bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of nutritional status and systemic immune-inflammation index on mortality in patients with acute myocardial infarction
Authors: Lee J , Rhee E , Jung J , Chang E , Jung M , Kwak H , Park B , Park Y , Kim H , Kim N , Jang S , Bae M , Yang D , Park H , Cho Y 
Published: November 2023

Abstract

Background
It has been known that malnutrition and elevated inflammatory markers are associated with clinical outcome in patients with acute myocardial infarction (AMI). However, few studies have investigated the association between nutritional status, inflammatory markers and survival in patients with AMI.

Purpose
The aim of this study is to investigate combined impact of nutritional status and systemic immune-inflammatory index (SII) on outcome in patients with AMI.

Methods
We examined 1,984 patients (mean age = 64 ± 12 year-old, 1,493 males) admitted for AMI. Nutritional assessment was evaluated at the admission by geriatric nutritional risk index (GNRI) calculation. Malnutrition was defined as GRNI &lt;92. We calculated SII from the equation, SII = P x N/L, where P, N and L are peripheral blood platelet, neutrophil and lymphocyte counts per liter at the time of admission, respectively. The primary endpoint was all-cause mortality at 1-year.

Results
GNRI was significantly correlated with SII (r = -0.135, p&lt;0.001). GNRI (95.2 ± 8.4 versus 102.7 ± 7.3) was significantly lower, whereas SII (1,906.9 ± 2,016.0 x 109 cells/L versus 1,100.9 ± 981.6 x 109 cells/L) was significantly higher in non-survivors. Patients with malnutrition had significantly higher mortality compared with patients without malnutrition (19.2% versus 4.3%, log-rank p &lt;0.001). In receiver operating characteristics curve analysis, area under the curve of SII for predicting all-cause mortality was 0.625. The optimum cut-off point for SII for a favorable prognosis was determined to be 1,425 x 109 cells/L. Patients with high SII had significantly higher mortality (9.6% versus 4.2%, log-rank p&lt;0.001). The patients were divided into four groups based on GNRI & SII; high GNRI &low SII (Group 1), high GNRI & high SII (Group 2), low GNRI & low SII (Group 3), and low GNRI & high SII (Group 4). In Kaplan-Meier survival curve, all-cause mortality was significantly higher in Group 4 compared with Group 1, Group 2, and Group 3 (3.5% versus 6.7% versus 14.1% versus 25.6%, log-rank p&lt;0.001; Figure). In Cox-proportional hazards model, compared with Group 1 (1, reference), Group 2 (HR 1.64, 95% CI 1.02 – 2.63; p=0.038), Group 3 (HR 1.97, 95% CI 1.06 – 3.68; p=0.032), and 4 (HR 4.17, 95% CI 2.40 – 7.24; p&lt;0.001) was an independent predictor of all-cause mortality after adjusting for confounding variables.

Conclusion
Nutritional status was significantly correlated with immune-inflammatory index. Malnutrition and high SII was independent predictors of overall survival in patients with AMI.
Quality-of-care for patients with spontaneous coronary artery dissection- a systematic review and meta-analysis
Authors: Dang Q , Othman F , Sheahen B , Marschner S , Szirt R , Zaman S 
Published: November 2023

Abstract

Introduction
In 2018 the first consensus documents to guide investigation and treatment of spontaneous coronary artery dissection (SCAD) were published. The global quality-of-care of patients with SCAD, as measured by adherence to these recommendations, has not been systematically reviewed.

Purpose
We aimed to evaluate the quality-of-care, measured by adherence to five recommendations from the 2018 consensus statement [antiplatelets, beta-blockers, angiotensin converting enzyme inhibitors or aldosterone receptor blockers (ACEI/ARBs) in patients with left ventricular systolic dysfunction, screening for fibromuscular dysplasia (FMD) and referral to cardiac rehabilitation] in patients with SCAD. Secondary aims were to explore the relationship of high versus low guideline-recommendation adherence with major adverse cardiovascular events (MACE).

Methods
Four databases (MEDLINE, EMBASE, SCOPUS, CINAHL) were systematically searched from inception to 16th June 2022. Studies reporting any cohort of 11 or more patients with SCAD that included results of at least one consensus-recommendations were included. The proportion of patients receiving each of the treatments were analysed by random effects meta-analysis. Associations were assessed using meta-regression analysis.

Results
54 studies, n=8456 patients (mean age 50.1 years, 89.5% female) were included in the analysis. A random effects meta-analysis found, 94.5% [95% confidence interval (CI): 90.8,97.7)\] received at least one antiplatelet, 78% (CI: 74.2,82.7) received beta-blockers, 54.6% (CI:42.0,66.6) were screened for FMD and 70.5% (CI: 62.6,77.3) were referred to cardiac rehabilitation. 59.3% (CI: 53.1,65.3) received ACEI/ARBs with left ventricular ejection fraction not reported in most studies. A single North American cohort reported 30% of patients met all four recommendations. There was significant heterogeneity in quality-of-care parameters, except for cardiac rehabilitation, according to geographic region (test of heterogeneity, p&lt;0.001). No significant difference was observed in adherence to recommendations in studies published before and after the consensus documents publication (2018), except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.006). There was no association between antiplatelet or beta-blocker use or FMD screening and follow-up MACE. Higher adherence to ACEI/ARBs was associated with lower MACE (p=0.02).

Conclusion
Adherence to consensus recommendations for care of patients with SCAD is far from perfect and varies significantly between regions of the world. Raising awareness among clinicians about consensus recommendations for care, combined with better evidence on treatment that can reduce MACE in patients with SCAD, are urgently needed.
Recurrence of acute coronary syndrome in the elderly: predictors and prognosis - insights from a multicentre national registry
Authors: Cabral M , Goncalves C , Fernandes S , Carvalho M , Ruivo C , Pernencar S , Loureiro M F , Morais J 
Published: November 2023

Abstract
The burden of cardiovascular (CV) disease remains at the top of society's health problems, with acute coronary syndromes (ACS) undoubtedly being one of the major causes. Patients with a known history of CVD are at increased risk of recurrent events. However, this recurrence's incidence rate and clinical impact vary between populations. Elderly patients represent a large proportion of patients admitted for a second ACS. The decision on its management lacks support in clinical guidelines, as studies generally exclude patients with significant comorbidities and tend to underrepresent this group.
This study aimed to analyse the characteristics and outcomes of elderly patients admitted with ACS with a previous history of myocardial infarction (MI) versus those who did not.
The authors performed a retrospective analysis of patients older than 75 years included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between 2010 and 2022. Comparison tests were performed. A COX proportional hazard regression method was applied to generate the proposed risk models. A p-value less than 0.05 was considered statistically significant.
A total of 8658 patients older than 75 years admitted for ACS were analysed, 6630 (76.6%) without a history of MI (group 1) and 2028 (23.4%) with a previous MI. Table 1 shows the most important baseline characteristics and differences between groups. Table 2 demonstrates the group differences regarding admission diagnosis, complementary study results and treatment. Table 3 represents in-hospital complications. At discharge, 16.5% of group 1 and 21.2% of group 2 had a planned cardiac rehabilitation program (CRP) (p-value=0.01). At 1-year follow-up, 15,6% of patients with more than 75 years admitted for ACS died and 17.4% were re-hospitalized by a CV cause. COX-regression analysis identified the history of MI as a predictor factor of CV re-hospitalization (HR 1,43; 95%CI [1.10;1.86], p-value&lt;0.01) and of the composite of mortality and CV re-hospitalization (HR 1,37; 95%CI [1.10;1.71], p-value&lt;0.01).
In conclusion, the elderly with a second episode of ACS tends to have more CV risk factors and comorbidities than those without a MI history. Furthermore, the recurrence of MI seems to be an independent predictor of 1-year re-hospitalization and the composite of mortality and CV re-hospitalization. Then, these results should increase the awareness of this group of patients.Table 1Table 2 (incomplete) and Table 3
Cumulative incidence and risk factors of myocardial infarction during 21 years of follow-up: comparing two cohorts of middle-aged men born 30 years apart
Authors: Sakalaki M , Pivodic A , Svardsudd K , Hansson P O , Fu M 
Published: November 2023

Abstract

Background
The morbidity and mortality burden associated with coronary artery disease (CAD) has declined over the past decades which are believed to be attributable to reductions in the prevalence of major cardiovascular risk factors alongside with improvements in acute management of myocardial infarction (MI). Nevertheless, CAD remains one of the leading causes of death globally. Recent studies indicated that some major cardiovascular risk factors have been modified over time, with decreasing number of smokers and hypercholesterolemia and increasing rates of obesity and diabetes. This may have impact on the incidence of CAD. Therefore, further understanding of changes of major risk factors for CAD overtime is needed.

Aim
To study cumulative incidence and predictors of MI in two random general population samples consisting of middle-aged men born 30 years apart.

Method
The "Study of Men Born In 1913" and the "Study of Men Born In 1943" are two longitudinal cohort studies investigating cardiovascular risk factors and diseases, performed in the same geographic area and using the same methodology, with repeated examinations. Both cohorts were followed prospectively for 21 years from the 50 years of age. MI was defined as new onset of myocardial infarction, fatal or non-fatal.

Results
A total number of 1625 participants were included in the study. Men born in 1943 had a 34% lower risk of acute MI [HR 0.66 (0.50-0.88), p=0.0051] during follow-up as compared to men born in 1913. Both cohorts had similar risk factors and hypertension was associated with at least 2-fold higher risk for incident MI in men born in 1943 [HR 2.33 (95% CI 1.41 - 3.83)], p=0.0009 as compared to the risk in men born in 1913 [HR: 1.10 (0.74-1.62)].

Conclusion
Despite declining incidence of MI the last five decades, risk profile of MI remained almost the same, and hypertension became an increasingly prominent risk factor to MI. Greater efforts should be dedicated in primary prevention in order to further reduce the risk of MI.
Dramatic improvements in survival in women and men with acute myocardial infarction over 30 years: a nationwide cohort study
Authors: Batra G , Lindhagen L , Szummer K , Alfredsson J , Erlinge D , Held C , Ravn-Fischer A , Yndigegn T , Jernberg T , Wallentin L 
Published: November 2023

Abstract

Background
Treatment of myocardial infarction (MI) has improved over the last decades due to the implementation of early revascularization and medical therapies for secondary prevention. The impact of these treatment changes on survival in women and men has not been documented over a 30-year perspective.

Purpose
The aim of this study was to assess implementation of new treatment strategies and their effects on changes in long-term outcomes in all patients with MI in Sweden over 30 years.

Methods
In SWEDEHEART, the Swedish register for coronary heart disease, we investigated treatments and outcomes and their associations in patients admitted with MI between 1991-2021. Patients were stratified in 2-year blocks, starting with a 3-year block for 1991-1993. Primary outcome was 1-year risk of cardiovascular (CV) mortality. Effect of treatments on outcome was assessed comparing observed event rates with event rates standardized by logistic regression accounting for differences in baseline characteristics and treatment.

Results
A total of 433,524 cases with MI were hospitalized between 1991-2021. Between 1991-1993 and 2020-2021, treatment with reperfusion and revascularization increased from 34.7% to 77.3%; in-hospital PCI from 1.8% to 73.8 %; dual antiplatelet therapy (DAPT) from 0.0% to 73.8%; statins from 3.0% to 91.7%; beta-blockers from 66.4% to 88.3%; and renin-angiotensin-system (RAS) inhibitors from 21.6% to 81.6% (Figure 1A). During the same period, the rates of 1-year CV mortality decreased from 24.1% to 8.3%. For women, CV mortality decreased from 28.9% to 10.3% and for men from 21.7% to 7.3%. When comparing observed with standardized event rates, most of the mortality improvement was explained by the implementation of early revascularization with PCI (Figure 1B).

Conclusions
In this unique nationwide cohort of patients with MI over 30 years, there was a gradual implementation of revascularization and novel medical treatment. Concurrently, there was a gradual absolute reduction in 1-year risk of CV mortality with 16 percentage points, which was similar in women and men. Most of the improvement in survival was related to implementation of early revascularization strategies.
Figure 1 (A) Temporal trends in treatment and (B) crude and standardized rates of cardiovascular mortality within 1 year in patients with myocardial infarction over 30 years in Sweden.
Atrial fibrillation status in patients with ACS and percutaneous coronary intervention
Authors: Iwanaga Y , Nakai M , Inoko M , Miyamoto Y 
Published: November 2023

Abstract

Background
Patients with acute coronary syndrome (ACS) often develop atrial fibrillation (AF) as a comorbidity or complication. We investigated the impact of AF status on in-hospital mortality and complications in ACS patients who underwent percutaneous coronary intervention (PCI) using a recent large-scale nationwide dataset.

Methods
Using a nationwide claims-based dataset from 1022 hospitals in Japan between 2012 and 2017, hospitalized patients with ACS and PCI were identified and classified into three groups according to the AF status: no AF, prevalent AF before admission, and incident AF after admission. In-hospital mortality, complications, and medical costs were compared in crude and propensity-matched cohorts.

Results
In 273,828 hospitalized patients with ACS and PCI, prevalent AF and incident AF were observed in 5.2% and 1.7%, respectively; the AF rates increased over 5 years. There was a greater proportion of older patients and patients with comorbidities in AF patients. Prevalent and incident AF statuses were associated with worse crude outcomes and complications during hospitalization. In propensity-matched cohorts, incident AF was associated with higher in-hospital mortality rate, longer length of stay, higher direct costs, and higher rate of complications, including stroke and acute kidney injury, than prevalent AF. These outcomes did not change in each AF status over 5 years.

Conclusions
Prevalent and incident AFs in patients with ACS and PCI had deteriorating effects on in-hospital clinical outcomes, and particularly, incident AF was associated with worse adjusted outcomes and complications. Further efforts are necessary to improve the outcomes in an aging society where AF incidence is increasing.
Acute myocardial infarction in patients without standard modifiable risk factors - preliminary data on clinical and laboratory biomarkers from the beyond-smurfs study
Authors: Moysidis D , Papazoglou A , Anastasiou V , Daios S , Liatsos A , Kartas A , Karagiannidis E , Makedou K , Savvopoulos C , Kamperidis V , Ziakas A , Giannakoulas G , Vassilikos V , Giannopoulos G 
Published: November 2023

Abstract

Background
Acute myocardial infarction (AMI) remains the leading cause of mortality worldwide. The majority of patients who suffer an AMI have a history of at least one of the standard modifiable risk factors (SMuRFs): smoking, hypertension, dyslipidemia, and diabetes mellitus. However, emerging scientific evidence recognizes a clinically significant and increasing proportion of patients presenting with AMI without any SMuRF (SMuRF-less patients). This study aims to define specific risk factors or biomarkers associated with the development of AMI in this subpopulation.

Methods
This is an analysis of the prospective ‘‘Beyond-SMuRFs" study reporting preliminary data of the first 350 consecutive patients with AMI fulfilling inclusion criteria. More than 300 clinical, laboratory, echocardiographic and angiographic parameters-variables were compared between patients with and without SMuRFs. Multivariable logistic regression analysis was implemented to investigate independent prognostic factors associated with the occurrence of SΜuRF-less AMIs. Only univariably-significant (P&lt;0.05) and clinically-relevant variables were inserted in in the models. Restricted spline curve models were utilized to demonstrate the association of significant continuous predictors with the risk of SMuRF-less AMI occurrence.

Results
Out of the 350 patients (mean age 60.8±12.0 years, 74.6% males) suffering AMI, 76 patients (21.7%) had no history of SMuRFS at baseline. Increased soluble urokinase plasminogen activator receptor (suPAR) levels, history of rheumatic or autoimmune disease, values of self-reported mental health status component of SF-36 questionnaire ≤50 prior to AMI and decreased age were univariably associated with increased risk for SMuRF-less AMI. In the multivariable regression model, increased suPAR levels (aOR= 1.001; 95% CI= 1.000-1.003; p=0.02 β=0.001), history of rheumatic or autoimmune disease (aOR= 2.634; 95% CI= 2.309-4.440; p&lt;0.001; β=1.848) and impaired mental health status retained their statistical significance (aOR= 0.413, 95% CI= 0.229-0.746; p=0.003; β=0.884).

Conclusions
In this prospective cohort of 350 consecutive patients with AMI, more than a fifth of them were SMuRF-less. History of prior rheumatic or autoimmune disease, increased suPAR levels and decline in self-reported mental health status metrics prior to AMI were found to be independent predictors of SMuRF-less AMI.Multivariable logistic regression modelRestricted spline curve models
Myocardial infarction mortality after COVID-19: a nationwide population-based cohort study
Authors: Brodersen K D , Ulrichsen S P , Soerup S , Pedersen L , Thomsen R W , Soerensen H T , Schmidt M 
Published: November 2023

Abstract

Background
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of myocardial infarction (MI). Small studies suggest that MI in patients with recent COVID-19 may have a distinct clinical course and a worse prognosis, compared to MI without recent COVID-19. Whether previous COVID-19 vaccination modifies the clinical course of MI after recent COVID-19 is also unknown.

Purpose
To compare mortality in people with MI with and without recent COVID-19, and to examine the impact of previous COVID-19 vaccination.

Methods
Using Danish health registries, we conducted a nationwide population-based cohort study comprising all adults (≥18 years) with a first-time MI between 26 May 2020 and 9 March 2022. We excluded patients with &lt;1 year of residence in Denmark prior to their MI. The exposure was recent COVID-19 defined by a positive SARS-CoV-2 PCR test ≤90 days before MI. We followed the patients for 30 days from the date of their MI admission until death (if any), or emigration, whichever came first. We used Cox proportional-hazards regression to compute hazard ratios (HRs) for death within 30 days after MI. Using propensity-score balancing of confounders with stabilised inverse probability weighting, we adjusted for differences in age, sex, DANCAMI comorbidity burden, use of selected medications, and calendar period between MI patients with and without recent COVID-19. We stratified by COVID-19 vaccination status.

Results
Of 11,919 included patients with MI, 332 patients had COVID-19 within 90 days before MI. The COVID-19 exposed patients were characterised by a larger proportion of males and COVID-19 vaccinations, lower age, and a longer median time from first COVID-19 vaccination to MI compared to the COVID-19 unexposed patients. 34 of the patients with recent COVID-19 (10.2%) and 702 of the patients without recent COVID-19 (6.1%) died within 30 days after their MI, resulting in a crude HR of 1.71 with a 95% confidence interval (CI) of 1.21–2.42 for the patients with recent COVID-19. After adjusting by stabilised inverse probability weighting, this HR further increased to 2.08 (95% CI: 1.23–3.52). Previous COVID-19 vaccination modified this association with a three-fold increased mortality in unvaccinated MI patients with recent COVID-19, while the mortality HR associated with recent COVID-19 was close to one in patients who were previously COVID-19 vaccinated.

Conclusion
Patients with recent COVID-19 had increased short-term mortality after MI, but only if unvaccinated.
Reticulated platelets predict cardiovascular death and adverse events in coronary artery disease
Authors: Bongiovanni D , Novelli L , Condello F , Laugwitz K L , Raake P , Kastrati A , Chiarito M , Bernlochner I 
Published: November 2023

Abstract

Background/Introduction
The pro-thrombotic immature or reticulated platelets (RPs) are known to be elevated in high risk patients and in different pathological settings. Several studies have shown that RPs correlate with an insufficient antiplatelet response to antiplatelet agents. In addition, RPs are emerging novel biomarkers for the prediction of adverse cardiovascular events in cardiovascular disease.

Purpose
The current study, using the totality of existing evidence, evaluated the prognostic role of RPs in patients with coronary artery disease.

Methods
We performed a systematic review and meta-analysis including trials of acute and chronic coronary syndrome reporting clinical outcomes according to RPs levels in the peripheral blood. Patients with elevated RPs were defined as RPshigh according to the single study definitions and compared to patients without elevated RPs (RPslow). Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were cardiovascular death, myocardial infarction, ischemic stroke, urgent coronary revascularization and any bleeding. Prospero Registration number: CRD42022381282.

Results
A total of 7 studies, including 2213 patients, were included. The risk for MACCE was significantly higher in RPshigh compared to RPslow patients (OR 2.67 [1.87; 3.81], I2=43.8%, Figure 1). RPshigh were significantly associated with cardiovascular death (OR 2.09 [1.36; 3.22], I2=40.4%). No significant associations for RPshigh were detected with the other singular components of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] I2=60.5%) and stroke (OR 1.72 [0.59; 4.96] I2=21%). Urgent revascularization was not significantly associated with elevated RPs (OR 2.09 [0.90; 4.86] I2=55.5%). The risk of bleeding did not significantly differ between groups(OR 0.58 [0.15; 2.22] I2=86.1%).

Conclusion
Elevated RPs are significantly associated with increased risk of cardiovascular events and cardiovascular death in patients with coronary artery disease and should be considered a useful prognostic biomarker in this setting.Figure 1