bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ticagrelor vs. clopidogrel in ST elevation myocardial infarction patients with hemoglobin &gt; 160
Authors: Zheng M Y , Zhang Y K , Hu S T , Gu T S , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y 
Published: October 2024

Abstract

Background
While some studies have provided therapeutic guidance for antiplatelet therapy in acute coronary syndrome (ACS) patients with anemia, research regarding ACS patients with elevated hemoglobin remains scarce.

Purpose
This study aims to evaluate the prognostic impact of different dual antiplatelet therapy (DAPT) regimens in ST-segment elevation infarction (STEMI) patients with hemoglobin &gt; 160 g/L.

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 3372 patients were included in the study. Patients were divided into either the ticagrelor group or the clopidogrel group based on their priscribed antiplatelet regimens. The primary endpoint was defined as major adverse cardiovascular and cerebrovascular events (MACCE), comprising of cardiac death, myocardial infarction, and ischemic stroke within one month. Secondary endpoints included all-cause death at one-year, net adverse clinical events (NACE) defined as cardiac death, recurrent MI, Bleeding Academic Research Consortium (BARC) level 3 or greater, and revascularization, and cardiac death at one year. Propensity score matching (PSM) was utilized to balance clinical characteristics between the two groups. Multivariable Cox regression analysis was conducted post PSM to evaluate the impact of different antiplatelet regimens.

Result
The study population comprised 3372 patients, with 2200 receiving clopidogrel and 1172 with ticagrelor. The median age in the clopidogrel group was 54.83 years, while in the ticagrelor group, it was 53.61 years (P = 0.005). The clopidogrel group had a higher proportion of females compared to the ticagrelor group (3.9% vs. 2.0%, p=0.003). After PSM, 1086 well-matched pairs were identified. The ticagrelor group demonstrated a significantly lower rate of one-year all-cause mortality (1.38% VS 2.85%, LogRank p = 0.018), MACCE events (6.53% VS 9.48%, LogRank p = 0.015), and cardiac death (1.29% VS 2.76%, LogRank p = 0.015), compared to the clopidogrel group. However, there was no significant difference in the incidence of NACE events between the two groups (8.38% VS 7.76%, p = 0.300). Multivariate Cox regression analysis showed that ticagrelor treatment was associated with a reduced risk of all-cause mortality ( aHR 0.408, 95%CI: 0.214-0.775, p = 0.006), MACCE events (aHR 0.640, 95%CI: 0.473-0.869, p = 0.042), cardiac death (aHR 0.384, 95%CI: 0.198-0.743, p = 0.004).

Conclusions
Among STEMI patients with hemoglobin &gt; 160 g/L, treatment with ticagrelor was associated with significantly lower rates of all-cause mortality, MACCE, and cardiac death compared to the treatment with clopidogrel.
Temporal trends in major bleeding after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction from 2003 to 2017: the Western Denmark Heart Registry
Authors: Thrane P , Olesen K K W , Thim T , Gyldenkerne C , Hansen M K , Stoedkilde-Joergensen N , Kristensen S D , Maeng M 
Published: October 2024

Abstract

Background
Management of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has changed during the last two decades. Introduction of more potent platelet inhibitors may carry an increased risk of bleeding complications, while other therapeutic options, such as use of radial artery access and proton pump inhibitors may reduce bleeding risk. The combined impact of these treatment changes on bleeding risk in patients with STEMI remains unknown.

Purpose
To examine temporal trends in 1-year risk of major bleeding after STEMI treated with primary PCI from 2003 to 2017.

Methods
We used the Western Denmark Heart Registry to identify first-time PCI-treated patients undergoing primary PCI for STEMI from 2003 to 2017. Patients were divided into 4 calendar periods based on the time of STEMI. The main outcome was 1-year risk of major bleeding defined as a hospital admission for bleeding using a validated definition with high accuracy. Additionally, the 1-year risk of major bleeding in STEMI patients was compared with the risk in an age- and sex-matched general population cohort without prior coronary artery disease.

Results
From 2003 to 2017, we identified 18,540 patients treated with primary PCI for STEMI (median age 64 years, 75% men)and 92,700 age- and sex-matched individuals. The 1-year risk of major bleeding after STEMI was similar across the different time periods; 4.1% in 2003-2006, 3.8% in 2007-2010, 3.8% in 2011-2014, and 4.5% in 2015-2017. The adjusted HR for bleeding in STEMI patients was 1.03 (95% CI 0.83-1.26) when comparing the latest period with the earliest period. The age- and sex-matched general population exhibited a 1-year risk of major bleeding of around 1% in all time periods (Figure 1).

Conclusions
Despite changes in management, the 1-year risk of major bleeding remained stable around 4% after primary PCI-treated STEMI from 2003 to 2017. This risk was approximately 4 times higher than the bleeding risk observed in an age- and sex-matched general population.
Influence of social factors on prompt reperfusion in patients with ST-segment elevation myocardial infarction: results from the KRAMI multicenter registry
Authors: Park J M , Kim M H , Lee K M , Song Z Y , Lim K H , Park J S , Kim R B , Hwang J Y , Lee J H 
Published: October 2024

Abstract

Background
The time from symptom onset to reperfusion therapy was particularly important for ST-segment elevation myocardial infarction (STEMI) patients. We sought to investigate the impact of social factors on prompt reperfusion in STEMI patients.

Methods
A total of 5,264 patients with a diagnosis of STEMI from Korean Registry of Acute Myocardial Infarction (KRAMI) was participated in present study. The association between social factors and process of symptom onset-to-timely reperfusion was evaluated. Process of symptom-to-reperfusion time was included door-to-balloon (DTB) time, symptom-to-door (STD) time and symptom-to-balloon (STB) time.

Results
In the entire study population, the median times of DTB, STD and STB were 55 min, 117 min and 175 min, respectively. With 3 parameters, only DTB was associated with in-hospital mortality (Fig. 1 and 2). Old age and male were more likely to delay treatment (p for age=0.000; p for gender &lt;0.0001). Moreover, higher education was linked to reduction of STD and STB time (p&lt;0.05). Living alone was associated with prolonged STB time, and symptom appearing outside was linked to delay medical care. Transportation with ambulance was significantly associated with reduction of reperfusion time, and inter-hospital transportation was particularly prominent (STD: OR 5.450, 95% CI 4.796 - 6.193, p&lt;0.0001; STB: OR 4.593, 95% CI 4.038 - 5.225, p&lt;0.0001). In addition, treatment time during off-hours was relatively delayed DTB time.

Conclusions
Door to balloon time is directy related to in-hospital mortality. Social factors, such as age, gender, and education level, and transportation with ambulance were related to timely reperfusion in STEMI patients.
Comparing the ability of GRACE 2.0 scores for predicting mortality in patients with and without diabetes
Authors: Soman B , Chatterjee T , Chrysostomou P , De Silva R , Sathyapalan T , Chattopadhyay S 
Published: October 2024

Abstract

Background
The GRACE 2.0 (G2) was an improvement on GRACE. Neither contains DM in the model. In the GRACE, DM independently predicted in-hospital but not the 6-month post-discharge mortality. Similar analysis for GRACE 2.0 score is unavailable.

Purpose
Assess the ability of the GRACE 2.0 score in predicting mortality in patients with and without diabetes.

Methods
Retrospective cohort analysis of data on non-STEMI and UA patients admitted in two hospitals between 2010 and 2019 entered into the Myocardial Infarction National Audit Project database. All baseline characteristics of the population and G2 scores were recorded. Death at 1 year was recorded from hospital and general practice records. Follow up was censored at the last recorded contact of the patient with a medical professional. The discriminative power of the G2 score in patients with and without diabetes in predicting mortality was determined by comparing the area under the receiver operating characteristic curve (c-statistics). Accuracy of calibration was evaluated by plotting the mean predicted vs observed mortality in each decile of predicted risk.

Results
Of 2841 patients entered, complete data was available for 2768 patients (age 69±14yrs, 62.3% male, 877(31.7%) with diabetes). G2 risk was higher in DM (8.3, IQR 3.9 to 19.0 v 5.5, IQR 2.6 to 13.0; p&lt;0.0001). 337 patients died, 156 with DM. Higher deaths occurred in DM group (17.8% vs 16.3; adjusted OR 1.81, 95% CI 1.41-2.33, p&lt;0.0001) (fig 1D). G2 discriminated between events well in whole cohort (AUC 0.81, p&lt;0.001) with no difference between DM and non-DM patients (AUC DM: 0.78, 95% CI 0.75 to 0.81; non-DM 0.81, 0.79 to 0.83; δAUC 0.0301, p=0.242) (fig1E). Calibration of predictions by G2 was excellent across all deciles of risk for the whole cohort (fig 1A). However, G2 underestimated mortality in DM versus non-DM (fig1B,C), especially in the higher deciles of risk (fig 1 F,G).

Conclusion(s)
Discrimination of the GRACE 2.0 model was excellent for mortality at 1-year with no difference between patient with and without diabetes in our cohort of NSTEMI and UA patients. However, calibration plots suggest GRACE 2.0 underestimates mortality in diabetic compare to non-diabetic patients. This may suggest that risk stratification with GRACE 2.0 in diabetic patients may have to be considered with caution.Figure 1.
The impact of pre-myocardial infarction exercise frequency on prognosis in Non-ST segment elevation myocardial infarction patients
Authors: 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
Non-ST segment elevation myocardial infarction (NSTEMI) presents a significant challenge in cardiovascular care, often requiring urgent management. Understanding the impact of exercise frequency prior to the onset of NSTEMI on post-event prognosis is crucial for developingmedical strategies.

Purpose
This study aimed to investigate the clinical characteristics and outcomes of NSTEMI patients based on their exercise frequency before experiencing NSTEMI, comparing those with regular exercise (once or more per week) versus those with infrequent or no exercise.

Methods
This study included acute myocardial infarction cohorts from 71 secondary or tertiary hospitals between January 1, 2010 and June 30, 2023. Inclusion criteria comprised NSTEMI patients evaluated for exercise frequency using the Community Health Questionnaire before hospitalization. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), net adverse clinical events (NACE), and all-cause mortality, with secondary outcomes comprising the individual components of MACCE and NACE. Propensity score matching (PSM) was employed to adjust for differences in clinical characteristics between the two groups. Multivariable Cox regression and robust multivariable Cox regression were conducted before and after PSM to evaluate the impact of exercise frequency on outcomes.

Results
The final study population consisted of 38753 participants (42.7% in the High-frequency exercise group). The median follow-up duration was 1518 days, the mean age was 67.80±11.47 years, 61.6% were male. Compared to individuals with infrequent exercise before NSTEMI, those with regular exercise exhibited significantly lower risks of MACCE [aHR 0.93(0.90-0.96), p&lt;0.001], NACE [aHR 0.91(0.88-0.95), p&lt;0.001], and all-cause mortality [aHR 0.88(0.85-0.92), p&lt;0.001]. However, regular exercise before NSTEMI was associated with an increased risk of coronary revascularization [aHR 1.14(1.06-1.23), p&lt;0.001]. These findings remained consistent in the robust multivariate Cox regression analysis conducted after adjusting for differences between the two groups with PSM (Figure 1). After PSM, survival analysis indicated that the incidence of primary outcomes was lower in individuals with high exercise frequency before NSTEMI compared to those with low exercise frequency before NSTEMI, with all-cause mortality rates of 26.9% vs. 30.8%, MACCE rates of 37.2% vs. 38.5%, and NACE rates of 37.9% vs. 39.1%, all with log-rank p-values &lt;0.001.

Conclusion
This study highlights the protective role of regular physical activity befor NSTEMI in reducing adverse post-NSTEMI outcomes. Promoting pre-NSTEMI physical activity can be a key element in preventive cardiology, potentially improving prognosis and decreasing the likelihood of cardiovascular events post-NSTEMI.Figure 1
Do DAN-GER-SHOCK eligible patients benefit from VA-ECMO treatment in infarct-related cardiogenic shock ? Results of an individual patient data meta-analysis.
Authors: Zeymer U , Freund A , Hochadel M , Ostadal P , Belohlavek J , Massberg S , Brunner S , Flather M , Adlam D , Schneider S , Desch S , Thiele H 
Published: October 2024

Abstract

Background
In a recent meta-analysis of randomized controlled trials routine use of venous-arterial ECMO (VA-ECMO) did not improve outcome in patients with infarct related cardiogenic shock (CS). Since the rate of patients with cardiac arrest and the need for cardio-pulmonary resuscitation was over 75 %, it has been speculated that a more selective approach might improve the effectiveness of VA-ECMO.

Methods
Patients included in four randomized clinical trials investigating the routine use of VA-ECMO in CS were centrally analysed. For the purpose of this sub-analysis only patients who would have been eligible for inclusion into the Dan-Ger SHOCK trial were analyzed (STEMI only, exclusion of comatose patients after out-of hospital cardiac arrest). The primary endpoint was 180-day total mortality.

Results
A total of 202 patients (106 randomised to VA-ECMO and 96 to control) were included into this analysis. There were no differences in baseline characteristics, angiographic and interventional features between the two groups. The table summarizes the results and revealed non-significant trends towards a reduced mortality with VA-ECMO.

Conclusions
In non-comatose patients with CS and STEMI the routine use of VA-ECMO is associated with a numerically lower mortality after 6 months. However, as indicated by the large confidence intervals the statistical power was limited, to draw definite conclusions. Therefore, a prospective trial with VA-ECMO in these patients seems warranted.Table
The effect of treatment srategy for acute myocardial infarction complicated by cardiac shock using Impella in accordance with institutional protocol
Authors: Tada T 
Published: October 2024

Abstract

Backgrounds
Team-based care for cardiogenic shock (CS) using mechanical circulatory support (MCS) including Impella in accordance with standardized protocol was reported to improve the prognosis of patients with CS.

Methods
Between February 2018 and September 2022, we performed percutaneous coronary intervention (PCI) in 63 patients with acute myocardial infarction (AMI) complicated by CS using Impella. We introduced institutional protocol (Figure 1) to standardize the treatment strategy for CS from June 2019, in which early Impella implantation preceding PCI was recommended. We retrospectively examined the incidence of Impella implantation preceding PCI, in-hospital outcomes including the rates of survival to Impella weaning and to discharge, and the incidence of major cardiovascular events (MACE) including all death, MI, and hospitalization for heart failure at 1-year before and after protocol introduction.

Results
The patients have a mean age of 67.1±13.2 years and 53 patients (84.1%) were male. The patients in preceding period were 16 cases, while 47 in latter period. The rate of Impella implantation preceding PCI was significantly higher in latter period than that in preceding period (61.7% vs. 25%, p=0.027) (Figure 2A). The rate of survival to Impella weaning was significantly higher in latter period than that in preceding period (83% vs. 56.3%. p=0.043). There was no difference in the rate of survival to discharge between each period (50% in preceding period vs. 68.1% in latter period, p=0.236). However, the cumulative MACE free survival rate was significantly higher in latter period than that in preceding period (56.9% vs. 31.3%, Log-rank p=0.020) (Figure 2B).

Conclusion
The introduction of institutional standardized protocol of MCS use might improve 1-year outcomes of patients with AMI complicated by CS treated with Impella.Figure 1Figure 2
Prevalence and prognostic relevance of non-obstructive coronary atherosclerosis in MINOCA: a meta-analysis of 35 studies
Authors: Ciarlantini M , Cavallo D , Suma N , Casuso M , Fedele D , Impellizzeri A , Bodega F , Bela' R , Pastore G , Ryabenko K , Foa' A , Rinaldi A , Angeli F , Paolisso P , Pizzi C 
Published: October 2024

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) can result from a variety of pathological mechanisms, not always associated with atherosclerosis. It has been suggested to distinguish between patients without obstructive coronary artery disease (NObs-CAD, stenosis diameter 1-49%), and patients with smooth coronary arteries (NCA), but differences in terms of prognosis or therapeutic approaches have not been clearly elucidated.

Objectives
The aim of this study is to evaluate the prevalence and prognostic impact of NObs-CAD as assessed by invasive coronary angiography (ICA) in MINOCA.

Methods
A meta-analysis was performed including studies reporting the prevalence of NObs-CAD versus NCA in MINOCA patients. Data on prognosis stratified by the presence of NObs-CAD were collected. Random-effects models were used to estimate the prevalence of NObs-CAD. Pooled risk ratios (RR) with 95% confidence intervals (CI) for all-cause death, myocardial infarction (MI), and the composite of both outcomes of patients with NObs-CAD compared to NCA were calculated at short-term (&lt;1 month), 1-year and long-term follow-up (more than 1 year).

Results
Thirty-five studies were analysed. The pooled prevalence of NObs-CAD estimated by ICA was 53% [95% CI 47-60%]. Heterogeneity was high (I2=98.0%), but none of the clinical and instrumental characteristics tested in meta-regression analyses had a significant impact on the I2, except for age (residual I2=97.2%, p=0.014) and geographical context. Specifically, studies conducted outside Europe reported a higher prevalence of NObs-CAD with lower I2 values. Thirteen studies provided prognostic data. The presence of NObs-CAD was associated with an increased risk of death or MI compared to NCA, as well as the risk of MI at 1-year follow-up (RR = 1.49 [95% CI 1.17-1.90] and RR = 1.80 [95% CI 1.26-2.59], respectively), whereas the risk of death was comparable. Similar results were observed at long-term, but not at short-term follow-up. Out of 13 studies, 4 provided information regarded the medications at discharge stratified by the presence or absence of NObs-CAD. NObs-CAD patients received more often aspirin (89% vs 69%; p&lt;0.01), P2Y12-inhibitors (52% vs 29%; p&lt;0.01), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53% vs 40%; p&lt;0.01), beta-blockers (70% vs 57%; p&lt;0.01), and statins (86% vs 60%; p&lt;0.01) compared to NCA.

Conclusions
Stratification of patients according to the degree of coronary stenosis has prognostic implications in the setting of MINOCA, since NObs-CAD patients present a higher risk of reinfarction. Further dedicated trials are needed to clarify whether these patients may benefit from a tailored approach in terms of secondary prevention strategies.Central illustration
Contemporary characteristics, outcomes and novel risk score for Takotsubo cardiomyopathy: a national inpatient sample analysis
Authors: Wang T K M , Agrawal A , Bhagat U , Bayat A , Sawhney A , Arockiam A D , Haroun E , Gupta R , Faulx M , Desai M Y , Jaber W , Menon V , Griffin B P 
Published: October 2024

Abstract

Background
Takotsubo cardiomyopathy (TC) is an established differential diagnosis in the category of myocardial infarction with non-obstructive coronaries with significant recent interest but limited data on prognostication. We reviewed the characteristics and in-hospital outcomes and developed a novel risk score for TC.

Methods
Adult patients (≥18 years of age) with a diagnosis of acute coronary syndrome (ACS) and TC were identified from the National Inpatient Sample 2016-2020 in the United States. The cohort was divided into ACS with and without TC, and the related baseline data was retrieved. Multivariable regression analysis was performed to identify clinical factors associated with TC and its adverse outcomes and to create a risk-scoring system estimating mortality risk in the TC cohort.

Results
Amongst 7,219,004 adult patients admitted for ACS, 78,214 (1.0%) were diagnosed with TC, with a mean age of 68.2 years, 64,526 (82.5%) being female, and 5,475 (7.0%, compared with 8.4% for other ACS) in-hospital mortality events. Key factors significantly associated with TC diagnosis were female sex (OR 6.78 (95%CI 6.47-7.09), p&lt;0.001) and chronic heart failure (OR 1.60 (95%CI 1.54-1.66), p&lt;0.001). Based on multivariable analyses for in-hospital mortality in TC patients, a novel risk score was developed, with parameters and score assignment listed in the Figure. The score can be divided into three categories: low risk (-3 to +3), moderate risk (4 to 7), and high risk (8 to 19), and its area under curves for in-hospital mortality were 0.716 in the derivation and 0.726 in the validation cohorts.

Conclusion
TC remains a high-risk diagnosis in a minority of ACS hospitalizations, with comparable in-hospital mortality rates to other causes of ACS. A novel score was developed to risk stratify TC inpatients with moderate discrimination and internal validation, warranting external validation.Takotsubo Cardiomyopathy Risk Score