bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical presentation and cardiovascular risk factors in patients with STEMI due to spontaneous coronary artery dissection (SCAD)
Authors: Malleier S , Troebs M , Achenbach S 
Published: November 2023

Abstract

Background
Spontaneous coronary artery dissection (SCAD) may occur in the absence of atherosclerotic and traumatic etiology and can lead to severe clinical manifestations such as ST-segment elevation myocardial infarction (STEMI). Compared to atherosclerotic STEMI, younger patients and females are predominantly affected. Hence, underdiagnosis is an important concern. We therefore systematically analyzed the prevalence of SCAD among a large cohort of young patients presenting with STEMI, as well as risk factors and presenting symptoms.

Methods
We retrospectively identified a consecutive cohort of 631 patients younger than 55 years who underwent coronary angiography due to STEMI between 01/2005 and 10/2022. Systematic review of coronary angiograms allowed identification of all STEMI caused by SCAD (n=20, 3.2%), including patients previously misdiagnosed as atherosclerotic STEMI. By reviewing medical records, we identified symptoms at presentation and cardiovascular risk factors in patients with SCAD-STEMI.

Results
Out of the 20 patients &lt;55 years presenting with SCAD-STEMI, 16 (80%) were female, and the mean age was 49.5 years. By far the most common presentation was typical angina (75%, n=15), being reported by all 4 male and 11/16 female patients (100% vs. 69%, respectively). Importantly, three patients presented with cardiac arrest due to malignant ventricular arrhythmia (15%). In 6 patients, symptoms were mild and atypical (nausea/vomiting, n = 3, 15%; atypical chest pain, n = 2, 10%; and diaphoresis, n = 1, 5%). There was no significant difference of symptoms between men and women.
11 patients (55%) were treated by primary PCI, none received emergency coronary artery bypass grafting (CABG). The mean maximum serum creatin kinase (CK) level was 1410 U/l (range 139-86144 U/l). Mean left ventricular ejection fraction (LVEF) was 50% (range 30-60%). Symptoms at presentation did not correlate with maximum CK levels, nor with LVEF.
In this caucasian cohort, the most common cardiovascular risk factor was arterial hypertension (n = 12, 60%), followed by smoking (n = 9, 45%). Six patients had hyperlipidemia (30%), and three (15%) were obese. Diabetes and a positive family history for cardiovascular events were rare (n = 2, 10% vs. n = 1, 5%, respectively).

Conclusion
In this large caucasian cohort of young patients with STEMI, SCAD accounted for 3.2 % of cases. Typical angina was the most common symptom at presentation, but cardiac arrest due to ventricular fibrillation was frequent. Symptoms in men and women were similar and did not correlate with LVEF, nor with maximum CK levels.
Machine learning for in-hospital cardiac events prediction in patients with acute coronary syndrome: results from ADDICT-ICCU study
Authors: Gall E , Dillinger J G , Hamzi K , Elbaz M , Gerbaud E , El Beze N , Lequipar A , Toupin S , Picard F , Trimaille A , Goralski M , Bedossa M , Boccara A , Pezel T , Henry P 
Published: November 2023

Abstract

Background
Acute coronary syndrome (ACS) remains a major cause of mortality worldwide. However, the accuracy of current prediction tools for in-hospital cardiac events after an ACS remains insufficient for individualized patient management strategies.

Purpose
To assess in patients with ACS the feasibility and accuracy of machine learning (ML)-based model using all data available at admission to predict in-hospital cardiac events.

Methods
We conducted a sub-study of ADDICT-ICCU registry, an observational prospective study including all consecutive patients admitted to intensive cardiac care unit (ICCU) in 39 centres throughout France between 7 and 22 April 2021. We evaluated 16 clinical, 4 biological and 6 transthoracic echocardiogram (TTE) features. ML involved automated feature selection with model building by random forest (RF), and then hyperparameter tuning was done by repeated cross-validation. The primary outcome was the occurrence of composite outcomes defined by death, resuscitated cardiac arrest or cardiogenic shock requiring medical and/or mechanical haemodynamic support.

Results
Of 1,499 consecutive patients, 765 (mean age 63±15 years, 70% male) were admitted for ACS. The overall in-hospital cardiac events rate for ACS patients was 4.0 %. Feature selection was performed using RF with the log-rank–based variable importance, and 6 of the available features at admission were selected for the RF model (1 clinical, 1 biological, and 4 from TTE) including mean blood pressure, renal function, cardiac output, filling pressures, tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure. The ML model exhibited a higher area under the curve compared with TIMI score, GRACE score, and traditional stepwise model score for prediction of in-hospital cardiac events (ML score: 0.96 vs TIMI: 0.54, GRACE: 0.68, traditional stepwise score: 0.87; all P &lt; 0.001).

Conclusions
The ML-model exhibited a higher prognostic value to predict in-hospital cardiac events compared with all traditional scores.
ML model for MACEs prediction ML model performance (AUC)
Family history of myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Hakansson H F K , Svensson P , Tornvall P 
Published: November 2023

Abstract

Introduction
Genetic factors play an important role in the development of myocardial infarction (MI), and a positive family history is a risk factor for MI. The significance of family history among patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) is not known, and previous studies of family history in MI have not made a distinction between MINOCA and MI due to coronary artery disease (MI-CAD) based on angiographic findings.

Purpose
To investigate family history of MI with and without obstructive coronary arteries in patients with a working diagnosis of MINOCA.

Methods
A nationwide register-based case-control study of 15 462 MINOCA cases and 38 220 controls without MI with a non-obstructive coronary angiography due to chest pain, together with 204 424 MI-CAD cases, defined as MI with obstructive coronary arteries with a degree of stenosis &gt;50%, between the years 1995-2020. Data from the Swedish coronary angiography and angioplasty register with information about angiographic findings was merged with information on first-degree relatives from the Swedish multi-generation register. Odds ratio (OR) was calculated with a 95% confidence interval (CI), to analyze the probability of MINOCA patients having first-degree relatives with 1) MINOCA, 2) MI-CAD, and 3) MI-CAD patients having first-degree relatives with MI-CAD. Logistic regression models adjusted for age, sex, hypertension, diabetes, hyperlipidemia and smoking status.

Results
A total of 161 MINOCA patients (1%) had ≥1 first-degree relative with MINOCA and the probability of having a positive family history of MINOCA did not differ compared to controls, with age and sex adjusted OR 1.08 (95% CI 0.89-1.31) and when adjusting for all covariates 1.08 (95% CI 0.87-1.34).
Conversely, 1436 MINOCA patients (9%) had ≥1 first-degree relative with MI-CAD and the probability of having a positive family history of MI-CAD was higher compared to controls with age and sex adjusted OR 1.12 (95% CI 1.05-1.20) and when adjusting for all covariates OR 1.16 (95% CI 1.04-1.20).
The sensitivity analysis showed that 24 972 MI-CAD (9%) patients had a positive family history of MI-CAD compared to controls, OR adjusted for age and sex 1.68 (95% CI 1.61-1.75), and OR adjusted for all covariates 1.68 (95% CI 1.60-1.75).

Conclusions
In this first study that examines family history of MINOCA, including data from over 250 000 coronary angiograms, a positive family history of MI-CAD was more common among patients with a working diagnosis of MINOCA compared to controls without MI and with non-obstructive coronary arteries. A family history of MINOCA was uncommon and was not associated with MINOCA. These results indicate that genetic factors and shared environmental factors within a family leading to CAD are important also for MINOCA, thus MI-CAD and MINOCA share underlying mechanisms.
Temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities in patients presenting with acute myocardial infarction: Insights from the AMIS Plus registry
Authors: Loosli J , Stahli B E , Foster-Witassek F , Rickli H , Roffi M , Pedrazzini G , Radovanovic D 
Published: November 2023

Abstract

Background
Little is known about temporal trends in the prevalence of cardiovascular and non-cardiovascular comorbidities in patients presenting with acute myocardial infarction (AMI).

Methods
AMIS Plus registry patients enrolled between 2004 and 2021 were stratified based on comorbidities in 3 groups: (1) «cardiovascular comorbidity»: at least one among past history of myocardial infarction, coronary artery bypass grafting or percutaneous coronary intervention, heart failure, peripheral vascular disease, cerebrovascular disease, or atrial fibrillation; (2) «non-cardiovascular comorbidity»: at least one among dementia, chronic lung disease, connective tissue disease, peptic ulcer disease, moderate or severe renal disease, diabetes, liver disease, or cancer disease; and (3) «any comorbidity»: at least one of the mentioned comorbidities. Prevalence and mortality were analysed according to the type of comorbidity in 2-year periods and stratified by sex. Temporal trends were analysed using the Mantel-Haenszel linear-by-linear association Chi-squared test.

Results
Among the 48’848 patients enrolled, 24’215 (49.6%) had at least one comorbidity. Of these, 17’441 (72.0%) were male and 6’774 (28.0%) female. Over the years, there was a significant decrease in the prevalence of «any comorbidity» (p&lt;0.001) as well as «cardiovascular comorbidity» (p&lt;0.001). A significant decrease in the prevalence of «any comorbidity» as well as «cardiovascular comorbidity» was detected for both sexes. With respect to the prevalence of «non-cardiovascular comorbidity», a significant reduction over time was observed in men but not in women. The reduction of in-hospital mortality over time was significant across all groups, overall and for both sexes individually.

Conclusions
Over more than a decade, a significant reduction in the prevalence of comorbidities was observed in patients presenting with AMI, with the exception of non-cardiovascular comorbidities in women. This reduction may have contributed, in addition to the improvements in pharmacologic treatments as well as in revascularization, to the improved survival observed over time.Temporal trends of comorbidities
Association of baseline and changes in health related quality of life with mortality following myocardial infarction: multicentre longitudinal linked cohort study
Authors: Dondo T , Munyombwe T , Hurdus B , Aktaa S , Hall M , Nadarajah R , Farooq M , Haris M , West R M , Hall A S , Gale C P 
Published: November 2023

Abstract

Background/Introduction
Health related quality of life (HRQoL) for patients following myocardial infarction (MI) is frequently impaired and often deteriorates. However, the association between HRQoL and clinical endpoints in patients with MI is unknown.

Purpose
To investigate the association of baseline and temporal changes in HRQoL with long term all-cause mortality following MI.

Methods
This nationwide longitudinal linked health record study includes individuals with MI admitted to 77 hospitals in England between 1st November 2011 and 24th June 2015 in the EMMACE-3 and -4 studies. Self-reported HRQoL was collected using the EuroQol EQ-5D-3L (EuroQOL Visual Analogue Scale (EQ-VAS) and EuroQOL 5-Dimensional Classification (EQ-5D)) instrument during hospitalisation and at 1, 6 and 12-months following hospital discharge. Flexible parametric and multilevel survival models estimated associations of baseline and change in HRQoL with long term all-cause mortality.

Results
Of 9,474 individuals with MI, 25% (2,360) were women and 22.5% (2,135) participants died during the 9 years follow up period (median 6.9 years). There was an improvement in HRQoL over 12 months following MI (baseline mean, mean increase: EQ-5D 0.76, 0.003 per month; EQVAS 69.0, 0.5 per month). Better HRQoL at baseline was inversely associated with mortality (HR 0.55, 95% CI 0.47-0.63) (Figure 1A). At baseline, problems with self-care (HR 1.73, 95% CI 1.56-1.92), mobility (1.65, 1.50-1.81), usual activities (1.34, 1.23-1.47) and pain/discomfort (1.34, 1.22-1.46), were associated with increased mortality (Figure 1A). Improvements in EQ-5D (HR 0.69, 95% CI 0.60-0.80), but not EQ-VAS reduced the risk of death (Figure 1B). Deterioration in mobility, pain/discomfort, usual activities and self-care over 12 months increased the risk of death (HR 1.43, 95% CI 1.31-1.58; 1.21, 95% CI 1.11-1.32; 1.20, 95% CI 1.10-1.32; 1.44, 95% CI 1.30-1.59, respectively) (Figure 1B).

Conclusions
For patients with MI, poor HRQoL at baseline, its dimensions and deterioration over time are associated with mortality. Measuring HRQoL in routine clinical practice could delineate an at-risk group for targeted interventions to improve prognosis.Figure 1
Referral pathway in primary PCI - delays depend on the origin
Authors: Dias Claudio F , Neves D , Carias M , Almeida A , Figueiredo M , Viana R , Russo C , Rocha R , Bras D , Bento A , Fernandes R , Patricio L 
Published: November 2023

Abstract

Background
Ischaemic heart disease is the single most common cause of death and its frequency is increasing. The mortality in patients presenting with an acute coronary syndrome with ST-elevation (STEMI) is associated with many factors such as the time delay to treatment, which comprises primary angioplasty (pPCI) or fibrinolysis.
Therefore, treatment delays should be recorded systematically and audited, so as to improve standard of care.

Purpose
To analyse the response time and delays in the emergent coronary referral pathway for our centre, taking into consideration the place of first contact.

Methods
Primary data for this study was obtained by evaluating consecutive patients from the year 2015 to 2021, admitted for pPCI in our centre in the context STEMI. Time variables were collected for all patients – schematically represented in Figure 1. Statistical analyses were performed using IBM SPSS Statistics for Windows Version 27.0.

Results
We included a total of 1452 cases of pPCI with a median patient age of 64 years and 75,3% male. Over 7 years of pPCI were analysed and median times are displayed in table 1. We found that ECG median delays were significantly lower in the emergency first responders (EFR) group when comparing to PCI Centre group (11,0 vs 22,0; p&lt;0,001), primary care physicians group(11,0 vs 23,0; p&lt;0,001) and non-PCI Centre group (11,0 vs 28,0; p&lt;0,001). Futhermore, median diagnostic delay was significantly lower in the EFR group compared to non-PCI centre group (28,0 vs 62,0; p&lt;0,001) and primary care physician group (28,0 vs 59,0; p&lt;0,001), as well as in the PCI Centre group compared to the non-PCI Centre group (30,0 vs 62,0; p&lt;0,001) and to primary care physician group (30,0 vs 59,0; p&lt;0,001).

Conclusions
Our data displays a clear heterogeneity in care which has an impact in the ischaemic time of STEMI patients. There seems to be a significant difference between the primary point of contact being the primary care physicians or a non-PCI centre when compared to our centre or the EFR, especially when it comes to the diagnostic timings. Hence, strategies must be developed to increase diagnostic sensibility and accuracy of STEMI patients throughout our geographical region.Time variable schemeTime according to groups
Performance of the High-STEACS Early Rule-Out Pathway for High Sensitivity Cardiac Troponin T at 30-days in a US population
Authors: Allen B , Millard M , Ashburn N , Snavely A , Nowak R , Mumma B , Madsen T , Wilkerson R G , Christenson R , Stopyra J , Mahler S 
Published: November 2023

Abstract

Background
The High-STEACS Early Rule-Out Pathway for High Sensitivity Cardiac Troponin T (hs-cTnT) is an algorithm designed to rule-out myocardial infarction (MI) in ED patients with symptoms concerning for acute coronary syndrome (ACS). High-STEACS was validated in the United Kingdom but has yet to be evaluated in the US.

Purpose
The objective of this secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) United States (US) multicenter study is to determine the performance of the High-STEACS hs-cTnT Pathway in a multisite US cohort.

Methods
Patients (≥ 21 years old) presenting to the (ED) with symptoms suggestive of ACS were enrolled (1/25/2017-9/6/2018) at 8 US medical centers. Participants with 0- and 1-hour hs-cTnT measures were stratified into outpatient and admission dispositions using the established High-STEACS hs-cTnT cut-points. Cardiac death or MI and major adverse cardiovascular events (MACE; a composite of cardiac death, MI, and coronary revascularization) at 30-days were adjudicated. Negative and positive predictive values (NPV and PPV) and negative and positive likelihood ratios (-LR and +LR) for the High-STEACS pathway were calculated for each outcome with 95% confidence intervals.

Results
Overall, 1430 patients were studied. 54.2% (775/1430) were male with a mean age of 57.6 ± 12.8 years. At 30-days, 12.8% (183/1430) of patients experienced cardiac death or MI and 14.2% (203/1430) had MACE. High-STEACS classified 59.9% (857/1430) to the outpatient disposition and 40.1% (573/1430) to admission. Among patients stratified to the outpatient group, 1.9% (16/857) experienced cardiac death or MI and 3.4% (29/857) had MACE at 30-days. The NPV and -LR for High-STEACS were 98.1% (95%CI 97.0-98.9) and 0.13 (95%CI 0.08-0.21) for 30-day cardiac death or MI and 96.6% (95%CI 95.2-97.7) and 0.21 (95%CI 0.15-0.30) for 30-day MACE. For patients stratified to admission, 29.1% (167/573) had 30-day cardiac death or MI and 30.4% (174/573) had MACE. This yielded a PPV and +LR for 30-day cardiac death or MI of 29.1% (95%CI 25.5-33.1) and 2.8 (95%CI 2.6-3.1) and 30.4% (95%CI 26.6-34.3) and 2.6 (95%CI 2.4-2.9) for 30-day MACE.

Conclusions
The High-STEACS hs-cTnT Pathway stratified nearly 60% of patients to an outpatient disposition, but these patients had high rates of 30-day cardiac events. These findings suggest that providers should be cautious before using this pathway among US patients with possible ACS.
Nourin miRNAs: novel biomarkers highly expressed in unstable angina patients with normal ECG and negative hs-troponin and dropped post percutaneous coronary intervention
Authors: Kandil H I , Yacoub B , Sadaka M , Yehia A , El-Khazragy N , Rashed L , El-Hadidi A S , Kreutzer D L , Christenson R H , Elgebaly S A 
Published: November 2023

Abstract

Background
We recently reported that Nourin-dependent miR-137 and miR-106b can identify reversible myocardial ischemia in chest pain patients with a confirmed diagnosis of chronic stable chronic artery disease (CAD) and unstable angina (UA). These patients showed normal resting ECG and hs-cTnI below the clinical decision (&lt;99th of URL). Normal, low-grade, baseline expression levels of Nourin miRNAs were detected in healthy subjects and in non-cardiac chest pain patients with hs-cTnI &lt;99th URL.

Purpose
1) To confirm the upregulation of Nourin miRNAs in chest pain patients with normal resting ECG and hs-cTnI &lt; 99th URL, who are suspected of having UA; 2) whether Nourin miRNA expression levels change after relieving myocardial ischemia by PCI; and 3) whether there is an association between severity of chest of pain and Nourin miRNA expression levels prior to PCI.

Methods
This study enrolled 36 consecutive chest pain patients with normal resting ECGs and hs-cTnI &lt;99th URL, from two large referral centers in Egypt. All enrolled patients had a single vessel disease with significant coronary stenosis (&gt;70%) during diagnostic coronary angiography that was treated by PCI using standard techniques. The gene expression levels of miR-137 and miR-106b were measured in serum samples collected prior to PCI, as well as 12 hours and 24 hours post PCI. The angina class was evaluated at presentation, discharge, and after 4 weeks to verify angina relief.

Results
All patients (n=36) underwent successful PCI. Gene expression levels of miR-137 and miR-106b were significantly upregulated prior to PCI (mean ± SD: miR-137 = 355±150 and miR-106b =317±122) compared to healthy subjects (n=16) who showed minimal expression levels ranged from 0.615 to 1.05 (P &lt;0.0001). Levels of both biomarkers dropped by 50% (12 hours) and 65% (24 hours) post PCI (P &lt;0.05) (Figure 1). The expression levels of Nourin miRNAs did not associate with the Canadian class levels of angina severity. All patients were asymptomatic at discharge, while 84% remained asymptomatic after 4 weeks.

Conclusions
This study: 1) confirms that Nourin miR-137 and miR-106b can identify myocardial ischemia in patients presenting with unstable angina; 2) confirms that these two novel molecular biomarkers are elevated during myocardial ischemia, in the absence of myocardial injury; and 3) for the first time, we report a significant drop of Nourin miRNA expression levels post PCI, with myocardial ischemia relief.