History Of Coronary Artery Disease Research Articles

Clinical and biochemical factors associated with amygdalar metabolic activity

We investigated clinical factors and biochemical markers associated with amygdalar metabolic activity evaluated by [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) in 346 subjects without a history of malignant neoplasms. Univariate regression analysis revealed significant relationships between amygdalar metabolic activity and fasting plasma glucose (FPG), glycated hemoglobin, coronary artery disease (CAD) history, aspirin use, oral hypoglycemic agents (OHAs) use, and asymmetric dimethylarginine (ADMA). In multiple stepwise regression analysis, FPG and CAD history were independently associated with amygdalar metabolic activity. Moreover, in 36 patients with type 2 diabetes mellitus (T2DM), additional OHAs treatment significantly improved glycemic and metabolic parameters, and decreased ADMA concentrations. Baseline and Δpigment epithelium-derived factor (PEDF), a marker of insulin resistance, was a significant associate with Δamygdalar metabolic activity. Our study demonstrates that FPG and CAD history were independently associated with amygdalar metabolic activity in subjects without a history of malignant neoplasms. In T2DM patients, PEDF might regulate amygdala metabolic activity.

Socioeconomic inequality in hypertension and its determinants in people over 60 years in Fasa, southern Iran: a Blinder-Oaxaca decomposition

BackgroundHypertension (HTN) is well-known as a major risk factor for various noncommunicable diseases. Evidence indicates a link between socioeconomic status and the likelihood of developing HTN. A thorough comprehension of the inequalities in HTN is crucial for implementing evidence-based interventions. This study aimed to assess the socioeconomic disparities in HTN among people aged 60 and older in Fasa County, located in southern Iran.MethodsA total of 1,632 seniors, aged 60 and above, were included in the analysis, with data obtained from the Fasa Adults Cohort Study (FACS). Initially, we utilized both simple and multiple logistic regression models to investigate the associations between HTN and the determinant variables. The Blinder‒Oaxaca decomposition method was used to decompose the disparity between the impoverished and the wealthy.ResultsThe research indicated that elderly individuals with a higher risk of developing HTN were notably linked to factors such as socioeconomic status, education level, a history of coronary artery disease, employment status, smoking habits, body mass index (BMI), waist‒hip ratio (WHR), and physical activity (p < 0.05). The decomposition model revealed a significant gap in HTN rate between rich and poor individuals, with those in the lower income bracket having a 7.59% higher rate of HTN (p = 0.001). Additionally, the leading factors contributing to the greatest disparities in HTN among older adults from different socioeconomic backgrounds include education level (33.07%), employment status (12.78%), BMI (12.25%), physical activity (-15.02%), and WHR (-9.22%).ConclusionsThe decomposition model illustrated a significant disparity in HTN rates among various socioeconomic groups, with a higher rate observed in the lower-income demographic. The analysis revealed that a substantial part of the explained gap can be attributed to factors including education level, employment status, WHR, BMI, and level of physical activity. Nonetheless, a considerable portion of HTN inequality among older adults remains unexplained by the model, highlighting the necessity for additional research that includes a wider variety of factors and variables to gain a deeper insight into the root causes of these disparities.

Osimertinib induced cardiac failure and atrial flutter in a patient with advanced pulmonary adenocarcinoma: A case report and review of the literature

&lt;b&gt;Background: &lt;/b&gt;Osimertinib-induced cardiotoxicity is a significant but rare condition. This article reports a case of an elderly patient who developed cardiac failure and atrial flutter due to Osimertinib treatment, potentially related to both the drug and the patient’s underlying factors.&lt;br /&gt; &lt;b&gt;Case presentation:&lt;/b&gt; A 63-year-old man diagnosed with advanced non-small cell lung cancer (NSCLC) with bone metastasis was found to have an epidermal growth factor receptor mutation (exon 19 deletion). He had undergone four prior treatment regimens, including afatinib and bevacizumab. After two years, he developed resistance and experienced brain and bone metastases, prompting a switch to Osimertinib (80 mg/day). Before starting Osimertinib, he had a history of coronary artery disease and hypertension, with a normal electrocardiogram (ECG) and a left ventricular ejection fraction (LVEF) of 53%. However, nearly two months after initiating Osimertinib, he was presented with cardiac failure symptoms, with LVEF decreasing to &amp;lt;53% and atrial flutter observed on ECG. Suspecting drug-induced cardiotoxicity, Osimertinib was discontinued. Following cessation of the drug, his cardiac function improved, and the ECG abnormalities resolved. This case represents the first reported instance of concurrent cardiac failure and atrial flutter associated with Osimertinib treatment.&lt;br /&gt; &lt;b&gt;Conclusions: &lt;/b&gt;As Osimertinib continues to significantly enhance survival in NSCLC, there remains a need for active monitoring of cardiac adverse events in patients undergoing Osimertinib treatment. These events can be life-threatening but are usually reversible after discontinuation of the drug.

Efficacy and Safety of Finerenone Across the Ejection Fraction Spectrum in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of the FINEARTS-HF Trial.

The effects of treatments for heart failure (HF) may vary among patients according to left ventricular ejection fraction (LVEF). In FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure), the nonsteroidal mineralocorticoid receptor antagonist finerenone reduced the risk of cardiovascular death and total worsening HF events in patients with HF with mildly reduced or preserved ejection fraction. We examined the effect of finerenone according to LVEF in FINEARTS-HF. FINEARTS-HF was a randomized, placebo-controlled trial examining the efficacy and safety of finerenone in patients with HF and LVEF ≥40%. The treatment effect of finerenone was examined in prespecified analyses according to LVEF categories (<50%, ≥50% to <60%, and ≥60%) and with LVEF as a continuous variable. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death. Baseline LVEF data were available for 5993 of the 6001 participants in FINEARTS-HF. Mean and median LVEF were 53±8% and 53% (interquartile range, 46%-58%), respectively. LVEF was <50% in 2172 (36%), between 50% and <60% in 2674 (45%), and ≥60% in 1147 (19%). Patients with higher LVEF were older, were more commonly female, were less likely to have a history of coronary artery disease, and more frequently had a history of hypertension and chronic kidney disease compared with those with a lower LVEF. Finerenone reduced the risk of cardiovascular death and total HF events consistently across LVEF categories (LVEF <50% rate ratio, 0.84 [95% CI, 0.68-1.03]; LVEF ≥50% to <60% rate ratio, 0.80 [0.66-0.97]; and LVEF ≥60% rate ratio, 0.94 [0.70-1.25]; Pinteraction=0.70). There was no modification of the benefit of finerenone across the range of LVEF when analyzed as a continuous variable (Pinteraction=0.28). There was a similar consistent effect of finerenone on reducing the total number of worsening HF events (continuous Pinteraction=0.26). In patients with HF with mildly reduced or preserved ejection fraction, finerenone reduced the risk of cardiovascular death and worsening HF events, irrespective of LVEF. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04435626. URL: https://eudract.ema.europa.eu; Unique identifier: 2020-000306-29.

Diagnostic accuracy of low-dose myocardial perfusion imaging in a real-world setting.

This large-scale study analyzes factors affecting the diagnostic accuracy of low-dose myocardial perfusion imaging and correlation with coronary angiography in a real-world practice. We compared data extracted from routine reports of (i) low-dose [99mTc]sestamibi stress-MPI performed with no attenuation correction and predominantly exercise stress testing and (ii) the corresponding coronary angiography. We considered 1070 pairs of coronary angiography/stress-MPI results reported by 11 physicians. Mean MPI effective dose was 4.5±2.1mSv. The extent of MPI-ischemia was predictive of >70% but not 50%-70% coronary stenoses. A positive test was associated with a sensitivity of 74.7% (413/553) and a specificity of 53.2% (275/517) for >70% stenosis detection. Positive predictive values were lower in patients with left bundle branch block or pacemakers (LBBB/PM) (45.6% vs 64.7%, P=.006) and markedly higher for patients with MPI-ischemia ≥3 segments or associated with ST-segment depression (75.0% (165/220)) as compared to those with <3 segments MPI-ischemia, MPI-infarction or isolated ST-segment depression (57% (248.0/435), P<.001). Negative predictive values were lower for patients with previous coronary artery disease (CAD) history (58.3%), male (61.0%), and elderly patients (59.6%) (vs 72.1%, 79.2%, and 72.4%, respectively, all P<.05). Routine results from low-dose stress-MPI, predominantly associated with exercise stress testing and uncorrected for attenuation, correlate with real-world coronary angiography results. However, this correlation is lower than that achieved with conventional study designs and affected by the definition of significant CAD and context variables (LBBB/PM, CAD history, sex, and age). Better consideration of these interacting factors could improve patient monitoring.

Elevated lipoprotein(a) is independently associated with the presence of significant coronary stenosis in de-novo patients with stable chest pain.

The role of lipoprotein(a) (Lp(a)) in the risk-assessment of patients with de-novo stable chest pain is sparsely investigated. We assessed the association between Lp(a) concentration and the presence of coronary stenosis on coronary computed tomography (CT) angiography in a broad population of patients referred with stable chest pain. Lp(a) measurements and coronary CT angiography were performed in 4,346 patients with stable chest pain and no previous history of coronary artery disease. The patients were included in the trial program, the Danish study of Non-Invasive testing in Coronary artery disease, Dan-NICAD. The prevalence and odds ratios for stenosis were calculated comparing normal Lp(a) (< 20 nmol/l) with moderately elevated (20 to <125 nmol/l), high (125 to <200 nmol/l), and very high (≥200 nmol/l) Lp(a) concentrations in both univariate and multivariate analyses. In total, 2,418 (55.6%), 1,276 (29.4%), 425 (9.8%), and 227 (5.2%) patients had normal, moderately elevated, high, and very high Lp(a) levels, respectively. The prevalences of coronary stenosis increased with increasing Lp(a) concentration (n = 569 (23.5%), n = 328 (25.7%), n = 129 (30.4%), and n = 77 (33.9%) in patients with normal, moderately elevated, high, and very high Lp(a), respectively). Likewise, the prevalence of patients with multivessel disease increased with increasing Lp(a) concentration (n = 252 (10.4%), n = 149 (11.7%), n = 61 (14.4%), and n = 41 (18.1%) in patients with normal, moderately elevated, high, and very high Lp(a), respectively). In an unadjusted model, odds ratios for stenosis increased with increasing Lp(a) concentrations (odds ratio (95% CI): 1.12 (0.96-1.31), 1.42 (1.13-1.77), and 1.67 (1.24-2.22) for moderately elevated, high, and very high Lp(a) versus normal Lp(a), respectively). Adjustment for age, sex, and cardiovascular risk factors did not affect the association. In stable, symptomatic patients without established coronary artery disease, Lp(a) levels are positively associated with the presence of coronary stenosis on coronary CT angiography. These findings may warrant using Lp(a) in the diagnostic management of patient with suspected coronary artery disease. The three studies within the Dan-NICAD program are registered on ClinicalTrials.gov: Dan-NICAD, NCT02264717, https://clinicaltrials.gov/study/NCT02264717?term=dan-nicad&rank=1. Dan-NICAD 2, NCT03481712, https://clinicaltrials.gov/study/NCT03481712?term=dan-nicad&rank=3. Dan-NICAD 3, NCT04707859, https://clinicaltrials.gov/study/NCT04707859?term=dan-nicad&rank=2.

Rate of Perceived Exertion Based on Repetitions in Reserve Versus Percentage of One-Repetition Maximum for Resistance Training Prescription in Cardiac Rehabilitation: A Pilot Study.

The aims of this study were to assess the efficacy of the rate of perceived exertion (RPE) scale based on the number of repetitions in reserve (RIR) before exhaustion for the prescription of resistance training in cardiac rehabilitation and to compare it to the percentage of estimated one-repetition maximum (1RM) prescription method. Sixteen male patients (age 60 ± 8) with history of coronary artery disease were randomly assigned to two resistance training rehabilitation protocols lasting nine weeks and consisting of three sessions per week, with the same exercise selection, number of sets and repetitions, and rest periods, but different load prescription method (RPE vs. %1RM). Patients' strength was evaluated pre- and post-intervention. Patients in the RPE group showed significant increases in strength across all the exercises of the protocol (leg press 24.25 ± 17.07 kg; chest press 7.25 ± 3.41 kg; seated row 13.88 ± 7.57 kg; leg extension 14.24 ± 4.53 kg; shoulder press 5.75 ± 4.06 kg; lat pulldown 7.50 ± 4.66 kg). Post-intervention between-group analysis showed no differences in strength gains (leg press p = 0.955; chest press p = 0.965; seated row p = 0.763; leg extension p = 0.565; shoulder press p = 0.868; lat pulldown p = 0.780) and trivial effect sizes (ES) for one prescription method over the other (leg press ES = -0.03; chest press ES = 0.00; seated row ES = 0.10; leg extension ES = -0.29; shoulder press ES = 0.18; lat pulldown ES = 0.05). RPE based on RIR seems to be an effective prescription method for resistance training in cardiac rehabilitation, showing similar efficacy to the standardized practice of percentage of 1RM.

In-hospital outcomes of acute aortic occlusion treated by endovascular intervention: A single center study

Background Endovascular intervention by means of thrombolysis is emerging as a promising management of Acute Aortic Occlusion (AAO). This study aims to evaluate the outcomes of endovascular thrombectomy for AAO cases in a single-center tertiary hospital in Indonesia. Methods We review retrospectively AAO patients treated by Rheolytic thrombectomy ± stenting or TEVAR at our referral center from 2011 to 2024. Clinical characteristics and outcomes were analyzed independently and in correlation to one another. Result Out of 21 episodes in 19 patients, AAO was correlated with thromboembolism in 57.1 %, in situ thrombosis in 23.8%, and malperfusion syndrome in 19% of patients. Most prevalent comorbidities found were coronary arterial disease, hypertension, heart failure, and atrial fibrillation. Method of revascularization were Rheolytic thrombectomy (12), covered stent (5), catheter-directed thrombolysis (2), and TEVAR (4) with an average 90.9% success rate. In-hospital mortality was 21% and did not vary significantly according to etiology (thromboembolism 30% vs in situ thrombosis 20%) except for malperfusion syndrome 0% which comprised of four patients. All fatality occurred among patients with history of coronary artery disease and one failed revascularization case required urgent amputation (5.3%). Average length of stay was 8.67 ± 5.31 days. Conclusion Based on our data, thromboembolism remained highly associated with occurrence of AAO. Endovascular approach by Rheolytic thrombectomy is proven to be comparable or slightly superior in restoring occluded aorto-iliac connection compared to conventional management options. Compared to previous studies, this study establishes a wider representation of AAO cases treated by endovascular means considering the rarity of cases.

Predicting severe multivessel coronary artery disease to guide access strategy in patients undergoing invasive coronary angiography.

Given radial artery conduits are increasingly utilized for coronary artery bypass grafting (CABG), avoiding transradial access (TRA) for invasive coronary angiography (ICA) may benefit patients who ultimately undergo CABG. We sought to predict the likelihood of severe multivessel disease (MVD) before ICA to guide this decision. This was a single-center study of 1485 patients with stable symptoms who underwent ICA. A model to predict severe MVD was developed. Relative importance analyses were performed to identify clinical characteristics most associated with the presence or absence of severe MVD. When predicting severe MVD, the model had a sensitivity of 70.3% and specificity of 71.8% (area under the curve = 0.7105). With a prevalence of 12.5% in our cohort, the model had a strong negative predictive value of 94.4%. Relative importance analyses showed factors most associated with the presence of severe MVD were a history of abnormal noninvasive tests, typical chest pain, aspirin use, insulin-dependent diabetes, increasing age, and a family history of coronary artery disease. Conversely, the absence of severe MVD was most associated with female sex, undergoing ICA as workup for either noncardiac or valve surgery, lung disease, atypical chest pain, and increased BMI. Clinical information available before ICA can risk stratify the likelihood of severe MVD and therefore aid in identifying patients that may need CABG and could stand to benefit from TRA avoidance. The potential benefits of maximizing radial artery conduit availability by avoiding TRA must be balanced against the risks of alternative access on an individual patient basis.

The VEGFA rs2010963 Gene Polymorphism Is a Potential Genetic Risk Factor for Myocardial Infarction in Slovenian Subjects with Type 2 Diabetes Mellitus.

Coronary artery disease (CAD) is a life-threatening condition caused by the chronic gradual narrowing of the lumen of the blood vessels of the heart by atherosclerotic plaque with a strong genetic component. The aim of our study was to investigate the association between the VEGFA polymorphism rs2010963 and myocardial infarction in patients with type 2 diabetes, as well as the expression of VEGFA. A total of 1589 unrelated Caucasians with T2DM lasting longer than 10 years were divided into two groups: case group subjects with MI (484) and a control group without a history of CAD (1105). A total of 25 endarterectomy sequesters were immunohistochemically stained to assess VEGFA expression. The rs2010963 polymorphism of the VEGFA gene was genotyped using a KBioscience Ltd. competitive allele-specific fluorescence-based PCR (KASPar) assay. The C allele was significantly more common in the case group according to the dominant model of inheritance (CC + CG vs. GG) (OR: 1.32; 95% CI: 1.05-1.66; p = 0.0197). A statistically significantly higher numerical areal density of VEGFA-positive cells was found in subjects with the C allele (CC + CG genotypes) in comparison to the GG genotype (117 ± 35/mm2 vs. 58 ± 21/mm2; p < 0.001). To conclude, the rs2010963 polymorphism is a potential genetic risk factor for myocardial infarction in Slovenian patients with T2DM.

Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study.

Exercise improves cardiovascular health, but high-volume high-intensity exercise is associated with increased coronary artery atherosclerosis and calcification (CAC). We aimed to identify predictors of CAC in athletes. We assessed the association of traditional and non-traditional cardiovascular risk factors with CAC using linear and logistic regression. 289 male athletes from the MARC-2 study were included, with a median age of 60 [Q1-3 56-66] years, lifelong weekly training load of 26 [17-35] MET-hours, BMI of 24.5 [22.9-26.6] kg/m2, systolic blood pressure of 139±18 mmHg, and reported 0.0 [0.0-8.0] smoking pack years. Thirty-one percent had a CAC score >100 and 13% >400. Among traditional cardiovascular risk factors, higher age, systolic blood pressure, smoking pack years, and family history of coronary artery disease independently predicted greater CAC scores, while body mass index, LDL cholesterol, and diabetes mellitus did not. Among non-traditional risk factors, higher training loads, serum phosphate, and lower adjusted energy intake and fat percentage of energy intake independently predicted greater CAC scores. The full model with all traditional and non-traditional risk factors had higher accuracy in predicting CAC>100 (ROC-AUC 0.76, 95%CI [0.70-0.82]) and CAC>400 (0.85 [0.77-0.92]) than traditional cardiovascular risk factors alone (0.72 [0.65-0.78], p=0.012, and 0.81 [0.74-0.90], p=0.038, respectively). Non-traditional risk factors, including training load, dietary patterns, and serum phosphate, were independently associated with CAC in aging male athletes. Prediction accuracy for CAC increased when including these variables in a prediction model with traditional risk factors.

Efficacy of Low-Density Lipoprotein Cholesterol Apheresis in the Treatment of Familial Hypercholesterolemia: Single Center Experience.

Familial hypercholesterolemia (FH) is a genetic disorder associated with extremely high levels of low-density lipoprotein cholesterol (LDL-C) and increased incidence of cardiovascular disease. We aimed to evaluate the efficacy and long-term outcomes of lipoprotein apheresis (LA) in the treatment of FH. Cardiovascular events that occurred before and after LA treatment were evaluated by reviewing previous medical records of patients with FH. Thirteen patients (female/male: 8/5) were included in this study. The mean Dutch score was 20±4. All patients were treated with a combination of statin and ezetimibe. Before the onset of LA, 8 patients had a history of coronary artery disease, and the median age at onset of cardiovascular disease (CVD) in these patients was 24 years. At the initiation of LA, the median age was 22 years and the mean LDL-C level was 410±130 mg/dL. The mean duration of LA treatment was 13.9±6.9 years. The mean LDL-C levels before and after the latest three LA treatments were 267±63.4 and 71.5±23.4 mg/dL, respectively. The mean reduction in LDL-C levels after LA was 73±8.2%. De novo cardiovascular events occurred in 10 patients during LA treatment; six of these patients had a known history of CVD before LA. Eight of these patients underwent invasive procedures for therapeutic purposes and the total number of procedures was 12. LA is an effective method of reducing LDL-C levels and an additional treatment option that may slow disease progression in patients with FH who are at high risk of cardiovascular events.

Retrospective Study on Short-Term Reverse Cardiac Remodeling in Obese Patients Undergoing Sleeve Gastrectomy.

Severe obesity is closely associated with an increased risk of comorbidities and alterations in cardiac structure and function. The primary objective of this study was to investigate cardiovascular (CV) risk factors and ventricular remodeling in individuals from an obese population eligible for bariatric surgery. The secondary objective was to evaluate changes in anthropometric, clinical laboratory, and echocardiographic measurements 12 weeks after surgery compared to baseline values. This retrospective observational cohort study involved patients from a single specialized bariatric surgery center. A total of 35 patients were included (mean age 41.5 ± 10.3 years; BMI 43.4 ± 6.6 kg/m2), of whom 34.2% had a family history of coronary artery disease (CAD), 5.7% had a prior history of CAD, 8 had essential hypertension, 11.4% had dyslipidemia, 20% were smokers, and 8.6% were former smokers. Approximately 57% of the patients exhibited concentric left ventricular remodeling, and 14% had grade I diastolic dysfunction. At 12 weeks post-surgery, with an average weight loss of 25 kg and a mean BMI reduction of 8.5 kg/m2, 14% of the patients still exhibited concentric left ventricular remodeling, and about 11% had grade I diastolic dysfunction. Bariatric surgery contributes to the improvement of cardiac function and structure over time as a result of significant weight loss.

Trends, risk factors, and outcomes of selective screening for abdominal aortic aneurysms in at-risk patients.

For men ages 65 to 75 years without a smoking history and for women ages 65 to 75 years with a smoking history, the United States Preventative Service Task Force recommends that primary care providers (PCPs) use their clinical judgement when offering abdominal aortic aneurysm (AAA) screening. This study describes the trends in screening for these cohorts, identifies factors that may influence screening rates, and compares outcomes between screened and unscreened patients. The TriNetX population database was queried for subjects with routine PCP visit between ages 65 to 75 from 2007 to 2023 to create cohorts of male smokers, male nonsmokers, and female smokers. Prevalence and 1- and 3-year incidences of AAA screening by ultrasound and computed tomography scans and magnetic resonance imaging (CT/MRI) were calculated. Screened and unscreened patients' demographics, diagnoses, and medications were compared. Rates of AAA diagnosis and repair were compared between unmatched screened and unscreened patients. Screening for all groups peaked in 2023. Male smokers had the highest screening prevalence (21.2%), followed by male nonsmokers (3.1%) and female smokers (0.90%). The 1-year incidence of screening increased for male smokers, peaking at 8.2% in 2021. The 1-year incidence plateaued at 1.9% for male nonsmokers in 2020 and remained between 0.25% and 0.35% for female smokers for the whole observation period. By 2023, 23.6%, 14.3%, and 24.3% of male smokers, male nonsmokers, and female smokers had been screened via CT/MRI, respectively, with CT/MRI comprising the majority of screening events for all three cohorts. Hyperlipidemia and statin use were associated with screening for all groups (P<.05), whereas a personal history of coronary artery disease was associated with no screening. Screening for male nonsmokers was associated with hypertension, diabetes, and chronic pulmonary obstructive disease (P< .05). Screening in female smokers was associated with family history of coronary artery disease (odds ratio, 1.50; P< .001). For all groups, screening was associated with unruptured AAA diagnosis and endovascular aortic repair (P< .05). Screened female smokers had similar rates of AAA diagnosis as male nonsmokers (4.58% and 4.37%, respectively). AAA screening in all at-risk populations increases diagnosis and treatment of AAA, but the screening rate is low for all groups, even with increasing CT/MRI use. Patients with strong risk factors for AAA are not undergoing screening. Collaboration with PCPs is necessary to increase screening rates and ensure that patients with the most clinically consequential risk factors are managed appropriately.

Impact of Anemia and Acquired Anemia on in-Hospital Mortality of Acute Coronary Syndrome Patients.

To investigate the associations of anemia-related parameters, with in-hospital mortality after acute coronary syndrome (ACS), as well as factors associated with prior anemia (PA) and hospital-acquired anemia (HAA) in patients with ACS. This was a retrospective cohort study conducted between June 2021 and May 2023. The data of patients diagnosed with ACS who were hospitalized and treated in our hospital were recorded, including age and sex, smoking and comorbidity status, laboratory findings, CHA2DS2-VASc scores, prior medication use, left ventricular ejection fraction, ACS type, the synergy between percutaneous intervention with taxus drug-eluting stents and cardiac surgery (SYNTAX) scores, stent thrombosis status and mortality status. Mortality was assessed according to in-hospital death. Patients were grouped based on anemia presence (PA and HAA). A total of 329 patients were included in the study. Of these, 219 (66.56%) were in the no anemia group, 58 (17.63%) in the PA group, and 52 (15.81%) in the HAA group. The mean age of all participants was 61.27±12.45 years and 76.29% of them were male. 14 (4.26%) patients died during hospitalization. Multivariable logistic regression analysis had revealed that, prior coronary artery disease (OR: 3.779, 95% CI: 1.141-12.508, p=0.030), PA (OR: 7.043, 95% CI: 1.574-31.517, p = 0.011), HAA (OR: 5.857, 95% CI: 1.260-27.236, p=0.024) and high WBC (OR: 1.190, 95% CI: 1.028-1.378, p=0.020) were independently associated with the increased risk of in-hospital mortality. Consequently, the risk of in-hospital mortality is higher in patients with a previous history of coronary artery disease, PA, HAA and high WBC, and additional precautions should be taken in these patients.

Coronary artery calcification severity in long term breast cancer survivors treated with isolated contemporary radiotherapy: Relation to dose and CV risk factors.

Ancillary breast cancer (BC) radiation therapy (RT), particularly associated with chemotherapy, increases the risk of coronary artery disease (CAD). However, it remains unclear whether this risk also applies to isolated contemporary radiotherapy without chemotherapy. Seventy-five BC patients (35 left-sided and 40 right-sided) treated with RT and available dosimetry, prospectively underwent Agatston calcium score (CAC) and coronary CT angiography (CTCA) a median of 11±1 years later and were compared to 75 age- and cardiovascular (CV) risk factor-matched female controls without a history of cancer. BC patients and controls had similar ages (62±7 vs. 61±7 years, p=0.63), CV risk factors and estimated Score2/OP risk (3.8% IQR 2.6-6 vs. 3.3% IQR 2.3-5.4, p=0.52). CAC scores (0 IQR 0-79 vs. 0 IQR 0-34, p=0.62) and age-predicted percentile CAC scores (p=0.61) were similar between BC patients and controls, with no significant difference between left- and right-sided RT. Multivariable analysis revealed that CAC scores in BC patients were predicted only by a family history of CAD and by Score-2/OP risk, but not by cardiac radiation exposure. By CTCA 68% of BC patients had no or very mild coronary disease, and only 14% had more than moderate stenosis (>50%), which was predicted by CAC scores>79 (AUC=0.97). Eleven years post-treatment with isolated contemporary RT for BC, patients exhibited similar CAC severity as age- and risk factor-matched controls. CAC was associated only with CV risk factors, but not radiation dose, suggesting contemporary RT for BC is not linked to higher subclinical CAD prevalence.

Клінічна характеристика пацієнтів похилого віку з ураженням основного стовбура лівої коронарної артерії

​The​ ​aim – to analyze the clinical features of elderly patients with left main coronary artery disease (CAD).Materials and methods. This prospective cohort study included 124 patients with left main CAD aged 60 to 75 years (elderly age group) and 100 control patients aged 44 to 60 who underwent coronary angiography between September 2021 and July 2024. Demographic data, history of coronary artery disease and associated diseases, laboratory test results, results of echocardiography and coronary angiography were collected and analyzed. Results. Elderly patients were characterized by a significantly higher (p = 0.030) frequency of myocardial infarction, as well as higher (p = 0.035) frequency of previous percutaneous coronary interventions compared to middle-aged patients. Elderly patients also had a significantly higher functional class according to NYHA compared to middle-aged patients (p = 0.0005), significantly higher rate of arterial hypertension (p = 0.012), diabetes mellitus (p = 0.033), cerebrovascular disease (p = 0.009), chronic kidney disease (p = 0.011) and anemia (p = 0.044), compared to middle-aged patients. Moreover, elderly patients were characterized by significantly higher creatinine, LDL and glucose levels.Conclusions. Elderly patients with left main CAD were characterized by a more severe course of the disease, more severe coronary lesions, and a higher frequency of concomitant cardiac and non-cardiac diseases compared to middle-aged patients.

Self-efficacy, Knowledge and Outcomes Expectations Foot Self-care among Diabetic Patients with High-Risk Feet in Jordan

Background: Patients with high-risk feet and diabetes are prone to develop diabetes-related foot ulcers (DFUs). To prevent DFUs and their costs and impacts on diabetes mellitus (DM) patients’ productivity and quality of life, patients’ foot self-care (FSC) practices are essential to screen for DFUs. Our study aimed to assess the self-efficacy and outcome expectations about FSC and evaluate the knowledge about DFUs among patients with DM in Jordan. Methods: A cross-sectional study was conducted with DM patients who attended two diabetes clinical centers in Jordan in the period from October 2022 to April 2023 in which data were collected through a self-administered questionnaire developed to assess patients’ understanding of DFUs, foot care outcomes expectations (FCOE), and self-efficacy about FSC. Results: The final sample included data from 107 patients. Patient awareness of DFUs and FCOE was good, and the level of self-efficacy for FSC was moderate to high. Multiple linear regression revealed that age was negatively associated with lower self-efficacy for FSC (β = -0.22, p = 0.03) and both confidence (self-efficacy) in FSC and living arrangements (i.e., living with family) were positively associated with higher FCOE (β = 0.19, p = 0.04 and β = 0.39, p &lt;0.001, respectively). Diagnosis of renal failure, diagnosis of retinopathy, elevated levels of glycated hemoglobin, and the settings in which the patient is receiving care for DM were positively associated with an understanding of DFUs. Both age and history of heart attacks and coronary artery disease were negatively associated with realizing DFUs (β = -0.26, p = 0.007, and β = -0.18, p = 0.045, respectively). Conclusion: Patients with diabetes mellitus in Jordan have good FCOE, good awareness of DFUs, and a moderate degree of self-efficacy to execute FSC. Health education and self-efficacy programs should focus on older adults with a history of heart attacks to boost their understanding of DFUs and raise their sense of self-efficacy around FSC.

Association of Oncogene Driver Mutations with Recurrence and Survival in Stage I Non-small Cell Lung Cancer

Stage I nonsmall cell lung cancer (NSCLC) is primarily treated with surgical resection and has a favorable prognosis with an expected recurrence rate of 30%. New methods to risk stratify patients with stage I NSCLC are needed to help select those that might benefit from more active surveillance or adjuvant therapy. We analyzed clinical data from 1330 patients (1469 tumors) with NSCLC and correlated it with next-generation sequencing (NGS). To reduce the potential confounding variables of stage and treatment, this analysis only included patients with stage I NSCLC in whom surgical resection was the primary treatment. In 570 patients (600 tumors), 75 (12.5%) developed recurrence. Recurrence occurred in 37.5% of patients with KRAS G12V mutation versus 11.1% of patients without this mutation (P < .001). A lower chance of recurrence was associated with "any EGFR" mutation (6.74% vs. 14.9%, P = .006). A history of coronary artery disease (CAD) increased the chance of recurrence: OR 2.7 (1.57-4.89, P < .001). Shorter survival was predicted by KRAS G12V (P = .009) and "other TP53" mutation (P = .025). KRAS G12V, KRAS G13D, MET E168D, PTEN, and "other TP53" were oncogene mutations associated with reduced survival in stage I NSCLC. CAD, type 2 diabetes (DM2), and "other cancer" were medical comorbidities associated with reduced survival in stage I NSCLC. Oncogene mutations such as KRAS G12V and EGFR may have implications for cancer surveillance strategies and inform future treatment trials of stage I NSCLC.

Abstract Su1205: The Effect of Targeted Temperature Management on Five-Year Mortality in Comatose Out-of-Hospital Cardiac Arrest Survivors: A Real-World Experience

Background: Hypothermia-Induced Targeted Temperature Management (TTM) is a neuroprotective treatment after the return of spontaneous circulation (ROSC) in comatose survivors of out-of-hospital cardiac arrest (OHCA). However, its effectiveness in all patient subpopulations is debated. While short-term survival has been well studied, the impact of TTM on long-term survival is still unknown. Methods: In a prospective cohort study, 98 comatose survivors of non-traumatic OHCA were recruited from four tertiary-level hospitals in Buffalo, Western New York and followed up for five years. Patients with active cancer, infection, cardiac pathology or surgery in three-month prior to presentation, were excluded. Cardiac arrest characteristics, demographics, comorbidities, and therapeutic interventions were recorded. According to TTM protocols, a target body temperature of 33°C was reached and maintained for 24 hours using either an intravascular cooling catheter or a surface cooling system. This was followed by gradual controlled rewarming over 12-24 hours to normothermia. Factors associated with the receipt of TTM were determined. The effect of TTM on five-year survival was studied using cox-regression analysis. Results: Among comatose patients with mean age of 60.1±14.9 years, 49% received TTM. Females were significantly less likely to receive TTM (35.1% vs 59.3%, p=0.021). In TTM group, the time to ROSC was significantly longer: median [IQR] 14.5 mins (5-19.7) vs 20 mins (12-27), p=0.018. TTM group was more likely to have a history of coronary artery disease (CAD) (12.5% vs 35.4%, p=0.009). Overall, 5-year mortality did not differ significantly between TTM vs. non-TTM: 72.9% vs 66.0%, (HR: 1.134, 95% CI: 0.705-1.826, p=0.603) in univariate and multivariate Cox-regression analysis (Table 1). Conclusion: While females are less likely to receive TTM treatment, TTM is more likely to be used in patients with a longer time to ROSC and a history of CAD. The overall five-year survival remains high in both treatment groups in all eligible patients, as well as in shockable and non-shockable rhythm groups studied separately. Larger cohort studies are needed to determine the patients who may benefit most from TTM.