bluuebunny/crossref_metadata_2025_split huggingface dataset:
It is not too late for ... percutaneous angiography in a 90-plus population
Authors: Costa C , Amador A , Calvao J , Pinto R , Proenca T , Carvalho M , Cabrita A , Marques C , Oliveira C , Santos L , Silva M , Silva J , Macedo F 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Elderly people represent a vulnerable but increasing population presenting to percutaneous coronary intervention (PCI). The benefit of revascularization in acute coronary syndromes (ACS) is well-stablished. However, the benefit in elderly patients has been questioned, considering the patient’s expected survival, functional and cognitive status, comorbidities, procedure’s risk and need for extended anti-thrombotic therapy.

Purpose
To evaluate the effect of PCI on the prognosis of a group of very old patients with acute coronary syndrome (ACS).

Methods
We retrospectively analyzed all consecutive very old patients (≥90-year-old) admitted with ACS submitted to coronarography (CA) in one tertiary center, from January 2008 to December 2021. Clinical features were collected, including major adverse cardiac events (MACE), a defined composite endpoint of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure, which were compared according if PCI was performed or not. Q-square, Cox regression and Log-rank tests were applied.

Results
A total of 79 patients were enrolled; 43 of them underwent PCI. Groups were comparable in basal characteristics, with similar median age at the event (92 years old, interquartile range IQR: 3), see picture 1.
Most patients with ST-elevation (STE) ACS (n=45) had PCI (70% vs. 41%, p= 0,01), while in non ST-elevation (NSTE) ACS and unstable angina there was higher proportion of non-PCI (30% vs. 58%, p= 0,01). Individuals submitted to PCI were more likely to have single or double lesion vessel (76% vs 27%, p&lt;001), while non-PCI patients presented more complex disease (23% vs 25%, p=0,5). Among the PCI-patients, the majority was singly revascularized (86%) and submitted to stent implantation (83%). Regarding in-hospital mortality, there was no difference between groups: 21% in the PCI group versus 33% in the non-PCI control group (p=0.2).
During median follow-up time of 6 months (IQR: 27), mortality was similar in both groups (79% vs 67%; p=0.1). Nevertheless, overall MACE-free survival was significantly longer in PCI group than in the no-PCI group, and PCI treated patients had a risk of MACE 52% lower than the patients assigned to medical therapy (hazard ratio 0.508, p=0.007); see picture 2.

Conclusion
Very old patients presenting with ACS treated with either PCI presented longer MACE-free survival. These finding suggest that very old patients with ACS and single vessel disease may benefit systematically from PCI with stent. Efforts should be made to optimize care in this under-represented population in the clinical trials.
30 day outcome after early discharge in low risk ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
Authors: Gjana A , Pavli E , Kristo A , Vasili E , Duka A , Shuka N , Voci A , Pane E , Zaimi G , Kastrati A , Dibra A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Current guidelines for management of patients with ST-segment elevation myocardial infarction (STEMI) encourage an early discharge (48-72 h) after a successful primary percutaneous coronary intervention (PCI) in selected low risk patients. Yet, this strategy is not routinely applied. The evidence on the relative outcome of patients discharged early compared to those discharged later, has been limited.

Purpose
To assess safety of early discharge in low risk STEMI patients treated with primary PCI by analyzing 30 days outcomes relative to early and late discharge strategies.

Methods
We prospectively enrolled 109 patients presented with STEMI from April 2019 to September 2019, who were categorized as low risk according to Zwolle risk score. 60 (55%) patients were discharged after 48-72 hours and 49 (45%) after &gt; 72 hours. We gathered clinical data at 30 days. Primary endpoints were occurrence of a major adverse event - a composite of death from any cause, nonfatal myocardial infarction and acute stent thrombosis. Secondary endpoints were acute angina and re-hospitalization.

Results
The mean age was 59.7 +/- 10.5 years in early discharge group compared to 62.8 +/- 10.5 years in late discharge group (p=0.132). 88 (80.7%) patients were male. 58 (53.2%) of them had inferior MI. Mean ejection fraction was 49.25% +/- 4.95%. Median symptom to balloon time was 9.3 +/- 6.7 hour. Median length of stay was 3.4 days +/-0.6. Primary endpoint occurred in one patient in the early discharge group, who had acute stent thrombosis and nonfatal myocardial infarction. No death from any cause was observed in both groups. Secondary endpoint occurred in 3 patients who had acute angina, 2 in late discharge group and 1 in early discharge group.

Conclusion(s)
Data from our study reveal that an early discharge strategy in selected low risk STEMI patients treated with successful primary PCI is not associated with a significant increase in major adverse events compared to late discharge strategy.
Association between new-onset right bundle branch block and primary or secondary ventricular fibrillation in ST-segment elevation myocardial infarction
Authors: Galcera-Jornet E , Consuegra-Sanchez L , Galcera-Tomas J , Melgarejo-Moreno A , Gimeno-Blanes J R , Jaulent-Huertas L , Wasniewski S , Degea-Garcia J , Vicente-Gilabert M , Padilla-Serrano A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
New-onset right bundle branch block (RBBB) in myocardial infarction (MI) is often associated with ventricular fibrillation (VF) but the nature of this relationship has not been determined.

Aims
To investigate the association between new-onset RBBB and VF in ST-segment elevation MI (STEMI) as well as its peculiarities attending to the permanent or transient character of RBBB and the distinction of VF as primary or secondary.

Methods and results
Between 1998 and 2014, among other data, incidence and duration of RBBB and VF occurrence were prospectively collected in 5301 patients with ST-segment elevation MI (STEMI) admitted to two Coronary Care Units. Multinomial adjusted logistic regression analyses were used to examine the association between RBBB, attending to its duration, and VF according to its primary VF (PVF) (&lt;24h from symptom-onset and Killip I) or secondary VF (SVF) (&gt;24h from symptom-onset and/or Killip&gt;I) character. Among 284 (5.4%) patients with new-onset RBBB, 158 were transient and 126 permanent. VF occurred in 339 (6.4%) patients, 201 PVF and 138 SVF, documented within the first 2 h of symptoms-onset in 78% and 60%, respectively. Newonset RBBB was more frequent in PVF (11.4%) and SVF (20.3%), than in non-VF (4.7%). Transient RBBB incidence was higher in PVF (9.0%) and SVF (9.4) than in non-VF (2.6%), whereas permanent RBBB was higher in SVF (10.9%) than PVF (2.5%) and non-VF (2.1%). New-onset RBBB 1.83 [95% confidence interval (CI): 1.07–3.11] and new-onset transient RBBB 2.39 (95% CI: 1.32–4.32) were independently associated with PVF. New-onset 3.03 (95% CI: 1.83–5.02), transient 2.40 (95% CI: 1.27–4.55), and permanent 2.99 (95% CI: 1.52–5.86) RBBB were independently associated with SVF.

Conclusion
New-onset RBBB and VF in STEMI are independently associated and show particularities based on the duration of the conduction disturbance and/or the primary or secondary character of the arrhythmia.
Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction
Authors: Paula S , Figueiredo M , Santos M , Santos H , Almeida S , Almeida L 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Prognostic value of brain natriuretic peptide (BNP) in STEMI is not yet fully stablished despite many studies demonstrating its potential in providing additional information.

Purpose
Evaluation of prognostic impact of BNP in coronary anatomy complexity and outcomes in the context of STEMI.

Methods
Retrospective analysis of patients admitted with STEMI in a multicentric registry between 2010-19. Patients were divided into 3 groups regarding BNP: &lt;100pg/ml in Group 1 (39%P); 100≤ BNP &lt;400pg/ml in Group 2 (39.5%); and BNP ≥400pg/ml in Group 3 (21.5%). Demographic and clinical characteristics were compared and outcomes evaluated. A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints. Survival was evaluated through Kaplan-Meier curve.

Results
1650 patients were reviewed. Group 1 was younger (58±11 vs 66±13 vs 72±12 years, p&lt;0.001). Mostly male (75.4%, p&lt;0.001). Patients with heart failure (HF) and chronic kidney disease (CKD) presented higher BNP: the prevalence of HF and CKD was 0.5 and 1.3% in Group 1; 1.8 and 2.5% in Group 2; 5.9 and 7.8% in Group 3 (p&lt;0.001). Mean BNP at admission was 43±26 in Group 1; 208±81 in Group 2; 1105±1073pg/ml in Group 3 (p&lt;0.001). Group 3 presented lower mean left ventricle ejection fraction (LVEF): 58±11 vs 53±12 vs 44±13% (p&lt;0.001). All patients were submitted to coronary angiography: the anterior descendent was the artery most frequently involved (57.4 vs 66.9 vs 80.3%, p&lt;0.001). The involvement of &gt;1 coronary artery was more frequent in Group 3 (34.4 vs 44.5 vs 51.3%, p&lt;0.001). Acute HF (6.5 vs 16.7 vs 45.4%, p&lt;0.001); cardiogenic shock (3.3 vs 5.1 vs 16.9%, p&lt;0.001), atrial fibrillation (3.0 vs 6.4 vs 16.9%, p&lt;0.001), stroke (0.5 vs 0.6 vs 2%, p 0.032), sustained ventricular tachycardia (1.6 vs 3.7 vs 6.8, p&lt;0.001) and mortality (1.2 vs 2.6 vs 8.5%, p 0.017) were more prevalent in Group 3. Kaplan-Meier curve confirmed that higher BNP was associated with higher rates of 1-year mortality (p&lt;0.001) and cardiovascular and all-cause rehospitalization (p 0.005 and 0.002). Presence of peripheral arterial disease or cancer, Killip Kimball class &gt;I, LVEF &lt;50% and occurrence of mechanical complications were predictor factors.

Conclusions
In context of STEMI, higher BNP levels were associated with more complex coronary anatomy and higher in-hospital and 1-year morbimortality.
Women take longuer to seek help when suffering a STEMI
Authors: Lopez Sobrino T , Guilleumes M , Castrillo- Golvano L , Ayala Borges B , Salazar-Rodriguez A , Moreno Monterde E , Arenas A , Anduaga Elorza I , Martinez Guisado A , Roca Guerrero C , De Diego O , Andrea R , Ortiz Perez J T 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Historically, the prognosis of those women suffering a STelevation myocardial infarction (STEMI), has been worse compared to men. Some causal factors are presentation at later ages, atypical symptoms, lower perception of risk and less sensitivity of the health care providers.

Purpose
Our hypothesis is that there are still differences in the presentation of STEMI based on gender, which could be identified to guide new public campaigns in this perspective. Therefore our primary outcome is to find gender differences in symptoms and time delays in a cohort of STEMI patients, and secondary outcomes are differences in mortality and bleeding.

Methods
We conducted a retrospective analysis carried out in the Acute Cardiac Care Unit (ACCU) of a tertiary care hospital, where 50% of the medical staff are women. Patients hospitalized for STEMI for one year were included and a detailed caracterization of symptoms, time delays, and adverse events was recorded. Finally, the patients were classified according to gender, and differences in primary and secondary outcomes between both groups were analyzed.

Results
Between May/2020 and May/2021, 1056 patients were admitted to the ACCU, 33% were women. A total of 115 STEMI patients were included for the analysis, 21% were women. Basal characteristics of both groups were equivalent, except for a non significand trens towards less prevalence of peripheral arterial disease in women (0% vs. 11%; OR 0.890, IC 95% 0.828-0.957; p=0.089). Opressive chest pain was the most frequent symptom, but it was less frequent in women (75% vs. 91.4%, OR 0.284, IC 95% 0.085-0.948; p=0.033), whereas they presented more frequently with stabbing pain (13% vs. 2.4%, OR 6, IC 95% 1.073-38.35; p=0.035), and their pain was more frequently radiated towards the neck (28.6% vs. 4.9%, OR 7.7, IC 95% 1.1936-30.631; p=0.001), and associated to nausea/vomiting (45% vs. 1.3%, OR 5.809, IC 95% 1.930-17.486; p=0.001). There was a non-significant trend towards a longer time delay between pain onset and seek for help in women (185min IQR 747 vs. 60min IQR 454, p=0.098), being the other system time delays equivalent between both gender groups. Women had an increased bleeding risk, with a higher CRUSADE score (47.48 ± 22.92 vs. 28.60 ± 16.72, p=0.001) and higher incidence of bleeding events (12.55% vs. 0%, OR 11.68, IC 95% 9.82-13.29, p=0.001). There were no differences in the treatments administered or in mortality (12.5% vs. 14.3%, p=0.822).

Conclusions
Women suffering a STEMI more often reported stabbing chest pain, radiating to the neck, and associated to nausea/vomiting compared with men, and took longer to seek for help. These findings could help in the design of future campaigns to minimize time delays, targeting these different symptoms in female population.
A novel echo-score for the prediction of cardiovascular outcomes in patients with STEMI
Authors: De Los Rios Arce L , Juarez Najarro S A , Najera Rojas A N , Robles Leedesma M , Alonso Bringas A P , Sanchez Leony G , Gopar Nieto R , Sierra Lara Martinez J D , Briseno De La Cruz J L , Gonzalez Pacheco H , Araiza Garaygordobil D , Arias Mendoza A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Echocardiography is a tool extensively studied for predicting adverse outcomes in heart failure and after MI. However, most studies are focused on predicting long-term events, and tools to predict in-hospital outcomes are needed.

Objectives
to identify echocardiographic parameters associated with the occurrence of in-hospital major adverse cardiovascular events and to develop an echocardiographic score to predict outcomes in patients with STEMI.

Methods
Single-center, observational, descriptive, longitudinal study, including consecutive STEMI patients undergoing reperfusion therapy within 12 hours since symptom onset. An echocardiogram was performed early (&lt;48h) during hospitalization. An echocardiographic score (Echo Score) including LVEF (0 = LVEF &lt;45%, 1 = LVEF between 44% and 35%, 2 &lt;35% ), left ventricular wall motion score index (LVWMSi) (1 = LVWMSi&gt;1.5, 0 = LVWMSi≤1.5) E/e’ ratio (1 = E/e’&gt; 15, 0 = E/e’≤ 15)and RV fractional shortening (RVFS) (1 = RVFS &lt;30%, 0 = RVFS ≥ 30%) was derived. The study's primary objective was to evaluate the primary endpoint (a composite of cardiovascular death, congestive heart failure, cardiogenic shock, and recurrent MI) and its relation with echo score during 30 days follow-up.

Results
A total of 270 consecutive patients participate in this study. The mean echo score was 2 (1-3). Patients with a mean echo score &gt; 2 exhibited an increased risk for the primary endpoint during 30-day follow-up (HR 2.18. 95%CI 0.99-4.86, p= 0.06). Individual components of the primary endpoint exhibited an increased risk of mainly heart failure 5.9 vs. 14.1% (p=0.03). AUC-ROC was analyzed for echo score, and GRACE / TIMI scores on admission; no significant differences were found between these scores (Echo score: 0.65, GRACE 0.66 & TIMI 0.68, p = 0.06).

Conclusion
in patients with STEMI receiving reperfusion, an echocardiographic score including LVEF, LVWMSi, E/e´ratio, and RVFS performed similarly to GRACE and TIMI scores in the prediction of major cardiovascular events in the short term.
Prediction of in-hospital mortality in patients with acute pulmonary embolism requiring invasive mechanical ventilation: comparation of risk scores
Authors: Devesa Neto V , Correia J , Fiuza J , Pereira J G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Multiple scores are used to predict in-hospital mortality of patients admitted to intensive care units. The purpose of this study is to assess which risk score is best at predicting in-hospital mortality in a specific population of patients requiring invasive mechanical ventilation.

Methods
Retrospective analysis of 33 patients admitted for high-risk pulmonary embolism requiring invasive mechanical ventilation in a general intensive care unit during a period of 15 years. Clinical, analytical, and imaging parameters were evaluated. The PESI, Apache II, SAPS II, and SOFA scores were obtained at ICU admission. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of each score for in-hospital mortality.

Results
Mean age was 59,1±16 years; 55% were men. 27% presented with a cardiorespiratory arrest at admission. Mean values risk scores were: PESI 138±51, Apache II 23±9, SAPS II 49±23, and SOFA 8±3. In-hospital mortality was 45,4%. The mean duration of hospitalization was 14,8±17,9 days. Mean pulmonary systolic arterial pressure was 51,5±14,63mmHg. Mean values of maximum troponin I and d-dimers were 2,97±7,99 and 6603±5541 ng/mL, respectively. ROC curve analysis revealed that Apache II (AUC 0,752; p=0,02; CI 95% 0,58;0,92), SAPS II (AUC 0,718; p=0,04; CI 95% 0,52;0,91) and PESI (AUC 0,754; p=0,02; CI 95% 0,6;0,91) had best predictive performance for in-hospital mortality compared to SOFA (AUC 0,641; p=0,2; CI 95% 0,42;0,9). The following cut-off values were obtained: PESI of 130 (sensitivity (S)≈85% and specificity (E)≈53%), Apache II of 26 (S≈62% and E≈77%), and SAPS II of 52 (S≈69% and E≈70%).

Conclusion
In this population, PESI, Apache II, and SAPS II scores were better predictors of in-hospital compared to SOFA score.
Impact of care bundles on the occurrence and outcomes of acute kidney injury among myocardial infarction patients
Authors: Shacham Y , Khoury S , Frydman S , Banai S , Banai A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Among Patients with myocardial infarction hospitalized patients, deterioration of renal function resulting in acute kidney injury (AKI) is an important complication, associated with increased length of hospital stay, morbidity and mortality. Given large variation in care for AKI patients and poor outcomes of AKI, the interest in implementing care bundles for AKI is growing. Several reports suggested that compliance with AKI bundles among hospitalized patients resulted in better kidney and patient outcomes non, however, included acute cardiac patients.

Purpose
We investigated the effect of AKI care bundle (AKI-CB ) utilization on the incidence and renal outcomes of AKI in a large cohort of myocardial infarction patients treated percutaneous coronary intervention (PCI).

Methods
We Included ST elevation myocardial infarction (STEMI) patients admitted to the cardiac intensive care unit following PCI between January 2008- December 2020. From January 2016 AKI- CB was implemented in our cardiac intensive care unit. AKI-CB consisted of simple standardized investigations and interventions, reminding clinicians of the importance of early AKI detection, management, via strict monitoring of serum creatinine and urine analysis, planning investigations and treatment and guidance about seeking nephrologist advice. .Patients' records were evaluated for the occurrence of AKI, its severity, AKI recovery, length of hospital stay and long term mortality before and after the implementation of AKI-CB.

Results
2646 patients were included (1945 patients in the years 2008-2015 and 705 patients in the years 2016-2020). Overall, 232 AKI episodes occurred within the study period (232/2646, 8.7%). Implementation of care bundles resulted in a decrease in the occurrence of AKI from 190/1945 ( 10%) to 42/705 (6%); P&lt;0.001, with a trend for lower AKI score&gt;1 (20% vs. 25% ; p=0.07), higher AKI recovery ( 62% vs. 45% , p=0.001) and reduction in the length of hospital stay ( 5.2± 6 days vs. 5.9 ± 5 days ; p=0.02). Over a median follow up period of 48 month, mortality was significantly lower following implementation of AKI-CB ( 3.7% vs. 5.8%,p=0.002,figure 1). Using a multivariable regression model, the use of care bundles resulted in a 45% decrease in the relative risk for AKI (HR 0.55, 95% CI 0.37-0.82, p=0.003; figure 2).

Conclusion
Among STEMI patients, compliance with AKI-CB was independently associated with a decrease in AKI occurrence and better renal outcomes following an AKI event. Further interventions are required to improve utilization of the AKI-CB.
Hemodynamic changes associated to increments of PEEP in mechanically ventilated patients admitted into the cardiac intensive care unit
Authors: Angeles Sistac D , Robles Conde I , Bragagnini W , Vila Perales M , Rodriguez Sotelo L , Pena Ortega P , Padilla Lopez M , Sionis A , Duran Cambra A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Current evidence suggests that incremental levels of PEEP generate an increase in right intracavitary pressures, diminishing venous return and consequently lessening left ventricular preload and stroke volume, resulting in a significant decrease of cardiac output. Nonetheless, most studies regarding these interactions have been done in patients requiring mechanical ventilation for non-cardiac disorders or in animals. We studied the effects of incremental levels of PEEP on cardiac intracavitary pressures and hemodynamics in mechanically ventilated patients admitted into the Cardiac Intensive Care Unit.

Purpose
We aimed to model how increments in PEEP alter cardiac output and other hemodynamic variables in patients with cardiac disfunction.

Methods
We included 14 mechanically ventilated patients admitted into a Cardiac Intensive Care Unit from 2018 to 2020. Data on intracavitary pressures and hemodynamics were recorded via Swan-Ganz catheterization and echocardiographic imaging. We documented measurements for all variables of interest at three different levels of PEEP: 5cmH2O, 10cmH2O and 15cmH2O. We conducted general descriptive statistics, mean comparison tests for paired data and linear regression models with Stata version 12.0 (StataCorp LP, College Station, TX).

Results
7 (50%) patients admitted in the study had cardiogenic shock, 11 (79%) patients were mechanically ventilated in a volume-controlled setting and 3 (21%) were on pressure support ventilation. Seven (50%) patients needed vasoactive drugs during the study. Only 1 (7%) patient required an intra-aortic balloon pump. Seven (50%) patients had a visual left ventricular ejection fraction lesser than 40% and 3 (21%) had a moderate-severe mitral regurgitation. Paired mean testing by groups associated to gains of PEEP revealed statistically significant increments in Mean Pulmonary Artery Pressure (mPAP), Pulmonary Capillary Wedge Pressure (PCWP) and Central Venous Pressure (CVP). Inversely, increments of PEEP were linked to significant decrements in Cardiac Output (CO) [Figure 1 & Table 1].

Conclusions
In mechanically ventilated patients admitted into the Cardiac Intensive Care Unit, rises in PEEP are associated to increments in intracavitary cardiac pressures, and inversely, with decrements in cardiac output. Although our findings are statistically significant, we have yet to clarify whether these are clinically meaningful, specifically within PEEP increments of 5 to 10cmH2O, the usual range in clinical practice.