bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome
Authors: Zhou J , Yan H , Liu C , Zhou P , Li J , Chen R , Zhao X , Wang Y 
Published: October 2021

Abstract

Background
Metabolic syndrome is associated with increased incidence of diabetes and cardiovascular diseases in patients initially free from these diseases. However, its prognostic value in patients with established coronary artery diseases remains controversial.

Purpose
Therefore, we aimed to illustrate the prevalence and investigate the impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome.

Methods
We conducted a large registry of consecutive patients with acute coronary syndrome referred to primary percutaneous coronary intervention and those with multivessel diseases were eligible for this analysis. Metabolic syndrome was defined using modified criteria based on the Adult Treatment Panel III definition from the National Cholesterol Education Program. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction, and stroke.

Results
A total of 2532 patients were included in current analysis and 993 (39.2%) of them had metabolic syndrome while 1539 (60.8%) did not. The prevalence of metabolic syndrome increased over the study period (p for trend = 0.005). There was a significant decline of metabolic syndrome prevalence in patients over 60 years old (p for trend = 0.002) and females had a higher prevalence than their male counterparts (61.5% verse 32.9%, p&lt;0.001). Over a median follow-up of 2.3 years, metabolic syndrome was not significantly associated with MACE (adjusted 95% CI 0.92 to 1.54). In addition, there was no significant difference observed between two groups in other individual outcomes, namely all-cause death, cardiac death, stroke, myocardial infarction, and any revascularization.

Conclusions
Metabolic syndrome was frequently observed in patients with multivessel coronary artery disease and acute coronary syndrome. Patients with metabolic syndrome were more likely to be young and female. However, it was not an independent predictor for MACE after primary percutaneous coronary intervention in those patients.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences Metabolic syndrome distribution in MVDOutcome according to metabolic syndrome
Association between serum osteoprotegerin levels and severity of coronary artery disease in patients with acute myocardial infarction
Authors: Cottin Y , Issa R , Benalia M , Mouhat B , Meloux A , Tribouillard L , Bichat F , Vergely C , Zeller M 
Published: October 2021

Abstract

Background
Osteoprotegerin (OPG), a glycoprotein of the tumor necrosis factor (TNF) superfamily is a main biomarker for vascular calcification.

Aim
We aimed to evaluate the association between serum OPG levels and extent of coronary lesions in patients with acute myocardial infarction (MI).

Methods
Consecutive patients hospitalized for an acute MI who underwent coronary angiography were included. SYNTAX score was calculated to assess the severity of coronary artery disease. The population was analysed in low (5 (3–6)), medium (11 (9–13)) and high (20 (18–23)) tertiles of SYNTAX score.

Results
Among the 378 patients included, there was a gradual increase in age, rate of diabetes, anterior wall location, and a reduction in left ventricular ejection fraction across the SYNTAX tertiles. OPG levels significantly increased across the tertiles (962 (782–1,497), 1,240 (870–1,707), and 1464 (1,011–2,129) pg/ml, respectively (p&lt;0.001)). In multivariate analysis, OPG [OR (CI95%): 2.09 (1.31–3.32) p=0. 002], were associated with the high SYNTAX group, beyond hypercholesterolemia, CV history and creatinine.

Conclusion
We found an association between OPG levels and coronary lesions complexity patients with acute MI. Determining OPG levels in combination with an ischemia test could be used in the clinical setting for the early diagnosis of subclinical atherosclerosis.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon BourgogneConseil Régional Bourgogne Franche Comté
Prognostic value of PCSK9 Levels in Non-ST elevation myocardial infarction patients undergoing percutaneous coronary intervention
Authors: Wang J.-X , Han P , Gao M.-D , Xiao J.-Y , Li X.-W , Zhang N , Ma J , Cui Z , Yao T.-T , Chen Y , Gao J , Liu Y 
Published: October 2021

Abstract

Background
The role of proprotein convertase subtilisin/kexin type 9 (PCSK9) in predicting major adverse cardiovascular events (MACEs) in Non-ST elevation myocardial infarction (NSTEMI) patients is still an open question and the PCSK9 concentration of clinical usefulness remains unknown in guiding treatment.

Purpose
To explore the role of PCSK9 in predicting major adverse cardiovascular events (MACEs) in Non-ST elevation myocardial infarction patients.

Methods
272 patients with NSTEMI were included in our study, all patients received PCI therapy after admission. Patients were followed up for 1 year and MACEs were recored. Their baseline plasma PCSK9 levels were determined by ELISA. Patients were divided into high, medium and low PCSK9 groups and the associations of PCSK9 with other biomarkers and MACEs were evaluated.

Results
The results showed that PCSK9 levels was related to levels of lipoproteins, high-sensitivity C-reactive protein (r=0.162, P=0.008), platelet volume distribution width (r=0.299, P&lt;0.001) and D-dimer (r=0.285, P&lt;0.001). And the concentrations of PCSK9 was greater higher in people with MACEs (137.2ng/ml vs 243.6ng/ml) (Fig. 1A). The Kaplan-Meier curves showed patients with high PCSK9 level had lower event-free survival rate (Fig. 1B). Survival analysis indicated high level of PCSK9 predicted MACEs independently after adjusted for traditional cardiovascular risk factors and GRACE score (HR=2.646, 95CI%: 1.047–6.686, P=0.027) (Fig. 1C, Fig. 2). Subgroup analysis demonstrated the prognostic value of high PCSK9 level was greater for patients classified by the GRACE score as high risk (Fig. 1D).

Conclusions
In a NSTEMI setting, the concentration of PCSK9 is associated with hypercoagulability and hyper-inflammation. High levels of PCSK9 independently predict future MACEs in NSTEMI patients, particularly those classified by the GRACE score as high risk.

Funding Acknowledgement
Type of funding sources: None.
Outcomes of patients admitted with high-sensitive cardiac troponin T levels meeting the new rule out criteria for myocardial infarction
Authors: Cohen B C , Cohen S C , Tor R T , Fuchs S F , Kornowski R K , Grossman A G , Hasdai D H 
Published: October 2021

Abstract

Background
The 2020 ESC non-ST-elevation (NSTE) acute coronary syndromes (ACS) guidelines have adopted the paradigm that patients presenting with suspected NSTE-ACS and high-sensitive cardiac troponin T (hs-cTnT) values &lt;99th percentile in a single test or small increment within 1/2 hours have a high negative predictive value for myocardial infarction (MI). Their management remains controversial.

Purpose
We examined the clinical outcomes and resource utilization of suspected NSTE-ACS patients who presented with hs-cTnT values meeting the early rule out criteria, but were nevertheless admitted.

Methods
Our single center retrospective cohort study included 4,263 visits for suspected NSTE-ACS triaged in the Emergency Room (ER), had hs-cTnT values that met the early rule-out criteria, and were admitted (Figure 1).
Routine quality control and dedicated tests proved a coefficient of variance of &lt;10% for hs-cTnT values &lt;99th percentile (14 ng/L).

Results
There were no deaths in-hospital and at 30 days. Discharge diagnosis of MI was documented in 10 patients (∼0.2%). Median ER stay and hospital stay were 6 hours and 3 days, respectively. In hospital evaluation included 844 gated cardiac CT angiography (CTA), 580 SPECT heart scans, 101 ECG-exercise tests, and 178 coronary angiography, of which 70 (∼1.6% of cohort) culminated in percutaneous/surgical intervention.

Conclusion
Our findings highlight the high negative predictive value for MI applying the early rule out algorithm and supports a policy of ER discharge for further evaluation, sparing unnecessary and resource-consuming hospital admissions.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Outcomes of patients admitted with limit of blank high-sensitive cardiac troponin T levels versus those with levels under the limit of detection
Authors: Cohen B C , Cohen S C , Tor R T , Fuchs S F , Kornowski R K , Grossman A G , Hasdai D H 
Published: October 2021

Abstract

Background
Patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) and high-sensitive cardiac troponin T (hs-cTnT) values below the level of detection (5 ng/L) in a single test have a high negative predictive value for myocardial infarction (MI).

Purpose
We compared the clinical outcomes and resource utilization of suspected NSTE-ACS patients who were admitted despite hs-cTnT values below the limit of detection (5 ng/L) versus those with values ≤ the limit of blank (3 ng/L).

Methods
This single center retrospective cohort analysis included 2,081 emergency room (ER) visits for suspected NSTE-ACS that manifested single hs-cTnT value &lt;5 ng/L (limit of detection) - 624 with single hs-cTnT ≤3 ng/L (limit of blank) and 1,457 with single hs-cTnT values &gt;3 ng/L and &lt;5 ng/L, and yet were admitted (Figure 1).
Routine quality control and dedicated tests proved a coefficient of variance of &lt;10% for hs-cTnT values &lt;99th percentile (14 ng/L).

Results
There were no in-hospital or 30-day deaths in both groups. Discharge diagnosis of MI was documented only in the 3–5 ng/L hs-cTnT group – 3 cases (∼0.2%). Median ER stay were 5 and 6 hours for ≤3 ng/L and 3–5 ng/L groups, respectively. Median hospital stay was 3 days for both groups. Coronary angiographies culminating in interventions were documented in 1 case (∼0.2%) and 24 cases (∼1.6%) for ≤3 ng/L and 3–5 ng/L groups, respectively.

Conclusion
Suspected NSTE-ACS patients with hs-cTnT values ≤ the limit of blank are at very low risk and may not need any further evaluation.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Determination of physiological cardiac myosin-binging protein levels (cMyc) in healthy populations
Authors: Inoue K , Shiozaki M , Sasaki S , Sasaki Y , Tamura H , Fukuda K , Kubota N , Hiki M , Funamizu T , Sumiyoshi M , Minamino T 
Published: October 2021

Abstract

Background
Cardiac myosin–binding protein C (cMyC) is a cardiac-restricted protein that has more abundant, rapid release and clearance kinetics than cardiac troponin. The current ESC guideline suggests the cMyC may provide value as an alternative to cardiac troponin. The 99th percentile value is universally endorsed as the reference cut off to aid in the diagnosis of acute myocardial infarction (AMI), however, none of the report of healthy population of cMyC.

Purpose
The aim of this study was to evaluate the distribution of cMyC values in healthy subjects.

Methods
We used two cohorts in this retrospective study. 1) Healthy subjects; a total of 500 subjects (250 men and 250 women) who had annual health examinations in 2012 in the area of Kamigoto, a suburb of Nagasaki city in Southern Japan were enrolled. All participants showed none of abnormal findings including cell blood counts, chemical analysis, liver function tests, general urine tests, occult blood tests of stool, barium swallow, mammography for women, abdominal ultrasound sonography, and electrocardiogram. All blood samples were obtained in a fasting state in the morning. 2) Chest pain subjects; we collected samples from 250 subjects including 50 with non-ST elevation myocardial infarction visited admitted to a university hospital for measurement of high-sensitivity troponin T and coronary artery assessment by coronary angiography. We measured cMyC level in both cohorts by HISCL™-800 system (Sysmex corporation, Japan). The assay has a limit of detection of 0.5 ng/L and a lower limit of quantification of 1.3 ng/L.

Result
In healthy subjects, median age (IQR) was 44 (20, 82) in men and 50 (23, 91) in women. The 99th percentile of cMyC was 27.3 ng/L, which was around one-third lower than that in previous report (87 ng/L). In chest pain subjects, the concentrations of cMyC at presentation were significantly higher in those with versus without AMI (median, 66 ng/L versus 10 ng/L, P&lt;0.001). Discriminatory power for AMI, as quantified by the area under the receiver-operating characteristic curve (AUC), was comparable for cMyC (AUC, 0.85 (95% CI 0.79–0.91) and hs-cTnT (AUC, 0.81 (95% CI 0.76–0.88)).

Conclusion
We defined the normal range of cMyC in healthy Japanese subjects. The level of cMyC at presentation provides discriminatory power comparable to hs-cTnT in the diagnosis of AMI. To determine the physiological value of a biomarker may be necessary to evaluate enough information about their health status.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research
Differential impact of renal function on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment
Authors: Ohashi H , Takashima H , Nawano T , Ando H , Nakano Y , Sakurai S , Suzuki A , Suzuki W , Amano T 
Published: October 2021

Abstract

Background
Fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in daily clinical practice. Recently, the resting full-cycle ratio (RFR) was Previous studies showed the better diagnostic performance of RFR comparing with FFR. It is well known that patients with chronic kidney disease (CKD) have poor prognosis. Therefore, we should carefully assess the functional lesion severity in CKD patients. However, it is unclear whether the diagnostic performance of RFR for detecting functional ischemia is similar regardless of the degree of renal function. The aim of this study is to compare the diagnostic performance of RFR based on renal function.

Method
This study was a prospectively enrolled observational study. A total of 265 consecutive patients with 373 intermediate lesions were enrolled in this study. There were classified into three groups according to renal function (Group 1: eGFR ≥60 mL/min/1.73m2; Group 2: 30 mL/min/1.73m2 ≤eGFR &lt;60 mL/min/1.73m2; Group 3: eGFR &lt;30mL/min/1.73m2). The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). The discordance between FFR and RFR were assessed the data using known cutoffs for FFR (≤0.80) and RFR (≤0.89).

Results
Of 373 lesions, the median age was 70.1±11.0 years. Functional significance was observed in 153 lesions (41.0%) of all lesions. RFR showed a significant correlation with FFR in each group (Group 1; r2=0.63 [p&lt;0.001], Group 2: r2=0.67 [p&lt;0.001], Group 3: r2=0.51 [p&lt;0.001], respectively). The ROC curve analysis of RFR showed differential results for predicting functional significance (Group 1: AUC 0.88, cut-off value 0.91; Group 2: AUC 0.88, cut-off value 0.89; Group 3: AUC 0.81, cut-off value 0.83; respectively) in each group. The prevalence of discordant between RFR and FFR was significantly different among 3 groups (Group 1: 16.5%, Group 2: 19.4%, Group 3: 25.0%, respectively, p&lt;0.05 for among 3 groups).

Conclusion
The diagnostic performance of RFR was different based on renal function. During RFR acquisition, the degree of renal function could influence concordance with FFR, and should be taken into account when interpreting RFR.

Funding Acknowledgement
Type of funding sources: None.
Evaluation of management strategies in patients with coronary ectasia: a retrospective cohort study
Authors: Sierra Gonzalez De Cossio A , Solis-Jimenez F , Viana Rojas J A , Villalobos Pedroza M , Terrazas Cervantes E , Jimenez Ruan L A , Reyes Tovilla J E , Ornelas Casillas M A , Cornejo Guerra J A , Araiza Garaygordobil D , Gonzalez Pacheco H , Pina Reyna Y , Eid Lidt G 
Published: October 2021

Abstract

Background/Introduction
Since patients with coronary ectasia have an increased risk of developing myocardial infarction and cardiovascular death, these patients could benefit from a more intensive treatment. Unfortunately, the evidence regarding outcomes with different management strategies is limited, especially with direct oral anticoagulants (DOAC).

Purpose
To compare clinical outcomes in patients with coronary ectasia based on the selected/chosen treatment strategy.

Methods
We conducted a retrospective cohort study in patients diagnosed with coronary artery ectasia. They were divided into 3 different groups based on the treatment they received at discharge and we evaluated the main cardiovascular outcomes at one-year follow-up.

Results
Between 2016 and 2019, 7,579 angiographies were performed, in which 510 patients with coronary ectasia were found (prevalence of 6.72%). Of these patients, 43.9% (n=224) had the diagnosis of STEMI, 21% NSTEMI (n=107), 5.1% unstable angina (n=26), 18.6% chronic stable angina (n=95) and other 11.4% (n=58). The angiographic distribution of the lesions was as follows: left main coronary artery 25.1%, Left descending coronary artery 62.7%, circumflex artery 52.1%, right coronary artery 79.2%.
It was possible to obtain the follow-up of 363 patients (71.2%) because 25 died during their hospitalization and data of 122 were not available at the time of analysis. Three groups were formed based on the treatment: (1) Dual Antiplatelet Therapy (DAPT) in 47% (n=174); (2) DAPT + Vitamin K Antagonist (VKA) in 8.5% (n=31); (3) DAPT + DOAC in 6.6% (n=24).
The overall MACE rate at 1-year of follow-up was 6.6% (n=15): 11 patients in the DAPT group (6.3%), 1 patient in the DAPT + VKA group (3.2%), and 3 patients in the DAPT + DOAC group (12.5%). During this period, 3 patients died from cardiovascular causes, all of them in the DAPT group. Myocardial infarction occurred in 12 patients, 8 in the DAPT group (4.2%), 1 in the DAPT + VKA group (3.2%) and 3 in the DAPT + DOAC group (12.5%). Stroke occurred in 2 patients: 1 patient in the DAPT group (0.5%) and 1 patient in the DAPT + DOAC group, 4.1% None of these findings were statistically significant.
One-year occurrence of bleeding events was also evaluated: 23 patients presented a bleeding event, 14 in the DAPT group (8%), 7 in the DAPT + VKA group (22.5%) and 2 in the DAPT + DOAC group (8.3%); p=0.010.

Conclusion(s)
Our findings suggest that there is no statistically significant difference in the incidence of thrombotic complications, when comparing the treatment options. Patients using the combination of DAPT+VKA have a higher incidence of bleeding.

Funding Acknowledgement
Type of funding sources: None.
Acute circumflex coronary artery occlusion; dilemma in diagnosis and management
Authors: Komatsu J , Nishimura Y , Sugane H , Hosoda H , Imai R , Nakaoka Y , Nishida K , Seki S , Kubokawa S , Kawai K , Hamashige N , Doi Y 
Published: October 2021

Abstract

Background
Acute coronary syndrome (ACS) with occlusion of the circumflex coronary artery (LCX) poses diagnostic dilemma that may lead to a delay in reperfusion.

Purpose
We sought to assess the diagnostic significance of initial electrocardiography (ECG) changes in patients with acute LCX occlusion in relation to its clinical characteristics and the management.

Methods
From consecutive 1269 patients with ACS who were admitted to our institution during a 5-year period (2015–2019), 138 patients with ACS due to LCX occlusion were analyzed for clinical, ECG and angiographic presentation, and the door-to-balloon (DTB) time. ECG changes were classified into 4 different patterns: 1) ST-elevation in inferior/lateral leads (ST-E); 2) ST-depression in V1-V4 (ST-D); 3) no significant ST changes (No-ST); and 4) others.

Results
(1) No-ST pattern was found in 47 patients (34%), ST-E in 47 patients (34%), ST-D in 25 patients (18%) and others in 19 patients (14%). (2) Occlusion site: Proximal LCX; 16 patients with No-ST (34%), 6 patients with ST-E (13%), 13 patients with ST-D (52%). Distal LCX; 28 patients with No-ST (60%), 35 patients with ST-E (74%), 11 patients with ST-D (44%) (p=0.007). (Table) (3) Echocardiographic identification of left ventricular asynergy; 31 patients with No-ST (66%), 38 patients with ST-E (81%), 22 patients with ST-D (88%). (4) No-ST group was associated with longer DTB time; 245 min (170–562 min), compared to 93 min (83–121 min) in ST-E group and 97 min (70–129 min) in ST-D group (p&lt;0.0001). DTB time ≤90 min was significantly uncommon in No-ST group (11%), compared to ST-E group (46%) and ST-D group (43%) (p=0.0004). (Figure)

Conclusion
One-third of the patients with LCX-ACS showed no ST changes, resulting in significantly longer DTB time. Improving diagnostic accuracy with anticipation for LCX-ACS and the use of echocardiographic examination and also the possible application of posterior leads (V7-V9) recording is challenging but critical to avoid delayed reperfusion and to improve outcomes in these patients without ECG changes.

Funding Acknowledgement
Type of funding sources: None.