bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical risk scores versus simple integrated clinical judgment in patients with suspected acute coronary syndromes
Authors: Boeddinghaus J , Meier M , Nestelberger T , Koechlin L , Lopez-Ayala P , Rubini Gimenez M , Miro O , Martin-Sanchez J , Kawecki D , Keller D , Nickel C , Bingisser R , Christ M , Mueller C 
Published: October 2022

Abstract

Background
The clinical utility of clinical risk scores in patients presenting with suspected acute coronary syndromes to the emergency department (ED) is uncertain.

Purpose
We aimed to directly compare the performance of three established clinical risk scores to simple integrated clinical judgment (ICJ) of the treating ED physician.

Methods
Thirty day major adverse cardiac events (MACE) including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (AMI, including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the emergency department (ED) with acute chest discomfort in an international multicenter study (12 centres in 5 European countries). ICJ for the likelihood that an ACS is the cause of acute chest discomfort was quantified by the treating ED physician using a visual analogue scale at 90 minutes after patient's presentation to the ED. At this time, the ED physician had obtained the patient history, physical examination including vital signs, the 12-lead electrocardiogram at presentation, and the first local (hs)-cTn measurement. We directly compared the prognostic performance of the HEART-score, the GRACE-score, and the T-MACS decision aid to simple integrated clinical judgment (ICJ) of the treating ED physician. We also assessed the safety for rule-out of MACE at 30-days.

Results
Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy as quantified by the area under the receiver-operating characteristics curve was 0.85 (95% CI, 0.84–0.87) for the HEART-score, 0.85 (95% CI, 0.84–0.87) for the GRACE-score, 0.79 (95% CI, 0.77–0.80) for the TIMI decision aid, and 0.87 (95% CI, 0.85–0.88) for ICJ (Figure). The HEART-score identified 1893/4551 (41.6%) patients as low-risk with an NPV of 96.0% (95% CI, 95.0–96.8), the GRACE score identified 1542/4551 (33.9%) patients as low-risk with an NPV of 97.0% (95% CI, 96.0–97.7), the TIMI score identified 2157/4551 (47.4%) patients as low-risk with an NPV of 93.1% (95% CI, 91.9–94.1), and simple ICJ identified 1743/4551 (38.3%) patients as low-risk with an NPV of 95.6% (95% CI, 94.5–96.5).

Conclusion
The simple ICJ of the treating physician performed well for the prediction of 30-day MACE and might be an alternative to the well-validated HEART-score, GRACE-score, and T-MACS decision aid.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The study was supported by research grants from the the Swiss Heart Foundation and the University of Basel.
Mitral regurgitation increases readmission due to heart failure after percutaneous coronary intervention among patients with ST-elevation myocardial infarction: a retrospective data review
Authors: Alkhalaila O , Rahhal A , Abdelghani M S , Altermanini M , Habib M B , Alkhateeb M H , Hailan Y , Barakat M , Shehadeh M , Shunnar K , Al-Hijji M , Arabi A R 
Published: October 2022

Abstract

Introduction
Post-ST elevation myocardial infarction (STEMI) course can be complicated with mitral regurgitation (MR) which has significant impact on in-patient outcomes and post-discharge course. MR in the setting of STEMI can be due to left ventricular dilatation, papillary muscle rupture or chordal rupture.

Purpose
In this retrospective study, we aimed to evaluate the impact of MR on readmission within one year after percutaneous coronary intervention (PCI) in STEMI patients.

Methods
We conducted a single-center retrospective observation cohort study. We included all patients admitted to the hospital with diagnosis of STEMI, underwent PCI during the same admission (index admission) and discharged alive in the period between Jan 1st, 2016 and Sep 30th, 2018. Factors associated with readmission due to heart failure within 1 year of discharge were evaluated using multivariate logistic regression and results were reported as odds ratio (OR) with p-value &lt;0.05 indicating statistical significance.

Results
A total of 1257 patients were included in our retrospective analysis. The mean age of the study population was 51±10 years. Around 16% (n=206) of the study population had mitral regurgitation (MR) during their admission for STEMI. Among them, 195 patients had newly discovered MR. MR severity was mild in 196 (95%) patients with MR. Unplanned readmission due to cardiac reasons within 1 year of discharge occurred in 103 (8.2%) patients. Among them, 37 (3%) were readmitted due to heart failure. MR was found to increase the likelihood of readmission due to heart failure within one year after PCI among patients with STEMI by three times (aOR=3.13, 95% CI 1.39–7.03; p-value 0.006). As demonstrated in table 1, other positive predictors for readmission due to heart failure were female gender (aOR=3.80, 95% CI 1.22–11.86; p-value 0.021), chronic kidney disease (aOR=4.56, 95% CI 1.22–17.03; p-value 0.024), and clinical heart failure during the index admission (aOR=4.82, 95% CI 1.53–15.15; p-value 0.007). Interestingly, reduced left ventricular ejection fraction was not a significant predictor of heart failure readmission.

Conclusion
Mitral regurgitation is relatively common in STEMI and most frequently presents with mild severity. In our study, MR was found to be a strong predictor for readmission due to heart failure within one year after PCI among patients with STEMI, which may warrant frequent follow-up for these patients and proper initiation of and titration of guideline-directed medical therapy (GDMT).

Funding Acknowledgement
Type of funding sources: None.
Body weight and mortality in takotsubo syndrome: insights from the International Takotsubo (InterTAK) registry
Authors: Stahli B , Cammann V L , Schindler M , Schweiger V , Szawan K A , Niederseer D , Wurdinger M , Schonberger A , Schonberger M , Koleva I , Mercier J C , Petkova V , Ruschitzka F , Ghadri J R , Templin C 
Published: October 2022

Abstract

Background/Introduction
The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking.

Purpose
The aim of this study was to determine the relation of body weight to mortality in TTS patients.

Methods
Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to July 2021 and with available data on BMI were included in the analysis. Patients were stratified according to BMI (underweight, &lt;18.5 kg/m2; normal weight, 18.5–24.9 kg/m2; overweight, 25.0–29.9 kg/m2; obese, 30.0–34.9 kg/m2; and very obese, ≥35.0 kg/m2). The primary endpoint was mortality at 1 year.

Results
Of the 2'707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese, and 118 (4.4%) very obese. Mortality at 1 year as a function of BMI with 95% confidence interval is given in Figure 1. Mortality at 1 year was 11.3%, 6.9%, 5.5%, 4.9%, and 9.3% in underweight, normal weight, overweight, obese, and very obese patients (p=0.02, Figure 2). Being overweight or obese was significantly associated with a lower mortality at 1 year (HR 0.70, 95% CI 0.51–0.96, p=0.03), and associations remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46–0.97, p=0.03). Associations were observed when including patients without emotional stressors (adjusted HR 0.64, 95% CI 0.43–0.94, p=0.02), but not when including those with emotional stressors (adjusted HR 1.14, 95% CI 0.30–4.27, p=0.85).

Conclusion
A U-shaped mortality curve across BMI categories was observed in TTS patients, with lowest mortality rates in obese patients. These observations provide first evidence for the existence of the obesity paradox in TTS.

Funding Acknowledgement
Type of funding sources: Foundation.
Opioid administered prior to onset of myocardial infarction is associated with atypical symptoms of acute coronary ischemia in emergency calls
Authors: Storgaard Noerskov A , Lykkemark Moeller A , Torp-Pedersen C , Folke F , Collatz Christensen H , Blomberg S N , Kragholm K , Loenborg J , Dominguez H , Bang C 
Published: October 2022

Abstract

Background
Acute identification and treatment of myocardial infarction (MI) is crucial for survival. MI symptom presentation is typically characterized by chest pain. Regular use of opioids to relief pain of chronic diseases is common. However, it has not been investigated whether opioid administered prior to onset of MI is associated more with atypical presentation of ischemia compared to non-opioid users.

Purpose
To investigate if opioid therapy is associated with atypical symptoms of MI.

Methods
The study is registry-based. MI is defined as patients with the ICD-10 discharge diagnoses I20.0 and I21 as primary diagnosis &lt;24 hours after a call to the Capital Emergency Medical Services, including the Emergency Number (1–1-2) and Out-of-hours Service (OOHS). MI patients with opioid treatment prior to onset of MI are compared with a control group of MI patients without opioid treatment. The primary symptom of MI is registered in calls to the Capital Emergency Medical Services, from 2014 to 2018. Opioid treatment includes opioid prescribed and picked up &lt;30 days prior to onset of MI.

Results
In total, 866 MI patients with opioid treatment and 10,061 MI patients without opioid treatment were included. The median age was 72.0 vs 67.8 years, 50.5% vs 34.5% were women, 61.0% vs 54.7% called the Emergency Number (1–1-2), ischemic heart disease was present in 48.5% vs 34.3% and type 2 diabetes in 23.1% vs. 16.2%. Atypical symptoms of MI were associated with opioid treatment and most prevalent in calls to OOHS, in women and by higher age. Acute symptoms of MI are visualized in Figure 1 and 2.

Conclusion
Opioid treatment prior to onset of MI was associated with increased atypical symptoms of MI, especially dyspnea, and increased in calls to the OOHS, in women and by higher age. This might challenge the clinician in early diagnose of MI in patients with opioid treatment and thereby delay acute lifesaving treatment.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
Outcomes of patients treated with blood transfusion in a contemporary tertiary intensive cardiac care unit
Authors: Karameh H , Taha L , Karmi M , Hamayel K , Perel N , Steinmetz Y , Levi N , Shaheen F , Manassra M , Maller T , Glikson M , Asher E 
Published: October 2022

Abstract

Background
Different trials showed that patients treated with blood transfusion (BT) have unfavorable prognosis regarding outcomes and mortality. Nevertheless, outcomes in patients treated with BT hospitalized in a contemporary tertiary intensive cardiac care unit (ICCU) is limited.

Objective
To determine mortality rate in patients treated with BT in a contemporary tertiary ICCU.

Methods
A prospective single center study to evaluate short- and long-term mortality rate of patients treated with BT between January 2020 and December 2021 in a tertiary ICCU.

Outcomes
During the study period 2132 consecutive patients were admitted with a mean age of 66.9±16 and 650 (30.5%) of them were women. Of the total population, 108 (5%) patients were treated with BT (BT-group) during their hospitalization. Patients were followed-up for 2 years with a median [IQR] follow up time of 82.5 [12.25–240.50] days in BT-group vs. 138.5 [34–325, 75] days in the non-BT (NBT) group. Mean age was 73.81±14 years in BT-group vs. 66.59±16 years in NBT-group, p&lt;0.0001. There was a higher rate of female gender in the BT-group 48.1% vs. 29.5% in the NBT, p&lt;0.0001. Crude mortality rate was 29.6% in BT-group and 9.2% in NBT-group, p&lt;0.0001. Median [IQR] length of stay was 5 [2–6] days in BT-group vs. 3 [2–4] days in the NBT-group. Multivariate Cox analysis for (Female gender, prior trans-catheter aortic valve replacement, prior cardiac intervention, sepsis, history of congestive heart failure, pulmonary hypertension, pacemaker implantation and anemia) showed that BT was independently associated with more than two folds the mortality rate [HR=2.19 95% CI (1.47–3.62)] as compared with the NBT-group, p&lt;0.0001. Receiver operating characteristic curve (ROC) was plotted for multivariable analysis and showed area under curve (AUC) of 0.8, 95% CI [0.760–0.852].

Conclusion
Even in contemporary tertiary ICCU, with advanced technology, equipment and delivery of care, BT remains a strong predictor for short- and long-term mortality.

Funding Acknowledgement
Type of funding sources: None.
Perioperative myocardial injury after non-cardiac surgery: long-term mortality according to cardiovascular risk
Authors: Gomes B F O , Silva T M B , Dutra G P , Peres L S , Camisao N D , Goudar H C , Butter A , Petriz J L F , Carmo Junior P R , Pereira B B , Oliveira G M M 
Published: October 2022

Abstract

Background
Perioperative Myocardial injury that occurs after non-cardiac surgery (MINS) is prevalent and increases mortality in 30 days. However, few studies have assessed the impact of cardiovascular risk and MINS in long-term mortality.

Methods
Retrospective study including all non-cardiac surgery patients admitted to a postoperative care unit who stayed at least one night in this unit and had at least one measurement of high-sensitive cardiac troponin. The study period was from January/2011 to December/2019, ensuring a minimum follow-up of 2 years. The criteria for defining a high cardiovascular risk patient (HCR) were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance &lt;60 ml/min, or presence of, at least, 3 risk factors (hypertension, smoking, dyslipidemia, or age &gt;65 years). The population was divided into 4 subgroups according to the presence of HCR and elevated troponin. Clinical characteristics and the occurrence of MINS were assessed between deaths and survivors using the chi-squared test and Student's t-test. Variables with p&lt;0.01 in the univariate model and the subgroups were included in the Cox regression model to identify predictor variables.

Results
2230 patients were included, with a mean follow-up of 6.21±2.74 years, mean age = 63.7±16.2 years, and 55.6% women. The prevalence of MINS was 9.4%. There were 556 deaths (24.9%). Group 1 (no MINS and no HCR) had 1521 patients (68.2%); Group 2, 126 patients (5.7%); Group 3, 500 patients (22.4%) and Group 4, 83 patients (3.7%). In the univariate analysis, the following variables were associated with death: age, arterial hypertension, BMI, previous myocardial infarction, urgent surgery, dementia, peripheral artery disease (PAD), and atrial fibrillation. These variables were included in Cox's regression model with the predefined subgroups and the predictive variables of all-cause death were: Group 2 (HR 2.12; 95% CI: 1.56–2.87), Group 4 (HR 2.50; 95% CI: 1.79–3.50), previous myocardial infarction (HR 1.44; 95% CI: 1.08–1.93); dementia (HR 2.90; 95% CI: 2.15–3.92), PAD (HR 1.91; 95% CI: 1.27–2.90) and age (HR 1.05; 95% CI: 1.04–1.06).

Conclusion
Cardiovascular risk did not influence long-term mortality in patients undergoing non-cardiac surgery, demonstrating that myocardial injury is one of the main predictors of death independently of cardiovascular risk.

Funding Acknowledgement
Type of funding sources: None.
Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study
Authors: Kwon W , Yang J H , Lee S H , Choi K H , Park T K , Lee J M , Song Y B , Hahn J Y , Choi S H , Ahn C M , Ko Y G , Yu C W , Jang W J , Kim H J , Kwon S U 
Published: October 2022

Abstract

Background
In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.

Methods and results
1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI &gt;25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.

Conclusions
Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.

Funding Acknowledgement
Type of funding sources: None.
Impact of persistent MVO late after STEMI on adverse left ventricular remodelling: a CMR study
Authors: Gavara J , Rios Navarro C , Lopez-Lereu M P , Monmeneu J V , De Dios E , Perez-Sole N , Marcos-Garces V , Canoves J , Nunez J , Chorro F J , Rodriguez-Palomares J F , Freixa A , Borras R , Ortiz-Perez J T , Bodi V 
Published: October 2022

Abstract

Background
Despite successful revascularization at the epicardial level, microvascular obstruction (MVO) appears soon after reperfusion in up to 50% of cases. Early MVO has been solidly associated with adverse resulting cardiac structure and heightened risk of future cardiovascular events. Although clinical and experimental studies demostrated the spontaneous repair of MVO, little is known about the occurrence and implications of persistent MVO late after infarction.

Purpose
We used cardiovascular magnetic resonance (CMR) to characterize the impact of persistent MVO late after reperfused ST-segment elevation myocardial infarction (STEMI) on adverse left ventricular (LV) remodelling (ALVR).

Methods
A prospective registry of 471 STEMI patients underwent CMR 7 [5–10] and 198 [167–231] days post infarction, and MVO (&gt;1 segment) and ALVR (relative increase &gt;15% at follow-up CMR) of LV end-diastolic (LVEDVI) and end-systolic volume indices (LVESVI) were determined.

Results
One-week MVO occurred in 209 patients (44%) and persisted in 30 of these (6%). Most patients with persistent MVO (22/30, 73%) displayed extensive (&gt;2.5% of LV mass) MVO at 1 week. Compared with patients without MVO (n=262, 56%) or with MVO only at 1 week (n=179, 38%), those with persistent MVO at follow-up (n=30, 6%) showed higher rates of ALVR-LVEDVI (22%, 27%, 50% p=0.003) and ALVR-LVESVI (20%, 21%, 53% p&lt;0.001). After adjustment, the extent (% of LV mass) of MVO at follow-up was independently associated with ΔLVEDVI (relative increase, %) (p=0.01) and ΔLVESVI (p=0.03). Compared to a 1:1 matched population of 30 patients with MVO only at 1 week, patients with persistent MVO more frequently displayed ALVR-LVEDVI (12% vs. 50%, p=0.003) and ALVR-LVESVI (12% vs. 53%, p=0.001).

Conclusion
MVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodelling. These findings fuel the need for further research on microvascular injury repair.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” [grant numbers PI20/00637, PI15/00531, FI18/00320, and CIBERCV16/11/00486] and by Conselleria de Educaciόn – Generalitat Valenciana (PROMETEO/2021/008).
Timing of active left ventricular unloading in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy
Authors: Schrage B , Sundermeyer J , Blankenberg S , Eitel I , Kirchhof P , Mangner N , Moebius-Winkler S , Orban M , Thiele H , Morrow D A , Schulze P C , Westermann D 
Published: October 2022

Abstract

Aim
To evaluate the impact of timing of active left ventricular (LV) unloading in relation to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation on outcomes of patients with cardiogenic shock (CS).

Methods and results
Data from 421 patients with CS treated with active LV unloading on top of VA-ECMO at 18 tertiary-care centers in 4 countries were collected. Only patients in whom both devices were implanted within 24 hours of each other were considered and patients were stratified by timing of device implantation in early vs. delayed active LV unloading (e.g. active LV unloading before vs. after VA-ECMO). Cox and logistic regression models (adjusted for age, sex, lactate, cardiopulmonary resuscitation (CPR), VA-ECMO assisted CPR and enrollment center) were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as several safety outcomes.
Overall, 310 (73.6%) patients were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (hazard ratio 0.63, 95% confidence interval 0.46–0.87) and a higher likelihood of weaning from mechanical ventilation (odds ratio 1.25, 95% confidence interval 1.03–1.52), but not with more complications. Importantly, postponing active LV unloading in these patients was associated with higher mortality risk (Figure 1), and lower likelihood of successful weaning from mechanical ventilation.

Conclusion
This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO as a primary treatment strategy, as opposed to a bail-out approach.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Unrestricted research grant from Abiomed