bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated troponin in patients presenting with atrial fibrillation-could CHA2DS2-Vasc help?
Authors: Stratinaki M , Stavrakis S , Pitarokolis M , Rogdakis E , Baclitzanaki E , Korela D , Papaoikonomou E , Detoraki M , Stavratis S , Kafarakis P , Garidas G , Lamprogiannakis E , Foukarakis E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial fibrillation (AF) is one of the most common reasons that patients visit the emergency department (ED). During the initial investigation, many of these patients are found to have increased troponin levels and it is not clear if this could be an indicator of underlying coronary artery disease (CAD). CHA2DS2-Vasc score is widely used to estimate the thrombotic risk in patients suffering from AF.

Purpose
To examine any possible relation between the elevated high sensitivity troponin I (hsTnI) observed in patients with AF that visited the ED of our hospital during one year and their CHA2DS2-Vasc score with the presence of underlying CAD.

Methods
We recorded the patients presenting in the ED with AF for a period of 12 months and found to have elevated troponin during their initial investigation. We calculated the CHA2DS2-Vasc score and then divided the patients in two groups : Group 1 (CHA2DS2-Vasc score &gt;4) and Group 2 (CHA2DS2-Vasc score &lt;4). We recorded the maximum level of hsTnI.All patients underwent noninvasive investigation for coronary artery disease (SPECT or stress ECHO) and when it was indicated coronary angiogram was performed.

Results
We recorded 428 patients, 256 male and 172 female wit mean age 64 ±10.72 years. Group 1 included 194 patients and group 2 234. We recorded a statisticaly significant difference in the maximum levels of hsTnI between the two groups (Group 1 8742±964.8 pg/ml vs Group2 1324±85.7 pg/ml, p&lt;0.01). In Group 1 the non invasive investigation was suggestive for coronary artery disease in 168 patients (86.8%), whereas in Group 2 in 113 (48.2%)(p&lt;0.05). The patients with positive SPECT or stress ECHO underwent coronary angiography or coronary CT scan. Non significant disease had (Group 1 vs Group 2 ) 17/194(10.11%) vs 75/234(66.37%)(p&lt;0.01), one vessel disease 66/194(39.28%) vs 19/234(16.81%)(p&lt;0.05), two vessels disease 54/194(32.14%) vs 14/234(12.38%) (p&lt;0.05) and three vessels disease 31/194(18.45%) vs 5/234(4.42%)(p&gt;0.05).

Conclusions
Higher CHA2DS2-Vasc score was related with higher levels of hsTnI in patients with AF. Moreover, patients with higher CHA2DS2-Vasc score were found to have more often underlying coronary artery disease and its severity was found to be related with the higher CHA2DS2-Vasc score. More studies are needed to investigate whether it would be useful to use CHA2DS2-Vasc score when evaluating the increased levels of hsTnI in patients with AF and if it could be included in an algorithm.
What is the clinical benefit of coronary chronic total occlusions treatment by percutaneous coronary intervention?
Authors: Costa H , Mota T , Santo ME , Fernandes R , Bispo J , Carvalho D , Palmeiro H , Guedes J , Mimoso J , Vinhas H , Jesus I 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary chronic total occlusions (CTO) are relatively common findings in the context of coronary angiography. The indication for revascularization of this type of lesions remains controversial. The recommendations of international cardiology societies consider the treatment of CTO by percutaneous coronary intervention (PCI) in selected patients, but this technique is not yet widely used in this context.

Objectives
Characterize the patient population undergoing CTO PCI and analyze its clinical benefit. Also, try to identify patient profiles according to the composite outcome (angor, heart failure symptoms (HF), myocardial infarction (MI) or death) in short and medium term (30 days (D) and 180D).

Methods
Observational and retrospective study with descriptive and comparative analysis of patients submitted to CTO PCI, between 1 January 2019 and 31 December 2020. A descriptive analysis was carried out. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%. CHIAD algorithm was applied to identify patient profiles, whose dependent variable was the presence or absence of the composite outcome (fixed 15 parent nodes- 5 children nodes). For statistical analysis, SPSS 24.0 was used.

Results
N177 patients were identified, with a mean age of 65.4 years (standard deviation of 11.1), 51% were female. The most frequent location of CTO was the right coronary in 41.2%. The composite outcome occurred in 23% (30D) and 16% (180D) of patients, regardless of past medical history. Angor was present in 9.4% (30D) and 5.3% (180D); HF symptoms in 12.3% (30D) and 5.3% (180D); MI in 2% (180D) mortality in 1.8% (30D) and 4.7% (180D). The complication rate was 5.1%, mostly cardio-respiratory arrest (2.5%) and vessel dissection (1.7%). In a logic of dependence and profiles, patients with LVEF&gt;36% (80.1%-p=0.017), without HF symptoms (82.9%-p=0.007) and non-smokers/ ex-smokers (87.6%-p=0.043), were those with the greatest benefit at 30D. Patients with a history of NSTEMI (24.5%-p=0.018) and CKD (37.5%-p=0.048) were those with most occurrences presented at 180D.

Conclusion
This analysis highlights the experience of the angiography laboratory. In this pool, the majority of patients experienced evident clinical improvement and recovered in short and medium term. The rate of serious events during and after the procedure was low. This analysis suggests that the greatest benefit were found in patients with LVEF&gt;36%, who didn´t develop post-procedure HF symptoms and in non-smokers/ex-smokers.
Analysis and results of early revascularization in non-ST segment elevation acute coronary syndrome
Authors: Gomez Gonzalez A , Lopez Flores L , Padilla Rodriguez G , Garcia Gonzalez N , Garcia Rubira J C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Virgen Macarena

Introduction
The time to diagnostic coronary angiography in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) is considered one of the main prognostic factors in patients at higher risk.

Purpose
Our aim is to know whether early coronary angiography modifies the prognosis of high-risk patients with NSTEACS and to compare it with performing this procedure later.

Methods
We include patients admitted to the coronary unit of a 3rd level hospital from January-2015 to December-2021 due to NSTEACS. We plan to examine whether the clinical characteristics of patients in whom early coronary angiography (ECA) is performed, the one performed in the first 24 hours from the onset of symptoms, differ from those in whom it is performed later. Likewise, we analyze the clinical results obtained according to the strategy.

Results
811 patients were included (73.4% men and 26.6% women), with an average age of 65, in which 229 (28.2%) of them underwent early coronary angiography. Initially, we found more smokers (44.5% vs 32.8, p = 0.006), a higher frequency of risk electrocardiographic changes (ST decrease&gt; 2 mm in 2 contiguous leads, transient ST segment elevation, left main stem pattern) (p = 0.000), greater need for inotropic drugs (14.5% vs 9.6%, p = 0.045), worse Killip-Kimball (KK) during hospital stay (p = 0.002), as well as higher frequency of cardiogenic shock (p = 0.005) among the patients in whom ECA was performed. Although in-hospital mortality was higher in patients who underwent ECA, no statistically significant difference was found. No differences were obtained in the other cardiovascular risk factors, previous history of acute myocardial infarction, heart failure, stroke, coronary revascularization, initial KK presentation, or post-catheterization LVEF.

Conclusions
In our study, we observed that in patients admitted for NSTEACS, we performed ECA more frequently in patients with a worse prognosis (pathological alterations in the initial ECG, greater frequency of support with inotropics and worse KK during hospital admission), without observing significant differences in in-hospital mortality or in post-catheterization LVEF. The results suggest that ECA improves the prognosis in the group with the worst clinical profile.
Long-term survival in patients treated with mechanical circulatory support for refractory out-of-hospital cardiac arrest
Authors: Moerk S , Christensen S , Boetker MT , Tang M , Terkelsen CT 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mechanical circulatory support (MCS) is used increasingly in the setting of refractory out-of-hospital cardiac arrest (OHCA). However, limited data exist on long-term survival.

Purpose
To investigate the long-term outcome in patients receiving MCS compared to patients with return of spontaneous circulation (ROSC) at hospital admission.

Methods
Retrospective, observational single centre study from 2015-2019. The study included all patients who achieved ROSC on admission and patients receiving MCS for refractory OHCA defined as either veno-arterial extracorporeal membrane oxygenation or Impella support. Kaplan-Meier survival analysis were performed to evaluate long-term survival in both groups and compared with the log-rank test.

Results
A total of 698 patients with ROSC on admission and 101 patients receiving MCS were included. Acute myocardial infarction was the most common aetiology of arrest in both groups. There were no differences in witnessed arrest, bystander cardiopulmonary resuscitation or initial presenting rhythm. Low-flow time was substantially longer in the MCS group compared to the ROSC group (median 105 (IQR, 94-123) minutes versus median 15 (IQR, 8-22) minutes, p &lt; 0.001). The 5-day mortality rate was 63% in the MCS group versus 24% in the ROSC group. Long-term survival from day 6 to day 90 was 71% in the MCS group and 83% in the ROSC group, p = 0.072.

Conclusions
In conclusion, the risk of death within the first 5 days was higher for OHCA patients treated with MCS than in patients with ROSC on admission. Among patients surviving the first 5 days, 90-day mortality was low in both groups.
Bleeding outcomes with ticagrelor versus clopidogrel in patients with acute coronary syndrome. A focused analysis from the multicenter CREA-ARIAM Andalucia registry
Authors: Padilla Rodriguez G , Hernandez-Meneses BG , Gomez-Gonzalez A , Carmona-Carmona J , Garcia-Gonzalez N , Arboleda Sanchez JA , Rodriguez Yanez JC , Soto Blanco JM , Fernandez Garcia I , Castillo Caballero JA , Hidalgo-Urbano RJ , Garcia-Rubira J C , Almendro-Delia M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): The study project was financially supported by a no conditional grant (AstraZeneca)

Background/Introduction
With the advent of more potent antithrombotic agents, bleeding has emerged as an important safety concern in patients with acute coronary syndrome (ACS). Moreover, hemorrhagic complications have been strongly linked with subsequent mortality in this clinical scenario.

Purpose
We sought to determine the incidence, types, timing and prognostic relevance of major bleeding events in ACS patients treated with ticagrelor or clopidogrel in contemporary practice.

Methods
Prospective, observational, multicentre all-comers registry of ACS patients who were intended to receive a 12-month DAPT course with ticagrelor or clopidogrel. Major bleeding was defined as a type 3 or 5 bleed using the Bleeding Academic Research Consortium (BARC) definition. Bleeding was further classified according to the anatomic location. All bleeding episodes were analysed accounting for death as a competing event, using competing risk regression models based on the on-treatment principle (i.e., according to the P2Y12 inhibitor actually received from date of index admission until either time of DAPT cessation plus 14 days or censoring, whichever occurred first).

Results
Among 2070 patients surviving to hospital discharge (mean age 63 years, 27% women, 62.5% STEMI), 106 (5.3%, 0.6%/year) experienced major bleeding event at a median time of 92 days (interquartile range, 6–187 days) after discharge. Most events (n=59, 55.7%) were BARC type 3a bleeds with 2 fatal bleeds (type 5b). In most cases (53%), the site of bleeding was gastrointestinal, followed by intracranial (n=13, 12%). After adjustments for baseline predictors, ticagrelor was associated with increased but not statistically significant risk of major bleeding compared with clopidogrel (5.6% vs 5.2%, adjusted hazard ratio [aHR] 1.40, 95% CI 0.96 – 2.05; P = .075). Major bleeding was significantly associated with nearly 2-fold higher risk of mortality (aHR 1.94; 95% CI 1.32– 2.86; P = .001), irrespective of P2Y12 inhibitor treatment (P interaction = .159).

Conclusion(s)
Bleeding was not rare within 1 year after index ACS, with incidence rates peaked at 30 to 60 days post-index admission. The most common bleeding site was gastrointestinal followed by intracranial haemorrhage. Ticagrelor use was not associated with significantly increased risk of major bleeding compared with clopidogrel whereas bleeding led to a nearly 2-fold higher risk of major bleeding.
Cardiac emergencies following earthquake
Authors: Babic Z , Pavlov M , Sikic J , Galic E , Letilovic T , Balenovic D , Horvat DH , Radic P , Percin L , Sipus D , Milicic D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In 2020 Croatia was stuck with two major earthquakes: on March 22nd with epicentre 7 km north of Zagreb city centre (5.5 magnitude on the Richter scale) and on 29th Decembre with epicentre 5 km south of city of Petrinja (6.2 magnitude on the Richter scale). The authors sought to investigate whether these events had an influence on the number of patients and their charactristics examined in the Emergency Departments (ED) of the five hospitals nearest to the epicentre.

Purpose
To examine the number and characteristics of patients with cardiac chief complaint examined in the EDs of the five hospitals nearest to the epicentre.

Methods
Data on all emergency visits of patients with cardiac chief complaint examined in two University Hospital Centres and two regional hospitals examined 7 days prior to earthquake, on the day of each earthquake, and during subsequent 7 days were collected. We compared the group of patients seen prior and on the day of the earthquake with the group of patients seen after the earthquake.

Results
In the examined period, there were 5575 ED visits, out of which in 1251 (22.4%) cases the chief complaint was cardiac. Daily frequencies of the visits are shown in the Figure. The population was predominantly male (55.2%) with median age of 67 (53-78) years. Patients seen after the earthquake were younger (68 (59-79) vs 72.5 (65-80); p&lt;0.001), less frequently had medical history of hypertension (63.4% vs 78.9%; p&lt;0.001) and cardiovascular disease (32.9% vs 42.8%; p&lt;0.001), and were admitted less frequently (34.6% vs 41.7%; p=0.01). In post-earthquake group, the primary diagnosis was less frequently unstable angina (1.9% vs 5.3%; p=0.001), acute coronary syndrome (15.6% vs 21.9%; p=0.005), heart failure (9.3% vs 19.4%; p&lt;0.001), dysregulated hypertension (13.9% vs 19.4%; p=0.01), but more often non-anginal chest discomfort (28.8% vs 18.0%; p&lt;0.001). Among admitted patients similar trends were observed – patients seen after the earthquake were younger (68 (59-79) vs 73 (65-80); p=0.009), less frequently had medical history of hypertension (73.7% vs 86.8%; p=0.001), the primary diagnosis was less frequently unstable angina (4.9% vs 10.0%; p=0.039), and heart failure (14.8% vs 25.1%; p=0.005). Other patients’ characteristics, including length of stay and intra-hospital mortality did not differ significantly.

Conclusion
Contrary to previous studies, in this study, no increment in the frequency of cardiac emergencies was detected after the earthquake, however non-anginal chest discomfort was observed more often. A possible explanation is a moderate magnitude of these earthquakes with low number of casualties and predominantly material assets damage.
The novel subcutaneously administered glycoprotein IIb/IIIa antagonist RUC-4 (Zalunfiban) did not cause thrombocytopenia in the phase 2a study of patients with ST-elevation myocardial infarction
Authors: Rikken AOF , Bor WL , Zheng KL , Gibson CM , Granger CB , Bentur O , Lobatto R , Postma S , Coller BS , Van ’T Hof AWJ , Ten Berg JM 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Celecor Therapeutics

Background/Introduction
Thrombocytopenia is a rare but severe complication (0.5%-2.0%) of all currently available glycoprotein IIb/IIIa inhibitors (GPI). As thrombocytopenia is inherently linked to bleeding, careful consideration is mandated in ST-elevation myocardial infarction (STEMI) patients as they require multiple antithrombotic medications. Moreover, thrombocytopenia is associated with poor clinical outcomes in comparison to patients without thrombocytopenia. Thus, there is a need for safer GPIs that are not associated with drug-induced thrombocytopenia. Zalunfiban is a novel, second-generation GPI primarily designed for the pre-hospital phase to initiate target vessel reperfusion. In addition, Zalunfiban has a unique mechanism of action that locks the receptor into an inactive conformation, potentially decreasing the likelihood of developing thrombocytopenia. In healthy individuals and in patients with stable coronary artery disease treated with Zalunfiban, no thrombocytopenia was seen.

Purpose
To assess the occurrence of thrombocytopenia of Zalunfiban in STEMI patients.

Methods
This was a prospective, single centre, open-label, phase 2a study designed to assess the pharmacodynamics, pharmacokinetics, and tolerability of Zalunfiban in patients with STEMI undergoing primary percutaneous coronary intervention. The primary endpoint in this sub-analysis was the occurrence of thrombocytopenia, defined as a platelet count less than 150 × 10^9/L, as measured at 4 time points up to 72 hours after drug administration. Secondary analyses were laboratory assessments including haemoglobin, creatinine and liver function tests.

Results
A total of 27 patients received a weight-adjusted subcutaneous injection of Zalunfiban in escalating doses (0.075 mg/kg [n=8], 0.090 mg/kg [n=9], or 0.110 mg/kg [n=10]). No thrombocytopenia (0.0%) was observed within the first 72 hours post dose. Also, haemoglobin, creatinine and liver function tests were stable during hospitalisation.

Conclusion
In this sub-analysis Zalunfiban did not cause thrombocytopenia in the 27 patients enrolled in the study, which is in accord with the lack of thrombocytopenia in the 44 patients receiving Zalunfiban in the Phase 1 studies in healthy volunteers and stable angina patients. The ongoing CELEBRATE study, in which Zalunfiban is administered in the ambulance, is scheduled to enrol 1667 STEMI patients and thus will provide important additional information on Zalunfiban safety and efficacy.
Impact of recurrent acute heart failure hospitalizations on prognosis of heart failure patients
Authors: Cardoso A , Tinoco M , Dias G , Faria B , Pereira T , Fernandes M , Almeida F , Lourenco A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Hospitalizations for acute heart failure (AHF) are significant events for heart failure (HF) patients (pts) with each hospitalization portending a poor prognosis. Our aim was to compare pts with recurrent AHF admissions to those without and to study the impact of recurrent admissions on overall mortality.

Methods
Single centre retrospective study that included all pts followed at the HF Clinic of the Cardiology Department that had at least one visit during 2018. All data since their initial follow-up on HF Clinic was considered. Recurrent admissions were defined as 2 or more admissions for AHF in the same year, during the follow-up.

Results
A total of 138 pts were included (83% male, mean age 61±11years). Dilated cardiomyopathy (65;47%) and ischemic cardiomyopathy (62;45%) were the most frequent aetiologies and most pts had HF with reduced ejection fraction (131;95%). Mean left ventricular ejection fraction (LVEF) was 26±9% and right ventricular dysfunction was present in 27% of the cases. The majority of patients was on NYHA class II (80, 58%).
A total of 84 (61%) pts was medicated with inhibitors of the renin-angiotensin system (iRAS), 45 (33%) with angiotensin receptor-neprilysin inhibitor (ARNI), 127 (92%) with beta-blockers (BB) and 116 (84%) with mineralocorticoid receptor antagonists (MRA).
Ninety-seven (70%) pts had a cardiac electronic device implanted (47 CRT, 50 ICD).
During a median follow-up of 40 months (IQR 32-58), 41 (30%) pts had hospitalizations for AHF and 21 (15%) had recurrent admissions. The median time to the first hospitalization was 16 months (IQR 6-29).
Pts with recurrent admissions had a similar comorbidity profile and HF aetiology in comparison to pts with one or none admissions. Considering baseline echocardiographic parameters on first visit, they had a higher mean E/E’ ratio (22±8 vs 14±6, p= .012) and pulmonary systolic artery pressures (52±20 vs 38±14 mmHg, p= .026). No differences were found in LVEF, left ventricular volumes, presence of right ventricular dysfunction or mitral regurgitation. They were less frequently medicated with iRAS or ARNI (81% vs 96%, p=.012) and BB (81% vs 94%, p= .043) and had a higher mean diuretic dosage (87±47 vs 63±43 mg).
During the follow-up a total of 31 (22%) pts died, 14 (10%) for cardiovascular reasons. Pts with recurrent AHF admissions were more likely to die from any cause (log rank =.01).
On a multivariate analysis, recurrent AHF hospitalizations were an independent predictor of all-cause death (HR 2.4, IC95% 1.1-5.2, p=.03).

Conclusion
Recurrent AHF hospitalizations are associated with a worse long-term outcome of HF pts. Efforts should be made for an earlier identification of these pts. A higher baseline pulmonary systolic artery pressure and mean E/E’ ratio may identify a higher risk group who benefits from a closer follow-up.