bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trimetazidine as adjunctive therapy for decreasing major adverse cardiac events in coronary artery disease patients undergoing reperfusion strategy: a meta-analysis of randomized controlled trials
Authors: Saroca C G , Tan J D , Tiongco R H 
Published: October 2021

Abstract

Background
Trimetazidine as adjunctive therapy in cardioischemic patients has shown improvement in angina and left ventricular ejection fraction. Recent trials have conflicting evidence on its effect on hard clinical outcomes.

Purpose
The objective of this meta-analysis is to compare the efficacy of trimetazidine versus placebo in reducing cardiac mortality and major adverse cardiac events (MACE) in coronary artery disease patients after reperfusion strategy.

Methods
A literature search was done using the terms “coronary artery disease” OR “acute myocardial infarction” OR “stable angina pectoris” AND “percutaneous coronary intervention” OR “thrombolysi” OR “reperfusion” AND “trimetazidine” OR “trimetazidine dihydrochloride” AND “randomized controlled trial”. We included trials using trimetazidine versus placebo in coronary artery disease patients who underwent percutaneous coronary intervention or thrombolysis. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were cardiac mortality and combined major adverse cardiac events; secondary outcomes were repeat revascularization, heart failure after reperfusion, stent restenosis, recurrence of angina, and reinfarction. Risk ratios were calculated for pooled data using random effects and fixed effects models.

Results
This study included five trials involving a total of 26,977 patients. Trimetazidine in comparison to placebo was associated with lower cardiac mortality and combined MACE, but results were not significant. Among secondary outcomes, only stent restenosis was significantly reduced (risk ratio, 0.53; 95% CI, 0.34–0.83; p=0.006).

Conclusion
Trimetazidine as adjunctive therapy does not reduce cardiac mortality, combined MACE, repeat revascularization, heart failure, recurrence of angina and reinfarction in coronary artery disease patients after reperfusion. However, it does significantly reduce stent restenosis in the said population. Further trials should be conducted with more standard dosing regimens, duration of therapy, and similar severities of ischemic disease.

Funding Acknowledgement
Type of funding sources: None.
New onset atrial fibrillation in STEMI patients: main prognostic factors and clinical outcome
Authors: Barbieri L , Dal Zotto B , Tumminello G , Saviano M , Gentile D , Lucreziotti S , Frattini L , Tarricone D , Carugo S 
Published: October 2021

Abstract

Background
New onset atrial fibrillation (NOAF) is not a so rare condition among patients hospitalized for ST-segment elevation myocardial infarction (STEMI). Several studies showed that NOAF during an acute coronary syndrome (ACS) leads to increased mortality, both at short and long term. The indications for the treatment of patients with known AF undergoing percutaneous coronary interventions (PCI) are clear, while less is available about the management of NOAF during ACS and in particular during STEMI. The purpose of this study is therefore to evaluate mortality and clinical outcome of this high risk subgroup of patients.

Methods
We analysed 1455 consecutive patients undergoing coronary angiography and/or PCI for STEMI. CHA2DS2-VASc and HAS-BLED scores were calculated for all patients. In-hospital, 1-year and long-term follow up mortality was evaluated for all patients. Cerebral ischemic and hemorrhagic events were also evaluated as clinical endpoints at 1 year.

Results
NOAF was detected in 102 subjects, 62.7% males, with a mean age of 74.8±10.6 years. We found a high prevalence of main cardiovascular risk factors such as hypertension, dyslipidemia, smoke and renal failure. Mean ejection fraction (EF) was 43.5±12.1% and the mean atrial volume was increased (58±20.9 ml). The most represented type of MI at admission was anterior STEMI (46%). NOAF occurred mainly in the peri-acute phase and had a very variable duration (8.1±12.5 min). During hospitalization all patients were treated with Enoxaparin, but only 25.2% of them were discharged with long term oral anticoagulation (16.7% warfarin, 4.9% direct oral anticoagulant). The majority of patients had a CHA2DS2-VASc score &gt;2 and a HAS-BLED score of 2 or 3. In-hospital mortality was 14.2%, while 1-year mortality was 17.2% and long term mortality 32.1% (median follow-up time 1820 days, range 341 to 3985). Through a logistic regression analysis we identified age as an independent predictor of mortality both at short and long term follow up, while EF was the only independent predictor for in-hospital mortality and arrhythmia duration for 1-year mortality. At 1-year follow up we recorded three ischemic strokes, while no bleeding complications.

Conclusions
STEMI patients who develop NOAF are a very high-risk population and are characterized by increased short and long term mortality. NOAF should be diagnosed and treated as soon as possible with a correct indication to long term OAC based on the ratio between ischemic and hemorrhagic risk.

Funding Acknowledgement
Type of funding sources: None.
Meta-analysis comparing sirolimus bioresorbable scaffolds versus everolimus-eluting metallic stents in coronary arterial disease
Authors: Prasad R P , Al-Abcha A A , Elshafie A , Radwan Y A , El-Sayed M ,   Michigan State University - Sparrow Hospital
Published: October 2021

Abstract

Introduction
In the acute setting, thin-strut bioresorbable scaffolds (BRS) are noninferior versus the thin-strut drug-eluting stent. Recently, randomized controlled trials (RCTs) with long-term follow-up data have been published.

Purpose
To evaluate the long-term clinical outcomes of sirolimus BRS versus the benchmark everolimus DES.

Methods
We reviewed the literature and conducted a meta-analysis of all RCTs comparing sirolimus BRS versus metallic DES stents in patients with CAD. The primary outcomes were all-cause mortality and target vessel failure (TVF). Furthermore, secondary outcomes included cardiac mortality, target vessel myocardial infarction, ischemia-driven target lesion revascularization (TLR), and stent thrombosis (probable and definite). Statistical analysis was conducted using Review Manager 5.4. Two-sided p values of &lt;0.05 were considered as statistical significance.

Results
A total of 15,930 patients were included with a median-weighted follow up period of 1.68 years. Heterogeneity was low-high across the trials (0–87%). All-cause mortality was insignificant between the two groups (OR 0.95; 95% CI 0.79–1.14; p=0.57) (Figure 1). The rate of TVF showed a trend favoring sirolimus BRS compared to everolimus DES with statistical significance (OR 0.84; 95% CI 0.73–0.98; p=0.02) (Figure 1). Ischemia-driven TLR also statistically favored sirolimus BRS (OR 0.64; 95% CI 0.53–0.77; p&lt;0.ehab724.12301) (Figure 2). Otherwise, all other secondary outcomes favored sirolimus BRS without statistical significance (Figure 2).

Conclusion
This updated meta-analysis illustrates that in the long term setting sirolimus BRS has significantly decreased rate of TVF and ischemia-driven TLR as compared to everolimus DES. However, there was no statistical difference in the all-cause mortality or cardiac mortality.

Funding Acknowledgement
Type of funding sources: None.
Prognostic significance of percutaneous coronary intervention associated blood loss in acute coronary syndrome
Authors: Monteiro E , Pedro Barbosa J , Guimaraes J , Fernandes D , Costa G , Gomes A , Saleiro C , Campos D , Sousa J , Lopes J , Puga L , Teixeira R , Lourenco C , Madeira M , Goncalves L 
Published: October 2021

Abstract

Background
Antiplatelet and anticoagulants are one of the mainstay treatment of acute coronary syndrome (ACS), however they are associated with a significant increase of bleeding risk. While anaemia is a recognized predictor of adverse outcomes, it is unknown if a variation of haemoglobin (HB) levels, even without associated anaemia, has the same impact.

Purpose
The aim of this study was to determine the prognostic impact of HB variation after percutaneous coronary intervention (PCI) in ACS patients.

Methods
Retrospective analysis of 822 consecutive patients admitted due to ACS and treated with PCI, in a single coronary intensive care unit. Delta HB – ΔHB – (HB at admission – HB 24 hours after PCI) was calculated. Clinical variables and therapeutic strategies were examined. The primary endpoint analysed during follow-up was all-cause mortality. Possible predictors for all-cause mortality were assessed by Cox regression models. When statistically significant values were found in univariate analysis, multivariate analysis was used to determine whether ΔHB was independent from other known factors in predicting the outcome.

Results
In the studied sample, 75.4% were male. Mean age was 66.4±13.1. ST-elevation myocardial infarction (STEMI) occurred in 45.5%, non-ST segment elevation myocardial infarction in 42.6% and unstable angina in 11 9% of the studied population. Moderate to severe systolic dysfunction was present in 23.5% of the cases. Regarding comorbidities and past medical history, 76% had hypertension (HTN), 30.3% diabetes, 16.4% chronic kidney disease (CKD), 62.2% dyslipidaemia and 10.5% heart failure (HF). Mean HB at admission was 13.8±1.8 g/dL, mean HB after PCI was 12.9±1.9 g/dL and mean ΔHB was 0.9±1.1 g/dL. The mean follow-up was 51.6±30.6 months. In univariate analysis, ΔHB was significantly associated with all-cause mortality (HR 1.15 per 1 g/dL loss, 95% CI 1.01–1.30, p=0.04), as was HB at admission, HB after PCI, age, sex, diabetes, HTN, dyslipidaemia, CKD and moderate to severe systolic dysfunction. In multivariate analysis, ΔHB remained significantly associated with the endpoint and gained even more statistical power (HR 1.25, 95% CI 1.10–1.43, p&lt;0.01). HB at admission and after PCI, age, CKD and moderate to severe systolic dysfunction were also independent predictors of this outcome.

Conclusions
In our study, irrespective of the admission and discharge HB, ΔHB was associated with more adverse outcomes in patients submitted to PCI. Hence, even patients with a normal HB after PCI have a worse long-term prognosis if a negative variation of HB occurs. This highlights the importance of identifying and optimising all the correctable factors that might lead to an increased bleeding risk.

Funding Acknowledgement
Type of funding sources: None.
Predictors of patient and system delay for primary percutaneous coronary intervention
Authors: Candjondjo A , Ferreira J , Esteves A , Farinha J , Fonseca M , Coelho R , Gama L , Sa C , Lopes A , Fernandes A , Perdigao A , Seixo F , Fonseca N , Santos R , Caria R 
Published: October 2021

Abstract

Background
The delay times of the patient and the system for primary percutaneous coronary intervention (p-PCI) have a determining impact on the prognosis of patients with acute myocardial infarction with ST segment elevation (STEMI).

Purpose
To identify the predictors of patient and system delay for p-PCI in the period of 2020 at a reference hospital for p-PCI.

Methods
Patients submitted to p-PCI in the period from March to September 2020 were included and compared with the same period in 2019. We analyzed the differences between the two groups regarding the patient's delay times, time from the onset of symptoms to the first medical contact (FCM) and the system (time from the first contact with the health system to p-ICP). Data collection of the patient's previous history, coronary intervention performed and post-PCI follow-up was performed using the electronic patient record. Univariate analysis and logistic regression models from multivariate analysis were used to determine the predictors of “patient delay” and “system delay” and adjusted for confounding factors. The analysis was performed with a significance level of 5%.

Results
We included in the study 255 patients who underwent p-PCI, of which 122 in the period from 2020 and 133 in the period from 2019. Regarding the characteristics of the population, there were no significant differences between the two periods. Regarding the patient's delay time, there were no statistically significant differences. The variable first medical contact with a non p-PCI center was the only variable associated with system delay&gt;90 minutes in the multivariate analysis, OR (6.18: 95% CI, 1.91–20), p=0.002. There was a statistically significant association between the period of 2020 (pandemic period) and total ischemia time, but with a negative effect, dependent variable adjusted for confounding factors [adjusted OR: −0.10; 95% CI: −107.61 to −5.57; p=0.03].

Conclusion
In this study, the patient's admission to a non p-PCI centers was identified as the only predictor of longer delay until p-PCI (system delay). However, these results should serve as a contribution to decision making in order to mitigate risks, regardless of any associated catastrophe and eventually alert the population not to neglect the symptoms suspected of acute myocardial infarction.

Funding Acknowledgement
Type of funding sources: None.
Use of biomedical photonics for in vivo and in vitro assessment of haemostasis and microcirculation in patients on antithrombotic therapy
Authors: Matskeplishvili S , Gurfinkel Y U , Dyachuk L , Lugovtsov A , Ermolinskiy P , Pigurenko A , Priezzhev A , Matskeplishvili S 
Published: October 2021

Abstract

Background
Antithrombotic therapy in patients with cardiovascular disease requires rapid translation of laboratory assessment of haemorrheological parameters in clinical cardiology practice. Both antiplatelet and anticoagulant agents, especially when used in combination, can potentially increase the risk of severe bleeding. The precise balance between thrombosis and hemorrhage is therefore pivotal to ensure optimal treatment results.

Purpose
To develop simple and reliable methods to control the haemorheological properties of the blood and to assess the risk of potential bleeding.

Methods
We assessed platelet aggregation parameters measured in vitro by laser aggregometry and optical trapping techniques in blood samples of 131 patients with coronary artery disease. Additionally, blood rheology and microcirculation parameters were assessed in vivo in the nail-fold area using the digital capillaroscopy system.

Results
We found a statistically significant correlation between the number of aggregated blood cells in vitro and the presence of aggregates in the blood capillaries in vivo. A significant correlation was also observed between red blood cells (RBC) aggregation time in vitro and capillary flow velocity in vivo. The most severe deterioration of the rheological properties was found in patients with diffuse atherosclerotic disease receiving combined antithrombotic therapy.
Interestingly, optical examination of soft tissues surrounding the capillaries of the nail-fold area revealed the presence of micro-hemorrhages in patients with history of hemorrhagic complications on antithrombotic therapy (Fig. 1).

Conclusion
Novel methods of biomedical photonics applied for in vivo and in vitro assessment of the blood haemorrheological properties can provide important additional information on microcirculation parameters and optimize treatment in patients on antithrombotic therapy.

Funding Acknowledgement
Type of funding sources: None. In vivo nail-fold digital capillaroscopy
Post-procedure anticoagulation in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Yan Y , Gong W , Ma C , Wang X , Smith Jr S C , Fonarow G , Morgan L , Liu J , Vicaut E , Zhao D , Montalescot G , Nie S ,   the CCC-ACS Investigators
Published: October 2021

Abstract

Background
Post-procedural anticoagulation (PPAC) after primary percutaneous coronary intervention (pPCI) in patient with ST-segment elevation myocardial infarction (STEMI) may prevent recurrent ischemic events but may increase the risk of bleeding. No consensus has been reached on PPAC use.

Methods
Using data from the CCC-ACS registry, conducted between 2014 and 2019, we stratified all STEMI patients who underwent pPCI according to the use of PPAC or not. Inverse probability of treatment weighting (IPTW) and Cox proportional hazards model with hospital as random effect were used to analyze differences in in-hospital clinical outcomes: the primary efficacy endpoint was mortality, and the primary safety endpoint was major bleeding.

Results
Of 34,826 evaluable patients 26,272 (75.4%) were treated with PPAC, and were on average younger, more stable at admission with lower bleeding risk score, more likely to have comorbidities and multivessel disease, and more often treated within 12 hours of symptom onset than those without PPAC. After IPTW adjustment for baseline differences, PPAC was associated with significantly reduced risk of in-hospital mortality (0.9% vs. 1.8%; hazard ratio (HR): 0.62 [95% confidence interval 0.43, 0.89]; p&lt;0.001) and a nonsignificant difference in risk of in-hospital major bleeding (2.5% vs. 2.2%; HR: 1.05 [0.83, 1.32]; p=0.14).

Conclusions
PPAC in STEMI patients after pPCI was associated with reduced mortality without increasing major bleeding complications. Dedicated randomized trials with contemporary STEMI management are needed to confirm these findings.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Improving Care for Cardiovascular Disease in China – Acute Coronary Syndrome (CCC-ACS) project is a collaborative study of the American Heart Association (AHA) and the Chinese Society of Cardiology (CSC). The AHA has been funded by Pfizer and AstraZeneca for quality improvement initiatives through an independent grant. In-hospital clinical outcomes
Different inflammatory markers reflect different platelet reactivties in percutaneous coronary intervention patients treated with clopidogrel: a large sample study from China
Authors: Li J , Yuan D , Yang Y , Gao R , Xu B , Yuan J , Zhao X ,   State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases
Published: October 2021

Abstract

Background
Platelet reactivity is closely associated with thrombosis and bleeding events in percutaneous coronary intervention (PCI) patients treated with clopidogrel. Inflammation also plays a crucial role in the development of coronary heart disease. How inflammation affects platelet reactivity needs furthrt study.

Aim
To investigate the association of inflammatory markers including leukocyte count and high-sensitivity C reactive proteins (hs-CRP) with platelet reactivity in PCI patients treated with clopidogrel.

Method
A total of 6772 PCI patients treated with clopidogrel who have the results of postoperative thromboelastogram (TEG) from January 2013 to December 2013 were enrolled. High on-treatment platelet reactivity (HTPR) was defined as adenosine diphosphate (ADP)-induced platelet maximum amplitude [MA(ADP)] of TEG &gt;47 mm, and low on-treatment platelet reactivity (LTPR) was defined as MA(ADP) &lt;31 mm.

Results
Among 6772 PCI patients, 2070 (30.57%) presented HTPR and 2568 (37.92%) presented LTPR. As for LTPR, multivariate logistic regression showed that increased leukocyte count (OR 1.153, 95% CI 1.117–1.191) and decreased hs-CRP (OR 0.920, 95% CI 0.905–0.936) were independent predictors, along with diabetes mellites (OR 0.868, 95% CI 0.759–0.993), hemoglobin (OR 1.023, 95% CI 1.019–1.028), platelet count (OR 0.997, 95% CI 0.996–0.998), and glucose (OR 0.962, 95% CI 0.931–0.994). As for HTPR, multivariate logistic regression showed that decreased leukocyte count (OR 0.885, 95% CI 0.854–0.917) and increased hs-CRP (OR 1.094, 95% CI 1.077–1.112) were independent predictors, along with sex (OR 0.636,95% CI 0.537–0.754), hemoglobin (OR 0.972, 95% CI 0.968–0.977), platelet count (OR 1.005, 95% CI 1.004–1.007), and glucose (OR 1.056, 95% CI 1.020–1.092).

Conclusions
This was the first large real-world study reporting that increased leukocyte count associated with more LTPR while increased hs-CRP associated with more HTPR in PCI populations treated with clopidogrel, which may contribute to understand the potential mechanism of the effect of inflammation on thrombosis and bleeding in patients with PCI.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Key Research and Development Program of China; Young and middle-aged talents in the XPCC Science and Technology Project
Role of inflammation in Myocardial Infarction with Non-Obstructive Coronary Arteries
Authors: Espinosa Pascual M J , Lopez Pais J , Izquierdo Coronel B , Nieto Ibanez D , Galan Gil D , Perela Alvarez C , Olsen Rodriguez R , Abad Romero R , Moreno Vinues C , Fraile Sanz A , Awamleh Garcia P , Mata Caballero R , Alonso Martin J J ,   IMACORN
Published: October 2021

Abstract

Background
The characteristics of patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) differ from those with Myocardial Infarction with Obstructive Coronary Artery Disease (MI-CAD). Thus, the mechanisms involved, such as inflammation, may be different. The objective of this study is to analyze the relationship between pro-inflammatory conditions and MINOCA, as well as the impact on their prognosis.

Methods
An analytical and observational study, including all patients admitted to our hospital with myocardial infarction and who underwent coronary angiography in the last four years (2016–2020; n=712). According to the definitions of the 2019 AHA Scientific Statement on Diagnosis and Management of MINOCA and ESC 2020 guidelines on Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation, we classified the patients into two groups: MI-CAD (n=643) and MINOCA (n=69). Besides general data, we recorded specific information about pro-inflammatory conditions (prevalence of autoimmune diseases, connective tissue disorders, and active infections and neoplasms). We also assessed C-reactive protein (C-RP) at admission, peak CK-MB and troponin levels. Follow-up analysis included death from any cause, major adverse cardiac events (MACE: cardiac death, MI, stroke), readmissions due to cardiovascular causes, and in-hospital mortality.

Results
The composite of pro-inflammatory conditions (autoimmune pathologies, connective tissue diseases and active cancer and infections) was significantly higher in the MINOCA group (30.4% vs 14.6%, p&lt;0.001). Patients with MINOCA had higher rates of connective tissue disorders (5.8% vs 1.4%, p 0.01), and autoimmune diseases (14.5% vs 7.8%, p 0.058) tended to be more frequent in these patients. However, MINOCA patients had lower C-RP levels (180 vs 206mg/L, p&lt;0.001), probably because they have smaller infarcts (peak CK-MB: 228 vs 325 U/L, p&lt;0.001; high-sensitivity cardiac troponin T levels: 111 vs 176ng/L, p&lt;0.001). In the follow-up of MINOCA patients, MACE did not occur more frequently in those patients with inflammatory conditions (4.8% vs 13%, p 0.3) than those without them. Moreover, pro-inflammatory disorders were not related to significantly higher mortality from any cause (8.7% vs 10%, p 0.86) nor readmissions due to cardiovascular causes (19.6% vs 23.8%, p 0.6). Our median follow-up was 29 months. There were no differences in in-hospital mortality.

Conclusion
This study suggests that pro-inflammatory disorders may be a risk factor for developing MINOCA without resulting in an unfavourable short- and long-term prognosis. Further research is needed to confirm this finding and identify its optimal management.

Funding Acknowledgement
Type of funding sources: None.