bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5482The lipid paradox in patients with non-ST elevation and ST elevation myocardial infarction and percutaneous coronary intervention
Authors: Sia C H , Ho A F W , Bulluck H , Zheng H L , Foo L L , Chan M Y Y , Hausenloy D J 
Published: October 2019

Abstract

Background/Introduction
Elevated levels of low-density lipoprotein (LDL-C) and triglycerides (TG) are well-described risk factors for the development of acute myocardial infarction (MI). Despite these well-established associations, previous studies have described the existence of a “lipid paradox” in acute MI patients – Patients paradoxically have worse outcomes despite having lower LDL-C and TG levels.

Purpose
We conducted this study to clarify the relationship of the lipid paradox and clinical outcomes amongst non-ST elevation (NSTEMI) and ST elevation MI (STEMI) patients in patients who have had percutaneous coronary intervention.

Methods
We included all acute MI patients reported to the Singapore Myocardial Infarction Registry from 2007 to 2013 who have had percutaneous coronary intervention. This information was linked to the national claims database to obtain the final discharge diagnosis for re-hospitalization outcomes. Exposure of interest was the lipid profile obtained within 72 hours of the acute MI (LDL-C, TG; Total cholesterol [TC]; high-density lipoprotein [HDL-C]). Primary outcomes were all-cause mortality during hospitalization, within 30-days and within 1-year. Secondary outcomes were re-hospitalization within 1-year for heart failure, stroke and MI.

Results
There were 8988 NSTEMI and 12453 STEMI cases available for analysis (n=21441). The NSTEMI patients were older (60.3 years vs 57.6 years, p<0.001) and more likely to be female (15.1% vs 22.6%, p<0.001). In the NSTEMI subgroup, a lower LDL-C was paradoxically associated with better outcomes for death during hospitalization, death within 30 days from MI onset and death within 1 year from MI onset (all p<0.001) across the various LDL-C levels. Adjustment for demographic variables, co-morbidities and MI characteristics eliminated this paradox. However, in the STEMI subgroup, the lipid paradox for LDL-C persisted for all primary outcome endpoints after adjustment. In the STEMI patients, a lower HDL-C also appeared to be protective. An elevated TG level did not appear to be protective in both NSTEMI and STEMI patients after adjustment.

Conclusion(s)
An elevated LDL-C appears to be a protective prognostic marker in STEMI but not NSTEMI patients who have undergone percutaneous coronary intervention. This difference may be due to differing underlying pathophysiological mechanisms between the 2 populations.
P5483Prognostic impact of skeletal muscle, fat, and bone mass in male patients with ST-segment elevation myocardial infarction
Authors: Satou R , Akiyama E , Konishi M , Matsuzawa Y , Kimura Y , Okada K , Maejima N , Iwahashi N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K 
Published: October 2019

Abstract

Introduction
Muscle, fat and bone mass may play some roles to keep physical activity and favorable outcome in patients with cardiovascular diseases. However, there is a paucity of data regarding the effects on the prognosis of skeletal muscle, fat, and bone mass in patients with ST-segment elevation myocardial infarction (STEMI).

Purpose
Our purpose was to examine whether skeletal muscle, fat, and bone mass each affect the prognosis after STEMI.

Methods
A total of 354 male patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization.

Results
During a median follow-up of 32 months, 57 patients experienced primary composite outcome. Each of skeletal muscle, fat, and bone mass were indexed by height squared (kg/m2) and divided into two groups using the cut-off value obtained from the maximum Youden index to predict the primary composite outcome. The event rate was significantly higher in patients with low appendicular skeletal muscle mass index (ASMI) (29.2% vs 11.7%, p<0.001), low fat mass index (FMI) (22.9% vs 13.3%, p=0.030), and low bone mass index (23.8% vs 11.6%, p=0.002). After adjustment for age, renal function, diabetes mellitus, infarct size, Killip classification, and body mass index, low ASMI but not FMI (p=0.150) and bone mass index (p=0.159) was independently and significantly associated with the primary composite outcome (adjusted hazard ratio 2.12, 95%-confidence interval 1.05–4.31, p=0.035).

Conclusions
Index about muscle mass rather than fat and bone mass have prognostic impact in male patients with STEMI.
P5484Cigarette smoking as a risk factor for ST-elevation of myocardial infarction in young women
Authors: Scarpone M L , Krljanac G , Vasiljevic Z , Kedev S , Valvukis M , Bergami M , Manfrini O , Milicic D , Cenko E , Badimon L , Bugiardini R 
Published: October 2019

Abstract

Background
St-elevation myocardial infarction (STEMI) is the most serious form of clinical presentation of coronary heart disease. Women with STEMI have worse prognosis compared with men. The overall reduction in both incidence of STEMI and active smokers makes it unclear what role smoking continues to play as a risk factor for STEMI in the two sexes.

Purpose
To use the relation between current cigarette smoking and myocardial infarction to quantify the relative risk (RR) ratio of STEMI in women and men.

Methods
Data were derived from 11,925 consecutive patients admitted to 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT0128776) from January 2010 to July 2018 with a first acute myocardial infarction. Outcome measures included rates of STEMI at clinical presentation as marker of larger infarctions. Estimates were obtained using logistic-regression and propensity score matching models for current versus never or former smokers. The RR was estimated using men as a reference value.

Results
Smokers experienced myocardial infarction (either STEMI or non-STEMI) much earlier than did non-smokers both in women (59.0±10.2 versus 68.7±11.30 years) and men (55.8±10.3 versus 63.3±11.7 years). Current tobacco smoking was more prevalent in men (50.35% vs 31.75%) and in younger patients (57.71 vs 28.81%). Among younger patients, smoking remained prevalent in men (60.11% vs 49.85%). Smoking was significantly related to STEMI (OR 1.45; 95% CI: 1.32–1.59) compared with non-STEMI. This association was noted in women (OR 1.61; 95% CI: 1.34–1.93) and men (OR 1.39; 95% CI: 1.24–1.56) and was stronger for younger (<65 years) compared with older ages (ORs 1.49; 95% CI: 1.33–1.67 vs 1.34; 95% CI: 1.13–1.59). The risk of STEMI in young women was higher than in young men (ORs 1.63; 95% CI 1.30–2.06 vs 1.45; 95% CI 1.26–1.66,). Propensity score matching analysis confirmed data. Rates of STEMI in young women and young men were 75.8% versus 64.5%, with a significant RR ratio (OR 1.15; CI 1.07–1.23) across outcomes.

Conclusions
Although current smoking still is an important risk factor for STEMI at all ages and sexes, it is especially relevant in younger women. Mechanisms underlying the sex difference are not related to differences in smoking behaviour. This finding is a critical reminder that physicians and society should address in rigorous tobacco-control programs in the general population with a distinctive emphasis on women, particularly in those countries where smoking among young women is increasing in prevalence.
P5488Temporal trends and prognostic impact of hospital length of three or less days in uncomplicated myocardial infarction after primary percutaneous coronary intervention in Spain
Authors: Caneiro B , Abuassi E , Bernal J L , Raposeiras-Roubin S , Elola F J , Fernandez C , Cobas Paz R J , Munoz Pousa I , Cespon Fernandez M , Dominguez Rodriguez L M , Dominguez Erquicia P , Fernandez Barbeira S , Castineiras M , Iniguez Romo A 
Published: October 2019

Abstract

Introduction and objectives
There is scarce data on the safety of hospital stay length in uncomplicated ST- elevation myocardial infarction (STEMI). We studied the trends of the hospital stay and the safety of short (≤3 days) vs. long hospital stay, in Spain.

Methods
Using data from the Minimum Basic Data set of Spanish taxpayer-funded health system. We identified patients with uncomplicated STEMI undergoing coronary angioplasty and who were discharged alive. The mean length of stay was calculated by multilevel Poisson regression with mixed-effects, including patients from 2003–15. The effect of short stay on cardiac diseases readmissions at 30 days and 1 year was evaluated by multilevel logistic regression, including patients from 2003–14. Thirty-day and 1-year cardiac diseases risk-standardized readmissions and mortality rates (RSRRs and RSMRs), respectively, were also compared.

Results
The adjusted mean length of stay was significantly reduced (incidence rate ratio <1; p<0.001) for each year since 2003. The percentage of short stay increased from 14.3% in 2003 to 19.5% in 2015 (p<0.001). In none of the specified models short stay was statistically significant (p>0.05). The RSRRs at 30 days and 1 year as well as RSMRs at 30 days, did not differ significantly between groups. 1-year RSMRs was significantly higher in the short stay group, although probably without clinical significance (0.103% vs. 0.109%, p<0.001). See Table.
Diff mean of RSRRs and RSMRs at 30 days & 1 year Stay length N Mean Standard deviation p-value RSRRs at 30-day ≤3 days 6,486 2.541 0.74 0.20 >3 days 31,651 2.554 0.72 RSRRs at 1 year ≤3 days 6,486 5.306 1.22 0.42 >3 days 31,651 5.292 1.14 RSMRs at 30-day ≤3 days 6,486 0.109 0.04 <0.001 >3 days 31,651 0.103 0.03 RSMRs at 1 year ≤3 days 6,486 0.429 0.13 0.25 >3 days 31,651 0.427 0.13 RSRRs = risk-standardized readmission rates; RSMRs = risk-standardized readmission mortality rates.

Conclusions
In Spain, short hospital stay increased significantly from 2003 to 2015 and seems a safety option in uncomplicated STEMI patients.
P5491Gender differences in long-term outcomes and predictors of all-cause mortality after percutaneous coronary intervention
Authors: Conradie A , Chowdhury E , Whelan A , Worthley S , Rafter T , Eccleston D 
Published: October 2019

Abstract

Background
Gender disparities have been consistently reported in the nature, presentation, and treatment of coronary artery disease, leading to significant outcome differences. Previous reports have suggested that after adjusting for differing baseline and procedural characteristics female gender was an independent predictor of all-cause mortality after Percutaneous Coronary Intervention (PCI). We examined this issue using data from the Genesis Cardiovascular Outcomes Registry (GCOR).

Methods
We prospectively collected data on 10,989 PCI procedures from January 2009 to January 2018 from 12 Australian Hospitals, and compared the baseline patient and procedural characteristics and 1-year mortality by gender.

Results
Female patients were more likely than males to present with NSTEMI (23.0% vs. 21.1%, p=0.042), however less likely to have prior MI (19.5% vs. 24.2%, p<0.001) or PCI (28.8% vs 33.6%, p<0.001). Procedural success rates were similar between females and males (97.2%). On multivariate logistic regression, female gender had a higher rate of all cause mortality (OR 0.58, 95% CI 0.31 to 1.07; P=0.08) but similar rates of MACE (OR 0.84, 95% CI 0.55 to 1.07, P=0.42). Variables contributing to an increased risk of mortality in female patients, included a history of previous heart failure (OR 2.45, 95% CI 1.15 to 5.22; p=0.02), myocardial infarction (OR 2.06, 95% CI 1.09 to 3.90; p=0.026), and peripheral vascular disease (OR 2.69, 95% CI 1.32 to 5.47; p=0.006). Performing PCI to the LMCA significantly increased the risk of mortality in female patients (OR 3.84, 95% CI 1.14 to 12.9; p=0.029), and the use of BMS vs DES contributed to a worse outcome in women compared to men (OR 0.46, 95% CI 0.25 to 0.84; p=0.012). The presence of hypercholesterolaemia in women significantly increased the risk of mortality (OR 0.44, 95% CI 0.22 to 0.86; p=0.016).
Multivariate logistic regression assessing 1-year outcome by gender for all-cause mortality, MACE, and unplanned admissions Outcome Male (vs female) Odds ratio 95% CI P-value Death (143) 0.58 0.31 to 1.07 0.08 MACE (334) 0.84 0.55 to 1.28 0.42 Unplanned readmission (888) 0.79 0.63 to 0.98 0.04

Conclusion
Women have significant differences in baseline characteristics and increased all-cause mortality at 1 year compared to men, although overall MACE rates are similar. This study increases awareness of women at high risk, highlighting the need to improve the care of women undergoing PCI.
P5496Sex differences in the association between diabetes and risk of cardiovascular disease, cancer, and all-cause and cause-specific mortality: a systematic review and meta-analysis of 5,016,608 participa
Authors: Wang Y , Nie Y , Yu C 
Published: October 2019

Abstract

Background
Previous meta-analyses, through internal, within-study comparisons of women and men participants, have observed that women with diabetes are at substantially higher risk of coronary heart disease (CHD), stroke and gastric cancer compared with affected men. However, the magnitude of the excess risk of these and other cause-specific outcomes that is conferred by diabetes for men and women is unknown.

Purpose
To estimate the relative effect of diabetes on risk of all-cause, cancer, cardiovascular disease (CVD), infectious disease and respiratory disease mortality in women compared with men.

Methods
Studies published from their inception to April 1, 2018, identified through a systematic search of PubMed and EMBASE and review of references. We used the sex-specific RRs to derive the women-to-men ratio of RRs (RRR) and 95% CIs from each study. Subsequently, the RRR for each outcome was pooled with random effects meta-analysis weighted by the inverse of the variances of the log RRRs.

Results
Forty-eight studies with 85 prospective cohorts met the inclusion criteria and were eligible for analysis. The pooled women to men RRR showed a 13% greater risk of all-cause mortality associated with diabetes in women than in men (RRR: 1.13, 95% CI: 1.07 to 1.19; P<0.001, Figure 1). The pooled multiple-adjusted RRR indicated a 30% significantly greater excess risk of CVD mortality in women with diabetes compared with men (RRR: 1.30 95% CI: 1.13 to 1.49; P<0.001). Compared with men with diabetes, women with diabetes had a 58% greater risk of coronary heart disease (CHD) mortality, but only an 8% greater risk of stroke mortality (RRRCHD: 1.58, 95% CI: 1.32 to 1.90; P<0.001; RRRstroke: 1.08, 95% CI: 1.01 to 1.15; P<0.001). However, no sex differences were observed among the population with or without diabetes, for all-cancer (RRR: 1.02, 95% CI: 0.98 to 1.06; P=0.21), infectious (RRR: 1.13, 95% CI: 0.90 to 1.38; P=0.33) and respiratory mortality RRR: 1.08, 95% CI: 0.95 to 1.23; P=0.26).

Conclusions
Compared with men with the same condition, women with diabetes have a 58% and 13% greater risk of CHD and all-cause mortality, respectively. This points to an urgent need to develop sex and gender specific risk assessment strategies and therapeutic interventions that target diabetes management for CHD prevention.
P5497The gender paradox in non-ST-segment elevation acute coronary syndrome: an outdated paradigm or a persistent reality-an analysis of contemporary practice from an integrate health care system
Authors: Elkoustaf R , Patel M , Rao R , Batiste C , Quon S , Newman D , Shi J 
Published: October 2019

Abstract

Introduction
Although sex related differences in Non-ST-Segment elevation (NSTEMI) acute coronary syndrome (ACS) have been well delineated in the past, there is a paucity of data from contemporary practice on the evolutions of this paradox and its clinical practice implications.

Purpose
We hypothesized that in the era of guideline driven contemporary practice, and in the setting of an integrated heath care model, gender related differences in care and outcomes would be marginal at best if no altogether absent.

Methods
We utilized data from an integrated health care system to identify 4099 patients with NSTEMI-ACS (1531 women; 2561 men). The patients were stratified by gender and a comparative analysis was performed on guideline directed medical therapy, revascularization strategy and major adverse cardiac events between the two groups.

Results
There were significant difference in pharmacologic treatment, catheter based interventions and surgical revascularizations strategies. Underutilization of guideline directed medical therapy was demonstrated in women specifically vis a vis angiotensin converting enzyme inhibitor (ACE-I) (p=0.0014), statins (p=0.0001), and antiplatelet therapy: clopodigrel (p=0.0004), prasugrel (p=0.0012), and ticagrelor (p=0.03). Additionally, clear differences emerged in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) options despite similarities in high risk status at index presentation by well validated risk algorithms. Specifically, men were more likely to undergo PCI (p=0.021) and CABG (p<0.001) than women. Finally, women had a greater incidence of bleeding complications (p=0.0003) and stroke (p=0,038).

Conclusions
There were treatment disparities in pharmacologic interventions, catheter based interventions, surgical revascularization access and clinical outcomes among patients with NSTEMI-ACS. The persistence of this gender paradox in contemporary practice and despite increasing education and awareness should potentiate further public policy initiatves as well as reinforce the need for geneder specific guidelines
P5506Proprotein convertase subtilisin/kexin 9 (PCSK9) and lipopolysaccharide (LPS) in patients with atrial fibrillation. A biomarker post-hoc analysis from the ATHERO-AF cohort
Authors: Pignatelli Spinazzola P , Farcomeni A , Pastori D , Violi F 
Published: October 2019

Abstract

Background
Proprotein convertase subtilisin/kexin 9 (PCSK9) and lipopolysaccharides (LPS) are emerging as novel risk factors for cardiovascular events (CVEs). In vitro evidence suggested that PCSK9 production may be elicited by LPS via oxidative stress, However, their relationship in patients with atrial fibrillation (AF) has not been investigated.

Methods
Post-hoc analysis of a prospective, single centre cohort study of 907 patients with non-valvular AF. At baseline, PCSK9, LPS and NADPH oxidase (sNOX2-dp) were measured. We also assessed adherence to Mediterranean Diet (Med-Diet). PCSK9 and LPS were correlated to incidence of CVEs.

Results
At multivariate analysis, with PCSK9 above the median as dependent variable we found that high adherence to Med-Diet and antiplatelet drugs were inversely correlated to PCSK9 (odds ratio [OR] 0.737 95% Confidence interval [CI] 0.643–0.845 p=0.001 and OR 0.437 95% CI 0.219–0.871 p=0.017 respectively), while sNOX2-dp and LPS concentrations (OR 1.759 C.I. 95% 1.167–2.650, p=0.007 and OR 1.727 C.I. 95% 1.147–2.600 p=0.009 respectively) were directly correlated. In particular use of oil and wine were negatively associated to high PCSK9 levels (OR 0.376 95% CI 0.185–0.763, p=0.001 and OR 0.460 95% CI 0.289–0.733 p=0.007, respectively). Patients with concomitant high PCSK9 and LPS (highest tertile for both) had and increased risk of CVEs as compared to those with low levels (lowest tertile for both) with 48 and 29 CVEs in each group respectively (Log-Rank test, p=0.022)

Conclusion
This study demonstrated for the first time in vivo that circulating levels of PCSK9 are associated with high LPS concentration and NADPH oxidase activation. Concomitant increase of PCSK9 and LPS increased the risk of CVEs.
P5507Growth differentiation factor-15 and mortality in suspected or known coronary heart disease patients with chronic kidney disease: a subanalysis of the ANOX study
Authors: Takagi D , Suzuki M , Matsuda M , Ajiro Y , Shinozaki T , Sakagami S , Yonezawa K , Shimizu M , Funada J , Takenaka T , Morita Y , Abe M , Akao M , Hasegawa K , Wada H 
Published: October 2019

Abstract

Background
Chronic kidney disease (CKD) is an independent risk factor for the development and progression of coronary heart disease (CHD). Growth differentiation factor-15 (GDF-15), a distant member of the transforming growth factor-β cytokine superfamily, plays a role in the initiation of inflammation in atherosclerotic lesions. Elevated GDF-15 was found in various diseases including CKD and stable CHD, and was reported to predict mortality and cardiovascular events in general or established CHD population. However, the prognostic value of GDF-15 in suspected or known CHD patients with CKD is unknown.

Methods
Serum GDF-15 levels were measured in 999 suspected or known CHD patients with CKD undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.

Results
During the follow-up, 154 patients died from any cause, 61 died from cardiovascular disease, and 96 developed MACE. After adjustment for established risk factors, GDF-15 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.78; 95% confidence interval [CI], 1.57–2.00), cardiovascular death (HR, 1.88; 95% CI, 1.58–2.25), and MACE (HR, 1.54; 95% CI, 1.32–1.79). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of GDF-15 levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.401; 95% CI, 0.231–0.571; P<0.001; integrated discrimination improvement [IDI], 0.041; 95% CI, 0.021–0.062; P<0.001) and cardiovascular death (NRI, 0.297; 95% CI, 0.039–0.555; P=0.024; IDI, 0.032; 95% CI, 0.010–0.055; P=0.005), but not that of MACE (NRI, 0.138; 95% CI, v0.070–0.347; P=0.194; IDI, 0.012; 95% CI, −0.000–0.024; P=0.053).

Conclusions
In suspected or known CHD patients with CKD undergoing elective coronary angiography, elevated GDF-15 levels may predict all-cause and cardiovascular mortality independent of established risk factors and cardiovascular biomarkers.

Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization.