bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of the society for cardiovascular angiography and intervention classification for predicting in-hospital mortality in patients with acute decompensated heart failure
Authors: Burgos L , Talavera L , Baro Vila R , Acosta A , Cabral M , Buscio M , Diez M 
Published: November 2020

Abstract

Introduction
Recently a multidisciplinary group of the Society for Cardiovascular Angiography and Interventions (SCAI) derived a new classification schema for cardiogenic shock (CS), simple, clinically based and suitable for rapid assessment at the bedside but also arbitrary. Validation in different clinical datasets, specifically in patients with acute decompensated heart failure (ADHF), is necessary to establish the utility of this proposed classification schema.

Purpose
We aimed to evaluate the ability of a new SCAI CS staging classification to predict in-hospital mortality in patients with ADHF.

Methods
We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data of consecutive patients admitted with ADHF as a primary diagnosis between January 2015 and January 2019. We excluded patients who were hospitalized for an acute coronary syndrome. Patients were assigned to the modified SCAI Classification for CS: Stage A is “at risk” for CS, stage B is “beginning” shock, stage C is “classic”, stage D is “deteriorating”, and E is “extremis”, and in-hospital mortality was evaluated for each group. All-cause mortality was compared across SCAI stages using Kaplan-Meier analysis and log-rank test. Cox proportional hazards models were used to determine the association between SCAI stages and in-hospital mortality after adjusting for age, gender, left ventricular ejection fraction, use of vasoactive medication, mechanical circulatory assist devices, mechanical ventilation, percutaneous coronary intervention and cardiac surgery.

Results
Among 668 patients with a mean age of 74.9±12 years, 63.9% were male. In-hospital mortality was 11.2%. According to SCAI classification, the proportion of patients in stages A through E was 51.7%, 26.7%, 14.4%, 4.6% and 2.5%. The unadjusted mortality in each stages was: A 0.6%, B 4.5%, C 32.3%, D 61.3%, and E 88.2% (Log Rank P&lt;0.0001). After multivariable adjustment, each SCAI shock stage remained associated with increased in-hospital mortality (all P&lt;0.001 compared to stage A). Compared with SCAI shock stage A, adjusted hazard ratio (HR) values in SCAI shock stages B through E were 5.2, 31, 107, and 185, respectively (Figure).

Conclusion
In this large clinical cohort of patients with ADHF exclusively, the new SCAI CS staging classification was associated with in-hospital mortality. This finding supports the rationale of the classification in this setting, further prospective trials are needed to validate these findings.
Adjusted in-hospital Mortality as a Func

Funding Acknowledgement
Type of funding source: None
Pre-test probability of obstructive coronary artery disease in the new guidelines: too much, too little or just enough?
Authors: Lopes P , Albuquerque F , Freitas P , Rocha B , Cunha G , Mendes G , Abecasis J , Santos A , Saraiva C , Mendes M , Ferreira A 
Published: November 2020

Abstract

Background
Previous 2013 ESC guidelines recommended the use of the Modified Diamond-Forrester method to assess the pre-test probability (PTP) of obstructive coronary artery disease (CAD). The 2019 ESC Chronic Coronary Syndrome guidelines updated this recommendation with a major downgrade in PTP. The aim of this study was to compare the performance of these two methods in patients with stable chest pain undergoing coronary computed tomography angiography (CCTA) for suspected CAD.

Methods
We performed a retrospective analysis on prospectively collected data from a cohort of consecutive patients undergoing CCTA for suspected CAD from October 2016 to 2019. Key exclusion criteria were age &lt;30 years-old, known CAD, suspected acute coronary syndrome or symptoms other than chest pain. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA. Whenever invasive coronary angiography (ICA) was subsequently performed, patients were reclassified if luminal stenosis was &lt;50%. The two PTP prediction models were assessed for calibration and discrimination.

Results
A total of 320 patients (median age 63 years [IQR 53–70], 59% women) were included. Chest pain characteristics were: 48% atypical angina, 38% non-anginal chest pain, 14% typical angina. The observed prevalence of obstructive CAD was 16.3% (n=52). Patients with obstructive CAD were more often male, were significantly older and had a higher prevalence of typical angina and cardiovascular risk factors (except for family history of CAD). On average, individual PTP was 22.1% lower in the new guidelines. The 2013 prediction model significantly overestimated the likelihood of obstructive CAD (mean PTP 37.3% vs 16.3%; relative overestimation of 130%, p-value for miscalibration 0.005). The updated 2019 method showed good calibration for predicting the likelihood of obstructive CAD (mean PTP 15.2% vs 16.3%; relative underestimation of 6.5%, p-value for miscalibration 0.712). The two approaches showed similar discriminative power, with a C-statistics of 0.730 and 0.735 for the 2013 and 2019 methods, respectively (p-value for comparison 0.933). Stratification by gender produced similar results.

Conclusions
In patients with stable chest pain undergoing CCTA, the updated 2019 prediction model allows for a more precise estimation of pre-test probabilities of obstructive CAD than the previous model. Adoption of this new score may improve disease prediction and change the downstream diagnostic pathway in a significant proportion of cases.
Graph 1

Funding Acknowledgement
Type of funding source: None
Use of coronary physiology in chronic coronary syndromes in Germany from 2007–2017
Authors: Von Zur Muhlen C , Kaier K , Heidt T , Staudacher D , Zehender M , Bode C.H , Stachon P 
Published: November 2020

Abstract

Objectives
Coronary physiology is increasingly used in evaluating coronary stenosis, but the penetrance of FFR (Fractional Flow Reserve) or resting indices (e.g. iwFR or RFR) in daily clinical routine is not known.

Methods
The number of coronary angiographies and use of coronary physiology (CP) in patients with chronic coronary syndromes (CCS) in Germany was identified by ICD and OPS codes.

Results
From 2007 to 2017, there was a constant increase in CP usage, with an application rate of 9.19% in 2017. Patients with use of CP were younger (68.8 vs. 70.8 years), had less often severe co-morbidities (peripheral or carotid disease, chronic obstructive pulmonary disease, pulmonary hypertension, renal disease, atrial fibrillation, diabetes), had milder symptoms (10.4 vs. 14.4% in NYHA class III or IV), and a lower EuroSCORE (6.1 vs. 8.3%). Less coronary stents were implanted in patients with use of CP (0.6 vs. 0.8, 95% CI: −0.14–0.26; p&lt;0.001), even after risk adjustment for co-morbidities. Concerning in-hospital outcomes, acute kidney injury occurred less in CP (1.8 vs 3.7%) with subsequent shorter hospital stays (4.3 vs. 5.9 days). Also in-hospital morbidity was lower in CP (0.28 vs. 1.5%), even after risk adjustment (OR 0.28, p&lt;0.001, 95% CI: 0.23–0.36).

Conclusions
In 2017, coronary physiology was used in 9.19% of patients with CCS in Germany. CP resulted in better in-hospital outcomes and less stent implantations. The reasons for a reduced use of CP in patients with significant co-morbidities, and their impact on clinical outcomes require further attention and evaluation in the future.

Funding Acknowledgement
Type of funding source: None
A contemporary definition of periprocedural myocardial injury after percutaneous coronary intervention of chronic total occlusions
Authors: Winter M.P , Goliasch G , Ayoub M , Bartko P , Mashayekhi K , Ferenc M , Buettner H , Hengstenberg C , Neumann F.J , Toma A 
Published: November 2020

Abstract

Background
Coronary chronic total occlusion (CTO) recanalization represents the most technically challenging percutaneous coronary interventions (PCI). The complexity harbours a significant increased risk risk for complications with CTO PCI as compared to non-CTO PCI. However there are evidenced biomarker cut-off levels that help to identify those patients at risk for an unfavorable clinical outcome.

Objective
This study aimed to assess the prognostic impact of postprocedural troponin T increase and mortality in patients undergoing CTO-PCI in order to define the threshold, where procedural related myocardial injury drives mortality.

Methods
We enrolled a total of 3712 consecutive patients undergoing PCI for at least one CTO lesion and performed comprehensive troponin Tmeasurements 6, 8, and 24 hours after the procedure. All-cause mortality was defined as the primary study endpoint.

Results
Using spline curve analysis, we observed that a more than 18-fold increase of troponin above the upper reference limit (URL) is significantly associated with mortality. In the Cox regression analysis we observed a crude hazard ratio (HR) of 2.32 (95% CI 1.83–2.93, P&lt;0.001) for a ≥18fold increase compared to patients with post-procedural troponin increase &lt;18-fold of the URL.Results remained virtually unchanged after bootstrap- or clinical confounder-based adjustment.

Conclusion
This large-scale outcome study demonstrates for the first time the prognostic value of post-procedural troponin T elevation after PCI in CTO patients. We could define a threshold for procedure related myocardial injury in CTO patients that differ non- CTO patients and may help guide the postprocedural clinical care in this high risk patient population.
Figure 1

Funding Acknowledgement
Type of funding source: None
Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the French RICO Survey
Authors: Yao H , Farnier M , Salignon-Vernay C , Chague F , Brunel P , Maza M , Brunet D , Bichat F , Beer J.C , Cottin Y , Zeller M 
Published: November 2020

Abstract

Background
Although patients with familial heterozygous hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI), coronary artery disease (CAD) burden of FH patients with acute MI remains to be investigated.

Methods
All consecutive patients hospitalized for an acute MI in a multicenter database (RICO) from 2012–2017 who underwent coronary angiography were considered. FH (n=86) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥6). The angiographic features of FH patients were compared with patients without FH (score 0–2) (n=166), after matching for age, sex and diabetes (1:2).

Results
When compared with patients without FH, patients with FH had higher prevalence of personal and familial history of CAD (17 vs 5%, and 74 vs 5%, p=0.002 and p&lt;0.001, respectively), and hypertension (54 vs 36%, p=0.006). Chronic statin treatment was used in only 45% of FH patients. At coronary angiography, FH had increased extent of CAD (SYNTAX score 11 (4–21) vs 8 (3–16), p=0.049) and multivessel disease (58% vs 43%, p=0.021). Significant stenosis was more frequent in left and right marginal coronary arteries. FH patients showed a trend toward more complex lesions, with less thrombus (28 vs 39%, p=0.076), but a 2 times higher rate of bifurcation lesions and calcifications (23 vs 12% and 20 vs 10%, p=0.021 and p=0.036).

Conclusions
This study addressing the coronary lesions features of FH patients with acute MI shows that FH patients had more severe CAD burden, and were characterized by complex anatomy features.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté, CHU Dijon Bourgogne
Cholesterol uptake capacity: a new measure of HDL functionality as a predictor of subsequent revascularization in patients undergoing percutaneous coronary intervention
Authors: Fujimoto D , Otake H , Kawamori H , Toba T , Nagao M , Sugizaki Y , Nagasawa A , Takeshige R , Harada A , Murakami K , Iino T , Irino Y , Toh R , Hirata K 
Published: November 2020

Abstract

Background
Recent studies have demonstrated the importance of high-density lipoprotein (HDL) functionality in the development of de novo coronary artery disease by using the cholesterol-efflux capacity, a measure of the ability of HDL to promote cholesterol removal from lipid-laden macrophages. Recently, we developed a rapid cell-free assay system to directly evaluate the capacity of HDL to accept additional cholesterol; the measurement of the cholesterol-uptake capacity (CUC) enables HDL functionality to be readily evaluated in our daily practice. However, prognostic implication of CUC measurement at the timing of percutaneous coronary intervention (PCI) remains unclear.

Purpose
We aimed to evaluate the association between baseline CUC and revascularization during follow-up in the patients who underwent PCI.

Methods
We retrospectively reviewed the patients who underwent PCI with follow-up coronary angiography (CAG) or ischemic-driven revascularization. The patients who had the frozen blood samples of which CUC were measurable at the index PCI and follow-up CAG or revascularization were enrolled. We excluded the patients under hemodialysis.

Results
Among a total of 703 consecutive patients who underwent PCI between Dec 2014 and Mar 2019, we finally enrolled 74 patients who underwent ischemic-driven revascularization (revascularization group) and 183 patients who underwent follow-up CAG without revascularization (non-revascularization group).There were no significant difference in baseline traditional cardiovascular risk factors between the groups. However, the presence of diabetes was significantly more frequent in the revascularization group (63.5% vs 41.0%; P=0.001) than in the non-revascularization group. CUC at the index PCI was significantly lower in the revascularization group than in the non-revascularization group (87.0±19.5 vs 93.9±19.2; P=0.004). Multivariate logistic regression analysis revealed that impaired HDL functionality assessed by decreased CUC level at the index PCI (odds ratio; 0.984, 95% confidence interval; 0.969–1.000) was independently associated with subsequent revascularization after PCI. Indeed, there was a graded inverse association between increasing tertiles of CUC levels and the incidence of revascularization during a median follow-up of 881 days (Figure). Especially in the subgroup analysis of non-diabetic patients, decreased CUC level at the index PCI was independently associated with subsequent revascularization (odds ratio; 0.947, 95% confidence interval; 0.915–0.981), while not in diabetic population.

Conclusion
Serum CUC level at the index procedure was associated with subsequent revascularization especially in non-diabetic patients who underwent PCI.

Funding Acknowledgement
Type of funding source: None
Complement component-7 is a long-term predictor of all-cause mortality in chest-pain patients with suspected acute coronary syndrome
Authors: Aarsetoey R , Ueland T , Aukrust P , Michelsen A.E , Ponitz V , Brugger-Andersen T , Leon De La Fuente R , Staines H , Nilsen D.W.T 
Published: November 2020

Abstract

Introduction
The complement cascade is an important component of the innate immune system. Complement activation plays a major role in chronic inflammation and has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (C7) binds C5bC6 complex being part of the terminal complement complex (TCC/C5b-9).

Purpose
To investigate the prognostic utility of complement C7 for long-term outcome in patients with suspected acute coronary syndrome (ACS).

Methods
Complement C7 plasma-levels were measured by enzyme immunoassay in admission samples from 1823 patients included in a transatlantic prospective cohort study, which consecutively included hospital admitted chest-pain patients with clinically suspected ACS from South-Western Norway and Northern Argentina. Data were pooled for analysis. Univariable- and multivariable Cox proportional-hazards models were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24 months, applying both quartiles (Q1–4) and loge-transformed continuous values of complement C7.

Results
There were 253 (13.9%) deaths, of which 150 (8.2%) were categorized as cardiac death and 76 (4.2%) as SCD. Complement C7 levels were significantly higher in patients who died as compared to long-term survivors [176.9 (142.1–228.7) μg/mL versus 139.8 (110.6–179.7) μg/mL (median, 25 and 75% percentile), p&lt;0.001], and were significantly associated with 24-month survival [log rank p&lt;0.001 for all-cause mortality and cardiac death, log rank p=0.035 for SCD]. In univariable analysis, patients with complement C7-concentrations in the highest quartiles had significantly increased risk of all-cause mortality (Figure 1), cardiac death [Q4: Hazard Ratio (HR) 4.58 (95% confidence interval (CI): 2.65–7.92), p&lt;0.001, Q3: HR 2.69 (95% CI: 1.51–4.80), p=0.001] and SCD [Q4: HR 2.83 (95% CI: 1.36–5.90), p=0.005, Q3: HR 2.33 (95% CI: 1.10–4.92), p=0.027] compared to patients in the lowest quartile (Q1). After adjusting for conventional clinical risk factors for coronary heart disease, complement C7-concentrations in Q4 [HR 2.09 (95% CI: 1.23–3.57), p=0.007] and Q3 [HR 2.21 (95% CI: 1.29–3.81), p=0.004] remained significantly associated with all-cause mortality, reproduced using loge-transformed continuous values.

Conclusion
High levels of complement C7 were found to independently predict long-term all-cause mortality in chest-pain patients with clinically suspected ACS.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority
Low serum calcium levels on admission independently predict mortality in patients with acute myocardial infarction
Authors: Su W , Zhu J.G , Wang M , Zhao X.Q , Li W.P , Chen H , Li H.W 
Published: November 2020

Abstract

Background
Serum calcium levels were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyze the association between serum calcium levels and all-cause mortality in patients with acute myocardial infarction (AMI).

Methods
A total of consecutive 3886 AMI patients with serum calcium data available were included in this analysis. The baseline characteristics, including clinical and laboratory parameters were collected. Patients were classified into 4 equally-sized groups based on serum calcium values (≤2.15, 2.16–2.23, 2.24–2.31, ≥2.32 mmol/L). Serum calcium tests were finished within 12 hours after admission. Patients were followed up for a median of 2.0 years (interquartile range 0.6–4.0). The primary endpoint was all-cause mortality.

Results
Compared to upper quartiles of serum calcium groups, subjects in the lowest quartile group (≤2.15 mmol/L) were older, lower body mass index (BMI), had lower levels of LDL-C and albumin, but higher level of NTproBNP. During a median follow-up period of 2.0 years, all-cause death occurred significantly more in the lowest quartile group (19.8%, 11.9%, 8.0% and 9.2% among the 4 groups from lowest to highest quartile, p&lt;0.001 for trend). After adjusting for potentially confounding variables, the Cox analysis revealed that low serum calcium levels independently predict subsequent all-cause mortality (OR=0.36, 95% CI: 0.18–0.73), and identified that older age, lower BMI, smoking, and higher levels of creatinine were also independently associated with increased risk of mortality.

Conclusion
Low serum calcium levels on admission independently predict mortality in patients with AMI. Further studies are required to determine whether calcium supplementation could improve outcomes in AMI patients with hypocalcemia.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Beijing Natural Science Foundation (no. 7194253);Scientific Research Common Program of Beijing Municipal Commission of Education (KM201910025017)
Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry
Authors: Xu S.L , Luo J , Li H.Q , Li Z.Q , Liu B.X , Qin X.M , Gong M.M , Shi B.B , Wei Y.D 
Published: November 2020

Abstract

Background
New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization.

Methods
This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics.

Results
A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p&lt;0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p&lt;0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p&lt;0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008).

Conclusion
NOAF complicating AMI is strongly associated with an increased long-term risk of heart.
Cumulative incidence of outcome

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai