bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in all-cause and cardiovascular mortality in patients with acute myocardial infarction: a nationwide analysis over 10 years
Authors: Angoulvant D , Bouteau J , Semaan C , Genet T , Darwiche W , Bisson A , Ivanes F , Fauchier L 
Published: October 2021

Abstract

Background
The decline in mortality reported during last decades in patients with acute myocardial infarction (AMI) has been attributed mainly to improved use of reperfusion therapy. We sought to determine the trends in all-cause and cardiovascular mortality for patients with AMI seen at a nationwide level in recent years.

Methods
Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. Adverse outcomes including all-cause death and cardiovascular (CV) death were investigated during follow-up.

Results
We used the French administrative hospital-discharge database, including all patients admitted for AMI between 2010 and 2019 (n=797,212, mean age 69 years, 66% male). Among them, 520,258 patients (65%) had ST-segment elevation myocardial infarction (STEMI) and 276,954 (35%) had non-STEMI (NSTEMI). Reperfusion therapy with primary percutaneous coronary intervention increased from 40% in 2010 to 58% in 2019 for patients with STEMI. Revascularization between day 0 and day 8 increased from 38% in 2010 to 49% in 2019 for patients with NSTEMI. At day 30, all-cause death was recorded in 78,826 patients (9.9%), among whom 56,582 (72%) had CV death. The rate of all-cause death and CV death in patients with STEMI and NSTEMI are in the table. Our data showed higher reduction rates in NSTEMI vs STEMI patients regarding both all cause death (−18,4% vs −14,1%) and CV death (−24.21% vs −9.2%).

Conclusion
In a large and systematic nationwide analysis of patients with AMI, the rate of all-cause death and CV death at day 30 decreased from 2010 to 2019, both for those with STEMI and those with NSTEMI. Both death rate reductions were more important in NSTEMI patients despite a lower increase of reperfusion therapy compared to STEMI patients. Earlier diagnosis and management as well as improvement of pharmacological intervention and revascularization strategy may explain this difference.

Funding Acknowledgement
Type of funding sources: None.
Deep learning algorithm predicts angiographic coronary artery disease in stable patients using only a standard 12-lead electrocardiogram
Authors: Leasure M , Jain U , Butchy A , Otten J , Covalesky V , McCormick D , Mintz G 
Published: October 2021

Abstract

Background
Current standard electrocardiogram analysis algorithms cannot predict the presence and extent of coronary artery disease (CAD), especially in stable patients.

Objectives
This study assessed the ability of a novel artificial intelligence algorithm (ECGio) to predict the presence, location, and severity of coronary artery lesions in an unselected stable patient population.

Methods
A cohort of 1659 stable outpatients were randomly divided into training (86%) and validation (14%) subsets, maintaining population characteristics. ECGio was trained and then validated using electrocardiograms paired with angiograms collected from electronic medical records. Coronary artery lesions were classified in two analyses. The primary classification was no/mild (≤30% diameter stenosis [DS]) vs moderate (30–70% DS) vs severe (≥70% DS) CAD; and the secondary classification was yes/no based on ≥50% DS in any vessel.

Results
In the primary analysis of the validation cohort, 22 had no angiographic CAD and were grouped with 56 patients with mild CAD (DS ≤30%), 31 had moderate CAD (DS 30–70%), and 113 had severe CAD (DS ≥70%). The weighted average sensitivity was 93.6%, and the weighted average specificity was 96.5%. In the secondary analysis of the validation cohort, 93 had significant CAD; and 128 did not have significant CAD. There was a sensitivity of 93.1% and specificity of 85.6% in determining the presence of clinically significant disease (≥50% DS) in at least one vessel. On a vessel level ECGio was able to predict stenosis severity with average error in the LAD of 18%, the LCX of 19%, the RCA of 18%, and the LM of 8%.

Conclusion
This validation study strongly suggests that it is possible to utilize an artificial intelligence algorithm to determine the presence and severity of CAD in stable patients using data from a standard 12-lead electrocardiogram.

Funding Acknowledgement
Type of funding sources: None. Confusion MatrixROC Curve
Artificial intelligence approach improves ischaemia prediction beyond the known pretest probability scores
Authors: Bakula A , Haaf P , Caobelli F , Thommen K , Tsirkin A , Failer M , Ruff P , Zellweger M J 
Published: October 2021

Abstract

Background
Pre-test probability (PTP) assessment is crucial in the assessment of patients with suspected ischaemia/coronary artery disease. Presently there is no established role for artificial intelligence in estimating PTP.

Purpose
Comparison of a recently developed memetic pattern based algorithm (MPA) with the diagnostic power of established scores in predicting ischaemia on positron emission tomography myocardial perfusion imaging (PET MPI).

Methods
Consecutive patients undergoing Rubidium PET MPI for routine clinical evaluation of ischaemia were included. The PTP for each patient was estimated by MPA, the Diamond and Forrester scores (DFS), the PTP models from the European Society of Cardiology Guidelines from 2013 (ESC 2013) and 2019 (ESC 2019) and the Framingham scores (FRS). The PET MPI studies were assessed for the presence of ischaemia. Ischaemia was defined as a summed difference score (SDS) ≥2.

Results
The mean age of the 531 patients was 66±11 years, 34% were female, and 50% had known prior coronary artery disease; 208 patients had evidence of ischaemia. No ischaemia was found in 323 patients. The areas under the curve (AUC) are shown in the figure. The artificial intelligence based MPA provided an AUC of 0.76, PTP (ESC 2013) AUC of 0.67, PTP (ESC 2019) AUC 0.67, DFS AUC 0.56, FRS 0.68.

Conclusion
The MPA outperforms the established scores for PTP assessment of the ESC, DFS and FRS in prediction of ischaemia on PET MPI. It has the potential to improve the accuracy of the established diagnostic algorithm for CAD and ischaemia.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was in part funded by the Swiss Heart Foundation.
Percutaneous coronary interventions in patients with left main coronary artery pseudobifurcation lesions: 5-years follow-up
Authors: Maximkin D , Shugushev Z , Faybushevich A , Chepurnoy A , Volkov S , Gitelzon E , Korobkov A , Bagin S , Veretnik G , Bolivougui J M 
Published: October 2021

Abstract

Aims
To increase the effectiveness of percutaneous coronary interventions (PCI) in patients with ostium coronary artery lesions: left arterial descending (LAD) or left circumflex (LCx) – pseudobifurcations.

Methods
220 patients were included in the study. Inclusion criteria: ostium atheroslerotic lesions of left arterial descending (LAD) or left circumflex (LCx) &gt;70% according to angiography and optical coherence tomography (OCT); myocardial ischemia according the FFR measurement. According OCT data, all patients were devoiced into 2 groups. In I group (n=110) according to OCT, atherosclerotic plaque spread from the ostium of LAD and/or LCx to the left main coronary artery (LMCA), and in group II (n=110) - the plaque did not spread into the LMCA. In Group I all patients were initially treated with “Provisional T” stenting of the LMCA, and in Group II – precision stenting of the ostium LAD or LCx. Primary endpoints: frequency of MACE (death, MI, revascularizations).

Results
The long-term results after 5-years were observe in 98 patients from group I and 92 patients from group II. The survival rate of patients from group I and II, free from cardiac events, were 94.9±4.03 and 81.5±3.23, respectively (p&lt;0.001). Cardiac death were observed in 2 (2.04%) patients from group I and 2 (2.17%) patients from group II (p&gt;0.05). Myocardial infarction were observed in 2 (2.04%) patients from group I and 5 (5.43%) patients from group II (p&gt;0.05). The target lesion revascularization (TLR) was performed in 3 patients (3.06%) in group I, and in 12 patients (13.04%) in group II (p&lt;0.001). The total incidence of MACE were 5.2% in group I and 18.5% in group II (χ2=7.825; p=0.023).

Conclusions
OCT-guiding analysis of ostium LAD or LCx could be help in choosing the optimal stenting technique, as well as reliably improve long-term PCI results. However, despite the use of intravascular imaging techniques during PCI, precision stenting of the ostium LAD or LCx, differs worst long-term prognosis of patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100
Feasibility, safety and long term outcomes of complex left main bifurcation treatment using the nano inverted t stenting: a multicentre registry
Authors: Rigatelli G , Zuin M , Vassilev D , Huy D , Nguyen V T , Nguyen N , Ronco F , Roncon L 
Published: October 2021

Abstract

Background
The role of double stenting techniques in distal bifurcation left main (LM) disease has gaining interest over the latest years.

Purpose
We present the 3-year multicentre registry outcomes of dual stenting using ultra-thin strut stents and the Nano Inverted-T (NIT) technique in complex unprotected true LM bifurcation disease.

Methods
We analysed the procedural and medical data of consecutive patients enrolled between 1st January 2014 and 1st December 2019 in a multicentre registry for complex LM bifurcation disease treated with the double stenting technique called NIT due contraindications and/or refusal to surgical treatment. Target lesion failure (TLF) was defined as the composite of cardiovascular death, target-vessel MI (TVMI) and clinically driven target lesion revascularization (TLR).

Results
Among two hundred-ninety-five patients (138 males, mean age 70.3±12.8 years), post-operative success was achieved in 100% of cases. Contrast volume, procedural time, and radiation exposure were 139.2±23.4 ml, 15.3±4.9 min, and 1080±1034 cGy/m2 (Figure), respectively. At a mean follow-up of 39.5±0.6 months TLF rate was 6.1% (n=18) while TLR and cardiovascular mortality rates were 3.0 (n=9) and 2.6% (n=8), respectively. Clinically driven angiographic follow-up was available in 26.4% of patients at a mean time from the procedure of 7.5±0.4 months. Clinically restenosis rate was 3.3%.

Conclusions
Revascularization of complex LM bifurcation disease using the NIT double stenting technique resulted feasible and safe with a low incidence of TLF, excellent survival rate and no stent thrombosis. Figure 1.The NIT technique is based on the use of ultra-thin strut (≤80 micron) stents and double stenting starting with side branch stenting frst. The side branch stent is precisely positioned with one possibly only strut protruding into the main vessel which is balloon crushed before the implantation of the main branch stenting. The Proximal optimization technique (POT)–snuggle kissing–POT sequence is mandatory to ensure the coverage of the side branch ostium by both side branch and main branch stents. Snuggle kissing was performed placing the LCX balloon with the proximal marker at the middle rather than at the proximal marker of the LM-LAD balloon, in order to minimize the elliptical deformation of the LM stent.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Mortality after bleeding versus myocardial infarction in coronary artery disease: a systematic review and meta-analysis
Authors: Oliva A , Avvedimento M , Franzone A , Windecker S , Valgimigli M , Esposito G , Juni P , Piccolo R 
Published: October 2021

Abstract

Background
Bleeding is the principal safety concern of antithrombotic therapy and occurs frequently among patients with coronary artery disease (CAD).

Aims
We aim to evaluate the prognostic impact of bleeding on mortality compared with that of myocardial infarction (MI) in patients with CAD.

Methods
We searched Medline and Embase for studies that included patients with CAD and that reported both, the association between the occurrence of bleeding and mortality, and between the occurrence of MI and mortality within the same population. Adjusted hazard ratios (HRs) for mortality associated with bleeding and MI were extracted and ratio of hazard ratios (rHRs) were pooled by using inverse variance weighted random effects meta-analyses. Early events included periprocedural or within 30-day events after revascularization or acute coronary syndrome (ACS). Late events included spontaneous or beyond 30-day events after revascularization or ACS.

Results
141,059 patients were included across 16 studies and 128,660 (91%) underwent percutaneous coronary intervention. Major bleeding increased the risk of mortality to the same extent of MI (ratioHR bleedingvsMI 1.10, 95% CI, 0.71–1.71, P=0.668). Early bleeding was associated with a higher risk of mortality than early MI (ratioHR bleedingvsMI 1.46, 95% CI, 1.13–1.89, P=0.004), although this finding was not present when only randomized trials were included. Late bleeding was prognostically comparable to late MI (ratioHR bleedingvsMI 1.14, 95% CI, 0.87–1.49, P=0.358).

Conclusions
Compared with MI, major and late bleeding is associated with a similar increase in mortality, whereas early bleeding might have a stronger association with mortality.
Impact on daily practice. Major and late bleeding should be considered prognostically equivalent to MI, given the similar association with mortality. Early bleeding has even a stronger association with mortality than early MI, emphasizing the importance of bleeding avoidance strategies among patients undergoing PCI.

Funding Acknowledgement
Type of funding sources: None. Visual AbstractBleeding vs MI risk of mortality
Pharmacodynamic evaluation of the platelet antiaggregant effect of swallowed Ticagrelor versus chewed Ticagrelor in patients with acute coronary syndrome
Authors: Barrera-Ramirez C F , Pineda-Pineda L R , Ilarraza-Lomeli H , Pacheco-Rios M R , Martinez-Gallegos J C , Cordova-Alvelais L T , Tellez-Reynoso O 
Published: October 2021

Abstract

Introduction
Dual antiplatelet therapy represents the standard of care for the treatment of patients with acute coronary syndrome (ACS). Ticagrelor is a direct-acting P2Y12 inhibitor and does not require metabolic activation.

Objective
To assess whether the chewed 180 mg of ticagrelor loading dose (LD), compared to conventional oral administration, increases platelet inhibition and reduces high on-treatment platelet reactivity (HTPR) in patients with ACS.

Method
Single-center randomized clinical trial in patients with ACS. We measured platelet reactivity and % platelet aggregation (%IPA) using VerifyNow P2Y12 (Accumetrics) at baseline, 30 minutes, 1, 4 and 24 hours after LD. HTPR was defined as ≥208 PRU and/or % platelet inhibition ≤15%.

Results
We studied 40 consecutive patients (Pts.), 21 Pts. in the swallowed ticagrelor group and 19 Pts. in the chewed ticagrelor group. At 30 minutes, platelet reactivity was 180.81±64.16 PRU vs. 117±58.62 PRU p&lt;0.01 (95% CI 24.3 to 103.3); At one hour 154.29±84.55 PRU vs 54.84±59.6 PRU p&lt;0.001 (95% CI 52.1 to 146.7) respectively. The baseline results, at 4 and 24 hours, had no differences (p=NS). %IPA was 11.19±22.42 vs 42.26±27.3 &lt;0.0001, (95% CI 15.3, 47); 25.33±34.03 vs 75.47±26.27 p&lt;0.0001, 95% CI (27.5, 66.7) Platelet reactivity in the chewed ticagrelor group was significantly reduced by 52.65% at 30 minutes after LD, compared to 16.79% in the swallowed group (95% CI −0.63 to −0.083; p&lt;0.01). The frequency of HTPR at one hour was 57.14% in the swallowed group vs. 5.26% in the chewed group; p&lt;0.001. After 4 hours, HTPR was not observed in any group.

Conclusions
Chewed ticagrelor allowed a significant reduction in platelet reactivity and HTPR from the first 30 minutes and the first hour.

Funding Acknowledgement
Type of funding sources: None.
Low ALT levels are associated with poor outcomes in acute coronary syndrome patients admitted to the intensive cardiac care unit
Authors: Segev A , Itelmad E , Beigel R , Segal G , Chernomordik F , Matezky S , Grupper A 
Published: October 2021

Abstract

Background
Frailty is an under recognized and important entity that bears worse prognosis.

Purpose
Although low serum alanine aminotransferase (ALT) can serve as a novel marker of frailty, its use was never assessed in acute coronary syndrome (ACS) patients.

Methods
A retrospective analysis of hospitalized ACS patients in the intensive cardiac care unit (ICCU) between 1/5/2011 and 1/12/2020 at a single tertiary medical center.

Results
The study included 3956 patients after excluding patients with ALT &gt;40 IU/L, cirrhosis and missing data, followed for a median duration of 47 months (IQR 20–77). Patients were stratified into two groups based on their first ALT measurement within the index hospitalization: low-normal ALT group (ALT ≤10 IU/L) vs. high-normal ALT group (ALT &gt;10 IU/L). Patients with ALT≤10 IU/L were older (mean age 71 vs. 65, P&lt;0.001), presented more frequently with non-ST elevation myocardial infarction (66.4% vs. 53.2%, P&lt;0.001), had higher rates of comorbidities at baseline, and had a lower Norton score upon admission. Hospitalization length was longer in the low-normal ALT group (P&lt;0.001). Although the in-hospital mortality rate was similar between the groups (0.9% vs. 0.7%, P=0.99), long-term mortality was significantly higher in the low-normal ALT group (22.7% vs. 7.9%, P&lt;0.001). In a multivariate regression model ALT ≤10 IU/l was associated with increased mortality (HR 2.1, 95% CI 1.46–3).

Conclusion
Lower serum ALT is associated with worse outcomes in ACS patients admitted to the ICCU.

Funding Acknowledgement
Type of funding sources: None. 5-year survival according to baseline ALForest plot of variables associated with
Prognostic value of growth differentiation factor-15 in patients with acute myocardial infarction
Authors: Sabirzyanova A , Galyavich A 
Published: October 2021

Abstract

Introduction
Growth differentiation factor-15 (GDF-15) is a member of the transforming growth factor-β superfamily. Its expression was found in various tissues under the circumstances of hypoxia, inflammation, acute injury. GDF-15 is considered as a biomarker of the risk of cardiovascular events, however, most of the studies on GDF-15 have been carried out in patients with chronic heart failure and comorbid pathology. Our study assessed the clinical value of GDF-15 in the acute stage of myocardial infarction (MI) in patients without concomitant inflammatory diseases, cardiac arrhythmias and with an ejection fraction above 40% according to echocardiography.

Purpose
To evaluate the prognostic value of GDF-15 in patients with acute MI.

Materials and methods
Our study included 118 patients under the age of 70 years with MI with and without elevation of the ST-segment on the electrocardiogram. We determined the levels of GDF-15 by enzyme-linked immunosorbent assay in the first 48 hours from the clinical onset of MI. The clinical dynamics was assessed by questioning patients at 1, 3, 6 and 12 months after discharge from the hospital. The statistical significance of differences in quantitative indicators was assessed by the Student's t-test for a normal distribution and by the Mann-Whitney U test for a non-normal distribution; in qualitative indicators – according to the Pearson's χ2 criterion. Pearson's and Spearman's correlation coefficients were used to assess the tightness of the relationship between quantitative indicators.

Results
The average GDF-15 level in patients with acute MI was 2.25±1.0 ng/ml. 29 cardiovascular events occurred during 12 months of observation, including 2 deaths and 8 recurrent MI. According to autopsy data both deaths occurred due to large-focal transmural MI. 22.8% of patients were re-admitted to hospitals for unstable angina pectoris or recurrent MI. Moreover, in 89.6% of that cases GDF-15 was in the third or fourth quartiles and was ≥2.07 ng/ml. Absolutely all patients with recurrent MI and in the case of death had GDF-15 level in the upper quartile (&gt;2.73 ng/ml). Patients with GDF-15 in the upper quartile had a significantly higher risk of recurrent cardiovascular events including cardiovascular mortality and hospitalizations for unstable angina and MI (RR 4.3 [95% CI 2.4–7.9], p&lt;0.05) in comparison with patients with GDF-15 in the three lower quartiles. We assessed the possibility of combined use of GDF-15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and it was revealed that patients who simultaneously had GDF-15 and NT-pro-BNP in the upper quartiles (GDF-15 &gt;2.73 ng/ml, NT-proBNP &gt;1418 pg/ml) had a 5.4 times higher risk of recurrent cardiovascular events (RR 5.4 [95% CI 3.4–8.5] p&lt;0.05).

Conclusion
The increased level of GDF-15 in the acute stage of MI has predictive value and may serve as an additional cardiovascular risk marker.

Funding Acknowledgement
Type of funding sources: None.
Assessment of the ESC quality indicators in patients with acute myocardial infarction: a systematic review
Authors: Masso Van Roessel A , Perello Bordoy A , Mas Llado C , Ramis Barcelo M , Vives Borras M , Pons J , Peral V , Rossello X 
Published: October 2021

Abstract

Background
Quality indicators (QIs) provide a mechanism for measuring opportunities to improve cardiovascular care and outcomes. To help improving quality of care in patients with acute myocardial infarction (AMI), the European Society of Cardiology (ESC) set (in 2017) 20 QIs to evaluate several dimensions of care. These 20 QIs are organized in 3 areas and 7 domains defined in structural, performance measures including patient's feedback and outcomes. Several registries have reported their performance using real-world data, and some of them have reported that higher compliance is associated with lower mortality. There is a need to compile and summarize QI availability, feasibility and global compliance in real-world registries.

Methods
A systematic review of PubMed and Web of Science was conducted including all original articles reporting the use of the ESC QIs in AMI patients. Methods and reporting follow the guidelines of the PRISMA Statement and the protocol was registered in PROSPERO (CRD42020190541). Inclusion criteria were studies providing original data, and studies evaluating the 2017 ESC ACVC set of QIs in patients with AMI (STEMI or NSTEMI). The main exclusion criterion was for non-original articles and studies evaluating a different set of QIs.

Results
Among de 220 screened citations, 9 studies met the inclusion criteria after full-text review. Among these 9 studies, there were 11 different cohorts. Patients were recruited from 3 different continents (31 countries) between 2003 and 2018. The number of QIs assessed ranged from 6 to 20, with 5 studies (56%) reporting data for at least 75% of the 20 QIs. There was variability in the percentage of data availability with 4 QIs from 3 different cohort with limited data (2.4, 3.1, 3.2 and 6.1) and 13 QIs reported in 64% of the cohorts. We found that some publications were unable to provide the exact definition determined by the ESC ACVC working group, with 6 QIs with suboptimal definition (QIs 2.2, 5.1, 6.1, and the 3 QIs from domain 7). The rate of attainment had a great variation. In performance measures we found a higher level of compliance in the QIs 2.1, 4.3 and 5.2, and lower in 2.2 and 4.2.

Conclusions
Our systematic review has shown that it is possible to measure most QIs in existing registries, and that there is room for improvement in terms of data availability, feasibility and levels of attainment to QIs. Our findings may influence the design of future registries to capture this information and help in QIs definition updates. In light of the experience accumulated from existing registries, there is a need to design registries and surveys specifically assessing QIs to have a more accurate picture.

Funding Acknowledgement
Type of funding sources: None.