bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sonothrombolysis delivered before percutaneous coronary intervention improves myocardial salvage in ST elevation myocardial infarction
Authors: Nirthanakumaran D , Jeyaprakash P , Pathan F , Sivapathan S , Madronio C , Yu C , Ozawa K , Nundlall N , Hallani H , Madan K , Khor L , Loh H , Negishi K 
Published: November 2023

Abstract

Background
Sonothrombolysis (STL) is the application of high mechanical index ultrasound whilst infusing an ultrasound contrast agent. Prior studies have shown that STL delivered pre & post primary percutaneous coronary intervention (pPCI) can reduce infarct size, and improve myocardial salvage in the setting of ST Elevation Myocardial Infarction (STEMI). However, it remains unclear whether this benefit is proportionately dependent on the amount of STL delivered, and whether the timing of STL relative to pPCI is important.

Purpose
To determine if there is a dose and time dependent relationship between sonothrombolysis delivery and myocardial salvage in patients presenting with STEMI.

Methods
We conducted a double-blind, pilot randomised controlled trial of STEMI patients (symptoms &lt;6 hrs, age 30-80). Patients were randomised (1:1:1) into 3 arms; Group 1 received STL pre & post pPCI, Group 2 received sham echo pre and STL post pPCI, while Group 3 received Sham echo pre and post pPCI. Measured endpoints were Infarct Percent and Myocardial Salvage Index (MSI) assessed with CMR at day 4±2 and 6±1 months. We performed a regression analysis using R Version 4.2.2 to determine if the number of delivered STL cycles were associated with an improvement in myocardial salvage.

Results
51 patients (Age 60, Male 82%) were recruited into Group 1 (n=16), Group 2 (n=19) or Group 3 (n=16). MSI was higher in Group 1 (79% [64, 85]) than Group 2 (51% [45, 70]) and Group 3 (48% [37, 73]) (p=0.047). Regression analysis (Figure 1) showed a non-significant trend towards improved myocardial salvage with more delivered cycles (β=0.32 [95%CI -0.15, 0.80]). Subgroup analyses of post pPCI STL (Figure 2) shows a fixed and sustained benefit in myocardial salvage with pre & post pPCI STL delivery, compared to post pPCI STL delivery alone. Given the regression lines for Group 1 and 2 are approximately parallel, we compared alpha intercept values to determine that pre & post PCI STL conferred an additional 17 percentage points (75% versus 58%) of myocardial salvage compared to post pPCI STL alone. No major adverse cardiac events occurred amongst included participants.

Conclusion
Pre pPCI sonothrombolysis appears to be an essential component of improving myocardial salvage in the REDUCE Pilot trial, and may improve myocardial salvage by an additional 17% compared to post pPCI STL alone. This benefit is independent of post pPCI sonothrombolysis duration.Figure 1:The relationship between numbeFigure 2:Group 1 and Group 2 sub-analys
Prevalence and outcome of clinical misdiagnosis of non-ST-elevation myocardial infarction
Authors: Boeddinghaus J , Sanzone A , Lopez-Ayala P , Koechlin L , Nestelberger T , Rubini Gimenez M , Wildi K , Keller D , Miro O , Christ M , Mueller C 
Published: November 2023

Abstract

Background
The prevalence of clinical misdiagnosis of non-ST-elevation myocardial infarction (NSTEMI) and its impact on patient outcomes is largely unknown.

Methods
We prospectively enrolled adult patients presenting with suspected acute coronary syndromes at 12 sites in five European countries. All patients provided written informed consent and were managed as per local clinical care using conventional, sensitive or high-sensitivity cardiac troponin (hs-cTn) assays. Study blood samples were taken at presentation and serially thereafter for measurements of hs-cTn concentrations. Final diagnoses were adjudicated by two independent cardiologists according to current guidelines and the 4th universal definition of myocardial infarction using all information including serial hs-cTnT measurements and imaging. The primary diagnostic endpoint was the prevalence of clinical NSTEMI misdiagnosis. Co-primary prognostic endpoints were 30 day and two year all-cause and cardiovascular (CV) death.

Results
In 7,678 patients (median age 61 [IQR 48-73], 34% women), the prevalence of adjudicated and clinical NSTEMI was 17.8% and 12.3%, respectively (P&lt;0.001). Among 1,363 patients with an adjudicated NSTEMI (77% type 1 MI, 23% type 2 MI), 470/1,363 (34%) had a clinical NSTEMI misdiagnosis. These patients were older, more often female, had lower median cTn concentrations, and were more likely managed at centers using non-hs-cTn assays at time of enrolment. Compared to patients with an adjudicated and clinical NSTEMI diagnosis, missed patients were less likely to undergo coronary angiography or revascularization and less often discharged on evidence-based treatment (dual antiplatelet therapy 24% vs 79%, statin 64% vs 92%, betablocker 68% vs 81%, all P&lt;0.001). Finally, patients with a clinical NSTEMI misdiagnosis were at much higher risk of premature all-cause (HR 1.51, 95% CI 1.18-1.94, P&lt;0.001) and CV (HR 1.93, 95%CI 1.42-2.63, P&lt;0.001) death.

Conclusion
One out of three adjudicated NSTEMI patients was misdiagnosed in routine clinical care. Clinical NSTEMI misdiagnosis was associated with lower use of guideline-recommended therapies and a substantial increase in premature death.Alluvial plotAll-cause death at 2-years
Hospital discharge after uncomplicated ST elevation acute myocardial infarction: How early is safe?
Authors: Certo Pereira J , Presume J , Ferreira J , Trabulo M , Tralhao A , Almeida M , Mendes M 
Published: November 2023

Abstract

Background
International guidelines recommend that hospital discharge within 48–72h is appropriate in selected low-risk patients admitted for ST elevation acute myocardial infarction (STEMI).

Objectives
To assess the safety of hospital discharge after 24 hours of admission in patients with uncomplicated STEMI submitted to primary percutaneous coronary intervention (PPCI).

Methods
We conducted a single-centre retrospective study enrolling consecutive patients admitted for STEMI from 2016 to 2018 submitted to PPCI. We defined clinically uncomplicated STEMI (UMI) as the absence of cardiorespiratory arrest, mechanical complications, tachy- and bradyarrhythmias, heart failure (Killip class &gt; 1 [HF]), reinfarction and types 2 or 3 Bleeding Academic Research Consortium. Additionally, we included the criterion of preserved left preserved ejection fraction (LVEF&gt;50%). Patients referred for coronary surgery (CABG) were excluded. Cumulative rates of death and clinical events defining UMI were reported at days 1, 2, 3, and 4. Death, clinical events defining UMI or repeat coronary revascularization at 1-year were reported after days 1, 2, 3, and 4.

Results
A total of 356 patients submitted to PPCI were included, with 64±14 years, 73% male. Median in-hospital stay was 4 [3;7] days. Applying UMI criteria we identified 271 patients (76%) in day-1, 249 (70%) in day-2, 244 (69%) in day-3, and 240 (67%) patients in day 4. Using UMI criteria, discharge after day 1 would be associated with 2.0% of early clinical events, 1.6% after day-2, and 1% after day-3. Post-discharge 1-year incidence of death, clinical events defining UMI or repeat coronary revascularization was roughly similar after day-2 (Table). Adding LVEF&gt;50% to UMI, we identified 176 patients (49%) in day-1, 168 (47%) in day-2, 165 (46%) in day-3 and 164 (46%) in day-4. Discharge after day 1 would be associated with 1.8% of early clinical events, 0.6% after day-2 and 0.6% after day-3. Post-discharge 1-year incidence of death, clinical events defining UMI or repeat coronary revascularization was similar after day-2.

Conclusions
In our cohort of patients with STEMI submitted to PPCI, clinically uncomplicated criteria identified 69% of patients eligible for safe discharge after day-3. The addition of preserved left ventricular ejection fraction criterion can anticipate a safe discharge after day-2 in almost 50% of patients.
Association of myocardial infarction with nonobstructive coronary arteries with in-hospital outcomes
Authors: Tao M , Miller A , Price J , Dhaliwal S , Masson R , Rahman T , Bench T J , Pyo R 
Published: November 2023

Abstract

Background
Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) is a disease classification that is not uncommonly encountered yet poorly characterized. The association of MINOCA with in-hospital cardiovascular outcomes has been inconsistently assessed with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of MINOCA with in-hospital cardiovascular outcomes.

Methods
A literature search was conducted for studies reporting on the association of MINOCA with clinical endpoints as compared to obstructive coronary artery disease (OCAD). The primary end-point was in-hospital mortality. Secondary endpoints included cardiogenic shock (CS) on admission and congestive heart failure (CHF) during hospitalization. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results
19 studies with 851,886 patients who had acute myocardial infarction (AMI) (45,475 patients with MINOCA, 80,6411 with OCAD) met inclusion criteria. Mean age was 63, 64% were male. Patients with MINOCA had significantly lower risk of in-hospital mortality compared to patients with OCAD (OR 0.42, 95% CI 0.31-0.57; p&lt;0.01), the overall effect size was large (z=5.59). Patients with MINOCA had significantly lower risk of having cardiogenic shock on presentation compared to OCAD, however had no difference in risk of developing CHF during hospitalization (OR 0.45, 95% CI 0.35-0.58; p&lt;0.01; OR 0.78, 95% CI 0.55-1.10; p=0.15).

Conclusions
Our results suggest that MINOCA is associated with lower risk of in-hospital mortality and lower risk of presentation with cardiogenic shock compared to OCAD. However, patients with MINOCA appear to have a similar risk of developing CHF during hospitalization compared to patients with OCAD.
Long-term outcome and characteristics of patients with NSTEMI and non-obstructive coronary arteries
Authors: Boukerche F 
Published: November 2023

Abstract

Introduction
Discordant data have been reported on the prognosis of myocardial infarction with nonobstructive coronary arteries (MINOCA).

Purpose
The objectives of this study were to assess characteristics and prognostic impact on the long-term follow-up of the diagnosis of MINOCA.

Methods
We included 274 consecutive patients with non–ST-segment elevation myocardial infarction (NSTEMI) who underwent coronary angiography between November 2015 and October 2016. MINOCA was classified according to angiographic findings as smooth coronary arteries, mild irregularities (&lt; 30% stenosis), and moderate atherosclerosis (30%-49% stenosis). The primary endpoint was a composite of cardiovascular mortality, nonfatal myocardial infarction, and revascularization (MACE) at a median of 6 years of follow-up.

Results
A total of 74 patients (27.0%) showed no obstructive lesions. Patients with MINOCA are characterized by younger age, a predominance of females, less diabetes mellitus, dyslipidemia, and smoking, lower GRACE score at admission, less marked electrocardiographic and echocardiographic changes, and lower troponin levels. MINOCA was associated with a lower occurrence of MACE (P&lt; 10-3; HR, 0.085; 95%CI, 0.031-0.231) and was confirmed as an independent factor in the multivariate analysis (P&lt; 10-3; HR, 0.121; 95%CI, 0.042-0.354). On analysis of the separate components of the main endpoint, MINOCA was significantly associated with a lower rate of cardiovascular mortality, myocardial infarction, and revascularization.

Conclusions
MINOCA is characterized by a low-risk profile at admission except for the positivity of troponin and is associated with a lower rate of MACE at the long-term follow-up.Table:Characteristics6-year outcomes
Impact of gender-related differences in outcomes in acute myocardial infarction: non-obstructive coronary arteries versus obstructive coronary arteries
Authors: Fedele D , Canton L , Armillotta M , Tattilo F P , Di Iuorio O , Suma N , Bodega F , Foa A , Rinaldi A , Angeli F , Bergamaschi L , Casella G , Paolisso P , Galie N , Pizzi C 
Published: November 2023

Abstract

Background
Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents 6-10% of acute myocardial infarction (AMI) and is more prevalent in females. The impact of gender on the outcomes of MINOCA patients has been poorly understood.

Purpose
To evaluate the impact of gender on the prognosis of MINOCA.

Methods
We enrolled 2455 patients with AMI undergoing coronary angiography from January 2016 to June 2021. Patients were divided according to type of AMI and gender: male (n=1593) and female (n=607) in AMI with obstructive coronary arteries (MIOCA); male (n=87) and female (n=168) in MINOCA. Each cohort was further stratified based on age (&lt;=/&gt; 70 years).
The primary endpoint was a composite of all-cause death, recurrent AMI, and hospitalization for heart failure (MACE) at 5-year follow-up. Secondary outcomes included: all-cause and cardiovascular death, recurrent AMI, HF re-hospitalization and stroke.

Results
MINOCA patients were more likely to be females compared to MIOCA ones (p&lt;0.001). The incidence of MACEs was significantly higher in females compared to males, both in MINOCA (p=0.018) and MIOCA cohorts (p=0.002). Age was an independent predictor of MACEs in both cohorts. No difference in outcomes was found comparing females to males &gt;70 years, in both MINOCA and MIOCA. MINOCA females &lt;70 years old had a higher incidence of MACEs (p=0.003), mainly driven by a higher prevalence of re-hospitalization for HF (p=0.045) and recurrence of AMI (p=0.006). Only in this sub-group of MINOCA patients, female gender was an independent predictor of MACEs (HR=3.09; 95%CI: 1.02-9.59; p=0.040). MINOCA females &lt;70 years old had worse outcomes than MIOCA peers.

Conclusion
MINOCA females &lt;70 years old had a significantly higher incidence of MACEs, compared to males and MIOCA peers, likely due to the different pathophysiology of the ischemic event.Survival curves in MINOCA and MIOCASurvival curves stratified for age
Utility of fractional flow reserve computed tomography angiography in patients with stable coronary artery disease
Authors: Tao M , Liu Y , Dhaliwal S , Ghosalkar D , Masson R , Al-Sadawi M , Rahman T , Pyo R 
Published: November 2023

Abstract

Introduction
Coronary CT angiography (CTA) has been established as an effective non-invasive modality for evaluation of patients with low-intermediate pretest probability of coronary artery disease (CAD). The utility of CTA is limited due to certain lesion characteristics. Fractional Flow Reserve Computed Tomography (FFRCT) may be useful in these situations, however the association of FFRCT with clinical outcomes has not been well established. The purpose of this study is to evaluate the association of FFRT with clinical outcomes in patients with stable coronary artery disease.

Methods
A literature search was conducted for studies reporting the association between FFRCT measurements and all-cause mortality, major adverse cardiac events (MACE), acute myocardial infarction (AMI), and need for revascularization. FFRCT value of ≤0.80 was considered positive, FFRCT value &gt;0.80 was considered negative. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results
A total of 10 studies with 10919 patients with stable CAD (6919 FFRCT positive vs 4000 FFRCT negative) were included; mean follow-up was 17 months (ranging 3-56 months). There was no difference in risk of all-cause mortality in patients with FFRCT positive lesions compared to FFRCT negative lesions (OR 1.53, 95% CI 0.62-3.79; p=0.35). However, FFRCT positive lesions were associated with increased risk of MACE, AMI, and need for revascularization with PCI or CABG (OR 2.37, 95% CI 1.48-3.80; p&lt;0.01; OR 4.6, 95% CI 1.58-13.41; p&lt;0.01; OR 9.56, 95% CI 3.18-28.71; p&lt;0.01). The overall incidence of revascularization in FFRCT negative patients was low compared to FFRCT positive patients (2.8% vs 31.7%).

Conclusion
FFRCT is a useful adjunctive modality for further risk stratification of patients with stable CAD. FFRCT positive lesions are associated with increased risk of MACE, AMI, and coronary lesions requiring revascularization.Figure 1
Myocardial infarction with non obstructive coronary arteries (MINOCA): clinical profile and prognosis
Authors: Gil Mancebo N , Mata Caballero R , Fraile Sanz A , Izquierdo Coronel B , Rodriguez Montes P , Martin Munoz M , Alvarez Bello Munoz M , Perela Alvarez C , Nieto Ibanez D , Abad Romero R , Olsen Rodriguez R , Espinosa Pascual M , Moreno Vinues C , Awamleh Garcia P , Alonso Martin J J 
Published: November 2023

Abstract

Background
MINOCA is a clinical condition that has grown interest in the last few years. The aim of this study is to compare the clinical profile, treatment and prognosis of MINOCA patients and those with myocardial infarction (MI) with obstructive coronary artery disease (MICAD).

Methods
We analyzed all consecutive patients with MI who underwent coronary angiography admitted in our Hospital. The database and all the patient's angiographies were revised by a group of experts in order to adequate MINOCA definition to 2020 ESC Guidelines definition and American Heart Association consensus statement.

Results
We included 915 patients, of whom 108 (12%) were MINOCA, with a median follow-up of 45 [21-65] months (see table 1). The underlying mechanism in MINOCA was coronary spasm (15%), plaque rupture (9.3%), coronary embolism (4.7%), coronary dissection (5.6%), type II infarction (17.8%) or unknown (43.8%). A total of 58.3% had angiographically smooth coronary arteries and 38.9% had plaques &lt;50%. MINOCA patients in our study were younger and mostly female, with higher prevalence of connective tissue diseases, migraine or patient-reported stress and less smoking, diabetes and chronic kidney disease compared to patients with obstructive coronary artery disease. Symptoms at admission did not differ between both groups, although MINOCA had EKG with fewer alterations, most had a diagnosis of non-ST-elevation MI (NSTEMI) and significantly lower myocardial injury biomarkers’ levels (Troponine T hs peak 176 [37.25-430] vs 860 [187.50- 2640.50] ng/L, p&lt;0.001 and CK 179 [86.75-342.75] vs 435 [159.50-1090] U/L, p&lt;0.001). They had fewer cardiovascular complications during hospitalization such as inotropic requirements (0% vs 8%, P=0.003), cardiogenic shock (0% vs 6.4%, P=0.007) or left ventricular dysfunction (11.1% vs 29.6%, P&lt;0.001). There were no significant differences in MACE (25.3% vs 34.7%, p=0,086): death (10.7% vs 15.5%, p=0.25), readmission (19% vs 28.7%, p=0.06), AMI (8.3 % vs 7.3%, p=0.74) and stroke (2.4% vs 3.4%, p=0.61) in both groups at follow-up.

Conclusions
1) MINOCA is frequent (12% of MI), 2) the clinical profile of MINOCA patients is different than MICAD (lower cardiovascular risk factors burden, younger and more females), 3) the severity of myocardial infarction is lower (more diagnosis of NSTEMI, lower myocardial injury biomarkers’ levels, fewer complications during hospitalization and less left ventricular dysfunction), 4) we found no differences in prognosis in both groups.Table 1
Impact of COVID-19 pandemics on the incidence and mortality in Takotsubo syndrome: a report from Swedish Coronary Angiography and Angioplasty Registry
Authors: Omerovic E , Gudmundsson T , Redfors B , Angeras O , Petursson P , Rawshani A , Frobert O , Alfredsson J , Ekenbeck C , Henareh L , Skoglund K , Ljungman C , Mohammad M , Jernberg T , Erlinge D 
Published: November 2023

Abstract

Background
The COVID-19 pandemic resulted in severe psychological, social, and economic stress. Countries applied different anti-pandemic strategies that substantially impacted citizens' psychosocial stress and health. Takotsubo syndrome (TS) is frequently triggered by emotional stress. Previous studies from the USA have reported a severalfold increase in TS incidence during pandemics.

Purpose
To determine the incidence and outcomes of TS in Sweden before (2015-March 2020) and during (April 2020-December 2022) the pandemic.

Methods
We assessed the incidence rate ratio (IRR) for all patients with TS referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry. Incidence rate ratios (IRRs) before and during the pandemic were calculated with Poisson regression adjusted for age and sex. We evaluated mortality with multivariable Cox proportional hazards regression, which accounted for clustering of patients within hospitals. The following variables were used for adjustment: age, sex, diabetes, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, and Killip class.

Results
We identified 3,180 patients (2,128 [76.0%] women) hospitalized with TS during the study period; 2,189 (69%) pre-pandemic and 991 (31%) during the pandemic. The average age was 68.3 ± 11.2 years. The median follow-up time was 1250 days (IQR 562-1995). The crude all-cause mortality rate was 2.57% at 30 days and 15.5% after long-term follow-up. The incidence of TS was 11% lower during the pandemic compared with the pre-pandemic period (IRR 0.90, 95% CI 0.83-0.98, P=0.009, Fig. 1). We found no difference in 30-day mortality (adjusted HR 1.12, 95% CI 0.69-1.78, P= 0.642) or long-term mortality (adjusted HR 0.96, 95% CI 0.73-1.28, P= 0.816) among patients with TS between the pre-pandemic and pandemic periods. When only data after 2016 are used, we found no difference in TS incidence (IRR 1.00, 95% CI 0.92-1.08, P=1.00).

Conclusions
In this observational study, the incidence of TS was lower during than before the pandemic but mortality was unchanged. The lower incidence of TS could be related to the specific anti-pandemic strategies applied at the national level in Sweden.Figure 1