POS0174 IMMUNOPHENOTYPE OF SJÖGREN´S SYNDROME AND SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IDENTIFIED TWO ENDOTYPES WITH POTENTIAL THERAPEUTIC IMPLICATIONS

Background:

Primary Sjögren’s syndrome (pSS) and systemic lupus erythematosus (SLE) are chronic autoimmune rheumatic diseases (ARDs) that share a strong female gender bias, as well as genetic, clinical and serological characteristics.Although significant progress has been made in improving treatment and patient related outcomes in pSS and SLE, there is a need for improved early diagnosis, adequate therapy monitoring, treatment of refractory manifestations and strategies to address co-morbidities.However, the results of many clinical trials are disappointing, and nobiologic treatments are licensedin pSS, while few are available for SLE patients with refractory disease.

Objectives:

Identifying shared immunological features between patients with pSS and SLE that could lead to better treatment selection using a stratification approach.

Methods:

Immune-phenotyping of 29 immune-cell subsets in peripheral blood from patients with pSS (n=45), SLE (n=29) and secondary SS associated with SLE (SLE/SS) (n=14) with low disease activity or in clinical remission, and sex-matched healthy controls (n=31), was performed using flow cytometry. Data were analysed using logistic regression and multiple t-tests andsupervised machine learning (balanced random forest-BRF, sparse partial least squares discriminant analysis-sPLS-DA). Patients were stratified by k-means clustering. Clinical trajectories were analysed over 5 year follow-up.

Results:

Comparing the immune profile of pSS and SLE patients using a variety of statistical and machine learning (ML) approaches, identified very few statistically significant differences between the two cohorts despite patients having a different clinical presentation and diagnosis. Thus, we hypothesised that immune-based subtypes could be shared between pSS, SLE and SLE/SS patients. Unsupervised k-means clustering was applied to the immunological features of the combined patient cohorts and two distinct patient endotypes, were identified: Group-1 (n=49; pSS=24, SLE=19, SLE/SS=6) and Group-2 (n=39; pSS=21, SLE=10, SLE/SS=8). Significant differences in immune-cell phenotypes across B-cell and T-cell subsets were identified by logistic regression, BRF (AUC=0.9942, assessed by 10-fold cross-validation) and sPLS-DA analysis. Comparison of the multiple analysis approaches identified eight common immune-cell subsets, including total and memory CD4+ and CD8+ T-cell subsets but no B-cell subsets. Using this common immune-signature the stratification between the groups was maintained and slightly improved (AUC=0.9979 and accuracy 96.16%). Interestingly, patients in Group-2 had elevated disease activity measures at baseline and over a 5-year trajectory compared to Group-1. Finally, correlation analysis identifed correlations between disease activity markers and the top ranked immune features from the ML models.

Conclusion:

The identified immune-cell signatures could reflect the underlying disease pathogenesis that spans diagnositc criteria and could be used to select patients for targeted therapeutic approaches.

Acknowledgements:

LM-G is supported by a project grant from The Dunhill Medical Trust (RPGF1902\117); JP is supported by Versus Arthritis (21226). GAR is supported by Lupus UK, The Rosetrees Trust (M409) and Versus Arthritis (21593). MN is supported by NIHR UCLH Biomedical Research Centre (BRC525/III/CC/191350). HP has a Versus Arthritis PhD studentship (22203). This work was performed within the Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH supported by grants from Versus Arthritis (21593 and 20164), GOSCC, and the NIHR-Biomedical Research Centres at both GOSH and UCLH.

We would like to thank Mr Jamie Evans for expert support with flow cytometry analysis and Ms Eve McLoughlin for support with patient recruitment.

Disclosure of Interests:

None declared

Factors associated with treatment failure of direct-acting antivirals for chronic hepatitis C: A real-world nationwide hepatitis C virus registry programme in Taiwan

BACKGROUND/AIMS

Direct-acting antivirals (DAAs) are highly effective in treating chronic hepatitis C virus (HCV)-infected patients. The real-world treatment outcome in Taiwanese patients on a nationwide basis is elusive.

METHODS

The Taiwan HCV Registry (TACR) programme is a nationwide registry platform including 48 study sites, which is organized and supervised by the Taiwan Association for the Study of the Liver. The primary endpoint was sustained virological response (SVR12, undetectable HCV RNA 12 weeks after end-of-treatment).

RESULTS

A total of 13 951 registered patients with SVR12 data available were analysed (mean age, 63.0 years; female, 55.9%; HCV genotype-1 [GT1], 57.9%; cirrhosis, 38.4%; preexisting hepatocellular carcinoma [HCC], 10.6%; and hepatitis B virus coinfection, 7.7%). The overall SVR12 rate was 98.3%, with 98.7%, 98.0%, 98.4% and 97.4% in treatment-naïve noncirrhotic, treatment-naïve cirrhotic, treatment-experienced noncirrhotic and treatment-experienced cirrhotic patients, respectively. The SVR12 rate was > 95% across all subgroups except treatment-experienced cirrhotic patients who received sofosbuvir/ribavirin (88.7%), treatment-naïve noncirrhotic patients (94.8%) and treatment-experienced cirrhotic (94.8%) patients who received daclatasvir/asunaprevir. The most important factor associated with treatment failure was DAA adherence < 60% ( adjusted odds ratio [aOR]/95% confidence interval [CI]: 117.1/52.4-261.3, P < .001), followed by GT3/GT2 (aOR/CI: 5.78/2.25-14.9, P = .0003 and aOR/CI: 1.55/1.05-2.29, P = .03, compared with GT1), active hepatocellular carcinoma (aOR/CI: 4.29/2.57-7.16, P < .001), the use of sofosbuvir/ribavirin (aOR/CI: 2.51/1.67-3.77, P < .001) and daclatasvir/asunaprevir (aOR/CI: 3.29/1.94-5.58, P < .001), decompensated liver cirrhosis (aOR/CI: 2.50/1.20-5.22, P = .02) and high HCV viral loads (aOR/CI: 2.16/1.57-2.97, P < .001).

CONCLUSIONS

DAAs are highly effective in treating Taiwanese HCV patients in the real-world setting. Maintaining DAA adherence and selecting highly efficacious regimens are keys to ensure treatment success.

[Expression of tuftelin protein and its clinical value in HBV-related liver cancer tissues]

Objective: To analyze the expression of tuftelin protein (TUFT1) and its clinical value in hepatocellular carcinoma (HCC)-related liver cancer tissues. Methods: The biological information data of TUFT1 mRNA expression in liver cancer and non-cancer tissues were analyzed from the TCGA and Oncomine database. After the approval of the ethics committee, the self-pairing method was used to collect the postoperative cancer and para-carcinoma tissues of 132 HCC cases hospitalized between January 2009 and December 2014. Tissue microarray and immunohistochemistry (IHC) were used to analyze the expression of TUFT1 in liver tissues. According to IHC staining, liver cancer was divided into high TUFT1 and low/no expression group. Combined with clinical data, the clinicopathological characteristics were statistically analyzed between and within the groups. The 5-year overall survival (OS) and disease-free survival (DFS) was analyzed by correlation analysis. Results: IHC staining showed that TUFT1 in cancer tissue was localized in the cytoplasm and cell membrane, and its positive expression rate was significantly higher in the liver cancer group (87.1%) than the para-carcinoma group (64.4%) (χ (2) = 18.563, P < 0.001). TUFT1 expression intensity in patients with liver cancer was significantly correlated with HBeAg positive (χ (2) = 4.080, P = 0.043), tumor size (χ (2) = 9.388, P = 0.002), vascular invasion (χ (2) = 14.885, P < 0.001), TNM stage (χ (2) = 13.516, P < 0.001) and ascites (χ (2) = 5.940, P = 0.015). TUFT1 high expression was negatively correlated with OS and DFS (P < 0.001). Conclusion: The overexpression of TUFT1 is closely related to HBV replication, vascular invasion and poor prognosis, and it is expected to become a useful marker for liver cancer diagnosis and prognosis.

Electronic frailty index for predicting mortality outcome of patients undergoing transaortic valvular implantation

Funding Acknowledgements

Type of funding sources: None.

Objective

Electronic frailty index for predicting mortality outcome of patients undergoing transaortic valvular implantation (TAVI) served as useful surrogates but is associated with a poor prognosis since it needs long time to determine the frailty status and develop the index based on electronic health records. We identify significant risk mortality predictors and tested the hypothesis that an electronic frailty index incorporating ECG measurements and laboratory examinations using a machine learning survival analysis approach can improve TAVI mortality prediction.

Design

A territory-wide observational study which involved a total of 450 patients (49.11% females, 22 mortalities) diagnosed undergoing TAVI and admitted to public hospitals from Hong Kong.

Methods

Demographics (TAVI presentation age, gender, severity of TR, AR, MR, PR, INR of TAVI presentation), prior comorbidities before TAVI presentation, ECG measurements, and CBC and LRFT laboratory examinations were analyzed. Cox regression and a supervised sequential ensemble learning algorithm: gradient boosting survival tree (GBST) model, was applied to predict mortality. Significant univariate and multivariate risk predictors of mortality were identified. Importance ranking of variables were obtained with GBST model and used to build the frailty models. Comparisons were provided with baseline models of random survival forests and multivariate Cox regression.

Results

The median TAVI presentation age was 82.3 years (83.8 years in mortalities, and 82.1 years in alive patients). INR of TAVI presentation in mortalities (median: 1.32) is much higher than alive ones (median: 1.07). Severe TR (hazard ratio, HR: 8.93, 95% CI: [3.22, 24.78], p value &lt; 0.0001), INR of TAVI presentation (HR: 2.74, 95% CI: [1.84, 4.09], p value &lt; 0.0001), cumulative hospital stays (HR: 1.01, 95% CI: [1.00, 1.01], p value = 0.0008), aspartate transaminase (HR: 1.01, 95% CI: [0.98, 1.002], p value = 0.0002), and bilirubin (HR: 1.02, 95% CI: [1.01, 1.02], p value = 0.0003) are significant mortality risk predictors. Machine learning survival analysis model found that APTT demonstrates the most important strength, followed by INR of TAVI presentation, severe TR status, cumulative hospital stays, cumulative readmission times, creatinine test, urate test ALP test, and ECG measurements of QTc and QT. GBST significantly outperformed random survival forests and multivariate Cox regression (precision: 0.91, recall: 0.89, AUC: 0.93, C-index: 0.96, and KS-index: 0.50) for mortality prediction.

Conclusions

 Electronic frailty index based on demographics, prior comorbidities, hospitalization characteristics, ECG measurements, and laboratory examinations can efficiently predict mortality outcome of patients undergoing TAVI. Machine learning survival learning model significantly improves the risk prediction performance and improves the construction of the frailty models for tailored interventions of TAVI patients in clinical practices.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Parsing the microRNA genetics basis regulating skeletal muscle fiber types and meat quality traits in pigs

Muscle fibers are closely related to human diseases and livestock meat quality. However, the genetics basis of microRNAs (miRNAs) in regulating muscle fibers is not completely understood. In this study, we constructed the whole genome-wide miRNA expression profiles of porcine fast-twitch muscle [biceps femoris (Bf)] and slow-twitch muscle [soleus (Sol)], and identified hundreds of miRNAs, including four skeletal muscle-highly expressed miRNAs, ssc-miR-378, ssc-let-7f, ssc-miR-26a, and ssc-miR-27b-3p. Moreover, we identified 63 differentially expressed (DE) miRNAs between biceps femoris vs. soleus, which are the key candidate miRNAs regulating the skeletal muscle fiber types. In addition, we found that the expression of DE ssc-miR-499-5p was significantly correlated to the expression of Myoglobin (r = 0.6872, P < 0.0001) and Myosin heavy chain 7 (MYH7; r = 0.5408, P = 0.0020), and pH_45 min (r = 0.3806, P = 0.0380) and glucose content (r = -0.4382, P = 0.0154); while the expression of DE ssc-miR-499-3p was significantly correlated to the expression of Myoglobin (r = 0.5340, P = 0.0024) and pH_45 min (r = 0.4857, P = 0.0065). Taken together, our data established a sound foundation for further studies on the regulatory mechanisms of miRNAs in skeletal muscle fiber conversion and meat quality traits in livestock, and could provide a genetic explanation of the role of miRNAs in human muscular diseases.

[Application of cloud-based information platform in China National Birth Cohort]

Birth cohort is an important observational study which can continuously and dynamically collect the exposure changes and health outcomes from gametophyte development to adolescence and even old age. However, because of its complex design and difficult implementation, how to construct birth cohort with high quality and high efficiency is the main difficulty faced by epidemiologists at home and abroad. In 2016, China National Birth Cohort was officially launched. The network and information technology were used to explore, and a set of "cloud-based information platform" was established to support this queue construction, containing 16 units in China. After four years of development, the platform has formed a complete set of programs about the construction of cohort information platform, which including recruitment and follow-up management of participants, real-time data interaction, queue quality control, multi-level authority management and function division. The relevant design framework and functional elements provide the references to the future information construction of large-scale birth cohort and even population-based research in China.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Gas explosion-induced acute blast lung injury assessment and biomarker identification by a LC-MS-based serum metabolomics analysis

The objective of this study was to evaluate the histopathological effect of gas explosion on rats, and to explore the metabolic alterations associated with gas explosion-induced acute blast lung injury (ABLI) in real roadway environment using metabolomics analyses. All rats were exposed to the gas explosion source at different distance points (160 m and 240 m) except the control group. Respiratory function indexes were monitored and lung tissue analysis was performed to correlate histopathological effect to serum metabolomics. Their sera samples were collected to measure the metabolic alterations by ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). HE staining in lung showed that the gas explosion caused obvious inflammatory pulmonary injury, which was consistent with respiratory function monitoring results and the serum metabolomics analysis results. The metabolomics identified 9 significantly metabolites different between the control- and ABLI rats. 2-aminoadipic acid, L-methionine, L-alanine, L-lysine, L-threonine, cholic acid and L-histidine were significantly increased in the exposed groups. Citric acid and aconitic acid were significantly decreased after exposure. Pathway analyses identified 8 perturbed metabolic pathways, which provided novel potential mechanisms for the gas explosion-induced ABLI. Therefore, metabolomics analysis identified both known and unknown alterations in circulating biomarkers, adding an integral mechanistic insight into the gas explosion-induced ABLI in real roadway environment.

Research Progress on Individual Identification by Frontal Sinus Imaging

Abstract

Frontal sinus imaging is an important research object in forensic individual identification due to the highly specific irregular air cavity shape of frontal sinus, the stability of its shape after maturity, and the wide clinical application of radiology technology. The use of frontal sinus imaging for individual identification has significance in the court. When the application of traditional individual identification methods such as fingerprint identification and DNA analysis are limited or cannot be effectively carried out, or when the corresponding dental records are lacking and in other special cases, individual identification with frontal sinus imaging comparison is an effective alternative. Various types of image data can be used for individual identification with frontal sinus, mainly based on artificial visual comparing. With limitations such as, high professional requirements, low efficiency and small application range, the methods cannot be used in mass disasters. In recent years, some computer image recognition techniques have been used in identification of frontal sinus imagings and can significantly improve the efficiency of recognition. Difficulties such as low manual recognition efficiency may be overcomed. This study summarizes the reports on forensic individual identification using frontal sinus imaging, to review the research progress on individual identification with frontal sinus imaging, to provide a reference for further research on frontal sinus imaging, and to provide ideas for exploration and establishment of a faster, more efficient and more accurate individual identification system.

Observations of heteroclinic bifurcations in resistive magnetohydrodynamic simulations of the plasma response to resonant magnetic perturbations

A class of topological magnetic island bifurcations that has not previously been observed in toroidal plasmas is described. Increasing an externally applied three-dimensional magnetic field in resistive magnetohydrodynamic simulations results in the asymmetric elongation of resonant island flux surfaces followed by a sequence of heteroclinic bifurcations. These bifurcations produce new sets of hyperbolic-elliptic fixed points as predicted by the Poincaré-Birkoff fixed point theorem. Field line calculations verify that the new fixed points do not connect to those of the prebifurcated islands as required for heteroclinic bifurcations on a torus with winding numbers composed of common integer factors.

Feasibility of photon-counting spectral CT in dental applications-a comparative qualitative analysis

PURPOSE

The goal of this study was to demonstrate the feasibility of using photon-counting spectral CT for dental applications. This paper qualitatively analyzes the visibility of accessory canals (ACs) and metal artefacts from dental implants for cone-beam CT (CBCT), microtomography (microCT), and photon-counting spectral CT (PCSCT).

MATERIALS AND METHODS

All of the teeth in this study were extracted, and eight teeth in total were scanned on a CBCT scanner, a microCT scanner and on a PCSCT scanner. Six of the teeth that were scanned have accessory canals, one has a titanium rod attached to it, and one has a gutta-percha point inside it. Qualitative analysis was done to compare the different imaging modalities.

RESULTS

The subjective image analysis demonstrated similar performance in AC detection and visualisation for PCSCT and CBCT (p value >0.05). Both PCSCT and microCT performed similarly for metal artefact reduction, and both were superior to CBCT (p value <0.05).

CONCLUSION

Although microCT provides detailed information about small anatomical structures, it is not suitable for in vivo use. However, the PCSCT scanner was able to detect small anatomical structures in teeth comparable to CBCT, as well as being superior in reducing metal artefacts from dental implants. This study showed that PCSCT is a promising modality for future dentistry applications.

[Whole genomic copy number variation score: an indicator of potential diagnostic and prognostic value for lung adenocarcinoma]

Objective: To verify the value of whole genomic copy number variation (WGCNV) detection and scoring system in the diagnosis and prognosis of lung adenocarcinoma. Methods: Seventy-six lung adenocarcinoma specimens including ninety-one tumor samples and twenty adjacent non-tumor lung tissue samples were collected using Laser capture microdissection (LCM). Whole genomic amplification (WGA) was used to enrich DNA and construct a sequencing library for next generation sequencing (NGS). Changes of larger than 5Mb CNV in this study were analyzed and scored. The nuclear grading and score of tumor cells in the surgery and pleural effusion cytology of lung adenocarcinoma specimens were evaluated separately. For each case, we evaluated (1) nuclear size, (2) mitotic counts, (3) nuclear atypia, (4) atypical mitoses. The data of disease-free survive (DFS) and overall survive (OS) were collected for assessing the prognostic value of WGCNV score. Meanwhile, receiver operating characteristic (ROC) and area under curve (AUC) were used to define a cut-off value and evaluate the diagnostic significance in lung adenocarcinoma. Results: The WGCNV scores of twenty adjacent non-tumor lung tissue samples were treated as normal control and all of WGCNV scores of tumor samples range from 0 to 9.95, the median score was 2.7. The WGCNV scores were divided into three groups: low score group <1.74, medium score grade 1.74~4.23, high score grade >4.23. The WGCNV score was positively associated with the nuclear grade scoring (r=0.780 90, P<0.001). The result for evaluation of prognostic value of the WGCNV scores showed that comparing with low WGCNV score group, Hazard Ratio (HR) of medium score group was 4.11 (95%CI=0.72~23.57) and high score group was 2.07 (95%CI=0.30~14.12). These results suggested that the risks of the medium and high WGCNV score group elevated. According to the analysis results of ROC curve, when the cut off value was 0.01, the sensitivity and specificity for lung adenocarcinoma diagnosis were 97.8% and 95.0% respectively, the positive predictive value (PPV) and negative predictive value (NPV) were 99.0% and 90.1%, respectively, the AUC was 0.981. In the differentiation of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) group and invasive adenocarcinoma group, when the cut off value was 1.8, the sensitivity and specificity between the two groups were 78.1% and 94.4%, and the PPV and NPV were 98.0% and 52.0%, respectively, the AUC was 0.896. Conclusion: This study verifies that WGCNV scoring system has a potential diagnostic and prognostic value in lung adenocarcinoma.

First Measurement of Differential Charged Current Quasielasticlike ν_{μ}-Argon Scattering Cross Sections with the MicroBooNE Detector

We report on the first measurement of flux-integrated single differential cross sections for charged-current (CC) muon neutrino (ν_{μ}) scattering on argon with a muon and a proton in the final state, ^{40}Ar (ν_{μ},μp)X. The measurement was carried out using the Booster Neutrino Beam at Fermi National Accelerator Laboratory and the MicroBooNE liquid argon time projection chamber detector with an exposure of 4.59×10^{19} protons on target. Events are selected to enhance the contribution of CC quasielastic (CCQE) interactions. The data are reported in terms of a total cross section as well as single differential cross sections in final state muon and proton kinematics. We measure the integrated per-nucleus CCQE-like cross section (i.e., for interactions leading to a muon, one proton, and no pions above detection threshold) of (4.93±0.76_{stat}±1.29_{sys})×10^{-38}  cm^{2}, in good agreement with theoretical calculations. The single differential cross sections are also in overall good agreement with theoretical predictions, except at very forward muon scattering angles that correspond to low-momentum-transfer events.

Anticoagulation profile of high-dose vs. standard-dose enoxaparin for percutaneous coronary intervention

Background

Although enoxaparin 0.5 mg/kg is a recommended anticoagulation regimen for percutaneous coronary intervention (PCI), a randomized study demonstrated that more patients receiving enoxaparin 0.75 mg/kg compared to those receiving 0.5 mg/kg achieved therapeutic anticoagulation without increase of major bleeding. However, no detailed data regarding the anticoagulation profile of enoxaparin 0.75 mg/kg was reported in the study.

Purpose

This study prospectively assessed the anticoagulation profile of enoxaparin 0.75 mg/kg vs. 0.5 mg/kg in troponin-negative patients undergoing elective trans-radial coronary angiography (CAG).

Methods

Eligible patients were randomly assigned to the Planned Single-dose group (0.75 mg/kg) or the Planned Staged-dose group (0.5±0.25 mg/kg). In the Planned Single-dose group, all patients received enoxaparin 0.75 mg/kg before CAG irrespective of their indication for subsequent PCI. In the Planned Staged-dose group, enoxaparin 0.5 mg/kg was administered to all patients before CAG and additional 0.25 mg/kg was given only to those undergoing subsequent PCI immediately before PCI. Patients without indication for subsequent PCI in each group were defined as High-dose (0.75 mg/kg) and Standard-dose (0.5 mg/kg) groups, respectively. Anti-Xa levels were assessed at 0 min (immediately before), 10 min, and 90 min after enoxaparin administration. Therapeutic anticoagulation was defined as anti-Xa level of 0.5–1.8 IU/ml. Bleeding was according to the thrombolysis in myocardial infarction (TIMI) criteria.

Results

In 170 randomized patients, 48 of 85 patients in the Planned Single-dose group and 47 of 85 patients in the Planned Staged-dose group were included in the High-dose and Standard-dose groups, respectively. The baseline characteristics were well balanced between the two groups. The anti-Xa levels were higher in the High-dose vs. Standard-dose group both at 10 min (1.354±0.228 IU/ml vs. 0.976±0.213 IU/ml, p&lt;0.001) and 90 min (0.827±0.195 IU/ml vs. 0.583±0.169 IU/ml, p&lt;0.001) (Figure 1). The percentages of patients with therapeutic anticoagulation were similar at 10 min (100% [46/46] vs. 100% [46/46], p=1.000) but higher at 90 min (100% [41/41] vs. 75% [33/44], p=0.001) in the High-dose vs. Standard-dose group. No TIMI major or minor bleeding occurred within 24 h of randomization in both groups.

Conclusions

Enoxaparin 0.75 mg/kg compared to 0.5 mg/kg provided higher anticoagulation which was adequate for up to 90 min of administration. Enoxaparin 0.75 mg/kg would be a superior anticoagulation regimen for PCI, especially when the procedure duration is long.

Figure 1. High-dose vs. Standard-dose

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): 2016 Peking Union Medical College Hospital (PUMCH) Science Fund for Junior Faculty

Anticoagulation profile of staged-dose vs. single-dose enoxaparin for trans-radial percutaneous coronary intervention

Background

Anticoagulation is indicated in patients undergoing trans-radial coronary angiography (CAG) with or without percutaneous coronary intervention (PCI). However, full-dose enoxaparin given before CAG to all patients may cause over-anticoagulation in those without indication for subsequent PCI.

Purpose

This study prospectively assessed the anticoagulation profile of staged-dose (0.5±0.25 mg/kg) vs. single-dose (0.75 mg/kg) enoxaparin in troponin-negative patients undergoing elective trans-radial PCI.

Methods

Eligible patients were randomly assigned to the Planned Staged-dose group or the Planned Single-dose group. In the Planned Staged-dose group, enoxaparin 0.5 mg/kg was administered to all patients before CAG and additional 0.25 mg/kg was given only to those undergoing subsequent PCI immediately before PCI. In the Planned Single-dose group, all patients received enoxaparin 0.75 mg/kg before CAG irrespective of their indication for subsequent PCI. Patients undergoing subsequent PCI in each group were defined as Staged-dose and Single-dose groups, respectively. Anti-Xa levels were assessed at 0 min (before) and 10 min after enoxaparin administration (CAG-0min and CAG-10min, respectively), and 0 min (before) and 10 min after the beginning of PCI (PCI-0min and PCI-10min, respectively), and at the end of PCI (PCI-end). Therapeutic anticoagulation was defined as anti-Xa levels of 0.5–1.2 IU/ml before PCI and 0.5–1.8 IU/ml during PCI, respectively. Bleeding was according to the thrombolysis in myocardial infarction (TIMI) criteria.

Results

In 170 randomized patients, 38 of 85 and 37 of 85 patients were included in the Staged-dose and the Single-dose groups, respectively. The baseline characteristics were well balanced between the two groups. The anti-Xa levels were lower before PCI (CAG-10min: 0.903±0.124 IU/ml vs. 1.303±0.207 IU/ml, p&lt;0.001; PCI-0min: 0.874±0.149 IU/ml vs. 1.215±0.185 IU/ml, p&lt;0.001) and higher during PCI (PCI-10min: 1.207±0.190 IU/ml vs. 1.083±0.157 IU/ml, p=0.004; PCI-end: 1.079±0.237 IU/ml vs. 1.050±0.255 IU/ml, p=0.62) in patients receiving staged-dose vs. single-dose enoxaparin (Figure 1). The percentages of patients with therapeutic anticoagulation were higher before PCI (CAG-10min: 100% [35/35] vs. 30.6% [11/36], p&lt;0.001; PCI-0min: 96.8% [30/31] vs. 54.1% [20/37], p&lt;0.001) and similar during PCI (PCI-10min: 100% [34/34] vs. 100% [36/36], p=1.000; PCI-end: 97.2% [35/36] vs. 100% [36/36], p=1.000) in the Staged-dose vs. the Single-dose group. No TIMI major or minor bleeding occurred within 24 h of randomization in both groups.

Conclusions

Although both regimens of enoxaparin achieved adequate anticoagulation during the entire course of PCI, the staged-dose compared to the single-dose regimen reduced over-anticoagulation before PCI. The staged-dose enoxaparin would be a superior anticoagulation regimen in patients undergoing trans-radial CAG, especially when the indication for subsequent PCI is unclear.

Figure 1. Staged-dose vs. Single-dose

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): 2016 Peking Union Medical College Hospital (PUMCH) Science Fund for Junior Faculty

Association of inflammatory disease and long-term outcomes among young adults with myocardial infarction: the Partners YOUNG-MI registry

Background

Autoimmune systemic inflammatory diseases are associated with an increased risk of cardiovascular disease, particularly myocardial infarction (MI). However, there are limited data on the prevalence and effects of inflammatory disease among U.S. adults who experience an MI at a young age.

Purpose

We sought to determine the prevalence and prognostic value of inflammatory disease in U.S. adults who experience an MI at a young age.

Methods

The YOUNG-MI registry is a retrospective cohort study of consecutive patients who experienced a Type 1 MI at or below the age of 50 years from 2000 to 2016 at two large medical centers. A diagnosis of rheumatoid arthritis (RA), psoriasis (PsO), systemic lupus erythematosus (SLE), or inflammatory arthritis was determined through physician review of electronic medical records (EMR). Demographic information, presence of cardiovascular (CV) risk-factors, medical procedures, and medications upon discharge were also ascertained from the EMR. Incidence of death was determined using a combination of EMR and national databases. Cox proportional hazard modeling was performed on a sub-sample following Mahalanobis Distance matching on age, sex, and CV risk factors.

Results

The cohort consisted of 2097 individuals (median age 45 years, 19% female, 53% ST-elevation MI). Among these, 53 (2.5%) individuals possessed a diagnosis of systemic inflammatory disease at or before their index MI (23% SLE, 9% RA, 64% PsO, 4% inflammatory arthritis). When compared to the remainder of the cohort, patients with a diagnosis of systemic inflammatory disease were more likely to be female (36% vs 19%, p=0.004) and be diagnosed with hypertension (62% vs 46%, p=0.025). There was, however, no significant difference in the prevalence of other CV risk factors – diabetes, smoking, dyslipidemia – or a family history of premature coronary artery disease. Despite these similarities, patients with inflammatory disease were less likely to be prescribed aspirin (88% vs 95%, p=0.049) or a statin (76% vs 89%, p=0.008) upon discharge. Over a median follow-up of 11.2 years, patients with inflammatory disease experienced an increased risk of all-cause mortality when compared with the full-cohort (Figure). Compared to the matched sample (n=138), patients with systemic inflammatory disease exhibited an increased risk of all-cause mortality (HR=2.68, CI [1.18 to 6.07], p=0.018), which remained significant after multivariable adjustment for length of stay and GFR (HR=2.38, CI [1.02 to 5.54], p=0.045).

Conclusions

Among individuals who experienced an MI at a young age, approximately 2.5% had evidence of a systemic inflammatory disease at or before their MI. When compared with a population of individuals with similar cardiovascular risk profiles, those with inflammatory disease had higher rates of all-cause mortality. Our findings suggest that the presence of a systemic inflammatory disorder is independently associated with worse long-term outcomes.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32 HL094301 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”