tbuckley/cabot-search huggingface dataset:
Abstract 15447: The Association of Maternal Statin Use During Pregnancy to Perinatal Outcomes
Authors: Heidi T May, Viet T Le, Tami L Bair, Joseph B Muhlestein, Kirk U Knowlton, Brianna S Ronnow, Stacey Knight, Jeffrey L Anderson
Journal: Circulation (2023)

Introduction: Statins are used to treat those with hyperlipidemia and at high risk for a cardiovascular event, including women of childbearing potential. Traditionally, statins have been contraindicated during pregnancy because of a theoretical risk of teratogenicity. The FDA removed the black box warning for usage during pregnancy in 2021and recent observational studies have reported a relatively safe profile of statin use during pregnancy. However, ongoing evidence is needed because of the small samples and limited data available. Therefore, the objective of this study is to report perinatal outcomes of statin use during pregnancy. Methods: Patients taking a statin while pregnant were matched 1:10 to non-statin pregnant patients by age (±1 years), date of delivery (±2 years), hypertension, diabetes, and smoking history. All patients were &gt; 18 years of age and received prenatal and delivery care between 1997 and 2021 at Intermountain Health, a system of 24 hospitals and 215 clinics in Utah, Idaho, and Nevada. Data for this study utilized electronic health records stored in Intermountain’s data warehouse. Results: A total of 57 statin-user pregnancies were well-matched to 570 non-statin user pregnancies (Table 1). No significant differences were found between the groups for miscarriage, pre-term delivery, preclampsia/eclampsia, and congenital anomalies (Table 2). Mean length of statin use prior to pregnancy was 1.3±2.5 years. Among those without miscarriages, 59.6% discontinued statin use, with a mean length of use while pregnant before discontinuation being 5 months. Conclusions: This study suggests that statin use while pregnant may be safe with no congenital anomalies being found. However, ongoing surveillance is needed because of the small sample size of statin users that can make it difficult to detect associations.
Abstract 13589: Prophylactic Anticoagulation to Prevent Left Ventricular Thrombus Following Myocardial Infarction: A Systematic Review and Meta-Analysis
Authors: Ethan Sacoransky, Danny Yu Jia Ke, Bryce Alexander, Wael Abuzeid
Journal: Circulation (2023)

Introduction: Left ventricular thrombus (LVT) complicates an estimated 12% of anterior STEMI. The current standard of care for STEMI patients includes primary PCI and dual antiplatelet therapy (DAPT). Guidelines from the American Heart Association recommend consideration of prophylactic anticoagulation to prevent LVT in select high-risk patients following STEMI. These guidelines have a low certainty of evidence (level C), with most studies published prior to the current era of primary PCI and DAPT. Therefore, an updated review is needed in this area. Methods: Electronic databases, including EMBASE, MEDLINE and CENTRAL were systematically searched from January 2012 to June 2022. We included primary studies that used PCI as the lone revascularization strategy for STEMI. Studies were included if they compared the incidence of LVT in patients receiving prophylactic anticoagulation and DAPT with those receiving DAPT alone. Results: 7,378 studies were screened, with 4 studies eventually included in this review. One study was a randomized control trial and three were retrospective cohort studies. Pooled analysis using a fixed-effects model showed LVT was significantly less common in the triple therapy (TT) group compared to the DAPT group (OR = 0.38; 95% CI = 0.17-0.86; p = 0.02). However, using a random-effects model, there was no significant difference in LVT between the TT and DAPT group (OR = 0.42; 95% CI = 0.04-4.67; p = 0.33). Conclusions: Based on the current state of knowledge, there is no compelling evidence to either support or oppose prophylactic anticoagulation in STEMI. An appropriately powered clinical trial is warranted due to the need for more robust data in this area.
Abstract 348: Machine Learning Approaches for Early Outcome Risk Stratification Within 6 Hours of Cardiac Arrest
Authors: Qingchu Jin, Richard R Riker, Hunter Williams, Teresa May, David B Seder, Raimond L Winslow
Journal: Circulation (2023)

Background: Formal prognostication should be delayed at least 72 hours after cardiac arrest, but early stratification of risk severity provides important information for medical decision making, research enrollment, and precision medicine. Hypothesis: EEG-derived indices are valid biomarkers of severity of injury after cardiac arrest and contribute to early identification of risk. Aims: To assess the relative impact of early clinical data and processed EEG indices in the first 6 hours after recovery of spontaneous circulation (ROSC). Methods: Data from the first 6 hours after ROSC in the International Cardiac Arrest Registry (INTCAR) from Maine Medical Center including demographics, cardiac arrest data, admission vital signs and laboratory results and processed EEG indices at 6 hours after ROSC (bispectral index or BIS6 and suppression ratio or SR6) were extracted. Cerebral Performance Category (CPC) scores at hospital discharge and 6-month follow-up were dichotomized into good (CPC = 1-2) and poor (CPC = 3-5) outcomes. Three models were trained, one with INTCAR data, a second with EEG data, and the third combining INTCAR and BIS6-SR6. Six machine learning algorithms were applied: Catboost, random forest, Xgboost, Adaboost, support vector machine and logistic regression. Variable importance was analyzed by the decrease of impurity of random forest. Results: Among 913 included patients, median age was 59 years (95%CI 23-85), 623 (68%) were male, initial rhythm was shockable in 405 (44%) patients, and average time to ROSC was 23 (95%CI 3 - 73) minutes. Survival to hospital discharge occurred in 41% (364/893), and poor outcome occurred in 72.7% at 6-month follow-up (607/835). For CPC at discharge, area-under-the curve (AUC) was 0.85 for the combined INTCAR and EEG data, greater than INTCAR (AUC = 0.80) or EEG (AUC = 0.77). For the CPC at follow-up, the AUC was 0.88 for the combined data, greater than INTCAR (AUC = 0.83) or EEG (AUC = 0.79). Variable ranking analysis showed that BIS6 and SR6 were the two most informative features for both outcomes. Conclusions: The processed EEG variables BIS6 and SR6 significantly contribute to risk identification in the first 6 hours after ROSC, and combined with early clinical data provide reliable risk stratification.
Abstract 359: Temporal Trends in Perioperative Cardiac Arrest Rates Following Transcatheter Aortic Valve Replacement
Authors: Steven Imburgio, Hira Akhlaq, Anmol Johal, Viraaj Pannu, Ndausung Udongwo, Matthew Saybolt, Daniel Kiss, Joseph Heaton
Journal: Circulation (2023)

Introduction: Transcatheter aortic valve replacement (TAVR) procedural volume has continued to increase over the past decade, coinciding with expanded indications by the Food and Drug Administration. Despite advancements in TAVR safety, serious procedure-related complications including cardiac arrest are still a concern. Aims: This study aims to investigate temporal trends of in-hospital cardiac arrest rates and clinical outcomes following TAVR. Methods: In this large-scale, retrospective cohort study, admitted patients with a primary or secondary diagnosis of nonrheumatic aortic stenosis who underwent TAVR were identified from 2016 to 2020 using the National Readmissions Database. Diagnoses and procedures were classified using the International Classification of Diseases, 10th edition codes. The primary outcome was temporal trends in the rates of cardiac arrest with cardiopulmonary resuscitation during the perioperative period. Secondary endpoints assessed annual discharge survival rates and 30-day readmissions. Results: Of 31,621 total TAVR procedures, perioperative cardiac arrest occurred in 1.8% (n = 579) of cases. Baseline characteristics are described in Table 1. No statistically significant change in perioperative cardiac arrest rates was observed from 2016 to 2020 (p = 0.674). The average annual discharge survival rate was 97.7% which did not change significantly over the 5-year study period (p = 0.551). From 2016 to 2020, 30-day readmissions decreased from 13.6% to 10.1%, respectively (p = 0.028). Conclusion: While perioperative cardiac arrest is associated with high mortality, it still remains a relatively rare complication as operators have become more experienced and valve device technology has improved. An overwhelming majority of TAVR patients are successfully being discharged with improved rates of 30-day readmissions observed over recent years, indicating potential improvements in postoperative care.
Abstract 18561: Trends Among Patients Undergoing Transvenous Lead Extraction: A Single Center Experience
Authors: Muhammad Talha Ayub, Don Mathew, Konstantinos Aronis, Krishna Kancharla, Aditya Bhonsale, Floyd W Thoma, Andrew Voigt, Sandeep Jain, Nathan A Estes, Samir Saba, Alaa Shalaby
Journal: Circulation (2023)

Background: In recent years there has been an increase in cardiac device-related infections and the need for transvenous lead extraction (TLE). Limited data exist on secular trends in baseline characteristics and outcome measures among patients undergoing this high-risk procedure. Objective: To examine secular trends in baseline characteristics and outcomes for patients undergoing lead extraction procedure at our institution. Methods: We conducted a retrospective chart review of patients undergoing TLE from 2010 to 2021, at a tertiary academic institution. Patients were divided into three epochs (2010-2013, 2014-2017 and 2018-2021). Baseline characteristics in hospital length of stay (LOS) and survival were compared between groups. Results: A total of 794 patients, with a mean age of 64±16 years, were analyzed. 481 (60%) patients had infection as the indication for TLE. On average, 2 ± 1 leads were extracted per patient. The longest lead dwell time was 6.5 ± 4.8 years. Significant progressive increase in baseline comorbidity over time is noted (Table 1). A concomitant increase in infection indication versus lead management was also noted. There was a significant increase in the median hospital LOS across epochs; 3.88 IQR (1.26-10.06) for epoch 1 vs 7.34 IQR (2.25-13.35) for epoch 2, vs 9.06 IQR (5.78-14.05) for epoch 3 (P &lt; 0.0001). While there was no difference in long term survival curves (log rank p =0.4), between group analysis showed higher risk for 30 day [RR 2.24(1.08-4.66) p=0.0306] and 1 year mortality [RR 1.44 (1.004-2.05) p=0.0478] between epoch 3 vs epoch 1. Conclusion: Across epochs, the number of TLE procedures performed decreased while patient morbidity increased with a notable increase in infection indication for the procedure. This corresponded to a progressive increase in hospital LOS and an emergent signal toward increased near-term mortality.
Abstract 168: Circulating Blood Neutrophils Are the Main Source of Plasma Nampt After Cardiac Arrest
Authors: Xiangdong Zhu, Jing Li, Shaoxia Lin, Terry L Vanden Hoek
Journal: Circulation (2023)

Introduction: Nampt functions as a novel extracellular damage-associated molecular pattern. It has been shown to be released from many cell types including neutrophils, adipocytes, and hepatocytes. In a mouse model of cardiac arrest, increased plasma Nampt correlates with inflammation, cardiovascular dysfunction and poor survival. However, the source of plasma Nampt after cardiac arrest is unknown. Hypothesis: We hypothesize that plasma Nampt is released from blood neutrophils. Methods: Circulating blood neutrophils from C57/BL6 mice were depleted by intraperitoneal injection of 500 μg murinized Ly-6G (1A8) antibody. 48 hours later, mice were subjected to 8 min KCl-induced cardiac arrest followed by resuscitation. Saline-treated mice served as the control group. Blood neutrophil counts were measured at 48 h after injection. Plasma NAMPT concentration at 4 h post-resuscitation was measured by ELISA. Results: Ly-6G antibody induces a nearly complete depletion of blood neutrophils at 48 h after injection. Neutrophil counts were 1.17 ± 0.07 for saline control mice and 0.12 ± 0.01 (10 6 /ml) for Ly-6G treated mice (p &lt; 0.01). Plasma eNampt concentrations at 4h post-ROSC were significantly lower in Ly-6G treated mice compared to control mice. Plasma concentration of NAMPT decreased from 12.67 ± 0.39 ng/ml for saline-treated mice to 5.34 ± 1.41 ng/ml for Ly-6G treated mice (p &lt; 0.01). Conclusion: Circulating blood neutrophils are sufficiently depleted by Ly-6G antibody, and neutrophils are the major contributor to plasma NAMPT during cardiac arrest. The study of neutrophil depletion on post-resuscitation inflammatory cytokine and mouse survival is ongoing.
Abstract 265: Sex-Based Differences in Clinical Outcomes of Out-of-Hospital Cardiac Arrest Patients
Authors: Steven Imburgio, Abbas Alshami, Vandan Upadhyaya, Sowmya Dandu, Sydney Zolezi, Claudia Ramirez, Palak Patel, Joseph Varon
Journal: Circulation (2023)

Introduction: Historically, studies have shown lower overall survival rates for women following out of hospital cardiac arrests (OHCA). Despite advancements in resuscitation care over recent years, it is not clear if sex-based differences in inpatient mortality and postresuscitation outcomes have improved. Aims: We aim to investigate if gender disparities still exist in the clinical outcomes of OHCA patients. Methods: A national cohort of patients primarily hospitalized for cardiac arrest was identified using the 2019 National Inpatient Sample database. The study cohort was divided into male and female populations. The primary outcome was inpatient mortality. Secondary endpoints assessed length of stay and discharge to home rates (as a surrogate to functional status on discharge). Results: A total of 28,890 admissions were identified during the study period. Of them, 63.6% (n = 18,365) were males and 36.4% (n = 10,510) were females. The overall unadjusted inpatient mortality rate was 52.2% (n = 15,065) and was lower in females than males [48% (n = 5,040) vs 54.6% (n = 10,025), p &lt; 0.001]. However, after adjusting for potential confounders in Table 1, the female sex was associated with higher adjusted inpatient mortality (aOR 1.085, 95% CI 1.023-1.150, p = 0.007). The average LOS for those who survived to hospital discharge was 5.0 days (IQR 2-10) and was similar between both groups (p = 0.703). Of those who survived to hospital discharge, disposition to home was significantly higher in males (49.3%, n = 4,940) than in females (41.3%, n = 2,080), (p &lt; 0.001). Conclusions: Female sex remains an independent predictor of inpatient mortality in patients admitted with OHCA. Discharge to home after successful resuscitation was lower in females than males, suggestive of worsened functional status on discharge.
Abstract 13023: Trends and Disparities in Cardiovascular Deaths in Non-Hodgkin Lymphoma: A Population-Based Retrospective Study in the United States From 1999 to 2020
Authors: Min Choon Tan, Yong Hao Yeo, Ramzi Ibrahim, Min Xuan Tan, Justin Lee, Abhishek Deshmukh, Avirup Guha
Journal: Circulation (2023)

Background: Non-Hodgkin lymphoma (NHL) survivors are at increased risks of cardiovascular disease related death (CVD) compared to the general population. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVD with comorbid NHL by race, sex, and geographic location. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients aged 18 and above from 1999 to 2020. Patients were identified when the primary causes of death were ischemic heart diseases (ICD 10 I20-I25), cerebrovascular diseases (I60-I69), or hypertensive disease (I10-I15), and NHL (C82-C85) was a contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint regression program. Results: In the 22-year study period, a total of 22,778 CVD with comorbid NHL were identified. Overall, there was a significant decrease in annual trends for the AAMRs of CVD from 6.91 per 1,000,000 individuals in 1999 to 4.12 per 1,000,000 individuals in 2020 (p&lt;0.05), with an annual percent decrease of 3.3. Overall, men recorded a higher AAMRs compared to women (6.76 vs 3.45, p&lt;0.05). When stratified by race, White individuals had the highest AAMRs (5.07), while the AAMRs for American African, Asian, American Indian individuals were 3.01, 2.77, and 2.48 per 1,000,000 individuals respectively. The AAMRs were higher in the rural region than in the urban region (4.97 vs 4.78, p&lt;0.05). Among all consensus regions, South region had the highest AAMRs. Conclusion: In conclusion, our study revealed a significant decrease in cardiovascular disease related deaths with comorbid NHL over the past two decades. It provides valuable insights into the effectiveness of management of comorbid CVD or CVD risk factors in patients with NHL.
Abstract 11582: The Fingertip Artery is Better Than the Brachial Artery in Evaluating Vascular Endothelial Function for Coronary Artery Disease in Diabetic Patients
Authors: Ueda Tomohiro
Journal: Circulation (2023)

Introduction: Several studies demonstrated that endothelial function is impaired in diabetic patients, but no study evaluated vascular parameters in diabetic patients trough a combined analysis of macro and micro-endothelial function. In addition, the difference in vascular parameters between diabetes patients with coronary artery disease (CAD) and without CAD remains unknown. We assessed whether CAD is related to macro or micro vascular endothelial function in diabetic patients. Hypothesis: We measured vascular function in 219 diabetic patients (age 68±10 years), including 147 patients with CAD (CAD group) and 72 patients without CAD (control group). Flow mediated vasodilatation (FMD)indicating macro-endothelial function in the brachial artery was measured by ultrasound using a semi-automatic device: UNEXEF18G (UNEX Co. Nagoya, Japan). Reactive hyperemia index (RHI) indicating micro-endothelial function in the fingertip artery was measured by peripheral arterial tonometry (EndoPAT 2000). Vascular function tests were measured on the same day. Results: RHI was significantly impaired in CAD group (RHI: 2.0±0.7 vs.1.7±0.5 P=0.012), however FMD had no deference in the two groups. Logistic regression analysis revealed that RHI (odds ratio: 0.44, 95% confidence interval: 0.21-0.94) was an independent predictor for CAD in diabetic patients. Conclusions: RHI, an acknowledged marker of micro-endothelial function was a more sensitive method than FMD in evaluating the risk assessment of CAD in diabetic patients. more peripheral vascular endothelial function was associated with CAD in diabetic patients.
Abstract 14084: Empagliflozin in Hospitalized Patients With Heart Failure
Authors: Tania Ahuja, Joshua Park, Purnata Anwar, thomas caraccio, Justine Lachmann, Shelley Brejt, Tyler Webster, Gregory Katz, Raymond A Pashun, Albert Jung
Journal: Circulation (2023)

Introduction: The sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as part of guideline-directed medication therapy (GDMT) for those with heart failure (HF) and New York Heart Associated (NYHA) class II-IV symptoms. The 2022 AHA/ACC/HFSA HF guidelines recommend SGLT2i in those with HF and reduced ejection fraction (HFrEF), and to consider in those with mid-range or preserved ejection fraction (HFmrEF and HFpEF). Hypothesis: We aimed to evaluate the initiation of empagliflozin in patients hospitalized with HF to prove tolerability over other GDMT and continuation at discharge. Methods: This was a multi-center, retrospective review of empagliflozin initiation at 2 campuses of the same health system (NYU Langone Hospital-Long Island and NYU Langone Health) from November 2021 -October 2022. We included patients &gt; 18 years of age with HF that received empagliflozin during hospitalization. Data collection included patient characteristics, empagliflozin dose, ejection fraction (EF), BNP, estimated glomerular filtration rate, and other GDMT including beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor/neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was empagliflozin initiation per EF. Secondary outcomes included evaluation of GDMT and continuation of therapies at discharge. Results: In total 434 medical records were reviewed, with 244 patients continued empagliflozin from home and 190 new initiations. When evaluated by EF, 73% of empagliflozin initiation occurred in patients with HFrEF, 22% in HFpEF and 5% in HFmrEF. The median age was 68 years (60-78), with a median BMI of 28 (24-34), and 64% were male. Concomitant GDMT included BB in 56%, ACEi/ARB in 33%, ARNI in 12%, MRA in 14% and loop diuretics in 48% of patients. The majority of these patients (87%) were able to continue empagliflozin at discharge. Out of the 13% that did not continue empagliflozin, the most common reason for discontinuation was lack of insurance coverage. Conclusions: Empagliflozin was safely initiated in patients hospitalized with a HF exacerbation and led to greater tolerability over other GDMT at hospital discharge.
Abstract 130: Sex Differences in Survival Outcomes of OHCA Patients With Adjustment of In-Hospital Managements With Sex Disparities
Authors: Sejoong Ahn, Woosik Kim, Hyunju Kim, Bo-Yeong Jin, Sukyo Lee, Kim Sung Jin, Hanjin Cho, Sungwoo Moon, Sung Joon Park, youngduck cho, Jong-Hak Park
Journal: Circulation (2023)

Introduction: Recently, our group reported that sex differences in in-hospital management such as coronary angiography, and percutaneous coronary intervention exist. Therefore, this study aimed to determine sex differences in survival outcomes of out-of-hospital cardiac arrest (OHCA) after adjusting prehospital and in-hospital variables. Methods: This is a retrospective observational study using prospective multicenter registry, Korean Cardiac Arrest Research Consortium. Adult OHCA patients between October 2015 and December 2021 were included. Primary outcome was survival to discharge. Multivariable logistic regression analyses were performed after adjusting prehospital and in-hospital variables. Results: Total 10879 adult OHCA patients were analyzed. Survival to discharge and good neurologic outcomes at discharge were lower in women than men (9.4% vs. 16.6%, p&lt;0.001 and 5.6% vs. 11.8%, p&lt;0.001, respectively). After adjustment of prehospital and in-hospital variables (coronary angiography, percutaneous coronary intervention, targeted temperature management and extracorporeal membrane oxygenation), women were more likely to survive to discharge and have good neurologic outcome than men (adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 1.02-1.43, p=0.033 and aOR 1.48, 95% CI 1.18-1.85, p&lt;0.001, respectively). The sex difference in survival to discharge pronounced in age from 45 to 74, and the sex difference in good neurologic outcome pronounced in age from 45 to 84. Conclusion: After adjusting prehospital and in-hospital variables, women with OHCA were more likely to survive to discharge and have good neurologic outcome than men.