tbuckley/cabot-search huggingface dataset:
Abstract 4143739: Enhancing Care for Patients with ACS in Mexico: Impact of the Get With The Guidelines®-Coronary Artery Disease Mexico Project at the National Institute of Cardiology
Authors: Andrea Najera-Rojas, Mariana Robles-Ledesma, Manuel De Los Rios, Leslie Marisol Lugo Gavidia, Jose Luis Leiva, Luis Fernando De los ríos Arce, Rodrigo Gopar-Nieto, Jorge Daniel Sierra Lara Martinez, Héctor González Pacheco, Alexandra Arias-Mendoza, Diego Araiza
Journal: Circulation (2024)

Background: The GWTG initiative has improved global patient care. We introduced GWTG-CAD at Mexico’s largest referral center, the National Institute of Cardiology. This is an independent before/after quality analysis. Hypothesis: Implementing a standardized tool will improve ACS patient management and guideline-recommended therapies. Aims: To compare the center’s data before/after implementing the GWTG-CAD tool registry. Methods: Retrospective, comparative study of ACS patients either transferred from eight referring hospitals or arriving directly to our center. We compared two groups: admissions from July 2022-March 2023 ( before ) and April 2023-April 2024 ( after ). Continuous variables are presented as mean±standard deviation or median and interquartile range, based on their distribution. Data: A total of 473 patients, (202 in the before -period and 271 in the after -period). Age, gender, comorbidities and medical history were non-different between groups. The diagnoses included STEMI 73.2% vs. 58.1%, NSTEMI 23.3% vs. 38.8%, UA 3.4% vs. 2.9%. Symptom onset to first medical contact median time was 504(195-972 min) vs. 395(170-688 min), p=0.28. From the before -period, 32.2% underwent pPCI and 61.7% thrombolysis, vs. 46.2% and 42.9% in the after -period. Among all patients, the median time of arrival at referring hospital to PCI was 2,329(356-5142 min) during the before -period vs. 559(164-1702 min) in the after -period (p=0.002). Among STEMI transfers, the time of arrival at referring hospital to PCI was significantly lower (151[110-460] vs. 106[91-142] min, p=0.02). Among direct arrivals, door-to-balloon time was numerically, but not statistically lower (78.5[51-162] vs. 71[45-90] min, p=0.08). Prescription of guideline-recommended therapies from the before -period vs. after -period was DAPT (93.1% vs. 94.1%, p=0.68), ACEI/ARB (83.7% vs. 85.1%, p=0.68), BB (84.8% vs. 89.8%, p=0.10) and statins (97.3% vs. 95.3%, p=0.26). The overall survival rate was (95.5 vs. 97.4%). Conclusions: In this comparative study we observed a significant reduction of transfer to PCI times in all ACS patients after the implementation of the GWTG-CAD project. High prescription of guideline-recommended therapies at discharge were documented.
Abstract 4143665: Study of Prognostic Importance of Hyponatremia in the Acute Phase of ST Elevation Myocardial Infarction
Authors: Vaishnavi Rathod, Darshankumar Raval, Kristina Patel, Wiaam Elkhatib, Juhi Ramnani, Dr Amalkumar Bhattacharya
Journal: Circulation (2024)

Introduction: Hyponatremia is a common electrolyte abnormality that has been associated with poor outcomes in several conditions including acute myocardial infarction (AMI). However, those studies were performed in the era before percutaneous coronary intervention (PCI), focused mostly on ST-elevation myocardial infarction (STEMI), and sodium levels up to 72 h of admission. Aim: The purpose of this study was to identify the prognostic importance of hyponatremia in patients with acute myocardial infarction. Methods: We performed a cross sectional and retrospective analysis of 100 patients with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and STEMI presenting at PSH, Vadodara, Gujarat, India from January 2022 to May 2024. Our independent variables were sodium levels on the day of admission. Dependent variables were in-hospital mortality, 30-day mortality, length of hospital stay, intensive care admission, new heart failure diagnosis, and ejection fraction. Infarct size was determined by echocardiographic examination that was performed on admission, day 2 or 3 of hospitalization Results: Hyponatremia, defined as a plasma sodium level &lt;135 mmol/L (&lt;135 mEq/L). 32% of patients had hyponatremia up to 7 days of admission. Intensive care admission was higher in patients with hyponatremia up to7 days (70% vs 383%), they had worse 30-day mortality (15% vs to 3%), in hospital mortality (12% vs 2%), and new heart failure diagnosis (32% vs 16%). Hyponatremia on admission was associated with in-hospital mortality (15% vs 4%), 30-day mortality (19% vs 6 %). Conclusions: This study suggests that hyponatremia on admission and at any point during the first seven days of hospitalization are associated with in-hospital and 30-day mortality and prognosis worsens with the severity of hyponatremia. Further studies are required to determine if plasma sodium levels may serve as a simple marker to identify patients at high risk.
Abstract 4143745: Short- and Long-Term Outcomes of Antegrade versus Retrograde Approaches in Patients Undergoing Percutaneous Coronary Intervention for Chronic Total Occlusion: A Meta-Analysis
Authors: Aman Goyal, Rozi Khan, Muhammad Daoud Tariq, Haleema Qayyum Abbasi, Hritvik Jain, Samia Sulaiman, Esha Kadam, Wael AlJaroudi
Journal: Circulation (2024)

Background: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure to restore blood flow in completely occluded coronary arteries with the aim of improving symptoms and quality of life. While CTO-PCI success rates have increased owing to advancements in antegrade and retrograde techniques, the choice of approach remains crucial. The antegrade approach is often the initial method chosen because of its relative simplicity, whereas the retrograde approach is considered in more complex cases or when the antegrade approach fails. Aims: The data suggest that the retrograde approach is associated with higher periprocedural complications, although the reports are conflicting. Our meta-analysis aimed to compare the efficacy and safety of the antegrade and retrograde approaches for CTO-PCI. Methods: A comprehensive literature search was conducted on PubMed, Embase, Google Scholar, and Scopus from inception until June 5, 2024. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using Review Manager, with a p-value of &lt;0.05 considered significant. Random-effects models were used for all statistical analyses. Results: Twenty-two observational studies involving 49,152 CTO-PCI patients, with 35,844 and 13, 308 patients in the antegrade and retrograde arms, respectively, were included. The antegrade approach was associated with a significantly lower risk of in-hospital outcomes than the retrograde approach, including reduced mortality (RR=0.45, 95% CI: 0.28-0.72, p=0.0008), myocardial infarction (RR=0.37, 95% CI: 0.28-0.50, p&lt;0.00001), major adverse cardiovascular events (RR=0.34, 95% CI: 0.25-0.46, p&lt;0.00001), and cerebrovascular events (RR=0.50, 95% CI: 0.29-0.85, p=0.01) (Figure 1). In terms of long-term outcomes, both approaches had comparable risks for all-cause mortality (RR=0.71, 95% CI: 0.44-1.14, p=0.16) and myocardial infarction (RR=0.76, 95% CI: 0.38-1.52, p=0.44) (Figure 2). Conclusion: The antegrade approach is associated with significantly reduced risks of several in-hospital outcomes, but both approaches have comparable risks for long-term outcomes. Skillful and judicious use of the retrograde approach for CTO-PCI is recommended.
Abstract 4143604: Efficacy and Safety of Rivaroxaban Versus Low Molecular Weight Heparin for Treating Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis
Authors: Abhigan Shrestha, Nischal Mainali, Sajina Shrestha, Vikash Jaiswal, Kripa Rajak, Maha Hameed, Ravi Sankar Reddy Edara, ANIL KC
Journal: Circulation (2024)

Background: Rivaroxaban is a novel oral anticoagulant suggested as an alternative to low molecular weight heparin (LMWH). However, its efficacy and safety compared to LMWH for treating venous thromboembolism (VTE) in cancer patients remain unclear. Hypothesis: This study aims to compare the efficacy and safety of rivaroxaban against LMWH for treating VTE in cancer patients. Methods: We conducted a literature search for relevant articles on PubMed, Google Scholar, and Embase. Outcomes were pooled using the DerSimonian and Laird random-effects model as risk ratios (RR) with 95% confidence intervals (CI). A p-value of &lt;0.05 was considered statistically significant. Results: A total of 14368 cancer patients (Rivaroxaban: 4378 and LMWH: 9990) from 13 studies were included with an average age of 62.5 and 61.9 respectively. At 3 months, rivaroxaban was associated with a decreased risk of recurrent VTE (RR 0.73, 95% CI: 0.59, 0.86, p&lt;0.05) and bleeding-related hospitalization (RR 0.79, 95% CI: 0.61, 0.97, p&lt;0.05) with statistical signifcant whereas, major bleeding (RR 0.87, 95% CI: 0.09, 1.65), non-major bleeding (RR 0.84, 95% CI: 0.60, 1.08) and all-cause mortality (RR 0.91, 95% CI: 0.72, 1.09) were comparable. At 6 months, rivaroxaban was associated with a decreased risk of all-cause mortality (RR 0.80, 95% CI: 0.62, 0.97, p&lt;0.05), and bleeding-related hospitalization (RR 0.81, 95% CI: 0.65, 0.98, p&lt;0.05) whereas major bleeding (RR 0.88, 95% CI: 0.52, 1.24), non-major bleeding (RR 0.85, 95% CI: 0.42, 1.29) and recurrent VTE (RR 0.83, 95% CI: 0.64, 1.01) were comparable. At 12 months, rivaroxaban was associated with a decreased risk of mortality (RR 0.71, 95% CI: 0.50, 0.92, p&lt;0.05), however non-major bleeding (RR 1.38, 95% CI: 0.83, 1.94), cancer-associated thrombosis recurrence (RR 0.94, 95% CI: 0.73, 1.16), and bleeding (RR 0.70, 95% CI: 0.26, 1.15) were comparable. Conclusion: While rivaroxaban is associated with low adverse outcomes suggesting its use in treating VTE in cancer patients, further research is recommended.
Abstract 4143796: Inpatient Mortality Trend in Obese Versus Non-Obese Patients With Acute Coronary Syndrome: “An Obesity Paradox” – 15-Year Nationwide Sample Analysis
Authors: Zaid Abood, Tanvir Bajwa, Balamrit Sokhal, Kirsten Tunink, Mohamed Hommeida, Suhail Allaqaband, M. Fuad Jan
Journal: Circulation (2024)

Background: Obesity is endemic in the United States. Previous studies have reported an obesity paradox in mortality associated with acute coronary syndrome (ACS). However, percutaneous coronary intervention (PCI) and inpatient mortality trends over a long period of time in this group of patients remain unknown. Aim: To evaluate PCI and inpatient mortality trends among ACS patients with obesity over a 15-year period. Methods: We used the National Inpatient Sample from 2005 to 2019 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcomes were (1) the trend in PCI use among obese patients admitted for ACS and (2) in-hospital mortality trends in these patients compared to non-obese ACS patients treated with PCI. The secondary outcome was total hospital costs over the years. Results: We evaluated 9,259,932 patients hospitalized in the United States for ACS. Of those, 1,345,937 (14.5%) were obese. Obese patients were younger (mean age 61 years) and had a higher percentage of females (41.3%) compared to non-obese counterparts (mean age 68 years, P&lt;.001; 38.4% female, P&lt;.001). Overall mortality among the obese patients was lower than in non-obese patients (3.0% vs 5.6%, P&lt;.001). A total of 663,128 (49.2%) obese patients underwent PCI compared with 45% in the non-obese group (P&lt;.001). From 2005 to 2019, the number of PCI procedures in the obese group increased approximately threefold (Figure 1A). During this period, the mortality rates among obese patients with ACS treated with PCI increased from 2.0% in 2005 to 2.9% in 2019 (P&lt;.001), yet remained lower than those in the non-obese group, which experienced a slight decrease in mortality from 4.3% in 2005 to 3.8% in 2019 (P&lt;.001) (Figure 1B). Length of stay and total cost were relatively similar, around 3.8 days and $23,000, respectively, in both groups. Conclusion: Over the past 15 years, an increasing trend of PCI adoption has been observed in obese patients. In these PCI-treated obese patients, we observed lower mortality rates compared with their non-obese counterparts. This obesity paradox suggests a potential protective effect of obesity, warranting further research to understand the underlying pathophysiology to improve treatment strategies for this demographic.
Abstract 4143800: Behavioral Components of Cardiovascular Health and Their Determinants Among Medical Students at the University of Danang, Vietnam
Authors: Hoang Thi Nam Giang, Minh Hieu Le Tho, Truong Thi Anh Nguyet, Nguyen Nguyen Hung, Thanh-Huyen Vu
Journal: Circulation (2024)

Background: Although cardiovascular health (CVH), especially health behaviors among youth and young adults, has been well-studied in the United States, similar research is limited in Vietnam. This study assesses the prevalence of various CVH behaviors—including ideal sleep health (ISH), ideal body mass index (IBMI), ideal physical activity (IPA), and non-smoking status—and identifies factors associated with these behaviors among medical students at the University of Danang, Vietnam (UD). Methods: We used cross-sectional data from a health survey conducted in March-April 2024, targeting all medical students at UD (Years 1-6) with a 98% response rate. Definitions of CVH behaviors were detailed in the Table's footnotes. Multivariable logistic regression was employed for analysis. Demographic information, depression and anxiety levels, other lifestyle factors, and living environment conditions were included in the models. Differences in determinants by sex were also examined. Results: Among 510 students (mean age 21.9 years; 51.4% female), 27.1% reported ISH, 19.8% achieved IPA, 61.2% had IBMI, 17.3% were underweight, and 96.3% were non-smokers. Multivariable regression indicated that age, anxiety levels, noise at night, and uncomfortable sleep space were associated with lower odds of ISH; odds ratios (95% confidence intervals) were 0.78 (0.68, 0.88), 0.99 (0.87, 0.99), 0.55 (0.35, 0.89), and 0.26 (0.11, 0.64), respectively. For other ideal behaviors, compared to males, females were significantly less likely to achieve IPA but more likely to have IBMI and be non-smokers (see Table). In gender-stratified analyses, working for pay was positively associated with IPA for females but negatively for males. Among females, better academic achievement was linked to a lower likelihood of IPA. Male students with less gaming time were more likely to be non-smokers. Conclusion: Ideal sleep health, BMI, and physical activity levels are low, while non-smoking rate is high among medical students in Danang, Vietnam. Key determinants of sleep health include age, mental health, and living environments. Factors such as working for pay, academic achievement, and time spent gaming link to other CVH behaviors differently for males and females. More comprehensive studies on cardiovascular health in Vietnamese college students are needed to identify effective interventions for improving cardiovascular health in the young adult population of this developing country.
Abstract 4143707: Subclinical Coronary Plaque and Atherosclerotic Cardiovascular Disease Events among Overweight Men and Women: A Multi-Cohort Study
Authors: Helena Tizon-Marcos, Mahmoud Al Rifai, Carolina Pappalettere, Michael Blaha, Jaume Marrugat, Olga Castaner, Khurram Nasir, Mouaz Al-Mallah, Raimund Erbel, Andreas Stang, Karl Jöckel, Nils Lehmann, Sara Schramm, Boerge Schmidt, Paul Poirier, Miguel Cainzos Achirica
Journal: Circulation (2024)

Introduction: The population of men and women who are overweight (defined as a BMI 25-29.9 kg/m 2 ) continues to grow at fast pace. The prevalence and prognostic implications of a high coronary artery calcium (CAC) score in this group are poorly defined. Aims: Using a multiethnic cohort of men and women, we compared the ASCVD event-risk at follow up in normal weight, overweight, and obese individuals, overall and further stratified by CAC scores. Methods: Individual-level pooled analysis of participants from MESA, JHS, HNR, and FHS free of ASCVD at baseline and in whom CAC and BMI data were available. Participants with BMI &lt;18.5 kg/m 2 were excluded. CAC was categorized as =0, 1-99, and ≥100 Agatston Units. The primary outcome was ASCVD events during follow-up, comprising fatal and non-fatal coronary heart disease and stroke events. Results: A total of 14,740 participants were included. The BMI was distributed as follows: BMI &lt;25 kg/m 2 : 27.4%, BMI 25-29.9 kg/m 2 : 40.0%, BMI 30-34.9 kg/m 2 : 20.8%, BMI &gt;=35 kg/m 2 : 11.8%. Among overweight participants, 52% had CAC&gt;0, and 22% had CAC≥100 (17% prevalence among individuals with normal weight). The distribution of CAC by BMI categories is presented in the Figure. The incidence of ASCVD events among overweight participants was: 3.8 per 1000 person-years for those with CAC=0, 8.1 for CAC&gt;0 - &lt;=99, and 20.7 for CAC≥100. In regression analyses, compared to BMI 18.5-25 kg/m 2 individuals (reference group), the adjusted HR of ASCVD events for overweight participants with CAC≥100 was higher than that for unselected obese participants (Figure). A sub-analysis restricted to participants free of prediabetes and diabetes yielded similar trends, with the combination overweight+high CAC score being associated with a higher ASCVD risk than those with obesity. Conclusions: The ASCVD risk of overweight people with CAC≥100 is higher than that observed among individuals with BMI≥30 kg/m 2 . Overweight individuals with high CAC scores comprise relatively frequent and high-risk group, which may benefit from systematic detection and aggressive risk-reduction interventions.
Abstract 4143737: Intravascular Ultrasound Guided Versus Coronary Angiography Guided Complex Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials
Authors: Yasmeen Shaikh, Tasleem Shaikh, Abdul Moeed, Farah Yasmin, Aman Goyal, Fatima Raza, mahboob alam
Journal: Circulation (2024)

Background: Randomized controlled trials (RCTs) examining the efficacy of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) when compared with coronary angiography (CA)-guided PCI, for complex coronary artery disease, have produced varied findings. We aim to provide conclusive evidence by pooling all RCTs, including the latest IVUS-ACS trial, on the clinical outcomes of IVUS- and CA-guided complex PCI. Methods: MEDLINE, Scopus, and EMBASE were queried from inception till June 2024 for RCTs comparing IVUS and CA in patients undergoing complex PCI for lesions defined as type B2/C according to the American College of Cardiology/American Heart Association guidelines of classification of coronary lesions. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction (MI), or ischemia-driven repeat revascularization. Secondary outcomes were cardiac death, MI, probable/definite stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), and post-procedural minimal lumen diameter (MLD). A random-effects meta-analysis was performed to derive risk ratios (RR) and mean differences (MD) and their corresponding 95% confidence intervals (CI). Results: This meta-analysis included 11 RCTs with a total of 9,828 patients (5,037 in IVUS and 4,791 in CA) with a mean age of 63.8 years. IVUS-guided PCI was associated with significantly lower MACE (RR 0.59; 95% CI 0.51–0.68, p&lt;0.00001) than CA. Similarly, patients in the IVUS group were significantly associated with a reduced risk of cardiac death (RR 0.47; 95% CI 0.29–0.73), MI (RR 0.77; 95% CI 0.60–0.99), TLR (RR 0.58; 95% CI 0.45–0.75), and TVR (RR 0.54; 95% CI 0.41–0.71). IVUS was also significantly associated with a greater MLD (MD 0.09; 95% CI 0.05–0.13) when compared with CA. However, no significant association could be ascertained in all-cause death (RR 0.66; 95% CI 0.40–1.10) and ST (RR 0.59; 95% CI 0.34–1.01). All outcomes reported non-significant heterogeneity and no publication bias was evident upon Egger’s regression (p=0.12). Conclusion: Patients undergoing complex PCI with IVUS showed significantly lower MACE, cardiac death, MI, TLR, and TVR while having a greater MLD when compared with CA-guided PCI.
Abstract 4143581: Dipeptidyl Peptidase 4 Inhibitor Linagliptin Improves Cardiac Function, Fibrosis and Apoptosis in a Swine Model of Chronic Myocardial Ischemia
Authors: Dwight Harris, Christopher Stone, Mark Broadwin, Meghamsh Kanuparthy, Sharif Sabe, Ju-Woo Nho, Jad Hamze, Ruhul Abid, Frank Sellke
Journal: Circulation (2024)

Introduction: Interest is increasing in using novel diabetic medications, such as GLP-1 receptor agonists, to manage coronary artery disease. Dipeptidyl peptidase-4 (DPP-4) inhibitors enhance GLP-1 activity through the same pathway as GLP-1 agonists; however, DPP-4 inhibitors have not been fully evaluated in the setting of ischemic heart disease. We chose to study the DPP-4 inhibitor linagliptin (LIN) in a swine model of chronic myocardial ischemia (CMI). Goals: Study the effect of DPP-4 inhibitor LIN in a clinically relevant swine model of CMI to gain insight into potential therapies for patients with myocardial ischemia. Methods: Seventeen Yorkshire swine underwent left thoracotomy and ameroid constrictor placement on the left coronary circumflex (LCx) at age 11 weeks. Two weeks later, swine received either vehicle without drug (CON, n=9, F=4, M=5) or LIN 2.5 mg (n=8, F=5, M=3). After 5 weeks of treatment, swine underwent terminal harvest. Results: LIN significantly increased cardiac output, stroke volume, ischemic myocardial perfusion at rest, ischemic myocardial perfusion while pacing at 150 beats per minute, and ejection fraction, while decreasing tau (all p&lt;0.05). Trichrome staining showed a marked reduction in ischemic myocardial interstitial and perivascular fibrosis, accompanied by decreased levels of transforming growth factor beta (all p&lt;0.05). Apoptosis, measured by TUNEL, was significantly reduced, along with decreases in apoptosis-inducing factor, Caspase-9, BAD, and cleaved Caspase-9 (all p&lt;0.05). Additionally, there were significant increases in PI3K, phospho-AKT, AMPK, phospho-AMPK, and ENOS, and a significant reduction in collagen 18 and angiostatin (all p&lt;0.05). There were no significant changes in heart rate, arteriolar density, capillary density, or total oxidative stress. Conclusion: LIN significantly improved myocardial function and perfusion, likely due to reduced fibrosis and apoptosis. The increased perfusion, independent of vascular density, suggests enhanced vascular reactivity. These benefits in a high-fidelity large animal model of CMI warrant further investigation of LIN to fully understand its potential as a therapy for ischemic heart disease.