bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prior fecal immunochemical test positivity is associated with adverse prognosis in patients with acute ST-segment elevation myocardial infarction
Authors: Dai W B , Gu T S , Hu S T , Zhang Y K , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y 
Published: October 2024

Abstract

Backgrounds
While fecal immunochemical testing (FIT) is commonly used for disease screening, its significance in other conditions, particularly in patients with ST-segment elevation myocardial infarction (STEMI), is not extensively researched.

Purpose
This study aimed to investigate the impact of prior positive FIT results on the clinical prognosis of patients with STEMI.

Methods
The data for this study were derived from the Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients discharged from 72 hospitals from 2010 to 2023. A total of 76,157 patients with acute STEMI patients were enrolled. Positive FIT was defined as "+-" or higher on the fecal occult blood test. Propensity score matching (PSM) was employed to balance differences between the two groups. Kaplan-Meier analysis with log-rank tests compared endpoint risks between groups, and a multivariable Cox regression model adjusted for potential confounders. The primary endpoint was Net Adverse Clinical Event (NACE), including cardiac death, recurrent myocardial infarction, revascularization, stroke, cerebral hemorrhage, and gastrointestinal bleeding.

Results
After 1:3 PSM,2,148acute STEMI patients were included, with 537 having prior positive FIT and 1,611 without. Patients with prior positive FIT were more likely to have comorbidities such as hyperlipidemia, prior malignancy, post-coronary artery bypass grafting, renal insufficiency, and prior cerebral hemorrhage. The prior positive FIT group had a higher proportion of prior clopidogrel and indobufen usage, while aspirin use during follow-up was lower. Kaplan-Meier analysis demonstrated a significantly higher risk of NACE in acute STEMI patients with prior positive FIT (before PSM: log-rank P = 0.001, after PSM: log-rank P = 0.005, Figure 1）, as well as increased rates of Major Adverse Cardiac and Cerebral Events (MACCE), all-cause death, and gastrointestinal bleeding (log-rank P &lt; 0.05 for all). Multivariate Cox-proportional hazard analysis adjusted for age, sex, percutaneous coronary intervention during hospitalization, diabetes, hypertension, ischemic stroke, atrial fibrillation, medication during hospitalization, and follow-up showed similar results (Figure 2).

Conclusions
This study reveals a significant association between prior positive FIT and higher rates of NACE, MACCE, all-cause death, and gastrointestinal bleeding in STEMI patients within 1 year. A history of positive FIT results could serve as a prognostic indicator in this specific patient population.
Coronary heart disease: leading cause of cardiovascular death from analysis of autopsies in a central european university centre
Authors: Petrkova J , Gavronova A , Sarvasova K , Bobek M , Dobias M , Petrek M 
Published: October 2024

Abstract

Introduction
Cardiovascular diseases (CVD) are the most common cause of death globally including in developed countries. Data from autopsies may provide additional and up-to-date information.

Purpose
1. To determine the proportion of deaths due to cardiovascular causes in the cohort of deceased persons who underwent autopsies 2. To describe the most frequent causes of cardiovascular death and record differences concerning age and gender.

Methods
A set of autopsies performed in the 6-year period (2017–2022) in a tertiary referral centre located in a Central European country were analyzed. The causes of death were classified as cardiovascular and non-cardiovascular. The division was performed based on the autopsy diagnosis according to the International Classification of Diseases (ICD)-10. Subsequently, cardiovascular causes of death were categorized by age (under 50 years, over 50 years) and gender (male, female).

Results
The total number of autopsies performed in the monitored period was 8651 (eight thousand six hundred and fifty-one) of which 4400 cases (50.9%) were classified by cardiovascular cause of death. Of those, coronary heart disease (CHD) was the most frequent cause of death (2340 cases; 50.9%). The vast majority of CHD patients were over 50 years of age (2083 cases, 92.2%), and males predominated (n=1569, 75.3%) over females (n=514, 24.7%). In the patients younger than 50 years of age, 155 deaths from CHD were recorded, males predominated nearly 6 times (132 males, 23 females, M:F ratio 5.74). Heart failure (HF) represented the second most common cause of cardiovascular death with 1191 cases (27.1%), again with dominance of patients over 50 years of age (684 male, 418 female, M:F ratio 1:64) In the patients under 50 years of age, the HF frequency was lower (89 cases), with a predominance of male patients (n=64) over females (n=25); M:F ratio 2.56. Pulmonary embolism accounted for the third highest share of deaths from cardiovascular reasons (370 cases; 8.4%), 330 patients were over 50 years of age and there was no significant gender difference observed (168 male, 162 female, M:F ratio 1.04). Other less frequent common diagnoses as causes of cardiovascular death observed in our cohort were as follows: hemorrhagic stroke (142 cases, 3.2%), aneurysm ruptures (107 cases; 2.4%), and esophageal varices (58 cases; 1.3%).

Conclusions
Death from cardiovascular causes accounted for more than half of the causes of death in the recent cohort of autopsied patients of a substantial size from a Central European country with coronary heart disease being the most common diagnosis accountable for half of the deaths from cardiovascular causes. Importantly, heart failure represented more than a quarter of deaths from cardiovascular causes. In both CHD and HF, the most vulnerable group was males over 50 years of age.
Genetic variations in PEAR1 are associated with progression of coronary artery disease
Authors: Nie W 
Published: October 2024

Abstract

Aim
Platelet endothelial aggregation receptor 1 (PEAR1) is a newly discovered membrane protein mainly expressed in endothelial cells and platelets. Previous researches have indicated the effect PEAR1 had on inflammation. This study aims to investigate the association between PEAR1 genetic variations and coronary artery disease (CAD) progression, which was regarded as a chronic inflammatory procedure.

Methods
We genotyped twelve common single nucleotide polymorphisms (SNPs) (rs2768759, rs2768762, rs12566888, rs12041331, rs11264579, rs77235035, rs57731889, rs822441, rs822442, rs11264581, rs56260937, and rs4661012) and detected the DNA methylation level of fourteen CpG loci in the promoter of PEAR1 in 162 Chinese patients with CAD. We accessed the association between PEAR1 genetic variants and the progression status of CAD, separated into stable angina, unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI).

Results
This CAD cohort included 40 (24.7%) with stable angina, 85 (52.5%) with unstable angina, 33 (20.4%) with NSTEMI, and 4 (2.5%) with STEMI. After adjusting for age, sex, hyperlipidemia, and diabetes mellitus as covariates in multiple logistic regression, rs12041331 was the only SNP that significantly associated with CAD type. Carriers of the A allele in rs12041331 were more likely to develop an unstable state (RR=1.996, 95%CI=1.075~3.710, p-value=0.029, Fig. 1). Carriers of A allele in rs11264579 is a potential risk factor of progression of atherosclerosis (RR=2.84, 95%CI=0.99~8.10, p-value=0.051, Fig. 1). Compared with other sites, SNPs of intron 1 were more likely to be associated with the risk of atherosclerosis progression (Fig.2).

Conclusion
Carriers of A allele in rs12041331 may lead to an increased risk of CAD progression. Region-specific genetic variant reinforces the association between PEAR1 and the risk of atherosclerosis progression.Effect of PEAR1 genetic variants.Correlation between PEAR1 SNPs and risk.
Usefulness of mean attenuation of pericoronary adipose tissue as a predictor of coronary microvascular dysfunction
Authors: Tanaka Y , Murata N , Kuronuma K , Miyagawa M , Migita S , Mizobuchi S , Fukumoto K , Arai R , Morikawa T , Mineki T , Kojima K , Sudo M , Dey D , Okumura Y 
Published: October 2024

Abstract

Background/Introduction
Coronary microvascular dysfunction (CMD) is a condition in which the distal microvasculature is compromised, resulting in inadequate blood flow to the subsequent arteries and myocardial ischemia. Index of microvascular resistance (IMR), which can quantify CMD, is becoming the standard for the diagnosis of CMD. Patients with CMD have a 4 to 5 times greater risk of cardiovascular death and myocardial infarction than patients without heart disease and similar cardiovascular risk. Early diagnosis of CMD may reduce cardiovascular risk and improve quality of life with therapeutic intervention. Pericoronary adipose tissue mean attenuation (PCATMA) is an indirect measure of adipocyte size and lipid content around coronary artery, reflecting inflammation status. Previous studies have shown that both PCATMA and CMD are associated with the functional severity of coronary artery disease, but no study has yet examined the relationship between PCATMA and CMD.

Purpose
We conducted a study comparing PCATMA in patients with and without CMD.

Methods
Between September 2022 and October 2023, 25 patients without significant stenosis (&lt;50% stenosis) who underwent IMR measurement on invasive coronary angiography and coronary CT angiography (CCTA) were included. CMD was diagnosed when the IMR exceeded 25 as measured by a pressure wire inserted into the left anterior descending artery after invasive coronary angiography had excluded significant stenosis. PCATMA was measured on CCTA using the average of the values of right coronary artery, left anterior descending artery, and left circumflex artery. Multivariable logistic regression analysis with stepwise forward selection was used to assess predictors for patients with abnormal IMR. The following variables were included for adjustment: PCATMA, age, sex, diabetes, dyslipidemia, hypertension.

Results
The mean age of 25 patients in this study was 63 years, 48.0% were female, 29.2% had diabetes, 62.5% had dyslipidemia and 66.7% had hypertension. PCATMA was significantly higher in patients with abnormal IMR (IMR&gt;25) (-79.6 [IQR: -82.1, -74.6] HU vs -86.3 [IQR: -89.8, -78.9] HU, p = 0.043). Multivariate logistic regression analysis demonstrated that PCATMA remained an independent predictor of patients with abnormal IMR (OR 1.27 [95% CI: 1.05–1.65], p = 0.039). Optimal cut-off value of PCATMA for predicting patients with abnormal IMR by Youden index was -82.1 HU (AUC = 0.75 [95% CI: 0.55-0.95]).

Conclusions
In patients without significant coronary artery stenosis, PCATMA on CCTA may be used to predict the patients with CMD, noninvasively.
Impaired high-density lipoprotein-associated cholesterol efflux capacity predicts coronary rapid plaque progression
Authors: Feng S , Shu X Y , Yang C D , Zhang R Y , Wang X Q 
Published: October 2024

Abstract

Background
Rapid progression of coronary atherosclerotic plaques is recognized as a surrogate endpoint of cardiac ischemic events. Low high-density lipoprotein (HDL)-associated cholesterol efflux capacity (CEC) has been associated with atherosclerotic cardiovascular disease independent of HDL cholesterol (HDL-C) level. In this study, we aim to investigate the predictive role of CEC in rapid plaque progression (RPP).

Methods
We consecutively enrolled patients with stable angina from January 2017 to August 2019 in our hospital who underwent elective coronary angiography with at least one untreated coronary lesion. A follow-up angiography was performed at around 12 months. Afterwards, these patients were followed-up for every 3 months to June 2021. The primary endpoint was RPP during the 12-month angiography follow-up. The second endpoint was defined as a composite endpoint of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or unplanned coronary revascularization. Fluorescence-labeled cholesterol and J774 macrophages were used to measure CEC of ApoB-depleted serum samples.

Results
A total of 430 patients with 586 coronary lesions were included in the final analysis. During a mean follow-up of 12.7 ± 2.0 months, 120 lesions (20.5%) in 80 patients (18.6%) exhibited RPP. CEC, rather than HDL-C, was inversely associated with the extent of plaque progression (net luminal loss from the lowest to highest CEC quartile: 0.22±0.42 vs. 0.20±0.41 vs. 0.13±0.36 vs. 0.11±0.34 mm, P = 0.035). In multivariate analysis, baseline CEC was inversely associated with RPP independent of conventional risk and protective factors including HDL-C or apolipoprotein A-I. Subgroup analysis demonstrated that the association between CEC and RPP was more prominent in patients with high (≥4.02 mmol/L) than low (&lt;4.02 mmol/L) total cholesterol. Finally, although patients with RPP had higher risk of the composite endpoint than those without RPP (P=0.012), no significant difference was observed between patients in different quartiles of CEC (P=0.720).

Conclusions
HDL-associated CEC is inversely associated with RPP in patients with coronary artery disease. HDL function assessment behaves as a better diagnostic biomarker than HDL-C for predicting RPP.
Clinical value of single projection angiography-derived FFR in non-infarct related artery
Authors: Lee S H , Choi K H , Hong D , Kim H K , Park K H , Choo E H , Kim M C , Hong Y J , Ahn S G , Lee S Y , Joh H S , Yang J H , Song Y B , Hahn J , Lee J M 
Published: October 2024

Abstract

Background
Murray law-based quantitative flow ratio (μFR) is an emerging technique which requires only one projection of coronary angiography with similar accuracy with quantitative flow ratio (QFR). However, it has not been validated for evaluation of non-infarct related artery (non-IRA) in acute myocardial infarction (AMI) setting. Therefore, our study aimed to evaluate the diagnostic accuracy of μFR and the safety of deferring non-IRA lesion with μFR&gt;0.80 in the setting of AMI.

Methods
μFR and QFR were analyzed for non-IRA lesions of AMI patients enrolled in the FRAME-AMI trial, consisting of fractional flow ratio (FFR)-guided PCI and angiography-guided PCI groups. Diagnostic accuracy of μFR was compared to QFR and FFR. Patients were classified by non-IRA μFR values 0.80 as a cutoff value. The primary outcome was vessel-oriented composite outcomes (VOCO), a composite of cardiac death, non-IRA-related MI, and non-IRA-related repeat revascularization.

Results
443 patients (552 lesions) were eligible for μFR and QFR analysis. μFR showed acceptable correlation with FFR (R=0.777, P&lt;0.001), comparable C-index with QFR to predict FFR≤0.80 (μFR vs. QFR: 0.926 vs. 0.961, P=0.070), and shorter total analysis time (mean 32.7sec vs. 186.9sec, P&lt;0.001). Non-IRA with μFR&gt;0.80 and deferred PCI had significantly lower risk of VOCO than non-IRA with performed PCI (3.4% vs. 10.5%; HR, 0.37; 95% CI, 0.14-0.99; P=0.048).

Conclusion
In multivessel AMI patients, μFR of non-IRA showed acceptable diagnostic accuracy comparable to that of QFR to predict FFR≤0.80. Deferred non-IRA with μFR&gt;0.80 showed lower risk of VOCO than revascularized non-IRA.
Antiplatelet can improve the short-term prognosis of type 2 myocardial infarction caused by acute respiratory failure
Authors: Jia Y Q , Dai W B , Gu T S , Hu S T , Zhang Y K , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y 
Published: October 2024

Abstract

Background
Type 2 myocardial infarction (T2MI) is characterized by myocardial infarction resulting from an imbalance between myocardial oxygen supply and demand, without the rupture of acute atherosclerotic plaque. Antiplatelet therapy is the cornerstone of treatment for Type 1 myocardial infarction, however, its efficacy in T2MI remains unclear.

Purpose
This study aimed to explore the impacts of antiplatelets on prognosis in patients with T2MI caused by acute respiratory failure.

Methods
The data for this study were derived from the Health and Medical Big Data Superplatform, comprising a retrospective cohort of patients admitted to and discharged from 72 secondary and tertiary hospitals from 2010 to 2023. A total of 4708 patients with T2MI due to acute respiratory failure were included. Participants were divided into two groups: those receiving antiplatelet therapy and those not. T2MI caused by acute respiratory failure was defined as NSTEMI patients caused by respiratory failure without percutaneous coronary intervention (PCI). Propensity score matching (PSM) was used to balance covariates between the groups, followed by building a multivariable Cox regression model to further adjust for potential confounders. Covariates adjusted in multivariable Cox regression included antiplatelet, anticoagulant, and lipid-lowering drug use during hospitalization, age, sex, KILLIP classification, history of diabetes, hypertension, percutaneous coronary intervention, stroke, renal insufficiency, cerebral hemorrhage, and atrial fibrillation. One-to-one matching was performed based on propensity scores using the nearest available pair matching method with a caliper width of 0.01. The primary endpoint was Net Adverse Clinical Events (NACE) within 1 month, including myocardial infarction, cardiac death, stroke and Bleeding Academic Research Consortium (BARC) criteria type 3 or 5.

Results
Following 1:1 propensity score matching, a total of 1418 participants were enrolled in the final study sample, with 709 patients retained in each group. Patients using antiplatelet were more likely to use ACEI/ARB, CCB, and β-blockers during hospitalization, all p&lt;0.05.Compared to non-antiplatelet therapy group, the use of antiplatelet was associated with a 0.69 times risk of 1-month NACE (aHR, 0.69; p&lt;0.001), a 0.69 times risk of 1-month Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) (aHR, 0.69; p&lt;0.001), a 0.70 times risk of 1-month cardiac death (aHR, 0.70; p&lt;0.001), and a 0.70 times risk of 1-month all-cause mortality (aHR, 0.70; p&lt;0.001); with no statistical significance for other clinical outcomes (p &gt; 0.05) (Figure 1).

Conclusions
The present study suggested that patients receiving antiplatelet therapy had a lower incidence of one-month NACE, primarily due to a reduction in major cardiac death and MACCE at 1 month.
Strike early-strike strong lipid-lowering strategy with PCSK9i in ACS patients. Real-world evidence from AT-TARGET-IT registry
Authors: Gargiulo P , Marzano F , Fontanarosa S , Basile C , Galasso G , Patti G , Ando' G , Calabro' P , Catalano A , Varbella F , Muscoli S , Musumeci G , Giallauria F , Porto I , Perrone-Filardi P 
Published: October 2024

Abstract

Background/Introduction
No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in real-world.

Purpose
This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major CV events in real-world.

Methods
The lipid control outcome was the percentage of patients reaching the LDL-C target of &lt; 55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all cause death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization) during follow-up in relation to quartiles of LDL-C at first lipid control.

Results
We included 771 patients with ACS from AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischemia-driven revascularization in lower quartile of LDL-C values at first lipid control (&lt;23 mg/dL) and in patients reaching LDL-C &lt;55 mg/dL.

Conclusions
Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.
Percutaneous coronary intervention of in-stent restenosis: A three-arm analysis from SWEDEHEART
Authors: Von Koch S , Zhou M , Rosen H C , Zwackman S , Jurga J , Grimfjard P , Gotberg M , Mohammad M A , Erlinge D 
Published: October 2024

Abstract

Background
During the last decades, there have been substantial improvements in treatment techniques for percutaneous coronary intervention (PCI). Yet, in-stent restenosis (ISR) continues to pose significant challenges as they account for 10% of all PCI cases and are associated with worse outcome compared to de-novo lesions. When assessing ISR with PCI, balloon angioplasty with drug-coated balloons (DCB) is frequently used.

Purpose
Despite frequent use of DCB, there is a lack of long-term data ensuring the safety of DCB for ISR as no randomized trial has extended beyond a 3-year follow-up. We aimed to study the long-term outcome and conducted a nationwide three-arm investigation on the outcome of ISR, comparing DCB with drug-eluting stents (DES) or plain old balloon angioplasty (POBA) within a 5-year follow-up.

Methods
We conducted a nationwide analysis using the SWEDEHEART (Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. The SWEDEHEART registry was used to include any ISR undergoing coronary angiography between June 11, 2013, and December 31, 2020. Target lesion revascularization (TLR) was the primary outcome. Secondary outcomes included all-cause mortality, myocardial infarction, and any PCI. The outcomes were analysed using a multivariable Cox regression model.

Results
A total of 9304 segments from 7987 patients were eligible. Compared to POBA, the use of DCB was associated with lower rates of TLR, hazard ratio (HR) 0.62 (95% confidence interval [CI]: 0.50-0.78), all-cause mortality, HR 0.60 (95% CI: 0.50-0.72), and any PCI, HR 0.78 (95% CI: 0.66-0.93). No difference was observed for myocardial infarction. Compared to DES, the use of DCB was associated with higher rates of TLR, HR 1.24 (95% CI: 1.08-1.42). No difference was observed for all-cause mortality, cardiovascular mortality, myocardial infarction, or any PCI.

Conclusions
In this nationwide analysis including any ISR undergoing PCI, the use of DCB showed superior outcomes compared to POBA within 5 years but higher rates of repeat revascularizations compared to DES. While DES demonstrated lower TLR rates than DCB, the lack of mortality differences indicates that DCB is a viable option, particularly for patients where DES might not be suitable, but that DES should be considered as the first line strategy.Table 1.5-year outcomeFigure 1.Kaplan-Meier curves