bluuebunny/crossref_metadata_2025 huggingface dataset:
P5406Impact of the albumin level on the prognostic value of diuretic response in patients admitted for acute decompensated heart failure: a prospective study
Authors: Yamamoto K , Yamada T , Morita T , Furukawa Y , Tamaki S , Iwasaki Y , Kawasaki M , Kikuchi A , Kawai T , Seo M , Abe M , Nakamura J , Fukunami M
Published: October 2019

Background

The reduced diuretic response (DR) has been shown to be associated with poor clinical outcome in patients with acute decompensated heart failure (ADHF). In addition, hypoalbuminemia, which is related to DR, has been also reported to predict poor prognosis in ADHF patients. However, there is no information available on the impact of albumin level on the prognostic value of DR in patients with ADHF.

Methods

We prospectively studied 296 consecutive patients who were admitted for ADHF and survived to discharge. The patients were divided into 2 groups according to the presence or absence of hypoalbuminemia at the admission, defined as the serum level of albumin at admission <3.5g/dl, and DR was defined as weight loss per 40mg intravenous dose and 80mg oral dose of furosemide up to day 4. The endpoint was a composite of all-cause mortality and unplanned hospitalization for worsening heart failure.

Results

There were 144 patients with hypoalbuminemia and 152 patients without hypoalbuminemia. During a mean follow-up period of 2.2±1.5 years, 88 patients with hypoalbuminemia and 53 patients without hypoalbuminemia reached the endpoint. In group with hypoalbuminemia, DR was significantly smaller in patients with than without the endpoint (0.85 [0.50–1.50] vs 1.60 [0.76–2.70] kg/40mg furosemide, p=0.003), while there was no significant difference in DR between them in group without hypoalbuminemia (1.17 [0.59–1.66] vs 1.07 [0.75–1.88] kg/40mg furosemide, p=0.381). At multivariate Cox analysis, in group with hypoalbuminemia, DR was significantly associated with the endpoint, independently of age, left ventricular ejection fraction, and serum creatinine and plasma BNP levels. On the other hand, in group without hypoalbuminemia, DR showed no significant association with the endpoint at univariate Cox analysis. Kaplan-Meier analysis showed that patients with poor DR (≤1.08 kg/40mg furosemide: median value) had a significantly higher risk of the endpoint in group with hypoalbuminemia, but not in group without hypoalbuminemia (Figure).

Figure 1

Conclusion

Our results suggested that prognostic value of DR in ADHF patients is affected by the presence or absence of hypoalbuminemia.
P5416A single-center, thirty-year experience of heart transplantation: analysis of the evolution of patients profile and long term outcomes
Authors: Turco A , Totaro P , Pellegrini C , Guida S , Cattadori B , Di Matteo A , Seminari E , Camporotondo R , Riccardi M , Ghio S , Raineri C , Scelsi L , D'Armini A M , Oltrona Visconti L , Pelenghi S
Published: October 2019

Background

Heart Transplantation is still the gold standard therapy for patients suffering from end-stage cardiomyopathy and has been successfully performed in our center since 1985. Over this 30 years period there has been a significant evolution in patients characteristics and in candidate selection (either as a donor and as recipient) as shown by the recent benchmark from International Society of Heart and Lung Transplantation (ISHLT). Here we analyze the evolution of patients profile in our population and we correlated such evolution to the clinical outcomes and to the overall data from ISHLT.

Materials and methods

Overall 1122 patients underwent heart transplantation at our center from November 19th1985 to date. To analyze the evolution patients profile and donor criteria, patient population was divided in 4 groups according era of transplantation following ISHLT model (Group A from 1985 to 1991; Group B from 1992 to 2003; Group C from 2004 to 2008 and Group D from 2009 to date). Patients characteristics at time of transplantation, donor criteria ad clinical outcomes were analyzed and compared within 4 groups. An overall comparison of our results to the data from ISHLT was also performed.

Results

Overall Kaplan-Meier survival curve correlates favourably with ISHLT data showing a 20 years survival approaching 40%. Patients age at transplantation changed significantly among 4 groups from a median of 49 years (95% CI 47 to 51) in Group A to 54 years (95% CI 50 to 57) in Group D (p<0.001). Likewise donor age also changed significantly from a median of 24 years (95% CI 22 to 28) in Group A to 43 years (95% CI 39 to 47) in group D (p<0.001). Time on waiting list also changed significantly from a median of 115 days (95% CI 94 to 137) in Group A to 293 (95% CI 200 to 401) in Group D (p<0.001). As a marker of evolution of accepted donor criteria also ischemic time changed from 125±52 minutes of Group A to 153±61 minutes of Group D (p<0.001). As showed in Fig 1, Kaplan-Meier survival curves demonstrated a worse 1-year survival in Group D compared to others 3 Group.

Figure 1

Conclusions

The significant changing characteristics of both recipients and donors, over 30 years of activity, had a significant impact in early (1 year) postoperative survival following heart transplantation. Although medium/long term outcomes are still satisfactory in patients surviving at least 1 year, these data clearly suggest a more accurate patients selection and the need of alternative treatment before patients conditions deteriorate while on waiting list for heart transplantation
P5423Exercise oscillatory ventilation improves the performance of prognosis scores currently used for heart failure
Authors: Gama F , Freitas P , Aguiar C , Ferreira A , Strong C , Ventosa A , Ferreira F , Mendes M
Published: October 2019

Background and aim

Several prognostic risk scores are available for heart failure with reduced ejection fraction (HFrEF), and are used, together with other criteria, to help decide the ideal timing for listing candidates for a heart transplant. The detection of an oscillatory ventilatory pattern (OVP) during cardiopulmonary exercise testing (CPET) has been associated with more advanced HF and a worse prognosis, but was not considered in the development of all the current risk scores. We evaluated whether OVP adds significant prognostic information to four contemporary HF scores.

Methods

Single-centre retrospective cohort study of consecutive HFrEF patients undergoing CPET for functional and prognostic assessment from October 1996 till May 2018. The Heart Failure Survival Score (HFSS), Seattle Heart Failure Model (SHFM), Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) and Metabolic Exercise Cardiac Kidney Index (MECKI) were obtained in each patient. Cox model was fit with time to death or urgent transplant (whichever came first within 2 years) as the dependent variable and OVP and respective HF score as the independent variables. We further assessed the added discriminative power by performing ROC curve comparisons.

Results

We studied 387 patients, median age 58 (IQR 49; 65) years, and 77% were male. The most common HFrEF aetiology was ischemic heart disease (54%). Median peak oxygen consumption was 15,7 mL/kg/min (IQR 12,8; 20,0). OVP was present in 150 (39%) patients. Over the 2-year follow-up period, 48 patients died, and 52 underwent heart transplantation (of which 25 were urgent). HFSS showed the weakest (c-statistic 0,625; 95% [CI] 0,54–0,71) and MECKI score the strongest (c-statistic 0,819; 95% [CI] 0,76–0,88) discriminatory ability. Contrasting with NTproBNP value, the presence of OVP predicted the study endpoint independently of the HF prognosis score used (see table). Adding the occurrence of OVP to the HFSS and the MAGGIC scores significantly improved their prognostic performance (see Table).

Conclusion

An OVP is a common finding in HFrEF patients undergoing CPET, and adds prognostic information to contemporary HF prognosis scores. Systematic evaluation of this easily available criterion may assist the decision on the appropriate timing for heart transplantation listing.
P5434P300-mediated inactivation of p53 protects against doxorubicin-induced cardiotoxicity
Authors: Adam M , Singh K K , Connelly K A
Published: October 2019

Introduction

Doxorubicin is amongst the most widely prescribed chemotherapy drugs due to its effectiveness in cancer treatment. However, progressive treatment using doxorubicin severely increases the risk of congestive heart failure. Mechanistically, researchers have shown that doxorubicin (i) intercalates into DNA and disrupts topoisomerase-II-mediated DNA repair and (ii) generates free radicals which then causes damage to cellular membranes, DNA, and proteins. Ultimately these cellular insults induce cardiomyocyte (CM) death mediated by the tumour suppressor, p53. Currently, there are no clinically applicable preventative treatments for doxorubicin-induced cardiotoxicity and so, extensive research is being done in discovering a potential therapy. One such candidate is curcumin – a natural polyphenol compound non-toxic to humans. We have previously demonstrated that curcumin inhibits lysine acetyltransferase activity of p300, therefore reducing both histone and non-histone protein acetylation. To induce CM death, p53 requires acetylation by p300. Therefore, we hypothesize that curcumin protects against doxorubicin-induced CM death and cardiotoxicity via p300-mediated inactivation of p53.

Methods

Rat H9c2 cardiomyoblast cells were cultured and treated with a 2.5 μM dose of doxorubicin for 16 hours. One group of cells were pre-treated with curcumin (15μM) 4 hours prior to doxorubicin treatment, and controls were cultured with only diluent added. Following treatment, the cells were harvested for total protein. At end point, we performed immunoblotting to measure protein expression of key proteins involved in DNA damage (y-H2A.X, p53), and apoptosis (cleaved-Caspase 3).

Results

Our findings show that following doxorubicin treatment, p53 expression was significantly increased (p<0.001), confirming its role in doxorubicin-associated cardiotoxicity. Furthermore, doxorubicin was associated with increased DNA-damage as evidenced by increased expression and activation of DNA double-stranded breaks (DSBs) marker, y-H2A.X (p<0.001). Elevated levels of DNA-damage were further associated with significantly increased doxorubicin-induced apoptosis as measured by immunoblotting for cleaved-Caspase 3 (p<0.001). However, DNA-damage and apoptosis were attenuated by pre-treatment of cells with curcumin. Curcumin treatment led to a significant decrease in both y-H2A.X (p<0.01) and cleaved-Caspase 3 (p<0.01) expression compared to cells treated with only doxorubicin.

Conclusions

Our data provides the first evidence that curcumin protects against doxorubicin-induced apoptosis in rat cardiomyoblast cells in vitro. Further studies are warranted in vivo to confirm the potential of curcumin as a cardio-protective drug. Curcumin is a natural compound with little to no side-effects in humans, therefore our finding may provide a novel therapeutic target and treatment approach for doxorubicin-associated cardiotoxicity.

Acknowledgement/Funding

Heart & Stroke Foundation of Canada
P5435Epigenetic modifications and gene expressions in Mybpc3 knockout mice
Authors: Hossain M , Elbeck Z , Li X , Siga H , Esfahani P , Knoell R
Published: October 2019

Background

DNA methylation and hydroxymethylation plays critical role in important biological processes, including differentiation of tissues in the embryo and cellular response to different diseases and diverse environmental factors. The epigenetic landscape in heart failure might be altered.

Purpose

Our objective was to determine how Mybpc3 deficiency, which produces hypertrophic cardiomyopathy, affects epigenetic landscape, gene expression, and regulation.

Methods

We generated and analysed genome-wide DNA methylomes and hydroxymethylomes from cardiac tissues of 12-week old Mybpc3−/− mice and littermate controls, and performed whole genome RNA sequencing (RNA-seq) for gene expression and validated the findings using qPCR.

Results

Single base resolution revealed overall lower 5-mC level in Mybpc3 deficient mice. In deficient mice, different genic regions including transcription start site, exons, and introns, had low levels of 5-mC. Although there was no overall difference in 5-hmC content, knockout mice had lower levels of 5-hmC in the distal part of the genes (last exon, transcription termination site, and 3'-flanking regions). The 5-hmC enrichment in the intronic regions was associated with higher gene expression, whereas, the presence of 5-mC in the 5'-flanking regions was associated with lower gene expression in both knockout and wildtype mice. Ingenuity pathway analysis (IPA) of differentially expressed genes revealed overrepresentation of genes involved in axonal-guidance pathway. Tet activity was downregulated in Mybpc3−/− mice, and it may explain the overall difference of 5-mC in deficient mice. We also observed that Mybpc3 ablation affected alternative splicing of Myh6 and Myh7.

Conclusion

This study establishes that knocking out of Mybpc3 changes epigenetic landscape in cardiac tissue, which is tightly linked to gene expression and regulation.

Acknowledgement/Funding

LeDucq 13CVD04, Hjärt och Lungfonden (Sweden)
P5447Prognostic significance of carboxy-terminal telopeptide (ICTP) and Caspase-3 in patients with non-ischemic dilated cardiomyopathy
Authors: Kazukauskiene I , Baltruniene V , Bironaite D , Cibiras S , Rucinskas K , Grabauskiene V
Published: October 2019

Background

Non-ischemic dilated cardiomyopathy (niDCM) is a common debilitating disease leading to heart failure and poor prognosis. Therefore, a reliable diagnosis of niDCM and search of prognostic biomarkers is a task of paramount importance preventing final destruction of myocardium and improving the outcomes of the disease.

The aim of the study was to evaluate the prognostic value of carboxy-terminal telopeptide (ICTP), a marker of myocardial collagen I degradation, and Caspase-3, a marker of apoptosis, in serum and endomyocardium biopsies (EMBs) of patients with niDCM.

Methods

34 consecutive patients (male 25 (78%); 43.83±12.17 years) with niDCM (average of left ventricle (LV) end-diastolic diameter 6.94±0.78 cm, LV ejection fraction 24.97±6.93%, mean pulmonary capillary wedge pressure 32.9±8.7 mmHg) were enrolled in the study. The levels of ICTP and Caspase-3 in patients' serum and EMBs were measured by ELISA. After a follow-up period of 5 years, 18 patients (53%) have reached the primary composite end-point of heart failure: 6 patients (17.6%) died, 6 patients (17.6%) had heart transplantation and 6 patients (17.6%) underwent left ventricle assist device implantation.

Results

Univariate Cox proportional hazard model and ROC curve analysis identified levels of ICTP and Caspase-3 in serum as predictors of composite end-point (Table 1). However, the levels of ICTP and Caspase-3 in EMBs had no prognostic value.

The cut-off values of serum biomarkers for prediction of the outcome were 13.43 pg/mg protein (sensitivity 67%; specificity 81%) for ICTP and 10.21 pg/mg protein (sensitivity 53%; specificity 87%) for Caspase-3. Univariate Cox regression analysis revealed that patients with higher levels of ICTP and Caspase-3 than cut-off values in serum had higher risk of reaching the composite end-point compared to the patients with lower cut-off values (HR 4.4 (95% CI: 1.6–12.1) and 3.15 (95% CI: 1.2–8.29), respectively). Kaplan-Meier survival analysis demonstrated that patients with serum Caspase-3 and ICTP levels above cut-off values had significantly worse outcome (p=0.01 and p=0.002, respectively).

Table 1 Biomarkers (pg/mg protein) Mean ± SD HR (95% CI) p-value AUC (95% CI) ICTP in serum 15.26±10.59 1.052 (1.013–1.093) 0.009 0.71 (0.53–0.89) ICTP in EMB 132±295 0.999 (0.998–1.001) 0.56 0.45 (0.28–0.61) Caspase-3 in serum 7.78±9.86 1.047 (1.002–1.093) 0.04 0.69 (0.51–0.87) Caspase-3 in EMB 283±282 1 (0.998–1.002) 0.92 0.50 (0.28–0.72)

Conclusion

The findings show that increased serum levels of Caspase-3 and ICTP are significantly associated with poor outcome in patients with niDCM.

Acknowledgement/Funding

the Research Council of Lithuania (Grants nos. MIP-086/2012 and MIP-011/2014), the European Union, EU-FP7, SARCOSI Project (no. 291834)
P5464Visit-to-visit glomerular filtration rate variability as a predictor for cardiovascular and renal outcomes in essential hypertension: Data from a Greek 8-year-follow-up study
Authors: Laina A , Tsioufis C , Dimitriadis K , Kasiakogias A , Liatakis I , Koutra E , Leontsinis I , Konstantinidis D , Kouremeti M , Dri E , Iliakis P , Vogiatzakis N , Thomopoulos K , Tousoulis D
Published: October 2019

Background/Introduction

Renal dysfunction is related with adverse prognosis in hypertension, however there are scarce data on the predictive cardiovascular and renal impact of kidney function variability in this setting.

Purpose

The aim of the present study was to assess the predictive role of visit-to-visit renal function changes on the incidence of coronary artery disease (CAD), stroke and end-stage renal disease in a cohort of essential hypertensive patients.

Methods

We followed up 2380 essential hypertensives (mean age 58.9 years, 1240 males, office blood pressure (BP)=144/91 mmHg) free of cardiovascular disease for a mean period of 8 years. All subjects had at least one annual visit and blood sampling was performed in all visits for estimation of glomerular filtration rate (GFR). We calculated standard deviation (SD) of mean GFR from visits from 6 months onward in patients with ≥5 visits during follow-up. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure, while stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings. End-stage renal disease was defined as GFR<15 mL/min/1.73 m2 or the need for long-term dialysis or transplantation.

Results

The incidence of CAD, stroke and end-stage renal disease over the follow-up period were 2.8% (n=68), 1.09% (n=26) and 0.6% (n=14). Hypertensives who developed CAD compared to those without CAD at follow-up (n=2312) had at baseline higher left ventricular mass index (115.7±24.6 vs 103.7±27.3 g/m2, p<0.0001), whereas there was no difference with respect to baseline GFR (78±19.6 vs 79.3±18.6 mL/min/1.73 m2 (p=0.573). In multivariate Cox regression models visit-to-visit glomerular filtration rate predicted end-stage renal disease (hazard ratio=1.758, p=0.01) but not CAD and stroke (p=NS for both). Baseline left ventricular mass index independently predicted CAD (hazard ratio=1.042, p=0.015) and stroke (hazard ratio=1.035, p=0.002).

Conclusions

In essential hypertensive patients GFR variability predicts future development of end-stage renal disease but exhibits no independent prognostic value for CAD and stroke. These results suggest that fluctuations of renal function are related with damage at the kidneys and not at the cardiac and cerebrovascular level.
P5470Studying target organ damage indices in newly diagnosed and never treated extreme dipper patients with essential hypertension
Authors: Triantafyllidi H , Schoinas A , Benas D , Varoudi M , Birba D , Voutsinos D , Ikonomidis I
Published: October 2019

Background

Cardiovascular risk estimation in arterial hypertension includes the investigation for target organ damage indices (TOD). 24h ambulatory blood pressure monitoring (ABPM) represents the gold standard method for the confirmation of the arterial hypertension disease. Dipping phenomenon, defined as blood pressure decrease >10% during night-time measurements, leads to hypertension burden reduce during night and carries a positive prognostic significance. However, there are doubts regarding its prognosis when it becomes augmented (extreme dipping defined as blood pressure decrease >20% during night-time measurements). Aim of our study is to explore TOD existence between extreme dipper and dipper hypertensive patients with newly diagnosed and never treated arterial hypertension.

Methods

From the 480 total patients with newly diagnosed and never treated arterial hypertension who subjected to ABPM, we excluded 190 non-dipper patients and we divided the rest 290 hypertensives (mean age 49±11 years, 193 males) in normal dippers (n=245, mean age 49±11 years, 160 males) and extreme dippers (n=45, mean age 49±10 years, 33 males). Both groups were subjected to the following measurements: arterial stiffness (PWV), 24h microalbumin levels (MAU), carotid intima-media thickness (IMT), diastolic dysfunction (E/Ea), left ventricular mass index (LVMI) and coronary flow reserve (CFR).

Results

We did not find any differences within groups regarding age, sex distribution, BMI, office SBP/DBP, cenrtal SBP/DBP and daytime average SBP/DBP as well as PWV, MAU, IMT, E/Ea and CFR. We noticed that extreme dippers had reduced 24h average SBP/DBP (p=0.001 and p=0.02, respectively) and increased LVMI (86±18 vs. 79±20 gr/m2, p=0.04) compared to normal dippers.

Differences in LVMI

Conclusions

Extreme dipper hypertensive patients have an increased LVMI, probably as a result of myocardial hypoxia due to severe blood pressure reduction over night. Our results point to the possible increased cardiovascular risk in this group of hypertensive patients.
P5471Baseline characteristics, healthcare resource use and clinical outcomes of stable post-myocardial infarction patients with diabetes: insights from the global prospective TIGRIS study
Authors: Nicolau J C , Brieger D , Goodman S , Cohen M G , Simon T , Westermann D , Granger C B , Grieve R , Chen J Y , Hedman K , Mellstrom C , Brandrup-Wognsen G , Owen R , Pocock S
Published: October 2019

Background

There is a growing prevalence of diabetes worldwide in patients in the general population, including those with prior myocardial infarction (MI).

Purpose

To describe the characteristics, health status, resource utilization and clinical adverse events of stable post-MI patients with diabetes.

Methods

The long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) prospective observational study (NCT01866904) obtained data from 8985 stable patients 1–3 years post-MI from 369 centres in 25 countries, who provided diabetes status (no, yes, insulin-treated) and follow-up. Diabetes status, other patient characteristics, medications, medical history and healthcare resource utilization were recorded at enrolment. Health status was assessed at enrolment, 1 and 2 years by EQ-5D-3L and converted to an EQ-5D score. Deaths, cardiovascular (CV) events, bleeding events and related hospitalizations were recorded during 2 years of follow-up.

Results

Diabetes mellitus (DM) was prevalent at enrolment in 2966 (33%) patients of whom 872 (29%) were insulin-treated. Compared to patients without DM, those with DM had a higher mean body mass index (28.2 vs 26.6kg/m2) and heart rate (71 vs 67bpm), were more likely to have had ≥2 prior MIs (12% vs 10%), chronic kidney disease (10% vs 6%), peripheral artery disease (10% vs 5%), heart failure (15% vs 10%), anaemia (4% vs 2%), angina (12% vs 9%), stroke (6% vs 4%) and chronic obstructive pulmonary disease (9% vs 7%). Patients with DM reported more problems for each domain of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which resulted in a lower mean EQ-5D utility score at enrolment (0.83±0.22 for no-diabetes vs 0.86±0.19 for diabetes). Moreover, they also had higher CV hospitalization rates in the 6 months prior to enrolment (6.4% vs 5%). All these measures were more marked in insulin-dependent diabetics. The incidences of all-cause death, CV death and the composite of CV death, MI and stroke were all significantly higher in patients with DM, especially those on insulin (see Figure). For CV death, MI and stroke the 2-year risk ratios, compared to patients without DM, were 2.64 (P<0.001) and 1.48 (P<0.001) respectively for those with insulin-treated DM and non-insulin treated.

Figure 1

Conclusions

Within a global population of stable post-MI patients, those with DM (especially those on insulin) have poorer health status and EQ-5D utility score, higher hospitalization rates and worse clinical outcomes compared with those without DM. Thus, in cardiac clinics worldwide, patients with DM require particularly close attention.

Acknowledgement/Funding

The study was funded by AstraZeneca
P5476Usefulness of haemoglobin level combined with CAMI-STEMI score for predicting MACCE in patients with acute ST-elevation myocardial infarction after PCI
Authors: Luo E , Wang D , Tang C , Yan G , Hou J , Liu B
Published: October 2019

Background

Early risk stratification was strongly recommended to guide therapeutic management and to improve outcome for ST elevation myocardial infarction (STEMI) patients. Anaemia and high haemoglobin levels are common in STEMI patients, but the effect of the haemoglobin level on the prognosis of STEMI patients remains in dispute. The China Acute Myocardial Infarction registry-ST Elevation Myocardial Infarction (CAMI-STEMI) score can predict in-hospital mortality among Chinese STEMI patients, with similar performance to the well-established Thrombolysis in Myocardial Infarction (TIMI) score, while relying solely on simple and practical variables. This study aimed to evaluate the prognostic value of the haemoglobin level combined with the CAMI-STEMI score in STEMI patients after percutaneous coronary intervention (PCI).

Methods

We included 360 STEMI patients who underwent PCI. The patients were divided into 3 groups according to the first haemoglobin value after PCI, group 1 (male: Hb<120 g/L, female: Hb<110 g/L; 42 cases), group 2 (male: 120 g/L ≤ Hb<160 g/L, female: 110 g/L≤Hb<150 g/L; 278 cases), and group 3 (male: Hb ≥160 g/L, female: Hb ≥150 g/L; 40 cases). Clinical characteristics, and the incidence of major adverse cardiovascular and cerebral events (MACCE) during the follow-up period were recorded.

Results

The incidence of MACCE in the 3 groups increased with a decrease in the haemoglobin level. Multivariate regression analysis showed that the CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI and that anaemia was an independent predictor of MACCE incidence at 6 months and 1 year after PCI. A high haemoglobin level was an independent predictor of MACCE incidence at 1 year after PCI. The area under receiver operating characteristic curves (AUCs) of the haemoglobin level, CAMI-STEMI score and haemoglobin level combined with CAMI-STEMI score predicting the occurrence of MACCE in STEMI patients within 30 days after PCI were 0.604, 0.614, and 0.639, respectively.

Figure 1. MACCE-free survival curve

Conclusion

The CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI. The haemoglobin level combined with the CAMI-STEMI score improved the predictive value of MACCE in STEMI patients within 30 days after PCI.

Acknowledgement/Funding

This study was supported by grants to Chengchun Tang from the National Natural Science Foundation of China (Research Grant #81670237)
P5477Usefulness of hypocalcemia at admission as a prognostic marker in patients with acute coronary syndromes
Authors: Gomez Polo J C , Ferrera C F , Ruiz-Pizarro V , Gomez-Alvarez Z , Romero-Delgado T , Rico C , Noriega F J , Macaya C , Fernandez-Ortiz A , Viana-Tejedor A
Published: October 2019

Background

Few studies have focused on the role of serum calcium levels (SCa) in patients with acute myocardial infarction (AMI).

Purpose

This study aimed to analyze the value of SCa as a prognostic marker in patients with AMI, including both with or without ST elevation.

Methods

From January-2015 to December-2017, all consecutive patients with AMI admitted to a tertiary care hospital were included. For the purpose of this study, total SCa levels were recorded at admission in each patient. Blood samples were obtained at the first medical contact when the patient arrived to the hospital. Patients were classified according to quartiles depending on their SCa at admission: Q1, under 8.3 mg/dl (N=300); Q2, between 8.4–8.7 mg/dl (N=264); Q3, between 8.8–9.1 mg/dl (N=279) and Q4, over 9.1 mg/dl (N=283).

Results

A total cohort of 1126 patients was included, 679 (60.3%) had STEMI and 447 (39.7%) were NSTEMI patients. Patients in the Q1 had more in-hospital complications, such as heart failure, bleeding events, new onset AMI, atrioventricular block and contrast induced nephropathy. Patients in the Q1 had higher in-hospital and one-year mortality as compared to that of patients in the Q2-Q4. After multivariate adjustment (Table), low SCa (<8.3mg/dl) remained as an independent predictor of in-hospital mortality (OR 2.91, 95% CI (1.15–7.41), p=0.025). These results were consistent in STEMI and NSTEMI patients.

Multivariable analysis Variable OR (95% CI) p GRACE score 1.00 (0.99–1.02) 0.727 CRUSADE score 1.03 (1.01–1.06) 0.011 Age (per year) 1.05 (1.00–1.09) 0.034 STEMI 1.35 (0.41–4.46) 0.617 Diabetes 2.57 (0.97–6.79) 0.056 Low SCa (<8.3) 2.91 (1.15–7.41) 0.025 Killip class at admission   1 Reference   2 4.73 (1.31–17.1) 0.018   3 6.83 (1.70–27.5) 0.007   4 9.83 (1.44–67.1) 0.020 STEMI: ST segment elevation myocardial infarction; SCa: Serum calcium levels; OR: Odds ratio; CI: Confidence interval.

Conclusion

In patients with AMI, low SCa levels at admission (<8.3mg/dl) are independently associated with higher mortality.
P5482The lipid paradox in patients with non-ST elevation and ST elevation myocardial infarction and percutaneous coronary intervention
Authors: Sia C H , Ho A F W , Bulluck H , Zheng H L , Foo L L , Chan M Y Y , Hausenloy D J
Published: October 2019

Background/Introduction

Elevated levels of low-density lipoprotein (LDL-C) and triglycerides (TG) are well-described risk factors for the development of acute myocardial infarction (MI). Despite these well-established associations, previous studies have described the existence of a “lipid paradox” in acute MI patients – Patients paradoxically have worse outcomes despite having lower LDL-C and TG levels.

Purpose

We conducted this study to clarify the relationship of the lipid paradox and clinical outcomes amongst non-ST elevation (NSTEMI) and ST elevation MI (STEMI) patients in patients who have had percutaneous coronary intervention.

Methods

We included all acute MI patients reported to the Singapore Myocardial Infarction Registry from 2007 to 2013 who have had percutaneous coronary intervention. This information was linked to the national claims database to obtain the final discharge diagnosis for re-hospitalization outcomes. Exposure of interest was the lipid profile obtained within 72 hours of the acute MI (LDL-C, TG; Total cholesterol [TC]; high-density lipoprotein [HDL-C]). Primary outcomes were all-cause mortality during hospitalization, within 30-days and within 1-year. Secondary outcomes were re-hospitalization within 1-year for heart failure, stroke and MI.

Results

There were 8988 NSTEMI and 12453 STEMI cases available for analysis (n=21441). The NSTEMI patients were older (60.3 years vs 57.6 years, p<0.001) and more likely to be female (15.1% vs 22.6%, p<0.001). In the NSTEMI subgroup, a lower LDL-C was paradoxically associated with better outcomes for death during hospitalization, death within 30 days from MI onset and death within 1 year from MI onset (all p<0.001) across the various LDL-C levels. Adjustment for demographic variables, co-morbidities and MI characteristics eliminated this paradox. However, in the STEMI subgroup, the lipid paradox for LDL-C persisted for all primary outcome endpoints after adjustment. In the STEMI patients, a lower HDL-C also appeared to be protective. An elevated TG level did not appear to be protective in both NSTEMI and STEMI patients after adjustment.

Conclusion(s)

An elevated LDL-C appears to be a protective prognostic marker in STEMI but not NSTEMI patients who have undergone percutaneous coronary intervention. This difference may be due to differing underlying pathophysiological mechanisms between the 2 populations.
P5483Prognostic impact of skeletal muscle, fat, and bone mass in male patients with ST-segment elevation myocardial infarction
Authors: Satou R , Akiyama E , Konishi M , Matsuzawa Y , Kimura Y , Okada K , Maejima N , Iwahashi N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K
Published: October 2019

Introduction

Muscle, fat and bone mass may play some roles to keep physical activity and favorable outcome in patients with cardiovascular diseases. However, there is a paucity of data regarding the effects on the prognosis of skeletal muscle, fat, and bone mass in patients with ST-segment elevation myocardial infarction (STEMI).

Purpose

Our purpose was to examine whether skeletal muscle, fat, and bone mass each affect the prognosis after STEMI.

Methods

A total of 354 male patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization.

Results

During a median follow-up of 32 months, 57 patients experienced primary composite outcome. Each of skeletal muscle, fat, and bone mass were indexed by height squared (kg/m2) and divided into two groups using the cut-off value obtained from the maximum Youden index to predict the primary composite outcome. The event rate was significantly higher in patients with low appendicular skeletal muscle mass index (ASMI) (29.2% vs 11.7%, p<0.001), low fat mass index (FMI) (22.9% vs 13.3%, p=0.030), and low bone mass index (23.8% vs 11.6%, p=0.002). After adjustment for age, renal function, diabetes mellitus, infarct size, Killip classification, and body mass index, low ASMI but not FMI (p=0.150) and bone mass index (p=0.159) was independently and significantly associated with the primary composite outcome (adjusted hazard ratio 2.12, 95%-confidence interval 1.05–4.31, p=0.035).

Conclusions

Index about muscle mass rather than fat and bone mass have prognostic impact in male patients with STEMI.
P5484Cigarette smoking as a risk factor for ST-elevation of myocardial infarction in young women
Authors: Scarpone M L , Krljanac G , Vasiljevic Z , Kedev S , Valvukis M , Bergami M , Manfrini O , Milicic D , Cenko E , Badimon L , Bugiardini R
Published: October 2019

Background

St-elevation myocardial infarction (STEMI) is the most serious form of clinical presentation of coronary heart disease. Women with STEMI have worse prognosis compared with men. The overall reduction in both incidence of STEMI and active smokers makes it unclear what role smoking continues to play as a risk factor for STEMI in the two sexes.

Purpose

To use the relation between current cigarette smoking and myocardial infarction to quantify the relative risk (RR) ratio of STEMI in women and men.

Methods

Data were derived from 11,925 consecutive patients admitted to 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT0128776) from January 2010 to July 2018 with a first acute myocardial infarction. Outcome measures included rates of STEMI at clinical presentation as marker of larger infarctions. Estimates were obtained using logistic-regression and propensity score matching models for current versus never or former smokers. The RR was estimated using men as a reference value.

Results

Smokers experienced myocardial infarction (either STEMI or non-STEMI) much earlier than did non-smokers both in women (59.0±10.2 versus 68.7±11.30 years) and men (55.8±10.3 versus 63.3±11.7 years). Current tobacco smoking was more prevalent in men (50.35% vs 31.75%) and in younger patients (57.71 vs 28.81%). Among younger patients, smoking remained prevalent in men (60.11% vs 49.85%). Smoking was significantly related to STEMI (OR 1.45; 95% CI: 1.32–1.59) compared with non-STEMI. This association was noted in women (OR 1.61; 95% CI: 1.34–1.93) and men (OR 1.39; 95% CI: 1.24–1.56) and was stronger for younger (<65 years) compared with older ages (ORs 1.49; 95% CI: 1.33–1.67 vs 1.34; 95% CI: 1.13–1.59). The risk of STEMI in young women was higher than in young men (ORs 1.63; 95% CI 1.30–2.06 vs 1.45; 95% CI 1.26–1.66,). Propensity score matching analysis confirmed data. Rates of STEMI in young women and young men were 75.8% versus 64.5%, with a significant RR ratio (OR 1.15; CI 1.07–1.23) across outcomes.

Conclusions

Although current smoking still is an important risk factor for STEMI at all ages and sexes, it is especially relevant in younger women. Mechanisms underlying the sex difference are not related to differences in smoking behaviour. This finding is a critical reminder that physicians and society should address in rigorous tobacco-control programs in the general population with a distinctive emphasis on women, particularly in those countries where smoking among young women is increasing in prevalence.
P5488Temporal trends and prognostic impact of hospital length of three or less days in uncomplicated myocardial infarction after primary percutaneous coronary intervention in Spain
Authors: Caneiro B , Abuassi E , Bernal J L , Raposeiras-Roubin S , Elola F J , Fernandez C , Cobas Paz R J , Munoz Pousa I , Cespon Fernandez M , Dominguez Rodriguez L M , Dominguez Erquicia P , Fernandez Barbeira S , Castineiras M , Iniguez Romo A
Published: October 2019

Introduction and objectives

There is scarce data on the safety of hospital stay length in uncomplicated ST- elevation myocardial infarction (STEMI). We studied the trends of the hospital stay and the safety of short (≤3 days) vs. long hospital stay, in Spain.

Methods

Using data from the Minimum Basic Data set of Spanish taxpayer-funded health system. We identified patients with uncomplicated STEMI undergoing coronary angioplasty and who were discharged alive. The mean length of stay was calculated by multilevel Poisson regression with mixed-effects, including patients from 2003–15. The effect of short stay on cardiac diseases readmissions at 30 days and 1 year was evaluated by multilevel logistic regression, including patients from 2003–14. Thirty-day and 1-year cardiac diseases risk-standardized readmissions and mortality rates (RSRRs and RSMRs), respectively, were also compared.

Results

The adjusted mean length of stay was significantly reduced (incidence rate ratio <1; p<0.001) for each year since 2003. The percentage of short stay increased from 14.3% in 2003 to 19.5% in 2015 (p<0.001). In none of the specified models short stay was statistically significant (p>0.05). The RSRRs at 30 days and 1 year as well as RSMRs at 30 days, did not differ significantly between groups. 1-year RSMRs was significantly higher in the short stay group, although probably without clinical significance (0.103% vs. 0.109%, p<0.001). See Table.

Diff mean of RSRRs and RSMRs at 30 days & 1 year Stay length N Mean Standard deviation p-value RSRRs at 30-day ≤3 days 6,486 2.541 0.74 0.20 >3 days 31,651 2.554 0.72 RSRRs at 1 year ≤3 days 6,486 5.306 1.22 0.42 >3 days 31,651 5.292 1.14 RSMRs at 30-day ≤3 days 6,486 0.109 0.04 <0.001 >3 days 31,651 0.103 0.03 RSMRs at 1 year ≤3 days 6,486 0.429 0.13 0.25 >3 days 31,651 0.427 0.13 RSRRs = risk-standardized readmission rates; RSMRs = risk-standardized readmission mortality rates.

Conclusions

In Spain, short hospital stay increased significantly from 2003 to 2015 and seems a safety option in uncomplicated STEMI patients.
P5491Gender differences in long-term outcomes and predictors of all-cause mortality after percutaneous coronary intervention
Authors: Conradie A , Chowdhury E , Whelan A , Worthley S , Rafter T , Eccleston D
Published: October 2019

Background

Gender disparities have been consistently reported in the nature, presentation, and treatment of coronary artery disease, leading to significant outcome differences. Previous reports have suggested that after adjusting for differing baseline and procedural characteristics female gender was an independent predictor of all-cause mortality after Percutaneous Coronary Intervention (PCI). We examined this issue using data from the Genesis Cardiovascular Outcomes Registry (GCOR).

Methods

We prospectively collected data on 10,989 PCI procedures from January 2009 to January 2018 from 12 Australian Hospitals, and compared the baseline patient and procedural characteristics and 1-year mortality by gender.

Results

Female patients were more likely than males to present with NSTEMI (23.0% vs. 21.1%, p=0.042), however less likely to have prior MI (19.5% vs. 24.2%, p<0.001) or PCI (28.8% vs 33.6%, p<0.001). Procedural success rates were similar between females and males (97.2%). On multivariate logistic regression, female gender had a higher rate of all cause mortality (OR 0.58, 95% CI 0.31 to 1.07; P=0.08) but similar rates of MACE (OR 0.84, 95% CI 0.55 to 1.07, P=0.42). Variables contributing to an increased risk of mortality in female patients, included a history of previous heart failure (OR 2.45, 95% CI 1.15 to 5.22; p=0.02), myocardial infarction (OR 2.06, 95% CI 1.09 to 3.90; p=0.026), and peripheral vascular disease (OR 2.69, 95% CI 1.32 to 5.47; p=0.006). Performing PCI to the LMCA significantly increased the risk of mortality in female patients (OR 3.84, 95% CI 1.14 to 12.9; p=0.029), and the use of BMS vs DES contributed to a worse outcome in women compared to men (OR 0.46, 95% CI 0.25 to 0.84; p=0.012). The presence of hypercholesterolaemia in women significantly increased the risk of mortality (OR 0.44, 95% CI 0.22 to 0.86; p=0.016).

Multivariate logistic regression assessing 1-year outcome by gender for all-cause mortality, MACE, and unplanned admissions Outcome Male (vs female) Odds ratio 95% CI P-value Death (143) 0.58 0.31 to 1.07 0.08 MACE (334) 0.84 0.55 to 1.28 0.42 Unplanned readmission (888) 0.79 0.63 to 0.98 0.04

Conclusion

Women have significant differences in baseline characteristics and increased all-cause mortality at 1 year compared to men, although overall MACE rates are similar. This study increases awareness of women at high risk, highlighting the need to improve the care of women undergoing PCI.
P5496Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,016,608 participa
Authors: Wang Y , Nie Y , Yu C
Published: October 2019

Background

Previous meta-analyses, through internal, within-study comparisons of women and men participants, have observed that women with diabetes are at substantially higher risk of coronary heart disease (CHD), stroke and gastric cancer compared with affected men. However, the magnitude of the excess risk of these and other cause-specific outcomes that is conferred by diabetes for men and women is unknown.

Purpose

To estimate the relative effect of diabetes on risk of all-cause, cancer, cardiovascular disease (CVD), infectious disease and respiratory disease mortality in women compared with men.

Methods

Studies published from their inception to April 1, 2018, identified through a systematic search of PubMed and EMBASE and review of references. We used the sex-specific RRs to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random effects meta-analysis weighted by the inverse of the variances of the log RRRs.

Results

Forty-eight studies with 85 prospective cohorts met the inclusion criteria and were eligible for analysis. The pooled women to men RRR showed a 13% greater risk of all-cause mortality associated with diabetes in women than in men (RRR: 1.13, 95% CI: 1.07 to 1.19; P<0.001, Figure 1). The pooled multiple-adjusted RRR indicated a 30% significantly greater excess risk of CVD mortality in women with diabetes compared with men (RRR: 1.30 95% CI: 1.13 to 1.49; P<0.001). Compared with men with diabetes, women with diabetes had a 58% greater risk of coronary heart disease (CHD) mortality, but only an 8% greater risk of stroke mortality (RRRCHD: 1.58, 95% CI: 1.32 to 1.90; P<0.001; RRRstroke: 1.08, 95% CI: 1.01 to 1.15; P<0.001). However, no sex differences were observed among the population with or without diabetes, for all-cancer (RRR: 1.02, 95% CI: 0.98 to 1.06; P=0.21), infectious (RRR: 1.13, 95% CI: 0.90 to 1.38; P=0.33) and respiratory mortality RRR: 1.08, 95% CI: 0.95 to 1.23; P=0.26).

Conclusions

Compared with men with the same condition, women with diabetes have a 58% and 13% greater risk of CHD and all-cause mortality, respectively. This points to an urgent need to develop sex and gender specific risk assessment strategies and therapeutic interventions that target diabetes management for CHD prevention.
P5497The gender paradox in non-ST-segment elevation acute coronary syndrome: an outdated paradigm or a persistent reality-an analysis of contemporary practice from an integrate health care system
Authors: Elkoustaf R , Patel M , Rao R , Batiste C , Quon S , Newman D , Shi J
Published: October 2019

Introduction

Although sex related differences in Non-ST-Segment elevation (NSTEMI) acute coronary syndrome (ACS) have been well delineated in the past, there is a paucity of data from contemporary practice on the evolutions of this paradox and its clinical practice implications.

Purpose

We hypothesized that in the era of guideline driven contemporary practice, and in the setting of an integrated heath care model, gender related differences in care and outcomes would be marginal at best if no altogether absent.

Methods

We utilized data from an integrated health care system to identify 4099 patients with NSTEMI-ACS (1531 women; 2561 men). The patients were stratified by gender and a comparative analysis was performed on guideline directed medical therapy, revascularization strategy and major adverse cardiac events between the two groups.

Results

There were significant difference in pharmacologic treatment, catheter based interventions and surgical revascularizations strategies. Underutilization of guideline directed medical therapy was demonstrated in women specifically vis a vis angiotensin converting enzyme inhibitor (ACE-I) (p=0.0014), statins (p=0.0001), and antiplatelet therapy: clopodigrel (p=0.0004), prasugrel (p=0.0012), and ticagrelor (p=0.03). Additionally, clear differences emerged in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) options despite similarities in high risk status at index presentation by well validated risk algorithms. Specifically, men were more likely to undergo PCI (p=0.021) and CABG (p<0.001) than women. Finally, women had a greater incidence of bleeding complications (p=0.0003) and stroke (p=0,038).

Conclusions

There were treatment disparities in pharmacologic interventions, catheter based interventions, surgical revascularization access and clinical outcomes among patients with NSTEMI-ACS. The persistence of this gender paradox in contemporary practice and despite increasing education and awareness should potentiate further public policy initiatves as well as reinforce the need for geneder specific guidelines