bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of anemia in patients with ST-elevation myocardial infarction
Authors: Costa R , Frias A , Campinas A , Luz A , Santos M , Torres S 
Published: October 2021

Abstract

Introduction
Haemoglobin (Hb) levels are an important outcome predictor in several diseases.

Purpose
We aimed to evaluate Hb at hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) as a predictor of in-hospital complications, mortality and heart failure (HF) during follow-up.

Methods
We retrospectively studied consecutive STEMI patients treated with primary percutaneous coronary intervention between January 2010 and December 2016. Clinical data was retrieved by review of patients' clinical records. Severity of anaemia was defined according World Health Organization cut-offs.

Results
Of 864 patients with mean age of 63±13 years, 646 (75%) were male. Mean Hb at hospital admission was 14±2g/dL, 682 (81%) with normal Hb, 118 (14%) with mild anaemia, 45 (5%) with moderate anaemia and 2 (0.2%) with severe anaemia. Female gender, smoking, diabetes, hypertension, previous myocardial infarction and peripheral artery disease were associated to higher incidence of anaemia at hospital admission. Anaemia was also associated to Killip-Kimball (KK) class ≥II at hospital admission. They also had higher incidence of in-hospital stroke, advanced atrioventricular block, gastrointestinal bleeding and blood transfusion. In-hospital mortality was 9%, higher patients with anaemia (13% vs 7%, p=0.022). Median follow-up was 43 (26–66) months. All-cause mortality was 14%, higher in patients with anaemia (27% vs 11%, p&lt;0.001, Log rank test p&lt;0.001). In multivariate analysis, age (HR 1.1, 95% CI 1.0–1.1), diabetes (HR 1.9, 95% CI 1.1–3.4), left ventricular ejection fraction (LVEF) at discharge (if &lt;50%, HR 3.4, 95% CI 1.6–7.2), and anaemia at admission (HR 1.8, 95% CI 1.0–3.2) were independent predictors of all-cause death during follow-up. Incidence of de novo HF, clinical worsening or hospitalization was 18%, higher in patients with anaemia (27% vs 17%, p=0.007, Log rank test p=0.007). In multivariate analysis, age (HR 1.1, 95% CI 1.0–1.1), KK class (if II, HR 2.1, 95% CI 1.3–3.5; if III, HR 4.0, 95% CI 1.8–8.9; if IV, HR 2.1, 95% CI 1.2–3.9), body mass index (if obese, HR 2.5, 95 CI 1.4–4.4) and LVEF at discharge (if &lt;50%, HR 4.2, 95% CI 2.2–7.7), but not anaemia at admission (p=0.633) were independent predictors HF.

Conclusion
In our contemporary cohort of STEMI patients, the presence of anaemia at hospital admission was not only associated to in-hospital complications, but also all-cause mortality during follow-up.

Funding Acknowledgement
Type of funding sources: None.
Location and impact of the infarct-related artery in acute coronary syndrome: insight from the Swiss SPUM- ACS cohort
Authors: Adjibodou B , Obeid S , Kraler S , Denegri A , Mach F , Matter C M , Nanchen D , Roffi M , Muller O , Raeber L , Luescher T 
Published: October 2021

Abstract

Background
Identifying the infarct-related artery (IRA) in patients with acute coronary syndromes (ACS) has prognostic and therapeutic implications.

Purpose
We aimed to evaluate the distribution, clinical presentation and impact of the culprit lesion location on long-term outcomes in ACS patients treated with primary percutaneous coronary intervention, medication and secondary prevention according to Guidelines.

Methods
Patients referred for ACS to one of the participating centres of the observational SPUM-ACS study between 2009 and 2017 with one year outcomes and independent events adjudication were included. The distribution of IRA, clinical presentation (STEMI/NSTEMI) and impact of IRA location on major adverse cardiac events (cardiac death, myocardial infarction, stent thrombosis, target vessel revascularisation) at one year were investigated.

Results
4'546 patients were included with 55% presenting as STEMI (mean age 62-years; 20% women), 42% as NSTEMI and 3% as unstable angina. The left anterior descending (LAD) artery was involved in 44.3%, the right coronary artery (RCA) and left circumflex artery (LCX) in 32.9% and 20%, respectively. Proximal and middle segments of the 3 main vessels were more often the culprit location compared to distal segments and side branches (78% versus. 22%). Left main (LM) and bypass graft were rarely involved (1.6% and 1.2% respectively), but most often responsible to overall cardiac dysfunction (higher NT-proBNP and hs troponin levels). Patients with an occluded IRA at angiography usually presented as STEMI on ECG (100% for LM, 90.5% for LAD territory, 83.8% for RCA territory, 56.6% for LCX territory). However 43.1% of patients with occluded LCX presented as NSTEMI. These patients were prone to extensive cardiac damage and significantly higher hs troponin levels as compared to those with patent LCX or STEMI presentation (626 ng/l vs 310 ng/l and 626 ng/l vs 580 ng/l respectively, p&lt;0.001). Overall, 1-year MACE occurred in 11.8%. In native coronaries, the location of IRA had no impact on outcomes (20% LM, 10.9% LAD, 11.8% RCA, 11.8% LCX, p=0.112). However, in NSTEMI-ACS there were twice as many events when the LM was the IRA (MACE 20%, p=0.023) and 3-times higher when a bypass-graft was the IRA (33.9%, p=0.0001).

Conclusions
ST elevations are highly suggestive of an occluded IRA. However more than 40% of patients presenting with ACS involving an occluded LCX did not demonstrate ST-elevation and were prone to extensive cardiac damage, urging the necessity for early invasive measures in these patients. In native coronaries the IRA location did not affect outcomes except in NSTEMI with LM involvement or ACS with bypass grafts as IRA that had much worse outcomes.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): - Swiss National Research Foundation - Zurich Heart House
The role of coronary collateral circulation in patients presenting with acute left main coronary artery occlusion
Authors: Calvao J , Braga M , Silva J C , Campinas A , Alexandre A , Brochado B , Amador A F , Costa C , Pinto R J , Proenca T , Carvalho M , Marques C , Cabrita A , Silveira J , Macedo F 
Published: October 2021

Abstract

Introduction
Acute occlusion of the unprotected left main coronary artery (LMCA) is an uncommon occurrence associated with a dismal prognosis. Whereas the role of early recruited coronary collateral circulation (CC) in prognosis of ST-segment elevation acute myocardial infarction (STEMI) patients is still controversial, it seems to be important in patients with acute LMCA occlusion. This study aimed to evaluate the coronary CC in patients with acute LMCA occlusion and its impact in short and long-term outcomes.

Methods
In a retrospective two-center study, we identified 7630 patients with STEMI or high-risk non-ST segment elevation myocardial infarction who underwent emergent coronary angiography between January 2008 and December 2020. Among this cohort, we analyzed 83 patients who presented with unprotected LMCA acute occlusion (Thrombolysis In Myocardial Infarction – TIMI ≤2) and classified them in 2 groups based on the degree of CC through the right coronary artery as seen in the emergent angiography: patients with no filling of collateral vessels or filling of collateral vessels without any epicardial filling of the occluded vessel [Rentrop class 0–1 (71 patients)]; and patients with partial or complete epicardial filling by collateral vessels [CC Rentrop class 2–3 (12 patients)].

Results
Compared to patients with CC Rentrop 0–1, patients with CC Rentrop 2–3 presented significantly later to medical attention (symptom to coronary angiography time 8.7 vs 4.3 hours, p=0.02). Despite that, patients with CC Rentrop 2–3 had a significantly lower prevalence of cardiogenic shock at admission (16.7 vs 57.7%, p=0.01). During hospitalization, Killip class III-IV presentation (33.3 vs 88.7%, p&lt;0.001) and inotropic/vasopressor therapy use (25.0 vs 69.0%, p=0.01) were less frequent in CC Rentrop 2–3 patients. The CC Rentrop 2–3 group had a significantly lower in-hospital (16.7 vs 53.5%, p=0.02) and 30-day mortality (9.1 vs 52.2%, p=0.01). In patients surviving hospitalization there was no significant difference in 1-year (30.0 vs 19.4%, p=0.48) and 5-year mortality (70.0 vs 77.4%, p=0.68).

Conclusion
A well-developed coronary CC was associated to lower short-term mortality in patients presenting with acute occlusion of the unprotected LMCA. Nevertheless, in patients surviving index-event, there was no difference in the long-term outcomes. Further studies are needed to clarify if clinical approach (eg. early short-term mechanical circulatory support) of patients with CC Rentrop 0–1 should be different from those with CC Rentrop 2–3 in order to improve the outcomes of the former patients.

Funding Acknowledgement
Type of funding sources: None.
High concentrations of plasma trimethylamine-n-oxide is associated with long-term cardiovascular mortality in patients with acute coronary syndrome
Authors: Eyileten C , Jarosz-Popek J , Jakubik D , Wolska M , Fitas A , Czajka P , Nowak A , Ufnal M , Postula M , Toma A , Lang I , Siller-Matula J M ,   I-COMET
Published: October 2021

Abstract

Background
Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7].

Purpose
To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention.

Methods
Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality.

Results
ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p&lt;0.001). The cut-off value of &gt;4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low.

Conclusions
High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier curvesTable 1
Circulating endothelial progenitor cells as predictors of long-term cardiovascular mortality after myocardial infarction: which definition should we use?
Authors: De Almeida Fernandes D , Leal V , Oliveiros B , Silva S , Goncalves L , Fontes Ribeiro C , Antonio N 
Published: October 2021

Abstract

Background
Endothelial progenitor cells (EPCs) are bone marrow-derived cells that play a crucial role in vascular repair after an acute myocardial infarction (AMI). Recent studies suggest that circulating EPCs levels may be useful as a surrogate biomarker for cardiovascular (CV) events. Nevertheless, the lack of a consensual definition and phenotypic characterization of EPCs hampers its use in clinical practice. CD34+KDR+, CD45dimCD34+KDR+ and CD34+CD133+KDR+ are among the most used antigenic phenotypes to define circulating EPCs but the best phenotype to predict CV outcomes remains to be determined.

Purpose
To determine the EPCs' surface phenotype that best predicts long-term CV death after an AMI, and to evaluate its optimal cut-off point.

Methods
One-hundred AMI patients were prospectively enrolled in the study. Circulating EPCs were quantified through high-performance flow cytometer within the first 24 hours of admission using different surface markers combinations allowing to simultaneously compare three EPCs definitions: 1) CD34+KDR+, 2) CD45dimCD34+KDR+, 3) CD34+CD133+KDR+. Mean follow-up time was 8.0±2.2 years.

Results
The mean age of our population was 59.7±11.0, the majority of patients were male (90%), 65% had ST-elevation myocardial infarction (STEMI) and 35% non-ST segment elevation myocardial infarction (NSTEMI). Diabetes mellitus was present in 38% and hypertension in 67% of the studied sample. During the long-term follow-up, 34 patients had re-admissions due to cardiovascular causes, 11 of them for AMI. Thirty-one patients had major adverse cardiovascular events (MACE) and 19 died.
Using ROC curves, the CD34+KDR+ phenotype showed the biggest area under the curve regarding prediction of CV mortality (0.722; p=0.010; confidence interval 95% (CI95%): 0.554 to 0.890). Patients with lower levels of EPCs according to this definition (≤0.022%) are 7 times more likely to die from CV causes at any time (hazard ratio = 7.55; p=0.008; CI95% 1.69 to 33.83).

Conclusion
The CD34+KDR+ phenotype appears to be the best definition of circulating EPCs for predicting long-term CV mortality after AMI. Further studies with larger samples are needed to clarify the optimal cut-off point for determining patients at risk and its role in everyday Cardiology.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Bolsa de Estudo João Porto da Sociedade Portuguesa de Cardiologia CD34+KDR+ as a predictor of CV death
Colchicine and quality of life in patients with acute coronary syndromes: results from the COPS randomized trial
Authors: Dawson L , Quinn S , Tong D , Boyle A , Hamilton-Craig C , Adams H , Layland J 
Published: October 2021

Abstract

Background
Recent data suggest that colchicine may reduce cardiovascular events among patients presenting with acute coronary syndromes. This sub-study of the Australian COPS trial aimed to assess whether colchicine affects health status outcomes.

Methods
Health status was assessed at baseline and 12-months using the EuroQol-5 Dimension 5-level (EQ-5D-5L) score and the full 19-question Seattle Angina Questionnaire (SAQ). Data were available for 786 patients (388 randomized to colchicine, 398 to placebo).

Results
Baseline characteristics were well matched between groups; mean age was 60.1 (SD 14.8) years, and 20% were female. Baseline health status scores were impaired, and most parameters demonstrated significant improvement from baseline to 12-months (EQ-5D-5L Visual Analogue Score [VAS] 69.3 to 77.7; SAQ angina frequency score 83.0 to 95.3, both p&lt;0.001). No significant differences in adjusted mean score change among any of the EQ-5D-5L or SAQ dimensions were observed between treatment groups in either intention-to-treat or per-protocol analysis. There were borderline interactions in EQ-5D-5L scores for those with previous MI vs not, and in SAQ scores for those with obesity vs not. In categorical analysis using observed data, patients treated with colchicine were more likely to have clinically significant improvement in physical limitation score over the period (36% improved vs. 28%, P&lt;0.05). Baseline health status scores were not associated with the primary endpoint at 12 months.

Conclusions
Treatment with colchicine did not appear to affect change in measures of health status following acute coronary syndromes, but it did lead to a greater likelihood of improvement in physical limitation scores.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Peninsula Health, Monash University
Clinical characteristics and outcomes of myocardial infarction with nonobstructive coronary arteries
Authors: Wong C J , Yap J , Gao F , Lau Y H , Huang W , Yeo K K ,   SingCLOUD
Published: October 2021

Abstract

Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is caused by a heterogenous group of conditions with clinically significant sequelae.

Purpose
This study aims to compare the clinical characteristics and prognosis of MINOCA with myocardial infarction with obstructive coronary artery disease (MICAD).

Methods
Data was obtained from the Singapore Cardiac Longitudinal Outcomes Database (SingCLOUD), a national multicenter registry of patients with cardiovascular disease. Patients with a first presentation of acute myocardial infarction who underwent coronary angiography between 1 January 2011 and 31 December 2014 were extracted from the database. Follow up was conducted until 31 December 2017. Subjects were classified as having either MICAD or MINOCA based on angiographic findings. The primary outcomes were all-cause mortality and major adverse cardiac events (MACE) defined as a composite of all-cause mortality, recurrent myocardial infarction, hospitalization for heart failure and ischemic stroke.

Results
All 4124 patients who met the inclusion criteria were included in this study, of which 159 (3.9%) were diagnosed with MINOCA. Patients with MINOCA were more likely to be female, present with a non-ST elevation myocardial infarction (NSTEMI), have a higher left ventricular ejection fraction and less likely to have diabetes mellitus, previous ischemic stroke or smoking history. Over a mean follow-up duration of 4.5 years, MINOCA patients had a lower incidence of all-cause mortality (10.1% vs. 16.5%, p=0.030) and MACE (20.8% vs. 35.5%, p&lt;0.0001) compared to patients with MICAD. On multivariable analysis, patients with MINOCA had a significantly lower risk of all-cause mortality (HR 0.42; 95% CI 0.21–0.82; p=0.011), MACE (HR 0.42; 95% CI 0.26–0.69; p=0.001) and recurrent myocardial infarction (HR 0.35; 95% CI 0.15–0.85; p=0.021). Within the MINOCA group, older age, higher creatinine, a STEMI presentation and the absence of antiplatelet use predicted all-cause mortality and MACE.

Conclusions
While patients with MINOCA had better clinical outcomes compared to MICAD patients, MINOCA is not a benign entity with about one in five patients experiencing a major adverse cardiovascular event in the mid-term.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council Project Grant
Differences between Takotsubo and the working diagnosis of myocardial infarction with non-obstructive coronary arteries
Authors: Lopez-Pais J , Izquierdo Coronel B , Raposeiras-Roubin S , Alvarez Rodriguez L , Uribarri A , Almendro-Delia M , Galan Gil D , Vedia O , Lopez Otero D , Espinosa Pascual M J , Garcia Acuna J M , Gonzalez-Juanatey J R , Alonso Martin J J , Perez De Juan Romero M A , Nunez-Gil I ,   Retako
Published: October 2021

Abstract

Aims
Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCA) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCA.

Methods and results
A cohort study based on two prospective registries: TTS from the XXXX1 registry (N:1055) and non-TTS MINOCA patients from contemporary records of acute myocardial infarction from 5 national centers (N:1080). Definitions and management recommended by the ESC were used. Survival analysis was based on Cox regression; propensity score matching was created to adjust prognostic variables.
TTS were more often women (85.9% vs. 51.9%; p&lt;0.001) and older (69.4±12.5 vs. 64.5±14.1 years; p&lt;0.001). Atrial fibrillation was more frequent in non-TTS MINOCA (10.4% vs. 14.4%; p 0.007). Psychiatric disorders were more prevalent in TTS (15.5% vs. 10.2%, p&lt;0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs 1.8%, (p 0.015) and 25.8% vs. 11.5%, (p&lt;0.001).
Median follow-up was 32.4 months; TTS had less major adverse cardiovascular events (MACE): Hazard Ratio (HR) 0.59; 95% confidence interval (CI) 0.42 to 0.83. There were no differences in global mortality (HR 0.87; CI: 0.64 to 1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35 to 0.98).

Conclusions
Compared to the rest of MINOCA, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis.

Funding Acknowledgement
Type of funding sources: None. Central Illustration
Dispatch of lay-responders is associated with bystander cardiopulmonary resuscitation, bystander defibrillation and 30-day survival following an out-of-hospital cardiac arrest
Authors: Jonsson M J , Berglund E B , Ringh M R ,   ESCAPE-NET
Published: October 2021

Abstract

Background
Dispatch of lay-responders in out-of-hospital cardiac arrest (OHCA) is increasingly common and the recent European Resuscitation Council (ERC) guidelines has a strong recommendation in using these systems. Some previous studies with various study designs have shown associations with increased survival rates. We aim to investigate if the dispatch of lay-responders increases bystander cardiopulmonary resuscitation (CPR) rates, AED usage, and 30-day survival following an OHCA.

Methods
We included all OHCA in the two most populous regions in Sweden. OHCAs occurring during hours where the lay-responder system was not active were excluded as well as cases where the OHCA was witnessed by EMS. Risk ratios (RR) were calculated using modified Poisson regression adjusted for age, sex, location, witnessed status, EMS response time and hour of the day. Continuous variables were used as restricted cubic splines.

Results
We included 5217 OHCAs between January 2016 and December 2019. In 2327 cases the lay-responder system was activated and in 2890 the system was not activated. The proportion receiving bystander CPR was 71.4% where the system was activated compared to 59.9% when not. The corresponding number for AED attachment was 10.4% vs. 7.2% and for bystander defibrillation the number was 7.2% vs. 4.1%. The proportion of patients alive after 30 days was 10.6% when the system was activated and 8.3% when it was not activated.
The adjusted RR for bystander CPR was 1.37 (1.31–1.43). For AED attachment the RR was 1.48 (1.21–1.82) and for bystander defibrillation the RR was 1.92 (1.34–2.75). For 30-day survival the RR was 1.29 (1.04 – 1.60).

Conclusion
Dispatch of lay-responders in OHCA is associated with bystander CPR, AED attachment, bystander defibrillation, and 30-day survival. These results supports the ERC guidelines that recommends the introduction of similar lay-responder systems.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020