bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systolic blood pressure and outcome in patients admitted with acute heart failure: a pooled analysis from 4 randomized clinical trials
Authors: Grand J , Miger K , Sajadieh A , Kober L , Torp-Pedersen C , Ertl G , Sendon JL , Maggioni AP , W Nielsen O 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background
In acute heart failure (AHF), low systolic blood pressure (SBP) has been associated with poor outcome. Less is known of the risk related to normal versus elevated SBP and interaction with left ventricular ejection fraction.

Purpose
The aim of the present study was to assess the association between baseline SBP and short- and long-term outcome in a large cohort of AHF-patients.

Methods
A pooled cohort of four randomized controlled trials investigating the vasodilator serelaxin versus placebo in patients admitted with AHF and an SBP from 125 to 180 mmHg. Endpoints were 180-day all-cause mortality and a short-term composite endpoint (worsening heart failure, all-cause mortality or hospital readmission for HF through Day 14). Left ventricular ejection fraction (LVEF) was categorized into HFrEF (&lt;40%) and HFpEF (= &gt;40%). Multivariable Cox regression was used and adjusted for age, sex, baseline body mass index, HFrEF, serum estimated glomerular filtration rate, allocated treatment (placebo/serelaxin), diabetes mellitus, ischemic heart disease, and atrial fibrillation/flutter.

Measurements and Main Results
A total of 10.533 patients with a mean age of 73 (±12) years and median SBP of 140 (130-150) mmHg were included within mean 8.2 hours from admission. LVEF was assessed in 8493 (81%), and of these, 4294 (51%) had HFrEF. Increasing SBP as a continuous variable was inversely associated with 180-day mortality (HRadjusted: 0.93 [0.88-0.98], p = 0.004 per 10 mmHg increase) and with the composite endpoint (HRadjusted: 0.90 [0.85-0.95], p &lt; 0.0001 per 10 mmHg increase). A significant interaction was observed regarding LVEF, revealing that SBP was not associated with mortality in patients with HFpEF (HRadjusted: 1.01 [0.94-1.09], p = 0.83 per 10 mmHg increase), but SBP was associated with increased mortality in HFrEF (HRadjusted: 0.80 [0.73-0.88], p &lt; 0.001 per 10 mmHg increase) (Figure).

Conclusions
Elevated SBP is independently associated with favorable short- and long-term outcome in AHF-patients. The association between SBP and mortality was, however, not present in patients with preserved LVEF. Abstract Figure. Survival plots by SBP and LVEF
Age independently predicts hemodynamic, but not arrhythmic STEMI-related complications. Data from a cohort study on 848 STEMI patients
Authors: Serban RC , Hadadi L , Sus I , Lakatos EK , Demjen Z , Ceamburu A , Scridon A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS-UEFISCDI

BACKGROUND
Age is one of the most relevant prognostic factors in patients presenting with ST-segment elevation myocardial infarction (STEMI). However, it remains unknown whether this impaired prognosis is due to the occurrence of hemodynamic and/or arrhythmic STEMI-related complications. Understanding the mechanisms involved in STEMI-related complications with advancing age could significantly improve outcomes in this high-risk population.

PURPOSE
We aimed to investigate the contribution of advanced age to the occurrence of hemodynamic and arrhythmic complications in STEMI patients.

METHODS
A total of 848 consecutive patients treated by primary percutaneous coronary intervention for STEMI were evaluated. Heart failure, cardiogenic shock, asystole, inotropic and diuretic use, and kidney dysfunction were used as in-hospital markers of hemodynamic complications. Ventricular fibrillation, conduction disorders, cardiac stimulation, and antiarrhythmic drugs use were used as markers of arrhythmic complications. The relationship between age and the occurrence of hemodynamic and arrhythmic complications was evaluated. The contribution of age to in-hospital death was also assessed.

RESULTS
In-hospital death occurred in 50 (5.8%) patients; patients who deceased were significantly older than their non-deceased counterparts (70.9 ± 10.9 vs. 61.2 ± 11.8 years; p&lt; 0.0001). There was no association between age and the occurrence of any of the evaluated arrhythmic complications (all p &gt;0.05). However, patients who presented hemodynamic complications were significantly older than those who did not (all p&lt; 0.05). Age &gt;60 years was a significant predictor of hemodynamic complications (p&lt; 0.0001) with 61.7% sensitivity and 60.4% specificity. The association between age and hemodynamic complications remained significant after correction for additional risk factors (i.e., hypertension, diabetes mellitus, pre-existing heart failure, Killip class on admission, symptom onset-to-cardiac catheterization laboratory time interval).

CONCLUSIONS
In the present study, age was identified as an independent predictor of STEMI-related hemodynamic, but not arrhythmic complications. These data indicate that whereas age does not seem to affect the occurrence of STEMI-related rhythm disorders, patients above the age of 60 should particularly benefit from closer follow-up and more intensive strategies to prevent life-threating hemodynamic complications.
Acute coronary syndrome in nonagenarians: gender gap?
Authors: Echarte-Morales JULIO , Martinez Gomez E , Cepas-Guillen PEDRO , Llagostera M , Tundidor Sanz ELENA , Viana Tejedor ANA , Vidal PABLO , Caldentey Adrover G , Borrego Rodriguez JAVIER , Macaya Miguel CARLOS , Flores Umanzor E , Sabate MANEL , Fernandez-Vazquez FELIPE 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Ischemic heart disease in the elderly people has increased accordingly with rising hope of life. In patients with acute coronary syndrome (ACS) women have a higher mortality than men. However, it is unknown if these differences remain in nonagenarians.
Purpose
The aim of the study was to evaluate the therapeutic strategies and mortality at 1 year according to gender.

Methods
We retrospectively included in a multicenter study all consecutive patients &gt; 90 yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) between 2005 and 2018. Strategies treatment and mortality at 1 year by gender were evaluated.

Results
680 patients were included (92.6 ± 2.4 years, 59% women) (Table 1). Women presented a greater prevalence of hypertension arterial. Conservative treatment was more frequent in women (73.5% vs 66.2%, p = 0.04) (Image 1), in particular in STEMI subgroup (p = 0.01). They had less capacity functional evaluated by Barthel index (p &lt;0.01) and higher number of infections during admission than men (17.45% vs. 11.7%, p &lt;0.01). The mortality evaluated at 12 months was similar in both groups (p = 0.38), with a trend of better prognosis in women who underwent percutaneous coronary intervention (PCI) (p = 0.08).

Conclusions
Women had lower functional capacity than men, which could explain that they were more likely to be treated with conservative strategy. Mortality was similar in both genders, however, in the subgroup of patients undergoing PCI, was achieved a trend of lower mortality in women. WomenMenPPatients402.0 (59,1%)278.0 (40,9%)Age92.5 ± 2,292.6 ± 2,50.82STEMI189.0 (47%)120.0 (43%)0.32Hypertension331.0 (82,6%)208.0 (74,8%)0.01CKD84.0 (20,9%)59.0 (21,2%)0.91COPD17.0 (4,2%)54.0 (19,4%)&lt;0.01Barthel index75.084.0&lt;0.01Atypical symptoms82.0 (20,4%)42 (15,1%)0.08GRACE175.0171.00.02LDL97.086.0&lt;0.07PCI44,8%54,3%0.04All cause mortality150.0 (37,3%)113.0 (40,6%)0.38Cardiovascular mortality97.0 (67,8%)63.0 (58,3%)0.12
Factors influencing the survival rate of patients after acute coronary syndrome and percutaneous coronary intervention, 5-year follow-up
Authors: Musikhina N , Kostousova A , Petelina T , Gorbatenko E 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science

Introduction
Reduction in mortality from acute coronary syndrome (ACS) is an important medical and social problem. Determination of survival predictors can improve the effectiveness of secondary prevention and medical care provision in patients with ACS.

Aim
To determine the factors influencing 5-year survival in patients after ACS and percutaneous coronary intervention (PCI).

Methods
The study presents data obtained as a result of a registry study The analysis included 135 with ACS and PCI. Patients were contacted and examined in a year, and then 5 years after. The laboratory parameters (lipids, markers of inflammation and endothelial dysfunction) were determined upon admission to the hospital and after 60 months. The probability of 5-year survival for patients undergoing ACS and PCI was assessed by Kaplan-Mayer method. Log-rank test was used to compare the survival rate for the entire follow-up period in two groups. The Cox regression model was used to assess the impact of independent factors on survival and to predict risk of event.

Results
During the follow-up period, 18 people died (the average age of the deceased was 60.9 ± 13.5 years; of the living, 60.0 ± 8.9 years). Survival after 1 year was 97.1%, after 5 years-86.7%. According to the results of the Cox regression analysis, the risk of death increased in the presence of chronic kidney disease (CKD) (HR 15.1; 95 % CI 4.30-52.93; p = 0.001); diabetes mellitus (DM) (HR 3.67; 95% CI 1.18-11.43; p = 0.025) and a history of stroke (HR 9.07; 95% CI 1.85-44.60; p = 0.007). The prognosis was negatively affected by high pulse blood pressure (PBP) ≥ 60 mm Hg (HR 4.68; 95% CI 1.60-13.72; p = 0.005), heart rate &gt;80 beats per minute (OR 4.34; 95% CI 1.51-12.26; p = 0.006). Significant risk factors for death from all causes were the number of platelets (OR 1.011 95% CI 1.003-1.019; p = 0.010), the level of homocysteine (OR 1.172 95% CI 1.008 - 1.364; p = 0.040), and an increase in matrix metalloproteinase-9 (MMP-9) &gt;249 ng/ml (OR 7.052; 95% CI 1.346 - 36.950; p = 0.021).

Conclusions
According to a register study, the survival rate of patients after ACS and PCI after 5 years depended on the presence of comorbid pathology (CKD, DM, and a history of stroke). Factors that had a negative impact on the prognosis were high indicators of PBP and heart rate, as well as laboratory markers of cellular (platelets) and vascular inflammation (homocysteine, MMP9).
Using of optical coherent tomography in the determination of the causes of non-obstructive coronary artery myocardial infarction
Authors: Leonova I , Feoktistova V , Boldueva S , Evdokimov D 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.
The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT.

Materials and methods
160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data.

Results
in 2 cases (22%) patients had ST elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non ST elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of hypertonic crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatosis, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, disaggregants were prescribed, patients with spontaneous dissection of CA had recommendation of examination in the medical-genetic center.

Conclusion
Based on the results of the study, in most cases, the cause of IMBOC development was atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.
Time to percutaneous coronary intervention in patients with ST-elevation myocardial infarction undergoing successful systemic fibrinolysis: does early or late make a difference?
Authors: Jackson-Pedroza C , Gallardo-Grajeda A , Dattoli-Alejo C , Gopar-Nieto R , Alfaro-Ponce D , Ruiz-Fuentes O , Pina-Fregoso V , Arias-Mendoza A , Araiza-Garaygordobil D 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
PHASE-MX
Background/Introduction: Early routine angiography with subsequent Percutaneous Coronary Intervention (PCI) (if needed) after fibrinolysis reduced the rates of reinfarction and recurrent ischemia compared with a ‘watchful waiting’ strategy. A crucial issue is the optimal time delay between successful lysis and PCI, there is a wide variation in delay in trials from a median of 1.3 h to 17h (CAPITAL AMI, GRACIA-1 and STREAM trials). At present a time window of 2-24h after successful lysis is recommended.

Purpose
To analyze the incidence of major cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI) according to the timing of PCI after lysis (pharmacoinvasive strategy, less/more than 24h).

Methods
A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom underwent pharmacoinvasive strategy during the first 12h since symptom onset. Patients were further stratified according to the time from the use of fibrinolysis to sheat insertion (&lt;24h or &gt;24h) in the completion of pharmacoinvasive strategy. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction or congestive heart failure at 30 days of follow-up.

Results
A total of 171 patients were included, of whom 34 underwent PCI after fibrinolysis in less than 24 hours and 137 underwent PCI in more than 24 hours (95% CI 24-120h). Mostly were male (86.4%), mean age was 56.4 ±12.1 years. The primary composite endpoint occurred in 2 patients (5.8%) in PCI &lt; 24 hours and 12 patients (8.6%) in PCI &gt;24 hours (p 0.58). PCI in &lt;24h after lysis was not associated with a reduced risk of the primary endpoint (HR 0.66 95%CI: 0.14-2.97).

Conclusion
In patients with successful fibrinolysis undergoing to PCI the first 24 h was not associated with a reduced risk of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days comparing with PCI after 24 h. Abstract Figure. Kaplan-Meier in primary endpoint
Admission lactate level and the GRACE 2.0 score are independent and additive predictors of 30-day mortality of STEMI patients treated with primary PCI - preliminary results of a real-world registry
Authors: Szabo D , Szabo A , Kugler S , Pinter A , Juhasz V , Ruppert M , Olah A , Edes IF , Becker D , Merkely B , Hizoh I 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
In many of the current risk estimation algorithms for patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), heart rate and systolic blood pressure are key predictors. Yet, these parameters may also be influenced by the actual medical treatment / circulatory support, thereby decreasing the discriminatory power of the models.
Purpose
We aimed to investigate whether venous lactate level, a marker of microcirculatory failure, may have an added prognostic value beyond conventional predictors.
Methods
In a pilot real-world registry, 174 cases were studied. Venous blood gas analysis was performed in all patients at hospital admission. Nested logistic regression models were built using the extensively validated "Global Registry of Acute Coronary Events" (GRACE) 2.0 score alone (base model) or with the addition of venous lactate level (expanded model) using 30-day all-cause mortality as outcome measure. Independence of predictors (lack of collinearity) was evaluated by the variance inflation factor (VIF). Instead of the insensitive c-statistic, difference in performance of the nested models was analyzed by the likelihood ratio test and the integrated discrimination improvement (IDI).
Results
The VIF was 1.0684, indicating independence of the measured lactate values from the calculated GRACE 2.0 scores. Both base and expanded models showed high discriminatory power: c-statistic = 0.88 and 0.89, respectively, p = 0.68). Nevertheless, addition of venous lactate level to the GRACE 2.0 score improved predictions of 30-day mortality significantly as assessed by both likelihood ratio test (chi-square = 8.97, p = 0.0027) and IDI (IDI = 0.1029, 95% CI: 0.0002-0.2055, p = 0.0494).
Conclusions
Venous lactate level may be an independent predictor of 30-day mortality of STEMI patients treated with primary PCI. The addition of this marker to the GRACE 2.0 model may improve mortality prediction of these patients. Abstract Figure.
High density lipoprotein cholesterol and alcohol consumption: are they related?
Authors: Santos MR , Pereira A , Sousa JA , Mendonca F , Monteiro JP , Temtem M , Sousa AC , Rodrigues M , Henriques E , Ornelas I , Drumond A , Mendonca MI , Palma Dos Reis R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
GENEMACOR

Introduction
High density lipoprotein cholesterol (HDL-C) is known to be inversely related to coronary artery disease (CAD). Previous observational studies have consistently reported that individuals with moderate alcohol consumption have a lower risk of cardiovascular disease compared with that of nondrinkers and heavy drinkers. The beneficial effects of moderate drinking appear to be mediated in large part by alcohol-induced increases in HDL-C concentrations.

Objective
To evaluate if a moderate alcohol consumption (30-50g a day) is associated with higher levels of HDL-C in coronary patients.

Materials and methods
1676 patients selected from GENEMACOR study population, with at least one &gt; 75% coronary stenosis by angiography (median age 53.3 ± 7.9 years, 78.6% male, median HDL 43.0 ± 11.1 mg/dL). Population was divided according to the HDL level quartiles (1st quartile HDL &lt; 35.3 mg/dL; 2nd quartile HDL 35.3 – 42 mg/dL; 3rd quartile HDL 42 – 49 mg/dL; 4th quartile HDL &gt; 49 mg/dL). Population of the 1st and 4th quartiles (825 patients, median age of 53.3 ± 8.0 years and 78.7% male) were adjudicated and prospectively followed-up by 5.0 ± 4.2 years. X2 and T student tests were used to analyze the demographic, laboratorial, angiographic and anthropometric characteristics of the population.

Results
420 (50.9%) patients were included in the 1st quartile group (median age 53.2 ± 7.9 years, 85.7% men) and 405 (49.1%) patients were included in the 4th quartile group (median age 53.4 ± 8.0 years, 71.4% men). The mean HDL level was higher in the population with moderate alcohol consumption (mean HDL 43.7 ± 15mg/dL in patients with alcohol consumption &lt;30g/day, mean HDL 48.8 ± 16mg/dL in patients with moderate alcohol consumption and mean HDL 41.6 ± 15mg/dL in patients with alcohol consumption &gt;50g/day). From 104 (median age 51.9 ± 7.9 years, 96.2% male) patients with a moderate alcohol consumption, 62.5% vs 37.5% were in 4th HDL quartile, p 0.01.

Conclusion
We conclude that in our population, a moderate alcohol consumption is associated with higher levels of HDL-C. However, even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the control of another risk factors.
Trends in mortality related to pulmonary embolism in the DACH countries: data from the WHO Mortality Database
Authors: Hobohm L , Sebastian T , Valerio L , Mahmoudpour H , Vatsakis G , Johner F , Keller K , Muenzel T , Kucher N , Konstantinides S , Barco S 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Little is known about the burden imposed by pulmonary embolism for Germany, Austria and Switzerland (DACH countries).

Purpose
We aimed to assess pulmonary embolism-related mortality and time trends for the DACH countries based on data from the WHO Mortality Database.

Methods
We analysed vital registration data from the WHO Mortality Database (2000–2016) covering subregions of the WHO European Region: Germany, Switzerland and Austria (DACH countries). Deaths were considered pulmonary embolism-related if International Classification of Disease-10 code for acute pulmonary embolism or any code for deep or superficial vein thrombosis was listed as the primary cause of death.

Results
Between 2000 and 2016, age-standardised annual pulmonary embolism-related mortality rates decreased linearly from 15.6 to 7.8 deaths per 1000 population. In the 5-year period between 2012 and 2016 an average of 9127 pulmonary embolism-related deaths occurred annually in the DACH countries with a population of 98 273 329. Interestingly, pulmonary embolism-related mortality rates were considerable higher among women aged 15-55 years compared to age-matched men. Between 2012 and 2016, Germany showed the highest age-adjusted mortality rate (9.2 to 10.8 per 100000 inhabitants) compared to Switzerland 4.9-5.3 per 100000 inhabitants) and Austria (5.2 to 6.0 per 100000 inhabitants). Moreover, this means that the age-adjusted mortality rate in Germany was higher than the West-European average.

Conclusion
The observed decreasing trends in pulmonary embolism-related mortality might reflect improved management of the disease including new treatment options as well as advances in imaging technologies. However, pulmonary embolism remains a substantial contributor to total mortality, especially among women aged 15–55 years. For this reason, campaigns to increase physician and public awareness are urgently required for further improvement of the management and treatment of this preventable thrombotic disorder, which still remains the leading preventable cause of death.