bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and one year outcome of periprocedural myocardial infarction following cardiac surgery: are the universal definition and SCAI criteria fit for purpose?
Authors: Hinton J , Augustine M , Gabara L , Mariathas M , Allan R , Borca F , Nicholas Z , Ikwoube J , Gillett N , Kwok C S , Cook P , Grocott M P W , Mamas M , Curzen N 
Published: October 2021

Abstract

Introduction
The diagnosis and clinical implication of periprocedural myocardial infarction (PPMI) following coronary artery bypass grafting (CABG) is contentious, especially given its importance in the interpretation of trial data. Two accepted definitions of PPMI yield discrepant results. Little is known about the association between the diagnosis of PPMI, using high sensitivity troponin (hs-cTn), and medium term mortality in patients who undergo CABG, either alone or in conjunction with another procedure. In addition, there are currently no criteria for the diagnosis of PPMI following non-CABG surgery.

Method
Consecutive patients admitted to a cardiothoracic critical care unit (CCCU) over a six month period following open cardiac surgery had hs-cTnI assay performed on admission and every day for forty-eight hours, regardless of whether there was a clinical indication. Patients were categorised as PPMI using both the Universal Definition of MI (UDMI) and Society of Cardiovascular Angiography and Interventions (SCAI) criteria. Comorbidity data, surgical details and clinical progress in CCCU were recorded. One year mortality data were obtained from NHS Digital.

Results
There were 245 CABG patients, of whom 20.4% met criteria for UDMI PPMI and 87.6% for SCAI UDMI (figure 1). The diagnosis of UDMI PPMI was independently associated with one year mortality (hazard ratio 4.175 (95% confidence interval 1.281 – 13.608)), whereas there was no association between SCAI PPMI and one year mortality (figure 2). Of the 243 patients who had non CABG cardiac surgery, 11.4% met criteria for UDMI PPMI and 85.2% for SCAI PPMI (figure1) but neither was associated with one year mortality.

Conclusions
The incidence of SCAI PPMI in a real world cohort of cardiac surgery patients is so high as to be of limited clinical value. By contrast, a diagnosis of UDMI PPMI post CABG is independently associated with one year mortality, so may have clinical utility.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Beckman Coulter - supplied the assays used in the study but had no role in the study Figure 1. Frequency of PPMIFigure 2. Kaplan Meier curves
The effect of early invasive strategy on mortality outcome in patients with chronic kidney disease presenting with non-ST segment elevation myocardial infarction
Authors: Sharon A , Fishman B , Itelman E , Fefer P , Barbash I , Segev A , Matetzky S , Guetta V , Grossman E , Maor E 
Published: October 2021

Abstract

Background
Current guidelines recommend an early invasive strategy for patients with non-ST segment elevation myocardial infarction (NSTEMI).

Purpose
To evaluate whether early invasive strategy is associated with better outcome among patients with chronic kidney disease (CKD).

Methods
Retrospective cohort analysis of consecutive patients with NSTEMI between 2008 and 2021. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation. Invasively treated patients were dichotomized into early (&lt;24 hours) and non-early groups. Mortality data was available for all patients from a national registry. Multivariate Cox regression models with interaction analysis were applied.

Results
Final study population comprised 7,107 NSTEMI patients, of whom 3,172 (45%) had eGFR &lt;60 ml/min/1.73m2. 1,988 (28%) and 973 (14%) patients had eGFR under 45 and 30 ml/min/1.73m2, respectively. 3,529 (50%) patients were treated invasively, among them 1837 (52%) underwent early invasive strategy. Patients in the early invasive group were younger (64 vs. 68 years, p&lt;0.001) and were less likely to have comorbidities including kidney disease. During a median follow-up of 3 years (IQR 1.2–5.2), 2,552 (36%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death was 50%, 15%, and 6% among patients in the conservative, non-early, and early invasive groups respectively (p Log-rank &lt;0.001). Subgroup analysis of invasively managed patients showed that early invasive strategy was associated with a significant 32% reduced risk of death in a multivariate model (95% CI 0.56–0.82, p&lt;0.001), but this associated benefit was modified by eGFR (p for interaction 0.045). The modification effect of CKD on the association of early invasive strategy with outcome was most pronounced among invasively treated patients with eGFR &lt;45 ml/min/1.73m2, with no survival benefit for early invasive approach in these patients (HR 0.8, 95% CI 0.57–1.14, p=0.221 vs. HR 0.6 95% CI 0.45–0.72, p&lt;0.001; p for interaction=0.046).

Conclusion
Among invasively treated NSTEMI patients, the benefit of early invasive strategy is modified by CKD, and limited to those with eGFR ≥45 ml/min/1.73m2.

Funding Acknowledgement
Type of funding sources: None.
Gender based outcome of IABP implantation in patients with acute coronary syndrome and cardiogenic shock: a national inpatient sample database analysis
Authors: Patel N , Amgai B , Chakraborty S , Hajra A , Aryal B , Patel Z , Ashish K , Reddy M , Aronow W , Khalid M 
Published: October 2021

Abstract

Background
Intra-Aortic Balloon counter-pulsation is frequently used as a circulatory support device in patients requiring hemodynamic support - in cardiogenic shock and in patients at risk of hemodynamic decompensation during a high-risk coronary intervention. Impact of IABP in this patient population has been variable. Certain studies have shown a beneficial effect of IABP on selected populations having acute coronary syndrome with cardiogenic shock (1–3). Our objective was to compare the outcomes based on gender in the ACS population with cardiogenic shock and IABP placement.

Methods
We analyzed the National Inpatient Sample database from Oct-2015 to Dec-2017 released under Healthcare Cost utilization Project in the USA using Stata 16.0. The population was identified using respective ICD-10 codes. We excluded the population with sudden cardiac arrest, pulmonary embolism, and patients with anatomical post-MI complications. Multivariate logistic regression analysis was done to determine the difference in outcomes based on gender using clinically relevant variables. Later, propensity-matched cohort analysis was performed based on the regression variables.

Results
Of 36, 990 patients who met our inclusion criteria 25,670 (69%) were male and 11,320 (31%) were female. The average age for male and female populations was 66±11 and 69±12 years. Femnales were more likely to have higher Charlson co-morbidity index three or above. We found higher mortality in the female population [3,146 (27.79%)] compared to male [5,884 (22.92%)] in univariate analyses. Propensity-matched multivariate regression analysis showed no difference [OR: 1.06 (0.91–1.22) with P-value: 0.482] in mortality after adjusting for clinically relevant variables. Subgroup analysis in STEMI and NSTEMI populations did not show a difference. The average hospital stay was similar in both cohorts, with the male having a higher cost per stay. We found no difference in most of the complications included in our study except for higher coronary artery dissection [OR: 2.98 (1.73–5.13), P-value: &lt;0.001] and lower rates of AKI [OR: 0.72 (0.63–0.83), P-value: &lt;0.001], AKI requiring hemodialysis [OR: 0.74 (0.56–0.97), P-value:0.031] and ventricular tachycardia [OR: 0.73 (0.64–0.84), P-value: &lt;0.001] in the female population.

Conclusion
The inpatient population of ACS with Cardiogenic shock and IABP insertion showed no significant difference in mortality between males and females which was valid for subgroup analysis of NSTEMI and STEMI groups. Complications such as coronary artery dissection were higher, whereas AKI, AKI requiring hemodialysis, and ventricular tachycardias, were lower in females than males.

Funding Acknowledgement
Type of funding sources: None.
Association between lowering heart rate during IMPELLA support and favorable short-term outcome in patients with cardiogenic shock
Authors: Maemura K , Ikeda Y , Eda Y , Oki T , Yazaki M , Fujita T , Iida Y , Nabeta T , Ishii S , Koriyama K , Maekawa E , Koitabashi T , Ako J 
Published: October 2021

Abstract

Background
Impella has been increasingly used in patients with cardiogenic shock (CGS). Target values for clinical indices for appropriate management of Impella have not yet been established.

Purpose
We aimed to elucidate the association between heat rate (HR) during Impella treatment in patients with CGS and clinical outcomes.

Methods and results
We retrospectively evaluated 62 patients (68±14 years; male 77%) with CGS receiving temporary circulatory support with the Impella between February 1, 2019, and February 31, 2021. The primary end point was 30-day mortality. Clinical characteristics, laboratory and hemodynamic markers at implantation of Impella (baseline), 12, 24 hr after implantation, and removal of Impella were assessed. There were 28 patients with concomitant use of extracorporeal membrane oxygenation (ECMO). Treatment periods using Impella were 8±6 days. After excluding 11 patients who died during Impella support, the relationship between clinical indicators at each time points and 30-day mortality was evaluated. There were 22 patients (43%) with 30-day mortality. Factors associated with 30-day mortality were: female, ECMO, higher 24-hr lactate level, lower 24-hr cardiac power output, and higher HR at removal. Lower HR of ≤81 bpm at removal was found to most accurately predict lower 30-day mortality (Figure 1). Higher increases in dose of beta-blockers during Impella support and lower absolute doses of norepinephrine at removal were correlated with decreases in HR during Impella support.

Conclusions
In patients with CGS treated with Impella, lower HR at removal was associated with lower incidence of 30-day mortality. Lowering HR during Impella treatment was recognized as a simple indicator for favorable clinical outcomes in patients with CGS. It was suggested that chronotropic interventions during Impella treatment may be novel therapeutic options in patients with CGS.

Funding Acknowledgement
Type of funding sources: None. Figure 1
First Asian validation of ORBI score in predicting in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention
Authors: Putra A , Juzar D A , Widyantoro B , Firdaus I 
Published: October 2021

Abstract

Background
Cardiogenic shock (CS) complicating an acute coronary syndrome still worsening the prognosis with 30-day mortality rates approximating 40–45%, despite improvements in the acute management of ST-segment elevation myocardial infarction (STEMI), particularly the widespread use of timely primary percutaneous coronary intervention (pPCI). The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making. This is essential in developing countries with wide variation in health care facilities, scarce resources and increasing burden of cardiovascular diseases.

Purpose
To validate ORBI Score in identifying patients at high-risk of in-hospital STEMI related cardiogenic shock in a multi-ethnic developing country.

Method
The ORBI risk score was evaluated in 1934 patients STEMI without CS on admission and treated by primary percutaneous coronary intervention (pPCI) in our national cardiovascular centre included this study. Model discrimination and calibration was tested in the overall population. Eleven variables from the ORBI score were independently associated with the development of in-hospital CS: age &gt;70 years, prior stroke/transient ischaemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay &gt;90min, Killip class, heart rate &gt;90/min, a combination of systolic blood pressure &lt;125 mmHg and pulse pressure &lt;45 mmHg, glycaemia &gt;10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI thrombolysis in myocardial infarction flow grade &lt;3. The score derived from these variables allowed the classification of patients into four risk categories: low (0–7), low- to-intermediate (8–10), intermediate-to-high (11–12), and high (≥13).

Results
Observed in-hospital CS rates were 0.3%, 6.4%, 19.5%, and 32.12%, across the four risk categories, respectively. The score demonstrated high discrimination (c-statistic of 0.91 (CI 95% 0.88–0.93), p&lt;0.001 in the validation cohort)

Conclusion
The ORBI risk score is valid and can be used for predicting the development of cardiogenic shock in STEMI patients for better targeted treatment.

Funding Acknowledgement
Type of funding sources: None. ROC curveObserved in-hospital CS rates
Association between mean arterial pressure and neurological outcome in survivors of a cardiac arrest undergoing targeted temperature management
Authors: Vasserot I , Severo A , Juarez V , Rivero B , Arbas E , Poveda D , Tebar D , Merino C , Marco I , Martin L , Garcia-Arribas D , Caro J , Rosillo S , Armada E , Lopez De Sa E 
Published: October 2021

Abstract

Background
Besides targeted temperature management (TTM), no other therapeutic strategy has shown to improve neurological outcome in cardiac arrest patients. Recently, it has been suggested that higher levels of mean arterial blood pressure (&gt;90 mmHg) may have a protective neurological effect in this population, yet data is scarce.

Objective
To describe the association between neurological outcomes and MAP during TTM.

Methods
Retrospective study of a prospective database including survivors of a cardiac arrest undergoing TTM and admitted to the acute cardiac care of a tertiary university hospital from September 2007 to July 2020. MAP was recorded from arrival and hourly during TTM. Neurological outcome was graded 3 months after initial event using the Pittsburgh Cerebral Performance Category (CPC) scale and patients were divided classified as follows: Group A patients with CPC of 1 to 2 (good neurological outcome), and group B, with CPC 3 to 5 (poor neurological outcome or death). As CPC 5 comprises patients who have died but whose cause of death may not be related to their neurological condition, we sort to control this potential source of bias, by including a variable of “severe neurological injury”, which includes patients with CPC 3–4 and those CPC 5 who died due to WLST due to poor neurological prognosis/brain death.

Results
A total pf 431 patients were analysed. Baseline and cardiac arrest characteristics are depicted in Table 1. Patients in group B had a higher proportion of non-witnessed cardiac arrest, out-of-hospital cardiac arrest, non-shockable rhythm, and longer time before ROSC. The relation between MAP and neurological outcome is shown in Table 2. The were no differences of MAP in day 1 and 3 between groups. MAP was statistically higher in Group A during day 2 or rewarming phase. Mean MAP during day 1 and 2; and during day 1, 2 and 3 was also significantly higher in group A. However, when same analysis was performed under the variable “severe neurological injury” no statistically significant differences were observed.

Conclusion
There is no association between MAP and neurological outcomes, when true “severe neurological injury” is analysed. Therefore, and until further data is obtained, following actual practical guidelines or avoiding hypotension seems to be the goal in this population, as higher MAP may also have deleterious effects.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital La Paz
High-degree atrioventricular block after valve-in-valve transcatheter aortic valve implantation: incidence and predictors
Authors: Jung S , Arnold M , Marwan M , Kondruweit M , Achenbach S 
Published: October 2021

Abstract

Background
High-degree atrioventricular (AV) block and permanent pacemaker (PPM) implantation represent major complications after transcatheter aortic valve implantation (TAVI). Data on the incidence of AV block for patients undergoing valve-in-valve (ViV) TAVI are scarce. We examined the incidence and predictors of periinterventional AV conduction disturbances in a cohort of subjects undergoing ViV TAVI compared to subjects undergoing TAVI of native aortic valves.

Methods
In 50 consecutive patients who underwent ViV TAVI, clinical characteristics, incidence and predictors for AV conduction disturbances as well as intrahospital outcome were assessed. Applying a matched pair approach for age, gender, type and size of transcatheter valve, these subjects were compared to 50 patients undergoing TAVI of native tricuspid aortic valves.

Results
Mean age in both groups was 80±6 years and 50% of subjects were male. In the ViV group, 22 patients (44%) had a stented bioprosthesis, 10 patients (20%) a stentless bioprosthesis and 18 patients (36%) a previous TAVI prosthesis (balloon-expandable: n=15, self-expandable n=3). The majority of subjects (92% in each group) were treated using balloon-expandable valves (ViV group: Sapien XT, n=20 or Sapien 3, n=26, control group: Sapien XT, n=19 or Sapien 3, n=27).
Periinterventional, non-reversible 3rd degree AV-block occurred in 6 patients within each group (12%), and all of the affected patients underwent PPM implantation. Among the 32 patients who underwent ViV-TAVI of a surgically placed bioprosthesis, only 2 (6%) developed a high-degree AV block (1/22 with a stented bioprosthesis and 1/10 with a stentless bioprosthesis). In contrast, high-degree AV block occurred in 4/18 patients (22%) who underwent ViV TAVI of a prior TAVI prosthesis. There was a significant difference in the occurrence of total high-degree AV blocks requiring postinterventional PPM implantation (p=0.033) between subjects who received TAVI of stented bioprostheses and those who received re-TAVI.
In logistic regression analysis, pre-existing RBBB represented a significant predictor for periinterventional 3rd degree AV block across the whole cohort (p=0.001, Exp(B)=10.667), both in ViV subjects (p=0.016, Exp(B)=12.0) and in the control group (p=0.018, Exp(B)=10.0).

Conclusion
Periinterventional AV block occurs infrequently in subjects undergoing ViV TAVI for treatment of degenerated surgical bioprostheses. However, patients undergoing ViV TAVI for degenerated transcatheter prostheses as well as subjects with pre-existing RBBB are at substantial risk for the occurence of AV block and require close peri-interventional monitoring.

Funding Acknowledgement
Type of funding sources: None.
Increased rate of new-onset left bundle branch block in patients with bicuspid aortic stenosis undergoing TAVR; data from a national registry
Authors: Shiyovich A , Kornowski R , Plakht Y , Aviv Y , Vaknin Assa H , Assali A , Lessick J , Kerner A , Segev A , Barabash I , Goitein O , Brodov Y , Finkelstein A , Perlman G , Hamdan A 
Published: October 2021

Abstract

Background
There is a growing interest in transcutaneous aortic valve replacement (TAVR) therapy among patients with bicuspid severe aortic stenosis (BAV). Conduction disturbances remain a frequent complication of TAVR, and new-onset permanent LBBB (NOP-LBBB) post-TAVR may be a marker of worse outcomes.

Purpose
To evaluate primarily the rate of NOP-LBBB following TAVR among patients with BAV as compared to tricuspid severe aortic stenosis (TAV).

Methods
Patients enrolled in the multicenter (5 centers) Bicuspid AS TAVR Registry were reviewed and compared with patients with TAV. Patients with prior aortic valve replacement, other valve morphologies and those with preprocedural LBBB or pacemaker were excluded. NOP-LBBB was defined as LBBB first detected and persisting 30-days following TAVR.

Results
A total of 387 patients (66 with BAV, 321 with TAV), age 80.3±7.3, 47% females were analyzed. The device success rates were 95% in both groups without any conversions to surgery. The rate of NOP-LBBB was significantly higher among patients with BAV vs. TAV (29.2% vs. 16.9%, p=0.02). However, the rate of post procedural pacemaker implantation was similar (14.8% vs. 12.5%; respectively, p=0.62). In BAV and TAV groups, 1-year mortality (6.1% vs. 7.2%; respectively, p=0.75) and stroke rates (6.1% vs. 3.5%; respectively, p=0.3) were not significantly different. Multivariate analysis identified BAV as an independent predictor of NOP-LBBB (OR=2.7, 95% CI 1.3–5.4). Furthermore, BAV subtypes with raphe (type 1) were identified as independent predictors of NOP-LBBB (OR=3.2, 95% CI: 1.5–6.7).

Conclusions
Patients with BAV undergoing TAVR have greater risk for developing NOP-LBBB compared with patients with TAV and the presence of raphe was associated with increased risk of NOP-LBBB. The prognostic significance for this finding warrants further evaluation in future studies.

Funding Acknowledgement
Type of funding sources: None.
Acute myocarditis with preserved ejection fraction: the role of CMR in long term follow up
Authors: Ghionzoli N , Mandoli G E , Gismondi A , Di Florio A , Cavigli L , Sciaccaluga C , Pastore M C , D'Ascenzi F , Cameli M , Focardi M 
Published: October 2021

Abstract

Background
Cardiac Magnetic Resonance (CMR) has an important role in subjects presenting with acute myocarditis and preserved ejection fraction (pEF); it is widely used as a non-invasive imaging test in patients with suspected myocarditis, both for diagnostic and prognostic purpose. Despite this, poor data is available regarding which parameters define a worst prognosis in acute myocarditis with pEF.

Purpose
The aim of this study was to analyze the role of CMR in acute myocarditis with pEF at long term follow up.

Methods
We retrospectively enrolled 61 patients admitted to our Cardiology Department with suspected acute myocarditis and pEF. In the acute phase we analyzed clinical parameters, blood sample tests, echocardiographic and CMR indices. Myocarditis was confirmed using the Lake-Louis criteria on CMR images. The patients were followed up for a median of 4.8 years for the development of two composite endpoints: the first including cardiovascular death, cardiac arrest and/or ICD implantation; the second hospitalization for acute heart failure and/or recurrence of myocarditis.

Results
The clinical presentation was infart-like in the 78% of subjects; they all had a NYHA class I and had a pEF at basal echocardiogram. CMR showed myocardial edema in 50 patients (83%) and late gadolinium enhancement (LGE) in 94% of subjects. LGE involved the inferolateral wall in the 70%, the interventricular septum in 25% and other walls in 5%. During follow up, the first composite endpoint occurred in the 8% of patients, while 7 subjects (11%) had a new hospitalization for cardiac causes (heart failure or recurrence of myocarditis). Those patients with events during follow up had a significantly higher LGE quantity (21±9,8 gr vs 12,8±6 gr; p=0.006 Figure 1) at basal CMR compared to the other group.

Conclusions
LGE quantification by CMR could represent a prognostic added tool at long-term follow up in patients presenting with acute myocarditis and left ventricular pEF.

Funding Acknowledgement
Type of funding sources: None. Figure 1