bluuebunny/crossref_metadata_2025_split huggingface dataset:
External validation of the simple NULL-PLEASE clinical score in predicting outcomes of out-of-hospital cardiac arrest in the Danish population - a nationwide register-based study
Authors: Byrne C , Barcella CA , Krogager ML , Pareek M , Ringgren KB , Wissenberg M , Folke F , Gislason G , Koeber L , Lippert F , Torp-Pedersen C , Kragholm KH , Lip GYH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
The Danish Foundation TrygFonden

Background
Clinical decision-making in patients with out-of-hospital cardiac arrest (OHCA) admitted to the hospital is challenging, and multiple scoring systems have been developed to predict survival. The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH &lt;7.2, Lactate &gt;7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may be able to identify patients with OHCA who are unlikely to survive; however, this score system have not previously been tested in a nationwide setting.

Purpose
The aim of this study was to validate the NULL-PLEASE clinical score to identify patients with OHCA in the Danish population who are unlikely to survive.

Methods
We retrospectively validated the predictive ability of the NULL-PLEASE score, using Danish nationwide registry data from 2001-2015. We identified OHCA survivors who had return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival and all NULL-PLEASE score parameters available. The primary outcome was 1-day mortality, and the secondary outcome was 30-day mortality. Outcomes were estimated using multivariable logistic regression with a NULL-PLEASE score of zero as reference.

Results
A total of 868 patients with all NULL-PLEASE score parameters available was included in the analysis. Overall, 1-day mortality was 33%, and 30-day mortality was 62%. A NULL-PLEASE score &gt;0 (assessed as a continuous variable) was associated with significantly increased 1-day mortality (odds ratio (OR): 1.62, 95% confidence interval (CI): 1.51-1.74) as well as significantly increased 30-day mortality (OR: 1.80, 95% CI: 1.66-1.96). Figures 1 and 2 show the ROC curves of NULL-PLEASE and 1-day mortality and 30-day mortality, respectively. Area under the curve (AUC) for 1-day mortality was 0.81, and AUC for 30-day mortality was 0.83. Assessed categorically, a NULL-PLEASE score ≥5 was associated with a particularly high OR for mortality: 1-day mortality (OR: 7.46, 95% CI: 5.42-10.27), and 30-day mortality (OR: 10.596, 95% CI: 7.32-15.33).

Conclusions
In a large nationwide OHCA-cohort, we found that a NULL-PLEASE score &gt;0 was associated with higher 1-day mortality as well as higher 30-day mortality.
Acute myocardial injury and infarction in patients under 45 years old - a single centre experience
Authors: Cabral M , Carvalho MF , Goncalves C , Santos B , Morais J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Acute myocardial injury and infarction is vastly described in patients over 45 years of age. However, the higher incidence of coronary artery disease (CAD) in young patients in recent decades has led to a concomitant increase in the importance of excluding coronary artery disease in this group.
The aim of this study was to analyse the prognosis in young patients with acute myocardial injury and infarction. Additionally, we intend to evaluate the clinical features and angiographic profile.
We retrospectively analysed all patients under 45 years of age with acute chest pain and elevated troponin who underwent coronary angiography in our department from January 2017 to April 2021. Patient selection and information collection were obtained through medical records. The patients were categorized into three groups, based on discharge diagnosis: group 1 for ST-segment elevation myocardial infarction (STEMI) patients, group 2 for non-ST-segment elevation myocardial infarction (NSTEMI) patients and group 3 for patients with angiographically normal coronary arteries. Outcomes were left ventricular dysfunction, assessed by left ventricular ejection fraction (LVEF) in transthoracic echocardiography; the occurrence of electrical complication during hospitalization, including sustained ventricular tachycardia, ventricular fibrillation or cardiorespiratory arrest; and in-hospital mortality. Group comparisons were performed. A p-value less than 0.05 was considered significant. Statistical analysis was performed using SPSS software v.25.0.
One hundred twenty-one patients were analysed: 59 (48.8%) in group 1, 28 (23.1%) in group 2 and 34 (28.1%) in group 3. Table 1 describes the main baseline characteristics. There was a significant difference between the groups for smoking (p-value = 0.03), more prevalent in group 1 and less prevalent in group 3. Regarding outcomes, there was a significant difference for left ventricular dysfunction at discharge, with a mean LVEF of 50% in group 1, 53% in group 2, and 58% in group 3 (p-value &lt; 0.01). The existence of electrical complications was similar for the three groups (p-value = 0.99), and all patients were discharged alive.
In conclusion, young patients with acute myocardial injury and infarction have a similar clinical history, with the exception of smoking in STEMI patients. There was a higher prevalence of left ventricular dysfunction in patients with STEMI, similar to that observed in older patients. A multicentric analysis, as well as a long-term follow-up, would be interesting to confirm these results.
Features of serum bilirubin in non ST elevation acute coronary syndrome
Authors: Mukhamedova M , Uzokov JK , Orziev DZ , Mukhitdinova OY , Payziev DD , Narzullaeva DS , Rakhimova DA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Even though, bilirubin is known to be an endogenous antioxidant, there is conflicting evidence whether level of serum bilirubin is associated with non-ST elevation acute coronary syndrome (NSTE ACS).

Purpose
We aimed to assess the possible impact of bilirubin level non-ST elevation acute coronary syndrome.

Methods
128 patients with NSTEACS were enrolled in the study (Aged 38-75 years; mean age 56.2±16.85 years; male 53%). Patients were divided into two groups in terms of level of total bilirubin. Group I included 56 patients (total bilirubin was higher 19 mMol/L) and Group II 72 patients with NSTA ACS (total bilirubin was lower 19 mMol/L). Anthropometric, laboratory including serum total, direct, indirect bilirubin level and instrumental data were obtained at baseline while admission prior to percutaneous coronary intervention. Follow-up was conducted via telephone in six months. Statistical analysis were performed by STATA software.

Results
Patients presenting with NSTE ACS having high level of bilirubin tended to have more severe course of the disease (62% vs. 53%, P&lt;0.05), high level of high sensitive troponin level (55ng/mL vs. 43 ng/mLK, P=0.001), multi-vessel disease (35% vs. 21%, P=0.001) and high rate of new revascularization (82% vs. 65%, P=0.001) than those ones with lower level of total bilirubin. Patients with high level of total bilirubin at admission with NSTE ACS had worse outcomes both in 1 month (1.24; 1.12-1.75; CI 95%; P&lt;0.05) and 6 months follow-up period than those NSTE ACS patients with lower bilirubin level at admission (1.512; 1.24-1.95; CI 95%; P&lt;0.05).

Conclusion
Total serum bilirubin level seems to be an independent predictor for severity of the disease and adverse outcomes in patients with NSTE ACS.
Comparison of long-term clinical outcomes in diabetic and non-diabetic patients of the mini-crush two-stent technique for percutaneous treatment of complex coronary artery bifurcation lesions
Authors: Sanchez Perez I , Moron Alguacil A , Gonzalvez Garcia A , Freites Esteves A , Concepcion Suarez R , Martinez Del Rio J , Munoz Garcia M , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Arizon Munoz JM , Lozano Ruiz Poveda F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Diabetic patients present more aggressive coronary artery disease and worse outcomes after percutaneous coronary intervention (PCI), especially in complex coronary bifurcation lesions. Currently, the benefit of "double stenting" techniques in the treatment of complex bifurcations in diabetics with coronary artery disease, is controversial.

Purpose
The aim of this study was to compare the outcomes of PCI with "mini-crush" two-stent technique in diabetic and non-diabetic patients, in terms of MACE: cardiovascular mortality, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after long follow-up (median 32 months).

Methods
Observational study in which were included 152 consecutive patients (mean age 69.5 years, 38.3% diabetics) with 152 complex bifurcated coronary severe lesions that underwent PCI from April 2014 to April 2020.

Results
No significant differences were observed in the baseline characteristics, clinical presentation and antiplatelet pretreatment between both groups. Clopidogrel was the P2Y12-receptor inhibitor most commonly used. There were no differences in mean complexity according to the Syntax score (29.7 ± 11.3 in diabetics vs 30.4 ± 14.4 in non-diabetics, p=0.293). Left main bifurcation was the most frequently coronary artery affected in both groups and circumflex was the most common side vessel. The characteristics of the procedure was similar in both groups: no differences observed in pre-dilation rate either in final kissing balloon post-dilation rate. Similar length and diameter of the stents implanted in both groups. Angiographic follow-up clinically guided was 15.8% in diabetics and 16.9% in non-diabetics. We found no significant differences in the incidence of MACE or in any of its components separately. TLR rate was similar in diabetics and non-diabetics patients.

Conclusions
Comparable to non-diabetic patients, PCI in complex coronary bifurcation lesions with "mini-crush" two-stent technique in diabetic patients shows favorable results with low event rates and need for revascularization at long-term follow-up.
Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest (OHCA): a four years experience
Authors: Bagliani A , Colombo CNJ , Damassa V , Voltini M , Ciarrocchi F , Tavazzi G , Mojoli F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Refractory cardiac arrest, defined as the absence of sustained return of spontaneous circulation (ROSC) despite advanced life support (ALS), remains common and is burden by poor outcome. The Extracorporeal Cardiopulmonary Resuscitation (E-CPR) may benefit organ perfusion, potentially improving OHCA outcomes.

Purpose
The aim of this study was to evaluate outcome of patients with refractory OHCA managed with E-CPR.

Methods
Single centre prospective observational registry of all patients with OHCA treated with E-CPR from 1 September 2017 to 28 February 2021. The enrolment to E-CPR was defined according to hospital protocol.

Results
We enrolled 166 patients with OHCA. Out of 59, 39 cases (66,1%) were included in E-CPR program. Prevalence of shockable rhythms was 59%. Survival at discharge from ICU was 10,2% (4 patients; 3 of them discharged with CPC 1-2 and all with ventricular fibrillation at presentation). E-CPR versus patients without refractory arrest have been compared: patients in the E-CPR group were younger (p=0,0002), had lower mean arterial pressure at ROSC and higher SOFA score (p&lt;0,0001). NSE values between survivor (53,8 ± 17,9 mcg/L) and non-survivor (104,8 ± 44,2 mcg/L) at 24 hours were statistically significant (p=0,0669) as well as lactate clearance in the first 48 hours (p=0,001).
In the univariate regression model serum lactate at admission (p&lt;0,001; 95% CI 0,87 to 6,83), longer low flow time (p&lt;0,002; 95% CI 0,99 to 1,29) and lower mean arterial pressure (p&lt;0,01; 95% CI 0,99 to 1,29) were associated to mortality. Whereas only lactates (p&lt;0,001; 95% CI 0,092 to 4,56) and low flow time (p&lt;0,001; 95% CI 0,092 to 0,17) retained the association in the multivariate model (figure 1 for ROC curves).

Conclusion
Mortality rate in OHCA remains unacceptably high. Patients undertaking E-CPR have worsen hemodynamic and clinical parameters at admission, likely to consequence of refractory cardiac arrest. Low-flow time and lactates level are related to higher mortality as expression of worsen metabolic condition related to hypoperfusion state in patients with delayed ROSC.
Differences in mortality between emergency and elective valve exchange surgeries in a tertiary hospital between 2010 and 2021
Authors: Mazetto A , Garcia R , Stein J , Cinesio H , Goncalves R , Boer B , Tarasoutchi F , Lavitola P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None. Main funding source(s): Public institutions.

Introduction
The natural history of valvular heart disease is very heterogeneous and varies according to the etiology and valve affected. It is well established that the presence of symptoms or some alarm signs indicates interventions to improve the patient’s prognosis. In some cases, the patient is subjected to at a late time of the natural history of his disease, sometimes during clinical instability and this can get a much worse prognosis. Therefore, follow-up of the valvopathic patient is essential to indicate the best moment of intervention. The aim of this study was to analyze the difference in mortality in patients submitted to valve replacement in an elective and in a tertiary hospital.

Objectives
The aim of this study was to evaluate the risk of morbidity and mortality when comparators the use of biological and metallic prostheses in elective surgeries and emergencies.

Methods
Medical records were reviewed of patients undergoing valve replacement surgery in an aortic and mitral position in an emergency and elective character between 2010 and 2021.

Results
A total of 5,340 valve replacement surgeries were performed in an aortic and mitral position, of which 945 were emergency surgical and 4395 in an elective scenario. Among the emergency procedures, there were a total of 270 deaths (28.57%). While in elective procedures mortality was 535 deaths (12.17%). Regarding the nature of the prosthesis, 91.57% were placed biological, where 874 (17.87%) of these procedures were emergency and of these, 255 deaths (29.17%) were recorded. In elective nature, 4,016 prostheses (82.12%) were, among these cases, 499 deaths (12.42%). In relation to mechanical prostheses, the total was 8.42%, 71 of which were placed as an emergency with 15 deaths (21.12%). Valve surgery with mechanical prosthesis was performed in 379 patients and 36 deaths were recorded (9.49%).

Conclusion
Valve replacement in an emergency context has mortality 2.34 times higher than when performed electively. This data reflects that the intervention at a late stage of the natural history of valvopathies, especially in situations of clinical instability brings the patient a worse prognosis and this shows us the importance of accompanying the valvopathic patient appropriately in an outpatient context to indicate the most opportune moment of valve replacement if the procedure is necessary.
Clinical outcomes of mitral valve repair for degenerative mitral regurgitation in elderly patients
Authors: Kawajiri Hidetake , Schaff Hartzell V , Dearani Joseph A , Daly Richard C , Greason Kevin L , Arghami Arman , Rowse Philip G , Viehman Jason K , Lahr Brian D , Gallego-Navarro Carlos , Crestanello Juan A 
Published: May 2022

Abstract

OBJECTIVES
This study analyzes the safety and outcomes of mitral valve repair for degenerative mitral valve regurgitation in patients 75 years of age or older.

METHODS
We retrospectively reviewed the clinical results of 343 patients aged ≥75 years who underwent mitral valve repair for degenerative mitral valve regurgitation as a primary indication between January 1998 and June 2017.

RESULTS
The median (interquartile range) age of the patients was 79.4 (76.9, 82.9) years, and 132 (38.5%) patients were women. Concomitant procedures were performed in 123 patients: tricuspid surgery in 68 (19.8%) and a maze procedure or pulmonary vein isolation in 55 (16.0%). Operative mortality was 1.2%. Operative complications included atrial fibrillation in 37.9%, prolonged ventilation in 7.0%, pacemaker implantation in 3.8, renal failure requiring dialysis in 1.5 and stroke in 3 (0.9%). The median follow-up was 7.4 years (interquartile range, 3.5–14.1 years). The cumulative incidence rates of mitral valve reoperation were 2.2%, 3.2% and 3.2% at 1, 5 and 10 years, respectively. Overall survival at 1, 5 and 10 years were 95%, 83% and 51%, respectively. Older age, smoking and over and underweight were associated with increased risk of mortality, while higher left ventricular ejection fraction and hypertension were associated with reduced risk.

CONCLUSIONS
Mitral valve repair in elderly patients can be accomplished with low operative mortality and complications. Mitral valve repair in the elderly remains the preferred treatment for degenerative mitral regurgitation.
Cardiovascular risk and protective factors in adults with and without diabetes mellitus (Italy, 2016–19)
Authors: Baldissera Sandro , Minardi Valentina , Masocco Maria , Ferrante Gianluigi 
Published: May 2022

Abstract

Background
Cardiovascular (CV) diseases are a major cause of the disease burden worldwide and contribute substantially to health care costs, in particular in people with diabetes. Their incidence can be reduced by multi-factorial interventions. This study intends to describe the occurrence of CV risk and protective/preventive factors in the adult population resident in Italy, to better target public health interventions.

Methods
Data collected in 2016–19 from adults aged 18–69 years, participating in the Italian Behavioural Risk Factor Surveillance System (PASSI) based on a cross-sectional design, were used. The frequency of CV risk/protective factors was estimated in people with and without diabetes. The contribution of socioeconomic level (SEL) to CV risk was also explored.

Results
Among 129 989 respondents, 4.7% received a diagnosis of diabetes. Many CV risk factors were significantly more frequent in people with diabetes, who often presented multiple risk factors. At the same time, they adopted protective behaviours and received treatments and preventive interventions more often than those without diabetes. Relevant disparities were observed between SEL groups in diabetic people, with the least advantaged showing a worse risk profile.

Conclusions
Adults resident in Italy with diabetes are exposed to CV risk factors more often than those without diabetes. However, they show an increased attention to control these factors and receive more frequent health care, although less than ideal in absolute terms. There is an opportunity to reduce the important CV disease burden in the population through preventive/health promotion targeted interventions, prioritizing people with diabetes and of lower SEL.
Screening and management of tobacco, alcohol, and unhealthy drug use in Saudi Arabia: uptake and practices from primary care physicians’ perspective
Authors: AlShamlan Nouf A 
Published: May 2022

Abstract

Background
Screening and management of tobacco, alcohol, and unhealthy drug use by primary care physicians are crucial because a minority of individuals seek medical advice. However, data regarding this practice are limited. The study objective was to assess the screening practices of primary care physicians in Saudi Arabia for tobacco, alcohol, and unhealthy drug use, barriers to screening, and management of such cases.

Methods
In this cross-sectional study, an online survey was sent to primary care physicians in Saudi Arabia.

Results
A total of 952 physicians participated in the study. Most did not use validated screening tools. A significant proportion of physicians believed that the patient could not answer accurately about using alcohol or drugs and considered it socially unacceptable to ask about these substances. Family physicians screened their patients more frequently for smoking than general practitioners (P &lt; 0.05). More years of experience and practice in the Northern Province of Saudi Arabia were predictors of frequent screening for alcohol and drug use (P &lt; 0.05 and P &lt; 0.01, respectively). Providing information about the risks of these behaviours and brief motivational interviews were the most reported practices.

Conclusions
Most physicians did not utilize validated screening tools. Addressing these barriers is a crucial step in initiating effective screening programmes. Several barriers have been reported from the physicians’ perspective; further study to explore these issues from patients’ perspectives is suggested. Moreover, raising physicians’ awareness about using validated screening tools and locally available services is recommended.
Gestational and childhood urinary iodine concentrations and children’s cognitive function in a longitudinal mother-child cohort in rural Bangladesh
Authors: Kampouri Mariza , Tofail Fahmida , Rahman Syed Moshfiqur , Gustin Klara , Vahter Marie , Kippler Maria 
Published: May 2022

Abstract

Background
Severe iodine deficiency adversely affects neurodevelopment; however, evidence regarding the association of non-severe deficiency and child cognitive functioning is inconclusive.

Methods
This prospective mother-child cohort study was nested in a population-based nutritional supplementation trial in Bangladesh (Maternal and Infant Nutrition Interventions in Matlab [MINIMat]). Participants with data on cognitive abilities at 5 and 10 years of age (n = 1530) and at least one measurement of urinary iodine concentration (UIC) (gestational week 8, 5, and 10 years) were selected. Cognitive abilities were assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Wechsler Intelligence Scale for Children (WISC-IV). UICs were measured with inductively coupled plasma mass spectrometry and thereafter adjusted for specific gravity.

Results
Median UICs in our population: (282 μg/L [pregnancy]; 406 μg/L [5 years]; 294 μg/L [10 years]) indicated that iodine intake corresponded to above ‘adequate’ or even ‘excessive’, according to the WHO classification. Maternal ‘UIC &lt;150 μg/L’ was associated with lower full-scale and verbal scores at 5 and 10 years, although the associations were weakened in the fully adjusted models. A tendency of decreased verbal scores was also observed for maternal ‘UIC ≥500 μg/L’ but not for the corresponding child iodine category (≥300 μg/L). Child ‘UIC &lt;100 μg/L’ was associated with lower processing speed (B=-3.1, 95% CI [-6.2, -0.1]; P-value = 0.041) compared with the reference group (100 μg/L≤ UIC &lt;300 μg/L).

Conclusions
Current findings add to the growing evidence of a causal association of early-life iodine intake with cognitive development, indicating that low iodine intake during childhood is associated with reduced processing speed and non-optimal gestational iodine intake is weakly associated with slightly poorer verbal development outcomes.