bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated serum carboxy-terminal telopeptide of type I collagen predicts clinical outcome in patients with acute coronary syndrome who underwent percutaneous coronary intervention
Authors: Aono T , Watanabe T , Toshima T , Takahashi T , Otaki Y , Wanezaki M , Kutsuzawa D , Kato S , Tamura H , Nishiyama S , Takahashi H , Arimoto T , Shishido T , Watanabe M 
Published: November 2020

Abstract

Introduction
Serum carboxy-terminal telopeptide of type I collagen (I-CTP) is a collagen degradation product of type I collagen in the extracellular matrix of the heart, blood vessels, and bone. The serum levels of I-CTP were reportedly a predictive marker for cardiac remodeling after acute myocardial infarction. However, it remains unclear whether I-CTP can predict poor clinical outcome in patient with acute coronary syndrome (ACS).

Purpose
The aim of this study was to investigate the association between serum levels of I-CTP and clinical outcome in patients with ACS.

Methods
Serum levels of I-CTP were measured in 200 patients with ACS who underwent percutaneous coronary intervention (PCI). All patients were prospectively followed during the median follow-up period of 1312 days with the end point of major adverse cardiovascular events (MACE). We divided the patients into tertiles according to serum I-CTP level: low I-CTP group (≤4.4 ng/ml, n=72), middle I-CTP group (4.4–6.4 ng/ml, n=65), and high I-CTP group (≥6.5 ng/ml, n=63).

Results
There were 44 MACE, including 24 all-cause death and 9 rehospitalization due to heart failure. I-CTP was significantly higher in patients with MACE than those without (4.90 [interquartile range (IQR): 3.80–6.38] ng/ml vs. 6.65 [IQR: 5.00–10.08] ng/ml, p&lt;0.001). Kaplan-Meier analysis demonstrated that patients in the highest tertile of I-CTP had the greatest risk of MACE. In a univariate analysis, age, Albumin, estimated glomerular filtration rate (eGFR), low-density lipoprotein cholesterol (LDL-C), brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hsCRP) and I-CTP were significant predictors of MACE. A multivariate Cox proportional hazard analysis showed that the high I-CTP group had a higher risk for MACE (Hazard ratio [HR] 2.6, p=0.049) compared with the low I-CTP group after adjusting for confounding factors.

Conclusions
I-CTP was significantly associated with MACE, suggesting that I-CTP could be a reliable marker for clinical outcome in patients with ACS who underwent PCI.
Figure 1

Funding Acknowledgement
Type of funding source: None
Sex differences in health-related quality of life among acute myocardial infarction survivors: an inverse weighted propensity score analysis
Authors: Dondo T , Munyombwe T , Hall M , Hurdus B , Oliver G , Gale C.P 
Published: November 2020

Abstract

Background
Over 800,000 women in the UK are living with coronary heart disease, which is the main cause of acute myocardial infarction (AMI). Marked improvements have been noted in clinical outcomes following AMI due to improved use of evidence-based treatments. However, sex differences in outcomes following AMI persist, with limited evidence in the literature concerning patient reported outcomes such as health related quality of life (HRQoL).

Purpose
To investigate sex differences in HRQoL following AMI.

Methods
Data on HRQoL among 9,566 survivors of AMI were collected from 77 National Health Service hospitals in England between 1 November 2011 and 24 June 2015. HRQoL at time of hospitalisation with an AMI as well as at 1, 6 and 12 months post discharge were collected using the self-reported EuroQol five dimension questionnaire which contains a descriptive system (EQ-5D ranging from −0.5 “worse than death” to 1 “full health”) and a visual analogue scale (EQ-VAS ranging from 0 “worst imaginable health state” to 100 “best imaginable health state”). Multilevel regression modelling coupled with inverse probability weighting propensity score analysis was used to investigate longitudinal trajectories of sex differences in perceived HRQoL following AMI.

Results
Overall, there were 2,397 (25%) women in the study. HRQoL improved over time, however, women had a lower baseline HRQoL compared with men (EQ-VAS mean (SD) 59.8 (20.4) vs. 64.5 (20.9), and EQ-5D median (IQR) 0.73 (0.52 to 0.88) vs. 0.81 (0.62 to 1.00). Sex differences in HRQoL over time persisted, with women having a reduced HRQoL (EQ-VAS coefficient: −4.41, 95% CI: −5.16 to −3.66 and EQ-5D coefficient: −0.07, −0.08 to −0.06) and across the individual EQ-5D dimensions women were more likely to report problems with anxiety (odds ratio 2.03, 95% CI: 1.80 to 2.29), mobility (1.82, 1.58 to 2.09), self-care (1.75, 1.47 to 2.08), usual activities (1.70, 1.52 to 1.89) and pain (1.59, 1.45 to 1.75).

Conclusion
Although quality of life improves for AMI survivors, women have a lower baseline and worse recovery compared with men.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation, Wellcome Trust, Sir Henry Wellcome Postdoctoral Fellowship
Endothelial dysfunction and cardiovascular mortality in patients with acute coronary syndrome
Authors: Yoshii T , Matsuzawa T , Nakahashi H , Satou R , Akiyama E , Kimura Y , Okada K , Maejima N , Iwahashi N , Hibi K , Kosuge M , Ebina T , Kimura K , Tamura K 
Published: November 2020

Abstract

Background
Although the prognostic value of non-invasive endothelial function test has been reported in several populations including heart failure patients and angina pectoris patients, it is unknown in patients with acute coronary syndrome (ACS). Furthermore, the role of endothelial dysfunction in increased risk for specific causes of death has not been investigated.

Purpose
To study the relation between endothelial dysfunction and the risk of death in ACS patients, both overall and with regard to the main causes of death.

Method
Six hundred and ninety-two patients who were hospitalized for ACS from 2010 to 2014 were enrolled. Reactive hyoeremia index (RHI) was measured to assess endothelial function non-invasively in all patients using the peripheral arterial tonometry. RHI values below 1.67 were interpreted as signs of endothelial dysfunction in accordance with the manufacturer. Patients were followed up for a median of 6.5 years.

Result
A mean age (standard deviation) was 66 (12) years, and 542 patients (78%) were male. The patients in this study consist of 377 ST-elevation myocardial infarction (54%), and 263 non ST-elevation myocardial infarction (38%), and 52 unstable angina (8%). Endothelial dysfunction was detected in 276 patients (40%). During the follow-up period, 84 patients (12%) died (48 from cardiovascular disease, 36 from other causes). Patients with endothelial dysfunction had an increased risk of death (hazard ratio (HR) 1.83, 95% confidence interval (95% CI): 1.19–2.83, p=0.006) compared with those without endothelial dysfunction. Analyses for specific causes of death showed that patients with endothelial dysfunction had a 2.4-fold higher increased risk of cardiovascular death (HR: 2.44, 95% CI: 1.35 ro 4.59, p=0.003) after multivariate adjustment. However there was no significant relation between endothelial dysfunction and non-cardiovascular mortality (HR: 0.69, 95% CI: 0.34 to 1.36, p=0.29).

Conclusion
Endothelial dysfunction is strongly associated with an increased risk of cardiovascular mortality in ACS patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
Haemorrhagic risk of oncology patients with myocardial infarction
Authors: Branco Mano T , Timoteo A.T , Aguiar Rosa S , Cruz Ferreira R 
Published: November 2020

Abstract

The approach of acute coronary syndrome (ACS) in oncology patients (pts) is challenging due to higher haemorrhagic risk.

Objectives and methods
Retrospective analysis of pts included in an ACS registry between October 2010 and September 2019 with cancer (active or diagnosed in &lt;5 years). Aim: evaluate safety and efficacy of single vs dual antiplatelet therapy (DAPT), anticoagulation and revascularization strategy. Primary safety endpoint: major haemorrhagic events (MHE). Secondary efficacy endpoints: ischemic events, intra-hospital (IH) mortality; combined efficacy endpoint of IH mortality, reinfarction and ischemic stroke.

Results
934 pts (5%) of a total of 18845 pts with ACS had diagnosis of cancer. Compare to pts without malignancy, oncology pts were older, had more atrial fibrillation (AF), lower left ventricle ejection fraction (LVEF), underwent invasive coronary angiography (ICA) and angioplasty less often. Oncology pts had more events: MHE (2.9% vs 1.5%, p&lt;0.001), mortality (5.8% vs 3.4%, p&lt;0.001) and combined endpoint (7.4% vs 4.9%, p&lt;0.001). Oncology population: pts with MHE (N=27) had more previous haemorrhagic events, AF, higher creatinine level, ST-Elevation Myocardial Infarction (STEMI), more use of anticoagulation, less use of DAPT or acetylsalicylic acid (ASA) and higher IHmortality. In multivariate analysis, previous haemorrhagic events, AF, STEMI and no ASA were independent predictors of MHE. Pts who reached combined endpoint (N=69) were older, had more renal impairment, thrombocytopenia, STEMI, Killip class &gt; I, lower LVEF, less prescribe with antiplatelet therapy and neurohormonal therapy, less submitted to ICA and a trend to less angioplasty. In multivariate analysis, STEMI, Killip &gt;I, creatinine &gt;2mg/dL, thrombocytopenia, LVEF&lt;40%, no ACEi therapy and no ICA were independent predictors of the combined endpoint (Table 1).

Conclusion
Oncology pts had worse prognosis than general population with ACS. MHE were mainly related to previous haemorrhagic event and AF, associated with anticoagulation strategy. On the other hand, IH mortality, reinfarction and ischaemic stroke were associated with lower use of antiplatelet and neurohormonal therapy and ICA.

Funding Acknowledgement
Type of funding source: None
Has the proportion of patients diagnosed with myocardial infarction that receives a 12 ECG in the prehospital setting in the UK changed over time?
Authors: Quinn T , Watkins A , Hampton C , Halter M , Weston C , Gale C.P , Gavalova L , Driscoll T , Davies G , Snooks H.A 
Published: November 2020

Abstract

Background
Two thirds of patients with Acute Myocardial Infarction (AMI) arrive at hospital in the UK by ambulance, usually staffed by paramedics who routinely carry out 12 lead ECGs for patients with suspected heart attack. However, recent research found that prehospital ECGs were missing for 40% of these patients, with better survival prospects in those who had received one.

Purpose
We are investigating reasons for non-administration of 12 lead ECG for patients diagnosed with AMI, in order to develop an intervention to improve practice. Firstly we explored whether the proportion of patients with AMI that receive a prehospital ECG has changed over time.

Methods
Interrogation of national UK national heart attack register (MINAP) database, extraction of data related to patients brought by ambulance by year.

Results
The cohort of patients diagnosed with AMI and taken to hospital by ambulance ranged from 32410 in 2005 to 60265 in 2017; the proportion with a prehospital ECG increased steadily across this period, from 51% to 78%, an average increase of 1.9% per annum.

Conclusions
Evidence based guidelines supporting the use of 12 lead ECG by ambulance paramedics may have contributed to improvements in care. However, 1 in 5 patients brought to hospital by ambulance still does not receive an ECG prior to arrival, which we know compromises their survival prospects. In order to optimise care we need to establish whether non-administration is a question of misdiagnosis, patient refusal or lack of availability of trained crews/equipment.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Socioeconomic status influences delays in the management of acute ST-elevation myocardial infarction
Authors: Cetran L , Lesaine E , Miganeh-Hadi S , Sevin F , Saillour-Glenisson F , Pradeau C , Coste P 
Published: November 2020

Abstract

Background
A prompt diagnosis to initiate the appropriate reperfusion therapy is crucial to improve clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients. Socio-economic status (SES) refers to parameters like income, educational status and occupation. A low SES negatively interferes with the prognosis of STEMI patients. However, the impact of SES on delay time in acute STEMI remains matter of debate.

Methods
We used databases from two French multicentric and prospective registries: ACIRA (patients undergoing coronary angiography in any catheterization laboratories of Aquitaine) and REANIM (acute STEMI patients supported by emergency medical system (EMS) in Aquitaine). An ecological indicator of social deprivation Fdep09 was calculated to describe geographical inequalities in health based on municipality of residence. The higher the value, the more disadvantaged the population. Low SES was defined as Fdep09 &gt; median value.

Results
Two-thousand-eight-hundred-and-forty consecutive patients with acute STEMI undergoing coronary angiography from January 2017 to December 2018 in Aquitaine were included. Patients with lower SES were more often initially referred to emergency departments of non-percutaneous coronary intervention capable centers whereas patients with higher SES were more often directly transferred to PCI centers by the mobile emergency care units as recommended by the most recent European guidelines (p&lt;10–4). Patients with low SES had longer delays from symptom onset to first medical contact (FMC) (116 [60–119] vs 98 [55–233] min, p=0.0078) and were more likely to receive fibrinolysis (9.9 vs 5.2%, p&lt;10–4). Linear regression modeling showed that each point of the Fdep09 index was associated with increase in the delay from symptom onset to FMC by a factor 1.1 (95% CI: 1.04–1.17, p&lt;10–3) after adjusting for potential confounders.

Conclusion
SES inequality has negative influence on the delays in the management of acute STEMI patients. Efforts to raise awareness of suspicious signs of acute MI among individuals in lower SES could be valuable.
FDep09 distribution

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ARS Nouvelle-Aquitaine
Moving in sync – concordance betweena artificial intelligence and cardiologist on detecting normal electrocardiograms
Authors: Mehta S , Avila J , Villagran C , Fernandez F , Niklitschek S , Vera F , Rocuant R , Cardenas G , Escobar E , Frauenfelder A , Vieira D , Vijayan Y , Pinto G , Ceschim M , Luna M 
Published: November 2020

Abstract

Background
Merging modern technologies with classic diagnostic tests often results in a sense of insecurity within the medical community, particularly so with potentially life-saving studies such as the electrocardiogram (EKG). In order to provide a greater sense of trust between Artificial Intelligence (AI) and cardiologists, we provide an AI-driven algorithm capable of accurately and reliably characterize an EKG as normal within a highly complex, cardiologist-reviewed EKG database and report the degree of concordance between this machine vs physician scenario.

Purpose
To provide a dependable and accurate AI algorithm that conducts EKG interpretation in a cardiologist-tier manner.

Methods
The International Telemedical System (ITMS) developed and tested an EKG assessing AI algorithm and incorporated it into the workflow of their Telemedicine Integrated Platform, a digital EKG reading program where cardiologists continuously report their findings remotely in real-time. During the month of April 2,019; 35 ITMS cardiologists reported a grand total of 61,441 EKG records, later submitting them to the AI algorithm implemented through the “One Click Report” process. Through this simple 2-step approach, the algorithm provides a suggestion of “Normal” or “Abnormal” to the cardiologist based on the patterns of the fiducial points included in said EKG reports. Confirmation of these suggestions by the cardiologists ensued.

Results
Overall, cardiologists confirmed 23,213 out of 25,013 AI outputs for “Normal” EKGs, demonstrating a concordance of 92.8% for Normal diagnosis.

Conclusion
Through this methodology, we provide an AI technology that can be reliably applied and trusted in EKG digital platforms to identify and suitably label a normal EKG. Further testing will accrue into a multi label algorithm compatible with abnormal cardiovascular entities, potentially precluding the role of the cardiologist for triaging, particularly in the prehospital setting. We anticipate that this approach will become a promising methodology in modern cardiology practice.

Funding Acknowledgement
Type of funding source: None
Clinical risk scores and integrated clinical judgment in patients with suspected acute coronary syndrome
Authors: Boeddinghaus J , Meier M , Nestelberger T , Lopez-Ayala P , Ratmann P.D , Wussler D , Wildi K , Rubini Gimenez M , Zimmermann T , Miro O , Martin-Sanchez J , Keller D.I , Gualandro D.M , Twerenbold R , Mueller C 
Published: November 2020

Abstract

Background
Clinical risk scores are recommended for formal risk stratification in patients presenting with suspected acute coronary syndrome (ACS). It is unknown, whether these scores still provide additional value in the era of high-sensitivity cardiac troponin (hs-cTn) compared to simple integrated clinical judgment.

Purpose
To evaluate the diagnostic and prognostic performance of integrated clinical judgment compared to clinical risk scores.

Methods
We prospectively enrolled patients presenting to the emergency department with symptoms suggestive of ACS such as acute chest discomfort. The primary prognostic endpoint was the composite of 30-day major adverse cardiac events (MACE) including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (AMI, including the index event), and urgent coronary revascularization and was adjudicated by two independent cardiologists. The performance of five well-established formal risk scores (T-MACS, HEART, GRACE, TIMI, and EDACS) for the prediction of 30-day MACE was directly compared with simple integrated clinical judgment for the ACS likelihood by the treating ED physician. Integrated clinical judgment was quantified using a visual analogue scale at 90 minutes after patient's presentation to the ED. The primary diagnostic endpoint was index AMI.

Results
Among 2031 patients, 417/2031 patients (20.5%) had at least one MACE within 30 days. Prognostic accuracy for 30-day MACE quantified by the area under the receiver-operating characteristics curve (AUC) was 0.87 (95% CI 0.85–0.89) for T-MACS, 0.87 (95% CI 0.85–0.89) for HEART, 0.84 (95% CI 0.82–0.86) for GRACE, 0.81 (95% CI 0.79–0.83) for TIMI, 0.75 (95% CI 0.73–0.78) for EDACS, versus 0.89 (95% CI 0.87–0.91) for simple integrated clinical judgment (p&lt;0.01 versus GRACE, TIMI, and EDACS; Figure 1). Similarly, diagnostic accuracy was 0.92 (95% CI 0.90–0.94) for T-MACS, 0.89 (95% CI 0.87–0.90) for HEART, 0.88 (95% CI 0.86–0.89) for GRACE, 0.80 (95% CI 0.78–0.82) for TIMI, 0.74 (95% CI 0.72–0.77) for EDACS, versus 0.89 (95% CI 0.88–0.91) for simple integrated clinical judgment (p&lt;0.01 versus GRACE, TIMI, and EDACS).

Conclusion
None of the formal clinical risk scores outperformed simple integrated clinical judgment for ACS in the prediction of 30-day MACE or the diagnosis of AMI. Therefore, in the era of hs-cTn testing as part of integrated clinical judgment, clinical risk scores seem to no longer provide incremental value.
Figure 1. Diagnostic accuracy for MACE at 30-days

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
Validation of a machine learned model to predict the diagnosis of myocardial infarction
Authors: Doudesis D , Yang J , Tsanas A , Stables C , Shah A , Anand A , Lee K , Strachan F , Pickering J , Than M , Mills N 
Published: November 2020

Abstract

Introduction
The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown.

Methods
In an observational analysis from a multi-centre randomised trial, we included all patients with suspected acute coronary syndrome and serial high-sensitivity cardiac troponin I measurements without ST-segment elevation myocardial infarction. Using gradient boosting, MI3 incorporates age, sex, and two troponin measurements to compute a value (0–100) reflecting an individual's likelihood of myocardial infarction, and estimates the negative predictive value (NPV) and positive predictive value (PPV). Model performance for an index diagnosis of myocardial infarction, and for subsequent myocardial infarction or cardiovascular death at one year was determined using previously defined low- and high-probability thresholds (1.6 and 49.7, respectively).

Results
In total 20,761 of 48,282 (43%) patients (64±16 years, 46% women) were eligible of whom 3,278 (15.8%) had myocardial infarction. MI3 was well discriminated with an area under the receiver-operating-characteristic curve of 0.949 (95% confidence interval 0.946–0.952) identifying 12,983 (62.5%) patients as low-probability (sensitivity 99.3% [99.0–99.6%], NPV 99.8% [99.8–99.9%]), and 2,961 (14.3%) as high-probability (specificity 95.0% [94.7–95.3%], PPV 70.4% [69–71.9%]). At one year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability compared to low-probability patients (17.6% [520/2,961] versus 1.5% [197/12,983], P&lt;0.001).

Conclusions
In unselected consecutive patients with suspected acute coronary syndrome, the MI3 algorithm accurately estimates the likelihood of myocardial infarction and predicts probability of subsequent adverse cardiovascular events.
Performance of MI3 at example thresholds

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Medical Research Council