bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic effect of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery
Authors: Esteban-Lucia L , Nieto-Roca L , Gonzalez-Lorenzo O , Franco-Pelaez J A , Pello-Lazaro A M , Acena Navarro A , Kallmeyer-Mayor A M , Venegas Rodriguez A M , Esteban-Chapel J A , Romero-Otero J M , Aldamiz Echevarria Del Castillo G , Tunon J 
Published: October 2021

Abstract

Introduction
Atherosclerosis vascular disease is one of the main causes of morbidity and mortality in the world. We aimed to evaluate the prognostic impact of a history of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery (CABG).

Methods
Single-center, observational and retrospective study including all patients undergoing CABG in our center between 2010 and 2018. Electronic health records were used to record clinical characteristics to identify patients with a history of peripheral vascular disease. This one was defined as having a history of stroke or transient ischemic attack (TIA), intermittent claudication, or previous percutaneous or surgical arterial procedure. Patients were followed until December 2019. The primary endpoint (PE) was the composite of stroke, TIA, myocardial infarction, new coronary revascularization, inferior limb vascular or aortic aneurysm intervention, and death.

Results
We included 567 patients, 138 (24.3%) with a history of peripheral vascular disease (stroke/TIA 34.1%; carotid surgery 6.5%; inferior limb surgery 12.3%; abdominal aortic aneurysm surgery 8.7% and intermittent claudication 38.4%). Baseline characteristics of the overall cohort and different subgroups (with and without peripheral vascular disease) can be seen in the table.
The group with peripheral vascular disease had a worse clinical profile. They were significantly older, more frequently males, and smokers. They also had a higher prevalence of hypertension, diabetes, dyslipidemia, chronic kidney disease, and neoplasms. In addition, the preoperative status was less favorable, left ventricular ejection fraction and hemoglobin were lower, and renal function was worse than the group without peripheral vascular disease.
The median follow-up was 4.2 years. During the study period, 55 patients (40%) with peripheral vascular disease and 80 patients (18.6%) without peripheral vascular disease reached the PE. After multivariate Cox modeling, variables independently related to PE were diabetes (HR=1.65 (1.17–2.33); p=0.004), creatinine levels (HR= 1.32 (1.19–1.47); p≤0.001) and peripheral vascular disease (HR= 2.28 (1.60–3.25); p≤0.001) (figure, panel A). Kaplan-Meier survival curves of PE according to the presence of peripheral vascular disease prior to CABG are shown in panel B of the figure.

Conclusion
According to our results, patients with peripheral vascular disease have approximately double the risk of suffering a major complication after CABG. Larger studies are needed to confirm these results.

Funding Acknowledgement
Type of funding sources: None. Description of studied population.HR and Kaplan-Meier curves
Comparing one-year outcomes of invasive versus medical management of patients with prior coronary artery bypass graft surgery presenting with non-ST elevation myocardial infarction
Authors: Ramtoola M T , Hartemink J W , Dhuny S , Nathan J , Shabbir H , Shafiq A , Garg S A 
Published: October 2021

Abstract

Background
Early percutaneous coronary intervention (PCI) has a Class 1A recommendation for patients with non-ST elevation myocardial infarction (NSTEMI). However, the benefits of this invasive approach in patients with previous coronary artery bypass graft (CABG) surgery are uncertain, as these patients have previously been excluded from pivotal trials.

Purpose
We hypothesised that routine invasive management in patients with previous CABG presenting with NSTEMI, but otherwise medically stable, carried similar prognostic outcomes to patients who were medically managed.

Methods
This single centre retrospective observational study screened patients with prior CABG presenting with NSTEMI between January 2015 and December 2019. Patients either underwent coronary angiography with or without PCI at their physician's discretion or received standard acute coronary syndrome (ACS) medical therapy. Follow up time was 365 days from admission date, and clinical, demographic, procedural and outcome data were collected. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause mortality and rehospitalisation for unstable angina, myocardial infarction, or heart failure.

Results
The study included 267 patients (mean ±SD age: 72±10 years, 82% male), of whom 80.1% (N=214) underwent cardiac catheterisation, and 19.9% (N=53) only received standard ACS medical therapy. Amongst the invasive group, 65.4% (N=140) received PCI. No one was referred for re-do CABG. At 1-year follow up, the primary composite outcome occurred in 18 (13%) patients in the PCI group, 13 (18%) in those managed conservatively following angiography, and in 27 (51%) patients receiving medical therapy only. Cox regression modelling showed no significant difference in the 1-year primary endpoint amongst those having an angiogram who received PCI versus those treated medically after invasive assessment (HR: 0.75 [95% CI: 0.38–1.48; P=0.412]). Previous revascularisation with PCI (HR: 1.90 [CI, 1.11–3.24; P=0.018]) and chronic kidney disease (CKD) (HR: 2.60 [CI, 1.56–4.34; P&lt;0.001]) at any stage, were the most important predictors of poor outcomes in CABG patients with NSTEMI irrespective of management strategy.

Conclusion
Patients with previous CABG who are admitted with NSTEMI who were not considered suitable for invasive angiography experienced significantly higher rates of MACE at 1-year follow up. The presence of CKD or previous PCI were key indicators of poor outcomes irrespective of management strategy. Outcomes amongst those deemed fit enough for invasive angiography were similar irrespective of treatment, suggesting that additional non-invasive testing may help further define which patients would benefit from an invasive strategy.

Funding Acknowledgement
Type of funding sources: None.
Early and chronic phased local coagulative responses following bioresorbable-polymer drug-eluting stent implantation
Authors: Yamaguchi K , Wakatsuki T , Okushi Y , Suto K , Matsumoto K , Takahashi T , Kadota M , Kawabata Y , Matsuura T , Ise T , Kusunose K , Yagi S , Yamada H , Soeki T , Sata M 
Published: October 2021

Abstract

Background
Neointimal maturation after bioresorbable-polymer (BP) drug-eluting stent (DES) implantation will not be complete in the absorption phase of the polymer. We have previously reported local persistent hypercoagulation after sirolimus-eluting stent (SES) implantation by measuring local plasma prothrombin fragment 1+2 (F1+2) levels. The aim of this study is to examine time-dependent local coagulative response after BP-DES implantation.

Methods
Sixty-four patients who were treated about ten months earlier with coronary angioplasty, with no evidence of restenosis, were studied [durable-polymer (DP)-DES {SES; Cypher®: 26pts and everolimus-eluting stent (EES); Xience®: 16pts} and BP-DES (BP-EES; Synergy®: 10pts and BP-SES; Ultimaster®: 12pts)]. We measured plasma levels of F1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V) at the early (2±1 months) and chronic (10±2 months) phases. The transcardiac gradient (Δ) was defined as CS level minus V level.

Results
No significant differences were observed in the percent diameter stenosis between the DP- and BP- DES groups (11.5±15.5 vs 14.1±11.9%). The ΔF1+2 was significantly lower in the BP-DES group than in the DP-DES group at the chronic phase (7.5±16.1 vs 16.4±17.1pmol/l, p&lt;0.05). In the BP-DES group, the ΔF1+2 did not differ significantly between the early and chronic phases (7.0±14.1 vs 7.5±16.1pmol/l, NS).

Conclusion
Lower local coagulative response was observed at the chronic phase after BP-DES implantation compared to DP-DES implantation, and local hypercoagulation after BP-DES implantation was not observed at the early phase compared to the chronic phase. These findings might lead to the possibility of shorter dual antiplatelet therapy after BP-DES implantation.

Funding Acknowledgement
Type of funding sources: None.
Statins for primary prevention among elderly men and women
Authors: Bergami M , Cenko E , Yoon J , Mendieta G , Kedev S , Zdravkovic M , Vasiljevic Z , Milicic D , Manfrini O , Van Der Schaar M , Gale C P , Badimon L , Bugiardini R 
Published: October 2021

Abstract

Background
The debate about statins in primary prevention of cardiovascular (CV) disease is still alive, especially in old and very old adults.

Purpose
We undertook a propensity match-weighted cohort study to investigate whether statin treatment recommendations translate into improved cardiovascular (CV) outcomes in the current routine clinical care of the elderly.

Methods
We included in our analysis 5,619 people aged 65 years or older from the ISACS (International Survey of Acute Coronary Syndrome) Archives (NCT04008173) who presented to hospital with a first manifestation of CV disease. Participants were stratified as statin users versus nonusers and as old (65 to 75 years) versus very old (76 years or over) adults. We estimated the effects of statins on the most severe clinical manifestation of CV disease, namely ST segment elevation myocardial infarction (STEMI), using inverse probability of treatment weighting models. Estimates were compared by test of interaction on the log scale.

Results
The risk of STEMI was much lower in statin users than in nonusers in both patients aged 65 to 75 years (14.7% absolute risk reduction; relative risk [RR] ratio: 0.55, 95% CI 0.45 to 0.66) and those aged 76 years and older (13.3% absolute risk reduction; RR ratio: 0.58, 95% CI 0.46 to 0.72). Estimates were similar in patients with and without history of hypercholesterolemia (interaction test; p value= 0.2408). Proportional reductions in STEMI diminished with female sex in the old (p for interaction=0.002), but not in the very old age (p for interaction=0.26). We also observed a remarkable reduction in the risk of 30- day mortality from STEMI with statin therapy in both age groups (10.2% absolute risk reduction; RR ratio: 0.39; 95% CI 0.23 – 0.68 for patients aged 76 or over and 3.8% absolute risk reduction; RR ratio 0.37; 95% CI 0.17 – 0.82 for patients aged 65 to 75 years old; interaction test, p value=0.4570).

Conclusion
Preventive statin therapy in the elderly reduces the risk of STEMI with benefits in mortality from STEMI, irrespective of the presence of a history of hypercholesterolemia. This effect persists after the age of 76 years. Benefits are less pronounced in women.

Funding Acknowledgement
Type of funding sources: None.
The evolution of management and outcomes of patients with myocardial injury during the COVID-19 pandemic
Authors: Case B , Abramowitz J , Shea C , Rappaport H , Yerasi C , Forrestal B , Chezar-Azerrad C , Medranda G , Zhang C , Satler L , Ben-Dor I , Hashim H , Rogers T , Weintraub W , Waksman R 
Published: October 2021

Abstract

Background
Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation, and associated with worse prognosis as compared with patients without myocardial injury.

Purpose
We sought to evaluate if the outcomes of these patients has improved as experience accumulated during the pandemic.

Methods
We analyzed COVID-19-positive patients with the evidence of myocardial injury (defined as troponin elevation) who presented to our large US healthcare system in the northeast region during the “Early Phase” of the pandemic (March 1–June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the “Current Phase” of the pandemic (October 1, 2020–January 31, 2021).

Results
The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the “Early Phase” and 621 during the “Current Phase”. The cohort's mean age was 70.2±14.9 years; 54.3% were men (Figure 1). Maximum troponin-I in the “Early Phase” was 13.46±34.72 versus 11.21±20.57 in the “Current Phase” (p=0.553) In-hospital mortality was significantly higher (50.3%) in the “Early Phase” group compared to the “Current Phase” group (24.6%; p&lt;0.001). Similarly, the incidence of intensive care unit admission (77.8% versus 46.1%; p&lt;0.044) and requirement for mechanical ventilation (61.7% versus 28%; p&lt;0.001) were higher in the “Early Phase” (Figure 2). In addition, 6% of those in the “Early Phase” underwent coronary angiography compared to 2.3% in the “Current Phase” (p=0.013). Finally, 3% of “Early Phase” and 0.8% of “Current Phase” patients underwent percutaneous coronary intervention (p=0.025).

Conclusions
Treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies and provider experience.

Funding Acknowledgement
Type of funding sources: None.
Observational study of Covid-19 patients presenting with acute coronary syndrome at a tertiary care center in India
Authors: Makkar K , Malhi T S , Batta A , Panda P , Sharma Y P 
Published: October 2021

Abstract

Aim
Patients with Covid-19 are theoretically at a higher risk of ACS, as respiratory infections can often lead to coronary endothelial damage and plaque rupture. Initial reports during start of pandemic suggested decrease in STEMI patients, however this has been explained by iatrophobia rather than actual decrease. Data on pathophysiology and outcome of patients presenting with ACS is scarce. We did a prospective observational study to study epidemiology and outcomes of Covid-19 patients with ACS.

Methods
A total of 654 patients were admitted with Covid-19 at PGIMER, Chandigarh from August 2020 to February 2021, 35 (5.3%) consecutive patients of ACS were enrolled into the study. Acute myocardial infarction was defined as per fourth universal definition of myocardial infarction. Diagnosis of Covid-19 was established using RT-PCR from nasopharyngeal swab. Angiographic assessment was done by two interventional cardiologists.

Results
Mean age of patients was 59.5±11.8 years, males comprised majority (80%) of study group. Most common risk factor was hypertension seen in around 70% followed by DM in 57% patients. Most common symptom at presentation was rest angina seen &gt;90% while history of fever was present in only 31.4%. STEMI was most common ACS seen in 45.7% followed by USA in 23% patients. CS was present in 15% patients at presentation while another 5% developed shock in hospital. Oxygen requirement was required in over half the patients while 25% patients succumbed to illness in hospital.Thrombolysis was done in half the patients of STEMI. In view of Covid-19 disease 71.4% required dexamethasone and remdesivir. Coronary angiography was done in around 20% patients, which revealed obstructive CAD in 83% patients with 60% patients having 100% occlusion of IRA. Percutaneous intervention was done in 66% patients. Hypoalbuminemia was commonly seen patients with mean albumin of 3.3 gm/dL. Low T3 syndrome was most common thyroid function abnormality seen in 37.1%.On univariate analysis age, BNP levels and albumin were able to predict 30-day mortality.

Conclusion
ACS can be first presentation of patients with Covid-19 as shown by our study only 30% patients had prior history of fever. Our data reaffirms that patients with Covid-19 and ACS have worse prognosis. Interestingly mortality in our study was comparable to western study, despite low rate of angiography and intervention thus underscoring individualization of therapy. We believe Type-2 myocardial infarction is common in pathophysiology of patients who benefit most from medical therapy.

Funding Acknowledgement
Type of funding sources: None.
D-dimer as a potential novel thrombus biomarker for predict stent thrombosis in patients on dual antiplatelet therapy after percutaneous coronary intervention
Authors: Zhao X , Li J , Li J , Li Y , Yang Y , Gao R , Xu B , Yuan J 
Published: October 2021

Abstract

Background
At present, it is worth noting that there is a lack of biomarker for the residual risk of thrombosis in patients underwent percutaneous coronary intervention (PCI). D-dimer is an important thrombus marker and widely used in clinical practice.

Purpose
We aim to investigate the correlation between D-dimer and the risk of stent thrombosis (ST) after PCI.

Method
This is a prospective, observational study of 10,724 patients who underwent PCI. The primary endpoint was ST, which was defined according to the Academic Research Consortium including definite, probable, and possible.

Results
Finally, 8565 patients were included in this study after excluding 2159 people with missing D-dimer data or lost to follow-up. After 2-year follow-up, there were 77 ST occurred. D-dimer levels were significantly higher in the ST group (0.33 [0.28, 0.56] μg/ml) than in the non-ST group (0.28 [0.20, 0.41] μg/ml) (P=0.001). Kaplan–Meier survival curve analysis showed that patients with high D-dimer levels had higher cumulative ST according to the median D-dimer level (0.28 μg/ml) in the total population, acute coronary syndrome (ACS) subgroup, and stable coronary artery disease (SCAD) subgroup, respectively. (log-rank test, all P&lt;0.001) (Figure 1). After multivariate-adjusted cox hazard analysis, high D-dimer levels (≥0.28 μg/ml) were significantly associated with ST in the total population (hazard ratio [HR]: 2.25, 95% confidence interval [CI]: 1.29–3.95, P=0.005) and ACS subgroup (HR: 2.13, 95% CI: 1.09–4.16, P=0.027); however, we did not find a statistically significant in the SCAD subgroup (HR: 2.56, 95% CI: 0.92–7.1, P=0.072).

Conclusion
In this real world and large sample data study, we reported for the first time that D-dimer was strong independent thrombosis biomarker in patient who underwent PCI. In the future, we may use D-dimer to guide individualized antithrombotic therapy after PCI.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CAMS Innovation Fund for Medical Sciences; Young and middle-aged talents in the XPCC Science and Technology Project
The association between international normalized-ratio and long-term mortality in patients with coronary artery disease: a large cohort study
Authors: Liu L , Li Q , Liu J , Chen W H , Chen J Y , Liu Y 
Published: October 2021

Abstract

Background
The association between international normalized-ratio (INR) and long-term prognosis among patients with coronary artery disease (CAD) without atrial fibrillation (AF) or anticoagulant therapy was still unclear. We analyzed the association of INR levels and long-term mortality in a large cohort of CAD patients without atrial fibrillation or using of anticoagulant drugs.

Method
We obtained data from 44,662 patients who were diagnosed with CAD and had follow-up information from January 2008 to December 2018. The patients were divided into 4 groups (Quartile 1: INR ≤0.96; Quartile2: 0.961.06). The main endpoint was long-term all-cause death. Kaplan-Meier curve analysis and Cox proportional hazards models were used to investigate the association between quartiles of INR levels and long-term all-cause mortality.

Result
During a median follow-up of 5.25 years, 5,613 (12.57%) patients died. We observed a non-linear shaped association between INR levels and long-term all-cause mortality. Patients in high INR level (Quartile4: INR &gt;1.06) showed a significantly higher long-term mortality than other groups (Quartile2 or 3 or 4), (Compared with Quartile 1, Quartile 2 [0.961.06], aHR=1.33, 95% CI: 1.22–1.45, P&lt;0.05).

Conclusion
Our study demonstrates high levels of INR were associated with an increased risk of all-cause mortality.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by Guangdong Provincial People's Hospital Dengfeng Project Fund (DFJH201919) and The National Science Foundation for Young Scientist of China (grant no.8197021596, 81500520). Survival curves for mortalitySubgroup analysis
Immature platelets in patients with Covid-19: association with disease severity
Authors: Harari E , Cohen A , Cipok M , Bryk G , Karp Lador N , Mann T , Mayo A , Lev E I 
Published: October 2021

Abstract

Background
Coronavirus disease 2019 (Covid-19) is associated with a high incidence of thromboembolic events, both venous and arterial. Currently, there are no clinical or laboratory markers to guide risk-stratification or antithrombotic therapy in Covid-19 patients. Circulating immature platelets represent a population of hyper-reactive platelets, which are associated with arterial thrombotic events.

Objectives
To assess whether the proportion of immature platelets in the circulation is associated with disease severity in patients with Covid-19

Methods
This prospective study evaluated consecutive patients with COVID-19 admitted with various degrees of disease severity, as determined by the standard Covid-19 severity Score. Disease severity was evaluated during hospitalization. Immature platelet fraction (IPF) absolute number and percentage were measured on admission and at additional time points during the hospital course using the SysmexXN-3000 auto-analyzer. The maximal values of IPF% and absolute IPF was analyzed according to disease severity.

Results
A total of 136 consecutive patients with Covid-19 were recruited. Mean age was 60±19 years for patients with mild and moderate disease and 69±14 years for patients with severe disease, 52% with mild and moderate disease and 48% with severe disease were woman, 11% with mild and moderate disease and 20% with severe disease with concurrent cardiovascular disease
The median of IPF% was higher in the severe COVID-19 group compared to patients with mild or moderate disease [4.2 (IQR 2.73–6.45) vs 5.8 (IQR 3.9–8.7), P=0.01, Figure 1)]. The median of IPF absolute number was also significantly higher in patients with severe disease comparing to patients with mild or moderate disease (4.2 (2.85–6.1) vs 5.1 (IQR 3.65–7.35), P&lt;0.0001, Figure 2].

Conclusions
Patients with severe Covid-19 have a higher level of IPF in the circulation than patients with mild or moderate disease. IPF may serve as a reliable prognostic marker for in-hospital disease severity in patients with Covid-19

Funding Acknowledgement
Type of funding sources: None. Figure 1. IPF% (median, 95% confidence interval)Figure 2. IPF# (median, 95% confidence interval)