bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic role of inflammatory status in type 2 myocardial infarction
Authors: Sara Amicone S A , Daniele Cavallo D C , Claudio Asta C A , Mariachiara Ciarlantini M C , Leonardo Bavuso L B , Lisa Canton L C , Damiano Fedele D F , Francesca Bodega F B , Giuseppe Pastore G P , Francesco Pio Tattilo F P T , Luca Bergamaschi L B , Andrea Rinaldi A R , Francesco Angeli F A , Pasquale Paolisso P P , Carmine Pizzi C P 
Published: October 2024

Abstract

Background
there is a wealth of evidence on the importance of inflammatory status in destabilization of chronic artery plaques that led to acute myocardial infarction. However, its role in the setting of type 2 myocardial infarction (T2MI) is not yet specifically known.

Purpose
We investigated prognostic role of inflammatory parameters in T2MI.

Methods
We consecutively enrolled 461 T2MI patients from January 2017 to June 2021. T2MI was defined according to the fourth Universal Definition of Myocardial Infarction. We divided the overall population in patients who experience major cardiovascular events (MACE), n=166, and in those who do not (n=277). Receiver operating characteristic (ROC) curve analysis were used to assess the diagnostic accuracy of various inflammatory parameters for predict MACE occurrence during long term follow-up. We divided patients into two groups (high and low inflammatory burden) based on the value associated with the highest Youen index. Cox proportional hazards regression models were constructed to estimate the independent role of these parameters in predict MACE.

Results
We found that patients who experienced MACE had a higher level of inflammatory parameters, in particular hs-CRP (2.21±3.7 vs 1.48 ±3.5, p&lt;0.001) and platelet-to-neutrophil ratio (3.72 ±1.52 vs 3.7±1.43, p=0.02). Using ROC analysis, the area under the curve (AUC) of hs-CRP was the largest among all inflammatory parameters and the optimal threshold, according to Youden’s index, was found to be 1.2 mg/dL. MACE-free survival curves, comparing groups with low hs-CRP (&lt; 1.2 mg/dL) and high hs-CRP (≥ 1.2 mg/dL), showed that high hs-CRP was associated with a worse prognosis (p&lt;0.001). At Cox regression models, hs-CRP value ≥1.2 mg/dL was independently associated with MACE (p=0.01) together with diabetes (p=0.006), chronic obstructive pulmonary disease (p=0.006), previous stroke (p=0.001) and older age (p&lt;0.001).

Conclusion
T2MI patients who experienced MACE exhibited higher levels of inflammatory parameters. Patients with hs-CRP levels ≥1.2 mg/dL had a worse prognosis, independently predicting MACE. These findings underscore the potential utility of hs-CRP as a prognostic biomarker in risk-stratifying patients with T2MI and highlight the importance of addressing inflammatory status in optimizing patient management and improving outcomes.
Predictors of microvascular spasm by spasm provocation testing in patients having angina with no obstructive coronary arteries
Authors: Mineo T , Usui E , Kanaji Y , Hada M , Nagamine T , Ueno H , Nogami K , Setoguchi M , Tahara T , Yonetsu T , Sasano T , Kakuta T 
Published: October 2024

Abstract

Background
Microvascular dysfunction in patients having angina with no obstructive coronary arteries (ANOCA) has been recognized to be associated with poor prognosis, while microvascular spasm (MVS) has not been fully studied due to its diagnostic challenge.

Purpose
We aimed to explore clinical and coronary physiological characteristics of MVS.

Methods
We retrospectively studied patients with ANOCA who underwent spasm provocation test (SPT) with intracoronary acetylcholine administration followed by coronary physiological assessment. Epicardial spasm and MVS were diagnosed in accordance with the latest guideline. Physiological indices such as coronary flow reserve (CFR), index of microcirculatory resistance (IMR) and microvascular resistance reserve (MRR) were assessed by bolus thermodilution method using pressure temperature wire in LAD and RCA.

Results
In a total of 141 patients, 40 (28.4%) patients were diagnosed as epicardial spasm and 22 (15.6%) were diagnosed as MVS according to the diagnostic criteria of the latest guideline. Women was more frequent (63.9% vs 27.3%, P=0.002) and IMR of LAD was significantly higher (34.80 vs 22.95, P=0.005) in patients with versus without MVS. In addition, hypertension tended to be frequent (81.8% vs 60.5%, P=0.089) in patients with MVS. In a multivariable logistic regression analysis, women (odds ratio 5.64 [OR], 95% CI 1.90 – 16.7, P=0.0018) and IMR of LAD (OR 1.02, 95% CI 1.00 – 1.05, P=0.029) were independently associated with the diagnosis of MVS. On the other hand, no clinical characteristics and physiological parameter were significantly associated with epicardial spasm.
In a comparison between microvascular and epicardial spasm, women (OR 8.30, 95%CI 2.23 – 30.9, P=0.0016) and IMR of LAD (OR 1.04, 95%CI 1.00 – 1.08, P=0.0462) were still significantly more frequent in MVS patients in multivariable analysis.

Conclusion
Women and higher IMR of LAD were significantly frequent in patients with versus without MVS, and hypertension tended to be frequent in MVS patients.
Percutaneous revascularization in late-presenting STEMI with absence of viability: effects on left ventricular remodeling and scar
Authors: Valente B P , Coelho B P A , Pinto I M F , Senra T , Junior J R T P , Delamain J H H D , Cervone A C C , Junior J R C , Souto M J S , Naranjo G C S , Sanches F B , Santos B V , Queiroz G S , Valente O P , Farsky P S 
Published: October 2024

Abstract

Introduction
In patients with ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) should be conducted within 12 hours of symptom onset. The potential benefits attributable to late reperfusion in STEMI fall under the "open artery hypothesis" where the stunned peri-infarction zone after revascularization would restore blood supply and contractility.

Purpose
To estimate the differences on the LV ejection fraction (LVEF), indexed LV end-systolic volume (iLVESV) and scar in patients with STEMI without viabilitity randomized to optimal medical therapy (OMT) alone or OMT and a late percutaneous coronary intervention (PCI) performed between 24 hours and 30 days after the event.

Methods
Patients with non-reperfused STEMI were evaluated from September 2021 to June 2022 at a tertiary cardiology hospital. The patients underwent Cardiac Magnetic Resonance (CMR) to assess myocardial viability and were classified as non-viable if they had only 1 wall segment with less than fifty percent thickness of the affected wall with late gadolinium enhancement. The patients were randomized to PCI or OMT alone. CMR was repeated at 6 months to evaluate LVEF, iLVESV and fibrosis. This summary presents a planned partial analysis of the 6-month results (N=51). Descriptive statistics analysis included central and dispersion estimators, or absolute and relative frequencies. To explore the differences between groups and time, Mann-Whitney and Wilcoxon tests were run, and results were given as point-estimates and confidence intervals at 95% (95% CI). A significance level of 5% was adopted for inferential analysis.

Results
51 patients (60±11 years, 71% male) were included in the analysis. Of this total, 24 were randomized to PCI + OMT, and 27 to isolated OMT. The groups showed balanced distribution regarding clinical characteristics and initial CMR parameters (LVEF, iLVESV, and fibrosis). The difference in LVEF at the end of 6 months between the OMT and PCI groups was 2.07%, favoring the OMT group; however, this difference was not significant (p= 0.677, 95% CI: -5 to 10). Between the groups, the difference at the end of 6 months in iLVESV was -6.82 ml/m², also without statistical significance (p= 0.858, 95% CI: -19 to 11). There was a significant reduction in the amount of fibrosis in both PCI group with -14.68g (p= 0.011) and in the OMT group with -12.57g (p= 0.009). Detailed results are presented in Table 1.

Conclusion
Despite a significant reduction in fibrosis in both groups, there was no superiority observed in late PCI compared to isolated OMT in reducing reverse remodeling and fibrosis in patients with non-viable STEMI when compared to isolated OMT.Remodeling changes.
The distribution and mass index of epicardial adipose tissue were correlated with microvascular obstruction formation in patients with ST-segment elevation myocardial infarction
Authors: Zhao J X , Li Y , Mu D , Kang L N , Xu B 
Published: October 2024

Abstract

Introduction
Epicardial adipose tissue (EAT), refers to a metabolically active fat depot between the visceral pericardium and the outer margin of the myocardium. EAT has gradually emerged as a novel target for risk stratification of coronary artery disease due to its distinctive location and multifaceted metabolic properties. Microvascular obstruction (MVO) after primary percutaneous coronary intervention (pPCI) is identified as an independent risk factor for poor prognosis in patients with acute myocardial infarction. However, the clinical implications of EAT in MVO formation in patients with ST-segment elevation myocardial infarction (STEMI) remain unclear. Recently, cardiac magnetic resonance (CMR) has emerged as the gold standard technique to detect the extent of MVO and evaluate EAT parameters.

Purpose
This study aimed to evaluate the correlation between EAT accumulation and MVO occurrence detected by CMR in STEMI patients.

Methods
A total of 129 STEMI patients who underwent pPCI successfully were enrolled. Clinical characteristics including demographic characteristics, cardiovascular risk factors, laboratory data and angiographic parameters were recorded from each patient by 1 trained physician. All patients underwent CMR within 1 week following pPCI to evaluate infarct size, MVO volume and EAT distribution. All CMR data were transferred to Q-MASS MR 8.1 imaging system (Medis, Leiden, The Netherlands) and interpreted twice by 2 expert radiologists who were blinded to the angiographic and clinical data of patients.

Results
Compared to STEMI patients without MVO, STEMI patients with MVO presented with higher peak troponin T levels, increase of neutrophil lymphocyte ratio (NLR) and C-reactive protein (CRP), larger infarct size and compromised left ventricular ejection fraction. Total EAT volume, EAT mass index, left atrioventricular EAT volume, left atrioventricular EAT mass index and thickness of EAT in the left atrioventricular groove were unanimously associated with the occurrence of MVO. The left atrioventricular EAT mass index in STEMI patients with MVO were significantly larger than that in STEMI patients without MVO (24.72±5.049 g/m2 vs 18.63±3.670 g/m2, P&lt;0.001). Multivariate logistic regression analysis demonstrated that NLR, peak troponin T levels and left atrioventricular EAT mass index were independent predictors of MVO. LV EAT mass index showed a robust and independent relationship with MVO formation and a cutoff value &gt;21.5192 g/m2 predicted the presence of MVO with a sensitivity and specificity of 79.5% and 80.4%, respectively.

Conclusions
Left atrioventricular EAT mass index is an independent predictor of MVO. Measurement of EAT using CMR could be used for risk stratification and might be a promising target in developing new therapies to reduce myocardial reperfusion injury in patients with STEMI.
Sex differences in cardiovascular-related hospital readmissions, adverse events and interventions within 1 year after ST-elevation myocardial infarction
Authors: Foster-Witassek F , Roffi M , Iglesias J , Wenzl F , Loosli J , Pedrazzini G , Rickli H , Radovanovic D 
Published: October 2024

Abstract

Introduction
Reducing cardiovascular (CV)-related hospital readmissions as well as adverse events following ST- elevation myocardial infarction (STEMI) is a critical goal to improve outcomes as well as quality of life and reduce healthcare costs. We aimed to study the rates of CV-related readmissions, adverse events and interventions after STEMI in women and men.

Methods
We included STEMI patients from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry, who underwent percutaneous coronary intervention (PCI) between 2013 and 2022 and participated in a telephone-based follow-up (FU) interview 1-year after hospital admission. Patients were asked if they had hospital readmissions (if yes: planned/emergency/both) during FU for any CV reason, if they suffered a reinfarction or stroke and if they had any or several of the following interventions: PCI, coronary artery bypass graft, pacemaker and/or defibrillator implantation. These self-reported data were analysed using descriptive statistics and logistic regression models were used to study the relationship between patient characteristics and hospital readmissions.

Results
Of 4388 PCI-treated STEMI patients contacted for FU, 275 (6.3%) were unreachable, 118 (2.7%) died, and 223 (5.1%) had no data on readmissions; therefore 3772 patients (78.4% men, 21.6% women) were analysed. Women were older (mean (SD) age at event: 68.4 (12.0) vs. 62.5 (11.5) years) while the Charlson Comorbidity Index (CCI) was similar (CCI&gt;1: 14.0% vs. 12.1%, n.s.). The mean rate of patients readmitted for CV reasons was 22.1%; 20.4% for women and 22.6% for men (p=0.198). Overall, 8.8% had at least one emergency and 13.9% at least one planned readmission. The occurrence of a planned readmission was significantly lower in women (11.1% vs. 14.7%, p=0.008). Patients with a readmission had during the index hospitalisation higher rates of in-hospital complications (18% vs. 14%), heart failure (NYHA III+IV) (2.2% vs. 0.8%), diabetes (18% vs. 14%) and peripheral arterial disease (3.9% vs. 2.5%). A multivariable adjusted model that included these factors together with age and sex identified heart failure (OR: 2.5, CI 1.34-4.66, p=0.004) and in-hospital complications (OR:1.4, CI 1.12-1.70, p=0.003) as independent predictors of hospital readmission.
The rates of the analysed adverse events and interventions were similar between sexes except that women had less often a PCI during the FU period (13.2% vs. 16.6%, p=0.026).

Conclusion
Over the last 10 years, on average 1 in 5 patients had at least one CV-related readmission within 1 year after PCI-treated STEMI, while no overall sex-difference was found. Heart failure and in-hospital complications were independent predictors of readmission. Women had less often planned hospital readmissions and additional PCIs.
Prognostic impact of composite lipid indices in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Khalaji A , Behnoush A H , Rafati A , Pasebani Y , Arzhangzadeh A , Mahmoodi T , Shamshiri Khamene S , Mohammadkhawajah I , Mehrani M , Vasheghani-Farahani A , Masoudkabir F , Hernandez A V , Hosseini K 
Published: October 2024

Abstract

Background
Composite lipid indices have been reported to have associations with several cardiovascular diseases and their negative adverse events. Among these, there are four novel indices that can be easily calculated, namely, triglyceride-glucose index (TyG, calculated from fasting plasma glucose [FPG] and triglyceride [TG]), lipid accumulation product (LAP, calculated from waist circumference [WC] and TG), visceral adiposity index (VAI, calculated from WC, TG, body mass index [BMI], and high-density lipoprotein [HDL]), and atherogenic index of plasma (AIP, calculated from TG and HDL). Herein, we aimed to investigate the impact of these indices on the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Methods
All the patients with ACS who underwent PCI at our institution during the 2015-2022 period were included in the analyses. Patients were divided based on each of the TyG, VAI, LAP, and AIP indices quartiles (Q). The median follow-up was 378 days and the outcome assessed was MACCE composed of all-cause mortality, myocardial infarction, stroke, target vessel revascularization, target lesion revascularization, and coronary artery bypass grafting surgery.

Results
There was a total of 13,682 patients with ACS undergoing PCI with a mean age of 62.67 ± 11 years and 72.61% male predominance. Regarding the TyG index, patients in Q4 had a higher incidence of MACCE, compared to those in Q1 (adjusted HR [aHR] 1.271, 95% CI 1.067 – 1.513], p-value &lt; 0.01). While in the crude model, patients in Q2, Q3, and Q4 of LAP had significantly higher rates of MACCE, compared to Q1, this association was not observed in the age- and sex-adjusted model and fully-adjusted model. Similarly, there was no difference among the quartiles of VAI and AIP regarding the incidence of MACCE. Kaplan-Meier curves also show that there were significant differences among TyG and LAP quartiles (p-value = 0.0049 and p-value = 0.035, respectively).

Conclusion
As our findings suggest, patients with higher TyG levels, as a surrogate marker of insulin resistance, had a higher incidence of MACCE. LAP could also play an important role in the incidence of adverse events after PCI. These novel lipid indices could help clinicians in determining the risks of patients with ACS undergoing PCI in order to provide better care to them.Risk of MACCE in different quartilesKaplan Meier Curves for risk of MACCE
The activation of cardiac sympathetic nervous system in the non-culprit lesion is a strong prognostic predictor in patients with acute myocardial infarction
Authors: Kondo T , Watanabe T , Yamada T , Morita T , Kawasaki M , Kikuchi A , Kawai T , Nishimoto Y , Seo M , Nakamura J , Fujita T , Taniichi M , Chang Y , Fukunami M 
Published: October 2024

Abstract

Background
The activation of cardiac sympathetic nervous system is associated with poor prognosis in patients with acute myocardial infarction (AMI). However, it remains to be determined whether regional assessment of cardiac sympathetic nerve activity (CSNA) in the culprit and non-culprit lesion of the cardiac MIBG SPECT imaging could have prognostic value in patients with AMI.

Purpose
The purpose of this study is to investigate the prognostic impact of regional CSNA in patients with AMI.

Methods
We prospectively enrolled 122 patients with AMI who visited our emergency department and underwent primary percutaneous coronary intervention. The late heart-to-mediastinum ratio (HMR) and washout rate (WR) was calculated to assess CSNA in the whole heart from planar images of in the cardiac MIBG imaging. The MIBG SPECT image parameters were calculated for each coronary artery, and the average WR in the culprit and non-culprit lesion were evaluated to assess the regional status of CSNA in patients with AMI. Abnormal WR in planar image was defined as 34% or more, as previously reported. The cut-off value of late HMR in planar image, WR in the culprit and non-culprit lesions were determined by ROC analysis. The primary endpoint was major adverse cardiac event (MACE) including all cause death, myocardial infarction, hospitalization for heart failure and target lesion revascularization.

Results
During a mean follow-up period of 3.1±1.8 years, 25 of 122 patients underwent MACE. The late HMR (p=0.004), WR in planar image (p=0.002), WR in the culprit lesion (p=0.023), and WR in the non-culprit lesion (p&lt;0.001) were significantly associated with MACE at univariate Cox proportional hazard analysis. The increased WR in the non-culprit lesion (defined as 28.3% or more: AUC 0.697 [0.576-0.817]) was significantly independently associated with MACE (hazard ratio: 4.36 [1.45-13.11], p=0.009) even adjusted by late HMR, WR in planar image or WR in the culprit lesion, while decreased HMR, abnormal WR in planar image and increased WR in the culprit lesion showed no significant association with MACE in the multivariate model with WR in the non-culprit lesion. Kaplan-Meier analysis revealed that patients with increased WR in the non-culprit lesion had significantly higher risk for MACE than those without increased WR (45% vs 11% p&lt;0.001).

Conclusion(s)
The activation of cardiac sympathetic nervous system in the non-culprit lesion is particularly associated with poor prognosis in patients with acute myocardial infarction.MACE risk by WR in non-culprit lesion
Addressing disparities in the long-term mortality of non-ST segment myocardial infarction (NSTEMI) patients according to the presence of diabetes mellitus: a nationwide cohort study
Authors: Cole A , Weight N , Mishra S , Grapsa J , Rutter M , Siudak Z , Moledina S , Khunti K , Mamas M 
Published: October 2024

Abstract

Background
Diabetes mellitus (DM) is an important risk factor for non−ST segment elevation myocardial infarction (NSTEMI). How DM is related to management and longer-term clinical outcomes in contemporary NSTEMI cohorts is not well described.

Methods and Results
We analysed data on 456,376 adults hospitalised with NSTEMI from the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics (ONS) death registry. We compared outcomes and quality of care by DM status. People with DM were older (median age 74 vs. 73 years, p&lt;0.001) and more commonly of Asian ethnicity (13% vs. 4%, p&lt; 0.001). Those with DM underwent invasive coronary angiography (59% vs. 63%, p &lt;0.001) or revascularization (PCI or CABG) (38% vs. 40%, p &lt;0.001) less frequently. Mortality risks for people with DM were significantly higher at 30-days (HR: 1.06, CI; 1.04-1.09, p &lt;0.001), 1-year, (HR: 1.17, CI; 1.15-1.18, p &lt;0.001) and 5-years, (HR: 1.25, CI; 1.24-1.26, p &lt;0.001), when compared to people without DM. In people with DM, higher-quality inpatient care, assessed by opportunity-based quality-indicator score category (OBQI; poor, fair, good or excellent), was associated with lower mortality rates (good: HR 0.70, CI 0.67-0.73, P&lt;0.001; excellent: HR 0.59, CI 0.57- 0.62, P&lt;0.001), when compared to people receiving poor quality care. In people with DM, "excellent-care", compared to those receiving poor quality care, was associated with the lowest mortality in diet-treated or insulin-treated subgroups (diet-treated: HR 0.55, CI 0.50-0.61, P&lt;0.001)(insulin-treated: 0.60 CI 0.56-0.64, P&lt;0.001).

Conclusion
People with DM experience wide disparities in inpatient care following NSTEMI. They have a higher risk of long-term mortality compared to people without DM, with some evidence that better quality inpatient care is linked to better survival.