bluuebunny/crossref_metadata_2025_split huggingface dataset:
The level of brain-specific protein S 100B in patients with acute coronary syndrome associated with anxiety-depressive disorders
Authors: Poponina T , Gunderina K , Poponina Y 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In clinical medicine, there is still a need for a highly sensitive laboratory marker that reflects brain damage. In some cases, myocardial infarction proceeds with aggravation of cerebral ischemia, stroke, psychosomatic disorders. One of the candidates for laboratory diagnosis of brain damage is the S 100B protein.

Aim of the study
to analyze the level of brain-specific protein S 100B in blood plasma in patients with acute coronary syndrome associated with anxiety-depressive disorders.

Methods and Results
All patients were diagnosed with clinically severe anxiety of 55.2 [40; 64] points and depression of an average degree of 24.5 [19; 28] points. In the hospital, blood samples were taken for S 100B protein. The intragroup analysis of the S 100B protein level revealed that in 3 patients (5%) the S 100B protein level was below the normal limit 42.56 [32.6; 52.6] ng/L, in 13 patients (24%) the S 100B was within the normal range of 84.1 [75.27; 86.57] ng/L. In 38 patients (70%), the concentration of S100B protein was increased to 129.65 [110; 144] ng/L. The analysis of the group with a high concentration of S 100B protein found that the highest indicators of the S 100B protein level were in patients suffering from carbohydrate metabolism disorders, with a long history of hypertension, high levels of anxiety and depression. When studying the mental status of patients, a positive correlation was found between the concentration of the S100B protein and the level of anxiety (p = 0.00065). In 5 patients (9%), the maximum increase in the level of protein S 100 B 184.6 [166.26; 209.34] ng/L was revealed. These patients aged 60 to 70 years, had stroke in the past, had a long history of ischemic heart disease, type 2 diabetes, the course of AMI proceeded with a decrease in left ventricular ejection fraction to 34-40%. Patients with a protein level of 84.1 [75.27; 86.57] ng/L were younger, age 50-60 years, without a history of diabetes, with preserved left ventricular ejection fraction.

Conclusion
An increase in the S 100B protein level was observed in polymorbid patients, with a history of possible impairment of the blood-brain barrier permeability, which could have formed due to the toxic effect of the S 100B protein. This group of patients has more pronounced anxiety-depressive symptoms. Thus, the S 100B protein can be considered as a potential therapeutic target.
Effect of remote ischemic post conditioning on kidney function in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Arara D , Fadil M , Karani Y , Nindrea RD 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Primary percutaneous coronary intervention (PPCI) is a treatment of choice in ST elevation myocardial infarction patients (STEMI). However, this approach could affect the kidney function due to iodinated contrast exposure to the patient. Remote ischemic post conditioning (RIPostC) is a non-invasive and simple method that not only has cardioprotective but also renoprotective effect for kidney function.

Purpose
The aim of this study was to investigate the effect of RIPostC to kidney function in STEMI patients undergoing PPCI.

Methods
This study uses pre and post-test only with control group design with experimental research designs. Data was taken at an Indonesian Heart Center from June 2019 until March 2020, there were 66 patients with ST-segment elevation myocardial infarction (STEMI) being performed RIPostC procedure with intermittent ischaemia and reperfusion applied to the arm through five cycles of 5-min inflation and 5-min deflation of an automated cuff device after crossing wire. Creatinine and eGFR were measured pre and 48 hours post PPCI. Kidney function were determined by eGFR post PPCI, ΔeGFR (pre and 48 hours post PPCI), creatinine post PPCI and Δcreatinine (pre and 48 hours post PPCI). Bivariate analysis was performed to determine the effect RIPostC to kidney function using the Chi-square test.

Result
A total of 66 patients who underwent the PPCI procedure were divided into two groups RIPostC (n = 33) and without RIPostC (n = 33). The baseline characteristic in both of group was similar. We found that there were no differences of eGFR (70,46 ± 23,06 vs 65,88 ± 23,36, p = 0,424), ΔeGFR (0 [-34,68 - 37,32] vs 0 [-121,53 - 29,70], p value= 0,406), creatinine (1,00 [0,70 - 4,60] vs 1,20 [0,60-4,10], p value= 0,633) and Δcreatinine (0 [-1,20-1,10] vs 0 [-0,50-0,90], p value= 0,390)
RIPostC group had a lower CI-AKI incident if we compare with the non RIPostC (15,2% vs 42,4%, p &lt; 0,05).

Conclusion
Remote ischaemic conditioning does not significantly improve kidney function (eGFR, ΔeGFR, creatinine and Δcreatinine) in patients with STEMI undergoing PPCI The differences of kidney functionVariableRIPostCControlp valueeGFR post PPCI (ml/min/1,73 m2), mean70,46 ± 23,0665,88 ± 23,360,424aΔeGFR(ml/min/1,73 m2), median0 [-34,68 - 37,32]0 [-121,53 - 29,70]0,406bCreatinine post PPCI (mg/dL), median1,00 [0,70 - 4,60]1,20 [0,60-4,10]0,633bΔcreatinine (mg/dL), median0 [-1,20-1,10]0 [-0,50-0,90]0,390ba = Independent sample T testb = mann whitney testAbstract Figure. ΔeGFR and Δcreatinine pre and post PPCI
Coronary angioplasty and stenting in acute coronary syndromes with very low contrast volume (Less than 30ml) using cordis diagnostic catheters and improved clinical outcomes
Authors: Arokiaraj MC 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
To safely perform angioplasties in acute coronary syndromes with very low contrast volume using Cordis diagnostic catheters and thereby improve the cardiovascular and renal outcomes.

Methods and results
In 1432 patients (1857 lesions/ 2148 stents) with acute coronary syndromes, angioplasty was performed with Cordis 6F diagnostic catheters. Primary angioplasty was performed in 457 cases. In 76% of cases, iodixanol was used. All contrast injections were given by hand. A regular follow-up of the patients was performed 30 days after the procedure. All the procedures were performed through the femoral route. Tirofiban was used in 99% cases with adjusted dosages based on the creatinine values. The mean contrast volume used per patient was 28 ml (±6 ml) including the angiogram prior to the angioplasty. Ninety one patients had creatinine more than 2mg/dl before the angioplasty procedures. Left main angioplasty was performed in 37 patients using single stents. 70 patients had cardiogenic shock at presentation. 76% of the cases had diabetes. IVUS was used in only two patients. A variety of coronary stents from various companies were used. Buddy wires were used in 36 cases. Ticagrelor was used in 92 cases, and in other cases clopidogrel was used. Mild reversible nephropathy (CIN) was observed in six patients. Four patients were already on dialysis, and dialysis was continued thereafter. Switch-over of angioplasty to the radial route was performed in five cases due to associated aortic/iliac obstructive lesions. 26 deaths in total were observed in this series; 16 of these patients had cardiogenic shock (7 late presenters), and three patients expired after discharge due to possible acute stent thrombosis. Groin haematoma was seen in five cases requiring one unit of blood transfusion. Proximal mild edge dissection in the deployed stent was seen in 3 cases which were treated with stents. Wire breakages were not seen. Acute in-hospital stent thrombosis was seen in 6 cases, which were managed with balloon dilatations and stents. Covid19 was positive in 16 cases by RT PCR.

Conclusions
Angioplasty and stenting can be performed safely in patients with acute coronary syndromes using Cordis diagnostic catheters and a very low volume of contrast with improved clinical outcomes.
Efficacy and safety of pharmacoinvasive strategy compared with primary PCI in patients with STEMI presenting to non-PCI hubs: A real world study
Authors: Gallardo-Grajeda A , Dattoli-Garcia C , Jackson-Pedroza C , Gopar-Nieto G , Ruiz-Fuentes O , Pina-Fragoso V , Alfaro-Ponce D , Arias-Mendoza A , Araiza-Garaygordobil D 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-elevation myocardial infarction (STEMI). Clinical practice guidelines recommend performing pPCI &lt;120 minutes after the diagnosis of STEMI. Nevertheless, in a real world model this treatment is not always the fastest option. This is mostly due to the transfer delays when patients arrive to non-PCI capable hubs. These delays can decrease the benefits of the PPCI. Regional networks have been created to speed up these times and administer reperfusion therapy as early as possible. The pharmacoinvasive strategy (PIs) consists of the administration of fibrinolytic drugs in the non-pPCI setting followed by the immediate transfer of the patient to a pPCI center.

Purpose
To compare the efficacy and safety of pharmacoinvasive strategy compared with referral for primary PCI in patients with STEMI presenting to non PCI hubs.

Methods
A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom initially presented to non-PCI hospitals and underwent either systemic fibrinolysis followed by pharmaco-invasive strategy or were transfer to perform primary PCIc according to the decision made by the doctor in the non-PCI center, the ease of referring the patient and the proximity of the PCI center. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up.

Results
A total of 448 patients were included, of whom 273 (60.9%) underwent PIs and 175 (39.0%) were transfered for pPCI. Mean age was 58+-10 years, and most patients (86.8%) were male. No statistically significant differences in risk factors and other clinically meaningful variables were found. There was a 40% reduction in the risk of the primary composite endpoint (HR 0.60 for PIs: 95% CI:0.36-0.99; p = 0.048) for those undergoing PIs compared with pPCI, (Figure 1).

Conclusion
The pPCI main limitation is the impossibility to use it in the entire population due to its limited geographic availability and the delays involved in the transfer of patients from non-pPCI centers to reference hospitals. Through the PIs patients who arrive at non-PCI hospitals with STEMI and receive thrombolysis and then are redirect to PCI center there was a 40% reduction in the risk of a major endpoint occurring. Abstract Figure 1
The impact of complete atrioventricular block on in-hospital and long-term mortality in patients with ST-elevation myocardial infarction
Authors: Savic L , Mrdovic I , Asanin M , Krljanac G 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/aim: Complete atrioventricular (AV) block is associated with worse in-hospital outcome in patients with ST-elevation myocardial infarction (STEMI), while whether it has an impact on long-term outcome is uncertain. The majority of previous studies that analyzed this issue are performed before introduction primary percutaneous coronary intervention (pPCI). The aim of this study was to analyse the incidence and the prognostic impact of complete AV block at admission on in-hospital and 6-year mortality in STEMI patients treated with pPCI.

Method
we analyzed 2863 consecutive STEMI patients without cardiogenic shock at admission. Clinical, laboratory and echocardiographic characteristics and prognosis were compared between patients with and without complete AV block at admission.

Results
Complete AV block at admission was registered in 134 (4.6%) patients; 117 (87.3%) patients with complete AV block had inferior infarction. In comparison without complete AV block, patients with complete AV block were older; they were more likely to have heart failure, lower blood pressure and lower creatinine clearance at admission, multi-vessel disease on initial coronary angiogram and lower pre-discharge left ventricular ejection fraction (EF). Temporary pacemaker was implanted in 68 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9% vs 3.6%, respectively, p &lt; 0.001. In patients with heart block and inferior infarction in-hospital mortality was 13%, whereas in patients with heart block and anterior infarction in-hospital mortality was 53%. When we analyze patients who were discharged alive from the hospital, we also find significantly higher long-term (6-year) mortality rate in those with complete AV block at admission vs patients without AV block: 7.8% vs 3.4% respectively, p &lt; 0.001 (Figure 1). The causes of death in patients with complete AV block during long-term follow up were cardiovascular, e.g. sudden death, reinfarction or worsening of heart failure. In Cox regression model complete AV block was an independent predictor for in-hospital and 6-year mortality: in-hospital mortality HR 2.54 85%CI 1.93-5.22, p = 0.011; six year mortality HR 1.61, 95CI 1,09-2.37, p = 0.017. Other independent predictors for both short- and long-term mortality were age, heart failure at admission, lower creatinine clearance at admission, EF and post-procedural flow TIMI &lt;3 thorugh infarct-related artery.

Conclusion
Complete AV block at admission is an independent predictor for in-hospital and long-term mortality in STEMI patients treated with primary PCI. Abstract Figure 1
Impact of audiovisual feedback in resuscitation on return of spontaneous circulation and survival
Authors: Obling LER , Hassager C , Blomberg SNF , Folke F 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Treatment with an automated external defibrillator (AED) and cardiopulmonary resuscitation (CPR) are important factors for outcome in out-of-hospital cardiac arrest (OHCA). Audiovisual (AV) feedback from an AED may improve quality of cardiopulmonary resuscitation (CPR). However, the association between AV feedback in resuscitation and clinical outcomes is not well assessed in real-life OHCA.
PURPOSE
We sought to assess the association between AV feedback from an AED with rates of return of spontaneous circulation (ROSC) and 30-day survival in a real-life cohort of OHCA patients.
METHODS
We included 325 patients treated with an AED in the time period 2016-2019 from the Capital Region of Denmark. AED ECG data was analyzed before merging with data from the Danish Cardiac Arrest Register. Patients were divided into a "feedback" and a "non-feedback" group, depending on the presence of AV feedback in the AED applied before arrival of the Emergency Medical Services. Rates of ROSC upon admission and 30-day survival were compared between groups using the chi-square test. Further, uni- and multivariate logistic regression models were applied to assess the association between AV feedback and ROSC along with survival. Multivariate models were adjusted for sex, age, primary ECG rhythm and location of OHCA.
RESULTS
A total of 155 (47.7%) patients had an AED applied with AV feedback and 170 (52.3%) without AV feedback. There was no difference in Utstein characteristics between groups. Overall ROSC at hospital admission and 30-day survival was 39.1% (n = 127) and 29.2% (n = 95). While there was no difference in 30-day survival between feedback groups (p = 0.49), we found a decreased rate of ROSC at hospital admission for the feedback group compared to the non-feedback group, 32.9% (n = 51) versus 44.7% (n = 76), (p = 0.03), respectively (Figure 1). In the univariate logistic regression analysis, the feedback group showed a decreased chance of ROSC (OR 0.61, 95%CI 0.38-0.95, p = 0.03), which remained significant even after adjustment in the multivariate model (OR 0.54, 95%CI 0.33-0.86, p = 0.01). There was no significant association with 30-day survival in uni- and multivariate analyses with an OR of 0.82 (95%CI 0.51-1.32, p = 0.42) and OR 0.90 (95%CI 0.49-1.67, p = 0.74), respectively.

CONCLUSION
We found an association of decreased rates of ROSC at hospital admission, though no association with 30-day survival, when comparing use of AEDs with and without AV feedback in real-life OHCA patients. Abstract Figure. ROSC and 30-day survival
Percutaneous dilatational tracheotomy in high-risk ICU patients
Authors: Luesebrink E , Massberg S , Orban M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT.

Methods
PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models.

Results
In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk.

Conclusion
In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.
Outcome of durable mechanical circulatory support devices in a tertiary care hospital in Saudi Arabia
Authors: Laimoud M , Saad E , Alburaiki J , Alibrahim M , Alsomali A , Alhussein M , Khaliel F 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart failure (HF) remains a significant cause of morbidity and mortality. Heart transplantation is the gold standard treatment for end stage heart failure. Durable mechanical circulatory support devices became a modality of treatment as bridge to transplantation or destination therapy because of the shortage of donor hearts.

Objective
To report the experience of durable mechanical circulatory devices in our tertiary care hospital as compared with the report of the International Society of Mechanically Assisted Circulatory Support (IMACS) registry.

Results
Between 2013 until December 2019, 73 durable mechanical circulatory support devices were implanted. Mean age 41.36 ±14.1 years and 83.6% of them were male. Etiology: 52.1% of the patients had dilated cardiomyopathy while 34.2% had ischemic cardiomyopathy. Age distribution: 45.2% of the patients were in the age group of 30-49 years while 32.9% were in the age group of 50-69 years. No devices were inserted in patients within the age group ≥70 years. Left ventricular assist devices with continuous pump flow accounted for 82.2% of implanted devices while biventricular support accounted for 15.1%. Total artificial hearts were implanted in 2.7% of the patients. INTERMACS categories at the time of implantation: 20.6% of patients were in INTERMACS I, INTERMACS II 38.4%, INTERMACS III 22%, INTERMACS IV17.6% while only 1.4% were INTERMACS V. Device strategy: 73.9% of devices were implanted as a bridge to candidacy for transplantation, 15.1 % were implanted as a bridge to cardiac recover, 8.2% were listed to heart transplantation while only 2.7% were left for destination therapy strategy. 50.7% of patients were discharged home after fulfilling education requirements. Forty per cent of the patients underwent heart transplantation. Major adverse events: 5.4% of the patients developed major cerebrovascular strokes after device implantation. Mediastinal significant bleeding and exploration occurred in 12.3% of patients and gastrointestinal bleeding in 8.2%. Driveline infection occurred in 16.4% of patients but only 2.7% had deep wound infection requiring urgent heart transplantation. Mortality on the device was 31.5%.

Conclusion
Our experience with mechanical circulatory support is similar to the reported major events and survival from the International Society of Mechanically Assisted Circulatory Support.