bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term outcome after a first myocardial infarction
Authors: Almosawi M , Ferrannini G , Buhlin K , Gustafsson A , Kjellstrom B , Klinge B , Nygren Å , Nasman P , Svenungsson E , Ryden L , Norhammar A 
Published: October 2021

Abstract

Background
Prognosis after a myocardial infarction (MI) have improved consistently over the last decades. In parallel, the incidence of cardiovascular (CV) events has been reduced and life expectancy in people free from CV disease improved.

Purpose
To explore the long-term mortality and burden of cardiovascular disease in patients after a first MI compared to matched controls in a contemporary setting.

Methods
The Swedish case-control study PAROKRANK recruited 805 patients &lt;75 years with a first MI and 805 age-, gender- and area-matched controls from 2010 to 2014. All participants were followed by means of registry-based information. The primary endpoint was the first of a composite of all-cause death, non-fatal MI, non-fatal stroke and heart failure hospitalization. Data on the outcomes were provided via linkage to the National Patient Registries and the Cause of Death Registry. Hazard Ratios (HR) for the first composite event were calculated by means of a Cox regression model, subsequently adjusted for smoking, education level and marital status at baseline. Event curves for the time-to-first event in patients and controls were computed by Kaplan-Meier curves and the two groups were compared by means of the log-rank test.

Results
Data from 804 patients and 800 controls (mean age in both groups 62 years; women 19%) were complete for an average period of 6.2 years (0.2–8.5 years). The total number of events was 211. Patients had a higher event rate than controls (log rank p&lt;0.0001). Unadjusted HR for the primary outcome was 2.08 (95% confidence interval (CI) 1.56–2.77) while the adjusted HR was 2.04 (95% CI 1.52–2.73). Mortality did not differ significantly between patients (n=38; 4.7%) and controls (n=35; 4.4%). In total, 82.5% of the patients and 91.3% of the controls were event-free during follow-up.

Conclusion
This long-term follow-up of a contemporary, nationwide case-control cohort illustrates that the likelihood for CV events is higher in patients with a first MI compared to their matched controls while mortality did not differ. The access to high quality of care and cardiac rehabilitation might explain the low rates of adverse outcomes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): AFA Insurance, Swedish Heart-Lung Foundation, Swedish Research Council, Swedish Society of Medicine, Stockholm County Council (ALF project and Steering committee KI/SLL for odontological research), and The Baltic Child Foundation. Figure 1. Kaplan-Meier curves
Clinical characteristics and outcomes in young patients with myocardial infarction
Authors: Lv J , Zhao Q , Ni L , Yang Y , Xu H 
Published: October 2021

Abstract

Background
Young people hold a stable or increasing percentage of patients with acute myocardial infarction in many countries. However, data on clinical characteristics and outcomes in young patients are lacking.

Purpose
To compare clinical characteristics and outcomes between patients aged ≤45 years and those aged &gt;45 years with acute myocardial infarction.

Methods
A total of 24125 patients with acute myocardial infarction between January 2013 and September 2014 from China Acute Myocardial Infarction (CAMI) registry were included in this study. Clinical characteristics, in-hospital and 2-year outcomes were compared between patients aged ≤45 years (young) and those aged &gt;45 years (older). Gender disparity in prognosis of myocardial infarction was analyzed among young patients.

Results
Of 24125 patients, 2042 (8.5%, 116 female) were aged ≤45 years. Compared with patients aged &gt;45 years, young patients were more often male, current smokers, having medical history of hyperlipidemia and family history of premature coronary artery disease. Young patients were significantly more likely to have clear trigger factor, present with persistent chest pain and suffer ST-segment elevation myocardial infarction. Symptom onset to admission time was shorter in patients aged ≤45 years. For patients undergoing emergency coronary angiography, those aged ≤45 years were more likely to suffer left anterior descending coronary artery related myocardial infarction. Young patients were significantly more likely to receive percutaneous coronary intervention and other medications at discharge, including dual antiplatelet therapy, statins, angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and β blockers. Compared with patients aged &gt;45 years, young patients experienced significantly lower in-hospital and 2-year mortality and major adverse cardiac and cerebrovascular events (MACCE, a composite of death, reinfarction and stroke) rates (Table 1). Among young patients, women experienced higher in-hospital mortality and MACCE rates than men (Table 2). Women who survived at discharge experienced significantly higher 2-year mortality (1.4% vs 3.8%, Log-rank P=0.0412, Table 2).

Conclusions
Compared with the older patients, young patients were more likely to present with typical symptoms and receive guideline-recommended medications. Clinical outcomes of patients aged ≤45 years were significantly better than older patients. However, our results showed significant gender disparity in both short- and long-term outcomes of young patients. More efforts are needed to improve prognosis in young patients with acute myocardial infarction.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Twelfth Five-Year Planning Project of the Scientific and Technological Department of China
Predictive value of neutrophil percentage-to-albumin ratio for contrast-associated acute kidney injury in patients without chronic kidney disease undergoing elective percutaneous coronary intervention
Authors: He H , Lin X , Luo M , He C , Zhang S , Lin M , Lin K , Guo Y 
Published: October 2021

Abstract

Background
Although previous studies have demonstrated that neutrophil and albumin are biomarkers of inflammation and malnutrition, which are highly related with contrast-associated acute kidney injury (CA-AKI). However, there has been no study investigated the combined evaluation of neutrophil and albumin in predicting CA-AKI.

Purpose
To explore the predictive value of neutrophil percentage-to-albumin ratio (NPAR) for CA-AKI in patients undergoing elective percutaneous coronary intervention (PCI).

Methods
We prospectively observed 5083 consenting patients without chronic kidney disease (CKD) undergoing elective PCI from January 2012 to December 2018. NPAR was calculated as neutrophil percentage numerator divided by serum albumin concentration. CA-AKI was defined as an increase in serum creatinine (SCr) ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. The association between NPAR and CA-AKI was investigated by logistic regression analysis. The area under the receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to make comparison for CA-AKI prediction.

Result
The incidence of CA-AKI was 5.6% (n=286). The median NPAR was 14.9 (13.0–17.1). According to the receiver operating characteristic curves (ROC), the best cut-off value of NPAR for predicting CA-AKI was 15.7 with 66.8% sensitivity and 61.9% specificity (C statistic=0.679; 95% CI, 0.666–0.691). NPAR displayed higher AUC value in comparison to neutrophil percentage (p&lt;0.001), but not albumin (P=0.063), as a predictor of CA-AKI. However, NPAR significantly improved the prediction of CA-AKI in the continuous NRI and IDI over neutrophil percentage (NRI: 0.353, 95% CI: 0.234–0.472, P&lt;0.001; IDI: 0.017, 95% CI: 0.010–0.024, p&lt;0.001) and albumin (NRI: 0.141, 95% CI: 0.022–0.260, P=0.020; IDI: 0.009, 95% CI: 0.003–0.015, p=0.003) alone. After adjusting for potential confounding risk factors of CA-AKI, multivariable logistic analysis showed that NPAR &gt;15.7 was a strong independent predictor of CA-AKI (OR=1.998, 95% CI, 1.511–2.643, p&lt;0.001).

Conclusion
NPAR is an independent predictor of CA-AKI, which significantly improved the prediction of CA-AKI over neutrophil and albumin alone in patients without CKD undergoing elective PCI.

Funding Acknowledgement
Type of funding sources: None. ROC for NPAR to predict CA-AKIPredictors of CA-AKI
Acute and long-term outcomes of ST-elevation myocardial infarction in cancer patients
Authors: Lange S A , Feld J , Kuehnemund L , Koeppe J , Makowski L , Engelbertz C H , Gerss J , Droege P , Ruhnke T H , Guenster C H , Freisinger E , Reinecke H 
Published: October 2021

Abstract

Background
Myocardial infarctions (MI) and cancer are each very serious morbidities. To evaluate their interaction in the “real world”, a retrospective analysis was performed in patients with ST-elevation MI (STEMI) and pre-existing cancer.

Methods
Anonymized data from patients admitted to hospital between 2010 and 2017 due to STEMI were analyzed from 24 months before and up to nine years after the index hospitalization by one of Germany's largest statutory Health Insurance Funds (Allgemeine Ortskrankenkasse - AOK). Qualitative data were tested via two-sided Chi-squared test and quantitative data were tested using a two- sided Wilcoxon test. The eight year overall survival (OS) rate was determined with a Kaplan Meier estimator. The endpoint OS was analysed using multivariable Cox-regression model.

Results
From 175,262 STEMI patients, 27,213 had cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older, presented more often with coronary three-vessel-disease, classical risk factors, atrial arrhythmias, kidney disease, heart failure, cerebrovascular and peripheral artery disease (PAD) (each p&lt;0.001). They showed more often previous MI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p&lt;0.001). Acute PCIs were applied approximately 2–6 percent points less frequently compared to those without (w/o) cancer, with less drug-eluting and more often bare metal stents (all p&lt;0.001). In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0% – 57.7%) w/o cancer, and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for death during follow-up found e.g. lung cancer (HR 2.04, 95% CI 1.92–2.17), PAD stage 4–6 (HR 1.78, 95% CI 1.72–1.84) and previous stroke (HR 1.44, 95% CI 1.31–1.54) to have the strongest effect, while obesity (HR 0.95, 95% CI 0.93–0.97) was associated with lower mortality (all p&lt;0.001).

Conclusion
In this large “real world” health insurance data from Germany, prognosis after STEMI was markedly reduced but differed widely between cancer types. No withholding of revascularization therapies in cancer patients could be observed.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051).
Acute coronary syndrome outside and during the COVID-19 pandemic
Authors: Maltcev A I , Koriagina N A , Koriagin V S , Prokhorov K V , Spasenkov G N 
Published: October 2021

Abstract

Objective
To analyze the register of patients with acute coronary syndrome (ACS) at the clinical cardiological dispensary from september to november 2018–2019 and 2020 during COVID-19.

Materials and methods
A retrospective study was conducted, the registry included 952 patients with ACS in 2018 and 1033 patients in 2019, as well as 964 patients in 2020 during the COVID-19 pandemic. Statistical analysis of the material was performed using the Statistica 11.0 software.

Results
When analyzing the provision of specialized care to patients with ACS in 2018, the average age of patients was 67 years, the mortality rate was 3.94%. The structure of ACS in 2018 was dominated by patients with ST-segment elevation myocardial infarction (STEMI) - 47%, myocardial infarction without ST-segment elevation (STEMI) occurred in 23%. The proportion of patients with unstable angina pectoris (NS) was 30%. Only 43.6% were registered with coronary heart disease (CHD) before ACS. 12.5% had a history of diabetes mellitus (DM), 31.2% had arterial hypertension (AH). This cardiovascular event recurred in 4% of patients. Average bed-days 9.73. In 2019, the average age of patients was 68 years, the mortality rate was 4.35%. In the structure of ACS in 2019, patients with STEMI were more common 47.5% than with STEMI 28%. The proportion of patients with HC was 24.5%. 52.1% of patients were registered at the dispensary before ACS with a diagnosis of coronary artery disease. A history of diabetes mellitus was in 13.0%, AH in 39.6% of patients. For 3.8% of patients, myocardial infarction in 2019 became recurrent. The average bed-days was 9.92. In 2020, the average age of patients was 66 years, the mortality rate was 6.25%. The structure of patients was dominated by patients with STEMI - 50.5%, STEMI was less common - in 17.5%. The proportion of patients with unstable angina pectoris was 32%. It was revealed that 54.4% were registered in the dispensary before ACS with coronary artery disease. 28.5% had a history of diabetes mellitus, 40.8% - AH. This event was repeated for 4.7% of patients. Average rate, bed-days rate is 8.85.

Conclusions
Initial analysis reveals that the group of patients with ACS in 2020 was younger than the group of patients in 2019–2020. ACS in combination with diabetes during the pandemic occurred 2 times more often than in the same period of 2018–2019. The proportion of patients registered with the dispensary increased over the period 2018–2019–2020, however, the mortality rate in the 2020 group had a clear upward trend, which may be due to various reasons, incl. the COVID-19 pandemic. The average number of bed-days also objectively decreased when comparing the 2020 and 2019–2018 patient cohorts, which may be due to the burden on the healthcare system during the pandemic.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Clinical Cardiology Dispensary
Association of high-sensitivity Troponin T and I blood levels with outcome of coronary artery disease – results from the INTERCATH cohort
Authors: Bay B , Blaum C M , Kroeger F , Gossling A , Koppe L , Max L , Lorenz T , Koester L , Westermann D , Zeller T , Kirchhof P , Blankenberg S , Seiffert M , Waldeyer C , Brunner F J 
Published: October 2021

Abstract

Background
High-sensitivity Troponin T and I (hsTnT/I) concentration is independently associated with coronary artery disease (CAD) severity and cardiovascular outcome. Here we explored whether hsTnT/I blood levels add predictive information irrespective of CAD severity and further confounders in unselected stable patients with angiographically characterized CAD.

Methods
Between 2015 and 2020, 3,012 patients undergoing coronary angiography were included in the observational Hamburg INTERCATH study. In 2,209 consecutive patients Troponin levels were quantified for hsTnT (Roche Diagnostics Elecsys) and hsTnI (Abbott Diagnostics ARCHITECT STAT). Patients presenting with acute coronary syndromes and heart transplant recipients were excluded, leaving 1,841 patients for analyses. CAD severity was graded according to the Gensini score. Major adverse cardiac events (MACE) as a composite of cardiovascular death, stroke, myocardial infarction, and coronary revascularization were defined as endpoint. Kaplan-Meier analyses stratified by hsTnT/I quartiles were performed. Multivariable Cox models were computed for the association of hsTnT/I with MACE adjusting for age, gender, arterial hypertension, hyperlipoproteinemia, smoking, diabetes mellitus, body-mass index, eGFR and Gensini Score.

Results
Mean age was 68.5±10.9 years (27.9% female). 81.1% were diagnosed with CAD by coronary angiography. Gensini score was 21.0±30.2. Median follow-up time was 4.42 years. hsTnT quartiles differentiated MACE across all categories (Figure 1A). For hsTnI, cardiovascular risk was differentiated between the lowest and highest quartiles as well as the 1st and 2nd quartile particularly beyond 24 months of follow-up (Figure 1B). However, MACE after 3 years was not associated with hsTnT after adjustment for classical cardiovascular risk factors and CAD severity (Figure 1C), whereas the hazard of MACE was increased in the 3rd and 4th hsTnI quartiles compared to the 1st quartile (HR 1.3, IQR 1.1–1.6 for both categories; Figure 1D).

Conclusion
Increasing hsTn concentration was related to intermediate term cardiovascular outcome in unselected stable patients. Only hsTnI concentration remained as independent predictor after testing for most possible confounders, including CAD severity. This data underpins the role of hsTnI in outcome prediction.

Funding Acknowledgement
Type of funding sources: None.
Association of growth differential factor-15, hs-cardiac troponin T and N-terminal pro-brain natriuretic peptide with coronary artery disease in patients undergoing elective coronary angiography
Authors: Souaid T , Hijazi Z , Barakett V , Sarkis A , Kadri Z , Batra G , Lindback J , Abdelmassih T , Noujaim M , Azar R R 
Published: October 2021

Abstract

Background
Although the importance of conventional risk factors is well established, a significant proportion of patients with coronary artery disease (CAD) lack any of these factors and many patients without CAD have one or more of them. Better tools are needed to improve risk stratification of patients.

Purpose
We aimed to investigate the association between plasma levels of growth differentiation factor 15 (GDF-15), a marker of stress and inflammation, high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with the presence of CAD in stable patients referred for elective coronary angiography.

Methods
Plasma levels of the three biomarkers were measured in 252 consecutive patients. Patients with known CAD, acute coronary syndrome, or with chronic inflammatory conditions were excluded. CAD was defined by the presence of at least one lesion causing &gt;50% stenosis. The outcome was defined as an ordinal variable with 3 levels: no CAD, 1- or 2-vessel CAD and 3-vessel or left main CAD.

Results
Median age was 63 years (56–71), and 35% of patients were females. Among conventional risk factors, hypertension was the most prevalent (70%), followed by hyperlipidemia (69%), smoking (42%), diabetes (33%) and family history of CAD (32%). Of the 252 patients enrolled, 153 (61%) had no CAD, 81 (32%) 1- or 2-vessel CAD, and 18 (7%) 3-vessel or left main CAD. Plasma levels of GDF-15, hs-cTnT and NT-proBNP in each of the 3 groups of CAD are summarized in table 1. In unadjusted ordinal logistic regression analysis, GDF-15 and hs-cTnT were statistically significantly associated with the presence and extent of CAD, while NT-proBNP was not (table 1). However, in a multivariable analysis including age, sex and traditional risk factors, the association of GDF-15 and hs-cTnT with angiographic CAD was attenuated and no longer statistically significant. Age, male sex, family history of premature CAD and the presence of hyperlipidemia, were independent predictors of the presence and extent of CAD (table 2).

Conclusion
In stable patients referred for coronary angiography, plasma levels of GDF-15 and hs-cTnT could predict the presence of CAD when evaluated separately. However, that association was attenuated by clinical characteristics.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Roche Diagnostics International LtdForrenstrasse 26343 RotkreuzSwitzerland Table 1Table 2
Worse outcomes of ACS patients without versus with traditional cardiovascular risk factors
Authors: Shiyovich A , Cohen T , Hamdan A , Klempfner R , Skalsky K , Porter A , Orvin K , Kornowski R , Eisen A 
Published: October 2021

Abstract

Introduction
Approximately 5–15% patients presenting with acute coronary syndrome were found to have no traditional cardiovascular risk factors (RFs). Data regarding the determinants, management and outcomes of these patients are scarce.

Purpose
To evaluate the management, outcomes and time dependent changes of ACS patients without RFs.

Methods
Evaluation of clinical characteristics, management strategies, and outcomes as well as time dependent changes (by 3 time periods: early [2000–2006], mid [2008–2013], and late [2016–2018]) of ACS patients without RFs (diabetes mellitus, hypertension, dyslipidemia, family history of IHD and current or past smoking) or known coronary artery disease, enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. We compared ACS patients without RFs (RF−) to those ≥1 RFs (RF+).

Results
Overall 583 out of 10,324 (5.6%) eligible ACS patients did not have any RFs (median age 64 [IQR 52–77], 25% females]. The RF− group were older, more educated, with lower BMI and prevalence of another cardiovascular comorbidity and chronic kidney disease compared with the RF+ group. The in-hospital PCI rates were lower among the RF− vs. the RF+ group (55% vs. 66%, respectively p&lt;0.001). Furthermore, lower rate of guideline-recommended medical therapy upon discharge were prescribed in the RF− vs. the RF+ group. The rate of in-hospital complications was greater in the RF− vs. RF+ group (31.4% vs. 26.1%, respectively p=0.006). The rates of 30-day major adverse cardiac events (MACE) were significantly higher among patients with RF− vs. RF+ (18.1% vs.12.8%, respectively p&lt;0.001). Similarly, the rates of 30-day and 1-year all-cause mortality (figure 1) were higher among patients with RF− vs. RF+ (8.7% vs. 4.2%, p&lt;0.001 and 11.9% vs. 7.7% p&lt;0.001 respectively). A trend of decline in the rate of MACE was observed between the early and the late study period in the RF− group (22% vs. 10.7% p=0.002 respectively). One-year mortality did not decrease significantly in the RF− group during the study periods (13.6% vs. 10% early vs. late period respectively p=0.16).

Conclusions
ACS patients without traditional cardiovascular risk factors comprise a unique group with reduced prevalence of comorbidities yet significantly worse short-and long-term outcomes. Additional research to identify unique risk factors and targets for interventions to improve outcomes of this group of patients is warranted.

Funding Acknowledgement
Type of funding sources: None.