bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic immune-inflammation index predicts major adverse cardiovascular events in patients with ST-elevation myocardial infarction
Authors: Denegri A , Obeid S , Raeber L , Windecker S , Gencer B , Mach F , Rodondi N , Heg D , Nanchen D , Matter C M , Klingenberg R , Luescher T F 
Published: October 2021

Abstract

Background
ST-elevation myocardial infarction (STEMI) represents the life-threatening manifestation of atherosclerosis, a chronic inflammatory disease of arterial wall, and is associated with high rate of morbidity and mortality. Thus, inflammatory biomarkers may be useful in identifying high inflammatory burden patients who may benefit from tailored high-intensity secondary prevention therapy.

Purpose
We therefore assessed the relationship between the systemic immune-inflammation index (SII) and CV outcomesamong 1144 all-comers patients admitted to four Swiss University Hospital for STEMI and enrolled in the prospective multicenter SPUM registry cohort I (NCT 01000701).

Methods
SII was calculated as platelet counts x neutrophil counts / lymphocyte counts. Patients were subdivided into three groups according to SII tertiles. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with SII and outcomes.

Results
Out of 1144 STEMI patients, 912 patients (79,7%) had available for SII. Patients within the highest tertile were slightly more frequently male (23.0 vs 22.0%, p=0.05), with higher plasma values of neutrophils (11.4±2.4 vs 6.5±3.7 G/l, p&lt;0.001), platelets (275.3±97.5 vs 202.5±51.6 G/l, p&lt;0.001) and lower levels of lymphocytes (1.0±0.6 vs 2.1±1.1 G/l, p&lt;0.001) and LVEF (46.4±11.5% vs 50.4±10.3%, p&lt;0.001) (Fig. 1A). At 1 year, these patients presented the highest rate of all-cause mortality (7.2% vs 2.6%, p=0.02) and MACCE (8.2% vs 3.3, p=0.03). This enhanced risk persisted for all-cause mortality and MACCE, after adjustment for age, sex, ace-inhibitors and statin therapy (Adj. HR 2.85, 95% CI 1.30–6.70, p=0.03 and Adj. HR 2.63, 95% CI 1.25–5.55, p=0.03, respectively, Fig. 1B).

Conclusions
Among a real-world cohort of STEMI-patients, SII highlights the highest inflammatory risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly identify patients who may derive the greatest benefit from tailored more intense secondary prevention therapies including inflammatory modulation.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Different COVID19 pandemic phases & STEMI: experience from an Italian hub centre
Authors: Tumminello G , Barbieri L , Toriello F , Lucreziotti S , Carla' M , Conconi B , Salerno Uriarte D , Mafrici A , Carugo S 
Published: October 2021

Abstract

Introduction and methods
During Coronavirus disease 2019 (COVID-19) pandemic a reduction in ST-elevation acute myocardial infarction with an increase in in-hospital mortality has been observed. In our region the pandemic temporal trend was sinusoidal with peaks and valleys. A first outbreak (phase-peak 1 “P-P1”) was in March 2020 (248.12 cases for 100,000 inhabitants), a reduction (phase-valley 1 “P-V1”) in May 2020 (16.68 cases for 100,000 inhabitants) and a second outbreak (phase-peak 2 “P-P2”) in November 2020 (540.17 cases for 100,000 inhabitants; data from Italian Health Ministry). Our hospital was reorganized as one of the 13 Macro-Hubs identified in Lombardy for the treatment of STEMI. Here we describe our experience in the treatment of STEMI patients in the three different phases of COVID-19 pandemic.

Results
In the three different phases the groups were superimposable for mean characteristics, but they differ for COVID-19 infection incidence (table). At multivariate analysis for the entire population COVID-19 infection (OR 45.8 [95% CI] 1.39–1511.79; p=0.03) was the only independent predictor of in-hospital mortality. Focusing on COVID-19 patients (figure) they experienced a 5-time increased incidence of in-hospital mortality (COVID-19pos vs COVID-19neg, 50% vs 11.1%; p=0.02). Moreover, the compresence of COVID-19 infection induced an 8 times increased risk of death (OR 8; [95% CI] 1.85–34.60; p=0.005) determined by a higher incidence respiratory complications (COVID-19pos vs COVID-19neg, 33.3% vs 8.9%; p=0.03) with a similar incidence of cardiac death (COVID-19pos vs COVID-19neg, 16.7% vs 11.17%; p=0.60).

Conclusions
In conclusion our data suggest the crucial necessity of an early and precise diagnosis of COVID-19 infection in STEMI to establish a correct management of this very high risk patients.

Funding Acknowledgement
Type of funding sources: None. STEMI mortality in COVID+ vs COVID−
Clinical impact of CREDO-kyoto risk score on in-hospital bleeding in patients with acute coronary syndrome
Authors: Minematsu Y , Natsuaki M , Yoshioka G , Shinzato K , Nishimura Y , Nishikido T , Node K 
Published: October 2021

Abstract

Background/Introduction
CREDO-Kyoto bleeding risk score was developed to predict the post-discharge bleeding events in patients with percutaneous coronary intervention. However, there were limited reports of the effectiveness of this score to predict the in-hospital bleeding events in patients with acute coronary syndrome (ACS).

Methods
We evaluated 562 consecutive ACS patients in Saga university hospital between 2014 and 2019. Primary outcome was major bleeding during hospitalization. Major bleeding was defined as the GUSTO moderate/severe bleeding. Patients were classified into three groups according to the CREDO-Kyoto bleeding risk score (low, intermediate and high).

Results
Major bleeding events occurred in 12.1% of all patients during hospitalization. Patients in the high risk group (n=22) had significantly higher incidence of major bleeding than those in the intermediate (n=113) and the low risk groups (n=427) (22.7%, 18.6%, versus 9.8%, respectively, p=0.018, see figure). Multivariate analysis showed that intermediate and high risk groups were independent predictors for the in-hospital major bleeding.

Conclusions
CREDO-Kyoto risk score successfully identified high risk ACS patients for the major bleeding during hospitalization.

Funding Acknowledgement
Type of funding sources: None. Results
Predictors and a novel risk score of statin non-adherence after hospitalisation for an acute coronary syndrome
Authors: Liao Y W L , Lee M L , Poppe K P , Kerr A K , Stewart R S 
Published: October 2021

Abstract

Background
Statin non-adherence after acute coronary syndrome (ACS) hospitalisation is associated with adverse prognosis. Identifying its risk factors can help to develop strategies and target high risk groups to improve outcomes. We evaluated the predictors and devised a risk score for statin non-adherence following ACS.

Methods
Consecutive ACS hospitalisations enrolled in the ANZACS-QI registry during December 2013 to October 2017 were linked to the National Pharmaceutical database for statin dispensing records. The primary endpoint was mean statin possession ratio (MPR) of &lt;0.8 at 6–12 months after discharge. Multivariable Poisson regression was performed to identify predictors and formulate a risk model for statin non-adherence.

Results
Primary endpoint occurred in 4736/19942 (24%) of ACS patients studied. Patients taking statin on admission with LDL-cholesterol&lt;2mmol/L had the lowest risk and were chosen as the reference group. Adjusted relative risks (RR) and 95% confidence intervals (95% CI) were highest in patients with prior cardiovascular disease (CVD) but not on statins 3.79 (3.42–4.20), followed but no prior CVD and not on statins 2.25 (2.04–2.48). RRs (95% CI) for patients on statin with LDL2.0–2.9 and LDL &gt;3.0mmol/L were 1.33 (1.17–1.50) and 1.96 (1.72–2.24) respectively. Other independent predictors were age&lt;45 years, Māori, Pacific and no revascularisation. Together, a risk score out of 25 for statin non adherence was created.

Conclusion
Statin non-adherence remains prevalent after ACS, with history of CVD, statin use and LDL levels being key predictors. A risk model was developed to help identify at risk patients that may benefit the most from delivery of adherence improving interventions and warrants external validation.

Funding Acknowledgement
Type of funding sources: None.
On- vs off-hours primary percutaneous coronary intervention: a single-centre experience
Authors: Mane F G , Flores R , Silva R , Conde I , Rodrigues C , Medeiros P , Oliveira C , Campos I , Ferreira A S , Costa J , Quina C , Braga C , Marques J 
Published: October 2021

Abstract

Introduction
In ST-segment elevation myocardial infarction (STEMI) patients, emergency medical system delays importantly affect outcomes. The effect of admission time in STEMI patients is dubious when percutaneous coronary intervention (PCI) is the preferred reperfusion strategy.

Aims
The authors aimed to retrospectively describe the association between admission time and STEMI patient's care standards and outcomes.

Methods
Characteristics and outcomes of 1222 consecutive STEMI patients treated in a PCI-centre were collected. On-hours were defined as admission on non-national-holidays from Monday to Friday from 8 AM to 6 PM. Time delays, in-hospital and one-year all-cause mortality were assessed.

Results
A total of 439 patients (36%) were admitted on-hours and 783 patients (64%) were admitted off-hours. Baseline characteristics were well-balanced between groups, including the percentage of patients admitted in cardiogenic shock (on-hours: 4.6% vs off-hours 4%; p=0.62).
Median emergency system dependent time to reperfusion (i.e. first-medical contact to reperfusion) did not differ between the two groups (on-hours: 120 min vs. off-hours 123 min, p=0.54). The authors observed no association between admission time and in-hospital mortality (on-hours: 5% vs. off-hours 4.9%, p=0.90) or 1-year mortality (on-hours: 10% vs. off-hours 10%, p=0.97).
In patients admitted directly in the PCI-centre, median time from first-medical contact to reperfusion (on-hours: 87 min vs off-hours: 88 min, p=0.54), in-hospital mortality (on-hours: 4% vs off-hours: 7%, p=0.30) and 1 year mortality (on-hours: 9% vs off-hours: 13%, p=0.27) did not differ between the two groups.
Survival analysis showed no survival benefit of on-hours PCI over off-hours PCI (HR 1.01; 95% CI [0.77–1.46], p=0.95).

Conclusion
In a contemporary well-organized emergency network, STEMI patients admission time in the PCI-centre was not associated with reperfusion delays or increased mortality.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier curve
STEMI around-the-clock: how off-hours admissions impact door-to-balloon time and the long-term prognosis of ST-segment Elevation Myocardial Infarction
Authors: Martinho M , Briosa A , Cale R , Pereira E , Pereira A R , Santos J , Ferreira B , Santos P , Vitorino S , Eusebio C , Morgado G , Martins C , Pereira H 
Published: October 2021

Abstract

Introduction
The outcomes of reperfusion in ST-segment Elevation Myocardial Infarction (STEMI) are time-dependent, and percutaneous coronary intervention (PCI) should be performed within 60 minutes from hospital admission in PCI centers – door-to-balloon time (D2B). The association between Off-Hours Admission (OHA) and long-term outcomes is controversial when considering contemporary organized STEMI networks.

Purpose
This study aims to analyze how OHA influences D2B and long-term mortality.

Methods
Retrospective study of consecutive STEMI patients (pts), admitted in a PCI-centre with a local Emergency Department, between 2010 and 2015. Pts submitted to rescue-PCI were excluded. OHA was defined as admission at night (8p.m. to 8a.m), weekends and nonworking holidays. Predictors of OHA and D2B were studied by logistic regression analysis. Demographic, clinical, angiographic and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of 5-year all-cause mortality (5yM). The cumulative incidence of 5yM stratified by hours of admission was calculated according to the Kaplan-Meier method.

Results
Of 901 pts, 472pts (52.4%) were admitted during off-hours. These pts were younger (61±13 vs 64±12, p=0.002) and had a lower median patient-delay time (128min vs 157min, p=0.014). Clinical severity at presentation, defined by systolic arterial pressure and Killip-Kimball (KK) class, did not differ between groups. OHA did not impact D2B (89 min vs 88 min, p=0.550), which was in turn influenced by age ≥75y (OR 1.85, 95% CI 1.31–2.61, p&lt;0.001). Mean clinical follow-up (FUP) was 68±37 months, with 75.1% of pts achieving a FUP &gt;5 years. 5yM rate was 9.7%. After multivariate cox regression analysis, independent determinants of long-term mortality were age (HR 1.05, 95% CI 1.02–1.08, p&lt;0.001), previous history of heart failure (HR 6.76, 95% CI 1.32–34.72, p=0.022) and pulmonary disease (HR 3.79, 95% CI 1.16–12.33, p=0.027), presentation with KK ≥2 (HR 2.82, 95% CI 1.32–6.01, p=0.007) and radial artery access in catheterization (HR 0.39, 95% CI 0.18–0.83, p=0.014) – figure 1. Although there was an association between a higher D2B time and 5yM (87min vs 101min, p=0.024), neither OHA nor D2B were independent predictors of long-term mortality – figure 2.

Conclusion
OHA did not seem to influence D2B and long-term STEMI outcomes in our PCI-centre. 5yM was mostly influenced by patient characteristics and clinical severity at presentation.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Predictors of long-term mortalityFigure 2. 5-year survival stratified by OHA
Relative impact of acute heart failure and acute kidney injury on short- and long-term prognosis of patients with STEMI treated with primary PCI
Authors: Milasinovic D , Mladenovic D J , Jelic D , Zobenica V , Zaharijev S , Vratonjic J , Isailovic N , Radomirovic M , Pavlovic A , Vukcevic V , Asanin M , Stankovic G 
Published: October 2021

Abstract

Background
Although both acute heart failure (AHF) and acute kidney injury (AKI) have been separately recognized as contributors to an increased mortality risk in patients with ST-segment elevation myocardial infarction (STEMI), their relative importance has not been extensively studied.

Purpose
Our aim was to investigate the relative impact of AHF and AKI on 30-day and 5-year mortality following primary PCI for STEMI.

Methods
8 054 patients referred to primary PCI during the years 2009–2019, and with the available repeated creatinine measurements, were analyzed. AKI was defined as ≥25% relative or ≥0.5 mg/dl absolute rise in creatinine from baseline, within 72 hours of intervention. Acute heart failure was defined as Killip class ≥2 on admission to hospital. Cox regression model was used to assess the effect of the interaction of AHF and AKI on mortality. Median follow-up was 5 years.

Results
The incidence of AKI was 9.9% (n=805) and of AHF 12.3% (n=1050). Concurrence of AHF and AKI was noted in 1.7% of the included patients (n=315). The combined presence of AHF and AKI significantly increased mortality both at 30 days (30.7%) and at 5 years (73.3%), as compared with AKI alone (8.2% at 30 days and 32.3% at 5 years) and AHF alone (13.0% and 53.0%). When adjusted for other significant predictors, such as age, prior stroke, hyperlipidemia, atrial fibrillation, ejection fraction, final TIMI flow in the culprit artery, the use of intra-aortic balloon pump and multivessel disease, both AKI and AHF were independently associated with mortality. The adjusted relative impact of AKI on mortality was stronger than that of AHF at 30 days (adjusted HR 3.5 and 2.2, respectively), whereas it was comparable at 5 years (adjusted HR 1.3 and 1.4, respectively). Furthermore, the combined presence of AHF on admission and the post-primary PCI development of AKI was associated with the highest magnitude of risk at both 30 days (HR 5.0, CI95% 3.0–8.3, p&lt;0.001) and 5 years (HR 2.4, CI95% 1.83–3.16, p&lt;0.001).

Conclusion
Acute kidney injury following primary PCI for STEMI was associated with a higher adjusted risk of short-term mortality when compared with acute heart failure, whereas their relative impact was comparable in the long-term.

Funding Acknowledgement
Type of funding sources: None.
Residual SYNTAX score in relation to culprit-plaque characteristics and cardiovascular risk in acute myocardial infarction:an optical coherence tomography study
Authors: Wang Y , Zhao X X , Zhou P , Liu C , Li J N , Zhou J Y , Chen R Z , Chen Y , Song L , Zhao H J , Yan H B 
Published: October 2021

Abstract

Introduction
The residual SYNTAX score (rSS) as the SYNTAX remaining after completion of percutaneous coronary intervention (PCI) was proved to be related to poor outcomes.

Purpose
This study aimed to investigate the association of culprit-plaque morphology with rSS and the predictive value of rSS for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods
A total of 274 STEMI patients undergoing preintervention optical coherence tomography examination were included and divided into 3 groups – rSS=0 (n=72), 0&lt;rss≤8&gt;8 (n=68). Baseline clinical data and culprit-plaque characteristics were compared. MACE was defined as the composite of all-cause death, recurrence of myocardial infarction (MI), stroke and unplanned revascularization of any coronary artery.

Results
There was a significant difference in the prevalence of plaque ruptures, lipid-rich plaques, and calcification among the three groups (plaque rupture: 44.4% versus 59.0% versus 64.7%, lowest to highest rSS, p=0.04; lipid-rich plaque: 40.3% versus 54.5% versus 69.1%, lowest to highest rSS, p=0.003; calcification: 38.9% versus 52.5% versus 61.8%, lowest to highest rSS, p=0.024). Multivariate logistic regression analysis indicated that rSS&gt;8 was an independent predictor for plaque rupture (OR: 2.21, 95% CI: 1.19–4.19, P=0.013). During a mean follow-up of 2.2 years, MACE occurred in 47 (17.2%) patients. In fully adjusted analyses, rSS was independently associated with MACE (HR: 1.06, 95% CI: 1.02–1.10, P=0.005); patients with rSS &gt;8 had higher MACE risk compared to rSS=0 (HR: 2.68, 95% CI: 1.11–6.5, P=0.029).

Conclusion
In STEMI patients, culprit-plaque morphology was significantly correlated with rSS, and elevated rSS was independently associated with cardiovascular risk.&lt;/rss≤8&gt;

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences OCT findingsSurvival curves according to rSS
Prehospital ECG in patients with acute myocardial infarction during the COVID-19 pandemic
Authors: Avvedimento M , Leone A , Spinelli A , Franzone A , Esposito G , Piccolo R 
Published: October 2021

Abstract

Background
A delayed presentation of patients with ST-segment elevation myocardial infarction (STEMI) has been reported globally after the outbreak of coronavirus disease-19 (COVID-19). However, it remains unknown whether differences already exist at the time of pre-hospital electrocardiograms (ECGs).

Purpose
We therefore compared pre-hospital ECGs of STEMI patients hospitalized in Italy after the first reported case of COVID-19 on February 21, 2020 with data from the same period in 2019 to identifying potential changes between the two periods.

Methods
We analyzed prehospital ECGs of patients with a final diagnosis of STEMI from February 21, 2020, to April 16, 2020. Data were divided in two periods, before and after the first confirmed case of COVID-19 in Italy. Pathological Q-waves and the Anderson-Wilkins acuteness score, which estimates the acuteness of ischemia, were independently assessed by two reviewers.

Results
167 (5.15%) of out 3,239 ECGs qualified for STEMI and were included in the analysis. ECGs recorded during the COVID-19 pandemic showed more frequently pathological Q-wave complexes compared with the control period (54.5% vs. 22.1%, risk difference 32.3%, 95% confidence intervals [CI], 21.2 to 43.5 percentage points) and presented a higher number of pathological Q-waves (1.4±1.6 vs. 0.5±1.2; p&lt;0.001). The Anderson-Wilkins acuteness score was significantly lower during the COVID-19 period (2.4±0.9 vs. 2.8±0.7; p&lt;0.001), suggesting a lower probability of acute ischemia.

Conclusions
Pre-hospital ECGs of patients with a final diagnosis of STEMI presented more frequently the signs of late ischemia during the COVID-19 pandemic.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Comparison between pre-hospital and in-hospital ST-Elevation Myocardial Infarction (STEMI) from 2003 to 2016 in New South Wales, Australia: a population-linkage data analysis
Authors: Ratwatte S , Ng A , Hyun K , Weber C , Boroumand F , Kritharides L , Brieger D 
Published: October 2021

Abstract

Background
Outcomes among patients presenting to hospital with STEMI (PH-STEMI) are favourably impacted by access to reperfusion, which has improved in Australia in recent years. Reperfusion rates and outcomes among patients with in-hospital STEMI (IH-STEMI) in Australia are not well described.

Purpose
We compared frequency of percutaneous coronary intervention (PCI) and all-cause mortality trends between patients with PH-STEMI and IH-STEMI over 13-years in a statewide cohort.

Methods
Patients diagnosed with STEMI (both PH and IH) were identified from the NSW Admitted-Patient-Data-Collection registry from 2003 to 2016 and linked to the death registry until 31-December-2018. We calculated the proportion with PCI over time, and rate of long-term mortality was determined with adjustment for age, sex, year of presentation and PCI.

Results
66,794 STEMI patients were identified; 57,721 (86%) had PH-STEMI. Patients with IH-STEMI were older (mean±SD: 75±13 vs 66±14 years), and more likely to be female (46.2% vs 29.8%) than PH-STEMIs. Patients with IH-STEMI were less likely to undergo PCI (17.1% vs 55.8%). From 2003-4 to 2015-6, overall rate of PCI increased for STEMI, but remained lower for IH-STEMI compared to PH-STEMI (9.5% to 23.9% vs 40.4% to 65.5% respectively).
All-cause mortality from STEMI fell over time in both groups. Predictors of mortality improvement in the PH and IH-STEMI populations respectively included PCI: (adjusted hazard ratio [aHR]=0.48, 95% confidence interval [CI]: 0.46–0.49 and (aHR=0.48 [95% CI: 0.44–0.53) and year of event: (aHR=0.74 [95% CI: 0.69–0.8] and aHR=0.79 [95% CI: 0.70–0.88]). Adding the interaction term PCI by year group to the mortality models showed that this progressive reduction in mortality by year grouping was accounted for by the performance of PCI in the PH-STEMI group (p&lt;0.0001) but not in the IH-STEMI group (p=0.65).

Conclusion
A fall in mortality in patients with PH-STEMI in NSW was observed from 2003 to 2016 and was accounted for by increasing use of PCI. A more modest fall in mortality was seen in patients with IH-STEMI and this was independent of PCI which was under utilised in this population. Efforts to further improve outcomes in STEMI should include a greater focus on patients with in-hospital events.

Funding Acknowledgement
Type of funding sources: None.