Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of guidelines have been issued in recent years by the European Society of Cardiology (ESC), as well as by other societies and organizations. Because of their impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (https://www.escardio.org/Guidelines/ Clinical-Practice-Guidelines/Guidelines-development/Writing-ESCGuidelines). The ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. In addition to the publication of Clinical Practice Guidelines, the ESC carries out the EurObservational Research Programme of international registries of cardiovascular diseases and interventions which are essential to assess, diagnostic/therapeutic processes, use of resources and adherence to Guidelines. These registries aim at providing a better understanding of medical practice in Europe and around the world, based on high-quality data collected during routine clinical practice. Furthermore, the ESC has developed and embedded in this document a set of quality indicators (QIs), which are tools to evaluate the level of implementation of the Guidelines and may be used by the ESC, hospitals, healthcare providers and professionals to measure clinical practice as well as used in educational programmes, alongside the key messages from the guidelines, to improve quality of care and clinical outcomes

Keywords: Guidelines, acute cardiac care, acute coronary syndrome, angioplasty, anticoagulation, antiplatelet, apixaban, aspirin, atherothrombosis, betablockers, bleedings, bivalirudin, bypass surgery, cangrelor, chest pain unit, clopidogrel, dabigatran, diabetes, dual antithrombotic therapy, early invasive strategy, edoxaban, enoxaparin, European Society of Cardiology

Among various mechanical support devices, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is the last resort for acute myocardial infarction (AMI) patients complicated with refractory cardiogenic shock or cardiac arrest. The purpose of this study was to investigate the V-A ECMO-related complications in AMI patients who underwent percutaneous coronary intervention (PCI), and to find the association between complications and in-hospital death in that population.

We retrospectively included 101 AMI patients who received V-A ECMO and underwent PCI to the culprit lesion, and divided them into the survivor group (n=43) and the in-hospital death group (n=58). We compared the clinical characteristics and outcomes including complications between the 2 groups, and performed multivariate logistic regression analysis to find factors associated with in-hospital death and major bleeding.

The incidence of major bleeding including V-A ECMO site bleeding and intracranial hemorrhage was higher in the in-hospital death group (34.5%) than in the survivor group (7%) (p=0.001). Multivariate logistic regression analysis revealed that final thrombolysis in myocardial infarction (TIMI) flow grade ≤2 (OR 4.453, 95% CI1.427-13.894, p=0.010) and major bleeding (OR 4.986, 95% CI1.277-19.466, p=0.021) were significantly associated with in-hospital death. Out-of-hospital cardiac arrest (OHCA) was significantly associated with major bleeding (OR 3.881, 95% CI 1.358-11.089, p=0.011). In AMI patients who received V-A ECMO and underwent PCI, final TIMI flow grade ≤2 and major bleeding were associated with in-hospital death. OHCA was closely associated with major bleeding

The emergence of novel coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity has led to the rapid transmission of COVID-19 beyond geographic regions facilitated by international travel, leading to a pandemic. To guide effective control and interventions, primary data is required urgently, globally, including from low- and middle-income countries where documentation of cardiovascular manifestations and risk factors in people hospitalized with COVID-19 is limited.

Objectives: This study aims to describe the cardiovascular manifestations and cardiovascular risk factors in patients hospitalized with COVID-19.

Methods: We propose to conduct an observational cohort study involving 5000 patients recruited from hospitals in low-, middle- and high-income countries. Eligible adult COVID-19 patients will be recruited from the participating hospitals and followed-up until 30 days post admission. The outcomes will be reported at discharge and includes the need of ICU admission, need of ventilator, death (with cause), major adverse cardiovascular events, neurological outcomes, acute renal failure, and pulmonary outcomes. Conclusion: Given the enormous burden posed by COVID-19 and the associated severe prognostic implication of CVD involvement, this study will provide useful insights on the risk factors for severe disease, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients particularly from low and middle income countries from where the data remain scant.

Impella (Abiomed, Danvers, MA, USA) is a recently-innovated (commercially available from 2017 in Japan) percutaneous left ventricular assist device which is inserted percutaneously and transfers blood from the left ventricle to the ascending aorta, improving systemic circulation and end-organ dysfunction as well as unloading left ventricle in patients with cardiogenic shock. Impella has not yet shown a significant survival benefit in patients with cardiogenic shock compared to intra-aortic balloon pump in randomized control trials, but gives powerful circulatory support immediately with minimally invasive manner when used in appropriate patients at optimal timing with adequate management. In this review article, we will introduce and discuss optimal and practical management of Impella therapy in Japan.