bluuebunny/crossref_metadata_2025 huggingface dataset:
The gut hormone GIP predicts CV prognosis in patients with acute myocardial infarction
Authors: Kahles F , Rueckbeil M V , Arrivas M C , Mertens R W , Moellmann J , Biener M , Giannitsis E , Katus H A , Marx N , Lehrke M
Published: October 2021

Background

The gut incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic peptide) are secreted by enteroendocrine cells following food intake leading to insulin secretion and glucose lowering. Beyond its regulatory effects in glucose metabolism activation of the GLP-1 receptor has been found to improve cardiovascular prognosis in patients with diabetes and high cardiovascular risk. The functional relevance of GIP (the other main incretin) in patients with cardiovascular disease is largely unknown. The aim of this study was to assess the predictive capacity of GIP serum levels for cardiovascular outcome in patients with acute myocardial infarction.

Methods and results

We investigated the predictive value of GIP serum levels at the time of hospital admission for cardiovascular prognosis in a cohort of 852 patients (67±13 years; 73% men) with acute myocardial infarction (34% STEMI, 66% NSTEMI). Kaplan-Meier curves (GIP median; cut-off: 69 pg/mL) and univariable Cox regression analyses showed that lower GIP levels were associated with an increased cardiovascular mortality (HR of logarithmized GIP values: 0.520; 95% CI: 0.30–0.90; p=0.020). After adjustment for age, sex, smoking, hypertension, hypercholesterolemia, diabetes and family history of cardiovascular disease the association between GIP levels and cardiovascular mortality remained significant with similar hazard ratios as in the univariable Cox regression model.

Conclusion

In summary, we found lower GIP levels to independently predict a poor cardiovascular outcome in high-risk patients with acute myocardial infarction. Future larger studies are needed to foster our understanding of the gut - heart axis as a yet fairly neglected field of system biology and to elucidate whether the GIP system might open novel therapeutic approaches for the treatment of patients with cardiovascular disease.

Funding Acknowledgement

Type of funding sources: None.
Bedside assessment of dependence as an independent correlate of mortality in elderly patients admitted for Acute Coronary Syndromes
Authors: Peron C , Lacote C , Guillemot V , Attou S , Kuefouet S , Rebouh I , Blanchart K , Briet C , Roule V , Beygui F
Published: October 2021

Background

Elderly patients are at high risk of dependence and mortality after acute coronary syndrome (ACS)

Purpose

To assess the impact of dependence detected by a simple bedside test in elderly patients admitted for ACS on 1-year mortality.

Methods

We compared mortality between patients with or without dependence based on an Activities of Daily Living (ADL) index <6 in a prospective, cohort of patients ≥75 years old admitted for an ACS to the cardiology department of our center using a Cox proportional survival model adjusted on pre-defined confounding variables (age, gender, revascularization, heart failure, left ventricular ejection fraction and admission GRACE and CRUSADE scores).

Results

In a cohort of 1011 consecutive patients, 946 underwent ADL assessment and completed one-year follow-up. Dependence was identified in 190 (20%). At 1 year follow-up 112 patients died, 52 (27.4%) in the dependent and 60 (7.9%) in the independent groups. Dependence was associated with higher rates of 1 year mortality both on undajusted (HR 3.79; 95% CI 2.62; 5.50], p<0.0001) and adjusted models (adj-HR 2.85; 95% CI 1.89; 4.33], p<0.0001). Other independent correlates of mortality were female gender (p<0.0001), CRUSADE score (p<0.0001) and coronary revascularization (p<0.001).

Conclusions

Dependence detected by a simple bedside test in patients ≥75 admitted for ACS is associated with a 2 to 3-fold increase of the risk of mortality independent of other predictors of poor outcome. Assessment of dependence should be performed in all elderly patients as a risk stratification tool and considered for the management of such patients.

Funding Acknowledgement

Type of funding sources: None.
A single-center prospective study: assessment of coronary arteries during routine echocardiography; feasibility and prognostic value
Authors: Zagatina A , Kalinina E , Guseva O , Shmatov D
Published: October 2021

Background

Previous pilot studies have shown a significant diagnostic value of coronary artery (CA) velocity parameter assessment acquired during echocardiography examinations [1]. The main limitations for the assessment of CA are considered low feasibilities and unknown cut-off values for patients' prognosis. Aims of the study were the evaluation of the feasibility of left-sided coronary artery assessment during echocardiography and its prognostic value analysis in non-selected patients' population.

Methods

This is a single-center prospective study. All consecutive patients who were referred to echocardiography were included in the study by having additional scans of left-sided CA. One thousand four hundred and fifty-one (1,451) consecutive patients were prospectively included in the study during two years (769 women, 59±14 years old). Death from any cause and nonfatal myocardial infarction (MI) were defined as primary end-points; revascularization cases were analyzed separately.

Results

It was feasible to assess velocities in left-sided CA in 1,231 patients (85%; 95% CI 83–87%). The feasibility was 82% during the first year and 90% during the second year. Over a median follow-up of 36 months, there were 42 deaths and 17 nonfatal MI and 198 patients underwent revascularization. Maximal proximal velocity (OR 1.01, CI 1.01–1.02, p<0.0006) and age (OR 1.07, CI 1.04–1.10, p<0.0001) were proven to be independent prognostic predictors of mortality. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p<0.0001), ejection fraction (OR 0.98, CI 0.95–0.99, p<0.04), and age (OR 1.05, CI 1.03–1.08, p<0.0003) were independent prognostic predictors for death/MI. Maximal proximal velocity (OR 1.02, CI 1.01–1.02, p<0.0001), smoking (OR 1.6, CI 1.1–2.4, p<0.02), and diabetes mellitus (OR 1.75, CI 1.2–2.4, p<0.003) were independent prognostic predictors for revascularization. The cut-off value for maximal proximal for predicting death within 36 months was 67 cm/s. Sensitivity was 67% and specificity was 75%, with an area under the ROC curve of 0.77, p<0.0001. Maximal velocity of 66 cm/s predicted death/MI with sensitivity 74%, specificity 75% (area under the ROC curve of 0.79, p<0.0001) were cut-off values.

Conclusion

Assessment of left-sided CA during echocardiography is a feasible and prognostically valuable method. Accelerated velocity in proximal part of CA is associated with a poor prognosis.

Funding Acknowledgement

Type of funding sources: None.
Dobutamine stress echocardiography-induced Takotsubo cardiomyopathy. Which triggers?
Authors: Meimoun P , De Zuttere D , Kasongo A , Lardoux H
Published: October 2021

Aims

Takotsubo cardiomyopathy (TTC) is a rare complication of dobutamine stress echocardiography (DSE), a non-invasive modality widely used to detect myocardial ischemia.

Purpose

Identification of clinical reports of TTC induced during DSE (TTC-DSE), and comparison to a selected group DSE exams group, with the objective to identify factors which could induce TTC during DSE.

Methods

From an exhaustive search and review, using key words “apical ballooning, stress cardiomyopathy and DSE”, 30 observations of DSE-TTC (2006–2020), with typical features of TTC were identified: (a) occurrence of TTC during DSE, (b) “InterTAK diagnostic criteria”. Over a 3-year retrospective period (2013–2015), 578 consecutive DSE patients were selected and then compared to the TTC-DSE cohort.

Results

The TTC-DSE cohort showed typical characteristics of TTC: strong predominance of aged female population >50 years (93.3%); depression and/or anxiety (26.7%); EKG: ST elevation (70%); normal coronary angiography; depressed angiographic left ventricular ejection fraction <40% (14/18 pts); typical segmental LV impairment: apical (7.3%); mid-ventricular (13.6%); reverse (9%); low troponin peak: 2.65±2.04 ng/ml; one death (acute heart failure), but rapid recovery of LVEF (29/30 pts) in few days. On the other hand, the DSE group of 578 consecutive patients showed: mean age 70 years (62–77 interquartile range), 44% of women, and frequent cardiovascular factors, diabetes (43%), hypertensive (41.4%) and dyslipidemia (28%). Significant differences with the TTC-DSE cohort were: mean age (70 vs 64), smoking (16 vs 36.6%), peak heart rate (94 vs 81%) and peak dose dobutamine (30 vs 40 μg/kg/mn), all p<0.01. In a multivariate analysis, female sex (OR=9.6; 95% CI: 3–28: p<0.01), smoking habit (OR=4.8; 95% CI: 2–11; p<0.01) and dobutamine dosage >30 μg/kg/mn (OR=1.07; 95% CI: 1.02–1.12; p<0.01) were independent predictors of DSE-TTC. Using ROC curve analysis, dobutamine dosage >30 μg/kg/mn gives the best cut off (AUC 0.7±0.04; p<0.01).

Conclusion

TTC-DSE is a rare and severe situation, superimposable to the usual TTC. It gives the rare opportunity to observe TTC in its acute phase. By comparison to DSE patients, independent factors (female sex, smoking habit, dobutamine dosage >30 μg/kg/mn) are predictive of TTC-DSE. However, the discrepancy between the volume of daily DSE exams and the scarcity of TTC-DSE, remains poorly explained.

Funding Acknowledgement

Type of funding sources: None.
The role of speckle tracking echocardiography in the identification of culprit lesion in patients with non ST-segment elevation acute coronary syndrome
Authors: Chiarello G , Guaricci A I , Gherbesi E , Pontone G , Siena P , Soldato N
Published: October 2021

INTRODUCTION An early evaluation of patients with non-ST elevation acute coronary syndrome patients (NSTE-ACS) is important to choose the appropriate treatment strategy. In this setting of patients, conventional echocardiographic assessment may reveal normal myocardial kinesis in 25 to 76% of cases. Global and territorial longitudinal strain (GLS and TLS, respectively) may be an early and accurate non-invasive tool for prediction of multivessel CAD in patients with NSTE-ACS.

AIM To evaluate the ability of TLS to predict culprit lesions in patients with NSTE-ACS.

Material and method

We studied 183 patients diagnosed with NSTE-ACS, in our Institution over 2 years of time. Conventional echocardiography and 2D speckle tracking echocardiography (STE) imaging were performed by two experienced echocardiographers, who were blinded to patient characteristics. The TLS was identified as the mean value of the segments'strain as respect to each vessel territory.Coronary angiography was performed in all patients. Significant CAD (luminal stenosis more than 70% in a major epicardial coronary vessel) and culprit lesion were identified and threated by PTCA when appropriate.

Results

A significant difference between mono- and tri-vessel CAD in the variation of WMSI has been demonstrated. There was a statistically significant difference between both 3-vessels vs 1-vessel disease and 2-vessels vs 1-vessel disease in changing of TLS-LAD, TLS-RCA and TLS-Cx values (p-value <0.001). There was a significant difference between 3-vessels vs 2-vessels disease for TLS-RCA values. There was a statistically significant difference for WMSI-LAD, WMSI-CX and WMSI-RCA values whether the respective artery was involved or not. Variations of TLS were statistically significant both when the territorial tributary artery was involved and also if the artery represented the culprit lesion (p-value TLS-LAD <0.001, TLS-LAD culprit <0.001, TLS-CX<0.001, TLS-cx culprit <0.001, TLS-RCA <0.001, p-value TLS-RCA culprit 0.022). A regression model was performed comparing the variation of WMSI as respect to the variation of WMSI+TLS in the territory of culprit lesions. For WMSI- LAD the OR was 0.94 and for TLS-LAD the OR was 1.19 and the p-value of the addition was 0.001. The OR of WMSI-CX was 1.76 and for TLS-CX the OR was 1.40 and the p- value of the addition was 0.001. The OR of WMSI- RCA was 0.71 and for TLS- RCA the OR was 1.17, the p- value of the addition was 0.019.

Conclusion

TLS allows an accurate identification of the culprit lesion in patients presenting with NSTE-ACS. TLS can be considered as part of routine echocardiography on top of WMSI in early evaluation for a better clinical assessment in this subset of patients.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Policlinico di Bari
Long-term clinical outcomes of patients with chronic total coronary occlusion caused by intra-stent re-stenosis
Authors: Gomez Monterrosas O , Martin Yuste V , Freixa X , Brugaletta S , Regueiro A , Masotti M , Sabate M
Published: October 2021

Objectives

In this study we aim 1) at identifying predictors of selecting percutaneous coronary intervention (PCI) to treat chronic total occlusion due to in-stent restenosis (CTO-ISR); and, 2) at comparing long-term clinical outcomes of patients treated with coronary artery by-pass graft (CABG), percutaneous coronary intervention (PCI) or optimal medical therapy (OMT).

Methods

Between June 2010 and January 2014 a total of 1290 CTO were included in a prospective Registry. 86 of those patients presented with CTO-ISR. Clinical follow-up was obtained until April 2019. Major adverse cardiac events (MACE) rate was defined as the composite end-point of cardiac death, acute myocardial infarction or target lesion revascularization (TLR).

Results

A total of 54 patients were treated with PCI (63%), 22 received OMT alone (25%) and the remaining 10 (12%) were treated with CABG. Patients treated with PCI were older and presented higher values of left ventricular ejection fraction than those of the other groups. From the anatomical point of view, calcification and ostial location were more frequently observed in the OMT group, whereas Syntax score was higher in the CABG arm. At multivariate analysis, age and Syntax score were the only independent predictors of selecting PCI. At long-term follow-up (mean 101 months), MACE rate was higher in the CABG arm mainly driven by a higher incidence of TLR.

Conclusions

Percutaneous coronary intervention could be an effective and safe procedure to treat CTO-ISR. Larger prospective trials are required to confirm these clinical results.

Funding Acknowledgement

Type of funding sources: None.
Prognosis and prescriptions of glifozines in candidates patients in a prospective, multicenter, quality-improvement study of patients with acute coronary syndrome
Authors: Montalto C , Carli S , Gargiulo C , Russo F A , Gazmawi R , Tua L , Galazzi M , Acquaro M , Guida G , Disabato G , Attanasio A , Camporotondo R , Guida S , Oltrona-Visconti L , Leonardi S
Published: October 2021

Background

Sodium-glucose transporter 2 inhibitors (SGLT2-i) have demonstrated substantial improvement in clinical outcomes for patients with heart failure (HF) and chronic kidney disease (CKD) with or without diabetes mellitus (DM). Prescription patterns and outcome of SGLT2-i candidates in patients hospitalized for an acute coronary syndrome (ACS) are less well established.

Purpose

We aimed to assess the proportion of candidates to SGLT2-i and to characterize their clinical outcome in a contemporary, prospective, multicenter, quality-improvement study of all-comers patients with ACS. We also aimed to ascertain prescriptions of SGLT2-i at discharge.

Methods

Between 2018 and 2020, subjects were enrolled in the study; baseline characteristics and medications were prospectively collected, and patients were followed-up at 1 year. Subjects were considered candidates to SGLT2-i if any of the following were: (i) known (medically treated) or new (HbA1c >6.5%) diagnosis of type 2 DM; (ii) left ventricular systolic dysfunction (LVSD; new or known left ventricular ejection fraction <40%) or clinical HF; (iii) CKD (estimated glomerular filtration rate 25–74 mL/min/m2, according to DAPA-CKD trial eligibility).

Results

Of the 2804 consecutive ACS patients enrolled, 798 (28.5%) had new or known DM and only 10 were already on SGLT2-I at baseline. Additionally, 1,098 (39.2%) patients qualified for SGLT2-i prescription as having known or new LVSD or HF, and 803 (28.6%) as having CKD. (Fig. 1A) Overall, these 1,767 (63.1%) SGLT2-i candidates had substantially higher hazard of death as compared to no candidate (Hazard Ratio [HR] at 1-year: 6.82; 95% Confidence Interval: 4.32–10.8; p<0.001; Fig. 1B) and each indication to SGLT2-i independently predicted death at 1 year (HR: 2.30/2.11/3.06; 95% CI: 1.78–2.97/1.62–2.74/2.35–3.97; all p<0.0001; for DM, HF, CKD, respectively; Fig. 2). At discharge, only 18 (1.0% of the candidates) were prescribed with SGLT2-i and, of those with DM, having a diabetological consultation before discharged modestly but significantly increased the likelihood of being discharged with SGLT2-i (4.3% vs. 6.6%; p=0.0015).

Conclusion

Most (two out of three) contemporary ACS patients are candidates to SGLT2-i therapy, and they have a significant and substantial higher risk of mortality at 1-year as compared to no candidates. Current prescription rates are still extremely low (1%) and highlight opportunity for quality improvement and multidisciplinary decision-making.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
P2Y12 inhibitors in patients with non-ST-segment elevation acute coronary syndrome: systematic review and network meta-analysis of randomized trials
Authors: Fujisaki T , Kuno T , Briasoulis A , Misumida N , Takagi H , Latib A
Published: October 2021

Background

Based on a recent randomized control trial (RCT), prasugrel is recommended in preference to ticagrelor for patients with non-ST-segment elevation ACS (NSTE-ACS), however, limited data exists.

Objectives

We aimed to investigate the effect of P2Y12 inhibitors on ischemic and bleeding events in NSTE-ACS patients.

Methods

Clinical trials enrolling NSTE-ACS patients were identified and relevant data was extracted. We performed a network meta-analysis on efficacy and safety outcomes.

Results

Our study including a total of 37, 268 patients with NSTE-ACS from 11 RCTs. Prasugrel decreased major adverse cardiovascular events (MACE) when compared to clopidogrel (Hazard ratio (HR): 0.84; 95% confidence interval (CI) [0.71–0.99]). For MACE, prasugrel showed the highest likelihood of event reduction (P-score=0.97) in comparison to ticagrelor (P-score=0.29) and clopidogrel (P-score=0.24). Prasugrel decreased myocardial infarction (HR: 0.82; 95% CI [0.68–0.99]) but increased major bleeding without statistical significance (HR: 1.30; 95% CI [0.97–1.74]) when compared to clopidogrel. Ticagrelor reduced cardiovascular death (HR: 0.79; 95% CI [0.66–0.94]) but increased major bleeding (HR: 1.33; 95% CI [1.00–1.77], p=0.049) in comparison to clopidogrel. There was no significant difference between prasugrel and ticagrelor for each endpoint, but prasugrel had higher likelihood of event reduction than ticagrelor for all endpoints except cardiovascular death.

Conclusions

Prasugrel and ticagrelor had comparable risk for each endpoint, but prasugrel had the highest probability being the best treatment in reducing the primary endpoint. This study highlights the need for further large-scale RCTs to investigate the optimal P2Y12 inhibitor selection in NSTE-ACS patients.

Funding Acknowledgement

Type of funding sources: None.
Association of beta-blockers or inhibitors of renin-angiotensin system with clinical outcomes in patients with mid-range left ventricular ejection fraction after acute myocardial infarction
Authors: Joo S , Lee J , Kim S , Beom J , Boo K , Choi J , Jeong M ,   KAMIR-NIH registry investigators
Published: October 2021

Background

In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (EF) (>40%, <50%) becomes increasing.

Purpose

This observational study aimed to investigate the association between oral beta-blockers or inhibitors of renin-angiotensin system (RAS) and 2-year clinical outcomes in patients with mid-range EF after AMI.

Methods

Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge.

Results

Beta-blocker therapy at discharge was associated with lower 2-year major adverse cardiac events (MACE) of cardiac death, MI, revascularization or re-hospitalization due to heart failure (8.7 vs. 12.8/100 person-year; hazard ratio [HR] 0.68; 95% confidence interval [CI] 0.50–0.93; P=0.015), and no significant interaction between EF ≤45% and >45% was observed (P for interaction=0.354). This association was mainly driven by lower MI in patients with beta-blockers (1.6 vs. 3.1/100 person-year; HR 0.50; 95% CI 0.26–0.95; P=0.035). Inhibitors of RAS at discharge were not associated with lower 2-year MACE, but with lower re-hospitalization due to heart failure (1.8 vs. 3.5/100 person-year; HR 0.53; 95% CI 0.33–0.86; P=0.010) without significant interaction between EF ≤45% and >45% (P for interaction=0.333).

Conclusions

Beta-blockers or RAS inhibitors at discharge were associated with better 2-year clinical outcomes without significant interaction between ≤45% and >45% in patients with mid-range EF after AMI.</ef<50%)>

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korea Centers for Disease Control and Prevention. 2-year clinical outcomes
Associations between metabolic syndrome at index PCI and 1-year outcomes
Authors: Chandrasekhar J , Chowdhury E , Eccleston D , Delacroix S , Worthley S
Published: October 2021

Background

The prevalence of obesity, diabetes and metabolic syndrome is rising, with negative health consequences for the community.

Purpose

We sought to examine the prevalence and impact of metabolic syndrome (MetS) on 1-year outcomes from an Australian cohort of all-comer PCI patients.

Methods

We retrospectively analysed the GenesisCare Outcomes multicentre Registry of prospectively collected data in patients undergoing PCI from 2008–2020. Metabolic syndrome was defined as presence of any 3 features including hypertension, diabetes, obesity with body mass index ≥30 kg/m2 and dyslipidaemia. We examined 1-year outcomes for death and MACE (death, MI or TLR), and the adjusted risk after accounting for each of the defining variables.

Results

During the study period from 2005–2018, 14,405 were included, of which 5480 (38%) had metabolic syndrome. MetS patients were somewhat younger without sex differences (∼76% men). They had greater prevalence of defining characteristics, and smoking and lower prevalence of myocardial infarction presentation compared to non-MetS patients. MetS patients had higher prevalence of B2/C type lesions, restenosis, chronic total occlusions and multivessel disease. At 30-days MetS patients had lower risk of re-infarction (0.1% vs. 0.3%, p=0.011) but from 30-days to 1-year they had greater risk of MI (1.1% vs. 0.5%, p<0.01), TLR (1.5% vs. 1.1%, p=0.03), readmissions (21.8% vs. 19.8%, p=0.008) and MACE (3.6% vs. 2.7%, p=0.03) without differences in mortality (1.3% in both, p=0.88). Unadjusted models showed trend for greater risk of 1-year MACE with MetS, HR 1.15 (95% CI 1.00–1.33), p=0.054. In multivariable models, this risk was lost after adjusting individually for hypertension, dyslipidaemia and insulin-treated diabetes, but not after adjustment for obesity and non-insulin diabetes (See Figure).

Conclusions

Metabolic syndrome was noted in over one-third of all-comer PCI patients, and was associated with greater risk of 1-year MACE. This risk appeared to be related to hypertension, dyslipidaemia and insulin-treated diabetes but not obesity.

Funding Acknowledgement

Type of funding sources: None.
TMAO (trimethylamine n-oxide) as a potential biomarker of individual severe stress perception in posttraumatic stress disorder (PTSD)-vulnerable patients after acute myocardial infarction
Authors: Von Lewinski D , Enko D , Rotenhaeusler H P , Amouzadeh-Ghadikolai O , Harpf H , Harpf L , Traninger H , Obermayer-Pietsch B , Von Lewinski F , Schweinzer M , Braun C , Meinitzer A , Baranyi A
Published: October 2021

Background

Acute myocardial infarction is not only a somatic disease but potentially triggers psychological effects, too. Post-traumatic stress disorder (PTSD) is a common stress-related disorder. It is characterized by numerous symptoms, such as flashbacks, intrusions, nightmares and severe anxiety, as well as uncontrollable, intense and disturbing thoughts and feelings related to the traumatic experience. However, with regard to the development of PTSD, individual stress perception might be crucial since not every serious traumatic experience leads to PTSD. To date, almost no biological correlates of an individual's perception of stress have been identified as being associated with the long-term development of PTSD.

Objective

The aim of the study was to determine whether blood levels of TMAO vary immediately after AMI (1) in patients with or without depression, and (2) in patients with AMI induced PTSD symptomatology (subsyndromal PTSD and full PTSD). Furthermore, we investigated whether TMAO is a potential biomarker that might be useful in the prediction of PTSD symptomatology in the long term.

Method

A total of 114 AMI patients were assessed with standardized clinical psychiatric interviews based on the Hamilton Depression Scale (HAMD-17) after admission to the hospital and 6 months later. In addition, the CAPS-5 was used to explore PTSD symptoms (subsyndromal PTSD and full PTSD) 6 months after AMI. To assess patients' TMAO status, serum samples were collected at hospitalization and 6 months after AMI.

Results

Study participants with post-myocardial infarction PTSD symptomatology (subsyndromal PTSD and full PTSD) had significantly higher TMAO levels immediately after AMI than patients without PTSD symptoms (ANCOVA: TMAO (PTSD x time), F = 4.544, df = 1, p=0.035). In contrast, depressive symptomatology 6 months after AMI had no influence on TMAO levels (TMAO (depression x time), F = 0.083, df = 1, p=0.774). With the inclusion of additional clinical predictors in a hierarchical logistic regression model, TMAO becomes a significant predictor of PTSD symptomatology.

Conclusions

An elevated TMAO level immediately after AMI might reflect severe stress in PTSD-vulnerable patients, which might also lead to a short-term increased gut permeability to trimethylamine (TMA), the precursor of TMAO. Thus, elevated TMAO might be a biological correlate for stress that is associated with vulnerability to PTSD and might help to identify patients at increased risk.

Funding Acknowledgement

Type of funding sources: None.
The prevalence and characteristics of patients with ST-elevation myocardial infarction during the first two months of the COVID-19 pandemics
Authors: Steinmetz Y , Wolff R , Farkash R , Dadon Z , Levi N , Anguizola F , Taha L , Shaheen F , Glikson M , Asher E ,   For the Jerusalem Platelets Thrombosis and Intervention in cardiology (JUPITER-7) study group
Published: October 2021

Background

ST-Segment elevation MI (STEMI) is one of the leading cause of mortality in the western world. The coronavirus disease-2019 (COVID-19) pandemic might have implications of the treatment of STEMI patients. Our aim was to evaluate the treatment of STEMI patients during 2 months of the COVID-19 pandemic as compared with the year before.

Methods

Data of 90 STEMI patients treated at the Shaare Zedek Medical Center intensive coronary care unit (ICCU) Between March-April 2019 and March-April 2020 were collected. Patients were divided into 2 groups: The pre COVID-19 group and the COVID-19 era group. Data regarding complications upon arrival and during hospitalization, door to balloon time and echocardiographic exams.

Results

Fifty one (56%) patients were admitted with STEMI in the pre COVID-19 group and only 39 (44%) in the COVID-19 era group. Of them 13.7% vs. 20.5% were female, p=0.392 with a mean age of 62.1 (±13.5) vs. 63.4 (±11) years old, p=0.635 in the pre vs. post COVID-19 era group, respectively. Interestingly, more Jewish vs. non-Jewish were admitted with STEMI in the COVID-19 era group. There were no differences regarding baseline characteristics, catheterization access, culprit vessel and percutaneous coronary intervention rate. Door to balloon time was also similar in both pre and post COVID-19 era groups 35.4 (±32) vs. 30.5 (±29.1) minutes (p=0.896). Moreover, there was no difference regarding infarct size. Complications including acute renal failure, cardiogenic shock, and the use of intra-aortic balloon pump were similar in both groups. 30-day mortality rate was low and similar in both pre and post COVID-19 era groups (5.9% vs. 2.6%, respectively, p=0.426).

Conclusions

During the beginning of COVID-19 era there was a reduction in STEMI admission rate, while no significant difference was found regarding baseline characteristics, door to balloon time, infarct size and mortality rate

Funding Acknowledgement

Type of funding sources: None.
Prediction of endogenous thrombolytic activity in patients with coronary artery disease
Authors: Suh J W , Kang H , Kim J , Cho H W , Lee W , Yoon C H , Youn T J , Chae I H
Published: October 2021

Background

Endogenous thrombolytic activity (ETA) has been suggested as an essential factor related to the acute coronary syndrome. However, there have been little data regarding clinical characteristics of ETA in East Asians.

Method

As an interim study of the entire cohort (n=2,000), we analyzed a total of 278 patients who underwent percutaneous coronary intervention (PCI) due to coronary artery disease (CAD). Informed consent was obtained from all research subjects. Blood samples of patients were brought before the procedure. The Global Thrombosis Test (GTT, Thromboquest, UK), a novel test for examining ETA, was used. Lysis time (LT), which means the time interval between blood flow occlusion and restart, was used as an indicator for ETA. Clinical, laboratory and angiographic characteristics were obtained. LT=3000 seconds was used as a cut-off value to divide patients into two groups. P value<0.05 was regarded as significant.

Results

LT of Korean CAD patients showed bimodal distribution. Median value was 1695 [IQR: 1099, 5932] and it was higher than previous data from Europeans (Figure 1). Patients with impaired ETA (LT>3000) were older and more diabetic. They showed higher creatinine, aPTT, fibrinogen, D-dimer, c-reactive protein, and proBNP values. Moreover, they had lower hemoglobin and platelet levels. Intracoronary thrombus was more frequently observed in LT>3000 group. In the multivariable regression analysis, hemoglobin (per g/dL, odds ratio 0.766, 95% confidence interval (CI) 0.632–0.928) and fibrinogen level(per 10mg/L, odds ratio 1.054, 95% CI 1.015–1.095) could significantly predict impaired ETA.

Conclusion

East Asian patients showed a right-shifted distribution of ETA compared to that of Europeans. Patients with impaired ETA had different clinical, laboratory and angiographic characteristics from those with intact ETA. Hemoglobin and fibrinogen level were significantly associated with impaired ETA. Further studies are warranted to confirm causal relationship among these factors.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation, Republic of Korea
Impact of smoking habit on baseline and on-treatment platelet reactivity in STEMI patients treated with 3rd generation P2Y12
Authors: Canonico M E , Scudiero F , Sanna G D , Siciliano R , Guarino S , Saba P S , Esposito G , Parodi G
Published: October 2021

Background

Smoking habit is a well known risk factor for cardiovascular disease. High on-treatment platelet reactivity has been associated with high risk of ischemic events in STEMI patients. The relationship between platelet reactivity and smoking habit was investigated only in few studies, and the impact of smoke on platelet reactivity in STEMI patients treated with 3rd generation P2Y12 inhibitor is still lacking.

Purpose

This study aim to assess the impact of smoking habits on baseline and on-treatment platelet reactivity in STEMI patients treated with 3rd generation P2Y12 inhibitor.

Methods

Overall, 429 STEMI patients were enrolled in this study. Patients were divided into two groups according to smoking habit. Platelet reactivity was assessed by VerifyNow at baseline and after 3rd generation P2Y12 inhibitor (ticagrelor or prasugrel) loading dose (LD). Blood samples were obtained at baseline (T0), and after 1 hour (T1), 2 hours (T2), 4–6 hours (T3) and 8–12 hours (T4) after LD.

Results

The mean age of the enrolled population was 62±12 and male rate was 75%. Patients with smoking habit were younger (75.8% vs 38.9%, p<0.001 for age <65 years), with higher prevalence of family history of CAD, while with a lower rate hypertension (43.4% vs 65.9%, p<0.001) and previous myocardial infarction (5.3% vs 11.4%, p=0.022) (Table). Smoker patients had lower platelet reactivity either at baseline [T0: 249 (205–285) vs 284 (230–324), p<0.001] or at 2 hours after the LD [T2: 107 (18–279) vs 136 (51–260), p=0.003] (Table). Similarly, Smoker patients experienced a lower rate of in-hospital composite adverse event of death, reinfarction, stroke or acute kidney injury (1.6% vs 12.4%; p≤0.001) (Table). Multivariate analysis demonstrated that left ventricular ejection fraction at admission (OR= 0.916, 95% CI 0.865–0.969; p=0.002), and platelet reactivity at baseline (OR= 1.013, 95% CI 1.002–1.024; p=0.024) were independent predictors of in-hospital composite adverse event.

Conclusions

Smoker status is associated with lower platelet reactivity either at baseline or after LD and with a better short-term prognosis in STEMI patients treated by dual antiplatelet therapy with ticagrelor or prasugrel.

Funding Acknowledgement

Type of funding sources: None.
Frequency and predictors of thin-cap fibroatheroma progression: a comprehensive and dynamic in-vivo OCT study
Authors: He L , Xu Y , Hu S , Qin Y , Weng Z , Feng X , Zhao C , Zeng M , Chen X , Yi B , Xie C , Zhang D , Hou J , Jia H , Yu B
Published: October 2021

Purpose

To assess the evolution of thin-cap fibroatheroma (TCFA) and to explore predictors for its progression by using optical coherence tomography (OCT) in patients with acute coronary syndrome (ACS).

Methods

We enrolled ACS patients with non-culprit TCFA at baseline and corresponding OCT images at follow-up of 9 to 15 months. Clinical, angiographic and OCT data were collected and analyzed according to established methods. TCFA was defined as a lipid plaque with maximum lipid arc >90° and fibrous cap thickness <65μm. Considering the resolution of OCT, the regression of TCFA was defined as an increase of fibrous cap thickness >10μm. Inversely, TCFA progression was defined as a decrease, constant or ≤10μm increase of fibrous cap thickness.

Results

41 patients with 55 non-culprit TCFAs were taken into final analysis. 17 patients (41.5%) had patient-level progression and 22 TCFAs (40.0%) progressed at plaque-level with a median follow-up duration of 371 days. 11 (20.0%) of the 55 TCFAs happened subclinical rupture at follow-up, including 10 with the formation a new layer and 1 without the detection of the new layer. Besides, another patient suffered re-myocardial infarction because of the rupture of TCFA induced acute thrombosis and lumen occlusion during follow-up. The baseline clinical and angiographic characteristics were similar between the two cohorts. The progression group had a significantly higher prevalence of macrophage infiltration and vasa vasorum at baseline than the non-progression group (Figure 1). Multivariate analysis identified macrophage infiltration (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 1.01 to 27.91; p=0.049]) as the independent predictor of TCFA progression. When it came to the evolution of lesion morphology and lipid components, the progression cohort had a higher percent change of lumen stenosis and lipid length (Figure 2).

Conclusions

About 40% of non-culprit TCFAs in ACS patients progressed in fibrous cap thickness at a median interval of 1 year. Macrophage infiltration was the independent predictor of non-culprit TCFA progression. The progression of fibrous cap thickness was usually accompanied with an aggressive evolution of other lesion characteristics.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): the National Key R&D Program of China Baseline OCT characteristicsPercent change of lesion morphology
A contemporary presentation of the incidence and management of spontaneous coronary artery dissection (SCAD) in New Zealand: an ANZACS-QI study
Authors: Mbizvo R M , Alfadhel M , Williams M J A , Coffey S , Kerr A , Webster M , Lee M
Published: October 2021

Background/Purpose

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and poorly understood condition that frequently affects younger women without cardiovascular risk factors. In this project we aimed to describe the present landscape of SCAD in New Zealand (NZ).

Methods

All patients in NZ who were admitted to hospital with a diagnosis of Acute Coronary Syndrome (ACS) from July 2019 to December 2020 and underwent coronary angiography were identified from the All NZ Coronary Syndrome Quality Imporvment (ANZACS-QI) registry.

Results

Of 12,053 patients admitted to hospital with an ACS, 122 had SCAD (1.0%). 80% of those with SCAD were female, with mean age of 57 years, and fewer traditional cardiovascular risk factors. Non-ST elevation myocardial infarction was the most common presentation (82.0%), while 16.4% presented with ST elevation myocardial infarction. The majority of patients were managed conservatively (91.8%) while 8.2% underwent PCI. 56.6% of SCAD patients had normal LV function. Nearly 80% of patients were discharged on Acetylsalicylic acid (ASA) therapy, while 60.7% had a P2Y12 inhibitor. Beta blockers, Statins and ACEI/ARB were part of the management strategy in 62.5%, 59.8% and 42.6% of patients respectively while 47.5% had a combination of all 3. Amongst 122 patients, only 1 in-hospital death and 1 inpatient recurrent MI occurred, with 3 patients having bleeding of any kind.

Conclusion

In NZ, incidence of SCAD is approximately 1%. Most patients affected in NZ are female with fewer traditional cardiovascular risk factors. Management is predominantly conservative, and there is a low rate of early adverse outcomes.

Funding Acknowledgement

Type of funding sources: None.
Rationale for CDR132L, an antisense inhibitor of miR-132, for a novel therapy for ventricular remodelling after myocardial infarction
Authors: Aimo A , Iborra Egea O , Bayes-Genis A , Passino C , Emdin M
Published: October 2021

Background

Heart failure (HF) development is a common complication of myocardial infarction (MI), which warrants a search for novel therapies able to prevent left ventricular remodelling after an MI. CDR132L is a synthetic antisense inhibitor of miR-132. In a pig model of reperfused MI, monthly intravenous administration of CDR132L proved safe and effective in preventing HF development. They expect CDR132L to have an additive, and possibly synergistic, effect to standard-of-care therapies (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers [ACEi/ARB], and mineralocorticoid receptor antagonists [MRA]) because of their distinct first targets. Nonetheless, a degree of overlap in the final effects of CDR132L and current therapies might exist, given that ACEi/ARB and MRA ultimately modulate myocardial inflammation and fibrosis, as CDR132L do. We assessed this point by searching for similar changes in protein expression between MI therapies and CDR132L.

Methods

We retrieved the 14 mRNAs significantly altered in the myocardium of pigs receiving CDR132L compared with control pigs: BMPR2, ADRA1D, GCLC, CD44, PRDX1, ECM1, LEP, GATA3, GPX1, EIF4G1, ACE2, HMOX1, RTN4 and LIFR. Except for RTN4, all these mRNAs were downregulated by CDR132L. We assumed a close correlation between changes in mRNA levels and the expression of the corresponding proteins. By using massive public databases, such as Drugbank, the Open Targets Platform and the Human Protein Atlas, we identified all approved, investigational and experimental drugs reported to modulate the expression of at least one of these 14 proteins in any setting.

Results

We did not find any drug modulating more than one of the 14 proteins. Therefore, no drug, including ACEi/ARB or MRA, proved able to mimic the effects of CDR132L on protein expression.

Conclusions

CDR132L might have an additive or synergistic action to standard drugs, given the different effects on protein expression profiles. CDR132L might then help prevent post-MI remodelling even on top of optimal medical therapy. This point should be verified in dedicated studies.

Funding Acknowledgement

Type of funding sources: None.
Long-term outcome in patients with Takotsubo syndrome: a single-center study from a city in Austria
Authors: Pogran E , Gargiulo L G , Abd El-Razek A A , Weihs V W , Kaufmann C K , Gepert A G , Nuernberg M N , Wesely E W , Smetana P S , Huber K H
Published: October 2021

Background

There is an increasing amount of evidence suggesting multiple fatal complications in Takotsubo Syndrome. However, findings on the long-term outcome are scarce and show inconsistent evidence.

Methods

This is a single-center study of long-term prognosis in Takotsubo patients admitted from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with Takotsubo syndrome. Furthermore, survivors and non-survivors and patients with a different cause of death were compared.

Results

Overall, 147 patients were included in the study. The mean age was 70 years (±12,3), and 85% of the study population were women. Forty-nine Takotsubo patients (33,3%) died during the follow-up, with a median of 126 months. The most common cause of death was a non-cardiac cause (71,4% of all deaths), especially malignancies (26,5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Age showed to be the only independent prognostic factor of cardiovascular mortality (HR=1,11, CI: 0,99–1,25, p=0,05). Female gender (HR=0,32, CI: 0,16–0,64, p<0,001), cancer (HR=2,35, CI: 1,15–4,8, p=0,019) and chronic kidney disease (HR=2,61, CI: 1,11–6,14, p=0,028) showed to be independent predictors of non-cardiovascular mortality.

Conclusion

Long-term prognosis of TTS patients is not favourable, mainly due to non-cardiac comorbidities. Hence, consequent outpatient care in relatively short time intervals after TTS event based on risk factor control and early detection of malignancies seems mandatory.

Funding Acknowledgement

Type of funding sources: None.
What are the predictors of heart failure in patients admitted with acute coronary syndrome? Data from a large national registry
Authors: Timoteo A , Aguiar Rosa S , Mano T , Cruz Ferreira R ,   ProACS Investigators
Published: October 2021

Background

Heart failure (HF) is a serious and frequent complication of acute myocardial infarction with important impact in outcome. Early treatment according to contemporaneous guidelines is essential to avoid that complication. Previous ischemic heart disease and HF are important predictors. Our objective is to identify additional predictors of HF in patients admitted with acute coronary syndrome (ACS).

Methods

Analysis of all consecutive patients prospectively included in a large national registry of ACS. Patients with a previous history of ACS, myocardial revascularization or heart failure were excluded from the analysis. The group that developed HF was compared with the group without HF and multivariate logistic regression analysis was performed to identify independent predictors of HF during hospitalization (Killip class >1).

Results

A total of 19,248 patients were included, and 17.3% developed HF during hospitalization. Patients with HF were older, less often males and smokers, and more often with hypertension and diabetes, as well as other comorbidities (p<0.001). ST elevation myocardial infarction (STEMI), atrial fibrillation, mechanical and electrical complications are also more frequent. Patients that developed HF have higher in-hospital mortality (0.9% vs. 12.1%). Independent predictors of HF are female gender (OR 1.64, 95% CI 1.15–2.33), age (1.42, 1.25–1.62, per 10-year increase) diabetes (1.97, 1.44–2.69), atrial fibrillation (2.65,1.66–4.23), STEMI (2.30, 1.70–3.10), multivessel disease (1.52, 1.13–2.05) and initial admission in a hospital without catheterization laboratory as a protective factor (0.71, 0.52–0.96). In STEMI patients, anterior location is also an independent predictor.

Conclusions

In patients admitted with a first ACS and without previous ischemic heart disease or heart failure, female gender, increasing age, diabetes, atrial fibrillation, STEMI and multivessel disease are the main predictors of worst outcome and these patients should be treated more aggressively to avoid HF development.

Funding Acknowledgement

Type of funding sources: None.
COVID-19 pandemic and admission rates for and management of acute coronary syndromes in Israel
Authors: Asher E , Fardman A , Zahger D , Orvin K , Mohsen M , Tsafrir O , Rubinshtein R , Jamal J , Efraim R , Kofman N , Halabi M , Shacham Y , Henri Fortis L , Beigel R , Matetzky S
Published: October 2021

Background

Since the COVID-19 pandemic outbreak several countries have reported a decrease in the number of patients admitted with non-ST elevation myocardial infarction (NSTEMI).

Purpose

We aimed to evaluate admission trend and outcomes of patients with NSTEMI in the COVID-19 era in a nationwide survey.

Methods

A prospective, multicenter, observational, nationwide study involving 13 medical centers across Israel. All NSTEMI patients admitted to intensive cardiac care units (ICCUs) over an 8-week period during the COVID-19 outbreak were compare them with NSTEMI patients admitted 2 years earlier (control period) during the Acute Coronary Syndrome Israeli Survey (ACSIS) 2018.

Results

There were 624 (43%) NSTEMI patients, of them 349 (56%) hospitalized during the COVID-19 era and 275 (44%) during the control period, representing a 27% increase in NSTEMI admission rate during the COVID-19 era. Approximately 76% were male, median age was 67 years (IQR 58–76). There were no differences in baseline characteristics between the two study periods. During the COVID-19 era, more patients arrived at the hospital via an emergency medical system (EMS) compared with the control period (p for trend = 0.005)

Time from symptom onset to hospital admission was longer in the COVID-19 era [687.00 (IQR147–2805) vs. 178.00 (IQR 102- 407), respectively, p-value <0.001]. Nevertheless, time from hospital admission to reperfusion was similar in both groups. Rate of percutaneous coronary intervention was higher in the COVID-19 era group (91.3% vs. 59.7%, respectively, p<0.001). In-hospital mortality rate was similar in both groups (2.3% vs. 4.7%, respectively, p=0.149) as was the 30-day mortality rate (3.7% vs. 5.1%, respectively, p=0.238).

Conclusions

In contrast to previous reports, in Israel, admission rate of NSTEMI was increased during the COVID-19 era. With longer time from symptoms to admission, but with the same time from hospital admission to reperfusion therapy and with similar in-hospital and 30-day mortality rates.

Funding Acknowledgement

Type of funding sources: None.