bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischemic stroke in low risk patients with atrial fibrillation: a nationwide, registry-based cohort study
Authors: Mandalenakis Z , Spanos E , Sandstrom T.V.S , Rosengren A.R , Hansson P.O.H 
Published: October 2021

Abstract

Background
Despite the good evidence on the prevention of ischemic stroke in high risk patients with atrial fibrillation (AF), the knowledge in AF patients without any cardiovascular risk factors is still limited and the treatment has been highly questioned.

Methods
We linked data from Swedish health registers to identify all patients with AF but without any previous cardiovascular comorbidity. The risk of ischemic stroke was investigated by using Cox regression models and patients with AF compared with two controls without AF, matched for age and sex.

Results
Altogether, 229,613 patients with AF and 457,332 matched controls without AF were included in the study; 44.4% of the population were women. Both the 1-year and the 5-year risk to develop ischemic stroke was higher in patients with AF compared to their matched controls without AF, hazard ratio (HR) of 3.7 (95%, confidence interval (CI) 3.5–3.8) and 2.5 (95%, CI 2.5–2.6) respectively. According to the age groups, patients with age of 35 to 49 years had the highest risk to develop ischemic stroke within the first year after AF diagnosis, HR 8.3 (95%, CI 4.0–17.1). Women with AF had 4.4 times higher risk to develop ischemic stroke (HR 4.4, CI 4.2–4.7) compared to matched women without AF.

Conclusions
In this large, register-based, nationwide cohort study, we found that the 1-risk and 5-year risk to develop ischemic stroke was significantly higher in patients with AF but without any cardiovascular risk factor for stroke, compared to matched controls without AF. Women and middle-aged patients with AF carried the highest risk to develop ischemic stroke indicating the need of further research on risk stratification despite traditional factors.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Swedish state and The Swedish Research Council
Impacts of off-label dosing noacs on clinical outcomes in very elderly patients with atrial fibrillation
Authors: Chao T , Chan Y.H , Lip G.Y.H , Chen S.A 
Published: October 2021

Abstract

Background
Studies about the comparisons of on-label and off-label dosing non-vitamin K antagonist oral anticoagulants (NOACs) regarding the risks of clinical outcomes among atrial fibrillation (AF) patients have been published. However, data among the very elderly AF patients were limited. In the present study, we aimed to investigate the impacts of inappropriate dosing of NOACs on clinical outcomes in AF patients aged ≥85 years of age.

Methods
We used medical data from a multi-center healthcare system in Taiwan enrolling 1,836 and 268 AF patients aged ≥85 years treated with NOACs and warfarin, respectively. Among 1,836 patients receiving NOACs, underdosing, overdosing and on-label dosing NOACs were prescribed in 248, 149 and 1439 patients, respectively. The risks of ischemic stroke/systemic embolism (IS/SE) and major bleeding were compared between warfarin and NOACs in different dosing groups. Also, the risks of clinical events of underdosing and overdosing NOACs were comapred to on-labeling dosing.

Results
Compared to warfarin, underdosing NOACs were associated with a higher risk of IS/SE (aHR 2.39; p=0.048) without a lower risk of major bleeding; while overdosing NOACs were not associated with a lower risk of IS/SE (aHR 0.74, p=0.604) (Figure 1). Compared to on-label dosing NOACs, underdosing NOACs were associated with a higher risk of IS/SE, while the risk was not lower for overdoing NOACs (Figure 2).

Conclusions
Even for very elderly AF patients aged ≥85 years, NOACs should still be prescribed at the dosing following the criteria defined in clinical trials and guideline recommendations.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Clinical significances of prothrombin time-international normalized ratio and activated partial thromboplastin time in patients with atrial fibrillation treated with direct oral anticoagulants
Authors: Chao T , Chan Y.H , Chen S.A 
Published: October 2021

Abstract

Background
Although the measurements of PT-INR or aPTT were not performed for patients with atrial fibrillation (AF) taking direct oral anticoagulants (DOACs) in randomized trials, these tests were commonly used and familiar to clinical physicians. We aimed to test whether there is an association between PT-INR or aPTT ratio and risks of ischemic stroke/systemic embolism (IS/SE) and major bleeding among AF patients taking rivaroxaban or dabigatran, respectively.

Methods
This multi-center cohort study included 3,192 AF patients taking rivaroxaban and 958 patients taking dabigatran for stroke prevention whose data about PT-INR and aPTT were available.

Results
For patients treated with rivaroxaban, a higher INR level was not associated with a higher risk of major bleeding compared to an INR level &lt;1.1. The risk of IS/SE was lower for patients having an INR ≥1.5 compared to those with an INR &lt;1.1 (aHR: 0.57; [95% CI: 0.37–0.87]; P=0.0088) (Figure). On-label dosing of rivaroxaban and use of digoxin were independent factors associated with an INR ≥1.5 after taking rivaroxaban. For patients taking dabigatran, a higher aPTT ratio was not associated with a higher risk of major bleeding. The risk of IS/SE was lower for patients having an aPTT ratio of 1.1–1.2 and 1.3–1.4 than those with an aPTT ratio &lt;1.1.

Conclusions
In Asian AF patients, PT-INR or aPTT ratios were not associated with the occurrences of bleeding events for rivaroxaban or dabigatran. Patients taking rivaroxaban with an INR ≥1.5 were associated with a lower risk of IS/SE. Appropriate dosages of DOACs and the compliances of patients should be confirmed for patients taking rivaroxaban with an INR &lt;1.5.

Funding Acknowledgement
Type of funding sources: None.
A novel research platform for sudden cardiac death based on continuous, real-life, unlimited follow-up of a cohort of high-risk patients
Authors: Boveda S.B ,   DAIPP consortium
Published: October 2021

Abstract

Background/Introduction
Currently, Sudden Cardiac Death (SCD) prevention is mainly based on implantable cardioverter-defibrillator (ICD) implantation in high risk patients. Real-time, prospective follow-up of such high-risk patients can afford a unique opportunity to improve SCD prevention. We previously conducted an exploratory retrospective project (DAIPP pilot program) focusing on &gt;5 000 ICD recipients, which provided us with valuable information and knowledge to set up a wider, prospective project (1–11).

Purpose
We present here the organizational outline for an innovative research platform for SCD, based on a real-life cohort with continuous, unlimited follow-up. The overall aim is to garner high-value information which can help optimize individualized risk stratification, cardiac defibrillation, and preventive strategies to eventually decrease SCD burden.

Methods and results
The DAIPP Consortium is an investigator-initiated, prospective, multicentre, independent, long-term, academic cohort study, focusing on patients at high risk of SCD and implanted with an ICD. More than 5 000 ICD recipients will be enrolled prospectively and consecutively through 17 French tertiary public and private hospitals during the first three years. All patients will be monitored continuously through a unique remote monitoring platform, and they will be linked to the national “Health Data Hub”, gathering information about medications, hospitalizations and outcomes. Quality and exhaustivity of the collected data will be regularly monitored through systematic monthly automatic indices in each center. Events will be centrally adjudicated. For the 2021–2023 period, 6 work-packages have already been created within the research platform, some being clinical and others translational research, including ischemic cardiomyopathy, new technologies, congenital cardiomyopathies, channelopathies, complications and artificial intelligence, to develop new approaches. Concomitantly, the consortium will be open to external collaborations, and an academic research program has been initiated with various European universities to enable Master, PhD and Post-doctoral students to conduct their research on SCD.

Conclusion
DAIPP is an investigator-initiated real-life continuous follow-up cohort of patients at high risk of SCD. This project will provide an open research platform to enhance the understanding of, and improve preventive strategies for SCD.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Inserm, Société Française de Cardiologie, Clinique Pasteur
The ADDition of DAPAgliflozin to angiotensin receptor blocker-neprilysin inhibitors non-responders in patient with refractory HFrEF
Authors: Jariwala P , Jadhav K.P 
Published: October 2021

Abstract

Objectives
We evaluated the efficacy and safety of dapagliflozin, a SGLT2i along with ARNI in refractory HFrEF irrespective of their diabetic status.

Methods
We performed a prospective, open-label study of symptomatic patients of HFrEF despite of optimal medical management with ARNI between January–June 2020. Despite the maximum tolerated dose of ARNI and other medications in patients the symptoms of heart failure persisted. The initial dose of 5 mg was started and after 4 weeks irrespective of their glycemic control, then the dose was escalated to 10 mg. They were followed for the 6-months after the combination of ARNI and SGLT2i.

Results
The 104 patients who had HFrEF despite of optical medical management were added dapagliflozin on top of ARNI. The primary endpoint of mean change in Left Ventricular ejection fraction (LVEF) +9.00±0.62 with a significant p value of &lt;0.001. The Mean difference in NYHA class was −2.9±0.057. A study of 104 patients at 6-months follow-up found that 92.6% of patients were in NYHA class I and 7.4% were in NYHA class II. They also reached the HbA1C goal of &lt;7% in the diabetic subgroup. None of them had either symptomatic hypotension, dyselectrolytemia, and elevation of serum creatinine. The drug was well received by most patients (Picture 1).

Conclusions
Dapagliflozin are not only oral hypoglycaemic agents but can be used in refractory HFrEF despite the use of ARNI. The combination of the ARNI and SGLT2i is well tolerated but we need large, randomized trials to prove this hypothesis (Picture 2).

Funding Acknowledgement
Type of funding sources: None. Picture 1. Screening and outcomes of patientsPicture 2. Graphical abstract
12-month post-trial follow-up of participants in the Australian arm of the second low-dose colchicine trial
Authors: Nidorf S M , Budgeon C , Eikelboom J W , Murray K , Nidorf L , Thompson P L ,   The LoDoCo2 Steering Committee
Published: October 2021

Abstract

Background
In the Australian arm of the LoDoCo2 trial, colchicine 0.5mg daily compared with placebo markedly reduced the risk of cardiovascular (CV) events in patients with chronic coronary disease (2.0 vs 3.9 events per 100 person years, HR 0.51; 95% CI 0.39–0.67). The purpose of this analysis was to explore CV and non-CV outcomes in the Australian cohort out to one year after cessation of trial medication.

Methods
Information was collected on all potential CV events and non-CV deaths as well as a range of other co-morbidities. All CV events were blindly adjudicated. The analysis examined the primary outcome (a composite of CV death, myocardial infarction, ischemic stroke, and unscheduled revascularization) and non-CV deaths by initial randomized treatment from the beginning of the trial up until one year after cessation of trial medication. A landmark analysis was then used to examine these outcomes from the date of last contact during the trial until one year after cessation of trial medication.

Results
The clinical status was confirmed in 1819/1824 (99.7%) participants who were alive at the end of the trial, and in 100% of those participants still taking trial medication at the end of the trial. During post-trial follow up, 515 patients (28.2%) were taking non-study colchicine, including 278 (30.5%) originally randomized to colchicine and 237 (25.9%) randomized to placebo. Over the entire follow-up period that included the 12-month period after the trial medication was ceased, the effect of prior exposure to colchicine on the primary CV outcome was still evident (2.2 vs 3.8 events per 100 person years, HR 0.58; 95% CI 0.45–0.74), however no post-trial CV benefit were apparent in the landmark analysis (3.3 vs 3.4 events per 100 person years, HR 0.97; 95% CI 0.56–0.1.69). Over the entire course of follow-up the incidence of new cancer (7.9% vs 7.2% RR 0.91; 95% CI 0.66–1.25) and non-CV death (0.9 vs 0.6 events per 100 person years, HR 1.44; 95% CI 0.92–2.27) was no different in the treatment groups.

Conclusion
Although the CV benefits of colchicine treatment that emerged during the trial were still evident in the year after stopping study treatment, no additional CV benefit accrued after it was ceased. These data suggest that colchicine should be continued long-term to maximize its CV benefits.

Funding Acknowledgement
Type of funding sources: None.
The association between diabetes and mortality in young adults presenting with myocardial infarction
Authors: Gyurjian K , Chiu S , Hammershaimb B , Nadadur M , Phan P , Shen Y J , Lin B , Lee M S 
Published: October 2021

Abstract

Background
The incidence of diabetes mellitus and coronary artery disease continue to rise and collectively comprise two of the most prevalent and costly diseases worldwide. The goal of this study is to report the prognosis of young patients with diabetes presented with acute myocardial infarction (AMI).

Methods
This is a retrospective observational cohort study that included consecutive patients aged 18–45 years who underwent cardiac catheterization for AMI between 2006 and 2016 in an integrated healthcare system in Southern California. The prognosis of patients with diabetes were compared to those without diabetes.

Results
A total of 1,560 patients (average age 40.2±5.3 years, 25.6% female) presenting with AMI were included. Of these 272 (17.4%) had diabetes. Diabetics were older (41.1±4.4 vs 40.0±5.4 years), more likely to be female (32.4% vs 24.1%, p=0.006), Hispanic (51.5% vs 40.5%, p&lt;0.001), have a higher body mass index (BMI) (33.6±7.1 vs 31.2±6.8kg/m2, p&lt;0.001), have hypertension (HTN) (67.6% vs 23.8%, p&lt;0.001), hyperlipidemia (HLD) (78.3% vs 24.1%, p&lt;0.001), peripheral vascular disease (9.9% vs 1.9%, p&lt;0.001), chronic kidney disease (CKD) (23.2% vs 2.7%, p&lt;0.001), hypothyroidism (7% vs 4%, p=0.034), and prior strokes (4.4% vs 2.2%, p=0.034).
On multivariate analysis accounting for other cardiovascular risk factors, the association remained significant (OR 1.82, 95% CI 1.04–3.19, p=0.036). At a median follow-up of 5.8 years (interquartile range 3.7–8.7 years), diabetes was independently associated with increased all-cause mortality (Hazard ratio [HR] 3.10, 95% CI 1.68–5.69, p&lt;0.001) when adjusting for age, sex, race, BMI, HTN, HLD, CKD, hypothyroidism, prior stroke, and ACS etiology. In a propensity score matched cohort, diabetes remained significantly associated with all-cause mortality (HR 5.29, 95% CI 2.34–12.02, p&lt;0.001).

Conclusion
Diabetes is an independent predictor of increased mortality in young adults &lt;45 years old presenting with AMI.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): KAISER PERMANENTE LOS ANGELES MEDICAL CENTER
Impact of epicardial adipose tissue accumulation on left ventricular mass and hypertrophy in non-obstructive coronary artery disease
Authors: Khan I , Eskerud I , Larsen T H , Berge C A , Pedersen E R , Lonnebakken M T 
Published: October 2021

Abstract

Introduction
Increased left ventricular mass index (LVMi) and left ventricular hypertrophy (LVH) by echocardiography are common in obesity and important cardiovascular risk predictors associated with myocardial ischemia in non-obstructive coronary artery disease (CAD). Accumulation of epicardial adipose tissue (EAT) suggest a possible direct impact on LVMi and LVH.

Purpose
To explore the association between EAT volume, LVMi and LVH in patients with chest pain and non-obstructive CAD.

Methods
We included 129 patients with chest pain and non-obstructive CAD (&lt;50% stenosis) by coronary computed tomography (CT) angiography. EAT volume was quantified using a semiautomatic analysis software on non-contrast cardiac CT images. Patients were grouped according to EAT volume, where high EAT volume was adjudicated when EAT volume was in the highest tertile (≥125 ml). Left ventricular mass was assessed by echocardiography, calculated by the Devereux formula and indexed for height in the allometric power of 2.7 (LVMi). LVH was defined as LVMi &gt;46.7 g/m2.7 in women and &gt;49.2 g/m2.7 in men. Coronary artery plaque burden was assessed as calcium score and segment involvement score on coronary CT angiography.

Results
High EAT volume was more common in men with higher BMI, waist circumference, serum triglycerides and higher prevalence of hypertension and obesity (all p&lt;0.05). Age, coronary calcium score and coronary artery segment involvement score did not differ between groups. Patients with high EAT volume had higher LVMi compared to those with low EAT volume (42.5 g/m2.7 vs. 36.1 g/m2.7, p=0.003), while there was no difference in EAT volume among patients with or without LVH. In univariable logistic regression analysis, high EAT volume was associated with higher LVMi (OR 1.05 [95% CI 1.01–1.10] per g/m2.7, p=0.015). After adjusting for hypertension and obesity in a multivariable model, higher LVMi remained significantly associated with high EAT volume (Model 1, Table 1), but the association was attenuated after adjusting for sex (Model 2, Table 1).

Conclusion
High EAT volume was associated with increased LVMi in patients with non-obstructive CAD, independent of hypertension and obesity, while there was no association with LVH. This suggest that direct infiltration of adipose tissue in the myocardium may contribute to the development of increased LVMi.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Western Norwegian Regional Health Authorities Table 1
Prognostic impact of CTO lesion in NSE-ACS patients: three-year outcome
Authors: Boukerche F , Laredj N 
Published: October 2021

Abstract

Introduction
CTO represents the most advanced form of CAD and affects adverse clinical outcomes in patients with AMI due to several pathophysiological mechanisms

Purpose
The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on two-year outcome in a prospective cohort of NSTE-ACS patients.
CTO is present in many patients with NSTE-ACS and is difficult to treat with percutaneous coronary intervention.

Methods
Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether CTO lesions were vs. were not present. Major outcomes were assessed at 3 years.

Results
A total of 296 patients were evaluated: mean age was 62±12 years and 58% were male. The three-year mortality was 12.2% (36 patients) and the three-year MACCE was 26.4% (78 patients).
The CTO group included 38 patients (12.2%). The three-year mortality and MACCE in the patients of CTO group was significantly higher (26.3% vs. 10.1%; p=0.013) and (50.0% vs. 22.9%; p=0.001) respectively.

Conclusion
In this prospective observational study of patients with NSTE-ACS, CTO was associated with a worst three-year outcome.

Funding Acknowledgement
Type of funding sources: None. MACCE: CTO Vs No CTO lesion
The incidence, time distribution and prognostic value of monomorphic ventricular tachycardia in ST-elevation myocardial infarction: the prespecified analysis of VALIDATE SWEADHEART trial
Authors: Demidova M M , Rylance R , Koul S , Dworeck C , James S , Aasa M , Erlinge D , Platonov P G 
Published: October 2021

Abstract

Background
The assessment of prognostic impact of ventricular arrhythmias in ST-elevation myocardial infarction (STEMI) is currently based mainly on their timing with regard to the symptom onset and does not distinguish between monomorphic ventricular tachycardia (VT) and polymorphic VT/ventricular fibrillation (VF). However, recent data indicate long-term hazard of monomorphic VT occurring early in the course of STEMI.

Purpose
To evaluate the incidence, time distribution and prognostic value of early monomorphic VT compared to polymorphic VT/VF in STEMI patients treated by primary percutaneous coronary interventions (PCI).

Methods
A prespecified analysis of the multicentre prospective registry-based randomised VALIDATE-SWEDEHEART trial included STEMI patients enrolled at 16 sites in Sweden between June 2014 and September 2016. Source data verification regarding the type and timing of arrhythmia from all patients with VT/VF during STEMI was performed. Survival status was obtained from the Swedish national population registry. Endpoint was total mortality at 180 days.

Results
In total, 2886 patients were identified. Among them, 97 (3.4%) had VF or polymorphic VT, 16 (0.5%) monomorphic VT, 6 (0.2%) had other undefined shockable rhythm. Total mortality (10.9% vs 2.8%, p≤0.001) was higher among patients with VT/VF. VT/VF was associated with total mortality (HR 3.18 95% CI 1.74–5.8; p≤0.001) after adjustment on age, gender and myocardial infarction localisation. In patients discharged from hospital, VT/VF did not influence the long-term prognosis.
Patients with monomorphic VT had similar clinical characteristics as compared to those with polymorphic VT/VF. The time distribution of VT/VF differed with regard to the type of arrhythmia: 63% of monomorphic VT/VF episodes occurred after PCI (n=10) compared to 24% (n=23) of all documented polymorphic VT/VF, p=0.003. Total mortality (12.5% vs 10.3%, p=0.678) did not differ between patients with monomorphic VT and polymorphic VT/VF. In Cox model, total mortality was not associated with the type of arrhythmia (Figure).

Conclusion
Early VT/VF is a marker of poor short-term outcome in patients with STEMI, which does not affect long-term prognosis in those who are successfully resuscitated and discharged from hospital.
The incidence of monomorphic VT in STEMI treated by primary PCI is low, and it occurs mainly after PCI. Though no significant difference in mortality was found between patients with monomorphic VT and polymorphic VT/VF, the observed low incidence hampers drawing conclusions with regard to the prognostic hazard impact of monomorphic VT.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Swedish Heart Lung Foundation