bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of ST elevation myocardial infarction (STEMI) hospitalizations during corona virus disease 19 (COVID 19) era
Authors: Simoni L , Alimehmeti I , Gina M , Tafaj E , Ceka A , Dibra A , Goda A 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Multiple studies reports a reduction of STEMI hospitalizations rates during COVID 19 pandemic outbreak. Contradictory STEMI complications rates are reported during COVID 19 pandemic regarding case fatalities rates, cardiogenic shock, life threatening arrhythmias and others.
Purpose. To evaluate the impact of the COVID 19 outbreak on STEMI patient outcomes and complication rates in country with low COVID 19 incidence and mortality and without changes in Cardiology hospital services.
Methods. Was conducted a retrograde study collecting data for STEMI hospitalizations, revascularization procedures and case fatalities and other complications from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center. Incidence rate ratio (IRR) was used to compare STEMI admissions and revascularization procedures and risk ratio (RR) to compare case fatality rate and other complications rate.

Results
Hospital admissions for STEMI declined during 2020 (COVID 19 period) from a total of 217 patients in 2019 to 155 patients hospitalization in 2020 representing IRR 0.72 (p = 0.009). Reduction were observed in the number of primary PCI from 168 procedures in 2019 to 113 in 2020 (IRR 0.67 p = 0.001). Symptom onset to our ICU (including regional transportation) was significantly higher in 2020 than in 2019 (939.97 ± 1122 versus 436.15 ± 383 minutes p &lt;0.0001) The STEMI case fatality was importantly increased during pandemic outbreak (13.55%) compared to 2019 (8.3%) (RR= 1.63 p = 0.001), but a similar a primary PCI-STEMI case fatality 6.2% versus 5.95%. Also an increase was observed for cardiogenic shock (IRR =1.75 p = 0.003).
Results; Hospitalizations and related invazive revascularization procedures for STEMI significantly reduced during COVID 19 pandemic. We identified a substantial increase of STEMI case fatalities and cardiogenic shock during pandemic outbreak. Delayed timely reperfusion by primary PCI has an important impact on infarct related mortality.
Relationship between CHA2DS2-VASC score on admission to emergency department and in-hospital major adverse cardiovascular events in patients diagnosed with ST-elevation myocardial infarction
Authors: Inan DUYGU , Genc DUYGU , Simsek BARIS , Tanik OZAN , Akdeniz EVLIYA , Korkmaz BETUL , Aydogdu UFUK , Vatanoglu ELIF G , Zeren GONUL , Ceylan BUSRA , Yumurtas CAGDAS , Yuksel GIZEM , Pay LEVENT , Tanboga HALIL , Karabay CAN Y 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Inotroduction
. CHA₂DS₂-VASc scoring system, which includes traditional risk factors of coronary artery disease, is actually created to determine the risk of thromboembolism in patients with atrial fibrillation. In this study; the value of CHA₂DS₂-VASc score, which can be calculated easily on admission, was evaluated for predicting in-hospital adverse outcomes in ST elevation miyocardial infarction (STEMI) patients without atrial fibrillation.

Method
This was a single center cross-sectional study. 1933 STEMI patients enrolled to the study. Primary end points include in-hospital death, cardiopulmonary arrest and cerebrovascular accident and were identified as MACE

Results
MACE rate was 10% (193 patients), in-hospital mortality rate was 9% (169 patients).In proportional logistic regression analysis, CHA₂DS₂-VASc score was an independent predictor for MACE (OR and CI 95%, 2.31[1.37-3.90]; p value:0.0016). In the regression analysis, the CHA₂DS₂-VASc score was taken as an uncatagorized continuous variable, and the relationship between the CHA₂DS₂-VASc score and MACE was observed to be linear. Additionally heart rate (OR and 95% CI, 1.56 [0.97- 2.50]; p value: 0.0242), killip class on admission (OR and 95% CI, 24.19[10.74-54.46]; p value &lt;0.0001), creatinine level on admission (OR and 95% CI, 1.54 [1.10-2.16]; p value: 0.0024), peak CK-MB level (OR and 95% GA, 1.63 [0.98-2.70]; p value: 0.0001) and presence of no-reflow (OR and 95% CI, 2.45 [1.25-4.80]; p value: 0.0085) were indendified as other independent predictors of MACE.

Conclusion
CHA₂DS₂-VASc score was observed as an indepented predictor for MACE in STEMI patients. To evaluate the relationship between CHA₂DS₂-VASc score and outcomes, the linear analysis of the CHA₂DS₂-VASc score without categorization in prediction model is used and this is the main difference of our study from others.
Table-1 Variables Odss Ratio (OR) and 95% CI p value CHA₂DS₂-VASc ( 0 to 3) 2.31 (1.37-3.90) p = 0,0016 Heart Rate (Beats per minute) ( 68 to 94) 1.56 (0.97-2.50) p =0.0242 Systolic Blood Pressure (mmHg) ( 115 to 156) 0.83 (0.51-1.34) p = 0.3523 Killip Class ( I to IV) 24.19 (10.74-54.46) p &lt; 0.0001 Hemoglobin (g/dL) ( 12 to 15) 0.96 (0.54-1.70) p = 0.4066 Creatinine ( mg/dL) (0.74 to 1.0) 1.54 (1.10-2.16) p = 0.0024 Peak CK-MB (IU/L) (40.8 to 165.1) 1.63 (0.98-2.70) p = 0.0001 No-reflow (yes) 2.45 (1.25-4.80) p = 0.0085 Independent predictors of MACE in STEMI patients according to penalized proportional odds logistic regression analysis
Abstract Figure. Partial impact plots of predictors
Non-ST elevation myocardial infarction; admission to angiogram time at a busy district general hospital
Authors: Harris A , Prabhakar M , Mattar W 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Timely management of acute coronary syndromes, including patients presenting with non-ST elevation myocardial infarction (NSTEMI), is crucial in improving outcomes and reducing mortality. Clinical Guideline 94 (CG94) by National Institute of Health and Care Excellence (NICE) states that patients presenting with a NSTEMI with an intermediate or higher risk score should be offered coronary angiography within 96 hours of admission to hospital.

Purpose
The purpose of this audit is to assess how well our General Hospital adhered to the recommended NSTEMI intervention set by the NICE guidelines.

Methods
Data was collected between September and December 2019 for patients admitted with an NSTEMI to the cardiology department at our General Hospital. Data was analysed using in-patient paper notes and Microsoft Excel.

Results
Of the 54 patients admitted with NSTEMI, 67% met the NICE guideline for angiogram within 96 hours of admission. The most common reason for delay was infection or raised inflammatory markers (28%). Other medical reasons include pulmonary oedema (11.1%), acute kidney injury (11.1%) and stroke (11.1%). Another notable reason for delay to angiogram was weekend admissions and wait for cardiology bed (22.2%). Six-month mortality rates showed that, 75% of deceased patients did not undergo an angiogram within 96 hours of admission.

Conclusion
We have an elderly population with multiple co-morbidities. Therefore, whilst patients are being managed for other acute medical problems they are deemed unfit for an immediate angiogram ultimately causing a delay. Furthermore, some patients were not referred to cardiology immediately after the NSTEMI event which causes delay in organising the angiogram. Finally, some patients were awaiting a cardiology bed in the Acute Admissions Unit. This causes delay as patients cannot undergo angiogram without a cardiology bed available for recovery. These delays are causing significant differences in the mortality rates of NSTEMI patients.
In order to address these issues, a hospital guideline for junior doctors regarding the management of NSTEMIs has been designed and distributed. The guideline emphasises the importance of early cardiology referral, the management of acute medical problems in NSTEMIs such pre-hydration to prevent acute kidney injury, and the medical management of NSTEMIs in line with the 2020 ESC guidelines. Finally, it would be useful to re-audit these findings to assess if mortality rates and adherence to the NICE and ESC guidelines improve following these interventions.
Symptoms, ecg-changes and family history of cardiac disease precedes sudden cardiac death in hypertrophic cardiomyopathy - A nationwide study among the young in Sweden 2000-2010
Authors: Borjesson E , Wisten A , Borjesson M , Stattin E-L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND - Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease associated with increased morbidity and mortality, and may be the most common cause of sudden cardiac death (SCD) in the young.
PURPOSE - To characterize detailed family history, symptoms, hospital utilization and ECG-changes before SCD due to HCM.
METHODS - Cases were identified using the SUDDY.se cohort database, a nationwide comprehensive cohort consisting of 903 individuals aged 0-35, who suffered from SCD, in Sweden 2000-2010. The database also includes five population-based controls from Statistics Sweden, per case, together with parents of cases and controls (n = 15 633). Our database encompasses data from mandatory national registries together with the autopsy reports, medical records, ECGs (also military conscript), and detailed family history from an interview-based questionnaire (relatives, post-mortem). All individuals with autopsy findings or clinical diagnosis pre-mortem consistent with HCM were included in the study.
RESULTS- HCM was the cause of death in 38 cases, (38/903, 4,2%); 31 male and 7 female, mean age 22 years. The majority of cases (27/38= 71%) presented with possible cardiac symptoms (Including chest pain (10/27 = 26,3%), syncope 22%, palpitations 37%), prior to death. A majority,69%, were attending hospital or outpatient care (vs 21% in controls) within 180 days prior to death. The majority of cases (68%) died during recreational activity (n = 14; 37%) or exercise/competitive sports (n = 12; 31%). In seven of the 12 sports-related cases, death occurred during competitive sports, with basketball being the most common sport (43%). Almost half of the cases had a known cardiac disorder prior to death (15/38, 39%), where HCM was diagnosed premortem in nine cases (9/38, 24%). In addition, we found that over half of the SCD-cases with HCM, presented with an abnormal ECG (n = 22; 58%) prior to death, 12 (55%) in the absence of symptoms. Half of the cases (n = 19) had a positive family history (1st-3rd generation) for heart disease.
CONCLUSION(S) - In this nation-wide study of SCD due to HCM, more than 2/3 of cases, had experienced cardiac symptoms prior death, and a high percentage was seeking hospital or outpatient care, in the last 6 months prior to death. A positive family history for cardiac disease, as well as ECG-abnormalities, was seen in half of the cases, respectively. These findings demonstrate that clinical screening including ECG and family history is of great importance in identifying individuals at risk of SCD due to HCM. Such screening, as well as increased attention to possible cardiac symptoms in the young, should possibly be expanded beyond professional athletes to aid prevention of SCD in the young population with HCM.
The quality of life in patients with takotsubo syndrome in the remote period of disease
Authors: Leonova I , Evdokimov D , Boldueva S , Feoktistova V 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
The quality of life in patients with takotsubo syndrome in the remote period of disease
Purpose of the study. To assess the quality of life and the severity of symptoms of heart failure (HF) in patients with takotsubo syndrome (TTS) in the long-term period of the disease.
Material and methods. 25 patients (women, mean age 57.5 ± 28.5 years) with TTS diagnosed based on InterTAK criteria were included in the study. The quality of life was assessed at the prehospital stage and one year after the acute episode using the following questionnaires: Minnesota CHF Quality of Life Questionnaire (MLHFQ), a scale for assessing the clinical state of a patient with heart failure, Health-related quality of life questionnaire (HeartQoL).
Results. When comparing the data of the MLHFQ questionnaire on the quality of life at the prehospital stage and one year after discharge, a significant decrease in the quality of life was revealed (before hospitalization - 19.6 ± 2.7 points, one year after - to 24.2 ± 2.8 (p &lt; 0.01). According to the HeartQoL questionnaire, a significant decrease in the quality of life was also revealed: a year after the disease in comparison with the initial data (from 31.2 ± 1.4 points decreased to 29.4 ± 1.2) (p &lt;0, 01). When comparing the results of assessing the clinical state before hospitalization, at the time of hospitalization and a year after discharge, an increase in the severity of CHF manifestations was noted (before hospitalization 1.2 ± 0.2; in the acute period - 6.5 ± 0.3; after year after discharge from the hospital - 3.8 ± 0.2) (p &lt;0.01).
Conclusions. After a year of follow-up, patients with CT showed a decrease in the quality of life and an increase in the severity of symptoms of heart failure compared to the period before the acute episode.
Cardiopulmonary exercise testing in repaired tetralogy of Fallot: a valuable tool for pulmonary regurgitation severity assessment
Authors: Garcia Bras P , Sousa L , Mano T , Monteiro A , Rito T , Ilhao Moreira R , Rio P , Silva S , Martins C , Coito S , Capile E , Agapito A , Ferreira R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction and purpose
The optimal timing for pulmonary valve replacement (PVR) in asymptomatic patients with repaired tetralogy of Fallot (TOF) and pulmonary regurgitation (PR) remains uncertain but is often guided by imaging characterization of the right ventricle. As cardiopulmonary exercise testing (CPET) performance is an accessible prognostic indicator, we assessed which CPET parameters best correlate with pulmonary regurgitation severity to potentially improve identification of high-risk patients.

Methods
A retrospective chart review was done from 2009 to 2018 on adult patients with repaired TOF who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected.

Results
Cardiopulmonary exercise testing was performed in 54 adult repaired TOF patients (59% male), with a mean follow-up of 60 ± 33 months. The mean age was 34 ± 9 years. 30 patients (56%) had severe pulmonary regurgitation and 26 patients (48%) were submitted to PVR, with a 0% mortality rate. PVR was performed a mean 28 ± 7 years after TOF repair surgery. There was moderate to severe right ventricular dysfunction in 11 patients (20%). 12 patients (22%) had a hospitalization for heart failure. Arrhythmic events occurred in 9 patients (17%), mainly atrial fibrillation or atrial flutter (67%). 2 patients (4%) received an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death.
Peak VO2 consumption (pVO2) showed no statistically significant correlation with severity of pulmonary regurgitation (HR 0.26, 95% CI 0.879-1.036, p= 0.262) or PVR (HR 0.92, 95% CI 0.829-1.028, p = 0.914), while percent of predicted pVO2 significantly correlated with severity of pulmonary regurgitation (HR 0.95, 95% CI 0.918-0.993, p = 0.020) and PVR (HR 0.94, 95% CI 0.886-0.992, p = 0.025).
VE/VCO2 slope was not a significant predictor of severity of pulmonary regurgitation (HR 1.03, 95% CI 0.929-1.130, p = 0.622) or PVR (HR 1.04, 95% CI 0.952-1.128, p = 0.414) or) and neither cardiorespiratory optimal point (HR 0.94, 95% CI 0.786-1.120, p = 0.480) nor maximum end-tidal carbon dioxide pressure (PETCO2) (HR 0.93, 95% CI 0.846-1.037, p = 0.213) correlated with severity of pulmonary regurgitation or PVR.

Conclusion
Percent of predicted peak VO2 had the highest predictive power of all CPET parameters analysed in adult repaired TOF patients. Preoperative CPET could be an accessible way to identify high-risk patients earlier for PVR and should therefore be included in the routine assessment of these patients.
Association between red blood cell transfusions and adverse effects after transcatheter aortic valve replacement- a meta analysis
Authors: Abdul Razzack A , Pothuru S , Mandava S , Adeel Hassan S , Theja Reddy K , Missael Rocha Castellanos D , Arshad J , Sattar Y 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging.
Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI).
Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p &lt; 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p &lt; 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p &lt; 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0)
Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution
Abstract Figure.
A systematic review and meta-analysis of the role of statins and their intensity in peripheral artery disease
Authors: Sagris M , Katsaros J , Giannopoulos S , Kokkinidis DG 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Peripheral artery disease (PAD) affects more than eight million Americans. However, several studies have shown that those patients are often undertreated, and that statin utilization is suboptimal. American Heart Association guidelines highlight statins as the first-line lipid-lowering therapy to treat patients with PAD. Our objective with this meta-analysis was to further explore the impact of statins on PAD outcomes and examine whether the actual statin (high vs low intensity) dose impacts outcomes.

Methods
We performed a systematic review and meta-analysis according to the PRISMA guidelines. Any study that presented a comparison of statins vs no statins for PAD patients or compared high vs low intensity statins and provided outcomes with hazard ratio was considered as potentially eligible. The Medline (PubMed) database was searched up to August 30, 2020. A random effects meta-analysis was performed.

Results
In total, 38 studies and 275,670 patients were included in this meta-analysis. In total, 136,025 (49.34%) were on statins vs 139,645 (50.66%) who were not on statins. Statins had an association with a reduction in all cause-mortality by 42% (HR:0.58, 95% CI: 0.49-0.67, I2= 96.26%) and cardiovascular death by 43% (HR:0.57, 95% CI: 0.40-0.74, I2= 80.39%). Statins use was associated with an increase in amputation-free survival by 56% (HR:0.44, 95% CI: 0.30-0.58, I2 = 15%). The risk of amputation and loss of patency was reduced by 35% (HR:0.65, 95% CI:0.41-0.89, I2 = 86.91%), 46% (HR:0.54, 95% CI: 0.34-0.74, Ι2 = 0%), respectively. Statins use was also associated with a reduction in the risk of major adverse cardiovascular events (MACE) by 35% (HR:0.65, 95% CI: 0.51-0.80, I2= 93.22%) and the incidence of myocardial infarction (MI) by 41% (HR:0.59, 95% CI: 0.33-0.86, I2 = 76.78%). Among patients treated with statins, high-intensity treatment group was associated with a reduction in all cause-mortality by 36% (HR:0.64, 95% CI: 0.54-0.74, I2 = 96.49%) compared to patients treated with low intensity statins.

Conclusion
Statin treatment among patients with PAD was associated with a statistically significant reduction in all-cause mortality, cardiovascular mortality, MI, MACE, risk for amputation or loss of patency. Statins were also associated with a higher amputation free survival.
24-hour blood pressure monitoring in hypertensive patients with abdominal obesity in the dynamics of antihypertensive treatment
Authors: Penkova MARINA , Koval SERGEY , Mysnychenko OLGA , Starchenko T , Rieznik L 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
24-hour blood pressure monitoring (ABPM) is an additional method for examining patients with arterial hypertension (AH). The list of indications for its implementation is constantly expanding. One of the most important indications is the evaluation of the effectiveness of treatment against the background of physical and emotional stress.

Aim
study of the parameters of 24-hour blood pressure monitoring in patients with AH and AO in the dynamics of antihypertensive therapy.

Methods
120 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: ACE inhibitors perindopril, thiazide diuretic indapamide and calcium antagonist amlodipine once in the morning at doses: 4 mg / 1.25 / 5 mg; 4 mg / 1.25 / 10 mg; 8 mg / 2.5 / 5 mg; 8 mg / 2.5 / 10 mg. ABPM was performed according to the standard method before and after 6 months of treatment.

Results
24-hour systolic blood pressure (SBP) and 24-diastolic blood pressure (DBP) in patients were 148 (141-158) / 97 (81-101) mm Hg. 24-hour pulse blood pressure - 59 (51-63) mm Hg. The SBP time index was 86 (67-96)%, the DBP time index was 84%. Daytime SBP variability in patients was 17 (11-20) mm Hg, daytime DBP variability was 13 (8-14) mm Hg. SBP variability at night was 14 (9-13) mm Hg, DBP variability at night was 10 (8-12) mm Hg. As a result of treatment, the target blood pressure level was achieved in 69% of the examined according to the data of the office measurement of blood pressure and in 50% of the patients according to the results of ABPM. The number of patients with pathological variability of blood pressure decreased from 47% to 25% (p &lt;0.05). An excessive morning rise in SBP at the beginning of the study was noted in 30% of patients, and at the end of the observation - in 15% (p &lt;0.05). Morning BP dynamics was in 43%, and after therapy in 23% (p &lt;0.01). The number of patients with nocturnal hypertension decreased from 75% to 35% after 6 months of treatment (p &lt;0.0001). The distribution of patients by blood pressure profiles revealed that at the beginning of the study, the "diper" type was in 44% of the patients, the "over-diper" type in 22% of the patients, the "non-diper" type was in 28%, and the "night-picker" type was observed at 6%. After 6 months of treatment, the number of patients with the "diper" profile increased to 73%, and the number of patients with the "over-diper" profile decreased to 7%, the number of patients with unfavorable non-diper and night-picker profiles changed to 5% and 1% of patients, respectively.

Conclusion
The fixed combination of perindopril, indopamide and amlodipine led to the normalization of all parameters of the 24-hour BP profile in hypertensive patients with AO. Treatment was not accompanied by metabolic disturbances in these patients.