bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of symptoms recognition in patients with recurrent acute myocardial infarction: from KRAMI-RCC
Authors: Kim K , Kim H R , Koh J S , Kang M G , Park J R , Hwang J Y 
Published: November 2023

Abstract

Background
Clinical significance of self-recognition for myocardial infarction symptom in the general population has been well-known. However, evidence of self-recognition for ischemic symptoms in patients with recurrent myocardial infarction is limited. The study is aimed to verify the association between self-recognition and clinical characteristics, and clinical outcomes in patients with recurrent myocardial infarction.

Method
From 2016 to 2019, the Korean Registry of Acute Myocardial Infarction for Regional Cardiocerebrovascular Centers (KRAMI-RCC), a web-based registry for myocardial infarction in South Korea, was used. We divided into two groups based on self-recognition in questionnaire. Patient characteristics and clinical outcomes were analyzed.

Result
Among 11,894 MI patients, the rate of recurrent MI was 9.7%. The rate of self-recognition in subjects with first MI and recurrent MI was 14.4% and 52.0%, respectively (p&lt;0.001). Patients without responses to the self-recognition questionnaire were excluded (n=86). Finally, enrolled subjects were 1,050. Males had a higher rate of self-recognition (79.3% vs. 69.0%). Younger patients, higher graduation levels, and living with a spouse were associated with the well-recognized symptoms. Chest pain, cold sweating, and radiating pain were related to being noticed as a symptom of MI. However, no difference of respiratory difficulties and stomachache in both groups was observed. The unrecognized group had more frequently occurred with cardiogenic shock and heart failure. A history of stroke and malignancy was associated with a low incidence of recognition. Patients with dyslipidemia had a high recognition rate. There was no difference of symptom recognition between ST elevation MI and non-ST elevation MI.
Interestingly, previously registered patients in KRAMI-RCC were significantly associated with higher recognition. The symptom recognition was related to prompt visit in regional cardiovascular centers (57% vs. 47%, p=0.002). The in-hospital mortality rate in the unrecognized group was higher at 6.7% compared to the recognized group (1.5%, p&lt;0.000). Unrecognized MI symptoms and a presentation with cardiogenic shock were independent predictors in multivariate analysis to predict a model for in-hospital mortality.

Conclusion
The MI symptom recognition rate was still low in patients with recurrent MI. Self-recognition of MI symptoms was an independent predictor for in-hospital mortality. In this study, it is thought that rapid symptom recognition might help patients with myocardial infarction visit the hospital as soon as possible, thereby reducing cardiogenic shock and death.Multivariable analysisSelf-recognition and Outcomes
Consensus on the diagnosis and management of patients with type 2 myocardial infarction: an international Delphi study
Authors: Taggart C , Ferry A , Chapman A R , Bularga A , Wereski R J , Boeddinghaus J , Eggers K , Thygesen K , Lindahl B , Mills N L 
Published: November 2023

Abstract

Background
Type 2 myocardial infarction occurs due to a reduction in myocardial oxygen supply or an increase in demand without evidence of atherosclerotic plaque rupture. It is common representing around 20% of myocardial infarctions (1-4). Outcomes are poor with up to one third alive at five years, with cardiovascular outcomes comparable to type 1 myocardial infarction (1,5,6). Despite this, there are no evidence-based guidelines to guide assessment and management for clinicians.

Purpose
To gain consensus on the assessment and management of type 2 myocardial infarction from an international group of experts.

Methods
A systematic review of type 2 myocardial infarction was undertaken to identify the corresponding or senior author of all original research studies. We identified 73 experts from multiple clinical specialties. A three-round international eDelphi study was circulated, with round one consisting of open questioning to generate statements for deductive analysis. Consensus was defined a priori as &gt;70% agreement on a 5-point Likert scale. Statements for which no consensus could be obtained were adapted and recirculated in round three (Figure 1).

Results
Of the 68 experts contacted there was a 56% (38/68), 54% (37/68) and 72% (49/68) response rate in round one, two and three, respectively. Consensus was achieved on 64% (43/67) of statements. Consensus varied across the following domains i) definition and diagnosis 42% (5/12), ii) risk stratification 75% (3/4), iii) assessment of coronary artery disease and cardiac function 50% (9/18), iv) specialty management 60% (6/10), v) treatment and secondary prevention 100% (9/9) and vi) communication and rehabilitation 79% (11/15). The panel agreed that all patients should undergo echocardiography (mean [SD] 2.08 [1.23]) and CT coronary imaging or a functional test should be performed on those with intermediate probability of future cardiovascular events (mean [SD] 1.81 [0.52]). Over 90% of the panel agreed that both patient and clinician understanding of type 2 myocardial infarction was poor and that further randomised controlled trials are need to direct care.

Conclusion
There remains uncertainty regarding the current definition of type 2 myocardial infarction and overall patient and clinician understanding was thought to be poor. However, it is generally accepted that the mainstay of management should be on the identification of coronary artery disease and left ventricular impairment with optimisation of therapies with proven benefit. Management should involve an individualised assessment and the multidisciplinary team.
LUV Score - a combination of bedside lung ultrasound and velocity-time integral (VTI) to predict mortality risk in STEMI patients
Authors: Pinheiro Machado G , Heiden Telo G , Barbato Da Rosa J P , Martins A , Azeredo W , Chies A , Nassif M , Da Silva J , Neves De Araujo G , Silveira A , Wainstein R , Wainstein M 
Published: November 2023

Abstract

Background
Early risk stratification is essential for in-hospital management of ST-segment–elevation myocardial infarction (STEMI). Development of acute heart failure and pulmonary edema is associated with poorer prognosis in this setting. Velocity–time integral (VTI) estimates stroke volume and cardiac output and has never been tested in acute coronary syndromes.

Purpose
Our aim was to evaluate the prognostic ability of a novel cardiothoracic ultrasound protocol for hemodynamic assessment with lung ultrasound (LUS) and VTI in patients with STEMI.

Methods
LUS and VTI were performed within 24h of admission for STEMI. LUS consisted of 8 scanning zones. A LUS combined with VTI (LUV) classification was developed. Receiver operating characteristic (ROC) analyses were performed to assess LUV score with in-hospital mortality, and it was compared with traditional Killip classification.

Results
From September 2022 and January 2023, 104 consecutive patients were admitted with ST-segment–elevation myocardial infarction. Fifteen patients were excluded from the analysis because were not assessed within 24h of admission. Therefore, 89 patients were included in the final analysis. Mean age was 62 years, 59% were male, 55% had hypertension, 32% had diabetes, 43% was anterior wall myocardial infarction and 16% had Killip 3 or 4 at admission. Overall in-hospital mortality was 7.9% and mortality across LUV categories were 0%, 0%, 8% and 50% for LUV A-D, respectively. A VTI ≥ 14 implied a negative predictive value for in-hospital mortality of 100%. The area under the ROC curve of LUV classification for in-hospital mortality was 0.92 (P=0.001), and Killip classification (0.85, P&lt;0.001; P=0.48 for the difference between curves – Figure 1). Incidences of culprit vessel according to LUV categories are illustrated at Figure 2. There were no left main culprit vessel in our sample.
The distribution of Cardiac Output (CO) and Cardiac index (CI) and Cardiac Power Output (CPO) were the following: LUV A: CO = 4.5 (1.2), CI = 4.0 (1.1) CPO = 0.9 (0.3); LUV B CO = 3.8 (0.9) CI = 3.4 (0.8) CPO = 0.7 (0.2); LUV C CO = 3.3 (0.8) CI = 3.0 (0.8) CPO = 0.6 (0.1) ; LUV D CO = 2.9 (0.7) CI = 2.7(0.5) CPO = 0.5(0.1).

Conclusions
In a cohort of patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention, LUV score provided an excellent AUC for prediction of in-hospital mortality. LUV score is an easy, noninvasive, rapidly acquired, and accurate method for risk stratification in STEMI patients.
Predictive values of age shock index and age modified shock index for in-hospital mortality in patients with ST-segment elevation myocardial infarction
Authors: Lyu S , Zhu J , Wang J , Wu S , Yang Y 
Published: November 2023

Abstract

Background and Purpose
This study aimed to evaluate the predictive values of admission age shock index (age SI) and age modified shock index (age MSI) for short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI).

Methods
7324 patients with STEMI were included in the present study. Shock index (SI), modified shock index (MSI), age SI, age MSI and the TIMI score were calculated on admission. The primary outcome was all-cause mortality and the secondary outcomes were recurrent MI, cardiogenic shock and major adverse cardiovascular events (MACEs) during 30-day follow-up. Univariate and multivariate Cox regression were performed to evaluate the association between age SI, age MSI and outcomes. Predictive values of SI, MSI, age SI, age MSI and the TIMI score were evaluated and compared through analysis of the receiver operating characteristic (ROC) curves and integrated discrimination improvement (IDI).

Results
According to the ROC curve, the best cutoff of age SI for 30-day all-cause mortality were 50.0. Patients with elevated age SI had more comorbidities, received less evidence-based treatments and carried worse 30-day mortality. Multivariate Cox regressions demonstrated that age SI and age MSI were independent predictors of 30-day all-cause mortality and MACEs. The predictive values of age MSI for 30-day mortality were comparable to that of the TIMI score (c statistic: 0.743 vs. 0.758, z=1.740, p=0.082; IDI: 0.011, p=0.055) and better than that of SI (c statistic: 0.743 vs. 0.660, z=14.317, p&lt;0.001; IDI: 0.046, p&lt;0.001). The prognostic performance of age MSI was slightly inferior to that of the TIMI score (c statistic: 0.741 vs. 0.758, z=2.060, p=0.039; IDI: -0.001, p=0.846).

Conclusion
Age SI and age MSI were independent predictors for 30-day all-cause mortality and MACEs in patients with STEMI. The predictive value of age SI was comparable with the TIMI score but better than SI. Age SI and age MSI are practical risk stratification tools for STEMI.Figure.Receiver operating characterisTable.Discrimination and Calibration
Prognostic impact of ventricular tachycardia/fibrillation timing on cardio-vascular death in STEMI patients: 5 years of follow-up
Authors: Kozhukhov S , Parkhomenko A , Irkin O , Lutay Y A , Dovganych N 
Published: November 2023

Abstract

Objectives
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening arrhythmias that have negative impact on prognosis. This study investigated the relationship between the timing of VT or VF and long-term prognosis among ST-elevation myocardial infarction (STEMI) patients.

Background
It is unknown whether the timing of VT/VF occurrence affects the prognosis of patients with STEMI.

Methods
From 2001 to 2011 among 1621 STEMI patients (mean age 54,4±9,3 years) who participated in a prospective study, 221 (13.6%) had VT/VF during in-hospital stay. The mean time from STEMI symptoms onset was 4,5±0,1 h. 632 patients underwent TLT (39.0%), 267 (16.5%) - primary PCI. 772 (44,5%) patients did not undergo revascularization due to spontaneous recanalization or late admission. Patients with VT/VF were divided into two groups: early VT/VF - within 24 hour (h) of admission, 154 patients and late VT/VF - &gt;24 h after admission, 67 patients. Patients have been monitored for 5 years of follow-up (FU). Cardiovascular (CV) death was the primary end-point.

Results
Patients with VT/VF were more likely to have cardiogenic shock, Killip Class II-III, AV block, and recurrent MI. Among STEMI patients the frequency of VT/VF occurrence was higher in patients with TLT – 19,0% and PTCA - 15,0% in compare to those without revascularization - 7,9%. However, the late VT/VF was 3.4 times less frequent among patients with TLT, 2.9 times - in PTCA, and twice less in patients without revascularization, compared to patients with early VT/VF. During FU long-term mortality has differed (Fig. 1). Kaplan-Mayer curves have significantly separated in late VT/VF group (p&lt;0.01) during the first year (Fig. 2). Independent predictors of CV death in STEMI patients with late VT/VF were: higher Killip class (OR: 1.372, 95%CI 1.023-2.174, p&lt;0.01), and higher peak CK-MB (OR: 1.031, 95% CI: 1.014-1.048, p&lt;0.05).

Conclusions
VT and VF are frequent complications in STEMI and are powerful and independent predictors of 5-year survival. The timing of VT/VF occurrence had a peak during the first 24 h. However, patients with late VT/VF are at high risk of CV death in long-term FU and therefore require an individualized approach.
Adjunctive cilostazol in patients with acute ST-elevation myocardial infarction: a multicenter, randomized, open-label, phase 4 trial
Authors: Park S , Rha S W 
Published: November 2023

Abstract

Background/Aims
Previous studies showed that triple antiplatelet therapy (TAT), involving the addition of cilostazol to conventional dual antiplatelet therapy (DAT; aspirin + clopidogrel), has better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) than that with DAT; however, the optimal duration of TAT has not yet been determined.

Methods
Altogether, 985 patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DES) were prospectively enrolled in 14 medical centers in Korea. We randomly assigned patients into three groups: DAT (aspirin and clopidogrel for 12 months), TAT 1M (aspirin, clopidogrel, and cilostazol for 1 month), and TAT 6M (aspirin, clopidogrel, and cilostazol for six months). The primary endpoint was 1-year major adverse cardiovascular events (MACEs), defined as the composite of all-cause death, recurrent myocardial infarction (MI), stroke, or repeat revascularization.

Results
The primary endpoint was not different among the three groups (8.8% in the DAT, 11.0% in the TAT 1M, and 11.6% in the TAT 6M; hazard ratio for TAT 1M vs. DAT, 1.302; 95% confidence interval [CI], 0.792–2.141; p=0.297; hazard ratio for TAT 6M vs. DAT, 1.358; 95% CI, 0.829–2.225; p=0.225). With in-hospital outcomes, more bleeding events occurred in the TAT group than in the DAT group (1.3% vs. 4.7% vs. 2.6%, p=0.029) without significant differences in major bleeding. Besides, the TAT groups had higher incidence of headache (0% vs. 1.6% vs. 2.6%, p=0.020).

Conclusions
The addition of cilostazol to the DAT did not reduce the incidence of 1-year MACE compared to that with DAT alone. Instead, it may be associated with an increased risk of cumbersome side effects such as in-hospital bleeding and headaches.
Impact of the size-dependent difference of excimer laser coronary angioplasty in ST-elevation acute myocardial infarction; nuclear scintigraphy findings
Authors: Shibata N , Ohi T , Morita Y , Kanzaki Y , Watanabe N , Yoshioka N , Arao Y , Miyazawa H , Shimojo K , Goto H , Karasawa H , Nakagawa Y , Morishima I 
Published: November 2023

Abstract

Background
Excimer laser coronary angioplasty (ELCA) is reported to provide a good percutaneous coronary intervention (PCI) outcome. The current lineups of laser catheter sizes are 0.9-mm, 1.4-mm, and 1.7-mm catheter diameters. Although the cross ability and irradiation time is better in smaller catheter size, the available irradiation area is more significant in larger catheter size; however, it is unknown the difference in laser catheter size impacts good results in patients with ST-elevation myocardial infarction (STEMI).

Aim
To investigate the relationship between the laser catheter size and clinical outcome in patients with STEMI.

Methods and Results
We retrospectively enrolled 123 consecutive patients with STEMI who underwent primary PCI (median age: 67 [69-72] years, male: 102 [82.9%]). Patients were divided into 0.9-mm-catheter diameter group (small group, n = 47) and 1.4/1.7-mm-catheter diameter group (large group, n = 76). The patients’ characteristics, procedural results, peak creatine kinase/ creatinine kinase-myocardial band, final thrombolysis in myocardial infarction flow, and periprocedural complications were collected. Furthermore, from nuclear scintigraphy data based on a 17-segment model with a 5-point scoring system, which was calculated via the difference between 123I-BMIPP at 3-7 days and 99mTc-tetrofosmin at 3-6 months following PCI, the improvement of ejection fraction (EF) and myocardial salvage through summed rest score (SRS) were investigated.
There was no significant difference in patients’ characteristics, PCI procedure, and results between the two groups. The occurrence of coronary slow flow was similar between the two groups. On the other hand, nuclear scintigraphy data demonstrated that the improvement of EF and SRS were significantly better in the small group (EF; 13.3% vs. 7.6%, p=0.016, SRS; 18 vs. 5, p=0.012, respectively).

Conclusions
The nuclear scintigraphy findings showed that ELCA with small catheter size is feasible in patients with STEMI.Figure 1
Cancelled STEMI patients: what happen to them?
Authors: Martin Dominguez C , Palacios J C , Agudelo V , Rodriguez A , Aguilo O , Perez V , Diaz G , Gaitan E , Martinez J M , Vicente M , Brugada R , Aboal J 
Published: November 2023

Abstract

Introduction
In the STEMI care network, the number of inappropriate cases sent to cathlab remains high 1. The use of technological innovations to share the diagnostic ECG tracing with the cardiology department has been shown to be effective in improving patient discrimination.

Objective
Our aim was to study the characteristics and prognosis (at discharge and 1-year follow-up) of patients whose transfer to the cathlab was cancelled.

Material and Method
Prospective study analysing all STEMI alert activations in 2022. Information on ECG pattern and clinical history was transmitted using an APP (ODiSEA 2-3) and used for cancellation. Patient characteristics, myocardial infarction, ECG activation pattern, angiography results, final diagnosis and clinical events during admission and 1-year follow-up were recorded. Patients who underwent urgent coronary angiography were excluded from the study.

Results
A total of 406 infarction codes were activated through the ODISEA APP. 122 (30%) of these were cancelled. The characteristics of the patients are shown in Table 1.
Reasons for cancellation based on ECG pattern are shown in Figure 1.B. The most common were ST depression (23%) and intraventricular conduction disturbances (22.9%). The final diagnosis was ACS in 32.8% (STEMI 2.5%, NSTEMI 27% and unstable angina 3.3%). In the remaining 67.2%, the final diagnosis was atypical chest pain with negative biomarkers in 22.9%, arrhythmia in 17.2%, pericarditis in 9%, gastrointestinal pathology in 4.9%, heart failure in 4.9%, aortic dissection in 3.2%, PTE in 1.6% and other pathologies in 3.5%. (Figure 1.A).
Coronary angiography was performed in 41 patients (33.6%). There were 36.6% with one vessel, 9.8% with two vessels and 22% with three vessels. Percutaneous revascularisation was required in 70% of patients.
Discharge from the emergency department occurred in 46% of the patients. Hospital mortality occurred in 14 patients (11.4%). Of these, 3 (2.4%) were due to cardiac causes. Regarding events at 12 months, 6 (4.9%) were deaths (5 natural deaths and 1 due to cancer). 5 patients (4%) had ACS, 3 patients (2.4%) had stroke and 1 patient (0.8%) had digestive bleeding.

Conclusions
STEMI alert cancelled transfer patients are older, have more comorbidities and are less likely to have a final diagnosis of ACS or to have coronary lesions. They have a high rate of non-cardiovascular in-hospital mortality and a low rate of cardiovascular events at one year of follow-up.A.Final diagnosis. B. ECG patternTable 1.Patients characteristics
Long-term prognostic value of white blood cell count variation during hospital stay in patients with STEMI
Authors: Boukhris M , Dierx Molie C , Chenard P , Gourceyrol A , Gasnier A , Pradel V , Virot P , Aboyans V 
Published: November 2023

Abstract

Background
In patients with ST-elevation myocardial infarction (STEMI), white blood cell count (WBCC) is associated with infarct size and cardiovascular outcome. We sought to determine the impact of WBBC variation (∆WBCC) during hospital stay on the long-term outcome after STEMI.

Methods
From 06/2011 to 12/2019, consecutive patients referred for STEMI were enrolled. Those with at least two WBCC during hospitalization were included in this study. ∆WBCC was calculated as: [WBCC (admission) – WBCC (before discharge)]. The population was divided into 3 groups according to ∆WBCC tertiles. The primary outcome was all-cause mortality.

Results
A total of 1782 patients (mean age 64.5 ±14.1 years, 75.7% males), were included and divided in 3 groups: Group 1 (∆WBCC&lt;880/mm3); Group 2 (∆WBCC 880-3265/mm3); and Group 3 (∆WBCC &gt;3265/mm3). Patients in Group 1 were the oldest (67.9±13.8, vs. 65.1±13.9 and 60.5±13.7 years in Groups 2 and 3 respectively, p&lt;0.001). Hypertension, prior coronary artery bypass and cancer were more prevalent in Groups 1 and 2. Troponin peak was the highest in Group 3 (3601±563, vs. 2810±439 and 2451±467 ng/ml in Groups 1 and 2, respectively; p&lt;0.001).
The 5-year survival was the lowest in Group 1 (78.5% vs. 87.4% and 87.5% in Group 2 and 3, respectively; p&lt;0.001) (Figure). Adjusted to age, gender, cardiovascular risk factors, MI territory and left ventricular ejection fraction, ∆WBCC&lt;0.880/mm3 was independently associated with all-cause mortality [HR 1.46; 95%CI 1.12-1.91; p=0.005].

Conclusion
Low variation of WBCC (∆WBCC&lt;880/mm3) is associated with increased mortality, and can represent an interesting prognostic tool in STEMI patients.