bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6385Association of prehospital acetylsalicylic acid and heparin administration with favourable neurological outcome after out-of-hospital cardiac arrest: a matched-pair analysis
Authors: Grabmaier U , Von Der Helm M , Massberg S , Weckbach L T , Fischer M 
Published: October 2019

Abstract

Background/Introduction
To date, no prehospital administered drug has shown to influence favourable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA). Early administration of antiplatelet and anticoagulant medication might affect organ microcirculation and therefore favourable neurological outcome in the setting of OHCA.

Purpose
To evaluate the effect of prehospital acetylsalicylic acid and heparin (AH) administration on favourable neurological outcome and overall survival after OHCA in a large multicentre registry.

Methods
We examined patients with cardiac causes of OHCA that were prospectively included in the German Resuscitation Registry. Patients that were administered AH in the prehospital setting were matched in a 1:4 ratio with patients that were not administered AH. Pairs were matched for age >80 years, public place of collapse, initial ECG rhythm, witnessed by lay people and by emergency medical services (EMS), bystander CPR, usage of vasopressors, ECG signs of ACS or diagnosed ACS, coronary angiography conducted and hypothermia conducted. Analyses in the patients were stratified by treatment arm. Data was collected from 2011 to 2017 and analysed from January 2019 to March 2019. The primary endpoint was favourable neurological outcome at hospital discharge defined as cerebral performance category (CPC) 1 or 2. Secondary endpoints were return of spontaneous circulation (ROSC) as well as survival to hospital discharge. Logistic regression analysis and chi square analysis were used to evaluate the primary and secondary endpoints, respectively.

Results
Within the German Resuscitation Registry, 17,139 patients included between 2011 and 2017 had a presumably cardiac cause of OHCA with completed follow-up data. 205 patients were administered AH in the prehospital setting, whereas 16,934 were not. After matching in a 1:4 ratio, 174 patients in the AH group and 696 in the noAH group were suitable for analysis of the primary and the secondary endpoints. Prehospital AH administration was associated with favourable neurological outcome (OR for CPC 1 or 2 at hospital discharge 1.489 [1.026–2.162], p=0.036). Patients with AH were more likely to have ROSC (73.6% vs. 65.7% in the noAH group, p=0.047). Survival to hospital discharge was not statistically different between groups (32.8% vs. 28.5% in the noAH group).
Consort flow-diagram

Conclusion(s)
In this matched-pair analysis, prehospital administration of AH was associated with an enhanced ROSC rate and with favorable neurological outcome. Randomized controlled trials are needed to confirm these results.
P6402Ischemic and bleeding events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients: a propensity score-matched analysis
Authors: Shimizu A , Sonoda S , Setoyama K , Inoue K , Miura T , Anai R , Tsuda Y , Araki M , Otsuji Y 
Published: October 2019

Abstract

Background
Dual-antiplatelet therapy (DAPT) after second-generation drug eluting stent (2-DES) implantation reduced the risk of stent thrombosis and subsequent ischemic events, with an increase in bleeding risk. Although chronic kidney disease patients have high ischemic and bleeding risk, little is known about both risks in hemodialysis patients after 2-DES implantation during DAPT.

Method
From July 2009 to March 2017, we retrospectively analyzed post-discharge major adverse cardiac and cerebrovascular events [MACCE: cardiac death, myocardial infarction, target vessel revascularization (TVR) and cerebral infarction] and bleeding events in 644 consecutive patients during DAPT after 2-DES implantation. We divided them into 2 groups [102 hemodialysis (HD) and 518 non-hemodialysis (Non-HD) patients, mean age, 71±10 years] after excluding 24 patients (lost to follow up and peritoneal dialysis). Follow-up period was 49±24 months. Median DAPT duration was 12 months. The primary endpoint was MACCE. The secondary endpoint was bleeding events according to the Bleeding Academic Research Consortium (BARC) type 2, 3, or 5. MACCE and bleeding events were compared between HD and Non-HD by using the propensity score-matching (PSM) method.

Results
Among the 620 eligible patients, the primary and secondary events occurred in 207 (33.3%) and 76 (12.3%) patients, respectively. The rates of unadjusted MACCE [HD vs Non-HD: 53.9% vs 29.3%; Hazard ratio (HR) 2.39, p<0.01] and bleeding events (HD vs Non-HD: 21.6% vs 10.4%; HR 2.50, p<0.01) were significantly higher in HD than Non-HD.
After 1-to-1 propensity score adjustment for baseline differences (hypertension, diabetes mellitus, low ejection fraction, low albumin, anemia, and high C-reactive protein), a total of 160 patients (80 HD vs 80 Non-HD) was created. The rate of MACCE [HD vs Non-HD: 52.5% vs 31.3%; adjusted HR 2.04, p<0.01] was significantly higher in HD than Non-HD. Regarding MACCE, cardiac death (HD vs Non-HD: 18.8% vs 8.8%; adjusted HR 2.65, p=0.03) and TVR (HD vs Non-HD: 15.0% vs 6.3%; adjusted HR 2.74, p=0.046) occurred significantly higher in HD. On the other hand, bleeding events did not exhibit significant differences though HD had a numerically higher event rate (HD vs Non-HD: 25.0% vs 16.3%; adjusted HR 1.68, p=0.15), indicating that the bleeding risk in HD would be strongly dependent on the patient's background.

Conclusions
As a result of PSM, HD was shown to contribute to ischemic risk rather than bleeding risk. Even in the 2-DES era, HD was an independent risk factor of cardiac death and TVR. Therefore, further study on the current regimen of DAPT would be necessary while balancing both ischemic and bleeding risk.
P6421Can cardiologists rely on artificial intelligence to identify the culprit vessel in STEMI?
Authors: Mehta S , Fernandez F , Villagran C , Frauenfelder A , Matheus C , Ceschim M , Vieira D , Torres M A , Mazzini J , Quintero S , Safie R , Aboushi H , Munguia A , Cecilio E , Lopez C 
Published: October 2019

Abstract

Background
The importance of culprit lesion identification is critical for risk stratification of a patient with an ST-Elevation Myocardial Infarction (STEMI). The aforementioned provide patients with a more elaborated strategy of management and treatment either they are treated with PCI or less invasive techniques such as thrombolysis. We report a novel approach that employs AI-guided electrocardiogram (EKG) algorithms for rapid and accurate identification of the culprit STEMI vessel.

Purpose
To create an innovative, machine learning tool for a more effective risk stratification of STEMI patients.

Methods
An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “LCX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.

Results
Global Accuracy: 79.4%; LAD: Sensitivity 86.2%; Specificity 84.8%. RCA: Sensitivity 85.7%; Specificity 83.7%. LCX: Sensitivity 43.5%; Specificity 96.9%.

Conclusions
Coupling an AI-augmented algorithm and 12-lead EKG provides encouraging results for STEMI culprit vessel localization. Overall, risk stratification is possible for individual lesions located in the LAD and RCA. However, our approach yielded uncertain results in the LCX territory. We plan to continue to exploring variables for improvement of our results.
P6425Comparative effectiveness and costs of enoxaparin versus unfractionated heparin in treating acute coronary syndrome
Authors: Xiao Z M , Rosenthal N , Kartashov A , Levorsen A , Shah B 
Published: October 2019

Abstract

Background/Introduction
Enoxaparin and unfractionated heparin (UFH) are guideline-recommended anticoagulants for patients with acute coronary syndrome (ACS) including unstable angina (UA) and myocardial infarction with (STEMI) or without ST-elevation (NSTEMI). Prior efficacy and safety evidence are mainly from clinical trials. Economic data is lacking.

Purpose
To examine differences in utilization, effectiveness, safety, and costs in treating ACS between enoxaparin and UFH using real-world data.

Methods
Using Premier Healthcare Database from 859 U.S. hospitals, inpatients 18 years or older with a diagnosis of initial episode of ACS between 2010–2016 were analyzed. Outcomes included 30-day risk of non-fatal myocardial infarction (MI), recurrent angina, in-hospital mortality, composite ischemic complication (having MI/recurrent angina/death), major bleeding, and costs. Multivariable regression was used to compare outcomes between enoxaparin and UFH monotherapy.

Results
Among 1,048,053 eligible patients (UA: 219,259; NSTEMI: 582,134; STEMI: 246,660), prevalence of enoxaparin monotherapy was 12.0%, 13.9%, and 5.1% and of UFH monotherapy was 45.1%, 43.1% and 59.8% for UA, NSTEMI, and STEMI patients, respectively. Compared to UFH, enoxaparin was associated with lower odds of MI (Adjusted Odds Ratio [OR]=0.95; 95% Confidence Interval (CI): 0.92, 0.99), recurrent angina (OR=0.88; 95% CI: 0.78, 0.98), in-hospital mortality (OR=0.88; 95% CI: 0.81, 0.95) and composite ischemic complications (OR=0.95; 95% CI: 0.92, 0.98) among NSTEMI patients but not in UA or STEMI patients. Enoxaparin was associated with lower odds of major bleeding in all three patients cohorts (UA: OR=0.77, 95% CI: 0.66, 0.91; NSTEMI: OR=0.68; 95% CI: 0.64, 0.72; STEMI: OR=0.72, 95% CI: 0.63, 0.83). Cost savings per patient during index admission and 30-day follow-up for enoxaparin over UFH was $2,813 for UA, $2,332 for NSTEMI and $2,928 for STEMI patients.

Conclusions
Enoxaparin was associated with lower odds of ischemic complications including death, lower costs and better safety than UFH among NSTEMI patients. Its relative effectiveness varied between patients with different ACS presentations. Improving upstream selection of appropriate anticoagulants in different type of ACS patients has the potential to optimize clinical outcomes and costs.

Acknowledgement/Funding
This study was funded by Sanofi Inc
P6431Association of circulating miR-765, miR-93-5p and miR-433-3p with obstructive coronary heart disease evaluated by cardiac computed tomography
Authors: Infante T , Forte E , Punzo B , Cademartiri F , Cavaliere C , Soricelli A , Salvatore M , Napoli C 
Published: October 2019

Abstract

Background
Although advances in diagnosis, treatment and prognosis, coronary heart disease (CHD) is still the most prevalent cause of mortality and morbidity worldwide. Thus, there is still the need to identify both novel diagnostic and prognostic biomarkers to improve the clinical decision-making and help to stratify patients for early preventive treatment. Epigenetic-sensitive mechanisms may be related both to pathogenesis and prognosis of CHD. Among the epigenetic hallmarks, microRNAs (miRNAs), acting as flexible modulators of gene expression, could represent attractive candidate biomarkers useful in clinical practice.

Purpose
We prospectively investigated the expression pattern of circulating miRNAs in patients undergoing Cardiac Computed Tomography (CCT) for suspected CHD (n=95) with the aim to integrate molecular findings with morphological and clinical parameters derived by CCT.

Methods
CCT was performed with a third-generation dual source multidetector computed tomography scanner. Peripheral venous blood samples were collected into EDTA after a 12 h fasting in the same day of CCT, before imaging execution and the levels of 42 selected plasmatic miRNAs were analyzed by qRT-PCR.

Results
Let-7c-5p, miR-765, miR-483-5p, miR-31-5p and miR-206 were upregulated in CHD patients (n=66) vs healthy subjects HS (n=29) as well as let-7c-5p, miR-765, miR- 483-5p showed higher expression in obstructive CHD (n=36) compared to no obstructive CHD patients (n=66). In addition, miR-93-5p and miR-433-3p showed an upregulation in patients with critical coronary stenosis. Multivariate regression analysis demonstrated that miR-765, miR-31-5p and miR-206 were independently associated with CHD also in combination with Framingham risk score. Relevantly, miR-765, miR-93-5p and miR-433-3p were obstructive CHD predictors. ROC curve analysis also revealed a good performance for miR-765, miR-93-5p and miR-433-3p on predicting CHD severity.
Circulating microRNA expression

Conclusions
Our study represents a combined epigenetic/imaging approach useful to support the diagnosis and prediction of CHD.

Acknowledgement/Funding
Italian Ministry of Health grants: “Giovani Ricercatori 2011-12” (project code GR-2011-02349436) and “Ricerca Corrente 2018”
P6436Soluble urokinase plasminogen activator receptor and functionally relevant coronary artery disease: a prospective cohort study
Authors: Walter J E , Amrein M , Koechlin L , Du Fay De Lavallaz J , Zimmermann T , Twerenbold R , Mueller C 
Published: October 2019

Abstract

Background
The urokinase system is pivotal in the pathogenesis of atherosclerosis. Therefore, soluble urokinase plasminogen activator receptor (suPAR) concentrations may help in the detection of functionally relevant coronary artery disease (fCAD).

Purpose
To evaluate suPAR as diagnostic marker for fCAD.

Methods
Among consecutive patients with symptoms suggestive of fCAD, fCAD was adjudicated blinded to suPAR concentrations in two domains: first, diagnosis of fCAD according to myocardial perfusion single photon emission tomography (MPI-SPECT) and coronary angiography; second, fCAD according to cardiovascular death, non-fatal acute myocardial infarction (AMI) and all-cause death during 2-year follow-up.

Results
Among 968 patients, symptoms were adjudicated to be causally related to fCAD in 26% (255/968). SuPAR concentrations were higher in patients with fCAD as compared to those without (3.45 ng/mL versus 3.20 ng/mL, p=0.007), but overall had only low diagnostic accuracy (area under the curve [AUC]: 0.56, 95% CI 0.52–0.60) and were not independent predictors of fCAD after multivariable adjustment. Circulating suPAR concentrations were modestly correlated with high-sensitivity cardiac troponin (hs-cTn) T (Spearman's rho 0.393, p<0.001), NT-proBNP (Spearman's rho 0.327, p<0.001) and age (Spearman's rho 0.364, p<0.001), but only weakly correlated with the extent of coronary atherosclerosis as quantified by perfusion defects (Spearman's rho 0.123, p<0.001). Prognostically, suPAR concentrations had moderate-to-high accuracy in the prediction of cardiovascular death (AUC 0.72, 95% CI 0.62–0.81) and all-cause death (AUC 0.72, 95% CI 0.65–0.79) at 2-years, and remained a significant predictor for all-cause death after multivariable adjustment (p=0.001). SuPAR concentrations did not predict non-fatal AMI.

Conclusions
SuPAR is an independent predictor of death, but not helpful in the detection of fCAD.

Acknowledgement/Funding
European Union, Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel,
P6440The perils of polyvascular disease with concomitant type 2 diabetes in a real-world cohort of patients with acute coronary syndrome
Authors: Denegri A , Magnani G , Rossi V A , Raeber L , Windecker S , Gencer B , Mach F , Rodondi N , Heg D , Nanchen D , Matter C M , Luescher T F 
Published: October 2019

Abstract

Background
Despite substantial improvement in type 2 diabetes (DM2) care, the burden of recurrent cardiovascular (CV) events remains high. Polyvascular disease (PVD), has recently emerged as a potential marker of heightened residual ischemic risk in DM2 patients, that are likely to derive a greater absolute risk reduction from more intense, individualized therapy.

Purpose
We sought to assess the relationship between DM2, PVD and CV outcomes among 2,168 all-comers patients admitted to four Swiss University Hospital for acute coronary syndrome (ACS) and enrolled in the prospective multicenter SPUM registry (NCT 01000701).

Methods
PVD was defined as concomitant peripheral artery disease, stroke or transient ischemic attack, or both. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: Stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with PVD disease in DM2 and outcomes, and intention-to-treat analysis was performed.

Results
Out of 2,168 ACS patients, 396 patients (18.3%) had DM2; of these 62 (15%) had PVD. Despite compared with the general ACS population, those with PVD + DM2 were more likely to have a complex history of CV disease, such as previous MI (27.4% vs 14.7%, p=0.021), prior percutaneous (37.1% vs 17%, p<0.001) or surgical (24.2% vs 5.1%, p<0.001) coronary revascularization, one third was not on statin therapy. At 1 year, patients with PVD + DM2 had a higher rate of MACCE compared to those presenting with PVD or DM2 alone. Rates of the single components of the primary endpoint and all-cause of death were all significantly higher in patients with PVD + DM2 vs. PVD or DM2 alone (Fig. 1A, all p<0.001). This enhanced risk persisted after adjustment for significant baseline differences, with a 34% (Adj. HR 1.34, 95% CI 1.15–1.49, p=0.02) increase in MACCE and a 44% increment of all cause of death (Adj. HR 1.44, 95% CI 1.06–1.54, p=0.02, Fig. 1B).
Outcomes by PVD and DM2 status.

Conclusions
Among a real-world cohort of ACS-patients, the coexistence of PVD and DM2 highlights the highest CV risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly stratify the very high risk population and to identify patients who may derive the greatest benefit from more intense secondary prevention therapies.
P6443Late outcomes in patients undergoing PCI for ST elevation myocardial infarction with respect to diabetic status and completeness of revascularisation
Authors: Burgess S , Juergens C , Nguyen T , Leung M , Thomas L , Mussap C , Lo S , French J K 
Published: October 2019

Abstract

Objectives
This paper examines the degree to which the poor prognosis of ST elevation myocardial infarction (STEMI) patients with diabetes mellitus (DM) can be attributed to incomplete revascularization (ICR).

Background
Cardiovascular disease is the most common cause of death for patients with DM; patients with DM often have complex coronary disease and ICR. In STEMI the relative impact of DM and ICR is uncertain as these two factors frequently co-exist, the potential for confounding is high.

Methods and results
Of 589 consecutive STEMI patients, 22% had DM, who compared to patients without DM were of similar age (59 years), were more often female, had more hypertension and dyslipidaemia, but less often were smokers. A residual SYNTAX Score (rSS) >8, which defined ICR, occurred in 33%. Late cardiac death [median 3.5 years] was 4% among those without DM and 12% in those with DM (p=0.002) (p<0.001), and was 3% among 396 with rSS≤8 and 12% in 193 patients with rSS>8 (p<0.001). Patients with both ICR and DM accounted for only 8% of the STEMI population but 30% of all cardiac deaths. At final follow up (3.5 years) cardiac death rates (see Figure) were 22% in patients with both DM and ICR; these were significantly higher than rates in patients with ICR but no-DM (9%, p=0.034), and those with DM and rSS≤8 (6%, p<0.019). Multivariable analysis for cardiac death found a HR for ICR of 2.89 (95% CI 1.31–6.37; p=0.009) and a HR for DM of 5.18 (95% CI 2.45–10.97, p<0.001).
Diabetes, cardiac death & rSS

Conclusions
While ICR in DM patients with STEMI predicts a significantly poorer outcome, the poor prognosis seen in patients with DM is not explained by the degree of ICR alone. Both ICR and DM contribute independently to the risk of cardiac death in STEMI patients.
P6447Prediabetes versus diabetes mellitus in acute coronary syndrome patients: two sides of the same coin
Authors: Vila Cha Vaz Saleiro C , Lopes J , Teixeira R , Campos D , Sousa J P , Puga L , Ribeiro J M , Lourenco C , Costa M , Goncalves L 
Published: October 2019

Abstract

Background
Prediabetic patients are at increased risk of composite cardiovascular (CV) events and all-cause mortality. The impact of prediabetes diagnosis in the context of an acute coronary syndrome (ACS) remains to be determined.

Purpose
To assess the differences on long-term mortality between well controlled diabetic and prediabetic patients admitted with non-ST elevation ACS.

Methods
352 non-ST elevation ACS patients admitted to a single coronary care unit between 2009 and 2016 were included. Clinical, laboratorial and echocardiographic data were evaluated. Two groups were created based on the diabetic status and HBA1c level: Group A (prediabetic patients, HBA1c between 5.7–6.4%) N=229; Group B (diabetic patients, HBA1c ≤7%) N=123. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The mean time of follow up was 48±30 months.

Results
The groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, peak troponin I, left ventricular (LV) systolic function, multivessel disease and treatment option (PCI, CABG or OMT). On the contrary, well controlled diabetic patients had a higher prevalence of chronic kidney disease (CKD) (27.9% vs 39.0%, P<0.05), hypertension (82.5% vs 91.9%, P<0.05), higher body mass index (BMI) (23±4 vs 24±4 kg/m2, P<0.05) and previous coronary artery disease (37.1% vs 51.2%, P<0.05). 95 patients met the primary outcome. Kaplan-Meyer curves showed a tendency to decreased survival in the diabetic group (72.8% vs 66.4%, Log Rank P=0.09 – Figure 1). After adjustment for age, CKD, BMI (6 categories), heart failure diagnosis, peak troponin I and LV systolic function, controlled diabetes was not associated with increased death (HR 1.40, 95% CI 0.87–2.26). In this model, only age (HR 1.05, 95% CI 1.02–1.08), peak troponin (HR 1.01, 95% CI 1.00–1.01) and moderate to severely impaired LV function (HR 2.00, 95% CI 1.12–3.56) remained associated with the outcome.

Conclusion
In the context of an ACS, prediabetics should be regarded as a high-risk group. This study raises the provocative question that prediabetics and diabetics patients should be approached in similar ways in terms of risk stratification and therapeutic options after an ACS. In these patients, age, peak troponin and impaired LV function appear to be the main contributors to decreased survival.