bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do the ESC guidelines improve the treatment of acute myocardial infarction due to acute circumflex artery occlusion?
Authors: Simek S , Kral A , Kovarnik T , Zemanek D , Anger Z , Lubanda J.-C , Linhart A 
Published: November 2020

Abstract

Background
The left circumflex artery (LCX) and its branches are less often recognized as infarct related artery (IRA) in STEMI compared to NSTEMI patients because of lower ability to detect posterior AMI on 12leads ECG. Significant proportion of patients with acute LCX occlusion therefore did not receive immediate reperfusion therapy. The recent ESC guidelines recommendation of immediate coronary angiography for NSTEMI with ongoing ischemia should change the situation.

Objectives
To estimate the change in proportion of patients receiving immediate reperfusion therapy for acute LCX occlusion within last 20 years.

Methods
Prospective registry of patients with acute coronary syndromes treated in the cardiac centre. The group of patients treated with direct PCI as STEMI and the group of patients treated as NSTE ACS were compared.

Results
Of 369 STEMI patients treated with primary PCI in 1995–2000, the LCX was recognized as IRA in only 29 (8%) patients. In the group of 809 STEMI patients treated in period 2008–2011, the LCX was detected as IRA in 133 (16%). In he recent group of 1006 patients treated as STEMI in period 2016–2019 the LCX was IRA in 166 (16.5%) patients. LAD, LM and RCA were detected as IRA in 407 (40.5%), 17 (1.7%) and 415 (41%) patients respectively. In the parallel group of 1087 NSTE-ACS patients the proportion of LCX, LAD, LM and RCA as culprit artery was 271 (25%), 438 (40%), 52 (5%) and 326 (30%) respectively. The difference of LCX involvement in STEMI (16%) compared to NSTE-ACS patients (25%) was highly significant (p&lt;0,001).

Conclusion
The disproportion of LCX involvement among the patients with STEMI and NSTE-ACS is not decreasing in the course of last 10 years. Our data show that still significant part of patients with acute LCX occlusion are diagnosed as having NSTE-ACS and are not treated with adequate immediate reperfusion. So even in recent era of modern reperfusion therapy these patients which mostly suffer posterior AMIs have a lower chance to receive the proper treatment in our region. The new ESC guidelines did not change this fading yet. Better diagnostics of AMI due to the acute LCX occlusion (including 15 leads ECG) is routinely needed or every suspected NSTEMI patient should undergo the acute coronary angiogram as he would be a STEMI patient.

Funding Acknowledgement
Type of funding source: None
Immature platelet fraction is a strong predictor of adverse cardiovascular events in patients with acute coronary syndrome. Results of the ISAR-REACT 5 reticulated platelet substudy
Authors: Bongiovanni D , Mayer K , Schreiner N , Karschin V , Wustrow I , Gosetti R , Schunkert H , Laugwitz K.L , Schuepke S , Kastrati A , Bernlochner I 
Published: November 2020

Abstract

Introduction
Reticulated or immature Platelets are pro-thrombotic RNA-rich young platelets, which have been reported to correlate with adverse events in several pathological settings including coronary artery disease. However, the predictive value of this subgroup of platelets in patients with acute coronary syndrome treated with the potent novel P2Y12 inhibitors prasugrel or ticagrelor has not been investigated yet. Moreover, their role as predictors of major bleeding is unclear.

Purpose
The primary aim of this prespecified reticulated platelet ISAR-REACT-5 substudy was to evaluate the immature platelet fraction (IPF%) in peripheral blood as a predictor of the composite primary endpoint consisting of death, myocardial infarction, or stroke at one year after randomization in patients with acute coronary syndrome.

Methods
IPF was assessed in the first 24h after randomization using a fully automated system and correlated to the incidence of the primary endpoint. All patients with available IPF values were included. The Sysmex system uses two fluorescent dyes to stain platelet RNA and a computer algorithm (Sysmex IPF Master) discriminates immature from mature platelets by the intensity of forward scattered light and fluorescence. The immature platelet fraction is displayed as percentage of the total optical platelet count (IPF%).

Results
IPF values within the first 24h after randomization were available in a total of 506 randomized patients. Baseline characteristics and IPF (median [IQR]) values did not differ between the 2 study groups (IPF: prasugrel 3.9% [2.7–5.8] ticagrelor 3.4% [2.5–5.6] p=0.56). Significantly higher IPF values were observed in patients reaching the primary endpoint (n=55 of 506) independent from the study group (p for interaction= 0.28). ROC-curve analysis revealed a cut-of value of IPF 3.6% for the prediction of death, myocardial infarction or stroke with a Hazard ratio (HR) according to cox-regression analysis of 1.98 (95% CI, 1.15–3.44), P=0.01 (Figure 1A). Interestingly, we also detected a trend for higher major bleedings (BARC 3–5) in patients with elevated IPF values above IPF&gt;4.8% according to ROC-curve analysis (Figure 1B).

Conclusion
IPF was significantly associated with the primary endpoint in the ISAR-REACT 5 substudy independent from the treatment group and therefore is a promising novel biomarker for the prediction of adverse cardiovascular events in patients with acute coronary syndrome.
Figure 1

Funding Acknowledgement
Type of funding source: None
Discrimination of myocardial infarction and myocardial injury using a multibiomarker approach
Authors: Neumann J , Soerensen N.A , Hartikainen T.S , Haller P.M , Lehmacher J , Weimann J , Blankenberg S , Zeller T , Westermann D 
Published: November 2020

Abstract

Background
In the Universal Definition of Myocardial Infarction (MI) myocardial injury was introduced as a specific diagnosis in patients with elevated troponin concentrations, but without evidence of acute myocardial ischemia. However, their differentiation within the acute setting might be challenging. Therefore, we sought to investigate a multibiomarker panel in these patients and determine the discriminative capacity to differentiation MI from myocardial injury.

Methods
We use a cohorts of acute patients presenting to the emergency department. All final diagnoses were adjudicated by two physicians in a blinded fashion and based on the fourth universal definition of MI. In case of disagreement a third physician referred. For the present analyses only patients diagnosed with MI or myocardial injury were used. A panel of 28 biomarkers was measured in blood samples collected directly at admission. Spearman correlations were calculated. A multivariable logistic regression model using MI as the dependent variable was used and the predictors were chosen via backward step-back selection. Odds ratios (OR) were calculated for each predictor.

Results
We included 359 patients; 138 were diagnosed as having MI and 221 has having myocardial injury. The median age of the study population was 73 years and 59.1% were males. Hypertension was diagnosed in 80.4%, dyslipidemia in 45.4% and diabetes in 19.0%.The biomarker panel showed a wide range of correlations (Figure 1). In the multivariable model five logarithmized biomarkers (N-terminal prohormone of brain natriuretic peptide [OR 0.62], pulmonary and activation-regulated chemokine [OR 0.51], tumor-necrosis-factor-receptor 2 [OR 2.22], copeptin [OR 1.59] and high-sensitivity troponin I [OR 1.80]) were significant discriminators between MI and myocardial injury. Internal validation of the model via bootstrap shows a for overoptimism corrected area under the curve of 0.84.

Conclusion
In the multivariable model five biomarkers were discriminators between MI and myocardial injury.
Spearman correlations

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research fellowship by the Deutsche Forschungsgemeinschaft
Development of saliva-based cTnI point-of-care test: a feasibility study
Authors: Westreich R , Neumann Y , Deutsch O , Krief G , Stiubea-Choen R , Zager D 
Published: November 2020

Abstract

Background
Cardiac troponin is the biomarker of choice for detection of myocardial injury. There is a great need for simple point of care troponin testing among patients with chest pain, mainly in the prehospital setting. In this preliminary study we evaluate the feasibility of a novel, saliva-based cTn test.

Aim
1) To evaluate the presence of cTnI in saliva of patients with myocardial injury. 2) To explore the feasibility a saliva-based point-of-care cTn assay.

Methods
Saliva samples were collected from 32 patients with myocardial injury who tested positive for conventional cTnT blood tests, and from 13 healthy volunteers. 25 and 9 of these samples, respectively, were subjected to a series of advanced saliva processing procedures:
“Amplification buffer” – A unique and complex composition which removes a broad spectrum of saliva inhibiting elements of physical, chemical and biological nature.
“Hampering remover” – A device which specifically removes salivary alpha amylase that constitutes ∼50% of the total saliva protein content and therefore increases the detection sensitivity of less concentrated components.
“Saliva Concentrator Cartridge” – based on the principles of solid phase extraction cartridges and allows rapid and easy analytes concentration.
Processed and unprocessed samples were tested with blood cTnI RDT (Troponin I Rapid Test. specifications: detection limit 1ng/mL of whole-blood; Sensitivity: 95.8%; Specificity: 99.7%). Results were interpreted independently by two investigators and only concordant readouts were included in the analyses. Results were compared to blood cTnT levels

Results
Among the 25 positive samples subjected to advanced saliva processing procedures, 21 were confirmed positive by both investigators (sensitivities of 84%). All 4 negative saliva samples were obtained from patients with relatively low blood cTnT levels of 155 ng/L or less. Testing untreated samples, only 2 out of 32 were positive (sensitivities of 6.25%). In both processed and unprocessed samples no false positive results were seen among healthy individuals (0 out of 9 and 0 out of 13, respectively), corresponding to a specificity of 100% for both processed and unprocessed groups. The negative predictive values for processed and unprocessed groups were 69.23% and 30.23 respectively. Statistical accuracies were 88.24% for the processed group and 33.33% for the unprocessed group.

Conclusion
This preliminary work demonstrates for the first time the presence of cTnI in saliva of patients with myocardial injury and possible detection of cTnI in clinical saliva samples utilizing a commercial blood-RDT platform. Further research is needed to determine the time activity of troponin in saliva as well as its sensitivity and specificity for myocardial injury.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Salignostics LTD
What is the relationship between high-density lipoprotein cholesterol and the extension of coronary heart disease?
Authors: Santos M.R , Pereira A , Mendonca F , Sousa J.A , Temtem M , Monteiro J.P , Sousa A.C , Freitas S , Rodrigues M , Ornelas I , Mendonca M.I , Palma Dos Reis R , Drumond A 
Published: November 2020

Abstract

Introduction
Coronary atherosclerosis is an important pathophysiological mechanism in the development of coronary artery disease (CAD). While it has been proven via multiple studies that elevated levels of low-density lipoprotein (LDL) contribute to the development of atherosclerosis, high-density lipoprotein (HDL) is widely thought to have atheroprotective effects. Multiple epidemiologic studies have given the idea that high HDL levels protect against CAD, however, other trials also shown that its benefit can be paradoxical.

Objective
To evaluate the relationship between HDL levels and the extent of CAD (one vessel vs multivessel disease) in coronary artery patients.

Materials and methods
Study analyses of 1676 patients selected from GENEMACOR study population, with at least one &gt;75% coronary stenosis by angiography (median age 53.3±7.9 years, 78.6% male, median HDL 43.0±11.1 mg/dL). Population was divided according to the HDL level quartiles (1st quartile HDL &lt;35.3 mg/dL; 2nd quartile HDL 35.3–42 mg/dL; 3rd quartile HDL 42–49 mg/dL; 4th quartile HDL &gt;49 mg/dL). Population of the 1st and 4th quartiles (825 patients, median age of 53.3±7.9 years and 78.7% male) were adjudicated and prospectively followed-up by 5.0±4.8 years. χ2 and T student tests were used to analyze the demographic, laboratorial, angiographic and anthropometric characteristics of the population according to HDL level.

Results
420 (50.9%) patients were included in the 1st quartile group (median age 53.2±7.9 years, 85.7% men) and 405 (49.1%) patients were included in the 4th quartile group (median age 53.4±8.0 years, 71.4% men). In our population, lower levels of HDL were associated with increased risk of multivessel coronary disease (OR 1.63, 95% CI 1.23–2.14, p 0.001).

Conclusion
Despite uncertainties about HDL benefit, in our population a higer level of HDL was associated with a shortest extent of coronary artery disease. We conclude that higher levels of HDL can be considered protective in coronary patients, and strategies to increase HDL levels may indeed translate in improved outcomes in CAD disease.

Funding Acknowledgement
Type of funding source: None
Feasibility and safety of non-contrast percutaneous coronary intervention in patients with complicated acute coronary syndrome
Authors: Higuchi S , Kabeya Y , Nishina Y , Miura Y , Yoshino H 
Published: November 2020

Abstract

Background
Contrast-induced acute kidney injury (CI-AKI) occurs in 10% to 20% of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), resulting in a poor short- and long-term prognosis. Reducing the amount of contrast medium can prevent CI-AKI.

Objectives
This study aimed to examine the feasibility and safety of non-contrast PCI in patients with ACS.

Methods
The study was a prospective and single-center registry. Successful non-contrast PCI was confirmed when contrast medium was not injected from the guiding catheter engagement to wire removal in ad-hoc PCI. Coronary angiography after the PCI procedure was permitted once. CI-AKI was defined as an increase in the serum creatinine of ≥0.5 mg/dL from or ≥1.25 times the baseline within 72 hours after PCI. Worsening renal function (WRF) was defined as an increase in the serum creatinine of ≥0.3 mg/dL from baseline after the PCI.

Results
The present study included 106 lesions from 81 patients. Forty-eight lesions were (45%) type C lesions. Successful non-contrast PCI was performed in 95 lesions (90%). CI-AKI was observed in 4 (5%); coronary perforation, 0; no/slow flow, 9 (11%); periprocedural death, 0. The follow-up period was 348 (190–492) days. Successful non-contrast PCI was not associated with the incidence of CI-AKI. However, WRF at 6-month was observed in 18 individuals (22%). Successful non-contrast PCI was inversely associated with WRF (hazard ratio, 0.28; 95% confidence interval, 0.09–0.90) after adjustment for renal function.

Conclusions
The present study suggests that non-contrast PCI is feasible and safe in ACS patients with complex lesions.

Funding Acknowledgement
Type of funding source: None
Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction
Authors: Asano T , Mitsuhashi Y , Yamashita J , Ito R , Saji M , Wakabayashi K , Yahagi K , Shinke T , Mase T , Miyachi H , Higuchi S , Miyauchi K , Yamamoto T , Nagao K , Takayama M 
Published: November 2020

Abstract

Background
It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients.

Methods
Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated.

Results
In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]).

Conclusion
The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased.

Funding Acknowledgement
Type of funding source: None
Effect of pre-existing chronic kidney disease, anaemia and diabetes mellitus on mid-term mortality in patients with STEMI treated with primary PCI
Authors: Rubartelli P , Bruzzone M , Ariel Sanchez F , Bologna E , Iannone A , Fedele M , Bellotti S , Bartolini D , Boasi V , Cannarile P , Vercellino M 
Published: November 2020

Abstract

Background
The negative prognostic effect of chronic kidney disease (CKD), anaemia and diabetes in patients with acute coronary syndromes is well known. However, data about the prevalence and the prognostic importance of these comorbidities in unselected, contemporary STEMI patients treated with primary PCI are limited.

Purpose
We sought to investigate the prevalence of CKD, anaemia and diabetes mellitus in this patient population, as well as possible interactions between these comorbidities.

Methods
Between January 2006 and December 2018, 3395 consecutive patients with STEMI underwent primary PCI in two centres. Hb and creatinine were determined on a blood test obtained immediately upon the arrival at the Hospital and eGFR was estimated with the CKD-EPI equation. Renal impairment (RI) was defined as stage 3B or worse CKD (eGFR ≤44 ml/min/1.73m2). Anaemia was defined as Hb &lt;13 g/dl in males and &lt;12 g/dl in females. The outcome measure was overall mortality at a median follow-up of 1.9 years.

Results
The age of patients was (mean±SD) 67.2±12.9 years and 27.3% of them were females. Diabetes was present in 22.1%, anaemia in 18.1%, and RI in 9.8% of patients. The presence of diabetes, anemia or RI, individually or in various combination, was associated with higher mortality (see figure). Interestingly, these comorbidities presented an addictive, but non synergistic, effect (P for interaction = NS for all combinations). The covariates associated with mortality are shown in the Table. Notably, female gender was independently associated with lower mortality.

Conclusions
In contemporary patients treated with primary PCI, diabetes, anaemia and RI are frequently present, individually or in combination. All these comorbidities are strong independent predictors of mortality, and the coexistence of more conditions has addictive, but not synergistic, effect. The identification of patients at higher risk could promote a closer follow-up and more stringent measures of secondary prevention.

Funding Acknowledgement
Type of funding source: None
Percutaneous coronary intervention during on- and off-hours in patients with ST-segment elevation myocardial infarction
Authors: Tokarek T , Dziewierz A , Plens K , Rakowski T , Zabojszcz M , Dudek D , Siudak Z 
Published: November 2020

Abstract

Introduction
There are conflicting data on the clinical outcomes of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on time of intervention. Concerns have been postulated regarding equally effective in-hospital outcomes for STEMI patients treated with PCI during normal working hours as compared to group treated off-hours.

Purpose
The aim of this study was to assess clinical outcomes in “real-world” patients with STEMI treated with PCI during off-hours and regular hours of work.

Methods
To avoid possible bias related to the non-randomized design, a propensity score was calculated to compare off- and on-hours groups. The study group consisted of 37, 469 matched pairs in STEMI treated with PCI and stent implantation between 2014 and 2018 during regular hours (weekdays 7:00 AM to 16:59 PM) and off-hours (weekdays between 17:00 PM and 06:59AM, weekends, and holidays) in 151 tertiary invasive cardiology centers in Poland (the ORPKI Polish National Registry).

Results
No differences were reported between both groups in baseline characteristics after the propensity score match (PSM). There were no differences in time from pain to first contact (p=0.2) and door to balloon time between both groups (p=0.7). After PSM higher radiation dose was observed in off-hours group (1055.18 (±1006.52) vs. 1081.59 (±1003.25)[mGy]; p=0.001). However, there was no difference in total amount of contrast (on-hours vs. off-hours: 175.69 (±74.71) vs. 176.48 (±74.41)[ml]; p=0.1, respectively). Similar rate of periprocedural complications was observed between both groups of patients, includind stroke, access-site-related bleeding, allergic reaction and coronary artery perforation. However, procedures performed during off-hours were associated with higher incidence of periprocedural death (1.17% (439) vs. 1.49% (559); p=0.001) and periprocedural cardiac arrest (1.76% (658) vs.1.97% (740); p=0.001) as compared to PCI conducted within normal working hours.

Conclusions
Percutaneous coronary intervention in STEMI performed durgin off-hours might be associated with higher rate of periprocedural mortality and higher radiation dose as compared to procedures conducted during regular working hours.

Funding Acknowledgement
Type of funding source: None