bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 patients with coronary artery disease have a higher mortality risk: a meta-analysis
Authors: Zuin M , Rigatelli G , Zuliani G , Roncon L 
Published: October 2021

Abstract

Background
The prevalence and prognostic implications of coronary artery disease (CAD) in patients infected by the novel coronavirus 2019 disease (COVID-19) remain unclear.

Purposes
We conducted a systematic review and meta-analysis to investigate the prevalence and mortality risk in COVID-19 patients with pre-existing CAD. PRISMA. guidelines were followed in abstracting data and assessing validity. We searched Medline, Scopus and Web of Science to locate all articles published up to December 8, 2020 reporting data of COVID-19 survivors and non-survivors with pre-existing CAD. Data were pooled using the Mantel-Haenszel random effects models with odds ratio (OR) as the effect measure with the related 95% confidence interval (CI). Statistical heterogeneity between groups was measured using the Higgins I2 statistic.

Results
Twenty-four studies, enrolling 22744 patients [mean age 58.2 and 70.9 years for survivors and non-survivors (p&lt;0.0001), respectively], met the inclusion criteria and were included into the final analysis. The pooled prevalence of pre-existing CAD in COVID-19 patients was 11.5% (95% CI 0.097–0.136) and resulted significantly higher in non-survivors compared to survivors (16.7% vs 7.1%, respectively, p&lt;0.0001). A random-effect model confirmed a significant higher risk of death in COVID- 19 patients with pre-existing CAD in the short-term period (OR 2.96, 95% CI 2.18–4.03, p&lt;0.0001, I2=79%) (Figure 1). A meta-regression, using age as moderator, did not identify any statistical significance (Coeff: −0.046, 95% CI −0.101–0.009, p=0.104). The Egger's regression test (t=0.596; p=0.06) confirmed that there were not statistically evidences of publication bias

Conclusions
Pre-existing CAD in COVID-19 patients significantly increased the risk of death during the infection.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Forest plot investigating the COVID-19 patients mortality risk in relation to pre-existing coronary artery disease.
Prognostic utility of fibrinogen in patients with coronary artery disease and prediabetes or diabetes following percutaneous coronary intervention: five-year findings from a large single-center cohort
Authors: Yuan D S , Jiang P , Jia S D , Zhang C , Liu Y , Zhao X Y , Yang Y J , Gao R L , Xu B , Gao Z , Yuan J Q 
Published: October 2021

Abstract

Background
The prognosis for patients with coronary artery disease (CAD) remains unfavorable despite advances in treatment. Fibrinogen (FIB) is an independent risk factor for mortality and cardiovascular events in general population. However, the relationship between FIB and long-term mortality among CAD patients undergoing PCI is less investigated, especially in individuals concomitated with diabetes mellitus (DM) and prediabetes (Pre-DM).

Methods
6140 patients with CAD undergoing PCI were consecutively enrolled in our study and subsequently divided into three groups according to FIB levels (FIB-L, FIB-M, FIB-H). These patients were further grouped by glycemic metabolism state [normoglycemia (NG), Pre-DM, DM]. The primary endpoint was all-cause mortality. The secondary endpoint was cardiac mortality.

Results
FIB was positively associated with hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) both in CAD patients with and without DM. During a median follow-up time of 5.1 years, elevated FIB was significantly associated with long-term mortality from all-cause (adjusted HR: 1.86; 95% CI: 1.28–2.69; P=0.001) and cardiac specific (adjusted HR: 1.82; 95% CI: 1.15–2.89; P=0.011). Similarly, patients with DM but not Pre-DM had increased risk of all-cause and cardiac mortality (all P&lt;0.05). When grouped by both FIB levels and glycemic metabolism state, diabetic patients with medium and high FIB levels had higher risk of mortality [(adjusted HR: 2.57; 95% CI: 1.12–5.89), (adjusted HR: 3.04; 95% CI: 1.35–6.82), all P&lt;0.05]. Notably, prediabetic patients with high FIB also had higher mortality risk (adjusted HR: 2.27; 95% CI: 1.01–5.12).

Conclusion
FIB was strongly associated with long-term all-cause and cardiac mortality among CAD patients undergoing PCI, especially in persons concomitated with DM and Pre-DM, indicating FIB test may help identify high-risk individuals in this specific patient population.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program of China (No. 2016YFC1301300, 2016YFC1301301); National Natural Science Foundation of China (No. 81770365)
Gender differences in characteristics, treatment and outcomes in ST elevation myocardial infarction patients in four European countries
Authors: Hellgren T , Blondal M , Ainla T , Jortveit J , Eha J , Loiveke P , Marandi T , Saar A , Veldre G , Lewinter C , Halvorsen S , Ferenci T , Andreka P , Janosi A , Edfors R 
Published: October 2021

Abstract

Introduction
Women receive less evidence-based care than men and have higher mortality after myocardial infarctions than men. But it is not known how the gender difference in risk factors, treatments and outcomes differs between European countries.

Purpose
In order to investigate the gender differences in European countries with different economic predispositions we aimed to describe and compare baseline characteristics, in-hospital management, medications at discharge and death outcomes of man and woman ST-elevation infarction (STEMI) patients following routine clinical practice in Sweden, Norway, Hungary and Estonia.

Methods
The study population is patients over the age of 18 with STEMI who were treated in hospital 2014–2017 (for Norway between 2013–2016) and registered in one of the national myocardial infarction registers. Patients with non-ST elevation infarction and unstable angina were excluded. Risk factors, hospital treatment, and prescription medications were obtained from the national myocardial infarction registries from each country. Mortality in-hospital, after 30 days and after 1 year, was obtained from national death registers.

Results
Women were on average older, had more comorbidities and higher mortality in hospital, after 30 days and one year after hospitalization. Women received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men.

Conclusions
The study illustrates that there are differences in characteristics, management, treatments and outcomes between men and women in all of the studied countries no matter economic predispositions. Generally, women are treated with guideline recommended therapy to a lesser extent than men in the studied countries.

Funding Acknowledgement
Type of funding sources: None.
Variation in in-hospital mortality and its association with procedure-related bleeding complications: a report from nationwide percutaneous coronary intervention registry in japan
Authors: Sawayama Y , Yamaji K , Kohsaka S , Yamamoto T , Higo Y , Numasawa Y , Inohara T , Ishii H , Amano T , Ikari Y , Nakagawa Y 
Published: October 2021

Abstract

Background
Large-scale registries have demonstrated that in-hospital mortality after percutaneous coronary intervention (PCI) varies widely across institutions; however, the underlying reasons are not fully understood. Bleeding has been regarded as one of the most serious PCI-related complications associated with increase in mortality. To date, reducing bleeding complications have tended to be addressed, though appropriate care for patients who developed bleeding complications may be also important. Therefore, we sought to investigate which was more involved in the inter-institutional variations in in-hospital mortality.

Methods
We analyzed 388,866 procedures at 718 hospitals performed from 2017 to 2018, using data from a representative nationwide PCI registry in Japan. A bleeding complication was defined as post-procedural bleeding that required a blood transfusion. We first divided the hospitals into quintiles according to their risk-adjusted in-hospital mortality (very low, low, medium, high, and very high). Then, the bleeding complication rate and in-hospital mortality rate among patients who developed bleeding complications were calculated for each quintile.

Results
In total, 4,048 (1.04%) in-hospital deaths and 1,535 (0.39%) bleeding complications occurred. In-hospital mortality varied widely from 0.22% to 2.46% in very-low- to very-high-mortality hospitals. The bleeding complication rate also increased modestly from 0.27% to 0.57% (odds ratio, 1.95; 95% confidence interval, 1.58–2.39). However, the mortality rate among patients who developed bleeding complications markedly increased by quintile; the mortality rate of very-high-morality hospitals was 6-fold higher than that of very-low-mortality hospitals (29.0% vs. 4.8%, respectively; odds ratio, 12.2; 95% confidence interval, 6.9–21.7).

Conclusions
Wide variation in in-hospital mortality was observed within the Japanese nationwide PCI registry, and this variation was largely driven by differences in mortality among patients with bleeding complications, rather than crude incidence of bleeding complications. These results underscore the importance of efforts toward reducing not only bleeding complications but also, even more importantly, mortality once bleeding has occurred.

Funding Acknowledgement
Type of funding sources: None.
Declines in in- and out-of-hospital coronary mortality from 2000 to 2016: results from the French MONICA registries
Authors: Gbokou S , Biasch K , Dallongeville J , Huo Yung Kai S , Montaye M , Amouyel P , Meirhaeghe A , Ferrieres J , Moitry M 
Published: October 2021

Abstract

Background
In the past decades, improvements in the management of acute coronary events (ACE) have dramatically reduced in-hospital Coronary Heart Disease (CHD) mortality. Little is known on recent evolutions in out-of-hospital mortality and its contribution to overall ACE mortality.

Purpose
To estimate trends of in- and out-of-hospital ACE mortality rates from 2000 to 2016 and their respective contribution to total CHD mortality.

Methods
Using data from the three CHD MONICA registries, all fatal myocardial infarctions, coronary deaths and sudden deaths occurring between January 1st, 2000 and December 31st, 2016 in patients age 35 to 74 were recorded. Age-standardized mortality rates (SMRs) were estimated by gender and calendar year. Crude mortality rates (CMRs) were estimated by 20-years age group. Trends were expressed as annual percentage changes (APCs).

Results
During the study period, 20,822 fatal events were recorded, of which 69.4% took place out-of hospital (Figure 1). Almost 90% of out-of-hospital deaths occurred at home. Standardized ACE mortality rates decreased more steeply in women as compared to men, with an APC of −4.4%, versus −3.5% in men. Decreases in ACE mortality were more pronounced inside than outside the hospital (APC: −4.6% versus −3.1% in men; −5.9% versus −3.7% in women), with an increase in the contribution of out-of-hospital mortality to overall ACE mortality from 64.7% to 71.1% in men, and from 64.4% to 71.4% in women. Decreases in CMRs were more pronounced for people age 55–74 compared to those age 35–54. In the 55–74 age group, in-hospital SMRs decreased more steeply inside than outside the hospital (APC −5.2% versus −3.6% in men; −6.3% versus −3.9% in women, Figure 2). This was not observed among the youngest subjects, in whom the decreases for in- and out-of-hospital CMRs were similar (APC −1.5% versus −1.6% in men; −3.6% versus −3.1% in women).

Conclusions
Over the study period, out-of-hospital mortality accounted for more than two-thirds of overall ACE mortality. Declines were more pronounced for in-hospital mortality than for out-of hospital, except in the youngest subjects, in whom they were similar. These results highlight the need to strengthen primary prevention.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): - Santé Publique France (SPF) - Institut national de la santé et de la recherche médicale (Inserm)
Trends in cardiovascular mortality of cancer patients in the US over two decades 1999–2019
Authors: Kobo O , Khattak S , Lopez-Mattei J , Van Spall H , Graham M , Cheng R , Osman M , Sun L , Ullah W , Fischman D , Roguin A , Mohamed O M , Mamas M A 
Published: October 2021

Abstract

Background
Cancer is the second most common cause of death globally after cardiovascular (CV) disease. The present study sought to compare the trends in CV mortality between patients with and without cancer in the US over two decades (1999 to 2019), stratified by sociodemographic factors such as age, sex and geographical location.

Methods
In this retrospective study, the number of deaths, crude- and age-adjusted mortality rates between January 1, 1999, and December 31, 2019, were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set

Results
We examined a total of 53,422,612 deaths between 1999 and 2019; of which 33.4% were defined as CV mortality and 25.6% had malignancy. During this period, among patients with cancer, the age-adjusted mortality rate dropped by 52%. (Vs, 38% in patients with no malignancy). CV mortality was highest in patients with gastrointestinal and prostate malignancy where CV mortality accounts together for over 40% of all CV mortality in patients with cancer in 1999 and 33.6% in 2019. The age-adjusted CV mortality rate (per 100,000 people) of patients with GI and prostate cancer nearly halved over twenty years from 2.7 to 1.0 and 2.5 to 1.0.
The CV age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with hematological malignancy (59–63% vs. 41%. We observed that crude CV mortality rates amongst patients with cancer declined over the study period in all age groups but was more prominent among patients over 65 years old than those aged 55–64 and under 55 (51%-55% Vs. 41%, 25%, respectively).Similar reductions in mortality in men and women (54% and 53% reduction) were observed
During the study period the decline in cardiovascular mortality was more prominent in metro areas which led to lower age adjusted CV mortality in Metro compared to non-Metro areas (5.7–6.3 vs 7.2). The decline in age adjusted CV mortality in patients with cancer differed significantly in different states

Conclusions
In our temporal analysis we show a 50% decline in CV mortality in the US over two decades in both male and female patients with cancer, that has exceeded the reduction in CV mortality seen in the non-cancer population. The greatest reductions in CV mortality were observed in patients with GI, breast and prostate malignancies, those residing in metro areas and in patients aged 65 and over.

Funding Acknowledgement
Type of funding sources: None. CV death among cancer patients
Cardiac and other presentation and clinical outcomes of COVID-19 pandemic among different ethnic and religious populations in the city of Jerusalem
Authors: Asher E , Samuel T , Yagel O , Wolak A , Farkash R , Durst R , Ben-Chetrit E , Helviz I , Tvito A , Nir-Paz R , Amir O , Glikson M 
Published: October 2021

Abstract

Background
The COVID-19 pandemic is an ongoing global pandemic. Jerusalem with its 919,400 inhabitants has a wide variety of populations, of which 62% are Jews (36% ultra-orthodox; 64% non-ultraorthodox) and 38% Arabs which were largely affected by the pandemic.

Objectives
The aim of our study was to understand the different presentations, course and clinical outcomes in these different ethnical and cultural groups in Jerusalem in the COVID-19 pandemic.

Methods
We performed a cohort study of all COVID-19 patients admitted between March 9 - July 16, 2020 to the two university medical centers in Jerusalem. Demographic data, presenting symptoms, comorbid conditions, medications, physical examination, laboratory and imaging data as well as outcome at 30-day were systematically recorded. Patients were divided according to their religion and ethnicity into 3 main groups: 1) Ultra-Orthodox Jews; 2) other (non-Ultra-Orthodox) Jews and 3) Arabs.

Results
Six hundred and two patients comprised the study population. Of them the 361 (60%) were Ultra-Orthodox Jews; 166 (27.5%) non-Ultra-Orthodox Jews and 75 (12.5%) Arabs. The Arab patients were younger than the Ultra-Orthodox Jews and the non-Ultra-Orthodox Jews (51±18 year-old vs. 57±21 and 59±19, respectively, p&lt;0.01), but suffered from significantly more co-morbidities. Fever, cough, dyspnea and fatigue, were more prominent, as presenting symptoms, in the Jewish patients as compared with the Arab patients. Moreover, hemodynamic shock, ischemic ECG changes and pathological chest x-ray were all more frequent in the Ultra-Orthodox patients as compared the other groups of patients. Being an Ultra-Orthodox was independently associated with significantly higher rate of Major Adverse Cardiovascular Events (MACE) [OR=1.96; 95% CI (1.03–3.71), p&lt;0.05]. Age was the only independent risk factor associated with increased mortality rate [OR=1.10; 95% CI (1.07–1.13), p&lt;0.001].

Conclusions
The COVID-19 first phase in Jerusalem, affected different ethnical and cultural groups differently, with the Ultra-Orthodox Jews mostly affected by admission rates, presenting symptoms clinical course and MACE (Acute coronary syndrome, shock, cerebrovascular event or venous thromboembolism). It is conceivable that vulnerable populations need special attention and health planning in time of pandemic, to prevent rapid distribution and severe morbidity.

Funding Acknowledgement
Type of funding sources: None.
Correlation of stress testing with anatomically significant coronary artery disease in the contemporary patient population
Authors: Choudhary J , Biondi-Zoccai G , Mukherjee D , Bashir R , Lakhter V , Chatterjee S 
Published: October 2021

Abstract

Background
The purpose of this study was to determine the accuracy and validity of stress testing compared to anatomic correlation at the level of individual coronary arteries.

Methods
PubMed, Embase, and the Cochrane Library were used to identify studies published between 2000 and 2020 comparing physiologic stress tests such as SPECT, PET, and echocardiography to an anatomical reference standard (CT coronary angiography or invasive coronary angiography) on a per-vessel level, and pooled analyses were conducted.

Results
Forty-one studies reporting ischemia at the level of at least one coronary artery were identified (N=4,778). For LAD, pooled sensitivity (sens) was 74% (95% CI: 69%-77%), specificity (spec) – 82% (95% CI: 79%-84%), positive likelihood ratio (LR) – 4.02 (95% CI: 3.42–4.73), negative LR – 0.32 (95% CI: 0.28–0.37), and DOR – 12.46 (95% CI: 9.58–16.20). For LCX, sens – 64% (95% CI: 59%-69%), spec – 86% (95% CI: 83%-89%), positive LR – 4.69 (95% CI: 3.84–5.74), negative LR – 0.41 (95% CI: 0.36–0.47), and DOR – 11.35 (95% CI: 8.61–14.96). Similarly, for RCA, sens – 71% (95% CI: 66%-75%), spec – 84% (95% CI: 81%-87%), positive LR – 4.42 (95% CI: 3.65–5.36), negative LR – 0.35 (95% CI: 0.30–0.40), and DOR – 12.64 (95% CI: 9.59–16.65). LAD ischemia was more significantly correlated with significant stenosis, and LCX was the least (p&lt;0.001).

Conclusion
There appears to be only modest correlation of physiologic ischemia with anatomically significant coronary artery disease, and this varies according to specific coronary artery territory.

Funding Acknowledgement
Type of funding sources: None.
Gamma glutamyl transferase and its fractions to predict coronary artery calcium and outcome in the general population
Authors: Chiappino S , Aimo A , Musetti V , Masotti S , Paolicchi A , Franzini M , Della Latta D , Ripoli A , Martini N , Susini C , Piagneri V , Storti S , Passino C , Emdin M 
Published: October 2021

Abstract

Background
Gamma glutamyl transferase (GGT) is a risk factor for plaque destabilization, particularly its fraction with the highest molecular weight (big-GGT, b-GGT). We explored the interplay between GGT, computed tomography (CT) findings that predict cardiovascular risk (coronary artery calcium [CAC] and epicardial fat volume [EFV]), and 10-year outcome.

Methods
Between May 2010 and October 2011, subjects aged between 45 and 75 years living in a city of Tuscany (Italy) and free from known cardiovascular disease were invited to participate to a screening including a CT scan.

Results
A subgroup of study participants (n=898, 65%) had total GGT and GGT fractions quantified (median age 65 years [25th-75th percentile: 55–70 yrs], 46% males, median 10-year risk of myocardial infarction or death based on the Framingham score 6% [2–11%]). GGT predicted CAC (Exp(B) 0.099, p=0.002) and EFV (Exp(B) 0.102, p=0.003) in a model including age, gender, diabetes, current or previous smoking status, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and aspirin therapy. Over 10.3 years (9.6–10.8), 74 individuals died (8%), and 36 (4%) experienced the composite of cardiovascular death or coronary revascularization. The risk of all-cause death and the composite endpoint increased quite steeply with GGT values, with thresholds of 19 UI and 20 IU, respectively (Figure). GGT predicted both endpoints independently from the Framingham 10-year risk (hazard ratio [HR] 1.01, 95% CI 1.01–1.02, p=0.004, and HR 1.01, 95% CI 1.01–1.02, p=0.002, respectively), as well as a model including CT findings. bGGT had the highest area under the curve value to predict the composite endpoint (0.586).

Conclusions
In a general population setting, plasma GGT independently predicts CAC and EFV, and the risk of all-cause death or a composite cardiovascular endpoint.

Funding Acknowledgement
Type of funding sources: None.