bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence, timing, predictors, and impact of sustained ventricular arrhythmia complicating st-segment elevation myocardial infarction
Authors: Auffret V , Bourenane H , Sharobeem S , Martins R , Leurent G , Bedossa M , Boulmier D , Le Breton H 
Published: November 2020

Abstract

Aims
To describe the incidence, predictors, and in-hospital impact of early SVA (eSVA, occurring &lt; day 2 post-STEMI) and late SVA (lSVA, occurring ≥ day 2 post-STEMI) in STEMI patients. To derive and internally validate a risk score to identify patients at high-risk of lSVA.

Methods
Data of 13523 patients enrolled in the ORBI registry were analysed. Logistic regression was performed to identify predictors of eSVA, lSVA, and in-hospital all-cause mortality. Predictors of lSVA were used to build a risk score.

Results
eSVA occurred in 678 patients (5%) whereas 120 patients (0.9%) experienced lSVA at a median timing of 3 days post-STEMI. eSVA associated with a significantly higher risk of all-cause mortality (adjusted OR:1.90, 95% CI: 1.39–2.61, p&lt;0.001) whereas only a trend was observed with lSVA (adjusted OR: 1.69, 95% CI:0.91–3.13, p=0.09). Multivariable predictors of eSVA are listed in Table 1. Multivariable predictors of lSVA are listed in the Figure. The score derived from these variables allowed the classification of patients into four risk categories: low (0–21), low-to- intermediate (22–34), intermediate-to-high (35–44), and high (≥45). Observed lSVA rates were 0.2%, 0.4%, 0.8%, and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow p=0.40).

Conclusion
eSVA are 5-fold more common than lSVA in the setting of STEMI, mainly associate with other early complications, and portends a 2-fold higher risk of in-hospital mortality. Moreover, we developed a risk score identifying patients at high risk of lSVA for whom early ICU discharge may not be suitable.

Funding Acknowledgement
Type of funding source: None
Delay between symptom onset and hospital admission in patients with ST-elevation myocardial infarction: different trends in men and women
Authors: Witassek F , Rickli H , Roffi M , Pedrazzini G , Eberli F , Fassa A , Jeger R , Fournier S , Erne P , Radovanovic D 
Published: November 2020

Abstract

Introduction
The aim of this study was to analyse whether prehospital delay in ST-elevation myocardial infarction (STEMI) has changed in men and women since 2002.

Methods
We used data from the AMIS Plus registry of patients who were admitted for STEMI between 2002 and 2019. Patients who were transferred from another hospital or were resuscitated before admission were excluded. Patient delay was defined as the difference between symptom onset and hospital admission time. Trends in delay according to gender were depicted by medians per year with a 95% confidence interval. Differences between men and women were tested using the Mann-Whitney test. To analyse the adjusted effect of gender on delay, multivariable quantile regression was applied including the interaction between gender and admission year as well as the covariates age, diabetes, pain at presentation and myocardial infarction (MI) history.

Results
Among the 15,154 patients included (74.5% men), the overall median (IQR) delay between 2002 and 2019 was 150 (84; 345) minutes for men and 180 (100; 415) for women. Women were older (71.3y vs. 62.8y, p&lt;0.001), had more often diabetes (20.0% vs. 16.9%, p&lt;0.001), but less often MI history (11.2% vs. 14.9%, p&lt;0.001) and less often pain at presentation (92.0% vs. 94.8%, p&lt;0.001).
The unadjusted median delay decreased over the admission years. The decreasing trend was stronger in women than men: the unadjusted difference in delay between men and women decreased from 60 min in 2002 (p=0.003) to 15 min in 2019 (p=0.155) (Fig 1). The multivariable model confirmed a significant interaction between gender and admission year (p=0.042) indicating that the decrease in delay was stronger for women (−3.1 min per year) than for men (−1.4 min per year) even after adjustment. The adjusted difference between men and women decreased from 27.4 min in 2002 to −1.6 min for women in 2019. Additional independent predictors of longer delay were the covariates age (+1.6 min per additional year, p&lt;0.001) and diabetes (+27.1 min, p&lt;0.001). Conversely, pain at admission (−46.3 min, p&lt;0.001) and MI history (−32.9 min, p&lt;0.001) predicted a shorter delay.

Conclusions
The difference in delay between symptom onset and hospital admission in STEMI patients between men and women steadily diminished from 2002 to 2019. This might indicate that the public and health professionals' awareness of STEMI in women has ameliorated over time.
Unadjusted delay according to gender

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): AMIS Plus Foundation
Association of microRNA-224 and microRNA-155 expressions with coronary microvascular obstruction following primary angioplasty for acute ST-segment elevation myocardial infarction
Authors: Dharma S , Dakota I , Wijaya S , Ekawati E , Siswanto B 
Published: November 2020

Abstract

Background
Proinflammatory stimuli induce a variety set of microRNAs (miRs) expressions in human mononuclear cells that regulate long pentraxin-3 (PTX3) gene, which associates with a procoagulant state in the endothelial cells.

Purpose
We evaluated, for the first time, the association of miR-224 and miR-155 expressions with coronary microvascular obstruction (MVO) and plasma PTX3 concentration in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty.

Methods
The expression levels of miR-224 and miR-155 on admission were evaluated in 217 consecutive patients with STEMI (symptom onset &lt;12h) undergoing primary angioplasty between January 2018 and August 2018, and results were analyzed by the median values. The miRs expression and plasma PTX3 concentration were measured by TaqMan real-time PCR and human ELISA kit, respectively. The primary outcome of the study was the occurrence of angiographic MVO, defined as a post-primary angioplasty TIMI grade &lt;3 flow or TIMI grade 3 flow with myocardial blush grade 0 or 1.

Results
After adjustment with sex, age and plasma PTX3 concentration, miR-244 ≥ median group was associated with angiographic MVO (odds ratio, 2.81; 95% confidence interval 1.34 to 5.92, p=0.006). Spearman analysis showed no correlations between miR-224 and miR-155 expressions with plasma PTX3 concentration.

Conclusion
This study suggests that miR-224 expression, (but not miR-155), associates with angiographic MVO following primary angioplasty for STEMI. However, miR-224 and miR-155 expressions did not correlate with plasma PTX3 concentration. Future studies are needed to find the molecular inflammatory pathway related with miR-224 expression in MVO.

Funding Acknowledgement
Type of funding source: None
Development of 1- and 5-year outcomes between 2006 and 2018 in patients with uncomplicated ST-elevation myocardial infarctions and successful percutaneous coronary intervention
Authors: Schmucker J , Fach A , Osteresch R , Retzlaff T , Garstka D , Langer H , Hambrecht R , Wienbergen H 
Published: November 2020

Abstract

Introduction
While modern P2Y12-inhibitors and drug eluting stents (DES) have changed therapeutic options in patients with ST-elevation mycoardial infarctions (STEMI) during the last decade, there is few data on their impact in real world registries. Aim of the present study was to analyze changes in mortality and major adverse cardiac and cererobrovascular event rates (MACCE: death, reinfarction,stroke) during the last 13 years in patients with uncomplicated STEMI after successful percutaneous coronary intervention (PCI).

Methods
All consecutive STEMI-patients, admitted between 2006 and 2018 and successfully treated with PCI (TIMI flow ≥2) in a large German heart center entered analysis. To reduce confounding pts. with STEMI complicated by heart failure and pts. &gt;70 yrs. of age were excluded.

Results
A STEMI-cohort of 5016 pts. was analysed, with a mean age of 55.9±8 yrs., 19% females, 16% diabetics and 59% smokers. At the beginning of the study period (2006) no patient was treated with ticagrelor/prasugrel and only 5% had a DES implanted. In 2018 92% were treated with prasugrel or ticagrelor and 96% with a DES. The reduction in 1-year-mortality during the study period was not significant: 2006–11: 3.4%, 2012–19: 3.1%, p=0.4, however the reduction in 1-year-MACCE was: 2006–11: 8.3%, 2012–18: 5.7%, p&lt;0.01. This could mainly be attributed to a reduction in reinfarctions: 2006–11: 4.9%, 2012–18: 2.8%, p&lt;0.01. Subgroup analysis revealed that with the exception of diabetics all subgroups showed a significant decline in MACCE-rates during the study period. It was more pronounced in women, non-smokers and patients with a high socioeconomic status (SES) (Table). Analysis of 5-year-data revealed a significant reduction in both 5-year-mortality (2006–09: 9.1%, 2010–13: 6.8%, p&lt;0.01) and 5-year-MACCE-rates: 2006–09: 19.3%, 2010–13: 14.5%, p&lt;0.01.

Conclusions
This analysis of registry data over a study period of 13 years reveals, that for patients with uncomplicated STEMI and successful PCI a significantly better 1- and 5-year-outcome could be achieved during the last years. This improvement of prognosis was more pronounced in specific subgroups, such as women, non-diabetics and patients with higher SES.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Stiftung Bremer Herzen, Gesundheit Nord
Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry
Authors: Martin-Demiguel I , Nunez-Gil I , Perez-Castellanos A , Vedia O , Uribarri A , Duran-Cambra A , Martin-Garcia A , Corbi-Pascual M , Guillen Marzo M , Martinez-Selles M 
Published: November 2020

Abstract

Background
Our aim was to describe the prevalence and prognostic significance of electrocardiographic features in patients with Takotsubo syndrome (TTS).

Methods
Our data come from the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with complete electrocardiogram were included.

Results
246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T-waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV. Mean corrected QT interval was 520±72 ms and it was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was also an independent predictor of the primary endpoint (p=0.001) and of developing acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Arrhythmias were independently associated with cardiogenic shock (p&lt;0.001).

Conclusion
Prolonged corrected QT interval, arrhythmia, heart rate at admission and broader repolarization alterations are associated with a poor outcome in TTS.
Typical ECG at admission and after 48h.

Funding Acknowledgement
Type of funding source: None
The association between early use of targeted temperature management and neurological outcome after cardiac arrest: a national registry research
Authors: Lin K.C , Huang W.C , Wang M.T , Kuo S.H , Jiang Y.C , Liang H.L , Hsu T.H , Chang Y.T , Huang C.H , Lin Y.S 
Published: November 2020

Abstract

Introduction
Targeted temperature management (TTM) was shown to have favorable outcome in patients with cardiac arrest. However, there were still limited publications about the impact of the time intervalsfromreturn of spontaneous circulation (ROSC) to the initiation of TTMin patients after cardiac arrest.The aim of this study is toinvestigate the association between the time intervalsfrom ROSC to the initiation of TTMand the favorable neurological outcomes.

Methods
The data used the Taiwan Network of Targeted Temperature Management for Cardiac arrest (TIMECARD) registry database. Patients with cardiac arrest received TTMwere collected from June 2018 to June 2019. Very early, early, late, very late, and delayed TTM groups were defined as the time from cardiac arrest to initiation of TTM 0 to 5 hours,5 to 8 hours, 8 to 11 hours, 11 to 14 hours, and &gt;14 hours respectively. A totalof 559 patients were divided into5 groups: very early group (N=82), early (N=150), late (N=118), very late (N=71) and delayed group (N=138).

Results
The baseline character were not different among 5 groups. Favorable neurological outcomes (cerebral performance category 1 and 2) in the very early, early, late, very late and delayed groupswere 66.67%, 33.33%, 50%, 25%, and 14.29% respectively. The Cox analysis showed very late and delayed group had worse neurologic outcome (HR=1.829, 95% CI=1.04- 3.23, p=0.0371). There is also trend to have worse neurologic outcome in late group (HR=1.734, 95% CI=0.91- 3.30, p=0.0939).

Conclusion
This national registry study demonstrated that early initiation of TTM in patients with cardiac arrest was associated with improved favorable neurological outcomes compared with those with late initiation of TTM.

Funding Acknowledgement
Type of funding source: None
Short-term immediate post-shock pacing in adult advanced life support – a feasibility study of modified ALS algorithm
Authors: Telec W , Klosiewicz T , Zalewski R , Zukowska J , Baszko A , Puslecki M 
Published: November 2020

Abstract

Introduction
It is well known that the majority of patients remains transiently pulseless after successfull defibrillation shock during routine advanced cardiovascular life support (ACLS). The post-shock asystole is longer than 120 seconds in as many as 25% of patients. Not only asystole, but also profound postshock bradycardia and high degree AV blocks are described as common.
The need for post-shock pacing (PSP) in adult ACLS is unknown, but there is extensive use of that feature in implantable cardioverters – defibrillators (ICD). PSP feature is widely used in these devices. The wide utilisation of PSP in ICD patients warrants the research towards any possible benefit of it during ACLS measures.

Material and methods
We performed high-fidelity simulation study including 60 paramedic at 20 scenarios. The participants were asked to perform routine resuscitation scenarios according to the AHA ACLS algorithm.
In the control group paramedics had to resume compressions after each shock. In experimental group simultaneously with the compressions, transcutaneous pacing with 200 mA output and rate of 80 ppm was delivered. Several parameters were monitored: chest compression fraction, compressions depth and rate, percent of recoiled compression, compressions on correct depth, and other.

Results
There were no statistically significant differences between both groups in respect of compressions depth and rate, time needed to achieve advanced airway, initiate and achieve intravenous line, administer medications (Table 1). The detailed results are presented in Table 1.

Discussion
According to the best of the authors knowledge, this is the first study describing the feasibility of PSP in resuscitation. The quality of resuscitation depends on adherence to the protocol. Any additional element in the protocol can negatively affect the outcome. In the presented study we present that major ACLS steps are delivered without significant delay when PSP is utilised.

Conclusions
The implementation of PSP had no negative impact on adherence to ACLS protocol. The authors see the need for further intensive research in this area.
Figure 1. Design of the study.

Funding Acknowledgement
Type of funding source: None
Circulating presepsin (soluble CD14 subtype) as a novel marker of mortality in patients treated at medical cardiac intensive care units
Authors: Ishii J , Takahashi H , Nishimura H , Fujiwara W , Ohta M , Kawai H , Muramatsu T , Harada M , Yamada A , Naruse H , Motoyama S , Watanabe E , Izawa H , Ozaki Y 
Published: November 2020

Abstract

Background
Presepsin, a subtype of soluble CD14, is an inflammatory marker, which largely reflects monocyte activation. The association between presepsin levels and mortality in patients treated at medical cardiac intensive care units (CICUs) remains poorly known.

Objective
We aimed to understand the prognostic value of presepsin levels on admission to medical CICUs for mortality.

Methods
We prospectively studied 1636 heterogeneous patients (median age; 71 years) treated at medical (non-surgical) CICUs. Patients with stage 5 chronic kidney disease (estimated glomerular filtration rate [eGFR] &lt;15 mL/min/1.73 m2) were excluded. Acute coronary syndrome was present in 46% of the patients, and acute decompensated heart failure in 36%. Upon admission, baseline plasma presepsin levels were measured. The primary endpoint was all-cause death.

Results
During a mean follow-up period of 44.6 months after admission, there were 323 (19.7%) deaths. Patients who died were older (median: 75 vs. 71 years, P&lt;0.0001); had higher levels of presepsin (194 vs. 110 pg/mL, P&lt;0.0001), B-type natriuretic peptide (BNP: 520 vs. 144 pg/mL, P&lt;0.0001), high-sensitivity C-reactive protein (hsCRP: 4.7 vs. 2.0 mg/L, P&lt;0.0001), and sequential organ failure assessment (SOFA) score (3 vs. 2, P&lt;0.0001); and had lower levels of eGFR (55 vs. 69 mL/min/1.73m2, P&lt;0.0001) and left ventricular ejection fraction (46% vs. 52%, P&lt;0.0001) than those of the survivors. Multivariate Cox regression analyses revealed presepsin levels as independent predictors of all-cause deaths when assessed as either continuous variables (relative risk [RR] 3.33 per 10-fold increment; P&lt;0.0001) or variables categorized according to quartiles (RR quartile 4 vs. 1, 3.60; P&lt;0.0001). Quartiles of presepsin levels were significantly (P&lt;0.0001) associated with increased risk of mortality (Figure). Adding presepsin levels to a baseline model that included established risk factors, BNP, and hsCRP further enhanced reclassification (P=0.009) and discrimination (P=0.0008) beyond that of the baseline model alone.

Conclusions
Circulating concentration of presepsin on admission may be a potent and independent predictor of mortality, and it may improve the risk stratification of patients admitted at medical CICUs.
Presepsin quartiles and mortality

Funding Acknowledgement
Type of funding source: None
Frailty is associated with chronic inflammation and pro-inflammatory monocyte subpopulations
Authors: Cybularz M , Wydra S , Berndt K , Poitz D , Barthel P , Pfluecke C , Linke A 
Published: November 2020

Abstract

Introduction
Patients with frailty represent an increasing patient group in the intensive care medicine. A connection between frailty and inflammation has been suggested. An increased mortality rate in patients with high grade aortic valve stenosis (AS) and frailty, who underwent Transcatheter Aortic Valve Implantation (TAVI) has been observed. A systemic inflammatory reaction in the intensive care unit in the first days after TAVI is a positive predictive factor for an unfavorable outcome. Exact mechanisms are still not fully explained. Monocyte subpopulations are associated with both cardiovascular diseases and a high APACHE II score in critically ill patients.

Purpose
This study investigates the correlation between frailty and cellular and systemic inflammatory mechanisms and mortality after TAVI.

Methods
We examined 120 patients with symptomatic AS who underwent TAVI. Before the implantation, frailty status has been assessed. In all patients a flow cytometry analysis has been performed. Monocyte subpopulations were defined as follows: Mon1 (CD14++CD16–), Mon2 (CD14++CD16+) and Mon3 (CD14+CD16++). Expression of CD11b has been measured as a marker for monocyte activation. Pro-inflammatory cytokines such as interleukin IL-8, as well as CRP have been measured with Cytometric Bead Array or standard laboratory methods.

Results
After 3 months 15 of 120 patients died, primarily without relevant dysfunction of the implanted aortic valve. In 8 of 15 (53%) of the deceased patients and 20 of 100 (19%) of the surviving patients, frailty could be diagnozed before TAVI (p=0.003). Patients with frailty showed prior to TAVI signs of chronic inflammation: elevated CRP (3.7 vs. 5.9 mg/l, p=0.001) and elevated levels of considered as pro-inflammatory Mon2 monocytes (37 vs. 53, p=0.001). Expression of CD11b and IL-8 showed an increasing trend in patients with frailty. Frailty, the monocyte markers, IL-8 and CRP prior to TAVI correlated with increased early mortality after TAVI.

Conclusion
A considerable number of elderly patients with high grade aortic valve stenosis can be described as frail. This syndrome is associated with increased mortality and with signs of chronic systemic inflammation and pro-inflammatory monocytes.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Heart Center Dresden
Predictive Role of Selvester QRS Score in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: Bignoto T , Le Bihan D , Barretto R.B.M , Ramos A.I.O , Moreira D.A.R , Simonato M , Siqueira D.A.A , Pinto I.M.F , Santos T.S.G , Sousa A.G.M.R , Abizaid A 
Published: November 2020

Abstract

Introduction
Few data exist regarding the late clinical impact of the Selvester score prediction of myocardial fibrosis after transcatheter aortic valve replacement (TAVR). This study evaluated the predictive power of the Selvester score on survival in patients with aortic stenosis (AS) undergoing TAVR.

Methods and results
Patients with severe AS who had preoperative electrocardiograms were included. Clinical follow-up was obtained retrospectively. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular death and major adverse cardiac events (MACE). Two hundred twenty-eight patients were included (mean age, 81.5±7.4 years; women, 58.3%). Deceased patients had a higher mean score (4.6±3.2 vs. 1.4±1.3; p&lt;0.001). At a mean follow-up of 36.2±21.2 months, the Selvester score was independently associated with all-cause mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.48–1.84; p&lt;0.001), cardiovascular death (HR, 1.59; 95% CI, 1.38–1.74; p&lt;0.001), and MACE (HR, 1.55; 95% CI, 1.30–1.68; p&lt;0.001). After 5 years, the mortality risk was incrementally related to the Selvester score. The involvement of the inferior wall of the left ventricle was a lower mortality risk (HR, 0.42; 95% CI, 0.18 to 0.98; p=0.046). For a Selvester score of 3, the area under the curve showed 0.92, 0.94, and 0.86 (p&lt;0.001), respectively, for 1, 2, and 3 years.

Conclusions
Elevated Selvester scores increase the risk of poor outcomes in patients with AS undergoing TAVR. The involvement of the anterior or lateral wall presents worse prognosis.
Kaplain Meier and ROC Curve

Funding Acknowledgement
Type of funding source: None