bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prevalence of young ST-elevation myocardial infarction, the risk factors, and the pattern of coronary artery involvement in the Serdang PPCI Registry over 7 years
Authors: Mat Lawi F , Abd Malek A M , Sk Abdul Kader M A LI , Abdullah Ramaiah A S R I R , Selvaraj K A M A R A , Abd Ghapar A B D K 
Published: November 2023

Abstract

Background
Acute coronary syndrome has remained Malaysia's leading cause of death for the past 15 years, with a more than 50% increase in the last ten years. There is limited published literature focusing on this population. Hence, we aim to assess the clinical risk factors, angiographic profile, and outcome of young patients (aged ≤ 40 years) with acute STEMI from the Serdang Primary PCI STEMI Network over a period of 7 years.

Methods
We evaluated all patients ≤40 years of age admitted with acute ST-segment elevation acute myocardial infarction (STEMI) who were studied between May 2015 and December 2022 at Serdang Heart Center Hospital. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause mortality.

Results
Out of 1374 patients, 184 were very young STEMI patients, accounting for 13.4% of all patients in our study, with the majority being male (92.9%). The average age was 34.61±4.71. The mean pain score was 5.7±2.4. Anterior wall MI was present in 90 patients (48.9%), inferior wall MI in 84 patients (45.7%), lateral wall MI in 9 patients (4.9%), and left main stem MI in 1 patient (0.5%). The prevalence of diabetes mellitus was 27.7%, with a mean HbA1c of 6.9±2.4. With a mean TC of 5.68±1.61 mmol/L and a mean LDL of 3.70±1.48 mmol/L, the prevalence of dyslipidaemia was 49.5%. The mean creatinine was 83.04±21.04. The majority presented a Killip I score, which accounted for 91.3%. The radial vascular access was 84.8%. Single-vessel disease was the most common finding, at 77.7%. At 1 month, 98.4% of patients survived.

Conclusion
STEMI in people under the age of 40 is almost entirely seen in men. Around 15% of patients have no significant stenosis of the coronary arteries. Anterior-wall MI is more common, and more than three-quarters of patients have single-vessel disease. The 1-month survival rate is high.
Clinical and long-term prognostic trends in ST-segment elevation myocardial infarction: a multicentre national registry analysis
Authors: Miguel Goncalves C , Cabral M , Carvalho M , Vazao A , Martins A , Fernandes S , Pernencar S , Saraiva F , Morais J 
Published: November 2023

Abstract

Background
Although significant advances in patient care, ST-segment elevation myocardial infarction (STEMI) remains a major health problem.

Purpose
To describe clinical and prognostic characteristics of 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. Baseline characteristics, clinical findings, treatment and mortality were analyzed. Multivariate analysis was performed to assess predictors of mortality.

Results
The authors studied 14470 patients with a mean age of 64 ± 14 years, of which 74% were male. A high frequency cardiovascular risk factors was observed, namely high blood pressure (63%), dyslipidemia (54%), smoking (35%) and diabetes (25%). Previous myocardial infarction was present in 11%. The most common symptom was chest pain (94%), Killip class 1 the most frequent presentation and left ventricular ejection fraction was preserved in 52%. Around 88% of patients were submitted to coronary angiography and coronary angioplasty was successful in roughly 98%. Multivessel disease was found in 44% although left anterior descending artery was the most frequent culprit artery - in about 44% of cases. Regarding in-hospital complications: shock (36%), congestive heart failure (17%) and death (5%) were reported. Thirty-day and one-year mortality occurred in 6% and 8%, respectively.
After multivariate analysis, older age (HR=4.06; CI 95% [2.556-6.448]; p&lt;0.001), left ventricular ejection fraction under 30% (HR=2.038; CI 95% [1.284-3.234]; p=0.003) and Killip class above 1 (HR=1.578; CI 95% [1.104-2.256]; p=0.012) remained as independent risk factors for one-year mortality.

Conclusions
Cardiovascular risk factors were highly prevalent in our population. Although multivessel disease was common, the most frequent culprit artery was the left anterior descending artery with successful treatment. Several clinical characteristics, namely age, left ventricular ejection fraction and Killip class, were independent risk factors for one-year mortality.
Coronary CT angiography a new promising tool in Heart transplanted patients: from clinical and economical benefits to coronary inflammation detection
Authors: Dellino C M , Cozza E , Amato F , Savo M , De Conti G , Tarantini G , Tessari C , Pradegan N , Motta R , Gerosa G , Iliceto S , Pergola V 
Published: November 2023

Abstract

Background
Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits.

Purpose
1) assess the non-inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non-immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary-fat-attenuation-index (pFAI) at CCTA in the progression of CAV.

Methods
179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022.

Results
CCTA and CA showed similar radiation doses (8.47 [1.46-30] versus 8.15 [1.38-87.34]; p=0.796) and rate of complications (0 (0%) vs 3 (3%); p=0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 12.31 hours; p&lt;0.001), lower costs (120 euros versus 2800 euros; p&lt;0.001) and less contrast agent (60.4 8.7 ml versus 95.68 47.6ml; p&lt;0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p=0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p=0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47-45.81; p=0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (&gt;-70.1HU) and the progression of CAV (p=NS).

Conclusions
CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.
STEMI patients after out-of-hospital cardiac arrest: should we cool?
Authors: Jarakovic M , Kacavenda G , Petrovic M , Bjelica S , Kovacevic M , Dimic S , Keca S , Trajkovic M 
Published: November 2023

Abstract

Introduction
Patients who have been successfully resuscitated after out-of-hospital cardiac arrest (OHCA) due to ST-segment elevation myocardial infarction (STEMI) have a high risk of death and poor neurological outcome. Application of therapeutic hypothermia (TTM) is recommended in addition to the reperfusion strategies in patients who remain comatose after resuscitation. However, data analysis in STEMI patients successfully resuscitated after OHCA who remain comatose are inconsistent and still a subject of discussion.

Objective
The aim of this research was to examine the impact of TTM on in-hospital survival and neurological outcome in comatose STEMI patients after OHCA.

Methods
The study was conducted as a retrospective observational analysis of data taken from a hospital OHCA registry. The examined sample consisted of 141 patients hospitalized from January 2007 to December 2021 due to STEMI complicated by OHCA and who remained comatose upon admission. Inclusion criteria for analysis were STEMI of any localisation and unresponsiveness on admission defined as Glasgow Coma Score (GCS) ≤ 8. Favorable neurological outcome was defined as Cerebral Performance Category Score (CPC) ≤ 2.

Results
Our research included 141 comatose survivors of OHCA due to STEMI, among whom 91 (64.5%) were men, and TTM was applied in 82 (58.2%) patients. Witnessed cardiac arrest (48.7% vs. 23.1%, p = 0.027), duration of resuscitation ≤ 20 minutes (66.1% vs. 28.4%, p &lt; 0.0005), initial shockable rhythm (55.2% vs. 22.9%, p = 0.001) and performed urgent percutaneous coronary intervention (PCI) (56.2% vs. 23.1%, p &lt; 0.0005) had a statistically significant influence on in-hospital survival, while good neurological recovery was influenced only by the duration of resuscitation ≤ 20 minutes (69.2% vs. 36.7%, p = 0.008). TTM was applied more often when the resuscitation lasted ≤ 20 minutes (51.2% vs. 29.3%, p = 0.015), with an initial shockable rhythm (85.4% vs. 14.6%, p &lt; 0.0005) and when urgent PCI was performed (82.9% vs. 35.6%, p &lt; 0.0005). TTM had a statistically significant effect on in-hospital survival (58.5% vs. 23.7%, p &lt; 0.0005), while it had no effect on favorable neurological outcome (54.7% vs. 56.3%, p = 1.000).

Conclusion
In our examined group of STEMI patients successfully resuscitated after OHCA who remained comatose at admission, TTM significantly improved in-hospital survival, but had no effect on favorable neurological outcome.
The natural history and prediction of 10-year plaque progression on serial coronary CT angiography
Authors: Nurmohamed N , Bom M J , Ibrahim S , Gaillard E L , De Groot R J , Jukema R A , Van Diemen P A , De Winter R W , Min J K , Earls J P , Danad I , Planken R N , Stroes E S G , Choi A D , Knaapen P 
Published: November 2023

Abstract

Background
Several studies have shown that plaque subcomponents such as low-attenuation or non-calcified plaque volume from coronary CT angiography (CCTA) are associated with the occurrence of major adverse cardiovascular events. However, it remains unknown how plaque morphology progresses over the long-term. Furthermore, it is unknown which plaque characteristics put patients at increased risk of plaque progression which would require more intensive image-guided follow-up. This study investigated the natural history and predictors of long-term coronary plaque progression in a serial CCTA cohort of patients with suspected coronary artery disease (CAD).

Methods
In this follow-up study, 539 patients from an earlier published CCTA cohort (Diemen, 2021) were invited for repeat CCTA imaging per-protocol, regardless of symptoms. A total of 299 patients underwent follow-up CCTA imaging with a median scan interval of 10.2 [8.7-11.2] years. Patients who underwent coronary artery bypass grafting (CABG) between baseline and follow-up imaging were excluded. All scans were analyzed using artificial intelligence-guided quantitative CCTA (AI-QCT). Revascularized vessels were excluded. Quantitative plaque volumes (total, low-density, non-calcified and calcified plaque) depicted by AI-QCT were divided by the total vessel volume to represent percent atheroma volume (PAV). PAV progression was calculated subtracting baseline PAV from follow-up PAV. The association of the plaque components with PAV progression was evaluated in a multivariate linear regression model adjusted for clinical risk characteristics (age, sex, hypertension, hypercholesterolemia, diabetes, BMI, smoking, family history of CAD and statin use).

Results
In total, 274 patients without CABG were used for the serial analysis, mean age was 57 years, 42% were women. At baseline, median PAV was 2.5% [IQR 0.7-8.1], which increased to 6.1% [IQR 1.2-12.9] at follow-up (Figure). The mean PAV progression was 0.4±0.5% per year. Adjusted for clinical risk characteristics and other plaque volumes, baseline percent non-calcified plaque volume (NCP) was the only plaque volume associated with PAV progression (0.5% PAV progression increase per % increase in baseline non-calcified plaque volume).

Conclusion
Using an unique long-term serial CCTA cohort undergoing per-protocol repeat imaging with a 10-year scan interval, we found that coronary plaque burden more than doubled. Interestingly, the amount of non-calcified plaque volume at baseline was the only predictor for disease progression.Figure
Fifteen-year mortality outcomes in the APEX-AMI trial compared to the general ST-elevation myocardial infarction population in Canada: Exploring lessons from numerators and denominators
Authors: Kaul P , Dover D C , Westerhout C M , Welsh R C , Armstrong P W 
Published: November 2023

Abstract

Background
It is well established that patients enrolled in clinical trials tend to be younger, more likely male, and have fewer comorbidities. Moreover, sites that enroll patients in randomized trials (RT) are often tertiary care centres in urban areas especially in the setting of STEMI. The impact of these potential selection biases on clinical outcomes both within and well beyond the proscribed RT follow-up window have not been adequately explored.

Objective
To compare 15-year mortality of ST elevation myocardial infarction of Canadian (STEMI) patients with high-risk electrocardiographic findings enrolled within 6 hours of symptom onset undergoing primary PCI in the APEX-AMI clinical trial of Pexelizumab (APEX-AMI group) with STEMI patients presenting to 25 APEX-AMI enrolling sites (APEX-AMI sites group); and STEMI patients presenting to 400 other sites (non-APEX-AMI site group).

Methods
APEX-AMI enrolled patients between 07/13/2004 – 05/11/2006. We conducted a probabilistic linkage (based on admission date, discharge date, age, sex, province, diagnosis of MI, presence of comorbidities) between APEX-AMI and the Canadian national Discharge Abstract Database (DAD), excluding Quebec, for the same time period. These data were further linked to tax files (for socio-economic data) and vital statistics data to obtain mortality status as of 2020.

Results
Of the 335 Canadian participants in APEX-AMI, 143 were from Quebec and were excluded. Of the remaining 192 patients, 188 (97.9%) were linked with the DAD. There were 8,470 patients in the APEX-AMI sites and 10,940 in the non-APEX-AMI sites groups, respectively (Table 1). Patients enrolled in APEX-AMI were less likely to be female, more affluent, have a lower comorbidity burden as measured by the Charlson Comorbidity Index, and higher PCI rates. Ninety-day all-cause mortality in the three groups was 4.3%, 8.5%, 12.7% in the APEX-AMI, APEX-AMI site, and non-APEX-AMI site groups, respectively. At 15-years, mortality rates were 34.0%, 45.8%, and 52.2% in the three groups (p&lt;0.01, Figure). Enrollment in APEX-AMI was associated with an unadjusted 45% reduction in risk of 15-year mortality (HR 0.55, 95% CI: 0.43-0.70). However, this association was attenuated after adjusting for demographic and clinical factors (adjusted HR (aHR), 0.69, 95% CI: 0.54-0.88), and completely nullified after adjusting for PCI (aHR, 0.82, 95% CI: 0.64-1.05).

Conclusions
Our study demonstrates the feasibility and value of extending clinical trial follow-up via linkage with routinely collected administrative data. While enrollment in clinical trials appears to be associated with better long-term outcomes, our findings highlight the need to be vigilant to the potential for selection bias, the generalizability of trial findings and the potential to more broadly enhance long-term STEMI outcomes.
Life expectancy in women and men after STEMI: a comparison to a matched general population
Authors: Thrane P , Olesen K K W , Gyldenkerne C , Hansen M K , Thim T , Kristensen S D , Maeng M 
Published: November 2023

Abstract

Background/Introduction
ST-elevation myocardial infarction (STEMI) is considered a risk factor for short- and long-term mortality. Further, studies indicate that female sex is associated with increased mortality among STEMI patients. Our aim was to assess the impact of female and male sex on short- and long-term excess mortality in comparison to matched general populations.

Methods
We identified all patients undergoing first-time percutaneous coronary intervention (PCI) who were treated with primary PCI (pPCI) for STEMI from 2003 to 2018 in the Western Denmark Heart Registry (covering approximately 3.3 million inhabitants). Each patient was matched in a 1:5 ratio by age and sex with individuals from the Western Denmark general population without prior myocardial infarction or coronary revascularization. To assess excess mortality after STEMI, we compared mortality in women and men to their matched general population using a stratified Cox proportional hazards model. Excess mortality was assessed in the periods from 0-30 days, 31-90 days, and 91 days – 4 years of follow-up.

Results
A total of 18,216 pPCI-treated STEMI patients were included, 4,833 (26.5%) women and 13,382 (73.5%) men. The matched general population cohort consisted of 91,075 individuals, 24,165 women and 66,910 men. Median age at STEMI diagnosis was 68 years (IQR 58-78) in women and 62 years (54-71) in men. Excess mortality was markedly higher in the first 30 days after STEMI with the relative risk being 35 times higher for both women (hazard ratio (HR) 34.63, 95% CI 26.11-45.95) and men (HR 35.18, 28.48-43.48) compared to their matched general populations. From 31-90 days, the excess mortality remained higher after STEMI for women (HR 3.58, 2.58-4.97) and men (HR 2.00, 1.58-2.55). However, in the 91 days - 4 years follow-up period there was only a marginal unadjusted 13% excess mortality in women (HR 1.13, 1.02-1.25) while an 8% lower mortality was observed in men (HR 0.92, 0.86-0.98; p for interaction&lt;0.05). After adjusting for comorbidities in the 91 days - 4 years period, an excess mortality in women was no longer observed (HR 1.03, 0.93-1.14), while men with STEMI remained at lower risk than the general population (HR 0.87, 0.81-0.94).

Conclusions
In a large, contemporary STEMI cohort mortality within the first 30 days were 35 times higher in both women and men when compared to mortality in an age- and sex- matched general population. However, STEMI patients surviving the first 90 days were no longer at higher risk than their matched general population individuals; the latter most likely reflecting guideline-directed prophylactic interventions.Excess mortality in women with STEMIExcess mortality in men with STEMI
Impact of very high doses of contrast media on acute kidney injury rates in patients admitted with ST-elevation myocardial infarctions
Authors: Schmucker J , Lutz J , Fach A , Osteresch R , Ruehle S , Hambrecht R , Wienbergen H 
Published: November 2023

Abstract

Introduction
Previous studies have shown that in patients with ST-elevation myocardial infarctions (STEMI) maybe the main contributor of acute kidney injury (AKI) is the STEMI itself with its hemodynamic sequelae and to a lesser extent contrast media induced nephropathy (CIN). However, the possible impact of very high doses of contrast media (CM) on kidney function in this context remains unclear. Aim of the present study was therefore to investigate, how very high doses of CM influenced AKI-rates in patients admitted with STEMI.

Methods
Patients admitted with STEMI between 2006 and 2022 to a large German heart center entered analysis. A very high dose of contrast media was defined as &gt;250 ml. AKI was defined by KDIGO-criteria (2012). To minimize impact of confounders patients were grouped by initial TIMI-risk-score and initial renal function (glomerular filtration rate (GFR)) in a 3x3 format.

Results
Of a total of 8845 patients included, 547 patients (6.2%) received a CM-dose &gt;250 ml with an average CM-amount of 318.2±64 ml vs. 135.8±48 ml in the control group. A multivariate model revealed that patients receiving very high CM-doses were more likely to be older (OR 1.31, 95% CI 1.1-1.6, p&lt;0.01) and to have more extensive STEMIs (CK&gt;2000 U/ml: OR 1.33, 95% CI 1.1-1.6), while they were less likely to be female (0.77, 95% CI 0.6-0.9,p=0.01) and less likely to have undergone successful percutaneous coronary intervention (PCI): OR 0.51, 95% CI 0.4-0.6, p&lt;0.01. Patients receiving very high doses of CM were more likely to develop AKI: 21.6% vs. 14.9,%, p&lt;0.01. This significant impact remained after adjusting in a multivariate model (OR 1.42 95% CI 1.1-1.9, p&lt;0.01). When stratifying patients into nine groups (3x3) both, initial TIMI-risk-score for STEMI and a lower GFR were associated with a marked increase in AKI-rates, with the lowest AKI-rate at 3.4% in patients with a low TIMI-risk and an initial GFR of 60-89 ml/min and the highest AKI rate at 37.8% in patients with a high TIMI-risk score and a GFR&lt;60 ml/min (table (A)). However, the impact of very high CM-amounts on AKI-rates in this pre-stratified cohorts was inconsistent and only independently associated with a higher AKI-risk in 1 out of 9 groups (marked by astrisk*, table (B)).

Conclusions
STEMI-Patients receiving very high amounts of contrast media during emergency cardiac catheterization were on average older with larger infarctions and showed lower rates of successful percutaneous coronary interventions (PCI). For the majority of these patients even very high amounts of contrast media were not independently associated with higher rates of acute kidney injury. AKI-rates were more likely to be determined by overall risk and initial renal function.