bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3123Enoxaparin versus unfractionated heparin in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
Authors: Graca Santos L , Ribeiro Carvalho R , Montenegro F , Ruivo C , Correia J , Pernencar S , Soares F , Morais J 
Published: October 2019

Abstract

Background
The use of intravenous enoxaparin (LBWH) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) was upgraded in the latest European Guidelines to a class IIa recommendation.

Purpose
The authors aim to compare safety and prognostic impact of LMWH versus unfractionated heparin (UFH) use in STEMI patients undergoing primary PCI.

Methods
Retrospective study of 3875 STEMI patients who underwent pPCI between October 2010 and September 2017 and were included in a national multicenter registry. Group A consisted of patients managed only with LMWH, and Group B patients were treated with UFH regardless of eventual LMWH associated exposure. The groups were compared according to their demographic, clinical and laboratory characteristics. The primary endpoint (PE) results from a composite which included: procedural failure (pPCI failure or bailout use of GPIIb/IIIa inhibitors), in-hospital mortality, re-infarction or major bleeding (according to the registry criteria). The secondary endpoint (SE) included: in-hospital major bleeding, need for red blood cell transfusion, or haemoglobin drop ≥2g/dL. A 1:1 propensity score (PS) analysis was performed according to demographic variables, medical history and previous medication, physical examination, electrocardiogram characteristics and left ventricular function, matching 1558 of the 3875 patients for later comparison between groups.

Results
Overall, Group A included 1083 (27.9%) and Group B 2792 (72.1%) patients. The mean age was 63±14 years, and 33.5% of the cohort were female. Despite the baseline characteristics heterogeneity between groups, this phenomenon was not observed after PS matching. The PE was more frequent in Group A, without reaching statistical relevance (15.6% vs 13.3%, p=0.07). The SE was superior in Group A (34.4 vs 29.4%, p=0.01). According to the PS matching analysis, there were no differences beetween groups in terms of the PE (13.9% vs 12.0%, p=0.28), while the SE kept more frequent among Group A (34.9% vs 28.5%, p=0.02) [Figure].
Propensity score: group comparison

Conclusion
In this study based on a national multicentric registry of STEMI patients, the use of LMWH was not associated with better in-hospital prognosis in terms of major cardiovascular events and was related with higher rates of bleeding related events in the scenario of pPCI, compared to UFH. According to these results, further studies are required to support the widespread use of LMWH in this clinical scenario.
P3126Immediate versus delayed revascularization in patients with transient ST-elevation myocardial infarction: 1-year follow-up of the randomized clinical TRANSIENT trial
Authors: Janssens G N , Van Der Hoeven N W , Lemkes J S , Everaars H , Van De Ven P , Marques K M J , Nap A , Van Leeuwen M A H , Appelman Y E A , Brinckman S L , Timmer J R , Meuwissen M , Van Der Weerdt A , Nijveldt R , Van Royen N 
Published: October 2019

Abstract

Background
Up to 24% of acute coronary syndrome patients present with ST-elevation but show complete resolution of ST-elevation and symptoms before revascularization. The current guidelines do not clearly state whether these transient ST-elevation myocardial infarction (TSTEMI) patients should be treated with a ST-elevation myocardial infarction (STEMI)-like or a non-STEMI-like invasive approach.

Purpose
The aim of the present study is to determine the effect of an immediate versus a delayed invasive strategy on infarct size measured by 4-month cardiac magnetic resonance imaging (CMR) and clinical outcome up to one year.

Methods
In this multicenter trial, 142 TSTEMI patients were randomized 1:1 to either an immediate or a delayed intervention. CMR was performed at four days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at four months and one year.

Results
Both in the immediate (0.4 h) and the delayed invasive group (22.7 h) CMR-derived infarct size at four months was very small and left ventricular function was good. In addition, major adverse cardiac events and all-cause mortality at one year were low and not different between both groups (table 1).
CMR and clinical outcomes up to one year Outcome Immediate invasive group (n=70) Delayed invasive group (n=72) p-value Myocardial infarct size (% of LV), median (IQR) 0.4 (0.0–3.5) 0.4 (0.0–2.5) 0.79 LVEF (%), mean ± SD 59.9±5.4 59.3±6.5 0.63 LVEF recovery (%), mean ± SD 2.2±5.4 1.7±5.3 0.66 MVO present, No. (%) 0 (0.0) 1 (1.9) 0.50 MACE (death, reinfarction, target lesion revascularization), No. (%) 3 (4.4) 4 (5.7) 1.00 Death from any cause, No. (%) 0 (0.0) 3 (4.3) 0.24 Reinfarction, No. (%) 2 (3.0) 1 (1.4) 0.62 Target lesion revascularization, No. (%) 2 (3.0) 1 (1.4) 0.62 Definite stent thrombosis, No. (%) 1 (1.5) 1 (1.4) 1.00 Abbreviations: IQR, interquartile range; LV, left ventricle; LVEF, left ventricle ejection fraction; MACE, major adverse cardiac events; MVO, microvascular obstruction; NA, not applicable; SD, standard deviation.

Conclusions
We demonstrated that patients with TSTEMI have limited infarct size and preserved left ventricular function and that an immediate or delayed approach has no effect on clinical outcome up to one year. Therefore, patients with TSTEMI can be treated with both an immediate or a delayed invasive strategy with similar outcome. These findings extend our current knowledge about the optimal timing of coronary intervention in patients with TSTEMI and complement the guidelines.

Acknowledgement/Funding
AstraZeneca, Biotronik
P3127Optimal revascularization strategy in non-ST-segment elevation myocardial infarction with multivessel coronary artery disease: staged vs. one-time vs. culprit-only revascularization
Authors: Kim M , Ahn Y , Jeong M H , Sim D S , Hong Y J , Kim J H , Ahn T H , Seung K B , Kim H S , Gwon H C , Chae S C , Hur S H , Cha K S 
Published: October 2019

Abstract

Background/Introduction
Although optimal revascularization strategy in patients with ST-segment elevation myocardial infarction with multivessel coronary artery disease (MVD) was well established, there are few studies which investigated optimal revascularization strategy in non-ST-segment elevation myocardial infarction (NSTEM) with MVD.

Purpose
We investigated 2-year clinical outcomes according to strategy of revascularization in patients with NSTEMI and MVD.

Methods
Between November 2011 and October 2015, a total of 2474 patients with NSTEMI and MVD who underwent successful percutaneous coronary intervention were analyzed from the Korea Acute Myocardial Infarction Registry-National Institute of Health (staged 308, one-time 1043 and culprit-only 1123 patients). We did not include patients with left main disease and cardiogenic shock. Primary endpoint was major adverse cardiac events (MACE: the composite of cardiac death, myocardial infarction [MI] or target-vessel revascularization [TVR]) during 2-year follow-up (median 737 days [interquartile range 705–764]). We also analyzed the of all-cause mortality, stroke and non-TVR.

Results
Baseline characteristics such as age, gender, and prevalence of atherosclerotic risk factors between multivessel revascularization (MVR; staged or one-time revascularization) and CVR were similar. There was also no difference in symptom to balloon time in 2 groups. MACE occurred in 305 patients (12.3%) during 2-year follow-up. MVR could reduce incidence of MACE (10.2% vs. 14.9%; adjusted hazard ratio [HR] 1.50 for CVR, 95% confidence interval [CI] 1.20–1.88, p<0.001), all-cause death (8.4% vs. 12.1%; adjusted HR 1.45 for CVR, 95% CI 1.13–1.87, p=0.003) and non-TVR (1,9% vs. 7.0%; adjusted HR 3.99 for CVR, 95% CI 2.55–6.27, p<0.001). There was no difference in incidence of stroke between MVR and CVR. We also analyzed same analysis between staged and one-time revascularization. Complete revascularization was more achieved in one-time revascularization group compared to staged revascularization group (62.0% vs. 76.1%, p<0.001). In multivariate Cox-regression analysis, staged revascularization was not associated with improved clinical outcomes in terms of MACE (HR 0.74, 95% CI 0.50–1.09, p=0.126), all-cause death (HR 1.07, 95% CI 0.69–1.68, p=0.759), stroke (HR 1.75, 95% CI 0.68–4.52, p=0.245) and non-TVR (HR 2.56, 95% CI 0.75–8.68, p=0.132). Analysis by propensity score matching and inverse probability of treatment weighting did not significantly affect the results.

Conclusions
MVR reduced 2-year adverse cardiac events in patients with NSTEMI and MVD compared to CVR. However, staged revascularization was not superior to one-time revascularization for reducing MACE among NSTEMI patients with MVD who received MVR.
P3136Percutaneous aspiration procedure as an adjunct to transvenous lead extraction procedures in patients with large lead vegetations
Authors: Starck C T , Schaerf R H M , Breitenstein A , Steffel J , Najibi S , Conrad J , Eulert-Grehn J J , Lanmueller P , Falk V 
Published: October 2019

Abstract

Background
Patients with systemic CIED (Cardiac implantable electronic device) infection with large lead vegetations are a clinical challenge and carry a high operative risk. In three lead extraction centers a treatment strategy with minimal-invasive percutaneous aspiration of vegetations and subsequent transvenous lead extraction was established. The results of this concept were evaluated with regard to safety and efficacy in this retrospective multi-center study.

Methods
Between June 2015 and December 2018 we performed combined percutaneous aspiration procedures and transvenous lead extractions in 107 patients with 262 targeted leads (179 pacemaker leads, 83 ICD leads) for extraction. Mean lead vegetation size in preoperative echocardiography was 30.6±13.3 mm. Mean lead implant duration were 82.8 (1–254) months. The aspiration system is based on a veno-venous extracorporeal circuit with an in-line filter and a specialized venous drainage cannula.

Results
Complete procedural success of the percutaneous aspiration procedure was 94.4% (n=101), partial success was achieved in 4.7% (n=5). Three complications (2.8%) related to the aspiration procedure were encountered. In the concomitantly performed transvenous lead extraction procedures complete procedural success per targeted lead was 99.2% (n=260). 30 day mortality was 2.8% (n=3).

Conclusion
The minimal-invasive percutaneous aspiration procedure proved to be safe and effective. It facilitated the subsequent transvenous lead extraction procedure, avoids septic embolization into the pulmonary circulation and abolished the need for open surgical extraction in this high-risk patient group.
P3347Pre-hospital time and 30-day mortality in patients with presumed heart conditions or dyspnea: a registry-based cohort study of patients requiring a highest priority emergency medical response
Authors: Mills E H A , Aasbjerg K , Hansen S M , Ringgren K B , Dahl M , Rasmussen B S , Torp-Pedersen C , Soegaard P , Kragholm K 
Published: October 2019

Abstract

Introduction
Centralization of emergency care is expected to increase average pre-hospital time for patients, leading to concerns about possible adverse outcomes for patients. Prior studies have found increased mortality for patients with prolonged transport following acute myocardial infarction.

Purpose
Examine the association between total pre-hospital time (from dispatch to hospital arrival) and mortality for patients, depending on the condition presumed by the emergency dispatcher (presumed heart condition, dyspnea or non-specific medial conditions).

Methods
Pre-hospital registry data from a Danish region from 2006–2012 was used. This contained information on ambulance dispatch priority, ambulance times, and patient condition, as well if procedures consistent with cardiac arrest (CPR or shock) were performed. We included patients with both highest priority dispatch and transport to the hospital. Linkage to nationwide registries of hospital admissions, comorbidities and mortality was performed. Logistic regression was used for analysis.

Results
95% of total pre-hospital times were below 84 minutes. 30-day mortality was highest among patients with dyspnea (36.6%). Compared to pre-hospital times of 0–30 min, odds ratios of 30-day mortality for times >60 min were: for presumed heart conditions 0.54 [95% CI 0.38–0.77] (p<0.001), for dyspnea 0.98 [95% CI 0.65–1.47] and for other medical conditions 1.14 [95% CI 0.98–1.32]
Patient characteristics and outcomes according to the presumed aetiology of the priority 1 emergency dispatch Presumed heart condition Dyspnea Other medical conditions N 1836 1101 11538 Age, median {IQR} 66.4 {55.3, 76.8} 70.5 {56.8, 80.8} 61.5 {40.3, 75.8} Male, n (%) 1194 (65.0) 585 (53.1) 6172 (53.5) 10-year Charlson comorbidity index score ≥3, n (%) 744 (40.5) 613 (55.7) 4311 (37.6) Response time, median {IQR} 9 {5, 13} 9 {5, 13} 8 {5, 13} Total pre-hospital time, median {IQR} 49{37,61} 45{34, 58} 46{34,58} Cardiac arrest procedures during transport, n (%) 266 (14.5) 133 (12.1) 844 (7.3) Cardiovascular diagnosis (DI00-DI99), n (%) 962 (52.4) 282 (25.6) 3285 (28.5) Respiratory diagnosis (DJ00-DJ99), n (%) 82 (4.5) 430 (39.1) 1036 (9.0) 1-day mortality, n (%) 289 (15.7) 225 (20.4) 1311 (11.4) 30-day mortality, n (%) 402 (21.9) 403 (36.6) 2264 (19.6)
Logistic regression, 30-day mortality

Conclusion
No overall association between total pre-hospital time and mortality, however for presumed heart conditions longer times may improve survival.

Acknowledgement/Funding
Program for clinical research infrastructure (PROCRIN) established by the Lundbeck and Novo Nordisk foundations & The Danish Heart Foundation
P3350Design of a multicenter, open-label, randomized controlled trial: effects of intensive systolic blood pressure lowering treatment in reducing risk of vascular events (ESPRIT)
Authors: Liu J , Li J , Huang X H 
Published: October 2019

Abstract

Background
Patients with cardiovascular diseases (CVD) are at high risk for recurrent major cardiovascular events. Effective public health strategies to lower blood pressure (BP) are necessary to reduce risk of cardiovascular disease. However, substantial uncertainty remains about the optimal target level to lower BP in patients with cardiovascular disease.

Purpose
To assess the effects on the incidence of major cardiovascular events in patients with CVD during the scheduled treatment period of greater reduction in blood pressure with a systolic BP (SBP) target <120 mmHg versus <140 mmHg.

Methods
This study is a multicenter, open-label, randomized controlled trial comparing two strategies for lowering SBP: lowering SBP to the standard target of <140 mmHg; and lowering BP to a more intensive target of <120 mmHg. This study will enroll 12,000 Chinese participants from 100–200 hospitals, follow-up for about 3 years. We will include participants aged ≥50 years old with SBP ≥130 mmHg, having a history of vascular disease (including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, carotid endarterectomy or carotid stenting, peripheral artery disease with revascularization, abdominal aortic aneurysm ≥5 cm with repair) or stroke. The primary outcome is the first occurrence of major cardiovascular events defined as a composite of myocardial infarction, stroke, coronary or non-coronary revascularization events, and cardiovascular death. Secondary outcomes include the components of the primary composite outcome, hospitalized heart failure and all cause of death and non-cardiovascular outcomes (kidney disease and cognitive outcomes).

Results
Regarding the results, we hypothesize that comparing with SBP target of <140 mmHg, more intensive SBP target of <120 mmHg can further reduce the occurrence of cardiovascular events in CVD patients with elevated blood pressure.

Conclusion
This study can provide reliable evaluation on whether more intensive SBP target of <120 mmHg is more desirable than SBP target of <140 mmHg in CVD patients with elevated blood pressure.
P3356Antiarrhythmic therapy with amiodarone decreases the uptake of 82-Rubidium-PET: studies in a rodent model
Authors: Bentsen S , Jensen J K , Ripa R , Hasbak P , Kjaer A 
Published: October 2019

Abstract

Introduction
Myocardial perfusion imaging using positron emission tomography (PET) with 82Rubidium (82Rb) is used as a standard clinical examination. 82Rb-PET provides important information for the correct diagnosis and aids in prognostic risk assessment in patients with ischemic heart disease. 82Rb enters the myocardial cells by active transport of the sodium/potassium adenosine triphosphate transporter. Some antiarrhythmic drugs inhibits sodium/potassium adenosine triphosphate transporter.

Purpose
To determent if the uptake of 82Rb-PET using standard uptake value (SUV) is affected by administration of antiarrhythmic drugs.

Methods
Twenty-one Sprague-Dawley rats were baseline PET/CT scanned with 82Rb, using a Siemens preclinical PET/CT Inveon MM system and a Cardiogen-82 Rb generator. After baseline scan, the rats were divided into three groups. One control group without any treatment, and two received treatment with either orally administered Metoprolol 50mg/kg/24h or orally administered Amiodarone 120mg/kg/24h for seven days. All three groups were again PET/CT scanned with 82Rb-PET after the last administration on day seven. Data are presented as mean ±SEM.

Results
In the control group, there was no difference in mean SUV in the heart from day one to day seven (SUVmean 3.47±0.11 vs 3.45±0.35 p=0.97). In the group treated with metoprolol, likewise there was no difference in mean SUV in the heart from day one to day seven (SUVmean 3.87±0.13 vs 4.4±0.21 p=0.096). In contrast, in the group treated with amiodarone there was a significant difference in mean SUV from day one to day seven (SUVmean 4.14±0.15 vs 3.38±0.18 p=0.001). In all three groups there was no difference in mean SUV from day one to day seven in the liver and kidney.

Conclusions
The antiarrhythmic drug amiodarone had a clear impact on SUVmean in the heart. To the best of our knowledge, this is the first time it has been shown, that amiodarone lowers the SUV in 82Rb-PET in the heart. Amiodarone therefore seems to change to uptake of 82Rb in the myocyte. This could potentially influence the calculation to estimate absolute flow through the coronary arteries and lead to wrong conclusions regarding myocardial perfusion in patients treated with amiodarone. Further studies are needed to characterize the mechanism and to confirm the effect clinically.
P3357Reproducibility of myocardial flow reserve estimation using Rubidium-82 PET/CT scans in healthy, young volunteers: comparison of three commercially available software packages
Authors: Byrne C , Kjaer A , Olsen N E , Forman J L , Hasbak P 
Published: October 2019

Abstract

Background
The use of myocardial blood flow (MBF) reserve assessed with cardiac positron emission computed tomography (PET/CT) is well established and contain important prognostic information e.g. in patients with ischaemic heart disease. However, perfusion data must be interpreted under consideration of the limitations of the method. It has previously been concluded that software specific age and sex matched normal values for MBF reserve should be used as reference. Furthermore, reproducibility between scans seems to vary more in persons with higher risk of cardiovascular disease than in those with no risk factors. Comparison between scans has previously been conducted using dipyridamole as a stressor. However, no former studies have addressed this using adenosine as stressor for 82Rb-PET/CT in a combined study of scan reproducibility and software comparison.

Purpose
The aim of this study was to investigate reproducibility of rest- and adenosine stress 82Rb-PET/CT estimated MBF reserve in healthy young volunteers between two scans analysed with three commercially available software packages.

Methods
Forty healthy young volunteers completed two 82Rb-PET/CT rest- and adenosine stress scans obtaining myocardial blood flow (MBF) and MBF reserve, syngo MBF, Quantitative Gated SPECT (QGS) and Corridor4DM (4DM) were used for analyses.

Results
Fifty percent were men and mean (±SD) age was 24±4 years. Varying reproducibility of MBF reserve between scans was found for the different software packages. MBF reserve with syngo.MBF (Figure 1A): mean difference (95% CI) 0.26 (−0.03 to 0.54), P=0.07, limits of agreement: −1.43 to 1.95, MBF reserve with QGS (Figure 1B): mean difference (95% CI) 0.19 (−0.08 to 0.46), P=0.15, limits of agreement: −1.38 to 1.76 and MBF reserve with 4DM (Figure 1C): mean difference (95% CI) 0.08 (−0.17 to 0.34), P=0.50, limits of agreement: −1.37 to 1.53. Significantly higher MBF reserve was measured with 4DM (mean±SD: 4.00±0.96) compared to syngo.MBF (mean±SD 3.75±0.91, P<0.001) and QGS (mean±SD 3.75±0.89, P<0.0001), whereas concordance between MBF reserve measured by syngo.MBF and QGS was high (P=0.87).
Figure 1

Conclusions
All software packages identified the participants with flow values in the high end of the normal range, as expected for healthy volunteers. Varying reproducibility of MBF reserve was found between scans for the different software packages and 4DM seemed to have the highest inter-scan reproducibility. Concordance between MBF reserve measures was high between syngo.MBF and QGS whereas higher MBF reserve measures was conducted from 4DM in comparison with the two other software packages. Our results suggest that MBF analysed with syngo.MBF and QGS may be mutually comparable but that 4DM may be preferred for analyses due to possibly higher scan to scan reproducibility.