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BACKGROUND: There are several patterns of special ST-segment elevation morphology in patients with ST-elevation myocardial infarction (STEMI), but their effect on prognosis is unclear. We, therefore, investigated the mortality of patients with these patterns by comparing them to patients with typical ST-segment morphologies. METHODS: This observational study assessed 1277 consecutive patients with STEMI. Their initial electrocardiograms were analyzed quantitatively and divided into four categories: typical (n = 1138), Tombstone (n = 62), Triangular (n = 39), and Lambda patterns (n = 38). The primary outcome was death (all causes). RESULTS: The Triangular and Lambda pattern patients had high proportions of cardiogenic shock (15.8%, 9.7%, 66.7%, and 47.4%, P < 0.01, for typical, Tombstone, Triangular, and Lambda, respectively) and out-of-hospital cardio-pulmonary arrests (4.8%, 6.5%, 38.5%, and 26.3%, P < 0.01). They also had higher frequencies of multivessel disease (37.2%, 30.7%, 66.7%, and 55.3%, P < 0.01) and left main trunk lesion (2.8%, 0%, 35.9%, and 13.2%, P < 0.01). During a median observation period of 717 days, the mortality rates were 18.3%, 17.7%, 71.8%, and 52.6% (P < 0.01; 7.4%, 9.7%, 53.9%, and 42.1% within 30-days, P < 0.01), respectively. The hazard ratios were 1.3 (95% CI: 0.6-3.0. P = 0.51) in Tombstone, 9.6 (95% CI: 6.0-15.3, P < 0.01) in Triangular, and 6.7 (95% CI: 4.0-11.2, P < 0.01) in Lambda patterns when referenced to typical patterns. CONCLUSION: The mortality rate in STEMI patients with Triangular and Lambda patterns was higher than that of those with typical and Tombstone patterns.

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Developing-world shark fisheries are typically not assessed or actively managed for sustainability; one fundamental obstacle is the lack of species and size-composition catch data. We tested and implemented a new and potentially widely applicable approach for collecting these data: mandatory submission of low-value secondary fins (anal fins) from landed sharks by fishers and use of the fins to reconstruct catch species and size. Visual and low-cost genetic identification were used to determine species composition, and linear regression was applied to total length and anal fin base length for catch-size reconstruction. We tested the feasibility of this approach in Belize, first in a local proof-of-concept study and then scaling it up to the national level for the 2017-2018 shark-fishing season (1,786 fins analyzed). Sixteen species occurred in this fishery. The most common were the Caribbean reef (Carcharhinus perezi), blacktip (C. limbatus), sharpnose (Atlantic [Rhizoprionodon terraenovae] and Caribbean [R. porosus] considered as a group), and bonnethead (Sphyrna cf. tiburo). Sharpnose and bonnethead sharks were landed primarily above size at maturity, whereas Caribbean reef and blacktip sharks were primarily landed below size at maturity. Our approach proved effective in obtaining critical data for managing the shark fishery, and we suggest the tools developed as part of this program could be exported to other nations in this region and applied almost immediately if there were means to communicate with fishers and incentivize them to provide anal fins. Outside the tropical Western Atlantic, we recommend further investigation of the feasibility of sampling of secondary fins, including considerations of time, effort, and cost of species identification from these fins, what secondary fin type to use, and the means with which to communicate with fishers and incentivize participation. This program could be a model for collecting urgently needed data for developing-world shark fisheries globally. Article impact statement: Shark fins collected from fishers yield data critical to shark fisheries management in developing nations.

Uso de Aletas Secundarias Proporcionadas por Pescadores para Llenar Vacíos Importantes de Información sobre las Pesquerías de Tiburones Resumen Con frecuencia no se evalúan las pesquerías de tiburones del mundo en desarrollo ni cuentan con un manejo activo de sustentabilidad. Uno de los principales obstáculos para esto es la falta de información sobre las especies y la composición de los tamaños en las capturas. Probamos e implementamos una estrategia nueva y potencialmente aplicable en todas partes para la recolección de estos datos: la entrega obligatoria de las aletas secundarias de bajo valor económico (aletas anales) obtenidas de los tiburones desembarcados por parte de los pescadores y el uso de estas aletas para reconstruir las especies y tamaños en la captura. Usamos identificaciones genéticas de bajo costo e identificaciones visuales para determinar la composición de las especies y aplicamos una regresión lineal a la longitud total y a la de la base de la aleta anal para la reconstrucción del tamaño en captura. Probamos la viabilidad de esta estrategia en Belice, primero en un estudio de prueba de concepto y después subiendo al nivel nacional para la temporada de pesca de tiburón 2017-2018 (1,786 aletas analizadas). Se registraron 16 especies en esta pesquería. Las más comunes fueron Carcharhinus perezi, C. limbatus, Rhizoprionodon terraenovae y R. porosus (consideradas como un grupo) y Sphyrna cf. tiburo. Las últimas tres especies fueron desembarcadas principalmente por encima del tamaño maduro, mientras que con las dos primeras especies lo hacían por debajo del tamaño maduro. Nuestra estrategia demostró ser efectiva en la obtención de información crítica para el manejo de la pesquería de tiburones y sugerimos que las herramientas desarrolladas como parte de este programa puedan ser exportadas a otras naciones en esta región y aplicadas casi de manera inmediata si existen los medios para comunicarse con los pescadores e incentivarlos a proporcionar las aletas anales. Fuera del Atlántico Occidental tropical, recomendamos una mayor investigación de la viabilidad del muestreo de aletas secundarias, incluyendo la consideración del tiempo, esfuerzo y costo de la identificación de especies a partir de estas aletas; cuál tipo de aleta secundaria utilizar; y los medios mediante los cuales comunicarse con los pescadores e incentivarlos a participar. Este programa podría ser un modelo para la recolección de información de necesidad urgente para las pesquerías del mundo en desarrollo.

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