bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rates and causes of readmissions following index admissions for Takotsubo syndrome-a meta-analysis of 118,941 index hospitalizations
Authors: Desai R , Sachdeva S , Singh S , Rajan S.K , Shaik A.S , Haider M , Fong H.K , Gangani K , Sachdeva R , Kumar G 
Published: November 2020

Abstract

Background
Rising trends in takotsubo syndrome (TTS)-related complications warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index TTS admissions.

Methods
PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through October 2019 reporting rates and causes of readmission following index TTS admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2 statistics were used to report inter-study heterogeneity.

Results
A total of 16 cohorts with 118,941 TTS index admissions (mean age 65–75 yrs; female &gt;85%, median follow-up 272.5 days) revealed a 16.6% [95% CI-13.2%-20.3%, I2=99%] pooled rate of readmission. Short-term and long-term pooled readmission rates are displayed in Fig.1. The readmission rate was higher in cohorts with young patients (&lt;70 vs. &gt;70 yrs), smaller sample size (n&lt;100 vs. n&gt;100) and single-centres vs. multicentres. Studies published from the USA (16.4% vs. 14.9%) had a higher readmission rate as compared to Italy. The most frequent causes were cardiac (40.6%), respiratory (15.7%) and renal (7.0%). Among readmissions with cardiac diagnoses, heart failure was most common (40.1%).

Conclusions
This global meta-analysis revealed that the pooled rate of readmission following index TTS admissions was ∼17% and causes were mainly cardiac or respiratory.

Funding Acknowledgement
Type of funding source: None
Functional assessment of myocardial ischemia by intracoronary electrocardiogram
Authors: Bigler M.R , Praz F , Siontis G.C.M , Stoller M , Grossenbacher R , Tschannen C , Seiler C 
Published: November 2020

Abstract

Background
In patients with chronic coronary syndrome (CCS), percutaneous coronary intervention (PCI) targets hemodynamically significant stenoses, i.e., those thought to cause ischemia. The hemodynamic severity of a coronary stenosis increases with its tightness and with the myocardial mass of viable myocardium downstream of the stenosis. Besides the structural angiographic approach, assessment of functional relevance by pressure measurements (fractional flow reserve, FFR; instantaneous wave-free ratio, iFR) is recommended. However, visual angiographic assessment continues to dominate the treatment decisions for intermediate coronary lesions. Conversely, intracoronary ECG (icECG) potentially provides an inexpensive, sensitive and direct measure of myocardial ischemia.

Purpose
The goal of this study was to test the accuracy of intracoronary ECG during pharmacologic inotropic stress to determine coronary lesion severity in comparison to established physiologic indices (FFR/iFR) as well as with quantitatively determined percent diameter stenosis (%S) using biplane coronary angiography.

Method
This was a prospective, open-label study in patients with CCS. The primary study end point was the maximal change in icECG ST-segment shift during pharmacologic inotropic stress induced by dobutamine plus atropine obtained within 1 minute after the point of maximal heart rate (estimated by the formula 220 - age). IcECG was acquired by attaching an alligator clamp to the angioplasty guidewire positioned downstream of a stenosis. For the pressure-derived ratios, i.e. FFR and iFR, the coronary perfusion pressure downstream of a lesion as well as the aortic pressure were continuously recorded.

Results
One hundred patients were included in the study. Pearson-Correlation coefficient was significant between icECG and all three comparators (%S p&lt;0.001, iFR p&lt;0.001, FFR p&lt;0.001). Using the FFR threshold of 0.80 defining coronary hemodynamic significance, ROC-analysis of the absolute icECG ST-segment shift showed an area under the curve (AUC) of 0.708±0.053 (p=0.0001, n=100, FFR&lt;0.80 n=41). AUC for iFR was 0.919±0.030 (p&lt;0.0001), for percent diameter stenosis it was 0.867±0.036 (p&lt;0.0001).

Conclusions
During pharmacologic inotropic stress, intracoronary ECG ST-segment shift provides specific evidence for regional myocardial ischemia irrespective of the etiology and thus, provides an additional (patho-)physiologic information for decision making in borderline coronary lesions.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation
Lipoprotein-associated phospholipase A2 levels, endothelial dysfunction and arterial stiffness in patients with stable coronary artery disease
Authors: Mourouzis K , Siasos G , Oikonomou E , Zaromitidou M , Tsigkou V , Antonopoulos A.S , Bletsa E , Stampouloglou P.K , Vlassis K , Vavouranakis M , Tousoulis D 
Published: November 2020

Abstract

Background
Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has inflammatory and atherogenic actions in the vascular wall. We investigate the impact of high Lp-PLA2 levels on endothelial function and arterial stiffness on patients with coronary artery disease (CAD).

Methods
We enrolled 374 consecutive patients with stable CAD (mean age 61±11 years). Endothelial function was evaluated by flow-mediated dilation (FMD) and reflected waves with augmentation index (AIx) of the central aortic pressure. Serum levels of Lp-PLA2 were measured with ELISA.

Results
In the studied population the median values of Lp-PLA2 levels was 125 (96–152) μg/L. There was no difference between subjects with Lp-PLA2 levels above and below 125μg/L concerning classical risk factors for CAD. Importantly, subjects with Lp-PLA2 values ≥125μg/L had significantly impaired FMD (4.44±2.19% vs. 4.89±2.07%, p=0.04) and AIx values (25.21±8.70% vs. 23.06±9.47%, p=0.03), compared to participants with lower Lp-PLA2 serum levels. A linear regression analysis revealed that Lp-PLA2 ≥125μg/L negatively relates to impaired FMD [b=−0.54 (95% CI: −1.05 to −0.02), p=0.04] and AIx values [b=2.14 (95% CI: 0.18–4.01), p=0.03] independently of cofounders.

Conclusions
Elevated Lp-PLA2 relates to endothelial dysfunction and arterial stiffness in CAD patients. These findings highlight the significant role of Lp-PlA2 in the process of atherosclerosis.

Funding Acknowledgement
Type of funding source: None
Quantitative flow ratio to predict non-target-vessel-related events at 5 years in STEMI patients undergoing angiography-guided revascularization
Authors: Baer S , Kavaliauskaite R , Ueki Y , Otsuka T , Engstrom T , Baumbach A , Roffi M , Von Birgelen C , Vukcevic V , Pedrazzini G , Kornowski R , Tueller D , Losdat S , Windecker S , Raeber L 
Published: November 2020

Abstract

Background
In patients with ST-segment-elevation myocardial infarction (STEMI), angiography-based complete revascularization is associated with superior outcomes compared with culprit-lesion-only percutaneous coronary intervention (PCI). Quantitative Flow Ratio (QFR) is a novel, non-invasive, vasodilator-free method to assess the hemodynamic significance of coronary stenoses.

Purpose
To investigate the incremental value of QFR over angiography alone in the assessment of non-culprit lesions (NCL) in STEMI patients undergoing primary PCI.

Methods
In the randomized, multicenter COMFORTABLE AMI trial, STEMI patients underwent angiography-guided complete revascularization. QFR was determined in untreated non-target vessels by assessors blinded for clinical outcomes.

Results
Out of 1161 STEMI patients, 946 vessels in 617 patients could be analyzed by QFR. At 5-year follow-up, the rate of the primary endpoint cardiac death, non-target vessel myocardial infarction (non-TV-MI) and clinically indicated, non-target vessel revascularization (non-TVR) was significantly higher in patients with QFR ≤0.80 compared with QFR &gt;0.80 (62.9% vs. 12.7%, HR 7.20, 95% CI 4.46–11.62, p&lt;0.001), driven by higher rates of non-TV-MI (15.4% vs. 3.6%, HR 4.59, 95% CI 1.72–12.23, p=0.002) and non-TVR (58.6% vs. 7.7%, HR 10.99, 95% CI 6.39–18.91, p&lt;0.001). No significant differences for cardiac death were observed. Multivariate analysis identified QFR ≤0.80, MI SYNTAX score and left ventricular function as independent predictors of the primary endpoint. QFR ≤0.80 showed an accuracy of 86.1%, sensitivity of 23.2%, specificity of 97.5%, positive predictive value of 62.9% and negative predictive value of 87.5% for the prediction of the primary endpoint.

Conclusions
Our study results suggest incremental value of QFR over angiography-guided PCI for NCL among STEMI patients undergoing primary PCI.
Kaplan-Meier curves of primary endpoint

Funding Acknowledgement
Type of funding source: None
Determinants of trajectories of cardiac allograft vasculopathy after heart transplantation: a population based study
Authors: Bonnet G , Coutance G , Van Keer J , Raynaud M , Aubert O , Bories M.C , Bruneval P , Varnous S , Leprince P , Empana J.P , Naesens M , Patel J.K , Loupy A , Kobashigawa J , Jouven X 
Published: November 2020

Abstract

Background
Cardiac allograft vasculopathy (CAV) is a major contributor of heart transplant recipient's mortality. Little is known about determinants of CAV trajectories at a population level.

Purpose
We aimed to identify the respective contribution of immune and non-immune factors in the different evolutive profiles of CAV.

Methods
Heart transplant recipients receiving care at 2 academic centers (2004 to 2016) were included. Patients underwent prospective, protocol-based monitoring consisting of repeated coronary angiographies together with systematic assessment of clinical, functional, histological and immunological parameters. The outcome was CAV trajectories, identified with unsupervised latent class mixed models. The independent, predictive factors of CAV trajectories were investigated with multinomial regressions (NCT04117152).

Results
Overall, 815 patients were included. The median follow-up post-transplant was 7.7 years (IQR=5.14) with 2,742 coronary angiographies analyzed. We identified 4 distinct profiles of CAV trajectories over 10 years that were characterized by i) Patients without CAV at baseline and non-progression (n=459, 56.3%), ii) patients without CAV at baseline and late onset CAV progression (n=62, 7.6%), iii) patients with mild baseline CAV and mild progression (n=188 23.1%), iv) patients with mild baseline CAV and accelerated CAV progression (n=106, 13.0%, discrimination 0.92). Six early independent predictors of CAV trajectories were identified: donor age (p&lt;0.001), donor male gender (p&lt;0.001), donor tobacco consumption (p=0.001), recipient post-transplant dyslipidemia (p=0.009), preexisting or de novo class II anti-HLA donor-specific antibodies (p=0.004) and episode of acute cellular rejection ≥2R during the first year post transplantation (p=0.028).

Conclusion
In a large multicentric and highly phenotyped prospective cohort of heart transplant recipients, we identified 4 robust CAV trajectories and their respective immune and non-immune determinants. Our results provide the basis for a trajectory-based assessment of heart transplant patients for early patient risk stratification and patient monitoring.
Factors associated CAV trajectories in multivariate analyses in the derivation cohort. This table shows the association of clinical, immunological, functional and structural parameters associated with CAV trajectories in multivariate multinomial regression analysis. The trajectory of reference was trajectory #1, including patients with no CAV at baseline and stable CAV grade over time.

Funding Acknowledgement
Type of funding source: None
Association of high-sensitivity C-reactive protein and long-term mortality may differ from lipoprotein(a) levels among patients undergoing coronary angiography
Authors: Guo Z , Lei L , Ying M , Wang B , Liu J , Liu L , He Y , Sun G , Chen S , Liu B , Chen G , Chen J , Liu Y 
Published: November 2020

Abstract

Background
The use of high-sensitivity C-reactive protein (hs-CRP) as an inflammation biomarker in predicting long-term mortality remains controversial. We aimed to investigate whether the association of hs-CRP with long-term mortality differs from another inflammation biomarker, lipoprotein(a), in patients undergoing coronary angiography (CAG).

Methods
A total of 2422 patients undergoing CAG were included in the final analysis from a prospective, observational study. We divided them into 4 groups according to hs-CRP level (high ≥4.8 mg/l, low &lt;4.8 mg/l) and lipoprotein(a) level (high ≥17 mg/dl, low &lt;17 mg/dl).

Results
The overall incidence of all-cause long-term mortality was 133/2422 (5.5%). In the high lipoprotein(a) group, after adjusting for LDL-cholesterol concentration (LDL-C), age, sex, smoking status, diabetes mellitus and estimated glomerular filtration rate (eGFR), a high hs-CRP level was an independent predictor of all-cause long-term mortality (hazard ratio: 2.01; 95% CI: 1.13–3.54; p=0.02). In the low lipoprotein(a) group, a similar result was not found (hazard ratio: 1.42; 95% CI: 0.92–2.01; p=0.24).

Conclusions
Our data suggested that the association of hs-CRP with all-cause long-term mortality may differ from lipoprotein(a) levels among patients undergoing CAG. In addition to hs-CRP, a high lipoprotein(a) level might be a simultaneous intervention target for improving long-term prognosis in the future.

Funding Acknowledgement
Type of funding source: None
Predictive value of preprocedural albuminuria for contrast-induced nephropathy non-recovery in patients undergoing percutaneous coronary intervention
Authors: Chen H , Lin K , He C , He H , Zhang S , Guo Y 
Published: November 2020

Abstract

Background
The degree of renal recovery from contrast induced nephropathy (CIN) may affect long-term outcomes. Albuminuria had been generally considered to be an independent risk factor of CIN. However, the predictive value of albuminuria for CIN non-recovery in patients undergoing percutaneous coronary intervention (PCI) remains unknown.

Purpose
To evaluate the association of preprocedual albuminuria and CIN non-recovery after PCI.

Methods
From January 2012 to December 2018, 550 consecutive patients developing CIN after PCI and reassessing kidney function among 1 to 12 months were enrolled. CIN non-recovery was defined as a relative decrease of serum creatinine ≥25% or 0.5 mg/dl over baseline at 1 to 12 months in patients who developed CIN. Patients were stratified into three groups according to urinary albumin: negative group (urine dipstick negative), trace group (urine dipstick trace) and positive group (urine dipstick ≥1+).

Results
Overall, 88 (16%)patients had trace urinary albumin, 74 (13.5%) patients had positive urinary albumin and 40 (7.3%) patients developed CIN non-recovery. Patients with positive urinary albumin had significantly higher incidence of CIN non-recovery [negative (3.4%), trace (11.4%) and positive (23.0%), respectively; P&lt;0.0001]. Multivariate analysis showed that trace and positive urinary albumin were associated with an increased risk of CIN non-recovery (trace vs. negative: OR: 2.879, P=0.022; positive vs negative: OR: 2.991, P=0.021).

Conclusion
Preprocedural albuminuria was associated CIN non-recovery in patients undergoing PCI.
Incidence of CIN non-recovery

Funding Acknowledgement
Type of funding source: None
The impact of emergent PCI on clinical outcome in AMI patients with out-of-hospital cardiac arrest: the Yamagata AMI registry
Authors: Otaki Y , Watanabe T.W , Goto J.G , Toshima T.T , Wanezaki M.W , Nishiyama S.N , Tamura H.T , Kato S.K , Takahashi H.T , Arimoto T.A , Watanabe M.W 
Published: November 2020

Abstract

Background
Despite improvement of survival rate in acute myocardial infarction (AMI), out-of-hospital cardiac arrest (OHCA) is still devasting condition. The association of emergent percutaneous coronary intervention (PCI) with clinical outcome in AMI patients with OHCA has not yet been fully elucidated.

Purpose
The purpose of the present study was to examine the impact of emergent PCI on the clinical outcome in AMI patients with OHCA.

Method and results
We analyzed the data from Yamagata AMI registry among 2012–2017, which is multicenter surveillance conducted in all institution on Yamagata prefecture. Among 3332 AMI patients, there were 254 AMI patients with OHCA. The acute death rate was higher in AMI patients with OHCA than those without (70% vs. 13%, P&lt;0.0001). Successful PCI was defined as TIMI grade flow III. AMI patients with OHCA were divided into three groups based on the PCI (successful PCI group, n=70; unsuccessful PCI group, n=14; and Non-PCI group, n=170). The acute death rates in successful PCI, unsuccessful PCI, and non-PCI group were 13%, 64%, 94%, respectively. Kaplan-Meier analysis demonstrated that acute death rate was the lowest in successful PCI group compared to other groups. Multivariate Cox proportional hazard regression analysis demonstrated that successful PCI was inversely associated with acute death after adjustment for confounding factors. The rate of thrombus aspiration was higher in successful PCI than in unsuccessful PCI group.

Conclusion
Successful PCI is of critical importance to prevent acute death in AMI patients with OHCA.

Funding Acknowledgement
Type of funding source: None
Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction
Authors: Satou T , Kitahara H , Ishikawa K , Nakayama T , Fujimoto Y , Sano K , Kobayashi Y 
Published: November 2020

Abstract

Background
The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients.

Purpose
To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients.

Methods
Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected.

Results
In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p&lt;0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups.

Conclusions
In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients.
Initial event occurrence timing

Funding Acknowledgement
Type of funding source: None
Can left ventricular global function index be a novel marker of unfavorable outcome in patients with acute coronary syndrome
Authors: Minushkina L , Brazhnik V , Selezneva N , Safarjan V , Alekhin M , Kapustina A , Zateyshchikov D 
Published: November 2020

Abstract

Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodeling. LVGFI has high predictive significance in young healthy individuals. The aim of the study was to assess prognostic significance in patients with acute coronary syndrome (ACS).
We include into this analysis 2169 patients with ACS (1340 (61.8%) men and 829 (38.2%) women), mean age 64.08±12.601 years. All patients were observed in 2 Russian multicenter observational studies: ORACLE I (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options) (2004–2007 years) and ORACLE II (NCT04068909) (2014–2019 years). 1886 (87.0%) pts had arterial hypertension, 1539 (71.0%) – history of coronary artery disease, 647 (29.8%) – history of myocardial infarction, 444 (20.5%) - diabetes mellitus. Duration of the follow-up was 1 years after the hospital discharge. Cases of death from any cause, coronary deaths, repeated coronary events (fatal and non-fatal) were recorded. An echocardiographic study was conducted 5–7 days from the time of hospitalization. The LVGFI was defined as LV stroke volume/LV global volume × 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/density).
During the follow-up, 193 deaths were recorded (8.9%), 122 deaths (5.6%) were coronary. In total, repeated coronary events were recorded in 253 (11.7%) patients. Mean LVGFI was 22.64±8.121%. Patients who died during the follow-up were older (73.03±10.936 years and 63.15±12.429 years, p=0.001), had a higher blood glucose level at the admission to the hospital (8.12±3.887 mmol/L and 7.17±3.355 mmol/L, p=0.041), serum creatinine (110.86±53.954 μmol/L and 99.25±30.273 μmol/L, p=0.007), maximum systolic blood pressure (196.3±25.17 mm Hg and 190.3±27.83 mm Hg, p=0.042). Those who died had a lower LVGFI value (19.75±6.77% and 23.01±8.243%, p&lt;0.001). Myocardial mass index, ejection fraction and other left ventricular parameters did not significantly differ between died and alive patients. Among the patients who died, there were higher rate of women, pts with a history of myocardial infarction, heart failure, diabetes. In a multivariate analysis, diabetes mellitus OR1.67 95% CI [1.12–2.51] p=0.012, history of heart failure (1.78 [1.2.-2.59], p=0.003), a history of myocardial infarction (1.47 [1.05–2.05], p=0024), age (1.06 [1.05–1.08], p=0.001) and LVGFI &lt;22% (1.53 [1.08–2.17], p=0.015) were independent predictors of death from any cause. The LVGFI was also independently associated with the risk of coronary death, but not with the risk of all recurring coronary events.
Thus, LVGFI may be useful the marker to assess risk in patients who have experienced an ACS episode.

Funding Acknowledgement
Type of funding source: None