bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1696Clinical value of QRS spatial dispersion in non-ST elevation myocardial infarction
Authors: Ibrahim I M , Frere A , Alcekelly M M 
Published: October 2019

Abstract

Background
More than 40% of patients with non-ST Elevation Myocardial Infarction (NSTEMI) have multi-vessel disease with the rate of in-hospital emergent bypass surgery ranging from 11–13%. So, rapid scoring is critical for optimum management even before P2Y12 loading.

Purpose
We aimed to determine the role of QRS dispersion at emergency department, as a simple and rapid sign, in predicting coronary anatomy complexity and in-hospital outcome.

Methods
192 (126 males, age 57.4±6.8 years) patients with NSTEMI and QRS duration <120 ms who underwent coronary angiography were included. QRS dispersion was automatically measured.

Results
Using Spearman's rank correlation, SYNTAX score was found to be positively correlated with admission HR (r 0.54, p value <0.001), maximum HsTnT level (r 0.523, p value <0.001), age (r 0.262, p value 0.015), male gender (r 0.286, p value 0.005), QRS dispersion (r 0.248, p value 0.015), QTc dispersion (r 0.289, p value 0.01), and Grace score (r 0.247, p value 0.015). ROC curve analyses for prediction of SYNTAX score >33 were done for variables with significant correlation. By multivariate logistic regression, male gender (OR 5.042, 95% CI 1.633 –15.567, p value 0.005), admission HR >80 bpm (OR 1.088, 95% CI 1.024 –1.157, p value 0.017) and QRS dispersion >20ms (OR 1.020, 95% CI 1.003 –1.037, p value 0.02) were independent predictors of SYNTAX score >33 (table). Patients with QRS dispersion >20 ms had in-hospital higher Killip class (P<0.001), recurrent ischemia (P 0.003), serious ventricular arrhythmias (P 0.01) and higher GRACE score (P<0.001).
Binary logistic regression for prediction of SYNTAX score >33 Variables Univariate analysis Multivariate analysis OR (95% CI) P value OR (95% CI) P value Age >61 (years) 1.337 (1.019–4.392) 0.015 0.953 (0.878–1.033) 0.242 Male gender 4.851 (2.014–5.301) 0.001 5.042 (1.633–15.567) 0.005 HR >80 (bpm) 3.945 (1.706–6.953) 0.002 1.088 (1.024–1.157) 0.017 QRS dispersion >20 (ms) 2.911 (0.617–13.738) 0.013 1.020 (1.003–1.037) 0.02 QTc dispersion >53 (ms) 6.101 (1.926–19.323) 0.002 2.378 (1.890–2.561) 0.043 Maximum HsTnT >1105 (ng/L) 3.837 (0.236–8.965) 0.004 2.785 (2.501–3.012) 0.034 Grace Score >112 (points) 7.122 (0.632–12.216) <0.001 2.912 (2.703–3.309) 0.030

Conclusion
In NSTEMI, QRS dispersion was positively correlated with SYNTAX score and a cut-off value of 20 ms independently predicted SYNTAX score >33. Regarding in-hospital outcome, QRS dispersion >20 ms was associated with in-hospital higher Killip class, recurrent ischemia, serious ventricular arrhythmias and higher GRACE score
P1701Sex-related difference in receiving bystander cardiopulmonary resuscitation and clinical outcome among out-of-hospital cardiac arrest patients
Authors: Ichihara S , Hirayama A , Tahara Y , Yasuda S , Noguchi T , Nishimura K , Yonemoto N , Nonogi H , Nagao K , Ikeda T , Sato N , Tsutsui H 
Published: October 2019

Abstract

Background
Early studies from US and Europe have reported that female out-of-hospital cardiac arrest (OHCA) patients were less likely to receive bystander cardiopulmonary resuscitation (CPR). However, little is known about sex-related difference in receiving CPR and clinical outcome among adult OHCA patients in Japan.

Methods
This study was a nation-wide, population-based observational study of OHCA in Japan from 2011 to 2015. We included all adult cardiogenic OHCA patients. We excluded patients witnessed by emergency medical services (EMS) from the present analysis. To account for the age-related difference, we stratified by age category: 18–39, 40–64, 65–79, and ≥80. To examine the association between patient sex and neurological outcome at 30-day, we fitted multivariable logistic regression model with adjustment for age, bystander CPR status, first document rhythm, dispatcher instruction and EMS response time.

Results
There were 339,317 adult cardiogenic, not EMS-witnessed OHCA patients (median age, 80; female, 43.5%) in Japan from 2011 to 2015. Overall, 171,122 (50.4%) received CPR by citizen, 34,283 (10.1%) had initial shockable rhythm, and 11,421 (3.4%) had favorable neurological status at 30-day. Female patients were more likely to receive bystander CPR (vs. male; 53.8% vs. 47.8%), and were less likely to have initial shockable rhythm (5.2% vs. 13.9%) and favorable neurological status at 30-day (1.8% vs. 4.6%) (all; p<0.001). With stratification by age category, elderly female patients (aged ≥65) were more likely to received bystander CPR (P<0.001), whereas male patients were more likely to received bystander CPR among patients aged <40. Multivariable logistic regression analysis showed that female patients had a lower rate of favorable neurological status at 30-day, compared to male patients in all age categories (all; P<0.05).
Sex difference in bystander CPR Overall Male (n=191,672) Female (n=147,645) p-value All (n=339,317) 50.4% 47.8% 53.8% <0.001 Aged 18–39 (n=6,216) 56.0% 56.9% 53.5% 0.02 Aged 40–64 (n=50,320) 48.5% 48.5% 48.3% 0.69 Aged 65–80 (n=105,141) 46.5% 45.5% 48.3% <0.001 Aged ≥80 (n=177,640) 53.2% 49.0% 56.7% <0.001
OR for neurological outcome at 30-day

Conclusion
Unlike the situation in Europe and US, female OHCA patients, especially elderly female, were more likely to receive bystander CPR in Japan. However, female patients had worse clinical outcome after OHCA. Further investigations including in-hospital treatment are needed to clarify the sex-difference in clinical outcome after OHCA.

Acknowledgement/Funding
None
P1721Determination of a predictive score of cardiogenic shock in acute coronary syndrome
Authors: Menezes Fernandes R , Mota T , Bispo J , Azevedo P , Guedes J , Silva D , Bento D , Marques N , Santos W , Mimoso J , Jesus I 
Published: October 2019

Abstract

Introduction
Cardiogenic shock is one of the leading causes of death in patients with acute coronary syndrome (ACS), reaching in-hospital mortality rates of 50%.

Purpose
To identify a predictive score of cardiogenic shock in patients with ACS.

Methods
We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of cardiogenic shock were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. Statistical analysis was conducted with SPSS 24.0.

Results
During this period, 4458 patients were admitted with ACS and 74 (1,7%) developed cardiogenic shock. In this subgroup, 59,5% were over 65 years of age, 63,5% were male and 93,2% presented with acute myocardial infarction with ST segment elevation. Also, 83,8% were in sinus rhythm at admission, 22,7% had creatinine>1,5 mg/dL and 17,9% had left ventricular ejection fraction (LVEF) <30%. The in-hospital mortality rate was 51,4%. LVEF <30% (p=0,018), creatinine>1,5 mg/dL (p=0,044) and absence of sinus rhythm at admission (p=0,041) were independent predictors of cardiogenic shock. A predictive score of this complication in patients with ACS was determined using the formula: 1,723 + 1,505 x (creatinine>1,5) + 4,483 x (LVEF <30%) – 2,094 x (sinus rhythm at admission). A cutoff of 0,58 was obtained with 44,4% sensitivity, 85,2% specificity and 85% discriminative power.

Conclusion
Cardiogenic shock occurred in 1,7% of patients admitted with ACS and was associated with a high mortality rate. We determined a predictive score of this complication with a good discriminative power, which included LVEF <30%, creatinine >1,5 mg/dL and the rhythm on admission's electrocardiogram. By taking into account clinical variables, this score can be used at a very early stage of admission, allowing risk stratification of developing cardiogenic shock in each patient. However, it needs validation to be applied in clinical practice.
P1722A new predictive score for mortality and cardiogenic shock in patients with ST-elevation myocardial infarction
Authors: Picarra B , Pais J A , Santos A R , Carrington M , Bras D , Carvalho J , Aguiar J 
Published: October 2019

Abstract

Introduction
Acute Myocardial Infarction with ST elevation (STEMI) presents a high rate of potentially fatal complications and in-hospital mortality.

Objective
To test the predictive capacity for Cardiogenic Shock (CS) and In-hospital Mortality (MIH) of a new risk score in patients (Pts) with STEMI.

Population and methods
Evaluated 5765 Pts with STEMI without CS at admission. The new score, was derived by previous studies in this population, and was calculated according to the following criteria: age ≥65 years (1 point), heart rate ≥100bpm (2 points), systolic blood pressure <100mmHg (2 points), blood glucose at admission above 180 mg/dL (1 point) and creatinine at admission >1.5mg/dL (2 points). The population was divided into three subgroups: group A low score (0–2 points), group B intermediate score (3–5 points) and group C score (6–8 points). The endpoints defined were CS during hospitalization, in-hospital mortality and combined end-point of MIH and CS. The relationship between each of the possible scores (from 0 to 8) and the various end-points was determined, and the sensitivity and specificity of the score as a predictor of MIH and CS was defined as the area under the ROC curve (ASC).

Results
After the application of the score, 3 subgroups were obtained: group A with 4819 Pts (83,6%), group B with 884 Pts (15,3%) and group C 62 Pts (1,1%). Patients of group C had a higher MIH (Group C: 45,2% vs B: 11,4% vs A: 2,0%, p<0,001), higher CS (C: 29,5% vs B: 12,0% vs A: 2,3%, p<0,001) and a higher combined end-point of MIH and CC (C: 53,2% vs B: 17,8% vs A: 3,4%, p<0,001) during hospitalization. The proposed score revealed a high predictive capacity of MIH (ASC 0,802, 95% CI 0,775–0,830, p=0,001), of CS (ASC 0,763, 95% CI 0,731–0,795, p=0,001) and for the combined endpoint (MIH and CC) ASC 0,781, 95% CI 0,756–0,806, p=0,001). The logistic regression models showed that Pts with a high score (group C) presented a 41-fold higher risk of MIH (OR 41,3; p<0,001) and 18-fold higher CS (OR 18,0; p<0.001) than patients with low score (group A). It was also found that the risk associated with an increase in one point score unit was 100% (OR 2,0 p<0.001) for MIH and 82% (OR 1,82, p<0,001) for CS.

Conclusion
This new score, with the use of practical and friendly variables, demonstrated a high predictive capacity of MIH and CS.
P1731High-sensitivity troponin with sex-specific thresholds in suspected acute coronary syndrome
Authors: Lee K K , Ferry A V , Anand A , Strachan F E , Chapman A R , Newby D B , Tuck C , Keerie C , Weir C J , Shah A S V , Mills N L 
Published: October 2019

Abstract

Background/Introduction
Major disparities between women and men in the diagnosis, management and outcome of acute coronary syndrome are well recognised. Whether sex-specific diagnostic thresholds for myocardial infarction will address these differences is uncertain.

Purpose
To evaluate the impact of implementing a high-sensitivity cardiac troponin I (hs-cTnI) assay with sex-specific diagnostic thresholds for myocardial infarction in women and men with suspected acute coronary syndrome.

Methods
In a stepped-wedge, cluster-randomized controlled trial across ten hospitals we evaluated the implementation of a hs-cTnI assay in 48,282 (47% women) consecutive patients with suspected acute coronary syndrome. During a validation phase the hs-cTnI assay results were suppressed and a contemporary cTnI assay with a single threshold was used to guide care. Myocardial injury was defined as any hs-cTnI concentration >99th centile of 16 ng/L in women and 34 ng/L in men. The primary outcome was myocardial infarction after the initial presentation or cardiovascular death at 1 year. In this prespecified analysis, we evaluated outcomes in men and women before and after implementation of the hs-cTnI assay.

Results
Use of the hs-cTnI assay with sex-specific thresholds increased myocardial injury in women by 42% (from 3,521 (16%) to 4,991 (22%)) and by 6% in men (from 5,068 (20%) to 5,369 (21%)). Whilst treatment increased in both sexes, women with myocardial injury remained less likely than men to undergo coronary revascularisation (15% versus34%), or to receive dual anti-platelet (26% versus43%), statin (16% versus26%) or other preventative therapies (P<0.001 for all). The primary outcome occurred in 18% (369/2,072) and 17% (488/2,919) of women with myocardial injury during the validation and implementation phase respectively (adjusted hazard ratio 1.11, 95% confidence interval 0.92 to 1.33), compared to 18% (370/2,044) and 15% (513/3,325) of men (adjusted hazard ratio 0.85, 95% confidence interval 0.71 to 1.01).
Patient management

Conclusion
Use of sex-specific thresholds identified five-times more additional women than men with myocardial injury, such that the proportion of women and men with myocardial injury is now similar. Despite this increase, women received approximately half the number of treatments for coronary artery disease as men and their outcomes were not improved.

Acknowledgement/Funding
The British Heart Foundation
P1744Patient prehospital delays in acute myocardial infarction. A nationwide patient survey. Heart attack-time is life campaign
Authors: Hudzik B , Korbel E , Popielarz B , Broja L , Botor B , Kozbial K , Piaseczna-Spitaleri E , Hawranek M , Przybylowski P , Gasior M 
Published: October 2019

Abstract

Introduction
A minimal delay from symptom onset to reperfusion therapy is essential in the management of acute myocardial infarction (AMI). The patient's response to initial symptoms (patient delay) substantially affects the delay. Nevertheless, predictors of patient-related delays are less clear. The aim of the study was to compare knowledge and awareness of heart attack symptoms and reactions to it in a general Polish population.

Methods
In this cross-sectional study, 1 376 persons aged 18 years or older enrolled in an Internet survey (computer assisted web interview, CAWI). Heart attack knowledge, self-efficacy for recognizing and responding to heart attack symptoms, and perceived risk for a future heart attack were measured. Primary exclusion criteria were: prior MI or family history of MI. The survey was carried out as a part of the nationwide “Heart attack – time is life” Campaign.

Results
Based on the Polish Registry on Acute Coronary Syndromes (PL-ACS) the median total ischemic time in Poland is 260 minutes, whereas the median patient delay is 142 minutes. The main factors associated with long time delays include interhospital transfers, symptoms presentation during the night, age >65 years, inhabitants of rural areas, diabetes mellitus, first-ever MI, female sex. The survey demonstrated that 73.8% of respondents recognize that chest pain may be associated with MI, but only 22.2% of them would call the emergency medical services. Age-, sex-, income-, and education-related responses are depicted in the Figure. Only 23% of these respondents would make the call immediately, whereas 31.7% would wait at least 3–4 hours (in some cases event until the next day). 66.4% of the surveyed population would ignore the chest pain main reason being “nothing serious” or “a result of extreme emotions”. Notwithstanding, the majority of the surveyed population is aware of the seriousness of the AMI-related complications (heart failure, disability, rehospitalizations, death).

Conclusions
These findings highlight the urgent need to develop effective, tailored campaigns to close the knowledge gap and, primarily, to educate the Polish society about the correct response to chest pain. Young age, higher education, and high income were not predictors of common sense and correct responses.
P1748TNF and ANXA2 gene polymorphism associated with outcome and coronary angiography features in patients with early acute coronary syndrome
Authors: Averkova A , Evdokimova M , Speshilov G , Zubova E , Brazhnik V , Zateyshchikov D 
Published: October 2019

Abstract

Background
Genetic predisposition makes a considerable contribution to premature acute coronary syndrome (ACS) development. Tumour necrosis factor (TNF) is an important proinflammatory cytokine influencing intravascular inflammation. Annexin A2 (ANXA2) is an endogenous PCSK9 inhibitor. Higher LDL level is associated with AA genotype of ANXA2 gene SNP rs17845226.

Aim
The aim of the study was to elucidate the association of TNF and ANXA2 gene polymorphism with coronary angiography features and outcome in patients (pts) with early ACS.

Methods
We analyzed data from two prospective observational trials (2004–2007; 2014–2016) - 672 pts (498 men and 174 women) with premature ACS (men≤55, women≤60 years of age). Coronary angiography (CAG) data were analyzed in 225 pts. Genotyping of SNP rs1800629 of TNF (502 pts) and rs17845226 of ANXA2 gene (235 pts) was performed by RT-PCR with allele-specific primers. The primary endpoint was calculated as a combination of all-cause mortality, recurrent ACS, stroke, and peripheral vascular disease. We also analyzed recurrent coronary events (CE) (coronary deaths & recurrent ACS). The mean follow-up time: 414±347.6 days.

Results
Mean age was 48.6±5.8 (M), 52.7±6.3 (F) years. 298 (44.3%) pts had STEMI, 362 (53.9%) pts – history of CAD, 500 (74.4%) – arterial hypertension, 32 (4.8%) – history of stroke, 81 (12.1%) – diabetes mellitus, 241 (37.1%) – heart failure (HF). The genotype distribution did not differ from the expected Hardy–Weinberg equilibrium: GG/AG/AA=0.557/0.191/0.006 (χ2=3.34, p=0.07) for TNF and CC/AC/AA=0.86/0.136/0.004 (χ2=0.05, p=0.82) for ANXA2. Carriers of allele A of TNF gene SNP had higher frequency of no significant coronary lesion (17.6% vs 5.9%; p=0.021) and NSTEMI (69.5% vs 50.8%, p<0.001). Carriers of allele A of ANXA2 gene SNP had higher frequency of coronary calcinosis (39.3% vs 19.6%; p=0.019) and HF (39.4% vs 22.3%, p=0.034). Carriers of A allele of TNF had higher frequency of CE (30.5% vs 19.5%, p=0.01, log-rank χ2=7.29, p=0.007). HF (OR, 2.686; 95% CI, 1.769–4.077; p<0.001), creatinine level (OR, 1.009; 95% CI, 1.001–1.017; p=0.025) and carrying of A allele of TNF gene SNP (OR, 1.836; 95% CI, 1.163–2.898; p=0.007) and STEMI at admission (OR, 1.009; 95% CI, 1.001–1.017; p=0.025) were independent predictors of any unfavorable outcome and CE in a multivariable Cox regression model. LAD and left main coronary artery involvement (OR, 1.836; 95% CI, 1.163–2.898; p=0.007) was an independent predictor of any unfavorable outcome. Identified relationship was independent of invasive treatment of ACS.

Conclusion
Thus, in patients with early ACS TNF mediated inflammation is associated with NSTEMI, no significant coronary lesion and could play a significant role in the development of unfavourable outcome. Carrying of A allele of ANXA2 gene may accelerate coronary atherosclerosis in these patients and is associated with HF.
P1751LATIN - A template for effective AMI management in developing countries
Authors: Mehta S , Botelho R , Fernandez F , Feres F , Abizaid A , Cade J , Perin M , Prudente M , Calvanti R , Dusilek C , Matheus C , Ceschim M , Vieira D , Torres M A , Mazzini J 
Published: October 2019

Abstract

Background
In resource-constrained nations, population-based AMI coverage is daunting. Telemedicine can transform the situation through an efficient, cost-effective and scalable program called the Latin America Telemedicine Infarct Network (LATIN). We present our innovative hub-spoke strategy, that has served >780,000 patients.

Purpose
To use telemedicine protocols to demonstrate appropriate access to quality AMI care, encompassing remote areas.

Methods
LATIN required technology and process metrics optimization as well as a scrupulous site selection, during a 12-month pilot. Spokes represent our strategy's nucleus; they consist of small, rural clinics and resource-limited facilities that are connected to PCI-capable hubs. Spokes require constant (3-T) training: Triage, Telemedicine, and Transportation. The latter two categories are the most challenging because they demand constant upgrading.

Results
784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). A total of 8,440 (1.08%) patients were diagnosed with AMI; 3,924 (46.5%) were urgently reperfused including 3,048 (77.7%) who underwent PCI. Globally, Time to Telemedicine Diagnosis (TTD) was 3 min exhibiting 98.9% tele-accuracy, D2B was 51 min, additionally, in-hospital mortality was 5.2%. Major reasons for non-treatment of patients were insurance, lack of ICU beds and delayed presentation.

Conclusions
LATIN is a valuable healthcare system prototype for developing countries. Our hub-spoke strategy focuses on providing adequate AMI management for populations. However, aspects such as ambulance availability, insurance denial and lack of ICU beds must be targeted to improve performance.
P1752Impact of frailty addition in ischemic and bleeding risk scores in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: a subanalysis from LONGEVO-SCA registry
Authors: Esteve Pastor M A , Martin E , Alegre O , Castillo Dominguez J C , Formiga F , Martinez-Selles M , Diez-Villanueva P , Sanchis J , Ariza-Sole A , Marin F 
Published: October 2019

Abstract

Background
The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss.

Purpose
The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores.

Methods
The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores.

Results
We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p<0.001) or statins 96.3% vs 82.6%; p<0.001). We analyzed the predictive performance of FRAIL score to adverse events and observed a modest predictive performance for mortality (c-statistic 0.648; 95% CI [0.605–0.690]; p<0.001), readmissions (c-statistic 0.600; 95% CI [0.557–0.642]; p<0.001) and for composite endpoint (c-statistic 0.620; 95% CI [0.577–0.663]; p<0.001). We compared the addition of FRAIL score to the original risk scores and observed a significant improvement for the primary endpoint with the addition to CHA2DS2-Vasc score (p=0.009), GRACE (p<0.001) and CRUSADE scores (p<0.001). (Table)
C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 <0.001 0.009 2.586 CHA2DS2-VASc score + FRAIL 0.641 0.598 to 0.683 <0.001 HAS-BLED score 0.649 0.606 to 0.691 <0.001 0.445 0.764 HAS-BLED score + FRAIL 0.634 0.590 to 0.675 <0.001 GRACE score 0.599 0.554 to 0.644 0.006 0.001 3.930 GRACE score + FRAIL 0.602 0.556 to 0.646 <0.001 CRUSADE score 0.660 0.613 to 0.705 0.051 0.001 3.287 CRUSADE score + FRAIL 0.664 0.617 to 0.709 <0.001 CI: Confidence interval. *For c-index comparison. p: P value.

Conclusions
This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.