bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early coronary revascularization among stable patients with non-ST-segment elevation acute coronary syndromes: the role of diabetes and age
Authors: Cenko E , Fabin N , Bergami M , Yoon J , Vadala G , Kedev S , Kostov J , Vavlukis M , Vraynko E , Milicic D , Vasiljevic Z , Zdravkovic M , Galassi A R , Manfrini O , Bugiardini R 
Published: October 2024

Abstract

Background
Diabetes mellitus affects 10-30% patients hospitalized with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and two-fold higher mortality risk compared to non-diabetics. Despite higher post-PCI complications in diabetic patients, guidelines advise early invasive NSTE-ACS treatment for all, based expert opinion, and limited evidence.

Purpose
To investigate the impact of an early coronary revascularization (&lt;24 hours) compared with initial conservative strategy on clinical outcomes in diabetic patients with NSTE-ACS who are in stable condition at hospital admission.

Methods
The ISACS-TC database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using logistic regression and inverse probability of treatment weighting models. Primary outcome measure was all cause 30-day mortality. Risk ratios (RRs) and odds ratios (ORs) with their 95% CIs were employed.

Results
Of the 7,589 NSTE-ACS patients identified, 2,343 were diabetics. The data show a notable reduction in mortality for the elderly undergoing early revascularization compared to those receiving an initial conservative strategy both in the diabetic (3.3% versus 6.7%; RR: 0.48; 95% CI: 0.28-0.80) and nondiabetic patients (2.7% versus 4.7%: RR: 0.57; 95% CI: 0.36-0.90). In multivariate analyses, diabetes was a strong independent predictor of mortality in the elderly (OR: 1.43; 95% CI: 1.03-1.99), but not in the younger patients OR: 1.04; 95% CI: 0.53-2.06).

Conclusions
Early coronary revascularization does not lead to any survival advantage within 30 days from admission in young NSTE-ACS patients who present to hospital in stable conditions with and without diabetes. An early invasive management strategy may be best reserved for the elderly. Factors beyond revascularization are of considerable importance for outcome in elderly diabetic subjects with NSTE-ACS.
Baseline heart rate as a key prognostic indicator in AMI patients with cardiogenic shock undergoing successful primary PCI
Authors: Abe T , Kamishima K , Shimazaki K , Shibahashi E , Yamada T , Kobayashi H , Oka T , Tanaka H , Yamaguchi J , Jujo K 
Published: October 2024

Abstract

Background
Cardiogenic shock presents as a critical condition in patients experiencing acute myocardial infarction (AMI). Even that primary percutaneous coronary intervention (PCI) has become widespread, the mortality rate of AMI complicated with cardiogenic shock remains high. However, comprehensive prognostic stratification remains elusive.

Objective
Our study sought to elucidate the relationship between baseline parameters and prognostic outcomes in AMI patients with cardiogenic shock.

Methods
From the GETBACK-AMI multicenter retrospective registry encompassing 935 AMI patients who underwent primary PCI and attained TIMI 3 flow upon final angiography. There were 73 patients diagnosed with cardiogenic shock were ultimately analyzed. The primary endpoint of our study was all-cause mortality.

Results
Over a median follow-up duration of 425 days, 17 patients (23%) succumbed, of which 14 were in-hospital fatalities. Employing the Cox regression model, we identified that heart rate (HR) at the time of admission bore a potent and independent correlation with the primary endpoint (hazard ratio: 1.04 [95% CI: 1.01-1.06], p=0.002), even post-adjustment for various covariates. ROC analysis pinpointed an admission HR of 82 bpm as the threshold for the primary endpoint. Kaplan-Meier curves further highlighted a pronounced elevation in the primary endpoint occurrence rate for patients with HR &gt; 82 bpm compared to those with HR &lt; 82 bpm (53% vs. 13%, p=0.0002).

Conclusions
Within our multicenter study cohort, a heightened admission HR was demonstrably linked to increased mortality in AMI patients with cardiogenic shock who reached a final TIMI 3 flow. This readily accessible and impactful prognostic marker may guide clinicians in identifying high-risk patients, subsequently allowing for enhanced support and interventions to optimize patient outcomes.
One-year prognosis difference of MINOCA versus MI-CAD in developing countries: insights from the Moroccan experience
Authors: Bouchlarhem A , Bazid Z , Ismaili N , El Ouafi N 
Published: October 2024

Abstract

Introduction
The debate remains open as to the difference in prevalence of mortality and occurrence of acute events in patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA) and others with Myocardial infarction with coronary arteries disease (MI-CAD) (1).

Purpose
We carried out an analysis of the clinical characteristics and one-year prognosis of MINOCA versus MI-CAD.

Methods
We conducted a prospective study for patients admitted for Acute coronary syndrome (ACS) during 2-years, to analyze the clinical and prognostic characteristics of patients with MINOCA versus MI-CAD. We defined 1-year all-cause mortality as the primary outcome, and the secondary outcome as a composite of 1-year readmission for myocardial infarction or acute heart failure (AHF). The primary and secondary outcomes was studied using a Cox proportional hazards regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for variables described in the literature.

Results
Our study included 1077 patients, 95.3% with MI-CAD and 4.7% with MINOCA. At admission, 71.1% patient were diagnosed STEMI and 28.9% with NSTEMI. The difference between the two groups was found on age (p&lt;0.001), hypertension, diabetes with consecutive p-values of 0.007 and 0.001, as well as Ejection fraction (p&lt;0.001). For the outcomes studied, we found, firstly before adjustment, that patients in the MINOCA group had a better prognosis than the MI-CAD group, for all-cause 1-year mortality (HR=0. 442; 95%CI 0.227-0.760; p=0.041) with a significant difference in the Kaplein Meier survival analysis with a log-rank test (p-value =0.02) (Figure 1), and a lower risk of readmission for ACS (HR=0.297; 95%CI 0.316-0.821; p=0.034), as well as for readmission for AHF (HR=0.555; 95%CI 0.329-0.836; p=0.045) also with a significant difference between the two groups in the Kaplein Meier analysis with consecutive log-rank test p-values of 0.033 and 0.035 (Figure 2). After adjustment for age, arterial hypertension, diabetes, active smoking, EF&lt;40%, proximal LAD or LM as culprit artery, TIMI 0-I flow, CRP &gt;300mg and cardiogenic shock during hospitalization, the results remained significantly in favor of a better prognosis for MINOCA: (HR=0. 672; 95%CI 0.376-0.872; p=0.003) for 1-year all-cause mortality, (HR=0.301; 95%CI 0.482-0.879; p=0.012) for readmission for ACS and finally (HR=0.604; 95%CI 0.309-0.812; p=0.039) for readmission for AHF.

Conclusion
Despite the ambiguity in the genesis of MINOCA, the short- and long-term prognosis of these patients remains generally favorable.Figure 1.Figure 2.
Cardiac magnetic resonance in MINOCA patients: a non-tertiary hospital experience
Authors: Mata Caballero R , Izquierdo Coronel B , Fraile Sanz A , Aguilar Rivilla E , Olsen R , Nieto Ibanez D , Perela C , Martin Munoz M , Alvarez Bello M , Gil Mancebo N , Rodriguez Montes P , De La Serna Real De Asua M , Espinosa Pascual M J , Carnicero Carreno J A , Alonso Martin J J 
Published: October 2024

Abstract

Background
Cardiac magnetic resonance (CMR) is a key tool in the diagnostic process of myocardial infarction with non-obstructive coronary arteries (MINOCA), impacting patient management and prognosis. Its use in non-tertiary hospitals is often constrained mainly by accessibility. Thus, the aim of this study was thoroughly evaluate CMR application in this context to optimize the process.

Methods
136 MINOCA patients who were admitted to our hospital between 2016 and January 2024 were analyzed. Each MINOCA patient was reviewed by experts to align with the diagnosis criteria outlined in the 2020 ESC Guidelines and the American Heart Association position paper, which recommended CMR for MINOCA patient’s evaluation. To assess the factors associated with normal-CMR, a logistic regression analysis was performed. In a first step, some factors were detected, showing a trend in the association. In a second step, a backward elimination procedure was used, excluding factors with p&gt;0.1.

Results
CMR was performed in 65 MINOCA patients (48% of the cohort), with a mean age of 59±15 years old, 35 of them were males (54% of total patients). During the follow-up, there were 4 deaths (6%) and 4 readmissions (6%). Out of the total 65 patients, the CMR diagnosis was myocardial infarction (MI) in 14 (21.5%) and myocarditis in 16 (24.6%), and was normal in 35 (53.9%). Therefore, CMR provided diagnostic information in 46% of the cases.
It was noted that a normal CMR was associated with female gender, (OR 2.7, 95% CI 0.96-7.34, p=0.057), hypertension (OR 2.25, 95% CI 0.81-6.22, p=0.11), absence of segmental abnormalities in echocardiography (OR 0.14, 95% CI 0.035-0566, p=0.06) and lower high-sensitivity Troponin T (OR 0.79, 95% CI: 0.66-0.95, p=0.001). In the second step, only segmental abnormalities (OR 0.2, 95%CI 0.04-1.09, p=0.063) and troponin (OR 0.31, 95%CI 0.10-0.99, p=0.048) remained included. Additionally, the Youden Index was determined to obtain the threshold for troponin, resulting a value of 606 nG/mL, area under ROC curve (AUC) = 0.784 (figure).

Conclusions
- CMR was performed in 48% of the MINOCA patients, reflecting the limitation for its use in routine clinical practice. Furthermore, it was useful in 46% of those patients.
- The main factors associated with normal CMR were absence of segmental echocardiography abnormalities and reduced troponin levels.
- A troponin cutoff point of 606 ng/mL identified patients with a normal CMR (AUC=0.784).Figure 1.CMR in MINOCA patientsFigure 2.Area under ROC curve = 0.784
Trends in Takotsubo syndrome
Authors: Schweiger V , Cammann V L , Wuerdinger M , Gilhofer T , Niederseer D , Luescher T F , Ruschitzka F , Bossone E , Ghadri J R , Templin C , Di Vece D 
Published: October 2024

Abstract

Background
Previously considered a rare and relatively benign cardiac condition, Takotsubo syndrome (TTS) has undergone a significant shift in perception over the last two decades. This shift was mainly driven by results indicating that TTS is associated with signicant mortality and morbidity. Consequently, also the criteria for diagnosing TTS have been updated to reflect its recognition as a complex, multifactorial disease.

Purpose
The aim of the present study was to investigate trends in clinical presentation, demographics, and outcomes of patients with TTS.

Methods
The study analyzed 3,675 patients diagnosed with TTS from 2004 to 2021. Participants were divided into groups based on diagnosis, using three-year intervals, to perform trend analyses on demographics, risk factors, clinical presentations, and outcomes. The Cochran-Mantel-Haenszel test was used for categorical data trends, while the Mann-Kendall test assessed numerical variables. Mortality rates were compared using the log-rank test.
Findings: The study period saw a steady increase in male patients (from 10% to 15%, p = 0.003). While apical TTS continued to be the most common type, the occurrence of midventricular TTS increased (from 18% to 37%, p = 0.002). Emotional triggers remained constant, whereas the prevalence of physical triggers significantly rose (from 35% to 50%, p = 0.034). The incidence of cardiogenic shock increased (from 11% to 20%, p=0.030), leading to a rise in in-hospital mortality rates (from 2% to 9%, p&lt;0.001). A landmark analysis showed a significant increase in 60-day mortality rates (p &lt; 0.001), but no difference in one-year mortality over the years (p = 0.140, Figure 1).
Summary: This study of temporal trends in TTS highlights a shift in patients demographic with agrowing prevalence among males, increasing recognition of midventricular TTS type, and increased rates of cardiogenic shock and mortality in recent years. This shift aligns with the rising prevalence of physical triggers, as an expression of increased recognition of TTS in association with acute comorbidities.
A new prehospital cardiac risk assessment index derived from vital signs by first contact emergency medical service, including prehospital oxygen saturation, for accurate prehospital triage of acute m
Authors: Kirii Y , Kurita T , Ito H , Takasaki A , Moriwaki K , Kumagai N , Omura T , Sawai T , Seko T , Tanigawa T , Kitamura T , Dohi K 
Published: October 2024

Abstract

Background: Rapid and accurate triage is essential to improve the prognosis of patients with severe acute myocardial infarction (AMI). However, prehospital triage using vital signs, including prehospital oxygen saturation (SpO2), by first medical contact has not been evaluated.
Purpose: The purpose of this study was to develop a new risk stratification index for AMI using vital signs including SpO2 for rapid and accurate prehospital triage.
Methods: From January 2013 to June 2022, 3006 AMI patients who were directly transported by ambulance were enrolled from the Mie ACS registry. Based on observed risk relationships in 3,006 AMI patients, we developed and evaluated a prehospital cardiac risk assessment index (P-CRAI) using age, heart rate, and systolic blood pressure (SBP) and SpO2 to predict 30-day mortality: (heart rate×[age/10]2)/SBP＋1.1(100-SpO2). We also analyzed whether P-CRAI predicted the need for mechanical circulatory support (MCS) or ventilator use.
Results: In the receiver operating characteristic (ROC) curve analysis, P-CRAI 38.1 has a sensitivity of 84.4%, specificity of 72.7%, and accuracy of 84.3% for predicting 30-day mortality, and P-CRAI was a strong predictor of 30-day mortality compared with the other indices and variables (Figure 1A). When divided into two groups with P-CRAI 38, Kaplan-Meier survival curves showed significant differences in 30-day survival between the high and low groups (83.7% vs. 98.7%, P&lt;0.001, Figure 1B). P-CRAI≥38 was the strongest independent predictor of 30-day mortality with a hazard ratio of 7.64 compared to the other factors by multivariate Cox regression analysis. The spline curve of 30-day mortality by P-CRAI shows a correlation with prognosis (Figure 2A). In this study, we then used the bootstrap method to generate a calibration curve and validate P-CRAI. The results showed an excellent fit and that P-CRAI accurately estimated patient prognosis (Figure 2B). In addition, P-CRAI was a robust predictor of the very early events of death at 24 hours and MCS or ventilator use by ROC curve analysis. (c-statistic 0.835 and 0.726, respectively, P&lt;0.01).
Conclusion: The P-CRAI was found to be a useful tool for prehospital triage of AMI patients, accurately predicting 30-day mortality and the need for MCS.Figure 1.Figure 2.
Preserved left ventricular ejection fraction with abnormal myocardial work in sepsis
Authors: Salinas P , Dieiev V , Barnett J , Kramer D , Lamptey M , Erickson L , Jain R 
Published: October 2024

Abstract

Background
Sepsis is a life-threatening condition associated with a dysregulated response to infection, leading to an increased risk of multi-organ dysfunction and death. Left ventricular (LV) dysfunction has been reported in up to 60% of patients with sepsis. Still, it’s true incidence is difficult to determine as defined by standard methods like left ventricular ejection fraction (LVEF) due to its dependency on loading conditions. Myocardial work (MW) is a validated novel parameter informing true LV contractility. MW is calculated using echocardiography strain data, noninvasive BP measurements, and GE Healthcare proprietary software. There are four MW indices; here, we evaluated the global work index (GWI), the indexed total work performed by the LV through mechanical systole, including isovolumic relaxation and contraction.

Purpose
To describe our patient population diagnosed with sepsis with GWI calculated as part of their echocardiography. We also sought to compare the GWI values with GWI normal reference values reported in current literature to determine whether our observed mean GWI in a cohort of patients with sepsis deviates significantly from these established benchmarks in an average healthy population.

Methods
This report was a retrospective analysis of 179 consecutive patients ≥18 years with sepsis as defined by the Third International Consensus Definitions for Sepsis and Septic Shock who presented at our center from January 2020 to October 2023. LVEF (%) and GWI (mm Hg%) were reported as mean (±SD). A one-sample t-test was used to determine if the mean MWI for males and females diagnosed with sepsis at our center significantly differed from the reported GWI literature of reference patients without sepsis.

Results
Males (n=90, 50.3%) from our center had a significantly lower GWI mean (1353.06 ± 490.75) than the literature-reported male reference value of 2062 (P &lt; 0.001) and a 95% confidence interval (1250 to 1455.84). See the Table.
In 89 (49.7%) females with sepsis, mean GWI was also significantly lower, 1511 ± 595.79 (P &lt; 0.001), than the normal reported female reference GWI value 2155 with a 95% CI (1385.57 to 1636.58). The pooled GWI mean was 1440.0±561.8 (ref: 2118±277). Septic males and females had preserved mean LVEF values of 51.6±13.11 and 56.8±14.4, respectively. The pooled mean LVEF was 54.0±13.8.

Conclusion
These findings revealed preserved LVEF alongside decreased global work index in patients with sepsis. To our knowledge, this is the first description of MW indices in septic patients. The results highlight the importance of further investigations into the role of MW indices in sepsis and the potential for these indices to enhance our understanding and clinical approach to myocardial dysfunction in sepsis.
Recreational drugs use as prognostic factor of major adverse cardiovascular and cerebrovascular events in patients hospitalised for acute cardiovascular events
Authors: Mirailles R , Trimaille A , Toupin S , Delmas C , Bouleti C , Schurtz G , Lattuca B , Rossanaly Vasram R , Noirclerc N , Fauvel C , Bochaton T , Gerbaud E , Dillinger J G , Henry P , Pezel T 
Published: October 2024

Abstract

Background
Among patients admitted to the intensive cardiac care unit (ICCU), systematic screening for recreational drugs evidenced a significant prevalence of recent use and was associated with a higher rate in-hospital outcomes. However, long-term cardiovascular consequences of recreational drug use remain uncertain.

Purpose
We aimed to evaluate the prognostic impact of recreational drugs use at 1-year follow-up to predict major adverse cardiovascular and cerebrovascular events (MACCE) in consecutive patients admitted to ICCUs for acute cardiovascular events from the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study.

Methods
In this prospective multicentric study, all consecutive patients admitted to ICCUs over two weeks in April 2021 at 39 centres across France were included. Screening for recreational drugs use was performed by systematic urinary testing. One-year follow-up consisted of a clinical visit or direct contact with the patient and the referring cardiologist. The primary composite outcome was the occurrence of one of the combined MACCE defined as cardiovascular death, nonfatal myocardial infarction (MI) or stroke. Subgroup analysis was performed in patients hospitalised at baseline for acute coronary syndrome.

Results
Of the 1499 consecutive patients screened, 1392 (93%) patients (63±15 years, 70% males) had a complete 1-year follow-up. Among them, 157 (11%) had an initial positive test for recreational drug use (cannabis, opioids, cocaine, amphetamines, 3,4-methylenedioxymethamphetamine [MDMA]). After 1-year of follow, 94 (7%) patients experimented MACCE. Patients with positive testing exhibited a higher rate of MACCE than non-users (13% vs 6%, respectively, p=0.002). After adjustment for traditional prognosticators, recreational drug use was independently associated with the occurrence of MACCE (HR=2.99; 95% CI: 1.73-5.16, p&lt;0.001).
In the subgroup analysis of 713 patients hospitalised at baseline for acute coronary syndrome, 96 (14%) had a positive recreational drug test and 50 (7%) experienced MACCE. Using a multivariable Cox analysis in this population, recreational drug use was still independently associated with MACCE after adjustment for traditional prognosticators (HR=2.98; 95% CI: 1.43-6.21, p=0.004).

Conclusions
In a large cohort of consecutive patients admitted to ICCUs for acute cardiovascular events, the prevalence of recreational drug use was 11%. Recreational drug use was strongly associated with the occurrence of 1-year MACCE even after adjustment for traditional prognosticators.Central illustrationPrognostic impact of drug use
The majority of 30-days survivors return to work one-year after in-hospital cardiac arrest
Authors: Yonis H , Granger C B , Torp-Pedersen C , Meaidi A , Kragholm K 
Published: October 2024

Abstract

Background
Surviving in-hospital cardiac arrest poses a significant risk of anoxic brain damage, which can impede survivors’ ability to return to work.

Purpose
This study aimed to examine return to work among in-hospital cardiac arrest survivors.

Methods
In this cohort study we included all 30-day survivors of working age (18-64 years), who experienced an in-hospital cardiac arrest between January 1st, 2013, and December 31st, 2018. Data was obtained from the national Danish in-hospital cardiac arrest registry (DANARREST) and employment status was retrieved from a registry from the Danish National Labor Market Authorities. We used a previously validated definition of "working" as any individual who was not on any social benefits, except state education fund grants, maternity leave pays, or leave-of-absence. Only patients working four weeks prior to the event were included in the study. Kaplan-Meier survival analysis was applied to estimate the probability of returning to work.

Results
Among 7,254 in-hospital cardiac arrest patients in Denmark from 2013-2018, 1,781 were of working-age, with 734 surviving at least 30 days. A total of 348 patients, who were working four weeks before their event, formed the final study population (Figure 1). Median age was 54 (Interquartile range (IQR) 46-59) and 70.4% were male. The cumulative incidence for return to work was 67.0% (95% CI: 62.0%-71.9%) with 4.6% (95% CI: 2.4%-6.8%) dying by one-year post-arrest as a competing risk (Figure 2). Age and sex distribution were comparable between survivors returning to work, those who did return to work, and those who died. A higher proportion of survivors returning to work had a Carlson’s Comorbidity Index score of 1 (70.8%) compared to survivors without work (58.1%) and those who died (33.3%). Additionally, an initial shockable rhythm was more frequent among survivors returning to work (49.8%) compared to survivors who did not return to work (45.2%), and those who died (9.1%).

Conclusion
We found that 67% of 30-day survivors of in-hospital cardiac arrest returned to work one year after their event. While survivors retuning to work shared comparable age and sex distributions with survivors who did not return to work and non-survivors, factors such as a lower Carlson’s Comorbidity Index score and a higher proportion with an initial shockable rhythm were distinguishing characteristics for those who returned to work.FlowchartCumulative incidence curves