bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender differences in the impact of plasma xanthine oxidoreductase activity on coronary artery spasm
Authors: Watanabe K , Watanabe T , Otaki Y , Murase T , Nakamura T , Hashimoto N , Kutsuzawa D , Kato S , Tamura H , Nishiyama S , Takahashi H , Arimoto T , Watanabe M 
Published: October 2021

Abstract

Background
It has been reported that decreased nitric oxide bioavailability due to increased reactive oxygen species (ROS) is one of the most important causes of coronary artery spasm (CAS). Xanthine oxidoreductase (XOR) is the rate-limiting enzyme for uric acid (UA) production and plays a pivotal role in generating ROS. It was reported that the gender differences exist in the impact of serum UA levels on cardiovascular risks. We previously demonstrated that increased plasma XOR activity is significantly associated with the incidence of CAS. However, the gender differences in the impact of plasma XOR activity on CAS remain unclear.

Purpose
The aim of this study was to examine the gender differences in the clinical impact of plasma XOR activity on CAS.

Methods
We investigated plasma XOR activity in 132 patients suspected for CAS (male, n=78; female, n=54), and underwent intracoronary acetylcholine provocation test. XOR activity assay was performed using stable isotope-labeled substrate and liquid chromatography-triple quadrupole mass spectrometry. Provoked CAS was defined as total or subtotal occlusion (≥90%) with accompanying symptoms of chest pain and/or ischemic ST-segment changes on the electrocardiogram. We excluded the patients who had significant coronary artery stenosis (≥50%) and/or were taking XOR inhibitors.

Results
Plasma XOR activity was significantly lower in female compared with male patients (30.3 pmol/h/mL, interquartile range (IQR) 22.8–42.7 vs. 51.7 pmol/h/mL, IQR 34.7–101.8; P&lt;0.001). CAS was provoked in 36 male patients and 17 female patients, and they each had significantly higher plasma XOR activity compared with those without, respectively. Multivariate logistic regression analysis showed that plasma XOR activity was independently associated with the incidence of CAS in both genders after adjustment for confounding factors. The optimal cut-off values for predicting CAS were lower in female than those in male patients (52.3 vs. 91.6 pmol/h/mL). Multivariate analysis demonstrated that female patients with high XOR activity (≥52.3 pmol/h/mL; odds ratio [OR] 22.6, P&lt;0.001) exhibited a higher incidence of CAS compared with that in male patients (≥91.6 pmol/h/mL; OR 8.2, P&lt;0.001).

Conclusions
Plasma XOR activity was an independent predictor for the incidence of CAS in both genders. The impact of plasma XOR activity on CAS was stronger in female patients than in male patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Post-angioplasty myocardial blush grade for long term prognostication in acute coronary syndrome: a systematic review and meta-analysis
Authors: Vera Cruz P , Palmes P , Bacalangco-Suerte N 
Published: October 2021

Abstract

Background
Reduced myocardial perfusion despite achieving adequate epicardial bloodflow after angioplasty has been reported to occur in up to 71–80% of Acute Coronary Syndrome (ACS) patients. This is associated with worsening myocardial function and has detrimentally affected long term survival of ACS patients. Myocardial Blush Grade (MBG) is an angiographic parameter of myocardial perfusion that has been found to correlate well with markers of post-infarction myocardial function. However, its acceptance as a reliable marker in routine clinical practice has not yet gained foothold.

Purpose
We aimed to determine the prognostic value of MBG for long term all-cause mortality and major adverse cardiovascular events (MACE) among acute coronary syndrome patients who underwent primary angioplasty.

Methods
PubMed, Google Scholar, Science Direct, and the Cochrane Central Registry were searched for relevant studies published from 1 January 1998 to 31 December 2020. The primary outcome was indexed all-cause mortality and the secondary outcome was major adverse cardiovascular event.
A Mantel-Haenszel random effects meta-analysis was used to derive the pooled estimate of each outcome.

Results
Ten studies involving a total of 11,531 ACS patients were included. Results showed that MBG 0/1 with no to poor myocardial perfusion had a cumulative negative prognostic value for mortality (OR=2.71, CI: 2.11–3.49, p&lt;0.ehab724.13141, I2=35%) and MACE (OR=1.28, CI: 1.03–1.58, p&lt;0.02, I2=39%). Subgroup analysis showed MBG 0/1 had a significant negative prognostic association for mortality among ST-elevation myocardial infarction patients (OR=2.86, CI: 2.17–3.76, p&lt;0.ehab724.13141, I2=44%) but did not have a significant association among unstable angina/Non-ST-elevation Myocardial Infarction patients (OR=1.68, CI: 0.76–3.71, p 0.20, I2=0%). Subsequently, MBG 3 with normal myocardial perfusion was associated with a reduced risk for long term all-cause mortality (HR=0.22, CI: 0.15 to 0.33, p 0.02, I2=39%).

Conclusion
Our results support the use of post-angioplasty Myocardial Blush Grade to prognosticate ST-elevation myocardial infarction patients. MBG 0/1 is a strong negative prognostic marker for long term all-cause mortality and major adverse cardiovascular events while an MBG 3 is a strong positive prognostic marker for long term survival. However, more data is still needed to determine its prognostic value for unstable angina and non-ST-elevation ACS patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1. MBG 0/1 and all-cause mortalityFigure 2. MBG 3 and long term survival
Clinical burden of MACE in patients with multivessel disease during the early period following acute myocardial infarction
Authors: Gabriel S , Herepath M , Zhang X , Were J J , Ruzangi J , O'Connell S P 
Published: October 2021

Abstract

Background
Despite numerous interventions that have improved outcomes in acute myocardial infarction (AMI) patients, the first 90 days after AMI remains a high-risk period for recurrent events. Due to higher disease burden and suboptimal outcomes, it is crucial to characterize the clinical burden upon patients with multivessel disease (MVD) and various comorbidities.

Purpose
To describe the post-AMI clinical burden of major adverse cardiovascular events (MACE) in patients with MVD at 30, 90, and 365 days.

Methods
This was a retrospective cohort study (1st January, 2008 to 31st December, 2018) using data from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD). This was linked to data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases to identify patients with a confirmed diagnosis code of MVD. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. The prevalence of MACE among post-AMI patients with MVD and the effect of concurrent risk factors was quantified.

Results
403,631 patients with MVD were identified (21.69% of the total study population), nearly one-fifth of whom (n=78,128; 19.35%) experienced an AMI after their first recorded diagnosis of MVD (MVD+). The mean and median age of MVD+ patients was 66 years, and the majority (72.9%) were male. Almost half (48.9%) had a Charlson co-morbidity score of at least 1, and 99.8% had an index of multiple deprivation recorded, distributed evenly across the quintiles. At least one of the composite MACE occurred in 9,533 (12.2%), 11,694 (14.9%), and 15,188 (19.4%) MVD+ patients within 30, 90, and 365 days, respectively. In MVD+ patients with 2 or more additional risk factors (peripheral artery disease [PAD], age &gt;65, prior AMI; w/out comorbid diabetes; n=7,531), the proportion of MACE within 90 days was substantially higher (42.7%). Non-fatal MI was the most common MACE episode in MVD+ patients, occurring in 7,696, (9.8%), 8,924 (11.4%), and 10,673 (13.7%) MVD+ patients at 30, 90, and 365 days, respectively. Within 90 days of AMI, 39.1% of MVD+ patients with 2 or more risk factors experienced non-fatal MI.

Conclusions
MVD patients have a considerable clinically relevant burden of MACE following AMI. The majority of 1-year recurrent events occurred within 90 days of MACE, with 90-day risk almost 3-fold higher in patients with two additional risk factors. For patients with MVD and other risk factors, opportunities remain for treatments that may reduce the risk of recurrent events in the early period following AMI.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
Hospital readmissions and economic burden associated with multivessel disease in the early period following acute myocardial infarction
Authors: Gabriel S , Herepath M , Zhang X , Were J J , Ruzangi J , O'Connell S P 
Published: October 2021

Abstract

Background
There is emerging evidence that particularly high rates of major adverse cardiovascular events (MACE) occur in the 90-day period after acute myocardial infarction (AMI). Post-AMI MACE are associated with additional resource utilization and economic burden for healthcare systems, with multivessel disease (MVD) conferring a 3- to 4-fold increase in risk of recurrent MACE in the first year post AMI vs. single vessel disease. Thus, characterizing the prevalence and outcomes of patients with MVD and various comorbidities is crucial to predict and mitigate clinical risk and associated costs.

Purpose
To describe post-AMI readmissions and economic burden in MVD patients at 30, 90, and 365 days.

Methods
This was a retrospective cohort study (1st January, 2008 to 31st December, 2018). Patients with MVD were identified by a confirmed diagnosis code from a longitudinal, representative UK population health dataset comprising primary care data from the Clinical Practice Research Datalink (CPRD), which was linked to secondary care data from the Hospital Episode Statistics (HES) and Office of National Statistics (ONS) databases. Patients who experienced at least one AMI after their first recorded MVD diagnosis were defined as MVD+. A MACE was defined as any one of non-fatal MI, non-fatal stroke, or cardiovascular death. Readmissions were defined as non-elective admissions with a MACE outcome diagnosis occurring up to 28 days from a previous admission with the same treatment speciality.

Results
The study population included 78,128 MVD+ patients (4.2% of the total patient population). In the MVD+ cohort, 3,753 (4.8%) patients were readmitted with at least one MACE event or other non-elective admission within the cardiovascular specialty: 2,394 (63.8%), 2,562 (68.3%), and 2,830 (75.4%) readmissions occurred within 30, 90, and 365 days, respectively. The mean length of hospital stay per patient, per readmission for MACE within 30, 90, and 365 days was 7.22, 7.46, and 7.74 days, respectively. The mean cost per MACE admission within 90 days of index AMI was £3,926.52. Non-fatal MI was the most common reason for readmission at all timepoints. Percutaneous transluminal balloon angioplasty and saphenous vein graft procedures (coronary artery bypass graft, CABG) were among the most common cardiac procedures in MVD+ patients, at 70,276 (22.7%) and 15,418 (5.0%), respectively.

Conclusions
In patients with MVD who suffer an AMI, there is high resource utilization and cost, particularly in the first 90-days post AMI; therefore, the 90-day post-AMI period represents significant economic costs to healthcare systems.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
Mortality and major cardiovascular events among patients with multiple myeloma: analysis from a nationwide French medical information database
Authors: Cottin Y , Boulin M , Doisy C , Mounier M , Caillot D , Chretien M L , Bodin A , Herbert J , Bonnotte B , Zeller M , Maynadie M , Fauchier L 
Published: October 2021

Abstract

Background
Cardiovascular disease (CVD) in patients with multiple myeloma (MM) may derive from multiple factors unrelated to the disease (age, diabetes, dyslipidemia, obesity, prior CV diseases), related to the disease and/or related to antimyeloma treatment. Based on a nationwide hospitalization database, we aimed to assess the risk of all-cause death, and CV outcomes in MM patients.

Methods
From 1st January 2013 to 31st December 2013, 3,381,472 adults (age ≥18 years) were hospitalized for any reason in French hospitals and then had at least 5 years of complete follow-up (or suffered death earlier). We identified 15,774 patients diagnosed with known MM at baseline. The outcome analysis (all-cause death, cardiovascular [CV] death, myocardial infarction (MI), ischemic stroke or hospitalization for major bleeding) was performed with follow-up starting at the time of last event. For each patient with MM, a propensity score-matched patient with no MM was selected (1:1) using the one-to-one nearest neighbor method.

Findings
The mean follow-up in the propensity-score-matched population was 3.7±2.3 years, median 5.0, IQR 1.3–5.7 years. During follow-up, matched patients with MM (15 774 patients) had a higher risk of all-death (yearly rate 20.02 vs 11.39%/year) than patients without MM. No difference was observed between MM group and no myeloma group for CV death (2.00 vs 2.02%/year). The rate of MI and stroke was markedly lower in the MM group, respectively for incidence rate, 0.86 vs 0.97%/year and 0.85 vs 1.10%/year. In contrast, MM group had a higher rate of rehospitalization for major bleeding with an incidence rate of 3.61 vs 2.24%/yr and a higher risk of intracranial bleeding (1.03 vs 0.84%/yr). Results were similar in sensitivity analysis limited to patients with recent MM (i.e. diagnosed within the 3 previous months).

Interpretation
From a large nationwide database, we show that although patients with MM are not at higher risk of CV death, they had a higher risk of mortality due to major bleeding and intracranial bleeding. Our findings highlight the key issue of anticoagulation treatment management in patients with MM.

Funding Acknowledgement
Type of funding sources: None.
Long-term validation of the GRACE and PRECISE-DAPT scores in patients with non-ST elevation acute coronary syndrome
Authors: Garcia-Rodeja Arias F , Alvarez Alvarez B , Gonzalez Ferrero T , Abou Jokh Casas C , Otero Garcia O , Martinon Martinez J , Jimenez Ramos V , Garcia Acuna J M , Rigueiro Veloso P , Agra Bermejo R M , Iglesias Alvarez D , Cacho Antonio C , Antunez Muinos P J , Tasende Rey P , Gonzalez Juanatey J R 
Published: October 2021

Abstract

Introduction and objectives
There is insufficient data regarding risk scores validation in patients with diabetes mellitus and non-ST elevation acute coronary syndrome (NSTEACS). We performed a diabetes mellitus-specific analysis of cardiovascular outcomes after NSTEACS using a large contemporary cohort of patients from two tertiary hospitals.

Methods
This work is a retrospective analysis from a prospective registry, that included 7415 consecutive NSTEACS patients from two Spanish Universitary Hospitals between the years 2003 and 2017. We tested the predictive power of the GRACE and PRECISE DAPT score, calculating the area under the ROC curve among with and without diabetes mellitus patients.

Results
Among the study participants, 2124 patients (28.0%) were diabetic. The median follow up was 54,3 months (IQR 24.7–80.0 months). Diabetic patients were more women (30.5% vs 25.7%) and older (70.0±10.8 vs 65.3±13.2 years old); they had higher GRACE (146±36 vs 137±36), PRECISE DAPT (15±7 vs 18±9) and CRUSADE (17±14 vs 30±18) at admission. Early invasive coronary angiography (≤24 hours after admission) was performed more frequently in non-diabetic. We tested the predictive power of the GRACE and PRECISE DAPT risk scores among diabetic and non-diabetic. PRECISE DAPT risk score showed a good predictive power for all-cause mortality, cardiovascular mortality and MACE in diabetic admitted with NSTEACS, without differences compared to non diabetic.

Conclusions
PRECISE DAPT risk score has an appropriate predictive power in diabetic patients admitted with NSTEACS compared to non diabetic NSTEACS. However, GRACE would be predictive worse in non diabetic during long term follow up in a large contemporary registry.

Funding Acknowledgement
Type of funding sources: None.
Long-term outcome of patients with myocardial infraction with nonobstructive coronary arteries
Authors: Barrett O , Edry Nadiv O , Peles I , Abramowitz Y , Cafri C , Rosenstein G , Merkin M , Zahger D , Koifman E 
Published: October 2021

Abstract

Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a condition of growing interest and research. We aimed to evaluate the long-term prognosis of MINOCA patients and identify possible risk factors associated with long term mortality in this patient's population.

Methods
We performed a retrospective observational cohort study including all patients aged ≥18 years hospitalized to a large tertiary center between 2005–2018 with a primary diagnosis of acute myocardial infarction (AMI) and non-obstructive lesions with less than &lt;50% stenosis in all coronary arteries. The aim of the study was to assess the long-term mortality and to evaluate factors associated with increased mortality in this population.

Results
MINOCA was diagnosed in 1544 patients during the study period. Mean age of patients was 61±12.3 and 46% were female. Common comorbidities were dyslipidemia (32.6%) and hypertension (21.2%) and 17% had prior PCI. More than third of the patients were treated with statins (37.2%), micropirin (32.7%) and angiotensin converting enzyme (ACE)-inhibitors (30.4%). While short-term prognosis was favorable with only 1.2% mortality at 30-days, 1-year mortality was 3.9% and 19.9% mortality at mean follow-up time of 8.5 years. While many factors were associated with unfavorable long-term outcome in the univariate analysis, only advanced age (HR =1.05, 95% confidence interval (CI) 1.02–1.07; p&lt;0.001) and congestive heart failure (HR=3.53, 95% CI 1.74–7.18; P&lt;0.001) were independently associated with increased mortality risk in the adjusted model.

Conclusions
MINOCA is not an infrequent condition that carries a good short-term outcome, but long-term outcome may be comparable to patients with obstructive coronary disease. Further research should be performed to elucidate the various mechanisms of MINOCA.

Funding Acknowledgement
Type of funding sources: None.
Is it justified to remove the intermediate risk group in the latest European guidelines for NSTEACS?
Authors: Gonzalez Ferrero T , Alvarez Alvarez B , Ave M T , Cordero A , Sampedro F G , Gonzalez Juanatey J 
Published: October 2021

Abstract

Background
Risk stratification in patients with non-ST elevation acute coronary syndrome (NSTEACS), becomes a priority after its diagnosis, due to the fact that it gives us information about prognosis and has crucial implications. The latest guidelines of European Society of Cardiology (ESC) suggest a new proposal of risk stratification dividing patients in three different groups: “low”, “high” and “very high risk”. Thus, they remove the intermediate risk group that defended the previous guidelines (2015).

Purpose
Our aim was to identify an intermediate risk group following the recommendations of the previous guidelines about risk stratification. We believe that the risk stratification in four groups if more accurate that the latest proposed in 2020 in three groups, because the “intermediate risk group” has a different prognosis that the subgroup nowadays considered “low risk”.

Methods
We included a cohort of 7 597 patients with NSTEACS admitted in two different Cardiology departments between 2003 and 2017 with 4,4±2,7 mean years of follow-up. Subsequently, a classification of the patients in four different risk groups was made following the 2015 guidelines and events during follow-up was assigned in the next categories:first adverse major cardiovascular event (MACE),all-cause mortality and cardiovascular mortality.

Results
Stratified analysis brought up that patients included in the intermediate risk group, had a different prognosis to the categories of “low” and “high risk” patients and we obtained the following results:
Mean incidence rate for total mortality measured in cases per 100 person-year [confidence interval (CI 95%)] was 1.96; for “low risk” patients CI95% 1.30–2.95, “intermediate risk” 3.91; (CI95% 3.28–4.57), “high risk” 4.94; CI95% 4.87–5.21 and “very high risk” 8.74; CI95% 7.75- 9.85.
Incidence rate for cardiovascular mortality for “low”, “intermediate”, “high” and “very high” was 1.02; (CI95% 0.58–1.18); 2.64 (CI95% 2.13–3.26); 3.32 (CI95% 3.11–3.55) and 6.71 (CI95% 4.84–7.69), respectively.
Using Cox analysis, the “intermediate risk group” (refference), still achieved statistical significance. Results expressed in hazard ratio demonstrated that:

Conclusion
These findings suggest that the four categories proposal could have better ability for risk stratification in NSTEACS patients and make us doubt about the new three groups classification displayed in the current ESC guidelines, particularly the “intermediate risk” group exclusion that would be reassessed as “low risk”.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): No funding sources.