bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome
Authors: Centola M , Maloberti A , Persampieri S , Castini D , Morici N , Sabatelli L , Oliva F , Giannattasio C , Carugo S 
Published: November 2020

Abstract

Background
Hyperuricemia has been associated with high mortality rates in patients with acute myocardial infarction. The role and the prognostic relevance of increased serum uric acid (SUA) in patients with acute coronary syndrome (ACS) are still under debate

Aim
We sought to assess the association between elevated admission levels of SUA and in-hospital adverse outcomes in a real-world patient population with ACS and to investigate the potential incremental prognostic value of SUA added to GRACE score

Methods
1088 consecutive patients admitted with a diagnosis of ACS to the Coronary Care Unit of two Hospitals were enrolled. Medical history, clinical characteristic, biochemical and electrocardiographic findings, angiographic data, treatments administered during hospitalization were all collected on an electronic database. All patients' data were entered prospectively in the database of the two hospitals and retrospectively analysed.

Results
The mean age was 68 years (IQR 60–78). Less than one-third of the total population was female (24%). Diabetes mellitus was present in 308 (28%) patients. The proportion of patients with STEMI and NSTEMI/UA was quite similar: 504 (46%) patients had a diagnosis of STEMI and 584 (54%) patients had a diagnosis of NSTEMI/UA. The GRACE score was 133 (IQR 112–156). In-hospital mortality rate was 2.3% in the overall population. Two variables were associated with a significantly increased risk of in-hospital death at the multivariate analysis: SUA (OR 1.72 95% CI 1.33–2.22, p&lt;0.0001) and GRACE score (OR 1.04 95% CI 1.02–1.06, p&lt;0.0001). To investigate the potential incremental prognostic value of SUA added to GRACE score for in-hospital death, we analyzed the results of adding hyperuricemia as categorical variable to the original GRACE risk model (GRACE-SUA score). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89–0.93, p&lt;0.0001) and 0.79 (95% CI 0.76–0.81, p&lt;0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93–0.95; p&lt;0.0001). The addition of hyperuricemia to the GRACE score led to reclassifying 18 of 211 (8.5%) patients without in-hospital deaths from high to low risk. No patients with o without events were incorrectly reclassified. The net-reclassification index (NRI) of the GRACE-SUA score was 1.7% (z value of 4.3; p&lt;0.001).

Conclusions
High admission levels of SUA are positively and independently associated with in-hospital adverse outcomes and mortality in a contemporary and unselected population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality and to improve risk classification in this study population.

Funding Acknowledgement
Type of funding source: None
Myocardial infarction coincides with increased expression of NO2X2 and the advanced glycation end product N-e-(carboxymethyl) lysine in the microvasculature of the brain
Authors: Korn A , Baylan U , Schalkwijk C.G , Niessen H.W.M , Krijnen P.A.J 
Published: November 2020

Abstract

Background
Acute Myocardial Infarction (AMI) is associated with mental health disorders such as cognitive impairment and depression. Neuroinflammation and cerebral microvascular dysfunction may play an important role herein. We previously showed an increased presence of the pro-inflammatory factors N-ε-Carboxymethyllysine (CML) and NADPH oxidase 2 (NOX2) in the microvasculature of the human infarcted heart and diabetic brain. In this study we have quantified the presence of CML and NOX2 in the cerebral microvasculature of patients in time after AMI.

Methods
Brain tissue was obtained at autopsy from 24 AMI patients and 9 control patients. According to their infarct age, the AMI patients were divided into three groups: 3–6 hours old (phase 1), 6 hours–5 days old (phase 2) and 5–14 days old (phase 3). The presence of CML and NOX2 in the microvasculature was quantified through immunohistochemical analysis.

Results
We observed a significant approximately 2.5 fold increase in microvascular CML in phase 2 and phase 3 AMI patients in comparison with control patients (p=0.015). NOX2 was present in significantly more microvessels in phase 2 AMI patients compared to control patients (p=0.042). However, no correlation was found between CML and NOX2 (r=0.06, p=0.74).

Conclusion
AMI coincides with an increased presence of CML and NOX2 in the microvasculature of the brain. These data point to pro-inflammatory alterations in the brain microvasculature that may underlie the mental health disorders associated with AMI.
CML and NOX2 in the brain microvessels

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novo Nordisk BV, European Foundation for the Study of Diabetes
Fluid-dynamics and biological features of unstable plaques: different shear stress for different plaques
Authors: Russo G , Pedicino D , Burzotta F , Lodi Rizzini M , Genuardi L , Vinci R , Bologna M , D'Aiello A , Gallo D , Chiastra C , Aurigemma C , Bonanni A , Trani C , Liuzzo G , Crea F 
Published: November 2020

Abstract

Background
The use of Optical Coherence Tomography (OCT) in acute coronary syndromes (ACS) allows recognizing ruptured fibrous cap (RFC) and intact fibrous cap (IFC) culprit lesions. The biological differences between them, as recently pointed out in translation studies, highlight different mechanisms for a similar clinical manifestation that might deserve different therapeutic approaches. The relationship between endothelial wall shear stress (WSS) and ACS has been demonstrated, however the differences in WSS features between RFC and IFC have not been elucidated.

Purpose
The aim of this study is to provide a fluid-dynamic and biological description of unstable and stable (SA) plaques, according to OCT analysis.

Methods
We enrolled 10 SA and 20 Non-ST Elevation Myocardial Infarction (NSTEMI)-ACS patients, with IFC (n=10) and RFC (n=10) culprit lesions according to OCT analysis. We performed Real-time PCR primer array on pooled Peripheral Blood Mononuclear Cell (PBMC) for 30 different molecules whose expression is strictly dependent on WSS. High-fidelity 3D-coronary artery models were created for 3 patients per group, applying previously validated methodologies.

Results
Among the groups we found a broad difference in molecular expression (Fig. 1A), with RFC displaying higher levels of molecules involved in vasoconstriction/dilatation (EDN1, NOS3), cellular adhesion (ICAM1), and peptidase inhibition (PI16). A significantly higher WSS was observed in RFC group (p&lt;0.001, Fig 1B and C), with larger variability and larger areas exposed to both low and high WSS (Fig. 1D). Interestingly, the molecules overexpressed in RFC are known to be upregulated by high WSS.

Conclusions
Our data demonstrated that IFC and RFC unstable plaques are associated with different WSS conditions, alongside with the expression of different molecular patterns specifically related to altered WSS. In the era of precision medicine these findings may have relevant therapeutical implications.

Funding Acknowledgement
Type of funding source: None
Cardioprotective strategy in ST-elevation acute myocardial infarction patients after reperfusion with percutaneous coronary intervention
Authors: Kozhukhov S , Parkhomenko A , Lutay Y.A , Yershova Y 
Published: November 2020

Abstract

Objectives
Reperfusion may cause no-reflow phenomenon. Both microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) have been recognized as poor prognostic factors in myocardial infarction (MI) patients. The aim of the study was to evaluate hypothesis whether cardioprotective strategy prevent IMH in MI patients after primary percutaneous coronary intervention (PCI).

Methods
This multicenter open-label randomized clinical trial enrolled 143 patients with first acute anterior ST-elevation MI (STEMI) reperfused within 6 h after symptoms onset. Cardiac magnetic resonance (CMR) was performed to assess left ventricular (LV) function and microvascular injury in 23 patients within the first week (3.5±1.2 days) after STEMI. Nine patients were randomized into soluble intravenous form of quercetin (Q) group and 14 - to the control group. Q infusions were started before PCI and used during the next 5 days. MVO was visualized using early gadolinium enhancement (EGE) and IMH was detected by using T2-WI.

Results
The study groups did not differ in terms of demographic characteristics, time to admission and main clinical data. Initially, the number of LV myocardial segments with edema was similar - 7.8±1.7 in patients of Q subgroup versus 6.8±1.8 in patients of the control subgroup (p=0.245). However, patients of the Q subgroup tended to have greater number of segments with gadolinium accumulation and higher value of the transmural index (7.7±1.2 compared to 6.2±1.5; p&lt;0.05) according to the late gadolinium enhancement (Area at Risk, gray zone of AMI). According to gadolinium enhancement MVO was detected in more than 90% patients of both groups, but IMH rate was higher in the control group (53.3 vs 11.1%; p=0.03). Additionally, Q limited final infarct size assessed by CK-MB AUC 18% compare to control group (p&lt;0.021).

Conclusion
Detection of MVO and IMH by CMR can accurately demonstrate the severity of myocardial injury. Intravenous Q can decrease the rate of IMH additionally to infarct size limitation. Further investigations are needed to confirm our results and to determine whether prevention of IMH can impact on better prognosis.

Funding Acknowledgement
Type of funding source: None
Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction
Authors: Kawai T , Nakatani D , Yamada T , Watanabe T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Seo M , Nakamura J , Hikoso S , Fukunami M , Sakata Y 
Published: November 2020

Abstract

Background
Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status.

Methods
To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years.

Results
During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247).

Conclusion
Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status.

Funding Acknowledgement
Type of funding source: None
Impact of percutaneous coronary intervention on short and long-term prognosis of elderly patients with acute myocardial infarction from 2010 to 2017 in Japanese population
Authors: Goto J , Watanabe T , Kobayashi Y , Toshima T , Wanezaki M , Nishiyama S , Otaki Y , Kutsuzawa D , Kato S , Tamura H , Arimoto T , Takahashi H , Shishido T , Kubota I , Watanabe M 
Published: November 2020

Abstract

Background
Advances in therapies have successfully decreased short-term mortality in patients with acute myocardial infarction (AMI). Although aging population is recently increasing in developed countries, there are few reports about the association between prevalence of percutaneous coronary intervention (PCI) and long-term prognosis in elderly patients with AMI in Japan.

Purpose
The aim of this study was to clarify the prevalence of PCI and the impact of PCI on short and long-term prognosis of elderly patients with AMI.

Methods and results
We investigated the prevalence of PCI and short-term mortality in 4,109 patients with AMI who were registered in Yamagata AMI Registry from 2010 to 2017. Long-term mortality was investigated using data from death certification in July 2019. We divided patients with AMI into three age groups (group 1, &lt;65 years old; group 2, 65–79 years old; and group 3, ≥80 years old). Short-term mortality within 30 days was 6.5%, 12.1%, and 28.6%, respectively. Also, prevalence of PCI was 88.0%, 84.7%, and 62.7%, respectively. Multivariate analysis revealed that age, PCI, and severity of Killip classification were significantly associated with short-term mortality after adjustment for confound factors in group 3. Since the prevalence of PCI in group 3 was the lowest among three groups, the cause of PCI not being executed was investigated in 1,429 patients aged ≥80 years old. Elderly patients who didn't undergo PCI was older, more women, and had higher prevalence of chronic kidney disease, previous stroke, and severe Killip classification. Multivariate analysis revealed that age and Killip III/IV were significantly associated with non-executed PCI after adjustment for confound factors. Next, we investigated impact of PCI on long-term mortality in elderly patients who escaped acute death. Multivariate Cox hazard analysis revealed that PCI was associated with lower mortality after adjustment for confound factors (adjusted hazard ratio 2.47, 95% CI: 1.47–4.06; p=0.0008).

Conclusion
Lower prevalence of PCI and higher short-term mortality were observed in elderly patients with AMI aged ≥80 years old. PCI ameliorated long-term mortality as well as short-term mortality in elderly patients with AMI.

Funding Acknowledgement
Type of funding source: None
Premature acute coronary syndrome patients do not have a better prognosis for their age than mature ACS patients by propensity score match analysis
Authors: Mizutani H , Kurita T , Takasaki A , Nakata T , Konishi K , Izumi D , Omura T , Masuda J , Ito M , Dohi K 
Published: November 2020

Abstract

Background
Acute coronary syndrome (ACS) is the most important cardiovascular (CV) disease with a prevalence that increases with age. There is no data which compared the prognosis with premature ACS and mature ACS using propensity score matched analysis

Purpose
The purpose of this study was to compare the prognosis of premature ACS patients and mature ACS patients using propensity score matched analysis.

Methods
We analyzed of 4249 ACS patients (69.1±12.6, male 77%) including 773 premature ACS patients (50.1±6.8, male 78%) and 3476 mature ACS (73.3±9.3, male 77%) from January 2013 to December 2018, using data from Mie ACS Registry, a prospective and multicenter registry in Japan.
Premature onset of ACS was defined as younger than 65 years old in male and 55 years old in female.
Primary end point was as major adverse cardiac event (MACE) including cardiovascular death, non-fetal myocardial infarction, heart failure requiring admission and unstable angina.

Results
During median follow duration of 742 days ranging from409 to 828 days, 502 MACE were occurred. Premature ACS patients were younger and showed higher body mass index compared to mature ACS patients (50.1±6.8 vs 73.3±9.3 y.o., 25.5 vs 23.0, P&lt;0.001, respectively). However, premature ACS patients were more likely to be associated with ST elevation myocardial infarction, dyslipidemia, family history of coronary artery disease (CAD) and lower Killip classification compared to mature ACS patients (P&lt;0.01, respectively). Common CAD risk factors such as hypertension, diabetes mellitus and past history of CAD were less associated with premature ACS patients compared to mature ACS patients (P&lt;0.01, respectively). Unadjusted Kaplan-Meier survival curves demonstrated the favorable prognosis in premature ACS patients compared to mature ACS patients with hazard ratio of 0.57 (95% CI 0.45–0.71, P&lt;0.001, see Figure 1A). We compared a 1:1 propensity score-matched cohort of 1208 patients with or without premature onset of ACS adjusting the several factors mentioned above (n=604, respectively). Age could not be introduced as a factor of propensity score match when comparing premature and mature ACS patients. After propensity score-match, premature ACS patients is about 18 years younger than mature ACS patients (50.7±6.5 vs 68.5±8.2 y.o., P&lt;0.001). The average age of premature ACS was younger than that of mature ACS, but MACE by Kaplan-Meier survival analysis for premature ACS patients was equivalent to mature ACS patients (P=0.77, see Figure 1B).

Conclusion
Premature ACS patients are required very careful management because they might have factors with unfavorable prognosis, such as lifestyle habit and genetics, that may be beyond age.
Figure 1

Funding Acknowledgement
Type of funding source: None
Temporal trends in treatment and outcomes of patients with acute coronary syndrome and concomitant moderate to severe renal failure
Authors: Bossard M , Witassek F , Radovanovic D , Moccetti F , Erne P , Rickli H , Kobza R , Cuculi F 
Published: November 2020

Abstract

Introduction
Limited information about the management and outcomes of patients with acute coronary syndromes (ACS) and moderate to severe renal failure (RF) is available owing to underrepresentation of this population in most studies.

Methods
We evaluated the use of guideline-recommended therapies and in-hospital outcomes of totally 49'191 ACS patients with normal-mild renal failure (RF) (defined as eGFR &gt;45ml/min/m2) versus moderate-severe RF (eGFR &lt;45ml/min/m2) enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2002 and 2019 according to 2-year periods.

Results
Overall, 3'478 (7.1%) patients had moderate-severe RF. They were older (65.2+12.9 versus 77.2+10.6 years) and had significantly more comorbidities (including heart failure, cerebrovascular and peripheral vascular disease). Moderate-severe RF patients received less frequently guideline-recommended drugs, including P2Y12 inhibitors, ACEI/ARBs and statins (p&lt;0.0001). Between the first and last 2-year periods, the number of patients with moderate-severe RF and number of performed percutaneous coronary interventions (PCI) increased in this cohort (p-for-trend=0.001). At the same time, in-hospital mortality significantly decreased among ACS patients with and without RF (17.5% to 10.5% and 6.0% to 3.9%, respectively, p-for-trend=0.001 for both, see Figure). Similar trends were observed for other complications, namely cardiogenic shock and reinfarction. However, major bleedings increased significantly over time in patients with and without RF (p-for-trend=0.038 and &lt;0.001, respectively).

Conclusions
Outcomes of ACS patients with moderate to severe RF improved over the last two decades. Even though the rate of PCI increased in ACS patients with moderate-severe RF, they were less likely to receive guideline-recommended therapies and still suffer a high in-hospitality mortality (&gt;10%). With respect to the increasing burden of ACS patients with RF, our study implicates that more efforts should be undertaken to further improve outcomes of those patients.

Funding Acknowledgement
Type of funding source: None
Real-world evidence on short- and long-term outcomes for acute coronary syndrome patients with a prior history of atrial fibrillation
Authors: Gouda P , Savu A , Bainey K , Welsh R , Sandhu R.K 
Published: November 2020

Abstract

Background
Acute coronary syndromes (ACS) are often complicated by new-onset atrial fibrillation (AF), which is associated with higher short-term mortality. It is unknown whether a prior history of AF affects outcomes beyond in-hospital mortality in a real-world setting.

Purpose
To assess (i) the prevalence of prior AF in patients with ACS, including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI); (ii) clinical characteristics of ACS patients with and without AF; and (iii) in-hospital mortality and long-term outcomes in the presence of prior AF.

Methods
We used linked administrative health databases to identify patients hospitalized with a primary diagnosis of ACS and prior history of non-valvular AF (ICD-9 code 427.3 and ICD-10 code 148), which was defined as 1 hospitalization or 1 emergency department visit or 2 outpatient visits at least 30 days apart in 1 year in any position, between April 2002 and March 2016 in Alberta, Canada. Outcomes included in-hospital mortality, long-term mortality and a composite of all-cause mortality, hospitalisation for myocardial infarction (MI) or stroke over 3 years. Kaplan-Meier curves were constructed for mortality and the composite outcome according to presence of prior AF and ACS type.

Results
Of 31,056 presenting with an ACS, 4,173 (13.4%) had a prior history of AF. Compared to patients without prior AF, patients with AF were older (75.7 versus 64.7 years), female (35.5% versus 29.9%), with a higher comorbidity burden (Charlson Comorbidity Index 1.7 versus 1.1). Patient with AF more often presented with NSTEMI (57.7% versus 48.2%) and UA (17.1% versus 16.4%) compared to STEMI (25.2% versus 35.4%). In-hospital mortality was higher for ACS patients in the presence of prior AF (8.1% versus 3.3%; p&lt;0.0001). Mortality and the composite endpoint were also significantly higher in patients with prior AF compared to those without AF (Panel A and B) over the 3-year period. A worse prognosis was observed for STEMI and NSTEMI patients with prior AF compared to any other group (panel C and D).

Conclusion
In this large, population-based study, we found that a history of AF is common in patients presenting with an ACS. In the presence of AF, short- and long-term prognosis is poor particularly for STEMI and NSTEMI patients. Aggressive modification of shared risk factors and use of evidence-based therapies to improve outcomes is needed in this high-risk population.
Outcomes by presence of AF and ACS type

Funding Acknowledgement
Type of funding source: None