bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-related differences and vascular function test findings in patients with vasospastic angina
Authors: Kato K , Tateishi K , Saito Y , Kitahara H , Fujimoto Y , Kobayashi Y 
Published: November 2020

Abstract

Background
Vasospastic angina (VSA) accounts for the majority of angina cases with no epicardial stenosis and develops amongawide range of age, which is reportedly induced by coronary functional abnormalities including endothelial dysfunction and smooth muscle hypercontraction. However, the relation of noninvasive vascular function tests to VSA remains to be fully elucidated.

Purpose
The aim of this study was to assess differences in clinical characteristics and findings from noninvasive vascular function tests among groups by age in patients with VSA.

Methods
We enrolled a total of 732 patients with angina who underwent intracoronary acetylcholine provocation test. VSA was defined as total or subtotal occlusion of epicardial coronary arteries accompanied by chest pain and/or ischemic electrocardiographic changes in response to acetylcholine administration. Patients with VSA were divided into 3 groups by age (young [&lt;50 years], intermediate [50–64 years], and elderly group [≥65 years]). Noninvasive vascular function test findings such as ankle-brachial index (ABI), brachial-ankle pulse wave velocity (baPWV), andpercentage of mean arterial pressure (%MAP) were compared among groups by age in patients with VSA.

Results
Of all patients, 367 (50.1%) were diagnosed as VSA with intracoronary acetylcholine test, including 66 (18.0%), 113 (30.8%), and 188 (51.2%) patients in the young, intermediate, and elderly groups. Among groups by age, there was no significant difference in gender (female, 31.8% vs. 40.7% vs. 44.7%, P=0.19). Patients in the young group were more often smokers and alcohol drinkers than those in the intermediate and elderly groups, while the prevalence of hypertension, dyslipidemia, and diabetes were lower in younger patients. A history of percutaneous coronary intervention was less frequently found in the young group compared tothe intermediate and elderly groups (7.6% vs. 16.8% vs. 20.7%, P=0.033). The baPWV was higher in the elderly group (1424±232 vs. 1537±247 vs. 1774±358 cm/s, P&lt;0.0001), while there was no difference in ABI between the 3 groups. %MAP at arms was significantly and progressively decreased with an increase in age (54.0±4.5% vs. 53.0±2.6% vs. 51.2±2.8%, P&lt;0.0001).

Conclusion
Our study demonstrated that there were distinct age-related differences in clinical characteristics of patients with VSA. The higher %MAP in younger patients suggests that more impaired endothelial dysfunction may play a role in the development of VSA in this age group.

Funding Acknowledgement
Type of funding source: None
Progressive left ventricular post-infarction remodelling: impact on outcome
Authors: Van Der Bijl P , Abou R , Goedemans L , Gersh B.J , Holmes D.R , Pellikka P.A , Ajmone Marsan N , Delgado V , Bax J.J 
Published: November 2020

Abstract

Background
While the presence left ventricular (LV) remodelling after ST-segment elevation myocardial infarction (STEMI) is known to worsen prognosis, the impact of progressive vs. stable LV remodelling on outcome has not been established.

Purpose
To investigate the impact of progressive LV remodelling on outcome in STEMI patients who were treated with primary percutaneous coronary intervention (PCI) and optimal pharmacotherapy.

Methods
Baseline, 3-, 6- and 12-month echocardiograms were analysed. Early LV remodelling (ER) was defined as a ≥20% increase in LV end-diastolic volume (EDV) during the first 3 months post-STEMI, and mid-term remodelling (MTR) as ≥20% LVEDV change by 6 months. Progressive LV remodelling was defined according to spline curve analyses: ≥0% LVEDV increase by 6 months (i.e. further increase after 3 months) for ER, and ≥20% by 12 months (i.e. an additional increase after 6 months) for MTR. The impact of progressive LV remodelling on outcome was evaluated with a Log rank test.

Results
589 STEMI patients (mean age 61±12 years, 78% male) who demonstrated LV remodelling in the first 6 months post-infarct, were analysed: 408 (69%) ER and 181 (31%) MTR. Progressive LV remodelling occurred in 146 (36%) ER and in 12 (7%) MTR. After a median follow-up of 90 (IQR 64–117) months, 39 (10%) ER were hospitalised for heart failure. 25 (14%) MTR remodellers died after a median follow-up of 86 (IQR 66–112) months. Progressive LV remodelling in ER led to a higher rate of heart failure hospitalisation (P=0.017 vs. non-progressive ER, Fig. 1A) but no mortality difference (P=0.10 vs. non-progressive ER). In contrast, MTR with progressive LV remodelling experienced worse survival (P=0.01 vs. non-progressive MTR, Fig. 1B) but no increase in heart failure hospitalisation (P=0.65 vs. non-progressive MTR).

Conclusions
Progressive LV remodelling causes an increased risk of heart failure in ER post-infarct, vs. higher mortality in MTR. These two patterns of progressive, post-infarct LV remodelling possibly represent different underlying pathophysiological mechanisms: i.e. evolution of true post-infarct remodelling in ER, vs. natural history of established heart failure in MTR.
Figure 1

Funding Acknowledgement
Type of funding source: None
Clinical factors associated with microvascular obstruction in early presenters of ST-segment elevation myocardial infarction
Authors: Rivero Monteagudo A.L , Arroyo Rivera B , Garcia Talavera C , Cortes Garcia M , Franco Pelaez J.A , Navarro Del Amo F , Tunon Fernandez J 
Published: November 2020

Abstract

Background
Microvascular obstruction (MVO) is a phenomenon that occurs frequently even after primary coronary intervention with recanalization of the infarct-related artery (IRA) and it has been shown to increase the risk of adverse cardiovascular events in ST-segment elevation myocardial infarction (STEMI) patients. The most important clinical predictor of MVO is ischemia duration, but there is a lack of information regarding predictor factors in promptly revascularized patients.

Methods
From January 2007 to October 2017, 987 patients with STEMI that underwent urgent coronary angiography were retrospectively enlisted. We included 321 patients that were revascularized in ≤3 hours from symptom onset. Clinical and angiographic data were taken from hospital records. A univariate and multivariate Cox regression analysis was made to assess the relationship between MVO (defined as final TIMI &lt;3 in IRA) and potential predictors.

Results
From the 321 patients included, 76.9% were male and the mean age was 63.6±13.4 years. LVEF at admission was 46.2±12%. The mean time between symptom onset and wire crossing was 2.2±0.6 hours and MVO was found in 43 cases (13.4%). Descriptive data of predictor factors and their association with MVO are shown in Table 1. After the multivariate Cox regression analysis, smoking was a protector factor of MVO (OR 0.39 [0.16–0.96]). Age (OR 1.03 [1.01–1.06]) and Killip class III-IV at admission (OR 5.96 [2.1–16.4]) were directly associated with MVO. No other clinical variables were independently associated with the occurrence of MVO.

Conclusions
In very early presenters of STEMI, age and Killip class III-IV at admission were clinical predictor factors of MVO. Current smoking could carry a protector mechanism for MVO in this population, that is yet to be confirmed with prospective studies.

Funding Acknowledgement
Type of funding source: None
ACTION and NCDR risk models outperform GRACE for prediction of in-hospital mortality in acute coronary syndrome – a retrospective analysis from a German Heart Center
Authors: Parco C , Kosejian L , Quade J , Bader S , Lin Y , Karathanos A , Krieger T , Brockmeyer M , Icks A , Perings S , Kelm M , Schulze V , Wolff G 
Published: November 2020

Abstract

Background
Risk prediction with the GRACE risk model is guideline-recommended clinical practice in acute coronary syndrome (ACS). However, more modern risk models such as ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With the Guidelines) and National Cardiovascular Data Registry (NCDR) risk models are available. We aimed to compare these models to the established GRACE risk model in ACS.

Methods and results
In-hospital mortality was retrospectively assessed in 1,138 patients undergoing cardiac catheterization for Non-ST-Elevation Myocardial Infarction (NSTEMI, 566 patients, 70.7% male) or ST-Elevation Myocardial Infarction (STEMI, 572 patients, 69.1% male) at a German University Hospital from 2014 to 2017. In-hospital mortality was 14.7% for STEMI and 3.7% for NSTEMI, respectively. GRACE, ACTION and NCDR risk models for prediction of in-hospital mortality were calculated for individual patients, 0.75% missing data were imputed. ACTION risk model showed a good discrimination of risk (c-index 0.85, 95% confidence interval (CI) 0.83–0.87) with a slight numerical advantage in NSTEMI (c-index 0.92, 95% CI 0.86–0.98) over STEMI patients (c-index 0.83, 95% CI 0.79–0.88). The NCDR risk model showed comparable performance in the overall cohort (c-index 0.86, 95% CI 0.84–0.88; NCDR vs. ACTION p=0.4097), also with superior performance in NSTEMI (c-index 0.89, 95% CI 0.86–0.91) vs. STEMI (c-index 0.81, 95% CI 0.78–0.84). The GRACE risk model showed significantly worse performance in the overall cohort (c-index 0.76, 95% CI 0.74–0.79; vs ACTION p&lt;0.0001; vs. NCDR p&lt;0.0001) and in STEMI patients (c-index 0.72, 95% CI 0.69–0.76; vs ACTION p&lt;0.0001; vs. NCDR p=0.0018). In NSTEMI patients, GRACE discrimination performance was comparable to NCDR (c-index 0.87, 95% CI 0.84–0.90, p=0.73), but still inferior to ACTION (p=0.04). The ACTION risk model showed a good calibration whereas NCDR and GRACE models lacked accuracy in our cohort.

Conclusion
In a contemporary German patient population with acute coronary syndrome, ACTION and NCDR risk models outperform the established GRACE risk model for prediction of in-hospital mortality. This performance difference was more pronounced in STEMI than in NSTEMI.

Funding Acknowledgement
Type of funding source: None
The vegf-a gene polymorphism in prognosis of outcomes in patients with stemi
Authors: Kutya I , Hilova Y , Rodionova J , Kopytsya M , Petyunina O 
Published: November 2020

Abstract

One of the promising parameter for the prognosis in patients with STEMI can be suggested the VEGF-A gene polymorphism.

Purpose
Estimate the role of the VEGF-A gene polymorphism in the prediction of outcomes in patients with STEMI.

Methods
The study involved 135 STEMI patients (80.7% male and 19.3% female) with an average age of 59.21±8.92 years. Control group of 30 healthy volunteers included. Patients were divided into two groups: the first one – “case” group, those who reached the end point, and the second group – “control”, those who did not reached. The combined endpoint included cardiovascular death, recurrent myocardial infarction, the occurrence / progression of heart failure that required hospitalization. The study of the VEGF-A gene polymorphism (rs 2010963) was carried out by polymerase chain reaction (PCR). Follow-up period was 6 month. VEGF-A level was measured by ELISA.

Results
The patients from the “case” group had significantly elevated VEGF-A levels compared to controls (217.40 [102.54–473.78] pg/ml; 311.45 [204.20–680.86] pg/ml; p=0.046). Multivariate linear regression analyses demonstrated that polymorphism G634C (rs2010963) of VEGF-A gene (G634C+C634C) – β=0.8079, CI [1.1907 to 5.6490] p=0.0465; and LVEF &lt;50.60% – β=0.0488 CI [0.9179 to 0.9882], p=0.0096 are significantly associated with negative outcomes (combined endpoints).

Conclusions
STEMI patients with G634C+C634C polymorphism G634C (rs2010963) of VEGF-A gene, and with LVEF &lt;50.60% have greater chances for adverse outcomes. Further investigations of the VEGF-A gene polymorphism are the perspective direction in the development of prevention and treatment of STEMI.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): GI “L.T. Malaya Therapy National Institute NAMSU”
Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction
Authors: Stiermaier T , Backhaus S.J , Matz J , Koschalka A , Kowallick J.T , De Waha-Thiele S , Desch S , Hasenfuss G , Thiele H , Eitel I , Schuster A 
Published: November 2020

Abstract

Background
Right ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking.

Purpose
To assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI.

Methods
Cardiac magnetic resonance (CMR) was performed in 1235 patients with MI (STEMI: n=795; NSTEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (edema representing reversible ischemia, irreversible infarction, microvascular obstruction [MVO]) and functional (ejection fraction, global longitudinal strain [GLS]) RV alterations. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE).

Results
RV ischemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischemia was associated with a significantly increased risk of MACE (10.1% versus 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% versus 3.8%; p&lt;0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (hazard ratio 1.05, 95% confidence interval 1.00–1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020), and left ventricular GLS (p=0.001), while RV ischemia was not independently associated with outcome.

Conclusions
RV GLS is a predictor of post-infarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome.

Funding Acknowledgement
Type of funding source: None
Angiopoietin-like 4 protein is a long-term predictor of outcome in chest-pain patients with suspected acute coronary syndrome
Authors: Aarsetoey R , Ueland T , Aukrust P , Michelsen A.E , Ponitz V , Brugger-Andersen T , Leon De La Fuente R , Grundt H , Staines H , Nilsen D.W.T 
Published: November 2020

Abstract

Introduction
Angiopoietin-like 4 protein (ANGPTL4) has multiple physiological functions including modulation of angiogenesis, vascular permeability and lipid-metabolism. Acting as an inhibitor of lipoprotein lipase, ANGPTL4 has previously been found to be associated with lipid levels and risk of coronary artery disease.

Purpose
To assess the prognostic value of ANGPTL4 for long-term outcome, in addition to conventional clinical risk factors, in chest-pain patients admitted with clinically suspected acute coronary syndrome (ACS).

Methods
1853 patients from Norway and Northern-Argentina were consecutively included in this prospective 2-center cohort study. ANGPTL4 concentrations were measured in 1829 admission-samples by enzyme immunoassay. Data were pooled for analysis. Multivariable Cox proportional-hazards models were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24-months, comparing event rates across ANGPTL4-quartiles (Q1–4). Of patients with suspected ACS, 845 had a troponin T (TnT) value above the detection-limit. Subgroup analysis was performed for all-cause mortality in patients stratified according to TnT release &gt;/≤0.01 ng/mL.

Results
During 24-months follow-up, 254 patients (13.9%) died, of which 150 (8.2%) suffered cardiac death and 76 (4.2%) SCD. Patients who died had significantly higher admission-levels of ANGPTL4 compared to long-term survivors [4.99 (3.54–8.37) ng/mL versus 3.18 (2.14–4.78) ng/mL (median, 25 and 75% percentiles), p&lt;0.001]. A stepwise increase in risk of all-cause death was seen with increasing quartiles of ANGPTL4, Figure 1. For cardiac death, ANGPTL4-levels in Q4 [Hazard Ratio (HR) 2.86 (95% confidence interval (CI); 1.10–7.45), p=0.031] as compared to Q1 were found to be an independent predictor of outcome. Similar results were seen for SCD in adjusted analysis for ANGPTL4-Q4 [HR 7.37 (95% CI: 1.75–31.1), p=0.007] as compared to Q1. In subgroup analysis, ANGPTL4 concentrations in the highest quartile were significantly associated with increased risk of all-cause mortality in patients with TnT-release [HR 2.07 (95% CI: 1.06–4.02), p=0.032], but not in patients without TnT-release.

Conclusion
High admission-levels of ANGPTL4 were found to be an independent long-term predictor of all-cause mortality, cardiac death and SCD in patients with suspected ACS.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority
Infarct-related artery and long-term mortality following recurrent ST-elevation myocardial infarction; insights from a Polish nationwide registry
Authors: Wolny R , Desperak P , Kwiecinski J , Gasior M , Witkowski A 
Published: November 2020

Abstract

Background
Recurrent ST-elevation myocardial infarction (rSTEMI) occurs either as an acute thrombotic event in the same (target-vessel, TV-STEMI) or different vessel (non-target, nonTV-STEMI) compared with the first infarction. Little is known about the frequency of rSTEMI in the era of primary percutaneous coronary intervention (PCI) and about the impact of the infarct-related artery (IRA) on long-term prognosis.

Purpose
We hypothesized that long-term mortality after rSTEMI varies according to IRA (either same or different compared with first STEMI).

Methods
We retrospectively analysed data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) and identified survivors of first STEMI treated with PCI who experienced rSTEMI and were discharged home. We divided rSTEMI into TV-STEMI and nonTV-STEMI group. We compared baseline clinical, angiographic and procedural characteristics and utilized propensity score matching to adjust for baseline differences. 1-, 3- and 5-year all-cause mortality was obtained from the Polish National Health Fund. Categorical variables were presented as counts and percentages and compared using Chi2 test. Continuous variables were presented as medians and interquartile ranges and compared using Mann-Whitney test. The registry was approved by local Ethics Committee and meets the conditions of the Declaration of Helsinki

Results
Between January 2003 and August 2019 a total of 3517 patients (mean age 62.9 years, 75% male) had rSTEMI, of whom 1941 (55%) had TV- and 1576 (45%) had nonTV-STEMI after 615 (77, 1683) days since first infarction (Figure 1). Patients with nonTV-STEMI had higher BMI (27.2 vs 26.8 kg/m2, p=0.03), more hypertension (76.9 vs. 73.5%, p=0.02) and atrial fibrillation (4.7 vs. 3.3%, p=0.04), but had lower left ventricular ejection fraction (43 [35,50] vs. 45 [38,50], p&lt;0.001) compared with TV-STEMI. On coronary angiography nonTV-STEMI had more frequently TIMI flow ≥1 (44.9 vs. 28.0%, p&lt;0.001), multivessel disease (51.8 vs. 41.1%, p=0.003), culprit lesion located in circumflex artery (15.2 vs. 4.8, p&lt;0.001) and more frequently underwent stenting (88.4 vs. 76.1%, p&lt;0.001) compared with TV-STEMI. There was no difference in unadjusted 1-, 3- and 5-year mortality between nonTV-STEMI and TV-STEMI group (14.9 vs. 14.7%, p=0.9; 23.4 vs. 24.2%, p=0.64 and 29.6 vs. 32.9%, p=0.1 respectively). The propensity-score matching of 825 patients with TV- and 826 patients with nonTV STEMI suppressed all baseline differences, but adjusted mortality remained similar between study groups (Figure 1).

Conclusion
While patients with recurrent nonTV-STEMI have different clinical and angiographic characteristics compared with TV-STEMI, the long-term mortality in these groups is similar.
Figure 1

Funding Acknowledgement
Type of funding source: None
Probability of coronary disease and clinical outcomes in patients with type 2 myocardial infarction
Authors: Wereski R , Hung J , Shah A.S.V , Anand A , Strachan F.E , Mills N.L , Chapman A.R 
Published: November 2020

Abstract

Background
Type 2 myocardial infarction is common in clinical practice. However, despite these patients having a similar rate of major adverse cardiovascular events as those with atherothrombotic type 1 myocardial infarction, there is currently no consensus on how these patients should be evaluated or managed. Whether risk assessment for coronary artery disease can identify patients at increased risk of death is unclear.

Methods
The High-STEACS trial was a stepped wedge cluster randomised controlled trial in ten hospitals across Scotland, including 48,282 consecutive patients with suspected acute coronary syndrome. The index diagnosis was adjudicated in all patients and the likelihood of underlying coronary artery disease recorded as either low-probability, high-probability, or known based on the clinical history, risk factors and comorbidities. The adjudicators were blinded to the primary and secondary outcomes including all-cause mortality at one year.

Results
High-sensitivity cardiac troponin I concentrations were above the sex-specific 99th centile in 22% (10,360/48,282) of patients. The adjudicated diagnosis was type 1 and type 2 myocardial infarction in 55% (4,981/9,115) and 12% (1,121/9,115), respectively. Compared to patients with type 1 myocardial infarction, those with type 2 myocardial infarction were older and more likely to be women. In patients with type 2 myocardial infarction, 20% were low-probability, 55% were high-probability and 25% had known coronary artery disease. All-cause mortality was highest in patients with known or suspected coronary artery disease (22.5% and 23.3%, respectively). Those with a low-probability of coronary artery disease had the lowest event rate (8.8%), even compared to those with type 1 myocardial infarction (Figure).

Discussion
A simple clinical assessment of whether patients have a low- or high-probability of coronary artery disease is associated with future risk of death in patients with type 2 myocardial infarction. Whether incorporating this assessment into clinical practice to guide secondary prevention could improve outcomes requires prospective evaluation.
Figure 1

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation