bluuebunny/crossref_metadata_2025_split huggingface dataset:
At the outer edge of STEMI time: even after 12 hours, the clock keeps ticking
Authors: Martinho M , Cale R , Nabais S , Briosa A , Pereira E , Pereira A R , Grade Santos J , Ferreira B , Santos Cunha D , Santos P , Vitorino S , Eusebio C , Morgado G , Martins C , Pereira H 
Published: October 2022

Abstract

Introduction
Although primary percutaneous coronary intervention (pPCI) is not a class I recommendation in all patients (pts) presenting within 12 to 48h of symptom onset (late ST-segment Elevation Myocardial Infarction, STEMI), there is increasing evidence supporting its routine use in this population. Data on long-term clinical outcomes is sparse.

Objective
To evaluate long-term MACE in late-STEMI pts submitted to pPCI and compare with clinical outcomes of early reperfusion groups.

Methods
Retrospective analysis of consecutive pts submitted to pPCI due to STEMI between 2010 and 2015 in a pPCI centre. Included pts were stratified in 5 groups according to symptom-to-balloon time (SBT): &lt;3h; 3–6h; 6–12h; 12–24h; 24–48h. Of a total of 903 pts, 19 pts were excluded due to SBT &gt;48h. Long-term events were established as 5y mortality and 5y-MACE (a composite endpoint of death, re-infarction, heart failure hospital admission and ischemic stroke). The cumulative incidence of long-term outcomes was calculated by the Cox regression analysis and presented according to the Kaplan-Meier method.

Results
Of the 884 pts included in the study, stratification according to SBT was: pPCI&lt;3h (47.4%), pPCI 3–6h (24.9%), pPCI 6–12h (16.5%), pPCI 12–24h (8.0%), and pPCI 24–48h (3.2%). These groups showed no significant difference in terms of demographic characteristics (age, CV risk factors, previous coronary disease or heart failure), clinical severity (systolic arterial pressure, Killip-Kimball class, left ventricle ejection fraction) and angiography findings (multivessel disease, complete revascularization and PCI success). After a median follow-up of 76 (56; 98) months, 5-year mortality was 20.6% (182 pts) and 5-year MACE was 23.3% (206 pts). MACE was associated with increased median SBT: 5.0 (2.0; 9.0) hours vs 4.0 (2.0; 6.5) hours, p&lt;0.001. Of the MACE components, the only that showed a significant association with higher median SBT was mortality: 5.0 (2.0; 10.0) hours vs 4.0 (2.0; 6.0), p&lt;0.001. Differences in long-term outcomes were significant when considering SBT stratified by revascularization time (Figure 1).

Conclusions
As expected, there is a clinical benefit of early reperfusion for long-term cardiovascular events. Within the late-STEMI group, there seems to be a clear distinction between pPCI&lt;24h and &gt;24h, although the clinical benefit of pPCI timing most probably acts a continuum.

Funding Acknowledgement
Type of funding sources: None.
Evolution of functional mitral regurgitation and left atrial function in patients receiving cardiac resynchronization therapy
Authors: Stassen J , Galloo X , Hirasawa K , Van Der Bijl P , Marsan N A , Bax J J 
Published: October 2022

Abstract

Background
Left atrial (LA) function is a strong prognostic marker in patients with heart failure and patients with functional mitral regurgitation (MR). Although cardiac resynchronization therapy (CRT) has shown to improve MR severity, the interaction between a reduction in MR severity and an improvement in LA function, as well as their association with outcomes, has not been investigated.

Purpose
To investigate the association between a reduction in MR severity and an improvement in LA function, as well as their association with outcomes.

Methods
LA reservoir strain (RS) was evaluated with speckle tracking echocardiography in patients with moderate and severe functional MR. MR improvement was defined as at least 1 grade improvement in MR severity at 6 months after CRT implantation. The association between MR improvement and change in LARS was evaluated using multivariable logistic regression analysis. Patients were dividing into 3 groups: MR non-improvers; MR improvers with no LARS improvement; and MR improvers with LARS improvement. The primary endpoint was all-cause mortality.

Results
A total of 340 patients (mean age 66±10 years, 73% male) were included, of whom 200 (59%) showed MR improvement after CRT implantation. On multivariable analysis, an improvement in MR was independently associated with an improvement in LARS (OR 1.008; 95% CI 1.003–1.013; p=0.002) (Table 1). MR improvers showing LARS improvement had the lowest mortality rate, whereas outcomes were not significantly different between MR non-improvers and MR improvers showing no LARS improvement (p=0.236) (Figure 1).

Conclusion
In patients with HF and significant functional MR, an improvement in MR after CRT implantation is independently associated with an improvement in LARS, which in turn, is associated with better survival.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
PCI of chronic total occlusions: what is the clinical benefit and impact on quality of life?
Authors: Costa H , Martins J , Mota T , Santo M E , Fernandes R , Carvalho D , Palmeiro H , Bispo J , Franco P , Marto S , Guedes J , Marreiros A , Mimoso J , Vinhas H , Jesus I 
Published: October 2022

Abstract

Introduction
Coronary chronic total occlusions (CTO) are relatively common findings in the context of coronary angiography. The indication for revascularization of this type of lesions remains controversial. The recommendations of international cardiology societies consider the treatment of CTO by percutaneous coronary intervention (PCI) in selected patients, but this technique is not yet widely used in this context.

Objectives
To evaluate the clinical and quality of life impact of patients undergoing PCI-CTO, including angina, heart failure (HF), acute myocardial infarction (AMI), mortality and improved quality of life (QoL) after the procedure.

Methods
Retrospective study for biennium 2019/2020, composed of n=177 patients undergoing PCI-CTO. A descriptive and comparative analysis of the sample regarding the demographic and clinical characteristics of patients was performed, to whom a quality of life questionnaire (WHOQOL-Brief) was applied. The descriptive analysis was based on means and standard deviations and on the analysis of statistical tests, t-Student and Mann-Whitney were performed according to the parametric and non-parametric context, respectively.

Results
A total of 177 patients were identified, with a mean age of 65.7±11.2 years, 51.5% female. 75% of patients showed high blood pressure, 39% diabetes and 80.5% NSTEMI. At 30 days after PCI only 21% of patients had symptoms (angina or HF), with clinical improvement at 180 days to 10% symptomatic. Regarding QoL, an average score of 4.3 (maximum of 5) was obtained for the 2 questions that independently assess the patient's perception of their QoL after the procedure. High levels of scores were also obtained by domains (QoL&gt;70%), with marked improvement in the Physical, Environmental and Psychological domains, becoming more evident in the latter at 30 days after the procedure in patients who remained asymptomatic (75.2%, p=0.023). This benefit was accompanied by improvement in left ventricular function (LVEF), being more evident in asymptomatic patients and without events after procedure. Mortality and AMI occurred in 6% and 2%, respectively.

Conclusion
The majority of patients had clinical benefit and expressed improvement in QoL after undergoing PCI-CTO, which was accompanied by improvement in LVEF, reinforcing the usefulness of the technique and the approach of this type of lesions in selected patients.

Funding Acknowledgement
Type of funding sources: None.
Thiamine as an outcome predictor in postoperative CABG patients
Authors: Garcia L R , Garzesi A M , Affonso P H D V , Tonon C R , Felicio M L , Brito F S , Martins A S , Campos N L K L , Okoshi M P , Paiva S A R , Minicucci M F , Polegato B F , Zornoff L A M 
Published: October 2022

Abstract

Introduction
Coronary artery bypass graft surgery (CABG) is one of the most performed cardiovascular procedures worldwide. Despite good outcomes, CABG induces systemic inflammation, increases oxidative stress and increases catabolism. As thiamine act as a cofactor in glucose metabolism and glutathione synthesis, its deficiency could have a high prevalence in critically ill patients.

Purpose
To assess the association between plasma thiamine concentrations and clinical outcomes and 30-day mortality in patients undergoing non-emergency CABG.

Methods
Prospective and observational study that included consecutive patients older than 18 years undergoing CABG that assigned the consent form. Plasma thiamine concentrations were determined before and 24 hours after the procedure by the high-performance liquid chromatography method. The clinical outcomes evaluated were perioperative acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke and acute kidney injury. Mortality was evaluated on the 30th day after CABG.

Results
The study included 131 patients submitted to CABG. The mean age was 61±9.1 years, 73.3% were men, and the mean EuroScore II value was 1.78±1.3%. Before CABG, plasmatic thiamine concentration was 33±15ng/ml, and 15% of the patients had thiamine deficiency. After CABG, plasmatic thiamine concentration was 20±8ng/ml. All patients diminished plasmatic thiamine concentration after CABG. Mortality was 16% and 24% of patients presented acute kidney injury. Combined outcomes, which included the presence of acute myocardial infarction, heart failure, cardiogenic shock, arrhythmias, stroke, acute kidney injury or death, was present in 52% of the patients. Percentage of thiamine variation between before and after CABG was not associated with mortality (34±14 vs 41±10%; p=0.063); however, it was associated with acute kidney injury (40±14 vs 34±13%; p=0.027) and combined outcomes (37±13 vs 33±14%; p=0.035).

Conclusion
Percentage of thiamine variation from before to after CABG was associated with acute kidney injury and combined outcomes in these patients.

Funding Acknowledgement
Type of funding sources: None.
BMI modifies the effect of HDL on outcomes after coronary artery bypass grafting surgery
Authors: Fallahzadeh A , Sheikhy A , Rezaee M , Behnoush A H , Jameie M , Hosseini K 
Published: October 2022

Abstract

Background
While the important role of both high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI) in the prognosis of coronary artery disease (CAD) is well known, the impact of BMI on the association between HDL-C and cardiovascular outcomes remains unclear.

Purpose
In this regard, we aimed to investigate whether BMI can modify the correlation between HDL-C levels and outcomes in patients who underwent coronary artery bypass grafting (CABG).

Methods
The present registry-based cohort study included patients who underwent isolated, elective, and first time CABG with 18≤BMI&lt;35 kg/m2. The median follow-up period was 76.62 (75.71–77.52) months. The participants categorized into three groups based on BMI: 18.5≤BMI&lt;25 kg/m2, 25≤BMI&lt;30 kg/m2, and 30≤BMI&lt;35 kg/m2. The Cox proportional hazards models and Restricted Cubic Splines (RCS) in the Cox models were applied to evaluate the association between HDL-C and all-cause mortality and occurrence of major adverse cardio-cerebrovascular events (MACCE) in different BMI categories.

Results
From 2006 to 2016, a total of 17309 patients (73% male, mean age 66.17±9.98) were included. Compared to other groups, diabetes, hypertension, dyslipidemia, and family history of coronary disease were more prevalent in patients with 30≤BMI&lt;35 kg/m2 (P&lt;0.05). Cox proportional hazards models did not show a significant correlation between each 1 mg/dl increase in HDL-C and risk of all-cause mortality and MACCE. In contrast, the results of RCS in the Cox models demonstrated a non-linear relationship between HDL-C and outcomes in patients with 30≤BMI&lt;35 kg/m2, with higher levels of HDL-C, were paradoxically associated with a higher risk of all-cause mortality and MACCE in this BMI category. In the 3D presentation of the association between BMI, HDL-C and all-cause mortality, the highest risk of all-cause mortality was seen in low levels of HDL-C (HDL-C &lt;20 mg/dl) and low or very high levels of BMI.

Conclusions
Very high HDL-C levels could be associated with a higher risk of adverse outcomes after CABG, in patients with 30≤BMI&lt;35 kg/m2. These findings suggest a role of obesity in the function and properties of HDL-C thereby, it seems necessary to consider the concomitant conditions such as BMI when evaluating the risk of cardiovascular events.

Funding Acknowledgement
Type of funding sources: None.
Comparison of trans-radial access and femoral access in cardiogenic shock patient who had undergone primary percutaneous coronary intervention from SMART RESCUE trial
Authors: Choi S H , Park S D , Lee M J , Lee K J 
Published: October 2022

Abstract

Introduction
Throughout the years of percutaneous coronary intervention (PCI), the debate regarding access route, whether it being trasns-radial or femoral, is an ongoing agenda yet to be solved. Recent guidelines suggest trans-radial approach as an option to be considered in acute coronary syndrome (ACS). However, data on cardiogenic shock patients undergoing PCI is relatively sparse.

Purpose
Compare the clinical implication of trans-radial and femoral approach in cardiogenic shock patients who had undergone PCI.

Method
Cardiogenic shock patients who had undergone PCI from January 2014 to December of 2018 were enrolled. Patients were divided according to their access route respectfully. Primary outcome was composite endpoints including all-cause death, re-admission due to heart failure, myocardial infarction (MI) and cerebrovascular accident.

Result
A total of 694 (572 via femoral approach, 122 via radial approach) cardiogenic shock patients who received PCI were enrolled. Mean age femoral and radial groups was 66.59±12.51 and 66.66±12.8 respectfully. Disease severity was higher for femoral patients compared to radial patients as represented by their LM involvement, mechanical organ support (extracorporeal membrane oxygenation, continuous renal replacement therapy, mechanical ventilation), left ventricular ejection fraction (LVEF) and vasoactive inotropic score. Cox regression analysis after adjusting for conventional risk factors showed that femoral route was a poor prognosticator with respect to composite endpoints (HR=2.059, 95% CI 1.249–3.397, p value = 0.005). Radial approach patients had higher survival probability compared to femoral approach patients (Figure 1).

Conclusion
Radial approach in cardiogenic shock patients who are in need for PCI with relatively less severe clinical condition could be a reasonable option for access route.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Inha University Hospital
Medical therapy for secondary prevention in patients with myocardial infarction with non-obstructive coronary artery disease: long-term outcome of a Portuguese centre
Authors: De Campos D , Saleiro C , Teixeira R , Botelho A , Lopes J , Goncalves L 
Published: October 2022

Abstract

Background
The outcomes of dual anti-platelet therapy (DAPT), β-blocker, renin-angiotensin-aldosterone system (RAAS) inhibitor and statin therapy are unknown in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). The aim of this study was to examine the effects of secondary prevention therapy at discharge on long-term outcomes in MINOCA.

Methods
Patients with MINOCA undergoing early coronary angiography between 2009 and 2016 were extracted from a clinical database. Patients were followed until 2018 for outcome events. All patients with a MINOCA diagnosis and without history of atrial fibrillation were included. A total of 646 consecutive patients were enrolled. The primary end point was major adverse cardiac events (MACE) defined as all-cause mortality, myocardial infarction (MI), stroke, and heart failure (HF). Secondary endpoints comprised all individual endpoints for the composite end-point. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis and Cox regression models.

Results
Mean age was 67.9±13.4 years and 31.6% were women. No patient was lost to follow-up. Mean left ventricular ejection fraction was 47.8±13.1%. At discharge, 87.2%, 82.5% and 79.5% of the patients were on statins, RAAS inhibitors and β-blockers, respectively. The majority (72.8%) were discharged on DAPT. During follow-up (Mdn 59 months), 303 (46.9%) patients experienced a MACE and 208 (33.4%) died. MI occurred in 98 patients (17.8%) and stroke in 31 patients (5.6%). HF admissions were also common (82, 14.9%). The hazard ratio (HR) for major adverse cardiac events was 0.31 (0.23–0.41) in patients on statins, RAAS inhibitors and β-blockers. For patients on DAPT the HR was 0.61 (0.48–0.78). In univariate Cox regression analyses, a reduced risk of MACE was found in patients using combined secondary prevention therapies (HR 0.58, 0.46–0.74). Regarding the individual endpoints, combined secondary prevention therapy reduced the risk of stroke (HR 0.45, 0.22–0.99, P=0.04) but not risk of future MI nor HF admissions. Patients in the combined therapy group had a higher median survival (66 months, IQR 27–82 months) than the group without secondary prevention (34.5 months, IQR 6.8–74 months; P&lt;0.001 of Log Rank test for equality of survivor functions). In a multiple Cox regression analysis including RAAS inhibitors, statins, DAPT and β-blockers in the model, none of these drugs was associated with lower MACE, except for RAAS inhibitors.

Conclusions
The results indicate long-term beneficial effects of treatment with secondary prevention medical therapies in patients with MINOCA. Properly powered randomized clinical trials are warranted.

Funding Acknowledgement
Type of funding sources: None.
Impact of metabolic syndrome and its components on clinical severity and long-term prognosis in patients with premature myocardial infarction
Authors: Wang Y , Wu X Y , Cui Y , Zou Z H , Liang Y , Li W Q , Yang Y N , Liu Y , Gao J 
Published: October 2022

Abstract

Background
Metabolic syndrome (MetS) is involved in the occurrence, development and prognosis of cardiovascular diseases, especially acute myocardial infarction (AMI). In recent years, the trend of AMI at a younger age has gradually attracted people's attention. Relevant studies have confirmed that MetS affects the prognosis of people aged ≥45 with AMI. However, there is still a lack of research on MetS in people with premature myocardial infarction (PMI).

Purpose
To explore the impact of MetS and its components on clinical severity and long-term prognosis in PMI patients.

Methods
772 Patients with AMI who aged ≤45 years old from 2015 to 2020 in a hospital were enrolled. The patients were divided into MetS group (n=417) and non-MetS group (n=355) according to the criteria proposed by NCEP ATP III in 2005 (Any 3 of the following 5): 1) Hypertension: BP ≥130/85 mmHg or consistent hypertensive patients undergoing treatment; 2) Hypertriglyceridemia: fasting plasma triglyceride ≥1.7 mmol/L; 3) Fasting HDL-C &lt;1.0 mmol/L in men and &lt;1.3 mmol/L in women. 4) Hyperglycemia: fasting blood glucose level ≥6.1 mmol/L or known diabetic patients undergoing treatment; 5) Central obesity: BMI ≥28.0 kg/m2. Patients were followed for median of 42 months for major adverse cardiovascular events (MACE). The parameters of clinical severity were compared using logistic regression analysis. Cox regression were used to analyze the relationship between MetS and its components and prognosis.

Results
A total of 772 patients were included in the analysis. Hyperglycemia was associated with multi-vessel disease (OR=1.700, 95% CI 1.172–2.464, P=0.005) and Syntax score ≥33 (OR=2.736, 95% CI 1.241–6.032, P=0.013).Increased MACE were observed in the MetS group (17.9% vs 10.3%, P=0.004) after 42 months follow-up. The Kaplan-Meier curve also showed significant differences (P&lt;0.001). MetS was an independent risk factor for MACE (HR=2.181, 95% CI 1.392–3.418, P=0.001). Of each component of the definition, BMI ≥28.0 kg/m2 (HR=2.047, 95% CI 1.229–3.410, P=0.006) and hyperglycemia (HR=2.911, 95% CI 1.850–4.580, P&lt;0.001) were independent risk factors for MACE.

Conclusions
In patients with PMI, (1) hyperglycemia usually indicates more severe lesions; (2) MetS as a whole was an independent risk factor for MACE; (3) Of each component of the MetS, BMI ≥28.0 kg/m2 and hyperglycemia were associated with MACE.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): This research was supported by the Key Project of Scientific and Technological Support Plan of Tianjin in 2020
Lipoprotein(a) levels and risk of adverse events after myocardial infarction in patients with and without diabetes
Authors: Esposito L , Cancro F P , Silverio A , Di Maio M , Bellino M , Romei S , Tedeschi M , Ciccarelli M , Vecchione C , Galasso G 
Published: October 2022

Abstract

Background
There is a positive continuous association between Lipoprotein(a) (Lp[a]) levels and the risk of recurrent ischemic events in patients with recent myocardial infarction (MI). However, the prognostic significance of the association between high Lp(a) levels and diabetes has been poorly investigated after MI.

Purpose
The aim of this study was to evaluate the association of Lp(a) levels with the long-term risk of adverse events in post-MI patients, and to investigate whether diabetes may influence this association.

Methods
Consecutive MI patients who underwent urgent/emergent coronary angiography at our Institution from February 2013 to June 2019 were prospectively collected. Lp(a) serum concentrations was expressed for increasing range values (≤10, &gt;10–30, &gt;30–50, &gt;50–70, and ≥70 mg/dL). The primary outcome was the recurrence of MI; the secondary outcome was all-cause death. The propensity score weighting technique was used to account for potential confounding between patients with and without diabetes.

Results
The study population consisted of 1018 post-MI patients (median age: 63 years; 76% males). Diabetes was reported in 280 patients (27.5%). The median value of Lp(a) was 10 mg/dL, and patients with diabetes showed significantly lower Lp(a) levels than patients without diabetes (p=0.025). At a median follow-up of 1121 days, the primary outcome was reported in 109 patients (10.7%), and the secondary outcome in 100 (9.8%). After propensity score weighting, there was a significant association between increasing Lp(a) range values and the primary outcome both in the overall population (p trend = 0.030) and in non-diabetic patients (p trend = 0.009), but not in diabetics.
Conversely, no significant association with the risk of all-cause mortality across increasing Lp(a) categories both in the overall population and in the study groups according to the presence or not of diabetes was found.
Compared with the lowest Lp(a) category, Lp(a) plasma levels &gt;70 mg/dL were independently associated with the risk of recurrent MI (HR: 3.222; 95% CI, 1.225–8.478, p=0.018) and all-cause death (HR: 2.656; 95% CI, 1.009–6.991, p=0.048) in non-diabetic patients, but not in diabetics.

Conclusions
In this real-world post-MI population, Lp(a) serum levels were lower in diabetic than in non-diabetic patients. Increasing Lp(a) levels were significantly associated with the risk of recurrent MI, and very high Lp(a) serum concentration (&gt;70 mg/dL) independently predicted recurrent MI and death in non-diabetic patients, but not in diabetics. These results reinforce the importance of routine assessment of Lp(a) levels after MI, particularly in patients without diabetes.

Funding Acknowledgement
Type of funding sources: None.