bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of hospital mortality in acute coronary syndrome in elderly and long-lived patients
Authors: Kruchinova S , Raff S.A , Kosmacheva E.D 
Published: November 2020

Abstract

Objective
To evaluate the effect of clinical and medical history, laboratory and instrumental indicators, patient management tactics on the level of hospital mortality in patients with ACS in senile patients and long-livers.

Materials and methods
The study included 1520 senile patients (75–90 years old) and 96 long-livers (90–103 years old) hospitalized with a diagnosis of ACS. Depending on the management tactics, each age group was divided into 2 subgroups - invasive management - balloon angioplasty and stenting of the coronary arteries (n=670 in the group of old age, n=12 in the group of long-livers) and conservative management - patients who refused invasive intervention (n=850 in the group of senile age, n=84 in the group of centenarians).

Results
Hospital mortality rates in elderly patients were 11%, long-livers were significantly higher - 30%, significantly differing in the subgroups of invasive and conservative treatment in elderly patients (7.5% vs 14.5%; p=0.0368) while in long-livers these differences did not reach statistical significance (15.8% vs 38.7%; p=0.1175). Most patients of both age groups died during the first days of hospitalization - 68.2% and 73.5% of cases for senile age and long-livers, respectively, while the level of pre-mortality was comparable with conservative and invasive approaches to treatment. Clinical-anamnestic, laboratory and instrumental indicators that had a significant impact on the level of hospital mortality in elderly patients, regardless of management tactics, included the presence of clinically manifest multifocal atherosclerosis (p=0.003), class acute cardiac failure III-IV according to Killip (p=0.007), the presence of ST segment elevation (p=0.001), decreased LVEF (S) &lt;42% (p=0.01), the development of acute kidney damage (p=0.006), and an electric storm (p=0.0005). In long-livers, these parameters also, regardless of management tactics, included Killip class acute cardiac failure III-IV (p=0.03), the presence of ST segment elevation (p=0.004), the development of acute kidney damage (p=0.001), and an electric storm (p=0.003), grade 3 atrioventricular block (p=0.02), acute erosive-ulcerative gastropathy with a decrease in hemoglobin level of more than 20 g / l (p=0.04).

Conclusions
Patients of older age groups are characterized by high rates of daily mortality. The level of hospital mortality in senile patients and long-livers is determined by a number of clinical and medical history, laboratory and instrumental parameters, the significance of which does not depend on patient management tactics. The choice of treatment strategy has a significant effect on hospital mortality in elderly people, while the development of complications of ACS played a large role in thanatogenesis in long-livers.

Funding Acknowledgement
Type of funding source: None
Prognostic implications of previously known or newly diagnosed diabetes and hypovitaminosis D in patients with myocardial infarction
Authors: Aleksova A , Santon D , Stenner E , Gagno G , Francescut C , Padoan L , Saro R , Beltrami A.P , Sinagra G 
Published: November 2020

Abstract

Background
Vitamin D deficiency and diabetes mellitus are frequent among patients with acute myocardial infarction. Independently, both were associated with a worse prognosis after myocardial infarction (MI). However, it is unclear whether the risk of worse outcome, associated with diabetes mellitus, may be accentuated in presence of hypovitaminosis D.

Purpose
We assessed if previously known or newly diagnosed diabetes is associated with worse outcome (major cardiovascular events) in combination with hypovitaminosis D in patients with acute MI.

Methods and results
Were enrolled 1004 patients with acute MI; 64.7% of them, had hypovitaminosis D and 37% were diabetic.
We grouped our population by diabetic status: previously known diabetes (diagnosis of diabetes before MI, n=330; 32.9%); newly diagnosed diabetes (during hospitalization for MI, but no known diabetes at presentation, n=47; 4.7%); or no diabetes (n=627; 62.5%).
Hypovitaminosis D was more frequent among patients with previously known (70.2%) and newly diagnosed diabetes (73.3%), when compared to non diabetic patients (61.2%).
During median follow-up of 15.6 months, patients with previously known and newly diagnosed diabetes had increased risks of major cardiovascular events (HR 1.72; 95% CI, 1.26 to 2.36. The risk of major events during the follow-up among diabetic patients, was further increased in presence of hypovitaminosis D (Figure 1).

Conclusions
The presence of both, previously known or newly diagnosed diabetes and hypovitaminosis D, in patients with MI is synergistically associated with a worse outcome.

Funding Acknowledgement
Type of funding source: None
Low-density lipoprotein cholesterol levels on admission and long-term outcomes in statin-naive patients with acute coronary syndrome
Authors: Satou R , Matsuzawa Y , Akiyama E , Konishi M , Yoshii T , Okada K , Maejima N , Iwahashi N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K 
Published: November 2020

Abstract

Introduction
Dyslipidemia, especially an increase in the low-density lipoprotein cholesterol (LDL-C) has been established as one of the most important risk factors for atherosclerotic cardiovascular diseases. In contrast, some recent studies have shown that the low LDL-C level was associated with short-term poor prognosis in patients with cardiovascular disease, and this is so-called “cholesterol paradox”. However, there is few data evaluating the effects on long-term outcome of “cholesterol paradox” in patients with acute coronary syndrome (ACS).

Purpose
The purpose of this study was to examine whether the low LDL-C level on admission affect long-term prognosis in patients with ACS.

Methods
A total of 434 ACS patients who survived to hospital discharge were enrolled in this study. All patients were statin-naïve on admission, and were received statin therapy after hospitalization. Patients were divided into the low LDL-C (≤114 mg/dl) and high LDL-C (&gt;114 mg/dl) groups using the first tertile of the LDL-C level on admission. The primary endpoint was composite outcomes of all-cause death, myocardial infarction, ischemic stroke, hospitalization for congestive heart failure and unplanned revascularization.

Results
During a median follow-up period of 5.5 years, primary endpoint occurred in 117 patients. Overall, event-free rates differed significantly between the low and high LDL-C groups, demonstrating the lower event-free rate in patients with the low LDL-C group (38.9% in low LDL-C group versus 20.7% in high LDL-C group, p=0.0002; Figure). Even after adjustment for age, sex, body mass index, and various classical risk factors, the low LDL-C group was significantly at higher risk for primary composite outcomes compared to the high LDL-C group (adjusted hazard ratio 1.65, 95%-confidence interval 1.10–2.49, p=0.02).

Conclusion
In patients with ACS, the low LDL-C level on admission was significantly associated with long-term worse prognosis, regardless of statin therapy at discharge. In ACS patients with low LDL-C level, it might be necessary for elucidating the residual risk for secondary adverse event to improve their prognosis.

Funding Acknowledgement
Type of funding source: None
Usefulness of troponin in selecting patients for invasive coronary angiography after cardiac surgery
Authors: Omran H , Deutsch M.A , Groezinger E , Renner A , Neumann J , Westermann D , Scholtz W , Rudolph T , Gummert J , Rudolph V , Hakim-Meibodi K 
Published: November 2020

Abstract

Background
Great uncertainty exists about the indication for invasive coronary angiography (ICA) in patients with suspected acute coronary syndrome following cardiac surgery.

Aim
The aim of this study was to define clinical criteria that best identify patients who benefit from ICA after cardiac surgery.

Methods
We performed a retrospective analysis of all patients who underwent cardiac surgery between January 2009 and May 2019 at our center. Exclusion criteria included pediatric patients as well as pacemaker, TAVR and LVAD implantation and heart transplantation procedures. The primary outcome was usefulness of ICA as defined by consequent PCI or re-operation due to ICA findings. ECG changes (ST-elevations) and high-sensitivity Troponin I (hsTrop I) were analyzed.

Results
48,136 patients were screened and after applying exclusion criteria 29,359 patients were finally included in the analysis (mean age 67.8±11.0 years, 31.1% females, Euroscore II 5.14±8.9%). A total of 1,171 patients (4%) underwent post-op ICA. The primary outcome occurred in 440 patients (1.5%) of which 290 underwent consequent PCI and 214 underwent consequent re-operation. Baseline characteristics are shown in table 1. Unadjusted analyses did not identify significant differences in the level of cardiac biomarkers between useful-ICA and unuseful-ICA groups.
In multivariate regression analysis, only ST-elevation on ECG predicted the primary outcome (OR 1.33, 95% CI 1.003–1.76).
Dichotomizing hsTrop I concentrations by applying the guideline-specified cut-off (&gt;70x URL) resulted in correct classification of useful-ICA patients in 95.7%. However, the false-positive rate was also extremely high (83.6%) with a positive predictive value (PPV) of 1.6% and a negative predictive value (NPV) of 99.6% (accuracy 17.5%).
Using area under the curve (ROC) analysis following optimal cut-off values for hsTrop I were identified: in CABG patients a cut-off value of &gt;650x URL (corresponding absolute value 17000 ng/L) was defined with a corresponding sensitivity of 83.3%, specificity of 83.6%, PPV of 8.9% and NPV of 99.6% (accuracy 83.6%). In non-CABG patients (i.e. valve or aortic procedures), the cut-off was about twice as high as that for CABG patients (1,350x URL or 35,000 ng/L) with a corresponding sensitivity of 84.1%, specificity of 89.2%, PPV of 5.9% and NPV of 99.9% (accuracy 89.1%).

Conclusion
Our study demonstrates that currently recommended cut-off concentrations of high-sensitivity troponin are not useful for guiding clinical decision-making in patients with suspected acute coronary syndrome following cardiac surgery, while substantially higher cut-off values might be useful. Those cut-off values critically depend on the type of cardiac surgery performed (CABG vs. non-CABG).
Troponin_Curves post-op

Funding Acknowledgement
Type of funding source: None
A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic
Authors: Johannessen T.R , Atar D , Vallersnes O.M , Larstorp A.C.K , Mdala I , Halvorsen S 
Published: November 2020

Abstract

Background
Patients presenting with acute chest pain outside of hospitals represent a diagnostic challenge.

Purpose
We aimed to validate whether a single high-sensitivity cardiac troponin T (hs-cTnT) safely can rule out acute myocardial infarction (AMI) in a primary care emergency setting. In addition, we aimed to investigate if the hs-HEART (History, Electrocardiogram (ECG), Age, Risk factors, and hs-Troponin) score would add valuable diagnostic information.

Methods
This is a secondary analysis from a prospective diagnostic study, including 1711 patients with acute non-specific chest pain presenting to a primary care emergency clinic from November 2016 to October 2018. The European Society of Cardiology (ESC) 0/1-hour algorithm triages patients towards direct rule-out if the 0-hour hs-cTnT is below 5 ng/L, combined with a normal ECG and a 3-hour symptom duration. The hs-HEART score (0–10 points) was calculated retrospectively, and a score ≤3 points was considered low-risk. In addition, a modified hs-HEART score, with more comparable hs-cTnT cut-off values, was applied. The primary endpoint was AMI during the index episode; the secondary the 90-day incidence of AMI (including index) and all-cause death.

Results
Among 1711 patients, 61 (3.6%) had an AMI, and 525 (30.7%) were assigned towards direct rule-out. With no AMIs in this group, the rule-out safety was high (negative predictive value (NPV) and sensitivity 100%). The hs-HEART score triaged more patients (n=966) as low-risk, but missed six AMIs (NPV 99.4% and sensitivity 90.2%). The modified hs-HEART score (n=707, AMI=3) increased the low-risk sensitivity to 95.1%. The 90-day incidence of AMI and all-cause death in the direct rule-out, low-risk hs-HEART, and modified hs-HEART group, were 0.0%, 0.7%, and 0.4%, respectively.

Conclusions
The ESC direct rule-out approach, with a single hs-cTnT below 5 ng/L, combined with a normal ECG, and a 3-hour symptom duration, is superior to the two hs-HEART scores in ruling out AMI in a primary care emergency setting.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The Norwegian Research Fund for General Practice
Influence of apoe and slco1b1 genes on lipid spectrum and clinical presentation in patients with myocardial infarction and diabetic nephropathy
Authors: Siverina A , Skorodumova E.A , Kostenko V.A , Skorodumova E.G , Fedorov A.N , Rysev A.V 
Published: November 2020

Abstract

Objective
To evaluate effect of APOE and SLCO1B1 genes on course of myocardial infarction (MI) in patients with diabetic nephropathy (DN).

Materials and methods
185 patients treated about MI were examined (Male – 60.5%, 39.5% – females, average age 64.1±4.2 years). Patients were divided into 2 groups: the first (I) – 93 patients with MI and DN, the second (II) – 92 persons with MI without DN. Polymorphism of the APOE (rs769452) and SLCO1B1 (rs4149056) genes. In first 3 days level of total cholesterol (TH) and low density lipoproteins (LDL) were determined in all patients.

Results
Based on the data presented in table 1, patients with MI and DN had a statistically more frequent rate of the LeuPro genotype than in the comparison group, relative to group II – 6.2%, p&lt;0.05. Heterozygotes of the ValAla gene (SLCO1B1) were also more often detected in patients of group I – 26.9% versus group II – 9.8%, p&lt;0.05. Analysis of lipid profile indices in heterozygotes revealed a statistically significant difference only between LDL indices, p&lt;0.05. Clinical presentation: acute heart failure (AHF) III–IV classes by Killip – 2.8 times more often in patients of group I, p&lt;0.05. Chronic heart failure (CHF) NYHA III-IV developed 3 times more often in group I than in the second, p&lt;0.05. High-grade ventricular heart rhythm disorders - more often in group I – 24.7%, relative to the control – 8.7%, p&lt;0.05. Relapses of acute coronary syndrome (ACS) occurred 3 times more often in I than the second, p&lt;0.05. Hospital mortality: I – 11.8%, II – 5.4%, p&lt;0.05.

Conclusions
1. Heterozygous type of inheritance of the Leu28Pro polymorphism of APOE gene and Val174Ala of SLCO1B1 gene, in patients with MI and DN that was confirmed by high levels of TH and LDL, p&lt;0.05.
2. Clinical course of MI in the group with DN against the background of genetically determined hyperlipidemia, and possibly, in association with it was characterized by multiple complications: AHF and CHF, ventricular arrhythmias, relapses of ACS and deaths.
Features of the clinical picture

Funding Acknowledgement
Type of funding source: None
Comparison of admission lung ultrasound and left ventricle end diastolic pressure in patients with ST-segment elevation myocardial infarction submitted to primary percutaneous coronary intervention
Authors: Araujo G.N.D , Beltrame R.B , Luchese J.L , Marques F.M , Scolari F.S , Machado G.M , Silveira A.S , Bergoli L.B , Goncalves S.G , Zimerman A.Z , Fuchs F.F , Wainstein M.W , Wainstein R.W 
Published: November 2020

Abstract

Background/Introduction
Elevated left ventricle end diastolic pressure (LVEDP) is related to diastolic dysfunction, increased retrograde pulmonary capillary pressure and pulmonary congestion. Diastolic dysfunction precedes the onset of systolic dysfunction in acute ischemia, and the prognostic utility of LVEDP in ST-segment elevation myocardial infarction (STEMI) is well known. Bedside lung ultrasound (LUS) is a simple and sensitive method for evaluating pulmonary congestion.

Purpose
The aim of this study was to assess the correlation between LVEDP and LUS and to evaluate their prognostic capacity in STEMI patients submitted to primary percutaneous coronary intervention (PPCI).

Methods
This was a prospective cohort of STEMI patients treated in a tertiary care hospital. LUS was performed by two independent operators before coronary angiography. Our protocol consisted of eight scanning zones; a zone was considered positive in case it presented three or more B lines. LVEDP was recorded before coronary angiography, assessed offline and blinded to LUS results.

Results
We have included 217 patients with mean age of 60 (±12.1) years and 63% were male. Killip 4 on admission was diagnosed in 16.5% of patients and total in-hospital mortality was 14.7%. Median LVEDP and LUS positive sites were 19 mmHg [13, 28] and 1 [0, 5], and spearman correlation between them was 0.33. LUS and LVEDP c-statistics for in-hospital mortality were 0.69 (0.58–0.79) and 0.60 (0.49–0.71), respectively. LUS and LVEDP c-statistics for in-hospital cardiogenic shock were 0.75 (0.67 – 0.83) and 0.65 (0.57–0.74), respectively. A multivariate analysis was performed including 4 or more positive LUS zones, LVEDP &gt;22 mmHg, diabetes and admission creatinine. In patients with 4 or more positive LUS zones, odds ratios of cardiogenic shock and in-hospital mortality were 7.04 (2.89–18.30, p&lt;0.001) and 4.52 (1.92–11.12, p=0.001), respectively. In patients with LVEDP higher than 22 mmHg, odds ratios for cardiogenic shock and in-hospital mortality were 1.43 (0.57–3.54, p=0.437) and 0.88 (0.36–2.09, p=0.768), respectively.

Conclusion
We found no significant correlation between LVEDP and LUS in a STEMI patient's cohort. Unlike LVEDP, LUS had a significant AUC to predict in-hospital mortality. LUS had a great magnitude hazard ratio for cardiogenic shock and in-hospital mortality when 4 or more scanning zones were positive. A high LVEDP did not predict cardiogenic shock or in-hospital mortality on this subset of STEMI patients.
LUS and LVEDP correlation

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Hospital de Clinicas de Porto Alegre and Universidade Federal do Rio Grande do Sul
Breast cancer patients have lower in-hospital mortality after acute coronary syndrome, a 5 year nationwide analysis
Authors: Huang Lucas C , Yue B , Wei X , Wu L , Abed R , Bachoo N , Lopes J , Isath A , Narasimhan B , Contreras J 
Published: November 2020

Abstract

Background
Breast cancer and cardiovascular disease (CVD) share common risk factors, and breast cancer therapies are well known to cause cardiotoxicity. Prior studies highlighted the higher burden coronary artery disease and the importance to further assess its consequences on breast cancer patients.

Purpose
We sought to evaluate the revascularization rate and in-hospital short-term outcomes of breast cancer patients following acute coronary syndrome (ACS) compared to the general female population.

Methods
We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify female patients with principal diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina). Two subgroups were identified, women with a history of breast cancer and women without, and were propensity matched.
Multivariate regression analyses were performed to evaluate the impact of breast cancer on primary outcome (in-hospital mortality) and secondary outcomes: occurrence of shock, acute kidney injury (AKI), mechanical ventilation (MV), and length of stay (LOS). We also compared the rate of cardiac procedures. Statistical significance of odd ratios (OR) is defined with p-value&lt;0.05 and reported 95% confidence intervals (CI).

Results
We identified a total of 245,563 female patients with primary diagnosis of ACS, among them 10,625 (4.3%) had a history of breast cancer. The comorbidity of breast cancer was associated with statistically significant lower rates of mortality (OR 0.83, CI 0.74–0.94), shock (OR 0.87, CI 0.77–0.99), AKI (OR 0.90, CI 0.82–0.98), MV (OR 0.81, CI 0.71–0.92) and relative 5.4% decrease in LOS (CI: −7.8%, −3.0%). The cardiac procedural rates were similar for left heart catheterization (OR 0.96, CI 0.90–1.02), for percutaneous coronary intervention (OR 0.95, CI 0.89–1.02) and for CABG (OR 0.88, CI 0.78–1.00) compared to control group.

Conclusion
Breast cancer patients received a comparable catheterization and revascularization procedure rate and exhibited a statistically significant lower morbidity and mortality rates during hospitalization after an ACS event compared to the general female population.

Funding Acknowledgement
Type of funding source: None
Optimization of GRACE risk stratification by NT-proBNP combined with D-dimer in patients with non-ST-elevation myocardial infarction
Authors: Lu P.J , Gong X.W , Tian F.S , Yang Q , Liu Y.W , Yao Z.H , Wang J.X , Cui Z , Liu Y , Gao J 
Published: November 2020

Abstract

Background
GRACE risk score is the most widely used tool to predict the risk of death and myocardial infarction in patients with Non-ST-elevation myocardial infarction (NSTEMI). Some biomarkers have been shown to have a high predictive value for prognosis. But the models constructed using these studies have some drawbacks, including the using biomarkers that are not routinely monitored.

Aims
To explore the optimizing role of multiple biomarkers in GRACE risk stratification in NSTEMI and then develop a new scoring system based on GRACE.

Methods
1.This multi-center, prospective, cohort study enrolled 1357 patients (mean age 65±12 years; 57% male). Common clinical indicators were collected within the first 12h after admission. 2.The outcome was 1-year all-cause mortality and major adverse cardiac events (MACE: all-cause death,unstable angina, heart failure, recurrent myocardial infarction and stroke). 3.Cox multivariate anlysis was used to quantify the biomarker effect. C-index, NRI and IDI were calculated to verify that the biomarkers improve the predictive accuracy of GRACE.

Results
1. During follow-up (mean: 339 days), 57 participants died and 211 participants had 231 MACE. In COX analysis, NT-proBNP (P&lt;0.0001), and d-dimer (P=0.0092) were significant independent biomarkers for death. NT-proBNP (P&lt;0.0001), fibrinogen (P=0.0177) and d-dimer (P&lt;0.0001) were significant independent biomarkers for MACE. 2. For all-cause death, the combination of NT-proBNP and D-dimer improved the predictive accuracy of GRACE the most. For MACE, trigeminal combination of NT-proBNP, fibrinogen, and D-dimer improved GRACE the most 3. NT-proBNP, D-dimer, fibrinogen, and GRACE comprise a new scoring system for assessing 1-year clinical events. Kaplan-Meier analysis revealed a significant rise in 1-year mortality and MACE between different score groups.

Conclusions
The combination of NT-proBNP, and d-dimer added the prognostic value of GRACE for all-cause death and MACE. Our newly developed scoring system can be easily calculated in clinical practice and strongly correlated with all-cause mortality and MACE.
Risk score and survival curve

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Major Science and Technology Projects of Tianjin Science and Technology Commission in 2016; Key Project of Healthcare Industry of Tianjin in 2016