bluuebunny/crossref_metadata_2025_split huggingface dataset:
The profile of T-cells (CD4 +, CD8 +) and natural killer cells (CD16 / 56+) in STEMI patients with poor prognosis
Authors: Dovhan O , Parkhomenko A , Talayeva T , Shumakov O , Tretyak I 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Institute of Cardiology, Kyiv, Ukraine
The role of lymphocytes in the progression of atherosclerosis is still unclear. T-cells helper (CD4+) and suppressor (CD8+) subtypes are activated in acute cardiac injury and myocardial infarction (AMI),including cytotoxicity mediated by CD8+ T-cells and immunoregulatory activity mediated by CD4+ T-cells (which can also enhance the CD8+ T-cell cytotoxicity). The natural killer (NK) cells are important in the infarcted myocardium, where it affects heart remodeling.
The aim of the study was to identify the difference in the dynamic profile of T-cells (CD4 +, CD8 +) and NK cells (CD16 / 56+) in STEMI patients with and without complications during 1-year follow-up.

Methods
The composition of individual subtypes of T-cells (CD4 +, CD8 +) and NK cells (CD16 / 56+) in the venous blood was evaluated retrospectively in 60 pts with STEMI, treated with primary PCI, at admission and on day 7. The following cardiovascular events were considered as the end point in remote (1 year) observation: death, AMI, stroke, revascularization, development/decompensation of heart failure and cardiac ischemia. All patients were divided into 2 groups depending on the presence (1st group - 35 pts) and absence of endpoint (2nd group - 25 pts). Both groups were comparable by the clinical profile. Results: There were lower number of T-suppressor on day 7 in patients with cardiovascular events during long-term follow-up (357.4 ± 36.2 /μl in group 1 vs 779.7 ± 222.8 /μl in group 2, p &lt;0,01) with the trend in their percentage (23.6 ± 1.5% vs. 27.6 ± 2.3% in group 2, p &lt;0.1). In pts with poor prognosis NK cells number and percentage has tendency to increase at the admission– 45,6% vs 37,3% in the group 2. Tab 1

Conclusion
We can assume that the initial tendency to increase in the number and percentage of NK cells (CD16 / 56 +) followed by a decrease in the number and percentage of T cells suppressor (CD8+) on STEMI day 7 are associates with an undesirable 1-year prognosis. Dynamics of T-cells subtypes in STEMI pGroup 1 (n = 35)Group 2 (n = 25)Р group 1 vs group 2Day1Day 7Day 1Day7T-cells suppressor (CD8+) %20,9 ± 1,623,6 ± 1,524,2 ± 2,127,6 ± 2,3&lt;0.1 on day 7T-cells suppressor (CD8+) /μl341,4 ± 40,1357,4 ± 36,2338,4 ± 46,8779,7 ± 222,8&lt;0.02 on day 7T-cells helper (CD4+) %42,0 ± 1,948,0 ± 1,345,3 ± 2,248,0 ± 2,1&gt;0.1T-cells helper (CD8+) /μl671,9 ± 72,9771,7 ± 68,0666,6 ± 94,2900,9 ± 115,8&gt;0.1Natural killer (CD16 / 56+) %18,4 ± 1,912,5 ± 1,413,4 ± 2,09,73 ± 0,96&lt;0.1 on day 1Natural killer (CD16 / 56+) /μl263,7 ± 31,9219,7 ± 33,8181,1 ± 26,7170,6 ± 25,9&lt;0.1 on day 1
Budget impact analysis of antiplatelet therapy with cangrelor in patients with acute coronary artery disease undergoing percutaneous coronary intervention in Portugal
Authors: Lizano-Diez I , Paz S 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Ferrer, Barcelona, Spain

Background
Cangrelor is a novel, intravenous, potent, fast onset, direct-acting, P2Y12 receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation with a half-life of 3-6 min. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) (ST-elevation myocardial infarction (STEMI), non-STEMI, stable CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) prior to PCI procedure and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable.

Purpose
To assess the economic implications of incorporating cangrelor into the hospital formulary for the acute care of CAD patients undergoing PCI in Portugal.

Methods
A budget impact model (BIM) was developed. The 3-year pharmacological and clinical event costs of two hypothetical scenarios, without and with cangrelor in the formulary for the total PCI population (base case) in Portugal were compared. Also, the primary PCI (STEMI) and a PCI population with special needs (ie. unable to swallow) were assessed as complementary setups. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on clinical trials, meta-analyses and on Portuguese registries. Only the costs of pre-treatment with oral P2Y12 inhibitors and glycoprotein IIb-IIIa inhibitors (GPI) for bail-out were considered. One-way sensitivity analysis established the effect of uncertainty on BIM results.

Results
The model assumes that the total PCI population grows from 13,422 to 14,370 adults (age 65 years, mean) over three years in Portugal. Pre-treatment with oral P2Y12 inhibitors increases from 9,932 to 10,634 patients, and uptake of cangrelor rises from 0.80% to 1.40% in the same period. The number of total PCI patients receiving cangrelor grows from 79 to 149. At current usage of antithrombotics and at existing pharmacological and management costs, adding cangrelor into the hospital formulary represents 115 thousand € over 3 years in Portugal. Results are most sensible to the percentage of patients on GPI bail-out.

Conclusions
Under BIM assumptions, introducing cangrelor for the acute care of CAD patients undergoing PCI represents a safe and affordable option in Portugal, particularly when the required control of thrombosis is not certain with oral pre-treatment.
Bioabsorbable magnesium scaffold implantation in acute coronary syndromes: profit and medium-term results
Authors: Noval Morillas I , Gutierrez Barrios A , Gheorghe L , Bretones Del Pino T , Camacho S , Calle Perez G , Canadas Pruano D , Vazquez Garcia R 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Puerta del Mar

OBJECTIVES AND METHODS
We aim to evaluate the long-term clinical and intravascular outcomes inACS patients treated with Magnesium-Based Bioresorbable Scaffold(MgBRS).Exclusion criteria:left main disease,bifurcations,ostial lesions,severe tortuosity and calcification,long lesions,high thrombus burden,haemodynamic instability,oral anticoagulants,contraindication to dual-antiplatelet therapy.Primary endpoint was the device-oriented composite end-point(DOCE):cardiac death,target vessel myocardial infarction,and target lesion revascularization(TLR).RESULTS:Between Dec2016 to Dec2018,90patients with ACS underwent PCI with MgBRS.46%patients presented with STEMI.Mean age55.9 ± 9.9,75.6%males and64.4%smokers.OCT was performed in 62patients.Mean scaffold length21.27 ± 7.7mm,mean diameter3.31 ± 0.24mm.15 patients required a second overlapped stent.There were 7complications:5edge dissection;1catheter-induced ostial dissection and 1case of slow-flow.Post-PCI OCT showed in-scaffold area stenosis of3.49 ± 21.29%.At 15months,diameter stenosis was31.95 ± 26.14%and restenosis was observed in 10cases(21.7%).Mean scaffold area shrinked from baseline(7.57 ± 1.77mm2)to15-month follow-up(6.13 ± 2.20mm2).The main mechanism of restenosis was scaffold collapse.DOCE was observed in 13.3%of patients.2patients with target-vessel myocardial infarction due to stent thrombosis.1case had recurrent angina at2weeks because of stent fracture and proximal edge dissection.9cases presented restenosis at different time-points.CONCLUSIONS:MgBRS is feasible in patients presenting ACS.At long-term follow-up,further development is needed to help to resolve these drawbacks
Efficacy of thrombolytics in patients with acute coronary syndrome
Authors: Vasin A , Mironova O , Fomin V 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: The optimal choice of the thrombolytic drug for emergency revascularization in patients with acute coronary syndrome (ACS) still remains to be defined. Percutaneous coronary intervention is a more safe and effective method of reperfusion compared with thrombolytic therapy, that’s why the last is relatively not common nowadays. But in the COVID-19 era in a number of cases some patients with ACS can’t be quickly hospitalized due to different reasons like the absence of the nearest available cardiovascular center, or lack of an ambulance. A long period of chest pain forces the doctors to use systemic thrombolytic therapy.

Purpose
This study investigates the efficacy and safety of Alteplase, Prourokinase, Tenecteplase, and Streptokinase in patients with acute coronary syndrome.

Methods
A retrospective, open, non-randomized cohort study was conducted. We have analysed 600 patients with ACS, who underwent systemic thrombolytic therapy at the prehospital and in-hospital stages from 2009 to 2011. Patients were divided into several groups according to the thrombolytic agent administered: Alteplase (254 patients), Prourokinase (309 patients), Tenecteplase (6 patients), Streptokinase (31 patients). Treatments were to be given as soon as possible. The ECG reperfusion criterion was a decrease in the ST segment by 50% or more from the initial elevation.

Results
Among 600 patients (mean age, 61 years (SD = 20); 119 women [19.7%]), 440 had successful reperfusion. The median time from chest pain onset to the start of treatment was 3 hours (P &lt; 0.001). The percentages of successful thrombolysis for each agent were similar: Alteplase 74,4% Prourokinase 71,2%, Tenecteplase 83%, Streptokinase 74,2%. No statistical differences were observed in thrombolytic results among these groups (OR: 0.60, 95% CI: 0,2868 to 1,217; P = 0.17). At the same time, the hospital treatment with prourokinase was more effective than prehospital care with prourokinase: 110 successful reperfusions in 138 patients (79.7%) and 110 successful reperfusions in 171 patients (64.3%), respectively. Regardless of the onset of the attack (OR: 0.45, 95% CI: 0,2004 to 0,9913; P = 0.05). The effectiveness of the other thrombolytics cannot be compared between prehospital care and hospital treatment due to the rare use at the hospital stage in our cases. In the study, there was also no statistical difference in complication rates among the treatment groups. Among all patients, there were 9 fatal outcomes (1.5%): Alteplase 3,15% Prourokinase 1,9%, Streptokinase 3,22%.
Conclusion(s): In patients with ACS, all thrombolytic drugs showed similar effectiveness. There is no difference in the safety and efficacy among the agents in our study, but there is a difference in cost and route of administration. However, upcoming prospective trials with long follow-up periods might be expected to determine the most appropriate systemic thrombolytic drug.
Midventricular takotsubo syndrome: different dyskinesia location leading to a different electrocardiogram?
Authors: Padilla Lopez M , Duran Cambra A , Vidal Burdeus M , Rodriguez Sotelo L , Sanchez Vega J , Carreras Mora J , Del Castillo P , Sans Rosello J , Vila Perales M , Sionis A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Takotsubo syndrome (TKS) is characterized by the appearance of apical reversible dyskinesia in its typical form. Electrocardiogram (ECG) in the acute phase (&lt;12 from symptom onset) generally shows anterior ST segment elevation. Nonetheless, other atypical forms of TKS have been described depending on the location of the dyskinetic segments, such as, mid-ventricular, basal and focal forms. Considering the different segments involved in these atypical forms, it seems reasonable to consider that ST changes in acute phase ECG could be different.

Purpose
To compare ECG in the acute phase of typical TKS versus mid-ventricular TKS, as it was the more frequent form of atypical TKS in our registry.

Methods
Patients included in the prospective TKS registry of our center according to the Mayo Clinic diagnostic criteria, with the first ECG performed less than 12 hours from the symptoms onset were reviewed. All cardiac left ventriculographies were reviewed to ensure a correct classification of the different types of TKS.

Results
A total of 297 patients were included in our local registry. 80 patients met our study inclusion criteria. 56 ECGs of typical apical TKS were compared to 24 ECGs of atypical midventricular TKS. There were no differences between the baseline characteristics in both groups, except for mid-ventricular TKS, that was more frequently triggered by physical stressor.
Regarding the ECG analysis, the main difference found in our serie was related to ST-segment deviation (Table 1). While ST-segment elevation was more common in typical TKS than in atypical TKS (73% vs 50%), ST-segment depression (generally in inferior leads) was observed in 54% of patients with atypical TKS and in no patient with typical TKS (figure 1).

Conclusion
The different location of dyskinesia between typical TKS and mid-ventricular TKS is associated to significant differences in the ECG obtained in the first hours after the onset of the clinical symptoms. The presence of ST-segment depression is highly suggestive of mid-ventricular TKS. ECG characteristicsTypical (n = 56)Midventricular (n = 24)pSTe &gt; 1mm, no (%)41 (73)12 (50)0,044STd &gt;0,5 mm, no (%)013 (54)&lt; 0,001T wave inversion, no (%)12 (21)4 (17)0,626Q wave, no (%)22 ( 39)12 (50)0,374cQT, mean (SD)445 (54)438 (37)0,578QRS low voltages*, n (%)9 ( 16)1 (4)0,328STe ST-segment elevation, STd: ST-segment depression, cQT: corrected QT interval *Voltages &lt;5mm in all limb leads or &lt;10mm in all precordial leads Abstract Figure. 12-lead ECG and left ventriculography
Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study
Authors: Laimoud M , Saad E , Koussayer S 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgroud
Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula .We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital.
Results : the study included 65 adult patients supported on femoral VA-ECMO for refractory cardiogenic shock . The studied patients had a mean age of 37.9 ± 14.87 years , mostly males (70.8%) , a mean BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients , femoral arteriovenous fistula in one patient and large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute limb ischemia had significantly frequent AKI (&lt;0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%) patients without significant difference between the patients with and without acute limb ischemia. The occurrence of acute limb ischemia was significantly correlated with failed percutaneous femoral cannulation (p = 0.039 ) while there was no significant statistical correlation between the cut-down technique and occurrence of limb ischemia(p = 0.053). The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001 ) and cut-down technique (p = 0.001) .
Conclusion : Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .
ADP-induced platelet reactivity and bleeding events in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Scherer C , Luesebrink E , Massberg S , Sibbing D , Orban M 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
While previous reports showed ADP-induced platelet reactivity to be an independent predictor of bleeding after PCI in stable patients, this has never been investigated in patients with cardiogenic shock (CS).

Methods
The association of bleeding events with respect to ADP-induced platelet aggregation was investigated in patients undergoing primary PCI for acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and with available on-treatment ADP-induced platelet aggregation measurements.

Results
Out of 233 patients, 74 suffered from a severe BARC 3 or higher bleed. ADP-induced platelet aggregation was significantly lower in patients with BARC≥3 bleedings (10 AU [IQR 3 - 13] vs. 15 AU [IQR 9 - 25], p &lt; 0.001). Multivariate analysis identified on-treatment ADP-induced platelet aggregation as an independent risk factor for bleeding (HR = 0.968 per AU, 95% confidence interval (CI) 0.942-0.994). An optimal cut-off value of &lt;12 AU for ADP-induced platelet aggregation to predict BARC≥3 bleedings was identified via ROC analysis. Moreover, use of VA-ECMO (HR 1.972, 95% CI 1.003-3.879) or coaxial left ventricular pump (HR 2.593, 95% CI 1.509-4.455), first lactate (HR 1.093 per mmol/l, 95% CI 1.037-1.152) and thrombocyte count (HR 0.994 per G/l, 95% CI 0.990-0.998) were independent predictors of BARC≥3 bleedings. There was no significant difference in survival nor ischemic events between patients with low and high on-treatment platelet reactivity. Conclusion: Lower on-treatment ADP-induced platelet aggregation was independently associated with severe bleeding events in patients with AMI-CS. The value of platelet function testing for bleeding risk prediction and guidance of anti-thrombotic treatment in CS warrants further investigation.
Anticoagulation after VA-ECMO decannulation, providing new insights
Authors: Maestro-Benedicto A , Duran-Cambra A , Vila-Perales M , Sans-Rosello J , Carreras-Mora J , Vidal-Burdeus M , Bragagnini W , Tauron-Ferrer M , Rossello E , Koller-Bernhard T , Cegarra V , Pastor-Del Amo A , Sobre-Lacaya C , Mirabet S , Sionis A 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol.

AIM
The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation.

METHODS
We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after).

RESULTS
Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%.

CONCLUSIONS
This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis