bluuebunny/crossref_metadata_2025 huggingface dataset:
P5462Arterial hypertension, right heart remodelling and intrarenal haemodynamics: the mysterious triangle in the cardiovascular continuum
Authors: Cabac-Pogorevici I , Revenco V
Published: October 2019

Purpose

In arterial hypertension (HTN), vascular structural changes develop as a consequence of haemodynamic as well as neurohumoral factors. Indeed, in the peripheral vessels a decrease in arterial compliance and, in the heart remodelling occurs respectively. The significant impact of HTN on left heart remodelling and its interconnection with intrarenal hemodynamics (IRH) has been widely studied. In the same time, there is lack of data concerning the affinity of HTN, IRH and right heart remodelling, as another important cluster of factors for prediction of mortality and morbidity in this group of patients.

Methods

The study included 104 patients (50 females and 54 males, mean age 48,26±11,2 years) with grade I-III arterial hypertension. All subjects underwent careful clinical history and physical examination to reveal risk factors, cardiovascular history and treatments. Blood test, echocardiography focused on right heart evaluation, intrarenal Doppler measurements were repeated in three parts of both kidneys (superior, median, and lower) untill three reproducible waveforms were obtained. The following IRH parameters were obtained: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT), renal volume (RV) and RV/RRI ratio.

Results

The mean RRI was 0,6672±0,0452, mean RPI 1,2533±0,178, mean AT 66,68±2,324 ms, mean RV 129,67±23,79 ml and mean RV/IRR ratio 195,52±41,587 ml. Mean 24 hours SBP was 146,12±13,96 mmHg, mean 24 hours DBP 86,59±6,78 mmHg. The mean pulse pressure (PP) was 59,10±22,90 mmHg. The mean 24 hours heart rate (HR) was 75,14±26,86 beats/minute. Mean value for the right ventricular (RV) basal diameter (4Ch) was 29,5±3,71 mm, right atrium (RA) diameter 39,71±3,38 mm, RA area 16,98±2,89 mm2, Sm RV 0,11±0,05 mm/sec, TAPSE 19,2±1,66 mm, SPAP 28,3±5,321 mmHg. We found an important positive correlation between RA diameter and RA area with RRI (r=0,364, p<0,01), (r=0,371, p<0,01), RPI (r=0,296, p<0,01), (r=0,320, p<0,01) and AT (r=0,155, p<0,05), (r=0,148, p<0,05), and negative correlation of RV Sm with RRI (r=−0,259, p<0,01), RPI (r=−0,232, p<0,01), AT (r=−0,162, p<0,05), meanwhile PASP showed an important positive connection with RRI (r=0,354, p<0,01), RPI (r=0,330, p<0,01) and AT (r=0,218, p<0,01).

Conclusions

The assumption that cardiac structural changes are progressing in parallel with extracardiac target damage could have an important scientific substrate, emphasizing the potential connection of IRH and the heart remodelling, including the right heart in HTN, and the eventual strengthening the IRH positions as a predictor of cardiovascular outcomes in this subset of population.
P5463Hyperfiltration could be a risk factor for development of hypertension: A five-year cohort study
Authors: Kuwabara M , Niwa K , Hisatome I
Published: October 2019

Background

Some recent studies showed that hyperfiltration is a risk for cardiovascular disease. However, the mechanism is still unknown. This longitudinal study tested the hypothesis that hyperfiltration could be a risk for hypertension.

Methods

This study retrospectively included Japanese healthy adults between 30 and 85 years of age who had medical check-up at our Center for Preventive Medicine, both at enrollment (2004) and at 5-year follow-up (2009). We excluded the subjects with hypertension, diabetes mellitus, dyslipidemia, hyperuricemia, or chronic kidney disease (estimated glomerular filtration <60 mL/min/1.73 m2) at the baseline. We divided this study subjects into three categories of eGFR (60–80 (reference), 80–100, and 100≤mL/min/1.73 m2), and defined hyperfiltration as more than 100 mL/min/1.73 m2 of eGFR. We used logistic regression analyses to examine risk factors for development of hypertension with multiple adjustments for age, sex, smoking, drinking habits, body mass index, and eGFR categories.

Results

In this study, 6045 subjects without comorbidities (mean age of 47±10 years, 1,842 men) were followed for 5 years. Of those, 450 subjects had developed hypertension. After multiple adjustments, hyperfiltration is a risk for development of hypertension (OR: 1.374; 95% confidence incidence (CI), 1.013–1.864), as well as aging (OR: 1.063; 95% CI, 1.052–1.073), higher BMI (OR: 1.244; 95% CI, 1.200–1.289), and drinking habits (OR: 1.387, 95% CI, 1.117–1.721).

Conclusion

Hyperfiltration carries a significant risk for developing hypertension in Japanese individual without comorbidities. We should take account for hyperfiltration as a risk for hypertension, as well as chronic kidney diseases.
P5473Perceived well-being after acute myocardial infarction according to diabetic status and its impact long-term mortality. The FAST-MI programme
Authors: Danchin N , Puymirat E , Bataille V , Cottin Y , Tabone X , Lucke V , Muligo A , Dillinger J G , Ferrieres J , Schiele F , Simon T
Published: October 2019

Background

Little information is available regarding subjective well-being according to diabetic status in patients surviving an acute myocardial infarction (AMI).

Aims and methods

A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2005, 2010 and 2015) one year after the acute episode of AMI, with a specific question on overall health condition (how do you feel: very well, well, fair, poor) (n=6082), and additional questions on the presence of any chest pain (n=4590), presence nuisance bleedings (n=3968), and reporting of perceived medication side-effects (n=2220). Answers were analysed according to diabetic status. We also analysed in the 2005 and 2010 cohorts whether subjective health status at one year was a correlate of 5-year mortality.

Results

Compared with non-diabetic patients (n=4692), those with diabetes (n=1390) had a poorer perceived health status (poor/fair health status: 40% vs 30%, P<0.001), more presence of chest pain (31% vs 23%, P<0.001), but less nuisance bleedings (47% vs 56%, P<0.001) and similar reported medication side-effects (37% vs 41%, P=0.12). Using logistic regression analysis, diabetes was an independent correlate of poorer health status (any diabetes OR vs non-diabetic 1.29, 1.13–1.49, P<0.001; non-insulin-treated: 1.17, 1.00–1.36, P=0.05, insulin-treated: 1.58, 1.29–1.94, P<0.001). In diabetic patients, perceived health condition at one year was an independent correlate of 5-year death (Cox multivariate analysis): compared with patients reporting very good health, HR (95% CI) 2.16 (1.08–4.32) for good health, 3.06 (1.53–6.11) for fair health, and 3.63 (1.55–8.55) for poor health; in non-diabetic patients, 5-year survival was similar in those reporting good or very good health status, but lower in those reporting fair or poor health status (Figure).

Figure 1. 5-year survival by health status

Conclusion

Compared with non-diabetic patients, patients with diabetes described a poorer general health and more residual chest pain after AMI, but had less nuisance bleedings. Health condition reported one year after AMI was an independent correlate of subsequent long-term mortality, particularly for diabetic patients.

Acknowledgement/Funding

Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
P5485The impact of meteorological parameters on the incidence of myocardial infarction
Authors: Skoda R , Szilagyi B , Lukacs M , Pongracz R , Barczi G Y , Vago H , Czimbalmos C S , Edes I , Ruzsa Z , Sotonyi P , Dinya E , Merkely B , Becker D
Published: October 2019

Introduction

The changing of some meteorological parameters have major burden on the human body. That's why it became necessary to adopt to the altering conditions. The air temperature, atmospheric pressure have a significant influence on the patient's physical shape, blood pressure and response to stress.

The aim of our study was to assess the impact of the fronts and all the factors forming the weather at the same time on the incidence of myocardial infarction and its prognosis.

Methods

We performed a retrospective analysis on the data of 11820 consecutive patients surviving acute myocardial infarction between 2005 and 2014. We used to scales applied in meteorology to characterise the days (Péczely Scale, Front Scale). We studied the incidence of the values of the different scales 2 days before and after the infarction.

Results

We had a database of 11820 patients, STEMI (n=5183) and NSTEMI (n=6004). We created different subgroups (age, 30-day mortality, occurrence of primary ventricle fibrillation) to make our estimation. Considering non VF patients the effect of Front 3 whereas among VF positive patients Front 5 is more significant. The incidence rates of Front 3 one day before and on the day of the infarction in the non-VF and NSTEMI group is 0.2041 and 0.1735, in the non-VF and STEMI group it is 0.1939 two days before the event. The incidence rate of Front 5 on the 2nd day in the NSTEMI and VF positive group is 0.0357, it is 0.0714 among STEMI and VF positive patients on the day of the event. The influence of the approaching warm front is significant (p<0.05).

Conclusion

The influence of the weather is not irrelevant in the occurrence of MI. The mortality rates are higher in several subgroups on days having a Péczely Scale 3. The different fronts have a major impact on the severity of the infarction. The Front 5 causes higher incidence of VF due to MI. We proved that warm fronts have a significant effect on patients dying within 30 days.
P5494Impact of the gender difference on long-term clinical outcomes in dyslipidemic South Korean AMI patients who underwent PCI with new-generation DES
Authors: Kim Y H , Her A.-Y , Jeong M.-H , Kim B.-K , Lee S.-Y , Hong S.-J , Shin D.-H , Ahn C.-M , Kim J.-S , Ko Y.-G , Choi D , Hong M.-K , Jang Y
Published: October 2019

Background

There are limited comparative data concerning long-term major clinical outcomes between male and female in dyslipidemic AMI patients after PCI with new-generation DES.

Purpose

We thought to investigate the impact of gender difference on the 2-year clinical outcomes.

Methods

Finally, a total of 2403 eligible dyslipidemic AMI patients who underwent PCI with new-generation DES were enrolled and they were separated into two groups; the male group (n=1800) and the female group (n=603). The primary endpoint was major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). The secondary endpoints were the incidence of the individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR

Results

Two propensity score-matched (PSM) groups (422 pairs, n=844, C-statistic = 0.850) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, re-MI, and TVF were significantly higher in the female group compared with the male group. However, after propensity score-matched (PSM) analysis, the cumulative incidences of MACE (HR, 0.971; 95% CI, 0.628–1.501; p=0.895), all-cause death (HR, 1.061; 95% CI, 0.536–2.100; p=0.865), re-MI (HR, 1.212; 95% CI, 0.433–2.907; p=0.813), and TVF (HR, 0.764; 95% CI, 0.474–1.229; p=0.267) were similar between the two groups. In addition, the cumulative incidences of cardiac death, TLR, TVR were not significantly different between the two groups (Table 1).

Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Male Female Log-rank Propensity score matched patients MACE 41 (10.4) 40 (10.3) 0.895 0.971 (0.628–1.501) 0.895 All-cause death 16 (4.0) 17 (4.2) 0.865 1.061 (0.536–2.100) 0.865 Cardiac death 13 (3.3) 9 (2.2) 0.391 0.691 (0.295–1.616) 0.393 Re-MI 8 (2.0) 9 (2.4) 0.813 1.212 (0.433–2.907) 0.813 TLR 7 (1.8) 6 (1.6) 0.781 0.857 (0.298–2.550) 0.781 TVR 16 (4.3) 10 (2.7) 0.236 0.623 (0.283–1.373) 0.241 TVF 39 (10.2) 30 (7.8) 0.265 0.764 (0.474–1.229) 0.267

Conclusion

The gender difference was not apparent in these dyslipidemic South Korean AMI patients who underwent PCI with new-generation DES during 2-year follow-up period.
P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction
Authors: Soeda T , Ishihara M , Fujino F , Ogawa H , Nakao K , Yasuda S , Noguchi T , Ozaki Y , Suwa S , Fujimoto K , Nakama Y , Morita T , Shimizu W , Hirohata A , Saito Y
Published: October 2019

Background

Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated.

Objective

To study the characteristics and prognosis in octogenarians who presented cTn positive AMI.

Methods and results

The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure).

Conclusions

J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn.

Acknowledgement/Funding

None
P5515Circulating galectin 1 is associated with severity of coronary artery disease and adverse cardiovascular events in patients undergoing coronary angiography
Authors: Chou R.-H , Lu Y.-W , Huang P.-H
Published: October 2019

Background

Galectin-1, a β-galactoside-binding lectin, was reported to attenuate the cardiac inflammation and ventricular remodeling after AMI. Its role in stable CAD was not fully elaborated. This study aimed to identify the relationship between galectin-1 and severity of CAD in patients with stable angina.

Methods

Totally 834 subjects underwent elective CAG were enrolled. Pre-procedure galectin-1 and hsCRP concentrations were determined. Subjects were grouped into tertiles according to their galectin-1 concentrations. SYNTAX scores were calculated to evaluate the severity of CAD. All patients were followed until January 2019, or the occurrence of major adverse cardiovascular events (MACE).

Results

Patients with higher galectin-1 concentrations were older and had higher prevalence of hypertension, diabetes, heart failure, and with higher levels of hsCRP and STNYAX scores. Patients with the highest tertile of galectin-1 were associated with higher risk of MACE (Fig 1A), even after adjusting age, gender, hypertension, diabetes, hemoglobin, creatinine, and LVEF (aHR: 2.13, 95% CI: 1.04–4.33, p=0.038). Gelection-1 (AUC: 0.802) showed better discriminatory performance than hsCRP (AUC: 0.696) in prediction the incidence of MACE (Fig 1B).

Table 1 Tertile 1 (n=278) Tertile 2 (n=278) Tertile 3 (n=278) P Age (years) 61.0 (54.8–71.0) 67.0 (60.0–75.0) 72.0 (61.0–80.3) <0.001 Male, n (%) 188 (67.6) 184 (66.2) 197 (70.9) 0.479 Hypertension, n (%) 153 (55.0) 185 (66.5) 219 (78.8) <0.001 Diabetes, n (%) 67 (24.1) 90 (32.4) 123 (44.2) <0.001 Heart failure, n (%) 10 (3.6) 8 (2.9) 44 (15.8) <0.001 Hemoglobin (g/dL) 13.5 (12.5–14.3) 13.4 (12.4–14.3) 12.3 (10.8–13.7) <0.001 Creatinine (mg/dL) 0.9 (0.8–1.1) 1.0 (0.9–1.2) 1.3 (1.1–1.9) <0.001 Hs-CRP (mg/dL) 0.1 (0.0–0.2) 0.1 (0.0–0.3) 0.2 (0.1–0.7) <0.001 Galectin 1 (ng/mL) 13.3 (10.2–14.7) 18.7 (17.4–20.5) 29.3 (25.5–38.5) <0.001 SYNTAX score 0.0 (0.0–5.0) 0.0 (0.0–7.0) 7.0 (0.0–16.1) <0.001 LVEF (%) 59.0 (54.6–62.2) 58.0 (52.0–63.0) 55.9 (49.0–60.9) 0.009 MACE: revascularization, n (%) 17 (6.1) 13 (4.7) 43 (15.5) <0.001 MACE: nonfatal MI, n (%) 1 (0.4) 1 (0.4) 7 (2.5) 0.018 MACE: nonfatal stroke, n (%) 0 (0.0) 1 (0.4) 2 (0.7) 0.367 MACE: death, n (%) 4 (1.4) 1 (0.4) 13 (4.7) 0.001

Conclusion

Serum galectin-1 levels were associated with the severity of CAD and subsequent MACE in patients with stable angina.

Acknowledgement/Funding

This study was supported in part by research grants from the Taipei Veterans General Hospital and Taiwan Ministry of Science and Technology Academic E
P5516Short-term and long-term mortality among acute myocardial infarction patients admitted to hospitals on weekends as compared with weekdays
Authors: Lai C , Kuo R N , Wang T C , Chan K A
Published: October 2019

Background

As in other countries, manpower shortage in weekends and holidays is a common problem in either private hospitals or public hospitals in Taiwan. Whether the manpower shortage in weekends and holidays is associated with poor quality of medical care is a noteworthy subject and several investigations from different countries have been published already.

Purpose

This study examined the difference of short-term and long-term mortality between acute myocardial infraction patients admitted to hospitals on weekends and weekdays in Taiwan.

Methods

We conducted a retrospective, nationwide cohort study based on the National Health Insurance claims database in Taiwan. Adult patients aged 20 years or older who were admitted with a diagnosis of acute myocardial infarction between Jan. 1 2006 and Dec. 31 2014 were identified. Only the first attack of acute myocardial infarction was retained for analysis. The multivariate logistic regression model was applied with adjustment of baseline characteristics at both patient level and hospital level. The outcome variables included in-hospital mortality and one-year cumulative mortality after the index hospitalization.

Results

We identified 53861 patients with acute myocardial infarction as the weekend group, while 130908 patients as the weekday group. The mean age was 68 years old and 68% of the subjects were male in both groups. ST-elevation myocardial infarction constituted 23% of the patients and up to 46% of the subjects underwent percutaneous coronary intervention during the index hospitalization in both groups. Among the weekend group, the in-hospital mortality was 15.8% while the in-hospital mortality was 16.2% in the weekday group (standardized difference = 0.01). The one-year cumulative mortality was 30.2% and 30.9% in the weekend group and the weekday group, respectively (standardized difference = 0.02). The adjusted odds ratio (aOR) concerning in-hospital mortality of the weekend group compared with the weekday group was 0.98 (95% confidence interval [CI]: 0.95–1.01, p=0.11). Also we found no difference in one-year cumulative mortality between the two study groups (aOR = 0.98, 95% CI: 0.96–1.01, p=0.15).

Conclusions

As for acute myocardial infraction patients in Taiwan, admission on weekends or weekdays did not have a significant impact on either in-hospital mortality or one-year cumulative mortality.

Acknowledgement/Funding

Ministry of Science and Technology, the Executive Yuan, Taiwan (MOST 106-2410-H-002-218-, and MOST 107-2410-H-002-237-)
P5521Door-to-balloon time and mortality of a PCI centre: how crucial can 30 minutes be for our STEMI patients?
Authors: Campos I , Costa-Oliveira C , Medeiros P , Marques Pires C , Flores R , Ferreira A S , Galvao Braga C , Costa J , Vieira C , Marques J
Published: October 2019

Introduction

STEMI time delays have been presented as an indicator of quality of care. Considering the system delay, the guidelines of European Society of Cardiology (ESC) and American Heart Association (AHA) for the management of STEMI patients (pts) diverge regarding the maximum time from STEMI diagnosis to wire crossing in pts presenting at primary PCI (pPCI) hospitals (≤60min versus ≤90min, respectively).

Objective

To compare the prognosis between pts presenting at pPCI hospital with maximum time from STEMI diagnosis to wire crossing of ≤60min and patients with times between 61 and 90min.

Methods

The records of 1679 STEMI pts admitted consecutively in our coronary care unit during six years were analysed retrospectively. Of this pts, 341 (20%) were admitted directly in a PCI centre and 1338 (80%) were rescued by an emergency medical system or presented to a non-PCI centre. Pts that presented at PCI centre were divided into two groups: group 1 – STEMI pts with maximum time from STEMI diagnosis to wire crossing of ≤60min (n=202,69%); group 2 – STEMI pts with times 61–90 min (n=91,31%). Pts with time from STEMI diagnosis to wire crossing >90min were excluded. Primary endpoints were the occurrence of death at 6 months and 1 year; follow-up was completed in 98% of pts.

Results

Group 2 pts were older (60±14 vs 67±143, p<0.001), with higher proportion of women (14.9% vs 25.3%; p=0.026), hypertension (45.5% vs 61.5%, p=0.035), diabetes (17.1 vs 24.4%, p=0.005) and presented more frequently Killip 4 at admission (2.1% vs 12.5%, p=0.003). Group 1 pts had higher proportion of smokers (62.2% vs 49.4%, p=0.03). Patient delay was statistically higher in group 2 (Mdn (h) 3.8±3.5 vs 5±2, p<0.001), as was the system delay (Mdn (min) 45±9 vs 74±8, p<0.001). In-hospital mortality (3.8% vs 5.1%, p=0.42) wasn't different between groups, but at 1-month (3.8% vs 10.3%, p=0.05), 6-months (4.4% vs 12.8%, p=0.02) and 1-year mortality (5% vs 15.4%, p=0.008) was higher in group 2. In multivariate analysis and after adjusting for different baseline characteristics, pts who complied with the recommended times according to the 2017 ESC guidelines had lower risk mortality at 1 year compared to group 2 [HR 0.42, 95% CI (0.23–0.74), p=0.006].

Conclusion

In patients presenting at this PCI centre, complying with the 2017 ESC STEMI guidelines in order to reduce the system delay to ≤60min was crucial, since pts who were reperfused within this recommended time had lower mortality rates.
P5522ST elevation myocardial infarction networks: relationship of hub-spoke distance with transfer time and clinical outcomes in rescue PCI
Authors: Galhardo A , Cardoso J P , Kanhouche G , Junior V S , Lima V M , Sato D N , Oliveira R B , Reis G C , Souza C G S , Corhs F M , Junior I G , Moises V A , Carvalho A C , Moraes P I M , Alves C M R
Published: October 2019

Background

In the establishment of ST elevation myocardial infarction (STEMI) systems of care, transfer times between primary care units (PCU) and the cardiac catheterization lab (CCL) are pillars to therapeutic success. Objective: To analyze the relationship between PCU-CCL distance with transport time and main clinical outcomes in STEMI patients (p) treated with pharmaco-invasive therapy (PIT) and referred for rescue PCI after failed fibrinolysis.

Methods

Between January 2010 and December 2018, of the 2241 patients who received tenecteplase in PCU inserted in a large city STEMI network, 801 (35.7%) evolved without reperfusion criteria after 90 minutes (persistence of chest pain, less than 50% reduction on ST elevation or hemodynamic instability), being urgently transferred to the CCL. The PCU were divided according to the distance to the tertiary center in Group 1: between 5 and 9km (N=208p), Group 2: between 16 and 18km (N=315p) and Group 3: between 22 and 30km=266p). Considering an alpha of 0.05, sample size n=801 and an effect size of 0.11, a power of 0.80 was obtained.

Results

The groups were comparable for baseline features (Table 1). Group 2 (intermediate distances) had the highest median transport time (G1 260 interquartile 145–437 min vs G2 355 interquartile 206–573 min vs G3 241 interquartile 125–418 min; p<0.01 for G2). There were no differences between the groups regarding cardiogenic shock (G1 24.5% vs G2 23.3% vs G3 24.1%, p=0.9) or in-hospital death (G1 17.4% vs G2 12.3% vs G3 13.0%, p=0.2).

Table 1. Group's baseline features G1: Short distances G2: Intermediate distances G3: Long distances p value (5–9 km) N=208 (16–18 km) N=315 (22–30 km) N=266 Age (median) 57.5 (51–64) 57 (49–66) 59 (52–67) 0.27 Female 29.7% 28.3% 35.1% 0.19 Hypertension 67.3% 60.9% 64.4% 0.31 Diabetes 37.0% 32.1% 37.8% 0.30 Renal failure 10.3% 9.7% 6.3% 0.21 Anterior STEMI 56.1% 58.4% 62.4% 0.36 Pain-to-needle time (median min) 197.5 (137–330) 195 (120–295) 195 (125–345) 0.38

Conclusion

In STEMI patients with failed fibrinolysis treated with pharmaco-invasive therapy, the PCU-CCL distance was not related to transfer time or to outcomes of in-hospital death and cardiogenic shock. The longer transport time of hospitals located at intermediate distance can possibly reflect local logistical difficulties and are not due to hub-spoke distance. Continuous improvement in structuring and coordination of public STEMI networks is aimed.
P5525Impact of clinical presentation at admission on long-term clinical outcomes in patients undergoing percutaneous coronary interventions - a contemporary registry data
Authors: Piatek L , Zandecki L , Kurzawski J , Janion-Sadowska A , Zabojszcz M , Siudak Z , Sadowski M
Published: October 2019

Background

Both unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) are still classified together in non-ST-elevation acute coronary syndromes despite the fact they substantially differ in both clinical profile and prognosis.

Purpose

The aim of the present study was to evaluate contemporary clinical characteristics and outcomes of UA patients after percutaneous coronary intervention (PCI) in comparison with stable angina (SCAD) and myocardial infarction (NSTEMI as well as STEMI) in Swietokrzyskie District of Poland in years 2014–2017.

Methods

A total of 7'187 patients after PCI from ORPKI Registry (38% with diagnosis of UA) were included into the analysis. Impact of clinical presentation (UA, SCAD, NSTEMI, STEMI) on 3-year outcomes were determined.

Results

UA patients were older that SCAD but younger than NSTEMI individuals. Diabetes and hypertension were more often encountered into UA group than in NSTEMI but less often than in SCAD cases. In UA group the percentage of previous myocardial infarction (MI), PCI or coronary artery bypass grafting (CABG) was the highest among all analyzed groups. In 3-year observation the risk of death as well as myocardial infarction (MI) and major adverse cardiac events (MACE) in unstable angina after PCI was higher than in stable angina but considerably lower than in NSTEMI group. Multivariate analysis confirmed that prognosis in NSTEMI was substantially worse in comparison with UA (RR 1.365, 95% CI: 1.126–1.655, p=0.0015). On the contrary there were no difference in mortality risk between UA and SCAD patients (RR 1.189, 95% CI: 0.932–1.518, p=0.1620). Parallel results were observed in respect of MI and MACE. Independ predictors of death were: age, kidney disease, hypertension, diabetes, previous stroke or previous PCI.

Multivariate logistic regression analyse Clinical presentation Death Myocardial infarction MACE RR 95% CI p-value RR 95% CI p-value RR 95% CI p-value NSTEMI/UA 1.365 1.126–1.655 0.0015 1.822 1.076–3.055 0.0260 1.514 1.267–1.807 <0.0001 NSTEMI/SCAD 1.624 1.251–2.109 0.0003 1.882 0.982–3.789 0.0568 1.604 1.275–2.094 <0.0001 UA/SCAD 1.189 0.932–1.518 0.1620 1.033 0.557–2.034 0.9219 1.060 0.855–1.323 0.6023 MACE, major adverse cardiac events; NSTEMI, non-ST-segment elevation myocardial infarction; UA, unstable angina; SCAD, stable angina.

Conclusion

Unstable angina accounted for 38% of all cases and was the most common diagnosis in patients that underwent PCI in that time. 3-year prognosis in UA was considerable better in comparison with NSTEMI. On contrary there was no difference in outcomes (death, MI, MACE) between UA and SCAD patients.
P5528Extremely elevated lipoprotein (a) as an independent risk factor for coronary heart disease in large patient cohort
Authors: Poudel M R , Kirana S , Mellwig K P , Horstkotte D , Knabbe C , Hinse D , Sauzet O , Stoyanova D , Gottfried R , Scholtz W , Scholtz S , Rudolph T , Rudolph V , Van Buuren F
Published: October 2019

Background

Elevated lipoprotein (a) [LP (a)] levels are an independent risk factor for coronary heart disease (CHD) and associated with myocardial infarction (MI). CHD took a devastating toll in Europe and in the United States in the 20th century, killing more people than any other disease. It remains the leading cause of death in most countries worldwide. CHD shares risk factors with atherosclerosis. It has been shown that elevated LP (a) levels are associated with an increased risk for CHD across various ethnic groups. LP (a) is genetically determined, stable throughout life and yet refractory to drug therapy. While 30 mg/dl is considered the upper normal value for LP (a) in central Europe, extremely high LP (a) levels (>150mg/dl) are rare in the general population.

The aim of our study was to analyse the correlation between lipoprotein (a) [LP (a)] levels and an incidence of coronary heart disease (CHD) in high-risk patients.

Patients and methods

We reviewed the LP (a) concentrations of 52.898 consecutive patients admitted to our cardiovascular center between January 2004 and December 2014. Of these, 579 patients had LP (a) levels above 150 mg/dl (mean 181.45±33.1mg/dl). In the control collective LP (a) was <30mg/dl (n=350). Other atherogenic risk factors in this group were HbA1c 6.58±1.65%, low density lipoprotein (LDL) 141.99±43.76 mg/dl, and body mass index 27.81±5.61. 54.40% were male, 26.07% were smokers, 93.2% had hypertension, and 24% had a family history of cardiovascular diseases. More than 82.6% were under statins. The mean glomerular filtration rate (GFR) was 69.13±24.8 ml/min [MDRD (Modification of Diet in Renal Disease)].

Results

64.98% (n=373) of the patients with LP (a) >150mg/dl had CHD. The prevalence of CHD in patients with LP (a) <30mg/dl in our control collective was 37.14%. (P- Value 0.0001). Patients with LP (a) >150mg/dl had a significantly increased risk for CHD (Odds ratio 5.98). 12.72% (n=73) of these patients suffered from CHD with single-vessel disease (VD), 14.63% (n=84) from CHD with 2VD and 37.63% (n=216) from CHD with 3VD. 47.92% of patients were re-vascularized by percutaneous coronary angioplasty (PTCA) and 37.06% of patients had to undergo coronary artery bypass grafting (CABG). 19.13% of patients had both, PTCA and CABG. Mean LP (a) level in patients with 1-vessel CHD was 181.5±29.98, in patients with 2-vessel CHD 178.94±34.26 and in patients with 3-vessel CHD 180.97±32.38 mg/dl.

Conclusion

Elevated LP (a) levels above 150 mg/dl are associated with a significantly increased risk of CHD in our collective and it confirms our hypothesis. Most of these patients had severe CHD with 3-vessel disease (VD) requiring coronary revascularization therapy. We need more prospective studies to confirm our findings.
P5535Gender differences with short-term vs 12 months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: a 1-year analysis of the REDUCE trial
Authors: Verdoia M , Suryapranata H , Damen S , Camaro C , Benit E , Barbieri L , Rasoul S , Van T Hof A W , Roolvink V , Ligtenberg E , Postma S , Kolkman J J E , Brouwer M A , Kedhi E , De Luca G
Published: October 2019

Background

Gender differences in the thrombotic and bleeding risk have been suggested to condition the benefits of antithrombotic therapies in Acute Coronary Syndrome (ACS) patients, and mainly among those undergoing percutaneous coronary interventions with drug eluting stents (DES). Therefore, the impact of gender on the optimal duration of dual antiplatelet therapy (DAPT) treated is still unclear and was therefore the aim of the present sub-study.

Methods

REDUCE is a prospective, multicenter, randomized, investigator-initiated study, designed to enroll 1500 ACS patients after treatment with the COMBO Dual Stent Therapy, based on a non-inferiority design. Patients were randomized in a 1:1 fashion to either 3 or 12 months of DAPT. Primary study endpoint was a composite of all-cause mortality, myocardial infarction, definite/probable stent thrombosis (ST), stroke, target-vessel revascularization (TVR) and bleeding (BARC II, III, V) at 12 months. Secondary endpoints were cardiovascular mortality and the individual components of the primary endpoint.

Results

From June 2014 to May 2016 300 women and 1196 men were randomized in the trial. Among them 43.7% of females and 51.9% of males were assigned to the 3 months DAPT treatment. Baseline characteristics were well matched between the two arms, but of a lower rate of TIMI flow <3 (p<0.001) and lower systolic blood pressure (p<0.05) among women and a more advanced age (p=0.05) among men receiving a shorted DAPT. At 1 year follow-up, no difference in the primary endpoint was observed according to DAPT duration (females: 6.9% vs 5.9%, HR [95% CI]=1.19 [0.48–2.9], p=0.71; males: 8.2% vs 9%, HR [95% CI]=0.92 [0.63–1.35], p=0.67). Results were confirmed after correction for baseline differences (females: adjusted HR [95% CI]=1.12 [0.45–2.78], p=0.81; males: adjusted HR [95% CI]=0.90 [0.61–1.32], p=0.60). Comparable rates of survival, thrombotic (MI, stent thrombosis, TVR, stroke) and bleeding events were observed with the two DAPT strategies, with no impact of gender.

Conclusions

The present study shows that among ACS patients randomized in the REDUCE trial, a 3 months DAPT strategy offers comparable results as compared to a standard 12 months DAPT at 1-year follow-up in both male and female gender.

Acknowledgement/Funding

None
P5543Features of treatment and outcomes in elderly patients. Results of the KRACS register
Authors: Kruchinova S , Kosmachova E D , Raff S A
Published: October 2019

Purpose

To evaluate the features of treatment and outcomes in elderly patients with acute coronary syndrome.

Methods

The elderly group comprised 2385 (28.9%) patients ≥75 years of the 8249 patients enrolled in the KRACS registry.

Results

When comparing patients of different ages, it was shown that among the elderly, dyspnoea was the most common manifestation of ACS, 9% vs 4% (p=0.015), they were less often hospitalized in “invasive” hospitals - 36% vs 49% (p=0.003), At admission, they often had the class Killip ≥ II - 36% vs 17% (p<0.001), a high risk for the GRASE-68% vs 30% (p<0.001). In addition, in elderly patients significantly lowered levels of Hb and increased creatinine were detected more often.

Drug treatment of elderly patients was characterized by less frequent use of ticagrelor - 3% vs 21% (p<0.001), LMWH or fondaparinux - 4% vs 12% (p=0.004). Thrombolytic therapy in STEMI in the elderly was more often streptokinase - 30% vs 18% (p=0.04), less often - tissue activator plasminogen - 2% vs 10% (p=0.03).

The frequency of performing any invasive interventions for any type of ACS in elderly patients was significantly lower - 16.7% vs 46.3% (p<0.0001), and the incidence of fatal outcomes during hospitalization for any type of ACS was significantly higher - 16, 0% vs 6.1% (p<0.0001). When assessing the incidence of fatalities in different facilities, it was found that STEMI, patients ≥75 years old hospitalized in “invasive” hospitals died significantly less frequently than when they got into “non-invasive” hospitals - 15.6% vs 50.0% (p=0.013). At the same time, among patients <75 years hospital mortality in “invasive” and “non-invasive” hospitals was not significantly different - 14.7% vs 9.9% (p=0.50).

There was also a clear trend towards a higher incidence of deaths among elderly patients who were left without PCI, compared with those who had been intervened. In patients <75 years, this trend was absent.

Conclusion

Thus, the results obtained indicate that elderly patients, with a higher risk and worse outcomes, receive treatment that is less consistent with the requirements of modern guidelines for the treatment of ACS. Important factors associated with better outcomes in elderly patients is their hospitalization in “invasive” hospitals and the implementation of PCI.
P5563Biopsy proven myocarditis: clinical and instrumental predictors of adverse prognosis at presentation
Authors: Gianstefani S , Cheng C Y , Baritussio A , Seguso M , Gallo N , Leoni L , Rizzo S , Perazzolo Marra M , Tarantini G , Plebani M , Basso C , Marcolongo R , Caforio A L P , Iliceto S
Published: October 2019

Background

Myocarditis is an insidious and potentially fatal illness with different clinical presentations and an unpredictable course. Prompt recognition of high risk patients is of paramount importance in preventing major adverse events.

Purpose

To identify predictors of dismal prognosis in a large cohort of patients with biopsy proven myocarditis.

Methods

Univariate analysis was used to identify predictors of death and heart transplant in a prospective cohort of 366 patients with biopsy proven myocarditis (aged 38±17, male 66%) using student's test and contingency tables as appropriate.

Results

At the time of follow up 46 patients (13%) were dead or received heart transplant (DHTX), 283 (77%) were alive (A) and 37 (10%) lost at follow up. Age at presentation was 33±20 y in DHTX v.s 39±15 in A cohort (p=0.057). Clinical features predicting adverse prognosis included female gender (p=0.002), heart failure at presentation (p=0.000), NYHA class II to IV (p=0.000). Clinical and radiographic signs of both left and right heart failure suggested worse outcome (p=0.000) as well as ongoing anticoagulation therapy (p=0.009). On ECG right (R) or left (L) axis deviation was a strong predictor of events (p=0.000). From an echocardiography perspective the presence of mild to severe mitral regurgitation (p=0.03), reduced left ventricular systolic function (FE) (p=0.000), reduced right ventricular fractional area change (FAC) (p=0.035) was strongly correlated to death or heart transplant. On cardiac catheterization the variables predicting unfavourable outcome included reduced left ventricular systolic pressure (LVSP) (p=0.000), reduced mean aortic pressure (mAP) (p=0.002), increased mean right atrial pressure (RAP) (p=0.001), FE on angiography (p=0.000). On cardiac biopsy (Bx) negative predictors were giant cell histology type (p=0.000) and PCR positive for viral genome (p=0.02) particularly for parvovirus B19 (p=0.04), adenovirus (p=0.04), and Epstein Barr virus (EBV) (p=0.03). See Tab 1

Table 1

Conclusion

Female gender, HF like presentation, reduced LV and RV systolic function, R or L axis deviation on ECG, presence of viral PCR or giant cell histology on Bx, reduced LVSP and mAP; increased RAP may be useful parameters to identify high risk patients on presentation. This may increase clinical efforts and surveillance in this subgroup in order to reduce the incidence of major adverse events.
P5584Causes of death within the first year after transcatheter aortic valve implantation: Lessons from EVERY-TAVI registry
Authors: Karam N , Jochheim D , Zadrozny M , Fischer J M , Gschwender S , Grundmann D , Baquet M , Bauer A , Theiss H , Hagl C , Pichlmeier M , Massberg S , Mehilli J
Published: October 2019

Background

According to current recommendations, transcatheter aortic valve implantation (TAVI) should only be performed among patients with a life expectancy of at least one year. However, many deaths occur within the first year after TAVI.

Purpose

To assess the causes of death within one year after TAVI.

Methods

Data was taken between November 2007 and December 2017 from the EVERY-TAVI registry. Patients who died during TAVI or experienced mechanical complications requiring surgery were excluded from the analysis. We assessed the causes of death over 3 periods post-TAVI: within the first 30 days, between 30 and 90 days, and between 90 and 365 days.

Results

Overall, 2389 patients underwent TAVI without mechanical complications. Among them, 320 (1.3%) died within one year. Age was the main cause of death, accounting for 73 deaths (22.8%), followed by heart failure (20.6%) and infections (18.7%). During the first month, cardiogenic shock was the main cause of death (25.4%), followed by infections (22.2%) and terminal heart failure (20.6%), while age was responsible of only one death (1.6%). During the two following months, heart failure was the main cause of death (33.3%), followed by infections (21.2%), and the percentage of deaths due to age increased to 18.2%. After 3 months, age was the main cause of death (31.4%), followed by infection (16.8%) and heart failure (16.2%).

Causes of death within one year of TAVI Cause of death All (n=320) <30 days (n=63) 30–90 days (n=66) >90 days (n=191) Older age, n (%) 73 (22.8) 1 (1.6) 12 (18.2) 60 (31.4) Terminal heart failure, n (%) 66 (20.6) 13 (20.6) 22 (33.3) 31 (16.2) Infection, n (%) 60 (18.7) 14 (22.2) 14 (21.2) 32 (16.8) Terminal renal failure, n (%) 26 (8.1) 4 (6.3) 5 (7.6) 17 (8.9) Cardiogenic shock, n (%) 26 (8.1) 16 (25.4) 4 (6.1) 6 (3.1) Malignancies, n (%) 18 (5.6) 0 (0.0) 2 (3.0) 16 (8.4) Sudden death, n (%) 17 (5.3) 6 (9.5) 2 (3.0) 9 (4.7) Stroke, n (%) 12 (3.7) 4 (6.3) 2 (3.0) 6 (3.1) Accident, n (%) 7 (2.2) 2 (3.2) 0 (0.0) 5 (2.6) Myocardial infarction, n (%) 7 (2.2) 2 (3.2) 2 (3.0) 3 (1.6) Non-cardiac surgery, n (%) 5 (1.6) 1 (1.6) 1 (1.5) 3 (1.6) Pulmonary embolism, n (%) 3 (0.9) 0 (0.0) 0 (0.0) 3 (1.6)

Conclusion

Cardiogenic shock is the main cause within the first month after TAVI, while older age is the main cause overall and after the initial months, highlighting the need to more carefully selection of patients undergoing TAVI.
P5588Early versus delayed oral anticoagulation in patients with acute pulmonary embolism: determinants and outcome
Authors: Becattini C , Cimini L A , Lankeit M , Pruszczyk P , Vanni S , Nazerian P , Kozlowska M , Casula C , Vinci A , Ottaviani M , Coppa A , Vedovati M C , Agnelli G
Published: October 2019

Background

Whether early oral anticoagulant treatment is appropriate for patients with acute pulmonary embolism (PE) regardless of PE severity is undefined. The aim of this study in patients with acute PE at intermediate risk of death were: I) to assess the determinants for the use of early vs delayed vs no oral anticoagulants in patients with acute PE and II) to assess the association between timing of oral anticoagulation and in-hospital mortality.

Methods

Prospective cohorts of patients with acute PE at intermediate risk of death according to the European Society of Cardiology Guidelines 2014 were merged in a collaborative database. The initiation of oral anticoagulation was classified as early (≤3 days) or delayed (between day 3 and 10 from diagnosis). Patients treated with parenteral anticoagulants for longer than 10 days were also included. In-hospital death was the primary study outcome.

Results

Overall, 557 patients were included in the study, 23 received thrombolytic treatment during the hospital stay. The mean duration of parenteral anticoagulation was 7±8 days (5 median), 348 patients were initiated on a direct oral anticoagulant and 79 on a vitamin K antagonist during the hospital stay. Initiation of oral anticoagulants occurred early or delayed in 209 (37%) and 218 (39%) patients, respectively and never occurred during the first 30 days in 130 (23%).

Intermediate-low risk patients more commonly received early and intermediate high delayed oral anticoagulation. Simplified PESI score of zero (OR 1.9, 95% CI 1.3–2.7) was independently associated with early oral anticoagulation; among sPESI components absence of cancer (OR 5.9, 95% CI 3.3–10) and heart rate <110 (OR 1.8, 95% CI 1.01–3.16) were independent predictors of early initiation of oral anticoagulants. The presence of both right ventricle dysfunction and injury was associated with delayed initiation of oral anticoagulants.

The incidence of death was 5.5%. Death occurred in 32 patients and was not related to the duration of parenteral anticoagulation (OR 1.01 per day, 95% CI 0.98–1.06) nor to right ventricle dysfunction but to sPESI 1 (OR 3.32, 95% CI 1.14–9.66). These results were partially confirmed in the 435 intermediate risk patients without cancer (OR 1.03, 95% CI 0.99–1.08 for days of parenteral treatment; OR 4.17, 95% CI 0.95–18 for sPESI 1).

Conclusion

The clinical severity of PE and not the timing of initiation of oral anticoagulants are associated with in-hospital death in patients with intermediate risk PE. Randomized studies are needed to definitively assess the role of heparin lead-in in patients with PE at intermediate risk for death.
P5595Non-invasive atrial work in the differential diagnosis of pre-capillary and post-capillary pulmonary hypertension
Authors: Vijiiac A E , Iancovici S , Scarlatescu A , Deaconu A , Dorobantu M
Published: October 2019

Background

Right heart catheterization (RHC) is the gold standard for the diagnosis of pulmonary hypertension (PH) and for the discrimination of pre-capillary from post-capillary PH, but it is an invasive method with high costs and limited availability. While echocardiography is widely used in the evaluation of patients with PH, no algorithm has been validated to discriminate between the various forms of PH.

Purpose

We aimed to assess the differences in echocardiographically-derived atrial work between patients with different forms of PH.

Methods

We included 80 patients in our study, which were divided in two groups. The pre-capillary group consisted of 28 patients with pulmonary arterial hypertension confirmed at RHC. The post-capillary group consisted of 52 patients with PH and severe left heart disease. All patients underwent transthoracic echocardiography. Atrial work is defined as the product between atrial volume and atrial pressure; for the right atrium, we estimated atrial pressure from the inferior vena cava diameter and change with respiration; for the left atrium, we used thetransmitral E-wave/ septal mitral annular Doppler Tissue Imaging e'-wave ratio (E/e') as a surrogate for atrial pressure and we defined left atrial work as E/e' × left atrial volume.

Results

The mean age was 54±14 years in the pre-capillary group and 71±13 years in the post-capillary group (p<0.001). Among the patients in the post-capillary group, 36 (69%) had severe left ventricular systolic dysfunction (mean ejection fraction=23±8%) and 16 (31%) had severe aortic stenosis. The right atrial work was significantly higher in the pre-capillary group: 1089±1105 vs. 382±508 in the post-capillary group (p=0.004). Using receiver operating characteristic (ROC) analysis, a cut-off value of 289.5 provided fair discrimination (area under the curve [AUC] = 0.762) between the two groups (sensitivity=67%, specificity=67%). The left atrial work was significantly lower in the pre-capillary group: 392±206 vs. 1907±1072 in the post-capillary group (p<0.001). Using ROC analysis, a cut-off value of 764 provided excellent discrimination (AUC=0.980) between the two groups (sensitivity=95%, specificity=96%). There was a moderate positive correlation correlation between right atrial work and left atrial work in the post-capillary group (r=0.60, p<0.001), but no significant correlation in the pre-capillary group (p=0.84).

Conclusion

Echocardiographically-derived atrial work, both right and left, differ significantly between pre-capillary and post-capillary PH. These two simple echocardiographic parameters might guide the differential diagnosis of PH and potentially reduce the need for RHC, should they be further validated.

Acknowledgement/Funding

This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF