bluuebunny/crossref_metadata_2025_split huggingface dataset:
P833Two-year clinical outcomes between statin with ACE inhibitor or ARB in patients with ST-segment elevation myocardial infarction after successful PCI with DES
Authors: Kim Y H , Her A.-Y , Jeong M.-H , Kim B.-K , Lee S.-Y , Hong S.-J , Shin D.-H , Ahn C.-M , Kim J.-S , Ko Y.-G , Choi D , Hong M.-K , Jang Y 
Published: October 2019

Abstract

Background
Limited comparative data are available.

Purpose
We decided to compare 2-year major clinical outcomes between statin with ACEI and statin ARB therapy in patients with STEMI after PCI with drug-eluting stents (DES).

Methods
A total 11706 STEMI patients who underwent PCI with DES and who prescribed statin were enrolled and they were divided into two groups, the statin with ACEI group (n=8705) and the statin with ARB group (n=3001). The primary endpoint was the major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR. The secondary endpoints were the cumulative incidences of individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR.

Results
Two PSM groups (2835 pairs, n=5670, C-statistic = 0.680) were generated. The relative risk of MACE was higher in the statin with ARB group compared to statin with ACEI groups after propensity score-matched (PSM) analysis (hazard ratio [HR]: 1.323, 95% confidence interval [CI]: 1.085–1.613, p=0.006). The relative risks of cardiac death (HR: 1.831, 95% CI: 1.199–2.740, p=0.005), total repeat revascularization (HR: 1.487, 95% CI: 1.133–1.950, p=0.004), and non-TVR (HR: 1.696, 95% CI: 1.122–2.564, p=0.012) were also higher in the statin with ARB group after PSM.
Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Statin + ACEI Statin + ARB Log-rank Propensity score matched Patients MACE 173 (6.5) 225 (8.5) 0.006 1.323 (1.085–1.613) 0.006 All-cause death 58 (2.2) 80 (3.0) 0.054 1.391 (0.992–1.950) 0.056 Cardiac death 35 (1.3) 63 (2.3) 0.004 1.831 (1.199–2.740) 0.005 Re-MI 39 (1.5) 44 (1.7) 0.548 1.141 (0.742–1.756) 0.548 Total repeat revascularization 88 (3.4) 128 (4.9) 0.004 1.487 (1.133–1.950) 0.004 TLR 26 (1.0) 40 (1.5) 0.075 1.561 (0.953–2.558) 0.077 TVR 53 (2.0) 71 (2.8) 0.086 1.364 (0.955–1.946) 0.088 Non-TVR 36 (1.4) 60 (2.3) 0.011 1.696 (1.122–2.564) 0.012 TVF 140 (5.3) 173 (6.6) 0.050 1.249 (1.000–1.561) 0.050

Conclusions
In this study, we suggest that the combination of statin with ACEI may be beneficial for reducing the cumulative incidences of MACE, total repeat revascularization rate, and non-TVR rather than the statin with ARB after PCI with DES in STEMI patients.
P840Predicting outcome in patients with symptomatic coronary artery disease: A comparison of available risk assessment scores
Authors: Zdanyte M , Wrazidlo R W , Groga-Bada P , Kaltenbach S , Gawaz M , Geisler T , Rath D 
Published: October 2019

Abstract

Introduction
Thromboischemic and bleeding events are rare but potentially life-threatening complications after percutaneous coronary intervention (PCI). Consequently, duration of dual antiplatelet therapy (DAPT) after coronary stent implantation might be altered due to bleeding or thromboischemic risk. Various risk assessment models have been established to predict adverse events in patients with symptomatic coronary artery disease (CAD). The aim of the present study was to compare available scoring systems based on their performance identifying high-risk patients with symptomatic CAD.

Methods and results
1469 patients were included (n=730 stable CAD and n=739 acute coronary syndrome (ACS)). GRACE 2.0, CALIBER, PREDICT-STABLE, PARIS MB, PARIS CTE and DAPT scores were calculated in appropriate patient subgroups. All patients were followed-up for 360 days for all-cause death (ACD), myocardial infarction (MI), ischemic stroke (IS) and bleeding. The primary combined endpoint (CE) consisted of ACD, MI and/or IS. Secondary endpoints were defined as single occurrence of either ACD, MI, IS, or bleeding. Strong discrimination performance for ACD (AUC=0.82) and IS (AUC=0.84) could be shown for PARIS-MB and CALIBER score, respectively. For ACD, good discrimination performance was found for GRACE (AUC=0.79), CALIBER (AUC=0.71), PARIS-CTE (AUC=0.71) and PREDICT-STABLE (AUC=0.70) score, respectively. For CE and bleeding, we could demonstrate good discrimination performance for GRACE (AUC=0.71) and CALIBER (AUC=0.76) score.
Figure 1

Conclusions
In short-term follow-up, several risk assessment models show strong to good discrimination performance for major adverse cardiovascular events. These prediction models might be used to adjust duration of DAPT in patients with symptomatic CAD.

Acknowledgement/Funding
DFG, KFO-274, SFB-TRR 240
P848Prevalence and Prognosis of Familial Hypercholesterolemia (FH) with Acute Myocardial Infarction (AMI) in China: Chinese Acute Myocardial Infarction (CAMI) Registry
Authors: Wu N Q , Yang J G , Li J J , Dong Q T , Guo Y L , Gao Y , Wang Y , Li W , Yang Y J 
Published: October 2019

Abstract

Background
The prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China is unclear.

Purpose
To invistigate the prevalence and prognosis of familial hypercholesterolemia (FH) with acute myocardial infarction (AMI) in China.

Methods
In China Acute Myocardial Infarction (CAMI) Registry, 13,002 patients with age 18–80 were consecutively enrolled with first-onset acute myocardial infarction who were naïve to statin before admission from Januanry 1st, 2013 to October 31st, 2014. According to Dutch Lipid Clinical Network Criteria (DLCNC), the patients were divided to heterozygous familial hypercholesterolemia (HeFH) (definite or probable HeFH, possible HeFH) or no HeFH group. All the patients were followed up (average follow-up period, 24 months) and composite major adverse cardiovascular events (ENDPOINT) were recorded which were defined as all-cause death, non-fatal myocardial reinfarction and stroke. Cox regression was performed to analyze the difference of composite endpoint occurrence between HeFH group and no HeFH group.

Results
The number of the patients in the three groups was as following, 62 in definite or probable HeFH group, 484 in possible HeFH group, 12456 in no HeFH group. The prevalence of HeFH is 4.2% (including 0.47% of definite or probable HeFH, 3.73% of possible FH). The average age of onset of first-time AMI was 54±12,56±12,63±12 years old (p<0.0001) in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. The percentage of Killip III or above (8.1% vs 4.3% vs 6.3%, p=0.1629), cardiac arrest (1.6% vs 0.6% vs 0.9%, p=0.6990), and TIMI 0–2 grade after primary percutaneous cardiac intervention (PCI) (0% vs 6.8% vs 4.3%, p=0.5866) was not significantly different in definite or probable HeFH group, possible HeFH group and no HeFH group, respectively. After Cox proportional analysis adjusting multiple factors, the rate of composite endpoint during follow-up period was not significantly different (definite or probable HeFH group vs no HeFH group, HR 0. 853, 95% CI 0.381–1.910, p=0.699, possible HeFH group vs no HeFH group, HR1.076, 95% CI 0.795–1.458, p=0.635).
The prognosis of FH with AMI in China

Conclusions
In CAMI Registry, the prevalence of HeFH was 4.2%, the diagnosis of HeFH was not a dependent risk factor for the rate of composite cardiovascular events.
P866Early vascular ageing and acute coronary syndromes in young patients
Authors: Gheorghe-Fronea O F , Ilina A R , Dorobantu M 
Published: October 2019

Abstract

Purpose
To evaluate the prevalence of atherosclerotic coronary lesions in young patients from a very high CV risk country, presented with a first ACS episode and to analyse the association between arterial stiffness, arterial age and the severity of CAD.

Methods
Sixty consecutive patients with age ≤45 years (mean age 41,25±3.99 years; range 22–45 years; 81.7% males) admitted in our department for a first ACS between January 2016 and January 2018 and underwent coronary angiography for evaluation of CAD were enrolled in the study after signing a written informed consent (ACS group) and compared with 60 healthy subjects, age and sex-matched, randomly selected from the SEPHAR III national representative survey's data base. Arterial stiffness parameters and arterial age were measured with an oscillometric device (Arteriograph). Association between arterial age and arterial stiffness and the severity of CAD was assessed by bivariate correlation analysis with adjustments for major confounders.

Results
The main pathogenic mechanism of ACS was represented by the coronarian atherosclerotic lesions (46 cases, representing 76,7%, p<0,001) and the most frequent clinical form was the ST-segment elevation myocardial infarction (53 cases, representing 88,3%, p<0,001). Of all those 46 patients from the SCA that have atherosclerotic lesions, most had univascular disease (univascular – 25 cases, 54.3% vs. bivascular: 14 cases, 30,4% vs. trivascular: 7 cases, 15.2%, p=0.005). ACS group had significantly higher PWVao values than CONTROL group, on average of 2, 87m/s [9,49±1,92 m/s vs. 6,62±1,12/s, p<0.0001; 95% CI = (−3,43m/s; −2,29m/s)]. Arterial age of ACS patients was significantly higher than their own biological age, on average with 5.78 years [mean arterial age 47.03 vs. biological age: 41.25; p<0.0001; 95% CI = (3.91ani; 7.66ani)] while arterial age and biological age were similar in CONTROL group [mean arterial age 40,53 ani vs. mean biological age: 39,63 ani; p=0,207; 95% CI = (−0,73ani; 3,29ani)]. In ACS group, while among patients with normal coronaries, the arterial and biological age were statistically similar (43.25 years vs. 41.53 years; p=0.500), in patients with atherosclerotic lesions (uni-, bi or tri vascular), arterial age was significantly higher compared to biological age, on average with 5.7 years, 5.7 years and 7.5 years respectively. Also, in STEMI group, the severity of CAD was correlated with both PWVao values [rs=0,521 rs2=0.271; p<0,0001] and arterial age [rs=0,512 rs2=0.262; p=0.035].

Conclusions
The results of our study shows that young ACS patients experience an early vascular ageing process reflected by an increased arterial stiffness and significantly higher vascular age compared with normal healthy age and sex-matched controls, leading to an early onset of CAD.

Acknowledgement/Funding
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF.
P871Coronary artery aneurysms: clinical features, management and long-term outcomes, insights from the international coronary artery aneurysm registry (CAAR)
Authors: Nunez-Gil I , Cerrato E , Bollati M , Nombela-Franco L , Alfonso E , Camacho Freire S , Villablanca P , Amat Santos I , De La Torre Hernandez J M , Pascual I , Liebetrau C , Camacho B , Pavani M , Feltes G , Fernandez Ortiz A 
Published: October 2019

Abstract

Background
Coronary Aneurysms are a focal dilatation of an artery segment of >1.5-fold the normal size of adjacent segments. Some limited series suggested an incidence of 0.3–12%. However, coronary aneurysms are not mentioned in practice guidelines and several questions remain unanswered.

Purpose
To investigate its clinical profile, prognostic predictors, and long term outcomes.

Methods
The coronary artery aneurysm registry (CAAR, NCT02563626) is a collaborative effort involving 32 hospitals across 9 countries (Canada, Cuba, Czech Republic, Germany, Italy, Netherlands, Spain, USA and Uruguay). When eligibility was uncertain, cases were reviewed by a core lab.

Results
We reviewed 436,467 consecutive angiographies between 2004–2016. 1,565 patients were ambispectively included. Global incidence was 0.35%. Most were male (78.5%) with a mean age of 65 years. Cardiovascular risk factors were frequent. An aortopathy history was present in 8.7% but a Kawasaki antecedent was unfrequent (0.3%).
The main indication for cath was an ACS in 966 cases. Most aneurysms were saccular and 82 giant. The number of aneurisms was low, mainly with 1–2 (95.8%) and only 3 patients with ≥6, proportionally with more coronary stenosis. The most affected artery was the LAD. Aortopathy was related with higher number of aneurysms. Most received any revascularization, commonly percutaneous (PCI). During a follow-up of 37.2 months, 485 suffered a MACE, (death/heart failure/unstable angina/reinfarction) and 240 died. Age, race, diabetes, renal failure, peripheral disease, acute cath, coronary stenosis, LVEF and anticoagulation remained as predictors of death/MACE after multivariate adjustments, without no major differences comparing CABG vs PCI. No restenosis was found in aneurysm with DES but those with BMS suffered 4 (p=0.002). MACE and death were more frequent in patients who received BMS.
Figure 1

Conclusions
Coronary aneurysmal disease is not uncommon. It is associated with severe coronary stenosis and a high cardiovascular risk burden, pointing out an aggressive atherosclerotic status. Antiplatelet therapy is a reasonable option and interventional procedures safe and effective, compared with surgery. Drug eluting stents should be preferred as the default strategy.

Acknowledgement/Funding
None
P891Psycho-social impact of predictive genetic testing in hereditary heart diseases (PREDICT Study)
Authors: Bordet C , Brice S , Maupain C , Gandjbakhch E , Bertrand I , Palmyre A , Moerman A , Toutain A , Odent S , Brehin A C , Staraci S , Richard P , Tezenas Du Montcel S , Gargiulo M , Charron P 
Published: October 2019

Abstract

Introduction
Hereditary heart diseases are most often characterized by autosomal dominant inheritance and delayed cardiac expression. Predictive genetic testing is offered to asymptomatic relatives to allow targeted medical care with early therapeutics in order to reduce the risk of complications. Psychological issues and socio-professional impact of predictive testing are complex and have been poorly studied. The aim of this study was to evaluate the psychological and socio-professional impact of predictive genetic testing in hereditary heart diseases through a prospective and retrospective study.

Patients and methods
This multicentric French study involved 20 expert centers in hereditary heart diseases. We included 517 adult relatives (42.3±16.7 years, 60.6% females) who performed predictive genetic testing (prospective study: N=264, retrospective study: N=253). The opinion and experience were collected via auto-questionnaires, at various moments in the prospective study, with different items and validated scales (STAI: score for anxiety and IES: impact of event).

Results
In the prospective study, family history was characterized by cardiomyopathy (88.4%) and channelopathies (11.6%). The main motivations for performing the test were: “to remove doubt” (65.3%), “for children” (64.0%), “to benefit from medical supervision” (34.9%). A mutation was present in 39.4% of relatives. No regret was expressed after testing (only 2.3% regrets). The result did not lead to a socio-professional change or family relationship change in 60.7%. Among those who had a change, it was perceived as unfavorable for only 3%. A change in socio-professional status and/or family relationship was mainly related to the result of genetic testing (p<0.0001). The level of anxiety (STAI scale) increased before the test result but then decreased and returned to baseline. Subjects with depression history were more likely to develop anxiety at long term after multivariate analyses (p=0.004). Quite similar results were observed in the retrospective study.

Conclusions
Our results show that contrary to a widespread opinion, the medical benefit was not the main motivation for predictive genetic testing. In most cases, no or marginal adverse psychological and socio-professional impact of genetic testing was observed when performed by a team expert in predictive testing. However careful management is required to identify and manage subjects at risk for increased anxiety or socio-professional change.
P896Effects of tafamidis in patients with transthyretin amyloid cardiomyopathy
Authors: Rettl R , Duca F , Binder C , Capelle C , Aschauer S , Badr Eslam R , Mascherbauer J , Hengstenberg C , Bonderman D 
Published: October 2019

Abstract

Background
Transthyretin amyloid cardiomyopathy (ATTR-CA) is caused by deposition of amyloid fibrils in the myocardium. The deposition occurs when transthyretin (TTR) becomes unstable and misfolds. Tafamidis is a kinetic stabilizer of TTR that prevents tetramer dissociation and amyloidogenesis by TTR.

Methods
Eighteen patients with diagnosis of ATTR-CA (hATTR or wtATTR) from our national amyloidosis registry were treated with 20 mg of tafamidis for a period of six months. In our explorative analysis we aimed to evaluate the effects of tafamdis by changes from baseline of the serum NT-proBNP concentration, 6-minute walking distance, as well as cardiac structure and function.

Results
The exploratory analysis showed a decrease in serum NT-proBNP concentration in tafamidis treated patients, compared to increase in untreated patients (median difference, −481.0 pg/mL). Tafamidis improved the walking distance during the 6-minute walk test at month six, compared to baseline (mean, 31.25 m). Echocardiographic findings revealed an improvement of the global longitudinal strain (mean, 0.77%), a decrease in left atrial size (mean, −1.65 mm) and a decrease in left ventricular size (mean, −4.13 mm) in tafamidis treated patients compared to untreated patients. Due to insufficient power the results did not differ significantly between tafamidis treated patients and untreated patients.
Change from baseline Tafamidis No treatment Treatment Difference p-value Cardiac Biomarkers n=18 n=15   NT-proBNP, ng/L Baseline, median 2740.0 2835.0 CFB to 6 months, median −207.0 274.0 −481.0 0.329 Functional Status n=8 n=7   6MWT, m Baseline, mean 441.00 420.50 CFB to 6 months, mean 31.25 −16.50 +47.75 0.373 Echocardiogram n=17 n=15   LA, mm Baseline, mean 63.41 61.33 CFB to 6 months, mean −1.65 0.60 −2.25   LV, mm Baseline, mean 44.13 41.80 CFB to 6 months, mean −4.13 0.33 −4.46 0.075   LV wall thickness, mm Baseline, mean 22.06 18.47 CFB to 6 months, mean 0.68 −0.60 +1.28 0.055   Longitudinal strain, % Baseline, mean −10.66 −12.42 CFB to 6 months, mean 0.77 −1.03 +1.80 0.652 MRI n=7 n=6   ECV, % Baseline, mean 52.26 44.22 CFB to 6 months, mean 0.81 3.70 − 2.89 0.493   LV mass, g Baseline, mean 187.71 170.33 CFB to 6 months, mean 24.29 19,67 +4.62 0.612

Conclusion
Treatment with tafamidis for a period of six months in patients with ATTR-CA leads to positive effects on NT-proBNP level, 6-minute walking distance, as well as cardiac structure and function compared to untreated patients.
P911High rate of cardiac amyloidosis in elderly patients with aortic stenosis: clinical presentation before and after aortic valve intervention
Authors: Zikry Deitch M , Haberman D , Lifshitz S , Tshori S , Fabricant Y , Voldarsky I , Meladin V , Gandelman G , Goland S , George J , Shimoni S 
Published: October 2019

Abstract

Background
Aortic Stenosis (AS) is the most common valvular heart disease in the Western world. Wild-type transthyretin amyloid (wtATTR) affects the heart, causing restrictive cardiomyopathy. Deposits can be found in up to 25% of individuals >85 years of age at autopsy. Recently several reports showed a relatively high prevalence of transthyretin cardiac amyloidosis (TTR-CA) in patients with AS.

Objectives
The aim of this study was to examine the clinical effects of TTR-CA in patients who have undergone aortic valve replacement therapy and evaluate the outcome of the intervention.

Methods
We recruited patients who underwent surgical (AVR) or percutaneous (TAVI) aortic valve intervention between 2011 and 2018. The patients underwent a Tc99m-PYP scan using SPECT technology which has been shown to be valid for the diagnosis of TTR-CA. We reviewed patient files before (time point 1) and after intervention (time point 2) and at 2 years (time point 3) follow up, and collected data on hospitalizations, laboratory, and echocardiography.

Results
The study included 86 patients, mean age 78±6 years, 55% women. Twenty-nine (33%) participants were diagnosed as positive (VAS 2 and 3) for transthyretin cardiac amyloidosis.There were no differences in baseline characteristics between patients with and without TTR-CA in cardiovascular risk factors and co-morbidities, laboratory parameters and nutritional status. There were no differences in baseline echocardiographic parameters including valve gradients and left ventricular hypertrophy. However, the patients with TTR CA had more advanced diastolic dysfunction compared to patients without TTR CA (P=0.03) and higher pulmonary artery pressure (44±14.75mmhg vs 30.5±11.38mmhg, p=0.06). Before the intervention, patients with transthyretin cardiac amyloidosis had 3.26 times more hospitalizations due to heart failure as compared to patients in the negative group (p=0.01).
After the intervention, diastolic function remained more severely affected in the positive group at all follow-up points compared to the negative group (p=0.05). Similar observations were seen in the measurements of pulmonary arterial pressure (p=0.019 at time 2 and p=0.015 at time 3). Consistent with the echocardiographic findings, patients with transthyretin cardiac amyloidosis had 2.84 times more hospitalizations after intervention for heart failure than patients in the negative group (p=0.02).

Conclusions
Co-existence of transthyretin cardiac amyloidosis and aortic stenosis in the older population is associated with a more severe clinical presentation and with more advanced clinical and echocardiographic signs of heart failure. Improvement after valvular intervention might be limited in terms of symptoms and hospitalizations in this subgroup.

Acknowledgement/Funding
None
P914Balloon aortic valve valvuloplasty as palliative therapy in severe aortic valve stenosis: 10 years experience in a single centre
Authors: Mantovani F , Clavel M A , Jayme F , Valli L , De Mola R M , Leuzzi C , Navazio A , Guiducci V 
Published: October 2019

Abstract

Background
Improved technology together with greater operator experience has led to refinement of balloon aortic valve valvuloplasty (BAV) in recent years. It may provide a palliative treatment option in high-risk patients, highly symptomatic, for whom no other invasive therapy is available. However, there has not been universal adoption of BAV as a standalone therapy.

Methods
A retrospective analysis of ten years of practice of BAV as palliative strategy in patient with symptomatic aortic stenosis between March 2008 and June 2018 was performed. Demographic, clinical, procedural, and follow-up data on all patients were collected.

Results
A total of 152 patients (95 women, 63%) with a mean age of 85±6 years underwent BAV. All patients had severe aortic stenosis, were considered not suitable to aortic valve replacement nor Trans-catheter aortic valve implantation (TAVI) for appreciable comorbidity (STS score 9±5) and had severe symptoms mainly of heart failure which required medical attention. A statistically significant decrease in trans-valvular gradient was observed (peak to peak gradient before BAV 52±22 mmHg, after BAV 29±16 mmHg, delta gradient 24±14 mmHg; p<0.0001). Only one patient, who undergone BAV because of cardiogenic shock, died during the procedure. Considering the high-risk population, intra-hospital mortality was low (7 patients died, 4%). Mortality at 1-year follow-up was 43% and survival free from new hospitalization for heart failure was 63% at 1-year follow-up and 53% at 2 years follow-up. 19 patients (13%) required repeated BAV during follow-up.

Conclusion
BAV as a palliative procedure in high-risk patients who are highly symptomatic, has a low operative mortality in our experience. BAV is associated with a significant reduction in aortic valve gradient and is valuable since half of the patients were alive without re-hospitalizations for heart failure at 2 years follow-up.

Acknowledgement/Funding
None