bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3613J-shaped relationship between cardiac mortality risk and admission systolic blood pressure in patients aged 65 years and over with acute coronary syndrome
Authors: Jiang C Y , Li H W 
Published: October 2019

Abstract

Objective
To observe the effects of different admission systolic blood pressure (SBP) levels on the in-hospital and long-term prognosis of elderly patients with acute coronary syndrome (ACS).

Methods
This retrospective cohort study included 5812 ACS patients aged 65 and over admitted from January, 2013 to September, 2018. Their blood pressure, medical history and laboratory examinations were recorded. The patients were divided into 5 groups according to the level of admission SBP (<100, 100–119, 120–139, 140–159, and ≥160 mmHg). The main endpoint of this study was cardiac death and all-cause death in hospital and during 6-year follow-up.

Results
Among the participants, the number of patients admitted with SBP <100, 100–119, 120–139, 140–159, and ≥160 mmHg were 143 (2.5%), 1014 (17.4%), 2456 (42.3%), 1607 (27.6%), and 592 (10.2%), respectively. The highest in-hospital cardiac mortality and all-cause mortality rate were found in the group with admission SBP <100 mmHg and the lowest were found in the group with SBP 140–159 mmHg (9.1% vs. 3.2% vs. 1.1% vs. 0.8% vs. 1.5%, P=0.000; 9.8% vs. 3.4% vs. 1.1% vs. 0.8% vs. 1.7%, P=0.000). Kaplan-Meier curve showed that patients with SBP 120–139 mmHg at admission had better prognosis (cardiac mortality: 3.9% vs. 10.9%, 5.6%, 5.1%, and 6.7% respectively, P=0.000; all-cause mortality: 7.6% vs. 14.7%, 9.7%, 9.1%, and 11.0%, respectively, P=0.000). Multivariate analysis showed that admission SBP <120 mmHg or ≥160 mmHg was a independent predictors of follow-up cardiac death (HR 1.747, 95% CI 1.066–2.861, P=0.027; HR 1.496, 95% CI 1.092–2.050, P=0.012; HR 1.630, 95% CI 1.120–2.372, P=0.011) compared with patients admitted with SBP 120–139 mmHg.
In-hospital and 6-year follow-up outcomes of ACS patients ≥65y by admission SBP Admission SBP Level <100mmHg ≥100mmHg and <120mmHg ≥120mmHg and <140mmHg ≥140mmHg and <160mmHg ≥160mmHg P In-hospital (n=143) (n=1014) (n=2456) (n=1607) (n=592)   Cardiac mortality, n (%) 13 (9.1) 32 (3.2) 28 (1.1) 13 (0.8) 9 (1.5) 0.000   All-cause mortality, n (%) 14 (9.8) 34 (3.4) 28 (1.1) 13 (0.8) 10 (1.7) 0.000 Follow-up (n=129) (n=980) (n=2428) (n=1594) (n=582)   Cardiac mortality, n (%) 14 (10.9) 55 (5.6) 94 (3.9) 81 (5.1) 39 (6.7) 0.000   All-cause mortality, n (%) 19 (14.7) 95 (9.7) 185 (7.6) 144 (9.1) 64 (11.0) 0.000
Kaplan-Meier analyses

Conclusion
In ACS patients ≥65 y, a “J” relationship between admission SBP and cardiac mortality is observed. For ACS patients aged 65 years and over, admission SBP <120 mmHg or ≥160mmHg is a independent risk factor for long-term cardiac death.

Acknowledgement/Funding
National Natural Science Foundation of China (No. 81300333))
P3619Incidence of progressively reduced LVEF during long-year follow-up after myocardial infarction: impact for mid-term outcomes
Authors: Yoshioka G , Shibata Y , Node K , Watanabe N , Kuriyama N , Koiwaya H , Ogata K , Goriki Y , Shinzato K 
Published: October 2019

Abstract

Background
Severely reduced left ventricular ejection fraction (LVEF≤35%) is commonly seen in approximately 5% of the myocardial infarction (MI) survivors in its acute-phase, which is recognized as a risk factor of post-MI cardiac death. However, clinical impact of the progressively reduced LVEF in the chronic-phase after MI has not been clarified.

Purpose
To evaluate clinical impact of the progressively reduced LVEF in the chronic-phase after MI.

Method
We evaluated 1659 consecutive patients with acute MI by serial echocardiography. Primary outcome was severely reduced LVEF. And secondary outcome was all cause death and cardiac death.

Result
During follow-up (median: 1097 days), severely reduced LVEF newly developed in 8.6% of AMI survivors. These patients had significantly higher incidence of all cause death (20.7% vs. 4.4%, p<0.01) and cardiac death (10.6% vs. 1.2%, p<0.01) than those with LVEF>35%. Severely reduced LVEF progressed in the chronic-phase associated with all cause death and cardiac death as well as those with severely reduced EF in the acute-phase.
Figure 1

Conclusions
Progressively reduced LVEF during chronic-phase occurred 8.6% per 10-year in MI survivors. Careful long-term follow-up after MI should be needed to identify possible candidate for the implantable cardioverter-defibrillator.
P3621Epidemiology of acute coronary syndrome by subtype in New Zealand 2006–2016: an ANZACS-QI nationwide linkage study of hospitalisation, procedures and case fatality
Authors: Wang T K M , Grey C , Jiang Y , Jackson R , Kerr A 
Published: October 2019

Abstract

Background
Acute coronary syndrome (ACS) is a common manifestation of cardiovascular disease. Inconsistent trends have been reported in the management and outcomes of the three main categories of ACS (ST-elevation myocardial infarction [STEMI], non ST-elevation myocardial infarction [NSTEMI] and unstable angina [UA]). The aims of this study were to evaluate recent trends in the incidence, invasive management and case fatality of these ACS subtypes in New Zealand.

Methods
All ACS hospitalisations between 2006–2016 were identified from routinely collected national data, and categorised into STEMI, NSTEMI, UA, and unspecified myocardial infarction (MI). For each ACS subtype, annual hospitalisation and coronary procedure rates, 28-day and 1-year fatality rates were calculated and trends tested using Poisson regression adjusted for age and sex.

Results
There were 188,264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MI unspecified. During this period, the incidence of all ACS subtypes fell, STEMI by 3.4%/y, NSTEMI by 5.9%/year and UA by 8.5%/year. There was also a rise in the proportion of ACS patients receiving angiography and revascularisation. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but rates of coronary artery bypass grafting increased only for NSTEMI and UA. Case fatality at 28 days and 1 year was higher for STEMI than NSTEMI, and lowest for UA. Over the period there was a relative 1.6%/y decline in one-year case fatality for NSTEMI (p<0.001), but no significant change for STEMI and UA.

Conclusions
The observed declines in the incidence of all ACS subtypes is reassuring, as is the increase in the rate of revascularisation among these patients. The finding that case fatality declined in NSTEMI patients but not in STEMI and UA patients, despite an increase in invasive management in all groups, require further investigation.
P3623Integrating depression and acute coronary syndrome care in low-resource hospitals in china: primary results from the I-Care randomised clinical trial
Authors: Wu Y , Yu X , Zhu Y , Shi C , Li X , Jiang R , Gao P , Gao R , Blumenthal J A 
Published: October 2019

Abstract

Background
Depression and acute coronary syndromes (ACS) are significant public health challenges. Patients with ACS often experience depression, which adversely affects prognosis. Low-cost, sustainable, and effective service models that integrate depression care into the management of ACS patients to reduce depression and improve ACS outcomes are critically needed.

Purpose
I-CARE study is a multi-center, randomised clinical trial (RCT) to evaluate the efficacy of an 11-month integrated care (IC) intervention compared to usual care (UC) in the management of ACS patients.

Methods
The I-CARE RCT was conducted between October 2014 and March 2018 in 16 rural Chinese hospitals. A total of 4041 patients with ACS were consecutively enrolled and randomly assigned in a 1:1 ratio to an IC intervention consisting of nurse-led risk factor management, group-based counseling supplemented by individual problem solving therapy and antidepressant medications as needed, or UC. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) scores from baseline to 6 and 12 months. Secondary outcomes included incidence of major adverse events (MAEs) after discharge, quality of life (EQ5D), and adherence to ACS secondary prevention medications. Data analysis used a multilevel mixed-effects model with hospital-level and subject-level random-effect intercepts and hospital-level random slope incorporated to adjust for clustering effect. Primary analyses followed the intent-to-treat principle.

Results
The mean age of the patients was 61±10 years and 63% were men; however, only 3.3% were classified as depressed based upon a cutoff of ≥10 on the PHQ-9, and 26.9% had PHQ-9 scores between 5 to 9 at the baseline. There were no significant differences in patients' clinical characteristics between IC and UC groups. Changes in PHQ-9 scores from baseline to 6- and 12-months did not differ between treatment groups (−1.47 in IC group vs −1.40 in UC group; adjusted mean difference, −0.04; 95% CI, −0.17 to 0.08 at 6-months; −1.62 in IC group vs −1.54 in UC group; adjusted mean difference, −0.06; 95% CI: −0.19 to 0.06 at 12-months).The risk of MAEs after discharge between IC and UC groups also did not differ significantly (42.1% vs 43.1%; p=0.307).

Conclusions
Results from the I-CARE trial showed that a nurse-coordinated ACS and depression IC intervention did not reduce depression or improve clinical outcomes among patients with ACS compared to usual care controls. The low prevalence of depression was unexpected and may have minimized the potential added benefits of the IC intervention on depression and clinical outcomes compared to UC.

Acknowledgement/Funding
This study is supported by a grant from the National Institute of Mental Health (R01MH100332).
P3627Characteristics and outcomes following myocardial infarction in patients with schizophrenia
Authors: Attar R , Koul S , Jensen S E , Erlinge D , Andell P 
Published: October 2019

Abstract

Background
Patients with schizophrenia are a high-risk population due to a high prevalence of cardiovascular risk factors that translates into increased cardiovascular morbidity and mortality.

Purpose
To describe the characteristics of patients with schizophrenia experiencing a myocardial infarction (MI) and to analyse the 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure) and prescriptions of guideline-recommended secondary preventive treatments at hospital discharge.

Methods
All patients with schizophrenia who experienced a MI in the period between 2000–2017 were identified and included from the SWEDEHEART registry and compared to patients without schizophrenia. Uni- and multivariable Cox proportional hazards and Kaplan-Meier survival models were used to compare the populations.

Results
The main results are shown in Table 1. Compared to the general population (n=285,325), patients with schizophrenia (n=1,008) were younger (63 vs 71 years), had a higher smoking burden and prevalence's of diabetes, heart failure, chronic obstructive pulmonary disorder and major bleeding (all p-values <0.05). On the contrary, lower prevalence's of diagnosed hypertension, hyperlipideamia, previous myocardial infarction, renal disease and peripheral artery disease were seen in this population. Lastly, patients with schizophrenia were less likely to be discharged with aspirin, P2Y12 inhibitors, ACE-inhibitors/angiotensin receptor blockers, beta blockers and statins (all p-values <0.005).
Table 1. Clinical endpoints at 5-years for patients with schizophrenia following a MI compared to patients without schizophrenia End-points Unadjusted HR (95% CI) Adjusted HR (95% CI) Model 1 Model 2 Model 3 MACE 1.35 (1.23–1.47)* 2.44 (2.23–2.67)* 2.20 (1.79–2.72)* 2.05 (1.63–2.58)* Mortality 1.44 (1.31–1.59)* 2.99 (2.72–3.29)* 2.53 (2.00–3.21)* 2.38 (1.84–3.09)* Reinfarction 1.00 (0.82–1.24) 1.53 (1.25–1.89)* 1.41 (0.86–2.30) 1.29 (0.77–2.13) Stroke 1.03 (0.80–1.34) 1.67 (1.29–2.17)* 1.72 (1.00–2.97) 1.72 (1.00–2.98) Heart failure 1.25 (1.10–1.42)* 2.14 (1.88–2.42)* 1.49 (1.13–1.98)* 1.39 (1.04–1.86)* *p<0.005. Model 1: adjusted for age and sex; Model 2: adjusted for age and sex, smoking, comorbidities, previous CAG and previous PCI; Model 3: adjusted for age and sex, smoking, comorbidities, previous CAG and previous PCI, discharge medications and treatment with CAG and PCI.

Conclusion
Patients with schizophrenia remain a high-risk population who experience a MI almost 10 years earlier than patients without schizophrenia and have worse outcome. Improved primary and secondary preventive measures are urgently warranted.
P3629Invasive versus medical management of non-ST elevation myocardial infarction in cancer patients: knowledge is bliss
Authors: Balanescu D V , Donisan T , Lee M , Tran P , De Sirkar S , Palaskas N , Lopez-Mattei J , Kim P Y , Iliescu G , Balanescu S M , Marmagkiolis K , Iliescu C 
Published: October 2019

Abstract

Background
Cancer patients with non-ST elevation myocardial infarction (NSTEMI) frequently present with comorbidities (e.g., anaemia, thrombocytopenia) that discourage invasive treatment.

Purpose
To compare outcomes of cancer patients with NSTEMI treated with optimal medical therapy (OMT) + percutaneous coronary intervention (PCI) versus OMT alone and to identify variables associated with overall survival (OS).

Methods
All cancer patients diagnosed with NSTEMI between March 2016 and December 2018 at our institution were included. Patients were classified based on treatment of NSTEMI into 2 groups: invasive strategy or OMT alone. The invasive group was further classified into early (PCI≤72 hours since presentation) or delayed strategy (PCI>72 hours). Clinical and laboratory data, oncologic history, major adverse cardiovascular events, and survival were collected. Univariate Cox proportional hazards regression analyses were conducted to identify variables associated with OS.

Results
We included 201 patients with a mean age of 68±11 years, 136 (68%) of which were women. Median OS was 13 months. Factors influencing OS are presented in Table I. Patients receiving PCI had better OS compared to patients treated with OMT only (Figure 1, p<0.0001). Procedure-related complications were non-fatal and present in 2 (1.85%) cases.
Table I Covariate Hazard Ratio (95% confidence interval) p-value Early invasive treatment (≤72 hours) 0.327 (0.207–0.516) <0.0001 Delayed invasive treatment (>72 hours) 0.496 (0.252–0.977) 0.0426 Presenting symptom: chest pain 0.406 (0.254–0.649) 0.0002 Presenting symptom: others 1.869 (1.223–2.855) 0.0039 Single agent antiplatelet therapy 0.434 (0.263–0.716) 0.0011 Dual agent antiplatelet therapy 0.294 (0.174–0.496) <0.0001 Statins 0.440 (0.276–0.703) 0.0006 Active cancer 4.487 (1.646–12.234) 0.0033 Prior chemotherapy 2.312 (1.328–4.023) 0.0030 Prior chest radiation 1.752 (1.065–2.884) 0.0272 Active chemotherapy 1.931 (1.271–2.934) 0.0021
Figure 1

Conclusions
An invasive management of NSTEMI in cancer patients, especially within 72 hours, appears to be associated with improved OS. Patients presenting with symptoms other than chest pain were less likely to undergo PCI and had worse outcomes. Active cancer, a history of chest radiation, and active or prior chemotherapy were also associated with decreased OS.

Acknowledgement/Funding
None
P3640Association of ceramide and phospholipid levels and cardiovascular events in stable coronary heart disease: findings from the STABILITY Biomarkers substudy
Authors: Laaksonen R , Hilvo M , Kauhanen D , Lakic T G , Lindback J , Held C , Granger C B , Koenig W , Stewart R A H , White H D , Siegbahn A , Wallentin L 
Published: October 2019

Abstract

Background
Both levels of protein and lipid biomarkers have been found associated with cardiovascular outcomes in patients with stable coronary heart disease (CHD). There are few large-scale studies comparing the prognostic value of and interactions between these two groups of biomarkers in CHD.

Methods
In the 15,828 CHD patients included in the STABILITY trial 10,205 provided plasma samples at baseline allowing measurements of distinct ceramide and phospholipid species by mass spectrometry and markers of cardiac dysfunction (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), high sensitivity cardiac troponin-T [cTnT-hs]), renal dysfunction (cystatin-C), oxidative stress (growth differentiation factor 15 [GDF-15]) by electro-immunoassays. During 3.7 years median follow-up, 1291 CVD, MI, and stroke events occurred. A previously developed ceramide and phospholipid species based risk score (CERT) and its associations to outcomes before and after adjustment were evaluated by Cox-regression models.

Results
The CERT model was significantly associated to all cardiovascular outcomes before and after adjustment for clinical characteristics and routine laboratory tests. However, the associations were attenuated after adjustment for other prognostic biomarkers. The data are summarized in Table 1 below.
Table 1. HR per 1 SD increase in CERT HR (95% CI) p-value MACE Model 1 1.30 (1.24–1.37) <0.0001 Model 2 1.23 (1.16–1.31) <0.0001 Model 3 1.08 (1.02–1.15) 0.0120 CVD Death Model 1 1.57 (1.45–1.69) <0.0001 Model 2 1.38 (1.26–1.50) <0.0001 Model 3 1.14 (1.04–1.26) 0.0052 MACE = CVD death, stroke and MI. Model 1 includes score and randomized treatment. Model 2 includes score, randomized treatment, age, gender, and prior (MI, coronary revas., multivessel CHD), B/L diabetes, hypertension, history of smoking, PVD, region, B/L systolic BP, B/L BMI, HB, WBC, CKD-EPI, LDL-C, HDL-C and TG. Model 3 includes the following covariates in addition to Model 2: TnT-hs, proBNP, Cystatin-C, CRP-hs and IL-6.

Conclusion
A ceramide/phospholipids based risk score is associated with the risk of fatal and non-fatal cardiovascular events in patients with stable CHD. The score is attenuated by adjustment for biomarkers indicating cardiorenal dysfunction and inflammatory activity and may be related to underlying mechanisms for adverse outcomes in stable CHD.

Acknowledgement/Funding
The original STABILITY study was funded by GlaxoSmithKline
P3644Plaque progression from normal vessel wall to fibroatheroma: lessons from over 5-year follow-up optical coherence tomography study
Authors: Takeshige R , Otake H , Kawamori H , Toba T , Nagano Y , Tsukiyama Y , Yanaka K , Yamamoto H , Nagasawa A , Onishi H , Sugisaki Y , Nakano S , Matsuoka Y , Tanimura K , Hirata K 
Published: October 2019

Abstract

Background
Progression of atherosclerosis is a non-uniform process characterized by coexistence of normal vessel wall (NVW) and advanced fibroatheroma within the same cross-section (Figure). Plaque progression from NVW to fibroatheroma usually takes years, that has never been investigated in human.

Purpose
To investigate the incidence and related factors associated with atherosclerotic progression from NVW to fibroatheroma using long-term serial optical coherence tomography (OCT) follow-up data over 5 years.

Methods
We enrolled 47 vessels in 30 patients who had undergone serial OCT imaging over 5 years (average: 6.8 years). Baseline and follow-up OCT images were matched for longitudinal and circumferential location and OCT cross-sections that had NVW >30 degrees were enrolled. NVW was defined as vessel wall having OCT-detectable three-layer structure with intimal thickening ≤300μm. Cross-sections were diagnosed as +Progression when NVW in the cross-section reduced by >30 degrees during >5-year follow-up.

Results
In the present study, atherogenic progression from NVW to fibroatheroma was observed only in 37.2% of the enrolled cross-sections. On the other hand, despite an average long-term follow-up period of 6.8 years, the extent of NVW was maintained in 62.8% of cross-sections. The incidence of microchannel in adjacent fibroatheroma within the same cross-section (23.6% vs. 13.1%, p=0.023), eccentric plaque distribution (21.7% vs. 11.4%, p=0.019), and concave shape (6.6% vs. 0%, p=0.001) at baseline was significantly higher in cross-sections with +Progression than those without Progression. Average intimal thickness of NVW (187.2±64.9μm vs. 170.7±68.6μm; p=0.048) at baseline was significantly thicker in cross-sections with +Progression than those without. Multivariate analysis demonstrated that the presence of microchannel, eccentric plaque distribution and thicker average intimal thickness of NVW at baseline were independently associated with plaque progression during the follow-up.
Atheroma progression

Conclusion
The presence of microchannel in adjacent fibroatheroma, eccentric plaque distribution, and thicker intimal thickening of NVW were potentially associated with plaque progression from NVW to fibroatheroma.
P3646A systematic review and meta-analysis on spontaneous coronary artery dissection: epidemiology, risk factors and outcomes
Authors: Franke K , Marshall H , Worthley M , Psaltis P J 
Published: October 2019

Abstract

Background
Spontaneous Coronary Artery Dissection (SCAD) is an elusive but increasingly recognised cause of Acute Coronary Syndrome (ACS). Most knowledge about SCAD has arisen from small to medium sized cohort studies that have been published since 2012.

Purpose
This systematic review and meta-analysis aimed to provide an update on SCAD's association with cardiovascular risk factors, angiographic variants and outcomes.

Methods
The term “Spontaneous Coronary Artery Dissection” was searched in PubMed, EMBASE and SCOPUS on the 2nd of February 2019, yielding a total of 1517 articles. Following exclusion (e.g. of isolated case reports and duplicate cohorts), 31 original studies that reported at least one desired parameter in patients with SCAD were included. Statistical analysis was performed independently for each parameter using random effects models.

Results
Of the k=31 studies (n=77,025 patients), only 3 were published before 2012 (n=68). Mean age was 62.4 years and 85.1% [78.9%-89.8%, I2=91.7, k=28] were female. Prevalence of associated conditions and traditional cardiovascular risk factors are outlined in the table. Importantly, only 37.4% [30.0%-45.4%, I2=77.0, k=10] were associated with a traditional Type 1 angiographic appearance. Yearly incidence was 3.4% [2.4%-4.4%, I2=73.4, k=16] for SCAD recurrence and 5.8% [4.1%-7.5%, I2=85.7, k=16] for MACE. Incidence of MACE at follow-up was 4.1% [1.7%-9.9%, I2=74.0, k=3] for conservative treatment and 7.2% [5.1%-10.3%, I2=43.7, k=4] for PCI (p=0.14).
Estimated prevalence of traditional cardiovascular risk factors, associated conditions and angiographic variants in cohorts of patients with SCAD Associated Patient Factor Number of Studies Prevalence (%, [95% CI]) Heterogeneity (I2) Hypertension 29 36.0 [29.9–42.6] 97.9% Dyslipidemia 27 28.7 [17.4–43.5] 99.7% Smoking 29 23.3 [14.5–35.3] 99.6% Depression/Anxiety 6 28.1 [19.3–38.9] 94.3% Fibromuscular Dysplasia 9 50.7 [40.0–61.3] 91.9% Type 1 Angiographic Appearance 11 37.4 [30.0–45.4] 77.0% Type 2 Angiographic Appearance 11 62.4 [50.0–73.3] 93.3% Type 3 Angiographic Appearance 6 10.2 [6.2–16.4] 78.3%
Incidence of Recurrence in SCAD Cohorts

Conclusions
This meta-analysis confirms associations of SCAD with fibromuscular dysplasia, anxiety and depression, and reveals a small but important risk of recurrence and MACE. Furthermore, a majority of SCAD cases present with non-traditional angiographic appearances highlighting the need for increased familiarity with this condition among treating physicians.