bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early vascular responses to ultrathin biodegradable polymer sirolimus-eluting stent for the treatment of st-elevation myocardial infarction
Authors: Oishi Y , Shinke T , Tanaka H , Ogura K , Arai K , Masaki R , Nomura K , Kosaki R , Sakai K , Sekimoto T , Tsujita H , Kondo S , Tsukamoto S , Mori H , Matsumoto H 
Published: November 2020

Abstract

Background
Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, safety profiles in very early phase have not been systematically addressed.

Objective and method
We exploratory investigate early vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT).
Consecutive twenty patients with STEMI who underwent FD-OCT immediately after primary PCI and were eligible for follow-up FD-OCT at 2 weeks after implantation were enrolled between June 2018 and November 2019.

Results
Twenty patients (age 62.7±11.3 years, male 85.0%) were enrolled with frequencies of hypertension (45.0%), diabetes mellitus (35.0%), dyslipidemia (55.0%) and smoking (80.0%). Aspiration catheter were used in all patients, and 1.13±0.34 stents were used. Only one patient (5.0%) received chronic antiplatelet therapy with aspirin prior to the onset of STEMI. All patients started to receive prasugrel as thienopyridine from this event and continued dual antiplatelet therapy for 2 weeks.
The percentage of uncovered struts significantly decreased from post-procedure to 2W follow-up (69±18% post-procedure versus 30±11% at 2W follow up, p&lt;0.0001). Malapposed struts also decreased (5.6±5.7% post-procedure versus0.9±1.2% at 2W follow up, p&lt;0.0001).The average protrusion area of athero-thrombotic burden numerically decreased (0.37±0.19 at post-procedure versus 0.34±0.14 mm2 at 2W follow up, p=0.19) and its volume showed similar tendency (10.60±6.40 at post-procedure versus 9.36±5.14 mm3 at 2W follow up, p=0.19).

Conclusion(s)
This study firstly elucidated very early vascular responses following ultrathin strut BP-SES implantation in STEMI patients, showing early progression of strut coverage and resolution of athero-thrombotic materials. This technology may have a potential to overcome the current generation DESs in this clinical setting.
Thrombus, uncovered and malapposed struts

Funding Acknowledgement
Type of funding source: None
The Family Income Ratio of Barcelona and its impact on treatment delays and one-year mortality in 3173 cases of STEMI treated at the Codi IAM network
Authors: Tizon Marcos H , Marrugat J , Vaquerizo B , Ariza A , Lidon R.M , Carrillo X , Garcia-Picart J , Garcia-Munoz J.F , Millan R , Ribas N , Menendez E , Duran X , Poirier P , Mauri Farre F 
Published: November 2020

Abstract

Introduction
STEMI networks have spread reperfusion and have decreased treatment delays.Increased treatment times have a negative impact on mortality after STEMI.The Family Income Ratio of Barcelona (FIRB) is an indicator that combines economic and socio-cultural welfare that is annually documented at the different Barcelona's neighborhoods by the Barcelona Public Health Office.

Purpose
To evaluate if FIRB has a prognostic impact on STEMI treatment times and mortality on patients of Barcelona city treated in the Codi IAM Network with primary PCI.

Methods
Analysis of all data from “Codi IAM Network” from STEMI treatment in Barcelona city from 2010 to 2016 -including treatment delays, clinical risk factors and 1-year all-cause mortality- and corresponding FIRB for each patient and episode.FIRB is divided into tertiles.Multilevel analysis is performed to obtain factors associated to EKG-opening artery time and cox-regression on 1-year all-cause mortality.

Results
3173 cases of STEMI were included with a mean age of 65±13, 25% women,21% diabetes mellitus and 42% hypertension.Characteristics of population, treatment and mortality per FIRB tertile is shown in Table 1.Multilevel analysis showed that age,diabetes mellitus,heart failure at admission,FIRB and who performed first care were associated to EKG-Opening Artery Time (all p&lt;0.003).However,only age,heart failure at admission,who performed first care and EKG-opening artery time&gt;120min were significantly associated to 1-year all-cause mortality (p&lt;0.005) but not FIRB.

Conclusions
Patients at the lower FIRB treated for STEMI in Barcelona showed younger age,worse cardiovascular profile and longer treatment delays.Longer EKG-open artery time was associated to diabetes mellitus, heart failure, first assistance care and lower FIRB.One-year all-cause mortality was not associated to FIRB.

Funding Acknowledgement
Type of funding source: None
Right coronary artery as a culprit artery for better prognosis in patients with acute myocardial infarction (AMI) with or without shock
Authors: Mizutani H , Kurita T , Ishise T , Seko T , Fujii E , Kitamura T , Kawasaki A , Makino K , Ito M , Dohi K 
Published: November 2020

Abstract

Background
Although patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, morbidity and mortality remain high even with early revascularization and modern intensive care.
Culprit artery and prognosis were associated in patients with acute myocardial infarction.

Purpose
Evaluation of short- and long-term prognosis of AMI with cardiogenic shock by right coronary artery (RCA) and left coronary artery (LCR)

Method
We investigated 3400 AMI patients (age 68.8±12.7 y.o.) were enrolled from Mie ACS registry. They were divided into 4 groups according to the culprit artery and presence or absence of cardiogenic shock: RCA without shock n=1114, RCA with shock n=74, LCA without shock n=2028, LCA with shock n=184. Primary endpoint was defined as all-cause mortality.

Results
During the median follow-up periods with 743 days, 12.6% of the patients experienced all-cause death. RCA and LAC with shock groups demonstrated significantly higher in-hospital mortality compared to groups without shock (p&lt;0.001, Figure 1A). Interestingly, after discharge, LCA with shock group showed significant higher all-cause mortality compared with other 3 groups. Surprisingly, RCA with shock group showed similar favorable prognosis to that of without shock groups (Figure 1B). Multivariate analyses for after discharge mortality showed that LCA with shock group was strongest independent poor prognostic factor with hazard ratio of 2.3 (95% CI 1.4–3.7), but RCA with shock group was not.

Conclusion
Association of cardiogenic shock is the hazardous risk factor for cases with AMI, especially LCA infarction. Surprisingly, RCA AMI cases with shock showed favorable prognosis as well as AMI without shock.
Kaplan-Meier survival curves

Funding Acknowledgement
Type of funding source: None
Relationship between electrocardiogram changes and myocardial edema in tako-tsubo syndrome
Authors: Salamanca Viloria J , Cecconi A , Alvarado Casas T , Antuna Alvarez P , Diez-Villanueva P , Aguilar Torres R , Gamarra A , Bastante Valiente T , Rivero Crespo F , Rojas Gonzalez A , Vera A , Gonzalez E , Aguilera M.C , Jimenez Borreguero L.J , Alfonso Manterola F 
Published: November 2020

Abstract

Introduction
During the acute phase of Tako-tsubo syndrome (TTS) electrocardiogram (ECG) features change and myocardial edema is a common finding in Cardiac Magnetic Resonance (CMR). However, the relationship between ECG changes and myocardial edema is still unclear.

Purpose
To define if the presence and extension of myocardial edema might be predicted by electrocardiographic changes since admission to CMR.

Methods
Consecutive patients with TTS undergoing CMR during hospitalization were included. All patients underwent serial electrocardiography during the acute phase. Myocardial edema presence and extension was assessed by expert observers using the 17-segments cardiac segmentation model. ECG were analysed by expert observers blinded to the presence of myocardial edema. ECG pattern as predictors of myocardial edema presence and its extension were analysed by a binary regression and Student's t test.

Results
A total of 42 patients were included. Admission cQT was 472±60 ms. Thirty patients (71%) developed widespread negative T-waves and 55% showed cQT prolongation (cQT 476±58 ms) by the time of CMR. The median (IQR) time from admission to CMR imaging was 5 days (2–7 days). Myocardial edema was found in 30 patients (71%) and mean number of myocardial segments affected by edema was 4.8±2.5. Widespread negative T-wave development at the time of CMR imaging was associated with a smaller number of myocardial segments with edema. However no significant correlation was found between extension of myocardial edema and QT prolongation. No ECG pattern predicted a full recovery of myocardial edema (Table).

Conclusions
Development of widespread negative T-wave at the time of CMR predicts smaller myocardial edema extension. However, no other ECG features by the time of CMR were able to predict the full recovery of myocardial edema.

Funding Acknowledgement
Type of funding source: None
CPR related injuries
Authors: Karasek J , Blankova B , Doubkova A , Pitasova T , Nahalka D , Bartes T , Polasek R , Adamek T 
Published: November 2020

Abstract

Introduction
CPR related injuries were not properly observed since were established new guidlines for resuscitation (CPR) 2015

Objectives
To describe incidency and seriousness of injuries related to CPR, compare it and try identify factors for seriousness of injury.

Methods
Multicentric study, retrospective analysis of autopsy reports of patients after CPR, trauma were excluded.
We objectivised the most serious injury with Abbreviated injury scale (AIS)and summary of all injuries with New injury severity score (NISS).

Results
We have analyzed 628 autopsies: 80,4% men, age median 67 years, out of hospital cardiac arrests 89,2%, bystander CPR 56,8% and cardiac ethiology 78,2%. Ribs injury were founded by 94,6%, injury of lung by 9,9%, sternal injury by 62,4%, liver by 2,5% and spleen by 1,8% Median of the most serious injury was 3 (AIS) and median of summry of injuries was 13 by NISS-low risk of fatal injury. By out of hospital cardiac arrest was hifgher incidency of pleural injury and thorax vessles injuries without influence on total seriousness of injury compared to hospital cardiac arrests. Bystanders provided CPR had similar incidency and seriousness of injury like CPR provided only by professional emergency stuff. Women are significant older (p=0,0001), frequency of their injuries are similar to men, but seriousness of their injuries by NISS is significant higher (p=0,01). Patients with life threatening injury (AIS 4 and more) has similar baseline profil to their without injury (AIS 0), except of significant higher cardiac etiology of cardiac arrest by AIS 4+. Manually CPR were provided by 559 patients and mechanical by 64 (11,4%) patients. Both groups are no diferent in baseline. Mechanical
CRP was significantly longer (p=0,0005). Both groups have no diferences in incidency of injuries of visceral organs. We have observed injuries by 80% of manual and 87,5% of mechanical CPR (p=0,18). The most frequent was thorax sceleton injury 85,5% vs. 87,5%. Median of the most seriuos injury was 3 (serious by AIS), median of summary of injuries (NISS) was 13 in both groups (low probability of fatal injury). If we analysed CPR by LUCAS 2 compared to manual, results are similar, only pericard injuries are higher with LUCAS 2.

Conclusion
Incidency of CPR related injuries from autopsy reports is very high, but life threatening injuries create only 3%. The highest incidency have injuries of thoreax sceleton, especially ribs. There is no difereneces if patients were resuscitated by bystander or compared to those by professional stuff or manually. Women has similar frequency of injuries like men, but significant more serious by NISS. Incidency a seriousness of CPR related injuries according to autopsy reports are no diferent in comapring of manually and mechanical CPR. Mechanical CPR is significant longer a LUCAS 2 leads to significant more pericard injuries without influence to total seriousness of injury

Funding Acknowledgement
Type of funding source: None
The effect of aspirin, ticagrelor and heparin pre-transfer vs. similar precatherization treatment in STEMI on pre-PCI TIMI flow
Authors: D'Entremont M.A , Laferriere C , Nguyen M , Berube S , Lepage S , Couture E , Verreault-Julien L , Lemaire-Paquette S , Garant M.P , Karzon A , Desgagnes N 
Published: November 2020

Abstract

Aims
Whether early combined antithrombotic therapy with aspirin, ticagrelor and unfractionated heparin (UFH) in STEMI patients can improve clinical outcomes is unknown. Data regarding the efficacy of UFH in this clinical setting is lacking. The objective of this novel study was to evaluate the effects of early pretreatment with aspirin, ticagrelor and UFH on pre-PCI TIMI flow in the IRA in acute STEMI patients.

Methods and results
Between January 2015 and June 2018, we retrospectively compared 488 STEMI patients receiving aspirin, ticagrelor and UFH pretreatment in a spoke peripheral hospital before transfer (PHT) versus 233 prehospital triage setting (PTS) STEMI patients receiving in-ambulance aspirin, followed by ticagrelor and UFH pretreatment in the hub catheterization laboratory before PCI. The primary outcome was the presence of a pre-PCI TIMI flow 2–3 in the IRA.
The median times from ticagrelor and UFH administration to angiography in the PHT group and in the PTS group were 80 minutes (95% CI: 68.5–93.9) and 10 minutes (95% CI: 5–15.5) respectively (p&lt;0.0001). Inverse probability of treatment weighting was used to minimize differences between groups. Main results are shown in Table 1. Each 10-minute delay between ticagrelor and heparin administration and angiography was associated with a reduced pre-PCI TIMI flow (OR 0.89, 95% CI: 0.85–0.93).

Conclusion
STEMI patients receiving aspirin, ticagrelor and UFH before peripheral hospital transfer have a significantly greater pre-PCI TIMI flow 2–3 and a lower rate of definite in-hospital stent thrombosis compared to patients receiving in-ambulance aspirin in the prehospital setting followed by ticagrelor and heparin in the catheterization laboratory without greater bleeding risk. While prehospital triage with rapid primary PCI remains the preferred scenario for STEMI patients, a prompt UFH initiation may play a synergistic role with ticagrelor and aspirin in decreasing pre-PCI thrombus burden in the presence of organizational delays.
Figure 1. Study Design and Main Results

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Université de Sherbrooke's Department of Medicine, Division of Cardiology
Residual inflammation is a major determinant of myocardial recovery and cardiovascular outcome in takotsubo patients
Authors: Lachmet-Thebaud L , Marchandot B , Matsushita K , Sato C , Dagrenat C , Greciano S , De Poli F , Leddet P , Peillex M , Hess S , Carmona A , Reydel A , Ohlmann P , Jesel L , Morel O 
Published: November 2020

Abstract

Background
Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo Syndrome (TTS).

Objective
In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS.

Methods
Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. 385 patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP&lt;5.2 mg/l, CRP range 5.2 to 19 mg/l, and CRP&gt;19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP&gt;19 mg/L at discharge, on cardiac death or hospitalization for heart failure.

Results
Follow-up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow-up (61.7 vs. 60.7 vs. 57.9%; p=0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; p=0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.97; 95% confidence interval: 1.11 to 3.49; p=0.02).

Conclusions
RHIR was associated with impaired LVEF recovery and was evidenced as an independent factor of cardiovascular events. All together these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.
Main results

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): GERCA (Groupe pour l'Enseignement, la prévention et la Recherche Cardiovasculaire en Alsace)
Impact of a PERT initiative on hospital mortality of patients with bilateral pulmonary embolism
Authors: Ramos Lopez N , Luque Diaz T , Ferrera C , Enriquez Vazquez D , Mahia Casado P , Noriega Sanz F.J , Manas Hernandez A , Abelaira Freire J , Islas Ramirez F , Perez Serrano M , Higueras Nafria J , Galvan Herraez L , Pedrajas J , Fernandez Ortiz A , Salinas Sanguino P 
Published: November 2020

Abstract

Background
Implication of rapid-response teams have demonstrated significant improvement in several cardiovascular diseases, such as myocardial infarction and stroke. Thus, pulmonary embolism (PE) response teams (PERT) for the management of high-risk PE are encouraged in the guidelines.

Purpose
We aimed to assess the impact of a PERT initiative on hospital mortality. PERT was designed to manage patients with bilateral PE with RV/LV ratio &gt;0.9 and positive biomarkers.

Methods
We prospectively recruited all consecutive patients with intermediate-high and high-risk bilateral PE who required PERT activation from February-2018 to September-2019 (PERT group, n=56 patients). We compared them with patients with bilateral PE admitted to our hospital in a previous 2-year period (2014–2016), managed with standard of care (SC-group, n=172 patients). As a secondary analysis, we focused on patients with a RV/LV ratio&gt;0.9 (n=52, in the SC-group; n=55, 98% in the PERT-group).

Results
Results are shown on Table. The SC-group had a lower risk profile at admission (lower PESI score, heart rate, and higher oxygen saturation), compared to PERT-group. The proportion of patients with RV enlargement on CT (RV/LV &gt;0.9) was lower in the retrospective cohort (p&lt;0.001). Peak Troponin I was significantly higher in the PERT-group (Table). Reperfusion treatment was more frequently needed in PERT patients. On the contrary, there was no difference in the use of vasopressors (5.8% vs 12.5%, p=0.098) and orotracheal intubation (4.1% vs 5.4%, p=0.689) between groups. In-hospital mortality was lower in the PERT-group in the whole cohort (Table) and much lower when considering patients with RV/LV ratio&gt;0.9 (17.6% vs 1.8%, p=0.005).

Conclusion
PERT initiative is associated with a significant reduction in mortality compared to the standard of care in patients with bilateral high-risk PE.

Funding Acknowledgement
Type of funding source: None
Outcomes associated with respiratory failure for patients with cardiogenic shock and acute myocardial infarction: a substudy of the culprit-shock trial
Authors: Rubini Gimenez M , Millet E , Alviar C , Van Diepen S , Granger C , Windecker S , Serpytis P , Oldroyd K , Fuernau G , Huber K , Sandri M , De Waha-Thiele S , Zeymer U , Desch S , Thiele H 
Published: November 2020

Abstract

Background
Respiratory insufficiency with the need for mechanical ventilation (MV) is one of the most common indications for admission to intensive care units. However, little is known about the clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) who require mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population.

Methods
Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored clinical outcome within 30 days in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission.

Results
Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV were younger, more frequently non-smokers, had higher body mass indices, presented more often with clinical signs of impaired organ perfusion including worse renal function, higher burden of coronary artery disease, were more likely to have experienced resuscitation within 24h before admission, had worse left ventricular function, and presented more often with non-ST-segment elevation myocardial infarction. The primary endpoint of all-cause death or need for renal replacement therapy occurred in 21.8% of patients without MV, in 53.3% of patients with MV at admission (adjusted odds ratio [aOR] 6.03, 95% confidence interval (CI) 3.17–11.47, p=0.002, compared to patients without) and 65.4% of patients with MV initiated within the first day after admission (aOR 8.09 95% CI 4.32–15.16, p&lt;0.001, compared to patients without). Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24h before admission, elevated heart rate and evidence of triple vessel disease.

Conclusions
Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Swiss National Foundation