bluuebunny/crossref_metadata_2025_split huggingface dataset:
How vigilant were we in the diagnosis of peri-operative myocardial infarction before 2022 ESC guidelines?
Authors: Celutkiene J , Januzyte L , Cerlinskaite-Bajore K , Platukis T , Barciene D , Dambrauskaite A , Jurgaityte J , Saukliene R , Jarasuniene D 
Published: November 2023

Abstract

Background
The diagnosis of myocardial infarction (MI) after non-cardiac surgical intervention is complicated due to possible absence of symptoms as well as of objective ECG or echocardiography signs of ischemia.

Aim
This is a retrospective analysis of the prevalence of clinically diagnosed MI after non-cardiac surgery in two district hospitals with large-scale surgical services in the period of 2017 - 2022.

Methods
We retrospectively collected study data using electronic hospital records of all patients that underwent surgical operations for 6 years. Peri-operative MI was selected according to code I21 following any surgical procedure and verified by symptoms, elevated TnI, ECG and Echo changes.

Results
Total 103 028 patients underwent orthopedic, vascular, abdominal, neuro- surgery from 2017 to 2022. We found 45 patients diagnosed with MI, what makes the prevalence of 0,04%. Diagnostic criteria were: median TnI levels 4925 [1171; 13162] ng/L, symptoms [62% had typical anginal pain, 38% felt dyspnea, 22% had no symptoms], ECG changes {40% with ST elevation, 42% with ST depression, 16% bundle branch block}. Three patients (7%) were administered with troponin test before surgery. Patients with peri-operative MI were 81 [70; 86] years old, 49% females, with the history of CAD (42%), hypertension (71%), diabetes (33%), CKD (13%), anemia (38%), atrial fibrillation (33%), heart failure (47%). The duration of anesthesia was from 20 min to 3h 05 min and it was general in most cases. Bleeding requiring blood transfusion was observed in 27% of cases. It is known that 42% of patients used beta-blockers, 22% used statins before the operation, and 33% saw cardiologist in last 5 years. STEMI occurred in 44%, NSTEMI in 38% of patients, in 18% MI was unspecified, PCI was performed in 44%. Patients were transferred to ICU in 78% of cases and in 20% to cardiology ward. In-hospital deaths occurred in 49% of cases.

Conclusions
Little number of peri-operative myocardial infarctions are recognized in current practice, however, the mortality of these patients is very high. These findings highlights the importance of implementation of non-cardiac surgery guidelines, namely, routine troponin evaluation in high-risk patients.
Association of coronary artery calcification with mortality and myocardial injury after noncardiac surgery
Authors: Park S , Kim J H , Lee S H , Kim S M , Park J C , Kim E K , Chang S A , Lee S C , Park S W 
Published: November 2023

Abstract

Objectives
This study aimed to evaluate the prognostic value of preoperative coronary artery calcium (CAC) scores for predicting in-hospital death and myocardial injury after noncardiac surgery (MINS).

Backgrounds
The CAC score is a surrogate marker for atherosclerosis and coronary artery disease. However, the association between preoperative CAC score and development of MINS has not been studied.

Methods
From 2010 to 2019, patients with CAC scores measured within three years prior to noncardiac surgery were enrolled from a tertiary hospital. Patients with a history of coronary revascularization were excluded from this study. The Agatston method was used to calculate CAC scores. The primary outcome was in-hospital death or MINS, defined as a peak high-sensitivity troponin I level higher than 0.040 ng/ml within 30 days after noncardiac surgery. The secondary outcome was 1-year mortality.

Results
A total of 740 patients were included in the analysis. The mean age was 67.0 years, and 68.9% were male. In-hospital death or MINS occurred in 129 (17.4 %) patients. The median CAC score was 164.0 and 70.5 in patients with and without in-hospital death or MINS, respectively (p=0.001). The preoperative CAC score was significantly associated with the development of in-hospital death or MINS (per 100 increases, odds ratio [OR] 1.05; 95% confidence interval [CI] 1.02–1.07). The best CAC score cutoff value for predicting in-hospital death or MINS was 619 (&lt;619 vs. ≥619, OR 2.47; 95% CI 1.60–3.81; p&lt;0.001), which was significant after adjustment for clinical risk factors. The 1-year mortality rate was significantly different according to CAC score strata.

Conclusions
A high preoperative CAC score was associated with a significant increase in in-hospital death or MINS independent of clinical risk factors.1-year mortality rate : CAC score1yr mortality rate by CAC score cut-off
Standard modifiable risk factors and mortality in patients with ST-segment elevation myocardial infarction: findings from the FRENCHIE cohort
Authors: Zeller M , Danchin N , Cottin Y , Rousseau A , Sauze D , Goube P , Cayla G , Prieur C , Auffret V , Simon T , Steg P G 
Published: November 2023

Abstract

Background
Improvements in the treatment of the 4 main standard modifiable cardiovascular (CV) risk factors (SMuRFs), hypertension (HTN), diabetes, hypercholesterolemia, and smoking, have led to better survival in patients with acute myocardial infarction (AMI). Recent large observational studies have reported that an increasing and sizable proportion of AMI patients have no SMuRF, and these SMURFless patients have (counterintuitively) worse outcomes than patients with at least one SMuRF.

Purpose
Using a French nationwide MI registry, we aimed to describe the proportion, characteristics and in-hospital mortality of ST-segment elevation MI (STEMI) patients according to the burden of SMuRFs.

Methods
The French Cohort of Myocardial Infarction Evaluation (FRENCHIE) is a large ongoing MI cohort, which collects data from all patients hospitalized for AMI &lt; 48 h of symptom onset in 21 french centres. For the present analysis, patients with STEMI and without prior coronary artery disease (CAD) admitted in 2019 and 2020 were studied. SMuRFless patients were compared to patients with 1 SMuRF or ≥2 SMuRFs.

Results
Among 4692 STEMI patients, 986(21%) were SMuRFless, 2001(43%) had 1 SMuRF, and 1705(36%) had ≥2 SMuRFs . Among patients with SMuRFs, smoking (51.8%) and HTN (51.1%) were the most frequent SMuRF and HTN+hypercholesterolemia (10.3%) and HTN+smoking (8.3%) the most frequent SMuRFs associations. When compared with patients with 1 or ≥ 2 SMuRFs, SMuRFless patients were characterized by older age (64.1 vs 60.2 and 62.8 y, respectively), but lower rate of female sex (21.7 vs 22.2 and 26.2%, respectively), LVEF&lt;40% (24.5 vs 26.7 and 26.2%), and lower admission CRP (14.8±38.3 vs 15.3±38.7 and 17.3±40.1 mg/L, respectively). There was a slight increase in BMI with increasing SMURFs (0 SMURF : 26±3.9 ; 1 SMuRF : 26.3±4.5 ; ≥2 SMuRFs : 28.0±5 kg/m²). As expected, SMuRFless patients were less frequently under chronic CV medications (7.9 vs 23.5 and 57.7%, respectively). However, acute STEMI medications were similar across the 3 groups. Crude in-hospital mortality showed a trend toward an increase with the number of SMuRFs (p = 0.123). By multivariate logistic regression analysis, the number of SMURFs was associated with increasing in-hospital mortality (Figure). In stratified analyses, the odds were similar for both sexes.

Conclusion
In French patients with an inaugural STEMI, one in 5 patient was SMURFless. The burden of risk factors was independently correlated to worse in-hospital survival. These observations emphasize the importance of standard RF on acute MI outcomes.SMuRF and in-hospital death(forest plot)
Inflammatory biomarkers and long-term outcome in young stable patients 3 months after a first myocardial infarction
Authors: Cederstrom S , Johansson F , Samnegard A , Silveira A , Tornvall P , Jernberg T , Lundman P 
Published: November 2023

Abstract

Background
Inflammation is an important driver of coronary artery disease (CAD). Several circulating inflammatory biomarkers have been associated with outcome, both before and after established CAD. However, studies in established CAD have often been limited by short follow-up period or blood sampling in the acute phase of a coronary event, which introduces a bias from the inflammatory response activated during a myocardial infarction (MI).

Purpose
This study aimed to compare the predictive value of several inflammatory biomarkers in a population of young stable patients 3 months after a first time MI.

Methods
382 men and women ≤60 years of age with a first time MI were included from three Swedish hospitals between 1996 and 2000. 383 age- and sex-matched healthy controls were recruited from the general population. Individuals with previous MI, chronic inflammatory disease, kidney disease (creatinine &gt;200 µmol/L), diabetes mellitus type 1, drug addiction or psychiatric disease were excluded. Three months after the acute index event, 15 biomarkers known to be involved in atherosclerosis were analysed; C-reactive protein (CRP), serum amyloid A (SAA), interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-18, interferon-gamma (IFN-γ), tumor necrosis factor-alfa (TNF-α), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase (MMP)-1, MMP-3 and MMP-9. The Swedish population register and national patient register were used to analyse cardiovascular outcome including all-cause mortality, recurrent MI and heart failure (HF) during 20 years of follow-up. A variable importance analysis and a Cox regression model were used. Biomarkers were divided in tertiles and compared with the lowest tertile as a reference.

Results
At inclusion, 82% of cases were men with a mean age of 52 years. 19% were smokers, 34% had a diagnosis of hypertension and 11% had diabetes mellitus. The level of each biomarker in cases and controls is shown in Table. When biomarkers were compared, IL-6 was identified as the most important biomarker to predict outcome. In cases, IL-6 was associated with a composite outcome of all-cause mortality, non-fatal MI and non-fatal HF in a model adjusted for age, sex and cardiovascular risk factors (HR 1.96, 95% CI 1.37-2.80) (Figure). IL-6 also was associated with all-cause mortality (HR 2.42, 95% CI 1.45-4.04) and HF (HR 2.58, 95% CI 1.54-4.33).

Conclusions
When 15 inflammatory markers involved in atherosclerosis were analysed, IL-6 was the most important biomarker to predict long-term cardiovascular outcome. This study is unique considering the extended follow-up period of 20 years in young individuals with blood sampled in a convalescent phase after a first myocardial infarction. IL-6 is a promising biomarker to predict long-term prognosis and a possible treatment target.Table.Medians for all 15 biomarkersOutcome in relation to IL-6 level
Sex and racial disparities in proportional mortality of premature myocardial infarction in the USA from 1999-2020
Authors: Gonuguntla K , Shaik A S , Chobufo M D C , Badu I B , Sandhyavenu H S , Taha A T , Sattar Y S , Thyagaturu H T , Balla S B , Gulati M G 
Published: November 2023

Abstract

Background
The incidence of premature myocardial infarction (PMI) (females &lt;65 years and males &lt;55 years) is increasing. We investigated proportional mortality trends related to PMI stratified by sex, race, and ethnicity from 1999-2020.

Methods
The CDC WONDER (Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) was queried to identify PMI deaths occurring within the U.S. between 1999- 2020. We calculated trends in the proportional mortality of PMI using the Joinpoint regression analysis.

Results
From 1999-2020, we identified a total of 3,017,826 AMI-related deaths. Of these 373,317 were PMI deaths, corresponding to proportional mortality of 12.5% (male 12%, female 14%). On trend analysis, the proportional mortality of PMI increased from 10.5% in 1999 to 13.2% in 2020 [AAPC of 1.0 (0.8 to 1.2, p&lt;0.01)] with a significant increase in females from 10% in 1999 to 17% in 2020 [AAPC of 2.4 (1.8 to 3.0, p&lt;0.01)] and no significant change in males, 11% in 1999 to 10% in 2020 [AAPC of -0.2 (-0.7 to 0.3, p=0.4)]. There was a significant increase in proportional mortality in both Blacks (18% in 1999 to 21% in 2020) and Whites (10% in 1999 to 12% in 2020), with no statistical difference among American Indian or Alaska Native, Asian or Pacific Islander, or Hispanics.

Conclusion
Over the last 2 decades there has been a significant increase in the proportional mortality of PMI in females and black population in spite of the overall downtrend in AMI-related mortality.AMI mortalityAMI mortality based on race
Choosing between coronary CT angiography and functional tests in patients with suspected coronary artery disease: mind the (gender) gap
Authors: Paiva M , Presume J P , Freitas P , Lopes P , Gomes D , Santos R , Guerreiro S , Abecasis J , Santos A C , Saraiva C , Mendes M , Ferreira A M 
Published: November 2023

Abstract

Introduction
There is a need for a simple method to choose between a functional vs. anatomical test as first line approach to patients with suspected coronary artery disease (CAD). While European Guidelines base the decision on pretest probability (PTP) without a clear threshold, American Guidelines rely uniquely on age, with a 65-year-old cut-off for both genders.
The aims of this study were: 1) to assess the proportion of patients undergoing coronary CT angiography (CCTA) in whom a functional test could have been more suitable due to extensive coronary artery calcification (CAC) and/or inconclusive CCTA results; 2) compare PTP vs. age to predict the presence of these suboptimal conditions for CCTA.

Methods
Individuals 40-80 years old were identified in a single center registry of patients with stable chest pain or dyspnea who underwent CCTA. Patients with known CAD, severe valvular disease, or irregular heart rhythms were excluded. PTP of obstructive CAD was calculated using age, sex, and symptom typicality.
Patients were considered to have suboptimal conditions for CCTA if extensive CAC was present (defined conservatively as an Agatston score &gt;400) or if one or more segments &gt;2mm were deemed non-evaluable despite CAC score ≤ 400.

Results
A total of 884 patients (57% women, mean age 62±10 years) were included. Symptoms consisted of chest pain in 705 patients (80%). The median PTP of obstructive CAD was 22% (IQR 14-32).
Overall, 162 patients (18%) had suboptimal conditions for CCTA due to CAC score &gt;400 (n=140), or ≥1 non-evaluable segments (n=22). The proportion of patients with suboptimal conditions for CCTA was significantly higher in men than in women (27% vs. 12%, respectively; p&lt;0.001). For both genders, the discriminative power to predict suboptimal CCTA conditions was significantly higher for age than for PTP (c-statistic in men 0.74 vs. 0.64, p&lt;0.001; in women 0.71 vs. 0.62, p=0.012). In every age group, the proportion of patients with suboptimal conditions for CCTA was at least 2 times higher in men than in women, with a 10-15 year gap between genders - Fig.

Conclusion
Suboptimal conditions for a fully diagnostic CCTA were found in 18% of patients, were more strongly associated with age than with PTP, and were at least 2 times more frequent in men than in women across all age groups. These findings support the use of an age cut-off for anatomical vs. functional testing in men, and the use of CCTA as first line test in most women regardless of age.Proportion of patients suboptimal CCTA
Association of left ventricular geometry early after an acute coronary syndrome to long-term mortality
Authors: Greer C E , Adamson P D , Frampton C M , Pickering J W , Pilbrow A , Troughton R W , Doughty R N , Richards A M 
Published: November 2023

Abstract

Background
Markers of adverse left ventricular remodelling following myocardial infarction are associated with an increased risk of adverse events. Remodelling patterns can be classified using left ventricular mass index (LVMI) and relative wall thickness (RWT) into normal geometry, eccentric hypertrophy, concentric remodelling and concentric hypertrophy. In this analysis we evaluated the association between geometric classifications early after an acute coronary syndrome (ACS) and longer-term survival.

Methods
The Coronary Disease Cohort Study is a prospective multicentre observational cohort study. Between 2002-2010, 2140 ACS patients were recruited across New Zealand. Echocardiography and blood biomarker sampling were obtained at 1, 4 and 12 months of follow-up after ACS. Echocardiographic data from 1 month after ACS were analysed and patients classified into 4 groups based on geometry. The relationship between geometry and mortality at a median of 14 years follow up were evaluated using cox proportional hazards models after adjusting for demographics, clinical characteristics and biomarkers.

Results
Of 2140 patients, 401 (19%) had normal geometry, 747 (35%) concentric hypertrophy, 569 (26.5%) eccentric remodelling, 153 (7.1%) concentric remodelling, and 271 (12.7%) had incomplete data to classify. 874/2055 (43%) of participants had died at most recent follow up in 2022. Compared to those with normal geometry, the risk of death for patients with abnormal geometry was increased: concentric hypertrophy (hazard ratio [HR]:2.1; 95% confidence interval [CI]: 1.6 – 2.9); eccentric hypertrophy (HR: 1.7; 94% CI :1.3 – 2.4); concentric remodelling (HR: 1.7; 95% CI :1.1 – 2.6) after adjusting for baseline demographic, clinical, and biomarker covariates.

Conclusion
Abnormal left ventricular geometry documented one month after ACS portends an increased risk of death. Concentric hypertrophy carried the highest risk of death at long-term follow up.Unadjusted survival curves
Longer symptom onset-to-door time persists despite reductions in STEMI door-to-balloon time: insights from the victorian cardiac outcomes registry
Authors: Vasudevan S , Dinh D , Brennan A , Bloom J E , Dawson L P , Nehme Z , Lefkovits J , Bray J , Nicholls S J , Stub D , Nelson A J 
Published: November 2023

Abstract

Background
Prompt revascularisation is central to achieving optimal outcomes for patients presenting with ST-segment elevation myocardial infarction (STEMI). To enable this, health systems have traditionally focused on the ‘door-to-balloon’ (DTB) component of total ischaemic time, while comparatively less attention has been given to symptom ‘onset-to-door’ (OTD) time.

Objective
To determine the temporal trends, predictors and outcomes among patients with increased OTD time.

Methods
Consecutive patients with STEMI treated with percutaneous coronary intervention (PCI) across 30 hospitals in the Victorian Cardiac Outcomes Registry were analyzed between 2014 and 2020. Linkage with data from Ambulance Victoria was performed for all patients transported via emergency medical services. Trends in OTD and DTB time were evaluated with Cochrane-Armitage test of trend. Characteristics and outcomes of patients with longer OTD time (&gt;60 mins) were compared to those with shorter OTD time (&lt;60 mins). Multivariable predictors of longer OTD were determined with logistic regression and presented as odds ratio and 95%CI in a forest plot.

Results
A total of 13,494 patients underwent PCI for STEMI with median OTD time of 150mins (86,328) and median DTB time of 66mins (43,107). DTB time progressively reduced over the study period (p=0.001) while the proportion of patients with longer OTD did not change (90.3%, p=0.91). Patients with longer OTD time were more likely to be older (&gt;65yo = 41% vs. 35%, p&lt;0.001), female (22 vs. 16%, p&lt;0.001), live in a lower-socioeconomic area (36 vs. 28%, p&lt;0.001), be treated for diabetes (17 vs. 13%, p&lt;0.001), have developed their symptoms out-of-hours (65 vs. 60%, p=0.002) and present via ambulance [vs. self-present] (81 vs. 63%, p&lt;0.001). Multivariable predictors of longer OTD time are presented in forest plot below. Higher rates of new renal impairment (6.7 vs. 5.0%, p=0.024) and 30-day MI (1.5 vs. 0.7%, p=0.017) were observed among patients with longer OTD, as were numerical trends in new 30-day heart failure (1.4 vs. 0.9%, p=0.22) and in-hospital shock (5.9 vs. 4.7%, p=0.081).

Conclusion
No change in the proportion of patients presenting with longer onset-to-door times was observed despite a parallel reduction in door-to-balloon time over the study period. Increased community awareness and education on the symptoms of myocardial infarction, particularly targeted at high risk demographic groups, are needed to further reduce ischaemic times.
External validation of the myocardial-ischemic-injury-index: a machine learning algorithm for the early diagnosis of myocardial infarction
Authors: Lopez Ayala P , Boeddinghaus J , Nestelberger T , Strebel I , Koechlin L , Rubini Gimenez M , Miro O , Martin-Sanchez F J , Keller D , Mueller C 
Published: November 2023

Abstract

Introduction
The myocardial-ischemic-injury-index (MI3) is a machine learning algorithm derived in 2019 for the early diagnosis of type 1 non-ST-elevation myocardial infarction (NSTEMI). MI3 incorporates age, sex, and two high-sensitivity cardiac troponin I (hs-cTnI) Architecht measurements. The performance of the MI3 algorithm is unknown in a setting where the time difference between the first and second troponin measurement is less than 3 hours. Thus, external validation seems mandatory before this algorithm could be considered for clinical use.

Purpose
To externally validate the performance of the MI3 algorithm and compare its performance with the ESC 0/1h-algorithm, the recommended algorithm by the European Society of Cardiology NSTEMI guidelines.

Methods
In a multicentre international diagnostic study, we prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of MI. Final diagnoses were centrally adjudicated by two independent cardiologists using all available medical records, including cardiac imaging, serial hs-cTn and 90-days follow-up. Hs-cTnI (Architect) concentrations were measured in a blinded fashion at presentation and serially thereafter. The primary endpoint was type 1 NSTEMI during the index visit.

Results
Among 6487 patients with two available hs-cTnI concentrations, type 1 NSTEMI was the adjudicated final diagnosis in 882 (13.6%) patients. The median time difference between blood draws was 60 minutes (IQR: 57-70). Model performance was good, with a very high area under the receiver-operating-characteristic curve (0.961 [95% CI: 0.957-0.965]) and an optimal calibration overall (intercept -0.09 [-0.2-0.02]; slope 1.02 [0.97-1.08]), Figure 1. The originally defined low-probability MI3 score&lt;1.6 and high-probability MI3 score≥49.7 triaged 4186 (64.5%) patients towards rule-out (sensitivity 99.1% [98.2-99.5]; negative predictive value [NPV] 99.8% [99.6-99.9]) and 915 (14.1%) patients towards rule-in (specificity 95.0% [94.3-95.5]; positive predictive value [PPV] 69.1% [66.0-72.0]), respectively (Figure 2). Both the sensitivity and the NPV of the ESC 0/1h-algorithm were greater than of the MI3 algorithm (difference for sensitivity: 0.84% [0.18-1.51], P=0.008; difference for NPV: 0.18% [0.05-0.33], P=0.016). In contrast, the specificity and PPV for the MI3 algorithm were higher (difference for specificity: 3.85% [3.29-4.40], P&lt;0.001; difference for PPV: 7.82% [5.9-9.74], P&lt;0.001).

Conclusion
In patients with two hs-cTnI (Architect) measurements with a median time difference of 60 minutes, the MI3 algorithm showed a very high discrimination and good calibration for type 1 NSTEMI.Diagnostic performance MI3 algorithmCutoff performance of the MI3 algorithm