bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3579Clinical characteristics of an intracoronary erosion and thrombus in patients with vasospastic angina
Authors: Teragawa H , Oshita C , Ueda T , Kihara Y 
Published: October 2019

Abstract

Background
Intracoronary erosion and thrombus are sometimes detected in patients with vasospastic angina (VSA) through intracoronary imaging modalities. However, the clinical characteristics of these intracoronary findings remain unclear. Therefore, we assessed the clinical and lesion characteristics of these intracoronary abnormalities in patients with VSA.

Methods
We included 48 patients with VSA who underwent coronary angiography (CAG), spasm provocation test (SPT), and coronary angioscopy (CAS). In all patients, acetylcholine was infused in the left and right coronary arteries. The vessels were classified into spastic vessels (SVs) and non-spastic vessels (NSVs) based on SPT results. SVs that could not be observed using CAS were excluded from the study. CAG and SPT findings were evaluated for the presence of atherosclerotic lesions (%stenosis <30%) and types of spasm (segmental or diffuse). Two experts examined the presence of an intracoronary erosion and thrombus on CAS. Other serious symptoms such as cold sweating or syncope were also assessed.

Results
Among the 48 patients, intracoronary erosion and thrombus were detected in 11 (23%) and 10 (21%) patients, respectively, and total intracoronary abnormalities were observed in 17 (35%) patients. Male sex (p<0.05), smoking (p<0.05), and presence of other serious symptoms (p<0.01) were associated with the presence of intracoronary abnormalities. The logistic regression analysis showed the presence of other serious symptoms to be the only factor associated with the presence of intracoronary abnormalities (p<0.05). In the lesion analyses, among the 72 vessels, intracoronary abnormalities were observed only in SVs (17/53, 33%) but not in NSVs (0/19, 0%, p<0.01). Among the 53 SVs, the presence of atherosclerotic lesions (p<0.05) and segmental spasm type (p<0.05) were found to be associated with the presence of intracoronary abnormalities.

Conclusions
Intracoronary erosion and thrombus were observed in approximately 35% of patients with VSA. Such intracoronary abnormalities may be partly affected by the forms of the coronary artery and coronary spasm, leading to the onset of serious symptoms of VSA.
P3584Optimal medical therapy improves survival in patients with ischaemic cardiomyopathy: an analysis of the STICH trial
Authors: Wolfe N , Mitchell J D , Brown D L 
Published: October 2019

Abstract

Background
Prior studies have demonstrated underuse of optimal medical therapy (OMT) in patients with coronary artery disease (CAD) after revascularization. However, there are limited studies assessing compliance with OMT on long-term survival in patients with CAD and no studies evaluating the impact of OMT in patients with severe CAD and reduced left ventricular (LV) function. The Surgical Treatment for Ischaemic Heart Failure (STICH) Trial was a randomized clinical trial that compared coronary-artery bypass grafting (CABG) with medical therapy versus medical therapy alone in the treatment of ischemic cardiomyopathy.

Purpose
This study sought to determine compliance with OMT over time and the impact of OMT compliance on survival in patients with or without revascularization.

Methods
STICH was a multicenter, randomized clinical trial of patients with an LV ejection fraction of 35% or less and CAD amenable to CABG who were randomized to CABG plus medical therapy (N=610) or medical therapy alone (N=602). A medication history was obtained at hospital discharge or 30 days after enrollment, 1 year, 5 years, and 10 years. OMT was defined as the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcome was all-cause mortality. Comparison of mortality between the OMT and non-OMT groups was performed using multivariate Cox regression modeling with OMT as a time-dependent covariate.

Results
Of the 1212 patients randomized, at a median follow-up of 9.8 years, all-cause mortality was 58.9% in the CABG group and 66.1% in the medical therapy group. In the CABG arm, 63.6% of patients were on OMT throughout the study period compared to 66.5% of patients in the medical therapy arm (p=0.3). Those on OMT were younger (59.6 vs. 61.4 years, p<0.001); were more often in NYHA class I-II (67.4% vs. 56%, p<0.001); and lower rates of atrial fibrillation (9.4% vs. 18.1%, p<0.001), current smoking (18.6% vs. 24.5%, p=0.015), and depression (4.8% vs. 8.8%, p=0.005). Those on OMT had higher rates of hyperlipidemia (63.8% vs. 54.4%, p=0.001) and prior myocardial infarction (79.4% vs. 73.1%, p=0.01). There was no difference in sex, diabetes, and hypertension between those on OMT and non-OMT. In multivariate survival analysis, OMT was associated with a significant reduction in mortality (adjusted hazard ratio, 0.69; 95% confidence interval, 0.58–0.81; p<0.001). The treatment effect with OMT (31% relative reduction in mortality over 10 years) was numerically greater than the treatment effect of CABG (24% relative reduction in mortality with CABG versus medical therapy alone).

Conclusions
OMT improves long-term survival in patients with ischaemic cardiomyopathy regardless of revascularization status. Strategies to improve OMT use and adherence in this population is needed to maximize survival.
P3600High-sensitivity troponin I can predict reduced TIMI coronary grade flow in patients with suspected myocardial infarction
Authors: Schaefer S , Neumann J T , Soerensen N A , Gossling A , Ojeda F , Blankenberg S , Westermann D 
Published: October 2019

Abstract

Background
Serial measurements of high-sensitivity troponin (hs-Tn) is recommended for rule-out or rule-in of myocardial infarction (MI) in patients presenting with acute chest pain. Based on dynamic hs-Tn changes invasive angiography is recommended in order to identify a culprit lesion. However, the association of hs-Tn with the intracoronary flow is unknown.

Purpose
We aimed to evaluate the association of hs-TnI with intracoronary flow, measured by the TIMI Coronary Grade Flow in coronary angiography, and its association with outcome.

Methods
1,940 consecutive patients presenting with suspected MI to the emergency department were included. Among those 543 patients underwent coronary angiography. Patients with prior coronary artery bypass graft surgery and patients with chronic total occlusion were excluded from further analysis, resulting in 420 available individuals. TIMI Coronary Grade Flow was scored in accordance with the definition of the TIMI study group. For further analysis two groups were distinguished. Group 1: Minimum TIMI Grade Flow <3 (no complete perfusion in at least one of the coronary arteries) and Group 2: Minimum TIMI Grade Flow = 3 (normal flow in all coronary arteries). Troponin I was measured using the ARCHITECT STAT high sensitive Troponin I immunoassay directly at admission, after 1 and 3 hours. Receiver Operating Characteristic (ROC) curves were used to investigate the association of hs-TnI with a reduced TIMI Grade Flow. Survival curves were produced for a combined endpoint of all-cause mortality, rehospitalisation, PCI and MI after 12 months.

Results
In patients with reduced TIMI Grade Flow the level of hs-TnI was significantly higher at admission (Group 2: 87.3 ng/l vs. Group 1: 15.0 ng/l, p<0.001), after 1 hour (298.3 ng/l vs 18.5 ng/l, p<0.001) and after 3 hours (1,071 ng/l vs. 27.7 ng/l, p<0.001). The prediction of reduced TIMI flow based on the absolute value of hs-TnI improved over time from admission (AUC 0.701, optimal cut off 34.8 ng/l, 95% CI (9.7, 74.6)), to 1 hour (AUC 0.759, optimal cut off 65.1 ng/l, 95% CI (25.1, 279.5)) and 3 hours (AUC 0.777, optimal cut off 90.7 ng/l, 95% CI (14.8, 200)). Using the hs-TnI delta to predict a reduced TIMI Grade Flow improved the accuracy only slightly with time from admission: hs-TnI 0/1h delta (AUC 0.758) vs. 0/3h delta (AUC 0.765). The survival curve for a combined endpoint after one year was significantly reduced in patients with reduced TIMI Grade Flow (Figure 1, p=0.012)
Figure 1

Conclusion
Absolute value and delta change of hs-TnI after 1 and 3 hours help to predict the presence of reduced TIMI Grade Flow in coronary arteries. Patients suffering from a lowered TIMI Grade Flow have higher event rates after 12-months.
P3607Temporal trends in the characteristics, management, and clinical outcomes of patients with prior myocardial infarction who are admitted with an acute coronary syndrome
Authors: Eisen A , Schechter A , Itzhaki Ben Zadok O , Harari E , Shlomo N , Iakobishvili Z , Kornowski R , Zusman O 
Published: October 2019

Abstract

Background
Patients with prior myocardial infarction (MI) are at increased risk for recurrent cardiovascular events. Advances in treatment in the last decade has improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior MI who are admitted with an ACS, a particularly high-risk group.

Methods
Patients admitted with ACS who were enrolled in the ACS Israeli Surveys (ACSIS). Patients were stratified by early (2000–2008) and late (2010–2016) time-periods and by prior MI status. Clinical outcomes included 30-d MACE (death, MI, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality.

Results
A total of 15,211 ACS patients were included, of whom 4627 (30%) had a prior MI. These patients were older (67y vs. 63y), more commonly male, had more prior comorbidities, and a higher proportion had a GRACE score>140 (38.4% vs 12.2%). Patients with prior MI received more prior medications such as aspirin, statins, antihypertensives and hypoglycemics. During time, utilization of guideline-recommended therapies such as P2Y12 inhibitors, statins, and PCI had significantly improved in patients with prior MI. However, compared with patients without prior MI, they were still treated less commonly by PCI (61% vs. 74%). Overall, patients with prior MI had a higher 30-d MACE (13.7% vs 17.2%, p<0.001) and 1-year mortality (8.2% vs. 13.1%, p<0.001). In patients with prior MI, during time, 30d MACE nearly halved (22.7% to 11.8%) and 1-year mortality also decreased (15.5% to 10.7%). Upon adjustment, prior MI was independently associated with 1-year mortality (HR 1.13, 95% CI 1.01–1.26, p=0.04) and the late time-period was associated with reduced 1-year mortality (HR 0.75, 95% CI 0.65–0.84, p<0.001).

Conclusion
Patients with prior MI have a worse prognosis after ACS despite being treated with prior medications and improvement in guideline-based therapies. Although still undertreated, their clinical outcome has significantly improved throughout the years.
P3614Impact of renal dysfunction in patients with acute myocardial infarction on early management and outcome: a first observational French study
Authors: Bernard V , El Khoury C , Fraticelli L 
Published: October 2019

Abstract

Background
Kidney dysfunction (KD) is largely associated to cardiovascular mortality.

Purpose
Analyse early management and outcome in real life of ST segment elevation myocardial infarction (STEMI) patients with KD compared to STEMI patients with normal renal function.

Methods
Using 10 years' data from OSCAR regional registry, we investigated the early management and outcome of all patients with STEMI. Kidney dysfunction (KD) has been defined by creatinine clearance (CrCl) <90mL/min and was assessed using Cockcroft-Gault (CG) equation. Among them, two groups were identified: patients with normal kidney function (NKF) (CrCl ≥90mL/min) and patients with KD (CrCl <90mL/min). KD patients were stratified into 3 groups: patients with mild KD (CrCl 60–90mL/min), patients with moderate KD (CrCl 30–60mL/min) and patients with severe KD (CrCl <30mL/min). The comparison of the groups concerned patient characteristics, therapeutic strategy and follow-up at 1, 6 and 12 months.

Results
Our study included 8 003 STEMI patients from 2009 to 2018, 4 234 (52.9%) of them with KD. Among these, 2441 (57.6%) patients had mild KD, 1494 (35.3%) moderate KD and 299 (7.1%) severe KD. NKF patients were younger than KD group (54 [48–61] vs 72 [63–81]). KD patients had more cardiovascular risk factors such as diabetes, hypertension and personal history of coronary disease (p<0.001), but were less smokers (p<0,001). KD patients presented less often chest pain, and more dyspnea or cardiac arrest (p<0,001). There was no difference in symptom-first medical contact delay (p=0.30). More than 14% of patients with KD presented with Killip≥2. In the KD group location of infarction was more often anterior and lateral. In-hospital treatment differed among the groups: KD patients received less prasugrel (11% vs 20%), ticagrelor (44% vs 49%), enoxaparin (70% vs 80%), morphine (29% vs 39%) or other analgesic (30% vs 35%), but more clopidogrel (33% vs 23%), diuretics (3% vs 0,7%) and catecholamines (5% vs 2%) (p<0.001). In-hospital mortality was higher in the KD group (9% vs 1%, p<0.001). One-year mortality was 14% in the KD group compared to 2% for patients with NKF (p<0.001). Also, in-hospital mortality was increasing exponentially with KD severity (2%, 8% and 24% for mild, moderate and severe KD) (p<0,001) as well as 1-year mortality (respectively 1%, 6% and 12% after 1 year) (p<0,001).

Conclusion
Kidney insufficiency is an independent risk factor for death in patients after myocardial infarction and was associated with poor prognosis at short- and long-term. We observed that mortality increased with KD severity. Despite a high cardiovascular risk, KD patients presenting STEMI are less likely to receive therapy, while having more co-morbidities and extended infarction. To achieve an optimal medical care of KD patients with STEMI, we should introduce evidence-based therapies in the acute phase.
P3615The number of coronary risk factors and mortality in patients with acute myocardial infarction from Japanese nation-wide real-world database
Authors: Mori H , Nishihara K , Honda S , Kojima S , Takegami M , Takahashi J , Itoh T , Watanabe T , Takenaka T , Ito M , Takayama M , Kario K , Sumiyoshi T , Kimura K , Yasuda S 
Published: October 2019

Abstract

Background
Hypertension, diabetes, dyslipidemia and smoking are so-called coronary risk factors for coronary heart disease, which were established by extensive epidemiological research. However, in Japanese patients with acute myocardial infarction (AMI), the impact of number of coronary risk factors on in-hospital morality has not been elucidated.

Methods
The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide real-world database integrated form 10 regional registries. We examined the association between number of coronary risk factors and in-hospital mortality from this JAMIR registry.

Results
The data were obtained from total of 20462 AMI patients (mean age, 68.8±13.3 years old; 15281 men, 5181 women). Figure 1 shows the prevalence of each coronary risk factors stratified by sex and decade. The prevalence of hypertension became higher with the advanced age while the prevalence of smoking became lower with the advanced age. Prevalence of diabetes and dyslipidemia were highest in middle age. Majority (76.9%) of the patients with AMI had at least 1 of these coronary risk factors and, 23.1% had none of them. Overall, except women under 50, number of coronary risk factor was relatively less in older age (Figure 2). In-hospital mortality by sex and decades was shown in figure 3. In-hospital mortality rates were 10.7%, 10.5%, 7.2%, 5.0% and 4.5% with 0, 1, 2, 3 and 4 risk factors, respectively (Figure 4A). After adjusting age and sex, there was an inverse association between the number of coronary risk factors and in-hospital mortality (adjusted odds ratio [1.68; 95% CI, 1.20–2.35] among individuals with 0 vs. 4 risk factors, Figure 4B).

Conclusion
In the present study of Japanese patients with AMI, who received modern medical treatment, in-hospital mortality was inversely related to the number of coronary risk factors.

Acknowledgement/Funding
Grant-in-Aid for Scientific Research
P3617Systolic blood pressure, glycemic control and clinical outcome in diabetic patients with acute myocardial infarction
Authors: Park Y J , Lee J H , Park B E , Kim H N , Jang S Y , Bae M H , Yang D H , Park H S , Cho Y , Chae S C 
Published: October 2019

Abstract

Background
Recent blood pressure guidelines recommend intensive blood pressure control in diabetic patients with cardiovascular disease.

Purpose
We sought to investigate combined impact of intensive blood glucose lowering and blood pressure control on clinical outcome in diabetic patients with acute myocardial infarction (AMI) has not been fully investigated yet.

Method
Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database included 12,179 patients (9,046 men; mean age = 63.6±12.6 year-old) who were discharged alive. Among them, 3,430 (28.2%) had a diabetes mellitus (DM). MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations at 1 year. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Result
We determined cut-off value of discharge systolic blood pressure (SBP) to predict 1-year MACCE in DM and non-DM patients. Discharge SBP of less than 130mmHg was associated with a lower MACCE at 1 year compared to SBP level of 130mmHg or greater (10.8% versus 15.4%; log-rank p=0.001) in DM patients, whereas discharge SBP cut-off level was 140mmHg to discriminate 1-year MACCE in non-DM patients (6.4% versus 8.5%, log-rank p=0.045). In DM patients, there were no significant difference in 1-year MACCEs between patients with HbA1c less than 7% versus 7% or greater (12.0% versus 10.7%; log-rank p=0.325). DM patients were categorized into 4 groups; discharge SBP <130mmHg and HbA1c <7% (Group 1); discharge SBP <130mmHg and HbA1c ≥7% (Group 2); discharge SBP ≥130mmHg and HbA1c <7% (Group 3); discharge SBP ≥130mmHg and HbA1c ≥7% (Group 4). Intensive BP control was associated lower 1-year MACCEs in patients with good glycemic control (Group 1 & 3; 10.7% versus 16.7%; log-rank p=0.009). However, in patients with poor glycemic control, intensive BP control did not improve 1-year MACCEs (Group 2 & 4; 10.6% versus 11.1%; log-rank p=0.761).

Conclusion
Strict BP control is more important than glycemic control to improve short-term clinical outcome in DM patients with AMI. However, in patients with poor glycemic control, strict BP control did not improve clinical outcome.
P3625Cocaine consumption and acute coronary syndrome: an analysis from the Swiss registry AMIS Plus
Authors: Garzoli G , Biasco L , Radovanovic D , Pedrazzini G 
Published: October 2019

Abstract

Introduction
The aim of this study is to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry with a focus on in-hospital outcomes.

Methods
We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 2007 to 2018. Baseline and in-hospital data of patients with ACS and cocaine use were compared with the remaining AMIS population as well as to a sex and aged matched ACS patients (1:5 ratio, 540 patients) without history of cocaine consumption. Primary endpoints were death and major adverse cardiac and cardiovascular events (MACCE).

Results
A total of 20'981 patients had been included in the AMIS Plus registry for ACS in the study period, of them 110 (0.5%) were cocaine user.
As compared to the remaining AMIS population, cocaine abusers were significantly younger (46.4±10.8 vs 66.4±13.2 years; p<0.001), presented more frequently with out of hospital cardiac arrest (11.8% vs 4.7%, p<0.001) and STEMI (68,2% vs 54.7%, p=0.007). Apart from active smoke and family history, had a lower burden of CV risk factors. In hospital mortality (3.6% vs 4.4%; p=1) and MACCE (5.4% vs 5.5%; p=0.83) were comparable.
When compared to the age matched ACS population without history of cocaine consumption, cocaine abusers were more frequently smokers (87.6% vs 63.6%, p<0.001) but less frequently obese (10.4% vs 25.6%, p=0,001). Clinical presentation was comparable among the two groups, nonetheless cocaine abuse was associated with a higher incidence of death (3.7% vs 0.7%, p<0.05) and MACCE (5.6% vs 1.3%, p<0.05).

Conclusion
This analysis presents the largest series of cocaine associated ACS available in literature. Cocaine abuse increases by 5 the risk of mortality and by 4 the risk of MACCE as compared to an age matched ACS population. No differences where observed in outcomes when compared to a 20 years older population.
P3628Contemporary coronary artery disease prevalence in a valvular heart disease population undergoing surgery
Authors: Carvalho Mendonca T J , Strong C , Roque D , Morais L , Reis J P , Daniel P M , Abreu P , Almeida M , Cacela D , Morais C , Mendes M , Ferreira R C , Baptista S B , Raposo L , Ramos R 
Published: October 2019

Abstract

Background
Patients undergoing heart valve surgery are routinely evaluated for the presence of Coronary Artery Disease (CAD), with the standard practice of combining valve intervention with a revascularization procedure, notably Coronary Artery Bypass Graft (CABG). Older studies suggest rates as high as 50% prevalence of CAD in this population. However, CAD prevalence, its treatment and prognostic implication has been questioned recently.

Objectives
The goal of this study is to evaluate the baseline characteristics, prevalence of CAD and treatment strategies in a contemporary population with valvular heart disease (VHD) referred for valve surgery.

Methods
In a national multicentre registry, consecutive patients, from Jan 2015 to Dec 2016, with a formal indication for heart valve surgery referred for a pre-op routine coronary angiogram were systematically analysed. Baseline characteristics, valve pathology and CAD prevalence and patterns were determined. Obstructive CAD was defined as luminal angiographic stenosis ≥70% (≥50% for left main artery). The prognostic impact of the different valve disease and CAD treatment strategies were assessed.

Results
1175 patients (mean age 72.5±10.1; male 49.2%) fulfilled the clinical or echocardiographic indication for valve surgery by European guidelines. Valvular disease prevalence was: aortic stenosis (66.7%), aortic regurgitation (6.6%), mitral stenosis (6%), mitral regurgitation (19.2%), tricuspid regurgitation (7.5%). Mean follow-up time was 29.06±18.46 months. Prevalence of comorbidities was: Diabetes Mellitus (DM) 26%, chronic obstructive pulmonary disease (COPD) 5.7% and chronic kidney disease (CKD) 23.4%. Mean Euroscore II was 2.6%. Obstructive CAD was present in 27.3% patients. Mean Syntax score was 10.2 (<22 in 88%, 23–32 in 10.2% and >33 in 1.8%). Left main artery and 3-vessel disease were found in 13.1% and 11.8% of patients with CAD, respectively. Valvular surgery was ultimately performed in 80.3%. In patients with CAD, 57.3% were revascularized. All-cause mortality rate during follow-up was 12.9%, with 7.8% from cardiovascular causes. In univariate analysis DM, COPD, CKD, NYHA class, obstructive CAD and no surgery (p<0.05) were associate with mortality on follow up. In multivariate analysis obstructive CAD (OR 2.36, 95% CI 1.53–3.65, p<0.01) and no surgery (OR 6.05, 95% CI 3.95–9.30, p<0.01) persisted as independent all-cause mortality predictors.

Conclusion
In a contemporary cohort of patients with VHD and surgical indication, CAD prevalence is lower (27.3%) than described in literature. Mortality rates were higher in patients with obstructive CAD, worse NYHA functional class and in those who never underwent surgery.