bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of epicardial adipose tissue increase after ST elevation Myocardial Infarction (STEMI) on IL-13 and left ventricular remodelling
Authors: Parisi V , Cabaro S , D'Esposito V , Petraglia L , Conte M , Gerundo G , Campana P , Caruso A , Grimaldi M.G , Pilato E , Comentale G , Leosco D 
Published: November 2020

Abstract

Background
The role of epicardial adipose tissue (EAT) in myocardial diseases is well established, and several evidence suggest that EAT may negatively affect left ventricular (LV) remodelling through an imbalanced production and secretion of pro and anti-inflammatory cytokines. Of these, the IL-13 it is known to play a positive activity on cardiac remodelling. Nowadays, the crosstalk between EAT and the myocardium is still poorly understood and the effects of myocardial ischemia on morphological and functional properties of EAT are almost unknown.

Purpose
In the present study we explored whether an increase of EAT thickness after STEMI might be associated with unfavourable LV remodelling at 3 months (T1). We also evaluated the relationship between changes (Δ) of EAT thickness and systemic levels of Interleukin (IL)-13 which is known to play a favourable activity on LV remodelling after STEMI.

Methods
We enrolled 66 patients with first STEMI, undergoing primary percutaneous angioplasty. At baseline and at 3 months we performed a complete echocardiogram, including EAT maximal thickness assessment, and determined circulating levels of IL-13.

Results
At 3 months after STEMI, the population was stratified into two groups according to different EAT remodelling after cardiac event: Group 1, patients with an increased EAT thickness (Δ EAT&gt;1; 30 patients) and Group 2, patients with unchanged or decreased EAT thickness (Δ EAT&lt;1). The two groups did not differ for age, gender and atherosclerotic risk factors. Group 1 had a worse LV remodelling at 3 months with higher LV diastolic and systolic volumes, lower LV ejection fraction (p=0.003; p=0.013; p=0.013 respectively) and worse diastolic function (E/e'; p=0.011). Of interest, EAT thickness increase was paralleled by circulating IL-13 reduction (p=0.022).

Conclusion
Myocardial injury can result in EAT increase which is associated to worse LV remodelling probably through the loss of the protective role of IL-13.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This research has been funded by the University of Naples “Federico II” and “Compagnia di San Paolo e l'Istituto Banco di Napoli” within the competitive grant STAR 2018; Valentina Parisi is the principal investigator
A real world analysis of NSTE-ACS in more than 4000 patients: accuracy of GRACE and TIMI scores in mortality prediction
Authors: Borges-Rosa J , Ferreira J , Oliveira-Santos M , Monteiro S , Goncalves F , Monteiro P , Baptista R , Goncalves L 
Published: November 2020

Abstract

Introduction
The TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) risk scores identify high-risk patients with Non-ST elevation acute coronary syndrome (NSTE-ACS) who can benefit from an early invasive strategy.

Purpose
We aimed to compare both scores predictive accuracy for mortality in a real-world cohort of patients presenting with NSTE-ACS.

Methods
We retrospectively evaluated 4264 patients admitted to our coronary intensive care unit between 2004 and 2017 with a diagnosis of NSTE-ACS. The TIMI and GRACE scores were calculated for each patient, and all-cause mortality was recorded during hospitalization, at one month and one year. To better characterize global troponin release, we defined Total Troponin (TT) as the sum of initial and discharge troponin. We used the area under the receiver operating characteristic curve (AUC) to compare the predictive value of both scores for mortality during hospitalization, at one month and one year.

Results
Mean patient age was 67.6±12.4 years and 66.4% were male (n=2833). Mean GRACE score was 124.6±35.8 and mean TIMI score was 2.7±1.6. There was a weak correlation between GRACE and TIMI score (r=0.3, p&lt;0.001). In-hospital mortality was 2.8%: the GRACE score showed higher AUC (0.845, 95% CI 0.805–0.804, p&lt;0.001) compared to TIMI (0.581, 95% CI 0.519–0.643, p=0.009) (Figure 1). Mortality at one month was 5.1%: the GRACE score showed higher AUC (0.842, 95% CI 0.814–0.869, p&lt;0.001) compared to TIMI (0.586, 95% CI 0.541–0.630, p&lt;0.001). Mortality at one year was 11.4%: the GRACE score showed higher AUC (0.811, 95% CI 0.789–0.822, p&lt;0.001) compared to TIMI (0.591, 95% CI 0.560–0.622, p&lt;0.001) (Fig. 1). Analyzing Unstable Angina and Non-ST segment elevation myocardial infarction separately, the GRACE score also showed higher AUC compared to TIMI. Exploratory analyses revealed a combined indicator (GRACE score + TT) which had higher AUC (0.876, 95% CI 0.844–0.907, p&lt;0.001) compared to GRACE score (0.855, 95% CI 0.823–0.887, p&lt;0.001) for one month mortality and for one year mortality (0.818, 95% CI 0.792–0.844, p&lt;0.001 vs. 0.813, 95% CI 0.788–0.839, p&lt;0.001).

Conclusion
In patients with NSTE-ACS, GRACE risk score is a better predictor of in-hospital, one month and one-year mortality, compared to TIMI risk score. TT, as a measure of ischemia burden, might improve accuracy of GRACE score in predicting short and long-term mortality.
Figure 1

Funding Acknowledgement
Type of funding source: None
The impact of renal function on the incidence and prognosis of new-onset atrial fibrillation in acute myocardial infarction
Authors: Cosentino N , Campodonico J , Ballarotto M , Milazzo V , Moltrasio M , De Metrio M , Lucci C , Rubino M , Marana I , Assanelli E , Grazi M , Lauri G , Marenzi G 
Published: November 2020

Abstract

Introduction
Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and renal function is also true in AMI has never been investigated.

Purpose
The aim of the study was to assess the incidence of new-onset AF according to renal function, estimated at hospital admission, and its relationship with short-term outcome and long-term all-cause mortality in a large real-world cohort of AMI patients.

Methods
We prospectively enrolled 2,445 AMI patients. New-onset AF was recorded during hospitalization. Glomerular filtration rate (eGFR) was estimated at admission and patients were grouped according to their renal function (group 1 [n=1,887]: eGFR&gt;60; group 2 [n=492]: eGFR 60–30; group 3 [n=66]: eGFR&lt;30 ml/min/1.73m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) all-cause mortality were the secondary endpoints.

Results
The AF incidence in the whole population was 10% and it was associated with a higher in-hospital (5% vs. 1%; P&lt;0.0001) and long-term mortality (34% vs. 13%; P&lt;0.0001). The AF incidence was 8%, 16%, 24% in groups 1, 2, 3, respectively (P&lt;0.0001). In each group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; P&lt;0.0001). A similar trend was observed for long-term mortality (20% vs. 9%, 51% vs. 24%, 81% vs. 50%, respectively; P&lt;0.0001). The higher risk for in-hospital and long-term mortality associated with AF in each group was confirmed also after adjustment for major confounders.

Conclusions
The study demonstrates that the incidence of new-onset AF during AMI, as well as its associated in-hospital and long-term mortality, increases in parallel with the severity of renal dysfunction assessed at hospital admission.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Centro Cardiologico Monzino, IRCCS, Milan, Italy
Heavy drinking habits are associated with worse in-hospital outcomes in patients with acute coronary syndrome
Authors: Tersalvi G , Biasco L , Radovanovic D , Rickli H , Roffi M , Eberli F , Moccetti M , Jeger R , Moccetti T , Erne P , Pedrazzini G.B 
Published: November 2020

Abstract

Introduction
The association between alcohol consumption and the occurrence of coronary heart disease is well described in literature. Data regarding the impact of regular alcohol consumption on in-hospital outcomes in the setting of acute coronary syndrome (ACS) are lacking.

Purpose
We aimed to evaluate the impact of self-reported alcohol consumption on in-hospital outcomes in patients with ACS.

Methods
Data derived from patients enrolled between 2007 and 2019 in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry were retrospectively analyzed. The primary endpoint was all-cause in-hospital mortality, while secondary endpoints were set as incidence of major adverse cardiac and cerebrovascular events (MACCEs). Outcomes comparisons according to quantity of daily alcohol intake were also performed.

Results
Records concerning alcohol consumption were available in 25707 patients; 5298 of them (21%) fulfilled the criteria of regular alcohol consumption. Daily alcohol intake was reported in 4059 (77%), of these patients (regular drinkers) with 2640 light drinkers (≤2 drinks/day) and 1419 heavy drinkers (&gt;2 drinks/day). Regular drinkers were predominantly male, younger, smokers, more comorbid and with a worse clinical presentation as compared to abstainers/occasional drinkers.
In-hospital mortality and MACCEs of heavy drinkers were significantly higher compared to light drinkers (5.4% vs. 3.3% and 7.0% vs. 4.4%, both p=0.001). When tested together with GRACE risk score parameters, heavy alcohol consumption was independently associated to in-hospital mortality (p=0.004).

Conclusions
Heavy alcohol consumption is an additional independent predictor of in-hospital mortality in patients presenting with ACS.
Figure 1. Study flowchart.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Swiss Heart Foundation
Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway and Sweden according to national ongoing registries
Authors: Bloendal M , Ainla T , Andreka P , Edfors R , Halvorsen S , Jernberg T , Jortveit J , Marandi T , Janosi A 
Published: November 2020

Abstract

Background
There is a high need for real-world international comparisons of management of patients with acute myocardial infarction. In Europe Estonia, Hungary, Norway and Sweden are among the few countries with national ongoing acute myocardial infarction registries with a high degree of completeness of data.

Purpose
To compare the management and outcome of hospitalized ST-segment elevation myocardial infarction (STEMI) patients in four European countries with a national ongoing myocardial infarction registry.

Methods
We compared patient baseline characteristics, use of in-hospital procedures and medications at discharge as well as 30-day and 1-year mortality for all patients admitted with STEMI during 2014–2017 using EMIR (Estonia; n=4,584), HUMIR (Hungary; n=23,685), NOMIR (Norway; n=12,414; data available for years 2013–2016) and SWEDEHEART (Sweden; n=23,342). Country-level results were compared as aggregated data.

Results
Mean age ranged from 65 to 69 years (table 1). Estonia and Hungary had compared to Norway and Sweden a higher proportion of women (resp. 39%; 38% vs. 29%; 31%), as well as patients with hypertension (resp. 79%; 72% vs. 39%; 50%), diabetes (resp. 21%; 27% vs. 14%; 19%) and peripheral artery disease (resp. 9% vs. 6%; 4%). Proportion of current smokers was highest in Norway (38%) and lowest in Sweden (27%). Rates of discharge medications were generally high. The results for in-hospital procedures and mortality are shown in table 1. Estonia had the lowest rates of dual antiplatelet treatment (78%) and statins (86%). Norway had the lowest rates of beta-blockers (80%) and angiotensin converting enzyme inhibitors/ angiotensin II receptor blockers (61%).

Conclusions
This cross-country comparison of four national European registries provide new insights into differences in risk factors, treatment regiments and outcomes of patients with STEMI. There are several possible reasons for the observed differences, including differences in underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council
Pre-admission cardiac arrest in ST-segment elevation myocardial infarction: incidence, predictors and related outcomes
Authors: Araujo G.N.D , Luchese J.L , Theobald A.T , Beltrame R.B , Machado G.M , Amantea R.A , Niches M.N , Fracasso J.F , Carpes C.C , Matte B.M , Krepsky A.K , Pimentel M.P , Wainstein M.V 
Published: November 2020

Abstract

Background/Introduction
ST segment elevation myocardial infarction (STEMI) is a frequent cause of Cardiac Arrest (CA), and early percutaneous coronary intervention is associated with increased hospital survival in these patients. Despite constant improvements in out-of-hospital CA management, survival remains low.

Purpose
Our aim was to assess pre-admission CA incidence, predictors and related outcomes in patients admitted with STEMI.

Methods
We prospectively included 1083 patients admitted with STEMI in a tertiary university hospital in southern Brazil between March 2011 and October 2019. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and in-hospital outcomes were evaluated.

Results
Mean age was 60.8 years (± 12), 66.2% were male, 62% had hypertension and 25.3% had diabetes. Pre-admission CA was present in 104 (9.8%) patients. Patients with CA had more frequently previous myocardial infarction, temporary pacemaker, smoking and Killip 3 or 4 on admission, and shorter pain–to-door time than patients without CA. In addition, CA patients had a higher incidence of periprocedural CA, cardiogenic shock and periprocedural and in-hospital mortality. In multivariate analysis, age (RR= 0.96, p=0.001), anterior MI (RR=1.67, p=0.04) smoking (RR=0.57, p=0.04), previous ASA use (RR=0.40, p=0.02), Killip 3 or 4 (RR=14.71, p&lt;0.001), temporary pacemaker (RR 2.53, p=0.01), pain-to-door time (RR=0.99, p=0.017) were independently associated with CA. Non Shockable Rhythm (RR=7.37, p=0.017), ROSC duration (RR=1.05, p=0.02) and cardiogenic shock (RR=31.2, p=0.003) were independent predictors of mortality among patients admitted with CA.

Conclusion
In this cohort of consecutive patients admitted with STEMI, pre-admission CA incidence was greater than seen in literature. Cardiogenic shock and in-hospital mortality were more common in patients admitted with CA, which may in part explain our higher rate of overall in-hospital mortality. Non shockable rhythm, increased ROSC and cardiogenic shock were independent predictors of mortality among patients admitted with CA. Understanding these characteristics may help taking measures to lower mortality rates.

Funding Acknowledgement
Type of funding source: None
Acute coronary events in patients with myeloproliferative neoplasms- a nationwide analysis of patient characteristics and in-hospital outcomes
Authors: Bhatia K , Handa S , Das S , Modi V , Joshi A 
Published: November 2020

Abstract

Background
Myeloproliferative neoplasms (MPN) are characterized by clonal expansion of cells belonging to the erythroid and/or myeloid lineages. Concomitant platelet dysfunction and thrombocytosis predispose these patients to arterial thromboses, causing a high burden of morbidity and mortality. With improving survival, an increasing number of patients with MPN are presenting with acute coronary syndromes (ACS). However, data regarding in-hospital outcomes and revascularization strategies utilized in these patients is limited, due to lack of representation in trials and rarity of the disease.

Methods
We conducted a retrospective cohort study using the 2016 Nationwide Inpatient Sample.Adult patients with a primary diagnosis of ACS and a secondary diagnosis of MPN, including essential thrombocytosis, polycythemia vera, primary myelofibrosis or chronic myeloproliferative disorder, were identified using the International Classification of Diseases (ICD) 10th revision codes. Outcomes of interest were compared using a multivariate logistic regression model.

Results
Out of 677,304 patients admitted for ACS, 2,485 also had a secondary diagnosis of MPN. Patients with MPN were less frequently female and diabetic but were more likely to have heart failure. No statistical difference in race, smoking or obesity was noted between the two cohorts. There was no significant difference in the in-hospital mortality in ACS patients with or without MPN. In terms of revascularization, patients with MPN were less likely to undergo percutaneous coronary intervention (PCI) and more likely to undergo coronary arterial bypass grafting (CABG). In addition, patients with MPN had a higher odds of acute pulmonary embolism, cardiogenic shock, and acute kidney injury as well as increased length of stay (LOS) and hospitalization costs

Conclusion
In patients with ACS and concomitant MPN, CABG was the preferred mode of revascularization over PCI, which may account for the increased LOS and total cost. Although the in-hospital mortality was similar, patients with MPN had higher odds of In-hospital complications.

Funding Acknowledgement
Type of funding source: None
Impact of high bleeding risk criteria on short- and long-term outcomes in patients with acute myocardial infarction
Authors: Dai K , Okada A.O , Hyodo Y.H , Nakano T.N , Tomomori S.T , Higaki T.H , Oi K.O , Kawase T.K , Nakama Y.N , Suenari K.S , Nishioka K.N , Otsuka M.O , Masaoka Y.M , Shiode N.S , Kihara Y.K 
Published: November 2020

Abstract

Background
The Academic Research Consortium (ARC) proposed the new definition of high bleeding risk (HBR) criteria. It remains unknown about the prevalence and the impact of HBR on clinical outcome after acute myocardial infarction (AMI).

Purpose
To assess the prevalence and the impact of HBR on short- and long-term outcomes in patients with AMI.

Methods
Between January 2015 and January 2018, 412 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. According to HBR criteria proposed by ARC, we divided patients into 2 groups; HBR and non-HBR group. We considered a patient HBR if the patient met at least 1 major criteria or 2 minor criteria. Major criteria included severe CKD (eGFR&lt;30 ml/min), severe anemia (Hgb&lt;11 g/dl), active cancer, and the use of oral anticoagulant drug. Minor criteria included high age (≥75), moderate CKD (eGFR 30–59 ml/min), moderate anemia (Hgb 11–12.9 g/dl for men and 11–11.9 g/dl for women). Kaplan-meier method was used to compare long-term outcome of HBR and non-HBR group. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fetal MI, and stroke.

Results
Patients with HBR were found in 37% of patients with AMI. In-hospital mortality (11.3% vs 4.2%, p=0.008) and MACE rate was significantly higher in HBR than non-HBR group (Figure). HBR group was associated with higher all-cause death (15.7% vs 2.5%, p&lt;0.0001) and intracranial bleeding (4.8% vs 0.5%, p=0.02) than non-HBR group, although the incidence of non-fetal MI was comparable between two groups (7.6% vs 8.5%, p=0.76).

Conclusions
AMI patients with HBR were associated with worse outcomes both short- and long-term.
Kaplan-Meier curves for MACE

Funding Acknowledgement
Type of funding source: None
Predictors of major bleeding following an acute coronary event: insights from a national study of 5,116 consecutive patients in clinical practice
Authors: Mullen L , Shaw M , Meah M , Elamin A , Aggarwal S , Shahzad A , Khand A 
Published: November 2020

Abstract

Background
Major bleeding after acute coronary syndrome (ACS) predicts a poor outcome. Although predictors of major bleeding following ACS have been validated, these have been mostly in clinical trial populations and few contemporary analyses have been undertaken in clinical practise

Methods
Major bleeding was assessed in a national study of ACS and antiplatelet choice. A total of 5116 consecutive patients [Clopidogrel (n 2,491, 2011–13) and Ticagrelor (n 2,625, 2013–16)] were enrolled in 5 UK hospitals. Clinical outcomes were identified from a national coding database (n=59.5 million) with bleeding events tracked to 11 health care facilities. Bleed severity was independently adjudicated by 2 consultant cardiologists, blinded to antiplatelet, sequence and year. Bleeding events were categorised using BARC 3–5 and PLATO criteria. A logistic regression analysis was used to define independent predictors of bleeding.

Results
The median age was 68 (IQR57–78, 30.5%&gt;75), 34% were female. 39% underwent PCI and 13% coronary artery bypass surgery. Clinical outcome data was 100% complete. 1-year mortality was 12.9%. Of 1193 icd10 codes for bleeding or anaemia 165 (3.2%) and 193 (3.8%) patients were adjudicated to have suffered a BARC 3–5 and PLATO major bleeding respectively. Independent predictors common between PLATO major and BARC 3–5 bleeding, in the year following ACS, were CRUSADE score &gt;40 (OR 1.63, CI 1.1–2.4, p=0.008) moderate left ventricular systolic dysfunction (OR, 1.65, CI: 1.2–2.4, p=0.006), age (OR per year increase in age 1.03, CI 1.02–1.05, p&lt;0.001) and subsequent coronary artery bypass surgery (OR 2.6, CI 1.8–3.8, p&lt;0.001)

Conclusion
In a broad real-world population of ACS, CRUSADE score &gt;40, incorporating simple clinical and laboratory criteria, remained an independent predictor of major bleeding using 2 internationally recognised bleed criteria

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Liverpool university hospitals; North-West Educational Cardiac Group