bluuebunny/crossref_metadata_2025_split huggingface dataset:
Between-hospital variation in outcomes of coronary artery bypass grafting in China, 2013–2019
Authors: Zhang D W , Gu D C , Qu J Y , Zhang H , Zheng Z ,   the Chinese Cardiac Surgery Registry Collaborative Group
Published: October 2021

Abstract

Background
Coronary artery bypass grafting (CABG) is widely performed across China. Understanding current between-hospital variation is important for further quality improving initiatives.

Purpose
To assess the between-hospital variation comprehensively on outcomes of isolated CABG, and explore hospital-level characteristics and practice patterns explaining the variation.

Methods
We used the data of Chinese Cardiac Surgery Registry (2013–2019) to examine the between-hospital variation of outcomes, including in-hospital mortality (or treatment withdrawal) and major complications (mortality, postoperative myocardial infarction, stroke, renal failure, mediastinal infection, and reoperation for bleeding). Multilevel mixed-effect models and propensity score adjusting technique were used to quantify the variability and study hospital-level factors associated with the variation. Risk-standardized mortality rate (RSMR) was used to classify hospital performance.

Results
Among 60876 patients (62.6 years old, 75.4% male) undergoing isolated CABG in 70 hospitals, the mortality was 2.0% and 5.3% had major complications. After adjusting for patient case-mix, the median hospital RSMR was 2.1% (inter-quartile range [IQR], 1.3%-3.1%), with the median odds ratio (MOR) of 2.1; and 5.7% (IQR, 3.7%-7.5%) for risk-standardized major complications, with the MOR of 1.9. Compared with patients admitted in average-performance hospitals, patients undergoing CABG in worse-performance hospitals had a nearly twofold higher odds of in-hospital mortality (adjusted odds ratio [AOR]=1.92; 95% confidence interval (CI), 1.37–2.69), whereas patients in better-performance hospital had an approximately 60% lower odds (AOR=0.41; 95% CI, 0.30–0.57). Hospital location and average surgeon volume explained 20.2% of the between-hospital variation, where hospital-level perioperative blood transfusion rate and use of secondary prevention medication further contributed to the proportion change variance of 3.3% and 2.3%, respectively. Similar results were obtained for major complications.

Conclusion(s)
Consistent between-hospital variation of CABG performance exists in China. Improving the clinical practice management and reducing variability may better the overall outcomes.

Funding Acknowledgement
Type of funding sources: None.
Long-term prognostic value of non-invasive lesion-specific hemodynamic index
Authors: Yang S Y , Choi G C , Lesina K L , Doh J H D , Zarins C Z , Jegere S J , Erglis A E , Leipsic J L , Taylor C T , Koo B K K 
Published: October 2021

Abstract

Background
With advancement in computational fluid dynamics (CFD) technology, novel lesion-specific hemodynamic parameters can be estimated non-invasively. However, their long-term prognostic implications have not been fully defined.

Purpose
We sought to investigate the ten-year outcomes of lesion-specific hemodynamic indices derived-from coronary CT angiography (CCTA).

Methods
A total of 145 vessels (95 patients) with stable coronary artery disease who underwent fractional flow reserve (FFR) derived by coronary computed tomographic angiography (FFRCT) and invasive FFR measurement was included from the first-in-human study of FFRCT. Study participants were enrolled from October 2009 to January 2011 and were followed up until December 2020. A total of 340 lesions with % diameter stenosis ≥30% were identified, and wall shear stress (WSS) and change FFRCT across the lesion (ΔFFRCT) were obtained using CFD techniques by an independent core laboratory. The optimal cut-off for WSS and ΔFFRCT was applied for outcome analysis. The primary endpoint was target lesion failure (TLF) including cardiovascular death, target vessel myocardial infarction, and target lesion revascularization at 10 years.

Results
The median WSS and ΔFFRCT was 183.3 [112.8; 273.9] and 0.06 [0.03; 0.13]. WSS and ΔFFRCT was mildly correlated with FFRCT (r=−0.18, P=0.001 for WSS; r=−0.36, P&lt;0.001 for ΔFFRCT). Of 179 lesions with deferral of revascularization at the index procedure of FFR measurement, TLF occurred in 16 (8.9%) lesions. In prediction of 10-year TLF, % diameter stenosis (per-lesion) ≥50%, FFRCT ≤0.80, WSS ≥256.1 dyn/cm2, and ΔFFRCT ≥0.06 were significant predictors. However, in multivariate analyses with those predictors, % diameter stenosis (per-lesion) ≥50%, FFRCT ≤0.80 became insignificant, and lesion-specific hemodynamic indices were only predictive of 10-year TLF (adjusted hazard ratio [aHR] 2.66, 95% confidence interval [CI] 0.98–7.22, P=0.055 for WSS ≥256.1 dyn/cm2; aHR 5.88, 95% CI 1.10–33.25, P=0.045 for ΔFFRCT ≥0.06). WSS ≥256.1 dyn/cm2 and ΔFFRCT ≥0.06 had higher information gain in predicting outcomes than % diameter stenosis (per-lesion) ≥50% and FFRCT ≤0.80, and both improved predictability for 10-year TLF risk of the model with % diameter stenosis (per-lesion) ≥50% and FFRCT ≤0.80 (P=0.068 for WSS ≥256.1 dyn/cm2; P=0.011 for ΔFFRCT ≥0.06) (Figure).

Conclusions
Non-invasive lesion-specific hemodynamic indices (i.e., high WSS and high ΔFFRCT) were the robust predictors of 10-year outcomes of a target lesion with incremental predictability over anatomical severity and low FFRCT. Clinical application of non-invasive hemodynamic indices will provide better long-term risk stratification over the current prognostication scheme before an invasive procedure.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott, Philips, HeartFlow
Gender-specific difference of clinical and plaque characteristics in myocardial infarction with non-obstructive artery (MINOCA): insights from optical coherence tomography
Authors: Zeng M , Hu S , Meng W , Zhao C , Wang S , Weng Z , He L , Qin Y , Feng X , Chen X , Xu Y , Yi B , Jia H , Yu B 
Published: October 2021

Abstract

Background
To date, sparse data are available with regard to gender differences in coronary plaque morphology and composition as underlying mechanism of MINOCA.

Purpose
To assess the differences in coronary plaque morphology in culprit lesion between women and men with MINOCA using intravascular optical coherence tomography.

Methods
Totally, 7404 consecutives acute myocardial infarction patients who underwent emergency coronary angiography between 2016 and 2019 were screened. MINOCA were identified in 292 patients (mean age: 72.6% male, 54.1% with ST-segment elevation). Optical coherence tomography was performed in 190 patients (men, n=142).

Results
Women with MINOCA were older (62.5±10.6 vs. 54.0±11.5, P&lt;0.001) and more over 55 years (75.3% vs. 43.6%, P&lt;0.001). Although women with MINOCA more frequently presented with NSTEMI (56.8% vs. 41.7%, P=0.025) and prior coronary artery disease (CAD) (33.3% vs. 6.3%, P&lt;0.001), they were less likely smoker (27.2% vs. 58.8%, P&lt;0.001). There was no significant difference in incidence of plaque rupture, erosion and calcified nodule between men and women. However, women were more likely to have thin-cap fibroatheroma (TCFA) (39.6% vs. 22.5%, P=0.025).

Conclusion
Women with MINOCA were older, more frequently presented with NSTEMI and less smoking compared to men. Besides, more TCFA were observed in women.

Funding Acknowledgement
Type of funding sources: None. Clinical and OCT plaque profilesProportion of clinical and OCT profiles
Evaluation of myocardial reperfusion in patients undergoing cangrelor supported primary PCI for STEMI
Authors: Muraca I , Pennesi M , Mattesini A , Migliorini A , Carrabba N , Scudiero F , Virgili G , Bruscoli F , Pontecorboli G , Marchionni N , Di Mario C , Valenti R 
Published: October 2021

Abstract

Background
Optimal myocardial reperfusion is the main goal of pharmaco-invasive treatment in STEMI patients. Cangrelor is a new intravenous P2Y12 inhibitor, mainly used in intra-procedural PCI setting of STEMI patients. Intracoronary cangrelor bolus application results in high local drug concentrations and may be more effective than a standard intravenous bolus.

Aim
This study aims to investigate the potential benefits of intracoronary versus intravenous cangrelor bolus in STEMI patients undergoing to primary PCI (p-PCI).

Materials and methods
Overall, 71 consecutive STEMI patients undergoing p-PCI were treated with intracoronary (n=37) or intravenous (n=34) bolus cangrelor administration with subsequent 2-hour intravenous infusion. The primary end point was ST-elevation reduction (STR) ≥50% at 30 minutes and at 24 hours after p-PCI. Secondary end points were STR ≥70% at 30 min after p-PC, TIMI frame count, and the QT dispersion (QTd). Moreover, stent thrombosis, bleeding events according to BARC classification, and 30-day mortality have been evaluated as safety explorative end points.

Results
STEMI patients treated with intravenous Cangrelor bolus had a higher rate of STR ≥50% either at 30 minutes (72% vs. 45%; p=0.033) or at 24 hours after p-PCI (87.1% vs. 63.6%; p=0.030) as compared to patients treated with intracoronary Cangrelor bolus; similarly, STR ≥70% at 30 minutes was more frequent in the intravenous bolus group as compared to intracoronary one (67% vs. 29% p=0.02). Furthermore, multivariable analysis demonstrated that intravenous Cangrelor bolus administration was an independent predictor of STR ≥50% (OR 3.586; 95% CI 1.134 to 11.335; p=0.030). No differences according to the TIMI frame count and the QTd were found. No stent thrombosis were observed at 30 days. The incidence of mortality and bleeding events (BARC 3–5) were comparable among study groups (30 days-death: 2.9% vs 5.4%, p=0.606; BARC 3–5 bleedings: 17.6% vs 13.5% p=0.630).

Conclusion
Intravenous coronary bolus administration of cangrelor in primary PCI is superior to intracoronary treatment with respect to extent of microvascular obstruction, and perfusion.

Funding Acknowledgement
Type of funding sources: None.
The clinical significance of procedural myocardial infarction in stable ischemic heart disease patients and implications for interpretation of Ischemia trial a registry analysis
Authors: Das S , Tran Q , Moosavi V , Itty C , Farshid A 
Published: October 2021

Abstract

Background
The definition, incidence, and clinical significance of procedural myocardial infarction (MI) remains controversial. Interpretations from landmark trials such as “Ischemia” was found to be sensitive to the definition of procedural MI used (1).

Purpose
Evaluation of the incidence of procedural MIs in our institution according to the standard definitions of Society of Cardiovascular Angiography & Intervention (SCAI) (2), Fourth Universal Definition of Myocardial Infarction (UDMI) (3) and Ischemia trial (4) and whether they predicted major adverse cardiovascular events (MACE) to validate clinical relevance of these definitions. Moreover, the study also explored the possibility whether HS-troponin alone could predict MACE thereby simplifying the definition of procedural MIs in the context of its wide-spread availability and its role as a standard biochemical marker of myocardial damage.

Methods
We analysed ECGs, coronary angiograms and next day HS troponin-I results on consecutive patients who underwent elective percutaneous coronary intervention for stable Ischaemic Heart Disease during 2014–2018. Primary outcome was MACE including death, MI, stent thrombosis and need for repeat revascularisation within 12 months from index procedure.

Results
We treated 909 patients with a mean age of 67.5 years and 78.4% were males. The proportion of patients in our cohort that met the troponin-based definition of procedural MI based on the Ischemia trial, SCAI and 4th UDMI were 10.1%, 6.3% and 25.1%. Occurrence of procedural MI according to these standard definitions were not predictive of MACE at 1 year (8.1% v 8.7% p=0.8; 11.1% v 8.5% p=0.5; 10.2% v 8.1%, p=0.3) (Table 1). The one-year MACE rate in the entire cohort was 8.5%. MACE rates were steady at troponin I levels below 2000 ng/L after which was there was a significant increase in MACE rates to 13.2% at troponin &gt;2500, 19.1% for troponin levels &gt;5000 and 33.3% for troponin&gt;10,000 ng/L.

Conclusions
Procedural MI according to the Ischemia Trial definition was not predictive of MACE at 1 year, whereas troponin elevations above 2000 ng/L were associated with higher incidence of MACE in our cohort. These findings have significant implications for the interpretation of the Ischemia Trial. Moreover, potential of HS-troponin I level as a stand-alone and clinically relevant criteria for procedural MIs may be explored.

Funding Acknowledgement
Type of funding sources: None.
Differences in biomarker concentrations and prediction of long-term outcome in patients with ST-elevation and non-ST-elevation myocardial infarction
Authors: Hjort M , Eggers K M , Lindhagen L , Baron T , Erlinge D , Jernberg T , Marko-Varga G , Rezeli M , Spaak J , Lindahl B 
Published: October 2021

Abstract

Background
Biomarkers offer insights into the pathobiology of myocardial infarction (MI). Differences in biomarker concentrations and its prognostic implications in ST-elevation MI (STEMI) and non-STEMI (NSTEMI) are incompletely understood and may offer insights into tailored treatment.

Purpose
We aimed to characterise differences in activation of pathophysiologic pathways in patients with acute STEMI versus NSTEMI by comparing multiple biomarkers, and investigating their prognostic implications.

Methods
538 STEMI and 544 NSTEMI patients were included in our hospitals between 2008–2014. Blood samples were collected shortly after admission and 92 biomarkers were analysed using Proximity Extension Assay and 87 biomarkers using Multiple Reaction Monitoring mass spectrometry. Adjusted Lasso analysis (penalized logistic regression) was used to select biomarkers that discriminated STEMI from NSTEMI patients. For biomarkers that were identified by the Lasso analysis, concentrations (log2-transformed) were then evaluated in adjusted Cox regressions on associations with death or major cardiovascular events (MACE), a composite of death, hospitalization for MI, ischemic stroke or heart failure.

Results
Eleven biomarkers differed between STEMI and NSTEMI patients (Table) with higher OR (&gt;1.00–1.42) and concentrations in STEMI patients of myoglobin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), serum amyloid A-1 (SAA1) and serum amyloid A-2 (SAA2) protein, ST2 protein, interleukin-6 (IL-6) and chitinase-3-like protein 1 (CHI3L1). NSTEMI patients had lower OR (0.83-&lt;1.00) and higher concentrations of fibroblast growth factor 23 (FGF 23), membrane-bound aminopeptidase P (MAMP), tumour necrosis factor-related activation-induced cytokine (TRANCE) and apolipoprotein C-I. During up to 6.6 years of prognostic follow-up, all of the biomarkers except MAMP displayed significant prognostic information in STEMI and/or NSTEMI patients. However, interaction analyses indicated that all biomarkers were similarly predictive (p&gt;0.05) of death or MACE between MI groups.

Conclusions
In the acute setting, biomarkers indicated greater myocardial dysfunction and inflammation in STEMI patients, whereas NSTEMI patients displayed a heterogeneous and more ambiguous activation of pathophysiologic pathways. These biomarkers were not associated with prognostic differences between STEMI and NSTEMI patients. Therefore, the results do not support treating STEMI and NSTEMI patients differently based on these biomarkers.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Foundation for Strategic Research. Swedish Association of Local Authorities and Regions. Table 1
Implications of left ventricular function on short-term outcomes in COVID-19 patients with myocardial injury
Authors: Medranda G , Case B C , Rappaport H , Zhang C , Yerasi C , Forrestal B J , Chezar-Azzerad C , Weintraub W S , Waksman R 
Published: October 2021

Abstract

Background/Introduction
Myocardial injury is a complication of coronavirus disease 2019 (COVID-19).

Purpose
We sought to describe a large multi-centre experience of COVID-19 patients with myocardial injury, examining the prognostic role left ventricular function plays on short-term outcomes.

Methods
We included adult COVID-19 patients admitted to our health system with evidence of myocardial injury and who underwent a transthoracic echocardiogram (TTE) during index admission. Patients were dichotomized into those with reduced ejection fraction (EF; &lt;50%) and preserved EF (&gt;50%).

Results
Across our 11-hospital system, 5032 adult patients were admitted with COVID-19 from March-September 2020. Of these, 235 had evidence of myocardial injury (troponin &gt;1 ng/mL). Included were 134 patients who underwent TTE, of whom 43.3% (n=58) had reduced EF and 56.7% (n=76) preserved EF (Figure 1). A subset of 6 patients had newly reduced EF, with 5 demonstrating evidence of stress cardiomyopathy and subsequently dying. Overall, mortality was high in those with reduced EF and preserved EF (in-hospital: 34.5% vs. 28.9%; p=0.494; 6 months: 63.6% vs. 50.0%; p=0.167; Kaplan-Meier estimates: p=0.2886). Readmissions were frequent in both groups (30 days: 22.2% vs. 26.0%; p=0.162; 6 months: 52.0% vs. 54.5%; p=0.839) (Figure 2).

Conclusions
Many COVID-19 patients admitted with evidence of myocardial injury did not undergo TTE. For those who did, short-term mortality was high. Patients who survived hospitalisation had frequent readmissions. In patients with newly reduced EF, most had evidence of stress cardiomyopathy and expired. Larger studies are needed to fully evaluate the prognosis of COVID-19 patients with evidence of myocardial injury and left ventricular dysfunction.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Correlation of chest CT severity score with D-dimer levels in patients with COVID-19
Authors: Inamdar A V 
Published: October 2021

Abstract

Background
Coronavirus disease 2019 (COVID 19) caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) predominantly affects lungs and leads to COVID-19 pneumonia. Studies have shown that COVID 19 is hypercoagulative prothrombotic state. The innate tropism of SARS CoV-2 for vascular endothelial cells and their consequent damage, together with the intense activation of inflammatory responses and of coagulation pathways, may explain the intense pro-coagulative state. It ultimately predisposes to systemic micro-thrombotic alterations and gives rise to the consistent rate of multi-organ failure, DIC and ARDS in severe COVID-19 patients.

Purpose
Aims of this retrospective study were to determine the correlation between a CT-based semi-quantitative score of pulmonary involvement in COVID-19 pneumonia with D-dimer and CRP levels.

Materials and methods
174 symptomatic SARS-CoV-2 patients were enrolled from August 4 to October 12, 2020, for this single-center analysis in rural India and chest CT examinations were retrospectively evaluated. The COVID 19 positivity was defined on the basis of RTPCR done at ICMR (Indian Council of Medical Research) approved laboratory. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1: &lt;5%; 2: 5–25%; 3: 26–50%; 4: 51–75%; 5: &gt;75%; range 0–5; global score 0–25). D-dimer and CRP were done at the time of admission. One way ANOVA and post hoc Tukey test were performed to compare the variables of Chest CT score in percentage to various other variables.

Results
CT score had significant positive correlation with D-dimer levels (p=0.002, r: 0.237). CT score was significantly correlated with CRP (p&lt;0.001, r: 0.392) levels. Subgroup analysis by post hoc Tukey test further showed that D-dimer levels were significantly elevated in 51–75% and &gt;75% lobar involvement groups on Chest CT with statistically significant p value of &lt;0.001.

Conclusions
This study data suggests that CT score has significant positive correlation with D-dimer and CRP. D-dimer is significantly elevated in the group where lobar involvement is more significant on Chest CT. D-dimer is an indirect marker of active coagulation and thrombin formation. Elevated D-dimer represents activation of endovascular thrombotic processes. This hypercoagulative infection-induced state is systemic, and may lead to various clinical manifestations such as myocardial infarction, stroke, limb ischemia and DIC. Monitoring of pro-thrombotic activity of SARS-CoV-2 with tests such as D-dimer, with consequent labelled administration of adjusted doses of anticoagulants are of paramount importance in order to prevent worsening of global conditions due to vascular parenchymal or systemic thrombotic dysfunction in COVID-19 patients.

Funding Acknowledgement
Type of funding sources: None.
Inflammation-frailty linkage and its long-term prognostic impact in patients with acute coronary syndrome
Authors: Satou R , Matsuzawa Y , Akiyama E , Konishi M , Yoshii T , Nakahashi H , Minamimoto Y , Okada K , Maejima N , Iwahashi N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K 
Published: October 2021

Abstract

Introduction
Chronic inflammation has been receiving considerable attention as an emerging risk factor for cardiovascular disease. In contrast, with the aging of the population, frailty has been also attracting a great deal of attention as the residual risk for cardiovascular disease. Although inflammation and frailty exacerbate each other and have an adverse effect on many diseases, the relationship between chronic inflammation and frailty and the impact of these combination on long-term prognosis in patients with acute coronary syndrome (ACS) are not elucidated.

Purpose
The aims of this study were to determine the association between chronic inflammation and frailty and its impact on long-term cardiovascular outcomes in patients with ACS.

Methods
A total of 482 consecutive ACS patients with obstructive coronary artery disease (age 66±12 years, male 81%) were enrolled in this observational study. We evaluated patients' gait speed as a measure of frailty before discharge. C-reactive protein (CRP) levels at 1 month after discharge were also evaluated as inflammation in the chronic phase. According to commonly used criteria of the residual inflammation (CRP&gt;0.2 mg/dL) and the definition of the European Working Group for Sarcopenia (gait speed ≤0.8 m/sec), patients were stratified by 4 subgroups: low/high CRP with slow/normal gait speed. The primary endpoint was composite outcomes of cardiovascular death, myocardial infarction and ischemic stroke.

Results
While there was no significant association between CRP levels and gait speed in all patients, a significant negative association between two variables was observed in the high CRP group (Spearman's ρ = −0.31, p=0.001). During the median follow-up of 6 years, primary endpoints have occurred in 82 patients. Overall, event-free rates differed significantly among the 4 groups, demonstrating the lowest event-free rate in the patients with high CRP and slow gait speed (p&lt;0.0001; Figure). In the multivariate analysis, high CRP (adjusted HR 1.99, 95% CI 1.14–3.46, p=0.02) and slow gait speed (adjusted HR 1.82, 95% CI 1.09–3.04, p=0.02) were independently and significantly associated with the primary endpoint. Moreover, the patients with both high CRP and slow gait speed had a 2.6-fold higher risk of cardiovascular events compared to others (adjusted HR 2.62, 95% CI 1.36–5.05, p=0.004).

Conclusion
In the patients with ACS, CRP levels and gait speed were negatively associated in the high CRP group. Chronic inflammation and frailty were both associated with poor prognosis in ACS and in particular, the combination of these factors was strongly associated with poor prognosis.

Funding Acknowledgement
Type of funding sources: None. Figure 1