bluuebunny/crossref_metadata_2025 huggingface dataset:
Centralisation of post-resuscitation care after out-of-hospital cardiac arrest at heart centres - a nationwide follow-up study
Authors: Rasalingam Mork S , Gregers E , Kragholm K , Kjaergaard J , Folke F , Torp-Pedersen C , Kober L , Boas Soja A M , Juhl Terkelsen C , Michalik F , Eifer Moller J , Lund Henriksen F , Bundgaard Ringgren K , Hassager C , Soholm H
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Recent guidelines recommend centralisation of post-resuscitation care in out-of-hospital cardiac arrest (OHCA) patients in dedicated Cardiac Arrest Centres (CACs) aiming to improve outcome.

Purpose

To describe the process of implementation of the centralisation policy and impact on 30-day mortality rate.

Methods

This nationwide study included all adult OHCA patients (>18 years) based on the Danish Cardiac Arrest Registry. Centralisation was introduced in 2009, 2010, and 2012 in four regions (A, B, C, D), and one region has not yet implemented the policy (control). Parallel trends assumption was made and a difference-in-difference model with repeated cross-sections was used to estimate the average treatment effect on the treated patients. The 30-day mortality was compared between patients living in regions that introduced centralisation versus control region without centralisation.

Results

A total of 20,566 patients with OHCA were identified between 2007 and 2020. The majority were between 50 to 75 years (53.7%) and 67.8% male. Bystander cardiopulmonary resuscitation was performed in 55.3%. Shockable rhythm was present in 34.6% of the patients. The policy of centralisation of OHCA in CACs has been gradually and not yet completely implemented (Figure 1A). Patients with shockable rhythms (72%), and younger patients < 50 years (64%) were more frequently transported to CACs. The 30-day mortality was lower among patients transported to CACs (Figure 1B). Centralisation significantly improved survival by 6% (95% CI: 2%-10%) percentage points compared to the control region after controlling for all known covariates (sex, age, Charlson Comobidity Index, shockable rhythm, and bystander cardiopulmonary resuscitation).

Conclusions

In this nationwide study, centralisation of post-resuscitation care of OHCA in dedicated CACs has been gradually implemented over time. Although, OHCA patients with favorable prognostic factors were more frequently transported to CACs, centralisation increased survival by 6 absolute percentage points.
Antiplatelet de-escalation switch in patients with acute coronary syndrome and percutaneous revascularisation in real life
Authors: Padilla Rodriguez G , Escalona Garcia F J , Arroyo Monino D F , Lorenzo Lopez B , Hidalgo Urbano R J , Garcia Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The current indication for the use of potent antiplatelet agents as the first choice after drug-eluting stent implantation in acute coronary syndrome (ACS) is sometimes difficult to achieve due to clinical problems in patients. The switch between higher and lower potency antiplatelet drugs (de-escalation) is particularly relevant and it is usually performed when there are contraindications or adverse effects related to the use of more potent P2Y12 inhibitors (iP2Y12).

Purpose

Our aim is to analyse the incidence and possible causes of in-hospital de-escalation switching in patients with ACS, as well as to compare the characteristics of these patients with those who continue with the higher potency antiplatelet drug initially indicated.

Methods

Observational, retrospective, single-centre study of a cohort of 3139 patients admitted to a Coronary Care Unit with ACS, treated with Ticagrelor or Prasugrel as a second antiplatelet agent at admission. Patients were classified according to whether or not they switched to Clopidogrel during their hospitalisation, comparing the characteristics between each group and the clinical events that potentially have caused that switch.

Results

From 3139 admitted patients, 188 (5.99%) were switched from Ticagrelor or Prasugrel to Clopidogrel. The majority of these occurred among patients receiving Ticagrelor (4.21 vs. 1.78%). Patients with de-escalation switch (mean age 64±11 years, 69% male) were similar to the non-switch group, with no statistical differences in baseline characteristics including the CRUSADE score (25 vs 27), except for the presence of a lower GRACE score (153 vs 146, P=0.02). The diagnosis of ST-elevation ACS as an ischaemic event was more prevalent in the "switch group". Regarding possible causes of de-escalation, a higher frequency of bleeding (9.3 vs 20.7%, P<0.01), new-onset atrial fibrillation (4.14 vs 20.21%, P<0.01) and indication for anticoagulation at discharge (6.64 vs 31.91 %, P<0.01) were observed in the "switch group" compared to the other one.

Conclusions

Although not very frequent, in-hospital de-escalation switch between iP2Y12 antiplatelet agents is sometimes required because of medical conditions, such as the presence of haemorrhages or the need for anticoagulation due to atrial fibrillation or other reasons; although, other times it happens due to a medical decision, without an objective event. In addition, in our sample, patients who underwent anti-platelet de-escalation switch had a lower ischaemic risk.
Differences in population characteristics and prognosis between cardiogenic shock in right ventricular infarction and anterior infarction
Authors: Lucas Garcia M , Rivas Garcia A P , Arroyo Monino D F , Garcia Gonzalez N , Hidalgo Urbano R J , Garcia Rubira J C
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

According to the literature, cardiogenic shock in the setting of right ventricular infarction (RV) has a high mortality, even equal to that related to left ventricular anterior infarction in some series. However, as well as many of the topics in acute cardiovascular care, more information is still necessary.

Purpose

We aim to assess the presence of differences in a cohort of patients with cardiogenic shock due to RV infarction versus anterior infarction. In order to achieve it, we analyzed the differences in baseline characteristics, in-hospital complications and mortality.

Methods

Descriptive, retrospective, observational, and single-center analysis of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock admitted to our Coronary Care Unit between July 2011 and August 2022. We collected the data of patients with cardiogenic shock and compared basal characteristics and prognosis according to the infarction location (anterior or RV).

Results

A total of 241 patients were included, 30.7% with RV infarction. The mean age of our patients was 68.6 years and 68% were male. There were no differences in the main cardiovascular risk factors between the two groups. Regarding complications during their hospitalization, there was a significantly higher percentage of patients requiring invasive mechanical ventilation and hemodialysis in patients with shock due to anterior infarction. There was also no significant differences in the frequency of ventricular arrhythmias or atrioventricular block. At last, in our cohort, there is a higher in-hospital mortality rate among patients with shock associated with anterior infarction.

Conclusions

Despite the fact that in some series the high mortality in shock due to RV infarction is similar to the shock caused by anterior infarction, in our study cardiogenic shock related to anterior infarction involve worse prognosis with higher in-hospital mortality, as well as a higher need of mechanical ventilation and renal replacement therapy.
Sex differences in outcome after targeting mean arterial blood-pressures and oxygenation in comatose patients after out-of-hospital cardiac arrest
Authors: Holle S , Winther-Jensen M , Kjaergaard J , Moeller J E , Hassager C , Schmidt H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation

Background

Previous studies have found lower survival rate and neurological outcomes for female patients with out-of-hospital cardiac arrest (OHCA) compared to males. Recently, the effect of liberal or restrictive oxygenation and lower or higher mean arterial blood-pressures (MAP) on outcome in comatose OHCA patients were investigated; showing no differences between the target groups. Evidence concerning sex differences in outcome after appropriate oxygenation and different MAP levels in comatose OHCA patients is limited.

Purpose

The aim of this study was to investigate whether female sex was associated with higher rates of unfavourable outcome after treatment with oxygenation and MAP in comatose patients after OHCA related to outcome.

Methods

Adult comatose OHCA patients (age ≥18 years) of presumed cardiac cause were included in a dual-center, double-blind, randomized trial with a 2-by-2 factorial design. Patients were allocated by a 1:1:1:1 ratio into a MAP target of 63 mm Hg or 77 mm Hg and arterial oxygen concentration during mechanical ventilation of 9–10 kPa (restrictive) or 13–14 kPa (liberal). The primary outcome was a composite of all causes of death within a year or hospital discharge with a cerebral performance category (CPC) of 3 or 4.

Results

Of the 789 included comatose OHCA patients, 152 (19%) were women. Mean age of women and men were similar, 61±14 years and 63±13 years, respectively. Comorbidities and characteristics of the cardiac arrest were comparable between sexes except for ischemic heart disease, which was more frequent in men (12% women, 24% men) and pulseless electrical activity, which was more frequent in women (8% women, 4% men). CPC 3 or 4 occurred equally in women and men (both 3%). Women had a higher, but non-significant one-year all-cause mortality (women: 42%, men: 35%), Figure 1. In a univariate Cox regression model, the difference in all-cause mortality was not significant (HR: 1.25, CI: 0.95-1.63), but showed significance after adjustment for age (HR: 1.31, CI: 1.004-1.72).

Conclusion

Men and women in comatose after OHCA had similar unfavourable outcome when treated in the same manner with oxygenation and MAP.
Predictors of delirium in patients with acute decompensated heart failure at a cardiac intensive care unit
Authors: Carvalho M , Cabral M , Goncalves C , Vazao A , Fernandes S , Graca Santos L , Morais J
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Delirium is commonly observed in critically ill patients and is associated with a worse overall prognosis in patients hospitalized with acute decompensated heart failure. However, in patients with acute decompensated heart failure (ADHF), the impact of delirium on prognosis and the factors that influence it have not been thoroughly examined.

Objective

To study the predictors of delirium in patients hospitalized in the cardiac intensive care unit (CICU) due to acute decompensated heart failure.

Methods

We retrospectively analyzed 105 patients admitted to a CICU due to ADHF. Delirium was diagnosed based on the Confusion Assessment Method for ICU (CAM­-ICU) during CICU stay. Echocardiography and laboratory measurements were performed during hospitalization. A logistic regression analysis was performed, looking for independent predictors of delirium development.

Results

Delirium was observed in 25 patients (23.8%) during CICU hospitalization. Multivariable analysis revealed that older age (odds ratio [OR]: 7.6; 95% confidence interval [CI]: 3.2-21.2; p<0.001), previous diagnosis of dementia (OR: 7.31, 95% CI: 3.65­-14.91, p<0.001), high plasma level of C reactive protein > 79 mg/L (OR: 1.26, 95% CI: 1.09-­1.61, p=0.031), and prior alcohol misuse (OR: 5.4; 95% CI: 2.76-13.40; p=0.003) as significant independent determinants of delirium. Furthermore, we determined that delirium was an independent predictor of in-hospital mortality (OR: 1.93, 95% CI 1.1-3.4.1, p=0.033). There was no relationship to the previous medical history of arterial hypertension, diabetes mellitus, or left ventricular ejection fraction.

Conclusions

In patients with ADHF, the development of delirium during CICU stay is associated with a higher risk of in-hospital mortality. Older age, dementia, high levels of C reactive protein, and alcohol misuse were identified as predictors of delirium. Therefore, this clinical entity's early diagnosis and proper management are essential.
Blood pressure targets in out-of-hospital cardiac arrest according to the time to return of spontaneous circulation
Authors: Paulin Beske R , Grand J G , Schmidt H S , Moeller J E M , Kjaergaard J K , Hassager C H
Published: May 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation and Lundbeck Foundation.

Introduction

Time to return of spontaneous circulation (ROSC) in patients resuscitated after out-of-hospital cardiac arrest (OHCA) is associated with the severity of brain damage and is an important predictor of mortality. We have recently shown no difference in mortality or neurological outcome with different mean arterial blood pressure targets (63 or 77 mmHg) in the initial phase of post-cardiac arrest management in resuscitated OHCA patients who remained comatose. Accordingly, in this post-hoc analysis, we explored whether time to ROSC modifies the effect of different blood pressure targets on mortality and neurological outcome.

Method

In a double-blind, randomized trial, a mean arterial blood-pressure target of 63 mm Hg vs. 77 mm Hg in comatose adults who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause was investigated (BOX-trial, N Engl J Med 2022). Primary outcome for the present analysis was a composite of discharge from hospital severe brain damage or death from any cause within 365 days from randomization for the blood pressure target intervention was analyzed in a proportional hazard model with time to ROSC (tertiles: short, medium, and long) as a subgroup following testing for interaction. The analysis was conducted in the intention to treat the population.

Results

A total of 789 patients were included in the analysis. The time to ROSC in the three tertiles was: Short [0 min - 13 min], medium [14 min - 22 min], and long [23 min - 117 min]. The three groups were well balanced in the two blood pressure target groups (In the high group (77 mmHg): Short, n=124 (49%); medium, n= 133 (50%), long, n=136 (51%). Age (short: 62.7 (± 14), medium 62.4 (± 13), and 62.6 (± 13) and sex (short: 19.5% female, medium: 19.0% female, long: 19.4% female) were similar in the three groups. The first monitored rhythm did not differ in the three groups (shockable in 82.6%, 86.2%, and 85.3% of patients, respectively). Time to the first defibrillation did, however, differ between the three groups ((short 6.2 min (± 3.3), medium 9.0 min (± 3.8), and long 11.0 min (± 6.6), p<0.0001). The primary outcome occurred in 44 (17.3%), 92 (34.3%), and 153 (57.5%) in the short, medium, and long groups, respectively (p<0.0001). No interaction of time to ROSC and blood pressure target was found (p=0.62). Hazard ratios in the high (77 mmHg) group for the three tertiles were: short: HR 1.34 (95% CI: 0.75 – 2.40), medium: HR: 0.99 (95% CI: 0.68 – 1.45) and long: HR 0.97 (95% CI: 0.71 – 1.32).

Conclusion

Longer time to ROSC is associated with an adverse outcome, but it does not modify the effect of different blood pressure targets in comatose OHCA patients.
The relevance of hs-troponin and global longitudinal strain in predicting the need for mechanical intubation in severe COVID-19 patients
Authors: Wardhani L F K , Alsagaff M Y , Dewi I P , Oktaviono Y H , Budianto C P , Susilo H , Dharmadjati B B , Subagjo A , Pikir B S , Luthfah N , Nugraha R A , Putra T S , Gunadi R I , Al-Farabi M J , Azmi Y
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Dr.Soetomo General Hospital Abbott

Background

The occurrence of an imbalance in oxygen supply results in the release of pro-inflammatory cytokines which leads to increased ventilation support requirement. Half of the intubated patients with COVID-19 manifest myocardial injury, which is associated with a graded increase in overall mortality.

Purpose

This study aims to analyze factors that contribute to worse outcomes among severe COVID-19 infections.

Methods

We performed an observational, single-center prospective cohort study from February 1st – July 31st, 2021 at an Isolated ICU. A total of 65 subjects were included. Subjects were recruited according to WHO criteria for severe COVID-19 and CDC criteria for myocarditis. All subjects recruited were examined using echocardiography to measure global longitudinal strain (GLS) and blood samples were taken to measure hs-Troponin. Subjects were then followed to assess their needs for mechanical ventilation and in-hospital mortality.

Results

Severe COVID-19 subjects with cardiac injury were associated with an increased need for intubation (78.5%) and an increased incidence of myocarditis (50.8%). There was an association between the use of intubation and the risk of mortality in patients (66.7% vs. 33.3%, p-value <0.001). Both reduced GLS and increased hs-troponin are associated with increased myocarditis (p-value <0.001 and 0.004 respectively). Reduced GLS is associated with higher mechanical ventilation needs (12.17 + 4.79 vs.15.65 + 4.90, p-value 0.02) and a higher mortality rate (11.36 + 4.64 vs. 14.74 + 4.82; p-value 0.005). Increased hs-troponin is associated with higher mechanical ventilation needs (25.33% vs. 3.56%, p-value 0.002) and a higher mortality rate (34.57% vs. 5.76%, p-value 0.002).

Conclusions

Severe COVID-19 subjects are associated with an increased incidence of myocarditis as indicated by myocardial injury through an increase in hs-troponin and a decrease in GLS. Both increased hs-troponin and reduced GLS are associated with higher mechanical ventilation needs and a higher mortality rate.
Optimal timing of surgery for patients with infective endocarditis
Authors: Manikantan P , Tao M , Despotidis G , Alkhalil A , Parikh P , Pyo R
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that surgery during index hospitalization may be performed safely without increased risk of adverse clinical outcomes. However, risk associated with specific surgical timing during index hospitalization remains unclear.

Purpose

The purpose of this meta-analysis is to assess the association of early surgery with mortality in patients with IE.

Methods

We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was in-hospital mortality. The secondary endpoint was long-term mortality. Early surgery was defined as surgery within 14 days of admission. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results

A total of 15 studies with 2491 participants (900 with early surgery vs 1591 with delayed surgery) were included. The mean duration of follow-up was 33 months (ranging between 6 to 66 months). Early surgery was not associated with increased risk of in-hospital or long-term mortality compared to delayed surgery (OR 1.08, 95% CI 0.80, 1.46; P=0.63; OR 1.12, 95% CI 0.68, 1.86; P=0.65). Heterogeneity was low: Chi2 = 7.85, I2 = 0%.

Subgroup analysis by time to surgery demonstrated that early surgery was not associated with increased risk of in-hospital mortality for surgeries performed within 2 days, 7 days, or 14 days of hospitalization (OR 0.87, 95% CI 0.58, 1.32; P=0.51; OR 1.06, 95% CI 0.78, 1.43; P=0.72; OR 0.51, 95% CI 0.21, 1.23; P=0.13). Heterogeneity was low: Chi2 = 4.84, I2 = 0%.

Conclusions

Early surgery performed within 14 days of initial hospitalization is not associated with increased risk of in-hospital mortality or long-term mortality compared to delayed surgery.
Fixed-dose ultrasound-accelerated thrombolysis for acute pulmonary embolism: short- and long-term outcome data from a single-center study
Authors: Zbinden S , Voci D , Kucher N , Barco S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Data on clinical outcomes after fixed-dosed ultrasound-accelerated thrombolysis (USAT) for acute pulmonary embolism (PE) is still limited, particularly concerning safety and long-term course.

Methods

We studied patients with acute PE treated with USAT at a University Hospital between 2018 and 2022. Patients were candidates to USAT if acute PE fulfilled the criteria of high-risk or intermediate-high risk (plus additional markers of clinical severity or early deterioration) as per European guidelines. USAT was given at a standard regimen of 10 mg alteplase/catheter over 15 hours. Early outcomes included: mean pulmonary arterial pressure (mPAP) before and after treatment, National Early Warning Score (NEWS) during USAT; 30-day all-cause death, 30-day hemodynamic decompensation, 30-day PE recurrence, and 30-day major bleeding complications (ISTH definition). Late outcomes were: confirmed CTEPH, persistent post-PE dyspnea, and "post-PE impairment" (PPEI), as defined by the combination of dyspnea with sPAP>35 mm Hg, TAPSE <1.6cm, or RV/RA gradient >36 mmHg, death.

Results

We included 161 patients: the mean age was 67.8 (SD 14.6) years and 96 were men. All had acute bilateral PE and were treated with two catheters for a median alteplase dose of 20 mg. All patients received anti-Xa activity-adjusted unfractionated heparin, except one, who received argatroban. mPAP decreased from a mean of 35.6 (SD 9.8) to 25.6 (SD 8.2) mmHg after a 15-hour course of treatment (absolute difference 10.2 mmHg; SD 8.1). The NEWS decreased from a median of 5 (Q1-Q3: 4-6) points before USAT to 3 (Q1-Q3: 2-4) points after USAT. No hemodynamic decompensations were recorded within 30 days of hospitalization. One (0.6%) recurrence of PE within 30 days occurred. Two major bleeding (1.2%), of which one (0.6%) was intracranial and fatal, were observed. No other deaths were recorded within 30 days of acute PE. Of 125 patients followed at our center and included in the long-term analysis (median follow-up time 104, Q1-Q3 91-200, days), CTEPH was diagnosed in 2 (1.6%) patients. In one patient, CTEPH was most probably pre-existing, namely present already at the time of "acute" PE, based on hemodynamic and radiological findings. CTEPH was incident in the other patient. 24 (19.2%) patients reported persistent dyspnea, of whom 5 (4.0%) fulfilled the PPEI criteria. Death was recorded in 8 (6.4%) patients after a median of 591 (Q1-Q3; 517-710) days and no event was PE-related. One (0.8%) recurrent PE occurred.

Conclusions

USAT rapidly reduced the mean pulmonary arterial pressure in selected intermediate-high and high-risk acute PE with a good safety profile. Only 4.0% patients had residual symptoms and right ventricular dysfunction over long-term follow-up. This data reassures USAT being an effective and safe option for acute PE also in terms of long-term outcomes.
5-year outcomes of pulmonary embolism patients according to symptoms at 6-month: the QOLAPE study
Authors: Benezech L , Laroche T , Lointier E , Beneyto M , Lapebie F X , Biendel C , Lairez O , Moine T , Martin R , Elbaz M , Bura-Riviere A , Delmas C
Published: May 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): CHU Toulouse Rangueil

Background

Venous thromboembolic disease is a common cardiovascular disease, but long-term data on patient survival according to mid-term symptoms are scarce.

Objective

To describe outcomes (mortality and functional status) of pulmonary embolism (PE) 5 years after a first inaugural symptomatic episode of acute PE according to symptoms persistence at 6-months.

Methods

137 patients with acute symptomatic PE were consecutively recruited at a French University Hospital from 2015 to 2017. Clinical characteristics were compared at 5-years between patients with persistent respiratory symptoms and asymptomatic patients at 6-month. Telephone collection of vital status, recurrence of VTE, NYHA score, current treatment, bleeding events as well as follow-up provided by a specialist were carried out in March 2022 on 105 patients (11% were lost of follow up).

Results

Patients were predominantly male (n=63, 57.5%) 60.2 yo. PE was initially classified at low, intermediate low, intermediate high and high risk respectively in 42.8, 25.7, 30.5 and 1%. 60 patients (57%) were symptomatics at 6 months. At 5 years, survival was 87.1% with a 17.7% recurrence rate regardless of initial PE presentation and severity, and 50% of patients remain symptomatic. Age, hypertension, diabetes, renal failure, obesity and the existence of a psychiatric pathology are associated with a higher mortality at 5 years. The survival and recurrence of MTVE at 5 years are similar between symptomatic or asymptomatic status at 6 months but symptomatic patients at 6 months are twice as many symptomatic at 5 years than asymptomatic patients at 6 months.

Conclusion

After an inaugural acute symptomatic PE is 5-year survival was 87%. Age, obesity, diabetes, renal failure, hypertension and the existence of an underlying psychiatric pathology are associated with a poorer prognosis at 5 years. The persistence of symptoms at 6 months of PE was not correlated with survival or recurrence of VTE at 5 years but at the persistence of symptoms at 5 years.
Remote vessels vs culprit-only angioplasty in ST-segment elevation myocardial infarction: reinfarction and all-cause mortality
Authors: Sa Couto D , Alexandre A , Faria J , Luz A , Campinas A , Frias A , Santos R , Brochado B , Silveira J , Torres S
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background and purpose

In ST-segment elevation myocardial infarction (STEMI) patients with multivessel coronary artery disease (MVCAD), remote-vessel percutaneous coronary intervention (PCI) has been associated with a reduction in the incidence of reinfarction when compared to a culprit-only revascularization strategy. Overall effects on long-term all-cause mortality are still unclear.

Methods

Between 2008 and 2013, a total of 584 consecutive patients were admitted with STEMI. 535 survived to discharge, from which 302 (56,5%) had MVCAD and were included in the analysis. We stratified the patients according to the revascularization strategy in two groups: culprit-lesion-only PCI and PCI of non-culprit vessels with angiographic significant stenosis. Patients were followed for 8 years. The primary endpoints were reinfarction in any vessel and all-cause death. Secondary endpoints included target vessel failure (TVF) (any repeat revascularization in the index culprit vessel), heart failure (HF) hospitalization and stroke.

Results

Of the 302 cases, 217 (74.2%) were men and the median age was 63 years. 150 (49.7%) had 2-vessel, 152 (50.3%) had 3-vessel disease and 104 (34.4%) underwent non-culprit vessel PCI. The mean follow-up time was 6.95 (± 2.29) years. Overall, the culprit-lesion-only group was older (median: 66 vs 59.5 years; p < 0.001) and had a lower proportion of smokers (41.9% vs 59.6%; p = 0.003). There were no significant differences between the groups’ other main comorbidities. The culprit-lesion-only group had a shorter hospital stay (median: 7.0 vs 7.5; p = 0.013), despite presenting at higher Killip class (24.4% vs 10.6% in Killip II-IV; p = 0.004). Regarding index PCI, no-reflow phenomenon was more common in the culprit-lesion-only group (7.1% vs 1.0%; p = 0.020), where the use of drug-eluted stents was more prevalent in the remote-vessel PCI group (69.2% vs 47.0%; p = 0.001). There was a higher risk of reinfarction (Adjusted hazard ratio (HR) 2.46; 95% CI [1.12 – 5.38]; p = 0.008) and TVF (Adjusted HR 2.37; 95% CI [1.02 – 5.48]; p = 0.044) in the culprit-lesion-only PCI group after relevant variable adjustment, with no significant differences in all-cause mortality. There were no significant differences in any of the remaining secondary outcomes.

Conclusions

Randomized trials and successive metanalysis have demonstrated benefit in complete revascularization after STEMI regarding the incidence of reinfarction and cardiovascular death. However, the long term impact on all-cause death is still unclear. This study corroborates the main findings in the literature, while suggesting lack of effect on overall mortality on a long-term follow-up.
Early outcome of on- versus off-hours admission in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) during COVID-19 pandemic
Authors: Gjana A , Skenderi A , Kristo A , Pavli E , Tafaj E , Simoni L , Kresto L , Seiti J , Duka A , Katana E , Kastrati A , Dibra A
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Most of studies have found no relevant impact of admission time on STEMI outcome among patients treated with primary PCI. Whether this observation has been affected by coronavirus disease (COVID-19) pandemic, in particular during the curfew application, has not been evaluated.

Purpose

To study the influence of admission time on the outcome of STEMI patients treated with primary PCI during COVID-19 pandemic in a large volume University Hospital Center, the only center capable of primary PCI serving a large area without an established STEMI network

Methods

Characteristics and outcomes of 308 consecutive STEMI patients admitted to our center between May 28 to December 2020, were collected. On-hours were defined as admission from Monday through Friday from 8:00 to 15:30 and off-hours admission from 15:30 to 8:00, weekends and non-working holidays. Clinical characteristics, key time delays and in-hospital and 3-month mortality were evaluated.

Results

75 (24%) patients were admitted on-hours and 233 (76%) patients were admitted off-hours. There were no differences between groups regarding baseline clinical characteristics, laboratory data and STEMI clinical presentation. Median time from pain onset to coronary care unit admission was 4.0 hours in the on-hours group versus 6.0 hours in the off-hours group (p=0.11). Median time from coronary care unit to cathlab was 1.5 hours in the on-hours group versus 1.0 hour in the off-hour group (p=0.14). There was no difference between on-hours versus off- groups regarding in-hospital mortality (4% versus 6%, p=0.77) and 3-month mortality (10% versus 10%, p=0.76), as well as recurrent infarction (p=0.56) and stent thrombosis (p=0.64).

Conclusion(s)

Despite the lack of an organized STEMI network, patients admitted to a large-volume primary PCI tertiary center during COVID-19 pandemic, had similar outcome regardless their admission during on-hours or off-hours. Althgouh the specific impact of curfew on out of hospital time delays could not be assessed, it did not appear to influence patient outcomes.
The prognostic impacts of frailty status on clinical and patient-related outcomes in patients undergoing coronary artery or valvular surgeries/procedures: a systematic review and meta-analysis
Authors: Wong C W Y , Yu D S F , Li P W C , Chan B S Y
Published: May 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Frailty is emerging as an important prognostic indicator for patients undergoing cardiac surgeries or procedures.

Purposes

We sought to evaluate the prognostic and differential impacts of frailty on patients undergoing coronary artery or valvular surgical procedures of different levels of invasiveness, as well as to explore the differential predictability of various frailty measurement models.

Methods

Nine databases were searched for prospective cohort studies that have adopted validated measure(s) of frailty and reported clinical, healthcare service utilisation, or patient-reported outcomes in patients undergoing coronary artery or valvular surgeries/procedures. Meta-analysis was conducted using random-effects model.

Results

Sixty-two articles were included (N = 16,679). Frailty significantly predicted mortality (short-term [≤ 30 days]: odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.28–4.26; mid-term [1 year]: OR: 3.93, 95% CI: 2.65–5.83; long-term [>1 year]: HR: 2.23, 95% CI: 1.60–3.11), postoperative complications (ORs: 2.54–3.57), discharge to care facilities (OR: 5.52, 95% CI: 3.84–7.94), hospital readmissions (OR: 2.00, 95% CI: 1.15–3.50), and reduced health-related quality of life (HRQoL; SMD: −0.74, 95% CI: −1.30 to −0.18) (Figure 1 and 2). Subgroup analyses showed that frailty exerted a greater impact on short-term mortality in patients undergoing open-heart surgeries than those receiving transcatheter procedures (Figure 1A), but no significant difference was observed for mid- and long-term mortality between these two groups of patients (Figure 1B and C). Multidimensional and physical-aspect-focused frailty measurements equally predicted mortality and complications, but multidimensional measurements were more predictive of hospital readmissions than physical-aspect-focused measurements (Figure 2B).

Conclusion

Frailty was predictive of postoperative mortality, complications, increased healthcare service utilisation, and reduced HRQoL. The impact of frailty on short-term mortality was more prominent in patients undergoing open-heart surgeries than those receiving transcatheter procedures. Multidimensional measures of frailty enhanced prognostic risk estimation, especially for hospital readmissions, demonstrating a need to incorporate a formal frailty assessment into routine preoperative risk evaluation to inform therapeutic decision-making.
Cardiogenic shock due to probable SARS-CoV-2 myocarditis—a case report
Authors: Klasen Martiene , Smit Marije , Renes Maurits , Damman Kevin , Droogh Joep M
Published: May 2023

Background

Since the start of the COVID-19 pandemic, many case reports have been presented describing different cardiac symptoms due to the SARS-CoV-2 infection. However, severe cardiac failure due to COVID-19 seems to be rare.

Case summary

A 30-year-old woman presented with COVID-19 and cardiogenic shock due to a lymphocytic myocarditis. Since she deteriorated under treatment with inotropes, she was referred to our centre, and veno-arterial extracorporeal life support was started. Subsequently, the aortic valve only opened sporadically, and spontaneous contrast appeared in the left ventricle (LV), pointing towards difficulties with unloading LV. Therefore, an Impella for venting the LV was implanted. After 6 days of mechanical circulatory support, her heart function recovered. All support could be weaned, and 2 months later, she had made a full recovery.

Discussion

We presented a patient with severe cardiogenic shock due to an acute virus-negative lymphocytic myocarditis associated with a SARS-CoV-2 infection. Since the precise aetiology of SARS-CoV-2-related myocarditis remains to be elucidated and no virus could be detected in the heart, a causal relationship remains speculative.
Micro-evolutionary response of spring migration timing in a wild seabird
Authors: Moiron Maria , Teplitsky Céline , Haest Birgen , Charmantier Anne , Bouwhuis Sandra
Published: May 2023

In the context of rapid climate change, phenological advance is a key adaptation for which evidence is accumulating across taxa. Among vertebrates, phenotypic plasticity is known to underlie most of this phenological change, while evidence for micro-evolution is very limited and challenging to obtain. In this study, we quantified phenotypic and genetic trends in timing of spring migration using 8,032 dates of arrival at the breeding grounds obtained from observations on 1,715 individual common terns (Sterna hirundo) monitored across 27 years, and tested whether these trends were consistent with predictions of a micro-evolutionary response to selection. We observed a strong phenotypic advance of 9.3 days in arrival date, of which c. 5% was accounted for by an advance in breeding values. The Breeder’s equation and Robertson’s Secondary Theorem of Selection predicted qualitatively similar evolutionary responses to selection, and these theoretical predictions were largely consistent with our estimated genetic pattern. Overall, our study provides rare evidence for micro-evolution underlying (part of) an adaptive response to climate change in the wild, and illustrates how a combination of adaptive micro-evolution and phenotypic plasticity facilitated a shift towards earlier spring migration in this free-living population of common terns.
Multi-omics identifies large mitoribosomal subunit instability caused by pathogenic MRPL39 variants as a cause of pediatric onset mitochondrial disease
Authors: Amarasekera Sumudu S C , Hock Daniella H , Lake Nicole J , Calvo Sarah E , Grønborg Sabine W , Krzesinski Emma I , Amor David J , Fahey Michael C , Simons Cas , Wibrand Flemming , Mootha Vamsi K , Lek Monkol , Lunke Sebastian , Stark Zornitza , Østergaard Elsebet , Christodoulou John , Thorburn David R , Stroud David A , Compton Alison G
Published: May 2023

MRPL39 encodes one of 52 proteins comprising the large subunit of the mitochondrial ribosome (mitoribosome). In conjunction with 30 proteins in the small subunit, the mitoribosome synthesizes the 13 subunits of the mitochondrial oxidative phosphorylation (OXPHOS) system encoded by mitochondrial Deoxyribonucleic acid (DNA). We used multi-omics and gene matching to identify three unrelated individuals with biallelic variants in MRPL39 presenting with multisystem diseases with severity ranging from lethal, infantile-onset (Leigh syndrome spectrum) to milder with survival into adulthood. Clinical exome sequencing of known disease genes failed to diagnose these patients; however quantitative proteomics identified a specific decrease in the abundance of large but not small mitoribosomal subunits in fibroblasts from the two patients with severe phenotype. Re-analysis of exome sequencing led to the identification of candidate single heterozygous variants in mitoribosomal genes MRPL39 (both patients) and MRPL15. Genome sequencing identified a shared deep intronic MRPL39 variant predicted to generate a cryptic exon, with transcriptomics and targeted studies providing further functional evidence for causation. The patient with the milder disease was homozygous for a missense variant identified through trio exome sequencing. Our study highlights the utility of quantitative proteomics in detecting protein signatures and in characterizing gene-disease associations in exome-unsolved patients. We describe Relative Complex Abundance analysis of proteomics data, a sensitive method that can identify defects in OXPHOS disorders to a similar or greater sensitivity to the traditional enzymology. Relative Complex Abundance has potential utility for functional validation or prioritization in many hundreds of inherited rare diseases where protein complex assembly is disrupted.
Traditional values, family, homeschooling: The role of Russia and the Russian Orthodox Church in transnational moral conservative networks and their efforts at reshaping human rights
Authors: Stoeckl Kristina
Published: May 2023

In the last two decades, Russian state actors and the Russian Orthodox Church have come to play an increasingly important role in the undermining of established understandings of international human rights law by reinterpreting its aims and repurposing its institutions, in particular the Universal Declaration of Human Rights, the United Nations Human Rights Council, and the European Court of Human Rights. Russian state and church leaders have appropriated and coopted the language of human rights in order to advance an illiberal and nationalist agenda that undercuts democratic values and targets particular groups and their rights and freedoms—most notably liberal civil society, political opposition, and the LGBTIQ+ community. Written from the angle of a constructivist sociology of human rights, this article brings together three case studies of Russian rights appropriation around the topics of traditional values, family, and homeschooling and draws six lessons on the (mis)appropriation of human rights for illiberal purposes. The analysis of Russia’s rights appropriation sheds light on the background and build-up for current events in Russia’s war against Ukraine.
Elites’ (De)legitimation Practices toward International Organizations
Authors: Uhlin Anders , Verhaegen Soetkin
Published: May 2023

Research on legitimacy of international organizations (IOs) has often focused on discursive self-legitimation by IOs. This article explores the role of other (de)legitimizing actors. Distinguishing between elites of different political and societal sectors, we use unique data from a survey of 860 political and societal elites in Brazil, Germany, the Philippines, Russia, South Africa, the United States, and a global elite group, to perform the first systematic analysis of elites’ (de)legitimation practices toward IOs. We analyze behavioral as well as discursive practices that may boost or challenge citizens’ legitimacy beliefs toward IOs, and describe how elites’ repertoires of (de)legitimation practices vary across IOs, elite sectors, and geographical locations. Explanatory analyses test whether the use of legitimation and delegitimation practices can be explained by characteristics of the interviewed elites. We find that most elites engage in (de)legitimation of IOs. Legitimation is more common than delegitimation. While discursive practices are more frequently used, behavioral practices are more widespread than acknowledged in previous research. Societal elites are more frequent (de)legitimizers of IOs than assumed in more state-centric accounts of global governance. Attitudes of elite individuals (confidence in the IO and ideological position) partly explain engagement in (de)legitimation. By providing the general pattern of elite (de)legitimation of IOs, the article sets the scene for more detailed case studies of diverse (de)legitimation practices toward specific IOs.
Proof-carrying parameters in certified symbolic execution
Authors: Arusoaie Andrei , Lucanu Dorel
Published: May 2023

Complex frameworks for defining programming languages aim to generate various tools (e.g. interpreters, symbolic execution engines, deductive verifiers, etc.) using only the formal definition of a language. When used at an industrial scale, these tools are constantly updated, and at the same time, it is required to be trustworthy. Ensuring the correctness of such a framework is practically impossible. A solution is to generate proof objects as correctness artefacts that can be checked by an external trusted checker. A logic suitable for developing such frameworks is matching logic. K framework is a canonical example having matching logic-based foundation. Since the (symbolic) configurations of the programs are represented by matching logic patterns, the algorithms computing the dynamics of these configurations can be seen as pattern transformers and a proof object should be generated for the relationship between these patterns. In this paper, we show that conjunctions and disjunctions of patterns, produced by semantics or analysis rules, can be safely normalized using unification and antiunification algorithms. We also provide a prototype implementation of our proof object generation technique and a checker for certifying the generated objects.
Clinical results of proton beam radiotherapy for inoperable stage III non-small cell lung cancer: a Japanese national registry study
Authors: Tatebe Hitoshi , Harada Hideyuki , Mori Keita , Iwata Hiromitsu , Akimoto Tetsuo , Murakami Masao , Waki Takahiro , Ogino Takashi , Nakamura Masatoshi , Taguchi Hiroshi , Nakayama Haruhiko , Satouchi Miyako , Aoyama Hidefumi
Published: May 2023

This study presents the first data of a Japanese nationwide multi-institutional cohort and compares them with the findings of systematic literature reviews on radiation therapies and inoperable stage III non-small cell lung cancer (NSCLC) conducted by the Lung Cancer Working Group in the Particle Beam Therapy (PBT) Committee and Subcommittee at Japanese Society for Radiation Oncology. The Lung Cancer Working Group extracted eight reports and compared their data with those of the PBT registry from May 2016 to June 2018. All the analyzed 75 patients aged ≤80 years underwent proton therapy (PT) with concurrent chemotherapy for inoperable stage III NSCLC. The median follow-up period of the surviving patients was 39.5 (range, 1.6–55.6) months. The 2- and 3-year overall survival (OS) and progression-free survival rates were 73.6%/64.7% and 28.9%/25.1%, respectively. During the follow-up period, six patients (8.0%) had adverse events of Grade ≥ 3, excluding abnormal laboratory values. These included esophagitis in four patients, dermatitis in one and pneumonitis in one. Adverse events of Grade ≥ 4 were not observed. The results of these PBT registry data in patients with inoperable stage III NSCLC suggest that the OS rate was at least equivalent to that of radiation therapy using X-rays and that the incidence of severe radiation pneumonitis was low. PT may be an effective treatment to reduce toxicities of healthy tissues, including the lungs and heart, in patients with inoperable stage III NSCLC.
First case of nickel-metal hydride battery ingestion in child
Authors: Hui Martha Lok-Yung , Ng Justin Ho-Yin
Published: May 2023

We describe a case of a 12-year-old female with a past history of autism spectrum disorder who presented to the emergency department of a rural hospital in Australia after ingesting two nickel-metal hydride (NiMH) batteries at home. Hitherto, no literature has described any gastrointestinal complications related to NiMH battery ingestion. This paper aims to provide insight into the management of NiMH battery ingestion and to increase the awareness of the need for prompt management to prevent further damage to the gastrointestinal tract.
Multiloculated omental cystic tumor hiding an angioleiomyoma: case report of a rare and atypical presentation and literature review
Authors: Giambusso Mauro , Caprino Paola , Sacchetti Franco , Potenza Angelo Eugenio , Pastena Dario , Sofo Luigi
Published: May 2023

Angioleiomyoma is a rare benign tumor arising from vascular smooth muscle and generally located in the subcutaneous tissue of the extremities. We reported a rare case of an intra-abdominal localization originating from the small omentum in which progressive growth detected on radiological follow-up indicated surgical excision. Histology documented a cavernous angioleiomuscular tumor with uncertain potential for malignancy. Although angioleiomyoma is described as a benign tumor, the uncertain behavior for malignancy of this case could have led to neoplastic degeneration. Early diagnosis followed by surgical excision of the neoplasia is crucial.
Observed dust surface density across cosmic times
Authors: Péroux Céline , De Cia Annalisa , Howk J Christopher
Published: May 2023

Our ability to interpret observations of galaxies and trace their stellar, gas, and dust content over cosmic time critically relies on our understanding of how the dust abundance and properties vary with environment. Here, we compute the dust surface density across cosmic times to put novel constraints on simulations of the build-up of dust. We provide observational estimates of the dust surface density consistently measured through depletion methods across a wide range of environments, going from the Milky Way up to z = 5.5 galaxies. These conservative measurements provide complementary estimates to extinction-based observations. In addition, we introduce the dust surface density distribution function – in analogy with the cold gas column density distribution functions. We fit a power law of the form log f(ΣDust) = −1.92 × log ΣDust − 3.65, which proves slightly steeper than that for neutral gas and metal absorbers. This observed relation, which can be computed by simulations predicting resolved dust mass functions through 2D projection, provides new constraints on modern dust models.