bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of cardiovascular diseases among breast cancer patients: a nationwide registry study 2013-2020
Authors: Engebretsen I , Oteiza F , Birkelund E F , Brandal S M , Bugge C , Halvorsen S
Published: October 2024

Background and aims

There is evidence to suggest that breast cancer (BC) treatment is associated with an increased risk of developing cardiovascular disease (CVD). Several countries have introduced clinical measures to reduce the impact of breast cancer treatment on cardiovascular function including activated breathing control during radiotherapy, lower radiation doses, and maximum anthracycline doses. The overall aim of this study was therefore to investigate whether breast cancer patients still exhibit higher rates of cardiovascular disease than the general population.

Methods

We conducted a registry-based cohort study using linked data from four nationwide health registries. Out study population included all Norwegian patients diagnosed with BC between 2013-2020 and matched them by age to 10 controls without BC. Health outcomes were measured from 2008 to 2021. We estimated the cumulative incidence from index date, for ten selected CVDs. For BC patients, the index date was defined as date of BC diagnosis. For controls, the index date was defined as the date of BC diagnosis for the matched BC patient. A wash-out period of 5 years was applied to identify incident cases of CVD.

Results

The study population included 27,535 patients with BC and 269,9994 matched controls. Median age in both groups was 62 years (IQR: 20). Prior to index date, there were no significant differences in the prevalence of heart valve disease, chronic ischemic heart disease heart failure and peripheral vascular disease in BC patients compared to controls (p>0.05) (Table 1). Hypertensive heart disease, pulmonary embolism, atrial fibrillation, and other cardiac arrythmias were more prevalent in BC patients, while angina pectoris and acute myocardial infarction were more prevalent among controls. After the index date, the incidence proportion for heart valve disease, hypertensive heart disease, pulmonary embolism, atrial fibrillation, other cardiac arrythmias, and heart failure were higher in BC patients compared to controls (p<0.001) (Table 2). No significant differences were found for angina pectoris, acute myocardial infarction, chronic ischemic heart disease, and peripheral vascular disease.

Conclusion

Breast cancer is still associated with an increased risk of developing several CVDs in current clinical practice, compared to matched controls without breast cancer.Baseline characteristicsIncidence of CVD
Influence of disturbed blood flow on endothelial function in people living with HIV
Authors: Preveden A , Maric D , Stojsic Milosavljevic A , Preveden M , Bjelobrk M , Velicki L , Barak O , Brkic S , Garipi E
Published: October 2024

Introduction

People infected with human immunodeficiency virus (HIV) are more susceptible to endothelial dysfunction due to the virus itself, side effects of the antiretroviral therapy and classical risk factors. Endothelial damage is most prominent at the locations where laminar blood flow is disturbed and oscillatory shear stress with retrograde blood flow is dominating.

Purpose

The goal of this study was to assess the endothelial function in people with HIV, and to determine whether their endothelium is more susceptible to a short-term increase in retrograde blood flow in comparison to healthy individuals.

Methods

The study included 62 people with HIV infection and 38 people without HIV infection, in whom endothelial function was assessed using flow-mediated dilatation, which was presented in absolute (FMD) and relative (FMD%) values. The intervention produced oscillatory shear stress and retrograde blood flow during 20 minutes, after which the endothelial function assessment was repeated.

Results

Baseline FMD (0.30±0.07 vs. 0.36±0.07 mm; p<0.05) and FMD% (6.84±1.57 vs. 7.89±1.19 %, p<0.05) were lower in the HIV group in compare to controls. FMD and FMD% decreased in the HIV group by 0.03 mm and 0.7% (p<0.05), while in the control group they decreased by 0.09 mm and 2.0% (p<0.05). The post-intervention FMD and FMD% were not different between the groups (p>0.05).

Conclusion

People with HIV infection express worse endothelial function in compare to healthy individuals. Retrograde blood flow and oscillatory shear stress deteriorate endothelial function in both HIV patients and healthy controls, although this decline is more pronounced in healthy individuals.
Pulmonary hypertension in patients on chronic hemodialysis
Authors: Buryskova Salajova K , Malik J , Valerianova A
Published: October 2024

Introduction

Pulmonary hypertension (PH) is a common condition in patients with advanced chronic kidney disease and is associated with higher morbidity and mortality. High arteriovenous fistula (AVF) flow is one of known etiological factors, but the association of AVF flow within the acceptable range and PH has not been tested. Moreover, the prevalence of PH differed among various studies.

Purpose

The aims of this study were: 1. to describe the prevalence of PH in the Czech hemodialysis population; 2. to analyze the relation between dialysis fistula flow and PH; 3. to reveal other etiology of PH in a cross-sectional non-invasive trial.

Methods

We analyzed index visits of the cohort CZecking HF-CKD study (ISRCTN 18275480). Thus, this is a cross-sectional analysis based on detailed echocardiography with cardiac output (CO) calculation, evaluation of the central venous pressure (CVP) and AVF flow, bio-impedance and basic laboratory tests. All these measurements were done within an hour. The presence of PH was based on the peak systolic pulmonary arterial pressure (PASP) estimation above 35 mmHg.

Results

We analyzed data of 162 patients. They were 73,2 ± 12,6 years old, dialysis vintage 30 ± 69 months. Pulmonary hypertension was present in 35 % of analyzed patients. Among these patients, mild PH was present in 35 %, moderate in 53 % and severe in 12 %.

There was no significant impact of AVF/AVG flow on the presence of PH or PASP value (Table 1.). However patients with PH had higher prevalence of heart failure (HF), which was present in 86 % of patients with PH and only in 46 % without PH (p<0.00001), see Figure 1. This and other differences presented in Table 1. document significant contribution of postcapillary PH. Patients with PH were also more overhydrated when considered by CVP, by overhydration measurement using bioelectrical impedance analysis and had higher N-terminal pro brain natriuretic peptide (NTproBNP) (Table 1.). There was a positive correlation between systemic vascular resistance (SVR) and PASP (R=0,333, p= .001).

Conclusions

PH is present in approximately one third of the dialysis patients. The presence of heart failure and changes of left heart chambers show for the postcapillary etiology of PH. Neither the prevalence nor the severity of PH were significantly related to arteriovenous access flow.
Coronary artery disease screening in renal transplant candidates: insights from a large prospective cohort
Authors: Giovachini L , Galichon P , Ourahma S , Charleux P , Rifai I , Redheuil A , Drouin S , Glasman P , Tamzali Y , Tourret J , Kerneis M , Silvain J , Francois-Pradier H , Montalescot G , Zeitouni M
Published: October 2024

Background

There is currently no specific consensus regarding the screening strategy for CAD in renal transplant candidates.

Purposes

To describe in renal transplant candidates 1/ Strategies and results of CAD screening and 2/ renal and cardiovascular outcomes in this population

Methods

All patients registered on kidney transplant waiting list in our tertiary centre were classified into no screening for CAD (unscreened), screened, or with prior CAD. Unscreened was defined as no ischemia or anatomic testing while on waiting list or within the year prior to listing. Screening was considered as "positive" when it led to diagnostic of obstructive CAD (stenosis > 50%). Primary outcome was a composite outcome defined as [death or unplanned revascularization]. Primary outcome and renal transplant were analysed using multivariable Cox model.

Results

From 2005 to 2023, 3248 patients were registered as candidates for kidney transplantation, 228 (7.0%) patients had a history of CAD, 1987 (61.2%) patients were screened for CAD and 1033 (31.8%) were unscreened. Initial screening investigation were mainly stress cardiovascular MRI (33.7%), stress TTE (27.7%) or myocardial perfusion imaging (26.4%). Among screened patients, 133 (6.7%) patients had a positive screening for obstructive CAD. Within 4.7 [1.2 – 7.2] years, using patients with a negative screening as a reference, patients with positive screening and known CAD were less likely to receive renal transplant (aHR 0.70 [0.53 ; 0.93] and 0.64 [0.49 ; 0.84] respectively), while patients without screening were similarly transplanted (aHR 1.01 [0.89 ; 1.15]). Patients without screening or with a prior history of CAD were at higher risk of primary outcome compared with patients with negative screening (aHR 1.49 [1.16; 1.91]) and aHR 1.97 [1.48; 2.62] respectively), along with patients on dialysis at registration (1.37 [1.13; 1.66]), diabetic patients (1.79 [1.47; 2.18]) and smokers (1.25 [1.03; 1.53]). Age was an interaction factor between unscreening and primary outcome, as there was no association in younger patients (aHR 1.21 [0.81; 1.81]).

Conclusion

Among candidates for kidney transplantation, 2 out of 3 patients underwent non-invasive testing for obstructive CAD resulting in less than 10 % of positive cases. Positive testing and history of CAD were associated with a lower opportunity for kidney transplantation compared with negative testing or absence of screening. Nonetheless, absence of screening was associated with a higher risk of [death + unplanned revascularization], especially in older patients.Central illustration
External validation of the CA-AKI score in patients with acute coronary syndrome: A real-world cohort analysis from Asia
Authors: Wang P , Yuan J
Published: October 2024

Background

Contrast-associated acute kidney injury (CA-AKI) is associated with long-term impairment of kidney function, the need for renal replacement therapy, and subsequent all-cause deaths. A practical risk score, the CA-AKI risk score is derived for the prediction of contrast-associated acute kidney injury. However, this novel score has not received sufficient evidence of external validation in real-world studies, especially in Asian individuals.

Methods

Short-term endpoints and long-term endpoints were assessed in 8,816 patients with acute coronary syndrome enrolled in a large Asia registry. Discrimination was assessed by Harrell’s C statistic, and calibration was assessed by calibration plots. The ability of the CA-AKI score to predict short-term and long-term prognosis was assessed.

Results

CA-AKI occurred in 5.3% of the patients, with a stepwise increase of CA-AKI rates from the lowest to the highest of the 4 risk categories. When predicting the risk of CA-AKI, both discrimination and calibration were helpful in model 2 (C-index: 0.72; slope: 0.97) and in model 1(C-index: 0.69; slope: 1.02). The risks of 1-year all-cause mortality and 1-year bleeding were higher in CA-AKI patients (HR: 2.70 [95% CI: 2.22-3.30] and HR: 1.76 [95% CI: 1.41-2.46]; respectively).

Conclusion

The updated CA-AKI risk score could accurately identify patients with contrast-associated acute kidney injury, the occurrence of which is strongly associated with long-term mortality and bleeding.
Cardiovascular risk factors and kidney transplantation: a retrospective analysis
Authors: Ardehali A , Taylor C , Althekrallah J , Gill J , Gill J , Ramanathan K
Published: October 2024

Introduction

Cardiovascular disease (CVD) poses a significant risk to end-stage kidney disease (ESKD) patients and remains the leading cause of morbidity and mortality among kidney transplant (KT) recipients. With a global rise in ESKD patients dependent on dialysis, transplant programs face growing pressure to consider candidates with a greater burden of CVD for KT despite potential long-term risks. Enhancing pre-KT cardiac risk assessment is crucial to prevent cardiovascular complications post-transplant and meet the demand for KT globally.

Purpose

High-quality studies evaluating pre-KT cardiovascular risk factors in patients with ESKD are lacking. Our study aims to evaluate the association between pre-KT cardiovascular risk factors and the development of major adverse cardiac events (MACE) post-KT.

Methods

This retrospective cohort study of ESKD patients at a tertiary center consisted of consecutive patients referred for cardiovascular assessment prior to KT between January 2013 and January 2023. Clinical and demographic data prior to KT and outcomes 1-year post-KT were extracted. Patients who underwent multi-organ transplantation were excluded. The primary endpoint was MACE, defined as all-cause death, myocardial infarction (MI), ischemic stroke, coronary revascularization, heart failure requiring hospitalization, and cardiac resuscitation.

Results

A total of n=233 patients were referred for cardiac evaluation prior to KT. Of these, n=145 (62%) patients had a KT, n=69 (30%) patients died pre-KT, and n=19 (8%) patients were removed from the transplant program. Of the n=143 KT recipients that met our inclusion criteria, 122 (85%) were free of MACE, while 21 (15%) met the primary endpoint in the year following KT. Patients with MACE were significantly older (mean age = 65 vs. mean age = 59, p < 0.001), and more likely to have coronary artery disease (85.7% vs. 50.8%, p = 0.01), cardiomyopathy (42.9% vs. 17.2%, p = 0.04), smoking history (71.4% vs. 46.7%, p = 0.04), and diabetes (85.7% vs. 49.2%, p = 0.02). Furthermore, deceased donor KT was associated with a greater likelihood of MACE (85.0% vs. 57.5%, p = 0.02) compared to living donor recipients. There were no significant differences with respect to left ventricular ejection fraction, diagnosis of heart failure, or prior MI between MACE and non-MACE groups (p > 0.17 for all).

Conclusion

Among pre-KT patients with CVD, there is a high mortality rate (30%) prior to KT. Following a successful KT, 15% of patients experienced MACE within 1-year. Our findings underscore the urgency of developing strategies to facilitate timely kidney transplantation, particularly in light of the anticipated rise in demand for kidney transplants. The elevated incidence of major adverse events in the year following a successful KT emphasizes the necessity of collaborative care by cardiologists and nephrologists for these patients, and the need for further studies to improve long-term outcomes.
Risk of Incident colorectal carcinoma in patients with type 2 diabetes on SGLT-2 inhibitor users: a population-based cohort study
Authors: Jong G P , Lin T K
Published: October 2024

Background

Patients with type 2 diabetes (T2D) are at substantially higher risk for developing colorectal carcinoma (CC) than the general population. Clinical studies have investigated the effects of sodium-glucose co-transporter-2 inhibitor (SGLT-2i) use on the development of incident CC in patients with T2D, but the findings are inconsistent.

Purpose

This study aimed to examine the association between SGLT-2i use and incident CC risk in patients with T2D.

Methods

We conducted a nationwide retrospective cohort study using the National Health Insurance Research Database (2015–2021). The primary outcome was the risk of incident CC by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Therefore, multiple Cox regression modeling was conducted to analyze the association between SGLT-2i use and incident CC risk in patients with T2D.

Results

268,495 propensity score-matched pairs of patients with T2D using SGLT-2i and non-using SGLT-2i, 1557 and 1264 incident CCs were recorded, respectively. There was a decreased risk of incident CC for SGLT-2i users after adjusting for the index year, sex, age, comorbidities, and concurrent medication (adjusted HR 0.79, 95% CI 0.74–0.84) compared with non-SGLT-2i users. The sensitivity test for the propensity score 1:2-matched analyses showed similar result (adjusted HR 0.79, 95% CI 0.74–0.85).

Conclusions

This population-based cohort study found that SLGT2i user was associated with a lower risk of CC by 21% compared to non-SGLT-2i users in T2D patients. More studies are needed to credibly evaluate the effects of SGLT-2i therapy on CC prevention in patients with T2D.
The effect of Glucagon-like peptide-1 receptor agonists on cardiovascular outcomes in type 2 diabetes mellitus patients with coronary artery disease
Authors: Tjerkaski J , Matthews A , Alfredsson J , Erlinge D , Hofmann R , Svensson P , Lindahl B , Mohammad M A , Omerovic E , Reitan C , Jernberg T
Published: October 2024

Background

Cardiovascular disease is the primary cause of mortality in patients with type 2 diabetes mellitus (T2DM). Randomized controlled trials (RCT) have shown that Glucagon-like peptide-1 receptor agonists (GLP-1RA) improve cardiovascular outcomes in T2DM patients, with greater therapeutic benefits observed in patients with established atherosclerotic cardiovascular disease. However, the effect of GLP1-RA therapy on cardiovascular outcomes has been inconsistent and the RCT have not been sufficiently powered to examine the effect of GLP1-RA on mortality or their therapeutic effect in different subgroups of T2DM patients.

Purpose

This study aimed to examine the effect of GLP1-RA therapy on cardiovascular outcomes and mortality in a real-world cohort of T2DM patients with coronary artery disease (CAD).

Methods

This study included T2DM patients with CAD who were treated with metformin at a daily dose of ≥ 1g for a period of ≥ 180 days. CAD was defined as ≥ 50% luminal stenosis in any coronary artery segment according to a nationwide angiography and angioplasty registry. We performed sequential emulated target trials at monthly intervals between January 1, 2013 and December 31, 2020 to examine the effect of GLP1-RA therapy on major adverse cardiovascular outcomes (MACE), a composite of myocardial infarction, ischemic stroke and all-cause mortality. Secondary outcomes included the individual components of MACE. Marginal structural models were used to compute pooled effect estimates. This was an intention-to-treat analysis with 5 years of follow-up for each emulated target trial. Inverse probability of treatment weighting was used to adjust for confounding due to differences in patient demographics at baseline.

Results

This study consisted of 26,746 individuals who were treated with GLP1-RA and 74,638 controls. The 5-year cumulative risk of MACE was 27.7 % in the GLP1-RA group and 32.7 % in the control group (risk ratio 0.85 [95% confidence interval 0.82 – 0.88]). GLP1-RA therapy was associated with a lower risk of all-cause mortality (risk ratio 0.76 [95% confidence interval 0.72 – 0.79]) and myocardial infarction (risk ratio 0.95 [95% confidence interval 0.89 – 1.00]). We found little or no effect of GLP1-RA therapy on the risk of ischemic stroke (risk ratio 1.13 [95% confidence interval 0.97 – 1.27]).

Conclusions

In this large real-world cohort of T2DM patients with established CAD, we observed that GLP1-RA therapy was associated with a lower risk of MACE, myocardial infarction and all-cause mortality.
Direct Oral Anticoagulants versus Vitamin K Antagonists for the management of left ventricular thrombus after myocardial infarction: A meta-analysis
Authors: Gogos C , Anastasiou V , Papazoglou A S , Daios S , Didagelos M , Moschovidis V , Papadopoulos S F , Giannakoulas G , Sachpekidis V , Ziakas A , Kamperidis V
Published: October 2024

Background/Introduction

Left ventricular (LV) thrombus formation is not an uncommon complication after acute myocardial infarction (AMI) in the modern era of early reperfusion. The optimal anticoagulation regimen in this clinical scenario remains poorly-defined.

Purpose

The present meta-analysis sought to investigate the efficacy and safety profile of direct oral anticoagulants (DOACs) compared with Vitamin K antagonists (VKAs) for the management of LV thrombus following AMI.

Methods

A systematic literature review was conducted in electronic databases to identify studies reporting efficacy and safety outcome data regarding the use of DOACs versus VKAs for patients with LV thrombus after MI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and random-effects meta-analyses were conducted to synthesize pooled ORs.

Results

Eight studies comprising a total of 605 patients were included (Table). DOACs were associated with an almost 2-fold higher likelihood for achieving thrombus resolution compared to VKAs (pooled OR 1.95 [1.25-3.04]; p =0.003, I2 =0 %), while they achieved a 70% lower risk for systemic embolism (pooled OR 0.30 [0.12-0.75]; p =0.01, I2 =0%). The use of DOACs was associated with a 54% lower risk for bleeding compared to VKAs (pooled OR 0.46 [0.26-0.84]; p =0.01, I2 =0 %). Overall, patients receiving DOACs had a 63% lower risk to reach the composite outcome of any bleeding, systemic embolism, cardiovascular hospitalization, or all-cause death, compared with patients using VKAs (pooled OR 0.37 [0.23-0.60]; p <0.0001, I2 =0%) (Figure).

Conclusion

DOACs appear to have a more favorable efficacy and safety profile compared to VKAs for the management of LV thrombus following AMI.Graphical abstractTable
Silent cerebral microvascular disease and longitudinal risk of cognitive decline in atrial fibrillation
Authors: Kondo Y , Senoo K , Nakano M , Kajiyama T , Kobayashi Y
Published: October 2024

Background

A relationship between silent stroke and cognitive disorder has recently been suggested in patients with nonvalvular atrial fibrillation (NVAF). This research is an exploratory research study to investigate the occurrence of asymptomatic cerebrovascular disorders with NVAF.

Methods

The SKAF (Silent cerebral microvascular disease and longitudinal risK of cognitive decline in Atrial Fibrillation) study is a prospective, investigator-initiated, multicenter, observational study of Japanese patients with NVAF aged 60 years or older. We had planned to enroll two hundred NVAF patients with no history of symptomatic stroke or dementia, and an anticoagulant therapy with edoxaban is being performed or an anticoagulant therapy is not being performed, and one hundred patients with sinus rhythm, for comparison. We collected patient characteristics, clinical course, the data of head MRI test and cognitive function test (Montreal Cognitive Assessment (MoCA)) at the baseline and the 24 months follow-up. The primary endpoint was the composite of silent ischemic stroke and micro-bleeding over a 24-month follow-up period. The secondary endpoint was cognitive decline over a 24-month follow-up period.

Results

The study was started in October 2016, with a planned 2-year recruitment period. As of January 31, 2018, a total of 326 patients were enrolled. Of those, 99 patients with sinus rhythm (SR group) and 214 patients with NVAF (NVAF group) were analyzed (male, 193 (62%) patients; age, 72.2±6.5 years). 156 of 195 (80%) patients with NVAF received the anticoagulant therapy with edoxaban. There was no significant difference of the primary composite for the endpoints between two groups (17.4% versus 17.4%; p=1.00). The incidences of silent ischemic stroke and micro-bleeding in SR and NVAF groups over a 24-month follow-up period were 9.3% and 10.8% (p= 0.833), and 8.1% and 9.2% (p=1.00), respectively. The NVAF group exhibited a significantly larger decline in cognition changes in MoCA score than SR group (-0.830 versus 0,000; p=0.0131). Notably, NVAF was found to be associated with cognitive decline.

Conclusion

The SKAF registry provided an equivalent risk of silent cerebral microvascular disease in patients with SR and NVAF. Clinically, NVAF had an impact on cognitive decline.
Real-world implementation of a genotype-guided p2y12-inhibitor de-escalation strategy in acute coronary syndrome patients
Authors: Azzahhafi J , Van Den Broek W A , Chan Pin Yin D R P P , Van Der Sangen N M R , Sivanesan S , Van Schaik R , Henriques J P , Kikkert W J , Ten Berg J M
Published: October 2024

Background

CYP2C19 genotype-guided de-escalation from ticagrelor or prasugrel to clopidogrel, may optimize the balance between ischemic and bleeding risk in ACS patients.

Purpose

Compare bleeding and ischemic event rates in genotyped patients versus standard care.

Methods

Since 2015, ACS patients in the FORCE-ACS registry received standard dual antiplatelet therapy (DAPT). Since 2021, immediate genotype-guided P2Y12-inhibitor de-escalation was applied, switching non-carriers of the loss-of-function allele CYP2C19*3 or CYP2C19*2 from ticagrelor or prasugrel to clopidogrel, while loss-of-function carriers, carrying at least one loss-of-function allele, remained on ticagrelor or prasugrel. The primary ischemic endpoint, a composite of cardiovascular mortality, myocardial infarction (MI) or stroke and the primary bleeding endpoint, BARC 2, 3, or 5 bleeding, were compared between genotyped those on standard DAPT after one year.

Results

Among 5,321 enrolled ACS patients, 406 underwent genotyping, compared with 4,915 non-genotyped ACS patients on standard DAPT. In the genotyped cohort, 65.3% (n=265) were non-carriers, whereas 34.7% (n=141) were loss-of-function carriers. The primary ischemic endpoint occurred in 5.2% of patients in the genotyped cohort compared to 6.9% in the standard care cohort (adjHR 0.88, 95% CI 0.56–1.38). The rate of the primary bleeding endpoint was lower in the genotyped cohort compared to the standard care cohort (4.7% vs. 9.8%; adjHR 0.50, 95% CI 0.31-0.78).

Conclusion

These results demonstrate the feasibility of a CYP2C19 genotype-guided P2Y12-inhibitor de-escalation strategy in a real-world ACS population. This strategy reduced bleeding events, while ischemic events were not increased as compared to a standard DAPT regime.Primary ischemic endpointBARC 2, 3 or 5 bleeding
Cangrelor versus no cangrelor during percutaneous coronary intervention in hemodynamically unstable patients: a cohort study on benefits and risks
Authors: Emilsson O L , Mohammad M , Grimfjard P , Persson J , Santos-Pardo I , Erlinge D , Koul S
Published: October 2024

Background

Cangrelor is an intravenous P2Y12 inhibitor which, according to the European guidelines, may be considered for administration in acute coronary syndrome during percutaneous coronary intervention (PCI). Little is known regarding benefits and risks of such administration in hemodynamically unstable patients.

Purpose

To investigate the effects of cangrelor versus no cangrelor during PCI regarding major adverse cardiac events (MACE), in-hospital bleeding, and all-cause mortality in patients with cardiogenic shock and/or cardiac arrest.

Methods

The study population was extracted from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and included patients with cardiogenic shock or cardiac arrest undergoing PCI during the years 2016-2022. Propensity score matching (PSM) was used to create comparable groups. After matching, all variables used for calculating propensity score were balanced (standardized mean difference<0.1). Outcomes were MACE within 30 days, in-hospital bleeding, and all-cause mortality within 30 days. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. When RR deviated from the null, the risk difference (RD) was determined.

Results

In all, 2,100 (66%) out of 3,206 patients with cardiogenic shock and/or cardiac arrest were included in the PSM analyses (median age: 69 years; 76% male; 78% ST-elevation myocardial infarction (STEMI)). Comparing cangrelor versus no cangrelor in this matched set of patients, the RR was 0.93 (95% CI: 0.84; 1.04) for MACE; 1.51 (1.02; 2.25) for in-hospital bleeding, with an RD of 1.9 percentage points (0.10; 3.7); and 0.93 (0.82; 1.04) for all-cause mortality (Table). In the PSM analysis regarding patients with cardiogenic shock, 1,098 (60%) out of 1,815 patients were included (median age: 71 years; 68% male; 82% STEMI). For these patients, RR was 0.85 (95% CI: 0.74; 0.97) for MACE, with an RD of -7.5 percentage points (-1.6; -13); 1.31 (0.82; 2.09) for in-hospital bleeding; and 0.83 (0.72; 0.95) for all-cause mortality, with an RD of -8.0 percentage points (-2.2; -14). In the PSM analysis regarding patients with cardiac arrest, 1,388 (76%) out of 1,827 patients were included (median age: 67 years; 81% male; 75% STEMI). RR was 0.98 (95% CI: 0.86; 1.12) for MACE; 1.53 (0.95; 2.49) for in-hospital bleeding; and 0.98 (0.86; 1.13) for all-cause mortality.

Conclusion

For patients with cardiogenic shock, but not for patients with cardiac arrest, administration of cangrelor versus no cangrelor during PCI was associated with a reduction in both MACE and all-cause mortality, with numbers needed to treat of 14 and 13, respectively. Overall, for patients with cardiogenic shock or cardiac arrest, administration of cangrelor versus no cangrelor during PCI was associated with an increased risk of in-hospital bleeding with a number needed to harm of 53.
Impact of different P2Y12 inhibitors in acute coronary syndrome patients with severe chronic kidney disease: insights from the CORALYS registry
Authors: Giacobbe F , Giannino G , Siliano S , Morena A , De Filippo O , Ghisletti A , Dusi V , Sagazio E , Bruno F , Marchini F , Wanha W , D'ascenzo F , De Ferrari G M
Published: October 2024

Background

The impact of the most potent P2Y12i ticagrelor and prasugrel after acute coronary syndrome in patients with chronic kidney disease (CKD) remains unclear. Most evidence on dual antiplatelet therapy (DAPT) comes from real-world study but is limited to glomerular filtration rate (GFR) under 60 ml/min whereas no data are available regarding patients with severe CKD (stages IV-V)

Methods

Consecutive patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and severe CKD defined as GFR under 30 ml/min not on dialysis from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of Net Adverse Clinical Events (NACE) defined as major adverse cardiac events (MACE, a composite of cardiovascular death, myocardial infarction and unplanned revascularizations) in addition to major bleedings (classified as BARC scale 3 to 5) was our primary endpoint. Overall MACE and their single components, all bleedings, major bleedings and hospitalizations for heart failure were the secondary ones.

Results

Of 14699 patients in the CORALYS registry, 257 presented with severe CKD not on dialysis and had available data on antiplatelet regimen at discharge. Patients were divided into two groups according to the type of P2Y12i prescribed at discharge: 193 (75.1%) were given clopidogrel while 64 (24.9%) with ticagrelor or prasugrel. Our populaiton was predominantly male (153, 59.5%) with an average age 75.8 ± 10.9 years old. Average GFR was 21.8 ± 6.3 ml/min.

Over a median follow-up of 459 days, Ticagrelor and Prasugrel were associated to lower rates of NACE compared to Clopidogrel (39.9% vs 25.0%, p=0.036). This was mainly driven by an excess of both CV mortality (31.1% vs 6.3%) and myocardial infarction (20.7% vs 9.4%) reported in the clopidogrel group. No difference was reported regarding overall bleeding events (5.7% vs 4.6% with clopidogrel and new P2Y12i respectively, p=0.81) and major bleedings (1.7% vs 4.6% with clopidogrel and new P2Y12i respectively, p=0.15). At multivariate Cox regression analysis DAPT with Ticagrelor/Prasugrel resulted independently associated with a lower risk of NACE (Adj Hr 0.41, 95%CI 0.23-0.74, p=0.003) whereas left main involvement or multivessel coronary disease led to higher risk of NACE (Adj HR 1.96 95%CI 1.21-3.18, p=0.006)

Conclusions

In ACS patients treated with PCI with severe CKD ticagrelor and prasugrel were associated to lower risk of NACE, MACE, CV death and myocardial infarction compared to clopidogrel. No significative difference was reported in overall and major bleedings despite a relative increase of major bleedings in the group treated with Ticagrelor or Prasugrel.
Evolving atrial fibrillation (AF) care in New Zealand (NZ): a nurse specialist-led clinic aiming to improve standardisation, equity, cost-effectiveness, and lifestyle modification in AF management
Authors: Hosking A , Jameson M , Stiles M , Ryan H , Sugden L , Joyson P , Tan C
Published: October 2024

Background

Management of atrial fibrillation (AF) in NZ is challenging and variable between regions. NZ has a diverse population with Māori and Pacific ethnic groups, in particular, facing significant difficulties with access to care and inequity in treatment. The integration of nurse specialists into the care of patients with AF is increasingly recognised and discussed in AF management, including the European Society of Cardiology (ESC) guidelines. This approach also allows emphasis on managing lifestyle factors, pivotal contributing factors in disease burden

Objective

This study assesses the efficacy of a nurse specialist-led AF clinic in a large regional centre in New Zealand. We look specifically at the standardisation of care, lifestyle management, the impact on health equity in managing AF, and the cost-effectiveness of these strategies.

Methods

A retrospective analysis of the first year of the clinic’s establishment was conducted reviewing the outcomes, attendance, and adherence to management guidelines. The clinic is running three days per week to follow up those presenting to the Emergency Department with a primary diagnosis of AF. After discharge, appointments are available within 48-72 hours of presentation. The clinics efficacy and ability to serve wider NZ populations will also be presented alongside a recently-published, similar initiative in Christchurch, NZ.

Results

Over the first year, 247 appointments were made (Median age 66, interquartile range 58-76, 48% male, 75% NZ European). 168 patients were established on a rhythm control strategy, with 20 directly referred for ablation, 26 receiving cardioversions, and the remainder established on anti-arrhythmic medication strategies. Lifestyle modifications were addressed with majority of these patients. Demographic data also highlighted once more, a need to focus on equity with only 17.4% of appointments attended by Māori and Pacific patients, lower than would be expected given population data and relative disease burden.

Conclusions

The Nurse Specialist-led AF clinic shows promising outcomes and is a positive step forward in AF management in this region of NZ. Incorporating ESC guidelines with emphasis on lifestyle factors and including rhythm control strategies to good effect. This clinic brings international standards to a local stage and throws a focus on our unique healthcare needs and an emphasis on equitable delivery of care. This clinic is scalable, effective, and an inclusive approach to AF care.
Sources of stress and outcomes in carepartners of persons with chronic heart failure
Authors: Dunbar S , Butts B , Ferranti E , Higgins M
Published: October 2024

Background

Serving as a carepartner (CP) for someone with chronic heart failure (HF) can be challenging and difficult and may yield adverse psychological outcomes. Sources of HF CP burden and strain may come from physical, informational, and tangential demands. Yet additional life events and sources of stress may be present and compound experiences of HF CPs. Greater understanding of the factors associated with stress sources is needed to direct CP assessment and interventions.

Purposes

To explore the contributions of CP perceptions of HF care burden and strain, other sources of stress from occupational type and working status, and financial concerns to CP psychological outcomes and to examine the influence of social support in mitigating these outcomes.

Methods

CPs of persons with chronic HF, defined as providing care for the person with HF at least 4 hours a week, were enrolled. Baseline variables and measures were demographics (age, marital status, education), sources of stress (CP perceived strain and burden [Oberst, STRAIN], caring for others, occupation type, working status, and financial concerns. Psychological outcomes were overall perceived stress (PSS) and depression (CES-D) with social support measured by the Enriched Social Support Inventory (ESSI). Relationships among stress sources and outcomes were assessed using best model subsets regression analysis (Akaike information criterion) comparing the models with and without adjusting for social support. For each model, age, caring for others, CG strain (mental and physical), CG burden (time and difficulty), financial worry, occupation type and status were considered for the model.

Results

CPs of persons with HF (n=127; 92% women; 58% Black; primarily spouses and adult children) were included. For stress, the best model included age, caring for others, mental strain, occupation and CP burden of difficulty and time (adjusted r2=0.381). After adjusting for social support, occupation type was not significant, and adjusted r2 increased to 0.462. For depression, caring for others and CP burden (difficulty) were included in the best model subset (adjusted r2=0.208). After adjusting for social support, caring for others was not significant, and the adjusted r2 increased to 0.286.

Conclusion

Sources of stress from higher perceived CP burden of the person with HF, occupation type, and having other caregiving roles contributed to overall stress with social support mitigating the effects of occupation type and caring for others. These findings support further study of comprehensive assessments of sources of stress and their contributions to adverse psychological outcomes for CPs within the context of social support to tailor CP interventions to the CP’s specific needs. The consistent role of social support in attenuating psychological stress warrants study of ways to clinically incorporate social support into interventions to improve outcomes for CPs.
Using the VES-13 score for risk stratification in outpatient heart failure management to predict mortality
Authors: Roig T , Lupon J , Domingo M , Santiago-Vacas E , Codina P , Borrellas A , Gonzalez B , Pulido A , Crespo E , Velayos P , Lopez Y , Diaz V , Diez-Quevedo C , Miralles R , Bayes-Genis A
Published: October 2024

Background

We have previously demonstrated the efficacy of the Vulnerable Elders Survey-13 (VES-13) as a valuable tool for identifying frailty and predicting outcomes, such as mortality and hospitalisations, in heart failure (HF) outpatients when frailty is detected using a cut-off value of ≥3.

Purpose

This study aims to assess whether scores obtained from the VES-13, beyond its initial use with a frailty diagnosis threshold, enable a more precise categorization of mortality risk among heart failure outpatients.

Methods

Nurses administered the VES-13 during patients' initial consultations. We examined a sample of 331 patients, analyzing their main characteristics and individual VES-13 scores. VES-13 scores were categorized into quintiles for risk assessment.

Results

A total of 331 outpatients were prospectively included in the study. Patient characteristics were as follows: mean age of 69.85±11.96 years, 68% males, 67.6% in NYHA class II, and 25.7% in class III; ischemic aetiology was the most common (42%), and the mean left ventricular ejection fraction (LVEF) was 38.79±13.58. The VES-13 mean’s score was 2.67±2.81. Quintile 1 corresponded to a VES-13 score of 0, quintile 2 to score of 1, quintile 3 to score of 2, quintile 4 to scores of 3 or 4, and quintile 5 to a VES-13 score of 5 points or higher. During a follow-up period of 17.6±6.6 months (up to 24 months), 41 patients died (12.4%). After adjusting for sex, LVEF and ischemic aetiology stratifying VES-13 scores into quintiles allowed us to observe an accurate stratification of the risk of death with a statistically significant relationship between higher VES-13 quintiles and higher mortality (p=0.001) (Figure 1). Indeed, quintiles 4 and 5 were showed a very high hazard of risk of death compared to quintile 1 group (HR 6.97 [1.53, 31.65], p=0.012 for quintile 4; and HR 12.17 [2.77, 53.54], p=0.001 for quintile 5).

Conclusions

The VES-13, a standard screening tool in our heart failure clinic for identifying frailty, demonstrated the ability, when divided in quintile groups, of accurately stratify the risk of death over a follow-up period of up to two years.
The trajectory of self-care over a 12-month period in patients with heart failure, comparing those with consistently good and poor self-care
Authors: Klompstra L , Stromberg A , Jaarsma T
Published: October 2024

Background

Self-care behaviour plays a pivotal role in enhancing the quality of life for patients with heart failure (HF) and reducing mortality and morbidity rates, but many patients struggle with suboptimal self-care behaviours. It is crucial to understand the factors influencing long-term self-care management.

Purpose

To assess the trajectory of self-care over a 12-month period and assess differences between patients who have constantly good self-care over a 12-month period compared to constantly poor self-care.

Method

This study use data from a randomised controlled intervention study, called the HF-Wii study. We included patients who had complete data on self-care during on baseline, 3, 6 and 12 months. Self-care was measured with the European Heart Failure Self-care Behaviour scale (EHFSBs). A threshold score of equal or higher than 70 was used to define self-care behaviour as good and a score lower than 70 as poor self-care.

Based on literature, the following characteristics (collected from questionnaires and medical records at baseline) were considered in the analysis: age, sex, marital status, education, history of myocardial infarction, duration of HF, New York Heart Association (NYHA) functional class, LVEF, comorbidity. Other factors assessed were Health-related Quality of Life (HrQoL, Minnesota living with HF questionnaire), depressive symptoms (Hospital Anxiety and Depression scale), cognition (Montreal Cognitive Assessment), sleep (Minimal Insomnia Symptom Scale) and level of HF knowledge (Dutch HF knowledge scale).

Logistic regression was performed with backwards elimination of the factors considered associated with the differences between patients who have constantly good self-care at baseline, 3, 6 and 12 months compared to constantly poor self-care.

Results

In total, 407 patients were included in this study. At baseline, the mean self-care was 65±21, with 41% of the patients (n=245) performing good self-care. In total, 126 patients had a constantly good self-care over 12 month (31%), 120 patients had a constantly bad self-care over 12 months (30%) and 161 (39%) fluctuated in their self-care (Figure).

In the multivariate analysis, patients that had continuously good self-care over 12-months were of older age (68±10 vs. 64±12, odds ratio (OR) 1.061, P-value<0.001), had higher HF knowledge (score 13±2 vs. 12±2, OR 1.439, P-value<0.001) and had higher HrQoL (score 28±20 vs 36±22, OR 0.984, P-value=0.022). compared to patients with consistently poor self-care. The variance was explained by 20%.

Conclusion

Younger patients with HF tend to struggle with consistent self-care over a year, underscoring the necessity for tailored interventions for this group. Conversely, patients with greater HF knowledge and higher HrQoL maintained good self-care habits.
Novel 3D-ECG algorithms for reliable screening of cardiac amyloidosis
Authors: Mahabadi A A , Kobeloch J , Wakili R , Michel L , Dykun I R Y N A , Fach C , Rassaf T
Published: October 2024

Background

Cardiac amyloidosis is associated with high morbidity and mortality. Early detection is crucial to allow for specific therapy and improvement of patient’s prognosis. However, there is no established screening tool for cardiac amyloidosis, leading to a delay in diagnosis in the majority of patients.

Aims

We aimed to develop and validate a screening tool for cardiac amyloidosis based on structured evaluation of 3-dimensional electrocardiograms (ECGs).

Methods

We included patients from a vascular center with confirmed cardiac AL- or ATTR-amyloidosis as well as controls of patients with other cardiovascular diseases but without amyloidosis into two independent cohorts, a derivation and validation cohort. All patients received 3-dimensional ECGs and vector loops were categorized based on pre-defined patterns by two independent cardiologists. Consecutively, an AI algorithm was trained in the derivation cohort (n=66 amyloidosis cases, n=89 controls). This algorithm was then applied to the validation cohort (n=33 amyloidosis cases, n=67 controls). Overall accuracy of the algorithm for detection of amyloidosis was evaluated in both cohorts.

Results

Overall, 99 patients with amyloidosis and 156 controls were included (mean age: 75±24 years, 82% male). In the derivation cohort, the AI algorithm reached a sensitivity of 85%, a specificity of 89%, a positive predictive value of 91%, and a negative predictive value of 87%. Applying the algorithm on the independent validation cohort, a sensitivity of 79%, specificity of 82%, a positive predictive value of 61%, and a negative predictive value of 92% was reached. The overall accuracy of the algorithm for detection of cardiac amyloidosis was 85%.

Conclusion

We here describe a novel screening tool, which allows for reliable detection of cardiac amyloidosis.
Comparison of machine learning and traditional methods for prediction of adverse clinical events after percutaneous coronary intervention
Authors: Zaka A , Gorcilov J , Mutahar D , Gupta A , Kovoor J , Stretton B , Mridha N , Sivagangabalan G , Thiagalingam A , Chow C , Zaman S , Kovoor P , Bacchi S
Published: October 2024

Background

Accurate prediction of clinical outcomes following percutaneous coronary intervention (PCI) is essential for mitigating risk and periprocedural planning. Traditional risk models have demonstrated modest predictive value. Machine learning (ML) models offer an alternative risk stratification that may provide improved predictive accuracy. We performed a systematic review and meta-analysis comparing ML models and traditional risk scores for prediction of clinical outcomes after PCI.

Methods

This study was reported according to PRISMA guidelines. PubMed, EMBASE, Web of Science and Cochrane databases were searched until 1st November, 2023 for studies comparing ML models with traditional statistical methods for event prediction after PCI. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality, major bleeding and the composite outcome major adverse cardiovascular events (MACE).

Results

Thirty-four models were included across 13 observational studies (4105916 patients). The summary C-statistic all ML models across all clinical endpoints was 0.81 (95% CI, 0.78-0.85), compared to traditional methods 0.79 (95% CI, 0.74-0.85). The difference in C-statistic was 0.02 (95% CI, 0.002-0.04, p=0.56). Of included studies, only 1 model was externally validated and 10 models were calibrated.

Conclusion

ML models did not outperform traditional risk scores in the discrimination of all-cause mortality, major bleeding or MACE following PCI. While integration of ML algorithms into electronic healthcare systems may improve periprocedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations.