Publications by authors named "Ofer Kobo"

32 Publications

Impact of cancer diagnosis on distribution and trends of cardiovascular hospitalizations in the USA between 2004 to 2017.

Eur Heart J Qual Care Clin Outcomes 2022 Aug 1. Epub 2022 Aug 1.

Keele Cardiovascular Research Group, Keele University, Keele, UK.

Background And Aims: There is limited data on temporal trends of cardiovascular hospitalizations and outcomes amongst cancer patients. We describe the distribution, trends of admissions, and in-hospital mortality associated with key cardiovascular diseases among cancer patients in the USA between 2004 to 2017.

Methods: Using the Nationwide Inpatient Sample we identified admissions with five cardiovascular diseases of interest: acute myocardial infarction (AMI), pulmonary embolism (PE), ischemic stroke, heart failure, atrial fibrillation (AF) or atrial flutter, and intracranial hemorrhage. Patients were stratified by cancer status and type. We estimated crude annual rates of hospitalizations and annual in-hospital all-cause mortality rates.

Results: From over 42.5 million hospitalizations with a primary cardiovascular diagnosis, 1.9 million (4.5%) had a concurrent record of cancer. Between 2004 to 2017, cardiovascular admission rates increased by 23.2% in patients with cancer, whilst decreasing by 10.9% in patients without cancer. Admission rate increased among cancer patients across all admission causes and cancer types except prostate cancer. Patients with hematological (9.7-13.5), lung (7.4-8.9), and GI cancer (4.6-6.3) had the highest crude rates of cardiovascular hospitalizations per 100 000 US population. Heart failure was the most common reason for cardiovascular admission in patients across all cancer types, except GI cancer (Crude admission rates of 13.6-16.6 per 100 000 US population for patients with cancer).

Conclusions: In contrast to declining trends in patients without cancer, primary cardiovascular admissions in patients with cancer is increasing. The highest admission rates are in patients with hematological cancer and the most common cause of admission is heart failure.
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http://dx.doi.org/10.1093/ehjqcco/qcac045DOI Listing
August 2022

Impact of Multisite artery disease on Clinical Outcomes After Percutaneous Coronary Intervention: An Analysis from the e-Ultimaster Registry.

Eur Heart J Qual Care Clin Outcomes 2022 Jul 25. Epub 2022 Jul 25.

Hillel Yaffe Medical Center, Technion - Faculty of Medicine, Israel.

Background: multisite artery disease is considered a 'malignant' type of atherosclerotic disease associated with an increased cardiovascular risk, but the impact of multisite artery disease on clinical outcomes after percutaneous coronary intervention (PCI) is unknown.

Methods: Patients enrolled in the large, prospective e-Ultimaster study were grouped into 1) those without known prior vascular disease; 2) those with known single-territory vascular disease 3) those with known 2-3 territories (i.e, coronary, cerebrovascular, or peripheral) vascular disease (multisite artery disease). The primary outcome was coronary target lesion failure (TLF) defined as the composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization at 1-year. Inverse propensity score weighted (IPSW) analysis was performed to address differences in baseline patient and lesion characteristics.

Results: Of the 37,198 patients included in the study, 62.3% had no prior known vascular disease, 32.6% had single-territory vascular disease, and 5.1% multisite artery disease. Patients with known vascular disease were older and were more likely to be men and to have more co-morbidities. After IPSW, the TLF rate incrementally increased with the number of diseased vascular beds (3.16%, 4.44% and 6.42% for no, single- and multisite artery disease, p<0.01 for all comparisons). This was also true for all cause death (2.22%, 3.28% and 5.29%, p<0.01 for all comparisons) and cardiac mortality (1.26%, 1.91% and 3.62%, p≤0.01 for all comparisons).

Conclusions: Patients with previously known vascular disease experienced an increased risk for adverse cardiovascular events and mortality post percutaneous coronary intervention. This risk is highest among patients with multisite artery disease.Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02188355.
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http://dx.doi.org/10.1093/ehjqcco/qcac043DOI Listing
July 2022

Morphine Use in ST-Elevation Myocardial Infarction With Downstream PY Receptor Blockers-Insight From Observational Study.

J Cardiovasc Pharmacol Ther 2022 Jan-Dec;27:10742484221107793

Department of Cardiology, 26736Hillel Yaffe Medical Center, Hadera, Haifa, Israel.

Background And Aims: Morphine use for patients presenting with NSTE-ACS is associated with excess mortality. However, the role of morphine in STE-ACS is ill characterized. We have recently confirmed direct prothrombotic effect of morphine using murine models. We sought to explore whether morphine use in STE-ACS patients, used to be scheduled for downstream PY blockers, is negatively associated with procedural and clinical outcomes.

Methods: A single-center, observational retrospective analysis enrolling 130 non-randomized stable patients sustaining STE-ACS as their first manifestation of coronary disease, who presented between December 2010 and June 2013. All were managed by early invasive approach. Of study patients, 55 were treated by morphine, and 75 were not. All were administered downstream PY blockers according to an already abandoned local policy. Outcomes evaluated included TIMI grade flow, thrombus burden, ST-segment resolution, myocardial function by echocardiography, and cardiovascular death.

Results: Morphine administration was associated with a significantly higher incidence of impaired final TIMI grade flow (TIMI < 3, 40% vs 4%, < .05), lower incidence of ST-segment resolution >70% (40.7% vs 76.5%, < .05), and a higher incidence of moderate or severe systolic dysfunction (48.1% vs 29.1%, < .05) compared with morphine naive patients. Interestingly, the overall mortality rate was higher in the morphine-treated group (18% vs 5.3%, < .05).

Conclusions And Relevance: Morphine administration combined with the downstream PY blockers practice signify a group with a higher occurrence of impaired myocardial reperfusion and cardiovascular death despite established on-time primary angioplasty.
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http://dx.doi.org/10.1177/10742484221107793DOI Listing
July 2022

Emergency department cardiovascular disease encounters and associated mortality in patients with cancer: A study of 20.6 million records from the USA.

Int J Cardiol 2022 Sep 22;363:210-217. Epub 2022 Jun 22.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK; Department of Cardiology, Thomas Jefferson University Philadelphia, PA, USA; Institute of Population Health, University of Manchester, UK. Electronic address:

Background: there is limited data on Emergency department (ED) cardiovascular disease (CVD) presentations and outcomes amongst cancer patients.

Objectives: The present study aimed to describe the clinical characteristics, prevalence, and clinical outcomes of the most common cardiovascular ED admissions in patients with cancer.

Methods: All ED encounters with a primary CVD diagnosis from the US Nationwide Emergency Department Sample between January 2016 to December 2018 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios of in-hospital mortality in different groups.

Results: From a total of 20,737,247 ED encounters with a primary CVD diagnosis, cancer was present in 3.4%. In patients with cancer the most common CVDs were DVT/PE (20%), hypertensive heart or kidney disease (14.7%), and AF/flutter (11.2%). The distribution of CVDs varied by cancer type, with AF/flutter most common in patients with lung cancer, AMI most common in patients with prostate cancer, heart failure most common in those with haematological malignancies, and patients with colorectal cancer having the greatest frequency of DVT/PE. Cancer status was independently associated with significantly higher risk of mortality in almost all CVD categories, consistent across all the cancer types, amongst which lung cancer patients had the highest risk of mortality across all CVD categories, except intracranial haemorrhage and hypertensive crisis.

Conclusions: Cardiovascular presentations to the ED varied by cancer subtype. Across all cancer subtypes, patients presenting with cardiovascular presentations carried a significantly increased risk of mortality compared to patients with no cancer.
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http://dx.doi.org/10.1016/j.ijcard.2022.06.053DOI Listing
September 2022

Temporal trends in disease-specific causes of cardiovascular mortality amongst patients with cancer in the USA between 1999 to 2019.

Eur Heart J Qual Care Clin Outcomes 2022 Apr 18. Epub 2022 Apr 18.

Keele Cardiovascular Research Group, Keele University, Keele, UK.

Aims: We report disease-specific cardiovascular causes of mortality amongst cancer patients in the USA between 1999 to 2019, considering temporal trends by age, sex, and cancer site.

Methods And Results: We used the Multiple Cause of Death database, accessed through the CDC WONDER (Centres for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) resource. We included 629,308 decedents with cardiovascular disease (CVD) recorded as the primary cause of death and active malignancy listed as a contributing cause of death. We created disease-specific CVD categories and grouped cancers by site. We calculated the proportion of CVD deaths attributed to each disease category stratified by sex, age, and cancer site. We also examined disease-specific temporal trends by cancer site. Ischaemic heart disease (IHD) was the most common cardiovascular cause of death across all cancer types (55.6%), being more common in men (59.8%), older ages, and in those with lung (67.8%) and prostate (58.3%) cancers. Cerebrovascular disease (12.9%) and hypertensive diseases (7.6%) were other common causes of death. The proportion of deaths due to heart failure was greatest in haematological (7.7%) and breast (6.3%) cancers. There was a decreasing temporal trend in the proportion of cardiovascular deaths attributed to IHD across all cancer types. The proportion of deaths due to hypertensive diseases showed the greatest percentage increase, with largest change in breast cancer patients (+191.1%).

Conclusions: We demonstrate differential cardiovascular mortality risk by cancer site and demographics, providing insight into the evolving healthcare needs of this growing high cardiovascular risk population.
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http://dx.doi.org/10.1093/ehjqcco/qcac016DOI Listing
April 2022

Management and outcomes of acute myocardial infarction in patients with preexisting heart failure: an analysis of 2 million patients from the national inpatient sample.

Expert Rev Cardiovasc Ther 2022 Mar 31;20(3):233-240. Epub 2022 Mar 31.

Keele Cardiovascular Research Group, Keele University, Keele, UK.

Background: Inpatient management and outcomes of patients presenting with acute myocardial infarction (AMI) with a history of heart failure (HF) have not been well characterized.

Methods: Hospitalizations for AMI from the Nationwide Inpatient Sample (2015-2018) were categorized according to a preexisting diagnosis of HF with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF), or absence of HF. Utilization of invasive management and in-hospital outcomes were analyzed.

Results: Among 2,434,639 hospitalizations with an AMI, 19.8% had a history of HFrEF and 11.9% had a history of HFpEF. Coronary angiography and PCI respectively were performed significantly less among patients with HF (36.6% and 17.4% in HFpEF, 51.1% and 24.6% in HFrEF, and 64.4% and 42.3% among patients without HF, all < 0.0001). Mortality was more common among patients with HFrEF (10.3%) and HFpEF (8.3%) when compared to patients without a history of HF (6.4%), < 0.0001.

Conclusion: HF is a common preexisting comorbidity among patients presenting with AMI and is associated with lower utilization of invasive procedures and higher complications including mortality, particularly among those with HFrEF.
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http://dx.doi.org/10.1080/14779072.2022.2058931DOI Listing
March 2022

Outcomes of Percutaneous Coronary Intervention in Patients With Acquired Immunosuppression.

Am J Cardiol 2022 05 15;171:40-48. Epub 2022 Mar 15.

Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom. Electronic address:

There are limited data on the clinical outcomes of percutaneous coronary intervention (PCI) in patients with acquired immunosuppression who are frequently underrepresented in clinical trials. All PCI procedures between October 2015 and December 2018 in the Nationwide Inpatient Sample were retrospectively analyzed, stratified by immunosuppression status. Multivariable logistic regression models were performed to examine (1) the association between immunosuppression status and in-hospital outcomes, expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CIs) and (2) predictors of mortality among patients with severe acquired immunosuppression. In this contemporary analysis of nearly 1.5 million PCI procedures, approximately 4% of patients who underwent PCI had acquired immunosuppression. Of these, chronic steroid use accounted for approximately half of the cohort who underwent PCI who had acquired immunosuppression, with the remainder divided between hematologic cancer, solid organ active malignancy, and metastatic cancer, with the latter group having the highest rates of composite of in-hospital mortality or stroke (9.3%) (mortality 7.5% and acute ischemic stroke 2.4%). In conclusion, immunosuppression was independently associated with increased adjusted odds of adverse clinical outcomes, specifically mortality or stroke (aOR 1.11, 95% CI 1.06 to 1.15, p <0.001) and in-hospital mortality (aOR 1.21, 95% CI 1.13 to 1.29, p <0.001), with outcomes dependent on the cause of immunosuppression.
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http://dx.doi.org/10.1016/j.amjcard.2022.01.045DOI Listing
May 2022

Factors Associated with Left Ventricular Function Recovery in Patients with Atrial Fibrillation Related Cardiomyopathy.

Isr Med Assoc J 2022 Feb;24(2):101-106

Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.

Background: The diagnosis of atrial fibrillation (AFIB) related cardiomyopathy relies on ruling out other causes for heart failure and on recovery of left ventricular (LV) function following return to sinus rhythm (SR). The pathophysiology underlying this pathology is multifactorial and not as completely known as the factors associated with functional recovery following the restoration of SR.

Objectives: To identify clinical and echocardiographic factors associated with LV systolic function improvement following electrical cardioversion (CV) or after catheter ablation in patients with reduced ejection fraction (EF) related to AFIB and normal LV function at baseline.

Methods: The study included patients with preserved EF at baseline while in SR whose LVEF had reduced while in AFIB and improved LVEF following CV. We compared patients who had improved LVEF to normal baseline to those who did not.

Results: Eighty-six patients with AFIB had evidence of reduced LV systolic function and improved EF following return to SR. Fifty-five (64%) returned their EF to baseline. Patients with a history of ischemic heart disease (IHD), worse LV function, and larger LV size during AFIB were less likely to return to normal LV function. Multivariant analysis revealed that younger patients with slower ventricular response, a history of IHD, larger LV size, and more significant deterioration of LVEF during AFIB were less likely to recover their EF to baseline values.

Conclusions: Patients with worse LV function and larger left ventricle during AFIB are less likely to return their baseline LV function following the restoration of sinus rhythm.
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February 2022

Gout Is Associated With Worse Post-PCI Long-Term Outcomes.

Cardiovasc Revasc Med 2022 08 4;41:166-169. Epub 2022 Feb 4.

Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.

Background: Gout is a common chronic inflammatory disease with increasing prevalence over the last decades. However, there is limited evidence on outcomes of PCI in patients with gout.

Methods: A Retrospective cohort study of all adult patients who underwent PCI in a large [1000 bed] tertiary care center from January 2002 to August 2020. Patients were stratified according to a diagnosis of gout. The primary outcome was defined as the first event of all-cause mortality or major CV event that included acute coronary syndrome -(ACS) or congestive heart failure -(CHF) related admission. To examine the association between gout and outcome, a multi-variable cox proportional hazard model was used.

Results: Out of 12,951 who patients underwent PCI during the study period, 344 (2.7%) had a diagnosis of gout. The study median follow-up time was 105 months. Patients with gout had significantly higher crude rates of clinical events (73.8% vs. 59.5%, p < 0.001). Gout was associated with increased risk for ACS and HF-admissions [HR 1.24 95%CI (1.07-1.43), p = 0.04; HR 1.99, 95%CI (1.57-2.54) p < 0.001, respectively], as well as for any clinical event (HR 1.2 95%CI (1.04-1.38), P = 0.01).

Conclusion: Gout is associated with increased post-PCI cardiovascular risk. Therefore, patients with gout should be considered as a higher risk cohort.
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http://dx.doi.org/10.1016/j.carrev.2022.01.026DOI Listing
August 2022

Impact of peripheral artery disease on prognosis after percutaneous coronary intervention: Outcomes from the multicenter prospective e-ULTIMASTER registry.

Atherosclerosis 2022 03 25;344:71-77. Epub 2022 Jan 25.

Hillel Yaffe Medical Center, Israel. Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Hadera, Israel.

Background And Aims: Patients with peripheral artery disease (PAD) represent a high risk group, and have an increased risk of cardiovascular events and worse cardiovascular outcomes. Our aim was to study the impact of PAD among patients undergoing percutaneous coronary intervention (PCI) with a newer-generation thin-strut DES.

Methods: In this analysis of the e-ULTIMASTER registry, patients with and without known PAD undergoing PCI were compared. A propensity-score was used to adjust for differences between the groups. The primary outcome was target lesion failure (TLF): a composite of cardiac death, target-vessel related myocardial infarction, and/or clinically driven target lesion revascularization at 1-year follow-up.

Results: Of 33,880 patients included in the analysis, PAD was present in 2255 (6.7%). Patients with PAD were older (69.0 ± 10.0 vs. 63.8 ± 11.3 years) with a higher burden of comorbidities. Patients with PAD were less likely to present with STEMI (9.6% vs. 21%), and more likely to undergo complex PCI (left main 5.5% vs. 3.0% ostial lesions 10.4% vs. 7.0%, bifurcations 14.5% vs. 12.3% and calcification 26.8% vs. 17.8%). PAD was found to be independently associated with 41% increased risk for TLF. The risk for all cause death and for cardiac death was 75% and 103% higher, respectably. No difference was found in the rates of stent thrombosis, clinically driven target lesion revascularization, or myocardial infarction (MI).

Conclusions: Patients with PAD are at higher risk for (cardiac) death post PCI, but not target vessel or lesion repeat revascularizations. The PAD cohort represents a population with a higher risk clinical profile. Further research combining medical and device therapies is needed to further improve the outcomes in this high-risk population.
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http://dx.doi.org/10.1016/j.atherosclerosis.2022.01.007DOI Listing
March 2022

Impact of the Admission Pathway on the Gender-Related Mortality of Patients With ST-Elevation Myocardial Infarction.

Am J Cardiol 2022 03 27;166:9-17. Epub 2021 Dec 27.

Heart Institute, Hillel Yaffe Medical Center, Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

The mortality of women with ST-elevation myocardial infarction (STEMI) exceeds that of men, supposedly the result of older age and co-morbidities. Patients with STEMI can be transported directly to the catherization lab by the emergency medical service (EMS) or to the emergency department (ED) by the EMS, a regular ambulance, or independently. This raises the question whether gender disparity in the transport of patients with STEMI may affect time to therapy and consequently explain the disparate outcome in men and women with STEMI. We analyzed a large nationwide registry of prospectively-recorded patients with acute coronary syndromes in order to determine if there is a survival gap between men and women with STEMI, and to assess the gender-related effect of admission pathway on time intervals and 5-year mortality. Study population included 2,740 patients with STEMI who underwent primary percutaneous coronary interventions, comprising 464 women (17%, median-70 years) and 2,276 men (83%, median-58 years). The unadjusted 5-year mortality of women was higher compared with men (26.4% vs 15.6%, p = 0.001) but adjustment abrogated this survival difference. Regardless of adjustment, the 5-year mortality of patients with STEMI admitted directly to the catherization lab or to the ED by EMS was similar for men and women but significantly lower in the directly admitted patients (p <0.028). In contrast, admission to the ED by non-EMS was associated with markedly worse survival among women. These results indicate that women suspected of STEMI benefit from transportation by the EMS and should use this pathway exclusively to reach the hospital.
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http://dx.doi.org/10.1016/j.amjcard.2021.11.025DOI Listing
March 2022

Can Transcatheter Aortic Valve Implantation (TAVI) Be Performed at Institutions Without On-Site Cardiac Surgery Departments?

Cardiovasc Revasc Med 2022 08 16;41:159-165. Epub 2021 Dec 16.

Hillel Yaffe Medical Center, Technion - Israel Institute of Technology, Haifa, Israel. Electronic address:

Transcatheter aortic valve implantation [TAVI] represents a paradigm shift in therapeutic options for patients with severe aortic stenosis [AS]. In less than 20 years, TAVI has rapidly disseminated to include a significant proportion of AS patients. The number of AS patients needing TAVI is expected to further increase. Since there is a limited number of centers performing TAVI, wait times are expected to increase. This might have a critical impact of AS patient life as mortality rate of AS patients awaiting TAVI, is substantial, ranging from 2 to 10%. With time, as more patients were treated, improved experience, better imaging and devices, this technology became safer with more reliable results. Today most TAVI complications are related to vascular access [4-6%] and there is less need for emergency thoracic bail out [0.2-0.5%]. In this review, we summarize the prognosis while waiting, the outcomes of patients undergoing TAVI at institutions without on-site cardiac surgery departments and the data describing rates and outcomes of TAVI patients requiring treatment of intra-procedural life-threatening complications. Similar to coronary interventions in the past, TAVI should be considered also in centers without on-site cardiac surgery departments under certain conditions such as, experienced operators, heart team discussion, well established imaging modalities, skilled and qualified support personal, and adequate pre- and post-care facility.
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http://dx.doi.org/10.1016/j.carrev.2021.12.009DOI Listing
August 2022

Left Ventricular Systolic Dysfunction Due to Atrial Fibrillation: Clinical and Echocardiographic Predictors.

Card Fail Rev 2021 Mar 22;7:e16. Epub 2021 Nov 22.

Department of Cardiology, Rambam Health Care Campus Haifa, Israel.

Diagnosis of AF-induced cardiomyopathy can be challenging and relies on ruling out other causes of cardiomyopathy and, after restoration of sinus rhythm, recovery of left ventricular (LV) function. The aim of this study was to identify clinical and echocardiographic predictors for developing cardiomyopathy with systolic dysfunction in patients with atrial tachyarrhythmia. This retrospective study was conducted in a large tertiary care centre and compared patients who experienced deterioration of LV ejection fraction (EF) during paroxysmal AF, demonstrated by precardioversion transoesophageal echocardiography with patients with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in sinus rhythm. Of 482 patients included in the final analysis, 80 (17%) had reduced and 402 (83%) had preserved LV function during the precardioversion transoesophageal echocardiography. Patients with reduced LVEF were more likely to be men and to have a more rapid ventricular response during AF or atrial flutter (AFL). A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of tricuspid regurgitation and right ventricular dysfunction. In 'real-world' experience, male patients with rapid ventricular response during paroxysmal AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Finally, tricuspid regurgitation and right ventricular dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.
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http://dx.doi.org/10.15420/cfr.2021.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674700PMC
March 2021

Predictors, Treatments, and Outcomes of Do-Not-Resuscitate Status in Acute Myocardial Infarction Patients (from a Nationwide Inpatient Cohort Study).

Am J Cardiol 2021 11;159:8-18

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom; Department of Cardiology, Jefferson University, Philadelphia, Pennsylvania. Electronic address:

Little is known about how frequently do-not-resuscitate (DNR) orders are placed in patients with acute myocardial infarction (AMI), the types of patients in which they are placed, treatment strategies or clinical outcomes of such patients. Using the United States (US) National Inpatient Sample (NIS) database from 2015 to 2018, we identified 2,767,549 admissions that were admitted to US hospitals and during the hospitalization received a principle diagnosis of AMI, of which 339,270 (12.3%) patients had a DNR order (instigated both preadmission and during in-hospital stay). Patients with a DNR status were older (median age 83 vs 65, p < 0.001), more likely to be female (53.4% vs 39.3%, p < 0.001) and White (81.0% vs 73.3%, p < 0.001). Predictors of DNR status included comorbidities such as heart failure (OR: 1.47, 95% CI: 1.45 to 1.48), dementia (OR: 2.53, 95% CI: 2.50 to 2.55), and cancer. Patients with a DNR order were less likely to undergo invasive management or be discharged home (13.5% vs 52.8%), with only 1/3 receiving palliative consultation. In hospital mortality (32.7% vs 4.6%, p < 0.001) and MACCE (37.1% vs 8.8%, p < 0.001) were higher in the DNR group. Factors independently associated with in-hospital mortality among patients with a DNR order included a STEMI presentation (OR: 2.90, 95% CI: 2.84 to 2.96) and being of Black (OR: 1.29, 95% CI: 1.26 to 1.33), Hispanic (OR: 1.36, 95% CI: 1.32 to 1.41) or Asian/Pacific Islander (OR: 1.56, 95% CI:1.49-race. In conclusion, AMI patients with a DNR status were older, multimorbid, less likely to receive invasive management, with only one third of patients with DNR status referred for palliative care.
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http://dx.doi.org/10.1016/j.amjcard.2021.07.054DOI Listing
November 2021

Trends in cardiovascular mortality of cancer patients in the US over two decades 1999-2019.

Int J Clin Pract 2021 Nov 20;75(11):e14841. Epub 2021 Sep 20.

Keele Cardiovascular Research Group, Keele University, Keele, UK.

Background: Cancer is the second most common cause of death globally after cardiovascular disease, and cancer patients are at an increased risk of CV death. This recognition has led to publication of cardio-oncological guidelines and to the widespread adoption of dedicated cardio-oncology services in many institutes. However, it is unclear whether there has been a change in the incidence of CV death in cancer patients.

Methods And Results: Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset, we determined national trends in age-standardised mortality rates attributed to cardiovascular diseases in patients with and without cancer, from 1999 to 2019, stratified by cancer type, age, gender, race, and place of residence (state and urbanisation status). Among more than 17.8 million cardiovascular deaths in the United States, 13.6% were patients with a concomitant cancer diagnosis. During the study period, among patients with cancer, the age-adjusted mortality rate dropped by 52% (vs 38% in patients with no cancer). In cancer patients, age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with haematological malignancy (59%-63% vs. 41%). Similar reduction was observed in both genders (53%-54%), but more prominent reduction was observed in older patients and in those living in metro areas.

Conclusions: Our findings emphasise the role of multidisciplinary management of cancer patients. Widespread adoption of cardio oncology services have the potential to impact the inherent risk of increased CV mortality in both cancer patients and survivors.
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http://dx.doi.org/10.1111/ijcp.14841DOI Listing
November 2021

Impact of malignancy on In-hospital mortality, stratified by the cause of admission: An analysis of 67 million patients from the National Inpatient Sample.

Int J Clin Pract 2021 Nov 14;75(11):e14758. Epub 2021 Sep 14.

Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom.

Objective: To describe the patient characteristics and the reason for admission of patients with malignancy by malignancy, and to study mortality rates for the different causes of admissions among the different types of cancer.

Patients And Methods: Using the nationwide Inpatient Sampling (2015-2017) we examined the cause of admission and associated in-hospital mortality, stratified by presence and type of malignancy. Multivariable logistic regression models were used to examine the association between in-hospital mortality and malignancy sites for different primary admission causes.

Results: Out of 67 819 693 inpatient admissions, 8.8% had malignancy. Amongst those with malignancy, haematological malignancy was the most common (20.2%). The most common cause of admission amongst all cancers were malignancy-related admissions, where up to 57% of all colorectal admissions were malignancy-related. The most common non-malignancy cause of admission was infectious causes, which were most frequent among patients with haematological malignancy (18.4%). Patients with malignancy had higher crude mortality rates (5.7% vs 1.9%). Mortality rates were highest among patients with lung cancer (8.7%). Among all admissions, the adjusted rates of mortality were higher for patients with lung (OR 3.65, 95% CI [3.59-3.71]), breast (OR 2.06, 95% CI [1.99-2.13]), haematological (OR 1.79, 95% CI [1.76-1.82]) and colorectal (OR 1.71, 95% CI [1.66-1.76]) malignancies compared with patients with no malignancy.

Conclusion: Our work highlights the need to consider the burden of cancer on our hospital services and consider how the prognostic impact of different types of admissions may relate to the type of cancer diagnosis and understand whether these differences relate to disparities in clinical care/treatments.
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http://dx.doi.org/10.1111/ijcp.14758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8983059PMC
November 2021

Long-term outcomes of patients with chronic inflammatory diseases after percutaneous coronary intervention.

Catheter Cardiovasc Interv 2021 11 14;98(5):E655-E660. Epub 2021 Jul 14.

Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.

Objective: To assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention (PCI).

Methods: A Retrospective cohort study of all adult patients who underwent PCI in a large tertiary care center from January 2002 to August 2020.

Results: A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247 (1.9%) patients; 70 with inflammatory bowel disease (IBD) and 173 with autoimmune rheumatic diseases (AIRD). The composite endpoint of mortality, acute coronary syndrome (ACS) or admission due to acute heart failure was similar at 30 days and more frequent in the inflammatory disease group (42.8% in AIRD group, 35.7% in the IBD group and 29.6% in the noninflammatory group, p < 0.0001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. Readmission due to ACS was also increases at 30 days in the AIRD group compared to the noninflammatory group (0.6% vs. 0.1%, p < 0.001) and 1 year (37.6% for the AIRD group, 34.3% in the IBD group and 25.5% in the noninflammatory group (p < 0.0001). Patients with inflammatory diseases were found to have a significantly increased risk congestive heart failure admissions at 1 year in a subgroup analysis of patients with myocardial infarction.

Conclusion: Patients with AIRD and IBD are at higher risk for cardiovascular events in long-term follow up once diagnosed with CAD and treated with PCI.
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http://dx.doi.org/10.1002/ccd.29870DOI Listing
November 2021

Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio.

PLoS One 2021 22;16(4):e0248365. Epub 2021 Apr 22.

Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.

Background: The treatment of myopericarditis is different than that of acute myocardial infarction (AMI). However, since their clinical presentation is frequently similar it may be difficult to distinguish between these entities despite a disparate underlying pathogenesis. Myopericarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We hypothesized that evaluation of the CRP/troponin ratio on presentation to the emergency department could improve the differentiation between these two related clinical entities whose therapy is different. Such differentiation should facilitate triage to appropriate and expeditious therapy.

Methods: We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large single center registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed on discharge as myopericarditis. CRP and troponin were sampled on admission in all patients and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of myopericarditis against all AMI, STEMI, and NSTEMI patients.

Results: Median admission CRP/troponin ratios were 84, 65, and 436 mg×ml/liter×ng in STEMI, NSTEMI and myopericarditis groups, respectively (p<0.001) demonstrating good differentiating capability. The Receiver-operator-curve of admission CRP/troponin ratio for diagnosis of myopericarditis against all AMI, STEMI, and NSTEMI patients yielded an area-under-the curve of 0.74, 0.73, and 0.765, respectively. CRP/troponin ratio>500 resulted in specificity exceeding 85%, and for a ratio>1000, specificity>92%.

Conclusion: The CRP/troponin ratio can serve as an effective tool to differentiate between myopericarditis and AMI. In the appropriate clinical context, the CRP/troponin ratio may preclude further evaluation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248365PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062049PMC
September 2021

Prognosis of Patients With Left Circumflex Artery Acute Myocardial Infarction in Relation to ST-Segment on Admission Electrocardiogram.

J Invasive Cardiol 2021 Jan;33(1):E20-E24

Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.

Background: Total thrombotic occlusion of the left circumflex (LCX) artery may present without ST-segment elevations; the clinical outcomes of such patients remain unclear.

Objective: To examine the difference in clinical outcomes between patients with acute myocardial infarction (MI) due to LCX occlusion or stenosis with and without ST-segment elevation.

Methods: The present study is based on an observational, retrospective cohort comprising all patients admitted to 2 centers between 2009 and 2019 with MI due to LCX disease. Clinical outcomes included recurrent percutaneous coronary intervention (PCI), hospitalization due to acute coronary syndrome (ACS), and mortality. Risk factors for mortality were assessed using logistic regression analysis.

Results: During the study period, a total of 897 patients with LCX-related MI were treated. Most (56.6%) presented with non-ST segment elevation MI (NSTEMI), which was associated with higher rates of 1-year hospitalization for ACS (15.8% vs 11.1%; P=.05) and PCI (20.9% vs 14.4%; P=.05) compared with ST-segment elevation MI (STEMI) patients. STEMI was associated with higher 30-day mortality compared with NSTEMI (3.9% vs 1.7%, respectively; P=.05), with no difference in mortality after 1 year (6.7% vs 5.6%, respectively; P=.55). Multivariate analysis found left dominant circulation (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.4-4.7) and diabetes mellitus (OR, 2.13; 95% CI, 1.2-3.6) to be independent predictors for 1-year mortality.

Conclusion: Patients suffering from NSTEMI and STEMI related to LCX occlusion or stenosis have similar 1-year mortality. Left dominant circulation was associated with higher short- and long-term mortality. These results suggest that a substantial population of patients who present as NSTEMI should be treated as promptly and aggressively as STEMI patients.
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January 2021

Impact of pre-existent vascular and poly-vascular disease on acute myocardial infarction management and outcomes: An analysis of 2 million patients from the National Inpatient Sample.

Int J Cardiol 2021 03 30;327:1-8. Epub 2020 Nov 30.

Keele Cardiovascular Research Group, Keele University, UK; Royal Stoke Hospital, Stoke on Trent, UK; Department of Cardiology, Thomas Jefferson University, USA. Electronic address:

Background: Patients with pre-existing vascular disease are known to have worse outcomes after acute myocardial infarction (AMI). However, there is limited data for outcomes stratified by type and number of vascular territories involved.

Methods: Using the Nationwide Inpatient Sample (2015-2017), we examined outcomes of AMI in patients with pre-existent vascular disease stratified by number as well as types of diseased beds including all five major vascular sites: cardiac, cerebrovascular, renal, aortic and peripheral vascular disease (PVD). Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) of adverse outcomes and invasive procedure utilization.

Results: Out of 2,184,614 AMI admissions, 49.7% had pre-existent vascular disease. The odds of major adverse cardiovascular and cerebrovascular events (MACCE), mortality, ischemic stroke and major bleeding incrementally increased and was highest in those with ≥3 vascular sites involved (aOR for MACCE 1.16, CI 1.13-1.19; mortality 1.3, CI 1.26-1.34; stroke 1.15, CI 1.1-1.2; major bleeding 1.21, CI 1.16-1.25). Amongst those with a single pre-existent diseased vascular bed, the adjusted odds of MACCE appeared to be higher in those with PVD (1.28, CI 1.26-1.31), aortic disease (1.24, CI 1.19-1.29), and cerebrovascular disease (1.22, CI 1.2-1.25). Patients with pre-existent vascular disease had a lower overall likelihood of undergoing invasive revascularization procedures.

Conclusions: Approximately half of the population presenting with AMI have pre-existent vascular disease. There is an incremental increase in adverse outcomes with increasing number of diseased vascular beds, with further differences in outcomes and utilization of invasive procedures based on sub-types of sites involved.
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http://dx.doi.org/10.1016/j.ijcard.2020.11.051DOI Listing
March 2021

The impact of lockdown enforcement during the SARSCoV-2 pandemic on the timing of presentation and early outcomes of patients with ST-elevation myocardial infarction.

PLoS One 2020 23;15(10):e0241149. Epub 2020 Oct 23.

Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.

Introduction: Early reports described decreased admissions for acute cardiovascular events during the SarsCoV-2 pandemic. We aimed to explore whether the lockdown enforced during the SARSCoV-2 pandemic in Israel impacted the characteristics of presentation, reperfusion times, and early outcomes of ST-elevation myocardial infarction (STEMI) patients.

Methods: A multicenter prospective cohort comprising all STEMI patients treated by primary percutaneous coronary intervention admitted to four high-volume cardiac centers in Israel during lockdown (20/3/2020-30/4/2020). STEMI patients treated during the same period in 2019 served as controls.

Results: The study comprised 243 patients, 107 during the lockdown period of 2020 and 136 during the same period in 2019, with no difference in demographics and clinical characteristics. Patients admitted in 2020 had higher admission and peak troponin levels, had a 2.4 fold greater likelihood of Door-to-balloon times> 90 min (95%CI: 1.2-4.9, p = 0.01) and 3.3 fold greater likelihood of pain-to-balloon times> 12 hours (OR 3.3, 95%CI: 1.3-8.1, p<0.01). They experienced higher rates hemodynamic instability (25.2% vs 14.7%, p = 0.04), longer hospital stay (median, IQR [4, 3-6 Vs 5, 4-6, p = 0.03]), and fewer early (<72 hours) discharge (12.4% Vs 32.4%, p<0.001).

Conclusions: The lockdown imposed during the SARSCoV-2 pandemic was associated with a significant lag in the time to reperfusion of STEMI patients. Measures to improves this metric should be implemented during future lockdowns.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241149PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584161PMC
December 2020

Good, Better, or Best - What to Choose?

Cardiovasc Revasc Med 2021 08 8;29:97-99. Epub 2020 Aug 8.

Hillel Yaffe Medical Center, Hadera, Faculty of Medicine, Technion Israel Institute of Technology, Israel. Electronic address:

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http://dx.doi.org/10.1016/j.carrev.2020.08.008DOI Listing
August 2021

Outcomes of Percutaneous Coronary Intervention in Patients With Crohn's Disease and Ulcerative Colitis (from a Nationwide Cohort).

Am J Cardiol 2020 09 17;130:30-36. Epub 2020 Jun 17.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom; Department of Cardiology, Jefferson University, Philadelphia, Pennsylvania. Electronic address:

Patients with inflammatory bowel disease (IBD) are at an increased risk of ischemic heart disease. However, there is limited evidence on how their outcomes after percutaneous coronary intervention (PCI) compare with those without IBD. All PCI-related hospitalizations from the National Inpatient Sample from 2004 to 2015 were included, stratified into 3 groups: no-IBD, Crohn's disease (CD), and ulcerative colitis (UC). We assessed the association between IBD subtypes and in-hospital outcomes. A total of 6,689,292 PCI procedures were analyzed, of which 0.3% (n = 18,910) had an IBD diagnosis. The prevalence of IBD increased from 0.2% (2004) to 0.4% (2015). Patients with IBD were less likely to have conventional cardiovascular risk factors and more likely to undergo PCI for an acute indication, and to receive bare metal stents. In comparison to patients without IBD, those with IBD had reduced or similar adjusted odds ratios (OR) of major adverse cardiovascular and cerebrovascular events (CD OR 0.69, 95% confidence interval (CI) 0.62 to 0.78; UC OR 0.75, 95% CI 0.66 to 0.85), mortality (CD: OR 0.94, 95% CI 0.79 to 1.11; UC OR 0.35, 95% CI 0.27 to 0.45) or acute cerebrovascular accident (CD: OR 0.73, 95% CI 0.60 to 0.89; UC: OR 0.94, 95% CI 0.77 to 1.15). However, IBD patients had an increased odds for major bleeding (CD: OR 1.42 95% CI 1.23 to 1.63, and UC: OR 1.35 95% CI 1.16 to 1.58). In summary, IBD is associated with a decreased risk of in-hospital post-PCI complications other than major bleeding that was significantly higher in this group. Long term follow-up is required to evaluate the safety of PCI in IBD patients from both bleeding and ischemic perspectives.
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http://dx.doi.org/10.1016/j.amjcard.2020.06.013DOI Listing
September 2020

Modern Stents: Where Are We Going?

Rambam Maimonides Med J 2020 Apr 29;11(2). Epub 2020 Apr 29.

Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.

Coronary artery stenting is the treatment of choice for patients requiring coronary angioplasty. We describe the major advancements with this technology. There have been significant developments in the design of stents and adjunctive medical therapies. Newer-generation drug-eluting stents (DES) have almost negligible restenosis rates and, when combined with proper anti-platelet treatment and optimal deployment, a low risk of stent thrombosis. The introduction of newer-generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new antiproliferative agents has further improved the safety profile of early-generation DES. In parallel the effectiveness has been kept, with a significant reduction in the risk of target lesion revascularization compared with the early-generation DES. However, to date, the development of completely bioresorbable vascular scaffolds has failed to achieve further clinical benefits and has been associated with increased thrombosis. Newer-generation DES-including both durable polymer as well as biodegradable polymer-have become the standard of care in all patient and lesion subsets, with excellent long-term results.
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http://dx.doi.org/10.5041/RMMJ.10403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202450PMC
April 2020

Proximal LAD Treated With Thin-Strut New-Generation Drug-Eluting Stents: A Patient-Level Pooled Analysis of TWENTE I-III.

JACC Cardiovasc Interv 2020 04 11;13(7):808-816. Epub 2020 Mar 11.

Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands. Electronic address:

Objectives: This study sought to assess 2-year clinical outcome following percutaneous coronary intervention (PCI) with thin-strut new-generation drug-eluting stents (DES) in patients treated in proximal left anterior descending artery (P-LAD) versus non-P-LAD lesions.

Background: In current revascularization guidelines, P-LAD coronary artery stenosis is discussed separately, mainly because of a higher adverse event risk and benefits of bypass surgery.

Methods: The study included 6,037 patients without previous bypass surgery or left main stem involvement from the TWENTE I, II, and III randomized trials. A total of 1,607 (26.6%) patients had at least 1 DES implanted in P-LAD and were compared with 4,430 (73.4%) patients who were exclusively treated in other (non-P-LAD) segments.

Results: Two-year follow-up was available in 5,995 (99.3%) patients. At baseline, P-LAD patients had more multivessel treatment and longer total stent length. The rate of the patient-oriented composite clinical endpoint (any death, any myocardial infarction, or any revascularization) was similar in P-LAD versus non-P-LAD patients (11.4% vs. 11.6%; p = 0.87). In P-LAD patients, the rate of the device-oriented composite clinical endpoint (cardiac death, target vessel myocardial infarction, or target lesion revascularization) was higher (7.6% vs. 6.0%; p = 0.020), driven by a higher rate of target vessel myocardial infarction (4.1% vs. 2.6%; p = 0.002). However, multivariate analysis showed no independent association between stenting P-LAD lesions and clinical endpoints.

Conclusions: In this patient-level pooled analysis of 3 large-scale contemporary DES trials, treatment of P-LAD lesions was not independently associated with higher 2-year adverse clinical event rates. These results imply that separate consideration in future revascularization guidelines may not be mandatory any longer.
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http://dx.doi.org/10.1016/j.jcin.2019.11.018DOI Listing
April 2020

Optimal Timing for Coronary Intervention in Patients With Transient ST-Elevation Myocardial Infarction.

Am J Cardiol 2019 12 26;124(12):1821-1826. Epub 2019 Sep 26.

Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.

STEMI patients admitted urgently to the hospital but experience early complete resolution of both ischemic symptoms and ST-elevations on the electrocardiogram are diagnosed as transient STEMI (TSTEMI). Current evidence indicates that primary intervention is plausible but in certain circumstances intervention can be delayed. We sought to examine whether there is a time limit to such a delay that may affect long-term outcome. Study population included prospectively admitted TSTEMI patients whose demographics, pertinent medical history, and clinical and angiographic features were recorded. Study patients were divided by the median time interval from admission to intervention and their characteristics and long-term survival were compared. Study population comprised 260 consecutive patients (age: 57±10 years, men: 84%) diagnosed as TSTEMI who were included from January 2000 to June 2019, which represent 6% of all STEMI patients. Coronary angiography was performed in 254 patients. The median time interval from admission to angiography was 17 hours (IQR: 7.2 to 38.7 hours). Early (<17 hours from admission) and late (>17 hours from admission) study groups were comparable. One patient died during admission and 41 throughout the long follow-up period of 8.5 ± 5.2 years (median: 8.2 years, IQR: 3.4 to 13.1). Mortality of early-treated TSTEMI patients (11.2%) was significantly lower than of the late-treated patients (21.6%, p <0.04). The Kaplan-Meier curve demonstrated a clear tendency toward improved survival in early-treated TSTEMI patients (p <0.09). In conclusion, the present data suggest that TSTEMI patients should be treated, if not by primary coronary intervention, then at least within 17 hours from admission to achieve better long-term outcome.
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http://dx.doi.org/10.1016/j.amjcard.2019.09.005DOI Listing
December 2019

Relative fat mass is a better predictor of dyslipidemia and metabolic syndrome than body mass index.

Cardiovasc Endocrinol Metab 2019 Sep 10;8(3):77-81. Epub 2019 Sep 10.

Department of Internal Medical C.

Relative fat mass (RFM) had been recently developed. We aimed to examine RFM predictability to various cardiometabolic risk factors, compared to BMI.

Methods: Observational, cohort study, among patients who visited the Rambam Periodic Examinations Institute (RPEI). We compared the correlation of BMI and RFM to hypertension, impaired fasting glucose, high LDL, low HDL and metabolic syndrome, by gender.

Results: During study years, 20 167 patients visited the RPEI and included in the trial. Compared to BMI, RFM showed significantly better predictability (odds ratio [OR], [95% confidence interval (CI), value]) of high LDL [1.618 (1.441-1.816, < 0.001) vs. 0.732 (0.67-0.8, < 0.001) in men; 1.572 (1.377-1.794, < 0.001) vs. 0.938 (0.849-1.163, = 0.94) in women], low HDL [2.944 (2.569-3.373, < 0.001) vs. 2.177 (2-2.369, < 0.001) in men, 2.947 (2.519-3.448, < 0.001) vs. 1.9 (1.658-2.176, < 0.001) in women], high triglycerides [4.019 (3.332-4.847, < 0.001) vs. 1.994 (1.823-2.181, < 0.001) in men, 3.93 (2.943-5.247, < 0.001) vs. 2.24 (1.887-2.62, < 0.001) in women] and metabolic syndrome [7.479, (4.876-11.47, < 0.001) vs. 3.263 (2.944-3.616, < 0.001) in men, 16.247 (8.348-31.619, < 0.001) vs. 5.995 (5.099-7.048, < 0.001) in women]. There was no significant difference in the predictability of BMI and RFM to hypertension and diabetes mellitus.

Conclusion: RFM provides high predictability for dyslipidemias and metabolic syndrome.
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http://dx.doi.org/10.1097/XCE.0000000000000176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779840PMC
September 2019

Non-ST-Elevation Myocardial Infarction with Non-significant Coronary Artery Disease as a Symptom of Occult or New Malignancy.

Isr Med Assoc J 2019 Jun;21(6):381-385

Department of Internal Medicine C, Rambam Health Care Campus, Haifa, Israel.

Background: Malignancy is a known risk factor for venous thromboembolism; however, the association with arterial thromboembolic events remains unclear.

Objectives: To examine the association between non-ST-elevation myocardial infarction (NSTEMI) and non-significant coronary artery disease (CAD) and the presence of new or occult malignancy.

Methods: An observational cohort, single-center study was performed 2010-2015. Adult patients with NSTEMI, who underwent coronary angiography and had no significant coronary lesion, were included. Using propensity score matching, we created a 2:1 matched control group of adults with NSTEMI, and significant coronary artery disease. Risk factors for new or occult malignancy were assessed using multivariate backward stepwise logistic regression analysis. The primary outcome was new or occult malignancy, defined as any malignancy diagnosed in the 3 months prior and 6 months following the myocardial infarction (MI).

Results: During the study period, 174 patients who presented with MI with non-obstructive coronary arteries were identified. The matched control group included 348 patients. There was no significant difference in the group demographics, past medical history, or clinical presentation. The incidence of new or occult malignancy in the study group was significantly higher (7/174, 4% vs. 3/348, 0.9%, P = 0.019). NSTEMI with non-significant CAD was an independent risk factor for occult malignancy (odds ratio [OR] 4.6, 95% confidence interval [95%CI] 1.1-18.7). Other risk factors included active smoking (OR 11.2, 95%CI 2.5-49.1) and age (OR 1.1, 95%CI 1.03-1.17).

Conclusions: NSTEMI with non-significant CAD may be a presenting or early marker of malignancy and warrants further investigation.
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June 2019

Orsiro: ultrathin bioabsorbable polymer sirolimus-eluting stent.

Future Cardiol 2019 07 18;15(4):295-300. Epub 2019 Jun 18.

Hillel Yaffe Medical Center, Hadera, Faculty of Medicine - Technion Israel Institute of Technology, Israel.

Recent stent developments aimed to reduce and eliminate the long-term inflammatory response include thinner struts, modifications to stent design and the development of bioresorbable polymers (BP). We aimed to summarize the main findings and to discuss the established and the potential benefits of the Orsiro BP sirolimus-eluting stents in everyday clinical use. We have reviewed the available evidence on the clinical performance of the Orsiro BP drug-eluting stents. Orsiro BP sirolimus-eluting stents is clinically proven and showed noninferiority against major drug-eluting stents and provides high safety and efficacy profile at long-term follow-up. Furthermore, it may be the preferred treatment option in specific subgroups as acute coronary syndrome, as shown in the BIOFLOW V trial.
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http://dx.doi.org/10.2217/fca-2019-0001DOI Listing
July 2019
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