bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes of hospital-level variation in use of optimal medical treatment for long-term follow-up from a multi-level methodological approach
Authors: Lee J , Jeong M , Rhee E , Jung J , Chang E , Kwak H , Jung M , Park Y , Park B , Kim H , Kim N , Jang S , Bae M , Yang D , Park H 
Published: November 2023

Abstract

Background
Contemporary guidelines documented that optimal medical therapy (OMT) should be prescribed to improve clinical outcome in patients with acute myocardial infarction (AMI). However, the changes of hospital-level variations in prescription rates of OMT for long-term follow-up are unknown.

Purpose
We aimed to investigate (1) impact of hospital-level variation on the use of each medication and OMT and (2) changes of hospital-level variation in prescription rates of individual medical therapy and OMT during the follow-up.

Methods
We examined hospital medications of 13,516 AMI patients without documented contraindications to antiplatelet agents, β-blockers (BB), angiotensin-converting enzyme inhibitors (ACE) /angiotensin II receptor blockers (ARB), or statins from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database. OMT was deﬁned as use of all 4 indicated medications. Hierarchical generalized linear mixed models estimated hospital-level variation in prescription rates of OMT and each medication after adjustment for patient-level factors. Variation was explored with a median rate ratio (MRR), which estimates the relative difference in risk ratios of 2 hypothetically identical patients at 2 different hospitals.

Results
The prescription rates of OMT and each effective cardiac medications are presented in Figure. There were substantial decreases in the prescription rates for OMT (from 66.7% to 51.6%) and dual antiplatelet agents (from 99.1% to 50.4%) for 2 years follow-up. After adjustment for patient-level covariates, hospital-level MRR for OMT was 1.47 at discharge, indicating an 47% likelihood that 2 random hospitals would differ in treating identical AMI patients. As the prescription rates of OMT and each effective cardiac medications decreased, adjusted hospital-level MRR for OMT (from 1.47 to 1.22), BB therapy (from 1.35 to 1.15), ACE/ARB therapy (from 1.68 to 1.16), and statin therapy (from 1.19 to 1.06) decreased for 2-year follow-up, whereas MRR for dual antiplatelet therapy increased at 1 year (MRR; 1.61) and 2 years (MRR; 1.63) follow-up (Figure). Among patient-level factors, age &gt;70 years, Killip class&gt;2, obesity, hypertension, previous coronary artery disease, renal dysfunction, reduced ejection fraction, percutaneous coronary intervention was independently associated with the use of OMT.

Conclusion
Hospital-level variations in the use of OMT and each effective cardiac medications were observed at discharge, but weakened overtime, except for use of dual antiplatelet therapy.
Effect of statin therapy on long-term mortality among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Nowak K , Stepien K , Kachnic N , Horosin G , Karcinska A , Walczak P , Nessler J , Zalewski J 
Published: November 2023

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is associated with the lack of visible atherosclerosis in coronary arteries. Current 2020 ESC Guidelines on the management of acute coronary syndromes state that statins may be beneficial to reducing all-cause mortality and major adverse cardiac events (MACE) among MINOCA patients. Although, the existing literature data remains conflicting, recent meta-analysis based on observational studies showed that statin therapy resulted in a reduction of MACE and mortality.

Purpose
We aimed to assess the effect of statin therapy on long-term mortality among MINOCA patients.

Methods
1011 patients were hospitalized between 2012 and 2017 with the diagnosis of MI based on clinical symptoms, electrocardiographic findings, and the evolution of myocardial necrotic biomarkers according to the universal criteria of MI. On admission, coronary angiography was performed in all patients to assess the existence of obstructive lesions in coronary arteries. 72 patients had lesions narrowing a coronary artery by less than 50% and were classified as MINOCA.

Results
Statins were used by 54 (75.0%) of MINOCA patients. Those treated with statins had a higher prevalence of hypertension (P=0.001), dyslipidemia (P&lt;0.001), lower Killip class on admission (P=0.005) and a higher LVEF (P=0.019) than MINOCA not treated with a statin. At the time of the decision about statin therapy, LDL cholesterol level was higher in the MINOCA population with subsequently prescribed statins (P=0.008). Long-term mortality was significantly higher in MINOCA patients not treated with statins (17.7%/year versus 6.6%/year, P=0.009) compared with those treated with statins.

Conclusions
According to our results, statins should be routinely prescribed in the heterogeneous group of MINOCA patients. However, more research regarding that issue is needed.The long-term outcomes.
Outcomes of early versus delayed invasive strategy in dialysis patients with non-ST-elevation acute coronary syndrome
Authors: Xie E , Ye Z , Wu Y , Yu C , Zhao X , Gao Y , Zheng J 
Published: November 2023

Abstract

Background
The association of early invasive strategy with improved outcomes in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) was previously established, particularly those at high risk. This benefit has not been evaluated in dialysis patients presenting with NSTE-ACS.

Purpose
This study aimed to investigate the prognostic impact of early invasive strategy in maintenance dialysis patients with NSTE-ACS.

Methods
This is a retrospective analysis of 455 617 consecutive cardiac catheterizations performed at 30 cardiac centers in China between January 2015 and June 2021. Patients were excluded if they did not receive dialysis therapy or received dialysis for less than 3 months, had normal coronary anatomy, or were admitted repeatedly . Patients were dichotomized into two groups based on the time interval from admission to invasive assessment: early (within 24 hours) invasive and delayed (more than 24 hours) invasive groups. The primary outcome of interest was all-cause mortality during follow-up. Standard univariate and survival methods were used. Propensity score matching and inverse probability of treatment weighting were used to diminish baseline differences.

Results
Overall, 1 012 patients met the final criteria, with a mean age of 61.7±10.4 years, and 398 (39.3%) of them received early invasive treatment. After a median follow-up of 21.8 months (interquartile range 12.6-34.9 months), 334 (33.0%) deaths were identified. Similar all-cause mortality rate was observed in the early invasive group compared with delayed invasive group (33.9% vs. 31.7%, respectively). After adjusting for baseline risk factors, early invasive was not associated with reduced all-cause mortality (hazard ratio 0.86, 95% confidence interval 0.69-1.08, p=0.198). Similar results were identified in the propensity score matching cohort and inverse Probability of Treatment Weighting cohort. Furthermore, no significant interaction was observed between the timing of invasive assessment and the Global Registry of Acute Coronary Events risk score (≤140 vs.&gt;140) on the risk of all-cause death (p for interaction =0.858).

Conclusion
This multicenter study demonstrated comparable all-cause mortality between early invasive and delayed invasive groups in dialysis patients with NSTE-ACS. These findings were inconsistent with previous studies on NSTE-ACS patients with normal renal function, and further prospective studies are needed to confirm.
Circulating dipeptidyl peptidase 3 predicts hemodynamic impairment and premature death in acute coronary syndromes: insights from the prospective multicenter SPUM-ACS study
Authors: Wenzl F A , Kraler S , Raeber L , Muller O , Bergmann A , Bourgeois K , Akhmedov A , Camici G G , Matter C M , Von Eckardstein A , Roffi M , Gencer B , Templin C , Luescher T F 
Published: November 2023

Abstract

Background
Dipeptidyl peptidase 3 (DPP3) is mechanistically involved in the degradation of angiotensin II and in the depression of systolic left ventricular function thereby disturbing peripheral blood pressure regulation. Small pilot studies suggested that circulating DPP3 (cDPP3) portends poor outcomes in acute heart failure and may refine risk assessment in patients with acute coronary syndromes (ACS).

Purpose
We aimed to assess the predictive value of cDPP3 in contemporary patients with ACS.

Methods
Circulating DPP3 was studied in 4311 patients with ACS in the prospective multicentre SPUM-ACS study. DPP3 levels were centrally measured in EDTA plasma by blinded study personnel using an established sandwich-type luminometric immunoassay. Kaplan-Meier survival curves and multivariable-adjusted regression models adjusted for sex, age, heart rate, systolic blood pressure, history of diabetes, levels of creatinine, centrally measured high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein, and the Global Registry of Acute Coronary Events (GRACE) risk score.

Results
At baseline, median cDPP3 levels were 19.0 ng/ml (interquartile range [IQR] 15.0-26.0) with higher levels observed in patients with ST-segment elevation myocardial infarction than in those with non-ST-segment elevation ACS (20.1 [15.9-28.2] vs. 18.0 [14.1-23.9], respectively, P&lt;0.001). High cDPP3 was linked to longer hospitalization and higher risk to require vasopressor use or mechanical circulatory support (per log2 increase: odds ratio [OR] 1.91, 95% confidence interval [CI] 1.62-2.24, P&lt;0.001; adjusted OR 1.35 95% CI 1.08-1.69, P=0.008). In line, high cDPP was strongly associated with increased mortality at 30 days (per log2 increase: hazard ratio [HR] 1.96, 95% CI 1.48-2.59, P&lt;0.001) and at 1 year (HR 1.51, 95% CI 1.24-1.83, P&lt;0.001). When accounting for established risk factors, cDPP3 remained an independent predictor of premature death with doubling in cDPP3 levels translating into an 58% and 40% increase in 30-day and 1-year mortality risk, respectively (adjusted HR 1.58, 95% CI 1.06-2.34, P&lt;0.023, adjusted HR 1.40, 95% CI 1.10-1.77, P=0.006, respectively).

Conclusion
We identified cDPP3 as a novel marker of cardiogenic shock and increased mortality in patients with ACS. Circulating DPP3 provides prognostic information beyond established risk factors and improves early risk assessment.DPP3 is linked to hemodynamic impairmentDPP3 independently predicts mortality
Sex-based differences in ST-segment elevation myocardial infarction: a multicentre national registry analysis
Authors: Miguel Goncalves C , Carvalho M , Vazao A , Cabral M , Martins A , Fernandes S , Pernencar S , Saraiva F , Morais J 
Published: November 2023

Abstract

Background
Sex differences in ST-segment elevation myocardial infarction (STEMI) are not fully understood. Female patients appear to have higher mortality.

Purpose
To establish sex-differences in Portuguese STEMI patients.

Material and methods
Retrospective multicentre analysis of STEMI patients included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and October 2022. Two cohorts were defined according to sex. Baseline characteristics, clinical findings, treatment and mortality were compared. Multivariate analysis was performed to assess predictors of mortality.

Results
A total of 14470 patients were included with a mean age of 64 ± 14 years, of which 26% were female. Female patients were significantly older (p&lt;0.001) and with higher prevalence of several cardiovascular risk factors such as: high blood pressure (p&lt;0.001), diabetes (p&lt;0.001) and dyslipidemia (p=0.015), as well as higher reported past medical history, namely ischemic stroke/transient ischemic attack (p=0.001), renal disease (p&lt;0.001) and dementia (p&lt;0.001). On the other hand, previous coronary artery disease was less common comparing to men. Reperfusion therapy was less frequent in females (p&lt;0.001), with less cases of multivessel disease (p=0.004). Regarding inpatient medical treatment women were less frequently prescribed medical therapy and more frequently needed inotropes (p&lt;0.001). Regarding discharge medication, similar tendencies were observed, and women were less frequently referred to cardiac rehabilitation programs (p&lt;0.001).
Concerning prognosis, women had more complications while at hospital, namely, congestive heart failure (p&lt;0.001), ischemic stroke (p&lt;0.001) and intra-hospital mortality (p&lt;0.001). Similarly, women had higher thirty-day and one-year mortality (p&lt;0.001) and non-cardiac hospital readmission (p&lt;0.001). After multivariate analysis, female sex (OR=1.633; CI 95% [1.065-2.504]; p=0.025) remained as an independent factor for intra-hospital mortality but not for thirty-day and one-year mortality.

Conclusions
In our population, female patients had statistically significant differences in comparison to men regarding clinical characteristics, treatment and prognosis. Nevertheless, female sex was an independent risk factor only for intra-hospital mortality.
No-reflow, acute heart failure and ventricular fibrillation are more common in STEMI patients in wartime conditions
Authors: Lutay I , Parkhomenko A , Irkin O , Shumakov O , Skarzhenskyi O , Khomiakov D , Bilyi D , Stepura A 
Published: November 2023

Abstract
Stress and logistical problems during the wartime can change the course of STEMI and contribute to the development of in-hospital complications.
The aim of our work was to analyze in-hospital complications in STEMI pts admitted during the first months of full-scale invasion of Ukraine and compare them with patients hospitalized during the same period of 2019 (pre COVID-19 era).
The total number of STEMI patients hospitalized in 2022 was half as much as in 2019 (49 vs. 98 patients), which can be partly explained by civilian migration and mobilization. The average age of patients (61.0±10.7 in 2019 vs 63.5±11.7 in 2022, p=0.197) and the number of women (20.4% vs 26.5%, p=0.420) did not change. There were no significant differences in other main clinical characteristics between groups. The GRACE score in groups was almost the same (154.3±33.0 pts vs 160.8±43.5 pts, p=0.366) and about 50% of pts had anterior MI. Acute heart failure (Killip 2-3) at admission was diagnosed in 27.4% and 20.4%, cardiogenic shock (Killip 4) in 9.4% and 8.2% in 2019 and 2022, accordingly. Despite the absence of a significant difference in the level of arterial pressure, heart rate at admission was 10 bpm more during the wartime (84,0±15,4 bpm vs 74,9±20,6 bpm, p=0.005). 11.3% of STEMI pts in 2019 and 24.5% of pts in 2022 (p=0.064) were admitted after the first 24 hrs from symptoms onset. The mean time to hospitalization in pts admitted during the first 24 hrs was 4.4±3.8 hrs in 2019 and 6.4±5.6 hrs in 2022 (p=0.044). This time delay led to a lower number of pPCI made during the wartime (82.5% vs. 59.2%, p=0.005), despite the same total number of coronary angiographies (90.7% in 2019 vs. 91.5% in 2022, p=0.821) and total PCI numbers (86.6% in 2019 vs. 79.6% in 2022=0.304). No-reflow (determined as TIMI&lt;3 or MBG&lt;2) was registered in 34.3% of pts in 2022 and 12.9% in 2019, p=0.039. There were no differences in medical treatment between groups. DAPT was used in 97.6% and 100% (&gt;80% ticagrelor), high intensity statins in 98.0% and 98.0%, beta-blockers in 89.5% and 90.9%, ACREI/ARB in 89.5% and 91.1%, MRA in 56.0% and 55.6% in 2019 and 2022, accordingly. In-hospital mortality in STEMI pts in wartime period was two times higher (but not significant) than in 2019 (4.9% in 2019 vs 10.2% in 2022, p=0.302). Patients with STEMI hospitalized during the first three months of the war had significantly higher rate of ventricular fibrillations (4.3% in 2019 vs 15.3% in 2022, p=0.043). Despite the lack of differences at admission acute heart failure was also significantly higher in pts treated during wartime on the 3d day of STEMI (11.2% in 2019 vs 24.5% in 2022, p=0.049).
During hostilities, patients with STEMI are hospitalized later, have worse results of revascularization and a greater number of in-hospital complications.
Every third patient with advanced renal failure dies within one year following non st-segment elevation myocardial infarction treated with percutaneous coronary intervention
Authors: Januszek R , Bujak K , Kasprzycki K , Gasior M , Bartus S 
Published: November 2023

Abstract

Background and Aims
Kidney failure is highly prevalent in patients with the non-ST-elevation myocardial infarction (NSTEMI). The aim of the study was to evaluate the prognostic significance of baseline renal function regarding in-hospital and 1-year mortality among patients with NSTEMI who were treated with percutaneous coronary intervention (PCI).

Methods
Data were obtained from the Polish Registry of Acute Coronary Syndromes (PL-ACS). We extracted all patients with NSTEMI (n=47,052) who were treated with PCI between 2017 and 2021. The cumulative incidence of all-cause mortality during the 1-year follow-up was presented using the Kaplan-Meier curves. The linearity of the association between the Esimated Glomerular Filtration Rate (eGFR) with all-cause mortality was evaluated using a likelihood ratio test. The multivariate Cox regression model was created to adjust the relationship between eGFR and all-cause mortality for potential confounders.

Results
After considering the exclusion criteria, 20,834 cases were evaluated, with a median eGFR of 72.7 (IQR 56.6-87.5) mL/min/1.73 m². The median age was 69 (62-76) years. The study comprised 4,505 patients with normal (90-120), 10,189 with mild (60-89), 5,539 with moderate eGFR (30-59), and 601 with severe renal impairment (15-29). There was a stepwise increase in the crude all-cause death rates across the groups at 1 year. The cox regression model revealed that the relationship between eGFR and the risk of death at 1 year was non-linear (reverse J-shaped, Fig. 1), and the risk was the lowest in patients with eGFR∼90 mL/min/1.73 m².

Conclusions
There is a J-curve relationship between the eGFR value and 1-year all-cause mortality in patients with NSTEMI and treated with PCI.
Validation of the GRACE 3.0 score and redefinition of the risk threshold for early invasive treatment in non-ST-segment elevation acute coronary syndromes: a modelling study from five countries
Authors: Wenzl F A , Bruno F , Kofoed K F , Raeber L , Roffi M , Stellos K , Camici G G , Kraler S , Engstroem T , Giannitsis E , Mueller-Hennessen M , Fox K A A , D'ascenzo F , Koeber L V , Luescher T F 
Published: November 2023

Abstract

Background
Clinical use of the GRACE scoring system is recommended across international guidelines to guide early treatment stratification in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Recently, the machine learning-based GRACE 3.0 score was derived from patients with NSTE-ACS undergoing contemporary treatment approaches. External validation studies and the reassessment of clinical risk categories are lacking.

Purpose
We aimed to evaluate the predictive performance of the GRACE 3.0 score and to explore clinically meaningful risk groups in contemporary patients with NSTE-ACS.

Methods
We studied the GRACE 3.0 score in 8070 patients with NSTE-ACS in contemporary ACS cohorts from Denmark (VERDICT, n=2147), Germany (Heidelberg-ACS, n=2034), Italy and Spain (CORALYS, n=1650), and Switzerland (SPUM-ACS, n=2239). Heterogeneity in the treatment effect of very early invasive management (within 12 hours) or standard invasive management (within 48 to 72 hours) on the primary composite outcome of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or hospital admission for heart failure in relation to baseline mortality risk was assessed in 2147 patients enrolled in the VERDICT trial who were randomized to different timing of invasive treatment.

Results
The GRACE 3.0 score showed excellent discriminatory properties with an area under the receiver operating characteristic curve (AUC) for in-hospital death of 0.89 (95% CI, 0.85–0.93) in the total study cohort. Similar results were observed in Denmark (AUC 0.93, 95% CI, 0.88–0.98), Germany (AUC 0.90, 95% CI, 0.85–0.94), and Italy and Spain (AUC 0.85, 95% CI, 0.77–0.94), and Switzerland (AUC 0.93, 95% CI, 0.86–1.00). Early invasive treatment reduced the composite endpoint (absolute risk reduction: 0.12, 95% CI, 0.03–0.21, P=0.011) in patients at high risk (≥1.7%), but not in those with lower risk profiles (P interaction=0.033). Based on this new high-risk threshold, GRACE 3.0 stratified 475 (42.2%) more patients into the high-risk group, as compared to traditional GRACE risk categories (P&lt;0.001).

Conclusion
GRACE 3.0 shows unprecedented predictive performance in patients with NSTE-ACS. In the context of a comprehensive clinical evaluation, GRACE 3.0 can support clinical decision making for the timing of invasive treatment. The high-risk group of patients with NSTE-ACS who benefit from early invasive treatment is substantially larger than previously described.ROC curve and risk groupsRestratfication towards high risk group
Current concepts of treatment for left ventricular thrombus: A sys-tematic meta-analysis comparing direct oral anticoagulants versus vitamin K-antagonists
Authors: Seiler T , Madanchi M , Attinger A , Wolfrum M , Moccetti F , Staempfli S , De Boeck B , Toggweiler S , Cuculi F , Bossard M 
Published: November 2023

Abstract

Background/Introduction
Left ventricular thrombus (LVT) is a dreaded complication after myocardial infarction (MI) and is traditionally treated with Vitamin K antagonists (VKAs) for 3-6 months. Despite a gap of evidence, the broad use of direct oral anticoagulants (DOACs) for other thromboembolic disorders has triggered an increasing off-label use for DOACs in LVTs and has stimulated for expanding research focusing on DOAC´s utility for patients with LVT.

Purpose
To assess the safety and efficacy of DOACs versus VKAs for the treatment of LVT with a systematic meta-analysis.

Methods
We conducted a systematic search according to the PRISMA guidelines to identify all existing studies comparing DOACs and VKAs for the treatment of LVT. Forest plots and pooled odds ratios have been calculated for major bleeding events, strokes and systemic embolism, and for thrombus resolution.

Results
We have included a total of 13 studies with a pooled sample size of 2243 patients. 601 patients (26.8%) were treated with DOACs and 1642 patients (73.2%) with VKAs. The mean age was 55 and 59 years in the DOACs and VKAs group and sex was equally distributed with a male predominance of 81% in both groups. As underlying heart disease, most patients suffered from acute or chronic ischemic cardiomyopathy and presented with a mean left ventricular ejection fraction (LVEF) of 32% at admission. Baseline characteristics of patients included in each primary study are summarized in table 1. The pooled odds ratio of stroke or systemic embolism in patients treated with DOACs versus VKAs was 0.84 (95% CI 0.59-1.19) (p= 0.32). Compared to VKAs, we suggest that the use of DOACs may be associated with a reduced risk for major bleeding incidents without reaching statistical significance (OR 0.63 (95% CI 0.39-1.04) (p = 0.07). LVT resolution was similar and independent of the antithrombotic regimen (OR 0.91 (95% CI 0.7-1.19), p=0.50).

Conclusions
Based on our meta-analysis we conclude that DOACs seem to be non-inferior to VKAs for the treatment of LVT in terms of thrombus resolution, stroke and systemic embolism, and bleeding incidents. Despite these promising findings, several important aspects such as the duration of anticoagulation, and the type and dosing of the DOAC agent are still poorly understood. To close the lack of evidence for DOACs in LVTs, an adequately powered, randomized trial is needed.