bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of thrombophilia and antiphospholipid syndrome in myocardial infarction with non-obstructive coronary arteries and cryptogenic stroke
Authors: Kruchinova S 
Published: November 2020

Abstract

The role of thrombophilia in myocardial infarction without obstructive coronary artery disease (MINOCA) is unclear.
We investigated thrombophilic factors in patients with MINOCA in comparison with a group of patients with cryptogenic stroke.

Methods
92 patients (mean age: 52.5 years) were evaluated at least 2 months after hospitalization for I MINOCA. The control group was age-comparable patients with cryptogenic stroke (n=90) and the group of patients with myocardial infarction with obstructive coronary artery disease (MI-CAD) (n=80). Thrombophilia screening included hereditary thrombophilia (factor V Leiden, prothrombin mutation G20210A, protein C, protein S or antithrombin deficiency), antiphospholipid syndrome (APS), along with factor VIII &gt;150%, homocysteine ≥15 μm and lipoprotein (a) ≫30 mg/dl.

Results
Compared to cryptogenic stroke, in the MINOCA group, men were more common among patients (56.2 vs. 33.3%, P&lt;0.001), obesity was more common among risk factors (31.5 vs. 16.9%, P=0.014), smoking (54.2 vs. 39.7%, P=0.042), as well as a burdened family history (18.4 against 7.0%, P=0.004). Hereditary thrombophilia occurred in 25.8% of patients with MINOCA and in 17.1% with cryptogenic stroke (P=0.17). APS was found in 15.5% of MINOCA. APS was diagnosed less frequently in patients with NSTEMI, (2.9 versus 21.3% P=0.002) and in patients with MINOCA aged ≤55 years (4.1 versus 36.3% for the elderly, P=0.005).

Conclusions
In patients with MINOCA, there is a high prevalence of thrombophilia, including APS, similar to cryptogenic stroke. Our first comprehensive study of thrombophilia in MINOCA confirms its clinical significance.

Funding Acknowledgement
Type of funding source: None
High sensitivity C-reactive protein is associated with worse infarct healing after revascularized ST-elevation myocardial infarction
Authors: Tiller C , Reindl M , Holzknecht M , Lechner I , Simma F , Schwaiger J , Mayr A , Klug G , Bauer A , Reinstadler S.J , Metzler B 
Published: November 2020

Abstract

Background
The inflammatory response due to myocardial tissue injury in the setting of acute ST-elevation myocardial infarction (STEMI) is essential for proper local infarct healing. However, an excessive inflammatory response may aggravate myocardial damage and hampers infarct healing processes. The present study aimed to investigate the association of systemic inflammatory biomarkers with infarct size (IS) dynamics post-STEMI, using cardiac magnetic resonance (CMR) imaging.

Methods
This prospective observational study included 245 STEMI patients treated with primary percutaneous coronary intervention (pPCI). Peak values of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBCc) and fibrinogen were determined serially until 96 hours after pPCI. Infarct healing, defined as relative IS reduction from baseline to 4 months after STEMI, was assessed using late gadolinium enhanced CMR imaging.

Results
IS significantly decreased from 16% of left ventricular mass (LVM) (Interquartile range [IQR]:8–24) at baseline to 10% (IQR:5–17) at 4 months (p&lt;0.001). Relative IS reduction was 35% (IQR:8–50). Whereas peak WBCc (p=0.926) and peak fibrinogen (p=0.161) were not significantly associated with relative IS reduction, peak hs-CRP showed a significant association with IS reduction (p=0.003). In multivariable logistic regression analysis, the association between peak hs-CRP and relative IS reduction remained significant after adjustment for baseline IS, hypertension, hs-cardiac troponin T and N-terminal pro B-type natriuretic peptide (odds ratio:0.35 [95% confidence interval:0.19–0.63]; p=0.001).

Conclusions
In STEMI patients treated with pPCI, hs-CRP was independently associated with 4 months IS reduction as determined by CMR, suggesting a pathophysiological interplay between inflammation and adverse infarct healing in survivors of acute STEMI.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Austrian Society of Cardiology
Characterizing genetic variants for DAG and IP3 signalling pathways in severe cases of coronary spastic angina
Authors: Shibutani S , Yonekura M , Nosaka M , Kawamura Y , Hanada K , Kasai S , Yokota T , Higuma T , Itoh K , Tomita H 
Published: November 2020

Abstract

Background
We previously reported that the activity of phospholipase C (PLC), a key molecule for intracellular calcium signaling, was enhanced in patients with coronary spastic angina (CSA). Furthermore, we found PLC-δ1 864 G to A mutation in about 10% of the male CSA patients. However, comprehensive understanding of genetic role in the pathogenesis of CSA remains to be elucidated.

Purpose
We tested the hypothesis that variants in the genes responsible for contraction signaling, especially a Ca2+-dependent mechanism, plays an important role in the pathogenesis of CSA.

Methods and results
Exome sequencing was performed to genotype comprehensively CSA cohort, enabling investigation of 258 gene network for diacylglycerol (DAG) and inositol trisphosphate (IP3) signallings, which are responsible for contraction signaling in the vascular smooth muscle cell (VSMC) by a Ca2+-dependent mechanism.
The study population included 30 Japanese patients with severe cases of CSA (18 men and 12 women with a mean age of 62.2±10.1 years). In 23 patients, ST segment elevation was recorded on the electrocardiogram during a spontaneous attack. In other 3 patients, ventricular fibrillation occurred following CSA attacks. The rests were diagnosed by ECG changes and elevated cardiac enzymes following CSA attacks. Genetic information from these CSA patients were compared with those from 914 healthy controls.
Frequencies of 17 common, functional polymorphisms of DAG and IP3 signallings were statistically similar to those of healthy controls. By high-quality (Call Quality ≥20, Read Depth ≥10), and predicted-deleterious (CADD score ≥20) filterings, the number of the candidate genes were narrowed from 234,445 to 17,738, and by selecting genes for DAG and IP3 signallings, further narrowed to 208 genes. Compared with 914 healthy controls, DAG and IP3 signalling genes revealed 26 variants in 15 genes in CSA cases, and by further filtering for rare (914 healthy control frequency &lt;1%), 21 variants in 12 genes were found. They shared variants in G protein subunit alpha q (GNAQ), phospholipase C beta 3 (PLCB3), inositol 1,4,5-trisphosphate receptor type 3 (ITPR3), glutamate ionotropic receptor NMDA type subunit 2D (GRIN2D) in ≥5 cases. By filtering for high-quality, predicted-deleterious, and rare, genetic variants related with DAG and IP3 signalling were more found in severe CSA patients compared with healthy controls (CSA 4.33/person vs healthy controls 2.60 /person).

Conclusions
These findings indicate genetic heterogeneity in CSA susceptibility and a likely polygenic basis, giving a cumulative effect on DAG and IP3 signalling pathways in a subset of individual CSA patients. Study of larger cohorts is warranted to define genetic risk factors for CSA.

Funding Acknowledgement
Type of funding source: None
Participation in a research study related to acute myocardial infarction is not a guarantee to live more longer: results from the FAST-MI registries
Authors: Puymirat E , Schiele F , Roubille F , Tea V , Ferrieres J , Simon T , Danchin N 
Published: November 2020

Abstract

Background
The main potential benefits of participating in a clinical trial is to have access to a treatment that is not available yet and to have a regular and careful attention from physicians. Several data have suggested that inclusion in a research study was associated with better clinical outcome.

Aims
The aim of this study is to describe the prevalence of inclusions in a research study (i.e., device or medication), clinical characteristics, management and clinical outcome in patients admitted for acute myocardial infarction (AMI) according to participation in a research study (versus not) using data from the French registries of Acute ST-or non-ST-elevation Myocardial infarction (FAST-MI) 2010 and 2015.

Methods
We used data from 2 one-month French registries, conducted 5 years apart, including 9,414 AMI admitted to coronary or intensive care units. We analyzed baseline characteristics, management and one-year survival according to participation in a research study.

Results
From 2010 to 2015, the prevalence of patients included in a research study decreased from 6.8% to 3.6% (P&lt;0.001). Inclusions were performed mainly in university hospitals (8%). Clinical characteristics according to participation in a research study were strongly different. Overall, patients included in a research study were younger (61.2±12.7 vs 65.7±14.1; P&lt;0.001) with less previous medical history and co-morbidities. Clinical presentation was preferentially a ST-elevation myocardial infarction (STEMI: 70% vs 52%; P&lt;0.001) in these patients who had a lower GRACE score (133±32 vs. 141±35; P&lt;0.001). The use of invasive strategies was more used in patients included in a research study (coronary angiogram: 99% vs 95%, P&lt;0.001) as prescriptions of recommended medications (i.e., antiplatelet agents, beta-blockers, angiotensin-converting-enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and statins) at discharge (72% vs 63%; P&lt;0.001).
In a cox multivariate analysis, participation in a research study was not associated with lower mortality at one-year (HR= 0.68, 95% CI, 0.39–1.18, P=0.17). Similar results were observed in patients discharge alive (HR= 0.81, 95% CI, 0.44–1.48, P=0.49). Recommended medications were however more used in patients included in a clinical trial (OR=1.34; 95% CI, 1.09–1.65; P=0.007).

Conclusions
The number of inclusions in a research study related to AMI in France is low. Our data suggest that patients included in a research study are selected and received more recommended medications and invasive strategies. However, this management is not associated with a lower mortality at one-year.

Funding Acknowledgement
Type of funding source: None
Premature acute coronary syndrome
Authors: Menezes Fernandes R , Mota T , Bispo J.S , Azevedo P.M , Bento D , Guedes J , Carvalho D , Marques N , Santos W , Mimoso J , Jesus I 
Published: November 2020

Abstract

Introduction
The prevalence of acute coronary syndrome (ACS) at an early age is rising, resulting in higher morbidity and mortality rates.

Purpose
To characterize patients admitted with premature ACS, comparing with those with non-premature ACS.

Methods
A retrospective study encompassing patients of a National Registry of ACS was performed. We compared two groups: one composed of men &lt;55 and women &lt;65 years-old; and other with men ≥55 and women ≥65 years-old at the ACS admission. Clinical characteristics, in-hospital evolution and 1-year clinical outcomes were analysed. Primary endpoint was the composite of in-hospital mortality, stroke and re-myocardial infarction (MI). Secondary endpoints were re-MI, stroke, in-hospital and 1-year mortality, 1-year cardiovascular (CV) and non-CV readmissions.

Results
A total of 26523 patients were enrolled and 6637 (25%) had premature ACS, with a mean age of 49±7 years-old. It was found a larger prevalence of smoking habits, obesity and dyslipidemia, but not diabetes. ST-segment elevation MI (STEMI) was the main admission diagnosis (51,2% vs 40,3%), with more frequent activations of the STEMI network (17,1% vs 12,8%) and a consequently shorter time from symptom onset to admission (483 vs 584 min). Coronary angiogram was largely performed in younger patients (91,4% vs 82,1%), mainly revealing one-vessel disease (49,3% vs 34,3%). They had lower Killip-Kimbal (KK) class (6% vs 18,1% with KK class &gt;1) and mostly preserved left ventricular ejection fraction (LVEF) (67,3% vs 58,6%). Major bleeding (0,9% vs 1,7%), sustained ventricular tachycardia (1,1% vs 1,5%) and mechanical complications (0,2% vs 0,7%) were uncommon. Composite endpoint was more frequent in non-premature ACS patients (6,2% vs 1,9%). Non-premature age, KK class &gt;1, multivessel disease and depressed LVEF were independent predictors of primary endpoint (each with p&lt;0,001). Younger patients had inferior rates of in-hospital mortality (1% vs 4,7%), re-MI (0,5% vs 1%) and stroke (0,4% vs 0,7%). One-year mortality (1,7% vs 9,1%), and 1-year CV (9,7% vs 15,5%) and non-CV readmissions (3,7% vs 8,2%) were also lower. All comparative data presented have a statistically significant p-value (p&lt;0,012).

Conclusions
Premature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, primary prevention is essential to correct modifiable CV risk factors and reduce coronary events in these patients.

Funding Acknowledgement
Type of funding source: None
Evaluation of clinical features and metrics of care in women with st-elevation myocardial infarction treated in a pharmaco-invasive strategy network
Authors: Melo E.S , Veloso P.M , Terencio A.S , Souza J.G , Batista E.P , Fragoso A.O.S , Moritz M.A , Gioia L.N , Coelho G.M.M , Galhardo A , Souza J.M.A , Moraes P.I.M , Goncalves Jr I , Barbosa A.H.P , Caixeta A.M 
Published: November 2020

Abstract

Introduction
Despite worse cardiovascular outcomes, including higher mortality, reported in women with acute myocardial infarction, it is uncertain whether these differences can be explained by a discordant risk profile between genders.

Objective
To compare clinical data and metrics of care between women and men diagnosed with ST elevation myocardial infarction (STEMI).

Methods
We analyzed 2723 consecutive STEMI patients, of whom 29.8% (811) were women, treated in a regional network from March-2010 to December-2019, first seen in primary hospitals, where they received fibrinolysis (96% tenecteplase), and then systematically transferred to a tertiary center for cardiac catheterization (pharmaco-invasive strategy). Categorical variables were compared using chi-square test and numerical variables expressed as median and interquartile range and compared using Mann-Whitney test. A binary logistic regression model was developed to determine whether female gender was an independent predictor of mortality.

Results
Compared to men, women were older (60 [53–69] x 56 [49–63] years; p&lt;0.01), had more hypertension (68.9% x 56.5%; p&lt;0.01), diabetes (36.6% x 28.3%; p&lt;0.01), hypothyroidism (12.0% x 3.3%; p&lt;0.01), kidney failure with an estimated creatinine clearance &lt;60 mL/min (24.7% x 15.4%; p&lt;0.01) and higher baseline LDL-cholesterol (128 [107–160] x 124 [100–154] mg / dL; p=0.03). Smoking (65.2% x 58.2%; p&lt;0.01) and alcoholism (16.1% x 3.1%; p&lt;0.01) were more frequent in men. Regarding the metrics of care, women had longer times from symptoms onset to first medical contact (120 [60–240] x 115 [60–210] minutes; p=0.02) and longer pain-to-needle median times (69 [42–120] x 72 [49–120] minutes; p=0.03). There was no difference between genders regarding percentage of failure reperfusion after lytic, median time from fibrinolysis to cardiac catheterization, maximum troponin values and days of hospitalization. Women had higher unadjusted in-hospital mortality (8.0% x 4.8%; p&lt;0.01). However, after adjusting for confounding variables in the multivariate regression model, the female gender was not an independent predictor of death (odds ratio 1.17 with a 95% confidence interval of 0.69–1.80).

Conclusion
After adjusting for risk variables, female gender was not related to higher in-hospital mortality in STEMI patients treated with pharmaco-invasive strategy. However, women had a higher cardiovascular risk profile compared to men and worse metrics of care, including greater delay in reperfusion therapy.

Funding Acknowledgement
Type of funding source: None
Aggressive lipid lowering therapy with pitavastatin and ezetimibe improve cardiovascular outcomes in patients with ST segment elevation myocardial infarction: insights from the HIJ-PROPER Study
Authors: Otsuki H , Arashi H , Nakazawa M , Inagaki Y , Ebihara S , Tanaka K , Nakao M , Watanabe E , Ogawa H , Yamaguchi J , Hagiwara N 
Published: November 2020

Abstract

Aims
The purpose of this study was to evaluate the effect of aggressive lipid-lowering therapy with pitavastatin and ezetimibe in patients with ST-segment elevation myocardial infarction (STEMI) as compared with those with other classification of an acute coronary syndrome (ACS) including non-STEMI (NSTEMI) and unstable angina pectoris (UA).

Methods
This is a post hoc sub-analysis of the HIJ-PROPER study. In the original study, ACS patients with dyslipidemia were randomized to either pitavastatin + ezetimibe therapy or pitavastatin monotherapy. In the present analysis, we divided HIJ-PROPER participants into the STEMI group (n=880) and NSTEMI + UA group (n=841). Cardiovascular events were analyzed between the two groups. The primary endpoint was a composite of major advanced cardiovascular events (MACE; all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina pectoris, and ischemia-driven revascularization)

Result
During median follow-up period of 3.4 years, the cumulative incidence of the primary endpoint in STEMI group was 31.9% in the pitavastatin+ezetimibe therapy, compared with 39.7% in the pitavastatin-monotherapy (HR, 0.77; 95% CI, 0.62–0.97; p=0.02). However, there was no effect of pitavastatin+ezetimibe therapy on the primary endpoint in the NSTEMI + UA group. Concerning the individual components of the primary endpoint in STEMI group, the percentage of occurrence of all-cause death was significantly lower in the pitavastatin+ezetimibe therapy compared to pitavastatin mono-therapy (14 patients (3.2%) vs. 31 patients (6.9%), respectively; HR, 0.45; 95% CI, 0.23–1.84, p=0.01). Multivariate analysis revealed that use of ezetimibe and prevalence of diabetes mellitus at baseline were independent predictors of primary endpoints in STEMI group (HR, 0.79; 95% CI, 0.63–0.99; p=0.04 for use of ezetimibe, HR 1.54; 95% CI, 1.22–1.94, p=0.0003 for diabetes mellitus).

Conclusion
Patients with pitavastatin+ezetimibe therapy as compared with pitavastatin-monotherapy had lower cardiovascular event in patients with ST-segment elevation myocardial infarction.
Kaplan-Meier curves for primary endpoint

Funding Acknowledgement
Type of funding source: None
Prognostic impacts of prehospital age shock index in patients with acute myocardial infarction
Authors: Hirota Y , Moriwaki K , Takasaki A , Takamura T , Kurita T , Fujii E , Saito Y , Yamada N , Ito M , Dohi K 
Published: November 2020

Abstract

Introduction
Early identification of high-risk patients is the cornerstone of managing patients with acute myocardial infarction (AMI). Age Shock index (ASI; age multiplied by the ratio of heart rate/systolic blood pressure) has been reported to be similar to Global Registry of Acute Coronary Events (GRACE) risk score for predicting mortality in patients with AMI. However, prognostic impacts of prehospital ASI (pre-ASI) in patients with AMI remain unknown.

Methods
We analyzed of 2578 AMI patients who underwent emergency primary percutaneous coronary intervention (PCI) from January 2013 to March 2018, using data from Mie ACS Registry, a prospective and multicenter registry in Japan. Pre-ASI was recorded by emergency medical services at the first contact with the patient before admission, and in-hospital ASI (in-ASI) was recorded prior to PCI at admission. The primary end point was defined as all-cause death.

Results
Median follow-up duration was 753 days (497–838 days). All-cause death was observed in 230 (8.9%) patients. The ROC-AUC (Receiver operating characteristic-area under the curve) of pre-ASI for all- cause death was 0.76 (p&lt;0.001), which was similar to that of in-ASI (0.78, p&lt;0.001) (p=0.25 for pre-ASI versus in-ASI). The cut-off value for pre-ASI and in-ASI was for the prediction of all-cause death was both 45 with a sensitivity of 0.66 and a specificity of 0.78, with a sensitivity of 0.68 and a specificity of 0.76 respectively. According to the Kaplan-Meier survival analysis by combination of pre-ASI≥45 and in-ASI≥45, the patients with pre-ASI≥45 and in-ASI≥45 showed significantly higher all-cause mortality compared to the patients with pre-ASI≥45 and in-ASI&lt;45, the patients with pre-ASI&lt;45 and in-ASI≥45, and the patients with pre-ASI&lt;45 and in-ASI&lt;45 (p&lt;0.001) (Figure). The addition of pre-ASI≥45 to in-ASI≥45 (global chi-squared score: 205) resulted in a significantly increased global chi-squared score, suggesting the incremental prognostic value of pre-ASI (267; p&lt;0.001). Multivariate cox proportional hazard regression analysis for all-cause mortality demonstrated pre-ASI≥45 was a significant independent predictor (HR: 4.86; 95% CI: 3.36 to 7.02, p&lt;0.001). It was strongest predictor compared to left ventricular ejection fraction&lt;40% (HR: 2.45; 95% CI 1.67 to 3.58, p&lt;0.001), hemodialysis (HR: 3.45; 95% CI 1.66 to 7.17, p=0.001), door to balloon time&gt;90 minutes (HR: 1.66; 95% CI 1.18 to 2.34, p=0.004).

Conclusions
High pre-ASI predict increase mortality and assessment of both high pre-ASI and high in-ASI enhance risk stratification in patients with AMI. Early recognizing high pre-ASI may help us make better strategies and improve prognosis for high-risk AMI patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
Outcomes in patients with acute myocardial infarction and a history of illicit drug use: a nationwide analysis
Authors: Genet T , Ma I , Bisson A , Bodin A , Herbert J , Ivanes F , Babuty D , Angoulvant D , Fauchier L 
Published: November 2020

Abstract

Background
Several reports suggest that illicit drug use may be a major cause of acute myocardial infarction (AMI) independently of smoking habits, and associated with a poorer prognosis.

Purpose
We sought to determine the frequency of history of illicit drug use in an AMI population and its impact on short- and mid-term prognosis.

Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2018 in France. We identified patients with history of illicit drug use and the adverse outcomes were investigated during follow-up.

Results
Among 797,212 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI (mean age 69 years, 66% male), 3827 patients (0.5%) had a known history of illicit drug use (cannabis, cocaine or opioid). Patients with illicit drug use were younger and had less comorbidities. They presented more frequently with STEMI and anterior localization compared to those with no history of illicit drug use. In univariate analysis, patients with illicit drug use had lower short-term mortality rates compared to those without history of illicit drug use: 4.9% vs 10.1% at one month (p&lt;0.0001), respectively. However, this might be attributed to a younger age at the time of presentation. Using logistic multivariable analysis with adjustment on age, gender, other cardiovascular and non-cardiovascular comorbidities, type and localisation of MI and procedures of revascularization, history of illicit drug use was associated with a non-significant higher risk of death at one year (adjusted odds ratio OR 1.12 95% CI 0.98–1.29). This trend was supported by a significantly higher risk of death at one year in patients with a history of opioid use (OR 1.27 95% CI 1.04–1.29, p=0.01).

Conclusion
In a large and systematic nationwide analysis of patients with AMI, history of illicit drug use was associated with a non-significant higher overall odds of mortality, which was significant among those with opioid use.

Funding Acknowledgement
Type of funding source: None