bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of right ventricular diastolic dysfunction in patients with inferior ST elevated myocardial infarction
Authors: El Amrawy A , Zaghloul S , El Sharkawy E , Sobhy M 
Published: October 2022

Abstract

Background
Right ventricle infarction (RVI) is predominantly a complication of inferior wall myocardial infarction; it occurs in approximately one third of these patients. Right ventricle dysfunction in patients with inferior STEMI and RV infarction was under assessed. Nevertheless, studies which targeted RV assessment by echocardiography, did not evaluate RV diastolic dysfunction.

Purpose
In this study, we aimed to evaluate RV diastolic dysfunction and its prognostic value in patients with inferior STEMI and RVI.

Methods
Sixty patients with inferior STEMI and RV infarction, who underwent primary PCI were enrolled in the study. Presence of a pre-existing clinical conditions that might affect RV function, were excluded. Echocardiography was performed within twenty-four hours following the PCI, to assess the RV systolic and diastolic functions with special focus on tricuspid inflow velocities (E velocity, A velocity and E/A ratio) by pulsed wave (PW) doppler and tricuspid annular velocities by tissue doppler index (TDI) (e', a' and E/e' ratio). Clinical features and MACE, including cardiogenic shock, arrhythmia, stroke, reinfarction and death were analyzed in all our patients within 3 months follow up period.

Results
The average age of the study population was 51.58±10.11 years, 10% were females. Five patients developed MACE (death, cardiogenic shock and pulmonary oedema, anterior STEMI and cardiogenic shock, recurrent inferior STEMI, and arrhythmia and stroke), of whom four occurred in hospital within the first 48 hours. Patients who developed MACE had high filling pressures, as all of them had E/e' &gt;6. E' velocity ≤6 cm/s was associated with increased MACE as 25% of patients with e' velocity ≤6 cm/s had MACE compared with 2.3% of patients with e' velocity &gt;6 cm/s with a P value of 0.015.

Conclusions
Because tricuspid inflow velocities by PW doppler varies with respiration, volume status and other conditions, tricuspid annular velocities by TDI are essential when evaluating RV diastolic dysfunction. E/e' and e' has a prognostic value in patients with Inferior STEMI and RV infarction.

Funding Acknowledgement
Type of funding sources: None.
Impact of multivessel versus single-vessel disease on the association between low diastolic blood pressure and mortality after acute myocardial infarction with revascularization
Authors: Kim M , Bae J W B , Bae J W B , Hwang K K H 
Published: October 2022

Abstract

Background
Previous studies demonstrated a J-shaped relationship between low diastolic blood pressure (DBP) and adverse clinical outcomes in patients with acute myocardial infarction (AMI) that was sensitive to revascularization. We hypothesized that this relationship differs between patients with multivessel disease (MVD) and those with single-vessel disease due to differing degrees of myocardial ischemic burden.

Methods
Among 9,983 AMI patients from the Korea Acute Myocardial Infarction Registry database who underwent percutaneous coronary intervention and were followed up for a median duration of 3.2 years, average on-treatment DBP was calculated at admission, discharge, and every scheduled visit and divided into &lt;70 mmHg, 70–74 mmHg, 75–79 mmHg, and ≥80 mmHg. The relationship between average on-treatment DBP and clinical outcomes including all-cause death, cardiovascular (CV) death, non-CV death, and _hospitalization for heart failure was analyzed using Cox regression models adjusted for clinical covariates.

Results
In patients with MVD, all-cause death (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.06–2.04) and CV death (HR: 1.59; 95% CI: 1.02–2.46) were significantly increased in patients with a DBP &lt;70 mmHg, showing a J-shaped relationship. However, these findings were not significant for single-vessel disease. On a sensitivity analysis excluding subjects with a baseline SBP &lt;120 mmHg, an increased risk of a low DBP &lt;70 mmHg remained in MVD.

Conclusions
The J-shaped relationship between low DBP and adverse clinical outcomes in AMI patients who underwent revascularization persisted in MVD, which has a high ischemic burden. These high-risk patients require cautious treatment.

Funding Acknowledgement
Type of funding sources: None.
Prognostic impact of right ventricular strain in isolated severe tricuspid regurgitation
Authors: Hinojar Baydes R , Garcia-Martin A , Gonzalez-Gomez A , Monteagudo J M , Garcia-Lunar I , Rivas S , Sanroman M , Pardo A , Sanchez-Recalde A , Zamorano J L , Fernandez-Golfin C 
Published: October 2022

Abstract

Background
Right ventricular (RV) systolic function is determinant in the evaluation of patients with severe tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is challenging. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detecting subclinical RV dysfunction.

Purpose
This study was aimed to evaluate the prognostic value of RV strain parameters in consecutive stable patients with severe TR.

Methods
Consecutive patients in stable clinical status with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Patients with previous episodes of heart failure or scheduled for TV intervention were excluded. RV systolic function was measured with conventional echocardiographic indices (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE], DTI S wave [`S]) and with Speckle-tracking echocardiography (STE) derived automatic peak global and free wall longitudinal strain (RV-GLS and RV-FWLS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. The interobserver variability of RV strain was assessed in 20 randomly selected patients.

Results
A total of 176 patients were included in this study. Strain parameters detected higher percentage of RV dysfunction compared to conventional indices (figure 1). After a median follow-up of 28 months (IQR: 15–48 months), n=65 patients (37%) reached the combined endpoint. 65 (37%) were admitted for right heart failure and 8% of the population (n=14) died. Cumulative event-free survival was significantly worse in patients with impaired RV-GLS and RV-FWLS. Conventional indices of RV systolic function were not associated with outcomes (p&gt;0.05 for all). In a multivariable analysis (in a model including NYHA class, BNP values, biplane VC, RV end-diastolic area, and RV-FWLS), RV-FWLS was an independent predictors of heart failure and CV mortality (figure 1 and 2; LR χ2: 40.2, p&lt;0.001). Inter-observer agreements for RV strain values were high (intraclass correlation coefficient for RV-GLS and RV-FWLS, r=0.96 and r=0.98 respectively)

Conclusion
Clinical outcomes demonstrate that RV strain parameters are superior to conventional indices of RV function in patients with isolated ≥ severe TR and absence of previous episodes of heart failure. Among all parameters of RV function, RV-FWLS is the strongest independent predictor of mortality and HF.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto Carlos III
The effect of P2Y12 inhibitor monotherapy according to bleeding risk: a systematic review and meta-analysis
Authors: Woelders E C I , Luijkx J P , Rodwell L , Winkler P J C , Dimitriu-Leen A C , Smits P C , Van Royen N , Van 'T Hof A W J , Damman P , Van Geuns R J M 
Published: October 2022

Abstract

Background/Introduction
P2Y12 inhibitor monotherapy is a promising novel strategy to reduce bleeding complications compared to DAPT. To determine which patients benefit most, we investigated the effect according to bleeding risk.

Purpose
The study aim was to analyse the safety and efficacy of P2Y12 inhibitor monotherapy versus dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients with and without high bleeding risk (HBR).

Methods
PubMed was searched for randomized clinical trials (RCTs) comparing P2Y12 inhibitor monotherapy to DAPT after PCI. Risk ratios (RR) and adjusted risk differences (ARD) of net adverse clinical events (NACE), major adverse cardiac and cerebral events (MACCE) and major bleedings were calculated according to bleeding risk.

Results
Five RCTs including 31750 patients were selected. Monotherapy reduced major bleeding significantly in all patients (HBR: RR 0.63, 95% CI: 0.46 to 0.85; non-HBR: RR 0.58, 95% CI: 0.41 to 0.82) with a higher ARD in patients with HBR versus non-HBR. There was no difference between treatment effects on MACCE in both subgroups. Next to the expected higher number of bleeding events, we found an increase in MACCE in patients with HBR which resulted in a non-significant reduction of NACE (RR 0.89, 95% CI: 0.77 to 1.04). In patients without HBR, NACE was significantly reduced by monotherapy (RR 0.80, 95% CI: 0.67 to 0.96).

Conclusions
P2Y12 inhibitor monotherapy post PCI reduces bleeding complications without increasing ischemic events compared to DAPT, regardless of bleeding risk. HBR patients experience more bleeding and ischemic events without a net benefit of monotherapy.

Funding Acknowledgement
Type of funding sources: None.
To pretreat or not no pretreat with dual antiplatelet therapy in non-ST elevation acute coronary syndrome patients: that is the question
Authors: Abella Vallina D , Cazorla Morallon D , Perez Rivera J A , Cordero Fort A 
Published: October 2022

Abstract

Background
The timing for the initiation of dual antiplatelet treatment (DAPT) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is controversial and the 2020 ESC guidelines suppressed the recommendation of routine pre-treatment. The aim of our study was to assess the effect of pretreatment on clinical outcomes according to the available evidence.

Methods
We conducted a meta-analysis of the main studies on pretreatment with P2Y12 receptor inhibitors in patients with NSTE-ACS. After a systematic review, we included four randomized clinical trials (PCI-CURE, ACCOAST, ISAR-REACT 5, and DUBIUS), and one observational study (SCAAR). Data was analyzed using the inverse variance method, using a fixed effects model since no statistically significant heterogeneity was observed.

Results
A total of 75,345 patients were included, 65,134 patients who followed a systematic pretreatment strategy with DAPT and 10,211 patients with a simple antiplatelet strategy with acetylsalicylic acid (ASA) and administration of a second antiplatelet during angiography and prior to angioplasty. No significant differences were observed in cardiovascular mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 0.90 to 1.60; P=0.2184) or acute stent thrombosis (OR 0.88; 95% CI, 0.65 to 1.18; p=0.3866). However, a significant increase in major bleeding was observed (OR 1.42; 95% CI, 1.15 to 1.75; p=0.0011).

Conclusions
Routine pretreatment with DAPT in patients with suspected NSTE-ACS is not associated with a decrease in cardiovascular death or an increase in acute stent thrombosis and, however, it is associated with a significant increase in major bleeding.

Funding Acknowledgement
Type of funding sources: None.
Comparative efficacy and safety of ticagrelor vs. prasugrel in patients undergoing PCI for NSTE-ACS. Results of the prospective ALKK-Registry
Authors: Zeymer U , Hochadel M , Schaechinger V , Zahn R 
Published: October 2022

Abstract

Background
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has become standard of care for patients with NSTE-ACS. Guidelines recommend prasugrel and ticagrelor over clopidogrel. In the ISAR-5 trial prasugrel was superior to ticagrelor in NSTE-ACS patients. We evaluated the outcome of patients undergoing PCI for NSTE-ACS in a large number of patients in real life and compared patients treated with prasugrel and ticagrelor.

Methods
We used the data of the prospective German ALKK-PCI registry and included patients treated with prasugrel or ticagrelor and undergoing PCI for NSTE-ACS treated in 42 centers. Baseline variables, procedural features, antithrombotic therapies and in-hospital outcomes were centrally collected and analysed. Patients with cardiogenic shock were excluded.

Results
Between 2011 and 2020 a total of 7888 patients &lt;75 years without prior stroke undergoing PCI for NSTE-ACS were included. Of these 4905 (62.2%) patients were treated with ticagrelor and 2983 (37.8%) were treated with prasugrel. Baseline characteristics, procedural features and in-hospital outcomes are given in the table.

Conclusion
In clinical practice in patients with NSTE-ACS undergoing PCI ticagrelor was used more often than prasugrel. Ticagrelor treated patients were older and had more comorbidities. Despite this higher risk profile in ticagrelor patients the in-hospital mortality and the short-term safety profile were comparable in both groups.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Institut für Herzinfarktforschung Ludwigshafen
Intracoronary thrombolysis facilitated primary percutaneous coronary intervention in ST-segment elevation myocardial infarction patients: an updated meta-analysis of randomized controlled trials
Authors: Alexiou S , Patoulias D , Theodoropoulos K , Kassimis G 
Published: October 2022

Abstract

Background
Primary percutaneous coronary intervention (PPCI) is the standard reperfusion treatment in ST-segment elevation myocardial infarction (STEMI). However, PPCI is often complicated by microvascular obstruction. Intracoronary thrombolysis (ICT) may mitigate thrombotic burden.

Methods
We conducted, according to the PRISMA statement, the largest meta-analysis of ICT as adjuvant therapy to PPCI. All relevant studies were identified by searching the PubMed, Scopus, Cochrane Library, and Web of Science, with no time or language restriction. The odds ratio (OR) and mean difference (MD) with a 95% confidence interval (CI) were calculated. Studies included STEMI patients undergoing PPCI receiving ICT. Both safety and efficacy outcomes were analyzed. Data were combined using a random-effects model.

Results
Thirteen randomized controlled trials (RCTs) involving a total of 1876 (1014 ICT) patients were included. Compared with the control group, ICT in STEMI patients could reduce the incidence of major adverse cardiac events (MACE) (OR 0.65, 95% CI, 0.48–0.86, P=0.003) and improve 6 months left ventricular ejection fraction (MD 3.78, 95% CI, 1.53–6.02, P=0.0010). Indices of enhanced myocardial microcirculation were more common with ICT [Post PCI corrected thrombolysis in myocardial infarction (TIMI) frame count (MD −3.57; 95% CI, −5.00 to −2.14, P&lt;0.00001); myocardial blush grade (MBG) 2/3 (OR 1.76; 95% CI, 1.16–2.69, P=0.008), and complete ST-segment resolution (OR 1.97; 95% CI, 1.33–2.91, P=0.0007). The incidence rate of major bleeding was comparable between the 2 groups (OR 1.27; 95% CI, 0.61–2.63, P=0.53).

Conclusions
Intracoronary thrombolysis was associated with improved MACE and myocardial microcirculation in patients with STEMI undergoing PPCI, without any significant increase in major bleeding. Our meta-analysis suggests that a targeted ICT is safe and potentially effective to improve PPCI. Nonetheless, the above results necessitate verification in a contemporary large RCT.

Funding Acknowledgement
Type of funding sources: None.
30-day outcomes of P2Y12 inhibitor pretreatment in patients with STEMI submitted to primary PCI – systematic review and meta-analysis
Authors: Presume J , Gomes D , Albuquerque F , Aguiar C , Almeida M , Ribeiras R , Uva M S , Ferreira J 
Published: October 2022

Abstract

Introduction
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is the cornerstone of antithrombotic therapy in patients with ST-segment elevation myocardial infarction (STEMI). Yet, there is uncertainty surrounding the optimal timing for the initiation of the P2Y12 inhibitor. This study aims to evaluate the effectiveness and safety of P2Y12 pretreatment by means of a systematic review and meta-analysis of studies in primary percutaneous coronary intervention (PCI) in STEMI.

Methods
We performed a systematic search of electronic databases Pubmed, CENTRAL and Scopus until March of 2021. Studies were considered eligible if they were: a) comparing P2Y12 inhibitor upstream administration vs. treatment during PCI; b) patients enrolled for STEMI and submitted to primary PCI. Studies with patients treated with fibrinolysis or medical therapy only were excluded. Major clinical outcomes included 30-day occurrence of all-cause death, definite stent thrombosis and re-infarction. Thrombolysis in myocardial infarction (TIMI) flow-grade pre-PCI and post-PCI, in-hospital cardiogenic shock and major bleeding events were analysed.

Results
Out of 2193 articles, 18 studies were included (1 randomized clinical trial [RCT] and 17 observational studies [non-RCT]), with a total of 76,836 patients, 52,181 in the pretreatment arm. At 30 days, pretreatment was associated with a reduction in definite stent thrombosis (1 RCT & 4 Non-RCT: OR 0.40; 95% CI 0.18–0.90), but no significant reduction in all-cause death (1 RCT & 7 Non-RCT: OR 0.77; 95% CI 0.56–1.04) or re-infacrtion (1 RCT & 4 Non-RCT: OR 0.73; 95% CI 0.49–1.09). Regarding in-hospital outcomes, pretreatment showed a significant reduction in the occurrence of cardiogenic shock (5 Non-RCT: 0.62; 95% CI 0.51–0.79), major bleeding events (1 RCT & 14 Non-RCT: 0.83; 95% CI 0.75–0.92) and in the number of patients with TIMI flow &lt;3 postPCI (1 RCT & 8 Non-RCT: 0.82; 95% CI 0.73–0.93). Pretreatment was not associated with lower number of patients with TIMI flow &lt;3 pre-PCI (1 RCT & 5 Non-RCT: 0.85; 95% CI 0.66–1.09).

Conclusion
Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with lower risk for definite stent thrombosis and cardiogenic shock, but was not associated with lower all-cause death or re-infarction.

Funding Acknowledgement
Type of funding sources: None.
Patient knowledge about risk factors, achievement of target values and guideline adherent secondary prevention 12 months after acute myocardial infarction. Results of the prospective GULLIVE-R study
Authors: Zeymer U , Goss F , Werdan K 
Published: October 2022

Abstract

Background
Little is known about patients knowledge about their risk factors and the achievement of target values and ESC guidelines adherent therapies in the chronic phase after an acute myocardial infarction.

Purpose
The prospective GULLIVE-R study aimed to evaluate adherence to guideline recommended secondary prevention, physicians and patients estimation of cardiac risk, and patients knowledge about target values of risk factors about 12 months after acute myocardial infarction.

Methods
We have performed a prospective study enrolling patients 9–12 months after acute myocardial infarction. Guideline recommended secondary prevention therapies and physicians as well as patients estimation about their cardiac risk, as well as patients knowledge about target values were prospectively collected. Guideline recommended secondary drug prevention has been defined as aspirin, a P2Y12 inhibitor, a statin, a beta-blocker, an ACE-I/ARB (5 drugs) and a MRA (6 drugs) in patients with heart failure and/or EF &lt;35%.

Results
Between 07/2019 and 06/2021 a total of 2509 outpatients were enrolled in 150 centres (56% cardiologists) in Germany. The mean age was 66 years, 26.4% were women, 45.3 had STEMI, 54.7% had NSTEMI, 93.6% had revascularization (84. % PCI, 7.4% CABG, 1.8% both). The correct target value for blood pressure was known by the patient in 37.9% and for LDL-C in only 8.2%. The achievement of target values and the rate of guideline recommended therapies are shown in the table.

Conclusions
There is still room for improvement in patient education and implementation of guideline recommended non-pharmacological and pharmacological secondary prevention therapies in patients in the chronic phase after myocardial infarction.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Astra Zeneca
Clinical significance of time-varying on-treatment platelet reactivity after percutaneous coronary intervention
Authors: Park J S , Jeong Y H 
Published: October 2022

Abstract

Objectives
This study aimed to determine the prognostic value of serial measurement of platelet reactivity (PR) using the VerifyNow, P2Y12 reaction unit (PRU) assay following percutaneous coronary intervention (PCI) during antiplatelet therapy.

Background
On-treatment PR changes over time, but the prognostic value of serial PR measurements has not been defined.

Methods
We enrolled 3204 patients who had PCI and who were measured at PCI and 1 month. We constructed regular and time-dependent Cox proportional hazard models to compare the prognostic value between baseline and serial FU of PR on a primary endpoint of cardiovascular death, myocardial infarction (MI) or stroke over a three-year period.

Results
Time-varying PR and baseline PR were both associated with an increased risk of the primary endpoint, but the duration of association with primary endpoint differed. The prognostic value of time-varying PR (adjusted hazard ratio (HR) 1.008, 95% confidence interval (CI) 1.005–1.011, p=0.001) was rapidly decreased until 3 month and no prognostic value of time-varying PR after 3 month (adjusted HR 0.999, 95% CI 0.997–1.002, p=0.683). Baseline PR was associated with an increased risk of primary endpoint upto 1 year (adjusted HR 1.005, 95% CI 1.003–1.008, p&lt;0.001) and no prognostic value of baseline PR after 1 year (adjusted HR 0.999, 95% CI 0.997–1.002, p=0.827) was not noted, which showed more slow reduction of the prognostic value of baseline PR.

Conclusions
Time-varying on-treatment PR reflects more real-world clinical practice. The prognostic value of PR decreased rapidly after PCI and we have to be cautious to use of single time point for the prediction of clinical event using on-treatment PR.

Funding Acknowledgement
Type of funding sources: None.