bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soluble urokinase plasminogen activator receptor (suPAR) predicts 2-year cardiovascular events in patients after acute chest pain
Authors: Chew-Harris J , Appleby S , Troughton R.W , Richards A.M , Pemberton C.J 
Published: November 2020

Abstract

Background
Soluble urokinase plasminogen activator receptor (suPAR) is an emerging biomarker of sub-inflammation related to plaque instability. Its modulation may reflect on immune dysfunction related to cardiovascular (CVD) outcomes. We assessed the prognostic performance of suPAR to predict 2-year clinical outcomes in patients with acute chest pain, suspicious of acute coronary syndromes.

Methods
A total of 812 patients presenting to the emergency department with the primary complaint of acute chest pain were prospectively recruited. Baseline suPAR concentrations were measured at presentation using the ViroGates CE-marked ELISA. Standard cardiac markers including hsTnT and NT-proBNP (both Roche) were also measured. Data for all biomarkers were treated as continuous and expressed as median [interquartile range (IQR)]. Statistical assessment was made using SPSS v25 (IBM). Groups were compared by Mann-Whitney U test/Spearman's rho. Prognostic performance of suPAR in comparison with hsTnT and NT-proBNP to predict the primary outcomes of new myocardial infarction (MI), new heart failure (HF), all cause readmission, and the composite of major adverse cardiac events (MACE) were assessed using binary logistic regression after the adjustment of traditional risk factors.

Results
In the entire chest pain cohort [median age: 63 yrs (IQR: 54–74), 34% female], 156/812 of patients had adjudicated AMI [STEMI (n=22)/NSTEMI (n=134)]. suPAR concentrations were found to be lower in males (Spearman's Rho, r=−0.17, P&lt;0.0001) and in those with eGFR ≥60mL/min/1.73m2 (n=439) (r=−0.40, P&lt;0.0001), but elevated in those older than 65 years (n=372) (r=0.55, P&lt;0.0001). During the 2-year follow-up period, there were 54 fatalities, 287 recorded as having new CVD events, 46 diagnosed with new heart failure, 71 with new MI (66 NSTEMI/5 STEMI), 54 with new unstable angina, 126 patients classified with MACE and 190 patients who were readmitted into hospital within 1-year from presentation. In logistic regression analyses, the odds ratio (OR) of suPAR; 8.5 (95% CI:1.8–40.9) to predict a 2-year event (for example new total CVD events) was stronger than hsTnT; OR: 1.2 (95% CI: 0.9–1.5) and NT-proBNP; OR: 0.8 (95% CI:0.8–1.3) (P&lt;0.0001) (Figure). Further, incorporation of baseline suPAR values into multivariate models for predicting events, such as MACE at 2-years (adjusted for age, gender and eGFR), resulted in an improvement in the C-statistic from 0.72 to 0.76.

Conclusion
In this acute chest pain cohort, suPAR concentrations are independent predictors of cardiovascular outcomes at 2 years. suPAR may add value in the risk assessment of patients with acute chest pain.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Health Research Council of New Zealand, National Heart Foundation of New Zealand
External validation of a suggested extension of the ESC 0/1h-algorithm for early rule out of myocardial infarction
Authors: Lopez Ayala P , Nestelberger T , Strebel I , Ratmann P.D , Boeddinghaus J , Koechlin L , Wussler D , Walter J , Rubini Gimenez M , Miro O , Martin-Sanchez F.J , Keller D , Twerenbold R , Mueller C 
Published: November 2020

Abstract

Background
The European Society of Cardiology (ESC) high sensitivity cardiac troponin T 0/1h-algorithm has substantially improved the management of patients with suspected acute myocardial infarction (AMI) by triaging about 75% of patients to rapid rule-out and/or rapid rule-in. However, about 25% of patients remain in the “observe-zone”, and the optimal management of these patients is unknown. Recently, a pilot single center study with a low prevalence of AMI suggested that an absolute change of less than 7ng/L between the 0h and 3h hs-cTnT concentration would allow to help in the evaluation of patients in the observe-zone and allow triage towards rule-out with very high negative predictive value [NPV].

Purpose
To externally validate this suggested modification of the ESC 0/1h-algorithm for early rule out of AMI.

Methods
In an ongoing multicentre international study, we prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of MI. Final diagnoses were centrally adjudicated by two independent cardiologists using all available medical records obtained during clinical care including 90 day follow-up information and cardiac imaging. High sensitivity-cTnT (Elecsys) concentrations were measured at presentation and after 1 and 3 hours. The primary outcome was safety, quantified by the sensitivity and NPV for early rule out of NSTEMI.

Results
Among 1633 enrolled patients with available 0, 1 and 3h hs-cTnT concentrations, NSTEMI was the adjudicated final diagnosis in 337 (20.6%) patients. The ESC 0/1h-algorithm ruled out 918 (56.2%) patients, with a sensitivity of 98.8% (95% confidence interval [CI], 97.0–99.5) and a NPV of 99.6% (95% CI, 98.9–99.8). A total of 428 patients (26.2%) remained in the observe zone. After applying the suggested 0–3 hour absolute change cut-off criteria of 7ng/L, 393 (92.0%) additional patients from the observe zone were triaged towards ruled out. However, the safety of this triage step was poor with 62 patients with NSTEMI missed, resulting in a sensitivity of 33.3% and a NPV of 84.2% for rule-out.

Conclusions
The suggested 0/3h absolute change cut-off of 7ng/L for patients remaining in the observe zone of the ESC 0/1h-algorithm does NOT allow safe rule-out of AMI and should therefore NOT be implemented into routine clinical care.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, the Swiss Heart Foundation, the Stiftung für kardiovaskuläre Forschung Basel, the University of Basel and the University Hospital Basel
Recombinant Interleukin-1 receptor antagonist for the treatment of ST-segment elevation acute myocardial infarction prevents future heart failure events: a pooled analysis of the VCUART program
Authors: Van Tassell B , Wohlford G.F , Ho A.C , Vecchie A , Garmendia C , Trankle C.R , Buckley L.F , Kadariya D , Canada J.M , Carbone S , Markley R , Turlington J.S , Appleton D , Lipinski M.J , Abbate A 
Published: November 2020

Abstract

Background
ST segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). We analyzed the effect of recombinant interleukin-1 receptor antagonist (anakinra) 100 mg subcutaneous injection given once or twice daily for 14 days on the occurrence of HF in a pooled analysis of 3 clinical trials.

Methods
Enrollment criteria and study procedures were the same across the three studies. High-sensitivity C-reactive protein (CRP) was measured at baseline, 72 hours, and 14 days to construct an area under the curve (AUC0–14). Clinical events up to 1 year were adjudicated by an independent committee blinded to treatment allocation. Data for anakinra once daily and anakinra twice daily were pooled into a single anakinra group. CRP data are presented as median and interquartile range to allow for deviation from Gaussian distribution and non-parametric tests were used to evaluate differences between groups. Kaplan-Meier survival analyses were conducted and the intervention groups were compared using a log-rank test.

Results
Between 2008 and 2017, 139 patients with STEMI were enrolled. 84 patients were randomized to anakinra and 55 patients were randomized to placebo. Anakinra significantly reduced the CRP AUC0–14 (76 [42–147] vs 222 [117–339] mg*day/L; P&lt;0.001), the composite of death or HF hospitalization (Chi2=7.167; P=0.007), and the composite of death or new onset HF (Chi2=9.43; P=0.002) compared with placebo. Treatment with anakinra had no effect on ischemic events (composite of death, myocardial infarction, and unstable angina; (Chi2=0.574; P=0.45) or the composite of death, myocardial infarction and cerebrovascular accident (Chi2=0.065; P=0.80). Patients receiving anakinra had increased injection site reactions (20.2% vs 3.6%; P=0.005) but no change in infections (14.3% vs 9.1%, P=0.435) versus placebo.

Conclusions
Treatment with anakinra for 14 days following STEMI blunts the inflammatory response and appears to reduce the occurrence of HF events at 1 year. These results support the hypothesis that early and targeted modification of the inflammatory response in STEMI may be a viable strategy to improve patient outcomes.
Adjudicated events at 1 year

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart Lung and Blood Institute (USA), American Heart Association (USA)
Prasugrel compared to ticagrelor in primary PCI
Authors: Doerler J , Edlinger M , Alber H , Berger R , Frick M , Hammerer M , Hasun M , Huber K , Lamm G , Lassnig E , Von Lewinski D , Roithinger F.X , Siostrzonek P , Steinwender C , Weidinger F 
Published: November 2020

Abstract

Background
Prasugrel and ticagrelor have similar recommendations in the setting of primary PCI by current guidelines. Data comparing both in daily clinical practice of primary PCI for ST-elevation myocardial infarction is limited.

Purpose
To compare the effect of prasugrel and ticagrelor on in-hospital outcomes after primary PCI.

Methods and results
We prospectively enrolled 5365 patients treated with prasugrel (n=2785, 51.9%) or ticagrelor (n=2580; 48.1%) in the setting of primary PCI from January 2011 to December 2018 in a nationwide registry. In-hospital outcomes were compared and multiple logistic regression analysis was performed. Prasugrel treated patients were younger, less often in cardiogenic shock, with lower rates of previous stroke and had shorter ischemic time. Both groups showed similar rates of previous MI, diabetes and current resuscitation. In the univariate analysis mortality was lower in patients with prasugrel (2.5% vs. 4.4% p&lt;0.01). Similarly, MACE (3.3% vs. 5.3%, p&lt;0.01) and NACE (4.0% vs. 5.7% p&lt;0.01) were lower in prasugrel treated patients, whereas major bleeding events did not differ (0.4% vs. 0.6% p=0.24).
After adjustment in multivariable analysis mortality (0.99 95% CI 0.57 to 1.72), MACE (OR 0.99 95% CI 0.65 to 1.52) as well as NACE (0.86 95% CI 0.61 to 1.22) did not differ in patients treated with prasugrel compared to ticagrelor.

Conclusion
Patients treated with prasugrel showed improved outcomes compared to ticagrelor in a large cohort of primary PCI. However, after adjustment for confounders the Advantage of prasugrel in primary PCI did not persist.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Austrian Society of Cardiology
Sex disparities in completeness of revascularisation and outcomes in patients with ST-elevation myocardial infarction and multivessel coronary artery disease
Authors: Mahdi N , Har B , Graham M.M , Basha A , Bizios A 
Published: November 2020

Abstract

Background
In patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD), complete revascularisation is associated with reduced mortality compared to culprit only revascularisation. However, there are limited data regarding the relationship between sex and revascularisation strategy in STEMI with multivessel CAD and outcomes.

Purpose
Our aim is to evaluate sex related differences in treatment strategies and outcomes in patients with STEMI and multi-vessel CAD.

Methods
We included all consecutive patients from a provincial registry presenting with STEMI and multivessel CAD treated with percutaneous coronary intervention (PCI) from 2008–2015. The study population consisted of 856 females and 3152 males who were treated with culprit vessel only PCI or complete revascularisation using staged-PCI. The outcomes were death, admission for acute coronary syndrome (ACS), and admission for heart failure (HF). Multivariate Cox proportional hazard models were used to examine the association between treatment strategy and outcomes. Backward stepwise logistic regression was used to identify predictors of patients undergoing staged-PCI versus culprit vessel only PCI.

Results
At 3 years, the incidence of death was higher in females than males (15.9% vs. 8.2%, p&lt;0.001), as were HF admissions (10.3% vs. 5.0%, p&lt;0.001). Females underwent less staged-PCI than males (10.4% vs. 14.8%; adjusted odds ratio 0.75; 95% CI 0.57–0.97). Younger age and increasing Duke jeopardy score were also associated with performing staged-PCI.
After adjusting for baseline characteristics, females had a higher risk of death (HR 1.35; 95% CI 1.07–1.71), ACS admission (HR 1.27; 95% CI 1.00–1.60), and HF admission (HR 1.38; 95% CI 1.03–1.85). Following additional adjustment for revascularisation strategy, only death and HF admission remained significant. Females undergoing staged-PCI had similar survival to males (figure), with no significant interaction between revascularisation strategy and sex (p for interaction = 0.19)

Conclusion
Females with STEMI and multivessel CAD were less likely to be treated with complete revascularisation by staged-PCI and had worse outcomes when compared to males. Survival in both males and females treated with staged-PCI was similar. Our study suggests that addressing the lack of complete revascularisation in females presenting with STEMI may improve outcomes.
Figure 1

Funding Acknowledgement
Type of funding source: None
External validation of PRECISE-DAPT score and PARIS bleeding risk score in a real-world cohort of patients with acute coronary syndrome
Authors: Chan Pin Yin D.R.P.P , Claassens D.M.F , Van Baal F.P , Vos G.J , Peper J , Kelder J.C , Ten Berg J.M 
Published: November 2020

Abstract

Background
In patients with acute coronary syndrome (ACS) shortened duration of dual antiplatelet therapy (DAPT) should be considered in those at high risk of bleeding. Risk scores may be used to assess the bleeding risk, but their predictive value remains unclear.

Purpose
To externally validate and compare the PRECISE-DAPT and the PARIS bleeding risk scores in patients with ACS.

Methods
From January 2015 to June 2018, all patients admitted with ACS were consecutively included in a single center, observational, prospective registry with follow-up of at least one year. In all patients, the PRECISE-DAPT and the PARIS risk-score were retrospectively assessed. Primary endpoint was moderate or severe bleeding defined as Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding within one year after ACS. Kaplan-Meier curves showed the probabilty of bleeding during follow-up as assessed by both scores. Score discrimination using c-statistic were calculated and calibration curves were visually assessed.

Results
2,729 patients were included for analysis. 93.6% were discharged with ≥2 antithrombotic drugs. At one year follow-up, the event rate of moderate or severe bleeding was 5.5%. High bleeding risk as stratified by both risk scores was associated with higher bleeding rates. Discriminative values for BARC 3 or 5 bleeding at one year were 0.67 [95% CI 0.61–0.72] for the PRECISE-DAPT score and 0.62 [95% CI 0.57–0.68] for the PARIS bleeding score (p=0.31).

Conclusion
The PRECISE-DAPT and the PARIS bleeding scores both showed adequate discriminative performances in predicting moderate or severe bleeding in this study.
Kaplan-meier and ROC-curves

Funding Acknowledgement
Type of funding source: None
Sex-related differences in mortality and heart failure after nstacs. the cardio chus-hsuj registry
Authors: Abou Jokh Casas C , Alvarez Alvarez B , Cordero A , Agra Bermejo R , Alvarez Rodriguez L , Rodriguez Ferreiro T , Martinez Gomez A , Rigueiro P , Garcia Acuna J.M , Gonzalez Juanatey J.R 
Published: November 2020

Abstract

Introduction and objectives
A sex-specific analysis of cardiovascular outcomes afternon-ST segment elevation acute coronary syndrome (NSTACS) using a large contemporary cohort of patients from two Spanish tertiary hospitals.

Methods
This retrospective observational study included 5686 consecutive NSTACS patients between the years 2003 and 2017. We performed a propensity score matching to obtain a well-balanced subset of patients, resulting in 3120 patients. Cox regression models performed survival analyses once proportional risk test were verified.

Results
Among the study participants, 1572 patients (27.6%) were women. The median follow-up was 60.0 months (standard deviation 32 months). Women had higher risk of cardiovascular mortality compared with men (OR (Odds ratio) 1.27, CI (confidence interval) 95% 1.08–1.49) and heart failure (HF) hospitalization (OR 1.39, CI 95% 1.18–1.63), but a similar risk of all-cause mortality (OR 1.10, CI 95% 1.08–1.49). After a propensity score matching, women were associated with a significant reduction in the risk of total mortality (OR 0.77, CI 95% 0.65–0.90) with a similar risk of cardiovascular mortality (OR 0.86, CI 0.71–1.03) and HF hospitalization (OR 0.92, CI 95% 0.68–1.23). After adjustment for baseline characteristics, the risks of all-cause mortality and cardiovascular mortality were less in women; although the risk of HF was similar among sexes.

Conclusions
Women are at similar risk to develop early and late HF admissions after NSTACS, and have better survival compared with male, with lower risk of all-cause mortality and cardiovascular mortality.
Cumulative risk according to gender

Funding Acknowledgement
Type of funding source: None
Early monomorphic ventricular tachycardia is associated with increased long-term mortality in STEMI
Authors: Demidova M , Ulfarsson A.O , Carlson J , Erlinge D , Platonov P.G 
Published: November 2020

Abstract

Background
Malignant ventricular arrhythmias occurring early during ST-elevation myocardial infarction (STEMI) are known to markedly contribute to increased in-hospital mortality, but not to influence the long-term prognosis. However recent data advocate differential approach to the type of arrhythmia and indicate long-term hazard of monomorphic ventricular tachycardia (VT).

Purpose
We aimed to evaluate the prognostic value of monomorphic VT compared to non-monomorphic VT or ventricular fibrillation (VF) during the first 48 hours of STEMI in non-selected cohort of STEMI patients admitted for primary PCI.

Methods
Consecutive STEMI patients admitted to a tertiary care hospital for primary PCI during 2007–2010 were included. The Swedish national SWEDEHEART registry was used for assessment of clinical characteristics and the presence of VT/VF during index admission. The occurrence and type of VT/VF during the first 48 hours from symptom onset were verified in medical records. Information on all-cause mortality endpoint 8 years after STEMI was obtained from the Swedish Cause of Death Register.

Results
In total, 2277 patients were included (age 66±12 years, 70% male). Early monomorphic VT during index STEMI was documented in 35 (1.5%) and non-monomorphic VT or VF – in 115 (5.1%) patients. Patients with monomorphic VT had similar clinical characteristics compared to those with non-monomorphic VT/VF with a trend of higher prevalence of history of myocardial infarction by index admission among those with monomorphic VT (31% vs 21%, p=0.256). In total, 22 (63%) patients with monomorphic VT and 43 (37%) with non-monomorphic VT/VF died by 8 years of follow up (p=0.011). Monomorphic VT was associated with a higher risk of all-cause mortality compared to non-monomorphic VT/VF in a univariate analysis (HR 2.03, 95% CI 1.21–3.39, p=0.007) and after adjustment for age and history of myocardial infarction (HR 1.74, 95% CI 1.02–2.97, p=0.041) (Figure).

Conclusion
Monomorphic VT during the first 48 hours of STEMI is associated with a higher risk of all-cause mortality compared to non-monomorphic VT/VF and deserves further studies in order to refine risk stratification strategies.
Survival after STEMI by VT/VF &lt;48 hours

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Swedish Heart-Lung Foundation
Impact of pre-hospital resuscitation on short-and long-term mortality in patients with cardiogenic shock and multivessel disease. Results of the CULPRIT trial
Authors: Zeymer U , Alushi B , Lauten A , Akin I , Desch S , De Waha-Thiele S , Leistner D , Ouarrak T , Schneider S , Thiele H 
Published: November 2020

Abstract

Background
There are only a few prospective data on the outcome of patients with cardio-pulmonary resuscitation (CPR) admitted with acute myocardial infarction (AMI) complicated by cardiogenic shock and an invasive strategy including primary percutaneous coronary intervention (PCI). Therefore, we evaluated the impact of pre-hospital CPR on outcomes in a large group of patients with AMI complicated by cardiogenic shock.

Methods
We used the data of the prospective CULPRIT-Shock trial and registry and including patients with acute myocardial infarction complicated by cardiogenic shock. The primary endpoint was 30-day mortality or renal replacement therapy.

Results
Between 2013 and 2017, a total of 1055 patients were included in the randomized trial (n=686) and in the registry (n=369), 550 (54%) had CPR, 40 had no information regarding CPR. Baseline characteristics, procedural features and outcomes in the two groups with and without CPR are given in the table.

Conclusion
Patients with pre-hospital CPR represent more than half of the population with AMI complicated by cardiogenic shock. They are younger, have less risk factors and more often LAD as infarct vessel. Despite the younger age and a high success rate of PCI patients with CPR have a high 30-day mortality.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Deutsches Zentrum fuer Herz-Kreislauf-Forschung - DZHK