tbuckley/cabot-search huggingface dataset:
Abstract 4141176: <u>Trends in 30-day readmission rate, mortality outcome, and resource utilization among patients admitted for ST-Segment Elevation Myocardial Infarction</u>
Authors: Michael Fatuyi, Stella Eze, Oluwasegun Akinti, Jeremiah Oluwadamisi, Ndausung Udongwo, Tolulope Olu-Lawal, Joseph Amoah, Mohun Ramratnam, Kurt Jacobson
Journal: Circulation (2024)

BACKGROUND: With limited data on recent outcomes, ST-segment elevation myocardial infarction (STEMI) continues to be a significant public health issue in the modern day. This study aims to evaluate the most recent trends in 30-day readmission rate (30-dRr), mortality, and resource utilization associated with STEMI. METHODOLOGY: We utilized the Nationwide Readmission Database to analyze data from 2016 to 2021. Patients aged ≥ 18 years with STEMI identified using ICD-10 codes. The primary aim was trends in 30-day readmission rates (30-dRr). Secondary objectives included investigating mortality rates, resource utilization measured by LOS, and mean hospital costs adjusted for inflation&amp;identifying readmission most common diagnosis (R-MCD) readmission. The study employed predictive marginal effects over years&amp;regression analyses. RESULTS: In recent years, we noticed a decrease in the total number of Index Admissions for STEMI, declining from 508,179 (203 per 100,000 person-year) in 2016 to 457,790 (177 per 100,000 person-year) in 2021 (p trend = 0.001). The median age at index admission was 74.2 years (SD ± 13), with males accounting for 58.8%. Among readmitted patients, the average age was 69.4 years (SD ± 13.7), with males at 58.6%. The 30-day readmission rate has consistently decreased from 9.84% in 2016 to 7.97% in 2021 (p trend = 0.001). The mortality rates for both index admission and readmission have remained stable over the years at 3.14% and 3.15%, respectively, in 2016, and 3.0% and 2.9%, respectively, in 2021 (p trend = 0.4 and 0.1, respectively). The mean LOS for index admission has decreased from 3.8 days in 2016 to 3.5 days in 2021 (p trend = 0.001), with readmission LOS showing a similar decrease from 4.0 days in 2016 to 3.8 days in 2021 (p trend = 0.001). Additionally, the inflation-adjusted mean hospital costs have risen over the years, increasing from $23,758.4 in 2016 to $26,038 in 2021 for index admission (p trend = 0.001) and from $15,335.5 in 2016 to $17,662 in 2021 for readmission (p trend = 0.001). The R-MCD was acute coronary syndrome (25%) and heart failure (23%) CONCLUSION: We observed a decrease in the prevalence of STEMI, accompanied by a reduction in the 30-dRr during the study year. Despite stable index and readmission trend mortality outcomes, the LOS has progressively decreased with a rise in hospitalization costs. Further prospective studies are crucial for risk stratification to effectively guide mortality outcomes&amp;cost.
Abstract 4141644: Sex Differences in Rates of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention
Authors: Neil Zhang, Kyla Sherwood, Brian Claggett, Sanket Dhruva, Ashishdeep Sandhu, Susan Cheng, Joseph Ebinger
Journal: Circulation (2024)

Background: Previous studies have shown conflicting results regarding higher rates of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) among women as compared to men. We sought to identify covariates that explain possible sex differences in rates of CI-AKI after PCI. Methods: This was a retrospective observational cross-sectional study of all PCIs performed at Cedars-Sinai Medical Center from 2020-2023, sourced from the National Cardiovascular Data Registry. The primary outcome and regressor were CI-AKI and sex, respectively. Covariates were other patient demographics, comorbidities, procedural factors, and health insurance. We excluded patients with pre-PCI dialysis requirement or without pre/post-PCI creatinine. We used multivariable-adjusted logistic regression to evaluate rates of CI-AKI among women versus men. Using additive adjustment, we identified factors that accounted for the sex differences. Results: Of 2971 PCIs included, 820 (27.6%) were performed in women, 316 (10.6%) in Black patients and 283 (9.5%) in Hispanic patients. On average, women were older than men (73.9 vs 68.6 years, p&lt;0.001). Women had higher rates of anemia compared to men (19.8% vs 10.9%, p&lt;0.001). In bivariate analysis, women experienced more CI-AKI than men (15.0% vs 11.4%, p=0.008) with an odds ratio (OR) of 1.37. Additive adjustment with demographics reduced the OR of CI-AKI for women to 1.26, accounting for ~30% of the identified sex difference. Additional adjustment with both demographics and anemia yielded an OR for CI-AKI of 1.14, explaining ~60% of the sex difference. Adjustment with demographics and all comorbidities accounted for ~75% of the sex difference, with an OR for CI-AKI of 1.11. Further additive adjustment for procedural factors and insurance had negligible contributions. The sex difference was no longer significant after adjustment for demographics. Conclusion: Women undergoing PCI had higher rates of CI-AKI as compared to men, though this was no longer significant with multivariable analysis. The risk for CI-AKI for women over men was primarily contingent on demographics and comorbidities, with anemia accounting for a substantial proportion of this risk.
Abstract 4141673: Immunologic Insights: Activated and Exhausted Circulating T-Cell Phenotype in Hypoplastic Left Heart Syndrome (HLHS)
Authors: Yvonne Kumah, Anastacia Garcia, Jordan Abbott, Julie Lang, Stephanie Nakano
Journal: Circulation (2024)

Background: While staged surgical palliation for infants born with hypoplastic left heart syndrome (HLHS) has enabled many patients to survive a previously fatal condition, there is now a growing population of HLHS children and young adults who experience significant co-morbidities and mortality secondary to their palliated physiology. Abnormalities of the immune system, including T-cell lymphopenia, have been documented in HLHS patients. However, the impact of altered T-cell homeostasis remains ill-defined. Hypothesis: Both intrinsic and acquired alterations in T-cell sub-populations results in T-cell activation/exhaustion and a pro-inflammatory phenotype. Methods: Peripheral T-cell sub-populations and activation/inhibition markers were quantified in HLHS (n=32, median age 1.65 years, range 0-13.2 years) and healthy, pediatric controls (n=14, median age 4.55 years, range 0.2-15.1 years) by mass cytometry (Helios Cytometry Time Of Flight, CyTOF). Comparison between HLHS and controls was performed by unpaired t-test or Mann-Whitney, based on normality. Results: In HLHS subjects, circulating CD4 + and CD8 + populations are significantly decreased (p&lt;0.001) compared to control. The proportions of CD4 + HLA-DR + (p&lt;0.05) and CD8 + EOMES + (p&lt;0.01) T cells are increased in HLHS. HLHS CD8 + TC1 + populations are increased (p&lt;0.05) while HLHS CD8 + TC2 + (p&lt;0.05) populations are decreased compared to controls. Notably, there is an increase in CD4 + regulatory T cells in HLHS subjects (p&lt;0.001). Conclusions: Immunoprofiling of peripheral T-cell populations suggests that abnormalities extend beyond a decrease in T-cell numbers: HLHS T cells demonstrate an activated and exhausted phenotype, which may impact development of co-morbidities in this population. Additional investigations are required to delineate the functional consequences of this unique HLHS immunophenotype.
Abstract 4141230: Systemic Sirolimus Therapy is Associated with Reduced Intervention Frequency in Pediatric Pulmonary Vein Stenosis
Authors: Alyssa Kalustian, Joseph Hagan, Paige Brlecic, Ionela Iacobas, Rachel Vanderlaan, Joseph Burns, Thao Wu, Ravi Birla, Sharada Gowda, Manish Bansal, Srinath Gowda, Lindsay Eilers, Asra Khan, Juan Pablo Sandoval-Jones, Michiaki Imamura, Yishay Orr, Chris Caldarone, Athar Qureshi
Journal: Circulation (2024)

Background: Pediatric pulmonary vein stenosis (PVS) has a guarded prognosis and often necessitates repeated interventions. Small retrospective studies suggest benefits to adjunctive enteral systemic sirolimus therapy (SST) for PVS, including improved survival, slowed progression of in-stent stenosis, and reduced frequency of catheterization procedures. Hypothesis: We hypothesized patients undergo PVS interventions less frequently while receiving SST compared to pre-SST. Aims: The principal aim was to determine the impact of systemic sirolimus therapy on PVS intervention frequency. Methods: We retrospectively identified 45 patients treated at Texas Children’s Hospital who completed &gt;1 month of SST for PVS between 2015-2022. First course of SST was analyzed. Primary endpoint was PVS intervention frequency (number of surgical or transcatheter PVS interventions/year), calculated for two intervals per patient: pre-SST (PVS diagnosis until start of SST) and on-SST (start of SST until cessation or follow-up if no interruptions &gt;1 month). Generalized Poisson mixed linear models were fit to test the impact of SST on intervention frequency, accounting for paired intervals within each patient. A multivariable model also included age at interval start, PVS type (primary/post-repair), sex, prematurity, and concurrent antiproliferative medications. Mean cumulative functions were also compared. Results: Median per-patient PVS intervention rate (interventions/year) was 5 (IQR 2.3-10.6) pre-SST and 1.7 (0.8-2.8) on-SST. PVS intervention rate was significantly lower on-SST compared to pre-SST by the univariable and multivariable Poisson models (P&lt;.0001, both). Patients accrued an increased mean cumulative number of interventions over time pre-SST compared to on-SST (P&lt;.0001, Figure). Median duration of SST was 1.7 years and follow-up time from SST initiation was 2.7 years. There were 6 mortalities with 90% (95% CI 75-96%) Kaplan-Meier estimated survival 2 years from SST initiation. Conclusions: SST was associated with a reduction in PVS intervention frequency. Prospective studies are warranted to determine potential causality, delineate patient and vein-level outcomes, and determine optimal therapeutic duration.
Abstract 4141157: Associations Between In Vitro Fertilization and Cardiovascular Outcomes in the United States
Authors: Ravi Thakker, Ritika Saxena, Wissam Harmouch, Aiham Albaeni, Wissam Khalife, Martha Gulati, Danielle El Haddad, Diann Gaalema, Hani Jneid
Journal: Circulation (2024)

Introduction: Use of in vitro fertilization (IVF), assisted reproductive technology to treat infertility, has risen recently. However, research to date is inconclusive if IVF is associated with increase in cardiovascular disease. We therefore performed a large retrospective study, identifying major adverse cardiovascular and cerebrovascular (MACCE) events in those undergoing IVF. We hypothesize IVF to be associated with an increase in MACCE. Aims: To determine the association between IVF and MACCE. Method: We utilized the TriNetX database (64 healthcare organizations in the United States (US)) to identify women ≥18 years of age who had an IVF-assisted pregnancy. Primary outcomes included overall mortality, acute myocardial infarction (AMI), stroke, peripartum cardiomyopathy, cardiogenic shock, and arrhythmias from index of IVF therapy up to 5 years. We also performed a 1:1 propensity matched analysis of our cohort on 12 characteristics: hypertension, hyperlipidemia, heart failure, atrial fibrillation/flutter, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, body mass index, alcohol abuse, nicotine dependence, and social determinants of health. Results: A total of 35,468 patients met criteria for analysis. Mean age at index was 33.9±5.6 years in the IVF cohort vs 29.4±7.9 years in the non-IVF cohort. The predominant race undergoing IVF were White (71.3%) followed by Asian (5.7%), and Black (5.7%). IVF use was predominant in the Midwest US (44%), followed by the South (25%), West (16 %), and Northeast (14%). There were no statistically significant differences across the 12 baseline characteristics in the matched cohorts. IVF-assisted pregnancy was associated with a decrease in AMI (0.43% vs 0.63%, Risk Ratio (RR) 0.69 (0.56, 0.84)), stroke (0.95% vs 1.83%, RR 0.51 (0.45, 0.59), peripartum cardiomyopathy (0.05% vs 0.18%, RR 0.25 (0.15, 0.44)), and arrythmias (0.93% vs 1.44%, RR 0.65 (0.56, 0.74)). There were no statistically significant differences between cohorts in overall mortality (0.80% vs 0.87%, RR 0.93 (0.79, 1.09)) and cardiogenic shock (0.03% vs 0.03%. RR 1 (0.42, 2.40)). Conclusion: In this large retrospective study of IVF-assisted pregnancy, we found that IVF was not associated with an increase in MACCE. Geographical and racial differences exist in the utilization of IVF in the US which further need investigation, especially socioeconomic status, which may account for the findings in our study.
Abstract 4141269: Prescriber Implementation of Guideline-Directed Medical Therapy Remains Poor in the Peripheral Artery Disease Population
Authors: Caroline Minnick, Ashlee Stutsrim, Timothy Williams, William Downey, Matthew Edwards, Matthew Goldman
Journal: Circulation (2024)

Background: Peripheral Artery Disease (PAD) is one of the most prevalent forms of cardiovascular disease, with many progressing to CV morbidity/death. Adherence to guideline-directed optimal medical therapy (OMT) in PAD is vital. This study evaluated adherence to prescribing OMT in patients with PAD. Methods: A retrospective study of 3,471 patients with PAD between 2017 and 2022 undergoing vascular laboratory imaging was performed. OMT was defined by 2016 AHA guidelines. Adherence to guidelines was denoted by active prescriptions for antiplatelet and statin therapy. Presence of high-intensity OMT (HIOMT) was defined as prescriptions for an antiplatelet and high-intensity statin. Prevalence and incidence (change to OMT /HIOMT within 60 days of index vascular laboratory visit) of OMT were evaluated. Multivariable models were created evaluating predictors of OMT and HIOMT prevalence and incidence. Results: OMT prevalence was 45.3% while HIOMT prevalence was 23.6% at the time of index vascular laboratory. Incident OMT was 24.3% while incident HIOMT was 11.2% within 60 days. Age, min/max ABI, insurance status, smoking status, and comorbidities were associated with prevalent OMT/HIOMT (table 1). Age, gender, min/max ABI, smoking status, and HgbA1c were associated with incident HIOMT (table 2). In multivariable models, incident HIOMT was less likely in women (OR 0.7; 0.52-0.91) whereas lower ABIs were predictive of HIOMT (OR 0.6; 0.51-0.72). Conclusions: Despite clear guidelines regarding OMT in patients with atherosclerotic cardiovascular disease, in this real-world study of guideline directed prescription management of PAD, adherence to OMT remains low, especially for HIOMT. Predictors of incident HIOMT include lower ABI while females were less likely to be on HIOMT. Given the high prevalence of PAD, heterogeneity of caregivers, widespread availability of screening, this population should be targeted for better adherence to HIOMT to prevent CV morbidity and death.
Abstract 4141163: Blood Pressure in Adolescence and Stroke at a Young Age in 1.9 Million Males and Females
Authors: Boris Fishman, Adi Vinograd, Avishai M Tsur, Aya Bardugo, Cole Bendor, Carmit Libruder, Inbar Zucker, Miri Lutski, Amit Ram, Yael Hershkovitz, Omri Orr, Ariel Furer, Maxim Perelman, Gabriel Chodick, Gal Yaniv, David Tanne, Estela Derazne, Dorit Tzur, Arnon Afek, Josef Coresh, Ehud Grossman, gilad twig
Journal: Circulation (2024)

Background: The rising incidence of stroke among young adults is partly explained by underdiagnosis of risk factors such as hypertension. Current blood pressure cutoff values for hypertension diagnosis in adolescence are not based on cardiovascular outcomes and lack specificity for sex, even though female adolescents have lower blood pressure values. Methods: A nationwide, population-based, retrospective cohort study including data of all Israeli adolescents (16-19 years) who were evaluated prior to mandatory military service in 1985 through 2013. The medical evaluation included routine measurements of height, weight, and blood pressure. The primary outcome was the first occurrence of a stroke at a young age (≤52 years) as documented in the National Stroke Registry. Cox proportional hazard models were applied separately for males and females and adjusted for adolescent body mass index and sociodemographic variables. Diabetes status in adulthood, as documented in the National Diabetes Registry, was also accounted. Several sensitivity analyses were conducted, including the evaluation of ischemic stroke cases only as the outcome and stroke occurrence at a very young age (≤45 years). Results: The cohort comprised 1,897,048 adolescents (42.4% females). During 11,355,476 person-years of follow-up, there were 1,470 first stroke events, 1,233 (83.8%) cases were of ischemic etiology. In male adolescents, a diastolic blood pressure of ≥80 mmHg was associated with an adjusted hazard ratio (aHR) for stroke at a young age of 1.28 (95% confidence interval 1.05-1.58) (Image 1). In male adolescents with blood pressure of 70-79 mmHg, the aHR was comparable to that of the reference group (&lt;70 mmHg). The aHRs of female adolescents with a blood pressure of 70-79 mmHg and ≥80 mmHg were 1.40 (1.09-1.80) and 1.39 (1.03-1.88), respectively (Image 2). In the sub-analysis of ischemic stroke cases as the outcome, the aHRs were 1.63 (1.23-2.16) and 1.59 (1.14-2.22) for females with blood pressure of 70-79 mmHg and ≥80 mmHg, respectively. The results persisted in extensive sensitivity analysis (Image 1, Image 2). Adolescent systolic blood pressure of 120-129 mmHg or ≥130 mmHg compared to &lt;120 mmHg was not associated with the outcome in adolescents of both sexes. Conclusions: Diastolic blood pressure in adolescence was associated with stroke at a young age, with a lower cutoff level among females.
Abstract 4141618: Endothelium dependent and non-dependent effects of age and blood pressure on the progression of arterial stiffness in hypertension
Authors: Hiroki Nakano, Hirofumi Tomiyama, Kazuki Shiina, Junya Kani, Masatsune Fujii, Chisa Matsumoto, Akira Yamashina, Kazuhiro Satomi
Journal: Circulation (2024)

Background: Endothelial dysfunction affects arterial stiffness. While age and blood pressure are major determinants for the progression of arterial stiffness and both also affect endothelial dysfunction, it has not been clarified whether these factors affect arterial stiffness directly or mediated by endothelial dysfunction. Methods: Flow-mediated vasodilatation in Japan (FMD-J) study was a multicenter prospective observational study to examine the clinical significance of FMD in the management of cardiovascular diseases and their risk factors. In this study, FMD and brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, were repeatedly measured three times {i.e., baseline, 1.5 year’s and 3 years’ follow-up (1.5fol and 3fol)} in 617 subjects under anti-hypertensive medication. Results: In cross-sectional assessment at baseline, at 1.5fol and at 3fol, multiple linear regression analyses adjusted with covariates demonstrated that age and systolic blood pressure (SBP) were independently associated with baPWV. During the study period, baPWV was increased significantly (from 1621 ± 295 to 1626 ± 294 cm/s, P&lt;0.001). The study participants were divided into two groups by the median of age or by that of SBP at baseline. The baPWV at 3fol was higher in age over median and in SBP over median as compared to the group of those under median (1537 ± 278 vs. 1714 ± 282, P&lt;0.001, 1593 ± 297 vs. 1656 ± 288, P&lt;0.001). In multivariate longitudinal assessments, age and SBP at baseline were significantly associated with baPWV at 1.5fol (beta 0.412, P&lt;0.001 and beta 0.216, P&lt;0.001) and that at 3fol (beta 0.424, P&lt;0.001 and beta 0.115, P= 0.002), but not with FMD. Multivariate mediation analyses demonstrated that age and SBP at baseline were directly associated with baPWV at baseline, at 1.5fol and at 3fol, but no significate mediated effect of FMD was conformed at each study period. Conclusion: In subjects under anti-hypertensive medication, the progression of arterial stiffness may be accelerated along with age and also along with the elevation of SBP. In there, age and blood pressure may directly affect the progression of arterial stiffness without mediating endothelial dysfunction.
Abstract 4140722: Racial Disparity among the clinical outcomes in post Ablation Atrial Fibrillation patients: A Global Retrospective Study
Authors: Muhammad Hanif, Vikash Jaiswal, Jenish Bhandari, Junaid Ali, Usman Akbar, Sahana Devakumar, FNU Sundas, Hamza Yousaf, Arshan Khan, Rohan Kumar Ochani, Farah Yasmin, Sabeeh Islam, Sumi Singh, Mayank Jha, Debanik Chaudhuri
Journal: Circulation (2024)

Background: Racial disparities have been well described in cardiovascular disease. However, the impact of race on the outcomes post atrial fibrillation (AF) ablation is not well understood. Objective: This study aim to investigate the clinical outcomes post AF ablation among Black and White patients. Method: The TriNeTX Global Collaborative Network database was used to identify patients aged ≥18 years of age from January 2000 to April 2023 which included atrial fibrillation post-ablation patients. Patients were categorized into two groups, one with Black or African American race and another with White race groups. Both groups were followed for 12 months. We used the international Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify comorbidities, and ICD-10 Procedure coding system for procedures. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, BMI, smoking, hypertension, diabetes mellitus, chronic kidney disease, hemoglobin level and left ventricular ejection fraction. The primary outcome was all-cause mortality (ACM), while secondary outcomes were ischemic stroke, hemorrhagic stroke, acute myocardial infarction (AMI), MACE (composite of ACM, heart failure, AMI, and ischemic stroke) and heart failure (HF). Result: After 1:1 propensity score matching, the study cohort comprised 10, 335 Black patients and 10,335 White patients. The mean age of patients was comparable between both groups (65.2 and 64.9 years). Post ablation, Black patients were having a significantly higher risk of ACM (RR 1.131, 95% CI: 1.002-1.277), HF (RR 1.473, 95% CI: 1.290-1.683), AMI (RR 1.312, 95% CI: 1.117-1.342), and MACE (RR 1.416, 95% CI: 1.250-1.603) as compared with white population. However, the risk of ischemic stroke (RR 1.069, 95% CI: 0.878-1.301) and hemorrhagic stroke (RR 1.466, 95% CI: 0.908-2.369) were found comparable between Black and White patients post ablation. Conclusion: These findings suggest that Black patients post AF ablation were having a higher risk of mortality and MACE.