bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 19144: New Ischemic Stroke and Outcomes with Vorapaxar vs. Placebo: Results from TRA 2°P-TIMI 50 Trial
Authors: Bonaca Marc P , Scirica Benjamin M , Braunwald Eugene , Wiviott Stephen D , Goto Shinya , Nilsen Dennis , Bonarjee Vernon , Murphy Sabina A , Morrow David A 
Published: April 2024

Vorapaxar is a potent platelet inhibitor that reduces thrombotic events in stable patients with a history of myocardial infarction (MI) or peripheral artery disease (PAD); however, this benefit is offset by increased bleeding including intracranial hemorrhage particularly in patients with established cerebrovascular disease (CVD). We investigated the outcomes in patients with MI or PAD experiencing a first ischemic stroke on vorapaxar.
METHODS: The TRA2P-TIMI 50 trial was a randomized, double-blind, placebo controlled trial of vorapaxar 2.5 mg daily in 26,449 patients with established atherosclerotic vascular disease. Patients were stratified at randomization by their qualifying atherosclerotic condition (MI, PAD, or CVD). After two years, the Data and Safety Monitoring Board recommended discontinuation of study treatment in those with prior stroke or incident stroke. We evaluated the risk of new ischemic stroke outcomes with vorapaxar in 20,170 patients with MI or PAD but no history of CVD.
RESULTS: In patients with MI or PAD and no history of CVD, vorapaxar significantly reduced ischemic stroke (HR 0.57, 95% CI 0.43 - 0.75, p<0.001)(Figure A). Overall there were numerically fewer hemorrhagic conversions in patients treated with vorapaxar who suffered a first ischemic stroke. The risk of hemorrhagic conversion (HR 1.19, 95% CI 0.49 - 2.91, p=0.70) or death (HR 1.09, 95% CI 0.57 - 2.07, p=0.79) during follow up was not significantly increased with vorapaxar. Although hemorrohagic stroke was increased (HR 2.78, 95% CI 1.00- 7.73, p=0.049) overall stroke was significantly reduced (HR 0.68, 95% CI 0.52 - 0.8, p=0.005) with vorapaxar (Figure B).
CONCLUSIONS: Vorapaxar reduces thrombotic events including ischemic stroke in stable patients with MI or PAD. There is no significant increase in the risk of hemorrhagic conversion or death in MI or PAD patients who experience a first ischemic stroke on vorapaxar. Hemorrhagic stroke is increased but all stroke is reduced.
Abstract 19296: In-Stent Neoatherosclerosis: Are First Generation Drug Eluting Stents Different Than Bare Metal Stents? An Optical Coherence Tomography Study
Authors: Karanasos Antonios , Witberg Karen , Ligthart Jurgen , van Geuns Robert-Jan , Daemen Joost , Bruining Nico , van Soest Gijs , Zijlstra Felix , Toutouzas Konstantinos , Regar Evelyn 
Published: April 2024

Purpose: In-stent neoatherosclerosis has been recognised in pathologic specimens of bare metal stents (BMS), and recently in first generation drug eluting stents (1st-DES) as well. However, in vivo data are scarce. By optical coherence tomography (OCT), we investigated the incidence and morphological characteristics of neoatherosclerosis (NA) very late after BMS or 1st-DES implantation.
Methods: From 1/1/2007 to 31/1/2012, 52 patients from two institutions underwent >24 months follow-up OCT assessment of a BMS or a 1st-DES (13 BMS - 39 1st-DES). NA was characterized using criteria for native atherosclerosis.
Results: Differences between BMS and 1st-DES are presented in the table. BMS had longer follow-up interval but no differences in clinical presentation at follow-up. No significant differences were evident in the incidence of NA, neointimal rupture, lipid content, neovascularization or macrophage infiltration between BMS and 1st-DES. There was however a trend for lower fibrous cap thickness (FCT) and for higher calcification in BMS (FCT: 51±31μ m vs. 92±59μ m, p=0.057; calcifications: 46.2% vs. 15.4%, p=0.051). 1st-DES with neoatherosclerosis had longer interval from implantation compared to 1st-DES with homogeneous coverage [Median 71 months (range 25-130) vs. 57 months (24-68), p<0.05], but there was no difference for BMS with or without neoatherosclerosis [Median 125 months (range 90-201) vs. 168 months (132-168), p=0.54].
Conclusions: The incidence and morphological characteristics of NA are similar between 1st-DES and BMS of more prolonged follow-up. Our findings suggest a time-dependent pattern in the incidence of NA in 1st-DES with 2-11 years follow-up.
Abstract 19564: Role of Insulin Resistance and Excess Free Fatty Acids in Determining Endothelial Function in the Metabolic Syndrome
Authors: Perlstein Todd S , Buck J. S , Kadivar Samoneh , Beckman Joshua A 
Published: April 2024

Introduction: It is hypothesized that insulin resistance and endothelial dysfunction are reciprocally linked, though clinical data are limited. In particular, impaired endothelial insulin signaling is thought to result in endothelial dysfunction. Excess circulating free fatty acids (FFAs) are hypothesized to impair insulin signaling and result in both insulin resistance and the associated endothelial dysfunction.
Aims: We examined the relationship between insulin resistance and endothelial function in the metabolic syndrome, a clinical state of insulin resistance. We also tested whether lowering of FFAs would improve endothelial function in persons with the metabolic syndrome.
Methods: A total of 70 adults, 39 with the metabolic syndrome and 31 healthy controls, were studied. Subjects underwent euglycemic hyperinsulinemic clamp to measure insulin resistance (‘M’, mg/kg/min) and insulin-stimulated, endothelium-dependent vasodilation (%), as well as ultrasound-measured brachial artery flow-mediated dilation (FMD, %) to measure endothelial function. Thirty-five subjects, 18 with the metabolic syndrome and 17 controls, completed a double-blinded, placebo controlled crossover trial to examine the effects of 7 days of FFA lowering with acipimox on endothelial function and insulin resistance.
Results: FFA levels were higher in the metabolic syndrome (p < 0.01). Persons with the metabolic syndrome were insulin resistant compared with control subjects (M 5.1 (1.4) mg/kg/min vs. 9.7 (3.9) mg/kg/min, p < 0.001), but FMD (10.9 (6.4) % vs. 10.7 (5.0)%, p = 0.92) and insulin stimulated vasodilation (36.9 (32.4) % vs. 86.6 (140) %, p = 0.31) were not different between groups. Acipimox therapy improved insulin resistance approximately 20% (p < 0.05) but did not alter FMD (p = 0.67) or insulin-stimulated dilation (p = 0.26).
Interpretation: These data demonstrate preserved endothelial function in persons with the metabolic syndrome despite severe systemic insulin resistance, and no effect of FFA lowering therapy on endothelial function despite improvement insulin sensitivity. Insulin resistance and elevated FFA levels may not be sufficient to cause endothelial dysfunction in humans.
Abstract 196: Does Health Status Influence the Willingness to Provide Informed Consent? Results from a Cardiac Arrest Trial Conducted Under Waiver of Informed Consent
Authors: Frascone Ralph , Salzman Joshua , Yannopoulos Demetris , Mahoney Brian , Swor Robert , Domeier Robert , Wayne Marvin , Aufderheide Tom , Olinger Michael , Wewerka Sandi , Tupper David , Holcomb Richard 
Published: April 2024

Background
Federal regulation 21 § CFR 50.24 allows an initial waiver of informed consent (IC) for treatment of certain medical emergencies but requires the consent process be initiated at the earliest feasible opportunity. In a recent out-of-hospital cardiac arrest (OHCA) trial conducted under 21 § CFR 50.24, data from public records were collected which shed light on whether the willingness to provide subsequent IC was associated with study outcomes. We hypothesized that IC was less likely to be obtained in subjects with significantly compromised health status.
Methods
A post-hoc analysis was conducted using data from a NIH-funded randomized, controlled OHCA clinical trial comparing active compression decompression CPR plus an impedance threshold device (ACD+ITD) with standard CPR. The primary endpoint was survival to hospital discharge (HD) with favorable neurologic function [Modified Rankin Scale (MRS) score <3]. The status of the consent process was tabulated for all subjects who survived to hospital admission. Unadjusted Fisher’s exact test and associated odds ratios were used to compare the MRS at HD by IC status.
Results
Among a total study population of 1655 subjects, 457 survivors were admitted to the hospital, and 440 had known HD status (see table).
Survival with a MRS≤3 was significantly higher in subjects where IC was given: 35.0% vs 4.1%, p < 0.001. Sixteen of the 17 cases with missing MRS outcomes were in the IC denied group. Even if all were considered to have favorable outcomes, the resulting rate (21.1%) was less than that seen among subjects with IC given (p = 0.015).
Conclusion
Subjects who denied IC were significantly less likely to have favorable outcome. These findings suggest that some resuscitation trials may unknowingly under-represent those subjects with the worst prognoses in a target study population despite pre-specified inclusion and exclusion criteria, due to the unwillingness or inability of the subjects or their families to provide IC.
Abstract 199: Automated External Defibrillator Awareness and Knowledge Among the Lay Public in a Busy Urban Transportation System
Authors: Gonzalez Mariana R , Cinousis Marisa J , Ward Michael A , DiPuppo Tucker Kathryn , Becker Lance B , Leary Marion , Abella Benjamin S 
Published: April 2024

Background: The prompt utilization of automatic external defibrillators (AEDs) by bystanders can greatly improve survival from sudden cardiac arrest occurring in public locations. A recent study of laypersons in a European transportation hub has suggested public knowledge and surrounding AED use is lacking; we sought to confirm and extend these findings in similar settings in the US. We hypothesized that awareness of AEDs and who can use them will be low among the general public.
Objectives: To characterize layperson knowledge about AED use and emergency response in a major US metropolitan area transportation system.
Methods: A survey instrument was adapted from a prior investigation performed in Europe. Trained survey personnel administered this oral survey (approx. five minute duration) to adult laypersons at two public transportation centers in a large US city during May 2012. The participants were asked questions relating to their knowledge of AEDs and who is permitted to use them, as well as their willingness to utilize an AED in an emergency.
Results: Surveys were completed by 222 individuals. Mean age of respondents was 49.4±17.1 y, 44% were female and 25% reported prior CPR training within the past 5 years. When presented with a hypothetical cardiac arrest scenario, 63% said they would call for help and/or dial 911, but only 8% of respondents spontaneously suggested using an AED when prompted for other actions. When an AED was described, 59% of participants were aware that AEDs are available in public places, but only 38% were aware that AEDs can be used by laypersons. When informed regarding the availability for layperson use, 60% of respondents said that they would be willing to use an AED in an emergency situation.
Conclusions: Though the majority of layperson respondents were willing to use an AED in an emergency when educated, few respondents considered an AED in their immediate response and the minority were aware that AEDs could be accessed by the general public. Additional broad efforts to educate the US public about AED availability and use should be prioritized.
Abstract 2: Orexin-A Improves Arousal from Post--Cardiac Arrest Coma in a Rodent Model
Authors: Akbari Yama , Maybhate Anil , Chen Cheng , Greenwald Elliot , Liang Lydia , Buitrago-Blanco Manuel , Jia Xiaofeng , Thakor Nitish , Geocadin Romergryko 
Published: April 2024

Introduction: Coma after cardiac arrest (CA) is common and leads to suffering for patients while being an emotional and financial burden to families and society. Other than hypothermia, there is currently no therapy to improve neurological outcome after CA. The hypothalamic Orexin pathway provides a potential pharmacologic target towards improving arousal after coma.
Hypothesis: Post-resuscitaion, Orexin-A intracerebroventricular (icv) infusion after bolus injection will provide immediate and long term term arousal after CA which can be assessed by quantitative EEG (qEEG) and behavioral testing (neurologic deficit scale; NDS).
Methods: Rats (N=17; Adult Male Wistar; 300-350gms) were implanted with icv cannula attached to an osmotic pump. One week later, rats underwent baseline EEG followed by intubation, mechanical ventilation, cannulation of the femoral vessels, followed by 7 minutes of asphyxial cardiac arrest. Forty-five minutes after the resuscitation, rats were randomized to either Orexin-A (n=8) or saline (n=9) icv bolus and infusion. EEG was monitored continuously for 4 hours after CA, and for 30 minutes at 24hrs, 48hrs, 72hrs, and 12 days post-CA. NDS was also conducted at these times. EEG was analyzed using a custom algorithm to analyze the information quantity (IQ), an entropy based nonlinear measure for the entire frequency domain and clinical sub-bands.
Results: Orexin-A treated rats demonstrated higher normalized IQ immediately after receiving the Orexin-A in comparison to saline (0.731±0.028[AM1] vs. 0.613±0.021; p<0.01). This acute improvement in IQ sustained for 4hrs Post-CA. Moreover, the band-specific analysis [RG2] showed that Orexin-A improved the IQ in β-band at 72hrs (1.160±0.039 vs. 1.052±0.029; p<0.05). Behaviorally, Orexin-A allows rats to perform significantly better on the NDS at 4hrs (38.3±3.2 vs. 30.1±1.9; p<0.05); 24hrs (67.1±4.1 vs. 49.8±3.8; p<0.01); 48hrs (73.4±4.3 vs. 61.0±3.6; p<0.05), and 72hrs (75.0±3.3 vs. 65.2±2.9; p<0.05).
Conclusions: Rats receiving icv Orexin-A post-CA showed better arousal on both qEEG and behavioral (NDS) testing. Orexin-A may have therapeutic potential in disorders of arousal and coma after CA.
Abstract 205: Are All Codes the Same? House Staff Perceptions of Cardiopulmonary Resuscitation in the Cardiac Catheterization Laboratory
Authors: Karol Janet , Borak Meredith , Beiser David G , Edelson Dana , Deal Nathan , Nathan Sandeep , Paul Jonathan , Babcock Christine , Shah Atman P 
Published: April 2024

Background:
Patients who are resuscitated after cardiac arrest (ROSC) are increasingly being taken to the cardiac catheterization laboratory (CCL) for diagnostic procedures and ventricular support. These critically ill patients may suffer a second arrest and need cardiopulmonary resuscitation (CPR) during their CCL procedure. The goal of this study was to assess housestaff perceptions of these codes and subsequent management.
Methods:
All codes at our institution are run by housestaff. Seventy-five internal medicine and emergency medicine residents at a single tertiary care university hospital were sent a web-based survey. Residents were asked their level of training, the quality of the CPR in the CCL compared to other clinical areas, and the top reason why they felt quality CPR was hindered in the CCL. The identities of the respondents were anonymous, but the respondents self-identified training program was recorded.
Results:
Fifty of the residents responded (66.7%). Compared to codes in the ICU, 40% felt that the CPR in the CCL was worse while 46% reported that it was the same and 14% felt that the codes were better. Compared to codes in the Emergency Department, 28% felt that the CPR was worse while 44% felt it was the same and 28% felt it was better. The top three reasons that CPR was felt to be compromised was the physical interference of the imaging equipment, the need for frequent stops of CPR, and the fear of radiation exposure (Table 1).
Conclusions:
This study identified perceived obstacles to resusitative efforts in the CCL. Standardization of care, identification of obstacles and removing these barriers are key to effective CPR and patient survival.
Abstract 211: Poor AED Availability Despite Improved AED Dissemination: A Challenge for Public Access Defibrillation
Authors: Malta Hansen Carolina , Wissenberg Mads , Weeke Peter , Ruwald Martin H , Lamberts Morten , Lippert Freddy , Gislason Gunnar H , Nielsen Soren L , Kober Lars , Torp-Pedersen Christian , Folke Fredrik 
Published: April 2024

Background
Strategic AED placement and availability are paramount for successful public access defibrillation (PAD). However, analyses of AED coverage in relation to location and incidence of cardiac arrest in community settings are limited. We assessed AED placement and coverage according to workday, weekends and hour of day in relation to out-of-hospital cardiac arrests (OHCAs) in public.
Methods
All OHCAs in public places from 1994-2011 and all publicly available AEDs in Copenhagen, Denmark, were geographically located. OHCA high-risk areas were defined as those with ≥1 arrest every 2 years, within a 100-meter radius. All OHCAs occurring within a 100-meter radius were counted as well as the number of AEDs in these areas. AEDs available for PAD were registered in a nationwide network with the following information: location, time and weekday availability.
Results
A total of 2151 OHCAs occurred in public locations. The mean age was 61.7 (SD±17.7) years (74.8% males). High-risk areas accounted for 1.1% (n=112) of the city and 16.5% (n=360) of all arrests. A significant proportion of arrests occurred on weekends and between 6 p.m. and 8 a.m (65.8%). The number of AEDs increased from 36 in 2007 to 555 by the end of 2011. Of these, 5.8% (n=32) covered 44.6% of the high-risk areas and 96.2%, 31.9% and 9.7% were available all weekdays during daytime, evening and nighttime, respectively. On weekends 29.4%, 17.7% and 9.2% of all AEDs were available in daytime, evening and nighttime, respectively. Only 18.8% (n=6) AEDs in high-risk areas had 24-hour and all-week availability.
Conclusion
Despite a large increase in public AEDs, the coverage of OHCA high-risk areas remains insufficient. Further, only 18.8% of AEDs in OHCA high-risk areas were available at all times although 65.8% of arrests occurred outside working hours. Hence, a much greater proportion of AEDs should offer 24-hour and all-week availability to cover the actual incidence of cardiac arrest.
Abstract 212: Can Return of Spontaneous Circulation Be Achieved Faster in a Resuscitation Algorithm that Directs the Duration of Postshock Chest Compressions According to the Preshock Value of the Amplitude-Spectral Area? A Study of Ventricular Fibrillation Cardiac Arrest in Normal Swine
Authors: McGovern Meghan , Allen Daniel , Chaudhry Fahd , Hilwig Ronald , Kern Karl B , Indik Julia 
Published: April 2024

Background: It has been previously demonstrated in a swine model of cardiac arrest due to ventricular fibrillation (VF) that a return of spontaneous circulation (ROSC) following a shock is predicted by the amplitude spectral area (AMSA), a quantitative measure of the VF waveform. These prior studies were a retrospective analysis of the VF waveform prior to shocks. We hypothesize that AMSA can be utilized in a prospective fashion as part of a resuscitation algorithm to direct the duration of post-shock chest compressions (CC). Specifically, we have tested whether such an AMSA-directed algorithm will shorten the time needed to achieve ROSC in normal swine.
Methods: VF was induced electrically in normal swine and untreated for 10 minutes. Resuscitation was commenced with 1 minute of CC, resumption of mechanical ventilation, followed by the first shock and administration of epinephrine. Subsequently, animals were randomized to a traditional or waveform guided group. In the traditional group, all shocks were followed by 2 minutes of post-shock CC. In the waveform guided group, AMSA was measured prior to each shock and if AMSA>20 mV-Hz then post shock CC duration was shortened to 1 minute. ROSC was defined as a systolic aortic pressure greater than 50 mm Hg and pulse pressure > 20 mm Hg lasting at least one minute. Time to ROSC was compared with a Kruskal-Wallis rank test. AMSA was compared between groups using regression analysis with random effects to account for multiple shocks within the same animal.
Results: A total of N=8 animals were assigned to the traditional group with 22 shocks delivered, and N=8 animals to the waveform guided group with 21 shocks delivered. Time to ROSC (from induction of VF) was 14.5 ±1.2 minutes in the traditional group and 13.5± 1.2 minutes in the waveform guided group, (P=0.2). There was a trend for higher AMSA values in the waveform guided group: 48 ± 15 versus 39 ± 16 mV-Hz (P=0.1).
Conclusions: A resuscitation algorithm that tailors the duration of post-shock chest compressions to the value of AMSA is feasible. In this study of normal swine we found small, but non-significant, reductions in the times to achieve ROSC and higher values of AMSA in swine treated with a waveform guided approach.
Abstract 222: Does Gender Matter for Postarrest Care?
Authors: Rac Valeria E , Dorian Paul , Slutsky Arthur S , Abramson Beth , Fowler Robert , Parsons Janet A , Kiss Alex , Dainty Katie N , Zwarenstein Merrick , Zhan Cathy C , Morrison Laurie J 
Published: April 2024

Introduction: Studies have shown that after cardiac arrest women have lower survival to discharge rates than men. These differences are surprising, considering that women are more often successfully resuscitated in the prehospital setting. Differences in survival to discharge rates might be partially attributed to disparity in post arrest care, similar to what is seen in myocardial infarction (MI).
Hypothesis: There is gender disparity in the provision of targeted post arrest care interventions.
Methods: This prospective study explores gender disparity in a prospective Canadian data set of non-traumatic, EMS treated, out of hospital cardiac arrest (OHCA) patients presenting to hospitals in the Strategies for Post Arrest Care (SPARC) network between March 16, 2010 and March 31, 2012. All patients with sustained return of spontaneous circulation (palpable pulse for >20 mins) were included in the analysis. Unadjusted chi square tests and logistic regression models were employed to examine the relationship between gender, and provision of post arrest care interventions (coronary angiography, percutaneous coronary intervention (PCI), therapeutic hypothermia, electrical physiology consultation and internal cardiac defibrillator (ICD) placement and two or more neuroprognostic testing ≥ 72 hours).
Results: From a total of 2,199 OHCA patients (1,447 men, 752 women), 992 had sustained return of spontaneous circulation (36.6% women, mean age 68.2 years; 63.4% men, mean age 63.9). There were gender differences in utilization of coronary angiography (12.1% in women vs. 20.8% in men, adjusted OR 0.53, 95% CI 0.36 to 0.77, p=0.013) and PCI (3.7% in women vs. 5.8% in men, adjusted OR 0.63, 95% CI 0.41 to 0.98, p=0.042). ICD was less utilized in women, but differences were not significantly different (4.9% in women vs. 8.1% in men, adjusted OR 0.59, 95% CI 0.33 to 1.02 p=0.062). There were no gender differences in utilization of therapeutic hypothermia and neuroprognostic testing ≥ 72 hours.
Conclusion: The observed gender differences in utilization of coronary angiography and PCI intervention may be due to disparity in care and/or differences in underlying pathophysiology of cardiac arrest between men and women contributing to women’s unfavorable outcomes.