bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the cardioprotective effect of pre-infarction angina blunted by age?
Authors: Pereira Santos M , Alexandre A , Campinas A , Sa Couto D , Ribeiro D , Santos R , Brochado B , Luz A , Silveira J , Torres S 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Pre-infarct angina (PIA) has been demonstrated to reduce infarct size and improve prognosis in ST-elevation myocardial infarction (STEMI). However, the effects of ischemic preconditioning with aging are still controversial.

Purpose
We aimed at comparing the effect of pre-infarction angina (PIA) on infarct size between two age groups.

Methods
We retrospectively studied consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. PIA was diagnosed if a patient had arm, jaw, or chest pain in the preceding eight days. Peak creatine kinase (CK) concentration was used as a surrogate of infarct size. Patients were divided into two groups, based on the median age: ≤62 years and &gt;62 years. Multiple linear regression was used to identify independent predictors for infarct size that included total ischemic time and classic cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, and smoking). Interaction between age and PIA was evaluated by 2-way factorial ANOVA.

Results
From the 1131 patients included in the study, 590 (52,2%) had ≤62 years and 541 (47,8%) had &gt;62 years. Older patients were more often women (17.2% vs 8.6%, p&lt;0.001) and had longer total ischemic time [4.6(3.0-9.0) vs 3.5(2.3-6.0) hours, p&lt;0.001]. They also had higher prevalence of hypertension (32.8% vs 22.8%, p&lt;0.001), diabetes (30.7% vs 18.7%, p&lt;0.001) and were less likely to be smokers (26.9% vs 71.4%, p&lt;0.001). The prevalence of PIA was similar across age groups (≤62Y 31.2% vs &gt;62Y 32.0%, p=0.668).
In older patients, PIA was associated with smaller infarct size [1.29(0.72-2.33) vs. 1.76(0.97-2.91) U/Lx103, p&lt;0.001]. This difference was not observed for younger patients [1.72(0.95-3.40) vs. 1.81(0.94-3.37) U/Lx103, p=0.392]. There was no significant interaction between the existence of PIA and age on peak CK (p=0.280 for interaction) (Figure 1).
In multivariate analysis, overall, PIA was associated with reduced peak CK (β=-0,320, p=0.011). On subgroup group analysis, PIA was a predictor of infarct size only in the older patients (β=-0,459, p=0.005), but not in the younger group (β=-0,182, p=0.394).

Conclusion
Older patients with PIA had significantly lower infarct size compared to patients in the same age group without PIA. After adjustment for risk factors and total ischemic time, PIA was a predictor of lower infarct size only for the older patients. These results suggest that the effect of pre-ischemic conditioning is not blunted by age, indicating that older patients should not be excluded from clinical trials investigation of cardioprotective strategies in STEMI patients.
Efficacy and safety of upstream unfractionated heparin compared with downstream administration in ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention
Authors: Costa G , Resende B L , Gameiro J , Teixeira R , Goncalves L 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Unfractionated heparin (UFH) is frequently administered before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI)1,2. However, current guidelines do not provide clear recommendations for UFH pretreatment before arrival at the coronary catheterisation laboratory1,3.

Methods
Between June and July 2023, we systematically searched PubMed, Embase and Cochrane databases for studies comparing UFH pretreatments in patients with STEMI. A random-effects meta-analysis and meta-regression analyses were performed.

Results
Fourteen studies were included, of which four were randomised clinical trials (RCTs). A total of 76446 patients were included: 31238 in the pretreatment group and 39208 in the control group. Our meta-analysis revealed a lower all-cause mortality for the pretreatment strategy when compared with the control group, albeit with high heterogeneity (pooled odds ratio (OR) = 0.61, 95% confidence interval (CI) [0.49-0.76], P &lt; 0.01; I² = 77%); lower in-hospital cardiogenic shock (pooled OR = 0.68, 95% CI [0.58-0.78], P &lt; 0.21; I² = 27%) and a higher rate of spontaneous reperfusion events (pooled OR = 1.68, 95% CI [1.47-1.91], P &lt; 0.01; I² = 79%). In terms of major bleeding, the UFH pretreatment strategy further revealed a decreased rate of events (pooled OR = 0.85, 95% CI [0.73-0.99], P = 0.40; I² = 4%).

Conclusions
From our study, UFH pretreatment in patients with STEMI undergoing primary PCI shows important benefits by reducing all-cause mortality, cardiogenic shock, enhancing reperfusion rates, whilst diminishing major bleeding events High-scale and high-quality RCTs will be required to fully address this clinical question in the future.1) Characteristics of included studies.2) Analyzed outcomes.
Diagnostic and prognostic value of NT-proBNP in patients with non-alcoholic fatty liver disease and acute decompensated heart failure
Authors: Khutsishvili N , Misan I A , Arisheva O S , Garmash I V , Galochkin S A , Kobalava Z H D 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Aim
To study N-terminal propeptide natriuretic hormone (NT-proBNP) values in patients with non-alcoholic fatty liver disease (NAFLD) with acute decompensated heart failure (ADHF) at admission and discharge to evaluate its impact on clinical outcomes.

Material and methods
Included were 566 patients hospitalized with ADHF, functional classes II–IV (NYHA) [49,3% men, mean age 72,4 ± 11.4 years, left ventricular ejection fraction (LVEF) - 45 (33; 55) %. Patients were divided into 2 groups: 1 – ADHF and NAFLD (n=168), 2 – ADHF without NAFLD (n=398). All patients had NT-proBNP levels determined upon admission and discharge. The degree of liver steatosis was determined using a sensor device using the CAP (Controlled Attenuation Parameter) ultrasound option. Threshold CAP values corresponded to the degree of hepatic steatosis - S0 (&lt;294 dB/m), S1 (295-309 dB/m), S2 (310-330 dB/m), S3 (≥331 dB/m).

Results
NAFLD was diagnosed in 29.7% of all patients. The incidence of NAFLD was higher in patients with preserved LVEF - 43% vs 25% - reduced LVEF. Patients with severe steatosis (S3) had significantly lower NT-proBNP values than patients with moderate steatosis (S1,S2) and no steatosis (S0) at admission [926 (256;1870) pg/ml, 1246 (298; 2000) pg/ml, 1850 (798;3515) pg/ml, respectively, p&lt;0.001] and at discharge [480 (107;1406) pg/ml, 1077 (250;1649) pg/ml, 1685 (628;2733) ) pg/ml, respectively, p&lt;0.001].
In patients with NAFLD and ADHF, according to multivariate Cox regression analysis, NTproBNP level &gt;1593 pg/ml at discharge (hazard ratio (HR) 3.14; 95% confidence interval (CI) 1.52– 6.43; p&lt;0.001) and LVEF&lt;40% (HR 2.90; 95% CI 1.46–5.76; p=0.002) were independently associated with a higher likelihood of all-cause death during the 3-year follow-up period.

Conclusions
NAFLD and ADHF group was characterized by lower NT-proBNP values, with an inverse correlation with the degree of steatosis, which may complicate timely diagnosis and prescription of adequate therapy. At the same time, assessment of NTproBNP and LVEF values in patients with ADHF and NAFLD at discharge had an important prognostic role for stratifying by risk of death from all causes during the observed period, despite lower NTproBNP threshold values.
Cardiogenic shock following ST-segment elevation myocardial infarction in women: complications and outcomes
Authors: Pereira Santos M , Sa Couto D , Campinas A , Alexandre A , Ribeiro D , Santos R , Brochado B , Luz A , Silveira J , Torres S 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Differences in women’s prognosis have been described for both ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS). These might reflect asymmetries in clinical management, but also gender-specific comorbidities and pathologic mechanisms.

Purpose
We aimed to evaluate the risk of in-hospital complications and mid-term outcomes of women with CS following STEMI.

Methods
We retrospectively studied STEMI patients treated by primary percutaneous coronary intervention (PCI) from 2008 to 2017 in a tertiary care centre, presenting or evolving in Killip class IV (defined as cardiogenic shock or hypotension and organ hypoperfusion). Clinical and demographic characteristics, as well as complications and outcomes, were collected. Major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up was a composite of death, cerebrovascular accident, new myocardial infarction in any vessel, or target lesion revascularization.

Results
Among 1131 patients presenting with STEMI, our study included 117 (10.3%) patients in CS, of which 40 (34.2%) were women. Women were older [71.8(±13.4) vs 64.6(±11.72) years, p=0.002] and less frequently smokers (25.0% vs 50.7%, p=0.008). Prevalence of classic cardiovascular risk factors, namely diabetes (34,1% vs 39.2%, p=0.860), hypertension (71.5% vs 60.8%, p=0.212), and dyslipidaemia (47.5% vs 70.0%, p=0.799), was the same for both groups. Body mass index was also similar [26.6(±5.2) vs 26.1(±3.4) kg/m2, p=0.539]. Women had lower haemoglobin [12.4(±1.9) vs 13.8(±1.9) g/dl, p&lt;0.001] and lower creatinine clearance at admission [52.4(±30.6) vs 67.3(±29.4) ml/min, p=0.017]. Door-to-balloon times [80(59-180) vs 68(48-105) min, p=0.302], total ischemic time [210(120-360) vs 203(120-476) min, p=0.302] and prevalence of anterior STEMI (35.0% vs 50.0%, p=0.123) were not significantly different between sexes.
The prevalence of in-hospital complications was generally similar for both sexes (Table 1), except for the risk of advanced atrioventricular (AV) block that was higher in women (32.5% vs 10.7%, p=0.004). Also, haemoglobin nadir was lower in women [10.6(±2.1) vs 11.7(±2.1) g/dl, p=0.023]. In a 1-year follow-up, the occurrence of MACCE was similar for both sexes (60.0% vs 59.7%, log-rank P 0.734) (Figure 1).

Conclusion
Women with STEMI complicated by CS submitted to PCI had a similar prevalence of in-hospital complications as men. Also, mid-term outcomes, assessed by MACCE at 1 year, did not differ between groups.
Impella vs Veno-arterial extracorporeal membrane oxygenation in cardiogenic shock: a systematic review and meta-analysis of propensity score matched studies
Authors: Stub D , Theng S , Tsintzos S I , Ball J , Mudge M , Seage T 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Abiomed Singapore PTE. Ltd.

Background/Introduction
Cardiogenic shock is a life-threatening condition associated with multi-organ failure and death. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is well-established in the management of cardiogenic shock; however, mortality rates have remained relatively consistent over the past two decades. Impella is a transluminal microaxial ventricular assist device that improves haemodynamics by unloading the left ventricle and represents an alternative to VA-ECMO. No randomised controlled trials exist to date comparing Impella versus VA-ECMO given difficulties in recruiting patients due to the acute nature of the condition. Whilst a plethora of non-randomised, comparative studies have been published, many are confounded by underlying differences in baseline disease characteristics. Propensity score matched / adjusted studies may mitigate confounding by accounting for differences in important covariates that impact outcomes.

Purpose
The objective of this study was to conduct a systematic review and meta-analysis of propensity score matched / adjusted studies to assess the clinical outcomes of Impella versus VA-ECMO in cardiogenic shock patients.

Methods
A systematic review was undertaken to identify all comparative studies of Impella and VA-ECMO in cardiogenic shock which performed propensity score matching / adjustment of outcomes to account for important covariates. The study limitations were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. In-hospital/30-day survival and bleedings requiring transfusion were meta-analysed using the random effects method.

Results
Six propensity score matched / adjusted studies comparing Impella versus VA-ECMO in cardiogenic shock were included in the meta-analysis. A statistically significant difference in in-hospital/30-day mortality was detected between patients treated with Impella (39.6%) versus VA-ECMO (53.8%) (odds ratio [OR] 95% confidence interval [95% CI]: 0.57 [0.44, 0.74]; p&lt;0.0001). Similarly, Impella (19.9%) was associated with statistically significantly fewer bleeding events requiring transfusion compared with VA-ECMO (28.8%) (OR=0.61 [0.46, 0.80]; p=0.0004).

Conclusion(s)
This systematic review identified no randomised controlled trials of Impella versus VA-ECMO. The meta-analysis of propensity matched observational trials, represents the highest level of evidence available to date, and suggests that Impella may be associated with increased survival rates and decreased bleeding. Randomised controlled trials are urgently needed to assess cardiac support modalities in cardiogenic shock.
Clinical predictors of late left ventricle recovery in tako-tsubo syndrome
Authors: Lopez Flores M , Rivas Garcia A P , Lopez Flores L , Marin Andreu P , Andres M , Perez Castellanos A , Uribarri Gonzalez A , Nunez Gil I , Garcia Rubira J C , Almendro Delia M 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Tako-Tsubo syndrome (TTS) or stress cardiomyopathy is characterized by transient dysfunction of the left ventricle (LV) and a clinical presentation that can mimic an acute coronary syndrome. Recovery from contraction abnormalities may occur hours to weeks after the acute event. Although traditionally considered a disease with a favorable prognosis, it has been observed to have a complication rate during hospitalization similar to acute myocardial infarction and a significant mortality rate during follow-up (greater than 5% per patient-year). The recovery time of LV function has demonstrated important prognostic value.

Purpose
The aim of this work was to determine the clinical predictors of late left ventricular recovery in TTS.

Methods
Data from the multicenter national registry on Takotsubo Syndrome (RETAKO) were utilized. Clinical, laboratory, echocardiographic, and other imaging test characteristics, as well as events during hospitalization and follow-up, were collected. Recovery within the first days after the acute event was considered early recovery. Patients who died within the first 10 days after the acute event were excluded.

Results
A total of 1,463 patients were analyzed, of whom 373 (25.5%) had late recovery. The mean age was 71 years, and 86.6% were women. In the late recovery group, factors more common were age over 75 years, male gender, neurological disease, lung disease, peripheral arterial disease, active cancer, physical trigger, initial presentation as dyspnea or syncope, presence of shock, greater left ventricular dysfunction at diagnosis, and higher levels of proBNP. In multivariate analysis, the presence of neurological disease, active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger were associated with late recovery.

Conclusions
Patients with TTS showing late recovery of LV function have different clinical characteristics and disease presentation compared to those with early recovery. Late recovery was associated with the presence of neurological disease or active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger.
Awake VA-ECMO in cardiogenic shock, single centre experiences
Authors: Dang V 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background/Introduction
"Awake" V-A ECMO when the patient is fully awake, breathing spontaneously, without deep sedation. Advantages of awake VA-ECMO include reduced sedative side effects, early active movements, reduced muscle mass loss, increased interaction with the family and medical staff, description of their symptoms, and more exact information than sedative patients so that early detection of complications.

Purpose and Methods
Present a series of 15 patients with cardiac support by awake VA-ECMO, techniques, parameters, complications, and treatment results.

Results
Enrolled in this study, including 15 patients: 04 NSTEMI (very high-risk PCI), 09 Myocarditis, 02 electrical storm; Age 53,2 ± 19,5. The local anesthesia, mild sedation when the patient is anxious; performed vascular access with DSA system. The duration from the patient's admission to ECMO was 3,8 ± 2,9 (day) and awake VA-ECMO 3,1 ± 2,5 (day) (min to max: 1 – 6). The CO of ECMO: 1,6 ± 1,2 (l/ph); 03 patients with continuous renal replacement therapy. A patient with acute thrombosis of the lower extremity had successful percutaneous thrombectomy; fifteen patients were successfully weaned from ECMO (100%), no patient death in 7 days, and 02 patient deaths in 30 days.

Conclusion
Awake VA-ECMO can be performed safety on the cardiac patient when waiting for recovery or management.
Impact of the guidelines recommendations in the management of non-ST-segment elevation myocardial infarction according to gender. Analysis of 30-day mortality
Authors: Carrete A , Perez Montoliu C , Ferrero Molina C , Grama E , Casquete Sanchez D , El Ouaddi N , Rueda Sobella F , Montero Aradas S , Oliveras Vila T , Labata Salvador C , Ferrer Massot M , Collado Lledo E , Bayes-Genis A , Garcia-Garcia C 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Current non-ST-segment elevation myocardial infarction (NSTEMI) guidelines recommend early invasive treatment (&lt;24h) and simple antithrombotic treatment with aspirin (ASA). Classic studies describe a gender bias in the infarct treatment.

Purpose
To evaluate the impact of the guidelines recommendations in real-life management of NSTEMI in regards to invasive strategy and dual antiplatelet pretreatment (DAPT), and to analyze 30-day mortality according to gender.

Methods
A prospective unicentric registry of NSTEMI patients admitted to an Acute Cardiac Care Unit was conducted from January 2017 and December 2022. We analyzed the rates of early angiography (&lt;24h) and pretreatment according to the guideline publication (01/09/2020). Patients were classified in two groups, depending on the time of admission in pre-guidelines (preCG) group (from January 2017 to September 1st 2020) and post-guidelines (postCG, admitted after September 1st 2020). We also analyzed the differences in management and 30-day mortality according to gender.

Results
A total of 787 consecutive NSTEMI patients were included, 24.9% women, mean age 65.3 years. Pretreatment with DAPT was routinely used in 90,2% of the cases, irrespective of gender or the new guidelines recommendation. Early angiography (&lt;24 hours) was performed more frequently in men than women (61.6% vs 53.1%, p=0,035), although since the new guideline publication the early invasive management has increased in both genders (51.3% vs 72.6% in men, p&lt;0,001; and 43.3% vs 64.1% in women, p=0,003). 30-day mortality tends to be higher in men, although the difference was not significant (4.6% in men vs 2.6% in women, p=0,212) and was not affected by the guideline publication (preCG 4.6% vs postCG 4.6% in men, p=0,994, preCG 2.9% vs post CG 2.2% in women, p=0,752).

Conclusions
In our NSTEMI registry there was an increase in the rates of early angiography, both in men and women, since the guideline publication, but there’s still a gender bias in the invasive treatment. Most NSTEMI patients still received DAPT pretreatment, without differences after the guideline publication. Despite the increase in early invasive management, 30-day mortality rates remain unchanged in both groups.
Prognostic predictors in infective endocarditis: a registry of a reference hospital from 2016-2022
Authors: Padilla Rodriguez G , Nunez Ruiz M , Gomez Gonzalez A , Jurado Vinteno V , Lopez Cortes L E , Pena Rodriguez A 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Introduction
Infective endocarditis (IE) is a cardiovascular pathology with a poor prognosis due to its intra- and extracardiac complications, which sometimes contraindicate surgery and determine its prognosis.

OBJECTIVES
Our aim was to analyze the prognostic determinants of patients diagnosed with IE.

Material and Methods
We included patients admitted to a cardiac surgery referral hospital with a diagnosis of IE from 2016-2022. We documented cardiac involvement, extracardiac complications, as well as whether or not cardiac surgery was performed. Their long-term monitoring included checking for major adverse events, such as cardiovascular (CVM) and all-cause mortality (A-CM). The use of Cox regression models resulted in the establishment of prognostic determinants.

Results
Among 162 patients (males 70.5%; median age 66 years old, P25: 58, P75: 76), the most frequent location of IE was aortic valve (44%), followed by mitral (31.9%), mostly native (50.6%). Fifty percent of the patients were diagnosed with recently developed valve dysfunction. The most frequent local cardiac complications were abscess (21.2%) and chordal/veil rupture (10.2%). The incidence of cerebral embolism was 21.8% and shock was up to 19.9%. In-hospital mortality rate was high (24.7%), with 82.6% not having undergone surgery.
At the follow-up (mean 35.7 months), it was noted that there was a rate of 22.9% CV mortality and 35.7% overall mortality; of these patients, the majority had no prior surgical intervention (69.9%).
Predictors of all-cause and CV mortality at follow-up were shock (HR 4.12 CI95% 1.7-10 in CVM, p=0.02 and HR 3.8 CI95% 1.9-7.4 in A-CM, p&lt;0.01), diabetes mellitus (CVM HR 7.82 CI95% 3.15-19.4 p&lt;0.01; A-CM HR 2.6 CI95% 1.4-5 p&lt;0.01), history of oncological disease (CVM HR 3.21 CI95% 1-10.3 p=0.05; A-CM HR 3.4 CI95% 1.4-7.9 p&lt;0.01), complete atrioventricular block (CVM HR 3.03 95% 1.1-8.5 p=0.04; A-CM HR 3 CI95% 1.4-6.8 p&lt;0.01) and valvular dysfunction (CVM HR 7.82 CI95% 3.15-19.4 p&lt;0.01; A-CM HR 1.59 CI95% 1.1-2.4 p=0.03). Low rates of EI recurrence (6.6%) and readmission (14.6%) were detected, with no statistically significant relationship with surgery.
Adjusted for valve type (aortic or mitral), operated patients had a better prognosis (HR 0.24, 95%CI 0.08-0.72, p=0.02) with a longer median survival (64.5 vs 51.1 months, p=0.05).

Conclusion
Infective endocarditis has a mortality rate of up to 25% in our series, mostly in-hospital, which is associated with shock, AVB, valvular dysfunction and a history of diabetes mellitus and oncological disease. Surgery seems to provide benefits regardless of the type of valve involved.