bluuebunny/crossref_metadata_2025_split huggingface dataset:
2-year real-world outcomes of prasugrel, ticagrelor or clopidogrel therapy following percutaneous coronary intervention from a large multi-centre Australian registry
Authors: Pol D , Chowdhury E , Delacroix S , Worthley S , Eccleston D 
Published: November 2020

Abstract

Background
Real-world data comparing outcomes for prasugrel, ticagrelor or clopidogrel use in patients undergoing percutaneous coronary intervention (PCI) is limited, with only smaller cohorts or 12-month observations available.

Methods
Data was collected prospectively from a total of 14 sites around Australia, from November 2008 until March 2019. The cohort included consecutively enrolled patients presenting electively or following acute coronary syndromes who were prescribed dual antiplatelet therapy following PCI. There were no exclusion criteria. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year and 2 years after PCI. Secondary end points included safety, which was the incidence of major bleeding (BARC 3,4 or 5) at discharge.

Results
A total of 12,940 patients were included over a 11-year period. Patients receiving prasugrel were more likely to be male, younger (mean age 62.3+8.7 years), obese and present with STEMI than those receiving either ticagrelor or clopidogrel (all p&lt;0.001). At 2 years the primary end point occurred in 120 of the 2968 patients (2.8 per 1000pyr) in the ticagrelor group, 446 of 9280 (2.7 per 1000pyr) patients in the clopidogrel group and 21 of 692 (1.8 per 1000pyr) prasugrel group (p=0.03). Major bleeding was observed in 0.2% in the ticagrelor group, 0.4% clopidogrel group and 0.1% in the prasugrel group (p=0.21).

Conclusion
For the first time we have shown in a large cohort of patients treated by PCI for ACS or CAD significantly lower 2-year rates of death, myocardial infarction and stroke amongst patients who received prasugrel than among those who received either clopidogrel or ticagrelor. The incidence of major bleeding did not differ between antiplatelet therapies.

Funding Acknowledgement
Type of funding source: None
Myocardial infarction triggered by exposure to air pollution – underestimated or overrated issue – 11 years study
Authors: Kuzma L , Struniawski K , Pogorzelski S , Zalewska-Adamiec M , Kralisz P , Bachorzewska-Gajewska H , Dobrzycki S 
Published: November 2020

Abstract

Introduction
Currently, the greatest threat to the health and life of people and the leading cause of death in Poland are cardiovascular diseases (CVD). Air quality is a well-known risk factor for the development of them.

Purpose
The aim of this study is to assess the impact of air pollution on the frequency of hospital admissions due to acute coronary syndrome (ACS).

Methods
The medical records of 30,695 patients hospitalized in the Department of Invasive Cardiology were analyzed. Patients treated for ACS and living within the borders of the analyzed city met inclusion criteria. Weather conditions such as temperature, humidity, atmospheric pressure, wind speed and the following components of air pollution were analyzed: carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2), trioxygen (O3), particulate matter with a diameter of 2.5 μm or less (PM2.5) and with a diameter of 10 μm or less (PM10). Poisson regression was used for statistical analysis.

Results
The study included 3,325 inhabitants of analyzed city (mean age 66.2 years, SD=12.2), male in majority (60.3%). The number of patients admitted for ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA) was 1002, 1265, and 1058, respectively. An increase of CO concentration by 1 g/m3 was associated with a higher number of admissions due to NSTEMI (RR 1.74; 95% CI, 1.08–2.8; P=0.02), this effect was more noticeable in the female population (RR - 2.8; 95% CI, 1.39–5.65; P=0.004). In male subjects an increase in the concentration of PM2.5 by 10 μg/m3 was associated with a 0.5% increase in the number of admissions for NSTEMI (RR 1.05, 95% CI 1.02–1.22; P=0.02) and UA (OR 1.14, 95% CI 1.02–1.25; P=0.014). An increase in the concentration of SO2 by 1 μg/m3 affected the frequency of admissions in men due to NSTEMI (0.5% increase, RR 1.04, 95% CI 1.01–1.07; P=0.007) and UA (OR 1.17, 95% CI 1.02–1.36; P=0.031). The concentration of 03 and NO2 did not affect admissions rate due to ACS.

Conclusions
Air quality had an impact on the occurrence of ACS among residents of Bialystok. Increased exposure to air pollution, in particular, elevated PM2.5, SO2 and CO levels, was associated with a higher incidence of NSTEMI and UA. This effect was more noticeable in the male population.

Funding Acknowledgement
Type of funding source: None
Parenteral anticoagulation in non-ST segment elevation acute coronary syndromes: which option to pick?
Authors: Sousa J.P , Lopes P , Azevedo P , Baptista R , Gavina C , Monteiro S 
Published: November 2020

Abstract

Background
According to the 2015 European Society of Cardiology's non-ST segment elevation acute coronary syndrome (NSTE-ACS) clinical practice guideline, fondaparinux is the parenteral anticoagulant with the most favorable efficacy/safety profile. Thus, it is recommended over enoxaparin, for instance, in that setting. However, its use and performance in a contemporary portuguese cohort has not been fully described.

Purpose
To assess fondaparinux utilization degree and to compare its in-hospital efficacy and safety profiles with those of enoxaparin, in a contemporary portuguese cohort of NSTE-ACS patients.

Methods
Patients consecutively admitted with NSTE-ACS, between October 2010 and January 2019, were retrospectively identified from a national registry of acute coronary syndromes and were further divided in two groups, as per parenteral anticoagulation strategy (fondaparinux vs. enoxaparin). Key exclusion criteria were specific contraindications to both agents, recent hemorrhagic stroke and indications for anticoagulation other than ACS. The primary efficacy endpoint was a composite of in-hospital reinfarction and mortality, whereas the primary safety endpoint was moderate-to-severe bleeding, as defined by the GUSTO criteria.

Results
A total of 5843 NSTE-ACS patients (mean age 65±13 years, 72.4% males) were included. Of these, 89.2% had a myocardial infarction, while the remaining 10.8% were diagnosed with unstable angina. The most frequent cardiovascular comorbidities were hypertension (71.3%), dyslipidemia (63.0%) and diabetes mellitus (31.7%). Fondaparinux was the anticoagulant of choice in 27.5% of patients, whereas the remainder were treated with enoxaparin. Compared with patients receiving enoxaparin, those in the fondaparinux group were younger, had less hypertension or diabetes mellitus and exhibited a less severe presentation; nonetheless, they had more often a previous history of coronary artery disease or hemorrhagic events. An invasive approach in terms of revascularization was adopted in 87.7% of the cohort (79.1% in the fondaparinux group vs. 90.9% in the enoxaparin group, p&lt;0.001). The primary efficacy and safety endpoints occurred in 2.4% and 4.7% of patients, respectively. After adjustment for relevant covariates, the use of fondaparinux was independently associated with a lower rate of both the primary efficacy (OR 0.56 [0.32–0.95], p=0.034) and the primary safety endpoints (OR 0.37 [0.23–0.59], p&lt;0.001).

Conclusion
In a contemporary portuguese cohort of NSTE-ACS patients, fondaparinux was underused but still independently associated with a lower risk of both a composite of in-hospital reinfarction or mortality event and major hemorrhage.

Funding Acknowledgement
Type of funding source: None
Trends in reperfusion therapy for acute ST-segment elevation myocardial infarction in an academic PCI centre in the metropolitan area of a developing country
Authors: Dharma S , Dakota I , Andriantoro H , Firdaus I , Limadhy I.G , Van De Werf F 
Published: November 2020

Abstract

Background
Long-term reports on reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in developing countries are scarce.

Purpose
We reported changes in acute reperfusion therapy for STEMI that have been observed over time in an academic tertiary care percutaneous coronary intervention (PCI) centre that hosting a STEMI network in the large metropolitan area of Jakarta, Indonesia since 2010 and covering around 11 million inhabitants.

Methods
A retrospective analysis was performed in 6336 patients with STEMI who admitted to the emergency department of a PCI centre in 2008 (before STEMI network introduction), and during 2011 to 2018.

Results
Among STEMI patients admitted during 2011–2018 (mean age: 56±10 years, 86% male), 57.6% had anterior wall myocardial infarction, and 71.3% presented with Killip classification I. Compared with the period 2011–2014 (N=2766), patients who were admitted in the period 2015–2018 (N=3250) were receiving more primary percutaneous coronary intervention (PCI) (61.6% vs. 44.2%, P&lt;0.001) with shorter door-to-device time (median 72 min versus 97 min, P&lt;0.001), and less in-hospital fibrinolytic therapy (2.7% vs. 4.8%, P&lt;0.001). The percentage of STEMI patients who did not receive reperfusion treatment decreased from 51% to 35.5% (P&lt;0.001). In-hospital mortality declined from 10% in 2008 (before the STEMI network was initiated) and 8% in 2011 to 6.4% in 2018 (P for trends = 0.05). Multivariable analysis showed that primary PCI was significantly associated with better in-hospital survival (adjusted odds ratio, 0.52; 95% confidence interval, 0.42 to 0.65, P&lt;0.001).

Conclusion
The data indicate that the introduction of a STEMI network resulted in more patients receiving timely primary PCI and lower early mortality rates in recent years.

Funding Acknowledgement
Type of funding source: None
Prognostic impact of SYNTAX II score in patients with cardiogenic shock complicating ST-elevation myocardial infarction: analysis of an 10-year all-comers registry
Authors: Juskova M , Tasende Rey P , Cid Alvarez B , Alvarez Alvarez B , Garcia Acuna J.M , Rigueiro Veloso P , Agra Bermejo R , Lopez Pais J , Sanmartin Pena J , Lopez Otero D , Fernandez Alvarez M , Trillo Nouche R , Gonzalez Juanatey J.R 
Published: November 2020

Abstract

Background
The SYNTAX II score (SS-II) can predict 4-year outcomes in patients with complex coronary artery disease and ST-segment elevation myocardial infarction (STEMI). Nonetheless, the prognostic value of SS-II for a cardiogenic shock (CS) in the setting of STEMI has not been assessed.

Purpose
This study aimed to investigate the predictive impact of SS-II in patients with CS complicating STEMI undergoing primary percutaneous coronary intervention, and whether SS-II adds prognostic information to predict major adverse cardiac events (MACE) and all-cause death in this population.

Methods
This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. The cohort of patients with CS (n=153) was identified and divided into three groups based on SS-II tertiles [SS-II low tertile &lt;38 (n=51), ≥38 SS-II intermediate tertile &lt;47 (n=51), and SS-II high tertile ≥48 (n=51)].

Results
Amongst the cohort of patients with CS mean age was 68.4±14.0 years, 69.2% were male and 51.6% presented with anterior STEMI (mean SSII was 45.1±14). In-hospital mortality was significantly higher in the high SS-II tertile (85.7% vs. 38.9% vs 24.4%, p≤0.001) compared with SS-II intermediate and low tertiles. During follow-up (median 2.5 years), SS-II was positively correlated with MACE (89.3% (high SS-II) vs. 52.8% (int SS-II) vs. 42.2% (low SS-II), p≤0.001), and with all-cause mortality (89.3% vs 44.4% vs 26.7%, p≤0.001).
The SS-II was also an independent predictor of MACE (HR=1.042, 95% CI: 1.020–1.063, p=0.000) and all-cause mortality during follow-up (HR=1.056, 95% CI: 1.033–1.079, p=0.000)

Conclusion
In a real-world cohort of patients with STEMI related CS, the SS-II added important prognostic information, being an independent predictor of MACE and all-cause mortality during follow-up.
Image 1

Funding Acknowledgement
Type of funding source: None
Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction
Authors: Zahn R , Hochadel M , Schumacher B , Pauschinger M , Stellbrink C , Schaechinger V , Behrens S , Mudra H , Elsaesser A , Zeymer U 
Published: November 2020

Abstract

Background
Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts.

Methods
We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access.

Results
Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend &lt;0.0001 with a strong variation between the participating centres (0% to 37%).

Conclusions
Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p&lt;0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution.

Funding Acknowledgement
Type of funding source: None
Sick euthyroid syndrome and its association with cardiogenic shock in acute coronary syndromes
Authors: Lobianco M , Costa D , Aladio J.M , Matsudo M , Swieszkowski S , Perez De La Hoz R 
Published: November 2020

Abstract

Introduction
Sick euthyroid syndrome (SES) constitutes an acute response to stress, and patients who develop it usually show more severe illness than those who do not. It could be related to disease severity in acute coronary syndrome (ACS), as assessed with Killip-Kimball class (KK), since cardiomyocytes are specifically sensitive to T3 levels.

Objective
To determine the prevalence of SES and low T3 in patients with ACS, and to assess its association with disease severity.

Methods
Prospective, observational and single center study in consecutive patients admitted to the CCU with a diagnosis of ACS. Clinical variables were collected from medical records; blood samples were obtained at admission to measure TSH, T3 and free T4 levels. SES was defined as low T3 with normal TSH and free T4. Maximum KK was determined by treating physicians. Categorical variables were compared with the chi-squared test, and categorical variables with Kruskal-Wallis and Wilcoxon tests. Statistical significance was set at p&lt;0.05.

Results
There were 149 patients with complete data available for analysis. Their age was 67.8±12.4 years, and 64% were male. A total of 16.3% had SES. There were 7.5% patients with SES and KK-A, 34.8% KK-B, 14.3% KK-C and 70% KK-D (p&lt;0.001). Thus, SES was more frequent in patients with some grade of heart failure, particularly cardiogenic shock. Figure 1 shows the difference in T3 values according to Killip-Kimball class.

Conclusion
Cardiomyocytes lack deiodinase and only possess T3 receptors, which makes them dependent on circulating T3 levels. T3 directly stimulates calcium channel and contractile protein synthesis in cardiomyocytes, and its deficit could affect cardiac contractility. Future studies should determine if thyroid hormone administration in cardiogenic shock can improve contractility and contribute to hemodynamic stability.
T3 values according to Killip-Kimball

Funding Acknowledgement
Type of funding source: None
Peripheral vascular disease and/or need for dialysis predicts mortality in acute myocardial infarction with shock treated with mechanical circulatory support
Authors: Ortiz F , Stouffer G , Rossi J 
Published: November 2020

Abstract

Background
Acute myocardial infarction (AMI) with left ventricular systolic dysfunction remains the largest cause for cardiogenic shock (CS) admissions. Aside for prompt revascularization few therapies have been shown to improve survival in this patient population. In the last decade, the use of mechanical circulatory support devices (MCS) for CS has increased, despite little evidence guiding their use.

Purpose
To explore for different baseline factors which may favor treatment with MCS vs pharmacological circulatory support (PCS) in AMI related CS.

Methods
Baseline clinical and procedural variables were retrospectively collected for all patient presenting to the cardiac cath lab with an AMI and CS at a large health care system. Patients were stratified by whether they received MCS or only PCS. The outcomes of interest were 30 day and one year mortality.

Results
Between 01/2014 andv08/2018, 205 patients presented to the cath lab with an AMI complicated by CS. The vast majority of cases were STEMIs (133/205, 65%). Overall mortality for the cohort at 30 days and one year were 41% and 50% respectively. There was no difference in 30 day or 1 year mortality between the MCS and PCS groups. A STEMI presentation was associated with increase 30 day mortality in the MCS group but the association was not seen at one year. Interestingly having a prior history peripheral vascular disease (PVD) and/or being on dialysis prior to the procedure was predictive of one year mortality in the MCS group (OR 3.8, 1.4–10.6, p=0.006) but not in the PCS.

Conclusion
Patients presenting with AMI complicated by CS have a high mortality despite successful revascularization. In our cohort having PVD and/or needing dialysis was predictive of mortality in patients receiving MCS. Patient selection is an important factor in choosing appropriate circulatory support, further prospective studies are needed.
Figure 1

Funding Acknowledgement
Type of funding source: None
Searching for the final diagnosis using cardiac magnetic resonance in MINOCA patients
Authors: Caldeira Da Rocha R , Picarra B , Santos A.R , Pais J , Carrington M , Bras D , Guerreiro R.A , Fernandes R , Aguiar J 
Published: November 2020

Abstract

Introduction
In patients with clinical evidence of acute myocardial infarction (AMI), absence of obstructive coronary disease does not imply absence of acute thrombotic process. Thereafter, it can be designated as Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). In these cases, performing Cardiac Magnetic Resonance (CMR) can be essential for establishing a final diagnosis, due to evaluation of the presence and pattern of late enhancement.

Purpose
The aim of this study is to evaluate the diagnostic and prognostic impact of cardiac magnetic resonance in patients with a possible diagnosis of MINOCA.

Methods
A 7-years prospective study in our centre, which included all patients proposed to CMR with a presumptive diagnosis of MINOCA due to acute chest pain, troponin raise and absence of angiographically significant coronary disease (luminal stenosis of &lt;50%). All patients performed functional, anatomical evaluation, as so late gadolinium enhancement search. We analysed clinical characteristics, electrocardiographic presentation, echocardiographic and coronariography results. A presumptive diagnosis was elaborated after coronariography and comparison was made with the definitive one after CMR.

Results
A total of 85 patients were included, 53% were male, with a mean age of 49±20 years old. Clinical history of hypertension was observed in 52% patients, 34% had dyslipidaemia, 8% with diabetes, obesity was present in 21% of patients and smoking habits in 33%. At admission, 47% had ST segment elevation, so emergent coronariography was performed. The mean highest troponin I was 7,54±9,39ng/mL. Late gadolinium enhancement was observed in 50 (59%) of patients. After CMR realization a final diagnosis of MINOCA was made in only 13 patients (15%) and in 51 patients (60%) CMR evaluation allowed a diagnosis modification, with impact on patients' management and prognosis. Of these 51 patients, a definitive diagnosis of myocarditis was seen in 65% of cases, of Takotsubo's myocardiopathy in 27%, and hypertrophic cardiomyopathy in 8%. In 21 (25%) of patients, late gadolinium enhancement was not found. However its absence could exclude type 1 AMI as definitive diagnosis.

Conclusion
CMR is a fundamental technique on MINOCA patients' management. In our population, performing CMR allowed initial diagnosis modification in about two thirds of the cases, with important therapeutic and prognostic implications.

Funding Acknowledgement
Type of funding source: None
Shall be takotsubo tear apart from working diagnosis of myocardial infarction with non-obstructive coronary arteries?
Authors: Lopez-Pais J , Izquierdo Coronel B , Raposeiras-Roubin S , Alvarez Rodriguez L , Vedia O , Almendro-Delia M , Uribarri A , Galan Gil D , Espinosa Pascual M.J , Martin De Miguel I , Garcia Acuna J.M , Iniguez Romo A , Alonso Martin J.J , Gonzalez Juanatey J.R , Nunez Gil I 
Published: November 2020

Abstract

Aims
Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCA) is still controversial. The aim of this work is to evaluate main differences between TTS and non-TTS MINOCA.

Methods and results
A cohort study based on two prospective registries: TTS from the RETAKO registry (N:1055) and non-TTS MINOCA patients from contemporary records of acute myocardial infarction from 5 national centres (N:1080). Definitions and management recommended by the ESC were used. Survival analysis was based on Cox regression; propensity score matching was created to adjust prognostic variables.
TTS were more often women (85.9% vs. 51.9%; p&lt;0.001) and older (69.4±12.5 vs. 64.5±14.1 years; p&lt;0.001). Atrial fibrillation was more frequent in non-TTS MINOCA (10.4% vs. 14.4%; p 0.007). Psychiatric disorders were more prevalent in TTS (15.5% vs. 10.2%, p&lt;0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs 1.8%, (p 0.015) and 25.8% vs. 11.5%, (p&lt;0.001).
Median follow-up was 32.4 months; TTS had less major adverse cardiovascular events (MACE): Hazard Ratio (HR) 0.59; 95% confidence interval (CI) 0.42 to 0.83. There were no differences in total mortality (HR 0.87; CI: 0.64 to 1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35 to 0.98).

Conclusions
TTS has a different patient's profile and a more aggressive acute phase than the rest of MINOCA. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a distinct entity with unique characteristics and prognosis.

Funding Acknowledgement
Type of funding source: None