Poster session 3

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[433] Poster: Silent myocardial infarction in women with type II diabetes mellitus

Doctor Elmir E. Omerovic¹, Assis. Prof. M. Muller², Doctor G. Brohall¹, Doctor T. Ramunddal¹, Assis. Prof. M. Matejka¹, Professor F. Waagstein¹, Professor B. Fageberg¹

¹Departement Of Cardiology, Wallenberg Laboratory At Sahlgrenska Academy, Gothenburg, Sweden; ²Gothenburg, Sweden

Introduction. Diagnosis of myocardial infarction (MI) is more complex in women than in men while cardiovascular mortality is higher in women than men with type II diabetes mellitus (DM). Unrecognized MI may be associated with a worse prognosis than clinically diagnosed MI. The aim of this study was to asses the presence of silent MI in women with recently diagnosed DM without previous history of ischemic heart disease (IHD).

Methods. The study population consisted of 15 women (age 64–66) with DM and albuminuria. The patients were selected after screening of 200 women with recently diagnosed DM. The control group (n = 16) consisted of BMI and age matched subjects. The individuals with previous history of IHD and ECG suggesting the presence of IHD were excluded. All subjects were investigated with magnetic resonance imaging (MRI) using standard protocols for assessment of myocardial perfusion, viability and coronary angiography.

Results. The results are summarised in the Table. MRI investigation has shown the presence of subendocardial MI in the two DM women (13%). No MI was detected in the control group. MR coronary angiography revealed the presence of significant stenosis in the proximal segment of left anterior descending coronary artery in one DM women who developed instable angina 2 weeks after the MRI investigation (requiring acute percutaneous coronary intervention). No difference was found in indices of left ventricular systolic and diastolic function. There was a tendency for increased LV mass in the DM group. No difference was found in the LV volumes.

Conclusion. Clinically significant proportion of the women with DM and albuminuria without previous history of IHD have had silent MI. MR screening of these high risk female patient is valuable diagnostic tool which may increase diagnostic accuracy and improve prognosis in DM patients with IHD.

Table. Cardiac MRI in women with type II DM

[434] Poster: Impact of optimal versus suboptimal therapy in diabetic patients with acute coronary syndromes

Doctor Susana S. Costa, Doctor P. Monteiro, Doctor F. Goncalves, Assistant Professor L. Goncalves, Professor M. Freitas, Professor L. A. Providencia

Coimbra, Portugal

Background. Diabetes mellitus (DM) is one of the major risk factors for cardiovascular diseases and is usually associated with a worse prognosis in acute coronary syndrome (ACS) patients. Many drugs and strategies used to treat ACS can improve this prognosis, but the impact of previous DM treatment on in‐hospital (IH) mortality is poorly understood.

Aim. To evaluate the impact of previous DM treatment in IH mortality in diabetic ACS patients.

Methods. Retrospective analysis of a database containing 216 patients admitted for ACS in a single coronary intensive care unit between May 2004 and December 2005 that were known to be diabetic at hospital admission. Optimal previous treatment for DM was considered to be insulin, aspirin, ACE inhibitors and statins. We evaluated 2 groups: group A – diabetic patients treated with these 4 drugs (n = 19) and group B – diabetic patients treated with <or = 3 drugs (n = 197).

Results. In both groups, patients were mainly of male gender (67.6%) with mean age of 70.1±10.1 years. Previous history of hypertension was present in 81% of patients, dyslipidaemia in 77.3%, family history of coronary disease in 12% and smoking habits in 11.1%. Group B patients had an IH mortality rate that was double that of group A (11.2% versus 5.3%). This occurred despite the higher prevalence of previous history of myocardial infarction (77.8% versus 30.8%), catheterization (68.4% versus 34.9%) and percutaneous coronary intervention (38.9% versus 12.8%) in group A. Ejection fraction, either evaluated by echocardiography or left ventriculography, was similar in the 2 groups of patients.

Conclusion. Our series shows that diabetic patients previously well treated have a better IH outcome. This reinforces the importance of using optimal DM treatment as a mean to prevent ACS and decrease the higher IH mortality rate usually associated with ACS in this group of patients.

[435] Poster: Homocysteine and hs C reactive protein. The difference between Serbains and Californians

Doctor I. Burazor¹, Professor A. Vojdani², Professor M. Burazor¹

¹Clinic for Cardiovascular diseases, Clinical center, NisSerbia and Montenegro; ²UCLA, Immunosciences Lab. Inc, Los Angeles, United States of America

Novel risk factors such as homocysteine (HCY) and C reactive protein might underline the process of atherothrombosis and might help us to determine the risk of future cardiac events. The aims of our study were to investigate the role of HCY and Hs CRP in acute coronary syndromes (ACS), relation with traditional risk factors and differences between citizens of Serbia and California.

Participants and methodes The study included 158 participans of whom 58 were patients admitted to our CCU due to ACS, 50 were healthy volonteers with no know cardiovascular diseases from Nis and 50 were helathy volonteers from California. Blood samples were sent on dry ice to Immunosciences Lab Inc where the analyzes were performed. We determined the circulating levels of HCY and HsCRP.

Results. Patients with ACS had significantly higher concetrations of HCY then controls from Serbia (p<0.001) and controls from California (p<0.001). Also there was a difference regard to concetrations of Hs CRP (p<0.001). Our results showed that controls from Serbia had higher levels of both novel risk factors then controls from California, indicating the high risk group for future cardiac event. Also, there was a correlation regard to cigarete smoking, BMI and cholesterol levels.

Conclusions. HCY and HsCRP might be consider as a novel risk factors for acute coronary events. Also, early detection of circulating levels might be used in primary prevention.There is a difference between country of citizenship. Californians have better quality of life then Serbians.

[436] Poster: Bisoprolol preventes a body mass index declining in patients with severe congestive heart failure with hypercholesterolemia treated by statins

Assoc. Prof. Alexsander E A. Berezin

Dept. of Cardiology, Hospital Therapy, Zaporozhye, Ukraine

Background. Recent studies have been demonstrated positive influence of beta‐blockade on clinical outcomes in patients with severe congestive heart failure (CHF). Clinical evaluation of any left ventricular dysfunction due to coronary artery disease may be associates with such risk factors as hypercholesterolemia, and neurohumoral activation as well. In these cases they usually implement statins, which may occur to body mass decrease and desirable worsening of heart failure outcomes.

Aim. To exam whether high selective beta‐blocker bisoprolol stabilizes body mass in patients with severe CHF when it adds to conventional treatment included statins.

Methods. 56 patients (mean age 58.9±6.77 years, 42 men) with IV NYHA CHF functional class, left ventricular ejection fraction less 35%, and total cholesterol values from 5.2 mmol/l to 6.6 mmol/l were enrollment to the study. All patients have written informed consent to the study and received ACE inhibitors, diuretics, spironolactone, and atorvastatin in dosage from 10 mg to 40 mg daily. 30 heart failure subjects had discontinued beta‐blockade due to intolerance and any adverse effects at least 3 weeks before including to the study. 26 patients were prescribed high selective beta₁ ‐blocker bisoprolol (2.5–10.0 mg daily) at the run‐in period (3 week before start of the study). During 48 weeks active treatment period these patients have been followed intake of bisoprolol in unchanged doses. Body mass index (BMI) for both patients' cohorts was 19– 24 kg/m2. C‐reactive protein, interleukin (IL) 6, IL 8, IL 12, tumor necrosis factor alpha (TNF alpha) plasma levels were examined by ELISA at the beginning and at the end of the study.

Results. Analysis of obtained outcomes has been showed that there was not a significant changes of BMI in bisoprolol patients during 48 weeks (P = 0.20). However, at the end of the study there was detected a pronounced trend to decline of BMI in cohort patients who did not received beta‐blockade (from 22.0±0.51 kg/m2 to 18.5±0.43 kg/m2; P<0.02). BMI decreasing is associates with a significant climbing of C‐reactive protein, IL 6, and TNF alpha in comparison with bisoprolol group patients. IL 8 and IL 12 plasma levels were the same in both cohorts. It was developed interrelation between BMI and bisoprolol dosage (r = 0.48; p<0.001), TNF alpha plasma level (r = −0.52; p<0.05), C‐reactive protein (r = −0.54; p<0.05), and IL 6 (r = −0.50; p<0.01).

Conclusion. High selective beta₁‐blocker bisoprolol terminates BMI declining in patients with severe CHF.

[437] Poster: Ezetimibe decreases readmission rates in acute coronary syndrome patients

Doctor P. F. Monteiro¹, Doctor S. I. Costa², Doctor F. Goncalves², Asst. Prof. L. M. Goncalves¹, Professor M. Freitas¹, Professor L. A. Providencia¹

¹Cardiology, Coimbra University Hospital & Medical School, Coimbra, Portugal; ²Cardiology, Coimbra University Hospital, Coimbra, Portugal

Introduction. Hypercholesterolaemia is a well know risk factor for coronary artery disease in general and acute coronary syndrome (ACS) in particular. Howerver, the impact of ezetimibe, a new lipid lowering drug, in the prognosis of ACS patients is not known.

Aim. To evaluate, in a population of ACS patients, if the prescription of ezetimibe at discharge (on top of optimal medical therapy) influences the rate of readmissions for new ACS episodes.

Population and methods Retrospective analysis of a database containing 1033 patients admitted in a single coronary care unit for ACS between May 2004 and December 2005. This population was divided in two groups, according to the fact of having been discharged on statins (Group A, n = 983) or on statins+ezetimibe (Group B, n = 50). Ezetimibe was prescribed if in‐hospital LDL‐cholesterol, determined at admission, was higher than 160 mg/dL. Mean follow‐up time was 12‐3 months in group A and 9‐2 months in group B (p<0.05).

Results. Group A included more female patients, with lower prevalence of dyslipidaemia and hypertension, but more previous history of coronary disease and cardiovascular medication. There were no differences regarding age, killip class and TIMI risk score at admission, coronary vessels with significant stenosis, left ventricular ejection fraction, C‐reactive protein, Hb A1c, creatinine at admission use of revascularization and medication prescribed at discharge, but group B patients received more glycoprotein IIb/IIIA inhibitors during their hospital stay. Biomarkers of necrosis were higher in group B patients, while the body mass index was lower. None of the patients treated with ezetimibe was readmitted for an ACS, while that occurred in 7.3% of group A patients (p<0.05); this difference persisted even after adjustment for the length of follow‐up.

Conclusion. In this ACS population, patients treated with ezetimibe had a significantly lower ACS recurrence rate, despite having larger necrosis during their index hospitalization and a worse risk factor profile. This data shows that, in high‐risk ACS patients, ezetimibe may have a positive impact in long‐term prognosis.

[438] Poster: Triple oral antithrombotic therapy in coronary artery disease: real life problem with no evidence based guideline

Assis. Prof. G. Koracevic¹, Doctor J. Glasnovic², Professor M. Pavlovic², Assis. Prof. Z. Perisic², Doctor T. Stanojlovic¹, Doctor M. Randjelovic¹, Doctor N. Bozinovic¹

¹Department for Cardiovascular Diseases, Medical Faculty, Nis, Serbia and Montenegro; ²Department for Cardiovascular Diseases, Clinical Center, Nis, Serbia and Montenegro

Number of patients requiring Aspirin (due to CAD), Warfarin (due to atrial fibrillation/prosthetic valve/left ventricular mural thrombus/venous thromboembolism) and Clopidogrel (due to stenting) has been increasing. If we decide not to treat such pts with all 3 drugs, it might be a mistake of underutilization of effective drugs. On the other had, there is a little doubt (if at all) that adding third antithrombotic drug will increase bleeding risk. Major bleeds are per se dangerous (especially in high risk CAD pts) and have the additional disadvantage of requiring the cease of any antithrombotic therapy for a period of time. A subgroup of patients at very high bleeding risk with the usage of triple antithrombotic therapy might be intuitively considered (prior ulcer, bleeding tendency, older pts, females, etc.), but there has been a gap in medical literature on this topic.

The aim of the work is to search for papers on combined usage of Aspirin, Clopidogrel and Warfarin, and to analyze its prevalence in patients hospitalized in University Department for Cardiology.

Results. Search of PubMed, Elsevier, Oxford University Press, Springer Blackwell Lippincott, Stanford University Press, Google schoolar, etc. for Aspirin+Clopidogrel+Warfarin+stent, retrieved 9 papers. There is not a single randomized clinical trial on benefit and safety of triple antithrombotic therapy. However, there are some helpful reports and a guideline – like paper, written by experts (and covering high/moderate/low thrombotic as well as bleeding risk), to close the gap until evidence‐ based guideline. In our Dpt, out of 1438 hospitalized CAD pts, 21 (1.46%) had triple antithrombotic Th. Indications for Warfarin were most frequently AF and thrombus, and stent for Clopidogrel. Triple Th was given in 9 pts (0.63% of all) in the absence of stent, in unstable CAD pts with high surgical or PCI risk.

Conclusion. Evidence – based guideline on efficacy and safety of triple antithrombotic therapy in CAD is missing. Prevalence of such therapy has been low in all reports (including the present one), but it has been increasing constantly, together with the need for randomized clinical trials.

[439] Poster: Differences in response to abciximab in patients with acute coronary syndromes with and without ST‐segment elevation

Doctor Armando A. Perez De Prado, Doctor C. Cuellas, Doctor F. Fernandez‐Vazquez, Doctor A. De Miguel, Doctor A. Diego, Doctor B. Samaniego, Doctor C. Olalla, Doctor R. G. Calabozo

S. Hemodinamica. Servicio De Cardiologia, Hospital De Leon, Leon, Spain

Purpose. It is well known that patients with ST‐elevation Myocardial Infarction (STEMI) show higher level of platelet aggregation than those with Non ST‐elevation Acute Coronary Syndrome (NSTEACS). Less data are available about the magnitude of the effect of antiplatelet agents, particularly abciximab, in these patients when Percutaneous Coronary Intervention (PCI) is performed. The main objective of thisstudy is to assess the degree of platelet aggregation inhibition (PAI) obtained with abciximab in STEMI and NSTEACS patients treated with PCI.

Methods. Consecuutive patients with moderate or high risk NSTEACS with an early coronary angiography and those with STEMI treated with primary PCI at our center were included in this analysis; abciximab was administered as soon as possible in STEMI patients (before angiography) and before PCI in NSTEACS patients (previously treated with 300 mg. loading dose+75 mg/d of clopidogrel). PAI was analyzed with Verify‐Now assay system (Accumetrics Inc.) and expressed in PAU (platelet aggregation units, arbitrary units) and % of PAI calculated as: (1‐(end‐procedure PAU / basal PAU))×100.

Results. 58 STEMI patients and 64 NSTEACS patients (71% met criteria for MI) were included. Basal characteristics were similar in both groups (82% male, 65±11 years‐old, 20% diabetics, 22% previous antiplatelet treatment). Basal values of platelet aggregation showed a non‐normal distribution with a median value of 157, Interquartile Range (IQR) 118–189 PAU; STEMI patients showed significantly higher values (median 179, IQR 144–215 PAU) than those with NSTEACS (median 138, IQR 101–177 PAU, p = 0.0001). After abciximab treatment, the % of PAI achieved did not follow a normal distribution without significant differences between groups: STEMI patients median value 98, IQR 91–100% vs. NSTEACS median 97, IQR 94–100%, p = 0.87. None of the clinical, analytic or treatment variables showed any relationship with basal platelet function or % of PAI achieved.

Conclusion. Platelet aggregation values are higher among patients with ST‐elevation myocardial infarction than patients with non ST‐elevation acute coronary syndrome. However, the platelet function inhibition obtained with abciximab is high and similar in both groups in our series.

[440] Poster: Oxidative stress status and levosimendan in acute heart failure

Doctor M. Torretta¹, Assis. Prof. A. Sapone², Doctor A. Limido², Doctor L. Valgimigli¹, Professor G. L. Biagi¹, Professor G. Cantelli‐Forti¹, Professor M. Paolini¹, Professor J. A. Salerno‐Uriarte²

¹Department of Cardiovascular Sciences, Insubria University School of Medicine, Varese, Italy; ²Department of Pharmacology, Alma Mater Studiorum, University of Bologna, Bologna, Italy

Oxidative stress status (OSS) has been suggested as a diagnostic marker of adverse cardiovascular events. We developed a laboratory technique for direct OSS assessment on peripheral blood samples using a new electron paramagnetic resonance (EPR) radical‐probe, bis(1‐hydroxy‐2,2,6,6‐tetramethyl‐4‐piperidinyl) decandioate di‐hydrochloride, which quantitatively and instantaneously reacts with reactive oxygen species (including superoxide) to yield the parent nitroxide, which is sufficiently persistent to be measured by EPR. We selected for OSS assessment during levosimendan infusion 7 patients with complicated severe heart failure resistant to standard therapy. In all cases a Swan‐Ganz catheter and an arterial line were positioned. Levosimendan was administrated from a central line with a bolus of 12 mcg/kg in 10', followed by 24 hours infusion at an initial rate of 0,05 mcg/kg/min gradually increased to 0,1 mcg/kg/min. Dobutamine was stopped, dopamine reduced to 3 mcg/kg/min. Hemodynamic parameters were recorded at the beginning of the treatment, after 6 and 24 hours; blood samples for OSS assessment were taken with the same timing. OSS resulted reduced in all patients with 30% minimum value up to 56% maximum value at 24 hours, matching the clinical and hemodynamic improvement. These preliminary data suggest levosimendan could improve clinical conditions also by OSS reduction.

[441] Poster: The effect of simvastatin and a low dose of rofecoxib on blood pressure in patients with acute coronary syndromes and mild hypertension.

Doctor A. Kuklinska¹, Doctor K. Kaminski¹, Doctor W. Modrzejewski¹, Professor W. J. Musial¹, Assis. Prof. B. Sobkowicz¹, Doctor P. Kralisz², Assis. Prof. S. Dobrzycki²

¹Department of Cardiology Medical University, Bialystok, Poland; ²Department of Invasive Cardiology, Bialystok, Poland

Background. Several studies have found the reduction of blood pressure (BP) associated with the use of statins. On the other hand the development of selective cyclooxygenase‐2 (COX‐2) inhibitors has raised the issue that the use of these drugs is associated with BP elevation.

Aim. We analyzed the possible effect of simvastatin alone or together with a low dose of rofecoxib on BP in a group of patients with acute coronary syndromes (ACS) and mild hypertension.

Methods. Thirty‐four patients (mean age 61.6±10.9 y, mean admission systolic and diastolic blood pressure 141.0±24.05 mmHg and 87.2±12.0 mmHg, respectively) with ACS without ST‐segment elevation were randomized to simvastatin (20 mg per day) alone or together with rofecoxib (12.5 mg per day). The patients were de novo treated. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before randomization and after one month of treatment on the right arm using a mercury sphygmomanometer with the patient seated in a quiet room. Pulse pressure (PP) was calculated by subtraction of DBP from SBP. Moreover serum levels 6‐keto‐PGF‐1alpha – a stable product of prostacyclin (PGI2) were assessed on enrollment and after one month of therapy. Concomitant anti‐hypertensive therapy was comparable in both groups.

Results. After one month of therapy SBP significantly decreased in a group of patients receiving both drugs (Wilcoxon signed‐rank test, p = 0.03), while the reduction was not significant in patients treated with statin alone (Wilcoxon signed‐rank test, p = 0.08). The significant reduction of mean DBP was observed only in a group of patients treated with statin alone (Wilcoxon signed‐rank test p = 0.007). During therapy in patients treated with rofecoxib significant correlation was found according to the reduction of SBP and the increase of 6‐keto‐PGF‐1alpha levels (Spearman correlations r = −0.57, p = 0.01), which was not observed in patients receiving statin alone (r = −0.059, p = 0.82). Moreover the decrease of mean PP values was slightly related to the increase of 6‐keto‐PGF 1alpha (Kruskal‐Wallis test, p = 0.07). The increase of 6‐keto‐PGF‐1 alpha was significantly higher in combination arm as compared to statin alone (ANOVA, p = 0.007).

Conclusions. Hypotensive effect was more pronounced in a group of patients treated with both drugs‐ a low dose of rofecoxib and simvastatin, probably due to significant increase of PGI2 synthesis.

[442] Poster: A decade (1995–2004) in the management and prognosis of acute myocardial infarction in the Comunidad Valenciana. The PRIMVAC registry.

Doctor Jose J. Valencia¹, Doctor A. Cabades², Doctor J. Cebrian², Doctor E. Gonzalez², Doctor F. Sogorb², Doctor V. Bertomeu², Doctor P. Morillas², Doctor I. Echanove²

¹Hemodinamica, Hospital General Alicante, Alicante, Spain; ²PRIMVAC, Valencia, Spain

Purpose and methods The PRIMVAC registry started in 1995 and has collected all acute myocardial infarctions episodes (MI) admitted in the coronary units (CU) of the main hospitals in the Comunidad Valenciana (southeastern Spain). Demographic, clinical, procedural and outcome variables were registered in such patients since 1995 till 2004.

Results. 19,719 patients with the diagnosis of STEMI were included in the decade 1995–2004. Mean age was 65±12 y with 24.3% female. Coronary risk factors: 48.3% had hypertension, 32.2% hypercholesterolemia, 36.5% were current smokers, 29.4% diabetics, 17.3% had prior MI and 4.3% had received prior revascularization (2.6% PTCA and 1.7% coronary bypass). Index MI characteristics: anterior location 42.1%, inferior 43.5%, not specified in 14.4% and Q wave in 72.6%. Complications: III/IV KK group 14.3%, ventricular taquicardia 5.8%. ventricular fibrillation 5.1%, atrial fibrillation 9.2%, complete AV block 5%, angina 9.3%, reinfarction 2.6%, right ventricle impairment 6.8%, mechanical complications 2.6%. Overall mean mortality was 12.2% with a slight but continuous and significant decrease over the years (14.1% in 1995 vs 9.1% in 2004, p<0.01). Procedural variables: coronariography was performed in 13.6% of patients, 2.9% Swan‐Ganz, 4.6%temporary pacemaker, intraaortic balloon pump 0.7%, mechanical ventilation 7.4%. Revascularization procedures: PTCA was performed in 9.5%, cardiac surgery in 0.8% and thrombolysis in 44% of patients. Betablockers were used in 27.8% of patients, aspirin in 89.2% and ACE inhibitors in 42.3%. Time delay for thrombolysis was 180 min, for symptoms onset to emergency room arrival 151 min and for symptoms onset to CU arrival 270 min (50 quartile).

Conclusions. In this large registry of MI admitted in CU of the Comunidad Valenciana, mortality remains high but with a significant reduction in the last years. Nevertheless, thrombolysis and other revascularizations procedures as PTCA are still offered to few patients. Improvement in MI management is mandatory to get better results in its prognosis.

[443] Poster: Coronary Care Unit today

Mrs R. Jenysova, Doctor O. Toman, Doctor J. Parenica, Doctor M. Poloczek, Miss A. Kucerova, Professor J. Spinar

Dpt. of Cardiology, University Hospital Brno, Brno, Czech Republic

Introduction. The aim of this paper is to describe spectrum of patients and procedures performed nowadays at our Coronary Care Unit.

Methods. There were 1338 consecutive patients hospitalised at 6 beds of our Coronary Care Unit (CCU) in the years 2004–2005. The mean age of our patients is 67 years, the most of them are men (around two thirds), and the mean duration of stay at CCU was 2.5 days. 85% of patients were hospitalised due to acute coronary syndrome (ACS), from the other diagnoses dominate acute cardiac failure, pulmonary embolism, serious arrhythmias, and atypical chest pains. There are 11% of the ACS patients hospitalised due to unstable angina pectoris (UAP), 39% due to acute myocardial infarction without ST elevations (NSTEMI) and 50% for acute myocardial infarction with ST elevations (STEMI). Early invasive strategy is preferred in most of the ACS patients, acute coronary angiography is performed in more than 90% of patients. Acute angioplasty (PCI) is performed in 22% patients with UAP, 54% patients with NSTEMI. Primary angioplasty (PPCI) is routinely performed in 95% patients with STEMI. Most of the patients after acute revascularisation are stable, nevertheless, artificial ventilation is necessary in 11% of the patients, we use hemodynamic monitoring in 8% and balloon contrapulsation in about 5% of the patients. Malignant ventricular arrhythmias are present in 9% of ACS patients, temporary pacing because of significant bradycardia is needed in 10% of patients. The overall mortality at CCU was 6.2% within these years, the overall hospitalisation mortality of these patients was 7.2%. Mortality of the STEMI patients who have undergone PPCI was 4.4%. The above mentioned data were obtained by retrospective analysis of our hospital documents.

Conclusion. The availability of early invasive therapy for the ACS patients reduces mortality, complications during the hospitalisation, shortens the duration of stay at CCU and the overall duration of the hospitalisation. However, an up‐to‐date CCU enables complex intensive care even for the very seriously ill patients. We have our first experiences with continuous elimination methods in the patients with acute renal failure, with therapeutic hypothermia in the patients after resuscitation and we plan both these and further methods to develop. Our organisation of prehospital care of ACS patients with the usage of transtelephonic 12‐lead ECG is and ideal example of utilisation of modern technologies in acute cardiology.