bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in risk profiles and clinical outcomes according to age in patients with high-risk myocardial infarction: insights from the PARADISE-MI trial
Authors: Jering K , Claggett B L , Solomon S D , Cikes M , Granger C B , Kober L , Landmesser U , Lewis E F , Maggioni A P , Mcmurray J J V , Merkely B , Opolski G , Rouleau J L , Senni M , Pfeffer M A 
Published: October 2024

Abstract

Introduction
Temporal declines in rates of rehospitalization and death after acute myocardial infarction (MI) have not been uniform across age groups. A better understanding of how risk profiles and clinical outcomes differ after MI by age may allow for targeted treatment and prevention strategies.

Aims
To investigate risk profiles and clinical outcomes following high-risk MI according to age in the Prospective ARNI vs ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI).

Methods
Adults without prior heart failure (HF) were randomized to sacubitril/valsartan versus ramipril within 0.5 to 7 days of a MI complicated by transient pulmonary congestion and/or left ventricular systolic dysfunction and additional risk-augmenting factors. Associations between age and clinical outcomes were analyzed using Cox proportional hazards regression models, which were additionally adjusted for baseline demographic and clinical covariates (Figure).

Results
The mean age of the 5,661 PARADISE-MI participants was 64 ± 11 years. Patients aged ≥75 years (n=1051) were more likely women, had more hypertension and atrial fibrillation and lower estimated glomerular filtration rate, were less likely to present with ST-segment elevation MI and regardless of type of MI were less likely to receive primary reperfusion and guideline-based medical therapy (Table). Age was significantly associated with all-cause death (HR 1.54 per 10-year increase; 95% CI, 1.41-1.68) and was more strongly associated with non-CV death (HR 2.09; 95% CI, 1.70-2.56) than with CV death (HR 1.43; 95% CI, 1.29-1.57). Age was also associated with incident HF (HR 1.37; 95% CI, 1.25-1.49) (Figure). Multivariable adjustment attenuated the risk relationship of age with recurrent fatal or non-fatal MI (HR 1.08; 95% CI, 0.96-1.21) and the coronary composite outcome (HR 1.01; 95% CI, 0.93-1.09). The relative treatment effect of sacubitril/valsartan versus ramipril on the primary composite outcome of CV death or incident HF was not significantly modified by age (p-interaction = 0.19).

Conclusions
Following high-risk MI, age was most strongly associated with subsequent non-CV death followed by CV death and incident HF, but was not independently associated with recurrent coronary events. The heightened risk of CV death and HF with advancing age was not explained by differences in clinical characteristics. Older patients may require closer surveillance and more aggressive treatment after MI to mitigate the elevated risk of CV death and HF.
The relationship between daily blood glucose fluctuation and readmission in patients with acute coronary syndrome
Authors: Wang X K , Wu Y , Li T , Shi X , Zeng F G 
Published: October 2024

Abstract

Background
Although the comprehensive diagnos and treatment of patients with acute coronary syndrome(ACS) has been greatly improved,the morbidity and mortality are still high. Previous literature has reported that about 70-75% of patients diagnosed with acute coronary syndrome have abnormal blood glucose metabolism1,and there existed gender differences. At present, most research results showed that elevated blood glucose is related to the prognosis of ACS. However, further intervention studies indicated that simply strengthen the reducement of blood glucose did not improve prognosis of these patients2. Glucose fluctuations, another dimension of blood glucose, reflect acute changes in blood glucose. However, there are few studies on the effect of blood glucose fluctuation on the prognosis of patients with ACS.

Purpose
This study aimed to explore the relationship between seven daily fluctuations of blood glucose and readmission in ACS patients.

Methods
In this study, a total of 664 patients admitted to our University from January 1, 2019 to December 31, 2019 were included and their blood glucose was monitored seven times a day during their hospitalization. The coefficient of variation of blood glucose (CV) was calculated from the results of seven daily blood glucose monitoring to represent the daily fluctuation of blood glucose. Univariate and multivariate regression analyses were performed to determine whether CV was an independent risk factor for re-hospitalization. In addition, the area under the curve (AUC) was used to evaluate the predictive efficacy of CV for outcome events. Finally, we performed a subgroup analysis based on gender and diabetes status to assess the association between CV and readmission in each subgroup.

Results
After a median follow-up of 21 months, the rate of readmission was 38.4%. Unstable angina pectoris (71.4%) and heart failure (16.4%) were the most common reasons for readmission. Patients with greater CV levels typically exhibited lower fasting blood glucose, higher post breakfast blood glucose, and higher admission blood glucose.The readmission rate increased with the increasing blood glucose variability after the cox regression analysis. Moreover, independent of glycated hemoglobin,CV could predict the risk of readmission in patients with ACS.When using 26.66% as the cutoff point of CV, the study population was divided into two groups and showed a significant differentiation for rehospitalization.In subgroup analysis, there was no significant association between seven daily blood glucose fluctuations and readmission in female and non-diabetes mellitus patients with acute coronary syndrome.

Conclusions
Besides some normal blood glucose index,seven daily fluctuations of blood glucose was associated with readmission in ACS patients. ACS patients who were male and combined with diabetes were more likely to be readmitted if their CV levels were greater.
The potential impact of bisphosphonates on major adverse cardiovascular events: a study of 1,097,406 patients
Authors: Atieh K , Miles B , Mackey J , Mehta A 
Published: October 2024

Abstract

Introduction
Up to 19.7% of adults worldwide suffer from osteoporosis, and the risk of acquiring the disease increases with age.1 A common therapy for osteoporosis is the bisphosphonate class of drugs. These drugs act in part by inhibiting osteoclasts, cells that resorb bone and experience increased activity relative to bone-forming osteoblasts with aging.2 As adults age, the risk of developing atherosclerosis increases, putting patients at an increased risk of major adverse cardiovascular events (MACE).3 Atherosclerotic plaques become calcified as they mature, which is the basis of CT coronary artery calcium score, a tool used to aid cardiovascular risk assessment and help guide clinical treatment in patients with coronary artery disease. One possible mechanism which could contribute to the calcification of atherosclerotic plaques involves the presence of arterial osteoblast and osteoclast-like cells, a phenomenon which has been described in a growing body of research4–7 The goal of this study was to use the TriNetX medical database to evaluate the effect of bisphosphonate use on the development of major adverse cardiovascular events in patients with osteoporosis.

Materials and Methods
The TriNetX research network was used for this study, with cohorts created via International Classification of Disease 10 (ICD-10) codes and medication codes in the TriNetX system. Both cohorts consisted of adult patients with a diagnosis of osteoporosis (M81). One cohort of patients was receiving treatment with alendronate, risedronate, ibandronate, or zoledronic acid while the other cohort was prohibited from those medications. The cohorts were balanced by propensity score matching and the greedy nearest neighbor algorithm for age, race, gender, and ethnicity, resulting in 548,703 patients in each arm. They were then compared for the outcomes of acute myocardial infarction (I21), cerebral infarction (I63), and mortality starting one year after meeting the index criteria (1 year of treatment for the bisphosphonate group).

Results
Bisphosphonate treatment was associated with a composite 16% increased risk of MACE (17.9% vs 15.4%, RR 1.16, 95% CI (1.15,1.17), p value &lt;0.0001. The risk ratios for the individual outcomes were 1.13 for acute myocardial infarction, 1.17 for cerebral infarction, and 1.18 for all-cause mortality.

Conclusion
The findings from our study suggests use of bisphosphonates for osteoporosis is associated with increased risk of MACE. Given the high rates of osteoporosis and atherosclerosis in the general adult population, future prospective studies will be needed to confirm these results and determine whether alternative agents such as denosumab have similar effects.
Evaluation of myocardial work indexes in patients with cardiac sarcoidosis
Authors: Santorio N C , Santorio P T , Conci N B , Krieger J E , Rochitte C E , Soares Junior J , Kairalla R A , Arimura F E , Fernandes F , Hotta V T 
Published: October 2024

Abstract

Background
Cardiac involvement is associated with worse prognosis and mortality in sarcoidosis. Diagnosis often requires expensive and less available tests.

Purpose
The aim of this study is to evaluate whether non-invasive measurement of myocardial work by transthoracic echocardiogram has incremental value in the diagnosis of cardiac involvement compared to left ventricular (LV) global longitudinal strain (GLS).

Methods
This is a cross-sectional, non-blinded, single-center pilot study. Patients of both genders &gt; 18 years old, with confirmed diagnosis of cardiac sarcoidosis according to the Heart Rhythm Society criteria, and controls consisting of individuals diagnosed with systemic sarcoidosis without cardiac involvement, were included. Patients with obesity grade 2 or higher , moderate or severe primary heart valve disease, myocardial diseases of other etiologies, established coronary artery disease, and inadequate acoustic window were excluded. All patients underwent transthoracic echocardiography and non-invasive blood pressure measurement, followed by subsequent analysis involving the construction of a pression-strain curve. The following LV indexes were calculated: GLS, global work index, global constructive work, global wasted work, and global work efficiency. ROC curves were calculated for all variables using the EasyROC online tool (v 1.3.1), and these were later compared to GLS. Confidence intervals were established by the DeLong method, and curves were compared by the Bonferroni method. A two-tailed p value of 0.05 was considered significant.

Results
Twenty patients with cardiac involvement and twenty patients without cardiac involvement were evaluated. The results of the variables are presented in table 1.

Conclusions
With exception of wasted work, all other LV myocardial work variables showed statistical correlation with cardiac involvement in sarcoidosis patients. However, there was no incremental value of myocardial work indexes compared to the isolated use of GLS.
Time trends in mortality, incidence and case-fatality of acute myocardial infarction in Norway - do we see the end of the coronary heart disease epidemic?
Authors: Bonaa K H , Krizak Halle K , Store Govatsmark R E , Bendiktsen Berge V , Almenning Kiel I , Kvale R 
Published: October 2024

Abstract

Background
In Norway and most industrialized countries the mortality rates from acute myocardial infarction (AMI) increased after World War II, peaked in the 1960s – 1970s, and have since that time declined (Figure). Recent studies have suggested that the decline may have leveled off, and that the favourable trends do not include younger age groups, possibly due obesity and diabetes. Also, the relative contribution of a reduction in incidence and improved case-fatality rates (CFR) to the AMI mortality trends are not known with certainty. We examined mortality trends of AMI in Norway during 1951 – 2021, and the incidence and CFR of hospitalized and non-hospitalized AMI during 2013-2021.

Methods
Fatal AMI cases were identified in the National Causes of Death Registry. Norwegian hospitals are required by law to register all patients hospitalized for AMI in the Norwegian AMI Registry. Hospitalized cases not registered in the AMI registry were retrieved from the Norwegian Patient Registry which contains discharge diagnoses for hospitalized patients. The national unique 11-digit identification number allowed linkage of the registries and identification of transfers between hospitals and re-hospitalizations. An AMI (either hospitalization or death) was classified as incident if no hospitalization was found for that individual during the previous 5 years. We calculated age-adjusted rates with the Norwegian population in 2017 as standard.

Results
Norwegian AMI mortality rates increased from 1951, peaked in the late 1960s, and have since that time declined steadily, although steeper after around 1990 (Figure). Present AMI mortality rates are lower than in the 1950s, and are still declining. Incidence of AMI (hospitalized and non-hospitalized) fell from 391/100 000 in 2013 to 271/100 000 in 2021, corresponding to a mean reduction of 3.6 % per year (p&lt;0.001). Incidence of out-of-hospital fatal AMI fell by 6.5 % per year, incidence of hospitalized ST-segment elevation AMI (STEMI) fell by 2.3 % per year, and incidence of non-ST-segment elevation AMI (NSTEMI) fell by 3.1 % per year (all p&lt;0.001). 30-days CFR of hospitalized and non-hospitalized AMI fell from 21.3 % in 2013 to 17.5 % (3.6 % per year; p&lt;0.001). CFR after NSTEMI fell from 8.2 % in 2013 to 6.4 % in 2021 (4.4 % per year; p&lt;0.001), whereas there was no significant change in CFR after STEMI (13.3 % in 2013 and 12.0 % in 2021). The incidence and CFR trends were similar in men and women aged 20-49, 50-79 and 80+ years.

Comments
Declining incidence of out-of-hospital fatal AMI and declining incidence of hospitalized STEMI and NSTEMI were major contributors to the declining AMI mortality rates in Norway. Improved case-fatality rates among hospitalized patients have contributed to the declining mortality rates, but there was no improvement in case-fatality in STEMI during 2013-2021.
Acute kidney injury in relation to high-sensitivity cardiac troponin T levels in the emergency department
Authors: Cyon L , Kadesjo E , Edgren G , Roos A 
Published: October 2024

Abstract

Background
The clinical implications of high-sensitivity cardiac troponin T (hs-cTnT) measurements in all-comers with AKI in the emergency department (ED) is largely unknown.

Purpose
To investigate the prevalence of myocardial injury, associations between serum-creatinine concentrations (SCC) and hs-cTnT kinetics, and the accuracy of established hs-cTnT-based myocardial infarction (MI) risk stratification algorithm criteria in patients with AKI.

Methods
This observational cohort study was based on patient visits to 7 EDs in Sweden from December 9, 2010 to August 31, 2017. All visits by patients ≥18 years fulfilling criteria for AKI with ≥1 hs-cTnT measurement and the exposure was dynamic change in SCC (ΔSCC) during the visits. Linear mixed models were used to estimate linear predictors of kinetic change in hs-cTnT (Δhs-cTnT). Logistic regression models were applied to calculate odds ratios (ORs) for Δhs-cTnT indicative of acute myocardial injury (Δhs-cTnT &gt;20% and elevated hs-cTnT) in relation to ΔSCC among patients without MI, and to assess the diagnostic performance of hs-cTnT for MI in a subgroup of patients presenting with chest pain.

Results
A total of 15,211 visits by patients with AKI were included, of whom 1174 (8%) had an MI. Four of five (81%) patients without MI had myocardial injury (hs-cTnT &gt;14 ng/l), and almost one of three (31%) had acute myocardial injury. These entities were common in both cardiac and non-cardiac conditions. The Δhs-cTnT in non-MI patients was 1.8-fold (β: 1.78, 95% CI: 1.62-1.96) in the highest quartile of ΔSCC and was paralleled by a 2-fold risk of acute myocardial injury (OR: 2.32, 95% CI: 2.08-2.59), compared with the lowest ΔSCC quartile. Using a 0 h hs-cTnT cut-off ≥52 ng/l assigned 627 (26%) patients to a high-risk group in whom the specificity and positive predictive value (PPV) for MI was low (78.5% (95% CI: 76.7-80.2) and 27.6% (95% CI: 24.1-31.3), respectively).

Conclusions
Hs-cTnT concentrations indicative of acute myocardial injury are frequently observed among all-comers with AKI in the ED and are associated with dynamic changes in SCC. These observations are accompanied by poor performance of recommended hs-cTnT-based algorithms for MI risk stratification in patients with chest pain.
The effect of physical activity on biochemical myocardial markers in patients with CKD 5D
Authors: Muminov S H K , Kasimova G B 
Published: October 2024

Abstract

Purpose of the study
to study the effects of intradialytic physical activity on myocardial markers in patients with chronic kidney disease.

Materials and methods
The study included 103 patients with CKD5d aged 18 to 65 years. The average HD experience is 8.45±0.57 months. When all patients were included in the study, natriuretic peptide (NUP), myocardial fraction of creatine phosphokinase (CPK-MB), and myocardial fraction of troponin (troponin T) were determined in the blood before the hemodialysis procedure, 60-90 minutes after cessation of HD.

Results
The study showed that intradialytic physical activity contributes to a significant reduction in the amplitude of the increase in the concentration of markers of myocardial necrosis and NUP compared with standard HD by the 60-90th minute of HD (+7.66% versus +18.04% for NUP, 87.2% versus +172 .8% for CPK-MB and +66.09% versus +263% for troponin T, p&lt;0.001 significance of comparison between HD regimens for all three markers). And also by the end of HD against the background of HD with FN, there was a decrease in the concentration of NUP and CPK-MB, in contrast to the dynamics with standard HD (+4.17% versus 19.84% and +28.9% versus 137.1%, respectively, p&lt;0.001 significance of the difference between HD modes for both markers). The concentration of troponin T at the end of HD with FN progressively increased, but the relative dynamics were significantly lower than during standard HD (+719.3% versus +867.8%, p&lt;0.001).

Conclusion
thus, intradialytic physical activity helps to reduce markers of myocardial damage in the blood compared to standard HD and possibly has a preventive effect on cardio myocytes.
Prediction of scar and microvascular obstruction after myocardial infarction
Authors: Breitbart P , Schmitt R , Brado J , Westermann D , Ruile P 
Published: October 2024

Abstract

Background
Myocardial scar, demonstrated by late gadolinium enhancement (LGE), and microvascular obstruction (MVO) at cardiac magnetic resonance imaging (CMR) are well described risk factors for cardiac events after myocardial infarction (MI).

Purpose
This study aimed to evaluate the prediction of myocardial scar and MVO based on cardiac biomarker levels.

Methods
We evaluated 631 patients with CMR 3 days [interquartile range 2-4 days] after myocardial infarction (420 with ST-segment elevation and 211 with non-ST-segment elevation myocardial infarction). Cardiac biomarker levels were measured at admission as well as 8, 16, 24 and 48 hours after percutaneous coronary intervention (PCI).

Results
A myocardial scar was detectable in 586 patients (92.9%), microvascular obstruction in 170 patients (29.3%). Patients with LGE showed significantly higher peak hs-cTnT levels than those without (3908.2±4374.0 ng/l vs 416.8±426.8 ng/l, p&lt;0.001). A cut-off value of hs-cTnT &gt;688.5 ng/l was a predictor for scar with a sensitivity of 81.7% and a specificity of 84.4%. Patients with MVO showed significantly higher peak hs-cTnT levels than those without (6909.8±5525.1 ng/l vs 2467.1±2993.0 ng/l, p&lt;0.001). A cut-off value of hs-cTnT &gt;1500.0 ng/l was a predictor for MVO with a sensitivity of 92.9% and a specificity of 43.4%.

Conclusions
Higher peak hs-cTnT levels are strong predictors for the occurrence of myocardial scar and MVO at CMR after MI as risk factors for future myocardial events. We propose the new cut-off value of hs-cTnT of &gt;688.5 ng/l within 48 hours after PCI for prediction of myocardial scar and hs-cTnT of &gt;1500.0 ng/l for prediction of MVO. This could be used as a screening tool for post-myocardial infarction patients, who may benefit from further evaluation using CMR.
Safety and efficiency of modified HEART scores without troponin or electrocardiography: an analysis based on two European out-of-hours primary care cohorts
Authors: Melessen I , Vallersnes O M , Harskamp R E , Atar D , Manten A , Halvorsen S , Johannessen T R 
Published: October 2024

Abstract

Background
Differentiating between acute chest pain of cardiac versus non-cardiac origin poses a diagnostic challenge. Risk stratification tools, such as the HEART (History, ECG, Age, Risk and Troponin) score, have been developed to aid in decision-making. These scores typically rely on troponin or electrocardiography (ECG), often unavailable in (low-resource) community-based healthcare settings.

Purpose
We evaluated the diagnostic performance of the HEART score in a low-risk setting when one of its five metrics is missing

Methods
We relied on data from two cohorts, OUT-ACS (n=1,711; for analyses with and without troponin) and TRACE (n=664; for analyses without troponin) of consecutive patients evaluated at primary care emergency clinics in respectively Norway (2016-2018; 47.7% female, median age: 56, 25th-75th percentiles:45-68) and the Netherlands (2017, 56.9% female, median age: 48, 25th-75th percentiles:32-67). We evaluated the HEAR score (all elements except troponin) and the HART score (all elements except ECG). The primary outcome was the diagnostic performance for ruling out myocardial infarction (MI) at index presentation, with a secondary outcome consisting of the composite of all-cause death or MI at 90-day follow-up.

Results
Among study participants, 61 (3.6%) were diagnosed with an MI in the OUT-ACS and 20 (3.0%) in the TRACE cohort. The percentages of patients deemed at low risk by HEAR (&lt;=3) were 925 (54.1%) and 527 (79.4%) in OUT-ACS and TRACE, respectively. Sensitivity and specificity were 70.5% (95 % confidence interval 57.4-81.5) and 55.0% (52.5-57.4), and 75.0% (50.9-91.3) and 81.1% (77.8-84.0) for HEAR in the two respective cohorts. For the HART score, low risk was found in 696 (40.7%) OUT-ACS participants, with a respective sensitivity and specificity of 96.7% (88.7-99.6) and 42.1% (39.7-44.5), Positive predictive values ranged from 5.5-15.3%, whilst negative predictive values were 98.1-99.1% for HEAR and 99.7% for HART. By comparison, the HEART score determined 639 (37.3%) patients as low risk, had a sensitivity and specificity of 98.4% (91.2-100) and 38.7% (36.3-41.1), and positive and negative predictive values of 5.6% (5.3-5.9) and 99.8% (98.9-100). Similar findings were found for analyses using the secondary outcome.

Conclusion
HEART score variants in which troponin or ECG are omitted have higher efficiency but at the cost of decreased safety, particularly when leaving out troponin. Therefore, these biomarkers are paramount for adequate safety, despite the overall high negative predictive values in this low-prevalence primary care setting.