bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic impact of coronary anatomy in myocardial infarction with nonobstructive coronary artery disease: a seven-year longitudinal follow-up
Authors: Tsaban G , Barret O , Peles I , Abramowitz Y , Shmueli H , Cafri C , Zahger D , Koifman E 
Published: October 2022

Abstract

Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a common condition associated with major adverse events (MAE) that may occur presence of normal or nonobstructive coronary artery anatomy (NCAA and NOCAA, respectively). The prognostic impact presence of NOCAA on long-term outcomes of MINOCA patients remains unclear.

Methods
This is a retrospective study among consecutive MINOCA patients in a large referral medical center in Israel between the years 2005–2018. Patients with probable alternative cause for myocardial injury, as stress-induced cardiomyopathy and myocarditis, were excluded. Patients were classified according to their coronary angiography diagnosis into NCAA and NOCAA. The primary outcome was MAE, defined as the composite of all-cause mortality and recurrent acute coronary syndrome (ACS). We performed survival analyses using multivariable Cox regression, controlling for potential cofounders.

Results
Among 36,501 admitted with AMI during the study period, 1,544 patients (4.2%) had MINOCA. Among MINOCA patients, 651 (42%) had NCAA, and 893 (58%) had NOCAA. The mean age was 61.2±12.6 years, and 710 (46.0%) were females. The NOCAA group had more females and were older with higher rates of diabetes, hypertension, dyslipidemia, atrial fibrillation, and chronic renal failure (p&lt;0.05 for all). At a median follow-up of 7 years, MAE occurred in 203 (22.7%) patients and 67 (10.3%) patients in the NOCAA and NCAA groups, respectively (p&lt;0.01). In fully-adjusted multivariable model, NOCAA remained a significant risk factor for long-term MAE [adjusted-hazard-ratio (aHR) 1.67, 95% confidence-interval (95% CI) 1.25–2.23; p&lt;0.001; figure]. Other factors associated with MAE were older age (aHR 1.05, 95% CI 1.03–1.06; p&lt;0.001), left ventricular ejection fraction (LVEF) &lt;40% (aHR 3.04, 95% CI 2.03–4.57; p&lt;0.001)

Conclusion
Among MINOCA patients, NOCAA was associated with a worse long-term prognosis than NCAA. Other risk factors for long-term MAE were older age and LVEF &lt;40%, while female sex and sinus rhythm at presentation were associated with lower MAE risk.

Funding Acknowledgement
Type of funding sources: None.
Prognostic impact of secondary prevention treatment following myocardial infarction with non-obstructive coronary arteries: Bayesian versus frequentist meta-analysis
Authors: Samaras A , Papazoglou A , Balomenakis C , Rampidis G , Bekiaridou A , Moysidis D , Giannakoulas G 
Published: October 2022

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity with a plethora of causes and pathophysiologic mechanisms. Traditional secondary prevention medications may not offer benefit for patients with MINOCA, calling into question the routine use of such therapies in this population.

Material and methods
Literature search was conducted in MEDLINE (PubMed), Scopus by ELSEVIER and Cochrane Central Register of Controlled Trials (CENTRAL) databases until 08 March 2022. Random-effects frequentist and hierarchical Bayesian meta-analyses were performed to assess the prognostic impact of secondary prevention medications (β-blockers, RAAS inhibitors, statins, DAPT, ASA and P2Y12 inhibitors) on the occurrence of major adverse cardiovascular events (MACE) and all-cause mortality in MINOCA patients. Sensitivity analyses accounted for the effect of: i. small sample size, ii. limited study follow-up period, and iii. different ethnicity.

Results
Of 2,569 articles initially retrieved, 9 observational studies were deemed eligible for this analysis, encompassing a total of 14,003 patients suffering from MINOCA (mean follow-up range from 6 to 90 months, mean age = 64.9±10.4 years).Administration of ASA, DAPT and P2Y12 inhibitors was not significantly linked with MACE [pooled adjusted hazard ratios (aHRs) = 0.94, 0.88, and 0.97, with 95% confidence intervals (CIs): 0.56–1.59, 0.47–1.65, and 0.562–1.53, respectively]. RAAS inhibitors and statins were independently associated with lower risk of MACE (pooled aHRs = 0.61 and 0.55 with 95% Cis: 0.46–0.82, and 0.34–0.90, respectively) and all-cause mortality (pooled aHRs = 0.58 and 0.55 with 95% Cis: 0.37–0.91, and 0.43–0.72, respectively). B-blockers were associated with significantly lower risk of all-cause death according to the frequentist analysis (pooled aHR = 0.80, 95% CI: 0.67–0.96) and with non-significantly lower risk of MACE (pooled aHR = 0.81, 95% CI: 0.65–1.01) [Figure 1]. The results deriving from the Bayesian analyses were generally consistent with the frequentist analyses, with the exceptions of the Bayesian analyses on statin and β-blocker effects, which were affected by the pre-test probabilities set herein [Figure 2]. The overall heterogeneity observed in our analyses was relatively small, and there was not substantial publication bias. Furthermore, the performed sensitivity analyses supported the robustness of the observed outcomes.

Conclusion
In this meta-analysis, it appeared that predominantly RAAS inhibitors and statins across secondary prevention medications were consistently associated with lower risk of MACE or all-cause death during the follow-up period of patients that experienced MINOCA.

Funding Acknowledgement
Type of funding sources: None.
Impacts on the short-term outcome of patients with Tako-Tsubo syndrome
Authors: Mousavi R A , Kronberger C , Han E , Litschauer B , Badr Eslam R 
Published: October 2022

Abstract

Background
Tako-Tsubo syndrome (TTS) is a form of acute heart failure which mostly affects postmenopausal women, often following an emotional or physical trigger factor. There are many hypotheses for the development of TTS but the complete pathophysiology still remains unclear. Although most patients recover after a few days, some have to be treated at the intensive care unit (ICU) and may even die from the condition.

Purpose
The aim of this study was to find out if pre-existing diseases, cardiovascular risk factors (CVRF), comorbidities and trigger factors have any impact on the short-term outcome of TTS patients.

Methods
Data of all patients who presented to our centre with TTS from 2009–2017 were gathered retrospectively. Baseline characteristics, including somatic and psychiatric pre-existing diseases, CVRF (smoking, hypertension, diabetes, dyslipidaemia) as well as physical and emotional trigger factors were collected. Somatic diseases were additionally categorised into cardiac, autoimmune, malignant and other diseases. Admission to intensive care unit post TTS and/or in-hospital death were defined as poor short-term outcome. Outcome predictors were analysed with binary logistic regression model using the combined variable admission to an ICU and/or death.

Results
Out of 102 patients, 84 (82.4%) were females and 18 (17.6%) males with a median age of 65±15 years. 30 (29.4%) patients had an emotional and 23 (22.5%) a physical trigger factor. 27 (26.5%) had a psychiatric and 88 (86.3%) a somatic pre-existing disease. 33 (32.4%) patients were smokers, 58 (56.3%) had hypertension and 18 (17.5%) were diabetics. 19 patients (18.6%) had to be admitted to ICU and 8 patients (7.8%) died.
No pre-existing diseases, baseline characteristics, CVRF or comorbidities behaved as significant independent predictor for bad outcome in TTS patients. Physical trigger was the only significant predictor for ICU admission and/or death (p=0.012).

Conclusion
Our study showed that patients with physical trigger factors have a higher risk of ICU admission and/or death than patients with emotional or no stressful trigger factors before TTS and should therefore be monitored closely. Interestingly, contrary to many other acute cardiac diseases, pre-existing diseases, cardiovascular risk factors and comorbidities do not seem to have any impact on the short-term outcome of patients with TTS.

Funding Acknowledgement
Type of funding sources: None.
The role of peak NT-proBNP/peak cardiac troponin T ratio obtained within 3 days of admission to discriminate Takotsubo from acute coronary syndrome
Authors: Rallidis L , Kosmas N , Iordanidis D , Kiouri E , Zapantiotis D , Samiotis E , Varounis C , Filippatos G 
Published: October 2022

Abstract

Background
Takotsubo syndrome (TS) is not usually diagnosed until a patient with suspected acute coronary syndrome (ACS) is found to have no hemodynamically significant lesions on coronary angiography (CA).

Purpose
We explored whether a cardiac biomarker profile can contribute to early diagnosis of TS, which could be useful when CA is either not available or does not provide a definitive diagnosis.

Methods
Ratios of N-terminal-pro brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) [admission and peak levels of the two consecutive days following admission, expressed in pg/mL] were compared in 41 patients with TS and 50 ACS patients.

Results
Both admission NT-proBNP/cTnT ratio and peak NT-proBNP/peak cTnT ratio were higher in patients with TS compared to those with ACS (38.8±57.1 vs 15.2±33.1, p=0.038 and 29.1±26.2 vs 2.2±3.9, p&lt;0.001, respectively). Only the association of peak NT-proBNP/peak cTnT ratio remained statistically significant after adjustment for age and gender when multiple linear regression analysis was used (R square=0.746, p&lt;0.001). ROC curve analysis of peak NT-proBNP/peak cTnT ratio discriminated patients with TS as opposed to those with ACS (AUC=0.921 with 95% CI: 0.851–0.990, p&lt;0.001). A cut-off value of peak NT-proBNP/peak cTnT ratio &gt;5.5 had a sensitivity of 85%, a specificity of 90% and an accuracy of 88.1% in detecting TS as opposed to ACS.

Conclusions
Peak NT-proBNP/peak cTnT ratio &gt;5.5 obtained within the first 3 days of admission has a good diagnostic accuracy to identify patients with TS among those presenting with ACS. This could be useful for the early discrimination between the two entities when CA is not easily available, particularly in patients without ST-segment elevation and low or intermediate-risk.

Funding Acknowledgement
Type of funding sources: None.
Distinctive characteristics among MINOCA and Takotsubo patients and their prognostic value in a multicenter prospective cohort
Authors: Mantzouranis E , Leontsinis I , Sakalidis A , Ntalakouras I , Kordalis A , Antonopoulos A , Dagre A , Poulimenos L , Mamarelis I , Tsioufis K 
Published: October 2022

Abstract

Background/Introduction
In the acute care setting, the working diagnosis of MINOCA exhibits increasing recognition and includes a broad spectrum of conditions, most of them yet not adequately understood. TakoTsubo syndrome (TTS) represents a significant proportion of such cases and despite its predominance on female gender as well as its imaging characteristics on the typical apical form it is not easily distinguishable from other MINOCA causes without the contribution of cardiac magnetic resonance (CMR).

Purpose
The aim of our study is to investigate for distinctive characteristics related to the index event among MINOCA cases from a multi-center prospective cohort with a mean follow up period of 18 months.

Methods
We divided our study population (n=74) into TTS (n=30) and non-TTS (n=44) according to multimodality imaging results. Information regarding the index event (Sep 2019-Feb 2021) were retracted from the medical notes.

Results
CMR results led to a post-discharge diagnosis reconsideration in 12 cases (16.2%). Female gender (n=29; 96.7% vs n=22; 50%, P&lt;0.001), older age (mean age 66±11 vs 59±11, P=0.04) and history of hypertension (n=21; 70% vs n=19; 44.3%, p=0.035) were more frequent in TTS group. There was no statistically significant difference in body mass index, baseline renal function, history of dyslipidemia, diabetes and smoking between the two groups. During the index event, peak troponin levels 576 pg/ml (IQR: 184–9915) vs 767 pg/ml (IQR: 47–47000), P=0.005], were lower in the TTS group, whereas NSTEMI presentation was the commonest among all patients. Angina was the dominant symptom for both groups. However, severe angina expressed as more than 2 episodes within 24 hours was more frequent among the TTS population (n=19; 65.5% vs n=10; 22.7%, P=0.001). TTS probability assessed with the INTERTAK score was higher among the TTS group (68±10 vs 38±21, P&lt;0.001). In hospital major cardiovascular events incidence was higher in the non-TTS group (n=2 vs n=11, P=0.06). Multivariate analysis revealed that the presence of severe angina (OR, 8.118, 95% CI: 1.173–56.157, P=0.038) is highly predictive of TTS in the acute care setting even independently of INTERTAK probability.

Conclusions
These preliminary results indicate that the presence of several anginal attacks may strengthen the predictive value of the INTERTAK score during MINOCA evaluation in the acute setting. Confirmation in a larger population is warranted.

Funding Acknowledgement
Type of funding sources: None.
Variation in health-care quality and outcomes according to time of chest pain presentation: a state-wide prospective cohort study
Authors: Navani R V , Dawson L , Andrew E , Nehme Z , Bloom J , Cox S , Anderson D , Stephenson M , Lefkovits J , Taylor A , Kaye D , Smith K , Stub D 
Published: October 2022

Abstract

Background
Previous studies examining temporal variation in cardiovascular care have largely been limited to assessing weekend and after-hours effects whereby those presenting on the weekend or after-hours have a poorer outcome. However, emerging evidence suggests more complex patterns in patterns and outcomes may exist.

Purpose
We aimed to determine patterns of temporal variation in chest pain presentations and subsequent health-care quality and outcomes.

Methods
This was an observational, prospective-cohort study of adult patients aged 18 and over who were attended by emergency medical services for non-traumatic chest pain between 1 January 2015 and 30 June 2019 in Victoria, Australia. Major exclusion criteria included pre-hospital diagnosis of ST elevation myocardial infarction or an out of hospital cardiac arrest. The exposure variable was time of day and day of week stratified into 168 hourly time periods. The primary outcome measure was 30-day mortality.

Results
The study cohort comprised 196,365 ambulance attendances for acute non-traumatic chest pain; mean age 62.4 years (SD 18.3) and 99,497 (50.7%) females. Three temporal patterns were observed for chest pain presentations (Figure 1): (1) a diurnal pattern with a sharp increase in presentations from 8 am, peaking around midday, before decreasing into late evening with a nadir between 3–4 am, (2) a weekend effect where Saturday and Sunday had a relatively lower rate of presentations compared to during the week, and (3) a Monday – Sunday gradient where more presentations were likely earlier in the week, than later. Six patterns were identified across pre-hospital and hospital key performance indicators (KPI) (diurnal, in/after-hours, weekend effect, Monday – Sunday gradient, a peak period and morning vs afternoon/evening effect. Risk of 30-day mortality was associated with weekend presentation (OR 1.15, 95% CI 1.06–1.24, p=0.001) and morning presentation between midnight and midday (OR 1.17, 95% CI 1.09–1.25, p&lt;0.001) (Figure 2).

Conclusion
Chest pain presentations, care quality and outcomes demonstrate complex temporal variation beyond the already established weekend and after-hours effect. Such relationships should be considered during resource allocation and quality improvement programs in order to improve treatment quality across all days and times of the week.

Funding Acknowledgement
Type of funding sources: None.
Prevalence and predictors of acquired long QT syndrome in the ER department
Authors: De Almeida Fernandes D , Camoes G , Ferreira D , Queijo C , Guimaraes J M , Ribeiro C , Goncalves L , Pina R , Antonio N 
Published: October 2022

Abstract

Introduction
Long QT syndrome (LQTS) is a rare heterogeneous syndrome that may be congenital or acquired, the latter being more common. Its real-world prevalence remains to be determined. We aimed to determine the prevalence of this syndrome in patients admitted to the emergency room (ER) and characterize the subset of patients with severely prolonged QT.

Methods
A retrospective analysis of ECG of all consecutively admitted patients in the ER of a tertiary hospital between the 28th of January and the 17th of March 2020 was made. All patients with Bazzett corrected QT interval greater than 470ms in men and 480ms in women were included. Repeated ECGs or with bad electrocardiographic quality, congenital LQTS, atrial fibrillation and pacemaker rhythm were excluded. Clinical data with a special focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without QT interval greater than 500ms.

Results
A total of 6280 ECGs of 5056 patients were analysed. After evaluation, 390 ECGs from 387 different patients were considered. Prevalence of LQTS at admission was 7.95%. Patients were more commonly men (53.1%) with an average age of 73.6±14.7 years old and mean QTc interval of 502.14±32.2ms. Only 20% of the patients were symptomatic, with the most common form of presentation being syncope (50%). No ventricular arrhythmias were recorded.
Regarding patients with a QT interval greater than 500ms, these were more frequently female (59.9% vs 37.2%, p&lt;0.001), were more frequently on QT prolonging drugs (77.8% vs 67.3%; p=0.002). Presence of clinical risk factors was not a risk factor per se (p=0.811) but a greater number of risk factors was linked to more severely prolonged QT (p=0.040). The main contributing factor was intake of antibiotics (odds ratio (OR) 3.497; CI 95% 1.074–11.321; p=0.038) followed by female gender (OR 2.518; CI 95% 1.668–3.800; p&lt;0.001) and use of antipsychotics (OR 1.960; CI 95% 1.159–3.316; p=0.012).

Conclusions
Acquired LQTS is particularly prevalent in the ER setting. The complex interaction of clinical factors and drug iatrogenesis and the unpredictability of its manifestations render its management and recognition difficult but essential. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made in order to avoid, detect and treat acquired LQTS as early as possible.

Funding Acknowledgement
Type of funding sources: None.
Dexamethasone improves cardiovascular outcomes in critically ill COVID-19, a real world scenario multicenter analysis
Authors: Jirak P , Van Almsick V , Dimitroulis D , Mirna M , Seelmaier C , Shomanova Z , Semo D , Dankl D , Mahringer M , Lichtenauer M , Hoppe U , Reinecke H , Pistulli R , Larbig R , Motloch L 
Published: October 2022

Abstract

Background
Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive.

Methods
In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. 113 patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9–10). 65 patients (36.5%) constituted the non-dexamethasone control group.

Results
While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231% vs. 700% indicated as relative to cut off value, p=0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14mg/l, p=0.002) reflected by a significant reduction in pulmonary embolism rate (4.4% vs. 20.0%, p=0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6% vs. 34.4%, p&lt;0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group.

Conclusion
In severe COVID-19, antiinflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.

Funding Acknowledgement
Type of funding sources: None.
Major adverse cardiac events in critically ill COVID-19 patients
Authors: Lopes V , Baptista J P , Moreira N , Goncalves L 
Published: October 2022

Abstract

Background
Critically ill patients hospitalized with COVID-19 are at high risk of developing major adverse cardiac events (MACE).

Purpose
This study aimed to identify independent predictors of MACE after intensive care unit (ICU) admission which could be used to identify high-risk patients who may benefit from preventive strategies.

Methods
We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19 and followed them for a median period of 7 months. Patients admitted due to trauma or emergent surgery were excluded. Logistic regression analysis was performed to evaluate which clinical characteristics predicted MACE. MACE was defined as all-cause ICU mortality, new-onset heart failure, acute coronary syndrome, ventricular arrythmias, pulmonary embolism, myocarditis, and stroke (ischemic or hemorrhagic).

Results
A total of 297 patients was included in the analysis. Median age was 62 (IQR 17) years, and most patients were male (198 patients, 66.7%). From a total of 297 patients, 108 (36.4%) developed at least one MACE: ICU all-cause mortality (92 patients, 31.0%), new-onset heart failure (27 patients, 9.1%), acute coronary syndrome (7 patients, 2.4%), ventricular arrythmias (7 patients, 2.4%), pulmonary embolism (13 patients, 4.4%), myocarditis (4 patients, 1.3%), and stroke (5 patients, 1.7%).
Univariate logistic regression analysis showed that the clinical variables associated with MACE were male sex, older age, APACHE II score, SAPS II score, hypertension, hyperlipidemia, known coronary artery disease, heart failure, new-onset atrial fibrillation, need for invasive mechanical ventilation, duration of mechanical ventilation, and vasopressor use. In multivariate logistic regression analysis, we found that the MACE's independent predictors were older age, higher APACHE II score, and new-onset atrial fibrillation. Main results are presented in Table 1.

Conclusion(s)
Among critically ill COVID-19 patients, older age, higher APACHE II score, and new-onset atrial fibrillation independently predicted MACE.

Funding Acknowledgement
Type of funding sources: None.