bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of baseline thrombocytopenia on outcomes in hospitalizations for acute coronary syndrome and non-elective percutaneous coronary intervention: meta-analysis
Authors: Borra V , Mahadevan A , Vempati R , Kukkala S , Makwana B , Senapati S G , Jaiswal V 
Published: October 2024

Abstract

Background
Thrombocytopenia's impact on acute coronary syndromes (ACS) outcomes is poorly understood. A systematic review and meta-analysis aim to elucidate its influence on both short-term and long-term clinical endpoints, guiding tailored management strategies for improved patient care.

Methods
Our meta-analysis is registered on PROSPERO (CRD42024511832). We conducted a systematic search of PubMed and SCOPUS databases up to February 2024, utilizing keywords to identify studies on ACS or non-elective PCI populations with or without baseline thrombocytopenia (TP) reporting on in-hospital and long-term outcomes. Baseline TP was defined as a platelet count less than 150 x 10⁹/L and had to be established before hospitalization or ACS management or intervention. Binary random effects models were used to estimate pooled unadjusted odds ratios (OR) and 95% confidence intervals (CI). Sensitivity analysis was done by the leave-one-out method, and the heterogeneity was assessed with the I² statistics.

Results
From 2,831 identified studies, 10 were identified as eligible for inclusion in our pooled analysis and included 6,588,688 patients. Thrombocytopenia was associated with higher risks of in-hospital mortality (OR=1.89, 95% CI:1.55-2.30, p&lt;0.01), in-hospital Major adverse cardiovascular events (MACE) (OR=1.99, 95% CI:1.63-2.43, p&lt;0.01), and in-hospital bleeding (OR=2.62, 95% CI:1.89-3.64, p&lt;0.01). Long-term follow-up revealed increased risks of MACE (OR=1.80, 95% CI 1.49-2.18, p&lt;0.01), bleeding (OR=1.63, 95% CI:1.63-2.25, p&lt;0.01), and cardiovascular mortality (OR=2.07, 95% CI:1.76-2.42, p&lt;0.01) with thrombocytopenia. No significant difference was found in in-hospital stroke outcomes and long-term outcomes for stroke and recurrent myocardial infarction between thrombocytopenic and non-thrombocytopenic groups.

Conclusion
Thrombocytopenia worsens ACS outcomes. Vigilance and tailored management are crucial for mitigating its impact on patient prognosis. Further research is needed for better interventions.Secondary outcomes forest plot
Comparative outcomes of drug-coated balloon angioplasty versus second-generation drug-eluting stent for in-stent restenosis: a real-world data analysis
Authors: Krefting J , Krueger N , Graesser C , Schmieder R , Starnecker F , Kufner S , Cassese S , Kastrati A , Schunkert H , Von Scheidt M , Wiebe J 
Published: October 2024

Abstract

Background
Coronary in-stent restenosis (ISR) poses a significant challenge in interventional cardiology, with optimal treatment strategies being the subject of ongoing debate. Current clinical guidelines offer a choice between drug-coated balloon angioplasty (DCB) and repeat stenting with second-generation drug-eluting stents (DES), each with distinct implications for long-term patient outcomes.

Purpose
The aim of this study is to compare 1-year outcomes between DCB angioplasty and second-generation DES in the treatment of ISR. Longitudinal real-world data are used from the OBSERVABLE database, which comprises German health claims data between 2012 and 2021.

Methods
A total of 10,440 ISR individuals undergoing DCB or DES intervention were identified. After exclusion of bare-metal stents, first generation stents and non-DCBs, 3,810 propensity score-matched individuals remained. The primary outcome was the composite of all-cause mortality and myocardial infraction (MI). Secondary outcomes included all-cause death, MI, and bleeding as a safety outcome.

Results
At 1-year follow-up, the primary outcome of all-cause mortality and MI was observed in 246 individuals (12.9%) in the DES group, compared with 201 individuals (10.6%) in the DCB group (HR, 1.27; 95% CI, 1.06-1.53). Sensitivity analysis confirmed the robustness of these findings. Secondary outcomes revealed higher all-cause mortality in the DES group (7.9%) compared to the DCB group (6.3%) (HR, 1.31; 95% CI, 1.03-1.66), with no difference in MI. Bleeding events were comparable between the two treatments, with 244 individuals (12.8%) in the DES group and 206 individuals (10.8%) in the DCB group (HR, 1.17; 95% CI, 0.89-1.53).

Conclusion
This real-world data analysis demonstrated a higher incidence of the primary composite endpoint of all-cause mortality and MI within one year, after treatment with DES compared to DCB. Our results support prior findings about the safety profile of repeated DES implantation and strengthen DCB as a potential superior alternative to DES in ISR management.
CSWT improves ventricular function by promoting angiogenesis through Rho/ROCK/ERK1/2 signal pathway in infarcted myocardium in rats
Authors: Wang Y , Wang L U , Li C , Yang Y A N 
Published: October 2024

Abstract

Objective
This study aimed to investigate the effects of extracorporeal cardiac shock wave therapy (CSWT) on myocardial ischemia and cardiac function in rats with myocardial infarction, and to explore its impact on the expression of myocardial vascular endothelial growth factor and the extent of myocardial fibrosis, thereby elucidating the mechanism of angiogenesis.

Methods
A rat model of myocardial infarction was induced by ligating the left anterior descending branch of the coronary artery, confirmed by echocardiography. Animals were randomly assigned to five groups: sham operation group, myocardial infarction group, myocardial infarction + CSWT group, myocardial infarction + Y-27632 group, and myocardial infarction + CSWT + Y-27632 group. Cardiac function was evaluated by echocardiography on the 16th and 72nd day post-surgery. Myocardial morphology was assessed by HE staining, and the extent of myocardial fibrosis was determined by Masson's trichrome staining. Immunohistochemical staining for factor VIII was conducted to observe angiogenesis in each infarcted area. Western blotting was employed to detect the protein expression of extracellular regulated kinase (ERK1/2) and pro-angiogenic cytokines in the infarct border zone.

Results
CSWT treatment significantly reduced myocardial fibrosis and improved cardiac function compared to the myocardial infarction group. Additionally, CSWT upregulated ERK expression and angiogenesis-related factors, promoting angiogenesis. The beneficial effects of CSWT were abolished by inhibiting the Rho/ROCK/ERK1/2 pathway. Furthermore, the area of myocardial fibrosis was significantly reduced in the MI+Y-27632 group compared to the myocardial infarction group (p &lt; 0.01), and left ventricular systolic function index was significantly higher in the myocardial infarction group.

Conclusions
CSWT may promote angiogenesis post-myocardial infarction by activating the Rho/ROCK/ERK1/2 pathway. Additionally, Y-27632 may improve cardiac function in rats with myocardial infarction, potentially through mitigating myocardial fibrosis.echo images of ratsprotein expression by WB
Efficacy and safety of Shexiang Baoxin pill in patients with ischemia with non-obstructive coronary arteries (LESS): a phase 4, multicenter, randomized, double-blind, placebo-controlled clinical trial
Authors: Liang C , Li N , He Z Q 
Published: October 2024

Abstract

Background
Patients with ischemia with non-obstructive coronary arteries (INOCA) present with ischemic signs and symptoms but no obstructive coronary artery disease (CAD) at coronary angiography. Shexiang Baoxin pill (MUSKARDIA) is effective in reducing angina frequency in patients with stable CAD.

Purpose
This phase 4 trial was conducted to evaluate the efficacy and safety of MUSKARDIA in INOCA patients.

Methods
This was a multicenter, randomized, double-blind, placebo-controlled clinical trial (NCT04897126). The enrolled patients with INOCA confirmed as eligible by leading PI were randomly assigned in a 1:1 ratio to receive MUSKARDIA or placebo (oral 4 pills 3 times a day) on the basis of conventional treatment until the end of follow-up. The primary endpoint was the angina-related outcomes based on the Seattle Angina Questionnaire (SAQ) score that assessed by same doctor at week 12.

Results
236 INOCA patients were randomized (MUSKARDIA group, n = 117; placebo group, n=119). At week 12, patients in MUSKARDIA group showed higher SAQ scores compared with placebo group (all P&lt;0.0001, Figure 1) indicating MUSKARDIA could significantly relieve symptoms of angina. According to the Canadian Cardiovascular Society (CCS) grading of angina pectoris, the severity of angina pectoris was significantly reduced in MUSKARDIA group compared with placebo group at week 12 (grade Ⅰ [91.09% vs 48.15%]; grade Ⅱ [8.91% vs 25.93%]; grade Ⅲ [0% vs 19.44%]; grade Ⅳ [0% vs 6.48%]; P&lt;0.001). After 12 weeks of treatment with MUSKARDIA, numbers of weekly angina attacks were significantly reduced compared with placebo group (-2.60 vs -0.42; LSM difference: -2.18; P&lt;0.0001). The percentage of patients who did not used nitroglycerin was noticeably higher in MUSKARDIA group than that in placebo group (84.16% vs 58.33%, P&lt;0.001). The incidence of adverse events did not differ meaningfully between two groups.

Conclusion
MUSKARDIA was confirmed to be an effective, safe and well-tolerated treatment for INOCA patients in clinical settings.
Clinical impact of Sarcopenia on long-term mortality in patients undergoing coronary bypass grafting
Authors: Lee S H , Jo J , Yang J H , Kim S M , Choi K H , Song Y B , Jeong D S , Lee J M , Park T K , Hahn J , Choi S , Cho Y H , Sung K , Kim W S , Gwon H 
Published: October 2024

Abstract

Background
Sarcopenia is an aging-related condition characterized by loss of skeletal muscle mass and is an indicator of subclinical atherosclerosis. The relationship between sarcopenia and long-term clinical outcomes in patients with advanced coronary artery disease who have undergone coronary artery bypass grafting (CABG) is not fully understood. This study aimed to evaluate the prognostic implications of sarcopenia in patients undergoing CABG.

Methods
A total of 2,810 patients who underwent CABG were derived from the Samsung Medical Center institutional registry from 2007 to 2017 and classified according to the presence of sarcopenia. The skeletal muscle index (SMI) was calculated as L3 muscle area (cm2)/height (m)2 on computed tomography. Sarcopenia was defined as SMI ≤45 cm2/m2 in men and ≤38 cm2/m2 in women. The primary outcome was all-cause mortality during follow-up.

Results
The median follow-up was 8.7 years, and 924 patients (32.9%) had sarcopenia. Patients with sarcopenia were older and more frequently women. SMI was significantly correlated with age (R=-0.34, P&lt;0.001), weight (R=-0.56, P&lt;0.001), and body mass index (R=-0.52, P&lt;0.001). SMI was significantly associated with risk of death on a restricted cubic spline curve (HR=1.04 per-1 decrease, 95% CI 1.03-1.05, P&lt;0.001). Patients with sarcopenia had a higher incidence of long-term mortality than those without sarcopenia (survival rate 41.4% vs. 62.8%; adjusted HR=1.18, 95% CI 1.03-1.36, P=0.02). Subgroup analysis showed that the prognostic implication of sarcopenia on long-term survival was more evident in men (adjusted HR=2.01, 95% CI 1.72-2.35) than women (adjusted HR=1.28, 95% CI 0.98-1.68) (interaction P=0.006).

Conclusions
Sarcopenia, defined by SMI on computed tomography, was associated with long-term mortality after CABG. These results provide contemporary data to allow the evaluation of physical frailty in patients with advanced coronary artery disease before surgery.
Sleep disordered breathing and in-hospital prognosis in acute myocardial infarction patients: a subset of the AMI-Sleep study
Authors: Balagny P , D'ortho M P , Sauze D , Rousseau A , Vidal-Petiot E , Drouet E , Gourmelen J , Durand-Zaleski I , Simon T , Steg P G 
Published: October 2024

Abstract

Background
Despite its high prevalence in patients with coronary artery disease (CAD), the association between sleep disordered breathing (SDB) and in-hospital prognosis is not well determined.

Purpose
We aimed to study in-hospital prognosis depending on the presence of SDB in patient hospitalized for acute myocardial infarction (AMI).

Methods
We prospectively enrolled a subset of patients hospitalized for AMI of the French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry included from January 2019 and December 2022 in the 16 AMI-Sleep-trained centers. Baseline and in-hospital information were collected through the FRENCHIE registry. A simplified polygraphy through ApneaLink Air+ was performed overnight during the initial hospitalization before discharge. Data were scored in centralized manner at a single center where trained physicians ascertained SDB severity based on Apnea-Hypopnea index (AHI). SDB screening was considered as positive for patients who have at least moderate SDB, defined by an AHI≥15/h.

Results
Among 1752 patients, 955 (54.5 [52.1;56.9] %) had at least moderate SDB. Compared with patients without SDB, SDB patients have major cardiac impairment including more 3-vessel CAD (26.8% vs 20.8%) and a lower admission left ventricular ejection fraction (52.2% vs 50.4%) associated with a higher use of non-invasive ventilation (3.8% vs 1.6% in non-SDB patients). SDB patients had also more in-hospital complications in particular more transfer to hospital intensive care (0.1% vs 0.9%) and an increased length of stay (4.8 vs 5.9 days).

Conclusion
More than half of the patients hospitalized for AMI had at least moderate SDB and presence of SDB was associated with more in-hospital morbidity. SDB screening should be considered to identify high risk sub-group of AMI patients.
Expression of cardiomyopathy-related genes in mononuclear blood cells predicts all-cause mortality in patients presenting with acute versus chronic coronary syndrome requiring revascularisation
Authors: Teren A , Beutner F , Scholz M , Holdt L M , Teupser D , Thiery J , Schuler G , Thiele H , Kirsten H 
Published: October 2024

Abstract

Objective
Despite advances in the revascularisation techniques their net clinical benefit differs substantially between patients presenting with myocardial infarction (ACS) and chronic coronary syndrome (CCS) due to obstructive coronary atherosclerosis.
Considering that leukocytes represents a key pathophysiological component of myocardial ischaemia, exploration of mononuclear blood cell (PBMC) gene expression profile in CCS and ACS setting could reveal clinically relevant transcriptomic signals. The aim of the present study was to identify differences in PBMC transcriptome between ACS and CCS patients which are linked to mortality after revascularisation.

Methods and Results
We analysed PBMC transcriptomes from719 ACS and 486 CCS patients creating discovery cohort. The results of transcriptomic analysis were verified in replication cohort (ACS: N=682 for CCS: N=489) generated based on propensity score matching. Median time from revascularisation to blood collection (IQR) was 15.68 (-4.52, 23.23) hrs. Patients with ACS showed consistent differential expression of 8173 genes (4544 upregulated, 3629 downregulated) when compared with CCS patients.
The subsequent pathway analysis also showed significant enrichment of several canonical pathways involved in major cardiovascular pathologies i.e. atherosclerosis (p = 1.22-06, enrichment = 3.39), vascular endothelial growth factor production (p = 1.16-06, enrichment = 16.73), positive regulation of vascular development (p = 2.78-06, enrichment = 5.30) and heterotopic cell adhesion including gene desmocollin 2 (DSC2, p = 3.64-04, enrichment = 6.30). In der multivariate survival analysis with differentially expressed genes, increased expression of DCS2, lamin A/C (LMNA), and UGGT2, and decreased expression of SNRNP70 predicted poor survival over the median follow-up 11.35 yrs. Consistently, controlling the false discovery rate at ≤ 5% these genes enriched pathways involved in cardiomyopathies such as arrhythmogenic right-ventricular cardiomyopathy (p = 4.19x10-4, enrichment = 58.9) and collagen disease (p = 2.29x10-3, enrichment = 23.8).

Conclusion
We found altered PBMC expression of multiple genes in patients requiring revascularisation for ACS versus CCS. Several differentially expressed genes included in cardiomyopathy pathways predicted long-term all-cause mortality in these patients.
Comparative analysis of vitamin K antagonists and direct oral anticoagulants for left ventricular thrombus management: a retrospective study utilising TriNetX
Authors: Yao Z , Gue Y 
Published: October 2024

Abstract

Introduction
Despite progress in cardiovascular medicine, guidelines for addressing left ventricular thrombus (LVT) remain limited. Furthermore, incorporating oral anticoagulants into dual antiplatelet therapy for acute myocardial infarction (MI) adds complexity to treatment decisions. While conventional guidance favors vitamin K antagonists (VKAs), emerging evidence suggests favorable outcomes with direct oral anticoagulants (DOACs).

Purpose
This study aims to assess the safety and efficacy of DOACs versus VKAs in managing LVT among patients with and without recent acute coronary syndrome (ACS).

Methods
This was a retrospective observational study conducted within TriNetX, a global federated health research network with access to electronic medical records (EMRs) from participating health care organizations including academic medical centres and community hospitals covering approximately 70 million individuals, mainly in the United States. The search was conducted on 26th Februrary 2024 with a study cohort comprising patients with LV thrombus treated with either DOAC or VKA between 1st December 2013 to 1st December 2023. Subgroup analyses were conducted for patients with ACS within one month and those without ACS within a month of treatment. Cohort data were subject to propensity matching (PSM) for age, gender, ethnicities, medical and drug history. Risk analysis and Kaplan-Meier survival analysis were computed for each subgroup at 90 days since the indexed event.

Results
Following PSM, a total of 39,770 patients were included and 14,302 were in the ACS group and 24,162 in the non-ACS group. DOAC treatment exhibited favourable outcomes for stroke, bleeding, and systemic embolism (p&lt;0.05) compared to VKA in the overall cohort (Table 1). In the ACS group, DOAC was linked to a reduced risk of stroke and systemic embolism (p&lt;0.05) but not bleeding (p=0.066). In the non-ACS group, DOAC was associated with a decreased risk of stroke and bleeding (p&lt;0.05) but not systemic embolism (p=0.113). Across all groups, there were no disparities in overall all causes of mortalities.

Conclusion
DOACs demonstrated better safety and efficacy outcomes when compared to VKAs in LVT treatment. Interestingly, DOACs utilisation within the ACS context resulted in a diminished risk of embolic complications without the benefit of reduced bleeding risk seen in patients without ACS, suggesting potential implications of triple therapy within first month of ACS treatment, removing the bleeding risk reduction of DOACs. This shows a fundamental difference in LVT between the 2 groups of patients so future studies should aim to differentiate between the 2.
Antithrombotic therapy in patients with atrial fibrillation after myocardial infarction and percutaneous coronary intervention
Authors: Skibniewski M , Venetsanos D , Zwackman S , Batra G , Janzon M , Karlsson L O , Alfredsson J 
Published: October 2024

Abstract

Background
Antithrombotic treatment with oral anticoagulants is recommended in clinical practice guidelines for patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) and concurrent atrial fibrillation (AF). Previous randomized controlled trials comparing warfarin and DOAC have primarily focused on bleeding complications. Consequently, the benefits and risks in an all-comer population remain uncertain.

Purpose
This study aimed to evaluate adherence to clinical practice guidelines within a large nationwide cohort and to compare outcomes among patients with MI and AF who were treated with dual antiplatelet therapy (DAPT), Warfarin, or DOAC.

Method
We utilized data from the nationwide SWEDEHEART registry to identify all patients with MI and AF between January 2010 and January 2021. We included all patients who underwent PCI and had a CHA2DS2-VASC score of ≥2 for men and ≥3 for women. The follow-up was one year. Patients were allocated into one of three antithrombotic treatment groups based on discharge medications: (1) Warfarin-based, (2) DOAC-based, and (3) DAPT only. The warfarin- and DOAC-based groups comprised patients on either dual or triple antithrombotic therapy. Study outcomes included: (1) major adverse cardiovascular events (MACE), defined as a composite of all-cause death, MI, or stroke; (2) net adverse cardiovascular events (NACE), which included MACE and bleeding complications; and (3) the individual components of MACE and NACE. Cox regression models were used to adjust for differences in baseline characteristics.

Results
Mean age among the 12,321 patients included was 76.1 years. At discharge, 3,563 (29%) were treated with warfarin, 3,671 (30%) received DOAC treatment, and 5,087 (41%) with DAPT alone. The percentage of patients treated with OAC increased from 30% in 2010 to 84% in 2021. Warfarin- and DOAC-based strategies were associated with lower MACE compared to DAPT alone, with adjusted hazard ratios [HR] (95% CI) of 0.77 (0.69-0.97) and 0.78 (0.69-0.90), respectively, as well as lower rates of NACE with adjusted [HR] (95% CI) of 0.84 (0.76-0.93) 0.84 (0.75-0.94), respectively. This difference was primarily driven by a difference in mortality, with adjusted ]HR] (95% CI) of 0.78 (0.67-0.91) and 0.80 (0.68-0.94), respectively. There were significantly fewer stroke events in the DOAC group (2.5 % vs 3.3%) compared with DAPT. No significant differences in bleeding events were observed between any of the treatment groups.

Conclusions
In this real-life retrospective study, we observed an increased utilization of guideline recommended OAC treatment over time. Both DOAC and warfarin treatment regimens were associated with a lower incidence of MACE and NACE compared to DAPT alone. No significant difference in outcomes were observed comparing DOAC vs Warfarin.