bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systemic periostin is associated with larger infarct size and worse clinical outcomes in patients with acute coronary syndromes and periodontal disease
Authors: Rodean I , Halatiu V-B , Benedek I , Benedek TH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Periodontal disease (PD) is associated with increased inflammation, which can contribute to atheromatous plaque rupture and consequent acute coronary syndrome (ACS). Periostin (Pn) is a new biomarker associated with inflammation, being involved in the complex process of myocardial recovery after an ACS; however, the association between Pn, other inflammatory biomarkers and concomitant PD in patients with ACS has not been elucidated so far.

Purpose
the aim of this study was to investigate the link between serum levels of Pn, other systemic inflammatory biomarkers and their impact on the clinical evolution following an ACS.

Methods
this was an observational prospective study in which 92 patients with ACS and concomitant PD were enrolled. Patients were divided into two groups, according to the median value of Pn which was 30,63 ng/ ml: group 1 included 46 patients with low Pn level and group 2 included 46 patients with high Pn level. Inflammatory status was investigated using serum levels of C reactive protein (CRP), interleukin 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, matrixmetalloproteases (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), alkaline phosphatase (AF) and sST2. For Ab, CRP, and AF the values were recorded at baseline and on day 7.

Results
Patients with high Pn levels presented more frequent STEMI type myocardial infarction (p=0.0004), heart failure (p=0.002) and a longer duration of hospitalization (p=0.008) and stay in the intensive coronary care unit (p=0.004). They also expressed significantly higher levels of MMP 9 (201 ± 69,37pg/ml vs 132,7 ± 112,2 pg/ml, p = 0.003), Ab (4,08 ±0,34 mg/dl vs 3,08 ± 1,46 mg/dl p=0.02), and AF at baseline at day 7 (53,84 ± 16,2 vs 47,36 ± 16,36 UI/l p=0.022; 58,73 ± 29,91 vs 42,56 ± 16,42 UI/l, p=0.0001). Patients in group 2 had also higher levels of triglycerides (p=0.02) and LDL cholesterol (p=0.0008), as well as a higher amount of myocardial necrosis, as expressed by total creatine kinase (p=0.0004) and CK-MB (p=0.0096). However, serum levels of CRP at baseline (9,2 ± 12,87 mg/ dl vs 26,61 ± 25,59 mg/dl, p=0.0009) and at day 7 (19,25 ± 26,77 mg/dl vs 31,84 ± 29,4 mg/dl, p=0.043) were significantly lower in group 2.

Conclusions
In patients with ACS and PD, increased systemic levels of circulating Pn indicate a larger myocardial infarction and worse clinical outcomes, being also associated with increased levels of matrixmetalloproteases, involved in the myocardial repair.
Therapeutic versus prophylactic anticoagulation in patients with COVID-19: a meta-analysis of randomised controlled trials
Authors: Sakurai R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Several systematic reviews and meta-analyses have been conducted to evaluate the effects of anticoagulation on patients admitted with coronavirus infectious disease 2019 (COVID-19). However, since most of them consist of observational studies, the optimal dose still remains controversial.

Purpose
The purpose of this study was to investigate the efficacy and safety of therapeutic anticoagulation compared with prophylactic anticoagulation in patients admitted with COVID-19.

Methods
A meta-analysis was conducted on randomised controlled trials (RCTs) to minimise bias. PubMed and the Cochrane Central Register of Controlled Trials were queried for the terms "covid-19," "(anticoagulation OR thromboprophylaxis)," and "randomised." The same terms or relevant studies were also queried on the website of the ClinicalTrials.gov and relevant reviews. The clinical endpoints of interest were all-cause death, thromboembolism, and major bleeding. Pooled estimates were calculated using a random-effects model.

Results
A total of 7 RCTs were included in this study. The risk of thromboembolism was lower (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.41-0.73; p &lt; 0.001) and the risk of major bleeding was higher (OR 1.87; 95% CI 1.21-2.90; p = 0.005) in the therapeutic anticoagulation group than in the prophylactic anticoagulation group. On the other hand, the risk of all-cause death was similar (OR 0.92; 95% CI 0.65-1.31; p = 0.65) between the 2 groups. In a subgroup analysis, the risk of thromboembolism was also lower in the therapeutic anticoagulation group compared with the prophylactic anticoagulation group both in moderately and severely ill patients, respectively. However, the risk of major bleeding was more likely to higher (OR 1.85; 95% CI 0.98-3.49; p = 0.06) in the therapeutic anticoagulation group than the prophylactic anticoagulation group only in severely ill patients.

Conclusions
Therapeutic anticoagulation is associated with a lower risk of thromboembolism and a higher risk of major bleeding compared to prophylactic anticoagulation in patients hospitalised with COVID-19. Therapeutic anticoagulation may be more beneficial for moderately ill patients.
Association between inflammatory biomarkers and 30-day mortality in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Bo Kunkel J , Josiassen J , Helgestad O K , Schmidt H , Holmvang L , Okkels Jensen L , Berg Ravn H , Eifer Moeller J , Hassager C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hjertecentrets Forskningsudvalg, Rigshospitalet

Background
Cardiogenic shock often induces an inflammatory response, but the prognostic importance of this is not well studied.

Purpose
The present study investigates whether the inflammatory response as reflected in routine blood samples taken during admission is associated with 30-day mortality in patients with cardiogenic shock due to acute myocardial infarction (AMICS). We assessed patients surviving 2 days, since a full CRP-response may take more than 48 hours to develop.

Methods
Consecutive patients (N=1716) with a validated diagnosis of AMICS admitted to one of two tertiary heart centres covering a base population of approximately 4 million in the period from 2010 to 2017 were included. The median values of total leucocyte count (WBC) and C-reactive protein (CRP) corresponded well to optimum thresholds found using ROC analysis and were used as cut-off for stratification.

Results
A total of 1114 (1122) of the 1716 patients were alive and had WBC (CRP) measured at day 3.
Median WBC was 12.6 x 109/L. Median CRP was 146 mg/L.
Patients with an elevated leucocyte response were significantly older (66 vs 64 yrs, P&lt;.001), had a higher prevalence of diabetes mellitus (18% vs 13%) and were admitted with lower left ventricular ejection fraction (LVEF) (P&lt;.001). Less had suffered out-of-hospital cardiac arrest (44% vs 58%, P&lt;.001) or underwent mechanical ventilation during admission (84% vs 91%, P&lt;.001).
Patients with an elevated CRP had higher Body Mass Indexes (BMI 27 vs 26, P=.03) and were admitted with higher lactates (6.4 vs 5.7 mmol/L, P=.01) and a lower EF (P=.05), while more underwent mechanical ventilation during admission (92% vs 82%, P&lt;.001).
Elevated WBC among patients alive at day 3 was associated with a significantly higher 30-day mortality rate of 43% vs 30%, Plogrank&lt;.001. Patients with an elevated CRP had a mortality rate of 42% vs 29%, Plogrank&lt;.001. (fig. 1,2)
In a multivariable model for each biomarker, adjusting for factors associated with mortality in AMICS, including age, sex, diabetes, stroke, out-of-hospital cardiac arrest, arterial lactate, LVEF and mechanical ventilation, an elevated inflammatory response remained significantly associated with mortality. (HR(WBC↑) = 1.63 [1.29;2.06], P&lt;.001. HR(CRP↑) = 1.51 [1.21;1.90], P&lt;.001).

Conclusions
Leucocyte and CRP response at day 3 of admission are associated with increased mortality in AMICS.
Safety and effectiveness of angiotensin receptor-neprilysin inhibitors in patients with heart failure with preserved ejection fraction (ARNI-PRESERVED study)
Authors: Jariwala PVJ , Jadhav KARTIK , Khetan SS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The goal of this study is to look at the safety and efficacy of ARNI (valsartan/sacubitril), a combination of angiotensin II receptor blocker and neprilysin inhibitor (ARNI), in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose
ARNI decreases the hazard of cardiovascular death and hospitalization in patients with chronic HFrEF (NYHA Class II–IV). Although there are several evidence based therapies for HFrEF, there is no effective therapy for HFpEF at the presently. In Paragon-HF trial, ARNI demonstrated a minimal evidence of additional improvements in patients with HFpEF

Material and methods
A retrospective research with a clinical population was carried out. A total of 154 HFpEF patients (87 females and 67 males) were treated with ARNI, which was subsequently titrated up to a maximum tolerable dose and monitored in an outpatient clinic. 56 patients were given ARNI while in the hospital for decompensated heart failure before being discharged.

Results
Patients were categorized as New York Heart Association (NYHA) class III (71.4%) and NYHA class II (28.6%). Diabetes mellitus was identified in 52% of patients, while hypertension was found in 78%. Symptomatic clinical improvement was observed, with a substantial decrease in NYHA class down to NYHA class II (p=0.018). A considerable decrease in NYHA class resulted in symptomatic clinical improvement as well as the rales and peripheral oedema had resolved (p&lt;0.001). The NT-pro-BNP levels were considerably lowered (p&lt;0.001). The echocardiographic parameters for diastolic function (E/A, E/E’ ratios) improved. In individuals with HFpEF, ARNI resulted in significant clinical benefits (Table -1).

Conclusion
In individuals with HFpEF, sacubitril/valsartan, ARNI resulted in significant clinical benefits A randomized research is also required to see if it results in beneficial outcomes for a wider sample.
Indications, outcomes and complications after ECMO implantation in the cath lab - a single-center retrospective study
Authors: Kralicek S , Meier CS , Distelmaier K , Niessner A , Heinz G , Lang IM , Hengstenberg C , Krychtiuk KA , Speidl WS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Despite the increase of extracorporeal membrane oxygenation (ECMO) employment around the globe over the last decades, studies describing the emergency use of venoarterial (VA)-ECMO in the cardiac catheterization laboratory (CCL) are scarce.

Purpose
The aim of this study was to describe the patient population that received ECMO in the CCL of a tertiary care center and the associated complications and outcomes.

Methods
In this single-center retrospective study we reviewed the baseline clinical and laboratory characteristics, indications and outcomes of adult patients, who received VA-ECMO between 2011 and 2019.

Results
In the given time period, ECMO use in the CCL increased drastically. Mean age of the 83 patients was 58.3 ± 12.5 years, 78.3% were male. From 2011 to 2018 ECMO-use in the CCL increased drastically. The most common indication for ECMO implantation was cardiac arrest (66%), followed by cardiogenic shock (12%), high-risk PCI (11%), and procedure-related complications (10%). While 30-day mortality in the total study population was 69%, it varied greatly depending on the underlying indication for ECMO therapy (cardiac arrest 78%, cardiogenic shock 20%, high-risk PCI 44%, procedure-related complications 88%). The most commonly occurring complications were acute kidney injury (20%) and cannula site bleeding (20%), followed by extremity complications (19%), sepsis (18%), major bleeding (10%) and stroke (8%). Of interest, patients receiving ECMO therapy after in-hospital cardiac arrest showed greater survival rates (28.2%) as compared to patients after out of hospital cardiac arrest (18.2%; p=0.045). High serum lactate levels (p=0.018) and low baseline pH values (p=0.001) at baseline were associated with a significantly increased 30-day mortality after ECMO implantation.

Conclusion
The emergency use of VA-ECMO in the CCL increased over the last years and was associated with a high 30-day mortality in our study population. Still, a &gt;20% survival rate in the group of patients with refractory cardiac arrest, an otherwise futile situation, suggests that VA-ECMO implantation is reasonable in selected patients. As high admission serum lactate levels and the baseline pH are strong predictors of outcome, such parameters may be used to guide decision making.
Experience with zotarolimus eluting stent in left main percutaneous coronary intervention at a very long-term follow-up
Authors: Sanchez Perez I , Concepcion Suarez R , Gonzalvez Garcia A , Freites Esteves A , Martinez Del Rio J , Moron Alguacil A , Munoz Garcia M , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Rayo Gutierrez M , Lozano Ruiz Poveda F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Drug eluting stents (DES) has improved the results of percutaneous coronary intervention (PCI) in terms of safety and effectiveness in left main coronary artery (LMCA) disease. Zotarolimus is a second-generation drug with excellent clinical outcomes but nowadays their results are unclear in this subgroup of high-risk coronary lesions.

Purpose
The main objective of this study was to evaluate the efficacy and safety of zotarolimus eluting stent (ZES) in LMCA disease at 14-year follow-up.

Methods
We prospectively included 432 consecutive patients (69 ± 12 years, 75.5% male) with LMCA disease treated with PCI and ZES between June 2006 and June 2020. We evaluated the presence of major adverse cardiovascular events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis, after 14-year clinical follow-up (median 61 months).

Results
52.8% of patients had stable coronary disease and 47.2% acute coronary syndrome (38.2% Non-STEMI and 9% STEMI). 40.7% were diabetic patients and 40.8% presented moderate-severe left ventricular systolic dysfunction. 5.8% were protected LMCA and 81.7% bifurcated lesions. An intra-aortic balloon pump was needed in 4.9% of the cases. Mean logistic EuroSCORE was 6.7% and Syntax score was ≥ 23 in 73.1% of patients. The most frequently bifurcation technique employed in LMCA was "provisional stenting" in 67.1% of cases with an angiographic success of 99.3%. Complication rate in the procedure was 4.6% with one intraoperative death. During follow-up, MACE rate at 14 years was 17.4% (12.5% cardiac death, 3.5% nonfatal myocardial infarction, 4.2% TLR and thrombosis rate 0.5%). We observed significant differences in the occurrence of MACE in diabetic patients (p=0.002), chronic kidney insufficiency (p&lt;0.001), severe left ventricular systolic dysfunction (p&lt;0.001) and patients in which we didn´t perform final kissing balloon (p=0.03). 21.07% of patients had an angiographic follow-up.

Conclusions
PCI treatment with ZES in LMCA disease is safe and effective with a low rate of immediate complications and a low rate of mayor cardiac events at very long-term follow-up. Patients with diabetes mellitus or chronic kidney insifficiency, severe left ventrcular systolic dysfinction or those in wich didn´t performe a final kissing balloon have worse prognosis.
Application of artificial intelligence to optimize the diagnosis and treatment of acute coronary syndrome: a real experience
Authors: Mota D , Kuster GW , Orletti D , Souza BF , Silva MA , Paiva LAPA , Burgard C , Candoti MW , Silva JHL 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
cardiovascular disease (CVD) is the leading cause of death in the world, with acute myocardial infarction (AMI) being the main responsible for this leadership. One of the determining factors in the outcome of Acute Coronary Syndrome (ACS) is the time to start treatment. An extremely promising path for obtaining earlier diagnosis and treatment has been the use of technological innovations in emergency care units.

Prupose
this study was carried out to assess the impact of applying a technology hub in the chest pain scenario in the emergency room, regarding the feasibility and potential reduction of time for diagnosis and treatment of ACS.

Methods
data obtained from 10 hospitals in the public health system in Brazil, which implemented the technology hub in the last 7 months (May to October 2021), were analyzed. This technology hub uses Artificial Intelligence (AI) to identify electrocardiograms (ECGs) with a high probability of alterations, which must be reported within 5 minutes by the cardiologist on shift (24/7) on the platform.

Results
5,506 ECGs were entered into the platform, of which 53.77% (2,961) were considered abnormal; of these, 9.92% (294) had alterations compatible with ischemic events (currents of injury or myocardial ischemia). The median time for the ECG report made by the specialist was 2 minutes and 51 seconds.

Conclusion
the implementation of a technology hub in the chest pain scenario in the emergency room proved to be feasible and has great potential for reducing the distance between symptoms and the treatment of patients with ACS.
Unstable angina in the context of high sensitive troponins: still a marker of high risk? A comparison of outcomes with adjudicated type 1 myocardial infarction
Authors: Dakshi A , Ihsan J , Khand A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Unstable angina (UA), considered historically a marker of high risk, has rarely been studied in the high sensitive troponin era. We sought to characterise this population and determine short and medium term outcomes for UA who did not have elevated high sensitive troponins and compared this to adjudicated type 1 MI and the global population of suspected ACS.

Method
We conducted a post-hoc analysis of 2 prospective cohort studies of suspected acute coronary syndrome in 2 hospitals in the northwest of England. (n=3018) We used a symptom scoring system to diagnose unstable angina. Type 1 MI was diagnosed by blinded, independent physician adjudication according to 3rd universal criteria for MI. Follow-up was 100% complete for all patients to 1 year.

Results
185 and 259 were adjudicated as suffering from UA and NSTEMI respectively. We restricted our analysis to 158 patients with UA with high sensitive troponin T (Roche elecsys) ≤14ng/l (≤99th percentile). Compared to NSTEMI population UA cohort were younger (59 vs 74, p&lt;0.002), had a lower incidence of hypertension (56% vs 69%, p= 0.009), had lower risk scores (TIMI 2 vs 3, p=0.001, GRACE 97.5 vs 140, p&lt;0.0001, HEART 4 vs 7, p&lt;0.0001) and had lesser ECG abnormalities ( ST depression &gt;1mm, 5% vs 15.6%, p=0.001, T wave flattened, biphasic or inverted 24% vs 47.8%, p&lt;0.0001).
Type 1 MI to 30 days and 1 year in the UA cohort was 1.9% and 3.1% respectively compared to a repeat type 1 MI in the NSTEMI cohort of 0.8% and 2.4% respectively. Only 1 (0.8%) all cause death was recorded within one year in the unstable angina cohort as opposed to 36 (14.4%) in the NSTEMI group. Revascularisation rates were unsurprisingly lower in the UA cohort to 30 days compared to NSTEMI cohort (table 1)

Conclusion
Unstable angina, in the high sensitive troponin era is associated with a small early and medium term risk of myocardial infarction. Risk of medium-term MACE is much lower compared to patients with confirmed type 1 myocardial infarction.
Optimal solution for coronary bifurcation lesions, a comparison between bioresorbable scaffolds and dedicated bifurcation stents
Authors: Alsinbili A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary bifurcation lesions (CBL) constitute 15-20% of all coronary lesions and they constitute a challenge both technically and prognostically.(1) Bioresorbable scaffolds (BRS) represent a novel invention in the realm of coronary stenting.(2) They have a degradable structure that survives for 12-24 months,(3) allowing enough time for re-endothelialisation while they gradually disappear leaving the artery geometrically intact. The use of BRS is potentially beneficial in the treatment of CBLs because of these lesions’ complex geometry.(4)

Purpose
The aim of this study was to assess the effectiveness and safety of BRS in CBL when compared to dedicated bifurcation stents (DBS) by comparing the 12-months clinical outcomes including rates of cardiac death (CD), myocardial infarction (MI), target lesion revascularisation (TLR), and stent thrombosis (ST).

Methods
This study was conducted using PRISMA guidelines (figure 1). (5) a systematic literature review was made by searching ScienceDirect, EMBASE, MEDLINE, NIH, TRIP database, PUBMED, and ClinicalTrials.gov. Eligibility criteria included studies published since 2013 in English language. They must be designed to study bifurcation lesions and reporting clinical outcomes rather than procedural results. Studies must have either studied BRS or DBS. Risk of bias was assessed through a combined score consisting of MINORS and modified Cowley’s criteria. (6) Qualitative synthesis of results is performed through Microsoft Excel 365. Tests of heterogeneity were conducted using Q statistic, and between-study heterogeneity was assessed with the I2 statistic; also, publication bias was investigated graphically using funnel plots.(7) Meta-analysis was performed using the "meta" package in R software application.

Results
14 studies were included with 1742 participants: eight studies of BRS (n=1038) and six studies for DBS (n=704), with an average follow-up period of 12 months. The mean age of participants was 60 years for the BRS arm and 65.6 years for DBS arm (p-value &lt; 0.001). Almost 80% of participants are male (p-value= 0.148) and around two-thirds who are smokers or suffer from hypercholesterolemia (p-value: 0.202, 0.094 respectively) (Figure-2). There were six cardiac deaths in the BRS group compared to seven CDs in the DBS group (p-value = 0.56) . Meta-analysis was performed for MI, TLR, major adverse cardiac events (MACE), and ST; showing statistically nonsignificant difference for the aforementioned outcomes with a slight trend favouring BRS except in stent thrombosis.

Conclusion
There was no statistical difference between BRS and DBS in the treatment of CBL in terms of MI, ST, TLR or MACE. There was, however, a trend for a more favourable outcome on all measures for BRS other than stent thrombosis. this study showed a lack of randomised controlled trials in this subject which may be an area for researchers to investigate further in the future.