bluuebunny/crossref_metadata_2025_split huggingface dataset:
Young female acute myocardial infarction patients have worse all-cause mortality compared to males: insights from a national myocardial infarction registry
Authors: Teo Y N , Yau C , Low C E , Wong H J , Chai P , Chan M Y , Teo Y H , Sia C H 
Published: October 2024

Abstract

Introduction
Existing studies have examined the differences in presentation and outcomes between male and female patients with acute myocardial infarction (AMI). However, the translatability of these findings to young AMI patients is uncertain. In this study, we aimed to investigate sex differences in young AMI patients.

Methods
Retrospective data for all patients ≤50 years of age with a first-time AMI occurring between 2007 and 2020 were analysed from a national myocardial infarction registry. We examined the outcomes of overall survival and cardiovascular-related survival. Cox proportional hazards regression was used to assess the association of survival with various covariates. Effect estimates were summarized using hazard ratios (HRs) and 95%-confidence intervals (95%CI).

Results
A total of 12435 patients was analyzed, of which 1699 (13.7%) were female. Onset age of first-time AMI was not significantly different between males (46.0 interquartile range (42.0, 48.0)) and females (46.0 interquartile range (42.0, 48.0)). Compared to males, more females had atypical symptoms (26% vs 22%, p&lt;0.001), hypertension (54% vs 43%, p&lt;0.001), diabetes mellitus (47% vs 32%, p&lt;0.001). Fewer females had hyperlipidemia (53% vs 62%, p&lt;0.001). The median follow-up time was 7.71 years (IQR (4.34, 11.22)). When adjusted for race, age of onset, heart failure status at admission, hyperlipidemia, diabetes mellitus, hypertension, previous percutaneous coronary intervention and chest pain at presentation, females had significantly higher all-cause mortality (adjusted HR: 1.30 (95%CI: 1.18, 1.45)) (Figure 1).

Conclusion
In conclusion, females who had first-time AMI under 50 years old were more likely to present atypically and have worse all-cause mortality.Figure 1
Symptomatic patients without coronary artery disease do not have excess cardiovascular risk compared to the general population
Authors: Olesen K K W , Andersen M H , Gyldenkerne C , Hansen M K , Stodkilde-Jorgensen N , Thrane P G , Norgaard B L , Mortensen M B , Maeng M 
Published: October 2024

Abstract

Background
Patients with stable angina with no coronary atherosclerosis by coronary computed tomography angiography (CCTA) have a lower cardiovascular risk compared to CCTA patients with greater atherosclerotic burden. However, it remains unknown whether these symptomatic patients have excess cardiovascular risk when compared to the general population and if any excess risk is sex or age dependent.

Purpose
To examine the 10-year cardiovascular risk and mortality in patients with no coronary atherosclerosis by CCTA compared to a matched general population comparison cohort.

Methods
We included every symptomatic CCTA patient with no coronary artery disease (CAD), defined as no coronary plaques and Agatston calcium score of 0, in Western Denmark from 2008-2021. Each patient was matched by age and sex with 5 individuals with no previous history of ischemic heart disease from the Western Danish general population. Maximum follow-up was 10 years. Outcomes were myocardial infarction, ischemic stroke, and all-cause death. We estimated 10-year risk difference (RD) and incidence rate ratios (IRR) using a conditional Poisson regression, comparing patients with no CAD to the general population cohort. Additionally, we performed age- (&lt;45 year, 45-65 years, and ≥65 years) and sex stratified analyses.

Results
We included 39,223 patients with no CAD who were matched with 196,115 individuals from the general population. Median age was 54 and 60% were women. Baseline use of anti-thrombotic agents, statins, and anti-hypertensive drugs was higher in patients with no CAD than the general population. Median follow-up was 6.1 years. CCTA patients with no CAD had lower risk of myocardial infarction [RD -0.2%, IRR 0.75 (95% CI 0.65-0.85)] and death [RD -3.3%, IRR 0.51 (95% CI 0.48-0.55)], but similar risk of ischemic stroke [RD 0.0%, IRR 0.93 (95% CI 0.84-1.02)] compared to the general population (Figure 1). However, patients &lt;45 years had higher 10-year risk of both myocardial infarction and ischemic stroke despite absence of CAD by CCTA compared the general population (Figure 2).

Conclusions
Symptomatic patients without CAD by CCTA do not have excess cardiovascular risk when compared to a general population cohort without known ischemic heart disease. Future cardiovascular risk management of these patients should therefore follow primary prevention guidelines. However, patients &lt;45 years did exhibit higher risk of ischemic outcomes and may require intensified preventative treatment.Figure 1Figure 2
Which is better for predicting and discriminating cardiovascular events: a traditional risk score, a calcium score or a genetic risk score?
Authors: Sousa F , Mendonca M I , Serrao M , Sa D , Abreu G , Henriques E , Freitas S , Rodrigues M , Borges S , Guerra G , Ornelas I , Drumond A , Sousa A C , Palma Dos Reis R 
Published: October 2024

Abstract

Background
The most effective approach to prevent coronary artery disease (CAD) in the general population remains to quantify the individual risk of CAD followed by controlling risk factors. There has been a lot of curiosity to investigate several scores individually for improving risk prediction. However, whether one would be better than the other in the same population is still unclear.

Aim
To evaluate the performance of the three individual scores, European SCORE2, Coronary artery calcium score (CACS) and a Genetic risk score (GRS), in predicting and discriminating cardiovascular (CV) events in an asymptomatic Portuguese population.

Methods
Prospective, observational population-based study, including 1002 asymptomatic subjects (mean age 53.1±6.8 years, 73.8% male) selected from a normal Portuguese population, without apparent CAD and diabetes at baseline. Data were recorded at the end of an extended follow-up (average 6.5±4.9 years). The European SCORE2, a computed tomography CACS, and a GRS were created to evaluate CV events’ predictive and discriminative ability through Receiver Operating Characteristics (ROC) analysis and Harrell’s C-statistics.

Results
ROC curve analysis showed 0.723 for SCORE2, 0.815 for CACS and 0.649 for GRS. Harrell’s C-statistics were 0.731 in the SCORE2, 0.785 for CACS and 0.684 for GRS.

Conclusion
The CAC score was the best individual score to predict and discriminate CV events in our asymptomatic population. Its capacity to identify high-risk individuals and those asymptomatic with subclinical atherosclerosis may improve CV risk management strategies to prevent future cardiovascular events. This result can be explained because CAC score, more than a risk marker, represents the existence of disease in the vessel wall.
Pre-discharge prediction of long-term prognosis in patients after ST-segment elevation myocardial infarction - the ValAMI-P risk score
Authors: Merenciano-Gonzalez H , Marcos Garces V , Bertolin-Boronat C , Perez N , Gavara J , Rios-Navarro C , De Dios E , Molina-Garcia T , Iraola-Viana D , Minguez Diaz De Alda S , Aulet-Manuel S , Canoves J , Nunez J , Sanchis J , Bodi V 
Published: October 2024

Abstract

Background
Despite contemporary management of ST-segment elevation myocardial infarction (STEMI) patients, cardiovascular death (CV death) and re-admission for acute heart failure (aHF) are frequent complications during follow-up. Several clinical, electrocardiographic, and echocardiographic variables have been identified as risk factors of major adverse cardiovascular events (MACE) in this setting. We aim to study the usefulness of a risk score using universally available clinical, electrocardiographic, and echocardiographic variables at discharge to stratify the risk of MACE during follow-up.

Methods
We prospectively included 712 patients treated with primary percutaneous coronary intervention after STEMI. We registered clinical, ECG and echocardiography-derived pre-discharge data. Left ventricular ejection fraction (LVEF) was categorized according to current recommendations. The primary endpoint was time to first MACE, defined as CV death or aHF, whichever occurred first. We created a risk score (ValAMI-P) including variables independently associated with MACE in multivariable analysis. Patients were classified in three groups (low, intermediate, and high risk) according to the ValAMI-P score.

Results
Mean age was 60±12 years, most patients (78.5%) were male, and smoking was the most prevalent risk factor (54.4%). During an 8.1-year median follow-up, 154 MACE (21.6%) were registered. In multivariable analysis, age (HR 1.03 [1.01-1.05], p=0.001), previous hypertension (HR 1.49 [1.04-2.12], p=0.029), GRACE score (HR 1.01 [1.01-1.02], p&lt;0.001), mildly reduced LVEF (41-49%; HR 1.92 [1.18-3.11], p=0.008), reduced LVEF (≤40%; HR 5.2 [3.53-7.65], p&lt;0.001) and the number of leads with Q-wave and residual ST-segment elevation at pre-discharge ECG (Q-STE; HR 1.13 [1.03-1.25], p=0.013) associated with long-term MACE. After classification according to the ValAMI-P risk score, patients with intermediate (8-13 points) and high (≥14 points) score depicted an increased risk of MACE (31% and 50%, respectively) compared to patients with low ValAMI-P risk score (≤7 points; 13%; p&lt;0.001 for all comparisons).

Conclusions
The ValAMI-P risk score, which comprises widely available clinical, ECG and echocardiographic variables at discharge, can identify patients at increased long-term risk of MACE after STEMI.ValAMI-P risk score after STEMI
Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia
Authors: Merenciano-Gonzalez H , Perez N , De Dios E , Monmeneu J V , Lopez-Lereu M P , Gavara J , Rios-Navarro C , Marcos Garces V , Moratal D , Bayes-Genis A , Sanz-Sanchez J , Martinez-Dolz L , Sanchis J , Nunez J , Bodi V 
Published: October 2024

Abstract

Background
In patients with established chronic coronary syndrome (CCS), the significance of myocardial ischemia is a controversial issue. Persistent angina within the first year after treatment intervention has ranged widely in previous studies and its association with subsequent hard clinical events is unclear. We aim to evaluate the long-term dynamics of angina class and the prognostic role of persistent angina in symptomatic chronic coronary syndrome (CCS) patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiography.

Methods
We analyzed 486 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficit in stress CMR and severe lesions in angiography submitted to treatment intervention (medical therapy plus, if feasible, CMR-guided revascularization). The dynamics and association of persistent angina at 6 months post-intervention with subsequent cardiac death, myocardial infarction, and admission for heart failure were investigated.

Results
All patients displayed angina class ≥2 (mean: 2.7±0.7), abnormal stress CMR (mean ischemic burden: 6.2±3 segments) and severe angiographic lesions. Most underwent CMR-guided revascularization (n=392, 81%). The angina resolution rate was 78% at 6 months, and 79%, 77%, and 75% at 1, 2, and 5 years respectively. Compared with medical treatment alone, CMR-guided revascularization was associated with less persistent angina (19% vs. 35%; HR 0.42 [0.2–0.7]; p=0.003). During an 8.3-year median follow-up, persistent angina was independently associated with higher subsequent cardiac death rates (18% vs. 4%; HR 10.9 [4.1–29.2]; p&lt;0.001), myocardial infarction (24% vs. 6%; HR 5.8 [3.2–10.4]; p&lt;0.001), and admission for heart failure (31% vs. 14%; HR 2.7 [1.7–4.2]; p&lt;0.001).

Conclusions
In CCS patients with robust diagnostic evidence by symptoms, stress CMR and angiography, sustained improvement of anginal symptoms can be achieved in most patients after treatment intervention. Angina resolution is more frequent in patients treated with CMR-guided revascularization and is associated with fewer cardiac events.Central Figure.Persistent angina and MACE risk
Chronic Coronary Syndromes with/without obstructive coronary arteries: are there differences in ongoing chest pain?
Authors: La S , Tavella R , Wu J , Spertus J , Pasupathy S , Girolamo O , Zeitz C , Worthley M , Arstall M , Sinhal A , Beltrame J 
Published: October 2024

Abstract

Background
Stable coronary artery disease (CAD) is the archetype chronic coronary syndrome, clinically manifesting as angina with obstructive CAD on angiography and managed via evidence-based guidelines. In contrast, patients with Angina with Non-Obstructive Coronary Arteries (ANOCA) are often diagnosed with ‘non-specific chest pain’ and not appropriately managed.

Purpose
To compare the Seattle Angina Questionnaire (SAQ) responses and 3-year rates of chest pain hospital presentations in patients with ANOCA compared to Stable CAD.

Methods
Consecutive angina patients undergoing elective coronary angiography enrolled in the CADOSA (Coronary Angiogram Database of South Australia) Registry between 2012-18 were included. Consenting patients participated in a longitudinal health status assessment utilising the SAQ. In-hospital clinical data was extracted from CADOSA and mortality and hospitalisation data over 12-months was extracted via administrative records.

Results
Of 6,372 consecutive patients undergoing elective angiography for the investigation of chest pain 2,287 had ANOCA and 4,085 Stable CAD. ANOCA patients were younger (61±11 vs 66±11, p&lt;0.05) and more often female (59% vs 27%, p&lt;0.05) compared to Stable CAD. The SAQ health status assessment was completed at baseline, 1 and 12-months for 377 patients (ANOCA n=156, Stable CAD n=221). At 12-month follow-up, there were no differences in SAQ scores amongst all domains (physical limitation- 92±16 vs 92±15, angina stability- 64±25 vs 62 ±24, angina frequency- 91±17 vs 92±16, treatment satisfaction- 94±13 vs 94±13 and quality of life- 78±22 vs 81±21) between ANOCA and Stable CAD, all p&gt;0.05. However, in the 12-month follow-up, ANOCA patients were less likely to have a chest pain hospital emergency department presentation (10% vs 15%, p&lt;0.001) or admission (6% vs 12%, p&lt;0.005) compared to the Stable CAD cohort.

Conclusion
Although patient-reported outcomes were identical between Stable CAD and ANOCA patients, the latter were less likely to present to emergency department or be admitted to hospital than their Stable CAD counterparts, reflecting the clinical nihilism encountered in the ANOCA patient journey.
Prognostic impact of the presence and absence of angina on mortality and cardiovascular outcomes in the ISCHEMIA trial
Authors: Singh A , Rodman J C S , Brown D L 
Published: October 2024

Abstract

Introduction
Patients with chronic coronary syndromes (CCS) manifested by myocardial ischemia may present with typical angina or with no anginal symptoms. It is unclear whether symptom status affects prognosis in these patients.

Purpose
To assess whether the risk of all-cause mortality and other cardiovascular (CV) outcomes varied according to the presence or absence of angina in patients with CCS and moderate to severe myocardial ischemia in the ISCHEMIA trial.

Methods
The ISCHEMIA data set was obtained from the National Heart, Lung, and Blood Institute under a data use agreement. Subjects were divided into quartiles by baseline Seattle Angina Questionnaire Angina Frequency (SAQ AF) score. Quartile (Q)1 included patients with SAQ AF scores from 1-70 whereas all patients in Q4 had SAQ AF scores of 100, indicating no angina at baseline. Categorical variables were compared using the chi-squared or Fisher’s exact test. Continuous variables were compared using the student T-test or Wilcoxon rank sum test. The cumulative incidence rate of outcomes up to five years was estimated with the Kaplan-Meier method and the rate curves were compared using the log-rank test. Multivariable Cox regression models were used to estimate hazard ratios (HRs) with potential confounders from baseline characteristics, clinical history, and angiographic characteristics included. All tests were two-sided and P&lt;0.05 was considered statistically significant.

Results
Of the 5,179 patients with CCS and at least moderate ischemia on stress testing, 1,434 were in Q1 and 1,635 were in Q4. Compared to Q1, patients in Q4 were older (66.4 (9.0) vs. 62.8 (9.6); P&lt;0.001), more often male (82% vs. 73%; P&lt;0.001), more often diabetic (43% vs. 38%; P=0.006) and less often current smokers (12% vs. 15%; P=0.001). The estimated glomerular filtration rate was lower in Q4 (82(22) vs. 86 (38); P=0.002). Fewer patients in Q4 had NYHA class II heart failure (37% vs. 62%) and more had Class I symptoms (63% vs. 38%) (P&lt;0.001). Q4 patients had a lower ejection fraction (59% vs. 60%; P=0.002), a lower Duke jeopardy score (4.9(3.5) vs. 5.5 (3.3); P&lt;0.001), less often had severe ischemia (47% vs. 56%), and more often had moderate ischemia (40% vs. 32 %) (P&lt;0.001). The cumulative 5-year event rates for Q4 vs. Q1 were: all-cause death, 10.6% and 6.4% (P=0.002); CV death/MI, 16.3% vs. 13.7% (P=0.97); CV death, 7% vs. 3.7% (P=0.009); MI, 11.4% vs. 11.4% (P=0.2). On multivariable Cox regression, angina quartile (Q4 vs. Q1) was not independently associated with all-cause death (HR 1.34, 95% CI: 0.76-2.31; P=0.33), CV death/MI (HR 0.77, 95% CI: 0.52-1.14; P=0.19), CV death (HR 1.10, 95% CI: 0.50-2.43; P=0.82), or MI (HR 0.70; 95% CI: 0.45-1.08; P=0.11).

Conclusion
In the ISCHEMIA trial, patients with CCS and moderate to severe myocardial ischemia are at elevated risk for all-cause mortality and other major CV outcomes. This risk is not modified by the presence or absence of angina.
Long-term clinical implications of routine follow-up coronary angiography of asymptomatic patients with long-duration diabetes mellitus after percutaneous coronary intervention in drug-eluting stent e
Authors: Kim H J , Jung Y S , Kim S O , Jung J C , Jung Y J , Park J I , Choi K U , Nam J H , Lee C H , Son J W , Kim U , Park J S 
Published: October 2024

Abstract

Background
Diabetes mellitus (DM) is a major risk factor for coronary artery disease (CAD), significantly contributing to mortality in affected patients. There are concerns about the adequacy of clinical follow-up for post-percutaneous coronary intervention (PCI) surveillance, especially in uncontrolled DM, due to potential asymptomatic CAD. This study assesses whether routine follow-up coronary angiography (FUCAG) offers a surveillance advantage over clinical follow-up in uncontrolled DM post-PCI.

Methods
From 2014 to 2020, a study was conducted on patients with DM who underwent PCI at our university medical. Poorly controlled DM was defined as a mean HbA1c of 9 or higher during the index PCI and follow-up period. Out of a total of 2,864 individuals, after excluding 538 individuals with a follow-up period of less than 4 years and 232 individuals who experienced an event within a year, a total of 2,094 was enrolled. Follow-up coronary angiography (FUCAG) was defined as angiography performed between 6- and 18-months post-index PCI for lesion evaluation. To adjust for any differences in baseline characteristics between the groups, propensity score matching (PSM) was implemented. The primary outcome was defined as Major Adverse Cardiac Events (MACE), comprising all-cause death, myocardial infarction, and target-lesion revascularization.

Results
PSM was conducted to correct the difference in baseline characteristics between the two groups. In the Kaplan-Meier analysis, there was no difference between FUCAG and clinical follow-up for MACE (Log-rank: P=0.770). Cox proportional regression analysis revealed a hazard ratio (HR) of 0.77 with a 95% confidence interval (CI) of 0.70-1.63, indicating no statistically significant difference.

Conclusions
Even in poorly controlled DM patients, there was no apparent clinical benefit of FUCAG compared to clinical follow-up. Particularly considering concerns such as renal function deterioration in DM patients, post-PCI surveillance through clinical follow-up may be advantageous.
Machine-learning based prediction of obstructive coronary artery disease using integrated submodules of clinical information, chest x-ray, and electrocardiography
Authors: Heo R , Park S J , Lim Y H 
Published: October 2024

Abstract

Background
The early diagnosis of obstructive coronary artery disease (CAD) is critical. However, delays in diagnosis may occur due to subsequent high-cost tests, contributing to substantial medical expenses. A more insightful interpretation of fundamental diagnostic tools, such as chest x-ray (CXR) and electrocardiography (ECG), could mitigate medical costs and facilitate a timely diagnosis.

Purpose
This study explores the application of machine learning to interpret each modality and create a consolidated prediction model for significant CAD, aiming to construct a diagnostic model based on primary tests, including CXR, ECG, and clinical information.

Methods
Clinical information-ECG-CXR paired data were generated from 19,140 patients, with CAD confirmed through coronary angiography (CAG). Machine learning (ML) was employed to develop submodules for each modality, and various integration methods were explored. The area under the curve (AUC) served as the outcome metric for predicting obstructive CAD.

Results
The development set comprised data from 17,976 patients, with CAG-confirmed obstructive CAD observed in approximately 60% of patients. The obstructive CAD group exhibited characteristics such as advanced age, male predominance, a higher prevalence of chest pain, and more risk factors. The ML model, incorporating clinical information, CXR, and ECG with submodules, demonstrated the optimal prediction of obstructive CAD (AUC 0.722). This model significantly outperformed the model without submodules (0.722 vs. 0.638, p&lt;0.0001) in obstructive CAD prediction.

Conclusions
Through the integration of submodules encompassing clinical information and basic tests, leveraging a high-quality database, the integrated ML algorithm offers improved prediction capabilities for CAG-confirmed obstructive CAD. This underscores the potential role of machine learning in clinical decision-making based on diverse modalities with distinct characteristics.