ST-elevation MI (NSTEMI) in 76 pts (72.4%), and angina in 12 pts (11.4%). Mean age was 65 ± 12 yrs and 76% of pts were male. Hypertension was present in 80% of pts, diabetes in 47%, renal insufficiency in 30%, prior MI in 58%, and prior PCI in 51%. Following PCI, 85% received beta blockers, and 78% received ACEI or ARBs. These variables were distributed equally between groups. Overall, mean LVEF improved significantly at follow-up (27.8 ± 6.8% vs 38.3% ± 14.7%, p<0.001). LVEF improved for all indications, though there was a trend toward greater improvement in pts with STEMI (table ). LVEF improved by > 5% in 76 pts (72%). In 60 pts (57%) LVEF improved to a value > 35%, including 14 pts with initial LVEF ≤ 25%. Multivariate analysis of variance with repeated measures demonstrated that the improvement in LVEF was independent of all other clinical variables (p< 0.001), none of which alone or jointly predicted improvement. These results suggest that significant improvement in LVEF can be expected in a majority of pts with ICM following PCI, irrespective of clinical indication, and cannot be predicted easily from standard clinical variables. Decisions regarding prophylactic ICD implantation should be deferred until after late reassessment of LVEF in most of these pts.

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HIT Moderated Poster session: imaging in everyday practiceP143Relationship of FDG-PET and pressure-strain loops as novel measures of regional myocardial workload in LBBB-like dyssynchronyP144Cardiotoxicity of anti-vascular endothelial growth factor therapies: results of a pilot studyP145A new animal model of rapid pacing-induced dilated cardiomyopathy and LBBBP146Three-dimensional echocardiography assessment of the systolic variation of effective regurgitant orifice area in patients with functional tricuspid regurgitation: implications for quantificationP147Clinical prognostic value of myocardial mechanics using speckle-tracking echocardiography in patients post primary coronary intervention for acute ST- segment elevation myocardial infarctionP148Relationship between left atrial volumes and emptying fractions and parameters of infarct size and left ventricular filling pressures in survivors of st elevation myocardial infarctionP149Left atrial dysfunction assessed by two dimensional speckle tracking echocardiography in patients with impaired left ventricular ejection fraction and sleep-disordered breathingP150Left atrial morphological and functional remodeling early after ST elevation myocardial infarction insights from threedimensional echocardiographyP151Circumferential strain and strain rate at early stages of dobutamine speckle tracking imaging: are they enough to detect ischemia in patients with coronary artery disease?P152Pulmonary hypertension in hypertrophic cardiomyopathy: a rest and exercise echocardiography study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jev261 ◽

2015 ◽

Vol 16 (suppl 2) ◽

pp. S1-S3 ◽

Cited By ~ 1

Author(s):

J Duchenne ◽

AM Popara-Voica ◽

J Duchenne ◽

P Aruta ◽

HK Teo ◽

...

Keyword(s):

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Functional Tricuspid Regurgitation ◽

Strain And Strain Rate ◽

St Elevation

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Intriguing New Faces Of Covid-19: Persisting Clinical Symptoms And Cardiac Effects in Children

Cardiology in the Young ◽

10.1017/s1047951121003693 ◽

2021 ◽

pp. 1-27

Author(s):

Nurdan Erol ◽

Abdullah Alpinar ◽

Cigdem Erol ◽

Erdal Sari ◽

Kubra Alkan

Keyword(s):

Blood Pressure ◽

Cardiovascular Health ◽

Clinical Symptoms ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Study Group ◽

Ventricular Ejection Fraction ◽

Significant Difference ◽

The Impact

Abstract Objective: This study was conducted to evaluate the persisting Covid-19-related symptoms of the cases included in our study and to assess their cardiac findings in order to determine the impact of Covid-19 on children’s cardiovascular health. Methods: In this study, 121 children between the ages of 0-18 with Covid-19 were evaluated based on their history, blood pressure values, and electrocardiography and echocardiography results. These findings were compared with the findings of the control group which consisted of 95 healthy cases who were in the same age range as the study group and did not have Covid-19. The results were evaluated using the statistics program, SPSS 21. Results: There was no significant difference between the study group and the control group in terms of age, weight, and body mass index. The clinical symptoms (chest and back pain, dizziness, headache, palpitation, fatigue, shortness of breath, loss of balance, coughing) of 37.2% of the cases persisted at least 1 month after Covid-19 recovery. Statistically significant differences were found in systolic blood pressure, left ventricular ejection fraction, relative wall thickness, and tricuspid annular plane systolic excursion. Conclusion: The continuation of some cases’ clinical symptoms post-recovery indicates that long Covid infection can be observed in children. The fact that statistically significant differences were observed between the echocardiographic parameters of the study and control groups suggests that Covid-19 may have effects on the cardiovascular system. To shed light on the long Covid cases among children and the infection’s cardiac impacts, it would be beneficial to conduct more comprehensive studies on this matter.

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Relationship between TRAIL and Left Ventricular Ejection Fraction in Patients with ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

BioMed Research International ◽

10.1155/2018/3709084 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Elena Teringova ◽

Martin Kozel ◽

Jiri Knot ◽

Viktor Kocka ◽

Klara Benesova ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Percutaneous Coronary ◽

St Elevation ◽

Sfas Level

Background. Apoptosis plays an important role in the myocardial injury after acute myocardial infarction and in the subsequent development of heart failure. Aim. To clarify serum kinetics of apoptotic markers TRAIL and sFas and their relation to left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods. In 101 patients with STEMI treated with pPCI, levels of TRAIL and sFas were measured in series of serum samples obtained during hospitalization and one month after STEMI. LVEF was assessed at admission and at one month. Major adverse cardiovascular events (MACE, i.e., death, re-MI, and hospitalization for heart failure and stroke) were analysed during a two-year followup. Results. Serum level of TRAIL significantly decreased one day after pPCI (50.5pg/mL) compared to admission (56.7pg/mL), subsequently increased on day 2 after pPCI (58.8pg/mL), and reached its highest level at one month (70.3pg/mL). TRAIL levels on days 1 and 2 showed a significant inverse correlation with troponin and a significant positive correlation with LVEF at baseline. Moreover, TRAIL correlated significantly with LVEF one month after STEMI (day 1: r=0.402, p<0.001; day 2: r=0.542, p<0.001). On the contrary, sFas level was significantly lowest at admission (5073pg/mL), increased one day after pPCI (6370pg/mL), and decreased on day 2 (5548pg/mL). Significantly highest sFas level was marked at one month (7024pg/mL). sFas failed to correlate with LVEF at baseline or at one month. Both TRAIL and sFas showed no ability to predict improvement of LVEF one month after STEMI or a 2-year MACE (represented by 3.29%). Conclusion. In STEMI treated with pPCI, TRAIL reaches its lowest serum concentration after reperfusion. Low TRAIL level is associated with worse LVEF in the acute phase of STEMI as well as one month after STEMI. Higher TRAIL level appears to be beneficial and thus TRAIL seems to represent a protective mediator of post-AMI injury.

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A randomized trial to evaluate the impact of exercise-based cardiac rehabilitation for the prevention of chemotherapy-induced cardiotoxicity in patients with breast cancer: ONCORE study protocol

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01970-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Estíbaliz Díaz-Balboa ◽

Violeta González-Salvado ◽

Beatriz Rodríguez-Romero ◽

Amparo Martínez-Monzonís ◽

Milagros Pedreira-Pérez ◽

...

Keyword(s):

Breast Cancer ◽

Cardiac Rehabilitation ◽

Study Protocol ◽

Transthoracic Echocardiography ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction ◽

Supervised Exercise ◽

The Impact

Abstract Background Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

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350 Effect of pre-hospital treatment for STEMI patients undergoing primary PCI

European Heart Journal Supplements ◽

10.1093/eurheartj/suab134.032 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Enrico Fabris ◽

Sara Menzio ◽

Caterina Gregorio ◽

Andrea Pezzato ◽

Davide Stolfo ◽

...

Keyword(s):

Myocardial Infarction ◽

Intervention Group ◽

Treatment Protocol ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Hospital Treatment ◽

Control Group ◽

Ventricular Ejection Fraction ◽

Pre Treatment

Abstract Aims The appropriate timing to administer antithrombotic therapies in ST-elevation myocardial infarction (STEMI) remains uncertain. This study aims to evaluate the role of antithrombotic therapy administration at first medical contact (FMC) compared to the administration in the Cathlab. Methods and results We conducted a ‘before-after’ observational study enrolling STEMI undergoing primary percutaneous coronary intervention (PCI). Outcomes were evaluated during two successive periods, before (control group: aspirin only at FMC) and after (pre-treated intervention group: heparin, aspirin plus ticagrelor at FMC) the introduction of a new regional pre-treatment protocol. 537 consecutive patients (300 in control vs. 237 in intervention group) were enrolled. The pre-treated compared to no pre-treated population showed better basal reperfusion, expressed as basal thrombolysis in myocardial Infarction (TIMI)-flow (p for trend P < 0.001). Pre-treated population showed lower frequency of TIMI 0 (56.5% vs. 73.7%, OR: 0.46, 95% CI: 0.32–0.67, P < 0.001) and higher frequency of TIMI 2–3 (33.3% vs. 19.7%; OR: 2.0; 95% CI: 1.38–2.00, P < 0.001) and TIMI 3 [14.3% vs. 9.7%, OR: 1.56, 95% CI: (0.92–2.65), P = 0.094]. Pre-treated compared to no pre-treated population showed reduced infarct size expressed as Troponin Peak [20 286 (8726–75027) vs. 48 676 (17229–113900), P = 0.001], and higher left ventricular ejection fraction at discharge [53% (44–59) vs. 50% (44–56), P = 0.027]. In-Hospital BARC ≥2 bleeding were similar (2.1% vs. 2.0%, P = 0.929, in pre-treated vs. no pre-treated population, respectively). Conclusions This study provides support for an early pre-treatment strategy in STEMI patients and confirmed the importance of an efficient organization of STEMI networks which allow initiation of antithrombotic treatment at FMC.

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The DAPA Trial in the Context of Previous Prophylactic ICD Landmark Trials

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2021.23 ◽

2021 ◽

Vol 10 (3) ◽

pp. 154-158

Author(s):

Danielle Haanschoten ◽

Arif Elvan

Keyword(s):

Primary Prevention ◽

Coronary Intervention ◽

Primary Angioplasty ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Icd Implantation ◽

Ventricular Ejection Fraction ◽

Ischaemic Cardiomyopathy ◽

Additional Value ◽

The Impact

In patients with ischaemic cardiomyopathy and severely reduced left ventricular ejection fraction (LVEF), an arrhythmogenic milieu is created by a complex interplay between myocardial scarring (assessed by cardiac MRI) and multiple other factors (ventricular ectopy, ischaemia and autonomic imbalance), favouring the occurrence of arrhythmic sudden cardiac death (SCD). Currently, a dynamic and robust model of dichotomised SCD risk assessment after primary percutaneous coronary intervention (PCI) is lacking, underlining the urgent need for further refinement of the widely accepted and guidelines-based criteria (ischaemic cardiomyopathy, LVEF ≤35%) for primary prevention. This review addresses the potential additional value of the recently published Defibrillator After Primary Angioplasty (DAPA) trial results. The DAPA trial conveys important messages and provides novel perspectives regarding left ventricular function post-primary PCI as an (early) risk marker for SCD and the impact of prophylactic ICD implantation on survival in this cohort. In the context of other previous primary prevention trials, DAPA was the first trial including only ST-elevation MI patients all treated with acute PCI.

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