bluuebunny/crossref_metadata_2025 huggingface dataset:
Angiography-derived radial wall strain as a predictor of myocardial ischemia, high-risk plaque, and outcomes
Authors: Park S H , Wang Z , Yang S , Hwang D , Zhang J , Han J K , Park K W , Doh J H , Shin E S , Nam C W , Hoshino M , Kakuta T , Kim H S , Koo B K , Tu S
Published: November 2023

Background

Angiography-derived radial wall strain (RWS) is a novel method to assess the biomechanical characteristics of the underlying plaque. There is limited data regarding how the biomechanical attributes of atherosclerotic lesions relate to their physiologic and morphological attributes.

Purpose

This study aimed to investigate the association of RWS with myocardial ischemia and high-risk plaque, and their prognostic implication.

Methods

From the international CCTA-FFR registry, 484 deferred vessels underwent RWS analysis. Angiography-derived RWS was defined as relative changes of lumen diameter within the cardiac cycle, expressed as a percentage of the largest lumen diameter. Plaque characteristics were assessed in a coronary CT angiography core laboratory and high-risk plaque was defined as 3 or more high-risk plaque characteristics (HRPC) including minimum lumen area <4.0 mm2, plaque burden ≥70%, low-attenuation plaque, and positive remodeling. Functional significance of coronary lesion was assessed by invasively measured fractional flow reserve (FFR). The primary outcome was vessel-oriented composite outcome (VOCO), a composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization at 5 years. All clinical outcomes were adjudicated by an independent clinical event committee.

Results

The mean FFR was 0.89±0.07, and that for maximum RWS (RWSmax) was 11.2±2.5%. RWS proportionally increased along with the decrease in FFR values, and the increase in the number of HRPC (Both p-for-trend <0.001). The proportion of vessels with FFR ≤0.80 and that of vessels with high-risk plaque increased in the order of RWSmax quartile group (Both p-for-trend <0.001) and these associations maintained after the adjustment of clinical characteristics (adjusted odds ratio [OR] 1.31, p value <0.001 for FFR ≤0.80; adjusted OR 1.24, p value <0.001 for high-risk plaque) and angiographic parameters (adjusted OR 1.24, p value <0.001 for FFR ≤0.80; adjusted OR 1.14, p value 0.012 for high-risk plaque). High RWSmax (>14.2%, optimal cut-off value for VOCO) was an independent predictor for VOCO after adjusting for diabetes and % diameter stenosis, FFR ≤0.8, or high-risk plaque (Figure 1). In a mediation analysis, RWS showed an independent effect from lesion-speciﬁc ischemia or high-risk morphological attributes in deﬁning prognosis (Figure 2).

Conclusion(s)

Angiography-derived RWS was closely related to coronary physiologic and plaque morphological attributes, but was an independent predictor of clinical events. This novel index can provide additional prognostic implications over physiological severity or plaque characteristics in patients with coronary artery disease.Prognostic implications of high RWSMediation analysis
Predictors of periprocedural myocardial infarction after left main bifurcation percutaneous coronary intervention guided by optical coherence tomography imaging: the PREVENT study
Authors: Ricchiuto A , Lombardi M , Bianchini E , Buonpane A , Maino A , Busco M , Leone A M , Aurigemma C , Romagnoli E , Burzotta F , Trani C , Vergallo R
Published: November 2023

Background

PMI is one of the most common and relevant complications that occur after PCI, but it is still a matter of controversy. This clinical entity has been frequently correlated to peculiar plaque morphological features by several intravascular imaging studies. PCI of the LM coronary artery is a complex procedural setting, where the prognostic value of PMI is higher. Intravascular ultrasound (IVUS) has a traditional predominance in the guidance of LM-PCI, but optical coherence tomography (OCT) outperforms IVUS in spatial resolution and has affirmed itself as a strong support to PCI.

Purpose

The aim of this study is to identify preprocedural and postprocedural optical coherence tomography (OCT) findings potentially related to periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI) for non-ostial left main (LM) bifurcation disease.

Methods

We retrospectively analyzed 76 patients who underwent OCT before and after LM-PCI. Definitions of OCT findings were derived from expert consensus documents and major OCT studies. PMI was defined in accordance with the Academic Research Consortium-2 (ARC-2) definition.

Results

The presence of TCFA was found to be an independent predictor of PMI, and coherently a significantly higher lipid core arc was observed in the PMI group. Mean stent area was the only post-PCI feature to result significantly higher in the PMI group.

Conclusions

We found the presence of TCFA at pre-PCI OCT was an independent predictor of PMI. A higher mean stent area at post-PCI OCT in patients who developed PMI may suggest that aggressive stent expansion could not always be the right choice in such a context.
Impacts of illicit drug use on coronary angiographic findings in a multicenter registry of patients with acute coronary syndrome
Authors: Lequipar A , Pezel T , Delmas C , Trimaille A , Boccara F , Roubille F , Lafont A , Gall E , El Beze N , Guiraud-Chaumeil P , Singh M , Gerbaud E , Picard F , Henry P , Dillinger J G
Published: November 2023

Background

Although illicit drug use may induce acute coronary syndrome (ACS), its impacts on coronary angiographic characteristics and the coronary artery disease (CAD) burden are a matter of debate.

Purpose

To assess the association between illicit drugs use and coronary angiographic findings in a multicenter patients with ACS.

Methods

From April 7 to 22, 2021, the Addiction in Intensive Cardiac Care Unit (ADDICT-ICCU) study included prospectively 1,499 patients admitted to ICCUs with a systematic urine multidrug test in 39 ICCUs across France. This prespecified study focuses on patients admitted for ACS with an angiography analysed by an independent Angiographic Core Laboratory. Patients with history of coronary artery bypass graft surgery were excluded. We compared coronary angiographic findings between illicit drugs users and others for the following parameters: the prevalence, location, type, and severity of CAD obstruction (stenosis≥50%), SYNTAX score, residual SYNTAX score, and the characteristics of percutaneous coronary intervention (PCI).

Results

Among the 283 patients with ACS (62±13 years, 77% men), 38 (13.4%) had a positive test for illicit drugs (cannabis: 12%, cocaine: 1.1%, MDMA: 0.7%). Drug users were younger than other patients (51±12 vs 64±12 years, p<0.001), but there were no significant difference in sex ratio (89.5% vs 75.5%, p=0.088). There was no significant difference in the rate of STEMI (52.6% vs 45.7%, p=0.535) and NTSEMI (47.4% vs 54.3%, p=0.535) between drug users and others. Regarding the CAD burden, drug users had significantly less obstructive coronary lesions (1.6±1.1 vs 2.2±1.4, p=0.012), less multivessel obstructive CAD (31% vs 61%, p=0.001), and a trend for a lower initial SYNTAX score (8.3±7.8 vs 10.8±8.4; p=0.084) compared to others. Concerning culprit lesion, drug users had less bifurcation lesions (p=0.008), a trend for more left anterior descending (LAD) artery lesions (p=0.091), a higher thrombus burden score (p=0.057), and less lesions above 20 mm (p=0.183).

Conclusion

In patients with ACS, recent illicit drug use is associated with less number of significant lesions and less multivessel CAD. Concerning culprit lesions, illicit drugs use is associated with less bifurcation lesions, with a trend for more LAD lesions and a higher thrombus burden score.ACS analysed with Core LaboratoryAngiographic findings according to drug
Clinical efficacy of permanent internal mammary artery occlusion in chronic coronary artery disease: a double-blind, randomized, sham-controlled trial
Authors: Bigler M R , Kieninger-Graefitsch A , Tschannen C , Grossenbacher R , Seiler C
Published: November 2023

Introduction

Natural internal mammary artery (IMA) bypasses to the coronary circulation have been shown to act as extracardiac sources of myocardial blood supply, which has been found augmented by right IMA device occlusion. The goal of this randomized, sham-controlled trial was to test the efficacy of permanent right or left IMA device occlusion on symptoms of chronic coronary artery disease (CAD), on coronary artery occlusive blood supply, as well as on myocardial ischemia.

Methods

This was a prospective superiority trial in 100 patients with chronic CAD randomly allocated (1:1) to IMA permanent vascular device occlusion (verum group) or to IMA sham intervention (placebo group). The primary study endpoint was the change in treadmill exercise time (DET in seconds, s) during 6 weeks of follow-up after trial intervention. Secondary study endpoints were the changes in simultaneously obtained collateral flow index (CFI), and angina pectoris during a 1-minute proximal balloon occlusion of the coronary artery of interest. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure.

Results

In the verum and placebo group, exercise time changed from 398±176s to from 421±198s in the verum group (p=0.1745), and from 426±162s to 430±166s in the placebo group (p=0.55); DET was +23±116s and +4±120s, respectively (p=0.44). CFI change during follow-up was +0.022±0.061 in the verum and -0.039±0.072 in the placebo group (p<0.0001). Angina pectoris at follow-up during the coronary balloon occlusion for CFI measurement had decreased or disappeared in 20/48 patients of the verum group, and in 10/47 patients of the placebo group (p=0.0336).

Conclusion

Permanent IMA device occlusion tends to augment treadmill exercise time in response to heightened coronary artery occlusive blood supply, the fact of which is reflected by mitigated signs of myocardial ischemia.
Changes in myocardial perfusion after coronary sinus reducer implantation for refractory angina - assessment using fully automated quantitative stress perfusion cardiac MRI
Authors: Cheng K , Alpendurada F , Falaschetti E , Pennell D , Bucciarelli-Ducci C , De Silva R
Published: November 2023

Introduction

Previous reports show angina improvement after Coronary Sinus Reducer (CSR) implantation [1,2]. However, the mechanistic basis remains unconfirmed. Preliminary studies using semi-quantitative metrics derived from stress perfusion cardiac MRI (CMR), have suggested improved myocardial perfusion particularly in ischaemic segments [3]. To date, assessment by fully automated quantitative myocardial perfusion CMR has not been reported.

Purpose

To assess the effect of CSR implantation on quantitative regional myocardial blood flow in patients with refractory angina and advanced coronary artery disease (CAD).

Methods

Prospective cohort study of patients undergoing CSR implantation. CMR was performed at baseline and median 7 months follow-up. Automated segmentation into a 16-segment American Heart Association model was performed to quantify segmental rest and stress myocardial blood flow (MBF, ml/min/g) and myocardial perfusion reserve (MPR). Rest MBF was corrected for heart rate by dividing by the scan heart rate and multiplying by the mean resting heart rate among all subjects. Wilcoxon matched-pairs sign rank tests were used to compare paired global and segmental perfusion values. A linear mixed-effects model with random slopes and intercepts was used to assess the relationship between baseline segmental MPR and associated change in MPR (ΔMPR) after CSR implantation.

Results

12 patients (10M:2F; mean age 67) were included. Median Canadian Cardiovascular Society class was 3. Globally, there was no change in rest (P=0.90), stress MBF (P=0.34) or MPR (P=0.72) from baseline to follow-up. However, ΔMPR was related to the degree of baseline ischaemia (panel A). Segments with baseline MPR<2.45 increased in MPR whereas segments with baseline MPR ≥2.45 experienced a decrease (P=0.003, conditional R2: 0.81). In segments with MPR<2.45 (n=138), median ΔMPR was +0.18 (15.4%; P<0.0001); whereas with MPR≥2.45 (n=52) it was -0.41 (-12.7%; P=0.03; panel B).

When assessed by myocardial layer, significant increases in MPR were observed in both subendocardial (+0.19 [15.6%]; P<0.0001) and subepicardial (+0.19 [12.3%]; P<0.0002) segments with baseline MPR< 2.45 (panel C). Conversely, in segments with baseline MPR≥2.45, there was a significant reduction in MPR in the subendocardium (-0.43 [-15.9%]; P=0.04) but not in the subepicardium (-0.36 [-9.90%]; P=0.08; panel D).

Conclusion

To our knowledge, this is the first study showing changes in quantitative myocardial perfusion after CSR implantation by fully automated inline quantitative perfusion CMR. Our analysis shows a relationship between baseline MPR and change in MPR after CSR implantation, supporting redistribution of perfusion into both subendocardial and subepicardial layers as potential mechanisms of action of CSR. Further studies are needed to confirm these preliminary results.
CSL112 (apolipoprotein A-I [human]) reduces the elevation in neutrophil-lymphocyte ratio (NLR) induced by acute myocardial infarction
Authors: Kingwell B , Duffy D , Clementi R , Velkoska E , Feaster J , Gibson C M
Published: November 2023

Background

CSL112 (apolipoprotein A-I [human]) is a novel therapy designed to reduce the risk of recurrent cardiovascular events following acute myocardial infarction (AMI). Preclinical data suggest that apolipoprotein A-I has anti-inflammatory properties which might contribute to atherosclerotic plaque stabilization (1). The neutrophil-lymphocyte ratio (NLR) is a clinically accessible measure of inflammatory status and predicts incident cardiovascular events in large outcome trials (2). It is unknown whether CSL112 can reduce inflammation as measured by the NLR.

Purpose

To evaluate whether infusion of CSL112 inhibits post-AMI inflammation as measured by NLR.

Methods

In a Phase 2 multicenter, double-blind study, 83 AMI patients with stage 3 chronic kidney disease were randomized 2:1 to receive 4 infusions of either 6 g CSL112 (n=55) or saline placebo (n=28) each separated by one week. The first infusion delivered on protocol Day 1 occurred 12h to 7d after presentation (mean 83 h). Blood samples were drawn prior to each infusion on Days 1, 8, 15 and 22 as well as at both Day 29 and 60 post the first infusion. Leukocyte data were available for up to 75 participants across the 6 sampling timepoints and neutrophil and lymphocyte counts were measured at the central laboratory. NLR was calculated and found to be non-normal in distribution and so analyses were performed on Loge transformed data. A mixed model repeated measures (MMRM) analysis was used to compare change from baseline (Day 1) in LogeNLR, neutrophil count and lymphocyte count between treatment groups (CSL112 6g versus Placebo) at the other 5 timepoints. An analysis of covariance (ANCOVA) was used to assess the effect of time from index MI to first infusion on change from baseline (Day 1) in LogeNLR at Day 8.

Results

The LogeNLR increased after AMI (between Day 1 and Day 8) with placebo treatment, whereas CSL112 infusion given after the Day 1 blood sample resulted in a decline (p=0.012; Fig 1, left panel, mean±SD). This effect of CSL112 was driven by reduction in neutrophil count (p=0.002; Fig 1, right panel) with lymphocyte levels remaining stable (p=0.537). Importantly, the magnitude of the effect of CSL112 to reduce NLR was greater if the timing of administration was closer to the index MI (treatment X time interaction and treatment effect both p=0.008).

Conclusion

CSL112 inhibits post-AMI elevation in NLR and this effect is maximized when infusion occurs early after presentation. It remains to be determined whether these anti-inflammatory effects of CSL112, in conjunction with previously demonstrated enhancement in cholesterol efflux capacity, will improve cardiovascular outcomes (3).Fig 1: Change in LogeNLR from baseline
Pretreatment with parenteral anticoagulation in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
Authors: Albuquerque F , Gomes D , Ferreira J , De Araujo Goncalves P , Felix Oliveira A , Campante Teles R , De Sousa Almeida M
Published: November 2023

Background and Aim

According to ESC guidelines, parenteral anticoagulation is recommended for all patients presenting with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PPCI). However, no specific recommendations are made regarding the timing of administration. In fact, whether upstream anticoagulation improves clinical outcomes in STEMI patients is not well established. We conducted a systematic review and meta-analysis of current evidence on parenteral anticoagulation timing for patients presenting with STEMI.

Methods

We performed a systematic search of electronic databases (PubMed, CENTRAL and Scopus) until December 2022. Studies were considered eligible if they a) compared upstream anticoagulation with administration at the catheterization lab; and b) enrolled patients with STEMI undergoing PPCI. Studies comparing different anticoagulants were excluded from the analysis. Random-effects meta-analyses were performed. Efficacy outcomes included TIMI flow-grade pre- and post-PPCI, in-hospital cardiogenic shock (CS) and 30-day all-cause mortality. Safety outcome was defined as major in-hospital bleeding events.

Results

Overall, 9 studies were included (all non-randomized), with a total of 69,571 patients (30,693 in the pretreatment arm). In all but one, anticoagulation strategy was exclusively based on unfractionated heparin. Pretreatment was associated with a significant reduction in the incidence of 30-day all-cause mortality (OR 0.61; 95% CI 0.47-0.80; p<0.001) and in-hospital CS (OR 0.69; 95% CI 0.59-0.81; p<0.001). Upstream anticoagulation was also associated with a significant increase of spontaneous reperfusion of the culprit artery before PPCI (pre-PPCI TIMI > 0: OR 1.47; 95% CI 1.35-1.60; p<0.001) and TIMI flow ≥ 2 after coronary intervention (OR 1.28; 95% CI 1.05-1.56; p=0.016). Regarding safety outcomes, pretreatment was not associated with an increase of in-hospital major bleeding (OR 1.01; 95% CI 0.70-1.44; p=0.970). Multiple sensitivity analyses, including propensity-matched populations, showed consistent results.

Conclusions

Upstream anticoagulation was associated with a significant lower risk of 30-day all-cause mortality, incidence of in-hospital cardiogenic shock and improved reperfusion of culprit artery. These benefits were not accompanied by an increased risk of major bleeding, suggesting an overall clinical benefit of early anticoagulation in patients presenting with STEMI. These results require confirmation in a randomized clinical trial.
Ticagrelor versus clopidogrel for complex percutaneous coronary intervention in chronic coronary syndrome: a post-hoc analysis of the ALPHEUS study
Authors: Lattuca B , Mazeau C , Guedeney P , Kala P , Nejjari M , Morel O , Leclercq F , Payot L , Beygui F , Range G , Motovska Z , Vicaut E , Collet J P , Montalescot G , Silvain J
Published: November 2023

Background

Whether ticagrelor utilization in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) could prevent type 4 myocardial infarction (MI) or myocardial injury as compared to clopidogrel is unknown.

Purposes

To evaluate the frequency and outcomes of complex PCI in stable coronary patients and the efficacy of ticagrelor versus clopidogrel in these patients randomized in the ALPHEUS trial.

Methods

All PCI procedures were blindly reviewed by two core laboratory readers and classified as complex if they had at least one of the following criteria: stent length ≥60 mm, two-stent bifurcation, use of atherectomy, left main, bypass graft, chronic total occlusion, use of guide catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b MI and major myocardial injury, defined by the 3rd and 4th universal definition of MI, during the 48h after PCI. Angiographic complications and the composite of death, MI, stroke at 48 hours and at 30 days were also evaluated. We compared the event rates in the randomized groups according to the presence or not of complex PCI criteria and evaluated the interaction with the randomization to ticagrelor or clopidogrel.

Results

Among the 1866 patients randomized, 910 (48.3%) PCI were classified as complex PCI and 956 (51.7%) as not complex. Multiple criteria of complex PCI were found in 14.4% (2 criteria) and 9.1% (≥3 criteria) of the patients. The primary endpoint was more frequent in complex PCI than in the not-complex PCI (45.6% vs 26.6%; p<0.001) driven by higher rates of type 4MI and angiographic complications (12.2% vs 4.8 %; p<0.001 and 19.3% vs 8.6%; p<0.05, respectively). The composite of death, MI, stroke at 48 hours (12.7% vs 5.1 %; p<0.05) and at 30 days (13.4% vs 5.3%; p<0.05) were also more frequent in complex PCI. No interaction was found between the complexity of PCI and the randomized treatment for the primary endpoint (p for interaction = 0.35) nor the secondary endpoints.

Conclusions

Complex PCI patients have higher rates of periprocedural and cardiovascular events which are not reduced by ticagrelor as compared with clopidogrel.
Association of LDL cholesterol levels and all cause mortality in a real world analysis using data from an international network
Authors: Costa L , Scudeler T L S , Nunes R A B N
Published: November 2023

Background

Current cholesterol guidelines have recommended low low-density lipoprotein cholesterol (LDL-C) treatment targets for secondary prevention of cardiovascular disease. However, recent studies have suggested that very low or very high levels of LDL-C may be associated with increased mortality and other adverse outcomes. The association between LDL-C levels and mortality remains to be determined.

Methods and Results

This cohort study included data from a large multinational electronic health record network (TriNetX) of patients aged 18 years or older with coronary artery disease. LDL-C levels were divided into 4 categories: <30 (cohort 1), 30-50 (cohort 2), 50-70 (cohort 3), and 70-100 (cohort 4). Deaths were ascertained by linkage to death records in the last 10 years before the analysis. Five-year Kaplan-Meier curves and hazard ratios were calculated. We identified 1,136,600 patients, of whom 36,060 had LDL-C <30 mg/dL, 282,500 had LDL-C <50 mg/dL, 255,964 had LDL-C 50-70 mg/dL and 596,136 had LDL-C 70-100 mg/dL. Comparative analyzes were performed on the cohorts (cohort 1 vs. cohort 2, cohort 2 vs. cohort 3, and cohort 3 vs. cohort 4) after propensity score matching. After adjustment, individuals of cohort 2 (n = 36,004), compared with those of cohort 1 (n = 36,004), had higher all-cause mortality (HR 1.086; CI 95% 1.064-1.109, p <0.0001), individuals of cohort 3 (n = 244,908), compared to those of cohort 2 (n = 270,359), had higher risk of all-cause mortality (HR 1.063; 95% CI 1.055-1.1071, p <0.0001), and induviduals of cohort 4 (n = 254,465), compared with those of cohort 3 (n = 254,465), had lower risk of all-cause mortality (HR 0.937; CI 95% 0.929-0.944, p <0.0001).

Conclusions

Lower LDL-C levels are associated with a reduced risk of all-cause mortality in patients with coronary artery disease.
Efficacy and safety of under-dose non-vitamin K antagonist oral anticoagulant with atrial fibrillation undergoing PCI: Insights from a nationwide population-based cohort study
Authors: Youk G S , Choi S Y , Jung A H , Choi S Y , Yuan S L , Song Z Y , Lee K M , Kim M H
Published: November 2023

Background

The under-dose non-vitamin K antagonist oral anticoagulants (NOACs) are required according to clinical conditions for patients with atrial fibrillation (AF). We aimed to assess the comparative effectiveness and safety of standard-dose and under-dose NOACs undergoing PCI.

Methods

We studied the retrospective nonrandomized observational cohort of oral anticoagulant native nonvalvular patients with atrial fibrillation treated NOACs (rivaroxaban, dabigatran, apixaban, or edoxaban) from January 2013 to December 2017, based on the Korean Health Insurance Review and Assessment database. We performed head-to-head comparisons of standard-dose and under-dose NOACs.

Results

We studied standard-dose and under-dose NOACs were 1,095 and 2,136, respectively (Rivaroxaban, 500 vs 782; Dabigatran, 233 vs 709; Apixaban, 244 vs 430; Edoxaban, 118 vs 214). Compared with standard-dose NOACs, low-dose NOACs were associated with lower risk of major bleeding in AF patients with PCI(Rivaroxaban, HR=0.72[0.58∼0.85]; Dabigatran, HR=0.73[0.60-0.86]; Apixaban, HR=0.82[0.69-0.95]; Edoxaban, HR=0.85[0.72-0.98]. Also, the ischemic stroke was significantly different for standard-dose and under-dose NOACs in AF patients with PCI (Rivaroxaban, HR=0.67[0.54-0.80]; Dabigatran, HR=0.68[0.55-0.81]; Apixaban, HR=0.69[0.56-0.82]; Edoxaban, HR=0.70[0.57-0.83]).

Conclusions

In this nonrandomized Asian cohort study, NOACs(rivaroxaban, dabigatran, apixaban, or edoxaban) were associated with lower risk of major bleeding and ischemic stroke for standard-dose and under-dose NOACs in AF patients with PCI.Table 1.Clinical outcomes
Association of revascularization with mortality in ischemic left ventricular dysfunction
Authors: Tao M , Liu Y , Radakrishnan A , Al-Sadawi M , Masson R , Rahman T , Mann N , Pyo R
Published: November 2023

Background

Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). The purpose of this meta-analysis is to evaluate the association of coronary revascularization with mortality in patients with ischemic LV dysfunction.

Methods

A literature search was conducted for studies reporting on all-cause mortality after revascularization with PCI or CABG compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results

A total of 21 studies with 6062 participants (2838 revascularized, 3224 on OMT) met inclusion criteria. Mean follow-up was 37 months (11-68 months), mean LV ejection fraction (EF) was 29%, mean age was 61, 85% of patients were male.

Revascularization was significantly associated with lower all-cause mortality compared to patients on OMT (OR 0.57, 95% CI 0.46-0.71; p<0.01). The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Heterogeneity between subgroups was low and test for subgroup difference was not statistically significant by EF cutoff of 35% or by revascularization method (p=0.43, I2=0%; p=0.12, I2=59.7%).

Subgroup analysis by viability demonstrated that revascularization was significantly associated with lower all-cause mortality compared to OMT for patients with viability and mixed cohorts with or without viability, but not patients without viability (OR 0.47, 95% CI 0.33-0.66; p<0.01; OR 0.57, 95% CI 0.38-0.84; p<0.01; OR 0.73, 95% CI 0.51-1.02; p=0.07). The effect size was larger in the subgroup with viable myocardium compared to mixed patients with viable or non-viable myocardium (Z=4.33 vs 2.79).

Conclusions

Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of all-cause mortality in patients without evidence of viable myocardium.
Percutaneous coronary intervention and medical therapy versus medical therapy alone in chronic coronary syndrome: A hierarchical win-ratio analysis from SCAAR
Authors: Von Koch S , Koul S , Erlinge D , Mohammad M
Published: November 2023

Background

Revascularization of patients with chronic coronary syndrome (CCS) using percutaneous coronary intervention (PCI) is frequently done. However, the role of a PCI in this subgroup of patients with coronary artery disease remains controversial.

Purpose

The objective is to determine whether PCI plus medical therapy is associated with better outcomes for patients with CCS, compared to medical therapy only.

Methods

We conducted a population-based nationwide observational study. Using the Swedish Coronary Angiography and Angioplasty registry (SCAAR) we identified all patients with CCS undergoing coronary angiography between 2010-2020. Patients with obstructive coronary artery disease, defined as having at least one stenosis with ≥50% luminal obstruction were included. Patients were stratified into two groups according to their received treatment with PCI plus medical therapy or medical therapy only. Propensity score (PS) matching was used to match the two groups on their baseline characteristics. Outcome was assessed with win-ratio and the primary endpoint was net adverse clinical event (NACE) within 5-years. In the win-ratio analysis, the components of NACE were ranked (1) all-cause mortality, (2) stroke, (3) bleeding and (4) myocardial infarction. Subgroup analysis was also performed.

Results

After propensity score matching, two groups comprising 16,937 patients each, were formed. Baseline characteristics were comparable between the two groups (Table 1). However, patients who underwent PCI were more likely to receive dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, while those treated with medical therapy were more commonly prescribed nitrates. Additionally, statins were prescribed more frequently to patients treated with PCI. The hierarchical outcome analysis showed no statistically significant difference between the two groups (win-ratio: 0.98; 95% confidence interval: 0.94-1.02; p=0.345). Subgroup analyses of men, women, patients aged 75 years and older, diabetic patients, and non-diabetic patients showed no significant differences in outcome between the two groups.

Conclusion

In this study, which aimed to assess the outcomes of patients with CCS using a hierarchical approach, revascularization with PCI did not result in better outcomes when compared to medical therapy alone. These findings suggest that for patients with CCS, medical therapy may be just as effective as PCI in improving outcomes.Baseline characteristicsWin-ratio
Clinical outcomes of drug coated balloon in coronary lesions: 3-year follow-up of CAGE FREE Registry
Authors: Wang R , Yang W , Liu J , Mou F , Liu Y , Zhou J , Yin Z , Wang Q , Yuan M , Li F , Li C , Gao C , Tao L
Published: November 2023

Background

Intervention with drug-coated balloons (DCB) is based on a leave-nothing-behind concept and has been recommended as the first-line treatment modality for in-stent restenosis (ISR) and small-vessel disease. However, DCB treated for de novo lesions and comparison between DCB treatment for de novo lesions and ISR has not been fully elucidated.

Purpose

To report and compare 3-year clinical outcomes between DCB treatment for ISR and de novo disease, and identify the risk factors of adverse events after DCB intervention.

Methods

The study population was derived from the CAGE FREE Registry, which was a prospective, dedicated DCB treated all-comers registry in ISR and/or de novo lesions. The primary outcome was vessel-oriented composite endpoint (VoCE) at 3 years, defined as a composite of vessel-related cardiac death, vessel-related myocardial infarction (MI), and target vessel revascularization (TVR).

Results

A total of 2473 consecutive patients with 2804 lesions were enrolled. DCB treated in 1478 patients with 1669 de novo lesions and 995 ISR patients with 1135 lesions. The median duration of follow-up was 2.5 years (IQR 1.8-3.2) overall. At 3 years, the rate of VoCE was 12.1% (vessel-related cardiac death: 3.0%, vessel-related MI: 2.2%, and TVR: 7.8%) in the overall cohort. Patients with ISR treated with DCB had a higher rate of 3-year VoCE than those with de novo lesions (16.8% vs. 8.9%, HR: 2.00, 95%CI: 1.56-2.57, p<0.001), with the HR remaining significant after adjustment (IPTW adjusted HR: 1.79, 95%CI: 1.37-2.35). In terms of procedure-related factors, TIMI flow after PCI less than grade 3 and residual stenosis more than 25% were independent risk factors of 3-year VoCE for patients with de novo lesions. In patients with ISR, residual stenosis more than 25% had a higher risk of 3-year VoCE, whereas TIMI flow after PCI less than grade 3 only had a trend.

Conclusion

Patients with ISR treated with DCB had a higher rate of 3-year VoCE than those with de novo lesions. DCB appears to be an attractive alternative treatment for de novo coronary lesions. Residual stenosis ≤25% combined with TIMI flow grade 3 should be attempted after DCB angioplasty.Kaplan Meier curve for 3-year VoCE
Comparison among ultra-thin coronary stents: a network metanalysis
Authors: Marengo G , Bruno F , De Filippo O , D'ascenzo F , De Ferrari G M
Published: November 2023

Background

Ultrathin-struts drug eluting stents (DESs) have been related to potential improvement in stent-related outcomes compared to thicker-struts DES. However, comparison among different ultrathin devices are lacking.

Methods

All Randomized Controlled Trials (RCTs) comparing ultrathin (strut thickness < 70 µm) vs thicker struts DES in an all-comers population were included. Target lesion failure (TLF), as defined by included trials, at one year follow up was the primary endpoint. Cardiovascular (CV) death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) were the secondary ones. Arms of included trials were compared by means of Network Meta Analysis (NMA).

Results

Nine studies encompassing 20081 patients were included: Orsiro DESs were evaluated in 7 arms with 8086 patients, MiStent in one arm (703 patients) and Supraflex in one arm with 720 patients. At one year follow up, no significant differences were noted for TLF. In particular, Orsiro was associated with similar risk of TLF compared with Supraflex (RR 1.7; CI 0.59 - 1.78) and with Xience (RR 0.98; CI 0.71 - 1.35), being the one with the highest probability of performing best. Orsiro stent was the one with the highest probability of performing best also for MI and TLR.

Conclusions

Ultrathin DES are all associated with a comparable risk of TLF as compared with second generation, thicker struts DES. As for the risk of repeat revascularization and of TLF, Orsiro was the one with the highest probability of performing best, either compared with other ultrathin DES or with thicker-struts devices.TLR: RRs among different devices
The effects of statins on cardiovascular and inflammatory biomarkers in primary prevention: A systematic review and meta-analysis
Authors: He W B , Ko H T K , Curtis A J , Zoungas S , Woods R L , Tonkin A , Neumann J T , Turner S L , Hopper I
Published: November 2023

Background

Statins are well-established for their treatment of cardiovascular disease (CVD) due to their cholesterol-lowering effects and potential anti-inflammatory properties. Although previous systematic reviews demonstrate that statins reduce inflammatory biomarkers in the secondary prevention of CVD, none examine their effects on cardiac and inflammatory biomarkers in a primary prevention setting.

Aims and Methods

We conducted a systematic review and meta-analysis to examine the effects of statins on cardiovascular and inflammatory biomarkers among individuals without established CVD. The biomarkers included are: cardiac troponin, N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), soluble E-selectin (sE-selectin) and endothelin-1 (ET-1). A literature search was performed through Ovid MEDLINE, Embase and CINAHL Plus for randomized controlled trials (RCTs) published up to June 2021.

Results

Overall, 35 RCTs with 26,521 participants were included in our meta-analysis. Data was pooled using random effects models presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Combining 36 effect sizes from 29 RCTs, statin use resulted in a significant reduction in CRP levels (SMD -0.61; 95% CI -0.91, -0.32; P<0.001). This reduction was observed for both hydrophilic (SMD -0.39; 95% CI -0.62, -0.16; P<0.001) and lipophilic statins (SMD -0.65; 95% CI -1.01, -0.29; P<0.001). There were no significant changes in serum concentrations of cardiac troponin, NT-proBNP, TNF-α, IL-6, sVCAM, sICAM, sE-selectin and ET-1.

Conclusions

This meta-analysis demonstrates the effect of statins in reducing serum CRP concentrations in the context of CVD primary prevention, with no significant changes in the other cardiac and inflammatory biomarkers studied. The meta-analysis highlights the need for further high quality, large-scale trials evaluating the effects of statins on cardiac and inflammatory biomarkers in primary prevention.Figure 1.Effect of statins on CRP
Coronary artery disease in cardiac amyloidosis
Authors: Dona C , Rettl R , Binder C , Schrutka L , Dalos D , Camuz Ligios L , Kain R , Loewe C , Hengstenberg C , Badr-Eslam R , Bergler-Klein J , Kastner J , Kammerlander A A , Duca F
Published: November 2023

Background

Cardiac amyloidosis is an important disease causing significant morbidity and mortality. Due to the ageing society as well as better diagnostic tools such as 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy (DPD scan), cardiac amyloidosis has increased in prevalence, however, the coexistence, as well as the differences in presentation with coronary artery disease (CAD), has not yet been discovered.

Purpose

The purpose of the study is to evaluate the prevalence of CAD in patients with cardiac amyloidosis, to assess differences in late gadolinium enhancement (LGE) in cardiac MRI, and to assess differences in symptoms such as dyspnea.

Materials and Methods

We retrospectively assessed all patients with cardiac amyloidosis at our center and screened for an evaluation of coronary artery disease with coronary angiography, coronary CT, or myocardial scintigraphy. In all patients, who underwent cardiac MRI we assessed the pattern of LGE using the cardiac left ventricular segmentation model published by the AHA [1].

Results

295 patients (27% female, 74 ± 11 years) with cardiac amyloidosis (26% AL-amyloidosis, 74% ATTR-amyloidosis) were retrospectively assessed. Of those, 205 (69%) had a CAD evaluation. In 69 patients (34%), significant CAD was present, 10 patients (5%) had undergone CABG and 48 patients (23%) had received a PCI in the past. In patients with CAD, 3 patients (4%) suffered from NYHA IV and 51 patients (74%) were symptomatic with NYHA II or NYHA III. There were no significant differences to patients without CAD (p=0.252).

In 153 patients (75%), cardiac MRI was performed. In 7% of the patients, no LGE was obvious, in 84%, a diffuse circular subendocardial to transmural LGE with basoapical gradient, typical for cardiac amyloidosis, could be observed. In 6% of the cases, a subendocardial pattern typical for post-ischemic changes could be observed; in 56% of the patients, a previous myocardial infarction was known. In the remaining 3%, LGE in the insertion points could be observed.

Conclusion

With 34%, CAD is highly prevalent in patients with cardiac amyloidosis. In 28%, a coronary intervention (surgical or interventional) was performed, making coronary interventions in patients with cardiac amyloidosis a feasible option. Cardiac MRI in patients with concomitant CAD and cardiac amyloidosis often shows the typical diffuse LGE, therefore, visualization of postischemic changes in these patients is difficult. Furthermore, symptoms do not differ between patients with CAD and no CAD.
A specific molecular signature of extra-vesicles (EVs) was associated with cardiometabolic risk profile and atherosclerotic burden in patients with chronic coronary syndrome: a pilot study
Authors: Ragusa R , Rocchiccioli S , Scholte A , Neglia D , Caselli C
Published: November 2023

Background

microRNAs (miRs) are pivotal regulators of mRNA and protein expression. They critically contribute to cardiovascular pathophysiology and circulate in the blood using extra-vesicles (EVs) as delivery carrier. The role of EV-associated miRs in atherosclerotic cardiovascular disease, however, is unclear.

Purpose

The aim of this study was to detect Coronary Artery Disease (CAD)-related miRs carried by EVs in stable patients with Chronic Coronary Syndrome (CCS). In particular we aimed to assess whether a specific miRs signature is associated with the cardiometabolic risk profile and coronary atherosclerotic burden and plaque features, as evaluated by coronary computed tomography angiography (CTA) in these patients.

Methods

miRs with known effects in the cardiovascular system were analysed by real time-PCR in EVs isolated from CCS patients by density gradient centrifugation (n=21). All patients underwent coronary CTA to assess total, calcified, and noncalcified plaque volume (PV). Obstructive CAD was defined as the presence of stenoses >50% in at least one of the main coronary vessels.

Results

All CCS patients (n=21) were statin users and had coronary atherosclerosis documented by coronary CTA. Among the 25 miRs tested, 7 were detected within EVs and 4 of them, miR-145-5p, miR-30e5-p, miR-126-5p, miR-375, were significantly related with cardiometabolic profile, showing an alternative association with glucose and insulin, a positive correlation with HDL-Cholesterol and a negative correlation with triglycerides, BMI and waist circumference. No association was observed with Total-Cholesterol and LDL-Cholesterol (Figure1). These miRs were also not associated with the presence of obstructive CAD, but were significantly related with total, calcified, and noncalcified PVs (Figure1).

Conclusions

In CCS patients, among the 25 miRs studied and out of the 7 EV-associated, only 4 miRs were related with a specific cardiometabolic risk profile, characterized by insulin-resistance, obesity, high triglyceride and low HDL-Cholesterol levels. They were also associated with an increased coronary atherosclerotic burden. These results suggest a potential involvement of specific EV-associated miRs in molecular mechanisms of residual atherosclerotic risk.Figure 1
Abscence of high lipoprotein(a) levels is and independent predictor of acute myocardial infarction without coronary lesions
Authors: Kallmeyer A , Pello Lazaro A M , Blanco Colio L , Acena A , Gonzalez Lorenzo O , Tarin N , Cristobal C , Gutierrez-Landaluce C , Huelmos A , Lumpuy-Castillo J , Lopez Castillo M , Alonso J , Egido J , Lorenzo O , Tunon J
Published: November 2023

Ministry of Science.

The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the probability of developing MINOCA. Moreover, the relationship between MINOCA and the plasma levels of other proatherogenic and proinflammatory molecules such as Interleukin-18 (IL18) and proprotein convertase subtilisin/kexin type 9 has not been studied. We conducted a prospective, multicenter study involving 1042 patients with acute myocardial infarction (AMI). Seventy-six patients had no significant coronary lesions. All patients underwent plasma analysis on admission. MINOCA patients were younger (57 (47–68) vs. 61 (52–72) years; p = 0.010), more frequently female (44.7% vs. 21.0%; p < 0.001), and had lower rates of diabetes and of Lp(a) > 60 mg/dL (9.2% vs. 19.8%; p = 0.037) than those with coronary lesions; moreover, High Density Lipoprotein cholesterol (HDL-c) levels were higher in MINOCA patients. The absence of Lp(a) > 60 mg/dL and of diabetes were independent predictors of MINOCA, as well as female sex, high HDL-c levels, and younger age. IL-18 and PCSK9 levels were not predictors of MINOCA. During a follow-up of 5.23 (2.89, 7.37) years, the independent predictors of the primary outcome (acute ischemic events or death) in the whole sample were Lp(a) > 60 mg/dL, older age, low estimated Glomerular Filtration rate (eGFR), hypertension, previous heart failure (HF), coronary artery bypass graft, use of insulin, and no therapy with acetylsalicylic acid. In conclusion, in AMI patients, the absence of high Lp(a) levels, as well high HDL-c levels, were independent predictors of the inexistence of coronary artery disease. High Lp (a) levels were also an independent predictor of ischemic events or death.
Circulating NETosis markers in NSTEMI and predicting of 1-year cardiac death
Authors: Munteanu M , Popovici M , Ivanov V , Popovici I , Ciobanu L , Popovici I , Cobet V
Published: November 2023

Aim

Evaluation of serum levels of markers having reliable link to NETosis phenomenon in patients with NSTEMI as well as their predictive value on 1-year cardiac death.

Material and methods

The study was undergone in 123 patients with NSTEMI without diabetes mellitus exposed to angioplasty. The admission serum level of 7 markers having specific (myeloperoxidase (MPO), metalloproteinase 8 (MMP8), neutrophil elastase (NE)) or less specific (selectin E (SE), ICAM-1, IL-8 and phospholipase A2 (PhA2)) pathogenic relation to NETosis have been determined using ELISA technic. Control markers have been assayed in 40 healthy persons. Post-infarction cardiac death rate was appreciated during 12 moths, and the inherent prediction value of these markers has been estimated using hazard ratio CI (95%).

Results

The revealed highest incremental variation of markers from control was characteristic for specific markers of NETosis: MYO by 156% (77,6±13,8 vs 30,4±5,5 U/ml), NE by 114% (35,9±6,2 vs 16,8±3,6 ng/ml) and MMP8 by 83% (53,8±9,4 vs 29,5±5,4 ng/ml). The other markers increased significantly, but in a lower range, 49-71%. The 1-year mortality rate reached a level of 18% (22 patients). The predictive value of studied markers according to risk of cardiac death for 1 year was also highest among direct markers of NETosis: MYO, HR 3,16 CI (1,98-5,25, p<0,01), NE, HR 2,73 CI (1,44-4,16, p<0,01) and MMP8 HR 2,38 CI (1,13-3,89, p<0,01).

Conclusion

A markedly increased admission serum level of MYO, NE and MMP8 (83-156%) in patients with NSTEMI justifies the pathogenetic role of NETosis as well as the diagnostical importance of these markers. Likewise, these markers quite highly predict 1-year cardiac death, and therefore could be useful in post-infarction prognosis.