bluuebunny/crossref_metadata_2025_split huggingface dataset:
P825Long-term clinical benefit of atorvastatin pretreatment before primary percutaneous coronary intervention in patients with STEMI: a multi-center propensity score-matched study
Authors: Yang J G , Gao P , Chen T G , Li X , Xu H Y , Gao X J , Yang Y J 
Published: October 2019

Abstract

Aims
We aim to investigate the effect of single dose of statin pretreatment prior to primary Percutaneous Coronary Intervention (PCI) on long-term clinical outcomes in patients with ST-elevation Myocardial Infarction (STEMI).

Methods
Using data from China Acute myocardial Infarction (CAMI) registry, we compared the outcome in STEMI patients with vs without atorvastation pretreatment prior to primary PCI. The primary endpoint was the composite outcome of all-cause mortality, non-fatal MI or stroke events during follow-up. Propensity-score (PS) matching was used to assemble a cohort of patients with similar baseline characteristics. All patients were followed till 24 months since baseline.

Results
Of all 3772 patients who met our inclusion criteria at 108 hospitals in China, 3288 patients (1644 patients in each arm) were included in our PS-matched cohort. In the PS-match cohort, overall 144 (8.65%) and 113 (6.79%) patients in the control group and pretreatment group had the primary endpoint respectively (p=0.048). The estimated HRs were 0.78 (95% CI: 0.606–0.997, p=0.046) in the unadjusted model and 0.76 (95% CI: 0.596–0.984, p=0.032) in the adjusted model (Figure). The HRs were broadly similar for the pretreatment dosage of 40 mg or 80 mg (0.78 vs 0.77, p=0.75). The HRs were even stronger in patients with single-vessel only than multi-vessel coronary artery disease (0.31 vs 0.75, p=0.014).

Conclusion
Among Chinese patients with STEMI, atorvastatin pretreatment before primary PCI may have better long-term composite outcome of all-cause mortality, non-fatal MI, or stroke events.

Acknowledgement/Funding
CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)
P826Peri-procedural treatment with high dose Rosuvastatin reduces soluble TNF receptor 1 in patients treated with primary percutaneous coronary intervention for ST elevation myocardial infarction
Authors: Larsen A I , Butt N , Aukrust P , Munk P S , Nilsen J M , Orn S , Ueland T 
Published: October 2019

Abstract

Background
The extent of cardiac injury in ST elevation myocardial infarction (STEMI) depends on the level of inflammation and subsequent immune cell recruitment. An inflammatory phase that is disproportionately prolonged, of excessive magnitude, or insufficiently suppressed, can lead to sustained tissue damage and improper healing, promoting infarct expansion, adverse remodelling and chamber dilatation. Soluble TNF receptor 1 (sTNFR-1) is believed to mirror systemic pan-inflammatory status more closely than a single cytokine antigenic level. sTNFR-1 levels might give prognostic information, independent from and, at the same time, additive with some well-recognized outcome predictors such as left ventricular ejection fraction.

Purpose
We hypothesised that sTNFR-1 and other inflammatory markers could be modulated by statins.

Methods
Plasma levels of inflammatory markers were measured at baseline, 2 days, 7 days and 2 months in consecutive patients with first time STEMI with single vessel disease. Twenty-five patients (treatment group (TG)) were treated with 80 mg Rosuvastatin daily with first dose before primary percutaneous coronary intervention (PCI) whereas the control group (CG) consisted of 34 patients in whom treatment with 20 mg simvastatin daily were initiated the day after PPCI.

Results
sTNFR1 increased during the first 48 hours following PCI and this increase was larger in the CG compared with the TG (0.22±0.30 ng/mL vs 0.08±0.19 ng/nmL, p=0.025). The difference in increase during one week was only borderline statistically significant (0.21±0.30 ng/mL vs 0.08±0.26 ng/mL, p=0.081). These differences in the kinetics of sTNRF-1 were mirrored by changes in Pentraxin 3 (PTX3) between groups from baseline to 1 week, CG vs TG. (0.28±0.70 μmol/l vs 0.10±0.05 ng/mL, p=0.014) and at 2 months (−0.42±0.56 ng/mL vs 0.08±0.60 μmol/l, p=0.032)

Conclusion
High dose Rosuvastatin therapy initiated peri-procedural during PPCI for STEMI reduces pan inflammation as reflected by sTNFR1 and is associated with a less abrupt fall in PTX3 at 1 week and 2 months supporting recent research suggesting that PTX3 plays a cardiovascular protective effect in cardiovascular disease and healing.

Acknowledgement/Funding
Western Norway Regional Health Authority
P845Comparison of the performance of the five validated risk scores in acute myocardial infarction patients undergoing primary PCI
Authors: Mehmedbegovic Z , Milasinovic D , Jelic D , Zobenica V , Dedovic V , Radomirovic M , Zaharijev S , Pavlovic A , Dudic J , Tesic M , Zivkovic M , Veljic I , Asanin M , Vukcevic V , Stankovic G 
Published: October 2019

Abstract

Background
Several risk scores have been developed to predict mortality of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI), with limited data on the comparative prognostic value of these models.

Purpose
We aimed to compare the prognostic value of five validated risk scores for in-hospital and one-year mortality of patients with AMI undergoing pPCI.
ume catheterization laboratory in a period from January 2009 to December 2017, a total of 3868 consecutive patients who underwent pPCI were available for analysis. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), ACTION Registry-GWTG in-hospital mortality risk score (ACTION), Age, Creatinine, and Ejection Fraction (ACEF), and ZWOLLE risk scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality were assessed (follow-up available for 92% of pts). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively.

Results
Mortality rates for in-hospital and one-year mortality were 1.8% and 6.9% respectively. All five scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1):
Table 1 Risk score H-L H-L p AUC in-hospital 95% CI Significant p AUC one-year 95% CI Significant p ZWOLLE 1.3 0.7 0.90 0.89–0.91 vs. CADILLAC <0.05 0.75 0.74–0.77 vs. TIMI <0.005 ACTION 13.1 0.1 0.87 0.86–0.88 vs. TIMI <0.005 0.79 0.77–0.80 CADILLAC 5.5 0.2 0.85 0.84–0.86 vs. TIMI <0.01 0.81 0.80–0.83 vs. ZWOLLE <0.000 vs. TIMI <0.000 ACEF 9.9 0.3 0.814 0.83–0.85 0.80 0.78–0.81 vs. ZWOLLE <0.000 vs. TIMI <0.05 TIMI 7.1 0.3 0.79 0.78–0.80 0.76 0.75–0.78
Figure 1

Conclusion
Risk stratification of patients with AMI undergoing pPCI using the ZWOLLE, ACTION, CADILLAC, ACEF or TIMI risk scores enables accurate identification of high-risk patients for in-hospital and one-year mortality in an all-comers population. Among evaluated scores, ZWOLLE model was better fitted for prediction of in-hospital mortality while CADILLAC and ACEF better predicted late events.
P865Mechanical Complications in ST elevation myocardial infarction: Trends in prevalence, acute phase prognosis and one-year mortality after the onset of reperfusion network
Authors: El Ouaddi N , Garcia-Garcia C , De Diego O , Labata C , Rueda F , Oliveras T , Camara M L , Serra J , Berastegui E , Ferrer M , Munoz C , Bayes-Genis A 
Published: October 2019

Abstract

Background
The development of mechanical complications (MC) following an ST elevation myocardial infarction (STEMI) is associated with a high acute phase and long-term mortality. However, the widespread use of reperfusion therapies with primary angioplasty (pPCI) and surgical management could have reduced the prevalence of MC and improved the prognosis of these patients in the last years.

Purpose
The aim is to analyze the changes in the prevalence, management and acute phase prognosis and 1-year mortality of STEMI patients complicated with MC between two periods, before and after the onset of pPCI reperfusion network.

Method
We included all STEMI patients in a single centre prospective registry. Between 1990 and 2000, 2,251 STEMI patients were consecutively admitted in the Coronary Care Unit of a University Hospital (pre-pPCI period). In 2007, pPCI reperfusion program was onset in our centre. Between 2007 and 2017, 3,783 consecutive STEMI patients were included in the registry (post-pCI period). We analyze the prevalence of MC, management (reperfusion therapies, surgery ...) and 28-day and 1-year mortality among these two periods.

Results
A total of 6,034 STEMI patients were included in the registry (men 78.8%, mean age 61.7 years, SD 12.8). Patients admitted in the post-PCI period were older (62.4 vs 60.4 years, p<0.001) and have more prevalence of hypertension and dyslipidemia. Reperfusion therapy increased in post-pPCI period (89.1% vs 49.7%, p<0.001), due to widespread use of pPCI. A total of 105 patients (1.7%) develop any mechanical complication: 35 with ventricular septal rupture (VSR), 22 with papillary muscle rupture (PMR) and 48 patients with free wall rupture (FWR). Prevalence of MC has not been change between both periods. VSR occurred in 0.6% pre-PCI and 0.6% post-pPCI, p=0.98; PMR 0.3% vs 0.4% post-PCI, p=0.33; and FWR 1% vs 0.7% post-PCI, p=0.22). Overall 28-day STEMI mortality has been reduced in post-pPCI period (5.9% vs 10.1%, p<0.001 in acute phase). This 28-day mortality remains very high and without significant changes when MC appears: VSR: post-pPCI 77.3% vs 58.0%, p=0.25; PMR: 25.0% post-PCI vs 58.3%, p=0.69; and FWR: 66.4% post-PCI vs 73.7%, p=0.84). One-year mortality has not been changed between both periods and stays in a very high ratio (65.7% for VRS, 45.4% for PMR and 66.7% for FWR).

Conclusions
Although reperfusion therapy greatly increased with the onset of a pPCI reperfusion network, prevalence of MC has not been change over three decades in our series. Acute phase (28-day) and one-year mortality remains very high and without significant reduction in post-pPCI period.
P874Role of Genetic Polymorphisms of ion channels in the pathophysiology of coronary microvascular dysfunction and ischemic heart disease: an update
Authors: Pucci M , Severino P , D'Amato A , Netti L , Scarpati R , Infusino F , Cimino S , Mariani M V , Maestrini V , Palmirotta R , Mancone M , Fedele F 
Published: October 2019

Abstract

Background
Ischemic heart disease (IHD) is classically associated with coronary artery disease (CAD) and conventional cardiovascular risk factors. However, IHD may exhibit in the absence of CAD, because of different pathophysiological mechanisms, such as the presence of specific genetic variants of ion channels, which act mainly in the microcirculation. Recently, we reported the correlation between some single nucleotide polymorphisms (SNPs) of ion channels genes and the presence of IHD, independently from the presence of conventional cardiovascular risk factors. The goal of this study is to confirm the results of the previous study on a bigger population and discover new SNPs of ion channels genes which may be associated with IHD.

Methods
A prospective, observational, single-center study was conducted on patients candidates for coronary angiography. Patients were divided in three groups: G1, coronary artery disease; G2, microvascular disfunction; G3, normal. Genetic polymorphisms relative to KCNJ11 encoding for the Kir6.1 and Kir6.2 subunits of K-ATP channels and KCNE1 encoding for the MinK subunit of IKs channels were analyzed.

Results
603 consecutive patients (G1: 409; G2:76; G3:118) were enrolled. Genetic analysis for the three groups showed a statistically significant difference for the SNP S38G of KCNE1 (p=0.001) and for the variants rs5215, rs5218, rs5219 of KCNJ11 (p<0.0001), as well as comparing G1-G3 (S38G p=0.006; rs5215, rs5218 and rs5219 p<0.0001). Regarding G1-G2 we confirmed differences only for the variants rs5215 (p<0.0001), rs5218 (p=0.005) and rs5219 (p=0.024), while regarding G2-G3 we found differences for the variants S38G, rs5215 e rs5219 (p<0.0001). A multivariate analysis was performed and highlighted that the SNP rs5215_GG of KCNJ11 may represent an IHD independent protective factor (p<0.0001; OR: 0.036; 95.0% CI: 0.018–0.069).

Conclusion
These results confirm the importance of genetic susceptibility and the role of SNPs of ion channels genes in the determinism of IHD, independently from the conventional cardiovascular risk factors. Moreover, these results may represent a future perspective for a genic therapy for IHD.
P881Differences during admission in patients with myocardial infarction with non-obstructive coronary arteries compared to myocardial infarction with obstructive lesions
Authors: Alcon Duran B , Lopez Pais J , Galan Gil D , Izquierdo Coronel B , Espinosa Pascual M J , Fraile Sanz A , Awamleh Garcia P , Moreno Vinues C , Alonso Martin J J 
Published: October 2019

Abstract

Introduction
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) means a non-negligible proportion of patients (pts) admitted for MI. However, there are still unsolved questions about this entity. The aim of our study is to analyse the differences between the MINOCA group compared with pts admitted for MI with obstructive coronary disease.

Method
Analytical and observational study developed in a Universitary Hospital, which covers 220.000 individuals. From january-2016 until december-2018 we reviewed all the pts that were admitted for MI who underwent coronariography. MINOCA pts (defined according 2016 ESC Working Group position paper) compared with MI pts with obstructive lesions.

Results
One hundred and nine from 521 pts admitted for MI in whom a coronariography was performed fulfilled the 2016 ESC criteria of MINOCA (20%). Clinical presentation showed no difference in Killip-Kimball classification (K-K > I was 6.1% in MI with obstructive lesions vs 6.5% in MINOCA pts, p 0.897). Chest pain (Angina) was more frequent in MI with obstructive lesions (82.8% vs 73.4%, p 0.027) and they also had more ST changes (ST elevation 41% vs 24%, p 0.001; ST descent 17% vs 8.3%, p 0.026). MINOCA pts had lower levels of troponine (troponine elevation less than 10 times the 99th percentile: 10.4% vs 26.6%, p<0.001). Left ventricular systolic dysfunction showed no difference neither in the % of pts with ejection fraction lower than 50% (MI with obstructive lesions: 32% vs MINOCA: 34.3%, p 0.659) nor in severe systolic dysfunction (ejection fraction lower than 30%: 4.9% in MI with obstructive lesions vs 7.4% in MINOCA pts, p 0.313). The average stay in MI pts with obstructive lesions was 12.6 days vs 8.9 days in MINOCA pts (p 0.274). Complications during hospital admission occurred in 17.6% of obstructive pts and in 13.8% of MINOCA pts (p 0.335). Only one MINOCA pts (0.9) died during admission compared to 3.4% of MI pts with obstructive lesions, being this result statistically non significant (p 0.213).

Conclusions
Although MINOCA pts have lower troponine levels and less severe alterations on the EKG, we did not find differences regarding left ventricular function and the rate of complications with hospital mortality that tended to be higher in patients with obstructive lesions.
P882Predictors of myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Espinosa Pascual M J , Lopez Pais J , Izquierdo Coronel B , Galan Gil D , Alcon Duran B , Awamleh Garcia P , Moreno Vinues C , Gorriz Magana J , Fraile Sanz A , Alonso Martin J J 
Published: October 2019

Abstract

Introduction
Increasing knowledge about MINOCA can improve its diagnosis and treatment. The aim of this study is to determine the predictors of MINOCA in the initial assessment of myocardial infarction (MI).

Methods
From 1 January 2016 to 31 December 2018, we carried out an analytical and observational study including all patients admitted to our hospital with MI and underwent coronary angiography. According to the definitions of 2016 ESC Position Paper on MINOCA, we classified the patients in two groups: infarction with obstructive coronary artery disease (MICAD) and MINOCA. We analyzed demographic, clinical, laboratorial and angiographic features. To determine MINOCA independent predictors, a multivariate analysis with logistic regression was carried out in those variables with a statistical signification lower than p<0.01 in the univariate analysis.

Results
During this 3-year period, 109 patients admitted with MI fully fit the 2016 ESC criteria of MINOCA. The table shows the results regarding our findings. Patients with MINOCA compared to those with MICAD, were younger and with fewer risk factors. Moreover MINOCA was found to be more frequent in women than men. More specifically, MINOCA patients more frequently had a previous history of psychiatric illnesses. They also suffered from higher stress levels either acute or chronic. Inflammatory condition rates were more than two-times higher in the MINOCA group and presented lower levels of troponine. After multivariate analysis, only female patients, inflammatory disorders, stress levels, and lower levels of hemoglobin and troponine, remained independent predictors of MINOCA.
Univariate analysis Multivariate analysis MINOCA MICAD P Odds Ratio 95% CI P Female patients 51,4% 21,8% <0.01 2.1 1.12–4.09 0.021 Smokers 41.9% 69.2% <0.01 0.5 0.3–1.02 0.059 Psychiatric disease 22.9% 10.7% <0.01 0.97 0.45–2.08 0.952 Emotional stress 65.9% 34.5% <0.01 3.4 1.81–6.36 <0.01 Autoimmune disorders 34.9% 14.1% <0.01 2.73 1.45–5.1 0.002 Heart rate at admission (lpm) 89±27.1 79±17.7 <0.01 1.92 0.95–3.86 0.068 Troponine I peak (ng/ml) 5.52±8.8 34.05±61.8 <0.01 2.32 1.16–4.65 0.017 Hb (g/dl) 13.5±2.13 14.17±1.83 0.03 2.89 1.48–5.6 0.02

Conclusion
MINOCA patients differ in some ways to those patients with MICAD. Being a woman, recognizing emotional stress, having autoimmune disorders and lower levels of troponine and Hb might predict having a MINOCA.
P886Exercise left ventricular outflow track obstruction in hypertrophic cardiomyopathy: peak exercise or post-exercise pressure gradients?
Authors: Nahmani Y , Hammoudi N , Huang F , Bouziri N , Pousset F , Maupain C , Charron P , Isnard R 
Published: October 2019

Abstract

Background
Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM), associated with poor prognosis and requiring specific management in symptomatic patients. Furthermore, new drugs targeting LVOTO are under investigation. Exercise echocardiography is the more relevant test to unmask latent obstruction in patients with HCM and to link obstruction to symptoms during physical activity. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery.

Objective
We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM.

Methods
We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position.

Results
121 patients with HCM were included (age 49±16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66±7%, max LV wall thickness 19±5 mm, 69% receiving betablockers). Exercise was performed until exhaustion at a mean workload of 118±58 Watts. Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17±18, 39±43 and 55±60 mmHg, p<0,0001). More than half of the patients (52%) had a gradient ≥30 mmHg at least in one phase, but a maximal gradient ≥50 mmHg (threshold for invasive treatment in symptomatic patients) was observed in only 7% of the population at rest, 25% at peak exercise and 37% at recovery (p<0.001). Finally, a maximal gradient ≥50 mmHg was recorded only during immediate recovery (69±25 mmHg) and not during exercise in 16 patients (13%). None of them experienced post-exercise syncope.

Conclusion
The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.
P887Atrial fibrillation is associated with sudden cardiac death risk factors in patients with hypertrophic cardiomyopathy
Authors: Marcuschamer I A , Zusman O , Schwartzenberg S , Vaturi M , Shapira Y , Kornowski R , Sagie A , Monakier D 
Published: October 2019

Abstract

Background
Atrial Fibrillation (AF) is prevalent in a fourth of patients with Hypertrophic Cardiomyopathy (HCM), but its clinical impact in these patients remains ill-defined.

Aim
To compare clinical characteristics in HCM patients with vs without AF and assess indirectly potential sudden cardiac death (SCD) risk.

Methods
Retrospective study in a single tertiary referral HCM center. Patients with HCM and AF were compared with matched controlled HCM patients without AF. NYHA class was assessed by a single physician. Propensity score matching was performed with a ratio of 2:1 by nearest neighbor with adjustment for age, sex, and left ventricular tract obstruction (LVOTO). Ordinal regression was used with NYHA as outcome.

Results
Among 298 patients with HCM, 68 patients (22.8%) had AF. After propensity matching, 66 patients with AF and 112 without AF had similar distribution of age (67.1 vs. 65.1 years), gender (57.6% vs. 61% males) and Basal Surface Area (1.88 vs. 1.87 m2) respectively. The prevalence of LVOTO (57.6% vs. 58.5%) and apical hypertrophy (19.7% vs 19.5%) was similar in the two groups. Cardiac risk factors including Hypertension (60.6% vs. 60.2%) and Diabetes Mellitus (15.2 vs. 20.3%) were similar in both groups. AF patients were diagnosed with HCM at a younger age than patients without HCM (48.5 vs. 55 years; p=0.01). HCM patients with AF had significantly lower LVOT gradients compared with patients without AF (28.1 mmHg vs 47.4 mmHg, p=0.005), had a higher prevalence of non-sustained ventricular tachycardia (39.4% vs. 9.4%; p<0.01), and ventricular tachycardia (9.1% vs 1.7%; p<0.04) and were more likely to have undergone implantation of an internal cardioverter defibrillator (ICD) (23.1% vs. 8.5%; p=0.001), respectively. Dyspnea was the most prevalent symptom in both groups (51.1% and 46.6% in AF and non-AF respectively). NYHA Class was similar in both groups: 1.88±0.69 in patients with AF vs. 1.73±0.74 in patients without AF (p=0.17). NYHA class did not differ in 26 patients with chronic persistent AF vs. 42 patients with paroxysmal AF (being in sinus rhythm at evaluation).

Conclusion
AF does not seem to impact functional level class in patients with HCM, but carries a higher burden of sudden cardiac death prognostic factors, incurring a higher rate of ICD implantation.

Acknowledgement/Funding
None