bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lymphopenia and risk for long-term mortality among patients undergoing coronary angiography
Authors: Zafrir B , Jaffe R , Sliman H , Barnett-Griness O , Saliba W 
Published: November 2020

Abstract

Background
Lymphopenia has been shown to be associated with adverse prognosis in chronic disease states that are related to immune dysregulation.

Purpose
We aimed to determine the association between lymphopenia and all-cause mortality in patients presenting to coronary angiography with or without acute coronary syndromes (ACS). We also investigated whether elevated red blood cell distribution width (RDW), an established cardiovascular prognostic marker, further refines risk stratification and improves predictive accuracy beyond lymphocytes count.

Methods
Retrospective cohort analysis of patients undergoing coronary angiography for evaluation or treatment of coronary artery disease between 2003 and 2018. Long-term mortality risk associated with relative (1000–1500 /μL) or severe (&lt;1000 /μL) lymphopenia was analyzed using Cox proportional hazards regression models, adjusting for comorbidities, ACS and RDW.

Results
Overall, 15179 patients underwent coronary angiography, at a mean age of 65±12 years. On cross-sectional analysis, lymphopenia was associated with kidney disease, cancer, heart failure and presentation with ACS, but lower rates of smoking and obesity. During a median follow-up of 7 (IQR 3.5–11.5) years, 4253 patients died. Compared to normal lymphocytes count (1500–5000 /μL), the multivariable adjusted hazard ratio (HR) (95% confidence interval) for mortality was 1.31 (1.21–1.41) and 1.97 (1.75–2.22) for relative and severe lymphopenia, respectively. The increase in mortality associated with severe lymphopenia was significant in patients presenting with non-ACS [HR 2.18 (1.74–2.73)], ST-segment elevation myocardial infarction (STEMI) [HR 1.59 (1.15–2.21)], or unstable angina/non-STEMI [HR 2.00 (1.70–2.34)]; p-for-interaction 0.626. The association of lymphopenia with mortality remained significant after additional adjustment to RDW. High RDW (&gt;14.5%) was associated with increased mortality risk in each of the lymphocytes count groups, and improved the predictive accuracy with AUC increase from 0.609 (0.601–0.616) to 0.646 (0.639–0.654) (p&lt;0.001).

Conclusions
Lymphopenia is associated with increased risk for long-term mortality in patients undergoing coronary angiography, regardless of coronary presentation. High RDW may enhance the predictive ability of lymphopenia.
Lymphocyte count and mortality risk

Funding Acknowledgement
Type of funding source: None
Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years
Authors: De Sousa Bispo J.P , Mota T.F , Fernandes R , Azevedo P , Carvalho D , Bento D , Marques N , Mimoso J , Jesus I 
Published: November 2020

Abstract

Objectives
To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal.

Methods
A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value &lt;0.05 was considered statistically significant.

Results
During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years.
We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p&lt;0.001), in coronary angioplasties (36.4% to 73.2%, p&lt;0.001), in the use of drug-eluting stents (0% to 70.1%, p&lt;0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p&lt;0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p&lt;0.001).
At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p&lt;0.001), beta-blockers (68.8% to 83.8%, p&lt;0.001), RAAS inhibitors (69.5% to 86.7%, p&lt;0.001) and statins (79.6% to 94.9%, p&lt;0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p&lt;0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p&lt;0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p&lt;0.001) as well as mortality (6.7% para 4.3%, p&lt;0.001).

Conclusion
Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality.
6 Month Outcomes over the years

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia
Treatment delay in STEMI is associated with heart failure and mortality. National data from the Norwegian myocardial infarction register
Authors: Halle K.K , Govatsmark R.E.S , Bonaa K.H 
Published: November 2020

Abstract

Background
European guidelines in ST-segment elevation acute myocardial infarction (STEMI) recommends a primary PCI (P-PCI) strategy if wire crossing of the occluded artery can be performed within 120 min of ECG diagnosis. A large proportion of the Norwegian population lives in remote geographical areas where P-PCI may not be performed expeditiously. Time delay from first medical contact to primary PCI is expected to be related to outcomes like heart failure and mortality. Norwegian hospitals are by law required to register clinical data for all patients treated for acute myocardial infarction in the Norwegian Myocardial Infarction. The register includes &gt;90% of eligible patients.

Purpose
The aim of the study was to investigate the association of time from first medical contact (FMC) to P-PCI with heart failure (EF &lt;50%) and mortality.

Methods
The study includes all patients registered during 2015–2018 in the Norwegian Myocardial Infarction Registry with STEMI who were &lt;85 years of age and had &lt;12 hours from symptom onset to FMC. For patients with missing values, FMC was calculated as time of prehospital ECG minus 10 minutes. The primary outcome variable was heart failure (defined as ejection fraction &lt;50% during hospitalization) or all-cause mortality within 1 year after hospitalization. We calculated ORs (95% CI) adjusted for age, gender, and history of myocardial infarction, hypertension, diabetes, and heart failure.

Results
During 2015–2018 a total of 6398 STEMI patients &lt;85 years of age were registered in the Norwegian Myocardial Infarction Registry with less than 12 hours from symptom onset to FMC. Time delay from FMC to P-PCI were &lt;90 minutes, 90–119 minutes, and &gt;120 minutes in 40%, 25%, and 35% of the patients, respectively. Compared to patients with P-PCI within 90 minutes after FMC, the multivariable adjusted OR (95% CI; p-value) for heart failure or 1 year mortality was 1.05 (1.02–1.08; p&lt;0.01) for patients with P-PCI within 90–119 minutes after FMC, and 1.05 (1.02–1.08; p&lt;0.001) for patients with P-PCI &gt;120 minutes after FMC. The corresponding ORs for 1 year mortality were 1.01 (0.99–1.02) and 1.03 (1.02–1.04), respectively, and the corresponding ORs for EF&lt;50% were 1.07 (1.04–1.11) and 1.07 (1.04–1.11).

Conclusion
In Norway, only 40% of STEMI patients undergo P-PCI within 90 minutes after FMC, and 35% of patients undergoes P-PCI &gt;120 minutes after FMC. Time delays of more than 90 minutes after FMC are associated with increased risk of heart failure and mortality. A fibrinolysis strategy may be preferred over P-PCI for a substantial proportion of STEMI patients.

Funding Acknowledgement
Type of funding source: None
Plasma desmosine, a biomarker of elastin degradation, predicts outcomes in coronary artery disease
Authors: Iskandar Z , Patel S , Lancefield T , Freeman M , Horrigan M , Farouque O , Huang J.T.J , Lang C.C , Burrell L.M , Choy A.M 
Published: November 2020

Abstract

Background
Recent evidence from animal studies suggests that elastin degradation accelerates atherosclerosis and increases risk of plaque rupture and subsequent myocardial infarction and stroke. Desmosine is an elastin-specific degradation product. We analysed the prognostic value of plasma desmosine (pDES) in a cohort of patients with coronary artery disease (CAD).

Methods
Patients with CAD (n=400) undergoing elective coronary angiography were prospectively recruited over 3 years and had bloods drawn for analysis of pDES using a validated stable isotope dilution liquid chromatography-tandem mass spectrometry method. Patients were followed up for 12 months for major adverse cardiovascular events (MACE: composite of death, myocardial infarction, target vessel repeat revascularisation, target lesion revascularisation, and heart failure hospital admission). The upper limit of normal for pDES is 0.35 ng/mL. The predictive value of pDES for MACE was analysed with Cox-proportional hazards ratio (HR) model and Kaplan-Meier survival analysis.

Results
During follow-up, there were 36 MACE events. Median pDES level across the entire cohort was 0.3 ng/mL (IQR 0.23–0.41 ng/mL). Patients with a pDES level &gt;0.35 ng/mL were more likely to be male and older with a mean age of 69.7±10.3 years, have a history of prior stroke or transient ischaemic attack (TIA) and COPD. In univariable analysis, a pDES level of &gt;0.35 ng/mL was associated with an increased risk of MACE (HR 4.76, 95% CI: 2.34–9.68, p&lt;0.001). In multivariable analysis, pDES &gt;0.35 ng/mL was associated with risk of MACE after adjustment for age, sex, COPD status and previous stroke and TIA (HR 3.97; 95% CI: 1.82–8.67, p=0.001) (Figure).

Conclusion
Increased elastin degradation as measured by elevated pDES levels, predicts outcomes in patients with CAD independent of traditional cardiovascular risk factors and may play a role as a future biomarker in these patients.
Kaplan-Meier survival analysis

Funding Acknowledgement
Type of funding source: None
The role of plateletcrit and red blood cell distribution width as a predictor of in-hospital mortality in patients with acute coronary syndrome
Authors: Sudharsono A , Khairina D , Fajar Muzakkir A , Hakim Alkatiri A , Muzakkir Amir M.Z 
Published: November 2020

Abstract

Introduction
Red Blood Cell Distribution Width (RDW CV) and Plateletcrit (PCT) are part of complete blood count (CBC) examination. There are few studies have been reported the use of these parameters to predict clinical outcome including mortality, but none of them conducted in Asian population. We seek to investigate the role of PCT and RDW CV as a potential objective biomarker to predict in hospital mortality coincide with Global Registry of Acute Cardiac Events (GRACE) score in Acute Coronary Syndrome (ACS).

Methods
We respectively analysed patients with ACS who were admitted to the coronary care unit between June 2018 and December 2019. The GRACE and CBC were taken consecutively.

Results
A total of 1053 patients with ACS (46% non-ST elevated ACS (NSTE-ACS) and 54% ST elevated myocardial infarction (STEMI)] were enrolled in this study. PCT and RDW-CV was found to be significantly correlated with mortality (p&lt;0.001). Further analysis showed significant higher level of PCT in patients with event compared to the other group (0.32 vs 0.24, p&lt;0.001). Similar result was found for RDW (14.1 vs 13.2, p&lt;0.001). ROC curve analysis for PCT and RDW-CV levels showed an AUC of 0.65, (cut off value: 0.25. p&lt;0.001) and 0.69 (cut off value 13.05, p&lt;0.001), respectively. High PCT and RDW-CV level were found to be a good predictor of mortality in ACS patients. (OR 2.6 and OR 3.4 respectively, p&lt;0.001) In patients with high risk GRACE risk categories, we found a significantly higher levels of PCT (0.27 vs 0.24, p&lt;0.001) and RDW-CV (13.8 vs 13.2, p&lt;0.001) compared to low-intermediate risk group.

Conclusion(s)
We found that both PCT and RDW-CV may act as novel and promising tool to predict in hospital mortality directly proportional with GRACE Score among ACS patient.
Figure 1. ROC curve for PCT and RDW-CV.

Funding Acknowledgement
Type of funding source: None
Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio and fractional flow reserve revascularization decision making strategy
Authors: Peper J , Van Hamersvelt R.W , Rensing B.J.M.W , Van Kuijk J.P , Voskuil M , Ten Berg J.M , Schaap J , Kelder J.C , Grobbee D.E , Leiner T , Swaans M.J 
Published: November 2020

Abstract

Background
Fractional flow reserve (FFR) adoption persists low mainly due to procedural and operator related factors as well as costs. An alternative for FFR, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperemia and wire-use. Currently, no outcome trials assess the role of QFR in the guidance of revascularization. Therefore, we evaluate a QFR-FFR hybrid strategy in which FFR is measured inside of the intermediate zone.

Methods
This retrospective multi-center study included consecutive patients who underwent both invasive coronary angiography and FFR in the participating centers. QFR was calculated for all vessels in which FFR was measured. Diagnostic performance of QFR was assessed using an FFR cut-off of 0.80 as reference standard. The QFR-FFR hybrid approach was modeled using the intermediate zone of 0.77 to 0.87 assuming that lesions within the intermediate zone follow the FFR binary cutoff.

Results
In total, 381 vessels in 289 patients were analyzed. The sensitivity, specificity and accuracy on a per vessel-based analysis were 84.6%, 86.3% and 85.6% for QFR and 91.1%, 95.3% and 93.4% for the QFR-FFR hybrid approach. The diagnostic accuracy of QFR-FFR hybrid strategy with invasive FFR measurement is 93.4% and results in a FFR reduction of 56.7%.

Conclusion
QFR has a good correlation and agreement with invasive FFR and a high diagnostic accuracy. A hybrid QFR-FFR approach could extend the use of QFR and reduces the proportion of invasive FFR-measurements needed while maintaining a high accuracy.
Hybrid QFR-FFR strategy

Funding Acknowledgement
Type of funding source: None
A bolus of saline injection leads to increase in coronary flow based on the viscosity reduction effect: the mechanism of saline induced Pd/Pa ratio
Authors: Baba T , Fujimori Y , Kurihara K , Yamanaka Y , Hashimoto S , Terasawa Y , Hata H , Yokota D , Wakabayashi T , Imai T 
Published: November 2020

Abstract

Background
In conjunction with fractional flow reserve (FFR), our previous study has shown the accuracy and utility of saline induced Pd/Pa ratio (SPR) for the assessment of myocardial ischemia. However, the potential mechanism how saline injection leads to increase in coronary flow remains speculative.

Purpose
This study aimed to clarify the underlying mechanism of SPR by using swine models.

Methods
The study was conducted in four swine models, and bolus of 25°C saline, 40°C saline, and 25°C dextran was injected at rates of 40mL/5sec through a catheter inserted into the superior mesenteric artery. Its peripheral arterioles were observed and recorded by a digital microscope, and transit time of each fluid and a luminal diameter of arterioles before and after injection were measured.

Results
The result from arterioles diameters of pre- and post-injection (0.049±0.016mm vs. 0.050±0.016mm; P=0.636) indicated that luminal diameters remained unchanged regardless of fluid administration. The transit time of 25°C saline was significantly shorter than 25°C dextran (3.19±0.68sec vs. 6.15±1.19sec; P&lt;0.0001). Although the result showed no significance, the transit time of 40°C saline with lower viscosity was shorten compared to 25°C saline (3.1±0.43sec vs. 3.65±0.46sec; P=0.088).

Conclusions
Compared to 25°C dextran (viscosity of 4.991mPa·s) having the same viscosity as 37°C whole blood, 25°C saline (viscosity of 1.012mPa·s) caused increasing to double the intravascular flow volume without dilating arterioles. The results strongly suggested that the potential mechanism of SPR was viscosity reduction effect. Combined with FFR which is based on vasodilation-mediated hyperemia, these findings may contribute to clarifying the pathophysiology and especially the microcirculation in coronary artery diseases.

Funding Acknowledgement
Type of funding source: None
Low-density lipoprotein cholesterol goal attainment and treatment patterns in a cohort of &gt;143,000 patients with atherosclerotic cardiovascular disease in Ontario, Canada
Authors: Fairbairn M , Oh P , Goeree R , Rogoza R.M , Packalen M , Pericleous L , Motsepe-Ditshego P , Colgan S , Goodman S.G 
Published: November 2020

Abstract

Background/Introduction
Limited real-world data are available on attainment of low-density lipoprotein cholesterol (LDL-C) treatment goals in patients with atherosclerotic cardiovascular disease (ASCVD) in Canada.

Purpose
A retrospective observational study was conducted to describe types of ASCVD events/procedures, time between events and use of lipid lowering treatment (LLT) in patients who did not achieve LDL-C goal.

Methods
Patients in Ontario ≥65 years with a primary ASCVD event/procedure between 1 Apr 2005 and 31 Mar 2016, treated with an LLT and with index and follow up LDL-C values were identified from claims data at the Institute for Clinical Evaluative Sciences data repository. Patients were assessed over a 1-year follow up period for LDL-C goal attainment (&lt;2.0 mmol/L or 50% reduction from index LDL-C) and analysed by LLT and by index event type.

Results
Overall, 28% of 143,302 patients ≥65 years on LLT failed to attain LDL-C goal at follow up (Figure). The proportion of patients failing to achieve LDL-C goal decreased from 35% to 22% over the 11-year study period. Mean time between index and follow up LDL-C (based on lowest score &gt;2 weeks and up to 1 year after index LDL-C) was 203±97 days. When analysed by low-, moderate- or high-intensity statin, 57%, 30%, and 22% of patients failed to achieve LDL-C goal at follow up, respectively.

Conclusions
In this study, more than 1 in 4 patients with ASCVD in Ontario failed to achieve guideline recommended LDL-C goal despite treatment. In particular, ∼1 in 3 patients with cerebral and peripheral arterial disease were not at goal. An opportunity exists to better manage these high risk ASCVD patients with further statin intensification and additional LLTs
This study made use of de-identified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada's Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Amgen Canada Inc.
Cardiopreventive effects of mitochondrial dynamics modulators in pre-diabetic rats subjected to cardiac ischaemia-reperfusion injury
Authors: Maneechote C , Palee S , Jaiwongkam T , Kerdphoo S , Chattipakorn S.C , Chattipakorn N 
Published: November 2020

Abstract

Background
Chronic exposure to a high-fat diet (HFD) consumption causes alteration of cardiac mitochondrial dynamics and function, leading to the abnormal left ventricular (LV) function. Since excessive mitochondrial fission and reduced mitochondrial fusion are correlated with both obesity and myocardial ischaemia, targeting mitochondrial fission and fusion could be an effective cardioprotective strategy. We previously showed that acute inhibition of mitochondrial fission and promotion of mitochondrial fusion exerted cardioprotection in obese rats. However, the chronic treatment with mitochondrial fission inhibitor (Mdivi-1) and mitochondrial fusion promoter (M1) in pre-diabetic rats subjected to cardiac ischaemia-reperfusion (I/R) injury has never been investigated.

Purpose
We investigated the cardiopreventive effects of chronic Mdivi-1 and M1 treatment in pre-diabetic rats with cardiac I/R injury on infarct size, mitochondrial function, and LV contractility.

Methods
Wistar rats (n=32, male) were fed with HFD for 12 weeks, then randomly divided into: 1) HFV (Vehicle, 0.1% DMSO), 2) HFMdivi1 (Mdivi-1, 1.2 mg/kg), and 3) HFM1 (M1, 2 mg/kg) with intraperitoneal injection. After 2 weeks of drugs administration, all rats underwent 30 min of left anterior descending coronary artery occlusion followed by reperfusion for 120 min. LV function was monitored throughout the experiment. At the end, the heart was removed to determine infarct size and mitochondrial function.

Results
Chronic treatment with Mdivi-1 and M1 similarly showed a decrease in mitochondrial reactive oxygen species and infarct size, leading to an improvement in LV function in HFD rats, as indicated by increased ejection fraction, when compared to HFV rats (Figure).

Conclusion
Mitochondrial fission inhibitor and fusion promoter exerted similar efficacy in protecting pre-diabetic rat hearts against cardiac I/R injury through attenuating mitochondrial dysfunction, reducing infarct size and increasing LV contractility.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Science and Technology Development Agency Thailand