bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extra cellular volume by computed tomography is useful for prediction of prognosis in cardiac sarcoidosis
Authors: Nishikawa Y , Takaoka H , Daimon M , Noguchi Y , Yoshida K , Ota J , Matsumoto M , Aoki S , Suzuki K , Yashima S , Kinoshita M , Suzuki-Eguchi N , Sasaki H , Kobayashi Y 
Published: October 2024

Abstract

Background
Extracellular volume (ECV) fraction on magnetic resonance imaging (MRI) has been useful in evaluating the degree of myocardial fibrosis and has been reported to help diagnose and evaluate the prognosis of cardiomyopathy. However, there are also several contraindications in the cardiac MRI, and the performance of it takes time. Computed tomography (CT) helps screen for coronary artery disease, is more versatile than cardiac MRI, and is also useful in screening for coronary artery disease. Myocardial extracellular volume (ECV) analysis on CT has been recently eligible and has shown a good correlation with ECV on MRI. We hypothesized that ECV on CT, a new fibrosis indicator, would be useful in predicting prognosis in patients with cardiac sarcoidosis (CS).

Purpose
The purpose of this study is to evaluate the utility of ECV analysis on CT for predicting major adverse cardiac events (MACEs) in cases with cardiac sarcoidosis (CS).

Methods
As a single-center study, 48 patients (18 males, 67 ± 11 years old) diagnosed with CS based on the 2016 Japanese Circulation Society criteria and who underwent cardiac CT using 320-row detector CT or 256-row detector CT, and including late-phase images from December 2008 to January 2024 were analyzed retrospectively. We evaluated the ECV of left ventricular myocardium (LVM) using commercially available software (Figure A). The primary endpoint was MACEs, a composite of all-cause death, heart failure hospitalization, and fatal ventricular arrhythmia.

Results
Among all 48 patients, 14 combined events (10 fatal ventricular arrhythmias, three heart failure hospitalizations, and one all-cause death) were observed during a follow-up of 56 ± 57 months. ECV of LVM on CT was significantly higher in patients with MACEs than the others (37 ± 5.6% vs 33 ± 4.6%, P = 0.0087). The best cut-off value of ECV of LVM on CT for prediction of MACEs was 34.97%, and the sensitivity and specificity of LV-ECV to predict MACEs were 71% and 76% at the best cut-off, and the area under the curve was 0.73 based on the receiver operating characteristics curve analysis (P = 0.009) (Figure B). The cases with ECV ≥ 34.97% (n = 18) had significantly higher MACEs than the cases with ECV &lt; 34.97% based on the Kaplan-Meier analysis (P = 0.0031) (Figure C). In the multivariate Cox proportional hazard model, ECV on LVM (Hazard ratio 1.11, 95% confidence interval 1.00-1.21, p=0.0493) and history of VT ablation (Hazard ratio 27.7, 95% confidence interval 4.27-180, p=0.0011) were the significant predictors of MACEs.

Conclusion
Adverse events mainly caused by fatal ventricular arrhythmia are relatively common in CS. Evaluation of ECV by CT may be useful for the prediction of MACEs in cases with CS.
Endothelial dysfunction in acute coronary syndrome: a complex association with cardiovascular risk factors, sleep quality and cardiorespiratory capacity
Authors: Hbaieb M , Charfeddine S , Hammouda O , Bosquet L , Driss T , Abid L 
Published: October 2024

Abstract

Introduction
It is widely acknowledged that normal endothelial function plays a pivotal role in conferring cardioprotective effects against ischemia-reperfusion injury following acute myocardial infarction (AMI) treated by a primary percutaneous coronary intervention (PCI), thereby limiting infarct size (1). However, endothelial dysfunction (ED) has been extensively documented in patients with cardiovascular (CV) risk factors (2). This study proposes a novel perspective, positing that ED could be intricately linked not only with traditional CV risk factors, but also it can be associated with poor sleep quality. Consequently, this interplay might significantly contribute to the attenuation of exercise capacity.

Objective
The aim of this study was to assess endothelial function following AMI treated with a PCI and investigate the link between endothelial function, CV risk factors, sleep quality and exercise capacity. Furthermore, the study aimed to determine if endothelial function could serve as a predictive factor for future major adverse acute cardiac events (MAACE) following AMI.

Materials and methods
Sixty-three patients with AMI (56.21 ± 7.6 years) volunteered to participate in this study, . Endothelial function was assessed using the Endothelium Quality Index (EQI) . Sleep quality was evaluated using both actigraphy and the PSQI (Pittsburgh Sleep Quality Index) questionnaire. Exercise capacity was quantified through the 6-minute walking test (6mwt).

Results
ED was evident, as indicated by an EQI of 1.4 ± 0.7. Furthermore, ED was notably influenced by CV risk factors such as low physical activity level, age, and smoking. A significant correlation was found between EQI and both sleep efficiency (r = 0.340; p = 0.006) and PSQI score (r = -0.533; p &lt; 0.001). Additionally, a strong association was observed between endothelial function and the results of the 6mwt (r = 0.291; p = 0.021). Furthermore, during a follow up period ( near 4 months) following PCI, MAACE were observed in patients with severe ED only.

Conclusion
In summary, findings of this study may emphasize the importance of enhancing sleep quality and advocating for an active lifestyle as modifiable elements to enhance endothelial function, which can be regarded as a prognostic tool subsequent to AMI, ultimately contributing to improved clinical outcomes. Moreover, this study concluded that AMI patients with severe endothelial dysfunction were more likely to develop MAACE.Endothelial Dysfunction after AMIED following AMI : Causes and effect
Favourable lifestyle changes 1 year after acute myocardial infarction
Authors: Loosli J , Foster-Witassek F , Roffi M , Wenzl F , Iglesias J F , Pedrazzini G , Rickli H , Radovanovic D 
Published: October 2024

Abstract

Background
Acute myocardial infarction (AMI) is a life-threatening event that should be an excellent motivator to adopt a healthy lifestyle. We aimed to evaluate the proportion of patients with AMI who reported favourable lifestyle changes 1 year after AMI.

Methods
Harnessing a nationwide prospective cohort of patients with AMI in Switzerland, ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled in the AMIS Plus registry between 2012 and 2022 were followed-up 1 year after the event by telephone interview. Favourable lifestyle changes, often addressed in hospitals or rehabilitation programmes were defined as smoking cessation, weight reduction (for overweight patients at index presentation), dietary changes, increased physical activity and stress reduction. Self-reported lifestyle changes were stratified according to AMI type, sex, and age.

Results
From 7906 AMI patients, 7234 (91.5%) with follow-up data were included. Of these, 5627 (77.8%) were male, 1607 (22.2%) female, 4664 (64.5%) had a STEMI, and 2570 (35.5%) a NSTEMI. At a median follow-up of 397 (interquartile range 371 to 465) days, 861 (50.9%) smokers at the time of the AMI had quit smoking, 1297 (35.0%) overweight patients had lost weight, 2567 (44.8%) patients had implemented nutritional changes, 2415 (41.2%) had increased their physical activity, and 1729 (30.5%) had reduced their stress levels. Patients with STEMI were more likely to stop smoking (53.0% vs. 45.1%, p=0.005), change their diet (46.4% vs. 41.6%, p&lt;0.001), increase their physical activity (43.5% vs. 36.8%, p&lt;0.001), or reduce stress (31.4% vs. 28.7%, p=0.04) compared to NSTEMI patients. Male sex was associated with smoking cessation [52.5% vs. 44.4%; p=0.008; age-adjusted odds ratio (OR), 0.78; 95% confidence interval (CI), 0.61-0.99; p=0.043], dietary change (47.8% vs. 33.7%; p&lt;0.001; age-adjusted OR, 0.67; 95% CI, 0.58-0.77; p&lt;0.001), and an increase in physical activity (43.5% vs. 32.9%; p&lt;0.001; age-adjusted OR, 0.77; 95% CI, 0.67-0.88; p&lt;0.001). However, after adjusting for age, stress reduction was comparable between males and females (30.9% vs. 28.9%; p&lt;0.001; age-adjusted OR, 1.09; 95% CI, 0.94-1.26; p=0.25).

Conclusions
A substantial proportion of patients with AMI in Switzerland reported favourable lifestyle changes within 1 year after the index event. In general, STEMI as well as male patients were more likely to report multiple favourable lifestyle changes. Nevertheless, there is still room for improvement in terms of secondary prevention measures.
Smoking cessation after acute myocardial infarction: a Swiss-wide cohort study
Authors: Loosli J , Foster-Witassek F , Roffi M , Wenzl F , Iglesias J F , Pedrazzini G , Rickli H , Radovanovic D 
Published: October 2024

Abstract

Background
Smoking is a major cardiovascular risk factor and of great importance in terms of both primary and secondary prevention. The present study aims to identify patient characteristics associated with smoking cessation within 1 year after acute myocardial infarction (AMI) to inform physician-patient interactions, secondary prevention measures, and public health planning.

Methods
ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled between 2012 and 2022 in the AMIS Plus registry who were active smokers at the time of the index event were included. At the 1-year follow-up, patients were questioned about their smoking behaviour via telephone interview and were further classified into those who had quit (stoppers) or continued (continuers) smoking. Patient characteristics were collected at the time of the index event and at follow-up and then compared using descriptive statistics.

Results
From a total of 4523 patients with AMI, 4242 (93.8%) provided information regarding their smoking status at a median follow-up of 395 days (interquartile range 370 to 469) after the index event. Of 1691 (39.9%) active smokers at the time of AMI, 861 (50.9%) reported quitting whereas 830 (49.1%) were still smoking at the 1-year follow-up. Stoppers were younger (57 vs. 58 years, p&lt;0.001), more likely to be male (82.8% vs. 77.7%, p=0.008) and have presented with STEMI (77.0% vs. 71.0%, p=0.005), and less likely to have had a previous AMI (6.6% vs. 13.3%, p&lt;0.001) than continuers. Smoking cessation was more common in patients with a more severe AMI characterised by a greater extent of myocardial injury (in-hospital median peak creatine kinase level 1291 IU/L vs. 1101 IU/L, p=0.012), at least one in-hospital complication (13.9% vs. 9.9%, p=0.01), and participation in a rehabilitation programme (83.7% vs. 68.8%, p&lt;0.001). Stoppers more frequently implemented other favourable lifestyle changes, such as dietary changes (56.2% vs. 45.2%, p&lt;0.001) and increased physical activity (54.6% vs. 37.7%, p&lt;0.001) than continuers. Self-reported weight gain was more prevalent among those who quit smoking (44.0% vs. 19.7%, p&lt;0.001).

Conclusions
In Switzerland, half of the patients with AMI who were active smokers at the time of AMI, reported to have stopped smoking 1 year after the index event. Smoking cessation was associated with participation in a rehabilitation programme and occurred more often in patients with larger AMI sizes, higher in-hospital complication rates and more frequent implementation of other favourable lifestyle changes after AMI. The significant weight gain after smoking cessation seems to represent a major issue that should specifically be addressed.
Comparison of 600 mg VS 300 mg clopidogrel loading dose for patients with ischemic heart disease: a meta-analysis of randomized controlled trials
Authors: Marcellana G , Gravador E J , Castro R T , Tan A D , Jimenez R M , Tiongco R H 
Published: October 2024

Abstract

Background
While a 600-mg loading dose (LD) of clopidogrel has demonstrated superior inhibition of platelet function compared to 300-mg LD, the clinical evidence supporting this superiority is limited. The debate centers on whether a higher clopidogrel LD regimen in primary percutaneous coronary intervention outperforms the standard 300 mg LD, with potential benefits being more pronounced in higher-risk patients. Balancing enhanced platelet inhibition to reduce ischemic events against the associated risk of increased bleeding remains a critical consideration in determining the optimal loading dose of clopidogrel for patients with ischemic heart disease.

Purpose
The objective of this meta-analysis is to validate current randomized trials that investigate the efficacy and safety of two clopidogrel loading regimens (600 mg vs 300 mg) in patients with ischemic heart disease treated with primary percutaneous coronary intervention.

Method
A systematic literature search for randomized controlled trials was performed comparing 600 mg with 300 mg LD of clopidogrel using PubMed, MEDLINE, Embase, Cochrane, Clinicaltrials.gov. and Herdin PH. Studies included those between 2010 - 2023 involving human subjects. The primary efficacy endpoint was a 1-month rate of major adverse cardiac event (MACE) and the primary safety outcome was bleeding adverse effects.

Result
Nine randomized control studies involving 29,827 patients were included in the efficacy analysis. Mean duration of follow-up was 30 days. Only 8 studies were eligible for safety analysis. Compared with standard LD clopidogrel, high LD significantly reduced incidence of overall MACE (OR:0.82, 95% CI:0.74-0.91, p=0.0002), nonfatal myocardial infarction (OR:0.56; 95% CI:0.32-0.99, p = 0.15) and target vessel revascularization (OR 0.63; 95% CI 0.41 to 0.95, p = 0.03 ), without significant difference in terms of cardiac death (OR:0.89; 95% CI:0.76-1.04, p=0.15) and stroke (OR 0.92; 95% CI 0.67 to 1.26, p = 0.61). However, major bleeding risk was higher in the 600 mg LD (1.9%; 261/13288) compared with 300 mg LD (2.4%; 328/13242) [OR:1.27; 95% CI:1.08-1.49, p=0.005] without significant difference in minor bleeding (OR:1.05; 95% CI:0.94-1.17, p=0.35).

Conclusion
The administration of 600 mg of clopidogrel LD reduces the overall risk of MACE with an associated increased risk of major bleeding in patients with ischemic heart disease undergoing primary percutaneous coronary intervention.MACE OUTCOMES
Post-PCI anticoagulation with unfractionated heparin in acute coronary syndrome: insight from the STOPDAPT-3 trial
Authors: Watanabe H , Natsuaki M , Morimoto T , Yamamoto K , Obayashi Y , Nishikawa R , Ando K , Suwa S , Isawa T , Takenaka H , Ishikawa T , Wakabayashi K , Onishi Y , Ono K , Kimura T 
Published: October 2024

Abstract

Background
The guidelines recommend the post-procedural anticoagulation should be discontinued after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) except for the specific indications.(1) However, these guideline recommendations were not well supported by data, and therefore, post-PCI parental anticoagulation has been commonly implemented in patients with ACS in the previous studies.(2-5)

Purpose
To clarify the preference and clinical situations of post-PCI unfractionated heparin (UFH) in ACS patients and to explore the influence of post-PCI UFH on cardiovascular and bleeding outcomes.

Methods
STOPDAPT-3 trial is a randomized controlled trial to demonstrate the efficacy and safety of the aspirin-free prasugrel monotherapy strategy compared to the conventional dual antiplatelet therapy after PCI in patients with high-bleeding risk or ACS.(6) Data on periprocedural heparin use and its doses were vigorously collected. The current study population was the ACS patients enrolled in the STOPDAPT-3 without use of mechanical circulatory support devices. The two co-primary endpoints were the bleeding outcome defined as the BARC 3 or 5 criteria and the cardiovascular outcome defined as a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, or ischemic stroke. Outcomes were assessed at 30 days from index PCI.

Results
Among 4088 ACS study patients, 2339 (57.2%) patients received post-PCI UFH. Median dose of UFH was 7.1 (IQR 6.0-8.8) units/kg/hour and the median duration was 25 (IQR 24-48) hours. As many as 57.7% of patients received 10000 units/day of heparin after PCI irrespective of body weight. STEMI patients more frequently received post-PCI UFH compared to NSTE-ACS (72.3% and 38.8%, P&lt;0.001) and the patients with intraprocedural adverse angiographic findings such as thrombus, slow-flow, no-reflow, or final TIMI flow &lt;=2 also more frequently received post-PCI UFH than those without (67.6% and 47.5%, P&lt;0.001). Post-PCI UFH was associated with a significantly increased risk of bleeding endpoint (4.75% and 2.52%, adjusted HR 1.69 [95%CI 1.15-2.46], P=0.007) and a numerically increased risk of cardiovascular endpoint (3.16% and 1.72%, adjusted HR 1.56 [95%CI 0.98-2.46], P=0.06). Even in the patients with intraprocedural adverse angiographic findings, post-PCI UFH did not show a clear benefit for cardiovascular endpoint (3.15% and 1.72%, adjusted HR 1.73 [95%CI 0.88-3.41]. P=0.11).

Conclusion(s)
Post-PCI anticoagulation with UFH was frequently implemented in ACS patients enrolled in the latest large Japanese clinical trial. Post-PCI UFH use was associated with harm in terms of bleeding without a benefit in reducing cardiovascular events.
Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study
Authors: Bruno F , Wenzl F , De Filippo O , Kraler S , Giacobbe F , Roffi M , Muller O , Raber L , Templin C , De Ferrari G M , D'ascenzo F , Luescher T F 
Published: October 2024

Abstract

Aims
Data on Glycoprotein IIb/IIIa inhibitors (GPI) use in real world ACS patients following the introduction of potent P2Y12 inhibitors and newer generation stents are scant. Here, we aimed to assess the utilization, effectiveness, and safety of GPI in a large prospective cohort of contemporary ACS patients.

Methods
SPUM-ACS is a prospective, multicentre study in which ACS patients between 2009 and 2017 were recruited. The primary endpoint of the present study was major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction (MI) and non-fatal stroke at one year. Any bleeding events, BARC 3-5 bleeding, and net adverse cardiovascular events (NACE) comprised the secondary endpoints.

Results
A total of 4395 ACS patients were included in the analysis. GPI-treated patients had more total coronary artery occlusion (56% vs 35%, p&lt;0.001) and thrombus (60% vs 35%, p&lt;0.001) at angiography. Among the propensity score matched (PSM) population (1992 patients equally split into two groups), GPI-treated patients showed lower MACE risk (PSM adjusted HR 0.70, 95% CI 0.49-0.99) but a higher risk of any (PSM adj HR 1.46, 95% CI 1.06-1.99) and major bleedings (PSM adj HR 1.73, 95% CI 1.09-2.76), resulting in a neutral effect on NACE (PSM adj HR 0.87, 95% CI 0.65-1.17). These results remained consistent across all subgroups. When including only patients treated with potent P2Y12, the incidence of MACE was not different between the two groups, (log rank p=0.50 and PSM adjusted HR 0.94, 95% CI 0.60-1.48). In the PSM population, GPI use (HR 0.76, 95% CI 0.59-0.99, p=0.04), TIMI 3 at the end of the procedure (HR 0.16, 95% CI 0.08-0.30, p&lt;0.001) and potent P2Y12 inhibitor use (HR 0.70, 95% CI 0.49-0.99, p=0.04) were protective independent predictors of MACE at follow-up, while oral anticoagulation at discharge (4.48, 95% CI 2.10-9.52, p&lt;0.001), multivessel disease (HR 1.95, 95% CI 1.09-3.48, p=0.02) and KILLIP class ≥ 2 at admission (HR 1.98, 95% CI 0.99-3.95, p=0.05) were adverse independent predictors.

Conclusion
In ACS patients undergoing PCI and broadly treated with potent P2Y12 inhibitors, GPI use reduced the risk of MACE at 1 year, while increasing the risk of major bleedings, with a neutral effect on NACE. The routine use of these pharmacological agents should be discouraged, while in selected patients GPI use should be considered following personalized balancing between ischaemic and bleeding risk.Events in PSM populationEvents in PSM population
Real-world evidence supports superior efficacy of prasugrel over ticagrelor in individuals with acute coronary syndrome
Authors: Kruger N , Krefting J , Kessler T , Starnecker F , Meyer-Lindemann U , Storz T , Manea I , Krase P , Offenborn F , Kastrati A , Cassese S , Schunkert H , Scheidt M 
Published: October 2024

Abstract

Background
In patients with acute coronary syndrome (ACS) undergoing invasive treatment, ticagrelor and prasugrel are guideline-recommended P2Y12 receptor inhibitors. Preference for one of the two drugs is under debate although the ISAR-REACT5 trial revealed advantages for prasugrel. This real-world data study evaluated the efficacy and safety of ticagrelor versus prasugrel in individuals with ACS undergoing invasive treatment by emulating a target trial analogous to ISAR-REACT5.

Methods
Following the Population, Intervention, Comparator, Outcome, and Timing (PICOT) framework, within a German health claims database, we adapted the inclusion and exclusion criteria from ISAR-REACT5 and identified a 1:1 propensity score-matched cohort with ACS being treated after hospital discharge with either ticagrelor or prasugrel (n=9,380, each). End points were defined as in ISAR-REACT5 at 1-year follow-up. Additionally, subgroup analyses of individual ACS components ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) were conducted.

Results
The primary composite end point occurred in 9.2% of ticagrelor and 7.4% of prasugrel treated individuals (hazard ratio 1.22; 95% confidence interval 1.10-1.35). Likewise, the secondary end points MI and stroke occurred significantly more often in the ticagrelor arm. All-cause mortality, stent thrombosis, and the safety end point bleeding revealed no significant differences. Subgroup analysis revealed superiority for prasugrel particularly in individuals with STEMI. Statistically, test results and hazard ratios of this real-world data study were in agreement with the findings of ISAR-REACT5.

Conclusions
With over four times the cohort size of ISAR-REACT5, this study indicates superior efficacy of prasugrel over ticagrelor in individuals with ACS undergoing invasive strategy.Cumulative incidence of primary endpointGraphical abstract