bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term outcome in patients with Takotsubo syndrome: a single-center study from a city in Austria
Authors: Pogran E , Gargiulo L G , Abd El-Razek A A , Weihs V W , Kaufmann C K , Gepert A G , Nuernberg M N , Wesely E W , Smetana P S , Huber K H 
Published: October 2021

Abstract

Background
There is an increasing amount of evidence suggesting multiple fatal complications in Takotsubo Syndrome. However, findings on the long-term outcome are scarce and show inconsistent evidence.

Methods
This is a single-center study of long-term prognosis in Takotsubo patients admitted from September 2006 to August 2019. We investigated the clinical features, prognostic factors and outcome of patients with Takotsubo syndrome. Furthermore, survivors and non-survivors and patients with a different cause of death were compared.

Results
Overall, 147 patients were included in the study. The mean age was 70 years (±12,3), and 85% of the study population were women. Forty-nine Takotsubo patients (33,3%) died during the follow-up, with a median of 126 months. The most common cause of death was a non-cardiac cause (71,4% of all deaths), especially malignancies (26,5% of all deaths). Moreover, non-survivors were older and more often men with more comorbidities (chronic kidney disease, malignancy). Patients who died because of cardiovascular disease were older and more often women than patients who died due to non-cardiovascular cause. Age showed to be the only independent prognostic factor of cardiovascular mortality (HR=1,11, CI: 0,99–1,25, p=0,05). Female gender (HR=0,32, CI: 0,16–0,64, p&lt;0,001), cancer (HR=2,35, CI: 1,15–4,8, p=0,019) and chronic kidney disease (HR=2,61, CI: 1,11–6,14, p=0,028) showed to be independent predictors of non-cardiovascular mortality.

Conclusion
Long-term prognosis of TTS patients is not favourable, mainly due to non-cardiac comorbidities. Hence, consequent outpatient care in relatively short time intervals after TTS event based on risk factor control and early detection of malignancies seems mandatory.

Funding Acknowledgement
Type of funding sources: None.
What are the predictors of heart failure in patients admitted with acute coronary syndrome? Data from a large national registry
Authors: Timoteo A , Aguiar Rosa S , Mano T , Cruz Ferreira R ,   ProACS Investigators
Published: October 2021

Abstract

Background
Heart failure (HF) is a serious and frequent complication of acute myocardial infarction with important impact in outcome. Early treatment according to contemporaneous guidelines is essential to avoid that complication. Previous ischemic heart disease and HF are important predictors. Our objective is to identify additional predictors of HF in patients admitted with acute coronary syndrome (ACS).

Methods
Analysis of all consecutive patients prospectively included in a large national registry of ACS. Patients with a previous history of ACS, myocardial revascularization or heart failure were excluded from the analysis. The group that developed HF was compared with the group without HF and multivariate logistic regression analysis was performed to identify independent predictors of HF during hospitalization (Killip class &gt;1).

Results
A total of 19,248 patients were included, and 17.3% developed HF during hospitalization. Patients with HF were older, less often males and smokers, and more often with hypertension and diabetes, as well as other comorbidities (p&lt;0.001). ST elevation myocardial infarction (STEMI), atrial fibrillation, mechanical and electrical complications are also more frequent. Patients that developed HF have higher in-hospital mortality (0.9% vs. 12.1%). Independent predictors of HF are female gender (OR 1.64, 95% CI 1.15–2.33), age (1.42, 1.25–1.62, per 10-year increase) diabetes (1.97, 1.44–2.69), atrial fibrillation (2.65,1.66–4.23), STEMI (2.30, 1.70–3.10), multivessel disease (1.52, 1.13–2.05) and initial admission in a hospital without catheterization laboratory as a protective factor (0.71, 0.52–0.96). In STEMI patients, anterior location is also an independent predictor.

Conclusions
In patients admitted with a first ACS and without previous ischemic heart disease or heart failure, female gender, increasing age, diabetes, atrial fibrillation, STEMI and multivessel disease are the main predictors of worst outcome and these patients should be treated more aggressively to avoid HF development.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 pandemic and admission rates for and management of acute coronary syndromes in Israel
Authors: Asher E , Fardman A , Zahger D , Orvin K , Mohsen M , Tsafrir O , Rubinshtein R , Jamal J , Efraim R , Kofman N , Halabi M , Shacham Y , Henri Fortis L , Beigel R , Matetzky S 
Published: October 2021

Abstract

Background
Since the COVID-19 pandemic outbreak several countries have reported a decrease in the number of patients admitted with non-ST elevation myocardial infarction (NSTEMI).

Purpose
We aimed to evaluate admission trend and outcomes of patients with NSTEMI in the COVID-19 era in a nationwide survey.

Methods
A prospective, multicenter, observational, nationwide study involving 13 medical centers across Israel. All NSTEMI patients admitted to intensive cardiac care units (ICCUs) over an 8-week period during the COVID-19 outbreak were compare them with NSTEMI patients admitted 2 years earlier (control period) during the Acute Coronary Syndrome Israeli Survey (ACSIS) 2018.

Results
There were 624 (43%) NSTEMI patients, of them 349 (56%) hospitalized during the COVID-19 era and 275 (44%) during the control period, representing a 27% increase in NSTEMI admission rate during the COVID-19 era. Approximately 76% were male, median age was 67 years (IQR 58–76). There were no differences in baseline characteristics between the two study periods. During the COVID-19 era, more patients arrived at the hospital via an emergency medical system (EMS) compared with the control period (p for trend = 0.005)
Time from symptom onset to hospital admission was longer in the COVID-19 era [687.00 (IQR147–2805) vs. 178.00 (IQR 102- 407), respectively, p-value &lt;0.001]. Nevertheless, time from hospital admission to reperfusion was similar in both groups. Rate of percutaneous coronary intervention was higher in the COVID-19 era group (91.3% vs. 59.7%, respectively, p&lt;0.001). In-hospital mortality rate was similar in both groups (2.3% vs. 4.7%, respectively, p=0.149) as was the 30-day mortality rate (3.7% vs. 5.1%, respectively, p=0.238).

Conclusions
In contrast to previous reports, in Israel, admission rate of NSTEMI was increased during the COVID-19 era. With longer time from symptoms to admission, but with the same time from hospital admission to reperfusion therapy and with similar in-hospital and 30-day mortality rates.

Funding Acknowledgement
Type of funding sources: None.
Oncostatin M is associated with adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction
Authors: Gusakova A M , Kercheva M A , Ryabova T R , Suslova T E , Ryabov V V 
Published: October 2021

Abstract

Introduction
The development of adverse left ventricular remodeling (LVR) after myocardial infarction (MI) remains a significant problem despite current achievements in invasive and pharmacological treatment. A large number of biomarkers are known that reflect various processes and pathophysiological mechanisms of the pathogenesis of MI and the development of adverse cardiovascular events in the post-infarction period. Oncostatin M (OSM) is a cytokine of the interleukin-6 family that is involved in the pathophysiology of cardiovascular diseases and takes part in processes of inflammation, tissue regeneration, cell development and growth.

Purpose
To assess the dynamics of serum levels of OSM and its association with the development of adverse left ventricular remodeling in the long-term post-infarction period in patients with acute primary myocardial infarction with ST-segment elevation (STEMI).

Methods
Subjects were 21 patients (59.2±8.1 y.o.) with STEMI, who underwent percutaneous coronary intervention during the first 24 h of the onset of MI. The serum level of OSM and echocardiography with 2D speckle tracking imaging were assessed at days 1 and 6 months after STEMI. The criterion of adverse LVR is an increased of end-diastolic (EDV) or/and end-systolic (ESV) volume more than 20% from admission to 6 month period.

Results
A significant increase of the serum levels of OSM during the first 24 hours of MI was detected [46.9 (18.9; 75.7)] pg/ml. A decrease of the OSM levels in 6 months after STEMI was revealed [13.1 (6.9; 19.6)] pg/ml (p&lt;0.0005). Correlation analysis showed strong positive association between the values of OSM with Troponin I (R=0.797 p=0.0001) and Nt-proBNP (R=0,713 p=0.0013). The relationship between OSM and Troponin I persisted in the long-term post-infarction period (R=0.751, p=0.0005). An inverse correlation between the OSM, measured at admission to hospital and the left ventricular ejection fraction at day 7 after MI was found (R=−0.63, p=0.023). Logistic regression analysis showed that the values of OSM at day 1 of the MI were associated with development of adverse LVR in the long term after STEMI. OSM level of more than 18.4 pg/ml at a time of admission was associated with the increased of ESV in 6 months after STEMI by more than 20% (p&lt;0.05).

Conclusions
Our study showed the serum levels of OSM statistically significantly decreased in 6 months after STEMI. The content of OSM was positive associated with Troponin I and Nt-proBNP. Elevated levels of OSM were associated with an increase of ESV in 6 months after STEMI. The serum levels of OSM can be used to predict of adverse remodeling in patients undergoing STEMI.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science
High levels of lipoprotein(a) are associated with the severity of coronary disease in patients with acute myocardial infarction. Data from the RICO survey
Authors: Farnier M , Chague F , Maza M , Bichat F , Beer J C , Masson D , Cottin Y , Zeller M ,   RICO survey
Published: October 2021

Abstract

Background
High level of lipoprotein(a), Lp(a), is a well-recognized independent risk factor for atherosclerotic cardiovascular disease (ASCVD) including acute myocardial infarction (MI). However, limited data are available on the relationship between coronary artery disease (CAD) burden and Lp(a) levels in patients with acute MI.

Methods
CAD burden was addressed in 1213 consecutive patients hospitalized for an acute MI in 2019–2020 who underwent coronary angiography from the RICO survey. Patients were compared according to Lp(a) levels (Lp(a) &lt;50 mg/dL (normal), ≥50 mg/dL and ≤100 mg/dL (high) and &gt;100 mg/dL (very high)).

Results
The prevalence of high and very high Lp(a) was elevated (13% and 6%, respectively). Median (IQR) age (normal: 68 (58–79)y; high: 70 (61–80)y; very high: 69 (60–78)y, p=0.502) and rate of diabetes (p=0.448) were similar across the 3 groups. When compared with normal Lp(a), patients with very high Lp(a) had more frequently hypertension, were more often under chronic statin therapy and their corrected LDL-cholesterol was lower. There was a gradual increase in prior ASCVD rates across the 3 Lp(a) groups (p=0.001). When compared with patients with high or normal Lp(a), patients with very high Lp(a) levels had elevated SYNTAX score at coronary angiography, (17 (6–25) vs 12 (6–19) and 10 (5–18), p=0.006, respectively), and had more frequently multivessel disease (74% vs 64% and 56%, p=0.003). By multivariate analysis, very high Lp(a) (OR(95% CI): 1.879 (1.065–3.312)) remained associated with high CAD burden, beyond confounding including age, diabetes and dyslipidemia.

Conclusion
Among real world patients hospitalized for an acute MI, high Lp(a) levels are common (≈20%) and independently associated with a severe CAD burden, beyond traditional risk factors, identifying a subset of patients with features of high ASCVD risk.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté
The relationship between high-sensitivity troponin taken on admission to critical care, regardless of whether there was a clinical indication for testing, and one year mortality
Authors: Hinton J , Augustine M , Gabara L , Mariathas M , Allan R , Borca F , Nicholas Z , Gillett N , Kwok C S , Cook P , Grocott M P W , Mamas M , Curzen N 
Published: October 2021

Abstract

Introduction
High-sensitivity troponin (hs-cTn) assays now form a key component of the diagnostic pathways for patients presenting to emergency medical services with chest pain. However, hs-cTn concentrations above the manufacturer-provided upper limit of normal (ULN) are now frequently reported in patients presenting with conditions not traditionally associated with type 1 myocardial infarction (T1MI). This is particularly true of severe illness states. We investigated the possible association between hs-cTn and 1 year mortality in critical care patients.

Method
Consecutive patients admitted to two adult critical care units (general critical care unit (GCCU) and neuroscience critical care unit (NCCU)) over a six month period had hs-cTnI assay performed on admission, regardless of whether there was a clinical indication, and the results nested unless a clinical request had been made. Comorbidity data, illness severity and critical care outcome were recorded and have been previously reported. One year mortality data were obtained from NHS Digital.

Results
After excluding patients diagnosed with T1MI by the clinical team, there were 1,033 patients remaining. At one year a total of 253 (24.5%) patients had died. The Kaplan-Meier curves in figure 1 demonstrate a positive association between mortality and increasing hs-cTnI concentrations relative to the ULN. Specifically, using the log-rank test, the mortality at one year was significantly higher (p&lt;0.001) in patients with hs-cTnI concentrations above the ULN. Furthermore, on multivariable Cox regression analysis, the log(10) hs-cTnI concentration was independently associated with the hazard of one year mortality (hazard ratio 1.587 (95% confidence interval 1.358–1.856).

Conclusions
These data suggest that admission hs-cTnI is a biomarker for one year mortality in critical care patients. Further work is now required to assess whether any medical intervention can alter this risk.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Beckman Coulter provided the assays for the tests used in this study. They had no other involvement in the study
Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome
Authors: Kumar D , Yasin U , Saghir T , Akbar Sial J , Khatti S , Khan K , Khan N , Naeem Mengal M , Qamar N 
Published: October 2021

Abstract

Background
High intensity statins are recommended in patients with acute coronary syndrome. Statins inhibit atherosclerotic plaque formation in the coronary arteries and reducing the burden of ischemic heart disease, therefore decreasing the morbidity and mortality. Muscle symptoms are most common adverse effect of statins. Hence, the aim of this study is to determine the statin induced myalgia by the statin myalgia clinical score.

Purpose
To monitor the Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome

Methods
This was an prospective observational study comprised of 418 patients with acute coronary syndrome who were commenced on high intensity statins (Rosuvastatin 20–40mg & Atorvastatin 40–80). These patients were followed at 4 weeks, 8 weeks and 12 weeks subsequently and the clinical myalgia score (SAMS-CI) was calculated at each visit to determine the statin induced myalgia. SAMS-CI was categorized as unlikely (2–6), possible (7–8) and probable (9–11)

Results
From 418 patients, 327 were males and 91 were females. Mean age was 55.6±11.14. Only 19 (7.63±1.8) patients developed muscle symptoms on high intensity statins (Rosuvastatin 20 mg and Atorvastatin 40 mg) on SAMS-CI Score. 5 patients were unlikely to develop myalgia on SAMS-CI and continued with the same dosage without any new symptoms. 6 patients were possible on SAMS-CI, therefore the dosage of these patients were decreased to moderate intensity statin (Rosuvastatin 10mg, Atorvastatin 20 mg), their symptoms were resolved and continued with the moderate intensity statins. Furthermore, Statin was hold in 8 patients in the probable category for 4 weeks until the resolution of symptoms followed by moderate intensity statins.

Conclusion
Statin induced myalgia is more reported in old aged and female patients. Most of the patients can better tolerate the lower range of high intensity statins with the similar benefits and should be prescribed in every patient

Funding Acknowledgement
Type of funding sources: None.
Temporal trends in adverse ischemic events, bleedings, kidney injury and overall mortality for patients with ST-elevation myocardial infarctions and advanced kidney disease
Authors: Schmucker J , Fach A , Osteresch R , Retzlaff T , Mata Marin L A , Garstka D , Hambrecht R , Wienbergen H ,   Bremen STEMI-registry
Published: October 2021

Abstract

Background
Although the negative effects of advanced chronic kidney disease (CKD) on the pathogenesis and prognosis of coronary artery disease (CAD) has been shown in prior studies, there is few data on the efficacy and safety of modern interventional therapies and medications in patients with advanced CKD. Aim of the present study was to analyse temporal trends in patients with ST-elevation myocardial infarctions (STEMI) and advanced CKD during the last 15 years.

Methods
All STEMI-Patients admitted to a German heart center between 2006–2019 were analysed. Advanced CKD, estimated with the CKD-EPI-equation, was defined as stage ≥G3b (glomerular filtration rate (GFR) &lt;45 ml/min). Cumulative ischemic events at 1 year were defined as a combination of in-stent-thrombosis, myocardial re-infarction and repeat target-lesion-revascularisation

Results
Of a total of 9605 patients, 1013 (10.6%) showed a moderately or severely (G3b-G5) reduced renal function with a mean baseline Serum creatinine of 2.2±4.2 mg/dl and a GFR of 32.3±10 ml/min/1.73 m2. CKD-Patients were less likely to be treated with a primary percutaneous coronary interention (PCI): 84.1 vs. 94.1% (p&lt;0.01) and showed higher all-cause-mortality (44.4 vs. 3.6%, p&lt;0.01) and bleeding-rates (9.4 vs 3.7%, p&lt;0.01) compared to non-CKD-patients at 1 year, while cumulative ischemic events did not differ (6.5 vs. 5.1%, p=0.12). Over time however, patients with advanced CKD were also more likely to be treated with primary PCI (2006–10: 75.8 to 2015–19: 90.1%, p&lt;0.01), ticagrelor/prasugrel (1.7 to 59.6%, p&lt;0.01) and drug eluting stents (DES: 1.3 to 90.7%, p&lt;0.01). After adjustment for confounders (multivariate analysis of outcomes adjusted for age, gender, diabetes and cardiogenic shock) patients with advanced CKD showed a decline in ischemic events at 1 year, however offset by an increase in bleedings (table). Neither overall mortality nor rates of acute kidney injury changed over time (table), despite an increase in amount of contrast media used (132±62 ml to 152±73 ml, p&lt;0.01). In patients with advanced CKD both ticagrelor/prasugrel (OR 0.48, 95% CI 0.2–0.98) and DES (OR 0.38, 95% CI 0.2–0.8) were associated with a decrease in ischemic-events.

Conclusions
This registry data shows, that during the last 15 years STEMI-patients with advanced CKD were more likely to be treated with primary PCI and are in their majority now treated with ticagrelor, prasugrel and modern DES. These changes in therapeutic strategies probably have contributed to the decline in adverse ischemic events, while overall mortality was not affected.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): State of BremenStiftung Bremer Herzen Multivariate outcome analysis over time
TOTAL risk score for predicting safe very early discharge in patients with ST-elevation myocardial infarction (STEMI)
Authors: Garg A , Rao-Melacini P , Quinn R , Ainsworth C , Belley-Cote E , Cairns J , Cantor W , Dzavik V , Gomez R M , Kedev S , Lavi S , Stankovic G , Jolly S 
Published: October 2021

Abstract

Background/Introduction
Previously validated risk scores for identifying low-risk patients after ST-segment elevation myocardial infarction (STEMI) have led to acceptance of the safety and feasibility of discharge after 48–72 hours of hospitalization, reducing hospital length of stay and costs. With ongoing improvements in outcomes, it may be possible to select patients who are safe to discharge very early (24–48 hours) but this has never been evaluated.

Purpose
We sought to develop and validate a novel risk score for identifying low-risk patients suitable for very early discharge (≤48 hours of hospitalization) post-STEMI.

Methods
We derived a novel risk score using data from patients enrolled in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in Patients with STEMI (TOTAL). The TOTAL database was randomly divided into a derivation cohort with 2/3 of the composite events and non-events and remaining 1/3 as the internal validation cohort. Using the derivation cohort, we identified risk factors for cardiovascular death (CV) or non-fatal cardiac arrest by performing a univariate and multivariable stepwise regression analysis of baseline clinical and angiographic characteristics. Each co-variate was assigned an integer score based on regression coefficients and the novel TOTAL risk score was developed by adding points from each risk factor profile. We externally validated the TOTAL score using data from the Radial versus Femoral Access for Coronary Intervention (RIVAL) trial.

Results
The TOTAL derivation cohort included 6331 participants with 287 events (CV death/cardiac arrest). Twelve independent risk-factors associated with risk of CV death and non-fatal cardiac arrest at 1 year were selected and weighted for the TOTAL risk score (Table 1). In the TOTAL validation cohort (n=3166), patients with a TOTAL score of 0–4 points (n=779 (24.6%)) were categorized as very low risk with only a 0.1% risk of CV death/cardiac arrest observed within 24 hours of hospitalization, and no further events observed between 24 hours and 30 days post-STEMI. In the RIVAL validation dataset (n=1451), patients with a TOTAL score of 0–4 points (n=737 (50.7%)) had a 0.3% risk of CV death/cardiac arrest within 24 hours, with no further events observed between 24 hours and 72 hours of hospitalization.

Conclusion
The TOTAL risk score identified a very low risk subset of patients for whom early discharge, 24–48 hours post-STEMI, is likely safe. These findings have the potential to change practice and support early discharge after STEMI.

Funding Acknowledgement
Type of funding sources: None.