bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of renal function on the incidence and prognosis of new-onset atrial fibrillation in acute myocardial infarction
Authors: Cosentino N , Campodonico J , Ballarotto M , Milazzo V , Moltrasio M , De Metrio M , Lucci C , Rubino M , Marana I , Assanelli E , Grazi M , Lauri G , Marenzi G
Published: November 2020

Introduction

Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and renal function is also true in AMI has never been investigated.

Purpose

The aim of the study was to assess the incidence of new-onset AF according to renal function, estimated at hospital admission, and its relationship with short-term outcome and long-term all-cause mortality in a large real-world cohort of AMI patients.

Methods

We prospectively enrolled 2,445 AMI patients. New-onset AF was recorded during hospitalization. Glomerular filtration rate (eGFR) was estimated at admission and patients were grouped according to their renal function (group 1 [n=1,887]: eGFR>60; group 2 [n=492]: eGFR 60–30; group 3 [n=66]: eGFR<30 ml/min/1.73m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) all-cause mortality were the secondary endpoints.

Results

The AF incidence in the whole population was 10% and it was associated with a higher in-hospital (5% vs. 1%; P<0.0001) and long-term mortality (34% vs. 13%; P<0.0001). The AF incidence was 8%, 16%, 24% in groups 1, 2, 3, respectively (P<0.0001). In each group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; P<0.0001). A similar trend was observed for long-term mortality (20% vs. 9%, 51% vs. 24%, 81% vs. 50%, respectively; P<0.0001). The higher risk for in-hospital and long-term mortality associated with AF in each group was confirmed also after adjustment for major confounders.

Conclusions

The study demonstrates that the incidence of new-onset AF during AMI, as well as its associated in-hospital and long-term mortality, increases in parallel with the severity of renal dysfunction assessed at hospital admission.

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): Centro Cardiologico Monzino, IRCCS, Milan, Italy
Heavy drinking habits are associated with worse in-hospital outcomes in patients with acute coronary syndrome
Authors: Tersalvi G , Biasco L , Radovanovic D , Rickli H , Roffi M , Eberli F , Moccetti M , Jeger R , Moccetti T , Erne P , Pedrazzini G.B
Published: November 2020

Introduction

The association between alcohol consumption and the occurrence of coronary heart disease is well described in literature. Data regarding the impact of regular alcohol consumption on in-hospital outcomes in the setting of acute coronary syndrome (ACS) are lacking.

Purpose

We aimed to evaluate the impact of self-reported alcohol consumption on in-hospital outcomes in patients with ACS.

Methods

Data derived from patients enrolled between 2007 and 2019 in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry were retrospectively analyzed. The primary endpoint was all-cause in-hospital mortality, while secondary endpoints were set as incidence of major adverse cardiac and cerebrovascular events (MACCEs). Outcomes comparisons according to quantity of daily alcohol intake were also performed.

Results

Records concerning alcohol consumption were available in 25707 patients; 5298 of them (21%) fulfilled the criteria of regular alcohol consumption. Daily alcohol intake was reported in 4059 (77%), of these patients (regular drinkers) with 2640 light drinkers (≤2 drinks/day) and 1419 heavy drinkers (>2 drinks/day). Regular drinkers were predominantly male, younger, smokers, more comorbid and with a worse clinical presentation as compared to abstainers/occasional drinkers.

In-hospital mortality and MACCEs of heavy drinkers were significantly higher compared to light drinkers (5.4% vs. 3.3% and 7.0% vs. 4.4%, both p=0.001). When tested together with GRACE risk score parameters, heavy alcohol consumption was independently associated to in-hospital mortality (p=0.004).

Conclusions

Heavy alcohol consumption is an additional independent predictor of in-hospital mortality in patients presenting with ACS.

Figure 1. Study flowchart.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Swiss Heart Foundation
Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway and Sweden according to national ongoing registries
Authors: Bloendal M , Ainla T , Andreka P , Edfors R , Halvorsen S , Jernberg T , Jortveit J , Marandi T , Janosi A
Published: November 2020

Background

There is a high need for real-world international comparisons of management of patients with acute myocardial infarction. In Europe Estonia, Hungary, Norway and Sweden are among the few countries with national ongoing acute myocardial infarction registries with a high degree of completeness of data.

Purpose

To compare the management and outcome of hospitalized ST-segment elevation myocardial infarction (STEMI) patients in four European countries with a national ongoing myocardial infarction registry.

Methods

We compared patient baseline characteristics, use of in-hospital procedures and medications at discharge as well as 30-day and 1-year mortality for all patients admitted with STEMI during 2014–2017 using EMIR (Estonia; n=4,584), HUMIR (Hungary; n=23,685), NOMIR (Norway; n=12,414; data available for years 2013–2016) and SWEDEHEART (Sweden; n=23,342). Country-level results were compared as aggregated data.

Results

Mean age ranged from 65 to 69 years (table 1). Estonia and Hungary had compared to Norway and Sweden a higher proportion of women (resp. 39%; 38% vs. 29%; 31%), as well as patients with hypertension (resp. 79%; 72% vs. 39%; 50%), diabetes (resp. 21%; 27% vs. 14%; 19%) and peripheral artery disease (resp. 9% vs. 6%; 4%). Proportion of current smokers was highest in Norway (38%) and lowest in Sweden (27%). Rates of discharge medications were generally high. The results for in-hospital procedures and mortality are shown in table 1. Estonia had the lowest rates of dual antiplatelet treatment (78%) and statins (86%). Norway had the lowest rates of beta-blockers (80%) and angiotensin converting enzyme inhibitors/ angiotensin II receptor blockers (61%).

Conclusions

This cross-country comparison of four national European registries provide new insights into differences in risk factors, treatment regiments and outcomes of patients with STEMI. There are several possible reasons for the observed differences, including differences in underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council
Pre-admission cardiac arrest in ST-segment elevation myocardial infarction: incidence, predictors and related outcomes
Authors: Araujo G.N.D , Luchese J.L , Theobald A.T , Beltrame R.B , Machado G.M , Amantea R.A , Niches M.N , Fracasso J.F , Carpes C.C , Matte B.M , Krepsky A.K , Pimentel M.P , Wainstein M.V
Published: November 2020

Background/Introduction

ST segment elevation myocardial infarction (STEMI) is a frequent cause of Cardiac Arrest (CA), and early percutaneous coronary intervention is associated with increased hospital survival in these patients. Despite constant improvements in out-of-hospital CA management, survival remains low.

Purpose

Our aim was to assess pre-admission CA incidence, predictors and related outcomes in patients admitted with STEMI.

Methods

We prospectively included 1083 patients admitted with STEMI in a tertiary university hospital in southern Brazil between March 2011 and October 2019. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and in-hospital outcomes were evaluated.

Results

Mean age was 60.8 years (± 12), 66.2% were male, 62% had hypertension and 25.3% had diabetes. Pre-admission CA was present in 104 (9.8%) patients. Patients with CA had more frequently previous myocardial infarction, temporary pacemaker, smoking and Killip 3 or 4 on admission, and shorter pain–to-door time than patients without CA. In addition, CA patients had a higher incidence of periprocedural CA, cardiogenic shock and periprocedural and in-hospital mortality. In multivariate analysis, age (RR= 0.96, p=0.001), anterior MI (RR=1.67, p=0.04) smoking (RR=0.57, p=0.04), previous ASA use (RR=0.40, p=0.02), Killip 3 or 4 (RR=14.71, p<0.001), temporary pacemaker (RR 2.53, p=0.01), pain-to-door time (RR=0.99, p=0.017) were independently associated with CA. Non Shockable Rhythm (RR=7.37, p=0.017), ROSC duration (RR=1.05, p=0.02) and cardiogenic shock (RR=31.2, p=0.003) were independent predictors of mortality among patients admitted with CA.

Conclusion

In this cohort of consecutive patients admitted with STEMI, pre-admission CA incidence was greater than seen in literature. Cardiogenic shock and in-hospital mortality were more common in patients admitted with CA, which may in part explain our higher rate of overall in-hospital mortality. Non shockable rhythm, increased ROSC and cardiogenic shock were independent predictors of mortality among patients admitted with CA. Understanding these characteristics may help taking measures to lower mortality rates.

Funding Acknowledgement

Type of funding source: None
Acute coronary events in patients with myeloproliferative neoplasms- a nationwide analysis of patient characteristics and in-hospital outcomes
Authors: Bhatia K , Handa S , Das S , Modi V , Joshi A
Published: November 2020

Background

Myeloproliferative neoplasms (MPN) are characterized by clonal expansion of cells belonging to the erythroid and/or myeloid lineages. Concomitant platelet dysfunction and thrombocytosis predispose these patients to arterial thromboses, causing a high burden of morbidity and mortality. With improving survival, an increasing number of patients with MPN are presenting with acute coronary syndromes (ACS). However, data regarding in-hospital outcomes and revascularization strategies utilized in these patients is limited, due to lack of representation in trials and rarity of the disease.

Methods

We conducted a retrospective cohort study using the 2016 Nationwide Inpatient Sample.Adult patients with a primary diagnosis of ACS and a secondary diagnosis of MPN, including essential thrombocytosis, polycythemia vera, primary myelofibrosis or chronic myeloproliferative disorder, were identified using the International Classification of Diseases (ICD) 10th revision codes. Outcomes of interest were compared using a multivariate logistic regression model.

Results

Out of 677,304 patients admitted for ACS, 2,485 also had a secondary diagnosis of MPN. Patients with MPN were less frequently female and diabetic but were more likely to have heart failure. No statistical difference in race, smoking or obesity was noted between the two cohorts. There was no significant difference in the in-hospital mortality in ACS patients with or without MPN. In terms of revascularization, patients with MPN were less likely to undergo percutaneous coronary intervention (PCI) and more likely to undergo coronary arterial bypass grafting (CABG). In addition, patients with MPN had a higher odds of acute pulmonary embolism, cardiogenic shock, and acute kidney injury as well as increased length of stay (LOS) and hospitalization costs

Conclusion

In patients with ACS and concomitant MPN, CABG was the preferred mode of revascularization over PCI, which may account for the increased LOS and total cost. Although the in-hospital mortality was similar, patients with MPN had higher odds of In-hospital complications.

Funding Acknowledgement

Type of funding source: None
Impact of high bleeding risk criteria on short- and long-term outcomes in patients with acute myocardial infarction
Authors: Dai K , Okada A.O , Hyodo Y.H , Nakano T.N , Tomomori S.T , Higaki T.H , Oi K.O , Kawase T.K , Nakama Y.N , Suenari K.S , Nishioka K.N , Otsuka M.O , Masaoka Y.M , Shiode N.S , Kihara Y.K
Published: November 2020

Background

The Academic Research Consortium (ARC) proposed the new definition of high bleeding risk (HBR) criteria. It remains unknown about the prevalence and the impact of HBR on clinical outcome after acute myocardial infarction (AMI).

Purpose

To assess the prevalence and the impact of HBR on short- and long-term outcomes in patients with AMI.

Methods

Between January 2015 and January 2018, 412 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. According to HBR criteria proposed by ARC, we divided patients into 2 groups; HBR and non-HBR group. We considered a patient HBR if the patient met at least 1 major criteria or 2 minor criteria. Major criteria included severe CKD (eGFR<30 ml/min), severe anemia (Hgb<11 g/dl), active cancer, and the use of oral anticoagulant drug. Minor criteria included high age (≥75), moderate CKD (eGFR 30–59 ml/min), moderate anemia (Hgb 11–12.9 g/dl for men and 11–11.9 g/dl for women). Kaplan-meier method was used to compare long-term outcome of HBR and non-HBR group. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fetal MI, and stroke.

Results

Patients with HBR were found in 37% of patients with AMI. In-hospital mortality (11.3% vs 4.2%, p=0.008) and MACE rate was significantly higher in HBR than non-HBR group (Figure). HBR group was associated with higher all-cause death (15.7% vs 2.5%, p<0.0001) and intracranial bleeding (4.8% vs 0.5%, p=0.02) than non-HBR group, although the incidence of non-fetal MI was comparable between two groups (7.6% vs 8.5%, p=0.76).

Conclusions

AMI patients with HBR were associated with worse outcomes both short- and long-term.

Kaplan-Meier curves for MACE

Funding Acknowledgement

Type of funding source: None
Predictors of major bleeding following an acute coronary event: insights from a national study of 5,116 consecutive patients in clinical practice
Authors: Mullen L , Shaw M , Meah M , Elamin A , Aggarwal S , Shahzad A , Khand A
Published: November 2020

Background

Major bleeding after acute coronary syndrome (ACS) predicts a poor outcome. Although predictors of major bleeding following ACS have been validated, these have been mostly in clinical trial populations and few contemporary analyses have been undertaken in clinical practise

Methods

Major bleeding was assessed in a national study of ACS and antiplatelet choice. A total of 5116 consecutive patients [Clopidogrel (n 2,491, 2011–13) and Ticagrelor (n 2,625, 2013–16)] were enrolled in 5 UK hospitals. Clinical outcomes were identified from a national coding database (n=59.5 million) with bleeding events tracked to 11 health care facilities. Bleed severity was independently adjudicated by 2 consultant cardiologists, blinded to antiplatelet, sequence and year. Bleeding events were categorised using BARC 3–5 and PLATO criteria. A logistic regression analysis was used to define independent predictors of bleeding.

Results

The median age was 68 (IQR57–78, 30.5%>75), 34% were female. 39% underwent PCI and 13% coronary artery bypass surgery. Clinical outcome data was 100% complete. 1-year mortality was 12.9%. Of 1193 icd10 codes for bleeding or anaemia 165 (3.2%) and 193 (3.8%) patients were adjudicated to have suffered a BARC 3–5 and PLATO major bleeding respectively. Independent predictors common between PLATO major and BARC 3–5 bleeding, in the year following ACS, were CRUSADE score >40 (OR 1.63, CI 1.1–2.4, p=0.008) moderate left ventricular systolic dysfunction (OR, 1.65, CI: 1.2–2.4, p=0.006), age (OR per year increase in age 1.03, CI 1.02–1.05, p<0.001) and subsequent coronary artery bypass surgery (OR 2.6, CI 1.8–3.8, p<0.001)

Conclusion

In a broad real-world population of ACS, CRUSADE score >40, incorporating simple clinical and laboratory criteria, remained an independent predictor of major bleeding using 2 internationally recognised bleed criteria

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Liverpool university hospitals; North-West Educational Cardiac Group
Do the ESC guidelines improve the treatment of acute myocardial infarction due to acute circumflex artery occlusion?
Authors: Simek S , Kral A , Kovarnik T , Zemanek D , Anger Z , Lubanda J.-C , Linhart A
Published: November 2020

Background

The left circumflex artery (LCX) and its branches are less often recognized as infarct related artery (IRA) in STEMI compared to NSTEMI patients because of lower ability to detect posterior AMI on 12leads ECG. Significant proportion of patients with acute LCX occlusion therefore did not receive immediate reperfusion therapy. The recent ESC guidelines recommendation of immediate coronary angiography for NSTEMI with ongoing ischemia should change the situation.

Objectives

To estimate the change in proportion of patients receiving immediate reperfusion therapy for acute LCX occlusion within last 20 years.

Methods

Prospective registry of patients with acute coronary syndromes treated in the cardiac centre. The group of patients treated with direct PCI as STEMI and the group of patients treated as NSTE ACS were compared.

Results

Of 369 STEMI patients treated with primary PCI in 1995–2000, the LCX was recognized as IRA in only 29 (8%) patients. In the group of 809 STEMI patients treated in period 2008–2011, the LCX was detected as IRA in 133 (16%). In he recent group of 1006 patients treated as STEMI in period 2016–2019 the LCX was IRA in 166 (16.5%) patients. LAD, LM and RCA were detected as IRA in 407 (40.5%), 17 (1.7%) and 415 (41%) patients respectively. In the parallel group of 1087 NSTE-ACS patients the proportion of LCX, LAD, LM and RCA as culprit artery was 271 (25%), 438 (40%), 52 (5%) and 326 (30%) respectively. The difference of LCX involvement in STEMI (16%) compared to NSTE-ACS patients (25%) was highly significant (p<0,001).

Conclusion

The disproportion of LCX involvement among the patients with STEMI and NSTE-ACS is not decreasing in the course of last 10 years. Our data show that still significant part of patients with acute LCX occlusion are diagnosed as having NSTE-ACS and are not treated with adequate immediate reperfusion. So even in recent era of modern reperfusion therapy these patients which mostly suffer posterior AMIs have a lower chance to receive the proper treatment in our region. The new ESC guidelines did not change this fading yet. Better diagnostics of AMI due to the acute LCX occlusion (including 15 leads ECG) is routinely needed or every suspected NSTEMI patient should undergo the acute coronary angiogram as he would be a STEMI patient.

Funding Acknowledgement

Type of funding source: None
Immature platelet fraction is a strong predictor of adverse cardiovascular events in patients with acute coronary syndrome. Results of the ISAR-REACT 5 reticulated platelet substudy
Authors: Bongiovanni D , Mayer K , Schreiner N , Karschin V , Wustrow I , Gosetti R , Schunkert H , Laugwitz K.L , Schuepke S , Kastrati A , Bernlochner I
Published: November 2020

Introduction

Reticulated or immature Platelets are pro-thrombotic RNA-rich young platelets, which have been reported to correlate with adverse events in several pathological settings including coronary artery disease. However, the predictive value of this subgroup of platelets in patients with acute coronary syndrome treated with the potent novel P2Y12 inhibitors prasugrel or ticagrelor has not been investigated yet. Moreover, their role as predictors of major bleeding is unclear.

Purpose

The primary aim of this prespecified reticulated platelet ISAR-REACT-5 substudy was to evaluate the immature platelet fraction (IPF%) in peripheral blood as a predictor of the composite primary endpoint consisting of death, myocardial infarction, or stroke at one year after randomization in patients with acute coronary syndrome.

Methods

IPF was assessed in the first 24h after randomization using a fully automated system and correlated to the incidence of the primary endpoint. All patients with available IPF values were included. The Sysmex system uses two fluorescent dyes to stain platelet RNA and a computer algorithm (Sysmex IPF Master) discriminates immature from mature platelets by the intensity of forward scattered light and fluorescence. The immature platelet fraction is displayed as percentage of the total optical platelet count (IPF%).

Results

IPF values within the first 24h after randomization were available in a total of 506 randomized patients. Baseline characteristics and IPF (median [IQR]) values did not differ between the 2 study groups (IPF: prasugrel 3.9% [2.7–5.8] ticagrelor 3.4% [2.5–5.6] p=0.56). Significantly higher IPF values were observed in patients reaching the primary endpoint (n=55 of 506) independent from the study group (p for interaction= 0.28). ROC-curve analysis revealed a cut-of value of IPF 3.6% for the prediction of death, myocardial infarction or stroke with a Hazard ratio (HR) according to cox-regression analysis of 1.98 (95% CI, 1.15–3.44), P=0.01 (Figure 1A). Interestingly, we also detected a trend for higher major bleedings (BARC 3–5) in patients with elevated IPF values above IPF>4.8% according to ROC-curve analysis (Figure 1B).

Conclusion

IPF was significantly associated with the primary endpoint in the ISAR-REACT 5 substudy independent from the treatment group and therefore is a promising novel biomarker for the prediction of adverse cardiovascular events in patients with acute coronary syndrome.

Figure 1

Funding Acknowledgement

Type of funding source: None
Discrimination of myocardial infarction and myocardial injury using a multibiomarker approach
Authors: Neumann J , Soerensen N.A , Hartikainen T.S , Haller P.M , Lehmacher J , Weimann J , Blankenberg S , Zeller T , Westermann D
Published: November 2020

Background

In the Universal Definition of Myocardial Infarction (MI) myocardial injury was introduced as a specific diagnosis in patients with elevated troponin concentrations, but without evidence of acute myocardial ischemia. However, their differentiation within the acute setting might be challenging. Therefore, we sought to investigate a multibiomarker panel in these patients and determine the discriminative capacity to differentiation MI from myocardial injury.

Methods

We use a cohorts of acute patients presenting to the emergency department. All final diagnoses were adjudicated by two physicians in a blinded fashion and based on the fourth universal definition of MI. In case of disagreement a third physician referred. For the present analyses only patients diagnosed with MI or myocardial injury were used. A panel of 28 biomarkers was measured in blood samples collected directly at admission. Spearman correlations were calculated. A multivariable logistic regression model using MI as the dependent variable was used and the predictors were chosen via backward step-back selection. Odds ratios (OR) were calculated for each predictor.

Results

We included 359 patients; 138 were diagnosed as having MI and 221 has having myocardial injury. The median age of the study population was 73 years and 59.1% were males. Hypertension was diagnosed in 80.4%, dyslipidemia in 45.4% and diabetes in 19.0%.The biomarker panel showed a wide range of correlations (Figure 1). In the multivariable model five logarithmized biomarkers (N-terminal prohormone of brain natriuretic peptide [OR 0.62], pulmonary and activation-regulated chemokine [OR 0.51], tumor-necrosis-factor-receptor 2 [OR 2.22], copeptin [OR 1.59] and high-sensitivity troponin I [OR 1.80]) were significant discriminators between MI and myocardial injury. Internal validation of the model via bootstrap shows a for overoptimism corrected area under the curve of 0.84.

Conclusion

In the multivariable model five biomarkers were discriminators between MI and myocardial injury.

Spearman correlations

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research fellowship by the Deutsche Forschungsgemeinschaft
Development of saliva-based cTnI point-of-care test: a feasibility study
Authors: Westreich R , Neumann Y , Deutsch O , Krief G , Stiubea-Choen R , Zager D
Published: November 2020

Background

Cardiac troponin is the biomarker of choice for detection of myocardial injury. There is a great need for simple point of care troponin testing among patients with chest pain, mainly in the prehospital setting. In this preliminary study we evaluate the feasibility of a novel, saliva-based cTn test.

Aim

1) To evaluate the presence of cTnI in saliva of patients with myocardial injury. 2) To explore the feasibility a saliva-based point-of-care cTn assay.

Methods

Saliva samples were collected from 32 patients with myocardial injury who tested positive for conventional cTnT blood tests, and from 13 healthy volunteers. 25 and 9 of these samples, respectively, were subjected to a series of advanced saliva processing procedures:

“Amplification buffer” – A unique and complex composition which removes a broad spectrum of saliva inhibiting elements of physical, chemical and biological nature.

“Hampering remover” – A device which specifically removes salivary alpha amylase that constitutes ∼50% of the total saliva protein content and therefore increases the detection sensitivity of less concentrated components.

“Saliva Concentrator Cartridge” – based on the principles of solid phase extraction cartridges and allows rapid and easy analytes concentration.

Processed and unprocessed samples were tested with blood cTnI RDT (Troponin I Rapid Test. specifications: detection limit 1ng/mL of whole-blood; Sensitivity: 95.8%; Specificity: 99.7%). Results were interpreted independently by two investigators and only concordant readouts were included in the analyses. Results were compared to blood cTnT levels

Results

Among the 25 positive samples subjected to advanced saliva processing procedures, 21 were confirmed positive by both investigators (sensitivities of 84%). All 4 negative saliva samples were obtained from patients with relatively low blood cTnT levels of 155 ng/L or less. Testing untreated samples, only 2 out of 32 were positive (sensitivities of 6.25%). In both processed and unprocessed samples no false positive results were seen among healthy individuals (0 out of 9 and 0 out of 13, respectively), corresponding to a specificity of 100% for both processed and unprocessed groups. The negative predictive values for processed and unprocessed groups were 69.23% and 30.23 respectively. Statistical accuracies were 88.24% for the processed group and 33.33% for the unprocessed group.

Conclusion

This preliminary work demonstrates for the first time the presence of cTnI in saliva of patients with myocardial injury and possible detection of cTnI in clinical saliva samples utilizing a commercial blood-RDT platform. Further research is needed to determine the time activity of troponin in saliva as well as its sensitivity and specificity for myocardial injury.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Salignostics LTD
What is the relationship between high-density lipoprotein cholesterol and the extension of coronary heart disease?
Authors: Santos M.R , Pereira A , Mendonca F , Sousa J.A , Temtem M , Monteiro J.P , Sousa A.C , Freitas S , Rodrigues M , Ornelas I , Mendonca M.I , Palma Dos Reis R , Drumond A
Published: November 2020

Introduction

Coronary atherosclerosis is an important pathophysiological mechanism in the development of coronary artery disease (CAD). While it has been proven via multiple studies that elevated levels of low-density lipoprotein (LDL) contribute to the development of atherosclerosis, high-density lipoprotein (HDL) is widely thought to have atheroprotective effects. Multiple epidemiologic studies have given the idea that high HDL levels protect against CAD, however, other trials also shown that its benefit can be paradoxical.

Objective

To evaluate the relationship between HDL levels and the extent of CAD (one vessel vs multivessel disease) in coronary artery patients.

Materials and methods

Study analyses of 1676 patients selected from GENEMACOR study population, with at least one >75% coronary stenosis by angiography (median age 53.3±7.9 years, 78.6% male, median HDL 43.0±11.1 mg/dL). Population was divided according to the HDL level quartiles (1st quartile HDL <35.3 mg/dL; 2nd quartile HDL 35.3–42 mg/dL; 3rd quartile HDL 42–49 mg/dL; 4th quartile HDL >49 mg/dL). Population of the 1st and 4th quartiles (825 patients, median age of 53.3±7.9 years and 78.7% male) were adjudicated and prospectively followed-up by 5.0±4.8 years. χ2 and T student tests were used to analyze the demographic, laboratorial, angiographic and anthropometric characteristics of the population according to HDL level.

Results

420 (50.9%) patients were included in the 1st quartile group (median age 53.2±7.9 years, 85.7% men) and 405 (49.1%) patients were included in the 4th quartile group (median age 53.4±8.0 years, 71.4% men). In our population, lower levels of HDL were associated with increased risk of multivessel coronary disease (OR 1.63, 95% CI 1.23–2.14, p 0.001).

Conclusion

Despite uncertainties about HDL benefit, in our population a higer level of HDL was associated with a shortest extent of coronary artery disease. We conclude that higher levels of HDL can be considered protective in coronary patients, and strategies to increase HDL levels may indeed translate in improved outcomes in CAD disease.

Funding Acknowledgement

Type of funding source: None
Feasibility and safety of non-contrast percutaneous coronary intervention in patients with complicated acute coronary syndrome
Authors: Higuchi S , Kabeya Y , Nishina Y , Miura Y , Yoshino H
Published: November 2020

Background

Contrast-induced acute kidney injury (CI-AKI) occurs in 10% to 20% of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), resulting in a poor short- and long-term prognosis. Reducing the amount of contrast medium can prevent CI-AKI.

Objectives

This study aimed to examine the feasibility and safety of non-contrast PCI in patients with ACS.

Methods

The study was a prospective and single-center registry. Successful non-contrast PCI was confirmed when contrast medium was not injected from the guiding catheter engagement to wire removal in ad-hoc PCI. Coronary angiography after the PCI procedure was permitted once. CI-AKI was defined as an increase in the serum creatinine of ≥0.5 mg/dL from or ≥1.25 times the baseline within 72 hours after PCI. Worsening renal function (WRF) was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline after the PCI.

Results

The present study included 106 lesions from 81 patients. Forty-eight lesions were (45%) type C lesions. Successful non-contrast PCI was performed in 95 lesions (90%). CI-AKI was observed in 4 (5%); coronary perforation, 0; no/slow flow, 9 (11%); periprocedural death, 0. The follow-up period was 348 (190–492) days. Successful non-contrast PCI was not associated with the incidence of CI-AKI. However, WRF at 6-month was observed in 18 individuals (22%). Successful non-contrast PCI was inversely associated with WRF (hazard ratio, 0.28; 95% confidence interval, 0.09–0.90) after adjustment for renal function.

Conclusions

The present study suggests that non-contrast PCI is feasible and safe in ACS patients with complex lesions.

Funding Acknowledgement

Type of funding source: None
Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction
Authors: Asano T , Mitsuhashi Y , Yamashita J , Ito R , Saji M , Wakabayashi K , Yahagi K , Shinke T , Mase T , Miyachi H , Higuchi S , Miyauchi K , Yamamoto T , Nagao K , Takayama M
Published: November 2020

Background

It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients.

Methods

Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated.

Results

In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]).

Conclusion

The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased.

Funding Acknowledgement

Type of funding source: None
Effect of pre-existing chronic kidney disease, anaemia and diabetes mellitus on mid-term mortality in patients with STEMI treated with primary PCI
Authors: Rubartelli P , Bruzzone M , Ariel Sanchez F , Bologna E , Iannone A , Fedele M , Bellotti S , Bartolini D , Boasi V , Cannarile P , Vercellino M
Published: November 2020

Background

The negative prognostic effect of chronic kidney disease (CKD), anaemia and diabetes in patients with acute coronary syndromes is well known. However, data about the prevalence and the prognostic importance of these comorbidities in unselected, contemporary STEMI patients treated with primary PCI are limited.

Purpose

We sought to investigate the prevalence of CKD, anaemia and diabetes mellitus in this patient population, as well as possible interactions between these comorbidities.

Methods

Between January 2006 and December 2018, 3395 consecutive patients with STEMI underwent primary PCI in two centres. Hb and creatinine were determined on a blood test obtained immediately upon the arrival at the Hospital and eGFR was estimated with the CKD-EPI equation. Renal impairment (RI) was defined as stage 3B or worse CKD (eGFR ≤44 ml/min/1.73m2). Anaemia was defined as Hb <13 g/dl in males and <12 g/dl in females. The outcome measure was overall mortality at a median follow-up of 1.9 years.

Results

The age of patients was (mean±SD) 67.2±12.9 years and 27.3% of them were females. Diabetes was present in 22.1%, anaemia in 18.1%, and RI in 9.8% of patients. The presence of diabetes, anemia or RI, individually or in various combination, was associated with higher mortality (see figure). Interestingly, these comorbidities presented an addictive, but non synergistic, effect (P for interaction = NS for all combinations). The covariates associated with mortality are shown in the Table. Notably, female gender was independently associated with lower mortality.

Conclusions

In contemporary patients treated with primary PCI, diabetes, anaemia and RI are frequently present, individually or in combination. All these comorbidities are strong independent predictors of mortality, and the coexistence of more conditions has addictive, but not synergistic, effect. The identification of patients at higher risk could promote a closer follow-up and more stringent measures of secondary prevention.

Funding Acknowledgement

Type of funding source: None
Percutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial infarction
Authors: Tokarek T , Dziewierz A , Plens K , Rakowski T , Zabojszcz M , Dudek D , Siudak Z
Published: November 2020

Introduction

There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on time of intervention. Concerns have been postulated regarding equally effective in-hospital outcomes for STEMI patients treated with PCI during normal working hours as compared to group treated off-hours.

Purpose

The aim of this study was to assess clinical outcomes in “real-world” patients with STEMI treated with PCI during off-hours and regular hours of work.

Methods

To avoid possible bias related to the non-randomized design, a propensity score was calculated to compare off- and on-hours groups. The study group consisted of 37, 469 matched pairs in STEMI treated with PCI and stent implantation between 2014 and 2018 during regular hours (weekdays 7:00 AM to 16:59 PM) and off-hours (weekdays between 17:00 PM and 06:59AM, weekends, and holidays) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry).

Results

No differences were reported between both groups in baseline characteristics after the propensity score match (PSM). There were no differences in time from pain to first contact (p=0.2) and door to balloon time between both groups (p=0.7). After PSM higher radiation dose was observed in off-hours group (1055.18 (±1006.52) vs. 1081.59 (±1003.25)[mGy]; p=0.001). However, there was no difference in total amount of contrast (on-hours vs. off-hours: 175.69 (±74.71) vs. 176.48 (±74.41)[ml]; p=0.1, respectively). Similar rate of periprocedural complications was observed between both groups of patients, includind stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. However, procedures performed during off-hours were associated with higher incidence of periprocedural death (1.17% (439) vs. 1.49% (559); p=0.001) and periprocedural cardiac arrest (1.76% (658) vs.1.97% (740); p=0.001) as compared to PCI conducted within normal working hours.

Conclusions

Percutaneous coronary intervention in STEMI performed durgin off-hours might be associated with higher rate of periprocedural mortality and higher radiation dose as compared to procedures conducted during regular working hours.

Funding Acknowledgement

Type of funding source: None
Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction
Authors: Jernberg T.J , Omerovic E.O , Hamilton E.H , Lindmark K.L , Desta L.D , Alfredsson J.A , Lundberg A.L , Kellerth T.K , Erlinge D.E
Published: November 2020

Background

Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined.

Methods

In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) <50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF <40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF <40% and at least one risk factor (Age ≥70, eGFR <60, diabetes mellitus, prior MI, atrial fibrillation, EF <30%, Killip III-IV and STEMI without reperfusion therapy).

Results

When all MIs, population 1 (HF or EF <50%), 2 (HF or EF <40%) and 3 (HF or EF <40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class >2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR <60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF <30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1).

Conclusion

Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Novartis
Prevalence and prognostic significance of malnutrition among patients with acute coronary syndrome
Authors: Lizancos Castro A , Parada Barcia J.A , Abu-Assi E , Cespon Fernandez M , Diaz L , Garcia F , Cabeza M , Dominguez R , Galan A , Torres J , Iniguez Romo A , Raposeiras Roubin S
Published: November 2020

Introduction

Knowledge is scarce about the role of malnutrition in Acute Coronary Syndrome (ACS). Existing evidence suggests that is likely to be present. We hypothesized that it is uncommon but associated with adverse outcomes. With this study we aim to report the prevalence, clinical associations, and prognostic consequences of malnutrition in ACS patients.

Methods

We applied the Controlling Nutritional Status (CONUT) score that is composed of the serum albumin concentration, total peripheral lymphocyte count and total cholesterol concentration. From the initial cohort of patients consecutively admitted with ACS (n=6,133), it was possible to calculate the CONUT score in 5,021 of them.

Results

Of the 5,021 patients enrolled, 566 patients were moderately or severely malnourished (11.3%) and 1,937 were mildly malnourished (38.6%). During a mean follow-up of 3.3±2.2 years, 828 patients died (16.5%). The cumulative incidence of mortality was 2.4, 6.1 and 15.8 per 100 patient/year in patients with good nutrition, mild malnutrition and moderate/severe malnutrition, respectively. After adjusting by age, sex, diabetes, prior myocardial infarction, peripheral artery disease, history of heart failure, left ventricular ejection fraction, complete revascularization and therapy at discharge, malnutrition was independently associated with mortality (HR 1.47 (95% CI: 1.22–1.77) and 2.02 (95% CI: 1.60–2.54) for mild and moderate/severe malnutrition, respectively) (Figure 1).

Conclusions

Malnutrition is common among patients with ACS (49.9%) and is strongly associated with increased mortality.

Figure 1

Funding Acknowledgement

Type of funding source: None
Epicardial adipose tissue is associated with the formation of left ventricular aneurysm after myocardial infarction
Authors: Yang C.D , Shen Y , Zhang R.Y , Lu L , Ding F.H , Yang Z.K , Hu J , Shen W.F , Wang X.Q
Published: November 2020

Background

Left ventricular aneurysm (LVA), a serious complication of transmural myocardial infarction, is generally related to poor cardiovascular outcomes. The formation of LVA is essentially an inflammatory remodeling process regulated by multiple systemic and local factors. Epicardial adipose tissue (EAT), a depot of visceral adipose tissue directly overlying the myocardium, is increasingly recognized as an important immune organ by secreting a variety of bioactive adipocytokines. However, the relation of EAT to the development of LVA is still unclear.

Purpose

In this study, we sought to investigate the association between EAT volume and the formation of LVA in subjects with previous myocardial infarction (MI).

Methods

A total of 55 subjects with previous MI and the presence of LVA, and age- and sex-matched 50 subjects with previous MI but without LVA were enrolled between October 2011 and June 2019. EAT was quantified and the presence of LVA was ascertained by cardiac magnetic resonance (CMR). EAT volume was indexed to body surface area.

Results

In the overall population, EAT volume index was correlated positively to log-transformed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (Pearson's r=0.332, P=0.002), and inversely to left ventricular ejection fraction (LVEF; Pearson's r=−0.240, P=0.031). The indexed EAT volume was significantly higher in subjects with than without LVA (41.10±11.73 vs. 33.25/11.70 mL/m2, P=0.003). In subjects with LVA, EAT volume index was further increased in those at older age (43.59±13.09 mL/m2 vs. 37.29±8.26 mL/m2, P=0.029) or with type 2 diabetes (43.38±12.32 mL/m2 vs. 35.20±7.67 mL/m2, P=0.013). After adjusting for sex, age and the presence of diabetes in the multivariate analysis, tertiles of EAT volume index remained significantly associated with the presence of LVA (P for trend=0. 003). Strikingly, compared to the lowest tertile (≤30.80 mL/m2), the intermediate (30.80–44.13 mL/m2) and highest (>44.13 mL/m2) tertiles of EAT volume index corresponded to 4.869– (95% CI 1.792–14.155, P=0.003) and 4.876– (95% CI, 1.787–14.206, P=0.003) increased risk for LVA.

Conclusion

Our study suggests that EAT volume is independently associated with the formation of LVA and reduced cardiac function after myocardial infarction.

EAT in patients with or without LVA

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China
Long-term prognostic benefit of beta-blockers use after discharge in patients with Tako-Tsubo syndrome
Authors: Jamhour-Chelh K , Raposeiras-Roubin S , Nunez-Gil I , Abu-Assi E , Aritza Conty D , Vedia O , Almendro-Delia M , Sionis A , Martin-Garcia A.C , Corbi-Pascual M , Martinez-Selles M , Uribarri A , Guillen M , Lopez Pais J , Blanco E
Published: November 2020

Background

Tako-tsubo Syndrome (TS) seems to be associated with a catecholamine-mediated mechanism. However, the impact of beta-blockers (BB) in-hospital and after discharge still remain uncertain. Objectives: The purpose of the study was to examine whether BB use after discharge in patients with TS, was associated with lower long-term mortality and recurrence.

Methods

Using a national multicentre large-scale inpatient database (RETAKO Registry), we analysed patients with a definitive TS diagnosis.

Results

A total of 970 patients were analysed (568 with BB therapy and 402 no-BB therapy). After discharge and over a median of follow-up of 1.1 years, treatment with BB have no shown prognostic effectiveness in terms of mortality and TS recurrence in unadjusted and adjusted Cox analysis (HR 0.86; 95% CI: 0.59 to 1.27; and 0.95; 95% CI: 0.57–1.13, respectively).

Conclusions

This data suggests that use of beta-blockers after hospital discharge has not shown long-term prognostic benefit in patients with Tako-tsubo Syndrome.

Prognostic impact of BB in TS.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Retako webpage was funded by a non-conditioned Astrazeneca scholarship.