bluuebunny/crossref_metadata_2025_split huggingface dataset:
The importance of evaluation for living alone among acute myocardial infarction patients
Authors: Fukumoto D , Kanda D , Ohmure K , Sonoda T , Anzaki K , Ikeda Y , Ohishi M 
Published: November 2023

Abstract

Background
Assessment of the mortality risk in acute myocardial infarction (AMI) patients is crucial when making medical decisions because AMI is an important public health issue and a major cause of death worldwide. The Global Registry of Acute Coronary Events (GRACE) risk score is useful for estimating in-hospital mortality at the time of admission and is in wide use. On the other hand, in the rapidly aging societies of the modern era, social isolation and absence of support are important welfare issues. Among them, living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease.

Purpose
The purpose of this study was to investigate the association between living alone and cardiac deaths in AMI patients after percutaneous coronary intervention (PCI), and to determine whether this association was independent of GRACE risk score as a score that is widely used in clinical settings.

Methods
This study was a retrospective cohort study, investigating 277 consecutive AMI patients who underwent successful revascularization of the culprit lesion by primary PCI. Associations between cardiac deaths after PCI and baseline characteristics including living alone and GRACE risk score were assessed. Furthermore, this study also assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI).

Results
Median duration of follow-up was 1153 days (IQR, 560–1566 days). In this population, median age was 69 years (IQR, 59–77 years), and 198 patients (71%) were male. Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of cardiac deaths compared with patients not living alone (14% vs. 4%, p=0.004). The proportion of males differed significantly between living alone and not living alone groups (p=0.004). GNRI was significantly lower in the living alone group than in the not living alone group (p&lt;0.001 and p=0.048). GRACE risk score was significantly higher in the living alone group (median, 140; IQR, 107–170) than in the not living alone group (median, 127; IQR, 103–149; p=0.038). Multivariate Cox proportional hazards regression analysis models showed living alone (hazard ratio [HR], 4.17; 95% confidence interval [CI], 1.60–10.84; p=0.003), GNRI (HR, 0.94; 95%CI, 0.91-0.98; p=0.003), and GRACE risk score (HR, 1.03; 95%CI, 1.01-1.04; p&lt;0.001) were significantly associated with cardiac death after PCI. A comparison of p values for the interaction of GRACE risk score and either living alone and GNRI were p=0.082 and p=0.244, respectively.

Conclusions
The current study revealed that living alone represents an independent risk factor for cardiac deaths in AMI patients after PCI, separate from GRACE risk score. Evaluation of living arrangements may provide more information regarding prognosis for AMI patients.
Mendelian randomization identifies sex differences in pain manifestation of coronary artery disease
Authors: Methorst R , Jongbloed M R M , Noordam R , Deruiter M C 
Published: November 2023

Abstract

Background and aim
Clinical manifestation of atherogenic cardiovascular disease differs between men and women. Men often present with classical symptoms i.e., chest pain radiating to left arm and jaw. Women may show a wide range of symptoms considered atypical, including but not limited to back pain and nausea. Anatomical pathways feeding cardiac pain have not been properly characterized with respect to sex-related differences in human at population level.

Methods
We performed sex-stratified GWAS analysis on CAD as well as chest, neck and shoulder, back and facial pain using the UK Biobank cohort (men N = 203,823; women N = 239,631). To unravel given differences in pain manifestation of atherogenic cardiovascular disease in men and women, we performed Mendelian Randomization to approximate the causal associations between coronary artery disease (CAD) and a variety of pain locations.

Results
We identified 32 and 19 independent instrumental variables (R2&lt; 0.001, p-value 5x10-6) associated with CAD for men and women, respectively. MR analysis revealed potential causality between CAD and self-reported chest pain for men (OR: 1.33, CI: 1.25 – 1.41) and women (OR: 1.44, CI: 1.20 – 1.73) as well as a link between CAD and clinical chest pain for both sexes (men OR: 1.22, CI: 1.17 — 1.26; women OR: 1.31, CI: 1.18 — 1.46). MR displayed a relationship between CAD and back pain in women (OR: 1.35, CI: 1.03 — 1.66) but not in men (OR: 0.99, CI: 0.90 — 1.11, p-value difference: 0.036). Manifestation of neck and shoulder pain revealed a suggestive difference in causality between men and women (p-value difference: 0.051).

Discussion
Our study provided evidence supporting a causal association between CAD with manifestation of chest pain in both men and women. Additionally, no stronger effect in men was found contrary to clinical observations suggesting pain perception of the chest at population level could be similar between the sexes. Manifestation of back pain with CAD, however, showed a more causal effect in women compared to men. Here we show that pain perception of the heart is not limited to the chest in women at population level. Future research is required to identify what drives these differences at multiple levels.
Incidence of flow-limiting coronary artery stenoses in patients with diabetes - a coronary angiography natural history study
Authors: Rosen H C , Mohammad M A , Erlinge D 
Published: November 2023

Abstract

Background
Diabetes is an established risk factor for the development of coronary atherosclerosis. We sought to assess the association between diabetes and the incidence of coronary artery atherosclerosis progression on coronary angiography.

Methods
Using the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), we included all coronary artery segments with mild to no atherosclerosis defined as &lt;50% luminal obstruction in patients undergoing a first-time coronary angiography in Sweden between 1989 and 2017. Patients with two or more vessel disease were excluded as were patients with a previous history of coronary artery disease. In patients with one vessel disease, the diseased vessel including all its branches were excluded. Patients were followed for 15 years until a clinically indicated re-angiography was done, death occurred or end of follow-up (April 2018). The primary outcome was plaque progression to flow-limiting coronary artery stenosis defined as ≥50% luminal obstruction on repeat angiography assessed using epidemiological tables, Kaplan Meier event rates, and Cox proportional hazard models. The importance of selected risk factors (smoking, hypertension, hyperlipidemia, and established coronary artery disease) was assessed.

Results
A total of 2 661 245 coronary segments in 248 736 patients were included in the study. Diabetes was present in 30 533 patients and 320 815 coronary artery segments. Kaplan-Meier event rates and incidence rates (IR) per 1000 segment-years were higher in patients with diabetes (5.5%, IR 2.78 [95% CI 2.70–2.85] vs. 3.0%, 1.44 [1.42–1.46]) resulting in an almost two-folded hazard ratio (HR) of plaque progression (HR 1.93 [95% CI 1.87– 2.00]). The anatomical distribution of plaque progression was similar between the two cohorts on all levels of analysis (coronary artery level, main artery and branches level, and coronary segment level artery). Diabetic patients with established coronary artery disease had a significantly higher risk of future events compared to those without clinically significant coronary artery disease.

Conclusions
Diabetes was associated with an almost twofold higher incidence rate of plaque progression but did not appear to alter the anatomical location of plaque development compared to the absence of diabetes. Once coronary artery disease is established, the rate of atherosclerotic events accelerates. Therefore, adopting aggressive primary prevention strategies is crucial to reduce the risk of adverse outcomes in diabetic patients.Event rates and anatomical distributionProgression of stenoses by risk factor
Sex aspects of guideline-directed therapy in young ST- elevation myocardial infarction patients
Authors: Fischer A J , Feld J , Makowski L , Engelbertz C , Lange S A , Kuehnemund L , Guenster C , Droege P , Ruhnke T , Freisinger E , Gerss J , Reinecke H , Koeppe J 
Published: November 2023

Abstract

Background
Young women are at specific risk for a poor outcome after ST- elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in adherence to a guideline-directed drug therapy for secondary prophylaxis and to assess its effect on overall survival.

Methods
Administrative health insurance data (≈26 million members) was screened for patients 18- &lt; 60 years with STEMI from 01/2008 to 12/2018. Patient demographics, details on in-hospital treatment, long-term adherence to guideline-directed drug therapy and the effect on mortality was assessed.

Results
59,401 patients &lt;60 years (19.3 % women, median age 53 (IQR 48 - 56) were treated in-hospital with STEMI. Overall, adherence to a guideline-directed heart failure therapy decreased over time. 180 days post STEMI, 80.3 % of women and 82.9 % of men &lt;60 were on complete secondary prophylaxis with ACE/AT1 blockers, beta blockers, statins and a platelet activation inhibitor. Five years after the event, however, only 36.6 % of women and 40.9 % of men were under complete therapy. Similarly with a lower drug adherence, women showed a poorer outcome after STEMI with a 90-day mortality of 7.9 % compared to 6.4 % in men as well as a poorer overall survival (p&lt;0.001).
After adjustment for patients’ risk factors, there was a clear association between guideline directed therapy and overall survival. The positive association increased with the number of drugs taken. Moreover, sex-specific differences were specifically evident, if all four drugs were prescribed. The effect on overall survival of one heart failure drug was marginal and not sex-specific with a HR of 0.88 (95% CI 0.76-1.02) in women versus HR 0.91 (95% CI 0.84 - 0.99) in men (pint =0.707). Under complete guideline directed therapy, however, HR for overall survival was 0.22 (95% CI 0.19-0.26) in women versus HR 0.31 (95% CI 0.28 - 0.33) in men (pint &lt;0.001).

Conclusion
Long-term adherence to an optimal guideline-directed drug therapy after STEMI is generally low with specifically women &lt;60 years lacking a consistent therapy. The lack of consistent therapy is one aspect explaining the poor outcome after STEMI in younger women. Our data show, that women specifically benefit from a consistent secondary prophylaxis. As the underutilization of heart failure drugs is contributory to the unfavorable outcome in young female and male patients, systematic approaches and education of healthcare providers are needed to ensure the long-term use of heart failure drugs specifically in this patient cohort at risk.Kaplan-Meier estimatesCox regression analysis
GLP-2 predicts cardiovascular outcomes in patients with myocardial infarction and increases atherosclerosis in mice
Authors: Kahles F , Sausen M , Quintana L , Rueckbeil M , Idel P , Mertens R , Just S , Arrivas M C , Moellmann J , Biener M , Giannitsis E , Katus H A , Drucker D J , Marx N , Lehrke M 
Published: November 2023

Abstract

Background
GLP-1 and GLP-2 (glucagon-like peptide-1/2) are incretin hormones that are co-secreted from intestinal L-cells in response to food intake and inflammatory stimuli. While GLP-1 is known to induce postprandial insulin secretion and to improve cardiovascular outcomes in patients with diabetes, GLP-2 enhances intestinal nutrient absorption. GLP-2 agonists are clinically used for the treatment of patients with short bowel syndrome. The relevance of GLP-2 beyond the gut is not well understood. The aim of this study was to investigate the role of GLP-2 for cardiovascular disease (CVD).

Methods
Total GLP-2 levels were assessed at time of admission in 918 patients with myocardial infarction presenting with acute chest pain, among them 597 patients with NSTEMI and 321 with STEMI. The primary composite outcome of the study was the first occurrence of all-cause death, nonfatal myocardial infarction, or nonfatal stroke (3-P-MACE) with a median follow-up of 311 days. To induce atherosclerosis, Glp2r−/− or WT mice were injected with PCSK9 virus and fed a diet high in cholesterol (HCD) for 12 weeks.

Results
Kaplan-Meier survival plots (separated by the median of GLP-2 with a cut-off value of 4.4 pM) and univariable cox regression analyses found GLP-2 values to be associated with adverse outcome (3-P-MACE and all-cause mortality; logarithmized GLP-2 values HR: 2.87; p&lt;.0001). Further adjustment for age, sex, smoking, hypertension, hypercholesterinemia, previous CVD and diabetes mellitus did not affect this association (logarithmized GLP-2 values HR: 2.66; p=0.0055). Receiver operating characteristic curve (ROC) analyses illustrated that GLP-2 is a strong indicator for early events (area under the curve of the combined endpoint at 7 days: 0.74; 14 days: 0.76; 30 days: 0.76; 6 months: 0.72), which proved to be superior to Troponin T and hs-CRP. To asses the functional role of GLP-2 in CVD in an experimental approach we injected Glp2r−/− or WT mice PCSK9 virus (to induce functional Ldlr-deficiency and hypercholesterolemia) and fed these mice a HCD. After 12 weeks Glp2r−/− mice compared to WT littermates presented with a significant reduction in plaque volume and lesion size. While body weight and circulating leukocyte numbers (FACS analysis) were unaffected, Glp2r−/− mice had lower cholesterol levels.

Conclusion
Circulating GLP-2 levels are associated with cardiovascular events in patients with acute myocardial infarction while inactivation of the GLP-2 system reduces atherosclerosis in mice. Future studies are needed to investigate whether the GLP-2 receptor might provide a novel therapeutic target for cardiovascular disease.
Patients cancelled after initial activation for suspected STEMI via the ODiSEA APP, what happens 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
The use of technological innovation in STEMI care networks has been shown to be effective in sharing diagnostic ECG tracing and clinical information with the cardiology department, reducing the number of inappropriate cases transferred to the cathlab. These inappropriate cases have been shown to be more likely to die than those undergoing urgent coronary angiography, but data on incidence, cause of cancellation and prognosis are limited1.

Objective
Our aim was to investigate the characteristics and prognosis of patients in whom transfer to the cathlab was cancelled, compared with those who underwent emergent coronary angiography (EC).

Material and Methods
Prospective study analysing all STEMI alert activations during the year 2022. Information on ECG pattern and clinical history was transmitted using an APP (ODiSEA2,3). Based on the ECG pattern and clinical history, cancellations were made. Patient characteristics, myocardial infarction, ECG activation pattern, angiography results and in-hospital mortality were studied.

Results
A total of 406 infarction codes were activated through the ODISEA APP, of which 284 (70%) underwent EC and 122 (30%) were cancelled. The cancelled patients had a higher comorbidity than the transferred patients. The reasons for cancellation based on ECG patterns are shown in Figure 1. The most common were ST depression (23%), concave ST elevation (18.8%) and intraventricular conduction disturbances (22.9%).
In addition, coronary angiography was performed in 33% of the cancelled patients compared to 99% of the transferred patients (p&lt;0.001). The number of patients with coronary arteries without lesions was significantly higher in the cancelled group (31.7% vs. 9.6% p&lt;0.001). In the EC group, 90.5% of patients presented with a final diagnosis of ACS, whereas in the cancelled group this was 32.8% (final diagnosis of STEMI 2.5% in the cancelled group vs. 83.5% in the CE group, p&lt;0.001). Discharge from the emergency department was 46% in the cancellation group versus 2.7% in the transfer group (p&lt;0.001). Finally, the in-hospital mortality rate was significantly higher in the cancelled group: 14 patients (11.4%) vs. 12 patients (4.2%) in the transferred group (p&lt;0.001).

Discussion
Compared to patients who are transferred to a centre with cathlab, the subgroup of patients initially activated as STEMI alerts and eventually cancelled have a high comorbidity, a low probability of a final diagnosis of ACS and a high in-hospital.Table 1.Patients characteristicsFigure 1.ECG pattern
Deep learning-based quantitative image analysis for detecting coronary artery stenosis, calcification, and vulnerable plaque in coronary computed tomography angiography
Authors: Kim D 
Published: November 2023

Abstract

Purpose
To develop a quantitative image analysis for detecting coronary artery stenosis, calcification, and vulnerable plaque in reconstructed coronary computed tomography angiography.

Materials and Methods
2,978 reconstructed coronary artery CT angiography (CCTA) of our hospital in South Korea from 2014 to 2022 were enrolled. For each CCTA scan, a total of 13 images were reconstructed for each coronary artery (CA) by CT Cardiac Package, TeraRecon Inc. A total of 769 CT images were independently selected as the test data set in the last period, while the remaining were utilized in a 4:1 ratio as train and validation datasets. The locations of stenosis and vulnerable plaques were strongly labeled by an expert radiologist with more than 10 years of experience to train a 2D segmentation model (SM). First of all, the correlation between a quantitative stenosis index (QSI) and conventionally measured quantitative angiographic analysis (QCA) was evaluated. We developed an SM for CA and stenosis using 2D nnU-Net. Using SM, the position and length of stenosis per image were evaluated, and a CA diameter profile was analyzed through Full Width at Half Maximum analysis. The QSI is acquired through the calculation of the CA diameter profile. Secondly, images with marked calcifications and calcification scores (CS) were evaluated by an expert cardiologist with more than 15 years of experience. The CS was calculated by measuring the number of voxels over 1100 Hounsfield units in the CA using the previously developed vascular SM. The result of CS was evaluated by visual scoring of the expert cardiologist with a 10-scale. Lastly, the presence or absence of vulnerable plaques per CA was evaluated. In addition, another SM for normal CA and vulnerable plaques were trained. For the evaluation method, sensitivity and specificity were calculated for each CA.

Results
The correlation between QSI and QCA was 0.715. Visual scoring on the result of CS was 7.150 ±2.354 to 10. The sensitivity and specificity of the vulnerable plaque for evaluating vascular unit classification were 0.929 and 0.910, respectively. Conclusions We developed an automated quantitative image analysis for evaluating QSI, detecting calcification, and vulnerable plaque in CCTA, which could be used in the actual screening setting.
The specificity of cardiac troponin elevations for myocardial infarction declines with age
Authors: Hasselbalch R , Sindet-Pedersen C , Pries-Heje M , Strandkjaer N , Kristensen J H , Porsborg Andersen M , Torp-Pedersen C , Bundgaard H , Iversen K 
Published: November 2023

Abstract

Background
Cardiac troponin T (cTnT) and I (cTnI) are the gold standard biomarkers of myocardial infarction (MI). Studies have shown that the concentration of cTn increases with age among healthy individuals, but the clinical impact of this is unclear. Further, there seem to be a difference in the increases in cTnI and in cTnT - the latter being more sensitive to increasing age.

Purpose
To investigate the impact of age on the diagnostic ability of cTnT and cTnI for myocardial infarction.

Methods
This nationwide cohort study includes patients admitted with cTn measurements from 2009-2022 using one of five cTn assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott Alinity high sensitivity cTnI (hs-cTnI), Siemens Vista Hs-cTnI, Siemens Atellica hs-cTnI and Beckman-Coulter hs-cTnI. We selected the peak concentration of cTn on admission and grouped patients into those who had cTnI and those who had cTnT measured which were divided into age groups of &lt;40 years, 40-50 years, 50-60 years, 60-70 years, 70-80 years, 80-90 years and &gt;90 years. The primary outcome was a diagnosis of MI during admission. Receiver operating characteristics (ROC) were used for the concentration of cTn normalized to the assays 99th percentile, and we explored the specificity of elevations of each assay above the 99th percentile.

Results
A total of 350,428 patients were included in this study with a median age of 67 years (IQR 52-77); 188,382 (54%) were males and 48,262 (14%) had a history of ischemic heart disease prior to the admission. When grouping for type of cTn used, more patients were treated when hs-cTnT (240,660, 69%) was used compared with hs-cTnI (109,768, 31%). The patient treated using hs-cTnT were slightly older than patients treated with hs-cTnI, 67 years (IQR 53-77) vs 65 years (53-77) p&lt;0.001.
During the admission 29,023 patients (8.3%) had a MI. Figure 1 panel A shows the ROC curve of hs-cTnT and hs-cTnI for each age group. Both biomarkers showed a decline in the area under the curve (AUC) with increasing age. Figure 1 panel B shows the AUC for each age group. Hs-cTnI had a higher AUC for all age groups and seemed to decrease less with age. Figure 2 shows the specificity for the 99th percentile of each assay for the age groups. There were substantial differences in the specificity at the 99th percentile between cTn assays, with the cTnT assay being the least specific for all age groups, while the two Siemens assays had the highest specificity. An elevation above the 99th percentile of the cTnT assay had a specificity of 3% in the group of patients &gt;90 years old.

Conclusion
The specificity of elevation of cTn for MI declined with increasing age for all assays. This decline seemed to be largest for the cTnT assay were an elevation above the 99th percentile among patients &gt;90 years old had a specificity of 3% for MI.Figure 1Figure 2