bluuebunny/crossref_metadata_2025 huggingface dataset:
Bleeding predictors in acute coronary syndrome: does the age or clinical presentation matters?
Authors: Marques Pires C , Campos I , Medeiros P , Flores R , Mane F , Azevedo P , Galvao Braga C , Pereira MA , Gaspar A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Bleeding is a quite common non-cardiac complication of acute coronary syndrome (ACS) and is associated with a negative prognosis impact.

AIMS

To determine the predictors of inhospital major bleeding (IHMB) in ACS and to evaluate whether they differ according to age and clinical presentation.

METHODS

A multicentric retrospective study which analysed 25524 patients(pts) with ACS, 25141 without and 383 with IHMB.

By multivariate analysis, we determined IHMB predictors and evaluated the differences between age groups (<80 years; ≥80 years) and clinical presentation- ST elevation myocardial infarction (STEMI) or non-ST elevation ACS (NSTEACS).

RESULTS

By multivariate analysis we found 15 significant IHMB predictors (pvalue < 0,05): age≥75years, hypertension, previous angina, pulmonary disease, previous bleeding, atypical presentation (without pain), cardiac arrest, admission heart rate (HR)>100bpm, Killip4 at admission, ST-elevation, admission haemoglobin (Hb)<10g/dL, aspirin or Vitamin K antagonist (VKA) or ivabradine as previous medication and  glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa) use.

Then, we made a sub-analysis in STEMI pts which revealed that IHMB predictors of pts <80 years were: female gender, age≥75years, chronic kidney disease (CKD), active neoplasm, previous bleeding, atypical presentation, cardiac arrest, admission HR > 100bpm, Killip IV on admission and GPIIb/IIIa use. By contrast, IHMB predictors of pts with ≥80 years were: valvular disease, atypical presentation, aspirin as previous medication and GPIIb/IIIa use.

Finally, we made a sub-analysis in NSTACS pts which revealed that IHMB predictors of pts <80years were: previous angina, CKD, previous bleeding, cardiac arrest, Killip≥2 at admission, admission Hb < 10g/dL and VKA as previous medication. Conversely, IHMB predictors of pts with ≥80 years were previous bleeding, cardiac arrest and absence of normal QRS.

In addition, by multivariate analysis we found that IHMB had an impact on inhospital mortality (OR = 2,2;pvalue < 0,001), however, by Cox regression there wasn’t an impact on 1-year mortality.

CONCLUSION

This study suggests that IHMB has impact on inhospital mortality and that its predictors differ with age and clinical presentation. The most powerful predictor was previous bleeding. Considering the importance of IHMB, increased efforts are needed to tailor antithrombotic therapy according to age, renal function and other comorbidities.
Hyperglycemia and stress response in acute coronary syndromes
Authors: Swieszkowski S , Costa D , Aladio M , Matsudo M , Perez De La Hoz A , Lopez GL , Brignoli A , Perez De La Hoz R
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University of Buenos Aires

Background

Cortisol is a stress marker in patients with acute coronary syndrome (ACS) and it has a permissive effect on the actions of hormones that increase glucose production. Its association with blood glucose levels in diabetic and non-diabetic patients could help to understand the relationship between stress, hyperglycaemia and mortality.

Methods

Prospective and observational single-centre study. All patients admitted with a diagnosis of ACS to the coronary care unit of a University Hospital were included. The age, sex and clinical characteristics were recorded, along with the clinical outcomes. On admission, blood samples were obtained to measure serum glucose (SG) and cortisol (SC).

Results

Over a total of 149 patients, 35.37% had a diagnosis of ST-segment elevation ACS. Median age was 69 (60.1 – 79) years, 61.1% were male, 59.5% were hypertense, 18.2% dyslipidemic, 23% smokers, and 28.4% diabetics. Total mortality during hospitalization was 6.8%, and cardiovascular mortality was 6.1%.

We observed a significantly higher SC and SG on admission in patients who died (table 1), with a mild and positive correlation between them (Spearman’s rho = 0.24, p = 0.005). Diabetic patients had a higher SG on admission [191.1 mg/dl (157.5 – 250,8) vs. 116.0 mg/dl (99.0 – 141.0), < 0.001]. Diabetes was not associated with mortality, although correlation between glucose and cortisol remained constant in diabetics and non-diabetics (figure 1).

Conclusion

Hypercortisolemia and hyperglycaemia were associated with an increased in-hospital mortality. Although hyperglycemia confers a worse prognosis, we found that its correlation with cortisol was constant in diabetics and non-diabetics. This suggests that hyperglycaemia could be a surrogate stress marker, not related to diabetes as a risk factor in an acute setting. Serum glucose and cortisol on admission LaboratorySurvivorsNon-survivorsp-valueGlucose (mg/dL)128 (101 - 163)156 (134.5 - 197.2)0.04Cortisol (ug/dL)13.7 (7,98 - 23.65)43.7 (34.6 - 50.0)0.0004Abstract Figure. Serum cortisol and glucose on admission.
Influence of plasma ST2 level on myocardial remodeling in NSTEMI
Authors: Maslovskyi VI , Mezhiievska IA
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

to establish a relationship between types of myocardial remodeling and plasma ST2 levels in NSTEMI.

Methods. 90 patients with NSTEMI were examined. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes.

All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association.

Results. It is established, that relatively low level (RL) corresponded to 24, the relatively moderate level (RM) to 44, and the relatively high (RH) level of ST2 to 24 individuals, respectively. For patients in the main group, these levels were < 26 and > 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng / ml.

It was determined that in patients with explosives in comparison with RH levels of ST2 in blood plasma there is a significant increase in the value of LA (42 mm vs. 38 mm, p-0.03), iLA (20.3 mm / m2 vs. 18.3 mm / m2, p-0.04), ESS (36 mm vs. 32 mm, p-0.008), EDS (52 mm vs. 49 mm, p-0.04), Ve / Va ratio (0.79 vs. 0.74, p-0.03), iLC (2.72 vs. 2.06, p = 0.03), iMMLV (121 g / m2 vs. 108 g / m2, p = 0.04), a decrease in the ratio of RV to EDS (0.49 vs. 0.54, p = 0.01) and the value of EF (56% vs. 61%, p = 0.03) (Tab. 1). The ratio of LA to RA was 1.13 against 1.06, p= 0.04. In addition, in patients with RH level compared with patients with RM level, there was a significant increase in the value of ESS (36 mm vs. 34 mm, p = 0.05). The ratio of Ve / Va was 0.79 vs. 0.66, p =0.01, iLC -2.72 vs. 2.43, p-0.0006.

Conclusion. Elevated ST2 levels greater than 56 ng / ml in patients with NSTEMI were found to be associated with more severe structural left ventricular remodeling, left atrial overload, and decreased left ventricular contractility. The latter is manifested by a decrease in the value of PV and an increase in the value of Ve / Va, which changes in the direction of the formation of a restrictive type of diastolic transmitral blood flow. In turn, the ratio of RV to EDS shows the advantage of LV dilatation over RV. Tab. 1Echo indicatorsRL level ST2RM level ST2RH level ST2PLA, mm38 (35; 39)39 (37; 41)42 (37; 42)Р1-3 = 0,03EDS, mm49 (46; 52)50 (48; 53)52 (48; 54)Р1-3 = 0,04EF, %61 (59; 64)59 (53; 62)56 (58; 60)Р1-3 = 0,03Ve/Va0,64 (0,56; 0,78)0,66 (0,58; 0,74)0,79 (0,60; 1,20)Р1-3 = 0,03 Р2-3 = 0,01іММLV, g/m2108 (91; 117)115 (100; 127)121 (106; 130)Р1-3 = 0,04
Dynamics of kidney M1 and M2 macrophages in patients with myocardial infarction
Authors: Kercheva M , Kercheva M , Rebenkova M , Kim B , Ilianova I , Kolmakov A , Ryabtseva A , Gombozhapova A , Rogovskaya Y , Kzhyshkowska J , Ryabov V
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The reported study was funded by RFBR. Project number 19-315-60005.

Introduction

Heart-kidney axis is an active participant of the formation and progression of chronic heart and renal failure in patients with myocardial infarction (MI). Innate immunity play a great role in this collaboration between the heart and kidney according to the experimental data. However, there is not enough data about clinical studies.

Purpose

to assess the dynamics of kidney CD68+, CD80+, CD206+, CD163+ and stabilin-1+ macrophages in patients with fatal MI.

Methods and results: 30 patients with fatal MI type 1 were included. STEMI was in 87% (n = 26), in 53% (n = 16) it was recurrent MI. Chronic kidney disease was diagnosed in 33% (n = 10). They were divided according to the timeline of MI histopathology into 2 groups: early phase – inflammatory and reparative periods (to the 3d day after MI), late phase - regenerative and late periods (from the 3d to the 28 day after MI). Macrophages infiltration was assessed by immunohistochemistry. CD68+ was used, as a biomarker for M1 and M2 macrophages; CD80+, as a biomarker for M1 macrophages; stabilin-1+ and CD163+, CD206+, as only for M2 macrophages. The numbers of kidney CD68+ macrophages did not change significantly during the 28 days after MI: 42.8 ± 8 (early phase), 36.4 ± 13 (late phase). The numbers of kidney stabilin-1+ cells did not change also 2.1 ± 1 (early phase), 2.4 ± 1 (late phase), as CD163+ 59.51 ± 6 (early phase), 65.9 ± 25 (late phase). However, the numbers of CD206+ cells (M2 macrophages) increased from the early to the late phase: from 2 ± 1 to 8.5 ± 1 (p = 0.0001). The numbers of CD80+ cells (M1 macrophages) decreased from the early to the late phase from 4.2 ± 1 to 2 ± 1 (p = 0.02).

Conclusions

The number of kidney CD68+, CD163+ and stabilin-1+ macrophages did not show significantly dynamics during the first 28 days after myocardial infarction. We have noted the increase of CD206+ macrophage infiltration in kidney from the early phase after myocardial infarction to the late phase. Dynamics of CD80+ cells was the opposite; they decreased to the late phase after myocardial infarction.
Acute coronary syndrome in COVID-19 patients. Clinical features, severity and outcomes. Results from Spanish multicenter registry Car-COVID19
Authors: Abellas Sequeiros M , Sanmartin Fernandez M , Cosin Sales J , Corbi Pascual M , Escudier Villa JM , Garcia Del Egido A , Becerra Munoz VM , Martinez Dolz L , Gonzalez Juanatey C , Raposeiras Roubin S , Barge Caballero E , Jorge Perez P , Baron Esquivas G , Anguita Sanchez M , Zamorano JL
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Fundación del Corazón

Introduction

COVID19 has spread uncontrollably all over the world through this 2020 year. As a new entity, we did not know the potential cardiovascular manifestations of this infectious disease. This national registry was created to describe the cardiac affection and its severity.

Methods and results

A multicenter registry was conducted, including 28 centers in Spain. Patients with COVID19 diagnosis presenting an acute cardiovascular event between March 1st and May 30th were included. Eighty-two patients were included. Of them, 49 (76,6%) presented with acute coronary syndrome; the rest were diagnosed of acute myocarditis or stress cardiomyopathy. The majority of cases were STEMI (n = 31), while the remaining 35,4% presented as NSTEMI. 29 patients (61,7%) underwent emergent percutaneous coronary intervention (PCI) (Figure 1). Anterior (n = 18) and inferior (n = 16) were the most frequent locations. Coronary angiogram showed total occlusion in 20 patients (55,6%); while 7 patients presented with non-obstructive coronary arteries. PCI was done in 31 patients.

Eight patients (17,8%) developed Killip III-IV myocardial infarction. A total of 10 patients required endotracheal intubation and vasoactive agent were needed in 11 patients; none required IABP or ECMO. In-hospital mortality rate was 26,2%.

Conclusions

Patients with COVID19 may present with acute coronary syndromes. This entity has a poor prognosis, with noteworthy mortality. Table 1. Baseline characteristics.n (%)Age69,0[63,0-76,5]Sex (female)9 (19,1%)Hypertension28 (57,1%)Dyslipidemia25 (51,0%)Diabetes mellitus11 (22,4%)Chronic coronary disease10 (20,4%)Previous PCI10 (20,4%)Previous CABG0Previous AAS15 (30,6%)Smoking10 (20,4%)PCI percutaneous coronary intervention; CABG: coronary artery bypass graft; AAS: aspirin.Abstract Figure 1.
Trends in major bleeding events in patients with acute coronary syndrome
Authors: Cordero A , Escribano D , Bertomeu-Gonzalez V , Quintanilla MA , Moreno-Arribas J , Perez-Berbel P , Zuazola P
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

bleeding events incidence has gained a crucial role in acute coronary patients (ACS) due to its independent effect prognostic value.

Methods

we assessed trends of in-hospital and first-year-after-discharge major bleeding  (MB) events in all ACS admitted in a single center between January 2009 and June 2019. MB was defined as those fitting definitions 3 or 5 of the BARC consortium. Patients were categorized as high-bleeding risk (HBR) according to the 2019 Academic Research Consortium HBR consensus if they met at least one major or two minor criteria. Inclusion period was divided in 3 groups: 2009-2012 (n = 884;29.5%), 2013-2015 (n = 1,046; 34.9%); 2016-2019 (n= 1,065; 35.6%). In-hospital MB was assessed by logistic binary regression and results are presented as odds ratio (OR); post-discharge MB were assessed by competing events regression models, taking all-cause mortality as a competing event, and results are presented as sub-hazard ratio (sHR).

Results

we included 2995 patients, mean age was 68.5 (13.0), 26.2% females, 32.9%  had diabetes and 42.4% STEMI. A total of 1,163 (38.8%) were categorized as HBR patients. A non-significant trend to higher incidence of in-hospital MB was noted through the 3 time periods: 1.36%; 1.43%; 2.63 (p = 0.056) and it was mainly driven by the significant increase only in HBR patients: 2.54%; 4.60%; 7.67% (p = 0.002). Multivariate analysis identified age (OR: 1.06  95% CI 1.03-1.08, p < 0.001) and the time period 2016-2019 (OR: 1.93 95% CI 1.13-3.31; p = 0.017) as main variables associated to higher in-hospital MB.

In contrast, postdischarge MB decreased over time periods: 6.0%; 4.59%; 2.07% (p < 0.01). The decreasing trend was mainly driven by the reduction of MB in HBR patients (figure). The competing risk regression analysis, adjusted by age, gender, previous cardiovascular disease, revascularization and medical treatments, identified an independent association between lower post-discharge MB risk and the time period 2016-2019 (sHR: 0.56 95% CI 0.35-0.90; p = 0.017). Conversely, diabetes (sHR: 1.52 95% CI 1.01-2.28) and previous heart failure (sHR: 2.42 95% CI 1.14-5.14) were associated to higher risk of MB.

Conclusions

This continuous 10-year registry highlights the opposite trend of in-hospital vs. postdischarge MB that was mainly driven by reductions in HBR patients with ACS. The advances in post-discharge MB reductions should be take under consideration to prevent and avoid in-hospital MB. Abstract Figure.
The impact of lockdown enforcement during the SARSCoV-2 pandemic on the timing of presentation and early outcomes of patients with ST-elevation myocardial infarction
Authors: Kobo O , Efraim R , Saada M , Kofman N , Abu Dogosh A , Abramowitz Y , Aronson D , Minha S , Roguin A , Meisel SR
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

We aimed to explore whether the lockdown enforced during the SARSCoV-2 pandemic in Israel impacted the characteristics of presentation, reperfusion times, and early outcomes of ST-elevation myocardial infarction (STEMI) patients.

Methods

A multicenter prospective cohort comprising all STEMI patients treated by primary percutaneous coronary intervention admitted to four high-volume cardiac centers in Israel during lockdown (20/3/2020 - 30/4/2020). STEMI patients treated during the same period in 2019 served as controls.

Results

The study comprised 243 patients, 107 during the lockdown period of 2020 and 136 during the same period in 2019, with no difference in demographics and clinical characteristics. Patients admitted in 2020 had higher admission and peak troponin levels, had a 2.4 fold greater likelihood of Door-to-balloon times> 90 min (95%CI: 1.2-4.9, p = 0.01) and 3.3 fold greater likelihood of pain-to-balloon times> 12 hours (OR 3.3, 95%CI: 1.3-8.1, p < 0.01). They experienced higher rates hemodynamic instability (25.2% vs 14.7%, p = 0.04), longer hospital stay (median, IQR [4 ,3-6 Vs 5, 4-6 ,p = 0.03]), and fewer early (<72 hours) discharge (12.4% Vs 32.4%, p < 0.001).

Conclusions

The lockdown imposed during the SARSCoV-2 pandemic was associated with a significant lag in the time to reperfusion of STEMI patients. Lockdown period 2020OR (95% CI)P valueD2B > 90 min2.4 (1.2-4.9)0.01P2B > 12 hours3.3 (1.3-8.1)<0.01D2B: Door-to-Balloon, P2B: Pain-to-BalloonReference group: 2019 admissions; Adjusted to age, gender, ischemic heart disease, hypertension, Smoker, diabetes mellitus, and dyslipidemia. D2B: Door-to-Balloon, P2B: Pain-to-Balloon
Prevalence and main causes of myocardial infarction type 2 in the structure of in-hospital mortality
Authors: Leonova I , Oblavatsky D , Boldueva S
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose

the assessment of the proportion of myocardial infarction (MI) type 2 in the structure of mortality in a multidisciplinary hospital

Material and methods. A retrospective study was made of 1,574 autopsy protocols carried out in a multidisciplinary hospital in the period from 01.01.10 to 31.12.16, of which a group with postmortem type II MI was identified. The control group was composed of persons who died from proven atherothrombotic type 1 MI

Results. In 360 cases (22.87%), the cause of death was MI. Of these, 137 cases were due to type 2 MI. The ratio of men and women was the same. Type 2 MI more often developed in elderly (48.2%) and senile (34.3%) ages; the average age of patients with type 2 MI was 71.7 ± years (68.2 ± 3 years among men and 75.3 ± 4 years among women p <0.05), which did not differ from the group with fatal type 1 MI. The main causes of death in type 2 MI were tachysystolic arrhythmias - 59.12% of cases, severe hypoxia of any etiology - 35.04%. The absence of significant stenoses of coronary artery (CA) is significantly more common in type 2 MI, and multivessel disease - in type 1 MI. In the group of patients with type 1 MI, 67.29% had multivessel lesions (Table 1).

When comparing mortality in different departments of a multidisciplinary hospital, it turned out that only 29.2% of patients with type 2 MI were initially hospitalized in the cardiology department; 45.3% of patients - therapeutic, 25.5% of patients – surgical.

Conclusion. Nearly one in four patients dies as a result of MI, with more than 1/3 of fatal MIs occurring in type 2 MI. The main reasons for the development of type 2 MI: tachysystolic arrhyhythmias - 59.12%, hypoxia of various origins - 35.04%, sepsis - 2.2%. 25% of fatal type 2 MIs occurred in surgical patients. Table 1. CA in type 1 and 2 MISign1 type MI (n = 223)2 type MI (n = 137)рNo significant stenosis2,24%32,85%0,001Single CA significant stenosis8.07%12,41%0,1932-CA significant stenosis23,3%23,36%0,272Multivessel stenosis66,4%31,38%0,005Occlusion of at least one СА48,9%4,38%0,001
Searching for ST-segment elevation myocardial infarction markers by absorption spectra analysis of exhaled air samples
Authors: Syrkina A , Ryabov VV , Borisov AV , Zakharova OA , Kistenev YV
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Myocardial infarction is one of the main causes of mortality and disability. The standard diagnosis of myocardial infarction is associated with cardiospecific enzymes blood sampling. At the same time, it is of interest to search for new non-invasive myocardial necrosis markers, and there are few data in the periodicals on exhaled metabolites in myocardial infarction patients.

Purpose. Detecting specific molecules or their combination for ST-segment elevation myocardial infarction patients  in exhaled air by analyzing the spectroscopic characteristics of exhaled air samples.

Methods. The target group included 17 patients. The control group included  18 healthy volunteers. Inclusion criteria for the target group: primary STEMI; admission within 12 hours from the onset of STEMI; age 18 and older. All patients underwent standard diagnostics of AMI, including determination of CPK, CPK-MB, troponin. Exclusion criteria: acute illness, or exacerbation of chronic, major surgery  1 month before myocardial infarction; severe lung pathology; congestive heart failure III, IV NYHA class; impossibility of air sampling due to various reasons.

In parallel, on the 1st day of hospitalization, as early as possible, air samples were taken on fasting. To do this, the patient three times calmly, until the lungs are completely empty, exhales into the surrounding space, at the end of the third exhalation - into a one-off air intake, which then was closed hermetically.

The absorption spectra of samples of exhaled air were determined using the method of laser optical-acoustic spectroscopy and using a system for terahertz spectroscopy with time resolution. A comparative analysis of the spectra of samples of exhaled air for the 1st and 2nd ranges was carried out.

The obtained spectra of exhaled  air  samples were analyzed using the principal component analysis. Statistical data processing was carried out by the STATISTICA 10.0.

Results.  Absorption spectra of exhaled air samples were obtained in two ranges - infrared (range 1, wavelength: 2.5-10 μm - using the method of laser optical-acoustic spectroscopy) and terahertz (range 2, frequency: 0.3-2 THz - s using a terahertz time-resolved spectroscopy system). A comparative spectra analysis of exhaled air samples for the 1st and 2nd ranges was carried out. It is shown that in the Principal Component space of the vector set  of signs for the spectra of exhaled air samples in ranges 1 and 2, corresponding to healthy patients and patients with primary myocardial infarction, it is possible to perform a visual separation.

Conclusion. With the help of optical-acoustic and terahertz spectroscopy, a specific combination of substances in the exhaled air for patients with ST-segment elevation myocardial infarction was found.
Role of neutrophil-lymphocyte ratio in predicting mortality in acute coronary syndrome patients
Authors: Imani AL , Setianto BY , Taufiq N , Bagaswoto HP , Damarkusuma A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Inflammation is the basic mechanism of acute coronary syndrome (ACS). Among the various inflammatory markers related to ACS is the neutrophil-lymphocyte ratio (NLR). Neutrophils act as a mediator of inflammatory response to acute damage of myocardium, while lymphocytes decrease because of apoptosis caused by inflammation. Therefore, high NLR suggests further risk of infarction of the myocardium.

Purpose

This study determines the cut-off value and the role of NLR at admission in predicting in-hospital mortality of ACS patients. 

Methods

 A retrospective cohort study was conducted using data of patients admitted with ACS from the SCIENCE registry between February 2019 and November 2020. The inclusion criterion was complete blood count measurement at presentation. NLR was calculated from the absolute neutrophil and lymphocyte count. The optimal cut-off value of NLR was determined using receiver operating characteristic (ROC) curve and Youden index (J) analysis. Patients was divided into two groups based on the NLR cut-off value. In-hospital mortality between the two groups was compared using Chi-square test with a risk estimate to obtain the relative risk.

Results

 A total of 1147 ACS patients aged 60,70 ± 10,951 years old were included in the study. Area under the ROC curve was 0,607 (95% CI: 0,559-0,655; p <0,001). The optimal cutoff value of NLR to predict mortality was 10,7566 (sensitivity: 39,8%, specificity: 79,5%, J: 0,193). In-hospital mortality occurred in 64 of 266 (24,1%) patients with NLR >10,7566 and in 97 of 881 (11%) patients with NLR <10,7566, with relative risk 2,185 (95% CI: 1,645-2,904; p <0,001).

Conclusion

 In ACS patients with NLR >10,7566, there is an increased mortality risk 2,185 times higher compared to ACS patients with NLR <10,7566. Therefore, NLR can be used to predict in-hospital mortality in ACS patients. Mortality incidence between NLR groupsNLR >10.7566 (n= 266)NLR <10.7566 (n= 881)P-valueRelative risk95% CIMortality64 (24.1%)97 (11%)<0.0012.1851.645-2.904Non-mortality202 (75.9%)784 (89%)NLR neutrophil-lymphocyte ratio, CI: confidence interval, P-value considered significant if <0.005Abstract Figure. ROC curve of NLR
Gender differences in patients presenting with NSTEMI in the STAR registry
Authors: Meer A , Kinsara A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 In most acute coronary artery (ACS) related literature, the female gender constitutes a smaller proportion compared to the male gender. The presentation of ACS in females is frequently atypical, causing a delay in diagnosis and management. This study is based on gender-specific data in the Saudi Acute Myocardial Infarction Registry Program (STARS-1 Program).

Methods

 A prospective multicenter study, conducted with patients diagnosed with ACS in 50 participating hospitals.

Results

 In total, 762 (34.12%) patients were diagnosed with Non ST segment Elevation Myocardial infarction Of this group, only 164 (21.52%) were women. The mean age of the female group (64.52 ± 12.56 years) was older and the mean body mass index (BMI) was higher (30.58 ± 6.23) than the male group. A significantly higher proportion of the female group was diabetic or hypertensive, however, a smaller proportion was smoking. Hyperlipidemia was not significant between the two groups, although present in almost half (48%) of the female group. The history of angina/MI/stroke and revascularization was similar, except for renal impairment. The presentation was atypical compared to the male group as only 70% presented with chest pain, and the rest with shortness of breath or epigastric pain. At presentation, the female group were more tachycardiac, had higher blood pressure, and a higher incidence of being in class 11-111 Killip heart failure. Only 32% had a normal systolic function, and the majority had either mild or moderate systolic dysfunction.

Guideline directed medical therapy were not different between the two groups, except for the initiation of a beta-blocker on admission. In particular, the rate of percutaneous coronary intervention (PCI) was similar. Overall, the in-hospital mortality was similar (5%), with more women diagnosed with atrial fibrillation and heart failure at follow-up.

Conclusion

 Women had a higher prevalence of risk factors affecting the presentation and morbidity but not mortality. Improving these risk factors and the lifestyle is a priority to improve the outcome and decrease morbidity.
Feasibility of non-invasive mechanical ventilation during percutaneous coronary intervention in patients with myocardial infarction and acute decompensated heart failure
Authors: Giordana F , Angelini F , Gribaudo M , Battaglia C , Cinconze S , De Benedetto Fabrizi M , Baralis G , Rolfo F , Rossini R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Non-invasive ventilation (NIV) is an established treatment for acute decompensated heart failure (ADHF).

Purpose

The aim of the present analysis was to evaluate the feasibility of continuous positive airway pressure (CPAP) in patients with myocardial infarction (MI) and ADHF, during percutaneous coronary intervention (PCI).

Methods

Consecutive patients admitted for MI, receiving CPAP for ADHF in the cath lab during PCI were retrospectively included. The main study outcome was the feasibility of CPAP, intended as well tolerated by the patient and exclusive cardiology staff management.

Results

Between December 2018 and October 2020, 15 patients were included; median age was 79 (40-87 IQR) years, 8 (53%) were males, 9 (60%) presented with STEMI and 10 (67%) in cardiogenic shock. At admission median ejection fraction was 35 (20-60 IQR) % and 6 (40%) patients had severe mitral regurgitation. Mean PaO2/ FiO2 was 188.1 ± 74.9 mmHg/%, mean lactate level was 2.6 ± 1.5 mmol/L and NTproBNP 7882 (3139-35000 IQR) ng/L. The CPAP was set with a median FiO2 of 50 (35-80 IQR) % with a PEEP of 7.5 (5-10 IQR) mmHg. CPAP was feasible in 14 (93%) patients, as in only one case it was interrupted for patient’s intolerance. CPAP was always managed by nurses of the cath lab, without the support of anesthetist. One patient suffered cardiac arrest that led to CPAP interruption for resuscitation maneuvers. No patients underwent intubation in the cath lab. Post-procedural PaO2/FiO2 ratio substantially improved to 259.4 ± 96.9 mmHg/% (p = 0.03) and lactate decreased to 1.5 ± 0.5 mmol/L (p = 0.01, 42% median reduction). One patient died in-hospital due to underlying disease, unrelated to study procedure.

Conclusion

CPAP during PCI in patients with MI and ADHF was feasible, well tolerated and easily manageable. Larger studies are warranted to confirm these results.
The effect of the COVID-19 pandemic on time to angiography and outcomes in patients presenting with non-ST elevation myocardial infarction
Authors: Hussain S , Osman S , Osheiba M , Choy CH , Mortimer N , Ludman P , Townend J , Nadir A , Doshi S , George S , Zaphiriou A , Khan SQ
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Covid-19 pandemic has had a profound impact on healthcare service delivery. Acute cardiovascular care however remains a priority despite the pandemic. Patients presenting with non-ST elevation MI (NSTEMI) have been poorly characterised during the pandemic.

Methods

We conducted a retrospective study of patients diagnosed with NSTEMI during the peak of the pandemic between April-May 2020 at our tertiary centre in the UK. Data was collected from electronic patient clinical records including time from admission to angiography, length of stay, mortality, prescription of secondary prevention pharmacotherapy and referral to cardiac rehabilitation. We compared this data to the same time period in 2019.

Results

As can be seen from Table 1, in 2020, the mean age, median time to angiography and length of stay were all significantly lower than the control period of 2019. Prescription of secondary prevention medication (Aspirin, P2Y12 inhibitor, Beta-blocker, Statin and ACEi/ARB) and referral to cardiac rehabilitation also improved in 2020, however neither was statistically significant.

During the 2020 period, 1 patient died due to late presentation NSTEMI and multi-organ failure. There were 3 deaths in 2019: complications following coronary bypass surgery, upper GI bleed and a subarachnoid haemorrhage.

Conclusion

Our results show that the mean age of the patients presenting with NSTEMI during the peak of Covid-19 pandemic was younger suggesting that elderly patients failed to present. Compared to 2019, there was significant improvement in patient treatment times with a significantly shorter stay in hospital, probably as a result of the reduction in elective activity allowing un-restrained access to the catheter labs.  We also saw improvement in prescription for secondary prevention and referral to cardiac rehabilitation services during this time suggesting that there may have been improved focus on these aspects of care again. Table 120192020p-valueAge (years)71.2 ± 12.265.0 ± 12.1p < 0.01Number of NSTEMI patients5659p = NSNumber of NSTEMI patients undergoing angiography5053p = NSMedian time to angiography (hours)68.614p < 0.01Median length of stay (days)5 (IQR 2:8)2 (IQR 1:4)p < 0.01Referral to cardiac rehabilitation77.4%84.5%p = NSPrescription of secondary prevention medication69.8%72.4%p = NSTable 1- Comparison of NSTEMI patients in 2019 and 2020Abstract Figure. Box and whisker plot for hospital stay
Potent protective effects of polysaccharide peptide on vascular endothelium and cardiac remodelling in post myocardial infarction patients: A prospective double-blind randomized controlled trial
Authors: Liemena HA , Sargowo D , Nugroho FW , Fadlan MR , Sugita P
Published: April 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Indonesia"s Ministry of Research and Technology/National Research and Innovation Agency grants

Background

Inflammation and oxidative stress contribute to endothelial dysfunction leading to progression of atherosclerosis and myocardial infarction (MI).

Purpose

To evaluate the effect of polysaccharide peptide of Ganoderma lucidum mycelium extracts (β-1,3/1,6-D-Glucan) as protective vascular endothelium and cardiac reverse remodelling in post MI.

Methods

This is a prospective, randomized double-blind clinical trial in 45 post MI patients. Treated group (TG) was given 3 divided dose of 540 mg β-1,3/1,6-D-Glucan daily for 90 days, and control group (CG) received placebo. Variable measured were EPC,CEC,IL-1,IL-6,TNF-α,hsCRP,NO,SOD,MDA and echocardiography parameters.

Results

β-1,3/1,6-D-Glucan administration significantly increased EPCs (P = 0.000), but not significantly reduced CECs (P = 0.069). Significant suppression was found in IL-1, IL-6 and TNF-α (all P < 0.05), but not in hsCRP (P = 0.064). TG exhibited significant elevation of NO (P = 0.02) and SOD (P = 0.023), and reduction of MDA (P = 0.001). TG revealed significant improvement of LVEF, LVMI, LVIDd, RWT, RWMA and LV diastolic dysfunction (all P < 0.05); but not in FS and TAPSE (P = 0.24, P = 0.20; respectively).

Conclusions

Polysaccharide peptide exhibits potent protective vascular endothelium and cardiac reverse remodelling in post MI patients, hence promising as add-on medication on top of standard medical regiment. Result comparison between study groupsVariableMeanPretestMean Difference Post-testP valuePolysaccharide peptide (β-1,3/1,6-D-Glucan)PlaceboVascular Endothelium BiomarkersCECsEPCs87.99 ± 76.7398.32 ± 44.52-48.01 ± 64.0714.90 ± 24.05-13.84 ± 58.67-17.65 ± 27.870.0690.000Oxidative Stress MarkersSODMDANitric Oxide2.93 ± 0.5419.68 ± 9.9737.98 ± 14.440.26 ± 0.74-5.52 ± 10.756.04 ± 9.27-0.23 ± 0.685.75 ± 10.29-0.62 ± 3.300.0230.0010.02Proinflammatory BiomarkershsCRPTNF-αIL-1IL-62512.90 ± 1332.11348.58 ± 85.0392.14 ± 29.62259.40 ± 125.52-6.78 ± 1099.60-44.98 ± 100.94-15.77 ± 27.06-29.63 ± 104.30-1.42 ± 795.35-1.34 ± 104.893.42 ± 33.1475.77 ± 130.830.0640.0060.0420.005Echocardiographic ParametersLVEFFSLVMITAPSELVIDdRWT57.20 ± 11.3930.85 ± 7.07114.07 ± 59.612.14 ± 0.354.86 ± 0.820.54 ± 0.352.30 ± 9.770.73 ± 7.59-4.55 ± 14.460.99 ± 0.49-0.49 ± 0.45-0.14 ± 0.29-2.08 ± 3.353.74 ± 9.2711.48 ± 23.94-0.17 ± 0.340.23 ± 0.430.03 ± 0.040.0080.2480.0430.2020.0000.017Abstract Figure. Comparison among pre- and post-treatment
Atrial fibrillation in patients with acute coronary syndrome under clopidogrel versus ticagrelor
Authors: Almeida I , Santos H , Santos M , Miranda H , Chin J , Sousa C , Almeida L
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes (ProACS)

Introduction

 Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that increases the plasma level of adenosine, which can lead to the development of atrial fibrillation (AF).

Objective

Evaluation of AF development in patients medicated with clopidogrel versus ticagrelor.

Material and methods

Retrospective analysis of patients admitted with ACS included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010-19. Patients were divided in two groups regarding the development of de novo AF. The role of ticagrelor vs clopidogrel in AF induction was compared. In-hospital outcomes were evaluated.

Results

25727 patients were included, mean age 67 ± 14 years, 72.3% male. 3.6% (n = 1067) presented de novo AF (of which 18.1% at emergency department admission). They were older (75 ± 12 vs 66 ± 14, p < 0.001), with more classic cardiovascular risk factors except for smoker status and family history of premature cardiovascular disease, with less previous cardiovascular disease although more cerebrovascular peripheral vascular disease. They presented more frequently with STEMI (53.4 vs 41.9%, p < 0.001) vs NSTEMI/ unstable angina or indetermined infarction. They presented lower systolic blood pressure (131 ± 30 vs 139 ± 28mmHg, p < 0.001), higher heart rate (85 ± 27 vs 77 ± 18bpm, p < 0.001) and Killip-Kimball (KK) class (KK class >I 35.6 vs 14.3%, p < 0.001) and had less kidney dysfunction (maximum creatinine 1,1 ± 0,4 vs 0,9 ± 0,4mg/dl, p < 0.001). Most patients (53.4%) were medicated with the clopidogrel P2Y12 inhibitor. However, 20.4% of patients who developed AF were medicated with ticagrelor versus 5.7% with clopidogrel. Left anterior descendent (LAD) was the most prevalent culprit vessel in both groups (40.9 vs 37.2%, p = 0.045). Multivessel disease was more prevalent in AF group (56.0 vs 51.5%, p = 0.011) and they needed more frequently advanced therapeutic devices and ventilatory support. In-hospital complications were also more frequent in AF patients: heart failure (45.7% vs 14.3%, p < 0.001), cardiogenic shock (16.1% vs 3.6%, p < 0.001), cardiopulmonary arrest (9.2 vs 2.4%, p < 0.001) and death (11.0 vs 3.4%, p < 0.001).

Conclusion

In our study, there was a trend to de novo AF development in patients admitted with ACS and medicated with ticagrelor versus clopidogrel.
Intracranial hemorrhage in adult patients on venoarterial extracorporeal membrane oxygenation
Authors: Luesebrink E , Massberg S , Orban M
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose

Intracranial hemorrhage (ICH) is one of the most serious complications of adult patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and is associated with increased morbidity and mortality. However, the prevalence and risk factors of ICH in this cohort are still insufficiently understood. Therefore, the purpose of this study was to further investigate prevalence, associated mortality and predictors of ICH in VAECMO patients.

Methods

We conducted a retrospective multicenter study including adult patients (≥18 years) treated with VA-ECMO in cardiac intensive care units (ICUs) at five clinical sites between January 2016 and March 2020, excluding patients with ICH upon admission. Differences in baseline characteristics and clinical outcome between VA-ECMO patients with and without ICH were analysed. Predictors of ICH were identified by uni- and multivariable regression models.

Results

Among 598 patients included, 70 (12%) developed ICH during VA-ECMO treatment with mean duration of 82 ± 84h between ECMO initiation and ICH diagnosis. Out of these ICH, 23% were intraparenchymal, 20% subarachnoid, 10% subdural, 3%

intraventricular and 44% combined hemorrhage. In-hospital mortality in the ICH cohort was 81% and 1-month mortality 86%, compared to 63% (p = 0.002) and 64% (p < 0.001), respectively, in the non-ICH cohort. In a multivariable regression model, ICH was independently associated with diabetes mellitus (Odds Ratio [OR] 1.952, 95% confidence interval [CI] [1.082, 3.492], p = 0.025), platelet count (OR 0.990, 95% CI [0.982, 0.996], p = 0.003) and fibrinogen (OR 0.996, 95% CI [0.993, 0.998], p = 0.002).

Conclusion

ICH occurred frequently in VA-ECMO patients and was associated with a significantly higher mortality rate. Diabetes mellitus, low platelet count and low fibrinogen level are independent predictors of ICH. These findings may help to develop effective strategies to prevent and treat ICH and build the basis for further investigations to optimize clinical outcome in patients on VA-ECMO.
Clinical and echocardiographic predictors of delirium in acute cardiac care unit after transfemoral aortic valve implantation
Authors: Noriega F , Viana-Tejedor A , Luque T , Travieso A , Corrochano D , Mcinerney A , Ferrera C , Tirado-Conte G , Jimenez-Quevedo P , Nunez-Gil I , Gonzalo N , Agustin A , Escaned J , Fernandez-Ortiz A , Nombela-Franco L
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Delirium is frequent in patients admitted to critical care units. Its incidence after transcatheter aortic valve implantation (TAVI) is up to 30%. Clinical and demographic factors have been related to delirium, but echocardiographic parameters have not been evaluated.

Purpose. The aim of this study was to assess clinical and echocardiographic predictors of delirium in patients admitted to an acute cardiac care unit (ACCU) after transfemoral TAVI.

Methods. 501 patients admitted to ACCU after TAVI were included. Delirium was evaluated by Confusion Assessment Method. Clinical cardiovascular and geriatric conditions were assessed, as well as echocardiographic parameters.

Results. The incidence of delirium was 22% (110 patients). Delirium was associated with age (83.8 ± 4.6 vs 82.6 ± 6.1 years, p = 0.026), dyslipidaemia (50.0% vs 61.4%, p = 0.032), prior peripheral arterial disease (11.9% vs 5.4%, p = 0.017) and cognitive impairment (10.0% vs 1.8%, p < 0.001). There was no relationship to gender, other cardiovascular risk factors or geriatric conditions. Table shows echocardiographic parameters at baseline and after TAVI, with no statistical association with delirium.

Conclusion. Delirium is a common complication after TAVI in ACCU. Age, the absence of dyslipidaemia, or the presence of cognitive impairment or prior peripheral arterial disease are clinical predictors of delirium. There are not echocardiographic predictors of delirium. Echocardiographic parametersWithout delirium(n = 391)With delirium(n = 110)p valueBaseline echocardiographic parametersLeft ventricular ejection fraction (%)57.7 ± 13.457.5 ± 14.10.912Mitral regurgitation (moderate to severe)106 (27.1)34 (30.9)0.433Pulmonary hypertension168 (43.0)53 (49.1)0.258Aortic regurgitation (moderate to severe)74 (18.9)21 (19.1)0.969Peak aortic gradient (mmHg)78.7 ± 25.278.5 ± 23.30.935Mean aortic gradient (mmHg)47.1 ± 16.146.7 ± 14.80.838Aortic valvular area (cm2)0.6 ± 0.20.6 ± 0.20.589Aortic annulus diameter (mm)22.5 ± 2.722.4 ± 2.50.615After TAVI echocardiographic parametersAortic regurgitation (moderate to severe)36 (9.3)11 (10.0)0.813Peak aortic gradient (mmHg)17.6 ± 9.617.7 ± 8.30.916Mean aortic gradient (mmHg)8.9 ± 5.49.3 ± 4.90.481Aortic valvular area (cm2)2.0 ± 0.62.2 ± 0.60.478Values are mean ± standard deviation, or n (%).
Weaning of invasive mechanical ventilation in a critical coronary care unit
Authors: Arroyo Monino DF , Rivadeneira Ruiz M , Ruiz Garcia MP , Seoane Garcia T , Garcia Rubira JC
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

In the recent years, we have assisted to a change of the prototype of the patient admitted to a Critical Coronary Care Unit (CCCU), with an increasing number of patients admitted due to acute heart failure (AHF) and the reduction of the patients diagnosed of acute coronary syndrome (ACS). It is common in these patients the requirement of ventilatory support, both invasive (IMV) and non-invasive. As a consequence, our knowledge about this technique must be improved. A critical moment when using IMV is the weaning of the IMV.

Objective

Our aim is to describe which factors may have an influence on the success or the failure of the weaning of IMV.

Methods

Observational, retrospective study, using a cohort of patients admitted to a CCCU between January 2.018 and November 2.020 who needed IMV. Data related with the personal history, basal situation and events in the follow-up during the hospitalization were collected.

Results

A total number of 94 patients were included, being 68 (72,3%) male and with a mean age of 68 years old. The most frequent reason of intubation was cardiac arrest (48 patients – 51,1%). Failure on weaning occurred in 19 patients (20,2%), being the most frequent reason of this failure need of re-intubation due to respiratory failure or a new event of cardiac arrest (14 patients – 14,9%). When assessing which factors could have an impact in this failure, we found that older age (66,6 years old vs. 73,9 years old, p value = 0,035), the previous diagnosis of chronic obstructive pulmonary disease (COPD) (17,1% vs. 28,5%, p value = 0,01), and the develop of sepsis during the hospitalization (45,7% vs. 57%, p value =0,04), determined a significative higher probability of failing in the weaning. As expected, failure in the weaning conditioned a significative longer stay in the CCCU (9 days vs. 22 days; p value <0,001). However, failure in the weaning was not related with a higher intra-hospital mortality in our study (p value 0,6).

Conclusion

In our population, the older age, the presence of COPD and the development of sepsis during the stay in the CCCU were related with a significative higher probability of failure in the weaning of IMV. This conditioned a longer stay in the CCCU but not a higher intra-hospitalary mortality.
Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at admission is associated with development of late cardiogenic shock and mortality in patients with STEMI
Authors: Frydland M , Moegelvang R , Moeller JE , Moeller-Helgestad O , Holmvang L , Mark PD , Jensen LO , Hassager C
Published: April 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Forskningsfond (Grant number: 07IO) Hjerteforeningen (Grant number A6024) Lundbeckfonden (Grant number R186-2015-2132)

BACKGROUND

In patients with ST-elevation myocardial infarction (STEMI) increased inflammatory response is associated with development of cardiogenic shock (CS). Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a glycoprotein released from mature neutrophils and the plasma concentration of NGAL likely increases immediately after STEMI. 

PURPOSE

We aimed to assess whether admission NGAL plasma concentration in patients with STEMI was associated with CS development after leaving the catheterization laboratory (late CS) and 30-day all-cause mortality.

MATERIALS AND METHODS

From 1892 consecutive patients with STEMI 1626 (86%) had plasma NGAL concentration measured upon hospital admission before angiography throughout a 1-year period at two tertiary heart centers in Denmark. Patients were stratified according to NGAL quartiles (Q1-4). To assess late CS development, we adjusted for the Observatoire Régional Breton sur l’Infarctus (ORBI) risk score for late CS. For mortality assessment, we adjusted for gender, age, post-PCI culprit Thrombolysis in myocardial infarction (TIMI) flow, left ventricular ejection fraction (LVEF), kidney dysfunction, admission lactate concentration and being comatose after cardiac arrest.

RESULTS

Increasing NGAL concentration was associated with higher age, more comorbidities (hypertension, diabetes, heart failure, previous stroke, and kidney dysfunction) and more critical patient conditions at presentation including lower blood pressure and LVEF. Plasma NGAL concentration was associated with both late CS development and 30-day mortality (Figure). When adjusted for factors associated with poor outcome, NGAL remained independently associated with both late CS development (Q4 vs. Q1-3) (OR (95% CI) 2.64 (1.57-6.03)) and 30-day mortality (HR (95% CI) 3.18 (1.46-6.93)).

CONCLUSION

High admission plasma concentration of NGAL in patients with STEMI was independently associated late CS development and 30-day all-cause mortality. Abstract Figure. NGAL quartiles and late CS/mortality