bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential electrocardiographic changes related to the culprit coronary artery in patients with acute myocardial infarction and left bundle branch block
Authors: Sole Gonzalez E , Soriano Amores M , Di Marco A , Barrabes J A , Torres Sanchez L M , Gonzalez Calle D , Tomas Querol C , Garcia Garcia C , Cinca J 
Published: October 2022

Abstract

Background
The electrocardiographic (ECG) recognition of acute myocardial infarction (AMI) in patients with concurrent left bundle branch block (LBBB) is hampered by background changes in QRS complex duration and ST segment, potential directly caused by LBBB. Currently available ECG algorithms were constructed to suspect the presence of AMI but they not take into a count the culprit coronary artery and this fact could explain their low sensitivity.

Objectives
To analyze the influence of the culprit coronary artery on the ECG changes and on the diagnostic yielding of ECG algorithms in patients with acute myocardial infarction and LBBB.

Methods
We analyzed the index ECG of 240 patients with acute chest pain and LBBB referred to emergent coronary angiography. Patients were classified in 3 groups according their coronary anatomy: a) acute coronary occlusion (n=48); b) critical non occlusive lesion (n=45); and c) absence of coronary lesions (n=76). In all ECGs we measured the ST-segment shifts and QRS duration and compared the pattern of changes in relation to the culprit coronary artery.

Results
Location of the culprit coronary artery induced differential ECG patterns: a) mean ST segment elevation ≥3mm in leads V2-V3 in patients with LAD occlusion (n=27); b) absence of ST segment depression in leads V5-V6 in LCX occlusion (n=11); and c) mean ST segment elevation ≥1.5 mm in leads III-aVF and attenuation of the ST elevation in leads V1-V2 (mean &lt;1mm) in cases of RCA occlusion (n=10). Patients with critical non occlusive lesions (n=45) did not show particular ECG changes. QRS complex duration was longer in patients with LCX occlusion. Sensitivity of the Sgarbossa score was around 50%, sensitivity of the Smith score was &gt;70% in all coronary groups and sensitivity of Barcelona score was really good for LCX and RCA occlusion. The combination of the three algorithms increased the sensitivity in all groups (&gt;74%) but more markedly in patients with LCX occlusion (90.9%) and RCA occlusion (90%). All the ECG algorithms lose sensitivity for the critical non occlusive lesions group.

Conclusions
Patients with acute myocardial infarction and LBBB present distinct patterns of QRS and ST segment changes and different diagnostic yielding of ECG algorithms in relation to the location of the occluded coronary artery. Data suggest that ECG prediction of the culprit coronary artery in patients with AMI and LBBB might be possible using artificial intelligence systems in larger series of patients.

Funding Acknowledgement
Type of funding sources: None.
First medical contact facility type as a determinant of prognosis in a regional ST elevation myocardial infarction network
Authors: De Diego Soler O , Garcia-Garcia C , Rueda F , Carrillo X , Andrea R , Regueiro A , Mauri F , Lidon R M , Tizon H , Garcia-Pitarch J , Bayes-Genis A 
Published: October 2022

Abstract

Background
Delay in primary percutaneous coronary intervention (PPCI) in ST elevation myocardial infartion (STEMI) is associated with worse prognosis. In our regional STEMI network, the first medical contact (FMC) facility type defines 4 different assistance pathways (i.e. emergency medical services'diagnosis on the field and direct transfer to the catheterization laboratory (cath. lab) of a PCI hospital (EMS group); direct admission to a PCI hospital (PCI-H group); admission to community hospital and transfer to the cath lab of the PCI-H (CH group); diagnosis in a primary care centre and transfer to the cath lab of the PCI-H (PCC group). Each different FMC has been associated with different degrees in reperfusion delay.

Objective
To determine the influence of FMC facility type on 1-year mortality in patients with STEMI in our regional STEMI network.

Methods
This is a retrospective study based on the STEMI network registry, a mandatory registry conducted since its implantation and supervised by the regional health authorities. We included STEMI patients treated with PPCI from January 2010 to December 2020. We analyzed differences in clinical variables, reprefusion times and 1-year all-cause mortality regarding the FMC facility type.

Results
We included 18332 patients (EMS 34.25%, PCI-H 12.28%, CH 33.47%, PCC 20.01%). Initial Killip classes III–IV: EMS 8.43%, PCI-H 7.51%, CH 5.54%, PCC 3.76%; p&lt;0.001. All comorbidities and complications in first medical assistance were more frequent in EMS and PCI-H groups (p&lt;0.05). PCC group had the lowest risk profile regarding comorbidities and first medical assistance complications (p&lt;0.05 for most of variables). The PCI-H group had the shortest system delay (median 82 min, p&lt;0.001), the EMS group had the shortest total ischemic time (median 151 min, p&lt;0.001). Crude 1-year mortality was EMS 8.6%, PCI-H 9.11%, CH 8.25%, and PCC 4.77% (p&lt;0.001). After adjusting for several covariables with a logistic regression model, PCI-H and CH groups were associated with higher 1-year mortality compared to EMS group (OR 1.23 (IC95% 1.01–1.49; p=0.04) and OR 1.16 (IC95% 1.01–1.34; p=0.04) respectively), while PCC group was associated with lower 1-year mortality (OR 0.69 (IC95% 0.57–0.84; p&lt;0.01)).

Conclusions
First medical contact with EMS and direct transfer to the cath lab was associated with lower adjusted 1-year mortality compared to first medical contact with a PCI hospital or a community hospital.

Funding Acknowledgement
Type of funding sources: None.
Association of accompanying dyspnea with diagnoses and outcome of patients presenting with suspected acute coronary syndromes
Authors: Boeddinghaus J , Nestelberger T , Koechlin L , Lopez-Ayala P , Wildi K , Rubini Gimenez M , Miro O , Martin-Sanchez J , Keller D , Christ M , Twerenbold R , Mueller C 
Published: October 2022

Abstract

Background
The presence of accompanying dyspnea is routinely assessed and common in chest pain patients with suspected acute coronary syndromes (ACS), but its impact on differential diagnoses, diagnostic work-up and outcome is incompletely understood.

Purpose
To determine the association of accompanying dyspnea with diagnoses, diagnostic work-up, and outcome of patients presenting with suspected ACS to the emergency department (ED).

Methods
We prospectively enrolled unselected patients presenting to the ED with chest pain as the main symptom suggestive of ACS in an international multicenter study. Final diagnoses were adjudicated by two independent cardiologists using all information including cardiac imaging. Patients were stratified by the presence or absence of self-reported dyspnea. The primary diagnostic endpoint was the differential diagnosis. The secondary diagnostic endpoint was the performance of high-sensitivity cardiac troponin (hs-cTn) and the European Society of Cardiology (ESC) 0/1h-algorithms for the diagnosis of myocardial infarction (MI). The primary prognostic endpoint was all-cause mortality at two years.

Results
Among 6045 patients, 2892/6045 (48%) had accompanying dyspnea. Final diagnoses in patients with versus without dyspnea were different (overall p&lt;0.001), but prevalence of ACS was comparable (MI 22.4% vs. 21.9%, p=0.602, unstable angina 8.7% vs. 7.9%, p=0.291). In contrast, patients with dyspnea more often had cardiac, non-coronary disease (15.3% vs. 10.2%, p&lt;0.001). Diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn)T/I concentrations at presentation for the diagnosis of MI was high and not affected by the presence of dyspnea (area under the curve 0.89–0.91 in both groups). The ESC 0/1h-algorithms performed excellent in both groups with negative predictive values &gt;99.4%. The presence of dyspnea was associated with all-cause death at two years (hazard ratio [HR] 2.487 [95% CI, 2.001–3.091, p&lt;0.001) and remained an independent predictor after adjustment for covariates at baseline (HR 1.813 [95% CI, 1.453–2.261, p=0.001]). Overall mortality rates were higher in patients with dyspnea at two years (9.0% vs. 3.7%, p&lt;0.001).

Conclusion
Accompanying dyspnea was not associated with a higher prevalence of ACS but with cardiac, non-coronary disease such as heart failure. While the safety of the diagnostic work-up was not affected, accompanying dyspnea was associated with and an independent predictor for two-year all-cause mortality.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss Heart Foundation, University of Basel.
Extending the no objective testing rules to patients triaged by the ESC 0/1-hour algorithms
Authors: Boeddinghaus J , Ratmann P D , Nestelberger T , Lopez-Ayala P , Koechlin L , Wildi K , Miro O , Martin-Sanchez J , Christ M , Gualandro D , Rubini Gimenez M , Keller D , Buser A , Mueller C 
Published: October 2022

Abstract

Background
It is unclear which patients, after rule-out of non-ST elevation myocardial infarction (NSTEMI) with the European Society of Cardiology (ESC) 0/1h-algorithms, require further objective anatomical or functional cardiac testing and which do not.

Purpose
To test the safety and efficacy of the no-objective-testing (NOT)-rules after NSTEMI rule-out by the well-validated ESC 0/1h-algorithms.

Methods
We prospectively enrolled adult patients presenting with acute chest pain to 12 emergency departments (ED) in five European countries in an international, prospective, diagnostic multicenter study. The final diagnosis of major adverse cardiovascular events (MACE), defined as nonfatal acute coronary syndromes (NSTEMI or unstable angina) or cardiovascular death was centrally adjudicated by two independent cardiologists applying the 4th Universal Definition of myocardial infarction using all information including cardiac imaging and serial measurements of high-sensitivity cardiac troponin (hs-cTn) T/I. The primary endpoints were the safety and efficacy of the NOT-rules for the rule-out of MACE within 30-days follow-up including index events. Secondary endpoints included MACE within 365 and 730 days.

Results
Among 4804 and 4569 eligible patients with available 0h and 1h hs-cTnT-Elecsys or hs-cTnI-Architect concentrations, 2783 (58%) and 2252 (49%) patients were eligible for application of the NOT-rules after rule-out of NSTEMI by the respective ESC hs-cTnT/I-0/1h-algorithm. The first rule (weighted score including age, sex, cardiovascular risk factors, previous MI or known coronary artery disease (CAD), nitrate use) identified 26% of patients, had a sensitivity of 100% (95% CI 98.3–100%), a negative predictive value (NPV) of 100% (95% CI, n.c.) for hs-cTnT-Elecsys and 99.4% (95% CI 96.7–99.9%) and 99.8% (95% CI 98.8–99.9%) for hs-cTnI-Architect, respectively. The dichotomized second (age &lt;50y, no previous MI or known CAD, &lt;3 risk factors, no nitrate use) and even simpler third rule (nitrate use omitted) both identified 31% of patients with 99.5% (95% CI 97.4–99.9%) sensitivity and a NPV of 99.9% (95% CI 99.2–99.9%) for hs-cTnT-Elecsys. Sensitivities were 98.8% (95% CI 95.7–99.9%) and NPV 99.7% (95% CI 98.9–99.9%) for hs-cTnI-Architect. High safety was confirmed with consistently very high sensitivities and NPV for 365-day and 2-year MACE.

Conclusion
All three NOT-rules performed very well for rule-out of MACE. The third NOT-rule best balanced feasibility, safety and efficacy by identifying nearly one out of three patients as low-risk, who may not require further cardiac testing.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss Heart Foundation, University of Basel.
Bleeding risk in patients hospitalized for non-ST-segment elevation acute coronary syndromes in Switzerland: performance of the CRUSADE score
Authors: Wenzl F , Kraler S , Raeber L , Staehli B E , Roffi M , Muller O , Rodondi N , Camici G G , Puhan M A , Rickli H , Radovanovic D , Luescher T F 
Published: October 2022

Abstract

Background
Evaluation of bleeding risk is critical to the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The CRUSADE score is the most established tool to estimate major bleeding events following the index NSTE-ACS.

Purpose
We aimed to assess the performance of the CRUSADE score and the predictive utility of the individual score variables in contemporary European populations.

Methods
The CRUSADE score was studied in prospectively recruited Swiss patients with NSTE-ACS included in the multicentre SPUM-ACS study (n=4'787) and main findings were validated in the nation-wide AMIS Plus registry (n=46'939). Major bleeding during hospitalization was defined as Bleeding Academic Research Consortium (BARC) class IIIB, IIIC, IV, or V. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC). Multivariable-adjusted risk ratios (adj RR) were estimated for each of the 8 score variables. Hematocrit estimates were based on hemoglobin concentrations in AMIS Plus. Analyses were performed on complete and imputed data (multiple imputation using chained equations).

Results
CRUSADE showed poor discriminatory performance (SPUM-ACS: AUC, 0.65; 95% CI 0.57 to 0.72) and low balanced accuracy (SPUM-ACS: 0.50). Risk predicted by CRUSADE exceeded the observed risk across all predefined risk categories (very low, low, moderate, high, and very high). Decision curve analyses suggested little to no net benefit from using the score. Adjusting for other score variables, signs of heart failure (adj RR, 3.83; 95% CI, 1.93 to 7.37), low hematocrit (adj RR, 2.16; 95% CI, 0.55 to 7.70; &lt;31% vs. &gt;40%), and low systolic blood pressure (adj RR, 2.70; 95% CI, 1.14 to 6.16; &lt;100 mmHg vs. &gt;121 mmHg) were the strongest predictors of major in-hospital bleeds in SPUM-ACS. These findings were similarly observed in AMIS Plus.

Conclusion
The CRUSADE score overestimates bleeding risk in NSTE-ACS. Among all 8 score variables, signs of heart failure, low hematocrit, and low systolic blood pressure are the strongest predictors of major in-hospital bleeds in contemporary patients with NSTE-ACS.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
Prognostic impact of plasma glucose on cardiogenic shock patients with or without diabetes ellitus: smart rescue trial
Authors: Choi S H , Park S D , Lee M J , Ko Y G , Yu C W , Chun W J , Jang W J , Kim H J , Bae J W , Kwon S U , Kim J S , Lee W S , Jeong J O , Lim S H , Yang J H 
Published: October 2022

Abstract

Background
Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population

Purpose
Investigate the clinical relationship between hyperglycemic status and in-hospital mortality in cardiogenic shock patients

Method
A total of 1,177 consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group 1 (≤8 mmol/L), group 2 (8–12 mmol/L), group 3 (12–16 mmol/L) and group 4 (≥16 mmol/L).

Results
The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2: 28.6%, group-3: 38.1%, group-4: 49.0%, p&lt;0.01) whereas in diabetic patients, mortality and admission plasma glucose level showed no significant association (group-1: 45%, group-2: 35.4%, group-3: 33.3%, group-4: 43.1%, p=0.26). Even after Multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in non-diabetic patients

Conclusion
In cardiogenic shock patients, plasma glucose obtained at admission was associated with in-hospital mortality in non-diabetic patients

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Inha University hospital
Impact of COVID-19 on mechanical complications in ST elevation myocardial infarction
Authors: El Ouaddi N , Escabia C , Rueda F , Oliveras T , Montero S , Labata C , Ferrer M , Garcia-Garcia C , Bayes-Genis A 
Published: October 2022

Abstract

Background
Mechanical complications (MC) give a poor prognosis for ST elevation myocardial infarction (STEMI). Its prevalence had decreased in the era of primary angioplasty, at the expense of free wall rupture (FWR).

Purpose
To analyse the prevalence of post-STEMI MC for two periods, before and after the COVID-19 pandemic.

Methods
Unicentric prospective registration of patients with STEMI admitted between January-2018 and December-2021. They are classified into two groups according to the onset of the pandemic by COVID-19: Pre-COVID: January-2018 to December-2019, and Post-COVID: January-2020 to December-2021. The prevalence of post-STEMI MC is analysed, including ventricular septal rupture (VSR), papillary muscle rupture (PMR) and FWR, and 30-day mortality.

Results
1507 consecutive patients with STEMI (Pre-COVID n=775, Post-COVID n=732) are included. Age 62.9 years vs 63.3 years (p=0.5097). Men 78.1% Vs 79.5% (p=0.493). No differences in cardiovascular risk factors, previous heart infarction or anterior wall STEMI. Primary angioplasty was similar in both groups (92%). The Post-COVID group has a higher prevalence of Killip&gt;I (21.7% vs 17.2% p=0.025) and LVEF ≤40% (27.2% vs 20% p=0.001), and longer symptom onset to balloon dilatation interval (316 min vs 257 min p=0.0004). MC are most developed in Post-COVID (2.6% vs 1.2% p=0.039), at the expense of FWR (1.91% vs 0.3% p=0.001). No significant changes in VSR and PMR prevalence or 30-day mortality. Multivariate analysis identifies the independent predictors of FWR: Age (OR 1.05, p=0.024), Primary angioplasty (OR 0.09, p&lt;0.001), and Post-COVID (OR 6.8, p=0.013).

Conclusions
The COVID-19 pandemic is independently associated with a higher prevalence of FWR, probably due to delayed reperfusion.

Funding Acknowledgement
Type of funding sources: None.
PARADISE-MI – event rates and treatment effect of sacubitril/valsartan v ramipril by the presence or absence of transient pulmonary congestion and/or LVEF less or greater than 40
Authors: Petrie M , Solomon S , Claggett B L , Jering K , Steg G , Granger C , Lewis E , Kober L , Mann D , Rouleau J L , McMurray J J , Maggioni A , Braunwald E , Pfeffer M A 
Published: October 2022

Abstract

Background/Introduction
Sacubitril/valsartan was compared to ramipril in patients with acute myocardial infarction in the PARADISE-MI trial. In the whole trial population sacubitril/valsartan did not reduce the composite primary outcome of CV death or incident heart failure compared to ramipril. Whether or not event rates and/or treatment effects vary in patients with different baseline characteristics is unknown.

Purpose
To investigate a) event rates b) the treatment effect of sacubitril/valsartan compared to ramipril and c) safety by the presence or absence of transient pulmonary congestion and/or left ventricular ejection fraction (LVEF) ≤40%.

Methods
PARADISE-MI was a double-blind, randomised clinical trial that compared sacubitril/valsartan to ramipril in 5661 patients with an acute myocardial infarction with either LVEF ≤40% and/or transient pulmonary congestion. 3 groups were investigated: 1) LVEF ≤40% with pulmonary congestion (n=2012) and 2) LVEF ≤40% without pulmonary congestion (n=2596) and 3) LVEF not ≤40% with pulmonary congestion (n=1044).

Results
Patients with pulmonary congestion (with and without LVEF ≤40%) were more likely to have had a prior MI, prior CABG or PCI, had more atrial fibrillation and were more often treated with mineralocorticoid receptor antagonists and diuretics than patients with no pulmonary congestion and LVEF ≤40%. Patients with LVEF ≤40% and pulmonary congestion had more than twice the rate of the primary composite outcome compared to those with LVEF ≤40% without pulmonary congestion: 10.2 (95% CI 9.2–11.3) vs. 4.8 (4.3–5.5) events per 100 patient-years, respectively). Patients with pulmonary congestion and LVEF not ≤40% had an intermediate event rate (6.6, 5.5–7.9, events per 100 patient-years). A similar pattern of event rates was seen for the components of the primary outcome and for all secondary outcomes whether Clinical Events Committee or investigator-reported events were analysed. The treatment effect of sacubitril/ valsartan versus ramipril did not vary between the 3 congestion/ LVEF subgroups. The safety of sacubitril/valsartan compared to ramipril did not vary between congestion/LVEF subgroups.

Conclusion
Patients with pulmonary congestion with or without LVEF ≤40% had higher rates of primary and all secondary outcomes than those without pulmonary congestion and LVEF ≤40%. The treatment effect, and safety, of sacubitril/valsartan compared to ramipril was consistent in patients with or without pulmonary congestion and with or without LVEF ≤40%.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis
Different clinical and pathological profiles of sudden cardiac death victims caused by coronary artery dissection or myocardial infarction with non-obstructed coronary arteries
Authors: Ciliberti G , Finocchiaro G , Guerra F , Papadakis M , Sharma S , Sheppard M 
Published: October 2022

Abstract

Background
Spontaneous coronary artery dissection (SCAD) is a potential cause of acute coronary syndrome and sudden cardiac death (SCD). Coronary fibromuscolar dysplasia (FMD) has been correlated to SCAD occurrence.The prevalence of SCAD and FMD among SCD victims are unclear. Myocardial infarction with non-obstructed coronary arteries (MINOCA) could represent a cause of SCD. Since SCAD could clinically manifest as acute myocardial infarction, expert consensus documents have often considered SCAD as a subtype of MINOCA (1,2), but studies which address direct comparison between these two conditions are lacking.

Purpose
To assess characteristics of decedents with SCAD and/or FMD found at autopsy, and to compare their clinical and pathological profile with MINOCA SCD victims.

Methods
We reviewed a database of 5325 consecutive cases of SCDs referred to our cardiac pathology center between 1994 and July 2017.

Results
We identified 21 (0.4%) with SCAD and 37 (0.7%) victims with MINOCA (3), whereas FMD was found only in 2 (0.04%). SCAD decedents were females in 81%, versus 38% of MINOCA (p=0.02).
No signs of coronary FMD were found among SCAD and MINOCA victims. Necrotic myocardium was identified in the totality of MINOCA and only in 8 (38%) of SCAD decedents (p&lt;0.001). Pre-mortem cardiac symptoms were present in 100% of SCAD and 49% of MINOCA victims (p&lt;0.001); illicit drug use was reported in none of SCAD versus 46% of MINOCA decedents (p=0.001).

Conclusions
SCAD is a rare cause of SCD. Compared to MINOCA, SCAD victims are more frequently females, always experienced pre-mortem cardiac symptoms and have no habit of substances abuse. At autopsy coronary FMD is not present among SCAD victims. SCAD and MINOCA shows different clinical and pathological profile. SCAD should not be considered a subtype of MINOCA.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Cardiac Risk in the Young (CRY) and the Charles Wolfson Charitable Trust.