bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exercise induced coronary inflammation in masters athletes
Authors: Papatheodorou E , Kissel C , Merghani A , Hughes R , Torlasco C , Bakalakos A , Downs E , Parry-Williams G , Finocchiaro G , Malhotra A , Moon J C , Papadakis M , Al Fakih K , Dey D , Sharma S 
Published: October 2022

Abstract

Background
Chronic endurance exercise has been linked to increased prevalence of coronary artery disease (CAD) in male master athletes. Data are limited regarding the presence of exercise-induced coronary inflammation and its association with atherosclerosis in master endurance athletes. Human coronary inflammation can be detected non-invasively by imaging pericoronary adipose tissue (PCAT). We tested the hypothesis that chronic endurance exercise leads to increased prevalence of atherosclerosis via coronary inflammation.

Methods
Computed tomography coronary angiogram CTCA scans from 2 cohorts of master athletes and age-matched controls, without known risk factors for CAD, were analysed post-hoc and the PCAT attenuation index was calculated around the proximal right coronary artery (FAIRCA). The athletes and the healthy controls also underwent an electrocardiogram, an echocardiogram, a cardiopulmonary exercise test (CPET), a 24-hour Holter tape and a Cardiac Magnetic Resonance (CMR) scan.

Results
Scans from 243 masters endurance athletes (62% females) and 58 age and Framingham CAD risk score matched healthy controls were analysed. FAIRCA was significantly higher (less negative) in male masters athletes vs female masters athletes [−61.3 Hounsfield Units (HU) vs −62.8 HU, p=0.01], in male athletes vs male controls (−61.3 HU vs −68.6 HU, p&lt;0.001) and in female athletes vs female controls (−62,8 HU vs −67.5 HU, p=0.005). In female masters athletes, peak oxygen consumption during CPET (peak VO2) statistically significantly predicted the FAIRCA, F(1,146) = 22.62, p&lt;0.0001. There was no correlation between the FAIRCA and presence of atherosclerosis in male masters athletes.

Conclusions
Masters athletes show increased markers of coronary inflammation. This effect appears to be greater in male masters athletes and is associated with a higher peak VO2 in female masters athletes. However, we did not identify a link between coronary inflammation and coronary atherosclerosis in this cohort.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiac Risk in the Young, UK
Reduced antioxiadant high-density lipoprotein function in patients with acute coronary syndrome
Authors: Pagonas N , Weiland L , Jaensch M , Dammernmann W , Christ M , Ritter O , Westhoff T , Kelesidis T , Sasko B 
Published: October 2022

Abstract

Background
High-density lipoprotein (HDL) function rather than concentration plays an important role in the pathogenesis of cardiovascular diseases associated with oxidative stress and inflammation such as coronary artery disease (CAD). In the last years, inflammation has been identified to have a pivotal role in the pathogenesis of acute coronary syndrome (ACS).

Purpose
The aim of the present study is to determine whether reduced antioxidant function of HDL is associated with ACS.

Methods
197 patients with ACS were prospectively recruited and blood samples were taken in the first 48h after enrollment. Patients with chronic coronary syndrome CCS (n=727) and with invasively excluded CAD (no CAD, n=498) from another cohort from our group served as control patients. A validated cell-free biochemical assay was used to determine reduced HDL antioxidant function as assessed by increased HDL-lipid peroxide content (HDLox) normalized by HDL-C levels and the mean value of a pooled serum control from healthy participants (nHDLox; no units).

Results
Patients with ACS had significantly increased HDLox blood levels compared to patients with CCS and to patients without CAD (p&lt;0.001, Figure 1A). Prior intake of statins did not influenc the differences of HDLox among the groups (Figure 1B). In the regression analysis increased HDLox was a strong risk factor for the presence of ACS compared to CCS (odds ratio 4.09 (2.98–5.62), p&lt;0.001, Figure 2).

Conclusions
HDL peroxidation is associated with the presence of ACS independent of the presence of other traditional risk factors.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): BIOX
Pressure-recovery adjustment of aortic valve area does not improve risk prediction in aortic stenosis
Authors: Lindow T , Playford D , Strange G , Kozor R , Ugander M 
Published: October 2022

Abstract

Background
In aortic stenosis (AS), overestimation of pressure gradients by Doppler compared to catheter-based measurement can be adjusted for by accounting for the pressure-recovery, expressed as an energy-loss index (ELI). However, evidence of improved risk assessment by ELI instead of aortic valve area indexed by body-surface area (AVAi) is scarce.

Purpose
We aimed to evaluate the prognostic performance of ELI and AVAi in a head-to-head comparison using large-scale, real-world data.

Methods
In the multi-center, mortality-data linked National Echocardiography Database of Australia (NEDA), patients with AS and requisite aortic area measurements were identified. The prognostic value of AVAi and ELI, respectively, was analyzed using Cox regression and compared by difference in C statistics.

Results
In patients with mild AS (n=3,179), moderate AS (n=4,194), and severe AS (n=3,120), there were 4,229 deaths of which 2,359 were cardiovascular deaths (median [interquartile range] follow-up 2.5 [1.1–4.5] years). There was an association with increased mortality risk per 0.1 cm2/m2 decrement for both AVAi (hazard ratio CV mortality [95% confidence interval] 1.18 [1.16–1.20]) and ELI (1.10 [1.09–1.12]). Prognostic performance for 5-year CV mortality did not improve by using ELI compared to AVAi (C statistic 0.626 vs 0.626, p=0.96).

Conclusions
In aortic stenosis, ELI was not associated with improved prognostic performance compared to AVAi using large-scale, real-world clinical data. These data do not support routine calculation of pressure recovery in echocardiographic reporting.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swedish Heart and Lung Foundationthe Swedish Cardiac Society
The obesity paradox in patients with acute coronary syndromes – is it still applicable to the current era? The ACSIS registry 2000–2018
Authors: Gurevitz C , Mohsen J , Ovdat T , Zwas D R , Fluk Gmach S , Beigel R , Eisen A 
Published: October 2022

Abstract

Background
Obesity is a major epidemic which is associated with major cardiovascular (CV) risk factors. Nevertheless, substantial data, mostly published more than a decade ago, have demonstrated an obesity paradox, where obese patients generally have a better short- and long-term prognosis than do their leaner counterparts with the same CV profile. As for the obesity paradox in acute coronary syndrome (ACS), prior studies demonstrated that the body-mass index (BMI)-mortality association followed a “U” shape curve: it is the highest in underweight (BMI&lt;19) or severely obese (BMI &gt;44), and is the lowest in overweight or mildly obese patients (BMI 30–34 and BMI 35–39) [1–2]. It is not fully elucidated whether the obesity paradox is still relevant in the current era in patients with ACS. We aimed to examine temporal trends in the clinical outcomes of ACS patients by their BMI status.

Methods
Data from the ACSIS registry including all patients with calculated BMI data between the years 2000–2018. Patients were stratified by BMI groups to underweight, normal, overweight and obese. Clinical endpoints included 30d MACE, and 1-year mortality. Temporal trends were examined in the late (2010–2018) vs. the early period (2000–2008). Multivariable models examined factors associated with clinical outcomes by BMI status.

Results
Among the 13,816 patients from the ACSIS registry with available BMI data, 104 were underweight, 3921 were normal, 6224 were overweight and 3567 were obese. 1-year mortality was highest among underweight patients (24.8%), as compared to normal weight patients (10.7%) and lowest among overweight and obese patients (7.1% and 7.5% respectively; p for trend &lt;0.001) [Figure 1]. 30-day MACE rates were qualitatively similar (24.3% for underweight, 13.6% for normal weight, 11.6% for overweight, and 11.7% for obese; p for trend&lt;0.001). Comparing the 2 time-periods, 30-day MACE was significantly lower in the late period in all BMI groups, excluding patients who were underweight. Similarly, 1-year mortality has not changed during the years in underweight patients, and has decreased in normal weight and obese patients.

Conclusions
In ACS patients, during 2-decades, 30-day MACE and 1-year mortality were lower among overweight and obese patients compared with underweight and normal weight patients. During time, 30-day MACE and 1-year mortality have decreased among the majority of BMI groups, excluding the underweight patients, in which the rates were consistently high. Our findings suggest that the obesity paradox is still relevant in ACS patients in the current era.

Funding Acknowledgement
Type of funding sources: None.
Impact of chronic GLP-1 receptor agonist and SGLT-2 inhibitor therapy on in-hospital outcomes of patients with diabetes mellitus hospitalized with acute myocardial infarction
Authors: Trombara F , Cosentino N , Genovese S , Bonomi A , Ludergnani M , Poggio P , Agostoni P G , Marenzi G 
Published: October 2022

Abstract

Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 inhibitors (SGLT-2i) demonstrated cardiovascular and renal protection in addition to their glucose-lowering effect. Whether their benefits occur also in patients with diabetes mellitus (DM) during hospitalisation with acute myocardial infarction (AMI) has not been investigated yet.

Purpose
We evaluated in-hospital outcomes of patients hospitalised with AMI according to their chronic use (before hospitalisation) of GLP-1 RA and SGLT-2i therapy.

Methods
Using administrative healthcare databases, we analysed patients hospitalised with a primary diagnosis of AMI from 2010 to 2019 in the Lombardy region, Italy. Patients were stratified according to their DM status, then divided into three cohorts: Group 1 (non-DM patients); Group 2 (DM patients taking GLP-1 RA or SGLT-2i); and Group 3 (DM patients not taking GLP-1 RA and/or SGLT-2i). Patients were matched in a 1:1:1 ratio using a propensity score including all available variables. The primary endpoint of the study was the composite of in-hospital mortality, acute heart failure, and acute kidney injury requiring renal replacement therapy.

Results
We identified 146,800 patients hospitalised with AMI (26% of them with DM). After propensity score matching, 1,030 patients were included in each group. The primary endpoint rate in the overall population was 16% (n=502) and it significantly increased going from Group 1 to Group 3 (13%, 16%, and 20% respectively; p for trend &lt;0.0001). The risk of the composite endpoint significantly increased from Group 1 to Group 3 (P for trend &lt;0.0001). In comparison with Group 2, Group 3 had a significant higher risk of the composite endpoint (OR 1.40 [95% CI 1.11–1.77]).

Conclusions
Our study shows that DM patients hospitalised with AMI and on chronic GLP-1 RA and/or SGLT-2i therapy have a better in-hospital clinical outcome than DM patients without them.

Funding Acknowledgement
Type of funding sources: None.
Development in long-term prognosis of first-time myocardial infarction in relation to use of guideline-recommended treatments: Danish total population cohort study
Authors: Christensen D M , Schjerning A , Smedegaard L , Charlot M , Phelps M , Gerds T , Gislason G , Sehested T S G 
Published: October 2022

Abstract

Background
Evidence from randomized trials during the previous decades have led to several improvements in acute and secondary preventive treatments for myocardial infarction (MI). However, there is a lack of recent knowledge about the implementation of these treatments and how they affected developments in the long-term prognosis of MI.

Purpose
To investigate developments in long-term outcomes after first-time MI and their relation to use of guideline-recommended treatments in a contemporary total population cohort.

Methods
All patients with a first-time MI from 2001 to 2018 were identified through Danish nationwide registries with follow-up through October 6, 2021. The study period was divided into 3-year periods. In each period, the Aalen-Johansen method was used to estimate the absolute 1-year risk for mortality, recurrent MI, heart failure, bleeding hospitalization, and ischemic stroke. The relative frequencies of pharmaceutical treatments and use of coronary procedures were calculated. In each calendar period, the 1-year mortality and recurrent MI risk was standardized to the 2016–2018 distribution of patient characteristics, procedure use, and treatment initiation. Treatment, standardized risks, and recurrent MI risk were evaluated in patients who survived to day 28 post discharge.

Results
In total, 134,884 patients (median age 69 years, 36.5% female) were included and 120,473 survived to day 28 post discharge (median age 68 years, 35.2% female). From 2001–2003 to 2016–2018, the 1-year risks of mortality (23.5% to 12.1%), recurrent MI (6.8% to 3.2%), and ischemic stroke (1.8% to 1.3%) decreased. Risk of heart failure remained relatively stable, whereas the 1-year risk of bleeding hospitalization increased from 2.1% to 3.0%. This pattern remained consistent during very long durations of follow-up (Figure 1). Initiation of statins (58.0% to 86.4%) and adenosine diphosphate receptor inhibitors (42.5% to 85.6%) increased considerably. Use of coronary angiography (37.3% to 84.5%) and percutaneous coronary intervention (24.8% to 63.5%) also increased. There was an attenuated decrease in the standardized 1-year risks of mortality and recurrent MI compared to the observed reference risks: from 8.7% (reference: 11.1%) in 2001–2003 to 6.1% in 2016–2018 for mortality and from 5.6% (reference: 6.8%) in 2001–2003 to 3.1% in 2016–2018 for recurrent MI (Figure 2).

Conclusions
There was a substantial improvement in the long-term risk of mortality and recurrent MI for patients with first-time MI. This improved prognosis was related to an increased use of guideline recommended treatments.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Danish Heart Foundation
Comparison between 2 futility scores in comatosed survivors of out of hospital cardiac arrest in a large tertiary centre in the United Kingdom: MIRACLE2 vs NULL-PLEASE
Authors: Elamin A , Ahmad H , Muhammed E , Anwar S , Lipp G , Appleby C 
Published: October 2022

Abstract

Background
The management of patients presenting with an out of hospital cardiac arrest (OHCA) is resource intensive, and mortality remains very high. Several scoring systems have been developed to predict mortality and adverse neurological outcomes, and thus aid decision making for patients arriving to heart attack centres. Two of the most commonly used scoring systems are NULL-PLEASE (1) and MIRACLE2 (2).

Purpose
The MIRCALE2 score predicts poor neurological outcome at 6 months, as measured by Cerebral Performance Category (CPC). The NULL-PLEASE score predicts in-hospital morality. We aimed to compare both scores in predicting their primary end-points in a large tertiary centre in the UK.

Method and results
This was a retrospective analysis of 435 patient who were admitted with OHCA via the primary PCI pathway to a large tertiary cardiac centre between January 2016 and September 2020. Only comatosed OHCA survivors requiring pre-hospital ventilatory support were included. 319 patients were eligible 238 patients had complete set of data and were included in the final analysis.
The association of the primary outcome was examined using logistic regression analysis. The predictive ability of the scores for the primary endpoint was tested using AUC analysis.
In-hospital mortality was 45% (108 patients), with 53% having good neurological outcome at 6 months (CPC &lt;3). The median MIRACLE2 score for our cohort was 5 (total score 10). The median neurological outcome measured by CPC was 2. The median NULL-PLEASE score was 2 (total 14). A ROC curve for both scores was plotted, with area under the curve at 0.73 for the MIRACLE2, and 0. 0.81 for NULL-PLEASE (figure 1 and 2). Our final analysis demonstrated a MIRACLE2 score of 5 or more had sensitivity of 67% to predict poor neurological outcome (CPC 3–5). The NULL-PLEASE, score of &gt;3 had 74% sensitivity to predict in hospital mortality.

Conclusion
To our knowledge, this is the first study to compare the MIRCLE2 and NULL-PLEASE scoring systems. Both scores did not perform as expected in our large retrospective analysis. The NULL-PLEASE was more sensitive in predicting in-hospital mortality, although MIRACLE 2 score was easier to use as it had less variables to collect.

Funding Acknowledgement
Type of funding sources: None.
Prognostic difference between walk-in and ambulance-transported patients with ST elevation myocardial infarction from Mie ACS Registry
Authors: Ishiyama M , Kurita T K , Ito H I , Hoshino K H , Yamanaka T Y , Seko T S , Kitamura T K , Yamada N Y , Kakimoto H K , Dohi K D 
Published: October 2022

Abstract

Background
The prognostic impact of walk-in patients with ST elevated myocardial infarction (STEMI) is unknown. The aim of this study was to compare the prognosis of walk-in STEMI patients and ambulance-transported STEMI patients.

Methods
We evaluated 260 walk-in STEMI patients and 1,641 ambulance-transported STEMI patients enrolled from Mie ACS registry, which was a prospective and multicenter registry between 2013 and 2019. Propensity score matched analysis was performed to validate the results. Coronary risk factor, sex, Killip class, and door-to-balloon time was used for compute the propensity score.

Results
Propensity score matching yielded 226 cases per group. All-cause mortality was tended to be higher in walk-in group than ambulance-transported group without reaching significant difference, although ambulance-transported group had slightly higher mortality before propensity score matching (See Figure 1). Symptom-onset-to-reperfusion time was significantly longer in walk-in group (241 vs 184 minutes, p&lt;0.01).

Conclusion
The short and mid-term prognosis of walk-in STEMI patients was similar with ambulance-transported patients. However, prehospital delay should be shortened by using ambulance for better prognosis in walk-in STEMI patients.

Funding Acknowledgement
Type of funding sources: None.
Comparison of CRUSADE and ORBIT bleeding risk scores in prediction of mayor bleeding in pacients with acute coronary syndrome
Authors: Chirino D , Vitale F , Iglesias J , Leonardi M , Rodriguez Vazquez M L , Calderon G , Dizeo C 
Published: October 2022

Abstract

Introduction
Mayor bleeding is the most important complication of antithrombotic treatment in acute coronary syndrome (ACS) and is even associated with higher mortality. The CRUSADE scrore has been developed to predict mayor bleeding in ACS and is one of the most used. however, it has a moderate predictive capacity and is relatively complex to calculate at the patient's bedside. On the other hand, different bleeding risk scores have been developed for atrial fibrillation witch have also been evaluated for ACS, for example HAS-BLED. Recently, the NICE guidelines suggest using the Orbit Bleeding score (ORBIT) to assess the risk of bleeding in atrial fibrillation due to its greater predictive capacity. Its usefulness in the context of ACS has been little studied.

Purpose
The aim of the study is to evaluate the usefulness of the ORBIT to predict major bleeding in patients with ACS compared to the CRUSADE

Methods
A obserbational retrsopective study was performed. Patients with diagnostico ACS in two coronary units of Argentina were included. All of them, received antocoagulation as a antithrombitic treatment. The CRUSADE and ORBIT scores were calculated with the clinical data on admission. The primary point of major bleeding, defined as a BARC classification 3 or 5, was analyzed. Multivariate analysis was performed by logistic regression. To establish the discrimination capacity of the scores, the area under the ROC curve (AUC) was evaluated and the comparison between the curves was carried out using the chi-square area homogeneity test.

Results
A total of 880 patients were included (68% with non-ST elevation ACS and 32% with ST elevation), the mean of age was 68±11 years and 35% were women. As antithrombotic treatment, 100% received aspirin, 96.3% received P2Y12 receptor inhibitors, 100% received anticoagulation with enoxaparin, and 9.5% received fibrinolytics.
The primary end point of major bleeding occurred in 3.4% (n=30).
In univariate analysis both CRUSADE and ORBIT were predictors of mayor bleeding, but in multivariate analysis only ORBIT was independent predictor of mayor bleeding. (ORBIT OR: 2.46 (95% CI 1,61 to 3,97), P&lt;0.001. The table shows the univariate and multivariate analysis.
The AUC of CRUSADE was 0.68 (95% CI 0.57–0.80) and the ORBIT was 0.80 (95% CI 0.72–0.90). The ORBIT score presented a higher AUC than the CRUSADE (p=0.03). See Figure 1.

Conclusion
The Orbit score was an independent predictor of major bleeding in patients with ACS, presenting a better predictive capacity than the CRUSADE.

Funding Acknowledgement
Type of funding sources: None.