bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of pre-infarction angina on no-reflow phenomenon and in-hospital MACE in primary PCI patients
Authors: Elkammash A , Ayad S , Zaki A , Sobhy M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
No reflow has detrimental outcomes in STEMI patients undergoing primary PCI (PPCI). It leads to poor post PCI LV function and higher mortality. The protective effect of ischemic pre-conditioning ( clinically manifested as pre-infarction angina) was controversial in the literature.

Purpose
Our aim was to study the effect of pre-infarction angina on the occurrence of no-reflow phenomenon and in-hospital major adverse cardiac events (MACE) in PPCI patients.

Methods
After obtaining ethical approvals and informed consents, we prospectively studied 120 STEMI patients admitted for PPCI in a consecutive manner. Patients with history of CABG or previous PCI and in-stent restenosis were excluded. The definition of in-hospital MACE included cardiac death, myocardial reinfarction, stent thrombosis, or target vessel revascularization. The data were analysed by professional statisticians using SPSS software.

Results
15 patients ( 12.5%) had no-reflow, 5 patients ( 4.2%) had cardiac death and one patient had both(0.8 %). The admission characteristics of the studied groups are presented in table 1. Pre-infarction angina was present in 43 patients in the normal flow group and 6 patients in the no-reflow/MACE group. The odds ratio for no-reflow/MACE in those who had pre-infarction angina was 0.52 (95% CI 0.19-1.45, P = 0.21).

Conclusion
In our studied group, pre-infarction angina has not shown to be protective against no-reflow and in-hospital MACE in PPCI patients. The loss of the protective effect of ischemic pre-conditioning might be secondary to higher admission random plasma glucose levels in our patients compared to those included in similar studies. Similar effect was previously shown in studies on mice. Further in-human studies are needed to confirm the negative effect of hyperglycemia on ischemic pre-conditioning.
Characteristics of studied groups Normal flow (n = 99) No-reflow/MACE(n = 21) P value Age (mean ± SD) 56.3 ± 10.3 62.3 ± 7.9 0.014 Male sex (n) 75 13 0.19 Diabetes (n) 37 12 0.094 Hypertension (n) 48 7 0.21 Smokers (n) 52 9 0.42 Dyslipidemia (n) 54 15 0.16 Family history of IHD (n) 17 2 0.52 Pre-infarction angina 43 6 0.21 Admission random plasma glucose in mg/dl(mean ± SD) 186.4 ± 84.7 275.3 ± 104.1 0.001
Cardiovascular risk factors as predictors of completed atrioventricular block during hospitalization for Acute Coronary Syndromes
Authors: Santos H , Santos M , Miranda H , Almeida I , Sa C , Chin J , Almeida S , Sousa C , Almeida L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Portuguese Registry of Acute Coronary Syndromes

Background
The presence of cardiovascular risk factors (CVRF) are directly related to acute coronary syndrome (ACS) occurrence. ACS is a major health problem with multiple complications. Completed atrioventricular block (CAVB) in context of ACS can impact the patient’s prognosis, and is not clarified if its presence can be predicted only by CVFR.

Objective
Evaluate the impact of the CVRF in CAVB during the hospitalization for ACS.

Methods
Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without CAVB during the hospitalization for ACS and B – with CAVB during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of CAVB in these patients.

Results
14031 patients were included, 401 in group B (2.9%). Both groups were similar regarding smoking status (p = 0.920), arterial hypertension (p = 0.928), diabetes mellitus (p = 0.249), peripheral arterial disease (p = 0.352) and chronic kidney disease (p = 0.783). Interestingly the group A exhibited higher body mass index (27.4 ± 4.3 vs 26.9 ± 4.5, p &lt; 0.001), dyslipidemia (62.8 vs 53.6%, p &lt; 0.001) and coronary artery disease (20.7 vs 15.0%, p = 0.001). On the other hand, group B presented more females (26.7 vs 31.5%, p = 0.012), mean age (66 ± 13 vs 71 ± 13, p &lt; 0.001) and neoplasia (4.8 vs 7.1%, p = 0.012). Logistic regression revealed that any of the CVRF were a predictor of CAVB during the hospitalization for ACS. Just, age (odds ratio 1.48, p &lt; 0.001, confidence interval 1.16-1.88) has been a predictor of CAVB during hospitalization for ACS.

Conclusions
Any CVFR was a predictor of CAVB in context of ACS. Age was a predictor of CAVB during hospitalization for ACS.
Heart Stroke Plus: Analysis of quality indicators to create an improved pathway for patients following an acute coronary syndrome
Authors: Perez De Isla L , Gomez Polo JC , Salinas Gallegos A , Mahia Casado P , Viana Tejedor A , Gomez Ciriano J , Machin Hamalainen S , Quintana Arencibia L , Macaya Miguel C , Perez-Villacastin J , Vilacosta I , Bengoa Terrero C 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Sanofi Aventis S.A.

Introduction
Optimisation of the care of patients after an acute coronary syndrome (ACS) is a fundamental step to improve health outcomes and avoid consecutive cardiovascular events however data on how care is provided is often absent.

Purpose
Our objective was to analyse the main quality indicators in the post-ACS patient pathway so as to determine the actions which avoid future CDV events.

Methods
In a random sample of 100 patients between January 2018 and December 2019, we selected the indicators which most affect secondary prevention in patients post-ACS. All patients had been diagnosed with ACS within a tertiary-care hospital with a 24h interventional cardiology lab. The indicators were retrospectively analysed using the patients’ health record.

Results
The main results are presented in Table 1.

Conclusions
Based on this, we proposed an integrated protocol for all patients post-ACS which will begin in 2021 within this tertiary-care hospital. Within this protocol, the information contained in the discharge report will be improved and automatized as much as possible so as re-evaluate at a later date.
Table 1: Demographics and results Title of the indicator Yes (%) No (%) Men 76 24 STEMI 40 60 NSTEMI 60 40 Dual antiplatelet therapy included in discharge report 100 0 High doses statins at discharge 98 2 BMI included in discharge report 0 100 LDL objective included in discharge report 14 86 HbA1c objective included in discharge report 13 87 Physical activity included in discharge report 15 85 Flu vaccination recomendations included in discharge report 0 100 Complete blood analysis completed 4-6 weeks after discharge 100 0 Blood pressure is measured on first post-discharge consultation 100 0 Blood pressure medication is changed on first post-discharge consultation 28 78 Patient arrives with measurement for HbA1c on first post-discharge consultation 78 22 Antidiabetic medication is modified on first post-discharge consultation 8 92 BMI is registered on first post-discharge consultation 0 100 Patients with LDL below 55mg/dl on first post-discharge consultation 29 71 Lipid-lowering medications is changed on first post-discharge consultation 29 71
Association of level of physical activity with outcomes of acute coronary syndrome
Authors: Porras CEB , Padilla BAJ , Rosales CJR , Enobio CMTB , Ong HHS , Ledesma JAB 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Primary Investigator funded Department of Internal Medicine Funded

Background
Acute coronary syndrome or "Heart Attack" is a medical emergency that takes the world by storm. Closely linked to this is a sedentary lifestyle that ls known by most to increase its likelihood. Unfamiliar to the majority is a tool called "International Physical Activity Questionnaire (IPAQ)" that can measure the level of activity to low, moderate and high intensity.

Purpose
In this study, the IPAQ will be utilized to determine the association of level of physical activity with outcomes of acute coronary syndrome through 30 days major adverse cardiovascular events (MACE). This can contribute to the knowledge of predicting likelihood of MACE after coronary syndromes and help discern aggressiveness of treatment.

Methods
This is a single - center prospective cohort study that was performed in a tertiary hospital. The participants included patients with ages 30 to 69 admitted with a diagnosis of acute coronary syndrome from September 2020 to November 2020. T - Test and Odds Ratio were employed to compute for likelihood of MACE 30 days after acute coronary syndrome.

Results
A total of 33 participants were included with mean age of 61 years. Fifty five percent were female. Majority of the patients were overweight with hypertension as the most common co morbidity. Among the participants, 36% (12) have low physical activity and 64% (21) have moderate to high physical activity. Upon follow up of participants, low physical activity showed significantly higher incidence of MACE (58%) versus moderate-high level of physical activity (24%). The odds ratio for low level of physical activity is 4.5 with 95% confidence interval (0.975 - 20.806) and 0.25 for moderate to high physical activity.

Conclusion
Analysis of the results revealed that low level of physical activity resulted with twice the proportion of 30- day MACE as compared to moderate-high activity. Association of level of physical activity with outcomes of ACS showed a 4.5 times more likelihood of developing MACE after 30 days for low level of physical activity.
Association of Activity to Risk of MACE Odds 95% CI P-value Level of physical Acitivty Lower Limit Upper Limit Low 4.504 0.975 20.806 0.054 Moderate to High 0.251 0.056 1.134 0.072
Whether inflammatory disorders matter for long-term prognosis after myocardial infarction?
Authors: Leonova I , Boldueva S , Bykova E , Ivanova M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In the acute period of myocardial infarction (MI) inflammatory disorders of blood are registered, but data of prognostic significance of these disorders is multiple-valued.

Purpose
Research of manifestation of the inflammatory response in patients who suffered MI, and estimation of its prognostic significance.

Materials and methods
772 patients with myocardial infarction were examined. Prospective follow-up from 1 to 7 years was performed.

Results
The death rate during all years of follow-up was 14,2 % of all included in the study. 61% of patients died suddenly, but 26% of them died as a consequence of the progression of chronic cardiac insufficiency. In patients died suddenly lower level of lymphocytes in the first 24 hours: 1,30 ± 0,47 * 109/l vs 1,80 ± 0,73*109/l, (p = 0,03) was registered. In patients who died due to heart failure progression, authentically registered higher leukocytosis in the first 24 hours, in comparison to survived ones, reached 13,83 ± 6,00*109/l (vs 11,9 ± 3,12*109/l; p = 0,005), but to 5th day in the compared groups leukocytes levels had practically the same values (7,36 ± 1,89*109/l vs 7,47 ± 1,99*109/l; accordingly p = 0,8). In the compared groups the number of lymphocytes, expressing CD 95 did not differ authentically, but in died abruptly patients this index was rather lower.
There were not authentic differences detected among groups of dead and survived patients, in terms of interleukins 1β,2, and 6, whereas TNF-α was almost twice as high in patients who died due to CHF progression. Studying inflammatory markers were not included in the number of independent indexes, connected with the risk of death when conducting multivariate regressive Cox-analysis.

Conclusion
In our opinion, inflammatory factors were displaced from the prognostic model for assessing the risk of death, both sudden and due to heart progression, by more powerful structural-functional predictors.
Does climate change affect the chronobiological trends in occurrence of acute coronary syndromes?
Authors: Kuzma L , Kurasz A , Niwinska M , Dabrowski EJ , Swieczkowski M , Bachorzewska-Gajewska H , Dobrzycki S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing.

Purpose
The aim of this study was to assess the influence of climate change on hospital admissions due to ACS.

Methods
Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology.

Results
Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P &lt; 0.001). In the second half of the study period (2013-2018) the relative risks of hospital admissions due to ACS were 1.043 (95%CI: 1.009-1.079, P = 0.014, lag 0) and 0.957 (95%CI: 0.925-0.990, P = 0.010, lag 1) for each 10ºC decrease in temperature; 1.049 (95% CI: 1.015-1.084, P = 0.004, lag 0) and 1.045 (95%CI: 1.011-1.080, P = 0.008, lag 1) for each 10 hPa decrease in atmospheric pressure and 1.180 (95% CI: 1.078-1.324, P = 0.007, lag 0) for every 10ºC change in temperature. For the first half of the study the risk was significantly lower.

Conclusion
We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.
Syndrome of senile asthenia and anxiety-depressive disorders in elderly patients with acute coronary syndrome
Authors: Petrova VB , Shumkov VA , Boldueva SA , Petrova AI 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Northwestern State Medical University named after I.I. Mechnikov
Introduction. The syndrome of senile asthenia (ASA) ("fragility") in combination with anxiety-depressive symptoms in patients contributes to an increase in the frequency of hospitalizations, reduces the effectiveness of treatment and the quality of life. To study the relationship of SSA with anxiety-depressive disorders in elderly patients after acute coronary syndrome (ACS).
Materials and methods. The study included patients with acute coronary syndrome. The inclusion criterion was also a signed voluntary informed consent to participate in the study. A total of 76 patients, 44 men and 32 women hospitalized for ACS were included in this prospective observational study. The average age of the patients is 73.2 years. A questionnaire was conducted with a validated questionnaire "Age is not a hindrance", and the hospital anxiety and depression scale (HADS) was also used.
Results. SSA was found in 32% (p = 0.01) of hospitalized elderly patients, in the majority of women (71%) than men (29%). The average overall score according to the questionnaire "Age is not a hindrance" in elderly patients with ACS was 4.58. The results of the HADS survey showed that anxiety and depressive symptoms in fragile elderly patients occurred in 53.7% and 46.8%, respectively. There was a pronounced relationship between the occurrence of SSA and the symptoms of anxiety according to HADS (p &lt;0.001), however, the more severe depressive symptoms were, the less frequent was SSA (p = 0.007).
Conclusions. "Fragility" in elderly hospitalized patients with ACS is associated with increased anxiety and depressive symptoms. In addition, a significant relationship was demonstrated between high scores on «the age is not a hindrance» questionnaire and the presence of anxiety, but not depression.
Incidence, characteristics and outcomes of Infective Endocarditis with low inflammatory markers
Authors: Maaroufi A , Zahidi H , Abdulhakeem M , Habbal R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration.
Aims
To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration.

Methods
This was a retrospective analysis of cases of IE discharged from a tertiary hospital between December 2013 and september 2019.
The 10% lowest CRP concentration (&lt;25mg/L) was used to define low CRP concentration. Right-sided cardiac device-related IE, non-bacterial IE, sequelar IE and IE previously treated by antibiotics were excluded.

Results
Of the 105 patients, 16 (16%; median age 41 [15–76] years) had definite (n = 12) or possible (n = 4) left-sided valvular IE with CRP &lt; 25mg/L (median 14.25 [1.5–24.8] mg/L). The median white blood cell count was 7.7 (4.2–12.5) G/L.
The main presentations were heart failure (n = 10; 62%) and stroke (n = 1; 6%). Transthoracic echocardiography (TTE) showed vegetations (n = 12) or isolated valvular regurgitation (n = 4).
Overall, nine patients (56%) had severe valvular regurgitation on transoesophageal echocardiography (TOE), and seven patients (43%) underwent cardiac surgery.
68% of patients survived at 1-year follow-up. Bacterial pathogens were documented only in four patients (streptococci, coagulase-negative Staphylococcus, gamella morbillorum) using blood cultures solely , due to lack of disponibility of specific serology / valve culture and/or polymerase chain reaction analysis

Conclusions
Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration.
Physical activity and its clinical correlates in chronic thromboembolic pulmonary hypertension
Authors: Schmidt C , Monteiro M , Reis A , Santos M 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação para a Ciência (FCT) Coordenação de Aperfeiçoamento de Pessoal de Nível (CAPES)

Background
Limited data is available on physical activity (PA) levels in chronic thromboembolic pulmonary hypertension (CTEPH) patients, as well as on the impact of using different tools to assess PA such as questionnaires and accelerometers.

Purpose
We aimed to quantify PA levels of CTEPH patients and study its clinical correlates, as well as to compare PA levels measured by the International Physical Activity Questionnaire (IPAQ) with measures from accelerometers.

Methods
This is a cross-sectional study (n = 50). Physical activity levels were measured using accelerometers and questionnaire (IPAQ). Clinical parameters evaluated were walked distance on the 6-minute-walking test (6MWT), pulmonary vascular resistance, N-terminal brain natriuretic peptide and quality of life (HRQoL) using the Cambridge Pulmonary Hypertension Outcome Review questionnaire.

Results
Accelerometer-derived data showed that CTEPH patients spent 60% of the recorded time in sedentary behaviours and only 2% in moderate-to-vigorous PA (MVPA). MVPA was mildly correlated with 6MWT (r = 0.359; p= 0.023) and symptom domain of HRQoL (r=-0.371; p = 0.044) but not with NT-proBNP, pulmonary vascular resistance or functional domain of HRQoL. Time spent in sedentary behaviour was lower in self-reported measurement (279 ± 165min/day) compared to accelerometry (446 ± 117min/day, p &lt; 0.001). Self-reported MVPA was significantly higher than the one registered by the accelerometer (411 ± 569 vs. 131 ± 108 min/week, p = 0.027). Bland-Altman analysis indicated poor agreement between the two methods.

Conclusions
Our results showed that CTEPH patients spend most of their days in sedentary behaviors and only a small amount of time in MVPA. MVPA was associated with symptoms domain of HRQoL and submaximal functional capacity. In addition, we showed a poor agreement between self-reported and accelerometer-derived PA in CTEPH patients, with the former overestimating the overall PA activity.
Impact of compliance with lifestyle recommendations and medication adherence on 1-year prevention of major cardiovascular events in diabetic patients undergoing partial foot amputation
Authors: Shalaeva E , Janabaev B , Shalaeva A , Dadabaeva N , Bano A , Saner H 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Partial foot amputation (PFA) is generally not considered a high-risk surgery. However, 3 years survival rate is less than 50-60%. The purpose of the study was to evaluate the impact of compliance with lifestyle recommendations and medication adherence on 1-year prevention of major cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) after PFA.

Methods
In this prospective single-center interventional cohort study, 785 consecutive T2DM patients after PFA were included in the 1-year follow-up. Physical examination and laboratory tests were performed at baseline and every month after PFA for 1 year. Patients were considered as compliant with lifestyle recommendations if they followed a healthy diet, smoking cessation, and at least ≥30 min/day physical exercise. Patients were defined as adherent to medication if they followed ≥80% prescribed medication intake. MACE was defined as a composite endpoint including cardiovascular death, myocardial infarction (MI), stent thrombosis, acute stroke, or unstable arrhythmia.

Results
During 1-year follow-up MACE occurred in 63/535 patients who were medication adherent compared to 137/249 non-adherent patients (Chi square = 167,2, p &lt; 0,001). Among lifestyle compliant patients, 55/498 had MACE compare with 145/286 non-compliant patients (Chi square = 150.3, p &lt; 0,001). The COX regression analysis was conducted to present the adjusted effect of compliance and adherence to the incidence of MACE (B = 0.989, p &lt; 0.001, and B= 1.096, p &lt; 0.001, respectively) (Table). The potential confounders such as age and previous MI were statistically significant (Table). Gender, smoking, diabetes severity, HbA1c, hypertension, symptomatic coronary artery disease, history of ischemic events, heart revascularization were not statistically significant.
Conclusion. Failure to follow lifestyle recommendations in T2DM patients after PFA increases the OR of the incidence of MACE 2.7 fold, non-adherence to medication 3 fold. Our results indicate that optimizing preventive interventions is of outmost importance for patients with diabetes undergoing PFA
Cox Regression Results for predictors of Indicator Odds ratio B Standard error P-value Age 1.031 0.031 0.009 0.007 History of myocardial infarction 4.017 1.391 0.184 &lt;0.001 Non-compliance to lifestyle changes 2.688 0.989 0.198 &lt;0.001 Medication non-adherence 2.992 1.096 0.186 &lt;0.001