bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic and prognostic value of neopterin and RNA-ase in patients with STEMI and NSTEMI
Authors: Ciobanu L , Popovici I , Ivanov V , Cobet V , Ivanov M , Popovici M 
Published: November 2020

Abstract

Background
Neopterin and RNA-ase are markers of inflammation with low disclosed role in diagnosis and prognosis of either STEMI or NSTEMI, although inflammation is well documented as a leader pathogenic mechanism in these pathologies.

Aim
Evaluation of serum admission levels of neopterin and ARN-ase in pts with STEMI and NSTEMI and their prediction value concerning the risk of MACE in 1 year of follow up period.

Material and methods
The admission serum concentration of neopterin and ARN-ase was determined by ELISA in 94 pts with STEMI and 92 pts with NSTEMI which was compared with normal markers appreciated in 32 healthy persons. Likewise, the rate of MACE in both groups was estimated during 1 year of post-infarction period. Diagnostic worth and MACE prediction power of markers have been established using respectively ROC curve and odds ratio.

Results
In patients with STEMI the serum level of neopterin was significantly increased compared with normal index by 3,5 times (11,6±3,4 vs 3,3±1,4 nM/L), but RNA-ase was significantly decreased by 43,4% (24,1±3,2 vs 42,6±5,2 nM/ml). In pts with NSTEMI neopterin level was lesser than STEMI, but significantly elevated by 39% (4,6±2,5 vs 3,3±1,4 nM/L) vs normal marker. RNA-ase level didn't significantly differ from normal level. However, adjusted to diabetes mellitus established in 19 pts, RNA-ase significantly diminished (36,4±3,9 vs 42,6±5,2 nM/ml), and its diagnostic value of NSTEMI according to ROC was 69,6% (RNA-ase level indicates inversely inflammation response, such as it breaks down extracellular RNA which has proinflammatory ability). Both markers in pts with NSTEMI and diabetes mellitus demonstrated a diagnostic value of 77,6%. In pts with STEMI highest tertile level of neopterin and lowest tertile level of ARN-ase had 2,8fold (adds ratio=2,8; CI=1,98–4,62; p&lt;0,05) and 2,3fold (adds ratio=2,3; CI=1,71–3,89; p&lt;0,05) higher risk of MACE development. In pts with NSTEMI the combination of these markers (highest and lowest quartile levels) also had a significant prediction regarding MACE risk (adds ratio=2,1; CI=1,86–3,77; p=0,029).

Conclusions
1. In STEMI both neopterin and RNA-ase could be as diagnostic markers, due to their significant change. In NSTEMI neopterin significantly elevated, but RNA-ase didn't shift from normal. In diabetic pts with NSTEMI, however, their combination demonstrated in ROC estimation a diagnostic value of 77,6%.
2. Prediction value of markers combination regarding MACE risk in pts with NSTEMI is significant and close to each marker in partly prediction of MACE for pts with STEMI.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Research Institute of Cardiology, Moldova Republic of
Multibiomarker model to discriminate Type 1 and Type 2 myocardial infarction
Authors: Neumann J , Soerensen N.A , Hartikainen T.S , Haller P.M , Lehmacher J , Weimann J , Blankenberg S , Zeller T , Westermann D 
Published: November 2020

Abstract

Background
The discrimination of patients with type 1 myocardial infarction (T1MI) from patients with type 2 MI (T2MI) is often challenging in the emergency department. Earlier we presented a discrimination model, which based on clinical variables, as well as on troponin concentrations. In the present analyses we sought to investigate the discriminative power of 28 biomarkers in patients with T1MI and T2MI.

Methods
Patients presenting to the emergency department with symptoms suggestive of MI were recruited. The final diagnosis of all patients was adjudicated by two physicians in a blinded fashion and based on the fourth universal definition of MI. For the present analyses only patients with T1MI and T2MI were used. In total 28 biomarkers were measured in blood samples collected directly at admission. A multivariable logistic regression model for T1MI vs T2MI as the dependent variable was used and the predictors were chosen via backward step-down selection.

Results
In total 138 patients (107 T1MI and 31 T2MI) were available for the analyses. The median age of the study population was 65 years and 66.7% were males. Hypertension was present in 77.4% and dyslipidemia in 41.3%. In the multivariable model four biomarkers (apolipoprotein A-II, n-terminal prohormone of brain natriuretic peptide, copeptin and high-sensitivity troponin I) were significant discriminators between T1MI and T2MI (Table 1). Internal validation of the model via bootstrap shows a for overoptimism corrected area under the curve of 0.82.

Conclusion
Using a multibiomarker approach discrimination between T1MI and T2MI could be improved. External validation of our findings is warranted.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research fellowship by the Deutsche Forschungsgemeinschaft
Changes in gut microbiota are associated with coronary angiographic severity and prognosis in patients with acute coronary syndrome
Authors: Gao J , Wang J , Zhao L.L , Li C.P , Cui Z , Ma J , Zhang X , Liu Y 
Published: November 2020

Abstract

Background
1. Studies have found that gut microbiota is a new participant and potential therapeutic target for CVD and even MI.
2. No clinical study to date, however, has investigated whether the changes of gut microbiota associated with coronary lesion degree and prognosis in patients with acute coronary syndrome (ACS).

Aim
We prospectively investigated associations, of gut microbiota in their feces and coronary lesion degree, and long-term prognosis of patients with ACS.

Methods
1. In prospective cohort study, a total 502 subjects including 402 ACS patients and 100 controls. Fecal specimens were used to extract bacterial genomic DNA
2. 16S rDNA sequence of bacteria were generated to analyse specific gut microbial taxa associated with ACS onset for 60 ACS patients and 30 healthy controls.
3. Specific primers were designed according to the 16S rDNA sequence of bacteria for real time PCR reaction to determine the number of different bacteria.
4. All ACS patients calculated SYNTAX score by coronary radiography results and followed up for one year. The correlation of gut microbiota with coronary angiographic severity and prognosis in the ACS patients was analyzed.

Results
1. Compared with the control group,the number of bacteria in Escherichia coli, Streptococcus and Enterobacteriaceae increased significantly (P&lt;0.05) and Lactobacillus decreased significantly (P&lt;0.05) in patients with ACS.
2. Lactobacillus were independent predictors of coronary angiographic severity in patients with ACS (HR=0.953; 95% CI: 0.935–0.970, P&lt;0.001).
3. Decreased Lactobacillus levels were independent protection factors with all-cause death (HR=0.954; 95% CI: 0.913–0.997, P=0.038) and risk of major adverse cardiac events (HR=0.952; 95% CI: 0.929–0.976, P&lt;0.001),especially for heart failure in long-term prognosis(HR=0.960; 95% CI: 0.932–0.989, P=0.007).

Conclusion
1. Number of Lactobacillus are significantly decreased in patients with ACS,and associated with SYNTAX score,suggesting that Lactobacillus is associated with severity of coronary artery disease, all-cause death and MACE.
2. It provides new ideas for the prevention and treatment of ACS.
Real time PCR

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
One-year outcome of the rule-out group according to the 0-h /1-hour algorithm with suspected myocardial infarction in Asian countries
Authors: Shiozaki M , Inoue K , Suwa S , Lee C.C , Chiang S.J , Fukuda K , Hiki M , Kubota N , Tamura H , Fujiwara Y , Miyazaki T , Hirano Y , Sumiyoshi M 
Published: November 2020

Abstract

Background/Introduction; A rapid rule-out or rule-in protocol based on the 0-h/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC). Around 40–50% were stratified into “rule-out” group, and their 30-days prognosis was excellent. However, the one-year prognosis is uncertain. We aimed to better characterize these patients.

Methods
This study was a prospective, multi-center, observational study of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS) admitted to 5 hospitals in Japan and Taiwan from 2014 November to 2018 December, respectively.
All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, standard blood test, chest radiography. Exclusion criteria were ST elevated myocardial infarction, chronic kidney disease (serum creatinine more than 3 mg/dL) and congestive heart failure, arrhythmia, or infection disease. The patients were divided into three groups according to the algorithm; “rule-out”, “observe” and “rule-in”. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction. After hospital discharge patients were follow after one-year b telephone or in written form. Major adverse cardiovascular events (including death myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention (PCI)) were recorded by establishing contact with the patient and the family physicians. The primary prognosis end point was all-cause mortality.

Results
Of the 1,187 patients were analyzed after exclusion. The prevalence rate of AMI was 16.1%. According to the algorithm, 42% (n=493) of patients were assigned to “rule-out” group and had no AMI nor death. The most common final adjudicated diagnoses were atypical chest pain (80%), gallstone attack (3%) and vasospastic angina pectoris (2%). All patients with unstable angina (4.7%) underwent PCI.

Conclusion(s)
Our findings suggest that the “rule-out” group patients according to ESC 0-h/1-hour algorithm provides very high safety and efficacy for the triage toward AMI.

Funding Acknowledgement
Type of funding source: None
High-sensitivity cardiac troponin concentrations at presentation in patients with ST-segment elevation myocardial infarction
Authors: Wereski R , Lee K.K , Smith S , Chapman A.R , Lowe D , Gray A , Mills N.L 
Published: November 2020

Abstract

Background
The widespread adoption of high-sensitivity cardiac troponin testing has encouraged the use of pathways to accelerate the rule-out and rule-in myocardial infarction in the Emergency Department. These pathways are not recommended for patients with ST-segment elevation, but there is a risk they may be applied incorrectly given that interpretation of the electrocardiogram is subjective, dependent on experience, and signs may be masked in those with posterior myocardial infarction.

Methods
Consecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge cluster randomized controlled trial across ten hospitals in Scotland. The index diagnosis was adjudicated two clinicians independently in all patients with high-sensitivity cardiac troponin I concentrations above the sex-specific 99th centile on serial testing and abnormalities on the electrocardiogram recorded. The proportion of patients with ST-segment elevation myocardial infarction and concentrations below the rule-out threshold (&lt;5 ng/L), 99th centile (&lt;16 ng/L and &lt;34 ng/L for women and men) and rule-in threshold (&lt;52 ng/L) at presentation were determined.

Results
In total 48,282 patients were recruited between June 2013, and March 2016 of which 22% (10,360/48,282) had peak cardiac troponin concentrations above the 99th centile. The adjudicated diagnosis was type 1 myocardial infarction in 55% (4,981/9,115) of patients and 10% (925/9,115) had ST-segment elevation myocardial infarction (age 65 [14] years, 68% men). The majority presented within 6 hours of symptom onset (67%, 619/925), and 84% (772/925) had cardiac troponin concentrations above the 99th centile at presentation. However, troponin concentrations were below the rule-out threshold in 2% (20/925) and the rule-in threshold in 26% (240/925) of patients with ST-segment elevation myocardial infarction.

Discussion
In patients with suspected acute coronary syndrome who have a final diagnosis of ST-segment elevation myocardial infarction, high-sensitivity cardiac troponin concentrations are below the rule-out and rule-in threshold at presentation in 1 in 50 and 1 in 4 patients, respectively. Clinicians should not rely on cardiac troponin concentrations to guide initial treatment decisions in patients with possible ST-segment elevation myocardial infarction.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Prospective validation of 0-hour/1-hour algorithm using high-sensitivity cardiac troponin I in Japanese patients presenting to emergency department
Authors: Ohtake H , Ishii J , Nishimura H , Kawai H , Muramatsu T , Harada M , Motoyama S , Watanabe E , Ozaki Y , Iwata M 
Published: November 2020

Abstract

Background
The diagnostic performance of 0-hour/1-hour algorithm using high-sensitivity cardiac troponin I (hsTnI) for non-ST-segment elevation myocardial infarction (NSTEMI) has not been evaluated in an Asian population.

Purpose
We aimed to prospectively validate the 0-hour/1-hour algorithm using hsTnI in a Japanese population.

Method
We enrolled 754 Japanese patients (mean age of 70 years, 395 men) presenting to our emergency department with symptoms suggestive of NSTEMI. The hsTnI concentration was measured using the Siemens ADVIA Centaur hsTnI assay at presentation and after 1 hour. Patients were divided into three groups according to the algorithm: hsTnI below 3 ng/L (only applicable if chest pain onset &gt;3 hours) or below 6 ng/L and delta 1 hour below 3 ng/L were the “rule-out” group; hsTnI at least 120 ng/L or delta 1 hour at least 12 ng/L were in the “rule-in” group; the remaining patients were classified as the “observe” group. Based on the Fourth Universal Definition of Myocardial Infarction, the final diagnosis was adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, and follow-up data. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 hour.

Results
Prevalence of NSTEMI was 6.5%. The safety of rule-out (NPV 100%), accuracy of rule-in (PPV 26%), and overall efficacy (54%) were shown in Figure.

Conclusion
The 0-hour/1-hour algorithm using hsTnI is very safe and effective in triaging Japanese patients with suspected NSTEMI.

Funding Acknowledgement
Type of funding source: None
Infarct size following loading with ticagrelor/prasugrel versus clopidogrel in ST-segment elevation myocardial infarction
Authors: Sabbah M , Nepper-Christensen L , Koeber L , Eik Hoefsten D , Aleksov Ahtarovski K , Goeransson C , Kyhl K , Ali Ghotbi A , Malby Schoos M , Sadjadieh G , Kelbaek H , Loenborg J , Engstroem T 
Published: November 2020

Abstract

Background
Treatment with newer direct-acting anti-platelet drugs (Ticagrelor and Prasugrel) prior to primary percutaneous coronary intervention (PCI) is associated with improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) when compared with Clopidogrel.

Purpose
We retrospectively compared infarct size following non-randomized treatment with
Ticagrelor/Prasugrel versus Clopidogrel in a population of STEMI patients treated with primary PCI.

Methods
Patients were loaded with Clopidogrel, Ticagrelor or Prasugrel in the ambulance before primary PCI. Infarct size and myocardial salvage index were calculated using cardiac magnetic resonance (CMR) during index admission and at three-month follow-up.

Results
693 patients were included in this analysis. Clopidogrel was given to 351 patients and Ticagrelor/Prasugrel to 342 patients. The groups were generally comparable in terms of baseline and procedural characteristics. Median infarct size at three-month follow-up was 12.9% vs 10.0%, in patients treated with Clopidogrel and Ticagrelor/ Prasugrel respectively (p&lt;0.001), and myocardial salvage index was 66% vs 71% (p&lt;0.001). Results remained significant in a multiple regression model (p&lt;0.001).

Conclusion
Pre-hospital loading with Ticagrelor or Prasugrel compared to Clopidogrel, was associated with smaller infarct size and larger myocardial salvage index at three-month follow-up in patients with STEMI treated with primary PCI.
Infarct size at three month follow-up

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Novo Nordisk Foundation. The Alfred Benzon Foundatioun.
Clinical outcomes and prognostic factors in very elderly women with ACS treated with successful PCI
Authors: Zhao S.M , Wang J , Chen H , Zhao H.Q , Zhao X.Q , Li H.W 
Published: November 2020

Abstract

Background
Whether elderly women over 80 years old with acute coronary syndrome (ACS) should actively receive PCI treatment is still controversial.

Purpose
We assessed the effectiveness and long-term clinical outcomes of PCI in very elderly women patients, and detected predictive factors which contributed to the major adverse cardiovascular and cerebrovascular events (MACCE).

Methods
Female ACS patients aged ≥80 years were continuously enrolled from the hospital database bank (n=729, a mean age of 83.6±3.1 years). All patients were followed up for MACCE: non-fatal MI, stroke, heart failure (HF) re-hospitalization, cardiovascular (CV) death, and the composite of them. Before and after Propensity Score (PS) Matching (1:1), the incidences of MACCE were compared between female PCI group (n=232) and medical group (n=497). Clinical and coronary artery characteristics were analyzed in PCI treatment patients with (n=56) and without MACCE (n=176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in female PCI patients.

Results
A total of 31.8% women (n=232) received PCI treatment in the retrospective study.Compared to medical group, PCI treatment significantly reduced the incidences of non-fatal MI (6.2%, 20.2%, p&lt;0.001), HF re-hospitalization (10.9%, 22.5%, p=0.012), CV death (12.4%, 28.7%, p&lt;0.001) and the composite MACCE (24.0%, 44.2%, p&lt;0.001) after PS matching (129 patients in PCI group vs 129 patients in medical group)during a follow-up period of 36 (23, 48) months. Meanwhile, there were no significant differences in composite MACCE (24.1% vs 19.7%, p=0.232) and CV death (10.8% vs 10.6%, p=0.951) between very elderly women and men (≥80 years old) treated with PCI during the same period. Multivariate Cox analysis revealed that STEMI (HR 1.944, 95% CI 1.11–3.403, p=0.02) and elevated NT-proBNP (HR 1.689, 95% CI 1.029–2.733, p=0.038) were independently associated with the incidence of composite MACCE, as well as adherence to P2Y12 receptor antagonist (HR 0.119, 95% CI 0.051–0.278, p&lt;0.001) and β-blocker (HR 0.452, 95% CI 0.254–0.805, p=0.007) medications may help to attenuate the risk of MACCE within elderly women treated with PCI.

Conclusion
In very elderly women with ACS, PCI treatment significantly decreased the risks of MACCE and improves the long-term clinical outcomes.STEMI and elevated NT-proBNP value were independently associated with the increase of the composite MACCE after PCI in this population.

Funding Acknowledgement
Type of funding source: None
The clinical and pathological features of intraplaque hemorrhage in coronary artery -insights from Japan DCA registry-
Authors: Nakamura N , Torii S , Ijichi T , Jujo K , Hara M , Ikari Y , Nakazawa G 
Published: November 2020

Abstract

Introduction
Intraplaque hemorrhage (IPH) is known to play an important role in plaque vulnerability in coronary artery. However, the biological reaction in IPH and clinical features of patients with IPH remain unknown, since most histological studies of IPH in coronary artery were performed on autopsy cases. Directional coronary atherectomy (DCA) enables the direct pathological evaluation of collected tissue from “living” patients.

Purpose
We aimed to clarify the clinical presentations and histopathologic features of IPH using specimens obtained by DCA.

Method
This multicentral prospective observational study included consecutive patients who underwent percutaneous coronary intervention for de novo lesions using DCA from June 2015 to February 2018. Histopathological sections that were collected from coronary plaques by DCA were evaluated and classified by the presence of IPH. IPH in DCA specimens was defined as clusters of hemosiderin (Figure A, arrows), erythrocytes (Figure B, arrow heads) and fibrin (Figure C, arrows) within the coronary plaque. A total of 154 de novo lesions from 154 patients were ultimately analyzed, and were divided into IPH group (n=37) and non-IPH group (n=117).

Result
Clinical profiles of patients in the two groups were comparable, except that unstable angina rather than chronic coronary syndrome was significantly more prevalent in the IPH group (32.4% vs. 16.2%, P=0.04). Histopathological analysis showed a significantly higher incidence of cellular-rich plaque (46.0% vs. 25.6%, P=0.02) and spindle-shaped cells (18.9% vs. 6.0%, P=0.02), which indicate active cell proliferations, in the IPH group. The prevalence of necrotic core was also higher in IPH group compared to non-IPH group (48.7% vs. 13.7%, P&lt;0.01).

Conclusion
Pathohistological analysis revealed that coronary plaques with IPH had an active cell proliferation, and patients with IPH likely to had clinical presentations of unstable angina.
Figure 1

Funding Acknowledgement
Type of funding source: None