tbuckley/cabot-search huggingface dataset:
Abstract 15391: Five-Year Outcomes in Patients With Acute Coronary Syndrome and Myocardial Revascularization Treated With Prasugrel or Ticagrelor
Authors: Nils Kruger, Johannes Krefting, Partho Sen, Raphael Schmieder, Fabian Starnecker, Alexander Dutsch, Christian Graesser, Anastasiia Grekova, Ulrike Meyer-Lindemann, Theresa Storz, Ulrich Gueldener, Adnan Kastrati, Salvatore Cassese, Heribert Schunkert, Moritz von Scheidt
Journal: Circulation (2023)

Background: In patients with acute coronary syndrome (ACS) treated with coronary intervention, potent P2Y12 inhibitors are recommended for 1 year in addition to aspirin. The ISAR-REACT 5 (IR5) trial demonstrated superior efficacy of prasugrel over ticagrelor in reducing the composite of death, myocardial infarction (MI), and stroke at 1 year with comparable bleeding risk. However, long-term data on the relative efficacy of these drugs in real-world settings are lacking. Methods: We performed a comprehensive, retrospective cohort study based on German health insurance data. Patients with ACS who underwent percutaneous coronary intervention or coronary artery bypass graft surgery and received either prasugrel or ticagrelor were observed for 5 years. For 36,813 eligible patients, 1:1 propensity score matching was performed based on age, sex, risk factors and type of ACS. Primary endpoint was a composite of death, MI, or stroke. Safety outcome was bleeding. Results: After matching, 26,494 patients were included in the study. Mean age was 61.8 years, and 25,3% were female. The risk for the primary endpoint was lower in the prasugrel group compared with ticagrelor at 1 year (hazard ratio (HR): 0.79; 95% confidence interval (CI): 0,73-0.87), and 5 years (HR: 0.84; 95% CI: 0.79-0.89). Prasugrel was statistically superior in reducing individual components of the primary endpoint at 1 and 5 years, respectively. The risk of bleeding was lower in the prasugrel group, though not statistically significant. Conclusions: In patients with ACS, prasugrel was associated with a lower risk of the composite of death, MI or stroke, compared with ticagrelor over a 5-year period. While recognizing the limitations associated with secondary data, the strength of these findings lies in the extensive follow-up period involving a large ACS cohort in a real-world setting. The consistency of these results with the IR5 trial reinforces prasugrel's superiority over ticagrelor.
Abstract 14894: The Impact of Coronary Artery Disease on Cardiovascular Events Differs Between Men and Women in the PARTNER Trials
Authors: Melissa A Daubert, Ke Xu, Kayla Brown, Rebecca T Hahn, Philippe Pibarot, Jonathon Leipsic, Marie-Annick A Clavel, Sammy Elmariah, Neil J Weissman, Federico M Asch, Omar Khalique, Martin B Leon, Paul C Cremer, Brian R Lindman, Maria Alu, Pamela S Douglas
Journal: Circulation (2023)

Introduction: Among individuals with severe aortic stenosis (AS), there is significant heterogeneity in the burden of coronary artery disease (CAD). Hypothesis: We hypothesize that a greater CAD burden will be associated with increased adverse events after AS treatment. Methods: Patients with severe AS in the PARTNER (Placement of Aortic Transcatheter Valves) 1, 2 and 3 trials and registries were categorized by CAD burden. Clinical characteristics, imaging, treatment, and outcomes were compared between those with obstructive CAD [defined invasively as coronary stenosis ≥50%, prior myocardial infarction (MI) or revascularization] and patients with no or non-obstructive CAD (all stenoses &lt;50% and no prior MI or revascularization). The primary endpoint was cardiovascular (CV) death or heart failure (HF) hospitalization at 2 years. Results: Among 8058 patients with severe AS, 2200 (27.3%) had non-obstructive or no CAD and were more likely to be female (61.2%) with fewer CAD risk factors. Left ventricular (LV) mass index and LV dimensions were smaller and LV ejection fraction was higher among those with non-obstructive or no CAD. TAVR was performed in 72.0% of non-obstructive or no CAD patients and in 81.3% of patients with obstructive CAD (p&lt;0.0001); the remaining patients received SAVR. After adjustment for clinical, imaging, and AS treatment differences, the rate of CV death or HF hospitalization was higher among those with obstructive CAD (HR 1.16, 95% CI: 1.03-1.30, p=0.01). However, there was a significant sex-related difference in the primary outcome particularly between males and females with non-obstructive or no CAD, p interaction =0.003 (Figure). Conclusions: Patients with a greater burden of CAD had worse clinical outcomes after treatment for severe AS. However, there was a significant interaction by sex. Further study is needed to understand the increased CV risk among females compared to males with non-obstructive or no CAD.
Abstract 18019: Gender Differences Among Elderly Patients Hospitalized With Acute Coronary Syndrome in the United States Between 2011-2019
Authors: Paola A Lecompte, Ivan Mijares-Rojas, Sukhpreet Kaur, Michael Dangl, Jelani Grant, Rhea Sancassani, Rosario Colombo
Journal: Circulation (2023)

Introduction: Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the elderly. Women in general are less likely to be referred for coronary catheterization, percutaneous coronary intervention, and fibrinolysis. Hypothesis: We tested the hypothesis that elderly females were less likely to undergo catheterization and revascularization for ACS as compared to elderly men. Methods: We identified hospitalizations for patients aged 75 years old or older admitted with a primary admitting diagnosis of NSTEMI or STEMI between 2016 and 2019 using the National Inpatient Sample Database. Baseline characteristics, in-hospital complications, mortality, and length of stay were compared between male and female patients. A p-value &lt;0.001 was considered significant. Results: We identified a total of 776,485 hospitalizations. See Table 1 for baseline characteristics and in-hospital outcomes. Male patients exhibited a higher prevalence of comorbidities. Furthermore, female patients were more prone to conditions such as hypertension, obesity, dementia, and stroke. In terms of in-hospital complications, male patients had the highest percentage of all complications. Male patients had a statistically significantly higher number of interventions compared to females, including cardiac catheterization (59.7 vs 51.4, p &lt;0.001), percutaneous coronary intervention (39.7 vs 32.8, p &lt;0.001), and CABG (0.8 vs 0.4, p &lt;0.001). Male patients also had the highest length of stay compared to females (4.9 vs 4.6 days, p &lt;0.001). Alternatively, Females were found to have the highest mortality compared to males (7.8 vs 7.5, p &lt;0.001). Conclusions: Our results on ACS outcomes in elderly females are consistent with literature demonstrating that females are less likely to undergo catheterization or revascularization and have higher mortality. More research is needed to address these gender disparities.
Abstract 14199: Whole Blood RNAseq Reveals a Pro-Inflammatory Signature in Patients With Coronary Microvascular Dysfunction and Ischemia With Non-Obstructive Coronary Arteries
Authors: Nathaniel R Smilowitz, Florencia Schlamp, Anais Hausvater, Amanda Joa, Claudia Serrano-Gomez, Ayman Farid, Judith Hochman, Tessa A Barrett, Harmony Reynolds, Jeffrey Berger
Journal: Circulation (2023)

Background: Coronary microvascular dysfunction (CMD) is a key mediator of ischemia with non-obstructive coronary arteries (INOCA), but pathogenic mechanisms remain unknown. Whole blood gene expression profiling is an unbiased method to investigate molecular and cellular pathways associated with disease. We analyzed whole blood expression profiles in patients with and without CMD to provide insights into INOCA mechanisms. Methods: Women with ischemic symptoms or myocardial ischemia on stress testing with &lt;50% stenosis in all major epicardial coronary arteries were enrolled. Coronary flow reserve (CFR) was measured invasively by thermodilution and CMD was defined as a CFR &lt;2.5. Whole blood RNA was collected at the time of coronary angiography and sequenced. Age adjusted differential expression analyses were performed with DESeq2 to identify differentially expressed transcripts in patients with and without CMD, and by CFR as a continuous function. Canonical pathways were obtained with Ingenuity Pathway Analysis (IPA). Nominal P-values &lt;0.05 were used to identify relevant genes and pathways. Results: We enrolled 28 women with INOCA (mean age 60 ± 8.4 years, 82% white, 32% Hispanic/Latino ethnicity), among whom 7 had CMD; 1,450 transcripts were differentially expressed when stratified by CMD status ( Panels A and B ). When CFR (median 3.2 [IQR 2.5-4.2]) was evaluated as a continuous variable, IPA revealed lower CFR was associated with upregulated inflammatory pathways including neutrophil extracellular trap signaling, macrophage activation, interferon, IL-8, and IL-6 signaling, Fcγ receptor-mediated phagocytosis, and pathways related to reactive oxygen species production (Panel C) . Conclusion: Among women with INOCA undergoing invasive testing, pro-inflammatory signaling pathways were upregulated in those with versus without CMD. Additional investigation is warranted to explore inflammation in CMD to identify possible treatment targets.
Abstract 18574: Association Between Left Ventricular Diastolic Function and Right Ventricular Morphology and Function Assessed With Automated 3D Software Analysis
Authors: Ardel J Romero Pabon, Kevin B Lo, Jafar Alzubi, Zachary A Port, Sarah Morris, Bridget Clift, Evan Friend, Gregg S Pressman
Journal: Circulation (2023)

Background: Left ventricular (LV) diastolic dysfunction (DD) is a hallmark of heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) function is a strong and independent prognostic factor in this population, but its correlation with LV DD has not yet been explored. 3D echocardiography allows for accessible, accurate, reproducible analyses of RV function. Our study aims to assess the association between LV diastolic function and RV function (measured via automated 3D echocardiography software) Hypothesis: The RV enlarges and its systolic function decreases, in a graded fashion, with increasing degrees of LV DD Methods: We conducted a prospective, single-center, cross-sectional cohort study in patients with clinically indicated echocardiography and 3D RV assessment. We excluded patients with non-WHO group 2 pulmonary hypertension, non-sinus rhythm during echocardiogram, and those with a LVEF &lt;40%. We conducted an interim analysis of the first 187 patients. Patients were stratified according to DD grading, and different RV parameters were compared using ANOVA Results: 187 patients underwent interim analysis, 65% were women. Mean age 60±17 years, 64% African-American, 16% Hispanic, 12% Caucasian. Mean BMI 29±6 kg/m 2 . Mean LVEF and LV GLS were 57±10% and -17.7±3.6, respectively. A graded worsening in RV systolic function and morphology were noted in patients with DD. Patients with grade II/ III DD had worse RV EDV (146±42 mL), RV FAC (32±9%), TAPSE (19±5 mm), and RVEF (40±9%), than patients without DD (RV EDV 114±36 mL, p=0.0011; RV FAC 39±7.4%, p&lt;0.001; TAPSE 21±5 mm, p&lt;0.001; and RVEF 47±8%, p&lt;0.001), and grade I DD Conclusion: Our results suggest that there is a graded worsening in the RV function and morphology as LV diastolic function worsens in patients with preserved EF. This denotes the importance of widespread, accurate, and reproducible RV assessment during standard echocardiography
Abstract 13069: Submitting ACC-NCDR CathPCI Data Are Not Enough
Authors: Bonnie H Weiner, Joaquin E Cigarroa, Michael J Cowley, J. Jeffrey Marshall
Journal: Circulation (2023)

Introduction: The majority of facilities performing PCI in the US report data to the ACC-NCDR CathPCI Registry. The large number of records included in this dataset provide benchmark comparisons for facilities to consider however it is of concern that this may not result in the development of meaningful actions for improvement. The current analysis was undertaken to understand changes in Registry findings over time in facilities undergoing accreditation reviews. Methods: A component of site visits for accreditation, executive summaries or dashboards for each facility are reviewed and findings are categorized as being ≤ 50 th percentile or ≤ 10 th percentile when compared to the registry benchmark data at the time they are reported. Results: Twenty-one facilities underwent 32 reviews. (Figure 1). Although there is a trend in decreasing percentage of variables ≤ 50 th percentile with subsequent reviews, these differences were not statistically significant. No such trend was observed for variables ≤ 10 th percentile. In general, facilities deferred have higher rates of both findings, but these differences also are not statistically significant overall or at each review point.(Figure 2) Conclusions: Facilities undergoing accreditation reviews, irrespective of the accreditation decision have high rates of NCDR registry variables that are ≤50th and ≤10th percentile. These do not change significantly over time and suggest that insufficient attention is paid to these variables, corrective action is not identified or is not effectively implemented. Ongoing support is necessary to achieve these changes.
Abstract 17101: Impact of a Longitudinal Virtual-First Cardiology Program on Identification and Management of Complex Cardiovascular Disease
Authors: Sudheesha Perera, Jana Goldberg, Stacey Pratt, Nicole Abdullah, Lindsey Mandrayar, Sarah Littleton, Cheri McGregor, Jeff Wessler
Journal: Circulation (2023)

Background: In the face of rising healthcare expenditures nationally, current literature suggests that primary care-based longitudinal payment models may improve care quality and lower cardiovascular care costs. Despite innovation in this space, there has been no study that critically examines the efficacy of virtual-first cardiology care as an adjunct to existing primary care models. Methods: We performed a retrospective review of patients enrolled in Heartbeat Health’s Longitudinal Care program which provides virtual-first cardiology care to patients in partnership with their primary care team. The program included telemedicine visits with specialist cardiology teams, medication prescription, testing, and remote patient monitoring when indicated. We reviewed all new diagnoses, changes in blood pressure, initiation of guideline directed medical therapy (GDMT), and patient satisfaction. Results: The final cohort included 230 patients (average age = 71.7 yrs). Meaningful increases in new diagnoses were evident (Figure). Regarding blood pressure control, 30.8% saw improvement during the program and another 20.6% were at their goal by the time of graduation. Aspirin therapy (either primary or secondary prevention) increased from 28.3% to 35.7% in all-comers, while primary stroke prevention in patients with atrial fibrillation increased from 50% to 62.5%. Additionally, 46.5% (n=107) of patients were placed on GDMT for at least one of the conditions listed in Figure. Average patient Net Promoter Score was 87. Conclusions: Virtual-first cardiology care is a promising opportunity for value-based care organizations. Among other benefits, increased use of preventative therapy, enhanced GDMT, and newly found and managed diagnoses hold the potential to close gaps in care and reduce long-term costs.
Abstract 13657: Cholesterol Content of VLDL Particles and Incident Coronary Artery Calcification Among ELSA-Brasil Participants - A Metabolomic Approach
Authors: William Tebar, Vandrize Meneghini, Giuliano Generoso, Alexandre Pereira, Marcio Bittencourt, Itamar S Santos, Paulo A Lotufo, Isabela M Bensenor
Journal: Circulation (2023)

Background: Very-low density lipoproteins (VLDL) are the smallest and most atherogenic particles. Research question: The association of cholesterol content in VLDL particles with incident coronary artery calcification (CAC) is unclear. Aim: To analyze the association of VLDL cholesterol content with 5-year CAC status among ELSA-Brasil participants. Methods: Data from 832 participants (50.3±7.2 years, 50.4% women) free of cardiovascular disease and statin use were analyzed. The cholesterol content of VLDL lipoproteins were assessed by high-throughput proton Nuclear Magnetic Resonance metabolomics platform. CAC score was assessed by computed tomography at baseline and after 5-year follow-up, being classified as absent CAC (baseline and follow-up CAC=0), prevalent CAC (baseline CAC&gt;0) and incident CAC (baseline CAC=0 and follow-up CAC&gt;0). Distribution of cholesterol content were compared by U-Mann Whitney test according to CAC status. Generalized linear models compared cholesterol concentrations according to CAC status, adjusted by sociodemographic (age, sex, race, education, health insurance), lifestyle (physical activity, alcohol and smoking) and comorbidities (hypertension, diabetes, obesity and total cholesterol ≥200mg/dL). Results: CAC incident was 6.6% of sample (n=55), whereas 26.2% was CAC prevalent (n=218) and 67.2% was CAC absent (n=559). VLDL cholesterol concentrations in CAC incident participants were higher than those with CAC absent, but similar to those with CAC prevalent - Figure 1. Regression models showed higher concentrations of all lipids in CAC incident than CAC absent, but there was no difference between CAC incident and CAC prevalent. The associations remained beyond adjustment for sociodemographic and lifestyle factors, but lost significance after adjustment for comorbidities. Conclusions: This finding suggests a predictive role of VLDL cholesterol content for CAC incidence among ELSA-Brasil participants.
Abstract 14540: Allostatic Load/Chronic Toxic Stress and Cardiovascular Outcomes in Breast, Lung and Colon Cancer Patients
Authors: Nickolas Stabellini, Jennifer Cullen, Marcio S Bittencourt, Justin Moore, John Shanahan, Priyanshu Nain, Nelson Hamerschlak, Susan F Dent, Arnethea L Sutton, Meng-Han H Tsai, Amitava Banerjee, Arjun K Ghosh, Diego B Sadler, Alberto Montero, Avirup Guha
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) and cancer share a common risk factor: chronic toxic stress/allostatic load (AL). Our previous research found that a 1-point increase in AL is linked to a 25-30% higher risk of major cardiac events (MACE) in prostate cancer patients. Hypothesis: Higher AL is associated with increased MACE risk in patients with breast, lung, and colon cancer. Methods: Patients ≥18 years diagnosed for the first time with the mentioned 3 cancers of interest between 2010-2019 at a large, hybrid academic-community practice were included in this retrospective cohort study. AL was modeled as an ordinal measure (0-11; Table 1 ). Adjusted Fine-Gray Cox proportional hazard regressions estimated the impact of AL pre- and 60 days post- cancer diagnosis on 2-year MACE. Results: Demographic characteristics are summarized in Table 1. Two-year mace MACE occurred in 12.3%, 23.3%, and 9.7% of breast, lung, and colon cancer patients, respectively. Heart failure was the most common MACE, observed in 7.9%, 14.4%, and 4.8% of breast, lung, and colon cancer patients, respectively. Before cancer diagnosis, a 1-point increase in AL raised MACE risk by 11% (aHR=1.11, 95% CI 1.07-1.16) in breast cancer, 18% (aHR=1.18, 95% CI 1.11-1.25) in lung cancer, and 9% (aHR=1.09, 95% CI 1.01-1.18) in colon cancer. After cancer diagnosis, a 1-point increase in AL increased MACE risk by 10% (aHR=1.10, 95% CI 1.06-1.15) in breast cancer and 19% (aHR=1.19, 95% CI 1.12-1.25) in lung cancer, but was not statistically significant in colon cancer (aHR=1.07, 95% CI 0.99-1.16). Conclusion(s): Higher AL levels prior to breast, lung, and colon cancer diagnoses are associated with increased MACE risk. Thus, effective implementation of patient-centered communication considering stress levels, stressors, and coping mechanisms is necessary during cardiovascular screening for these cancer patients. Further prospective studies are needed.
Abstract 14964: Unsupervised Machine Learning of Imaging-Based Sub-Phenotypes of Aortic Stenosis With Differential Risks of Conduction Disturbances After Transcatheter Aortic Valve Replacement
Authors: Mustapha El Zeini, Matthew Tran, Umarani Badarabandi, Chun Liu, Andrew Y Chang, Sachin Malik, Guson Kang, Nazish Sayed, Karim Sallam, Philip S Tsao, Joseph C Wu, Ian Y Chen
Journal: Circulation (2023)

Background: It is currently unclear whether various measurements of the aortic valvular complex routinely performed on pre-operative computed tomography angiograms (CTA) can collectively predict the risk of conduction disturbances after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). Here, we aimed to use unsupervised machine learning to analyze a multitude of CTA features and identify distinct patient sub-phenotypes with different risks for TAVR-related conduction disturbances. Methods: The pre-TAVR CTAs of 660 AS patients (330 males, 330 females) were analyzed using TeraRecon to extract 21 features that included aortic valve leaflet calcification loads, dimensions of the aortic root (annulus, sinus of Valsalva, sinotubular junction) and the ascending aorta, coronary ostial heights, and aortic angle. Agglomerative hierarchical clustering was performed separately on male and female datasets using R, with assessment of clusterability based on Hopkins statistics and agglomerative coefficient and the optimal number of clusters based on 30 previously validated indices (NbClust package). Multivariable logistic regression was conducted to assess the dependence of significant conduction disturbances (new left bundle branch block, advanced atrioventricular block) on cluster type. Results: Both male and female datasets were fairly clusterable (Hopkins statistics, 0.70 vs 0.68; agglomerative coefficient, 0.93 vs 0.93), with 3 and 2 as the optimal number of clusters, respectively. Of the 3 male clusters identified, the cluster with intermediate median values of aortic valve leaflet calcification loads and aortic root dimensions (M2) was associated with the greatest risk of conduction disturbances, compared to clusters with low (M1) and high (M3) median values of these variables (OR M2/M1 =9.24, p =0.03; OR M2/M3 =1.33, p =0.40; OR M3/M1 =6.97, p =0.07). The risk of the M1 cluster was not statistically different from those of the female clusters (F1, F2; OR M1/F1 =0.31, p =0.27; OR M1/F2 =0.25, p =0.21), which were not different from each other (OR F1/F2 =0.82, p =0.68). Conclusion: Machine learning of pre-TAVR CTAs can help identify subgroups of patients with similar or varying risks of TAVR-related conduction disturbances.