bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous coronary intervention in patients with peripheral artery disease and adverse cardiovascular adverse event and bleeding
Authors: Kang M G , Kim K H , Park H W , Koh J S , Hwang S J , Hwang J Y , Park J R
Published: October 2021

Background

Peripheral artery disease (PAD) increase the risk of comorbidity and mortality in coronary artery disease (CAD).

Objectives

We evaluate influence of PAD on prognosis in patients undergoing percutaneous coronary intervention (PCI).

Methods

We analyzed all consecutive patients included in our dedicated local registry for PCI between January 2011 and December 2016. Presence of PAD was defined by decreased ankle-brachial index (<0.9). Major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, non-fatal myocardial infarct, revascularization, and ischemic stroke. Major bleeding was defined as Bleeding Academic Research Consortium 3 or 5.

Results

Among the 4,747 patients who underwent the PCI, 12.9% (n=610) of PAD were identified. Old age (>60 years), renal dysfunction, reduced ejection fraction, and presence of PAD were predictors with both MACE and major bleeding event. Among them, presence of PAD was an independent risk factor of MACE and major bleeding (MACE, HR 8.26, 95% CI 2.33- 29.41, p=0.036; major bleeding, HR 3.11, 95% CI 1.10–10.63, p=0.040, respectively). The MACE and major bleeding rate at 5-year was significantly increased in patients with PAD (MACE, 30.0% vs. 15.8%, log rank test p<0.001; major bleeding, 6.7 vs. 3.6%, log rank test p=0.003, respectively) (Figure).

Conclusion

Presence of PAD was strongly associated with higher rate of long-term MACE and major bleeding. These findings could have a clinical relevance in requiring individualized pharmacologic strategies to reduce the burden of cardiovascular disease.

Funding Acknowledgement

Type of funding sources: None.
Predictive value of the left ventricular function in coronary artery disease: should we tailor risk-stratification for men and women?
Authors: Molenaar M , Bouma B J , Isgum I , Verouden N J , Selder J L , Chamuleau S A J , Schuuring M J
Published: October 2021

Introduction

Left ventricular function (LVF) is a well-known recognized predictor of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and is recommended in all CAD patients by the guidelines of the European Society of Cardiology. As non-obstructive CAD is more common among women, the predictive value of LVF might differ between men and women.

Purpose

The aim of this study is to evaluate sex-related differences in the predictive value of LVF in patients with suspected or documented CAD.

Methods

Patients with suspected or documented CAD who underwent transthoracic echocardiography (TTE) with LVF assessment in a tertiary center between 2014 and 2021 were included. LVF was classified with left ventricular ejection fraction (LVEF) as normal (≥52%) or impaired (LVEF <52%). MACE were defined as death, heart failure (HF), acute coronary syndrome (ACS) and stroke. Time-to-first-event analysis was performed with Kaplan-Meier survival analysis and multivariate Cox proportional hazard analysis adjusting for age as covariate.

Results

In total, 1763 patients were included of which 59% were men (age 65±12 years) and 41% were women (age 65±13 years). 225 (22%) men and 100 (14%) women had impaired LVF (p<0.001). Median follow-up time was 1.9 years (1.2–3.8); median event-free survival for men and women was 1.6 years (1.0–3.3) and 1.6 years (1.0–3.0), respectively (p=0.8). MACE and deaths were reported in 422 patients (23% of men, 25% of women) and 15 patients (12% of men, 10% of women), respectively. Impaired LVF was associated with a significantly higher risk of MACE in both men (HR 1.3, 95% CI: 1.2–1.4, p<0.005) and women (HR 1.2, 95% CI: 1.0–1.3, p=0.02).

Conclusions

Impaired LVF was more common in men with suspected or documented CAD. In patients with impaired LVF, the predictive value of LVF is similar for both men and women.

Funding Acknowledgement

Type of funding sources: Private hospital(s). Main funding source(s): Amsterdam UMC, Amsterdam MACE_men_women
High plasma levels of soluble LOX-1 portends poor survival in acute coronary syndromes beyond GRACE 2.0: a multicentre prospective cohort study
Authors: Kraler S , Obeid S , Liberale L , Von Eckardstein A , Wenzl F A , Paneni F , Matter C , Muller O , Raeber L , Mach F , Akhmedov A , Luescher T F
Published: October 2021

Background

While inflammatory states and dyslipidemias confer a dismal prognosis following myocardial ischaemia, the role of the lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) which sits at the confluence of these conditions remains elusive. Given soluble LOX-1' (sLOX-1) pivotal role in inflammatory processes underlying atherosclerotic plaque progression, we sought to study its prognostic utility on the risk of adverse events in acute coronary syndromes (ACS).

Purpose

Hence, we aimed to investigate whether sLOX-1 is an independent predictor of all-cause death at one year beyond traditional and emerging risk factors for poor survival following ACS.

Methods

2678 ACS patients were recruited in the prospective, multicentre SPUM-ACS trial, of which 2525 completed follow-up at one year. Major adverse cardiovascular events, including death from any cause, were adjudicated by an independent clinical endpoint committee. By employing high-sensitive enzyme-linked immunosorbent assay, sLOX-1 was assessed in the plasma at the time of presentation in ACS and age-matched chronic coronary syndrome (CCS) patients. Kaplan-Meier survival analysis and Cox proportional hazard regression models, adjusted for baseline variables and the GRACE 2.0 score, were used to study the predictive utility of sLOX-1.

Results

At the time of presentation, ACS patients, specifically those with ST-segment elevation ACS, had significantly elevated sLOX-1 levels as compared to patients with CCS (median, 35.40 vs. 2.00 pg/ml, P<0.0001). Patients in the upper sLOX-1 tertile were at heightened risk for both death from any cause (crude HR 1.785, 95% CI 1.083–2.941, P<0.05; adjusted HR 2.035, 95% CI 1.176–3.519, P<0.05) and CV death (crude HR 2.447, 95% CI 1.285–4.663, P<0.01; adjusted HR 2.383, 95% CI 1.206–4.710, P<0.05) compared to those in the first tertile. Importantly, sLOX-1 remained an independent predictor of all-cause death after adjustment for known risk factors of adverse outcome and the GRACE 2.0 score (adjusted + GRACE 2.0 HR 1.896, 95% CI 1.034–3.476, P<0.05).

Conclusions

Plasma sLOX-1 is elevated in ACS patients and predicts poor survival independent of both traditional and emerging risk factors and provides prognostic information beyond GRACE 2.0.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationFoundation for Cardiovascular Research - Zurich Heart House
Relationship of the degree of coronary lesion and serum adipokine levels in patients with myocardial infarction
Authors: Belik E , Gruzdeva O V , Dyleva Y U A , Naumov D Y U , Barbarash O L
Published: October 2021

The role of adipokines in the development of myocardial infarction (MI) is being actively discussed. It is of interest to determine the association between the degree of coronary lesion and serum levels of the studied parameters, as well as the prognostic role of these factors in relation to the risk of developing an unfavorable outcome of MI, which is important for choosing the tactics of a therapeutic strategy.

Aims

Identification of the presence and characteristics of the relationship of the degree of coronary lesions with the levels of adiponectin and leptin in the blood serum of patients with MI.

Materials and methods

The study included 119 patients with ST-segment elevation MI who signed voluntary informed consent. Depending on the degree of coronary lesion, patients were divided into 3 groups by the SYNTAX Score: 47 moderate (≤22, Group 1), 42 severe (23–31, Group 2) and 30 extremely severe (≥32, Group 3). The concentrations of adiponectin and leptin was determined in blood serum by ELISA on the 1st and 12th days of hospitalization (BioVendor, USA). Statistical analysis was performed using Statistica 9.0.

Results

The concentrations of the studied parameters in the blood serum of patients on the 1st day of hospitalization were: adiponectin 7.72 (6.5; 13.0) μg/ml, leptin 7.48 (5.98; 12.5) ng/ml. On the 12th day, there was an increase in the level of adiponectin by 1.5 times and a decrease in leptin by 1.6 times. Correlation analysis revealed significant dependences of the degree of coronary lesion according to the SYNTAX Score with the serum adiponectin level both on the 1st (r=−0.48; p=0.01) and on the 12th day (r=−0.44; p=0.02), and leptin level on the 1st (r=0.35; p=0.01) and 12th days (r=0.37; p=0.01).

Conclusions

The results of this study indicate a relationship between the degree of coronary lesion, assessed by the SYNTAX Score, and the serum adipokine profile in patients with MI. Based on the data obtained, it can be concluded that the studied markers are capable of reflecting the degree of coronary artery disease already on the 1st day of myocardial infarction and the possibility of using the risk of developing myocardial infarction as biomarkers.

Funding Acknowledgement

Type of funding sources: None.
Diagnostic performance of fractional flow reserve derived from computed tomography in the stented coronary arteries
Authors: Toba T , Otake H , Roy A , Choi G , Gobi N , Schaap M , Takahashi Y , Fukuyama Y , Nakano S , Tanimura K , Matsuoka Y , Kawamori H , Taylor C , Ken-Ichi K
Published: October 2021

Background

The current system of HeartFlow fractional flow reserve derived from computed tomography (FFRCT) is not available for stented coronary arteries. However, the latest version of HeartFlow FFRCT has the potential of rendering an accurate assessment for stented coronary arteries.

Objectives

To evaluate the feasibility of FFRCT for the stented coronary arteries.

Methods

We retrospectively enrolled patients with a history of coronary stent implantation who underwent invasive fractional flow reserve (FFR) for the stented coronary arteries within 3 months after coronary computed tomographic angiography (cCTA). As a subgroup analysis, we analyzed optical coherence tomography (OCT) images in patients who underwent OCT for stented vessels. OCT was performed as a part of the Kobe University Hospital OCT registry, which is a single-centre registry of consecutive patients who underwent OCT for the coronary arteries. The diagnostic performance of HeartFlow FFRCT for stented vessels was evaluated by comparing with that of cCTA alone. Minimum lumen area (MLA) within stent segments derived from cCTA was also compared with MLA derived from optical coherence tomography (OCT).

Results

A total of 30 vessels in 23 patients were studied. The diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of FFRCT for myocardial ischemia using invasive FFR as a reference standard was 73.3%, 88.9%, 67.7%, 53.3% and 93.3%, respectively. FFRCT provided superior diagnostic performance than cCTA alone (p=0.016). FFRCT was significantly correlated with the invasive FFR (r=0.620, p<0.001), and Bland-Altman plot showed a mean bias of −0.041 with 95% limit of agreement of −0.173 to 0.092 (Figure 1). Among a total of 30 studied vessels, OCT was available for 25 vessels. MLA derived from cCTA correlated significantly with that derived from OCT (r=0.695, p<0.001), and Bland-Altman plot showed a mean bias of −0.32 mm2 with 95% limit of agreement of −2.89 to 2.25 mm2 (Figure 2).

Conclusions

The latest version of the HeartFlow FFRCT has the potential to be available for stented coronary arteries. Further investigation is required to elaborate our results.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Is there a real difference in approach between women and men with non-ST-segment elevation myocardial infarction? Insights from a multicentre national registry
Authors: Cabral M , Fernandes S , Santos L G , Carvalho M , Carvalho R , Santos B , Loureiro M F , Morais J
Published: October 2021

In patients with non-ST-elevation myocardial infarction (NSTEMI), the early invasive strategy has shown benefit in morbidity and mortality, especially in intermediate-to-high risk patients. However, women still seem to have a lower revascularization rate, regardless of the risk.

The aim of this study is to describe our clinical practice reality about the performance of the invasive strategy between genders among NSTEMI patients, in Portugal.

The authors performed a retrospective analysis of patients admitted with NSTEMI included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and February 2021. A propensity score matching included baseline characteristics and previous history was applied. Comparison tests and log-rank test were performed. A p-value less than 0.05 was considered statistically significant.

A total of 11858 patients with NSTEMI were included, of which 71.3% (n=8450) were men. After the propensity score performing, 4458 patients were analysed, 50.0% (n=2229) men. Table 1 shows the most important baseline characteristics.

The authors found a significant delay in hospital admission after the onset of symptoms in women (median of 6 hours and 48 minutes) compared to men (median of 5 hours) (p<0.01). Grace score was higher in males (mean 153 points) than in females (mean 145 points) (p<0.01).

The cardiac catheterization was performed in 82.9% (n=3695) of the patients, with no difference between genders (p-value=0.19), as shown in table 2. Among those who underwent cardiac catheterisation, the presence of significant stenosis and coronary occlusion was greater in males, for almost all localizations. The absence of obstructive coronary lesions was more common in females (p-value<0.01).

During hospitalization, sustained ventricular tachycardia was more prevalent in males (p-value =0.01), with no significant difference for other complications or in-hospital mortality.

A 1-year follow-up of 2351 patients (1184 men and 1163 women) was analysed, with survival of 91.2% (n=1080) in men and 91.0% (n=1056) in women, with no significant difference (p-value=0.80).

In conclusion, we observed that women are admitted to the hospital later than men and have a lower Grace score at admission. However, the standardized analysis of the groups allows us to infer that the invasive strategy does not seem to be less frequent or late in women, as observed in other populations. A more recent analysis, including risk groups, would be interesting to clarify the results.

Funding Acknowledgement

Type of funding sources: None.
Left ventricular thrombus and anticoagulation: how long should we treat?
Authors: Lorente Ros A , Alonso Salinas G L , Monteagudo J M , Rajjoub Al-Mahdi E , Vieitez Florez J M , Abellas Sequeiros M , Sanmartin M , Fernandez Golfin C , Zamorano J L
Published: October 2021

Background

Left ventricular thrombus (LVT) is a potential complication of acute myocardial infarction and is associated with a high rate of thromboembolic events. With the advent of more potent antithrombotic medications and quicker reperfusion strategies, the incidence of LVT has been reduced. However, current guidelines recommendations are based on older evidence and some aspects of the treatment are being questioned, such as the optimal duration of anticoagulation.

Purpose

To determine how length of anticoagulation influences the risk of thromboembolic events and mortality in a tertiary-care cardiac center with primary percutaneous coronary intervention (PCI) capability.

Methods

A cohort of consecutive cases of patients with IVT diagnosed by transthoracic echocardiography between 2014 and 2020 was retrospectively analyzed.

Results

A total of 72 cases of LVT were identified. Etiology was ischemic cardiomyopathy in 60 (82.0%) patients and 13 (20.0%) were female. LVT was diagnosed in the setting of acute myocardial infarction in 23 (32.0%) of cases. Prolonged anticoagulation regimes were significantly associated with fewer systemic thromboembolic events (21.4% vs 6.1%; p=0.04), without a significant effect on mortality (Figure 1).

Conclusion

Clinical manifestations and epidemiology of LVT has recently changed after the advent of improved treatments. In our cohort, an indefinite anticoagulation strategy was significantly associated with fewer thromboembolic events, suggesting that future investigations should clarify these issues.

Funding Acknowledgement

Type of funding sources: None.
Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy
Authors: Gallinoro E , Monizzi G , Candreva A , Sonck J , Mileva N , Mastrangelo A , Andreini D , Bartorelli A L , Galli S , Nagumo S , Munhoz D , Barbato E , De Bruyne B , Collet C
Published: October 2021

Background

Percutaneous coronary interventions (PCI) in calcified coronary artery lesions is associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using dedicated calcium modifying techniques such as RA or IVL has been advocated. Studies comparing these technologies are lacking.

Objectives

To compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either rotational atherectomy (RA) or intravascular lithotripsy (IVL).

Methods

Patients undergoing either RA- or IVL-assisted PCI from two European centers were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post- PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad, calculated as the difference between the vFFR at the proximal minus distal edge of the stent). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥0.90.

Results

From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0,65±0,13 RA and 0,67±0,11 IVL). After PCI, in-stent pressure gradient was significantly lower in the IVL group (0.032±0.026 vs 0.043±0.026 in the RA group, p=0.024). The proportion of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; p=0.669)

Conclusions

Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL.

Funding Acknowledgement

Type of funding sources: None. In stent gradients after RA and IVL
Prognostic effect of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery
Authors: Esteban-Lucia L , Nieto-Roca L , Gonzalez-Lorenzo O , Franco-Pelaez J A , Pello-Lazaro A M , Acena Navarro A , Kallmeyer-Mayor A M , Venegas Rodriguez A M , Esteban-Chapel J A , Romero-Otero J M , Aldamiz Echevarria Del Castillo G , Tunon J
Published: October 2021

Introduction

Atherosclerosis vascular disease is one of the main causes of morbidity and mortality in the world. We aimed to evaluate the prognostic impact of a history of peripheral vascular disease in patients undergoing coronary artery bypass graft surgery (CABG).

Methods

Single-center, observational and retrospective study including all patients undergoing CABG in our center between 2010 and 2018. Electronic health records were used to record clinical characteristics to identify patients with a history of peripheral vascular disease. This one was defined as having a history of stroke or transient ischemic attack (TIA), intermittent claudication, or previous percutaneous or surgical arterial procedure. Patients were followed until December 2019. The primary endpoint (PE) was the composite of stroke, TIA, myocardial infarction, new coronary revascularization, inferior limb vascular or aortic aneurysm intervention, and death.

Results

We included 567 patients, 138 (24.3%) with a history of peripheral vascular disease (stroke/TIA 34.1%; carotid surgery 6.5%; inferior limb surgery 12.3%; abdominal aortic aneurysm surgery 8.7% and intermittent claudication 38.4%). Baseline characteristics of the overall cohort and different subgroups (with and without peripheral vascular disease) can be seen in the table.

The group with peripheral vascular disease had a worse clinical profile. They were significantly older, more frequently males, and smokers. They also had a higher prevalence of hypertension, diabetes, dyslipidemia, chronic kidney disease, and neoplasms. In addition, the preoperative status was less favorable, left ventricular ejection fraction and hemoglobin were lower, and renal function was worse than the group without peripheral vascular disease.

The median follow-up was 4.2 years. During the study period, 55 patients (40%) with peripheral vascular disease and 80 patients (18.6%) without peripheral vascular disease reached the PE. After multivariate Cox modeling, variables independently related to PE were diabetes (HR=1.65 (1.17–2.33); p=0.004), creatinine levels (HR= 1.32 (1.19–1.47); p≤0.001) and peripheral vascular disease (HR= 2.28 (1.60–3.25); p≤0.001) (figure, panel A). Kaplan-Meier survival curves of PE according to the presence of peripheral vascular disease prior to CABG are shown in panel B of the figure.

Conclusion

According to our results, patients with peripheral vascular disease have approximately double the risk of suffering a major complication after CABG. Larger studies are needed to confirm these results.

Funding Acknowledgement

Type of funding sources: None. Description of studied population.HR and Kaplan-Meier curves
Comparing one-year outcomes of invasive versus medical management of patients with prior coronary artery bypass graft surgery presenting with non-ST elevation myocardial infarction
Authors: Ramtoola M T , Hartemink J W , Dhuny S , Nathan J , Shabbir H , Shafiq A , Garg S A
Published: October 2021

Background

Early percutaneous coronary intervention (PCI) has a Class 1A recommendation for patients with non-ST elevation myocardial infarction (NSTEMI). However, the benefits of this invasive approach in patients with previous coronary artery bypass graft (CABG) surgery are uncertain, as these patients have previously been excluded from pivotal trials.

Purpose

We hypothesised that routine invasive management in patients with previous CABG presenting with NSTEMI, but otherwise medically stable, carried similar prognostic outcomes to patients who were medically managed.

Methods

This single centre retrospective observational study screened patients with prior CABG presenting with NSTEMI between January 2015 and December 2019. Patients either underwent coronary angiography with or without PCI at their physician's discretion or received standard acute coronary syndrome (ACS) medical therapy. Follow up time was 365 days from admission date, and clinical, demographic, procedural and outcome data were collected. The primary endpoint was major adverse cardiac events (MACE), a composite of all-cause mortality and rehospitalisation for unstable angina, myocardial infarction, or heart failure.

Results

The study included 267 patients (mean ±SD age: 72±10 years, 82% male), of whom 80.1% (N=214) underwent cardiac catheterisation, and 19.9% (N=53) only received standard ACS medical therapy. Amongst the invasive group, 65.4% (N=140) received PCI. No one was referred for re-do CABG. At 1-year follow up, the primary composite outcome occurred in 18 (13%) patients in the PCI group, 13 (18%) in those managed conservatively following angiography, and in 27 (51%) patients receiving medical therapy only. Cox regression modelling showed no significant difference in the 1-year primary endpoint amongst those having an angiogram who received PCI versus those treated medically after invasive assessment (HR: 0.75 [95% CI: 0.38–1.48; P=0.412]). Previous revascularisation with PCI (HR: 1.90 [CI, 1.11–3.24; P=0.018]) and chronic kidney disease (CKD) (HR: 2.60 [CI, 1.56–4.34; P<0.001]) at any stage, were the most important predictors of poor outcomes in CABG patients with NSTEMI irrespective of management strategy.

Conclusion

Patients with previous CABG who are admitted with NSTEMI who were not considered suitable for invasive angiography experienced significantly higher rates of MACE at 1-year follow up. The presence of CKD or previous PCI were key indicators of poor outcomes irrespective of management strategy. Outcomes amongst those deemed fit enough for invasive angiography were similar irrespective of treatment, suggesting that additional non-invasive testing may help further define which patients would benefit from an invasive strategy.

Funding Acknowledgement

Type of funding sources: None.
Early and chronic phased local coagulative responses following bioresorbable-polymer drug-eluting stent implantation
Authors: Yamaguchi K , Wakatsuki T , Okushi Y , Suto K , Matsumoto K , Takahashi T , Kadota M , Kawabata Y , Matsuura T , Ise T , Kusunose K , Yagi S , Yamada H , Soeki T , Sata M
Published: October 2021

Background

Neointimal maturation after bioresorbable-polymer (BP) drug-eluting stent (DES) implantation will not be complete in the absorption phase of the polymer. We have previously reported local persistent hypercoagulation after sirolimus-eluting stent (SES) implantation by measuring local plasma prothrombin fragment 1+2 (F1+2) levels. The aim of this study is to examine time-dependent local coagulative response after BP-DES implantation.

Methods

Sixty-four patients who were treated about ten months earlier with coronary angioplasty, with no evidence of restenosis, were studied [durable-polymer (DP)-DES {SES; Cypher®: 26pts and everolimus-eluting stent (EES); Xience®: 16pts} and BP-DES (BP-EES; Synergy®: 10pts and BP-SES; Ultimaster®: 12pts)]. We measured plasma levels of F1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V) at the early (2±1 months) and chronic (10±2 months) phases. The transcardiac gradient (Δ) was defined as CS level minus V level.

Results

No significant differences were observed in the percent diameter stenosis between the DP- and BP- DES groups (11.5±15.5 vs 14.1±11.9%). The ΔF1+2 was significantly lower in the BP-DES group than in the DP-DES group at the chronic phase (7.5±16.1 vs 16.4±17.1pmol/l, p<0.05). In the BP-DES group, the ΔF1+2 did not differ significantly between the early and chronic phases (7.0±14.1 vs 7.5±16.1pmol/l, NS).

Conclusion

Lower local coagulative response was observed at the chronic phase after BP-DES implantation compared to DP-DES implantation, and local hypercoagulation after BP-DES implantation was not observed at the early phase compared to the chronic phase. These findings might lead to the possibility of shorter dual antiplatelet therapy after BP-DES implantation.

Funding Acknowledgement

Type of funding sources: None.
Statins for primary prevention among elderly men and women
Authors: Bergami M , Cenko E , Yoon J , Mendieta G , Kedev S , Zdravkovic M , Vasiljevic Z , Milicic D , Manfrini O , Van Der Schaar M , Gale C P , Badimon L , Bugiardini R
Published: October 2021

Background

The debate about statins in primary prevention of cardiovascular (CV) disease is still alive, especially in old and very old adults.

Purpose

We undertook a propensity match-weighted cohort study to investigate whether statin treatment recommendations translate into improved cardiovascular (CV) outcomes in the current routine clinical care of the elderly.

Methods

We included in our analysis 5,619 people aged 65 years or older from the ISACS (International Survey of Acute Coronary Syndrome) Archives (NCT04008173) who presented to hospital with a first manifestation of CV disease. Participants were stratified as statin users versus nonusers and as old (65 to 75 years) versus very old (76 years or over) adults. We estimated the effects of statins on the most severe clinical manifestation of CV disease, namely ST segment elevation myocardial infarction (STEMI), using inverse probability of treatment weighting models. Estimates were compared by test of interaction on the log scale.

Results

The risk of STEMI was much lower in statin users than in nonusers in both patients aged 65 to 75 years (14.7% absolute risk reduction; relative risk [RR] ratio: 0.55, 95% CI 0.45 to 0.66) and those aged 76 years and older (13.3% absolute risk reduction; RR ratio: 0.58, 95% CI 0.46 to 0.72). Estimates were similar in patients with and without history of hypercholesterolemia (interaction test; p value= 0.2408). Proportional reductions in STEMI diminished with female sex in the old (p for interaction=0.002), but not in the very old age (p for interaction=0.26). We also observed a remarkable reduction in the risk of 30- day mortality from STEMI with statin therapy in both age groups (10.2% absolute risk reduction; RR ratio: 0.39; 95% CI 0.23 – 0.68 for patients aged 76 or over and 3.8% absolute risk reduction; RR ratio 0.37; 95% CI 0.17 – 0.82 for patients aged 65 to 75 years old; interaction test, p value=0.4570).

Conclusion

Preventive statin therapy in the elderly reduces the risk of STEMI with benefits in mortality from STEMI, irrespective of the presence of a history of hypercholesterolemia. This effect persists after the age of 76 years. Benefits are less pronounced in women.

Funding Acknowledgement

Type of funding sources: None.
The evolution of management and outcomes of patients with myocardial injury during the COVID-19 pandemic
Authors: Case B , Abramowitz J , Shea C , Rappaport H , Yerasi C , Forrestal B , Chezar-Azerrad C , Medranda G , Zhang C , Satler L , Ben-Dor I , Hashim H , Rogers T , Weintraub W , Waksman R
Published: October 2021

Background

Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation, and associated with worse prognosis as compared with patients without myocardial injury.

Purpose

We sought to evaluate if the outcomes of these patients has improved as experience accumulated during the pandemic.

Methods

We analyzed COVID-19-positive patients with the evidence of myocardial injury (defined as troponin elevation) who presented to our large US healthcare system in the northeast region during the “Early Phase” of the pandemic (March 1–June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the “Current Phase” of the pandemic (October 1, 2020–January 31, 2021).

Results

The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the “Early Phase” and 621 during the “Current Phase”. The cohort's mean age was 70.2±14.9 years; 54.3% were men (Figure 1). Maximum troponin-I in the “Early Phase” was 13.46±34.72 versus 11.21±20.57 in the “Current Phase” (p=0.553) In-hospital mortality was significantly higher (50.3%) in the “Early Phase” group compared to the “Current Phase” group (24.6%; p<0.001). Similarly, the incidence of intensive care unit admission (77.8% versus 46.1%; p<0.044) and requirement for mechanical ventilation (61.7% versus 28%; p<0.001) were higher in the “Early Phase” (Figure 2). In addition, 6% of those in the “Early Phase” underwent coronary angiography compared to 2.3% in the “Current Phase” (p=0.013). Finally, 3% of “Early Phase” and 0.8% of “Current Phase” patients underwent percutaneous coronary intervention (p=0.025).

Conclusions

Treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies and provider experience.

Funding Acknowledgement

Type of funding sources: None.
Observational study of Covid-19 patients presenting with acute coronary syndrome at a tertiary care center in India
Authors: Makkar K , Malhi T S , Batta A , Panda P , Sharma Y P
Published: October 2021

Aim

Patients with Covid-19 are theoretically at a higher risk of ACS, as respiratory infections can often lead to coronary endothelial damage and plaque rupture. Initial reports during start of pandemic suggested decrease in STEMI patients, however this has been explained by iatrophobia rather than actual decrease. Data on pathophysiology and outcome of patients presenting with ACS is scarce. We did a prospective observational study to study epidemiology and outcomes of Covid-19 patients with ACS.

Methods

A total of 654 patients were admitted with Covid-19 at PGIMER, Chandigarh from August 2020 to February 2021, 35 (5.3%) consecutive patients of ACS were enrolled into the study. Acute myocardial infarction was defined as per fourth universal definition of myocardial infarction. Diagnosis of Covid-19 was established using RT-PCR from nasopharyngeal swab. Angiographic assessment was done by two interventional cardiologists.

Results

Mean age of patients was 59.5±11.8 years, males comprised majority (80%) of study group. Most common risk factor was hypertension seen in around 70% followed by DM in 57% patients. Most common symptom at presentation was rest angina seen >90% while history of fever was present in only 31.4%. STEMI was most common ACS seen in 45.7% followed by USA in 23% patients. CS was present in 15% patients at presentation while another 5% developed shock in hospital. Oxygen requirement was required in over half the patients while 25% patients succumbed to illness in hospital.Thrombolysis was done in half the patients of STEMI. In view of Covid-19 disease 71.4% required dexamethasone and remdesivir. Coronary angiography was done in around 20% patients, which revealed obstructive CAD in 83% patients with 60% patients having 100% occlusion of IRA. Percutaneous intervention was done in 66% patients. Hypoalbuminemia was commonly seen patients with mean albumin of 3.3 gm/dL. Low T3 syndrome was most common thyroid function abnormality seen in 37.1%.On univariate analysis age, BNP levels and albumin were able to predict 30-day mortality.

Conclusion

ACS can be first presentation of patients with Covid-19 as shown by our study only 30% patients had prior history of fever. Our data reaffirms that patients with Covid-19 and ACS have worse prognosis. Interestingly mortality in our study was comparable to western study, despite low rate of angiography and intervention thus underscoring individualization of therapy. We believe Type-2 myocardial infarction is common in pathophysiology of patients who benefit most from medical therapy.

Funding Acknowledgement

Type of funding sources: None.
D-dimer as a potential novel thrombus biomarker for predict stent thrombosis in patients on dual antiplatelet therapy after percutaneous coronary intervention
Authors: Zhao X , Li J , Li J , Li Y , Yang Y , Gao R , Xu B , Yuan J
Published: October 2021

Background

At present, it is worth noting that there is a lack of biomarker for the residual risk of thrombosis in patients underwent percutaneous coronary intervention (PCI). D-dimer is an important thrombus marker and widely used in clinical practice.

Purpose

We aim to investigate the correlation between D-dimer and the risk of stent thrombosis (ST) after PCI.

Method

This is a prospective, observational study of 10,724 patients who underwent PCI. The primary endpoint was ST, which was defined according to the Academic Research Consortium including definite, probable, and possible.

Results

Finally, 8565 patients were included in this study after excluding 2159 people with missing D-dimer data or lost to follow-up. After 2-year follow-up, there were 77 ST occurred. D-dimer levels were significantly higher in the ST group (0.33 [0.28, 0.56] μg/ml) than in the non-ST group (0.28 [0.20, 0.41] μg/ml) (P=0.001). Kaplan–Meier survival curve analysis showed that patients with high D-dimer levels had higher cumulative ST according to the median D-dimer level (0.28 μg/ml) in the total population, acute coronary syndrome (ACS) subgroup, and stable coronary artery disease (SCAD) subgroup, respectively. (log-rank test, all P<0.001) (Figure 1). After multivariate-adjusted cox hazard analysis, high D-dimer levels (≥0.28 μg/ml) were significantly associated with ST in the total population (hazard ratio [HR]: 2.25, 95% confidence interval [CI]: 1.29–3.95, P=0.005) and ACS subgroup (HR: 2.13, 95% CI: 1.09–4.16, P=0.027); however, we did not find a statistically significant in the SCAD subgroup (HR: 2.56, 95% CI: 0.92–7.1, P=0.072).

Conclusion

In this real world and large sample data study, we reported for the first time that D-dimer was strong independent thrombosis biomarker in patient who underwent PCI. In the future, we may use D-dimer to guide individualized antithrombotic therapy after PCI.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CAMS Innovation Fund for Medical Sciences; Young and middle-aged talents in the XPCC Science and Technology Project
The association between international normalized-ratio and long-term mortality in patients with coronary artery disease: a large cohort study
Authors: Liu L , Li Q , Liu J , Chen W H , Chen J Y , Liu Y
Published: October 2021

Background

The association between international normalized-ratio (INR) and long-term prognosis among patients with coronary artery disease (CAD) without atrial fibrillation (AF) or anticoagulant therapy was still unclear. We analyzed the association of INR levels and long-term mortality in a large cohort of CAD patients without atrial fibrillation or using of anticoagulant drugs.

Method

We obtained data from 44,662 patients who were diagnosed with CAD and had follow-up information from January 2008 to December 2018. The patients were divided into 4 groups (Quartile 1: INR ≤0.96; Quartile2: 0.961.06). The main endpoint was long-term all-cause death. Kaplan-Meier curve analysis and Cox proportional hazards models were used to investigate the association between quartiles of INR levels and long-term all-cause mortality.

Result

During a median follow-up of 5.25 years, 5,613 (12.57%) patients died. We observed a non-linear shaped association between INR levels and long-term all-cause mortality. Patients in high INR level (Quartile4: INR >1.06) showed a significantly higher long-term mortality than other groups (Quartile2 or 3 or 4), (Compared with Quartile 1, Quartile 2 [0.961.06], aHR=1.33, 95% CI: 1.22–1.45, P<0.05).

Conclusion

Our study demonstrates high levels of INR were associated with an increased risk of all-cause mortality.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by Guangdong Provincial People's Hospital Dengfeng Project Fund (DFJH201919) and The National Science Foundation for Young Scientist of China (grant no.8197021596, 81500520). Survival curves for mortalitySubgroup analysis
Immature platelets in patients with Covid-19: association with disease severity
Authors: Harari E , Cohen A , Cipok M , Bryk G , Karp Lador N , Mann T , Mayo A , Lev E I
Published: October 2021

Background

Coronavirus disease 2019 (Covid-19) is associated with a high incidence of thromboembolic events, both venous and arterial. Currently, there are no clinical or laboratory markers to guide risk-stratification or antithrombotic therapy in Covid-19 patients. Circulating immature platelets represent a population of hyper-reactive platelets, which are associated with arterial thrombotic events.

Objectives

To assess whether the proportion of immature platelets in the circulation is associated with disease severity in patients with Covid-19

Methods

This prospective study evaluated consecutive patients with COVID-19 admitted with various degrees of disease severity, as determined by the standard Covid-19 severity Score. Disease severity was evaluated during hospitalization. Immature platelet fraction (IPF) absolute number and percentage were measured on admission and at additional time points during the hospital course using the SysmexXN-3000 auto-analyzer. The maximal values of IPF% and absolute IPF was analyzed according to disease severity.

Results

A total of 136 consecutive patients with Covid-19 were recruited. Mean age was 60±19 years for patients with mild and moderate disease and 69±14 years for patients with severe disease, 52% with mild and moderate disease and 48% with severe disease were woman, 11% with mild and moderate disease and 20% with severe disease with concurrent cardiovascular disease

The median of IPF% was higher in the severe COVID-19 group compared to patients with mild or moderate disease [4.2 (IQR 2.73–6.45) vs 5.8 (IQR 3.9–8.7), P=0.01, Figure 1)]. The median of IPF absolute number was also significantly higher in patients with severe disease comparing to patients with mild or moderate disease (4.2 (2.85–6.1) vs 5.1 (IQR 3.65–7.35), P<0.0001, Figure 2].

Conclusions

Patients with severe Covid-19 have a higher level of IPF in the circulation than patients with mild or moderate disease. IPF may serve as a reliable prognostic marker for in-hospital disease severity in patients with Covid-19

Funding Acknowledgement

Type of funding sources: None. Figure 1. IPF% (median, 95% confidence interval)Figure 2. IPF# (median, 95% confidence interval)
Gender differences in the impact of plasma xanthine oxidoreductase activity on coronary artery spasm
Authors: Watanabe K , Watanabe T , Otaki Y , Murase T , Nakamura T , Hashimoto N , Kutsuzawa D , Kato S , Tamura H , Nishiyama S , Takahashi H , Arimoto T , Watanabe M
Published: October 2021

Background

It has been reported that decreased nitric oxide bioavailability due to increased reactive oxygen species (ROS) is one of the most important causes of coronary artery spasm (CAS). Xanthine oxidoreductase (XOR) is the rate-limiting enzyme for uric acid (UA) production and plays a pivotal role in generating ROS. It was reported that the gender differences exist in the impact of serum UA levels on cardiovascular risks. We previously demonstrated that increased plasma XOR activity is significantly associated with the incidence of CAS. However, the gender differences in the impact of plasma XOR activity on CAS remain unclear.

Purpose

The aim of this study was to examine the gender differences in the clinical impact of plasma XOR activity on CAS.

Methods

We investigated plasma XOR activity in 132 patients suspected for CAS (male, n=78; female, n=54), and underwent intracoronary acetylcholine provocation test. XOR activity assay was performed using stable isotope-labeled substrate and liquid chromatography-triple quadrupole mass spectrometry. Provoked CAS was defined as total or subtotal occlusion (≥90%) with accompanying symptoms of chest pain and/or ischemic ST-segment changes on the electrocardiogram. We excluded the patients who had significant coronary artery stenosis (≥50%) and/or were taking XOR inhibitors.

Results

Plasma XOR activity was significantly lower in female compared with male patients (30.3 pmol/h/mL, interquartile range (IQR) 22.8–42.7 vs. 51.7 pmol/h/mL, IQR 34.7–101.8; P<0.001). CAS was provoked in 36 male patients and 17 female patients, and they each had significantly higher plasma XOR activity compared with those without, respectively. Multivariate logistic regression analysis showed that plasma XOR activity was independently associated with the incidence of CAS in both genders after adjustment for confounding factors. The optimal cut-off values for predicting CAS were lower in female than those in male patients (52.3 vs. 91.6 pmol/h/mL). Multivariate analysis demonstrated that female patients with high XOR activity (≥52.3 pmol/h/mL; odds ratio [OR] 22.6, P<0.001) exhibited a higher incidence of CAS compared with that in male patients (≥91.6 pmol/h/mL; OR 8.2, P<0.001).

Conclusions

Plasma XOR activity was an independent predictor for the incidence of CAS in both genders. The impact of plasma XOR activity on CAS was stronger in female patients than in male patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Post-angioplasty myocardial blush grade for long term prognostication in acute coronary syndrome: a systematic review and meta-analysis
Authors: Vera Cruz P , Palmes P , Bacalangco-Suerte N
Published: October 2021

Background

Reduced myocardial perfusion despite achieving adequate epicardial bloodflow after angioplasty has been reported to occur in up to 71–80% of Acute Coronary Syndrome (ACS) patients. This is associated with worsening myocardial function and has detrimentally affected long term survival of ACS patients. Myocardial Blush Grade (MBG) is an angiographic parameter of myocardial perfusion that has been found to correlate well with markers of post-infarction myocardial function. However, its acceptance as a reliable marker in routine clinical practice has not yet gained foothold.

Purpose

We aimed to determine the prognostic value of MBG for long term all-cause mortality and major adverse cardiovascular events (MACE) among acute coronary syndrome patients who underwent primary angioplasty.

Methods

PubMed, Google Scholar, Science Direct, and the Cochrane Central Registry were searched for relevant studies published from 1 January 1998 to 31 December 2020. The primary outcome was indexed all-cause mortality and the secondary outcome was major adverse cardiovascular event.

A Mantel-Haenszel random effects meta-analysis was used to derive the pooled estimate of each outcome.

Results

Ten studies involving a total of 11,531 ACS patients were included. Results showed that MBG 0/1 with no to poor myocardial perfusion had a cumulative negative prognostic value for mortality (OR=2.71, CI: 2.11–3.49, p<0.ehab724.13141, I2=35%) and MACE (OR=1.28, CI: 1.03–1.58, p<0.02, I2=39%). Subgroup analysis showed MBG 0/1 had a significant negative prognostic association for mortality among ST-elevation myocardial infarction patients (OR=2.86, CI: 2.17–3.76, p<0.ehab724.13141, I2=44%) but did not have a significant association among unstable angina/Non-ST-elevation Myocardial Infarction patients (OR=1.68, CI: 0.76–3.71, p 0.20, I2=0%). Subsequently, MBG 3 with normal myocardial perfusion was associated with a reduced risk for long term all-cause mortality (HR=0.22, CI: 0.15 to 0.33, p 0.02, I2=39%).

Conclusion

Our results support the use of post-angioplasty Myocardial Blush Grade to prognosticate ST-elevation myocardial infarction patients. MBG 0/1 is a strong negative prognostic marker for long term all-cause mortality and major adverse cardiovascular events while an MBG 3 is a strong positive prognostic marker for long term survival. However, more data is still needed to determine its prognostic value for unstable angina and non-ST-elevation ACS patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1. MBG 0/1 and all-cause mortalityFigure 2. MBG 3 and long term survival