bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of type 2 diabetes with stable coronary artery disease but without prior myocardial infarction or stroke and THEMIS-like patients from the SNDS French nationwide claims database
Authors: Blin P , Darmon P , Henry P , Dureau-Pournin C , Bernard M.-A , Guiard E , Maizi H , Thomas-Delecourt F , Lassalle R , Droz-Perroteau C , Moore N 
Published: November 2020

Abstract

Background
The THEMIS randomized controlled trial showed that patients with stable coronary artery disease and type 2 diabetes mellitus (CAD-T2DM), without prior myocardial infarction (MI) or stroke, and who received ticagrelor plus aspirin, had a lower incidence of ischemic cardiovascular events but a higher incidence of major bleeding than those who received placebo plus aspirin. The number of patients concerned and their characteristics in current practice are not well known.

Purpose
To assess the characteristics of CAD-T2DM adults (≥18 years) without prior MI-stroke, and more specifically, of THEMIS-like patients in a real world setting.

Methods
Cohort within the main scheme of the SNDS (Système National des Données de Santé), the French nationwide claims database, representing about 86% of 66 million people. All CAD-T2DM prevalent patients without prior MI-stroke were identified on January 1st, 2014 (index date) based on a 5-year database history, and followed for two years. The THEMIS-like population included CAD-T2DM patients without prior MI-stroke ≥50 years at index date without renal failure with dialysis, cirrhosis or liver cancer history, as well as no intracranial and gastro-intestinal bleeding for the last 6 months, or anticoagulant or antiplatelet agent 2 months before and after index date. Study prevalence was standardized for the European population for 1,000 adults (‰) using sex and 5-year age classes from Eurostat statistics.

Results
From the 359,595 CAD-T2DM patients identified in the database, 71.8% had no prior MI-stroke (n=258,260), including 24.9% of THEMIS-like patients (n=64,334). CAD-T2DM without prior MI-stroke and THEMIS-like patients had the same mean age of 72 years, with 68% and 66% men, 26% and 25% with more than 4-year CAD and T2DM history, 79% and 76% of hypertension, 28% and 19% of revascularisation procedure, 19% and 11% of peripheral arterial disease, 16% and 9% of heart failure, and 39% and 32% of diabetes complications, respectively. The table below presents prevalence estimation per 1,000 European adults with differences according to both populations, as well as sex and age-classes.

Conclusions
The two populations had similar characteristics, although noting some differences in comorbidities. The THEMIS-like prevalence was estimated to 1.50‰ European adults, representing about a quarter of CAD-T2DM patients without prior MI-stroke.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Study performed with unconditional funding from AstraZeneca
The impact of gender on outcomes in patients with chronic total coronary occlusions undergoing percutaneous coronary intervention: results from a Dutch nationwide registry including 7560 patients
Authors: Van Veelen A , Elias J , Van Dongen I.M , Henriques J.P.S , Knaapen P 
Published: November 2020

Abstract

Background
Females comprise a minority of patients with chronic total occlusions (CTO). It is known that men have a greater benefit from CTO percutaneous coronary intervention (PCI) than women. We aimed to determine gender-based differences in baseline characteristics and outcomes after PCI in patients with CTO.

Methods
The Netherlands Heart Registration (NHR) is a nationwide registry that registers outcomes of cardiac interventions. For the purpose of this analysis, the data of all patients undergoing PCI from inception of the NHR to December 2018 were selected, that included PCI with at least one CTO in one of the treated coronary arteries. We compared baseline characteristics and the outcomes 1 year mortality, 30 day myocardial infarction (MI) and target vessel revascularization (TVR) &lt;1 year between men and women.

Results
A total of 7560 patients were identified that underwent PCI between January 1, 2015 and December 31, 2018 with at least 1 CTO in the treated vessel. A total of 5850 was male (77.4%) and 1710 was female (22.6%). Women were older (68.5±10.6 versus 64.7±10.6 years old, p&lt;0.001), and more frequently had diabetes (29.4% [n=529] versus 25.0% [n=1602], p&lt;0.001) and kidney disease (4.5% [n=529] versus 2.2% [n=142], p&lt;0.001). However, men had more extensive cardiovascular disease, i.e. multi-vessel disease (56.0% [n=3584] versus 50.4% [n=912], p&lt;0.001), previous MI (39.7% [n=2527] versus 31.0% [n=555], p&lt;0.001), previous PCI (48.2% [n=1967] versus 40.2% [n=455], p&lt;0.001) and previous coronary artery bypass grafting (16.8% [n=1085] versus 10.5% [n=191], p&lt;0.001) and more frequently presented with an out-of-hospital cardiac arrest, compared to women (2.1% [n=136] versus 1.1% [n=20], p=0.004). The 1-year mortality was higher in women (10.3% versus 7.5%, p&lt;0.001), as well as the 30-day MI (0.9% versus 0.4%, p=0.043), but men had higher risk for TVR&lt;1 year (11.7% versus 9.5%, p=0.044). Corrected for age and comorbidities, female gender was an independent predictor for mortality (Figure 1; odds ratio 1.83, 95% confidence interval 1.08–3.11, p=0.025).

Conclusion
In this nationwide registry comprising 7560 CTO patients undergoing PCI, significant gender-based differences were found. Males were found to have more extensive cardiovascular disease. However, females were at higher risk of mortality, possibly due to higher age and higher prevalence of concomitant comorbidities.
Figure 1. Survival curve

Funding Acknowledgement
Type of funding source: None
What troponin I level post PCI in SIHD is predictive of higher risk of MACE?
Authors: Moosavi V , Ebrahimi R , Yang Q , Harvey T , Das S.K , Ariarathna N , Tran Q , Marley P , Farshid A 
Published: November 2020

Abstract

Background
According to the 4th universal definition of myocardial infarction (MI), post percutaneous coronary intervention (PCI) MI is defined as an elevation of cardiac troponin values more than five times above the 99th percentile upper reference limit. The ISCHEMIA Trial in stable ischaemic heart disease (SIHD) patients reported post PCI troponin rise as part of the primary endpoint. What represents a clinically significant troponin rise post PCI has not been clearly established.

Purpose
The aim of our study was to correlate the level of troponin I rise with adverse events post PCI in SIHD.

Methods
We performed a retrospective analysis of our PCI registry in patients with SIHD between 2014 and 2018. Patients with acute coronary syndrome were excluded. HS-troponin I was measured one day after the procedure. The primary end point was major adverse cardiac events (MACE) including death, MI, stent thrombosis (ST) and need for repeat revascularization within 12 months from index procedure.

Results
Between 2014 and 2018, 920 patients (mean age 67.5 years, 78% male) underwent PCI for SIHD. Troponin rise post PCI was a common event and a level more than 100ng/L (reference range &lt;26 ng/L) occurred in 54% of patients. Mean and median troponin I level post PCI was 675 ng/L±2530 and 118 ng/L respectively. In patients with MACE, mean troponin I level was 1361 ng/L compared with 611 ng/L in patients without MACE (P=0.0176). Correlation of troponin I level with one year MACE rates are shown in the Graph. MACE rates were steady at 8.5% with troponin I levels below 2500 ng/L after which there was a significant increase in the MACE rates. At troponin I level above 5000 ng/L MACE was 13.6% and above 10,000 ng/L it was 33.3%.

Conclusion
Troponin I levels above 2500 ng/L (x100 upper limit normal) correlated with an increase in the risk of MACE in patients undergoing PCI for SIHD. Our results suggest that current definitions of procedural MI overestimate the clinical significance of post PCI troponin rise.

Funding Acknowledgement
Type of funding source: None
Younger patients have an increased risk for dementia after coronary artery bypass grafting, a population-based cohort study from the SWEDEHEART registry
Authors: Nielsen S , Giang K.W , Karlsson M , Hansson E.C , Pivodic A , Lindgren M , Jeppsson A 
Published: November 2020

Abstract

Background
Previous studies investigating the association between coronary artery bypass grafting (CABG) and risk for dementia show conflicting results.

Purpose
To compare the long-term risk for dementia in CABG patients to matched individuals in the general population, and to identify independent predictors for developing dementia after CABG.

Methods
Data from the SWEDEHEART registry and three other mandatory national registries were merged to compare all patients who underwent isolated CABG in Sweden from 1992 to 2015 (n=111.335) with an age- and sex-matched control individuals from the general population (n=222.396). Cumulative incidence adjusted for the competing risk for death and Cox regression models with Hazard Ratio (HR) and 95% confidence interval (CI) adjusted for age, gender, co-morbidity and socioeconomic variables, were used to calculate the risk of dementia. Median follow-up was 10.1 years (IQR 2.5–14.7) among CABG patients and 10.7 years (5.6–15.7) among the controls. Identified interactions of the excess risk for dementia with sex and age categories (&lt;65, 65-&lt;75, ≥75 years) resulted in analyses being stratified on those sub-cohorts.

Results
The overall cumulative incidence at 20 years follow up of all-cause dementia was 9.6% (95% CI 9.4–9.9) among CABG patients and 9.0 (8.8–9.2) among individuals in the general population. The adjusted relative risk for all-cause dementia was increased among CABG patients &lt;65 years and 65–75 years, (HR 1.29 (95% CI 1.17–1.41) and HR 1.06 (1.01–1.11), respectively (fig 1). The risk for all-cause dementia was higher in CABG women than in CABG men (HR 1.62 (1.30–2.03) vs HR 1.22 (1.10–1.35)). In the oldest age group (75 years and older) the risk for all cause dementia, vascular dementia and Alzheimer's disease was lower for CABG patients compared to controls (HR 0.73 (0.69–0.78). Female CABG patients &lt;65 years had an increased risk for Alzheimer's disease (HR 1.83 (1.06–3.15). Hypertension, diabetes, preoperative stroke, renal failure, heart failure, atrial fibrillation, depression and low income were independent predictors for all-cause dementia in CABG patients.

Conclusion
CABG patients younger than 75 years at the time of surgery have an increased risk of all-cause dementia compared to an age- and sex-matched population. Women younger than 65 years that underwent CABG had also a markedly higher risk for Alzheimer disease. Increased awareness of the higher risk for dementia in younger CABG patients is warranted to avoid delay of diagnosis and treatment.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish Heart and Lung Foundation, Swedish State
Outcomes of 7560 chronic total occlusion patients undergoing percutaneous coronary intervention: results from a Dutch nationwide registry
Authors: Van Veelen A , Elias J , Van Dongen I.M , Henriques J.P.S , Knaapen P 
Published: November 2020

Abstract

Background
The presence of a chronic total coronary occlusion (CTO) is associated with worse clinical outcomes. We aimed to identify CTO patients that are at risk of these outcomes in a nationwide registry.

Methods
The Netherlands Heart Registration (NHR) is a nationwide registry that registers outcomes of cardiac interventions. For the purpose of this analysis, the data of all patients undergoing PCI from inception of the NHR to December 2019 were selected, that included PCI with at least one CTO in one of the treated coronary arteries. We used multivariate logistic regression of baseline characteristics for the outcome measures target vessel revascularization (TVR) &lt;1 year, 30-day myocardial infarction (MI) and 1-year mortality. The impact of the assessed risk factors on outcomes was described as odds ratio (OR) with corresponding 95% confidence intervals (CI).

Results
A total of 7560 patients underwent PCI with ≥1 CTO in one of the treated arteries between January 1, 2015 until December 31, 2018 (mean age 65±10 years, 77.4% male [n=5850]). Five percent of patients deceased within 1 year after PCI (n=375), TVR&lt;1 year occurred in 11% (n=525/4804) and 30-day MI occurred in 0.5% (25/4985). In multivariate regression, the only predictor for TVR&lt;1 year was the presence of diabetes mellitus (OR 1.29, 95% CI 1.06–1.56). Predictors for the outcome MI &lt;30 days were female gender (OR 2.24, 95% CI 1.05–4.79), chronic kidney disease (OR 3.94, 95% CI 1.15–13.50) and cardiogenic shock at presentation (OR 7.94, 95% CI 2.28–27.7). Strong predictors for 1 year mortality were the presence of cardiogenic shock at presentation (OR 17.86, 95% CI 2.90–109.92) and the presence of chronic kidney disease (OR 4.56, 95% CI 2.04–10.16), other predictors were age (OR 1.04, 95% CI 1.01–1.07), female gender (OR 1.83, 95% CI 1.08–3.10), diabetes (OR 1.66, 95% CI 1.01–2.73) and left ventricular ejection fraction (LVEF; OR 0.95, 95% CI 0.93–0.97).

Conclusion
In this nationwide registry of 7560 CTO patients undergoing PCI, cardiogenic shock and chronic kidney disease were strong predictors for 1 year mortality and 30 day MI. Diabetes mellitus was the only predictor for the occurrence of TVR &lt;1 year. Identification of patients at risk for poor clinical outcomes may help improve the outcomes of CTO patients in the future.

Funding Acknowledgement
Type of funding source: None
Circulating secretoneurin concentrations are increased in patients with acute coronary syndrome and provide prognostic information
Authors: Myhre P , Ottesen A.H , Faaren A.L , Tveit S.H , Springett J , Pyylampi J , Stridsberg M , Christensen G , Omland T , Rosjo H 
Published: November 2020

Abstract

Background
Secretoneurin (SN) is associated with both myocardial ischemia and cardiomyocyte Ca2+ handling, and circulating SN levels provide incremental prognostic information to established risk indices in patients with acute heart failure, acute respiratory failure, and after cardiac arrest.

Purpose
To determine whether SN concentrations are increased in patients with acute coronary syndrome (ACS), and assess the prognostic value of SN among patients with suspected ACS.

Methods
We included 402 patients hospitalized with chest pain at a teaching hospital and adjudicated all hospitalizations as ACS or non-ACS by two physicians working independently. Blood samples were drawn within 24 h from hospital admission and SN was measured by a novel ELISA assay. Patients were followed for mean 6.2 years and mortality was obtained from the Norwegian Cause of Death Registry.

Results
SN concentrations were higher in patients with ACS (n=161 [40%]) compared to patients with chest pain without ACS (n=241 [60%]): median 32.8 (IQR 27.5–42.8) vs. 28 (24.5–34.0) pmol/L, p&lt;0.001. The C-statistics of SN was 0.66 (95% CI: 0.61–0.71) to separate chest pain patients with ACS from chest pain patients without ACS compared to 0.82 (0.78–0.86) for high-sensitivity cardiac troponin T (hs-cTnT). Patients with ECG changes reflective of acute myocardial ischemia had higher SN concentrations (p=0.005). Sixty-five (16%) patients died during follow-up. Stratifying patients according to SN concentrations separated patients with a poor and favorable prognosis, and patients with SN in the top quartile had 4-fold higher risk of mortality compared to the patients with low SN concentrations (Figure). Higher SN concentrations were also associated with increased risk of mortality in Cox regression models, including in models that adjusted for age, sex, blood pressure, previous myocardial infarction, atrial fibrillation, and heart failure: hazard ratio 1.71 (1.03–2.84), p=0.038. The C-statistics of SN to separate patients with poor prognosis from favorable prognosis was 0.72 (0.65–0.79) and adding SN on top of hs-cTnT improved prognostication as assessed by the integrated discrimination index: 0.05±0.014, p&lt;0.001.

Conclusions
SN concentrations are increased in patients with ACS and provide prognostic information in patients with chest pain.
Figure 1

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Akershus Unviersity Hospital, CardiNor AS
Credibility of Risk scores in predicting coronary artery disease severity in non-ST segment elevation acute coronary syndrome patients
Authors: Elhusseini S 
Published: November 2020

Abstract

Objectives
We aimed to assess the value of Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores (RSs) for predicting coronary artery disease (CAD) severity and prognosis in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).

Background
Patients with NSTE-ACS are at varying risks of death and recurrent cardiac events, early risk stratification plays a central role, different scores are now available based on initial clinical history, ECG, and laboratory tests that enable early risk stratification on admission.

Methods
A prospective study was conducted including 100 patients (age, 45–68 years) with NSTE-ACS who were admitted at our hospital from January 2018 to January 2019. The two RSs (TIMI& GRACE) were calculated from the initial clinical history, electrocardiogram, and laboratory values collected and recorded on admission. All patients were subjected to conventional coronary angiography during admission, Patients were divided into two groups: 1) patients with syntax score ≤32 (test group, 80 patients) and 2) patients with syntax score &gt;32 (comparative group, 20 patients). Median follow-up duration was 6 (4–9) days.

Results
Regarding correlation between coronary angiographic severity based on syntax score and the clinical profile based on the two RSs (TIMI&GRACE) in NSTE-ACS patients, statistically significant correlation were found between GRACE score and syntax score (r=0.789; P=0.001) with GRACE score accuracy: 94% and negative predictive value (NPV): 98.7%, whereas no statistically significant correlation were found between TIMI score and syntax score (r=0.087; P=0.388) with TIMI score accuracy: 32% and NPV: 73.1%.

Conclusions
In conclusion the GRACE score provides a quick and reliable prediction of CAD severity in NSTE-ACS patients, It allows accurate risk estimation, categorizes patients and consequently can help in making accurate therapeutic decisions either with the use of invasive strategies in high risk selected patients or the use of conservative strategies in low risk patients in presence of limited resources.

Funding Acknowledgement
Type of funding source: None
Optimizing diagnosis of obstructive coronary artery disease by CT angiography: RCT's final results and 12-months follow-up
Authors: Dias Ferreira Reis J.P , Ramos R , Modas Daniel P , Aguiar Rosa S , Almeida Morais L , Cruz M , Moreira R , Mendonca T , Monteiro A , Leal C , Marques H , Figueiredo L , Cruz Ferreira R 
Published: November 2020

Abstract

Aim
In patients (pts) with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve pt selection for invasive coronary angiography (ICA) as alternative to functional testing. However. the role of CTA in symptomatic pts after abnormal functional test (FT) is incompletely defined.

Methods and results
This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic pts with mild to moderately abnormal FT referred to ICA to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Pts with high risk features on FT, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR&lt;60ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic (DY) and revascularization (RY) yields of ICA in either group were also assessed. Pts were followed up for at least 1 year for the primary safety endpoint of all cause death/ nonfatal myocardial infarction/ stroke. Unplanned revascularization
(UP) and symptomatic status (SS) were also evaluated. Pts averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, non-obstructive
CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (p&lt;0.001 Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, p=0.152). Both DY (84.4% vs 41.7, p&lt;0.001) and RY (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard FT-guided ICA. The rate of the primary safety endpoint was similar between both groups (1.9% vs 0%, p=0.244), as well as the rates of UP (0.9% vs 0.9%, p=1.000) and SS (persistent angina: 29.6% vs 24.8%, p=0.425).

Conclusions
In pts with suspected CAD and mild to moderately abnormal ischemia test, a diagnostic strategy including CTA as gatekeeper is safe, effective and significantly improves diagnostic and revascularization yields of ICA.

Funding Acknowledgement
Type of funding source: None
Early vascular healing following bioresorbable-polymer sirolimus-eluting stent implantation in comparison with durable-polymer everolimus-eluting stent: sequential optical coherence tomography study
Authors: Ogura K , Tsujita H , Arai T , Sakai R , Tanaka H , Masaki R , Oishi Y , Nomura K , Arai K , Sekimoto T , Kondo S , Tsukamoto S , Mori H , Matsumoto H , Shinke T 
Published: November 2020

Abstract

Background
Orsiro ultrathin-strut bioresorbable-polymer sirolimus-eluting stent (BP-SES) might facilitate early vascular healing responses that seems to be associated with improved long-term clinical outcomes. We compared the early vascular healing responses to BP-SES and Xience durable-polymer everolimus-eluting stent (DP-EES) in patients with chronic coronary syndrome (CCS) using optical coherence tomography (OCT).

Methods
A total of 40 patients with CCS receiving OCT-guided PCI were included. 20 patients were assigned to BP-SES, and 20 to DP-EES. OCT was performed immediately after stent placement (post-procedure) and at 1 month follow-up. Struts were recorded as uncovered if any part was visibly exposed in the lumen or covered if a layer of tissue covered all reflecting surfaces. The incidence of intrastent thrombus (IS-Th) and irregular protrusion (IRP) were also assessed.

Results
At 1 month, the percentage of uncovered struts was significantly lower in the BP-SES compared with the DP-EES (2.8±1.6% vs. 5.8±1.8%, respectively; p&lt;0.001), and that of malapposed struts was similar between both groups (2.5±3.1% vs. 2.4±2.2%; p=0.76). There were no differences in the incidence of IS-Th (65.0% vs. 55.0% at post-procedure; p=0.54, 30.0% vs. 35.0% at 1 month; p=0.75) and IRP (30.0% vs. 25.0% at post-procedure; p=0.74). IRP had completely resolved at 1 month in both groups.

Conclusion
Early vascular healing response to Orsiro BP-SES implantation was revealed in CCS patients at 1 month compared with Xience DP-EES. Orsiro BP-SES may have a potential to shorten the dual antiplatelet therapy duration.

Funding Acknowledgement
Type of funding source: None