bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term outcomes following percutaneous coronary intervention (PCI)
Authors: Pottle A , Bellchambers J , Harrison N , Harrison S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Outcomes measures following PCI usually focus on in-hospital and 30-day mortality and readmission rates following discharge. There are numerous cardiac registries worldwide but there is a lack of data on longer-term patient-centred outcomes. ESC guidance recommends that patients are re-evaluated at least annually following myocardial revascularisation to reassess symptoms and adherence to secondary prevention measures and reinforce medical therapy and lifestyle changes when appropriate (1C recommendation). The International Consortium for Health Outcome Measures have produced a dataset of recommended outcome measures including long-term follow-up to 5 years and beyond, focusing on aspects of health experience that are important to patients. Real life data on long-term outcomes following PCI is needed in addition to short-term outcome measures to establish patient experience of PCI.

Purpose
The study was carried out to evaluate the long-term outcomes of patients undergoing PCI in this tertiary centre.

Method
Nurse-led follow-up for all patients post PCI has been carried out since 2001. Outcome data were initially collected prospectively during clinic appointments; short-term at 1-month, and medium-term at 6-months and 1-year. Long-term outcome data at 3 and 5-years were collected from 2012 via telephone appointment or purpose-made questionnaire.

Results
Data are available from 3-year follow-up for patients who underwent PCI between 2009 and 2014 and 5-year follow-up from patients between 2007 and 2012. The results only relate to patients followed-up in the nurse-led service. There were 3568 patients followed-up at 3-years and 2088 followed-up at 5-years (total 5656). 59.4% of patients had undergone primary PCI at 3-years and 64.1% at 5-years. 76% of the respondents were male at both time periods. The average age was 75.4 years. The data showed that at 3-years, 45.2% of patients reported they had no chest pain, or no angina on normal activity. At 5-years this number was 48.6%. 80.7% were free of MACE events at 3-years and 78.4% at 5-years. Approximately 50.0% of MACE events were non-cardiac hospitalisations. The number of patients requiring further intervention at both time periods was small.

Conclusion
Procedural outcome from PCI is good in the long, as well as short-term. Patient reported outcomes indicate that symptom control is potentially not as good as would be expected. Patients need long-term follow-up with a healthcare professional to establish if reported symptoms are truly cardiac and therefore warrant further investigation, however, healthcare resources may limit the ability to do this.
Results from healthy donors for novel point-of-care high-sensitivity troponin test
Authors: Christenson R , Briseno T , Wilson E , Fonville J , De Theije F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
This study evaluates healthy donor values of a novel high-sensitivity troponin test, an 8-minute whole blood assay performed with fingerstick or Lithium-heparin samples using a handheld sized platform designed for Point-of-Care or in-lab measurements. In accordance with the Fourth Universal Definition of Myocardial Infarction, whole blood 99th percentile upper reference limits (URLs) and 50th percentile (median) values for healthy individuals were characterised per gender; values were established for fingerstick, venous whole blood, and plasma.

Purpose
To determine 99th percentile URLs for hs-cTnI in healthy donors as myocardial injury cut-off for use in clinical trials and clinical practice. The median values were determined to confirm high-sensitivity performance in all matrices.

Methods
Whole blood from consented healthy subjects, 22 to 85 years (n=810), were collected across 5 clinical sites. Subjects taking cardiac history/medications or having abnormal hemoglobin A1c, NT-proBNP, and eGFR values were excluded. hs-cTnI values were determined in capillary (fingerstick), Li-Heparin venous whole blood, and venous Li-Heparin plasma matrices. Sex-specific and overall 99th percentile URLs using the recommended non-parametric approach and median values for each sample matrix were determined.

Results
Statistical outliers were eliminated by the Dixon-Reed test, prior to calculating the 99th percentile and median values. There was no significant difference between the three sample types. The median results are tabulated below: as expected, the female values are lower than the male values (p &lt;0.01). These data additionally show that &gt;50% of results exceed the assays limit of detection [ref .1] for all matrices, confirming this assay is a high-sensitive assay for troponin-I.

Conclusion
The novel hs-cTnI system is the first that demonstrates high-sensitivity cTnI performance in fingerstick, whole blood and plasma matrices. Quality measurements in all three matrices translates to use with confidence in emergency department and other diagnosis and triage settings. Hence, the data presented here are of relevance to current and future studies and clinical implementation of this device.
Table 1: median hs-cTnI values in healthy subject, % of subjects above LoD (limit of detection) and %CV at 99th URL.
Predictive value of cerebral natriuretic peptide in acute myocardial infarction without obstructive coronary disease
Authors: Rocha Carvalho P , Goncalves F , Carvalho C , Bernardo M , Fontes P , Moreira J I 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The brain natriuretic peptide (BNP) has a protective role on the coronary vasculature. On the other hand, vascular dysfunction is one of the main factors associated with acute myocardial infarction without obstructive coronary disease (MINOCA). Therefore, one can theorize that BNP might be involved in the pathophysiological mechanism of this disease.

Purpose
This study sought to determine whether a low BNP value is a significant predictor of MINOCA.

Methods
This was a national multicenter retrospective study of patients hospitalized for an acute myocardial infarction (AMI) between October 2010 and September 2019. Patients with previous history of heart failure, severe valvular disease, chronic kidney disease, atrial fibrillation and who didn’t have a coronary angiography during hospitalization were excluded.

Results
Of a total of 4954 patients with an AMI, 306 (6,2%) were diagnosed as MINOCA. The MINOCA group had a higher percentage of women (42,5% vs 24,6%, p&lt;0,001) and was more frequently hospitalized for a non-ST-segment elevation myocardial infarction (70,9% vs 39,3%, p&lt;0,001). Left ventricular ejection fraction was significantly higher in these patients (58±13% vs 54±13%, p=0,002). MINOCA was associated with a better in-hospital prognosis: less cardiogenic shock (1,0% vs 4,0%, p=0,008), less cardiac arrests (1,0% vs 4,8%, p=0,002), less major bleeding events (0% vs 1,8%, p=0,019) and lower mortality (0% vs 2,2%, p=0,010).
The BNP median was lower in patients with MINOCA (91 (38;269) pg/mL vs 141 (56;328) pg/mL, p&lt;0,001). The BNP cut-off, determined by ROC curve analysis, was 85,5pg/mL. Therefore, 49,3% of the patients with MINOCA had BNP values considered low, in contrast to 35,3% of the patients with obstructive coronary disease (p&lt;0,001). In a multivariate regression analysis, we found that a low BNP value was a significant predictor of MINOCA (adjusted OR 2,46, 95% CI 1,87-3,23).

Conclusions
As expected, MINOCA was an entity associated with a better in-hospital prognosis when compared to AMI with obstructive coronary disease. In this study, a low BNP value was able to independently and significantly predict MINOCA.
Prognostic importance of neuron-specific enolase measured in plasma or serum in patients resuscitated after out-of-hospital cardiac arrest
Authors: Abdi Isse Y , Frikke-Schmidt R , Kjaergaard J , E Moeller J , Schmidt H , A S Meyer M , Hassager C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients who are successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to the hospital in a comatose stage are in high risk for anoxic brain injury. Multimodal approach for neuroprognostication include measurement of neuron-specific enolase (NSE) as a biomarker for neurological injury. NSE has been intensively studied over the past years and has shown a valid predictive value for neurological outcome. However, there has been no clinical studies comparing NSE analyzed on plasma and serum samples.

Purpose
To compare NSE at 48 hours obtained from both in serum and plasma samples, and to investigate the performance of both these measuring techniques in predicting all-cause mortality at 365-days among patients resuscitated from out-of-hospital cardiac arrest.

Methods
This is a post-hoc sub study of the BOX trial in which resuscitated OHCA patients admitted to the hospital in comatose stage were included. NSE was measured 48 hours after admission, both in serum samples used for clinical analysis with no freeze-thaw cycle (NSE-Serum), and plasma samples from biobank (NSE-Plasma). The comparison of NSE-Serum and NSE-Plasma was performed by Spearmans correlation. The area under the receiver operating characteristics curve (AUROC) for predicting all-cause mortality at 365-days for both NSE-Serum and NSE-Plasma were determined.

Results
369 patients had NSE values from both serum and plasma at 48 hours available for comparison. In these patients the NSE-Serum was median 21.2 µg/L (IQR 15.7 - 45.5), NSE-Plasma was median 19.3 µg (IQR 11.3 - 40.9), and mortality at 365-days was 32.5%. The correlation between NSE-Serum and NSE-Plasma was r=0.63 P&lt;0.001. AUROC for NSE-Serum and NSE-Plasma were 0.94 and 0.83 respectively (FIGURE), and the differences in AUROC was -0.10 (95% confidence limits: -0.14 to -0.06), p&lt;0.001.

Conclusion
In this sub study, we found moderate correlation between serum NSE values and plasma NSE values. Moreover, both measuring techniques had good predictive value against 1 year mortality, with clinically measured NSE from serum being slightly superior to NSE from plasma in predicting mortality.
Incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST-elevation myocardial infarction: Results from the Korea Acute Myocardial Infraction Registry
Authors: Cho K , Shin M H , Kim M C , Sim D S , Hong Y J , Kim J H , Ahn Y , Kim H S , Hur S H , Lee S R , Hwang J Y , Oh S K , Cha K S , Jeong M H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korea Centre for Disease Control and Prevention.

Background/Introduction
Data regarding the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST-elevation myocardial infarction (STEMI) in the modern era of percutaneous coronary intervention are limited.

Purpose
We investigated the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of STEMI from a nationwide, prospective Korean registry of acute myocardial infarction.

Methods
Out of 28,470 patients with acute myocardial infarction between November 2011 and June 2020, 11,796 were eventually diagnosed with STEMI following a coronary angiogram. They were classified into two groups: patients with an initial working diagnosis of STEMI before starting the initial treatment and patients with an initial working diagnosis of non-STEMI (misdiagnosed group).

Results
Out of 11,796 patients with a final diagnosis of STEMI, 165 (1.4%) were misdiagnosed. The door-to-angiography time in the misdiagnosed group was five times longer than that in the timely diagnosed group (median 220 [interquartile range 66–1177] vs. 43 [31–58] minutes, P &lt;0.001). In a multivariable adjustments model, patients with a history of heart failure, atypical chest pain, anaemia, or symptom-to-door time ≥4 hours had significantly higher odds, whereas those with systolic blood pressure &lt;100 mmHg or anterior ST-elevation or left bundle branch block on electrocardiogram had lower odds of STEMI misdiagnosis (Figure 1). For patients with culprit lesions in the left anterior descending artery (n = 5838), the adjusted one-year mortality risk for STEMI misdiagnosis was 1.84 (95% confidence interval 1.01–3.38; Figure 2).

Conclusion
Misdiagnosis of STEMI is not uncommon and is associated with a significant delay in coronary angiography, resulting in an increased one-year mortality for patients with culprit lesions in the left anterior descending artery.
Atrial fibrillation is associated with mortality and increased admission biomarkers reflecting neurohormonal activation and inflammation in patients with ST-elevation myocardial infarction
Authors: Frydland M , Moeller J E , Holmvang L , Helgestad O K L , Jensen L O , Goetze J P , Hassager C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Righospitalets Forskningsfond (07IO) Lundbeck Foundation (R186-2015-2132).

Background
Neurohormonal activation and inflammation is associated with mortality in STEMI patients. We sought to assess, whether AFIB – a known risk factor in MI – also was associated with increased 1-year mortality as well as neurohormonal activation and inflammation in STEMI patients.

Methods
In 1892 consecutive STEMI patients from two danish tertiary heart centers biomarkers reflecting neurohormonal activation (copeptin, pro-atrial natriuretic peptide (proANP), and mid-regional pro-adrenomedullin (MRproADM)) and inflammation (ST2) was measured. Patients were stratified according to known AFIB or new onset AFIB on admission vs no AFIB.

Results
In total, 198 (10%, 100 known/98 new onset) patients had AFIB, which was associated with increased 1-year mortality (19% vs. 8.4%, p&lt;0.0001). Patients with AFIB were older (mean (SD) age 70 (13) vs 63 (13) years, p&lt;0.0001), had more comorbidity (e.g. hypertension 61% vs. 43%, p&lt;0.0001; stroke 13% vs 6.4%, p=0.002; heart failure 11% vs 2.3%, p&lt;0.0001), lower left ventricular ejection fraction (LVEF) (mean (SD) 41 (13) vs 45 (13), p&lt;0.0001), were more often comatose after cardiac arrest (12% vs 6%, p=0.001), and in cardiogenic shock (CS) (20% vs 9.1%, p&lt;0.0001). Plasma concentration (median (IQR)) of all four biomarkers were higher in AFIB patients (copeptin 124 (39; 298) vs 66 (21; 170) pmol/L; proANP 1678 (1018; 2439) pmol/L; MRproADM 0.96 (0.76; 1.41) vs 0.70 (0.58; 0.90) nmol/L; ST2 48 (34; 74) vs 39 (29; 55) ng/ml, p&lt;0.0001 for all). When adjusting for age, sex, hypertension, previous stroke, LVEF, CS, and being comatose after cardiac arrest, AFIB remained associated with increased plasma concentration of all four biomarkers (two-fold increase – OR (95% CI): Copeptin 1.21 (1.02-1.23); proANP 2.22 (1.82-2.72); MRproADM 2.01 (1.56-2.60); ST2 1.21 (1.03-1.43)).

Conclusion
AFIB in STEMI patients is associated with increased admission biomarkers reflecting neurohormonal activation and inflammation and 1-year mortality.
Periodic repolarization dynamics in patients undergoing primary PCI for acute myocardial infarction
Authors: Theurl F , Schreinlechner M , Sappler N , Massmann C , Dolejsi T , Reinstadler S J , Bauer A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Innsbruck.

Background and aims
Periodic Repolarization Dynamics (PRD) is a novel ECG-based risk marker which quantifies sympathetic-activity associated oscillation of repolarization in the low frequency range. [1] Previous studies demonstrated that increased PRD is a strong and independent predictor of mortality in ischemic and non-ischemic cardiomyopathy being closely linked to malignant arrhythmias and sudden death. [2] [3] PRD could also be a useful marker in the setting of acute myocardial ischemia. We therefore aimed to investigate PRD in acute myocardial infarction (MI) and the effects of primary PCI on PRD.

Methods
Consecutive patients aged ≥ 18 years presenting with acute ST-elevation MI were included. In all patients, a high-resolution (1000Hz) 24-hour ECG recording in Frank leads configuration was started at hospital admission. PRD was assessed for the period before primary PCI and for 24 successive 1-hour periods thereafter according to previously established procedures. [1] Time of PCI was defined as wire crossing.

Results
Between January and April 2022, a total of 23 patients were enrolled. Median age was 63 (IQR 56 - 70) years, 6 (26 %) patients were female. Average length of the pre PCI segment was 60 (IQR 40 – 78) minutes. Coronary blood flow prior to PCI was TIMI 0 in 10 patients and TIMI 1 in 13 patients. Primary PCI was successful with an achieved TIMI 3 flow in all patients. PRD before primary PCI was increased at 7.8 (IQR 6.4 - 10.5) deg². Within the first six hours after recanalization PRD decreased to 4.1 (IQR 2.8 - 6.2) deg² (p = 0.004 for difference). No significant change of PRD was observed between 6 h and 24 h after PCI (p = 0.652 for difference).

Conclusion
In patients with acute STEMI, PRD is significantly increased. Revascularization by primary PCI results in a decrease in PRD within the first 6 hours. Our results suggest that arrhythmic risk is increased within the first 6 hours after primary PCI.
A prediction model for ventricular arrythmias in the acute phase of infarction
Authors: Rivadeneira Ruiz M , Marin Andreu P , Garcia Gonzalez N , Izquierdo Bajo A , Hidalgo Urbano R J , Garcia Rubira J C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) in the acute phase of infarction (first 24-48 hours) has declined over recent decades, probably due to the uptake of reperfusion strategies and the early use of beta-blockers. However, according to some series, 6–8% of patients still develop hemodynamically significant VT or VF during this phase.

Purpose
The objective of our study was to evaluate the baseline characteristics of patients who suffered VT or VF in the acute phase of the infarction and to create a predictive model of ventricular arrhythmias in this setting which allow us to anticipate arrhythmic events.

Methods
We performed an observational, retrospective, and single-centre study carried out through the review of clinical records of patients who suffered an acute myocardial infarction with ST-segment elevation (STEMI) and were admitted in our Coronary Care Unit between July 2011 and August 2022.

Results
In our cohort we observed 179 episodes of VT/VF (10,7%) in a population of 1668 patients underwent STEMI. The mean age in this subgroup was 61,69±12,61 years old, 78% were males and 56% smokers. Approximately a quarter of the patients were diabetic or obese. There was a very low percentage of previous myocardial infarction (12%) and heart failure (3%) (Table 1). We estimated the best prediction model (Mallows’ Cp=5.12) for VT/VF. The variables included in our model (LL=-435,43) were: male sex, absence of diabetes, smoking habit, use of fibrinolysis, worst Killip at admission and hypotension at admission (Table 2).

Conclusion
The presence of VT or VF in the acute phase of infarction is still considered a controversial factor in the prognosis of these patients. In our cohort we identified that males, smokers, non-diabetics, and the use of fibrinolysis and the worst haemodynamical situation at admission were independent predictors of developing VT/VF in this context.
Myocardial reporalization duration reflects autonomic nervous system activity in Takotsubo syndrome
Authors: Mantzouranis E , Leontsinis I , Sakalidis A , Dalakouras I , Dris E , Drogkaris S , Vlachakis P , Liatakis I , Manta E , Antonopoulos A , Fragkoulis C , Konstantinidis D , Kordalis A , Dimitriadis K , Tsioufis K 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sympathetic overdrive has been proposed as a major precursor in Takotsubo syndrome (TTS) development. ECG changes in TTS often persist in time beyond the recovery of the cardiac systolic function and their prognostic significance remains unclear. Autonomic nervous system (ANS) fluctuations affect myocardial repolarization as well as the presence of myocardial oedema and active ischemia.

Purpose
In this study we aimed to investigate the correlation between indices of ANS activity and the degree of QT interval prolongation during the course of TTS.

Methods
We studied 30 patients (29 women, mean age: 66 ± 11 years, 17.2% history of diabetes mellitus) with a TTS diagnosis established after multimodality imaging evaluation, which included cardiac magnetic resonance imaging. Daily ECG recordings during the acute phase of the TTS were available for all patients. Both sympathetic and parasympathetic activity were evaluated with time and frequency domain indices of heart rate variability (HRV). Moreover, sympathetic tone was assessed by means of muscle sympathetic nerve activity (MSNA). All investigations were completed within 30 days of the index event. ANS indices were correlated with the maximum measured QTc interval of each patient during the acute phase of TTS.

Results
Maximal QTc interval during the acute TTS phase exhibited a linear correlation with indices of sympathetic withdrawal. Specifically, QTc duration was positively correlated with rMSSD (r=430, p=0.036) and high frequency FFT (=0,497, p=0,016) whereas it was inversely associated with MSNA results measured in oscillations/100 heart beats (r=-573, p=0,007). In a multivariate analysis model standardized for patients’ age, left ventricular ejection fraction (synchronous with ECG measurements) and the usage of beta blocker medications the aforementioned results remained statistically significant (Table 2).

Conclusion
In our population of TTS patients, increased parasympathetic activity and sympathetic withdrawal within the first month of the index event reflect increased repolarization duration during the acute phase of the syndrome.