bluuebunny/crossref_metadata_2025_split huggingface dataset:
286 A CASE REPORT OF TYPE II KOUNIS SYNDROME
Authors: Napoli Francesca , Sganzerla Paolo , Giannattasio Cristina 
Published: December 2022

Abstract

Case presentation and management
A 81-years old female presented to the emergency department of our hospital with dyspnea and chest pain. She had a history of chronic kidney disease and left bundle brunch block (LBBB) never further investigated. Non diagnostic ECG was performed in the setting of pre-existing LBBB. HS-T-Troponin level was significantly elevated (986 ng/L). A transthoracic echocardiogram (TTE) revealed inferior and posterior wall hypokinesis. NSTEMI was diagnosed and coronary angiography via the femoral artery revealed subocclusive stenosis of the right coronary artery (RCA) and 80% stenosis of left anterior descending artery (LAD). Coronary stent positioning was performed for the RCA culprit lesion and staged complete revascularization was planned.

Complications
After two days, the patient experienced sharp pain in the right groin and a femoral pseudoaneurysm was diagnosed by Ultrasound Color Doppler. Subsequently anemia suggested the development of retroperitoneal hematoma but it was excluded by contrast CT. Unfortunately, the patient developed acute chest pain, wheezing and erythematous pruritic rash 10 minutes after injection of contrast medium agent. The ECG didn't show any new ischemic abnormalities in the setting of pre-existing LBBB. The peak CK- MB level was significantly elevated (87 ng/mL). New onset apical region akinesia and anterior wall hypokinesia were detected on TTE. Acute coronary syndrome (ACS) was suspected consistent with symptoms, new onset wall motion abnormalities and CK-MB elevations. The patient was diagnosed with allergic reaction and coronary vessel spasm secondary to contrast agent injection in pre-existing atherosclerotic plaque. Due to the high probability of an hypersensitivity reaction to the contrast medium agent we did not perform a new coronary angiography to confirm the diagnosis. Promethazine, Urbason and Nitroglicerin were administered with clinical improvement. The next day we observed recovery of the anterior and apex wall motion abnormalities consistent with coronary vessel spasm.
Echocardiographic wall motion abnormalities before and after coronary spasm:

Take home message
We presented the case of an allergic reaction leading to the release of inflammatory mediators responsible of coronary vessel spasm causing acute myocardial infarction. It can also be induced by injection of contrast medium like in the presented case. Therefore, clinicians and radiologist should recognize this rare but critical disease to ensure prevention and appropriate management.
534 PROGNOSTIC IMPACT OF CONTRAST-INDUCED ACUTE KIDNEY INJURY IN OLDEST OLD STEMI PATIENTS: A MULTICENTER REGISTRY
Authors: Ruzzarin Alessandro , Muraglia Simone , Zilio Filippo , Unterhuber Matthias , Baessato Francesca , Zanon Sofia , Flaim Massimo , Oberhollenzer Rainer , Bonmassari Roberto , Donazzan Luca 
Published: December 2022

Abstract

Introduction
Contrast-induced acute kidney injury (CI-AKI) is a well-known complication of ST-elevation acute myocardial infarction (STEMI) with an adverse impact on prognosis. Elderly patients are at higher risk for cardiovascular events. Moreover, renal function decreases with age. We sought to evaluate the incidence of CI-AKI in very elderly STEMI patients undergoing primary PCI (pPCI) and its impact upon outcomes in these patients.

Methods
We retrospectively evaluated all very elderly patients (i.e. age above 85 years) treated with pPCI for STEMI in two hub-centers between January 2010 and June 2021. We defined CI-AKI as a rise in serum creatinine of ≥0.30 mg/dL over baseline during the first 48h from procedure. Follow-up data were determined from local clinical records during a twelve-months period.

Results
Among 451 patients referred for STEMI at our institutions, 404 patients underwent pPCI.
Overall, the incidence of CI-AKI was 16.3%. There was no significant age difference between CI-AKI and non CI-AKI groups (89.3 ± 2.9 vs 88.6 ± 2.7, p=0.11). Baseline features were similar except for higher prevalence of diabetes mellitus (31.1% vs 18.7%, p=0.03) and chronic kidney disease (CKD) (77% vs 25.7%, p&lt; 0.01) in CI-AKI vs non CI-AKI group. CKD appeared to be strongly associated to higher risk of CI-AKI (OR 9.69, 95% CI: 5.0–18.5; p&lt;0.01).
Time-to-first composite MACE (all cause death, stroke, heart failure hospitalization) tended to be shorter without a significant difference between CI-AKI vs non CI-AKI group (252.3 vs 296.2 days, p=0.06) at one year follow-up,

Conclusions
Underlying CKD is strongly associated with CI-AKI in oldest-old STEMI patients. CI-AKI group had a nonsignificant trend toward a reduction in time-to-first MACE.
42 SEASON VARIABILITY IN ATHEROSCLEROSIS COMPOSITION: INSIGHTS FROM 1848 NON-CULPRIT CORONARY PLQUES
Authors: Sammartini Emanuele , Biccirè Flavio Giuseppe , Debelak Caterina , La Porta Ylenia , Budassi Simone , Varricchione Giuseppe , Romagnoli Enrico , Marco Valeria , Boi Alberto , Fineschi Massimo , Fabbiocchi Franco , Taglieri Nevio , Calligaris Giuseppe , Ozaki Yukio , Arbustini Eloisa , Alfonso Fernando , Prati Francesco 
Published: December 2022

Abstract

Background
Several environmental and seasonal factors are thought to be crucial in the risk of acute coronary syndromes (ACS), including temperature, latitude, longitude, atmospheric air pressure, wind velocity and circadian period. However differences in coronary plaque composition according to season variation is still poorly understood.

Purpose
Our study aims to analyse the characteristics of non-culprit coronary plaques in patients undergoing optical coherence tomography evaluation (OCT) evaluation of the left anterior descending artery.

Methods
We included 1848 non-culprit coronary plaques from 1003 patients of the CLIMA registry. The season of OCT pullback acquisition was collected for each patient.

Results
Overall, median age was 66 years (56-74), with 24.6% of women and 53.4% of ACS. At patient-level analysis, patients admitted in summer were less frequently affected by hypertension (59.8% vs 69.4% in autumn, 68.5% in winter and 72% in spring; p=0.027) and chronic kidney disease (14.8% vs 15.9% in autumn, 10.3% in winter and 19.4% in spring; p=0.037) in. At lesion-level analysis, similar values of fibrous cap thickness, maximum lipid arc, length of plaques and presence of macrophages were observed (Table 1). Summer plaques had a smaller minimum lumen area than spring plaques (5.7±3.1 vs 5.1±239; p=0.044) and also a less frequent superficial macrophage infiltration (23% vs 36.1% in autumn, 30.5% in winter and 30.6% in spring; p=0.030) and presence of cholesterol crystals (16.7% vs 23.8% in autumn, 28.4% in winter and 22.1% in spring; p=0.037 than three other season).
Table 1

Conclusions
Coronary plaques during summer had less local sign of inflammation such superficial macrophage infiltration and cholesterol crystals. Further studies are needed to confirm these results and investigate clinical implications.
54 EXPLORING FEATURES AND OUTLOOK OF WOMEN DISCHARGED AFTER AN ACUTE CORONARY SYNDROME MANAGED INVASIVELY: INSIGHTS FROM THE 23,072 PATIENTS PRAISE MULTICENTER REGISTRY
Authors: Spadafora Luigi , Zoccai Giuseppe Biondi , Bernardi Marco 
Published: December 2022

Abstract

Background
Acute coronary syndromes (ACS) are a common cause of morbidity and mortality, irrespective of sex. While several studies have focused on ACS at admission or long-after the acute event, limited if any research is available on sex-based comparison of patients discharged after ACS. We aimed at appraising the outlook of women discharged after ACS, exploiting a large multinational registry.

Methods
Details on women enrolled in the PRAISE multicenter registry, a large database spanning 23,702 patients included between 2003 and 2019, were systematically collected. We focused on patient and procedural features, medications at discharge, and 1-year outcomes. The primary endpoint was the composite of death, myocardial infarction, or major bleeding after discharge. Secondary outcomes were the individual components of the primary endpoint.

Results
Characteristics of 17,804 men and 5,466 women discharged after ACS were collected. Several baseline differences were found, including risk factors and history of prior revascularization (all p&lt;0.05). At discharge, men underwent radial access more frequently, and received also more commonly beta-blockers, renin-angiotensin system inhibitors, and statins (all p&lt;0.05). Focusing on antithrombotic therapy, men received more frequently prasugrel, whereas women receive more commonly clopidogrel (all p&lt;0.05). At 2-year follow-up incidence of death, reinfarction, major bleeding, non-fatal major bleeding were significantly higher in women (all p≤0.01). All such differences were however due to residual confounding and did not hold true at multivariable analysis, with the exception of major bleeding, which appeared surprisingly lower in females at adjusted analysis (odds ratio=0.70 [95% confidence interval: 0.52-0.94], p=0.017).

Conclusions
Women are treated less aggressively with apparently worst outcomes 2 years after discharge for ACS managed invasively. On the basis of these findings, we should change our approach and adopt a more aggressive management of women with ACS.
Figure 1. Sex-based comparison of clinical outcomes 2 years after discharge for an invasively managed acute coronary syndrome (ACS) (all p&lt;0.05).
289 DIAGNOSTIC PATHWAY OF PATIENTS WITH CHRONIC CORONARY SYNDROME AFTER THE ISCHEMIA TRIAL PUBLICATION
Authors: Spagnolo Marco , Laudani Claudio , Occhipinti Giovanni , Agnello Federica , Legnazzi Marco , Scalia Lorenzo , Mauro Maria Sara , Rochira Carla , Finocchiaro Simone , Greco Antonio , Capodanno Davide 
Published: December 2022

Abstract

Introduction
Patients with chronic coronary syndrome (CCS) can initially undergo an invasive (i.e., early referral to invasive coronary angiography [ICA]) or a conservative (i.e., anatomical or functional testing before ICA) management. The ISCHEMIA trial showed no difference between these two strategies in CCS patients with moderate-to-severe ischemia. The aim of our study was to assess whether the results of the ISCHEMIA trial impacted on the management of CCS patients.

Methods
Trends in the management of patients with CCS in our centre, according to the ISCHEMIA trial publication date, were analyzed and patients categorized into pre-ISCHEMIA (before March 2020) and post-ISCHEMIA (from July 2020 to February 2022) groups, with an in-between blanking period of three months. The primary outcome was incidence of referral to ICA by coronary computed tomography angiography (CCTA). Secondary objectives included the incidence ischemia test-referred ICA, incidence of CCTA-referred ICA and subsequent percutaneous coronary intervention (PCI), incidence of ischemia test-referred ICA and subsequent PCI and incidence of CCTA-referred ICA without subsequent PCI. Differences between the pre-specified subpopulations (age ≥75 years, diabetes, chronic kidney disease [CKD], peripheral arterial disease [PAD], gender male, unstable angina, active smoking status, body mass index [BMI] &gt;30, hypertension, family history of coronary artery disease [CAD], atrial fibrillation [AF], prior percutaneous coronary intervention [PCI], prior coronary artery bypass grafting [CABG]) and the general population of the study were tested using a regression analysis.

Results
A total of 2,365 patients were included, 487 (20.6%) and 1,878 (79.4%) in the pre-ISCHEMIA and post-ISCHEMIA groups, respectively. There were no notable between-group differences in baseline characteristics. The primary outcome occurred more frequently in the post-ISCHEMIA group (73.5% vs. 32.5%; p&lt;0.01). Compared to pre-ISCHEMIA, the post-ISCHEMIA group displayed less referrals to ICA by ischemia testing (31.6% vs. 52.5%; p&lt;0.01) and more ICA referrals by CCTA with subsequent PCI (8.3% vs. 12.0%; p&lt;0.01). There were no within-group differences in ischemia test-referred ICA and PCI, and CCTA-referred ICA without subsequent PCI. A regression analysis between the primary endpoint incidence in the general population compared to the incidence in the pre-specified subpopulations showed no significant difference in the p values for interaction.

Conclusions
In the first two years from publication, the ISCHEMIA trial significantly impacted on the decision-making algorithm for patients with CCS, increasing referral to ICA by CCTA and diminishing ICAs indicated by an ischemia test.
952 SAFETY OF CLASS IC ANTIARRHYTHMIC DRUGS IN CORONARY ARTERY DISEASE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Turturiello Dario , Cristiano Ernesto , De Lucia Carmine , Bessi Riccardo , Paganini Edoardo , Lupo Pierpaolo , Deambroggi Guido , Foresti Sara , Ali Hussam , Cappato Ricccardo 
Published: December 2022

Abstract

Introduction
Class IC antiarrhythmic drugs (AADs) currently represent a cornerstone in the therapy of atrial fibrillation (AF). They also play an important role in the treatment of idiopathic ventricular arrhythmias. Following the results of the CAST study flecainide and by extension the other class IC AADs were contraindicated in patients with ischemic and structural heart disease, because of their proarrhythmic effect and the consequent increase in mortality observed in the study.
Recent studies, carried out on patients with chronic coronary heart disease, have shown a good safety profile for this class of drugs.

Methods
The aim of our study was to evaluate the mortality and the mortality rate in patients affected by ischaemic heart disease who take Class IC AADs. A systematic review and meta-analysis was conducted using Pubmed and Embase databases, following the PRISMA guidelines, to collect literature data reporting Class IC AADs safety in patients affected by coronary artery disease.

Results
The final analysis included four studies accounting for a total of 3643. In the Classe IC AADs group the events (all cause death) were observed in 104/1170 patients, while in the control group were observed in 338/2473 patients, showing an ODDS ratio of 1.431 (IC 0.748-2.740), p value 0.279 (TABLE 1A). The event rate per year was 5,5% in the CLASS IC AADs group and 5,1 in the control group, with an ODDS ratio of 1.524 (IC 0.807-2.879), p value 0.194 (TABLE 1B).

Conclusion
Class IC AADs doesn't increase the overall mortality and mortality rate in patient affected by icheamic heart disease. These observations await confirmation through randomised clinical trial.
976 APP-BASED DIAGNOSTIC WORKUP OF DYSLIPIDEMIC STATUS IN ISCHEMIC AND NOT ISCHEMIC PATIENTS
Authors: Velato Letizia , Cardia Giada , Romano Letizia , Bartone Anna , Malizia Biagio , Indolfi Ciro , Curcio Antonio 
Published: December 2022

Abstract

Background
Despite many therapeutic resources and technological innovations, coronary artery diseases (CAD) yet represent the first cause of death in industrialized countries. In order to improve outcomes in CAD and other chronic diseases, it has been proposed to implement personalized and continuous home-monitoring through digital applications. Currently, dyslipidemias are considered the ideal target condition for the development of such telemedicine approaches.

Objectives
The main goal is to evaluate the efficacy of a mobile app on the clinical cardiovascular outcomes, by analyzing the adherence to lipid-lowering therapy of dyslipidemic patients, compared to out clinics patients followed under standard work-ups.

Materials and methods
From March 2022 to September 2022, 15 patients were enrolled who were able to benefit from remote monitoring and 8 patients undergoing outpatient monitoring. The two groups were divided into four categories: 8 ischemic patients to whom the mobile app was recommended admitted with a diagnosis of CAD and undergoing PCI (percutaneous coronary intervention), 4 ischemic patients undergoing outpatient follow-up, 7 not ischemic admitted for other procedure for which remote monitoring was proposed, 4 non-ischemic patients with outpatient procedure. the lipid profile was assessed by mobile application and outpatient visit, respectively.

Results
In the evaluation between the group of patients who underwent the diagnostic application procedure and the outpatient group, greater adherence to the use of telemedicine was found in patients aged 40-69 years or who could benefit from the help of family members. Lack of information and experience in using the systems and devices was a significant obstacle in 5 percent of patients all over 78 years of age and in the absence of a family member. Given the many logistical and waiting time problems for hospital visits, 57 percent of patients who underwent a medical examination via the app benefited most from using the remote app. Mean LDL values of 97 mg/dL at one month after discharge were found in 66% of patients particularly the subgroup of ischemic patients who, given the strong correlation between atherosclerotic disease and ischemic heart disease, require closer follow-up, with mean LDL values of 95mg/dL found.

Conclusions
Telemedicine has the potential to improve clinical outcomes in patients with dyslipidemia, although efficacy is influenced by parameters such as age and family support; in the future, telemedicine platforms could be an aid to evaluate new therapeutic opportunities for innovative treatments, such as bempedoic acid. Telemedicine helped patients in understanding the importance of reducing LDL cholesterol.
29 PROGNOSTIC IMPACT OF TARGET VESSEL FAILURE AS FIRST EVENT AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHT FORM 10-YEAR FOLLOW-UP OF THE EXAMINATION EXTEND TRIAL
Authors: Verardi Filippo Maria , Bujak Kamil , Sabaté Manel , Brugaletta Salvatore 
Published: December 2022

Abstract

Background
Outcome after primary PCI for ST-segment elevation myocardial infarction may be very different. Either it may be free of events during years or it may be characterized by many recurrent events. It is unknown whether to have a target vessel failure (TVF) as first event may impact subsequent outcomes during follow-up. We aim to evaluate very long-term outcomes of STEMI patients according to the occurrence of TVF as the first event during follow-up.

Methods
EXAMINATION-EXTEND trial randomized STEMI patients to everolimus-eluting stent or bare-metal stent with 10-year follow-up. All the patients were stratified according to their first event (TVF-First vs. NonTVF-First). TVF was defined as the composite of TV cardiac death, TV myocardial infarction, or TV revascularization. The primary endpoint of this study was 10-year POCE, defined as the composite of all-cause death, any myocardial infarction, or any revascularization.

Results
Out of the 1498 enrolled patients, 161 (10.7%) had a TVF as first clinical event during follow-up. TVF-First patients had higher rates of previous MI or PCI, with less use of manual thrombectomy, and received more BMS with a longer total stent length. On multivariate analysis, manual thrombectomy and bare-metal stent implantation were independent predictors of TVF as first event. Ten-year adjusted POCE was statistically higher in TVF-First patients compared to the NonTVF-First group (31.1% vs 27.5%, adjHR: 1.82; 95%CI: 1.34 - 2.48; p &lt; 0.001).

Conclusions
In our STEMI population TVF occurred in 10.7% as the first event during follow-up. At 10-year follow-up, patients who experienced a TVF as first event exhibited a high risk for subsequent POCE events as compared to patients who did not.
1053 PHARMACOLOGICAL REDUCTION OF OXIDATIVE STRESS COUNTERACTS CARDIAC DISFUNCTION IN A MURINE MODEL OF DYSTROPHIC CARDIOMIOPATHY
Authors: Cattapan Irene , Sabatino Jolanda , Di Candia Angela , Arusei Ruth Jepchirchir , Brugnaro Marco , Di Lisa Fabio , Kaludercic Nina , Di Salvo Giovanni 
Published: December 2022

Abstract

Introduction
Dystrophic cardiomyopathy culminates in heart failure and arrhythmias and is a major burden for Duchenne muscular dystrophy (DMD) patients. Mechanism-driven therapies designed to contrast the development of muscle and cardiac dysfunction are still missing. Antioxidant treatments counteract myocyte injury in mdx mice, a genetic model of DMD, supporting the possible role of enhanced reactive oxygen species (ROS) in the pathophysiology of muscular dystrophies. Previous evidence shows that monoamine oxidases (MAO) represent an important source of ROS, thus contributing to cardiomyocyte damage and dysfunction in different models of heart disease.

Objectives
we tested whether MAO-induced ROS formation contributes to the progression of pathology in dystrophic hearts.

Materials and methods
wild type (WT) and mdx mice at 3 and 12 months of age were employed. Cardiac function was determined by echocardiography measuring: fractional shortening, ejection fraction and left ventricle strain. Cardiac structure and fibrosis amount were assessed through histology (H&E, Masson's Trichrome). To test whether reduction in ROS burden could ameliorate cardiac structure and function in mdx mice, MAO-B inhibitor safinamide was administered to WT and mdx mice respectively at 3 and 12 months of age.

Results
We found that fractional shortening (FS) and ejection fraction (EF) were reduced by 1.2- and 2-fold at 3 and 12 months of age, respectively, in mdx mice vs their WT counterpart. In addition, left ventricle (LV) strain was impaired in mdx mice already at 3 months of age. This functional impairment was accompanied by a 5-fold increase in fibrosis in mdx hearts, evident already at 3 months. Safinamide administration for 30 days, led to a significant improvement of FS, EF and LV strain in mdx mice. Half of the mice in the safinamide cohort showed reduced levels of myocardial fibrosis.

Conclusions
Taken together, these results suggest that pharmacological MAO-B inhibition improves cardiac function in a genetic model of DMD and may represent a clinically relevant target for the treatment of dystrophic cardiomyopathies.