d8b8e663c0ec78b37c922a07a0cd00ff 280887.pdf c40384557862dc245e165bc42699c53b065b08cc 280887.pdf 0d3230062ec5bd01ec2eff0ee3a67aa2c4d9062646bbe9bba708604aaf28d64a 280887.pdf Title: Major Adverse Cardiovascular Events in Coronary Type 2 Diabetic Patients: Identification of Associated Factors Using Electronic Health Records and Natural Language Processing Subject: Patients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk of developing major adverse cardiovascular events (MACE). This is a multicenter, retrospective, and observational study performed in Spain aimed to characterize these patients in a real-world setting. Unstructured data from the Electronic Health Records were extracted by EHRead®, a technology based on Natural Language Processing and machine learning. The association between new MACE and the variables of interest were investigated by univariable and multivariable analyses. From a source population of 2,184,662 patients, we identified 4072 adults diagnosed with T2DM and CAD (62.2% male, mean age 70 11). The main comorbidities observed included arterial hypertension, hyperlipidemia, and obesity, with metformin and statins being the treatments most frequently prescribed. MACE development was associated with multivessel (Hazard Ratio (HR) = 2.49) and single coronary vessel disease (HR = 1.71), transient ischemic attack (HR = 2.01), heart failure (HR = 1.32), insulin treatment (HR = 1.40), and percutaneous coronary intervention (PCI) (HR = 2.27), whilst statins (HR = 0.73) were associated with a lower risk of MACE occurrence. In conclusion, we found six risk factors associated with the development of MACE which were related with cardiovascular diseases and T2DM severity, and treatment with statins was identified as a protective factor for new MACE in this study. Keywords: diabetes mellitus; coronary artery disease; MACE; risk factors; electronic health records; natural language processing Author: Carlos González-Juanatey, Manuel Anguita-Sánchez, Vivencio Barrios, Iván Núñez-Gil, Juan José Gómez-Doblas, Xavier García-Moll, Carlos Lafuente-Gormaz, María Jesús Rollán-Gómez, Vicente Peral-Disdier, Luis Martínez-Dolz, Miguel Rodríguez-Santamarta, Xavier Viñolas-Prat, Toni Soriano-Colomé, Roberto Muñoz-Aguilera, Ignacio Plaza, Alejandro Curcio-Ruigómez, Ernesto Orts-Soler, Javier Segovia, Víctor Fanjul, Ángel Cequier and SAVANA Research Group Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Oct 13 05:10:22 2022 CEST ModDate: Thu Oct 13 05:14:07 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1233004 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YQOTQA+VnURWPalladioL Type 1 Custom yes yes no 10 0 ODQXMO+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 VUWJLC+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 EXRFRO+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 JGMOZW+CMSY10 Type 1 Builtin yes yes no 28 0 WIRPUU+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 53 0 ACJMLJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 91 0 ACJMLL+PalatinoLinotype TrueType WinAnsi yes yes no 94 0 ACJMMN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 97 0 ACJMLJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 111 0 ACJMLL+PalatinoLinotype TrueType WinAnsi yes yes no 114 0 ACJMMN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 117 0 ACJMLJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 131 0 ACJMLL+PalatinoLinotype TrueType WinAnsi yes yes no 134 0 ACJMMN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 137 0 ACJMLJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 151 0 ACJMLL+PalatinoLinotype TrueType WinAnsi yes yes no 154 0 ACJMMN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 157 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-08-01 02:35:48 CEST RepresentationInformation: 280887.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-07-31 12:41:03 CEST Size: 1233004 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 320 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Children: Item: Title: Study Design Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Item: Title: Data Source Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Study Subjects Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Extraction of the Unstructured Free-Text from EHRs Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: External Validation of EHRead® Performance Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Statistical Data Analyses Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Ethical Considerations and Study Approval Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Children: Item: Title: Study Population Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Demographic and Clinical Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Disease Management Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Major Adverse Cardiovascular Events (MACE) Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Limitations Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Info: Title: Major Adverse Cardiovascular Events in Coronary Type 2 Diabetic Patients: Identification of Associated Factors Using Electronic Health Records and Natural Language Processing Author: Carlos González-Juanatey, Manuel Anguita-Sánchez, Vivencio Barrios, Iván Núñez-Gil, Juan José Gómez-Doblas, Xavier García-Moll, Carlos Lafuente-Gormaz, María Jesús Rollán-Gómez, Vicente Peral-Disdier, Luis Martínez-Dolz, Miguel Rodríguez-Santamarta, Xavier Viñolas-Prat, Toni Soriano-Colomé, Roberto Muñoz-Aguilera, Ignacio Plaza, Alejandro Curcio-Ruigómez, Ernesto Orts-Soler, Javier Segovia, Víctor Fanjul, Ángel Cequier and SAVANA Research Group Subject: Patients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk of developing major adverse cardiovascular events (MACE). This is a multicenter, retrospective, and observational study performed in Spain aimed to characterize these patients in a real-world setting. Unstructured data from the Electronic Health Records were extracted by EHRead®, a technology based on Natural Language Processing and machine learning. The association between new MACE and the variables of interest were investigated by univariable and multivariable analyses. From a source population of 2,184,662 patients, we identified 4072 adults diagnosed with T2DM and CAD (62.2% male, mean age 70 11). The main comorbidities observed included arterial hypertension, hyperlipidemia, and obesity, with metformin and statins being the treatments most frequently prescribed. MACE development was associated with multivessel (Hazard Ratio (HR) = 2.49) and single coronary vessel disease (HR = 1.71), transient ischemic attack (HR = 2.01), heart failure (HR = 1.32), insulin treatment (HR = 1.40), and percutaneous coronary intervention (PCI) (HR = 2.27), whilst statins (HR = 0.73) were associated with a lower risk of MACE occurrence. In conclusion, we found six risk factors associated with the development of MACE which were related with cardiovascular diseases and T2DM severity, and treatment with statins was identified as a protective factor for new MACE in this study. Keywords: diabetes mellitus; coronary artery disease; MACE; risk factors; electronic health records; natural language processing Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Oct 13 05:10:22 CEST 2022 ModDate: Thu Oct 13 05:14:07 CEST 2022 ID: 0xde1541f358533d2e064307b65b0d96ad, 0xde1541f358533d2e064307b65b0d96ad Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: WIRPUU+VnURWPalladioL-Bold FontSubset: true FirstChar: 129 LastChar: 243 FontDescriptor: FontName: WIRPUU+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: VUWJLC+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 250 FontDescriptor: FontName: VUWJLC+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: EXRFRO+URWPalladioL-Ital FontSubset: true FirstChar: 40 LastChar: 241 FontDescriptor: FontName: EXRFRO+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: YQOTQA+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 243 FontDescriptor: FontName: YQOTQA+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: JGMOZW+CMSY10 FontSubset: true FirstChar: 6 LastChar: 21 FontDescriptor: FontName: JGMOZW+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: ODQXMO+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 241 FontDescriptor: FontName: ODQXMO+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 99, 335, 152, 344 Annotation: Subtype: Link Rect: 34, 323, 102, 332 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 126, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 147, 87 Annotation: Subtype: Link Rect: 34, 756, 176, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 166, 642, 177, 655 Annotation: Subtype: Link Rect: 390, 642, 401, 655 Annotation: Subtype: Link Rect: 154, 629, 165, 643 Annotation: Subtype: Link Rect: 262, 629, 273, 643 Annotation: Subtype: Link Rect: 529, 629, 540, 643 Annotation: Subtype: Link Rect: 497, 616, 508, 630 Annotation: Subtype: Link Rect: 142, 604, 153, 617 Annotation: Subtype: Link Rect: 501, 604, 512, 617 Annotation: Subtype: Link Rect: 209, 591, 220, 605 Annotation: Subtype: Link Rect: 294, 591, 305, 605 Annotation: Subtype: Link Rect: 385, 591, 396, 605 Annotation: Subtype: Link Rect: 130, 17, 267, 28 Annotation: Subtype: Link Rect: 424, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 480, 87, 499 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 310, 632, 317, 641 ActionDest: 167 Annotation: Subtype: Link Rect: 320, 632, 327, 641 ActionDest: 167 Annotation: Subtype: Link Rect: 381, 619, 388, 628 ActionDest: 167 Annotation: Subtype: Link Rect: 335, 594, 342, 603 ActionDest: 167 Annotation: Subtype: Link Rect: 389, 581, 396, 591 ActionDest: 167 Annotation: Subtype: Link Rect: 208, 506, 215, 515 ActionDest: 167 Annotation: Subtype: Link Rect: 312, 481, 319, 490 ActionDest: 167 Annotation: Subtype: Link Rect: 460, 355, 467, 365 ActionDest: 167 Annotation: Subtype: Link Rect: 470, 355, 482, 365 ActionDest: 167 Annotation: Subtype: Link Rect: 478, 204, 490, 213 ActionDest: 167 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 307, 396, 314, 405 ActionDest: 167 Annotation: Subtype: Link Rect: 314, 396, 326, 405 ActionDest: 167 Annotation: Subtype: Link Rect: 327, 396, 339, 405 ActionDest: 167 Annotation: Subtype: Link Rect: 339, 396, 351, 405 ActionDest: 167 Annotation: Subtype: Link Rect: 352, 396, 364, 405 ActionDest: 167 Annotation: Subtype: Link Rect: 367, 396, 379, 405 ActionDest: 167 Annotation: Subtype: Link Rect: 231, 321, 243, 330 ActionDest: 167 Annotation: Subtype: Link Rect: 243, 321, 255, 330 ActionDest: 167 Annotation: Subtype: Link Rect: 195, 256, 202, 265 ActionDest: 167 Annotation: Subtype: Link Rect: 202, 256, 214, 265 ActionDest: 167 Annotation: Subtype: Link Rect: 215, 256, 227, 265 ActionDest: 167 Annotation: Subtype: Link Rect: 227, 256, 239, 265 ActionDest: 167 Annotation: Subtype: Link Rect: 365, 231, 372, 240 ActionDest: 167 Annotation: Subtype: Link Rect: 459, 131, 466, 140 ActionDest: 167 Annotation: Subtype: Link Rect: 466, 131, 478, 140 ActionDest: 167 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 281, 216, 288, 228 ActionDest: 78 Annotation: Subtype: Link Rect: 342, 216, 349, 228 ActionDest: 81 Annotation: Subtype: Link Rect: 536, 204, 543, 216 ActionDest: 78 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 527, 146, 534, 158 ActionDest: 81 Annotation: Subtype: Link Rect: 371, 121, 377, 133 ActionDest: 81 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 353, 680, 360, 692 ActionDest: 101 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 272, 705, 279, 717 ActionDest: 121 Annotation: Subtype: Link Rect: 207, 459, 214, 471 ActionDest: 121 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 381, 494, 388, 506 ActionDest: 141 Annotation: Subtype: Link Rect: 272, 66, 284, 76 ActionDest: 167 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 280, 723, 292, 732 ActionDest: 167 Annotation: Subtype: Link Rect: 292, 723, 304, 732 ActionDest: 171 Annotation: Subtype: Link Rect: 403, 710, 410, 719 ActionDest: 167 Annotation: Subtype: Link Rect: 524, 698, 531, 707 ActionDest: 167 Annotation: Subtype: Link Rect: 531, 698, 543, 707 ActionDest: 167 Annotation: Subtype: Link Rect: 544, 698, 556, 707 ActionDest: 171 Annotation: Subtype: Link Rect: 410, 622, 422, 631 ActionDest: 171 Annotation: Subtype: Link Rect: 239, 610, 246, 619 ActionDest: 167 Annotation: Subtype: Link Rect: 420, 535, 432, 544 ActionDest: 171 Annotation: Subtype: Link Rect: 469, 472, 481, 481 ActionDest: 171 Annotation: Subtype: Link Rect: 477, 459, 489, 468 ActionDest: 171 Annotation: Subtype: Link Rect: 412, 422, 424, 431 ActionDest: 171 Annotation: Subtype: Link Rect: 462, 372, 474, 380 ActionDest: 171 Annotation: Subtype: Link Rect: 252, 296, 264, 305 ActionDest: 171 Annotation: Subtype: Link Rect: 209, 271, 221, 280 ActionDest: 171 Annotation: Subtype: Link Rect: 222, 271, 234, 280 ActionDest: 171 Annotation: Subtype: Link Rect: 544, 233, 556, 242 ActionDest: 171 Annotation: Subtype: Link Rect: 279, 170, 291, 180 ActionDest: 167 Annotation: Subtype: Link Rect: 292, 170, 304, 180 ActionDest: 171 Annotation: Subtype: Link Rect: 338, 158, 350, 167 ActionDest: 171 Annotation: Subtype: Link Rect: 418, 120, 430, 129 ActionDest: 171 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 315, 736, 327, 744 ActionDest: 171 Annotation: Subtype: Link Rect: 231, 547, 243, 556 ActionDest: 171 Annotation: Subtype: Link Rect: 246, 547, 258, 556 ActionDest: 171 Annotation: Subtype: Link Rect: 525, 370, 560, 381 Annotation: Subtype: Link Rect: 165, 358, 365, 369 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 477, 696, 515, 707 Annotation: Subtype: Link Rect: 521, 696, 557, 707 Annotation: Subtype: Link Rect: 187, 662, 225, 672 Annotation: Subtype: Link Rect: 59, 639, 96, 649 Annotation: Subtype: Link Rect: 297, 615, 334, 626 Annotation: Subtype: Link Rect: 340, 615, 376, 626 Annotation: Subtype: Link Rect: 478, 603, 515, 614 Annotation: Subtype: Link Rect: 521, 603, 557, 614 Annotation: Subtype: Link Rect: 448, 581, 485, 591 Annotation: Subtype: Link Rect: 491, 581, 527, 591 Annotation: Subtype: Link Rect: 59, 535, 96, 545 Annotation: Subtype: Link Rect: 341, 511, 378, 522 Annotation: Subtype: Link Rect: 59, 478, 96, 488 Annotation: Subtype: Link Rect: 301, 431, 338, 442 Annotation: Subtype: Link Rect: 520, 396, 557, 407 Annotation: Subtype: Link Rect: 372, 373, 409, 384 Annotation: Subtype: Link Rect: 176, 340, 213, 350 Annotation: Subtype: Link Rect: 520, 316, 557, 327 Annotation: Subtype: Link Rect: 348, 293, 385, 304 Annotation: Subtype: Link Rect: 460, 270, 498, 281 Annotation: Subtype: Link Rect: 453, 247, 490, 258 Annotation: Subtype: Link Rect: 109, 202, 146, 212 Annotation: Subtype: Link Rect: 490, 178, 527, 189 Annotation: Subtype: Link Rect: 481, 120, 519, 131 Annotation: Subtype: Link Rect: 194, 87, 232, 97 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 59, 711, 96, 721 Annotation: Subtype: Link Rect: 520, 676, 557, 687 Annotation: Subtype: Link Rect: 187, 607, 225, 617 Annotation: Subtype: Link Rect: 421, 573, 459, 583 Annotation: Subtype: Link Rect: 284, 549, 321, 560 Annotation: Subtype: Link Rect: 240, 504, 277, 514 Annotation: Subtype: Link Rect: 287, 480, 325, 491 Annotation: Subtype: Link Rect: 59, 446, 96, 456 Annotation: Subtype: Link Rect: 59, 400, 96, 410 Annotation: Subtype: Link Rect: 102, 400, 138, 410 Annotation: Subtype: Link Rect: 274, 365, 312, 376 Annotation: Subtype: Link Rect: 318, 365, 354, 376 Annotation: Subtype: Link Rect: 104, 331, 142, 341 Annotation: Subtype: Link Rect: 148, 331, 184, 341 Annotation: Subtype: Link Rect: 177, 284, 215, 295 Annotation: Subtype: Link Rect: 490, 261, 527, 272 Checksum: 2ede0b57 Type: CRC32 Checksum: d8b8e663c0ec78b37c922a07a0cd00ff Type: MD5 Checksum: c40384557862dc245e165bc42699c53b065b08cc Type: SHA-1