bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender differences in patients presenting with NSTEMI in the STAR registry
Authors: Meer A , Kinsara A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In most acute coronary artery (ACS) related literature, the female gender constitutes a smaller proportion compared to the male gender. The presentation of ACS in females is frequently atypical, causing a delay in diagnosis and management. This study is based on gender-specific data in the Saudi Acute Myocardial Infarction Registry Program (STARS-1 Program).

Methods
A prospective multicenter study, conducted with patients diagnosed with ACS in 50 participating hospitals.

Results
In total, 762 (34.12%) patients were diagnosed with Non ST segment Elevation Myocardial infarction Of this group, only 164 (21.52%) were women. The mean age of the female group (64.52 ± 12.56 years) was older and the mean body mass index (BMI) was higher (30.58 ± 6.23) than the male group. A significantly higher proportion of the female group was diabetic or hypertensive, however, a smaller proportion was smoking. Hyperlipidemia was not significant between the two groups, although present in almost half (48%) of the female group. The history of angina/MI/stroke and revascularization was similar, except for renal impairment. The presentation was atypical compared to the male group as only 70% presented with chest pain, and the rest with shortness of breath or epigastric pain. At presentation, the female group were more tachycardiac, had higher blood pressure, and a higher incidence of being in class 11-111 Killip heart failure. Only 32% had a normal systolic function, and the majority had either mild or moderate systolic dysfunction.
Guideline directed medical therapy were not different between the two groups, except for the initiation of a beta-blocker on admission. In particular, the rate of percutaneous coronary intervention (PCI) was similar. Overall, the in-hospital mortality was similar (5%), with more women diagnosed with atrial fibrillation and heart failure at follow-up.

Conclusion
Women had a higher prevalence of risk factors affecting the presentation and morbidity but not mortality. Improving these risk factors and the lifestyle is a priority to improve the outcome and decrease morbidity.
Feasibility of non-invasive mechanical ventilation during percutaneous coronary intervention in patients with myocardial infarction and acute decompensated heart failure
Authors: Giordana F , Angelini F , Gribaudo M , Battaglia C , Cinconze S , De Benedetto Fabrizi M , Baralis G , Rolfo F , Rossini R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Non-invasive ventilation (NIV) is an established treatment for acute decompensated heart failure (ADHF).

Purpose
The aim of the present analysis was to evaluate the feasibility of continuous positive airway pressure (CPAP) in patients with myocardial infarction (MI) and ADHF, during percutaneous coronary intervention (PCI).

Methods
Consecutive patients admitted for MI, receiving CPAP for ADHF in the cath lab during PCI were retrospectively included. The main study outcome was the feasibility of CPAP, intended as well tolerated by the patient and exclusive cardiology staff management.

Results
Between December 2018 and October 2020, 15 patients were included; median age was 79 (40-87 IQR) years, 8 (53%) were males, 9 (60%) presented with STEMI and 10 (67%) in cardiogenic shock. At admission median ejection fraction was 35 (20-60 IQR) % and 6 (40%) patients had severe mitral regurgitation. Mean PaO2/ FiO2 was 188.1 ± 74.9 mmHg/%, mean lactate level was 2.6 ± 1.5 mmol/L and NTproBNP 7882 (3139-35000 IQR) ng/L. The CPAP was set with a median FiO2 of 50 (35-80 IQR) % with a PEEP of 7.5 (5-10 IQR) mmHg. CPAP was feasible in 14 (93%) patients, as in only one case it was interrupted for patient’s intolerance. CPAP was always managed by nurses of the cath lab, without the support of anesthetist. One patient suffered cardiac arrest that led to CPAP interruption for resuscitation maneuvers. No patients underwent intubation in the cath lab. Post-procedural PaO2/FiO2 ratio substantially improved to 259.4 ± 96.9 mmHg/% (p = 0.03) and lactate decreased to 1.5 ± 0.5 mmol/L (p = 0.01, 42% median reduction). One patient died in-hospital due to underlying disease, unrelated to study procedure.

Conclusion
CPAP during PCI in patients with MI and ADHF was feasible, well tolerated and easily manageable. Larger studies are warranted to confirm these results.
The effect of the COVID-19 pandemic on time to angiography and outcomes in patients presenting with non-ST elevation myocardial infarction
Authors: Hussain S , Osman S , Osheiba M , Choy CH , Mortimer N , Ludman P , Townend J , Nadir A , Doshi S , George S , Zaphiriou A , Khan SQ 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Covid-19 pandemic has had a profound impact on healthcare service delivery. Acute cardiovascular care however remains a priority despite the pandemic. Patients presenting with non-ST elevation MI (NSTEMI) have been poorly characterised during the pandemic.

Methods
We conducted a retrospective study of patients diagnosed with NSTEMI during the peak of the pandemic between April-May 2020 at our tertiary centre in the UK. Data was collected from electronic patient clinical records including time from admission to angiography, length of stay, mortality, prescription of secondary prevention pharmacotherapy and referral to cardiac rehabilitation. We compared this data to the same time period in 2019.

Results
As can be seen from Table 1, in 2020, the mean age, median time to angiography and length of stay were all significantly lower than the control period of 2019. Prescription of secondary prevention medication (Aspirin, P2Y12 inhibitor, Beta-blocker, Statin and ACEi/ARB) and referral to cardiac rehabilitation also improved in 2020, however neither was statistically significant.
During the 2020 period, 1 patient died due to late presentation NSTEMI and multi-organ failure. There were 3 deaths in 2019: complications following coronary bypass surgery, upper GI bleed and a subarachnoid haemorrhage.

Conclusion
Our results show that the mean age of the patients presenting with NSTEMI during the peak of Covid-19 pandemic was younger suggesting that elderly patients failed to present. Compared to 2019, there was significant improvement in patient treatment times with a significantly shorter stay in hospital, probably as a result of the reduction in elective activity allowing un-restrained access to the catheter labs. We also saw improvement in prescription for secondary prevention and referral to cardiac rehabilitation services during this time suggesting that there may have been improved focus on these aspects of care again. Table 120192020p-valueAge (years)71.2 ± 12.265.0 ± 12.1p &lt; 0.01Number of NSTEMI patients5659p = NSNumber of NSTEMI patients undergoing angiography5053p = NSMedian time to angiography (hours)68.614p &lt; 0.01Median length of stay (days)5 (IQR 2:8)2 (IQR 1:4)p &lt; 0.01Referral to cardiac rehabilitation77.4%84.5%p = NSPrescription of secondary prevention medication69.8%72.4%p = NSTable 1- Comparison of NSTEMI patients in 2019 and 2020Abstract Figure. Box and whisker plot for hospital stay
Potent protective effects of polysaccharide peptide on vascular endothelium and cardiac remodelling in post myocardial infarction patients: A prospective double-blind randomized controlled trial
Authors: Liemena HA , Sargowo D , Nugroho FW , Fadlan MR , Sugita P 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Indonesia"s Ministry of Research and Technology/National Research and Innovation Agency grants

Background
Inflammation and oxidative stress contribute to endothelial dysfunction leading to progression of atherosclerosis and myocardial infarction (MI).

Purpose
To evaluate the effect of polysaccharide peptide of Ganoderma lucidum mycelium extracts (β-1,3/1,6-D-Glucan) as protective vascular endothelium and cardiac reverse remodelling in post MI.

Methods
This is a prospective, randomized double-blind clinical trial in 45 post MI patients. Treated group (TG) was given 3 divided dose of 540 mg β-1,3/1,6-D-Glucan daily for 90 days, and control group (CG) received placebo. Variable measured were EPC,CEC,IL-1,IL-6,TNF-α,hsCRP,NO,SOD,MDA and echocardiography parameters.

Results
β-1,3/1,6-D-Glucan administration significantly increased EPCs (P = 0.000), but not significantly reduced CECs (P = 0.069). Significant suppression was found in IL-1, IL-6 and TNF-α (all P &lt; 0.05), but not in hsCRP (P = 0.064). TG exhibited significant elevation of NO (P = 0.02) and SOD (P = 0.023), and reduction of MDA (P = 0.001). TG revealed significant improvement of LVEF, LVMI, LVIDd, RWT, RWMA and LV diastolic dysfunction (all P &lt; 0.05); but not in FS and TAPSE (P = 0.24, P = 0.20; respectively).

Conclusions
Polysaccharide peptide exhibits potent protective vascular endothelium and cardiac reverse remodelling in post MI patients, hence promising as add-on medication on top of standard medical regiment. Result comparison between study groupsVariableMeanPretestMean Difference Post-testP valuePolysaccharide peptide (β-1,3/1,6-D-Glucan)PlaceboVascular Endothelium BiomarkersCECsEPCs87.99 ± 76.7398.32 ± 44.52-48.01 ± 64.0714.90 ± 24.05-13.84 ± 58.67-17.65 ± 27.870.0690.000Oxidative Stress MarkersSODMDANitric Oxide2.93 ± 0.5419.68 ± 9.9737.98 ± 14.440.26 ± 0.74-5.52 ± 10.756.04 ± 9.27-0.23 ± 0.685.75 ± 10.29-0.62 ± 3.300.0230.0010.02Proinflammatory BiomarkershsCRPTNF-αIL-1IL-62512.90 ± 1332.11348.58 ± 85.0392.14 ± 29.62259.40 ± 125.52-6.78 ± 1099.60-44.98 ± 100.94-15.77 ± 27.06-29.63 ± 104.30-1.42 ± 795.35-1.34 ± 104.893.42 ± 33.1475.77 ± 130.830.0640.0060.0420.005Echocardiographic ParametersLVEFFSLVMITAPSELVIDdRWT57.20 ± 11.3930.85 ± 7.07114.07 ± 59.612.14 ± 0.354.86 ± 0.820.54 ± 0.352.30 ± 9.770.73 ± 7.59-4.55 ± 14.460.99 ± 0.49-0.49 ± 0.45-0.14 ± 0.29-2.08 ± 3.353.74 ± 9.2711.48 ± 23.94-0.17 ± 0.340.23 ± 0.430.03 ± 0.040.0080.2480.0430.2020.0000.017Abstract Figure. Comparison among pre- and post-treatment
Atrial fibrillation in patients with acute coronary syndrome under clopidogrel versus ticagrelor
Authors: Almeida I , Santos H , Santos M , Miranda H , Chin J , Sousa C , Almeida L 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Portuguese Registry of Acute Coronary Syndromes (ProACS)

Introduction
Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that increases the plasma level of adenosine, which can lead to the development of atrial fibrillation (AF).

Objective
Evaluation of AF development in patients medicated with clopidogrel versus ticagrelor.

Material and methods
Retrospective analysis of patients admitted with ACS included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010-19. Patients were divided in two groups regarding the development of de novo AF. The role of ticagrelor vs clopidogrel in AF induction was compared. In-hospital outcomes were evaluated.

Results
25727 patients were included, mean age 67 ± 14 years, 72.3% male. 3.6% (n = 1067) presented de novo AF (of which 18.1% at emergency department admission). They were older (75 ± 12 vs 66 ± 14, p &lt; 0.001), with more classic cardiovascular risk factors except for smoker status and family history of premature cardiovascular disease, with less previous cardiovascular disease although more cerebrovascular peripheral vascular disease. They presented more frequently with STEMI (53.4 vs 41.9%, p &lt; 0.001) vs NSTEMI/ unstable angina or indetermined infarction. They presented lower systolic blood pressure (131 ± 30 vs 139 ± 28mmHg, p &lt; 0.001), higher heart rate (85 ± 27 vs 77 ± 18bpm, p &lt; 0.001) and Killip-Kimball (KK) class (KK class &gt;I 35.6 vs 14.3%, p &lt; 0.001) and had less kidney dysfunction (maximum creatinine 1,1 ± 0,4 vs 0,9 ± 0,4mg/dl, p &lt; 0.001). Most patients (53.4%) were medicated with the clopidogrel P2Y12 inhibitor. However, 20.4% of patients who developed AF were medicated with ticagrelor versus 5.7% with clopidogrel. Left anterior descendent (LAD) was the most prevalent culprit vessel in both groups (40.9 vs 37.2%, p = 0.045). Multivessel disease was more prevalent in AF group (56.0 vs 51.5%, p = 0.011) and they needed more frequently advanced therapeutic devices and ventilatory support. In-hospital complications were also more frequent in AF patients: heart failure (45.7% vs 14.3%, p &lt; 0.001), cardiogenic shock (16.1% vs 3.6%, p &lt; 0.001), cardiopulmonary arrest (9.2 vs 2.4%, p &lt; 0.001) and death (11.0 vs 3.4%, p &lt; 0.001).

Conclusion
In our study, there was a trend to de novo AF development in patients admitted with ACS and medicated with ticagrelor versus clopidogrel.
Intracranial hemorrhage in adult patients on venoarterial extracorporeal membrane oxygenation
Authors: Luesebrink E , Massberg S , Orban M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
Intracranial hemorrhage (ICH) is one of the most serious complications of adult patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and is associated with increased morbidity and mortality. However, the prevalence and risk factors of ICH in this cohort are still insufficiently understood. Therefore, the purpose of this study was to further investigate prevalence, associated mortality and predictors of ICH in VAECMO patients.

Methods
We conducted a retrospective multicenter study including adult patients (≥18 years) treated with VA-ECMO in cardiac intensive care units (ICUs) at five clinical sites between January 2016 and March 2020, excluding patients with ICH upon admission. Differences in baseline characteristics and clinical outcome between VA-ECMO patients with and without ICH were analysed. Predictors of ICH were identified by uni- and multivariable regression models.

Results
Among 598 patients included, 70 (12%) developed ICH during VA-ECMO treatment with mean duration of 82 ± 84h between ECMO initiation and ICH diagnosis. Out of these ICH, 23% were intraparenchymal, 20% subarachnoid, 10% subdural, 3%
intraventricular and 44% combined hemorrhage. In-hospital mortality in the ICH cohort was 81% and 1-month mortality 86%, compared to 63% (p = 0.002) and 64% (p &lt; 0.001), respectively, in the non-ICH cohort. In a multivariable regression model, ICH was independently associated with diabetes mellitus (Odds Ratio [OR] 1.952, 95% confidence interval [CI] [1.082, 3.492], p = 0.025), platelet count (OR 0.990, 95% CI [0.982, 0.996], p = 0.003) and fibrinogen (OR 0.996, 95% CI [0.993, 0.998], p = 0.002).

Conclusion
ICH occurred frequently in VA-ECMO patients and was associated with a significantly higher mortality rate. Diabetes mellitus, low platelet count and low fibrinogen level are independent predictors of ICH. These findings may help to develop effective strategies to prevent and treat ICH and build the basis for further investigations to optimize clinical outcome in patients on VA-ECMO.
Clinical and echocardiographic predictors of delirium in acute cardiac care unit after transfemoral aortic valve implantation
Authors: Noriega F , Viana-Tejedor A , Luque T , Travieso A , Corrochano D , Mcinerney A , Ferrera C , Tirado-Conte G , Jimenez-Quevedo P , Nunez-Gil I , Gonzalo N , Agustin A , Escaned J , Fernandez-Ortiz A , Nombela-Franco L 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Delirium is frequent in patients admitted to critical care units. Its incidence after transcatheter aortic valve implantation (TAVI) is up to 30%. Clinical and demographic factors have been related to delirium, but echocardiographic parameters have not been evaluated.
Purpose. The aim of this study was to assess clinical and echocardiographic predictors of delirium in patients admitted to an acute cardiac care unit (ACCU) after transfemoral TAVI.
Methods. 501 patients admitted to ACCU after TAVI were included. Delirium was evaluated by Confusion Assessment Method. Clinical cardiovascular and geriatric conditions were assessed, as well as echocardiographic parameters.
Results. The incidence of delirium was 22% (110 patients). Delirium was associated with age (83.8 ± 4.6 vs 82.6 ± 6.1 years, p = 0.026), dyslipidaemia (50.0% vs 61.4%, p = 0.032), prior peripheral arterial disease (11.9% vs 5.4%, p = 0.017) and cognitive impairment (10.0% vs 1.8%, p &lt; 0.001). There was no relationship to gender, other cardiovascular risk factors or geriatric conditions. Table shows echocardiographic parameters at baseline and after TAVI, with no statistical association with delirium.
Conclusion. Delirium is a common complication after TAVI in ACCU. Age, the absence of dyslipidaemia, or the presence of cognitive impairment or prior peripheral arterial disease are clinical predictors of delirium. There are not echocardiographic predictors of delirium. Echocardiographic parametersWithout delirium(n = 391)With delirium(n = 110)p valueBaseline echocardiographic parametersLeft ventricular ejection fraction (%)57.7 ± 13.457.5 ± 14.10.912Mitral regurgitation (moderate to severe)106 (27.1)34 (30.9)0.433Pulmonary hypertension168 (43.0)53 (49.1)0.258Aortic regurgitation (moderate to severe)74 (18.9)21 (19.1)0.969Peak aortic gradient (mmHg)78.7 ± 25.278.5 ± 23.30.935Mean aortic gradient (mmHg)47.1 ± 16.146.7 ± 14.80.838Aortic valvular area (cm2)0.6 ± 0.20.6 ± 0.20.589Aortic annulus diameter (mm)22.5 ± 2.722.4 ± 2.50.615After TAVI echocardiographic parametersAortic regurgitation (moderate to severe)36 (9.3)11 (10.0)0.813Peak aortic gradient (mmHg)17.6 ± 9.617.7 ± 8.30.916Mean aortic gradient (mmHg)8.9 ± 5.49.3 ± 4.90.481Aortic valvular area (cm2)2.0 ± 0.62.2 ± 0.60.478Values are mean ± standard deviation, or n (%).
Weaning of invasive mechanical ventilation in a critical coronary care unit
Authors: Arroyo Monino DF , Rivadeneira Ruiz M , Ruiz Garcia MP , Seoane Garcia T , Garcia Rubira JC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In the recent years, we have assisted to a change of the prototype of the patient admitted to a Critical Coronary Care Unit (CCCU), with an increasing number of patients admitted due to acute heart failure (AHF) and the reduction of the patients diagnosed of acute coronary syndrome (ACS). It is common in these patients the requirement of ventilatory support, both invasive (IMV) and non-invasive. As a consequence, our knowledge about this technique must be improved. A critical moment when using IMV is the weaning of the IMV.

Objective
Our aim is to describe which factors may have an influence on the success or the failure of the weaning of IMV.

Methods
Observational, retrospective study, using a cohort of patients admitted to a CCCU between January 2.018 and November 2.020 who needed IMV. Data related with the personal history, basal situation and events in the follow-up during the hospitalization were collected.

Results
A total number of 94 patients were included, being 68 (72,3%) male and with a mean age of 68 years old. The most frequent reason of intubation was cardiac arrest (48 patients – 51,1%). Failure on weaning occurred in 19 patients (20,2%), being the most frequent reason of this failure need of re-intubation due to respiratory failure or a new event of cardiac arrest (14 patients – 14,9%). When assessing which factors could have an impact in this failure, we found that older age (66,6 years old vs. 73,9 years old, p value = 0,035), the previous diagnosis of chronic obstructive pulmonary disease (COPD) (17,1% vs. 28,5%, p value = 0,01), and the develop of sepsis during the hospitalization (45,7% vs. 57%, p value =0,04), determined a significative higher probability of failing in the weaning. As expected, failure in the weaning conditioned a significative longer stay in the CCCU (9 days vs. 22 days; p value &lt;0,001). However, failure in the weaning was not related with a higher intra-hospital mortality in our study (p value 0,6).

Conclusion
In our population, the older age, the presence of COPD and the development of sepsis during the stay in the CCCU were related with a significative higher probability of failure in the weaning of IMV. This conditioned a longer stay in the CCCU but not a higher intra-hospitalary mortality.
Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at admission is associated with development of late cardiogenic shock and mortality in patients with STEMI
Authors: Frydland M , Moegelvang R , Moeller JE , Moeller-Helgestad O , Holmvang L , Mark PD , Jensen LO , Hassager C 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Forskningsfond (Grant number: 07IO) Hjerteforeningen (Grant number A6024) Lundbeckfonden (Grant number R186-2015-2132)

BACKGROUND
In patients with ST-elevation myocardial infarction (STEMI) increased inflammatory response is associated with development of cardiogenic shock (CS). Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a glycoprotein released from mature neutrophils and the plasma concentration of NGAL likely increases immediately after STEMI.

PURPOSE
We aimed to assess whether admission NGAL plasma concentration in patients with STEMI was associated with CS development after leaving the catheterization laboratory (late CS) and 30-day all-cause mortality.

MATERIALS AND METHODS
From 1892 consecutive patients with STEMI 1626 (86%) had plasma NGAL concentration measured upon hospital admission before angiography throughout a 1-year period at two tertiary heart centers in Denmark. Patients were stratified according to NGAL quartiles (Q1-4). To assess late CS development, we adjusted for the Observatoire Régional Breton sur l’Infarctus (ORBI) risk score for late CS. For mortality assessment, we adjusted for gender, age, post-PCI culprit Thrombolysis in myocardial infarction (TIMI) flow, left ventricular ejection fraction (LVEF), kidney dysfunction, admission lactate concentration and being comatose after cardiac arrest.

RESULTS
Increasing NGAL concentration was associated with higher age, more comorbidities (hypertension, diabetes, heart failure, previous stroke, and kidney dysfunction) and more critical patient conditions at presentation including lower blood pressure and LVEF. Plasma NGAL concentration was associated with both late CS development and 30-day mortality (Figure). When adjusted for factors associated with poor outcome, NGAL remained independently associated with both late CS development (Q4 vs. Q1-3) (OR (95% CI) 2.64 (1.57-6.03)) and 30-day mortality (HR (95% CI) 3.18 (1.46-6.93)).

CONCLUSION
High admission plasma concentration of NGAL in patients with STEMI was independently associated late CS development and 30-day all-cause mortality. Abstract Figure. NGAL quartiles and late CS/mortality