tbuckley/cabot-search huggingface dataset:
Abstract 4146812: Cardiac Comorbidities has worse outcomes in Multiple Myeloma patients; A retrospective Analysis
Authors: Rabia Iqbal, Ahmad Taimoor Bajwa, Amina Jafar, Hnin Nadi Linn
Journal: Circulation (2024)

Background: Multiple myeloma, a type of blood cancer characterized by recurring and remitting episodes, has historically been difficult to manage. While advancements in treatment have led to improved survival rates, they have also introduced new cardiac complications. Notably, many multiple myeloma patients already possess pre-existing cardiac risk factors. Unfortunately, there is limited information available on the prevalence of these risk factors, making it crucial to investigate this issue further to better understand and address the cardiac burden associated with this disease. Methods: We used the National Inpatient Sample Database (NIS) from 2017 to 2020 to identify patients with primary diagnosis of Multiple Myeloma (MM) using ICD-10 codes. Our analysis aimed to determine the prevalence of cardiac risk factors among MM patients and their impact on mortality. We used multivariable logistic and linear regression models to estimate the adjusted odds ratio (AOR) for the outcomes. A p-value of &lt;0.05 was considered statistically significant Results: Analysis showed that a total of 690789 patients were admitted with multiple myeloma. Out of them, almost 68% of the patients had cardiac comorbidities. The mean age of the patients was 69 years. Males were in majority (55%) while female patients comprised 45% of the patients. Out of them, 23% of patients had coronary artery disease (CAD), 21% had congestive heart failure (CHF), 18% had atrial fibrillation, 3% had ventricular arrhythmias, 5% had non-rheumatic heart disease (NRHD), 3% had heart block and 0.08% of the patients had infective endocarditis. Among the patients, CHF (OR 1.5, p-value 0.00) , atrial fibrillation (OR 1.1, p-value 0.001), ventricular arrhythmias (OR 3.2, p-value 0.00) was associated with higher mortality risk in multiple myeloma patients. Other comorbidities, such as NRHS (OR 0.9, p-value 0.8) and CAD (OR 0.9, p-value 0.5) were associated with lower risk, although the result was not significant (p-value &gt;0.05). Although endocarditis was associated with higher risk (OR 1.8, p-value 0.7), the result was also not significant. Conclusion: The prevalence of cardiac comorbidities in multiple myeloma (MM) patients is 68%, significantly increasing mortality risk. Conditions such as congestive heart failure, atrial fibrillation, and ventricular arrhythmias are particularly associated with higher mortality. The mortality was observed to be higher in the presence of cardiac risk factors.
Abstract 4146824: Performance of Clinician-Assigned SCAI Shock Staging in the AHA Cardiogenic Shock Registry
Authors: David Berg, Erin Bohula, Siddharth Patel, Michael Palazzolo, Mitchell Krucoff, David Morrow
Journal: Circulation (2024)

Background: SCAI staging of cardiogenic shock (CS) severity facilitates communication about the presentation and trajectory of CS. Most prior validations of SCAI staging have used registry-specific algorithmic adaptations of the staging criteria. Few studies have evaluated clinician-assigned SCAI staging based on holistic assessment of all clinical data. Aim: To assess the ability of initial and serial clinician-assigned SCAI staging to stratify risk of in-hospital mortality in a large, broadly representative CS population from the AHA CS Registry. Methods: Consecutive CS admissions enrolled in the Registry (64 sites, 2022-2024) were included. Clinician-assigned SCAI stage was captured at CS onset (first 6h) and serially (6-12h after CS onset). Cases with available SCAI stage at both timepoints were classified as having improved, unchanged, or worsened SCAI stage. Associations of in-hospital mortality with initial and early change in SCAI stage were assessed using logistic regression; for the latter, models were adjusted for initial SCAI stage. Key subgroups defined by CS etiology (AMI-CS vs. HF-CS) and preceding cardiac arrest (CA) were examined. Results: Among 4,311 CS admissions, 3,110 (72%) had initial SCAI stage assessments (median age 66y, 33% women, 30% AMI-CS, 50% HF-CS, 21% preceding CA) and 2,867 (67%) had serial assessments. Most CS was initially staged as SCAI C (B: 12%; C: 59%; D: 19%; E: 10%), with a higher proportion of SCAI D/E in those with AMI-CS (34%) or preceding CA (60%). There was a stepwise gradient of mortality across SCAI stages (p&lt;0.001; Fig-A ), consistent when stratifying by CS etiology and preceding CA (p&lt;0.001 for each; Fig-B/C ). In the 12h after CS onset, most SCAI staging was unchanged (73%; worsening: 15%; improving: 12%); however, SCAI staging was more dynamic in those with preceding CA. Early worsening or improvement in SCAI stage was associated with higher (aOR 3.7, 95% CI 2.9-4.6) and lower (aOR 0.4, 95% CI 0.3-0.5) odds of mortality, respectively ( Fig-D ). Conclusion: In this initial analysis from the AHA CS Registry, clinician-assigned SCAI staging effectively stratified in-hospital mortality risk, and early changes in SCAI stage further refined prognostication in CS.
Abstract 4147535: Cryptogenic stroke and Patent Foramen Ovale: Elevated Lipoprotein (a), a factor in the equation
Authors: Joan Rodriguez-Taveras, Danna Reyes Herrera, Bradly Garcia Diaz, Alejandro Araujo, Claudia Suero, Gabriella Castillo de la Cruz, Juan Fondeur Acosta, Javier Santiago, Ernesto Perez Colome, Christian Guzman, Ramón Romano Peralta, Karla Herrera Baez, Ana Paula Urena Neme, Jorge A. Tarafa, Pedro Enrique Ureña Velasquez
Journal: Circulation (2024)

Background: Despite the association between cryptogenic stroke and patent foramen ovale (PFO), data on the efficacy of PFO closure for secondary prevention remains limited. Guidelines recommend PFO closure only for patients with a prior stroke. As recent studies indicate a correlation between elevated Lipoprotein(a) levels and stroke, its measure could be relevant in evaluating the need for PFO closure. Aims/Hypothesis: This study aims to determine if elevated Lipoprotein (a) levels in patients with PFO increase the likelihood of stroke or transient ischemic attack (TIA). We hypothesize that elevated Lp(a) levels, given their known association with cryptogenic stroke, should be considered when evaluating patients for PFO closure. Methods: Case-control study on patients with PFO between January 2018 to April 2024. Patients with previous TIA or evidence of a prior stroke on CT/MRI were classified as “Stroke Group”. An Lp(a) level ≤ 30mg/dL was considered normal. Multivariate logistic regression was used to analyze the impact of age, gender, hypertension, diabetes, smoking status, coronary artery disease, hypothyroidism, dyslipidemia, and LP(a) levels on developing stroke or TIA. Results: A total of 96 patients were included (Stroke group=55; Control group=45). Significant differences were found between groups in age [46.38±11.06 vs 44.42±13.01; p=0.02], BMI [27.75(4.8) vs 25.34(4.8); p=0.02], hypertension [43.6% vs 17.1%; p&lt;0.01], and migraine [27.3% vs 7.3%; p&lt;0.01]. Elevated Lp(a)was more prevalent in the Stroke Group [60% vs 39.02%; p=0.04]. No significant differences were observed in LDL [94.80±33.95 vs 108.84±28.92; p=0.669], HDL (54.77±13.63 vs 63.89±15.16; p=0.205), Non-HDL (132.35±47.88 vs 156.23±38.86; p=0.651), and HbA1c [5.5%(0.35) vs 5.3%(0.30); p=0.143]. The logistic regression model revealed that besides the difference in baseline characteristics, only dyslipidemia (OR=4.02, 95% CI:1.145–14.125, p&lt;0.002), migraine (OR=4.02, 95% CI:1.145–14.13, p&lt;0.03), and elevated Lp(a) (OR=8.68, 95% CI: 2.15–35.02, p&lt;0.002) were significantly associated with increased odds of TIA/Stroke. Conclusion: In patients with PFO, elevated LP(a) increases the odds of developing cerebrovascular events. Measure of Lp(a) should be included in the evaluation for PFO closure.
Abstract Sa504: Association between Dispatch-Performance and Outcomes after Out-of-Hospital Cardiac Arrest in North Carolina: A registry analysis
Authors: Harman Gailan Hassan Yonis, Lisa Kaltenbach, Audrey Blewer, Monique Starks, Stephen Powell, Lisa Monk, James Jollis, Hussein Al-Khalidi, Sana Al-Khatib, Daniel Mark, Carolina Malta Hansen, Steve Vandeventer, Bryan McNally, Christopher Granger, Konstantin Krychtiuk
Journal: Circulation (2024)

Introduction: Each year in the U.S., over 350,000 people experience out-of-hospital cardiac arrests (OHCA), with a survival rate of just 10%. Most do not receive bystander CPR before professional rescuers arrive. Telecommunicator CPR (T-CPR) allows dispatchers to guide callers in performing CPR, a practice recommended by the American Heart Association (AHA). This study investigates the association between T-CPR and time to first compression and clinical outcomes. Methods: This analysis included all OHCAs in North Carolina (NC) from July 1, 2022, to December 31, 2023, with data from the RACE-CARS trial embedded in the Cardiac Arrest Registry to Enhance Survival (CARES) dispatch module. Exclusions were pediatric, traumatic, EMS-witnessed arrests, cases in healthcare facilities, and cases where CPR was already in progress or data on dispatcher recognition of need for CPR were missing. The primary outcome was survival to hospital discharge with good neurological function (cerebral performance category 1 or 2). Results: Overall,1,903 OHCA cases met the inclusion criteria. Median (25 th - 75 th percentiles) age was 64 (50-75) years, 29.0% were Black, and 37.6% were female. Dispatchers recognized the need for CPR in 81.6% of cases and chest compressions were initiated in 63.0%. Median times from call receipt were: 87 sec (52-158) to recognition of cardiac arrest, 137 sec (88-215) to T-CPR instructions, and 213 sec (151-293) to first compression. Of the 997 cases with information available, 24.6% met the AHA-recommended time of &lt;150 sec from call to first chest compression. Among patients meeting those criteria, there was a trend towards higher survival with good neurological outcomes compared to those that did not meet the benchmark (10.2% vs. 8.3%, p=0.4). Conclusions: In this contemporary OHCA population in NC, the AHA benchmark of median time from call to recognition of &lt;90 sec was met while the benchmark for time from call to first chest compression &lt;150 sec was not met in most cases. In patients with time to first chest compression of &lt;150 sec, a numerically higher survival rate with good neurological outcome was observed but this was not statistically significant. These results emphasize the need for enhanced strategies to overcome barriers and improve T-CPR performance as part of the comprehensive strategy to improve cardiac arrest survival. Further analyses with adjustments for confounders are necessary to fully understand the implications of these findings.
Abstract 4146894: Switching to Ticagrelor from clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: A meta-analysis of 4334 patients
Authors: Ahmed Abdelaziz, Mariam Desouki, Ahmed Elshahat, Atef Hassan, Ahmed Helmi, Ahmed Mohamed, Raneem Afify, Ahmed Nasr, Ahmed Hamdy G. Ali, Sandi Banour, Basel Abdelazeem
Journal: Circulation (2024)

Introduction: For patients undergoing fibrinolytic therapy for ST-elevation myocardial infarction (STEMI), The concurrent administration of aspirin and clopidogrel as dual antiplatelet therapy is the recommended standard of care for these patients. However, the efficacy and safety of switching to ticagrelor within 24 hours following fibrinolytic treatment compared to clopidogrel continuation is still a debate. Purpose: We aimed to compare ticagrelor and clopidogrel regarding the efficacy and safety outcomes in patients with STEMI receiving fibrinolytic therapy. Methods: We performed an extensive electronic search on PubMed, Scopus, Web of Science, and Cochrane Library from inception till February 2024. All randomized controlled trials (RCTs) that compared between ticagrelor and clopidogrel in the setting of STEMI were included. The primary endpoint was all-cause death. The secondary outcomes were myocardial infarction and Bleeding Academic Research Consortium classification (BARC) 1-2. Results: Four randomized controlled trials involving 4334 patients were included in the analysis. Ticagrelor showed higher rates of BARC 1-2 bleeding events compared to clopidogrel (OR= 1.68, 95% CI [ 1.22 to 2.31], P=0.002), with no significant difference regarding the incidence of all-cause death (OR= 0.89, 95% CI [ 0.61 to 1.31], P=0.56) or MI (OR= 0.76, 95% CI [ 0.42 to 1.35], P=0.35). Conclusion: Ticagrelor was associated with a higher incidence of bleeding events compared to clopidogrel, with no significant difference in other clinical outcomes. Switching to ticagrelor from clopidogrel might worsen the case regarding clinical outcomes. Large-volume RCTs should be implanted with longer follow-up to validate the current findings.
Abstract 4147346: Efficacy of OCT versus angiography in post-procedural lesions complications after percutaneous coronary intervention with drug-stent implementations: A systematic review and meta-analysis
Authors: Eric Katsuyama, Christian Fukunaga, Naieli Andrade, Rafael Petri Santos Pinheiro, Alonzo Prata, Pedro Gabriel Scardini, Ana Carolina Coan, Wilson Falco Neto, Julia Fernandes, Luciana Gioli-Pereira
Journal: Circulation (2024)

Background: Although recent studies have suggested the advantages of utilizing optical coherence tomography (OCT) for image guidance during percutaneous coronary intervention (PCI) with drug-eluting stent implantation over conventional angiography, the specific impact on post-procedural lesion complications has remained uncertain. To address this gap, we conducted an updated systematic review and meta-analysis focusing on post-procedural lesion complications associated with OCT-guided versus angiography-guided procedures in lesions undergoing PCI with drug-eluting stent implementation. Methods: We searched systematically through Pubmed, Embase, and Cochrane for randomized controlled trials(RCTs), which included lesions undergoing PCI and drug-stent deployment guided by OCTversus angiography. Our primary outcome of interest was (1) stent malposition under OCT analysis. We also included the following secondary outcome: (2) dissections under OCT analysis. We excluded studies that did not use OCT imaging to analyze post-procedure lesions. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model. Results: Five RCTs comprising 3,266 lesions undergoing OCT or Angio PCI-guided and drug stent implementation were included, of whom 1,549(48,34%) underwent OCT. The number of moderate-severe calcified lesions was 370 (11.33%). Our results show a significant association with decreased stent malposition risk in the OCT group, showed a significant decrease in post-procedure risk regarding stent malpositioning ( RR: 0.80; 95% CI: 0.75-0.84; P&lt;0.001; Fig.1) compared to angiography. However, our findings did not detect any difference in dissection undergoing OCT post-procedure analysis (RR: 1.58; 95% CI: 0.31- 8.06; P=0.583; Fig.2)., compared to the angiography group. Conclusion: In this meta-analysis comparing OCT versus angiography in lesion complications post-procedure undergoing PCI and drug-stent implementation, the OCT group was associated with decreased stent malposition.
Abstract 4146920: <u>Potential Effects of Preoperative Blood Transfusions on Cardiac Transplantation Patient’s Postoperative Condition</u>
Authors: Sneha Gonipati, Abul Kashem, Yoshiya Toyoda
Journal: Circulation (2024)

Introduction: Perioperative anemia can cause a host of complications, such as renal injury, stroke, and mortality. However, the use of transfusions preoperatively also can cause various complications, such as an overload of fluids and the risk of infection. Learning if, and how much an effect transfusion has in cardiac surgery can lead to better decision-making to reduce postoperative complications. Hypothesis: The hypothesis tested was that there is a significant difference in postoperative outcomes between cardiac transplant patients who received a blood transfusion preoperatively and those who did not. Methods: The UNOS database was used to find adult patients who received a heart transplant between 2000 and 2023 (n = 51,325). The remaining individuals were split into groups that received preoperative blood products (n=10,873) or did not (n=40,452). Endpoints analyzed include mortality, length of stay, graft status, and acute rejection. Mortality was analyzed using a Kaplan-Meier curve and log-rank tests, and Cox proportional hazards were used to find risk factors. All analysis was done in JMP. Results: After analysis, it was found that there was a significant difference in length of stay (p&lt;0.0001), graft status (p&lt;0.0001), and acute rejection (p=0.0430), with transfusion patients having a longer LOS, and higher percentages of graft failure and acute rejection. The Kaplan-Meier curve shows a significant difference in mortality between the two groups (p&lt;0.0001). Life support at registration also showed significant differences, with ECMO utilization (p&lt;0.0001), ventilator utilization (p&lt;0.0001), and IABP utilization (p&lt;0.0001) having higher percentages with patients with preoperative transfusions. Cox regression results showed that there is an increased risk of mortality in patients who did not receive transfusions before transplant (p&lt;0.0001). Conclusion: While there was an increase in postoperative complications with patients with preoperative transfusions, there also appears to be a correlation between the need for life support and the use of blood products preoperatively. This, along with the reduced risk of mortality from preoperative transfusion patients, shows the possibility that differences in outcomes relating to transfusions may be due to patient conditions before the surgery rather than transfusions alone.
Abstract Sa1003: Variability In Arrest Characteristics in A Multicenter Swine Cardiac Arrest Registry
Authors: Mohamad Tiba, Renaud Tissier, Giuseppe Ristagno, Aurora Magliocca, Francesca Fumagalli, Cindy Hsu, Mikulas Mlcek, Jan Belohlavek, Hans Friberg, Olof Persson, Michael Holzer, Szinovatz Alexander, Wolfgang Weihs, Asger Granfeldt, Lauge Vammen, Kyoung-Chul Cha, Woo Jin Jung, Robert Neumar
Journal: Circulation (2024)

Introduction: Many post-cardiac arrest (CA) therapies shown to be effective in animal models have failed to translate in human clinical trials. The predominance of single site pre-clinical studies, which lacks the heterogeneity and variability inherent in multicenter human clinical trials, could contribute to this failure. Multicenter pre-clinical studies might yield variability that more closely approximates human clinical trials, and thus result in reduction of bias and better initial screening of interventions. Here we describe the variability of CA characteristics among participating centers of an international multicenter preclinical CA research network. Methods: This is a retrospective analysis of control group subject data from swine CA studies submitted to the TRANSatlantic Cardiac arrEst Neuroprotection aDvancement (TRANSCEND) Network pre-clinical registry. Data for 101 animals from ten different models at seven institutions across the U.S.A, Europe, and Asia were included in this analysis. Data related to CA characteristics (intervals), post-CA characteristics (hemodynamics and blood gas at 1 hour post-ROSC), and neurological outcome were compiled and compared between the ten models. One-way ANOVA and Bartlett Test were used to estimate differences in means and standard deviations (SD). Chi Square test was used to compare proportions. Results: There were significant differences in CA characteristics between all ten models. The mean (SD) interval from CA to start of cardiopulmonary resuscitation was 8 (4)min (range of 2 to 14min) and from onset of CA to ROSC was 19 (7)min (range 13 to 38min) ( p &lt;0.0001). There were also significant differences between models when comparing sex, weight, post-ROSC hemodynamics, arterial blood gas results, and neurological outcome ( p &lt;0.0001). Data is detailed in the table. Conclusion: This analysis illustrates significant variability in CA and post-ROSC characteristics and neurologic outcomes when comparing different swine CA models in an international pre-clinical registry. Such variability could make interventional CA studies performed in a multicenter network more predictive of human clinical trials.
Abstract 4147702: Identifying Sex-Specific Risk Profiles in Patients with Non-ischemic Cardiomyopathy: A Cardiac MRI Study
Authors: Diane Rizkallah, Theerawat Korkerdsup, Carl Ammoury, Kashyap Bodi, Yanjun Wu, Tom Kai Ming Wang, Tess Calcagno, Wai Hong Tang, David Chen, Christopher Nguyen, Xiaofeng Wang, Deborah Kwon
Journal: Circulation (2024)

Introduction: Sex-based differences in cardiac remodeling have been identified in patients with non-ischemic cardiomyopathy (NICM). There is conflicting data regarding sex differences in outcomes in these patients, which may be related to heterogenous risk profiles. We sought to assess sex specific modulators of risk, based on assessment with cardiac magnetic resonance (CMR) imaging. Methods: We conducted a retrospective analysis of patients with NICM who underwent cardiac MRI between 2001 and 2017. The primary endpoint was a composite outcome of death, heart transplant, heart failure admission and LVAD. The study cohort was divided into male and female subgroups, and univariate cox regression was performed to evaluate differential risk factor profiles. Results: We evaluated 634 patients: 255 females (40.3%) and 377 males (59.7%), see fig 1(A) for baseline demographic characteristics and CMR parameters. On Kaplan-Meier analysis, outcomes were similar in males and females (p=0.662). On Cox regression, hypertension (HR: 1.91 [CI 1.22-3.0]; p=0.005 ), diabetes (HR: 3.17 [CI 1.94-5.18]; p&lt;0.001 ) and LGE (HR: 1.11 [CI 1.01-1.21]; p=0.030 ) were associated with adverse outcomes in females only. While LA ejection fraction (LAEF) (HR 0.87 [CI 0.82 - 0.93]; p&lt;0.001 ) and eGFR (HR 0.88 [CI 0.80-0.95]; p=0.002 ) were associated with adverse outcomes in males only, see fig 2, left atrial volume index (LAVi) and LA reservoir strain were associated with the composite outcome in both males and females. Conclusion: Despite similar outcomes in men and women with NICM, we found significant differences in the modulators of risk and cardiac structure and function based on sex. Notably, LGE and diabetes were unique predictors of risk in females, despite similar prevalence. On the other hand, LAEF and renal function were uniquely predictive of adverse outcomes in males. Further work is needed to elucidate sex specific biologic mechanisms of risk to better characterize sex specific phenotypes.