bluuebunny/crossref_metadata_2025_split huggingface dataset:
P836Glasgow Prognostic Score predicts the readmission caused by acute decompensated heart failure after myocardial infarction
Authors: Namiuchi S , Sunamura S , Ushigome R , Noda K , Takii T 
Published: October 2019

Abstract

Purpose
The Glasgow Prognostic Score (GPS), combination of C-reactive protein (CRP) and serum albumin concentration, provides predictions of prognosis in patients with heart failure. We evaluated the GPS of patients with acute myocardial infarction (MI).

Methods
We investigated the prognosis of 1182 patients with acute MI in our institution. These patients were classified into three groups by GPS at admission. GPS was defined as follows: patients with both elevated CRP (>1.0mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a score of 2, patients with only one of these biochemical abnormalities were allocated a score of 1, and patients with neither of these abnormalities were allocated a score of 0.

Results
Of the patients, 70.3% (n=831), 19.2% (n=227), and 10.5% (n=124) had GPS of 0, 1, and 2, respectively. In-hospital mortality of GPS 0, GPS 1, and GPS 2 were 4.7%, 18.1%, and 31.5%, respectively (p<0.0001). Relative to a GPS of 0, the hazard ratios for the readmission caused by acute decompensated heart failure (ADHF) were 3.27 (95% CI: 2.04–5.18) for a GPS of 1 and 3.62 (95% CI: 1.93–6.42) for a GPS of 2 in the age- and sex- adjusted Cox proportional hazard model. After propensity score matching, baseline characteristics were balanced, and 250 paired patients constituted GPS 0 group and GPS 1–2 group. Patients with GPS1 or 2 had a higher risk of the development of ADHF compared with patients with GPS 0 (Hazard ratio: 1.96, 95% confidence interval: 1.13–3.47, p=0.017).

Conclusions
The GPS, which is based on systemic inflammation, is useful for predicting the development of acute decompensated heart failure after myocardial infarction.
P839Lifetime cost-effectiveness of diagnostic artificial intelligence tool for evaluating individuals with stable chest pain. The co-operative ARTICA registry database
Authors: Mazzanti M , Shirka E , Gjergo H , Pugliese F , Goda A 
Published: October 2019

Abstract

Background
Non-invasive cardiac imaging testing has been often favored as an initial test for symptomatic patients with at least intermediate pre-test likelihood (pt-lk) of obstructive CAD. Despite this condition, uncertainty remains regarding the optimal testing strategies. It is known that intelligence applied with automatic decision support system (AI DSS) is able to correctly identify absence of significant CAD versus standard care (SD) in patients with stable chest pain (SCP). No evidence of long-term cost-effectiveness about AI DSS has been published in this setting.

Purpose
The aim is to determine the cost-effectiveness of AI DSS when applied to individuals without known CAD presenting with stable chest pain syndrome.

Methods
1725 subjects, 982 males, age 61±12 years, with SCP were referred for clinical evaluation by human standard care (SD) and AI DSS administration during same day visit on a 2 years period. Exercise treadmill test (ETT), coronary tomographic angiography (CTA), invasive coronary angiography (ICA), stress echocardiography (SE)/gated myocardial perfusion scintigraphy (gMPS) and follow up/no tests (FNT) alone and combined strategies were analyzed. For the post-diagnosis follow up period of 16±3 months, we employed a Markov model based on 1-year cycle to account for outcomes for those correctly diagnosed with CAD. All subjects performed CTA to verify presence of CAD. CAD was defined as ≥70% stenosis in at least one major epicardial coronary artery vessels. Monte Carlo simulation was performed to derive mean values for costs and QALYs at different CAD prevalence of 15%, 50% and 80%.

Results
Data from ARTICA registry about lifelong costs based upon different diagnostic strategies in subjects with 15%, 50% and 80% CAD pt-lk are shown in Table.
Lifelong costs related to strategies FNT (€) ETT-SE/gMPS-ICA (€) SE/gMPS-ICA (€) CTA-ICA (€) CTA-SE/gMPS-ICA pt-lk CAD 15% AI DSS 350 8,250 8,850 10,450 11,020 SD 1,015 11,100 12,715 12.215 12,215 pt-lk CAD 50% AI DSS 1,610 17,375 19,540 20,410 20,110 SD 1,855 19,650 21,340 22,950 22,115 pt-lk CAD 80% AI DSS 2,910 28,210 30,875 31,215 31,765 CD 4,110 32,715 34,815 35,755 35,660

Conclusion
Data from ARTICA registry demonstrate that automatic use of AI DSS result in improved costs and enhanced effectiveness when compared with human SD in subjects with stable chest pain.
P842Calculated plasma volume status provides additional prognostic value to global registry of acute coronary event (GRACE) score in patients with acute myocardial infarction
Authors: Kawai T , Nakatani D , Yamada T , Morita T , Furukawa Y , Tamaki S , Iwasaki Y , Kawasaki M , Kikuchi A , Seo M , Hikoso S , Sakata Y , Fukunami M 
Published: October 2019

Abstract

Background
Plasma volume status (PVS) has been shown to be a well-validated prognostic indicator which relate to morbidity and mortality in heart failure. However, it remains unclear whether PVS would have the prognostic significance in patients with acute myocardial infarction (AMI). Global Registry of Acute Coronary Events (GRACE) risk score is a powerful predictor of prognosis after acute coronary event, but there is no information available on the additional prognostic value of PVS to GRACE in AMI patients.

Methods
We retrospectively studied 3930 AMI patients. GRACE score and PVS was obtained on the admission. PVS was calculated as follows: actual PV = (1 - hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] × 100 (%). The endpoint was All cause of death (ACD) within 5 years.

Results
During a mean follow-up period of 2.4±1.9 years, 406 patients had ACD. PVS was significantly greater in patients with ACD than without ACD (8.1±14.9% vs −1.7±13.3%, p<0.001). Each 5% increase in PVS was linked to a 27% estimated risk of 5-year mortality (p<0.001, HR: 1.05 [1.03–1.08]). PVS was still independently associated with ACD, after adjustment with GRACE score as a potential confounding factor. Kaplan-Meier analysis revealed that patients with PV expansion (PVS>0%) were significantly higher risk of ACD than those without PV expansion in patients both with high risk in GRACE score (>140) (28% (225/803) vs 19% (78/412), p=0.01, HR: 7.5) and with low risk in GRACE score (≤140) (6% (52/894) vs 3% (51/1821), p=0.009, HR: 6.2).
Survival rate curves

Conclusion
PVS, which represents intravascular compartment and congestion, could identify poor prognosis in patients with AMI. In addition, PVS would provide additional prognostic information to GRACE score.
P843Study of the CHA2DS2-VASc score in acute coronary syndrome
Authors: Wadie M , Alhaithami A , Wafa A , Yossof M 
Published: October 2019

Abstract

Background
To predict outcomes, acute coronary syndrome (ACS) can be assessed using GRACE and TIMI risk scores, whereas SYNTAX score is used to assess coronary artery disease (CAD) severity and clarify the management. CHA2DS2-VASc score is used as a predictive tool for stroke prevention in non-valvular atrial fibrillation, and it was studied in ACS in terms of outcome and CAD severity

Methods
Between December 2016 and June 2017, 125 ACS patients (mean age: 57.78 (±9.5) years, 78.4% males) were enrolled in this observational prospective study, 89 patients had been followed-up for six months. Patients were assessed based on history, clinical examination, 12-lead ECG, and coronary angiography.

Results
Subjects with a CHA2DS2-VASc score ≥2 had a higher proportion of multivessel disease (3.9%), left main coronary artery lesions (9.9%), and totally occluded, bifurcational, or long coronary lesions (60%) (All p-values<0.05). We found significant positive associations of the CHA2DS2-VASc score with the SYNTAX score (p<0.001) and the Gensini score (p<0.001). Receiver operating characteristic (ROC) curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff>2; 76% sensitivity; 76.8% specificity; p<0.001) in predicting coronary multivessel diseases. Subjects with a CHA2DS2-VASc score ≥2 had a higher in-hospital complications, including heart failure, cardiogenic shock, renal impairment, and AF (all p-values<0.05). The CHA2DS2-VASc score showed significant positive associations with in-hospital (11.9%, p=0.21) and six-month mortality (25%, p=0.042). ROC curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff>2; 88% sensitivity; 65.3% specificity; p<0.001) in predicting six-month-mortality. Multivariate logistic regression analysis showed that the CHA2DS2-VASc score (p<0.001 with odds ratio 2.28; 95% CI 1.47–3.53) and the GRACE score (p<0.001 with odds ratio 1.07; 95% CI 1.03–1.09) were predictors of six-month mortality.

Conclusion
CHA2DS2-VASc score is associated with increased CAD severity and in-hospital and six-month outcomes.

Acknowledgement/Funding
None
P844NAS2H score, a novel predictive score of 1-year all cause mortality in Acute Coronary Syndromes
Authors: Faria Da Mota T , Sousa Bispo J , Azevedo P , Fernandes R , Guedes J P , Bento D , Marques N , Santos W , Mimoso J , Jesus I 
Published: October 2019

Abstract

Introduction
In patients admitted for Acute Coronary Syndromes (ACS), mortality is influenced by several clinical and therapeutical factors, and management of these patients should be guided by an estimate of individual risk.

Objective
To develop a simple predictive model of 1-year mortality in patients admitted for ACS.

Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for ACS in a Cardiology department between the 1st of October 2010 and the 1st of October 2017. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Patients with 1y mortality (1yM) events were studied regarding baseline demographic and clinical characteristics, risk factors and hospitalization data, and a correlational analysis with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%) was performed. Independent predictors of 1yM were identified through binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.

Results
A total of 3251 patients were included, 826 (25,4%) of which were female, with a mean age of 65,5±13,4 years. In the studied sample, 268 patients (8,2%) died in the year following hospital discharge; this group had a mean age of 65,6±13,2 years, and 80 (29,9%) were female patients. There was a significant association between 1yM and multiple clinical, therapeutical and laboratorial variables, but after multivariate analysis only age greater than 65 years old (yo) [p=0,001], previous stroke [p=0,005], haemoglobin (Hb) <10mg/dL [p<0,001], brain natriuretic peptide (BNP) >100pg/mL [p=0,001], and left ventricular ejection fraction (LVEF) <50% [p <0,001] proved to be independent predictors of the studied outcome. Using these variables, the authors developed a scoring model to predict 1yM in patients admitted for ACS with the following formula = 0,002 + (0,736 x Age >65yo) + (0,91 x previous stroke) + (2,562 x Hb <10) + (0,63 x BNP >100) - (1,207 x FEVE >50%). In this function, variables should be substituted by 1 or 0, depending on wheter they are present or not. The discrimination cutoff was 0,57, with a 70,6% sensibility and 75,9% specificity, and a discriminant power of 75,4%.

Conclusion
Defining the mortality risk of ACS patients after discharge represents a real challenge and demands a careful evaluation of multiple factors in an attempt to achieve an accurate estimation of risk. The authors developed a predicting model for 1yM in ACS patients, with a good discriminant power, based on simple variables. The present score will require validation in a larger cohort of ACS patients before it can be applied in a clinical context.
P850Clinical difference of recent myocardial infarction compared with acute myocardial infarction - Insights from Tokyo CCU network multicenter registry
Authors: Ito R , Takayama M , Yamashita J , Yahagi K , Shinke T , Mase T , Abe K , Miyaji H , Higuchi S , Tanaka H , Yamazaki M , Miyauchi K , Yamamoto T , Nagao K , Chikamori T 
Published: October 2019

Abstract

Background
Although the patient's characteristics and outcome of acute myocardial infarction (AMI) have been sufficiently investigated and primary percutaneous coronary intervention (PCI) has been recognized as established treatment strategy, those of recent myocardial infarction (RMI) have not been fully evaluated.

Purpose
The purpose of the present study was to clarify clinical characteristics and in-hospital outcomes of RMI patients from the database of the Tokyo CCU network multicenter registry.

Methods
In Tokyo CCU network multicenter registry database from 2013 to 2016, 15788 consecutive patients were registered as AMI (within 24 hours from onset) and RMI (within 2–30 days from onset). However 1246 patients were excluded because of inadequate data. And we excluded 66 cases because of out of onset period and 129 cases that strongly suspected of involvement of vasospastic events. Therefore, remaining 14347 patients were categorized to RMI group (n=1853) and AMI group (n=12494), and analyzed.

Results
Compared with AMI group, average age was older (70.4±12.9 vs 68.0±13.4 years, p<0.001), male was less (72.4 vs 76.4%, p<0.001), chest pain as chief complaint was less (75.2 vs 83.6%, p<0.001), prevalence of diabetes mellitus was higher (35.9 vs 31.0%, p<0.001), multi-vessel coronary disease was more (54.7 vs 44.6%, p<0.001), patients undergoing PCI was less (79.0 vs 91.2%, p<0.001), and the incidence of mechanical complication was more in RMI group (3.0 vs 1.5%, p<0.001). Although 30-day mortality was equivalent between 2 groups (5.3 vs 5.8%, p=0.360), the major cause of death in AMI group was cardiogenic shock, while in the RMI group it was a mechanical complication. On Kaplan-Meier analysis, the 2 groups had significantly different cumulative incidence of death due to cardiogenic shock (p=0.006, Log-rank test) and mechanical complication (p=0.021, Log-rank test). Furthermore death due to mechanical complication in AMI group was plateau after about 1 week from hospitalization, whereas in RMI group it continued to increase.
Kaplan-Meier analysis

Conclusions
RMI patients had distinctive clinical features in backgrounds and treatment strategies compared with AMI patients, and the major cause of death of RMI patients was different from that of AMI patients. Furthermore, even though treatment during hospitalization of RMI patients was well done, death due to mechanical complications continued to increase.
P856Incidence and Outcomes of irregular protrusion after stent implantation in patients with acute myocardial infarction: An in in vivo optical coherence tomography study
Authors: Kato T , Higuma T , Yokota T , Kudo N , Yokono Y , Senoo M , Narita N , Endo T , Nishizaki F , Shibutani S , Hanada K , Tomita H 
Published: October 2019

Abstract

Background
Irregular protrusion, a protrusion of material with an irregular surface into the lumen of the vessel after stent implantation, can only be identified by optical coherence tomography (OCT). A previous study demonstrated that irregular protrusion after stent implantation was an independent predictor of 1-year major adverse cardiac events (MACE) in CAD patients. However, the true incidence and prognostic significance of irregular protrusion after stenting in patients with ST-segment elevation myocardial infarction (STEMI) have not previously examined.

Aims
The aims of this study were the following: 1) to evaluate the incidence of irregular protrusion detected by OCT in STEMI patients after stenting; and 2) to compare the long-term outcomes between patients with and without irregular protrusion.

Methods and results
A total of 210 STEMI patients who had post-procedure OCT imaging after coronary stenting within 12 hours after symptom onset were studied. We divided them into two groups: those with irregular protrusion (n=159) and those without (n=51) after stenting. There were no significant differences in baseline characteristics between the 2 groups except that peak CK-MB levels were higher in patients with irregular protrusion than those without (289 (137–563) vs. 260 (63–349) U/L, p<0.05). During mean follow-up period of 298 days, the overall incidence of MACE defined as cardiac death, target vessel-related myocardial infarction, and target lesion revascularization was 15.3%. Kaplan-Meier curve showed that the incidence of MACE did not differ between patients with and without irregular protrusion (14.7% vs. 17.7%, p=0.53 by Log-rank).

Conclusions
Irregular protrusion after stent implantation was detected in three-fourth of STEMI patients. Although patients with irregular protrusion had a greater myocardial damage, it did not influence clinical outcomes.

Acknowledgement/Funding
Donation course from Abbott Japan
P858High endothelial shear stress and local Reynolds number are associated with lipid growth of coronary plaques
Authors: Thondapu V , Poon E K W , Tacey M , Zhu S , Dijkstra J , Revalor E , Serruys P , Ooi A , Barlis P 
Published: October 2019

Abstract

Background
Local haemodynamic disturbances in coronary blood flow are associated with abnormal endothelial shear stress (ESS) and progressive atherosclerosis. However, standard techniques to estimate ESS lack the diagnostic specificity necessary for future clinical utility. Possible improvements include use of a more realistic non-Newtonian model of blood, which may provide more accurate ESS measurements and is further able to detect local variations in blood viscosity.

Purpose
To compare accuracy of ESS generated by Newtonian versus non-Newtonian rheological models to detect coronary plaque progression. To investigate local Reynolds number (ReL), a viscosity-based haemodynamic metric calculated by the non-Newtonian model, as an independent marker of plaque progression.

Methods
Sixteen patients with non-culprit plaques completely visualised in serial optical coherence tomography (OCT) imaging were identified. Plaques were analysed in 0.2mm intervals at each timepoint for lipid and calcium arc. Computational fluid dynamic simulations were performed using Newtonian and non-Newtonian models to calculate ESS, whereas ReL was calculated by the non-Newtonian simulations. Each haemodynamic index was compared to interval changes in lipid and calcium using multivariate regression.

Results
In total, 894 matched arterial segments from baseline and follow up imaging were analysed. In the Newtonian results, baseline segments exposed to ESS>1.7Pa had a 12.5° increase in lipid arc (95% CI 2.2° to 22.8°, p=0.018) while segments exposed to ESS<1.1Pa had an 8.1° decrease in calcium (95% CI −14.0° to −2.2°, p=0.007). In the non-Newtonian results, baseline regions exposed to ESS>2.2Pa had a 14.4° increase in lipid (95% CI 4.2° to 24.7°, p=0.006) while areas with ESS<1.4Pa had an 8.7° decrease in calcium (95% CI −14.6° to −2.8°, p=0.004). Baseline regions exposed to ReL<34 showed an average 11.9° increase in lipid arc (95% CI 0.6° to 23.2°, p=0.039). Regions exposed to ReL>55 had an average increase in lipid arc of 26.6° (95% CI 14.5° to 38.6°, p<0.001).

Conclusions
Both Newtonian and non-Newtonian rheological models show that high ESS is associated with increased lipid while low ESS is associated with decreased calcium. ReL is independently associated with interval increases in lipid arc, suggesting a mechanistic role of local blood viscosity in lipid accumulation. ReL may serve as a novel haemodynamic marker of plaque progression.
P862Hypoxemia during sleep in patients with vasospastic angina
Authors: Nakagawa Y , Sairyo M , Nozaki S 
Published: October 2019

Abstract

Background
Previous studies have shown the associations between sleep-disordered breathing (SDB) and vasospastic angina (VSA). However the characteristics of SDB related to VSA have been unknown.

Purpose
We investigate the characteristics of SDB in VSA patients, with focus on the role of nocturnal hypoxemia, which may trigger nocturnal ischemic attacks, typical attacks occurred during sleep in early morning.

Methods
We studied 33 patients who were diagnosed with VSA, based on diagnostic algorithm in the Japanese Circulation Society guidelines 2013 for VSA. All patients underwent polysomnography. Twenty one patients with moderate-severe SDB [apnea-hypopnea index (AHI) of at least 15/hour] diagnosed with polysomnography, but without cardiovascular diseases, were served as controls.

Results
Only 3 patients with VSA were free of SDB (AHI less than 5/hour). Moderate to severe SDB was found in 25 of 33 patients with VSA. These 25 patients were further studied. Daytime sleepiness assessed by the Epworth sleepiness scale, was lower in SDB patients with VSA than those without it (4.8±4.2 vs. 8.9±4.0; p=0.02). There were no differences in AHI between SDB patients with and without VSA (41.2±17.2/hour vs. 39.9±14.4/hour), but hypoxemic burden (time with oxygen saturation <90%) was higher in those with VSA than those without it [(median 20.7minitutes, interquartile range 6.4–48.0minitues) vs. median 5.9minitutes, interquartile range 3.9–11.0minitues); p=0.01]. In VSA patients, 39% of hypoxemia was observed in rapid eye movement (REM) periods of sleep, which accounts for only 18% of total sleep.

Conclusions
A high prevalence of moderate-severe SDB was found in VSA patient, although the symptoms were mild. Hypoxemia is a characteristic of SDB associated with VSA, which may be a target for therapeutic intervention in addition to drug therapy.
P867Detecting cholesterol crystals in coronary artery disease
Authors: Komatsu S , Takahashi S , Yutani C , Takewa M , Ohara T , Kodama K 
Published: October 2019

Abstract

Background
Cholesterol crystals (CCs) have been recognized as only ghost images. Recently, free monolayer and multilayer CCs besides atheromatous materials from aortic ruptured plaque, obtained using nonobstructive angioscopy, were demonstrated using polarized light microscopy.

Purpose
The aim of the study was to detect free CCs from coronary slow flow.

Methods
A total of 86 patients with coronary artery disease underwent angioscopy with coronary artery sampling. Blood in the coronary artery with and without temporary slow flow was sampled. The blood sample was spread onto a filter paper, and the filter paper was rinsed with distilled water (filter paper-rinse method). The rinse water was scanned using polarized light microscopy, and CCs were detected. The dimensions of CCs from the coronary artery and aortic ruptured plaques were measured for 100 randomly selected samples. The lengths and widths of the CCs were measured.

Results
CCs were obtained in 31 of 86 patients (36.0%). CCs were detected in 38.4% of patients with acute coronary syndrome and in 31.9% of patients with stable angina. CCs were detected 47.1% with slow flow and in 25% without slow flow.
Cholesterol Crystals in Coronary Artery

Conclusions
CCs from the coronary artery can be successfully obtained by using our original method. CCs were detected in patients with clinically stable angina and in those without coronary artery slow flow.