bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of low diastolic blood pressure on 30-day mortality of patients with acute myocardial infarction
Authors: Asano T , Mitsuhashi Y , Sachi M , Wakabayashi K , Yahagi K , Shinke T , Mase T , Miyachi H , Tujiguchi S , Yamashita J , Yamazaki M , Miyauchi K , Yamamoto T , Nagao K , Takayama M 
Published: November 2020

Abstract

Background
It is known that low diastolic blood pressure (DBP) is associated with long-term cardiovascular events after acute myocardial infarction (AMI). However, the impact of low diastolic blood pressure on short-term outcome has not yet been well investigated.

Methods and results
We included 15,208 patients who were hospitalized for AMI and registered in the Tokyo CCU network registry between 2013 and 2016. Thirty-day in-hospital mortality rate was 4.8% (728/15,208). To assess the relationship between DBP at the time of admission and 30-day mortality non-linearly, spline regression model was applied with the stratification of the cohort according to tercile of systolic blood pressure (SBP, low:≤122 mmHg, intermediate:123–148 mmHg, high:≥149 mmHg) and J-curve phenomenon was observed in the low and high SBP groups. In multivariate logistic regression analysis, adjusted odds ratio of the lowest quintile of DBP (≤64 mmHg) was 1.65 (95% CI:1.02–2.66) in low SBP group and 4.55 (95% CI:1.72–12.00) in high SBP group.

Conclusion
Low DBP was associated with increased 30-day in-hospital mortality rate after AMI even in patients with high SBP.

Funding Acknowledgement
Type of funding source: None
Performance of the ESC 0/3-hour algorithm for rapid triage of myocardial infarction: systematic review and meta-analysis
Authors: Chiang C , Chiang C.H , Lee G.H , Lee C.C 
Published: November 2020

Abstract

Objective
The European Society of Cardiology (ESC) 0/3-hour algorithm is one of the most widely strategies used for rule-out or rule-in of acute myocardial infarction (AMI). However, a systematic evaluation of its performance has not been conducted. Furthermore, recent studies showed that the 0/3-hour algorithm is non-superior to the 0/1-hour algorithm.

Purpose
This study aims to summarize the safety and efficacy of the 0/3-hour algorithm and its comparative performance with the 0/1-hour algorithm.

Methods
We conducted literature search on PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between 1 January 2008 and 31 May 2019. A bivariate random-effects meta-analysis was used to estimate the primary and secondary outcomes, defined as index myocardial infarction and triage efficacy, major adverse cardiac event (MACE) or mortality at 30 days, respectively.

Results
A total of 10,832 patients from 9 studies with a pooled AMI prevalence of 16% were analyzed. The 0/3-hour algorithm ruled out 69% of the patients with a pooled sensitivity of 94.2% [95% CI: 87.6%–97.4%] and negative predictive value of 98.6% [95% CI: 97.0%–99.4%]; 17% of the patients were ruled in with a pooled specificity of 94.9% [95% CI: 88.6%–97.8%] and positive predictive value of 72.9% [95% CI: 54.6%–85.7%]. The 30-day mortality and 30-day MACE for patients that were ruled out were 0.0% [95% CI: 0.0%–0.0%] and 1.4% [95% CI: 0.9%–2.0%], respectively. In a pooled analysis of 3 cohorts, the 0/3-hour algorithm had a non-superior sensitivity compared with the 0/1-hour algorithm (94.4% [95% CI: 87.0%–97.7%] vs. 98.4% [95% CI: 95.4%–99.7%]). The 0/3-hour algorithm also had a similar rule-out efficacy compared with the 0/1-hour algorithm (52% [95% CI: 39%–65%] vs. 53% [95% CI: 42%–64%]).

Conclusion
The widely used 0/3-hour algorithm has sensitivity substantially below the consensus goal of 99% and may not be sufficiently safe for triage of myocardial infarction. Furthermore, the 0/3-hour algorithm is not superior to the 0/1-hour algorithm despite the additional triage time.
Performance of ESC 0/3-hour algorithm

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Taiwan National Ministry of Science and Technology Grants
Association between variation of troponin and prognosis of acute myocardial infarction before and after primary percutaneous coronary intervention
Authors: Zhao Z.X.X , Wang W.Y , Liu L.C , Zhou Z.P , Sheng S.Z.X , Li L.J.N , Zhou Z.J.Y , Chen C.R.Z , Yan Y.H.B 
Published: November 2020

Abstract

Background
Circulating levels of cardiac troponin I (cTnI) after STEMI were considered prognostic factors for predicting MACE. ΔcTnI is the difference between peak cTnI post-primary PCI and cTnIon initial admission.

Purpose
Study aimed to assess the relationship between ΔcTnI, the ratio of ΔcTnI to cTnI on initial admission and MACE during the follow-up period.

Methods
A total of 2596 patients with cTnI measured upon admission and one-time measurement of cTnI during hospitalization were enrolled.

Results
In the adjusted models of the survival ROC curve, ΔcTnI and the ratio of ΔcTnI to cTnI on initial admission have stronger discrimination power of MACE [AUC 0.730 and 0.717] compared with peak cTnI post-PPCI and cTnI at admission (AUC 0.590, 0.546). Multivariate Cox regression analysis identified ΔcTnI [HR 1.018, 95% CI 1.001 to 1.035] as a relevant factor for MACE during follow-up. On the K-M survival curves,the incidence of MACE, mortality and angina pectoris were significantly higher in the group with maximum ΔcTnI (p=0.035, 0.049, 0.026).

Conclusion
ΔcTnI level and the ratio have stronger discrimination power of MACE. The group with maximum ΔcTnI has higher incidence of MACE, mortality and angina pectoris during the follow-up period.
Flow chart + survival ROC curve + K-M curve

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): This study was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences
IL-10 / IL-6 serum ratio as a prognosis marker of STEMI
Authors: Leboube S , Bochaton T , Paccalet A , Crola Da Silva C , Jeantet P , Amaz C , De Bourguignon C , Varillon Y , Prieur C , Tomasevic D , Genot N , Rioufol G , Bonnefoy-Cudraz E , Mewton N , Ovize M 
Published: November 2020

Abstract

Introduction
IL-6 and IL-10 are two major cytokines secreted at the acute phase of myocardial infarction (MI). IL-6 has a pro-inflammatory effect whereas IL-10 has anti-inflammatory effect.

Objective
Our objective was to assess the prognosis value of IL-6, IL-10 and IL-10/IL-6 ratio serum level at the acute phase of ST elevation MI (STEMI).

Methods
We prospectively enrolled 247 patients admitted for acute STEMI from 2016 to 2019. Blood samples were collected at 5 time points: admission, 4, 24, 48 hours and 1 month (H4, H24, H48, M1). IL-6 and IL-10 were assessed using ELISA. Patients underwent cardiac magnetic resonance imaging at one month for infarct size (IS) and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes were prospectively recorded over 18 months.

Results
Patient mean age was 59±12 years. IL-6 reached a peak at H24 at 5.4 pg/mL interquartile range (IQR) [2.1–11.0] and IL-10 peaked as early as admission at 5.6 pg/mL IQR [8.7–29.3] followed by a decrease within the first month. Median IL-10/IL-6 ratio at admission was 4.2 [1.4–8.6] with a strong decrease at H24 (0.5 [0.2–1.3]). IL-6 and IL-10 levels at H24 were correlated with IS (respectively r=0.44, p&lt;0.0001, and r=0.29, p=0.0001) and inversely correlated with LVEF (respectively r=−0.42, p&lt;0.0001 and r=−0.26, p=0.0003). Patients with IL-10/IL-6 ratio ≥1 had smaller IS compared to patients with IL-10/IL-6 ratio &lt;1 (respectively 9.0% IQR [2.4–15.4] of LV versus 17% IQR [8.7–29.3] of LV, p&lt;0.0001) and they had higher LVEF (58.0% IQR [52.0–62.3] versus 49.0% IQR [41.5–56.0], p&lt;0.0001). Patients with IL-10/IL-6 ratio &lt;1 were more likely to have an adverse clinical event (MI, stroke, hospitalization for heart failure and all-cause death) during the first 18 months after STEMI compared to patients with IL-10/IL-6 ratio ≥1 (HR=2.7, 95% CI [1.2–5.5], p=0.04).

Conclusion
Serum IL-10/IL-6 &gt;1 was associated with a poor outcome after STEMI and might be a valuable prognostic marker.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Hospices Civils de Lyon, Fédération Française de Cardiologie
Usefulness of lung ultrasound in patients with acute coronary syndrome
Authors: Cristo Ropero M.J , Seoane Garcia T , Izquierdo Bajo A , Madrona Jimenez L , Rivera Rabanal F.J , Almendro Delia M , Hidalgo Urbano R , Vilches Arenas A , Garcia Rubira J.C 
Published: November 2020

Abstract

Background
The development of heart failure (HF) is a factor of poor prognosis in patients admitted due to acute coronary syndrome (ACS).

Research question
The aim of this study is to establish the usefulness of lung ultrasound (LU) to predict patients at risk of developing HF and the need for mechanical ventilation.

Methods
Prospective study with consecutive inclusion of patients with ACS type infarction without HF on admission and admitted to our centre between February 2017 and 2018. A lung ultrasound was performed in the first 24 hours, considering it positive when they presented 3 or more B lines in two or more quadrants of bilateral form. The result was related to the need for mechanical ventilation.

Results
We included 119 patients (65.1±12.8 years, 75.6% men), 12.6% presented a need for mechanical ventilation. Patients with a positive LU adjusted for a history of atrial fibrillation and the Killip-Kimball class have a risk 72.79 [95% CI: (9.21, 575.28)] times higher than needing mechanical ventilation at any time of the follow-up Adjusted for sex and heart rate, the result is 101.28 [95% CI: (12.83, 799.15); p=0.00005] times more risk of needing mechanical ventilation at any time of follow-up.

Conclusions
LU has a high positive predictive value for the development of severe HF and the need for mechanical ventilation, in patients admitted for ACS. Our findings suggest that LU should be incorporated in the initial stratification of patients with ACS.
Survival analysis mechanical ventilation

Funding Acknowledgement
Type of funding source: None
Invasive versus conservative management in spontaneous coronary artery dissection: a meta-analysis and meta-regression study
Authors: Bocchino P.P , Angelini F , Franchin L , D'Ascenzo F , Fortuni F , Conrotto F , Alfonso F , Saw J , Escaned J , De Ferrari G.M 
Published: November 2020

Abstract

Background
There is a paucity of data regarding the best treatment for spontaneous coronary artery dissection (SCAD).

Purpose
To compare the prognostic impact of conservative versus invasive treatment in patients with SCAD.

Methods
We systematically searched the literature for studies evaluating the comparative efficacy and safety of invasive revascularization versus medical therapy for the treatment of SCAD from 1990 to 2019. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups.

Results
24 observational studies with 1720 patients were included. After 28±14 months, a conservative approach reduced target vessel revascularization rate compared with invasive treatment (OR=0.50; 95% CI 0.28–0.90; P=0.02). No difference was found regarding all-cause mortality (OR=0.81; 95% CI 0.31–2.08; P=0.66), cardiovascular mortality (OR=0.89; 95% CI 0.15–5.40; P=0.89), myocardial infarction (OR=0.95; 95% CI 0.50–1.81; P=0.87), heart failure (OR 0.96; 95% CI 0.41–2.22; P=0.92) and SCAD recurrence (OR=0.94; 95% CI 0.52–1.72; P=0.85). The meta-regression analysis suggested that male gender, diabetes mellitus, smoking habit, prior coronary artery disease, left main coronary artery involvement and lower ejection fraction at admission are related with higher overall mortality, whereas SCAD recurrence was higher among patients with fibromuscular dysplasia.

Conclusion
A conservative approach provides similar clinical outcomes and lower target vessel revascularization rates compared to an invasive strategy in the setting of SCAD; therefore, when feasible, it should be preferred in this scenario.
Forest plots on the study outcomes

Funding Acknowledgement
Type of funding source: None
Bleeding risk prediction in elderly patients managed invasively for Acute Coronary Syndromes: external validation of the PRECISE-DAPT and PARIS risk scores
Authors: Montalto C , Crimi G , Morici N , Piatti L , Grosseto D , Sganzerla P , Tortorella G , De Rosa R , De Luca L , De Luca G , Palmerini T , Valgimigli M , Savonitto S , De Servi S 
Published: November 2020

Abstract

Background
Tailoring Dual Antiplatelet Therapy (DAPT) to each patient bleeding and ischemic risk profile is a majopr challenge in everyday clinical practice. As the elderlies were underrepresented in validation cohorts of bleeding risk scores, their generalizability in this context is uncertain.

Purpose
We sought to assess the clinical utility of the PRECISE-DAPT and PARIS bleeding risk scores to elderly patients suffering from ACS and undergoing invasive management.

Methods
Our external validation cohort included 1,883 patients older &gt;74 years admitted for ACS and treated with PCI from 3 multicenter, randomized trials. Bleeding risk scores were calculated on a patient-level and subjects were stratified into risk categories according to each risk score definition.

Results
After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3–5 bleedings (log rank p=0.002) while this was not observed for those in the high-risk category according to the PARIS risk score (log rank p=0.3). Both scores had a moderate discriminative power (c-statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ2&gt;0.05), but PARIS risk score was associated to a greater overestimation of the risk (mean D observed-predicted probability = −0.65 for PRECISE DAPT and −4.62 for PARIS, p=0.02; Figure 1). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. A sensitivity showed that calibration and discrimination power was moderate for both risk scores also after including BARC 2 events.

Conclusion
In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance and a higher net benefit.
Figure 1

Funding Acknowledgement
Type of funding source: None
Ticagrelor pretreatment in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Graca Santos L , Ribeiro Carvalho R , Fernandes S , Montenegro Sa F , Ruivo C , Soares F , Correia J , Pernencar S , Morais J 
Published: November 2020

Abstract

Introduction
Dual antiplatelet therapy is recommended in non-ST elevation acute coronary syndrome (NSTACS), regardless of the treatment strategy (invasive vs. conservative). Although prasugrel pretreatment is not recommended due to safety concerns, the timing of ticagrelor administration is still debated.

Aim
To investigate the clinical effects of ticagrelor pretreatment in NSTACS patients (pts) undergoing percutaneous coronary intervention.

Methods
Retrospective multicentre study of 5213 NSTACS pts who underwent percutaneous coronary intervention (PCI) up to 72 hours following hospital admission, between January 2013 and December 2018. Patients with prior chronic exposure to oral antithrombotics (except acetylsalicylic acid), not acutely managed with ticagrelor, and those with missing data were excluded. A total of 415 pts were included for analysis, 256 (61.6%) received ticagrelor pretreatment (Group 1) and 159 (38.3%) were treated with ticagrelor only in the catheterization laboratory (Group 2). The primary safety endpoint was a composite of in-hospital major bleeding, need for red blood cell transfusion or haemoglobin drop ≥2g/dL and the secondary endpoint of periprocedural events was a composite of PCI failure, bailout use of GPIIb/IIIa inhibitors and in-hospital re-infarction. Multivariate analysis was performed to determine the correlates of ticagrelor pretreatment and each of the endpoints. One-year follow up was achieved in 103 pts (24.8%).

Results
Overall, mean age was 62±11 years and 20.7% were female. Crude event rates did not differ regarding primary endpoint (16.5 vs 11.5%; p=0.17), while secondary endpoint was more frequent among group 2 (2.1% vs 7.1%; p=0.01). Multivariate analysis showed no association between the timing of ticagrelor administration and the primary safety endpoint, while periprocedural events were less frequent in pretreated pts (Figure 1A). At the Kaplan-Meier analysis, one-year cumulative event-free (all-cause death, stroke or re-infarction) rates did not differ (Figure 1B).

Conclusion
In this cohort of NSTACS pts undergoing PCI in the first 72 hours after hospital admission, ticagrelor pretreatment was associated with less periprocedural events with no compromise regarding safety, compared to treatment in the catheterization laboratory. Additional data is still needed to clarify these findings.

Funding Acknowledgement
Type of funding source: None
Optimal antithrombotic strategy for patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention: updated meta-analysis of randomised controlled trials
Authors: Liao B , Wang T.K.M 
Published: November 2020

Abstract

Background
The optimal antithrombotic strategy for the growing proportion of patients with indications for both dual antiplatelet therapy and long-term anticoagulation remains controversial, with recent randomized trials published and mixed recommendations in guidelines. We meta-analysed bleeding and cardiovascular outcomes comparing dual versus triple and non-vitamin K oral anticoagulants (NOAC) versus vitamin K oral anticoagulants (VKA) antithrombotic regimens.

Methods
MEDLINE, Embase and Cochrane databases were searched for original randomised trials with relevant search terms from January 1980-December 2019. Two authors evaluated studies for inclusion and extracted data to pool efficacy and safety endpoints.

Results
The search yielded 331 articles, with 22 full-texts reviewed and six randomised trials totalling 12,146 patients included. Dual antithrombotic strategies had reduced TIMI major and minor bleeding (odds ratios 0.59, 95% confidence interval 0.44–0.80), as well as all, major, and minor bleeding (odds ratios 0.55–0.59, all P&lt;0.05), with no differences in mortality, myocardial infarction, stroke, stent thrombosis or composite cardiovascular events (odds ratio 0.91–1.26, all P&gt;0.05), compared with triple antithrombotic strategies in six trials. NOAC regimens had lower TIMI major and minor bleeding (odds ratio 0.64, 0.49–0.85), as well as major, minor and intracranial bleeding (odds ratios 0.36–0.66, all P&lt;0.05), and similar no differences in mortality or all cardiovascular endpoints (odds ratios 0.85–1.13, all P&gt;0.05), compared with VKA regimens in four trials.

Conclusion
Dual antithrombotic therapy with NOAC had significantly reduced bleeding without increase in cardiovascular events and mortality compared to their counterparts, and should generally be recommended in patients needing dual antiplatelet and long term anticoagulation therapy.

Funding Acknowledgement
Type of funding source: None
Impact of morphine treatment with and without metoclopramide co-administration on myocardial and microvascular injury in acute myocardial infarction: insights from a randomized trial
Authors: Stiermaier T , Schaefer P , Saad M , Meyer-Saraei R , De Waha-Thiele S , Fuernau G , Langer H , Barkhausen J , Desch S , Thiele H , Eitel I 
Published: November 2020

Abstract

Background
Intravenous morphine administration in patients with acute myocardial infarction (AMI) can adversely affect platelet inhibition induced by P2Y12 receptor antagonists, potentially resulting in an increased risk of adverse clinical events. In contrast, some evidence suggests that opioid agonists may have cardioprotective effects on the myocardium. Currently available data in this regard are, however, sparse, inconsistent, and methodologically limited.

Purpose
The aim of this study was to investigate the impact of morphine with or without metoclopramide (MCP) co-administration on myocardial and microvascular injury after AMI assessed by cardiac magnetic resonance (CMR).

Methods
This prospective, randomized, single-center study assigned 138 patients with AMI in a 1:1:1 ratio to (a) ticagrelor 180 mg plus intravenous morphine 5 mg (morphine group); (b) ticagrelor 180 mg plus intravenous morphine 5 mg and MCP 10 mg (morphine + MCP group); or (c) ticagrelor 180 mg plus intravenous placebo (control group). Study drugs were administered before primary percutaneous coronary intervention. CMR was performed in 101 patients on day 1–4 after the index event to assess infarct size, microvascular obstruction, and left ventricular ejection fraction.

Results
Infarct size was significantly smaller in the morphine only group as compared to controls (15.5%LV [IQR 5.0 to 21.4%LV] vs. 17.9%LV [IQR 12.3 to 32.9%LV]; p=0.047). Furthermore, the number of patients with microvascular obstruction was significantly lower after morphine administration (10/36 [28%] versus 21/39 [54%]; p=0.022) and the extent of microvascular obstruction was smaller (0%LV [0 to 1.40%LV] versus 0.74%LV [0 to 3.10%LV]; p=0.037). In multivariable regression analysis, morphine administration was independently associated with a reduced risk for the occurrence of microvascular obstruction (odds ratio 0.37; 95% confidence interval 0.14 to 0.93; p=0.035). Left ventricular ejection fraction did not differ significantly between the morphine and the control group (p=0.970) and there was no significant difference in left ventricular ejection fraction (p=0.790), infarct size (p=0.491), and extent (p=0.753) or presence (p=0.914) of microvascular obstruction when comparing the morphine + MCP group to the control group.

Conclusions
In this randomized study, intravenous administration of morphine prior to primary percutaneous coronary intervention resulted in a significant reduction of myocardial and microvascular damage following AMI. This potential cardioprotective effect of morphine requires further evaluation in well-designed future trials with clinical endpoints.

Funding Acknowledgement
Type of funding source: None