bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of the ESC 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis
Authors: Chiang C , Chiang C.H , Lee G.H , Lee C.C 
Published: November 2020

Abstract

Background
The European Society of Cardiology (ESC) 0/1-hour algorithm has been recommended for early rule-out and rule-in of non ST-segment elevation acute coronary syndromes. This algorithm has primarily been validated in Europe, America, and Australasia, with less knowledge of its performance outside of these settings.

Purpose
We aim to conduct a systematic review and meta-analysis to evaluate the performance of the ESC 0/1-hour algorithm across different contexts.

Methods
We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for relevant studies published between 1 January 2008 and 31 May 2019. The primary outcome was index myocardial infarction and the secondary outcome was major adverse cardiac event or mortality. A bivariate random-effects meta-analysis was used to derive the pooled estimate of each outcome.

Results
A total of 11,014 patients from 10 cohorts were included in this meta-analysis. The algorithm based on hs-cTnT (Roche), hs-cTnI (Abbott), and hs-cTnI (Siemens) had pooled sensitivity of 98.4% [95% CI=95.1%-99.5%], 98.1% [95% CI=94.6%-99.3%], and 98.7% [95% CI=97.3%-99.3%], respectively. The algorithm based on hs-cTnT (Roche) and hs-cTnI (Siemens) had pooled specificity of 91.2% [95% CI=86.0%-94.6%] and 95.9% [95% CI=94.1%-97.2%], respectively. Among patients in the rule-out category, the pooled mortality rate at 30 days and at 1 year was 0.1% [95% CI=0.0%-0.4%] and 0.8% [95% CI=0.5%-1.2%], respectively. Among patients in the observation zone, the pooled mortality rate was 0.7% [95% CI=0.3%-1.2%] at 30-days but increased to 8.1% [95% CI=6.1%-10.4%] at 1-year, comparable to the mortality rate in the rule-in group.

Conclusion
Our results support the use of the 0/1-hour algorithm to triage patients with suspected non-ST segment elevation acute coronary syndromes. However, the algorithm may not be sufficiently safe if the 1% miss-rate for myocardial infarction is desired. Patients in the observation zone have a poor prognosis and management strategies for these patients are urgently needed.
Performance of the 0/1-hour algorithm

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Ministry of Science and Technology, R.O.C
Distribution of high sensitivity troponin taken without conventional clinical indications in critical care patients and its association with mortality
Authors: Hinton J , Augustine M , Gabara L , Mariathas M , Allan R , Borca F , Nicholas Z , Beecham R , Kwok S , Cook P , Grocott M.P.W , Mamas M.A , Curzen N 
Published: November 2020

Abstract

Background
High sensitivity troponin (hs-cTn) concentrations above the manufacturer's upper limit of normal (ULN) are frequently seen outside the context of MI, particularly in critical care units. The current evidence regarding the prognostic value of hs-cTn in critical care settings is discrepant.

Purpose
To describe the distribution of hs-cTn in a consecutive cohort of patients in critical care units, regardless of whether there is a conventional clinical indication, and the association of this distribution with clinical outcomes.

Methods
Consecutive patients admitted to three adult critical care units (cardiothoracic (CCU), general (GCU), neuroscience (NCU)) over a six month period had hs-cTnI tests performed serially throughout the admission, regardless of whether the supervising team felt there was a clinical indication. The results were nested and not revealed to patients or clinicians unless they were requested as part of routine care. The hs-cTnI results were correlated with parameters of clinical outcome.

Results
After excluding those diagnosed with a type 1 MI, there were 1,563 patients remaining in the study cohort (CCU 530, GCU 750, NCU 283). The median hs-cTnI was 77ng/L (IQR 11–1932ng/L, with 1081 (69.2%) patients above the manufacturer-provided ULN. Overall there was a bimodal distribution; GCU and NCU were positively skewed and CCU negatively skewed. Hs-cTnI concentrations above the ULN were associated with age, comorbidity, illness severity and need for organ support (table 1). The degree by which the hs-cTnI concentration was above the ULN remained an independent predictor of critical care mortality (figure 1) in NCU and GCU.

Conclusion
Hs-cTnI elevation taken outside the context of conventional clinical indications is common in the critically ill and is associated with age, comorbidity and illness severity. Admission hs-cTnI is an independent predictor of mortality and provides additional discriminative ability to the APACHE II score alone. This assay may represent a novel prognostic biomarker on admission in non-CCU critical care settings.
Mortality relative to ULN

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Beckman Coulter
Interleukin-1Beta and risk of premature death and MACE in patients with myocardial infarction
Authors: Silvain J , Kerneis M , Zeitouni M , Lattuca B , Mertens E , Procopi N , Suc G , Salloum T , Frisdal E , Le Goff W , Collet J.P , Vicaut E , Lesnik P , Montalescot G , Guerrin M 
Published: November 2020

Abstract

Background
Inhibition of the interleukin-1β (IL-1β) innate immunity pathway is associated with anti-inflammatory effects and a reduced risk of recurrent cardiovascular events in stable patients with previous myocardial infarction (MI) and elevated high sensitivity C-reactive protein (hs-CRP). However, the prognosis value of IL-1β level in acute myocardial infarction patients has never been evaluated. We aim to assess the association between IL-1β level with all-cause mortality in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention and the interplay between IL-1β and hs-CRP concentrations on the risk of premature death.

Methods
IL-1β concentration was measured among 1398 STEMI patients enrolled in a prospective cohort study. Crude and hazard ratios for all-cause and cardiovascular mortality were analyzed at 90-days and one-year using a multivariate-cox proportional regression analysis. Major cardiovascular events (MACE) were also analyzed.

Results
In a STEMI population, IL-1β concentration measured at admission was independently associated with all-cause mortality at 90 days (adjusted hazard ratio [adjHR], 1.43 per 1SD increase; 95% CI, 1.12 to 1.83; p&lt;0.005). The relation was nonlinear, and we identified a threshold of IL-1β &gt;10 pg/mL that was markedly associated with higher mortality rates at 90 days (adjHR: 2.80; 95% CI: 1.63–4.80, p=0.0002) and one-year (adjHR: 1.75; 95% CI: 1.09–2.78, p=0.019), regardless of the hs-CRP concentration. The relationship was even stronger when considering cardiovascular mortality and MACE at 90 days (adjHR: 2.31; 95% CI: 1.30–4.10, p=0.004 and 2.17; 95% CI: 1.24–3.80, p=0.006) and at one year (adjHR: 2.26; 95% CI: 1.31–3.87, p=0.03 and 2.25; 95% CI: 1.33–3.79, p=0.004).

Conclusion
IL-1β measured at admission in acute MI patients is associated with the risk of mortality and recurrent major cardiovascular events, regardless of the CRP level. A threshold of 10 pg/mL identifies patients at higher risk of events.
Survival

Funding Acknowledgement
Type of funding source: None
Modified HEART score, utilising a single high-sensitive troponin sample, allows early, safe discharge of suspected acute coronary syndrome: a prospective multicentre cohort study of 3016 patients
Authors: Khand A , Obeidat M , Campbell M , Batouskaya K , Mullen L , Fisher M , Neoh K , Johnson C , Chew P.G , Carlton E , Backus B 
Published: November 2020

Abstract

Background
Combining HSTnT (high sensitive troponin T) values at low levels with composite risk scores may improve early safe, discharge in suspected acute coronary syndromes (ACS). We tested this hypothesis by a prospective study of 3016 consecutive patients with suspected ACS in 2 large hospitals.

Methods
Consecutive chest pain (CP) presentations with HSTnT sampled and ECG undertaken at presentation were prospectively defined in 2 time periods (2011-12, n=1642 [derivation] 2018, n=1376 [validation]).
The HstnT input was modified: dichotomous HSTnT input was lowered to &lt;5 (limit of detection, LOD) or ≥5ng/l (mod TIMI and GRACE), HEART score was re-calibrated (&lt;5 = 0 [LOD], ≥5–14 = 1, &gt;14 = 2 [99th percentile]). All biomarker positive CP index and re-admissions to any regional hospital (catchment population 2.6 million) were independently adjudicated for MI by 2 experienced physicians. Primary outcome was MACE (adjudicated type 1 MI, unplanned coronary revascularisation and all cause death) at 6 weeks.

Results
In the 2 cohorts demographic factors were similar: median age 59 and 56, male 52% and 52%, previous MI 20% and 14% for 2011-12 and 2018 respectively. At 6 weeks 180 (11%) and 75 (5.4%) suffered type 1 MI and 211 (12.9%) and 92 (6.7%) patients suffered MACE in the 2011-12 and 2018 cohorts respectively.
Only Mod HEART ≤3 and undetectable HSTnT, with a nonischaemic ECG, achieved prespecified NPV of &gt;99.5% in both derivation and validation cohorts (table). However Modified HEART ≤3 score could discharge approximately 12% more patients as compared to undetectable HSTnT strategy.

Conclusion
Modified HEART score ≤3, with the use of a single HSTnT, appears the optimum early discharge strategy for suspected ACS

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Liverpool university Hospitals, North-West Educational Cardiac Group
The relationship between residual cholesterol risk and plaque characteristics in patients with acute coronary syndrome evaluated by optical coherence tomography
Authors: Gao Y.N , Liu W , Zhou Y.J , Wu S.J 
Published: November 2020

Abstract

Background
It has been demonstrated that high sensitive-C reactive protein (hs-CRP) and low density lipoprotein cholesterol (LDL-C) are independently associated with major adverse cardiovascular events (MACEs). Whether the level of LDL has impact on plaque characteristics in acute coronary syndrome (ACS) patients with normal hs-CRP are still unknown.

Methods
We retrospectively enrolled ACS patients with the level of hs-CRP&lt;2mg/L on admission from 1st January, 2017 to 31st December,2017, from our hospital. All patients underwent pre-intervention optical coherence tomography (OCT) to evaluate the plaque characteristics. Residual cholesterol risk (RCR) was defined as LDL-C≥1.8mmol/L, while hs-CRP&lt;2mg/L. According to the level of baseline LDL-C, patients were divided into RCR group and non-RCR group.

Results
A total of 90 patients (94 vessels) were included, with 50 patients in RCR group and 40 patients in non-RCR group. Compared with non-RCR group, patients in RCR group had higher levels of total cholesterol (4.39±0.89 vs 3.05±0.48, p=0.000), LDL-C (2.56±0.57 vs 1.54±0.22, p=0.000), triglycerides (1.11±1.12 vs 1.02±0.74, p=0.003). Patients in RCR group were younger (54.0±11.04 vs 58.4±9.59, p=0.049) and had higher rate of multivessel disease (6.0% vs 2.5%, p=0.028) than those in non-RCR group. With regard to plaque characteristics, fibrous plaque (0.0% vs 12.5%, p=0.003) was less seen and atherosclerotic plaque (79.6% vs 50.0%, p=0.028) was more seen in RCR group. In addition, patients in RCR group had significantly higher rate of plaque rupture than that in non-RCR group (24.1% vs 5%, p=0.008). To be noticed, cholesterol crystal and thin-cap fibroatheroma (TCFA) were more commonly in RCR group, though the difference was not statistical.

Conclusion
Patients with RCR have a great extent of plaque rupture, indicating more vulnerable plaque phenotype.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): China Youth Clinical Research Foundation-VG Foundation
Deferred versus performed revascularisation according to hyperaemic and nonhyperaemic physiological indexes in acute coronary syndrome: insights from the IRIS-FFR Registry
Authors: Ahn S.G , Yoon Y.H , Lee J.W , Youn Y.J , Lee S.H , Yoon J , Kim S.E , Lee S.J , Park D.W , Ahn J.M 
Published: November 2020

Abstract

Background/Introduction
Physiology-guided PCI in the ACS setting remains debatable.

Purpose
We aimed to determine the long-term prognostic utility of fractional flow reserve (FFR)- or resting distal coronary pressure to aortic pressure ratio (Pd/Pa)-directed percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) cases.

Methods
This study included 11,415 coronary stenoses in 7945 patients, including 1668 ACS cases who underwent FFR and resting Pd/Pa. The primary endpoint was the rate of a composite of cardiac death, spontaneous myocardial infarction (MI), and repeat revascularisation.

Results
During a median follow-up of 3.9 years (IQR: 2.0–4.9), 108 events (12 cardiac deaths, 9 MIs, and 100 revascularisations) of the primary endpoint occurred in 101 patients. In the deferred lesions with FFR &gt;0.80 or Pd/Pa &gt;0.91, the primary endpoint rate was higher in ACS patients than those with stable ischaemic heart disease (SIHD) (adjusted HR 1.87, 95% CI 1.37–2.55 for FFR; adjusted HR 1.78, 95% CI 1.34–2.38 for Pd/Pa). Among ACS patients with FFR ≤0.8 or Pd/Pa ≤0.91, performed revascularisation was associated with a lower rate of the primary endpoint compared to deferred PCI. (6.0% vs. 15.4%, adjusted HR 0.42, 95% CI 0.23–0.77 for FFR; 4.3% vs. 14%, adjusted HR 0.33–0.71, 95% CI 0.33–0.71 for Pd/Pa). However, performed and deferred groups had similar outcome rates in ACS patients with FFR &gt;0.80 or Pd/Pa &gt;0.91.

Conclusion
ACS patients who deferred revascularisation based on physiology had higher cardiovascular events than did those with SIHD. FFR- and resting Pd/Pa-directed decision-making for PCI is likely useful even in the ACS setting.

Funding Acknowledgement
Type of funding source: None
Onyx ONE: outcomes in patients with acute coronary syndrome
Authors: Kedhi E.K , Windecker S.W , Latib A , Kandzari D , Kirtane A , Mehran R , Price M.J , Parke M , Lung T , Abizaid A , Simon D.I , Worthley S , Zaman A , Stone G.W 
Published: November 2020

Abstract

Background/Introduction
The Onyx ONE Global Study (Onyx ONE), a randomized, single-blind, international trial, demonstrated non-inferiority of a zotarolimus-eluting stent (ZES) to a polymer-free drug-coated stent (DCS) in high-bleeding risk patients treated with 1-month dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT). More than half of the Onyx ONE patients presented with an acute coronary syndrome (ACS). The safety and effectiveness of ZES and DCS in ACS patients treated with SAPT after 30 days remains unknown.

Purpose
To evaluate the safety and effectiveness outcomes for ZES and DCS in Onyx ONE patients presenting with ACS.

Methods
The primary outcome of the trial was a composite of cardiac death, myocardial infarction, or stent thrombosis at 1 year. To align with the time that DAPT is interrupted, we also evaluated the primary endpoint between the 2 stent groups in a landmark analysis between 30 days and 1 year. All analyses were performed in ACS patients (includes unstable angina, non ST-elevation myocardial infarction and ST-elevation myocardial infarction).

Results
Among the 1996 patients randomized in Onyx ONE, 982/1902 (51.6%) presented with ACS, of which 511/982 (52.0%) and 471/982 (48.0%) were treated with ZES and DCS respectively. In a pre-defined subgroup analysis in ACS patients, the event rates between the two stent groups regarding the primary outcome at one year were similar (18.5% ZES; 20.8% DCS; HR: 0.91; 95% CI [0.68, 1.22]; p=0.523). In the landmark analysis beyond day 30, the primary outcome rate tended to be lower among those treated with the ZES (8.4%) compared with the DCS (12.1%) [HR: 0.66 (95% CI: 0.43, 1.01), p=0.055] (Figure). This was primarily driven by lower rates of myocardial infarction with ZES (6.5% ZES; 10.2% DCS; [HR: 0.58 (95% CI: 0.36, 0.93); p=0.025], while other components were similar: cardiac death, 2.6% ZES vs. 2.8% DCS [HR: 1.00 (95% CI: 0.44, 2.27); p&gt;0.99) and stent thrombosis, 1.4% ZES vs. 1.4% DCS [HR: 0.93 (95% CI: 0.27, 3.21); p=0.91].

Conclusions
In Onyx ONE, high-bleeding risk patients presenting with ACS had similar safety and efficacy at 1 year in both the ZES and DCS stent groups. However, a trend was present for greater safety with the ZES with SAPT treatment beyond 30 days driven by lower myocardial infarction rates in that time period thus warranting additional confirmatory studies.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic sponsored the Onyx ONE Global Study
Baby steps in the path of modifying the role of cardiologists for interpreting EKG for AMI
Authors: Mehta S , Niklitschek S , Fernandez F , Villagran C , Avila J , Cardenas G , Rocuant R , Vera F , Frauenfelder A , Vieira D , Quintero S , Coutelle N , Bou Daher D , Vijayan Y , Luna M 
Published: November 2020

Abstract

Background
EKG interpretation is slowly transitioning to a physician-free, Artificial Intelligence (AI)-driven endeavor. Our continued efforts to innovate follow a carefully laid stepwise approach, as follows: 1) Create an AI algorithm that accurately identifies STEMI against non-STEMI using a 12-lead EKG; 2) Challenging said algorithm by including different EKG diagnosis to the previous experiment, and now 3) To further validate the accuracy and reliability of our algorithm while also improving performance in a prehospital and hospital settings.

Purpose
To provide an accurate, reliable, and cost-effective tool for STEMI detection with the potential to redirect human resources into other clinically relevant tasks and save the need for human resources.

Methods
Database: EKG records obtained from Latin America Telemedicine Infarct Network (Mexico, Colombia, Argentina, and Brazil) from April 2014 to December 2019. Dataset: A total of 11,567 12-lead EKG records of 10-seconds length with sampling frequency of 500 [Hz], including the following balanced classes: unconfirmed and angiographically confirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal and abnormal (200+ CPT codes, excluding the ones included in other classes). The label of each record was manually checked by cardiologists to ensure precision (Ground truth). Pre-processing: The first and last 250 samples were discarded as they may contain a standardization pulse. An order 5 digital low pass filter with a 35 Hz cut-off was applied. For each record, the mean was subtracted to each individual lead. Classification: The determined classes were STEMI (STEMI in different locations of the myocardium – anterior, inferior and lateral); Not-STEMI (A combination of randomly sampled normal, branch blocks, non-specific ST-T abnormalities and abnormal records – 25% of each subclass). Training & Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10; respectively. The last dense layer outputs a probability for each record of being STEMI or Not-STEMI. Additional testing was performed with a subset of the original dataset of angiographically confirmed STEMI.

Results
See Figure Attached – Preliminary STEMI Dataset Accuracy: 96.4%; Sensitivity: 95.3%; Specificity: 97.4% – Confirmed STEMI Dataset: Accuracy: 97.6%; Sensitivity: 98.1%; Specificity: 97.2%.

Conclusions
Our results remain consistent with our previous experience. By further increasing the amount and complexity of the data, the performance of the model improves. Future implementations of this technology in clinical settings look promising, not only in performing swift screening and diagnostic steps but also partaking in complex STEMI management triage.

Funding Acknowledgement
Type of funding source: None
Early overexpression of miR-499 in non-ST elevation acute coronary syndromes predicts long-term risk of major adverse cardiac events
Authors: Miskowiec D , Kupczynska K , Simiera M , Michalski B , Filipiak-Strzecka D , Wejner-Mik P , Wierzbowska-Drabik K , Szymczyk E , Lipiec P , Kasprzak J.D 
Published: November 2020

Abstract

Background
Some studies reported utility of microRNAs in myocardial infarction diagnostic process, whereas their prognostic remains unclear.

Aim
To evaluate the prognostic value of five circulating miRs (miR-1, miR-21, miR-133a, miR-208, miR-499) levels for predicting major adverse cardiac events (MACE), including death, nonfatal myocardial infarction (MI) or cardiovascular rehospitalization (reh.) in patients with NSTE-ACS.

Material and methods
In our prospective, single-center observational study we recruited patients (pts) with NSTE-ACS with symptoms onset &lt;24 hours before the hospital admission and age, gender-matched patients with stable coronary artery disease (SCAD) as controls. Blood was sampled twice (at admission and 4h after in NSTE-ACS and once in SCAD). Relative expression of miRs were calculated using the ΔΔCt method after normalization to the cel-miR-39 spiked-in control. The mean value of miRs relative expression from two time samples in NSTE-ACS pts were used for further analysis. Subjects were categorized according to mean miRs expression at hospital admission into two group (≤ or &gt; median level of miRs).

Results
103 NSTE-ACS pts (median age 67 years, 68% male) were included in this study. During median 1569 (IQR 935–1842) days of follow-up the primary endpoint (MACE) occurred in 66 (64.1%) pts: 18 pts (18.7%) died, 30 pts (20%) presented with MI and 85 pts (56.7%) were readmitted. In a Cox proportional-hazards regression model miR-499 expression &gt; median level (HR=1.82, 95% CI 1.07–3.09) and high-sensitivity troponin T level (HR=1.24, 95% CI 1.05–1.46) were independent predictors of MACE in long term observation, even after adjustment for other covariates (including other miRNAs). Incidence of MI [34% vs 10%, HR=4.1 (2.0–8.5)], rehospitalization for cardiovascular reasons [67% vs 49%, HR=2.1 (1.3–3.3)] and MACE [76% vs 55%, HR=2.2 (1.5–3.5)] was significantly higher in pts with elevated (&gt; median) miR-499 levels at hospital admission. None of analyzed miRNAs was related to long-term mortality, whereas the left ventricular ejection fraction (EF) has been identified as the only one survival predictor (HR=0.95, 95% CI 0.92–0.98).

Conclusions
Elevated miR-499 levels independently of high sensitivity troponin T levels in early phase of NSTE-ACS are related to increased rate of MACE in 4-year follow-up.
Figure 1. miR499 and MACE

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the Polish Ministry of Science and Higher Education “Diamond Grant” program.