bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thrombosis and major bleeding risk after primary percutaneous coronary intervention among patients with multi-vessels coronary artery disease
Authors: Zhao X , Liu L C , Zhou Z P , Sheng S Z X , Li L J N , Zhou Z J Y , Chen C R Z , Wang W Y , Chen C Y , Song S L , Zhao Z H J , Yan Y H B 
Published: October 2021

Abstract

Background and aims
The present study aimed to develop and validate separate risk prediction models for thrombosis events (TEs) and major bleeding (MB) in patients with multi-vessel coronary artery lesions who had undergone primary percutaneous coronary intervention (PCI).

Methods and results
TEs were defined as the composite of myocardial infarction recurrence or ischemic cerebrovascular events, whereas MB was defined as the occurrence of bleeding academic research consortium (BARC) 3 or 5 bleeding. The derivation and validation cohorts comprised 2976 patients who underwent primary PCI between January 2010 and June 2017. At a median follow-up of 3.07 years (1122 days), TEs and MB occurred in 167 and 98 patients, respectively. Independent predictors of TEs were older age, prior PCI, non-ST elevated MI (NSTEMI), and stent thrombosis (ST). Independent predictors of MB were triple therapy at discharge, coronary artery bifurcation lesions, lesion restenosis, target lesion of the left main coronary artery, and PTCA. In the derivation and validation cohorts, the areas under the curve were 0.817 and 0.820 for thrombosis and 0.886 and 0.976 for bleeding, respectively. In the derivation cohort, high thrombotic risk (n=755) was associated with a higher 3-year incidence of TEs, major adverse cardiovascular events (MACEs), and all-cause death, compared to low risk (n=1275) (p=0.0022, 0.019, 0.012, respectively). High bleeding risk (n=1675) was associated with a higher incidence of bleeding, MACEs, cardiac death, compared to low risk (n=355) (p&lt;0.0001).

Conclusion
Simple risk scores can be useful in predicting the risks of ischemic and bleeding events after primary PCI, thereby stratifying thrombotic or MB risks and facilitating clinical decisions.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This study was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-I2M-1–009), National Natural Science Funds (number: 81970308) and the Fund of “Sanming” Project of Medicine in Shenzhen (number: SZSM201911017). Figure 2Figure 3
Colchicine in patients with acute myocardial infarction: an updated meta-analysis of randomized controlled trials
Authors: Mendoza R , Bailon D , Bernardo J , Jimenez R , Te-Rosano A , Tiongco R 
Published: October 2021

Abstract

Background
Improvement in cardiovascular outcomes and treatment with anti-inflammatory agents have been the subject of many research. Colchicine inhibits tubulin polymerization and is used in treating pericarditis. Recent studies have shown its benefit when used for coronary events. The objective of this meta-analysis is to reexamine the role of colchicine in reducing cardiovascular events in acute coronary syndromes in light of more recent trials.

Methods
A systematic search for randomized controlled trials which involves use of colchicine and acute coronary syndrome was done using PubMed, Google Scholar, MEDLINE and Clinicaltrials.gov. Studies done in the last decade and those involving human subjects were included in the study.

Results
Seven RCT's (n: 11,282) were included in this meta-analysis comparing colchicine vs. placebo. Dose ranged from 0.5mg/day to 1mg/day. Among patients being treated for ACS, colchicine was associated with a significant reduction in composite cardiovascular outcomes (RR 0.69, 95% CI 0.60 – 0.79, P&lt;0.ehab724.12731), unstable angina (RR 0.67, 95% CI 0.55 – 0.82, P&lt;0.0001), and myocardial infarction (RR 0.75, 95% CI 0.62 – 0.92, P&lt;0.005,). Gastrointestinal events were evident in the colchicine group with no statistical difference between the two (RR 1.28, 95% CI 0.98 – 1.67, P 0.07).

Conclusion
Use of colchicine reduces composite cardiovascular outcomes, recurrence of unstable angina and MI among patient who had ACS. There was no statistically significant difference between colchicine and placebo in terms of gastrointestinal events. It is possible that colchicine be part of the standard treatment in patients with acute coronary syndrome.

Funding Acknowledgement
Type of funding sources: None. Myocardial infarction forest plot
Prognostic implications of cholesterol chrystals at ACS causing culprit lesions, insights from the translational OPTICO-ACS study program
Authors: Nelles G , Abdelwahed Y , Seppelt C , Meteva D , Staehli B , Kraenkel N , Steiner J , Skurk C , Riedel M , Sieronski L , Haghikia A , Sinning D , Landmesser U , Joner M , Leistner D ,   OPTICO-ACS
Published: October 2021

Abstract

Aims
Cholesterol chrystals (CC) represent a feature of advanced plaque remodeling. Optical coherence tomography (OCT) allows for detailed morphological assessment of the culprit lesion, including the presence of CCs, in vivo. Since CCs have been identified as prognostically relevant plaque feature in coronary artery disease (CAD), the present analysis aims to further characterize their impact on adverse cardiovascular outcome in a large cohort of patients, presenting with acute coronary syndrome (ACS).

Methods
Within the translational OPTICO-ACS study program, 371 consecutive ACS-patients were included into the final analysis. OCT-characteristics, including the presence of CCs, were assessed by a standardized CoreLab analysis following universal consensus standards for OCT-derived plaque features. All patients were followed up for 12 months after the index event and major adverse cardiac events (MACE) consisting of death, myocardial infarction, target vessel revascularization plus re-hospitalization due to unstable or progressive angina pectoris were documented.

Results
215 patients (58.1%) presented with cholesterol chrystals (CCs) at the culprit lesion. Plaque rupture (RFC-ACS) represented the primary ACS-causing pathophysiology (75.3%) in those patients. Further, the presence of CCs was associated with other high-risk features within the culprit lesion, i.e. the presence of thin cap fibroatheroma (77.7% vs. 63.2%; p&lt;0.05), plaque calcification (80.5% vs. 67.1; p&lt;0.01) and microchannels (80.1% vs. 70.1; p&lt;0.05) as well as an increased area stenosis (0.77 vs. 0.73 mm2; p&lt;0.01) and a greater maximum lipid arc (282.8 vs. 242.6°; p&lt;0.01) as compared to culprit lesions free of CCs. Of note, there was a strong association among the occurrence of macrophages within the plaque and cholesterol crystals. Finally, and most importantly MACE during 12 months follow-up, consisting of cardiac death, myocardial infarction, target vessel revascularization and re-hospitalization due to progressive or unstable angina pectoris, occurred with nearly twice the frequency in CC-patients (20.3% vs. 10.6%; p&lt;0.01) as compared to patients without CCs at the culprit site.

Conclusion
The present analysis introduces cholesterol chrystals as a novel prognostically relevant high-risk plaque feature allowing individual risk stratification for patients after ACS.

Funding Acknowledgement
Type of funding sources: None.
Clinical outcomes by angiographic type of spontaneous coronary artery dissection
Authors: Mori Junco R , Macaya F M , Cerrato E C , Escaned J E ,   DISCO
Published: October 2021

Abstract

Background
Spontaneous coronary artery dissection (SCAD) is an increasingly diagnosed cause of myocardial infarction. Although different SCAD angiographic classifications exist, their clinical impact remains unknown.

Purpose
To evaluate the relationship between an angiographic classification and the development of adverse clinical events during the follow-up of a large, unselected cohort of patients with SCAD.

Methods
We conducted an observational study of consecutive SCAD patients from 26 centers across Italy and Spain. Cases were classified into 5 different angiotypes according to the latest classification endorsed by the European Society of Cardiology. The main composite endpoint included all-cause death, non-fatal myocardial infarction (MI), and any unplanned revascularisation.

Results
In total, 302 SCAD patients (mean age 51.8±19 years) were followed up for a median of 22 months (IQR 12–48). At 28 days, the composite outcome was higher for the angiotypes with a circumscribed contained intramural hematoma (2A and 3): 20.0% vs. 5.4%, p&lt;0.001 (non-fatal MI: 11.0% vs. 3.5%, p=0.009; unplanned revascularisation: 11.0% vs. 2.5%, p&lt;0.001), which was sustained during follow-up (24.5% vs. 9.9%, p=0.001). There were no differences in mortality (0,3% overall). The presence of an angiotype 2A or 3 was an independent predictor of a higher incidence of the composite outcome (adjusted HR: 2.44, CI 1.24–4.80, p=0.010).

Conclusions
The SCAD angiographic classification correlates with outcome. Those presenting with an angiographically circumscribed contained intramural hematoma (angiotypes 2A and 3) showed an increased risk of short-term adverse clinical events that was maintained during follow-up.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Society of Cardiology KM curves for angiotypes 2A & 3 vs otherKM curves for angiotypes 2A & 3 vs other
Impact of COVID-19 pandemic on ST-elevation myocardial infarction: data from two Portuguese centers
Authors: Oliveira L , Campante Teles R , Machado C , Madeira S , Vale N , Almeida C , Brito J , Leal S , Raposo L , Araujo Goncalves P , Pacheco A , Mesquita Gabriel H , Almeida M , Martins D , Mendes M 
Published: October 2021

Abstract

Introduction
Recently during the COVID-19 pandemic there was a general belief in a reduction of hospital admissions due to non-infectious causes, namely cardiovascular diseases.

Objectives
To evaluate the impact of the pandemic in the admissions by ST elevation acute myocardial infarction (STEMI), during the first pandemic wave.

Methods
Multicentric and retrospective analysis of consecutive patients presenting in two Portuguese hospital centers with STEMI in two sequential periods – P1 (1st March to 30th April) and P2 (1st May to 30th June). A comparison of patient's clinical and hospital outcomes data was performed between the year 2020 and 2017 to 2019 for both periods.

Results
A total of 347 consecutive STEMI patients were included in this study. The patient's baseline characteristics and cardiovascular risk factors were similar across the considered periods. During P1 of 2020, in comparison with previous years, a reduction in the number of STEMI patients was observed (26.0±4.2 vs 16.5±4.9 cases per month; p=0.033), contrary to what was observed during P2 (19.5±0.7 vs 20.5±0.7 cases per month; p=0.500). Percutaneous coronary interventions in the setting of failed thrombolysis were more frequent (1.9% vs 9.1%; p=0.033). A global trend in longer delays in time-key bundles of STEMI care was noted, namely pain to first medical contact, door to needle, door to wire crossing and symptoms to wire crossing times, however without statistical significance. Mortality rate was six-fold higher during P1 comparing to previous years (1.9% vs 12.1%; p=0.005), and also an increase in the number of mechanical complications (0.0% vs 3.0%; p=0.029) was observed.

Conclusions
During the first COVID-19 pandemic wave there were fewer patients presenting with STEMI at catheterization laboratory for coronary angioplasty. These patients presented more mechanical complications and higher mortality rates.

Funding Acknowledgement
Type of funding sources: None.
ACE Insertion/Deletion gene polymorphism aassociations in STEMI Patients
Authors: Kozhukhov S , Parkhomenko A , Dovganych N , Lutay Y A 
Published: October 2021

Abstract

Objective
ACE Insertion/deletion (I/D) polymorphism has been reported to be associated with various cardiovascular conditions, however its impact in patients with AHF remains controversial.
This study aimed to analyze ACE I/D distribution, rate of acute heart failure (AHF) and survival in ST segment elevation myocardial infarction (STEMI) patients.

Methods
Genomic DNA from 245 STEMI patients and 87 healthy control subjects were analyzed by single polymerase chain reaction method. Based on the ACE I/D genotype STEMI patients were divided with AHF/no AHF, and then - for preserved/reduced ≤40% left ventricle (LV) ejection fraction (EF) to investigate the frequency of the mutant allele D.

Results
ACE gene polymorphism analyses revealed that D allele had been found more often in STEMI patients than in controls (84.1 vs. 72.4%). The frequency of II, ID, and DD genotypes in STEMI patients was 27.6%, 52.9% and 19.5% compared to 15.9%, 54.3% and 29.8%, respectively in controls with a significant difference in mutant homozygous genotype. Distribution of I/D ACE gene variants among AHF cases vs no AHF, showed similar frequency of II allele (15.8 vs 13.5%), ID allele (54.9 vs 52.8%) and DD allele (29.3 vs 33.7% respectively). In patients with preserved EF there was not statistical significance among different alleles with and without AHF. However, ACE DD polymorphism has been found in AHF patients with reduced EF significantly more often (50.0 vs 30.5%; p&lt;0.05) in compare to AHF patients with preserved EF. Finally, cardiovascular death among all STEMI patients during 3-year follow up was more frequent in patients with DD allele (17.7% vs 5.7% with II and vs 9.9% with ID allele).

Conclusion
Presented results confirmed ACE DD polymorphism to be associated with higher rate of cardiovascular death and presence of AHF with reduced LV EF in STEMI patients. Future studies are needed to evaluate importance of ACE DD polymorphism in order to find optimal treatment strategies and to prevent negative outcomes in those patients.

Funding Acknowledgement
Type of funding sources: None.
Incremental prognostic value of worsening renal function parameters in addition to the GRACE score in patients with acute coronary syndrome
Authors: Presume J , Gomes D , Albuquerque F , Strong C , Trabulo M , De Araujo Goncalves P , Campante Teles R , Almeida M , Mendes M , Ferreira J 
Published: October 2021

Abstract

Background
Baseline renal function, one of the parameters included in the GRACE score, has prognostic relevance in patients admitted for acute coronary syndrome (ACS).

Purpose
The aim of this study was to compare different worsening renal function (WRF) parameters during hospitalization for ACS and their impact on all-cause mortality. Furthermore, we aimed to assess if these parameters had any incremental prognostic value in addition to the GRACE score.

Methods
We conducted a single-center retrospective study enrolling consecutive patients admitted for ACS from January 2016 to December 2018. Estimation of glomerular filtration rate (eGFR) for each patient was calculated based on the CKD-EPI formula. WRF during hospitalization was assessed by means of: serum creatinine (sCr) elevation ≥0,3mg/dL, duplication of the sCr value or maximum sCr value ≥2,0mg/dL.

Results
A total of 555 patients were included (65±13 years old, 72% male). Overall, 402 (72%) had hypertension, 167 (30%) were diabetic, 88 (16%) had left ventricular ejection fraction &lt;40%. Mean GRACE score was 102.7±29.1 and median sCr at baseline was 0.83 mg/dL [0.70; 0.97]. Median length of hospitalization was 4 days [2; 10] and the mean follow-up of 963 days.
Baseline eGFR showed significant correlation with mortality during follow-up (HR 0.742 [95% CI 0.691–0.797] per 10 mL/min/1.73m2 increase in eGRF). Moreover, all WRF parameters showed significant association with all-cause mortality during follow-up on a univariate analysis - p&lt;0,001 (Table 1). Elevation of sCr ≥0,3 mg/dL during hospitalization was the most frequent WRF parameter (210 patients - 38%) and the most sensitive parameter to predict our endpoint, occurring in 56 patients who died during follow-up (sensitivity 66.7%). Both duplication of sCr and absolute sCr ≥2,0mg/dL during hospitalization showed a lower prevalence; however, the majority of patients with one of these findings died during follow-up (51,4% and 68,5%, respectively).
On a multivariate Cox regression analysis, adjusted for the GRACE score, all individual WRF parameters remained independently associated with all-cause mortality during follow up (Table 2).

Conclusion
Worsening renal function has significant prognostic impact in patients admitted for ACS. Identification of these parameters during hospitalization adds significant value to the prognostic stratification of the GRACE score.

Funding Acknowledgement
Type of funding sources: None.
Acute heart failure: a mechanism underscoring sex differences in outcomes following acute coronary syndromes
Authors: Cenko E , Yoon J , Van Der Schaar M , Bergami M , Manfrini O , Vasiljevic Z , Zdravkovic M , Stankovic G , Vavlukis M , Kedev S , Milicic D , Badimon L , Bugiardini R 
Published: October 2021

Abstract

Background
It remains uncertain whether female sex is itself a strong risk factor for worse outcomes in acute coronary syndromes (ACS).

Purpose
We hypothesized that sex differences in vulnerability to heart failure after ACS may modify the association between sex and outcomes.

Methods
Data were drawn from the ISACS-Archives network of registries. The study population consisted of 87,812 patients with known time from symptom onset to hospital presentation. Participants were stratified by ACS subtypes: STEMI and NSTE-ACS Data on presenting heart failure symptoms were collected from medical record abstraction. Heart failure was categorized as Killip class &gt;2. Time from symptom onset to hospital presentation was categorized as early (≤120 minutes) or late (&gt;120 minutes). Primary outcome measure was 30-day mortality. Estimates were performed using a parametric balancing strategy by weighting and compared by test of interaction on the log scale.

Results
Among the study sample, 30922 (35.2%) patients were women. Patient outcomes varied according to subtype of ACS. The mortality rates at 30-days were significantly higher among women vs men in STEMI (RR:1.65; 95% CI: 1.56–1.73) compared with NSTE-ACS (RR:1.18; 95% CI: 1.09–1.28; P interaction &lt;0.0001). Similarly, the women vs men RR of heart failure was higher in STEMI (RR: 1.24; 95% CI: 1.20–1.29) compared with NSTE-ACS (RR:1.02; 95% CI: 0.97–1.08; P interaction &lt;0.0001). Sex difference in heart failure rates with STEMI presentation were independent (P&lt;0.0001) of early (34.3% in women vs 24.2% in men) or late (35.5% in women vs 30.7% in men) hospital presentation. The same finding was not seen in NSTE-ACS patients. Overall, women presenting with heart failure was had higher 30-day mortality than did their male counterparts with heart failure (29.8% vs 25.5%; RR: 1.24; 95% CI: 1.17–1.31).

Conclusions
Women exhibit substantially more vulnerability to heart failure in STEMI than men: a greater percentage of women have heart failure, and women with heart failure have higher 30-day mortality than men with heart failure. This finding was not seen in NSTE-ACS. heart failure on initial assessment is a key feature to explain the sex gap in mortality after ACS.

Funding Acknowledgement
Type of funding sources: None.
Mean platelet volume-to-lymphocyte ratio as a predictor of no-reflow phenomenon and in-hospital mortality following primary percutaneous coronary intervention in patients with STEMI
Authors: Willim H A , Sari K R , Cipta H 
Published: October 2021

Abstract

Background
ST-segment elevation myocardial infarction (STEMI) is the most severe form of acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is currently the treatment of choice for STEMI. However, many factors can influence the outcomes of primary PCI. Inflammation and platelet activation play a vital role in the development of complications following primary PCI. Recently, the mean platelet volume-to-lymphocyte ratio (MPVLR) has emerged as a novel biomarker of worse outcomes linking inflammation and thrombosis.

Purpose
The aim of this study was to conduct a systematic review and meta-analysis to investigate the prognostic value of MPVLR as a predictor of no-reflow phenomenon and in-hospital mortality following primary PCI in patients with STEMI.

Methods
A systematic literature search was performed in the databases of PubMed, ScienceDirect, ProQuest, and Google Scholar. The primary outcomes were no-reflow phenomenon and in-hospital mortality following primary PCI for STEMI. The outcomes were compared between patients with high and low MPVLR at admission. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The Review Manager 5.3 was used to perform the meta-analysis.

Results
Four cohort studies involving 3038 patients with STEMI undergoing primary PCI were included in this meta-analysis. The pooled analysis showed that a high MPVLR at admission was associated with higher no-reflow phenomenon (odds ratio [OR] = 4.54, 95% confidence interval [CI]: 2.45–8.41, P&lt;0.ehab724.13681, I2=86%) and higher in-hospital mortality (OR=2.69, 95% CI: 1.96–3.68, P&lt;0.ehab724.13681, I2=0%) following primary PCI.

Conclusions
This systematic review and meta-analysis showed that a high MPVLR predicts no-reflow phenomenon and in-hospital mortality following primary PCI in patients with STEMI.

Funding Acknowledgement
Type of funding sources: None. MPVLR and no-reflow phenomenonMPVLR and in-hospital mortality
Diagnostic value of circulating microRNAs compared to high-sensitivity troponin T for the detection of non-ST-segment elevation myocardial infarction
Authors: Biener M , Giannitsis E G , Thum T , Baer C , Costa A , Andrzejewski T , Stoyanov K M , Vafaie M , Meder B , Katus H A , De Gonzalo Calvo D , Mueller-Hennessen M 
Published: October 2021

Abstract

Background/Introduction
MicroRNAs (miRNAs) are promising biomarkers due to their high specificity and may facilitate differential diagnosis of patients presenting with suspected acute coronary syndrome (ACS) to the emergency department (ED).

Purpose
To assess the diagnostic value of eleven miRNAs for the detection of non-ST-segment elevation myocardial infarction (NSTEMI).

Methods
1,042 patients presenting between August 2014 and April 2017 to the ED with suspected ACS were included. NSTEMI was diagnosed per criteria of the 4th Universal definition of myocardial infarction (UDMI) using high-sensitivity troponin T (hs-cTnT). Expression levels of eleven microRNAs (miR-21, miR-22, miR-29a, miR-92a, miR-122, miR-126, miR-132, miR-133, miR-134, miR-191, miR-423) were determined using RT-qPCR. Discrimination of NSTEMI was assessed for individual and a panel of miRNAs compared to the hs-cTnT reference using C-statistics and reclassification analysis.

Results
NSTEMI was diagnosed in 137 (13.1%) patients. The AUC of the hs-cTnT based reference was 0.937. In a multivariate model three miRNAs (miR-122, miR-133 and miR-134) were found to be associated with NSTEMI with AUCs between 0.506 and 0.656. A panel consisting of these miRNAs revealed an AUC of 0.662 for the diagnosis of NSTEMI. The AUC of the combination of the miRNA panel and troponin reference was significantly lower than the reference standard (AUC: 0.897 vs. 0.937, p=0.006). Despite a significant improvement of NSTEMI reclassification measured by IDI and NRI, miRNAs did not improve specificity of hs-cTnT kinetic changes for the diagnosis of NSTEMI (ΔAUC: 0.04).

Conclusion
Although single miRNAs are significantly associated with the diagnosis of NSTEMI a miRNA panel does not add diagnostic accuracy to the hs-cTnT reference considering baseline values and kinetic changes as recommended by 4th version of UDMI.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Heart Foundation/German Foundation of Heart Research.CIBERES (CB07/06/2008 to DdGC) is a project from Carlos III Health Institute. Central illustration