bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ecgto reperfusion time analysis ant its impact in the prognosis of acute myocardial infarction
Authors: Oliveira CC , Braga C , Medeiros P , Campos I , Pires C , Mane F , Flores R , Azevedo P , Pereira M , Gaspar A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
According to 2017 ESC guidelines for STEMI, reperfusion time of patients not admitted in centers with primary PCImust be ≤120 minutes (min). OBJECTIVE: To analyze the proportion of patients with STEMI admitted in hospitals without primary PCI in which reperfusion time was ≤120 min and to understand its prognostic impact. METHODS: Multicentric, retrospective study. 1909 STEMI pts with &lt;12h of symptoms evolution, admitted in hospitals without primary PCI betweenOctober 2010 and September 2019 who underwent primary PCIwere analyzed. Patients were studied according to the ECG-reperfusion time: ≤120 min (Group 1 – G1) or &gt;120 min (Group 2 – G2). RESULTS: G1 corresponded to 42.5% while G2 to 57,5%. In both groups patients were mainly male. G1 1 was younger (61 ± 13 vs 64 ± 14, p &lt; 0.001) and had more prevalence of smoker patients (44.1% vs 36.1%, p &lt; 0.001). G2 have more often diabetes (25.9 % vs 21.2%, p = 0.02). Time until the 1 st medical contact and admission was longer inG2 (120 min vs 105 min, p = 0.004). "Via verde coronária"was more frequently activated inG1 (5.5% vs 1.8%, p &lt; 0.001). There were no significant differences on the KK classification on admission, but G2 had more prevalence of severe left ventricular disfunction (LVEF ≤ 30%: G1 = 3%, G2 = 6%, p = 0.002). During the hospitalization, G2 had significantly higher rates of heart failure (11.7% vs 17.4%, p &lt; 0.001) and cardiogenic shock (3.6% vs 5.7%, p = 0.036). Cardiac arrest on admission was more prevalent inG2 (3% vs 5.2%, p = 0.017). Mortality during hospitalization was higher inG2 (1.6 vs 4.2%, p &lt; 0.001). Patients admitted on North were mainly inG2 (n = 493, 39.6% vs 60.4%) as on Center (n = 253, 25.7% vs 74.3%) and South (n = 304, 35.3% vs 64.7%). In Lisbon and Tejo Valley patients were mainly onG1 (n = 860, 51.6% vs 48.4%). Follow-up was performed in 859 patients (G1 = 42.6% vs G2 = 54.4%). After 1 year, there were no differences in mortality (G1 = 16 deaths, G2 = 26 deaths, p = 0.520). Cardiovascular and noncardiovascular readmissions were also not difference between the groups mortality (p = 0.782 and p = 0.548, respectively). CONCLUSION: Most of the patients did not comply the current guidelines. Reduction of system delay in STEMIremains crucial, since lower reperfusion time have less in-hospital complications and mortality. Follow-up was not performed in all patients which can justify the results. This work shows that it is fundamental to adopt organizational measures to reduce system delay.
Stroke occurrence in patients with STEMI: does BNP help to predict?
Authors: Almeida I , Santos M , Santos H , Miranda H , Chin J , Sousa C , Almeida L 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Portuguese Registry of Acute Coronary Syndromes (ProACS)

Introduction
Although brain natriuretic peptides (BNP) has been primarily identified in brain tissue, its clinical application is primarily related to cardiac disease, namely heart failure. The current information on this natriuretic peptide in cerebrovascular disease is limited, however some studies performed showed an acute elevation of BNP during the acute phase of ischemic stroke.

Objective
Evaluation of prognostic value of BNP in the occurrence of in-hospital ischemic stroke in patients admitted with ST elevation myocardial infarction (STEMI).

Material and methods
Retrospective analysis of patients´ data admitted with STEMI at multicentric registry between October 2010 and January 2019. Patients were divided into two groups: group 1 – patients who suffered an ischemic stroke (0.8%) and group 2 – without stroke (99.2%). Demographic and clinical characteristics were compared. A logistic regression was performed to evaluate prognostic value of BNP in the occurrence of in-hospital stroke and cardiovascular events.

Results
Admitted 1650 patients with STEMI. There was no statistically significant difference between mean age in both groups (mean age 64 ± 13 years, p 0.122) and most patients were male (75.4%). A higher percentage of group 1 patients had a previous diagnosis of stroke/ transitory ischemic accident (28.6 vs 5.4%, p 0.006) but there was no significant differences regarding the percentages of previous arterial hypertension, diabetes, dyslipidaemia neither peripheral vascular disease. Mean values of BNP at admission were higher in group 1: 839 ± 1088 vs 333 ± 639 pg/ml (p 0.04). All patients were submitted to coronary angiography, without evidence of significant differences regarding severity of coronary disease. In group 1 patients mean left ventricle ejection fraction (LVEF) during hospitalization was lower: 43 ± 11 vs 53 ± 13 %, p 0.005. Logistic regression identified as prognostic factors of in-hospital ischemic stroke: previous stroke/ transitory ischemic accident (p 0.007), dementia (p 0.005) or thoracic pain at STEMI presentation (p 0.005). Although patients with higher levels of BNP had suffered more stroke (0.5% in group with BNP &lt; 100pg/ml; 0.6% in group with 100 ≤ BNP &lt; 400 pg/ml; and 2.0% in group with BNP ≥ 400 pg/ml), BNP did not show to be predictor of stroke occurrence in this context (p 0.862).

Conclusion
Although patients with higher levels of BNP had suffered more stroke, BNP did not show to be predictor of stroke occurrence in patients admitted with STEMI.
Initially elevated troponin I in rapid atrial fibrillation should lead to coronary angiography
Authors: Esteves AF , Parreira L , Marinheiro R , Fonseca M , Farinha JM , Pinheiro A , Ferreira J , Mesquita D , Amador P , Fonseca N , Santos R , Seixo F , Costa C , Caria R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients admitted to the emergency department (ED) with rapid atrial fibrillation (AF), the decision to undergo coronary angiography is usually due to elevated cardiac biomarkers. However, a study evaluating the rentability of this approach has never been done.

Purpose
Evaluate the predictors of a positive coronary angiography performed in patients with rapid AF and elevated cardiac biomarkers.

Methods
We retrospectively studied patients admitted to the ED between January 2016 and December 2018 with rapid AF who have undergone coronary angiography. We analysed symptoms, risk factors, initial value, peak value and curve of troponin I (TnI) and ST-T segment abnormalities. We evaluated the presence of significant coronary artery stenosis with the need of revascularization at coronary angiography and we used logistic regression to assess the predictors of a positive result.

Results
From 2265 patients admitted to the ED with rapid AF, 46 patients, 60.9% (28) male, median age 73 (IQR 14.75) years, were submitted to coronary angiography. Significant coronary artery stenosis was present in 24 (52.2%) patients. Regarding cardiovascular risk factors, 39 (85.6%) patients had hypertension, 15 (32.6%) had type 2 diabetes mellitus, 36 (78.3%) had dyslipidaemia, 25 (54.3%) were obese or overweight and 12 (26.1%) had a previous history of CAD. Twenty-eight (60.9%) patients presented with chest pain and 27 (58.7%) had ST-T segment abnormalities. Of note, in 17 (37.0%) cases high-sensitivity TnI was measured.
In univariable analysis, ST-T segment abnormalities, the presence of typical TnI curve and an elevated initial TnI predicted the presence of significant CAD in coronary angiography.
In multivariable analysis, an initial TnI value above the upper reference limit (URL) was the only independent predictor of significant CAD in coronary angiography.

Conclusion
In this group of patients with rapid AF an initial elevated TnI was the only independent predictor of the presence of significant CAD. Therefore, maybe it would be advisable to perform coronary angiography in these patients. Without CADWith CADUnivariate analysisOR (95% CI), p-valueMultivariate analysisOR (95% CI), p-valueAge in years, median (IQR)69 (15)77.5 (17)1.045 (0.988-1.106), 0.1270.967 (0.882-1.062), 0.484Type 2 diabetes mellitus, n (%)5 (23.8)10 (41.7)2.286 (0.629-8.313), 0.2095.865 (0.566-60.806), 0.138ST-T segment abnormalities, n (%)8 (36.4)19 (79.2%)6.650 (1.788-24.730), 0.0055.338 (0.491-58.063), 0.169Typical TnI curve, n (%)10 (52.6)20 (90.9)9.000 (1.628-49.756), 0.01217.900 (0.475-674.480), 0.119Elevated initial TnI, n (%)10 (45.5)18 (75.0)3.600 (1.033-12.542), 0.04415.167 (1.363-168.778), 0.027Peak TnI elevation &gt;2 times URL, n (%)11 (50.0)18 (75.0)3.000 (0.863-10.428), 0.0840.169 (0.005-5.298), 0.312
The c- reactive protein to troponin ratio enhances the differentiation of perimyocarditis from acute myocardial infarction
Authors: Kobo O , Meisel SR , Hamuda N , Natour R , Saada M , Abu Fanne R , Amsalem N , Levin C , Frimerman A , Levi Y , Shotan A , Roguin A , Kleiner Shochat M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Differentiating perimyocarditis from acute myocardial infarction (AMI) is frequently difficult . Perimyocarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We surmised that the CRP/troponin ratio on presentation could improve the differentiation between these two clinical entities.
We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large hospital registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed as perimyocarditis. CRP and troponin were sampled on admission and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of perimyocarditis against STEMI with or without NSTEMI.
Median admission CRP/troponin ratios were 84, 65, and 436 mg × ml/liter × ng in STEMI, NSTEMI and perimyocarditis groups, respectively (p &lt; 0.001) demonstrating good differentiating capability. The ROC of admission CRP/troponin ratio for diagnosis of perimyocarditis against STEMI with or without NSTEMI yielded a similar AUC of 0.74 and 0.73, respectively. CRP/troponin ratio &gt; 500 resulted in specificity exceeding 85%.
The CRP/troponin ratio is an effective tool that enhances the differentiation between perimyocarditis and AMI.
Women and elderly: do we delay treatment even after identifying ST-segment elevation?
Authors: Araujo Leite Medeiros P , Martins J , Campos I , Oliveira C , Pires C , Flores R , Mane F , Silva R , Ferreira A , Quina C , Costa J , Braga C , Marques J 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
It is known that some subgroups (e.g. women or elderly) may experience a delay in diagnosis of acute myocardial infarction (AMI). This may be due to atypical symptoms that don’t trigger further evaluation as promptly as typical symptoms or due to underestimation of patient’s complaints. However, we don’t know if there is any delay in treatment after the diagnostic electrocardiogram (ECG).

Aim
To evaluate the association between patients’ gender and age and reperfusion (by percutaneous coronary intervention - PCI) time after ECG.

Methods
Single-center retrospective study of individuals that underwent primary PCI between June 2011 and December 2017. We included patients aged ≥ 18, with time registry of the first ECG with ST segment elevation (or equivalent) and time of PCI. No patients were excluded. We defined the time between the first ECG and reperfusion as the ECG-PCI time.

Results
A total of 1679 patients were included; 78% male (n = 1317) and 22% female (n = 362); 59% were younger than 65 (n = 985) and 41% were 65 or older (n = 694). Median ECG-PCI time was higher in females [104 minutes (IQR = 68)] than in males [94 minutes (IQR = 61)]; this association was statistically significant (U = 269124, p &lt; 0.001). Median ECG-PCI time was also higher in older (≥ 65 years) patients [101 minutes (IQR = 68)] than in younger patients [93 minutes (IQR = 55)], with statistical significance (U = 381141, p &lt; 0.001). After stratifying patients’ gender by age, we observed that, in male patients, median ECG-PCI time was lower in younger patients [91 minutes (IQR = 55)] than in older patients [100 minutes (IQR = 69)]; this association was also significant (U = 220025, p &lt; 0.001). On the other hand, the same analysis in female patients found no significant association between younger and older patients (U = 13799, p = 0.522).

Conclusion
Despite a median ECG-PCI time difference of only 9 minutes between males and females, this difference was found to be significant. Factors delaying evaluation after onset of symptoms in women may also delay PCI after diagnostic ECG; borderline ECG criteria may be devalued in women. Older patients may take longer to PCI due to the higher incidence of comorbidities, specially diabetes mellitus, which can mask typical AMI symptoms. Survival impact of these differences should be further studied. Abstract Figure. ECG-PCI time according to gender and age
Nutritional status in older patients with acute coronary syndrome and comorbidity
Authors: Efremova E , Shutov AM , Menzorov MV , Mashina TV 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Older patients with acute coronary syndrome (ACS) require a special management, taking into account comorbidity and gerontological syndromes. Obesity paradox and nutritional status as a factor of poor prognosis need further study. The aim of this study was to investigate nutritional statusin older patients with ACS and comorbidity.

Materials and methods
90 older patients (51 males and 39 females, mean age was 67.0 ± 6.2 years) admitted to hospital with ACS were studied. ACS with ST-segment elevation (STE-ACS) and without ST segment elevation (NSTE-ACS) were diagnosed according to ESC Guidelines (2017 and 2015, respectively). STE-ACS was diagnosed in 17 (18.9%) patients, NSTE-ACS - in 73(81.1%) patients. All patients had cardiovascular pathology before hospitalization: 86 (95.6%) patients had arterial hypertension, 71 (78.9%) - coronary artery disease, 37 (41.1%) patients - myocardial infarction in history. Charlson comorbidity index (CCI) was estimated. Comorbidity was regarded as high at index ≥ 6 scores. Nutritional status was assessed: the presence of obesity, type of obesity, body composition, including percentage of lean and fat tissue. Quality of life, frailty syndromeand personal characteristics were evaluated.

Results
The CCI was 5.9 ± 1.9 scores. 50 (55.6%) older patients with ACS had high comorbidity. Half of patients (43; 47.8%) had frailty syndrome.Obesity was observed in33 (36.7%) patients, 52 (57.8%)hadoverweight,62 (68.9%)- abdominal obesity. 85 (94.4%) - had a higher percentage of fat tissue.Patients with ACS and high comorbidityhad lowertotal water volume (37.9 ± 5.1and40,8 ± 5.8 liters resp., p = 0,01) and lean body mass (51.9 ± 7.0and55,9 ± 7.5 kg resp., p = 0,01)and higherthe percentage of body fat(40.9 ± 8.9and35,8 ± 6.7 % resp., p = 0,01)compared to patients with low comorbidity. Olderpatientswith ACS andfrailty syndrome had higherthe percentage of body fat(43.9 ± 9.4and31,9 ± 6.3 % resp., p = 0,002)andlowerthe percentage of leanbody(62.9 ± 6.4and71,3 ± 4.9 % resp., p = 0,00008)compared to patients without frailty syndrome. There was a direct relationship between the level of anxiety and depression and the percentage of body fat( r = 0.45, p &lt; 0.0001; r = 0.36, p = 0.001 resp.) and negative relationship with physical functioning (r=-0.46, p &lt; 0.0001).

Conclusions
Older patients withACS are characterized byhigh comorbidity and frailty. Body composition is dependent on comorbidity: patients with ACS and high comorbidityhadlowertotal water volume, lean body massandhigher percentage of body fat(sarcopenic obesity)compared to patients with low comorbidity.
Inferior acute myocardial infarction caused by left anterior descending coronary artery, worse prognosis? experience in our center
Authors: Martinez Primoy IR , Carmona Carmona J , Seoane Garcia T , Martinez Nunez R , Arroyo Monino DF , Garcia Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

I
Key diagnostic test in acute myocardial infarction with ST segment elevation(STEMI)is 12-lead electrocardiogram, which guides initial treatment and informs about area at necrosis risk, necrosis extension, and culprit coronary artery. ST elevation in leads II, III, aVF is related to obstruction of right coronary artery(RCA)or circumflex artery. Inferior STEMI with occlusion of left anterior descending artery(LAD)has been described. Our goal is to analyse incidence and characteristics of inferior STEMI due to LAD occlusion.

M
Observational retrospective study, of patients admitted to our Coronary Care Unit due to inferior STEMI, between08/2011-12/2020. We analysed all patients whose culprit artery was LAD and a random sample of138patients among those with RCA as culprit. Chi-square, Student-t or Mann-Whitney tests were used.

R
there were a total of2498acute coronay syndromes, 1541were STEMI. 47.7%of them(n:735)were from inferior wall. From inferior STEMI, 12were caused by LAD occlusion(1.6%, 95%confidence interval0.8-2.8%), representing0.8%of all STEMI. There were21.3%women(n:32)and a mean age of61.6 ± 12.5years, without differences by culprit artery. STEMI related with RCA presented a 28.3% of either right ventricular dysfunction or atrioventricular block, versus none of those related to LAD(p0.037). There was difference in dominance: STEMI caused by LAD presented right dominance in72.7%of cases, while caused by RCA in94.4%(p0.034). All inferior LAD STEMIs had normal left ventricular ejection fraction(LVEF) at admission. There was no statistically significant difference in LVEF at discharge(RCA54.3 ± 7.6vsLAD50.5 ± 13.6), but there was in maximum troponin, which was higher in those STEMI related to RCA(2208 ± 1756mg/dl vs 4095 ± 3833mg/dl, p0.040). Complementary comparisons in Table.

Conclusion
we found that1.6%of inferior STEMI are caused by LAD occlusion instead of RCA or circumflex coronary artery. These STEMI do not cause more severe affectation of left ventricle and run without typical complications of inferior STEMI. RCALADSite of occlusion-nProximal65(47.1%)5(41.7%)Medium41(29.7%)5(41.7%)Distal32(23.2%)2(16.7%)Worst Killip-Kimbal-nI112(81.2%)10(83.3%)II11(8.0%)1(8.3%)III2(1.4%)1(8.3%)IV13(9.4%)0
Inflammation and neurohormonal activation is increased at hospital admission in patients with ST-elevation myocardial infarction with diabetes compared to non-diabetic patients
Authors: Kunkel JB , Hassager C , Moeller JE , Holmvang L , Jensen LO , Frydland M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Forskningsfond. The Lundbeck Foundation.

Background
Patients with diabetes have an increased risk of coronary artery disease (CAD). In patients with myocardial infarction (MI), diabetes is associated with a poor outcome. Inflammation and neurohormonal activation have previously been shown to be associated with poor outcomes in patients with ST-elevation MI (STEMI). We therefore sought to assess whether STEMI-patients with diabetes (DM) had increased levels of inflammation and neurohormonal activation upon hospital admission.

Methods
In 1892 consecutive STEMI-patients from two danish tertiary heart centres, biomarkers reflecting neurohormonal activation (pro-atrial natriuretic peptide (proANP) and mid-regional pro-adrenomedullin (MRproADM)) and inflammation (soluble suppression of tumorigenicity 2 (sST2) and C-reactive peptide (CRP)) were measured upon admission before angiography. Patients were stratified according to DM or not.

Results
In total, 245 (13%) patients had DM. DM patients were older (mean (SD) 66 (11) vs 63 (13) years old, p = 0.0002), had more comorbidities (hypertension, previous stroke/TIA, ischemic heart disease (IHD), chronic kidney dysfunction (CKD)), and higher body mass index (BMI). In addition, DM patients had a longer time from symptom debut to angiography and more often multivessel disease (MVD). We found no difference in admission troponin plasma concentrations.
Upon hospital admission, DM patients had higher concentrations of MRproADM (median (IQR) 0.88 (0.64-1.20) vs. 0.71 (0.58-0.90) nmol/L, p &lt; 0.0001), sST2 (41 (64-31) vs. 39 (55-28) ng/ml, p = 0.01), and CRP (4.5 (1.9-12.1) vs. 3.4 (1.4-8.3) mg/L, p = 0.001) but not proANP (figure). When adjusted for age, BMI, CKD, IHD, time from symptom debut to angiography, and MVD, DM remained associated with increased MRproADM (OR (95% CI) 1.35 (1.05; 1.74), p = 0.02) and sST2 (1.20 (1.02; 1.41), p = 0.03), but no longer with CRP. Patients with DM had a higher one-year all-cause mortality rate (12% vs. 9.4%, p = 0.03).

Conclusion
STEMI patients with diabetes have increased neurohormonal activation and inflammation at hospital admission compared to patients without diabetes. This may play a role in the increased mortality in STEMI patients with diabetes. Abstract Figure.
Effects of daily mindfulness practice on fatigue, kinesiophobia, and quality of life in patients with acute myocardial infarction: a randomized controlled trial
Authors: Karadas C , Oksul M , Ozer N , Ozdemir L 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Aim
Mindfulness meditation (MM) leads to controlled blood pressure and positive improvements in other symptoms which may trigger acute coronary diseases. The present randomized controlled study was aimed to investigate the effect of the MM on fatigue, kinesiophobia, and the quality of life (QoL) in patients with acute MI.

Method
The study was carried out with 56 MI patients. Participants were randomly assigned to meditation group (MG; n = 28) or control group (CG; n = 28). The MG patients received a 15 min MM session comprising sitting and breathing for a total of eight weeks, while the CG patients received only a single-time attention-matched education. Piper Fatigue Intervention, Tampa Scale for Kinesiophobia-Heart and MacNew Quality of Life scales were utilized for data collection.

Results
After completion of the 8-week MM, any significant difference was not found in the fatigue scores of the patients (p &gt; 0.05). On the other hand, kinesiophobia scores in the MG were significantly lower in the 4th, 8th and 12th weeks (p &lt; 0.05). Similarly, the QoL scores were significantly higher in the MG in 8th week (p &lt; 0.05). Significant change in the emotional function sub-dimension of QoL continued in the follow-up assessment at 12th week (p &lt; 0.05).

Conclusion
The MM can significantly improve the QoL and decrease kinesiophobia in patients with MI. Beneficial effect of MM is maintained particularly in the emotional aspect. Based on the results of the study, MM may be recommended as a mind-body based complementary approaches within the scope of secondary protection after MI. Comparison of the study groupsGroupBaseline(Mean ± SD)4th week(Mean ± SD)8th week(Mean ± SD)12th week(Mean ± SD)PFSMM2.08 ± 1.870.90 ± 0.990.47 ± 0.780.44 ± 0.76CG1.56 ± 2.011.12 ± 1.590.98 ± 1.520.76 ± 1.33tp1.004 0.32-0.6210.54-1.5840.12-1.0850.28TSK-HMM40.25 ± 5.0436.18 ± 4.4934.39 ± 4.6134.96 ± 4.71CG41.71 ± 7.2841.89 ± 6.7441.82 ± 5.8441.00 ± 5.54tp-0.8750.39-3.7340.001-5.279 0.000-4.3900.00MacNewMM5.04 ± 0.715.53 ± 0.455.76 ± 0.475.77 ± 0.47CG5.17 ± 0.855.32 ± 0.605.37 ± 0.525.53 ± 0.46t; p-0.640; 0.531.436; 0.162.933; 0.0051.964; 0.06(Mean ± SD): Mean ± Standard Deviation; PFS: Piper Fatigue Scores; TSK-H: Tampa Scale for Kinesiophobia-Heart; MacNew: MacNew Quality of life Scale; EFS: emotional functioning sub-dimension; PFS: physical functioning sub-dimension; SFS: social functioning sub-dimension; t= Student T Test value; p&lt; 0.05