bluuebunny/crossref_metadata_2025 huggingface dataset:
Ticagrelor induces ischaemic preconditioning in coronary artery disease
Authors: D'amario D , Restivo A , Galli M , Laborante R , Leone A M , Trani C , Romagnoli E , Burzotta F , Crea F
Published: November 2023

Ticagrelor is a reversibly P2Y12 antagonist used in patient undergoing coronary interventions, able to block adenosine re-uptake through inhibition of ENT-1 cotransporter. The increased levels of adenosine are responsible for some of its side effects (dyspnea, bradycardia), but adenosine bioavailability increase could also provide beneficial effects. We sought to investigate whether ticagrelor, as compared to clopidogrel, could enhance ischemic preconditioning in patients with stable CAD undergoing PCI.

Methods and results

The "Ticagrelor and preconditioning in patients with stable coronary artery disease (TAPER-S)" trial was a prospective, randomized 1:1, blinded end-point trial enrolling stable patients with CAD requiring fractional flow reserve (FFR)-guided PCI. Ischemic preconditioning was assessed by measuring the ST-segment elevation at intracoronary ECG during a two-step sequential coronary balloon inflation (2 minutes each, with a 5-minute interval) in the reference vessel.

The primary endpoint of the study was the comparison of the delta (difference in millimeters) of ST-segment elevation extent at first and second coronary balloon inflations between ticagrelor and clopidogrel arms. Secondary endpoints were: 1) changes in coronary flow reserve (CFR), index of mcrovascular resistance (IMR), and FFR measured in the index vessel before and at the end of PCI; 2) difference in anginal pain (measured with VAS) during inflations. Also, lab tests with assessment of adenosine serum concentration and ENT-1 expression were conducted at baseline and after index procedure.

The study was stopped by the DSMB after two thirds (n=53) of the patients qualifying

for the primary endpoint were enrolled. Indeed, an independent statistical report evaluating the

blinded results at a pre-specified interim analysis found a statistically significant difference in

primary endpoint between the groups.

The primary endpoint was significantly higher with ticagrelor as compared to clopidogrel (p < 0.0001). Ticagrelor group was also associated with lower extent of chest pain during coronary balloon inflations (p=0.04), wheras no difference was observed in the delta between pre and post PCI values of FFR (p=0.70), CFR (p=0.72) or IMR (p=0.72). Among lab tests, ticagrelor administration promoted a statistically significant increase in adenosine serum concentration when compared with clopidogrel group, while ENT-1 expression was not different.

Conclusions

Ticagrelor induces ischemic preconditioning among patients with stable CAD undergoing PCI and reduces intraprocedural anginal pain. Adenosine bioavailability was confirmed to be increased in ticagrelor-treated patients. However, since ENT-1 expression was proved not to be different between groups and all patients in this study underwent adenosine infusion during pre-PCI FFR, our results suggest ticagrelor can further induce ischemic preconditioning via non-adenosine mediated mechanisms.
Anatomic classification of renal artery involvement in patients with Stanford type A aortic dissection based on CT angiography images
Authors: Xie E , Jiang W , Yu C
Published: November 2023

Objective

This study was conducted to classify the anatomy of renal artery involvement in Stanford type A aortic dissection based on CT angiography images and to explore the clinical value of this classification system.

Methods

Data of 1331 patients with Stanford type A aortic dissection who underwent surgery at our hospital from January 2010 to December 2017 were analyzed. According to the aortic CT plane scan, the anatomical involvement of one side of the renal artery was divided into the following five types: type T, true lumen involvement; type F, false lumen involvement; type B, both lumens involvement; type C, crushed intimal flap; and type S, sandwich model. Based on the actual CT tomographic observation statistics, bilateral renal artery involvement was classified as TT, TF, TB, BB, BF, CF, and TS types. The incidence of postoperative AKI and CRRT, as well as early postoperative mortality of patients with bilateral renal artery involvement were analyzed among the patients.

Results

The 1331 patients with Stanford type A aortic dissection with bilateral renal artery involvement were grouped according to their anatomic classification as follows: 575 patients had TT type; 352 patients had TF type; 198 patients had TB type; 17 patients had BB type; 30 patients had BF type; 84 patients had CF type; and 75 patients had TS type. The incidence of postoperative AKI for the TT, TF, TB, BB, BF, CF, and TS types was 14.61% (84/575), 22.44% (79/352), 36.36% (72/198), 52.94% (9/17), 40.0% (12/30), 65.48% (55/84), and 36.0% (27/75), respectively. The incidence of postoperative CRRT for the TT, TF, TB, BB, BF, CF, and TS types was 3.48% (20/575), 6.82% (24/352) ,12.12% (24/198), 17.65%(3/17) , 10.00%(3/30), 32.14 (27/84) , and 9.33% (7/75) , respectively. The early mortality rate for the TT, TF, TB, BB, BF, CF, and TS types was 4.17% (24/575), 4.26% (15/352), 11.11% (22/198), 11.76% (2/17), 13.33% (4/30) , 17.86% (15/84), and 5.33% (4/75), respectively. Analysis of the results revealed statistically significant differences in the incidence of AKI, CRRT use, and early mortality among the identified subtypes (all P values < 0.01). The incidence of CF type was the highest, followed by BB and BF types.

Conclusions

The incidence of AKI, CRRT, and early mortality was significantly different among the anatomical types of renal artery involvement in Stanford type A aortic dissection. Notably, CF type had the highest incidence followed by types BB and BF.result_1result_2
Myocardial injury in hip fractures: a HIP ATTACK-1 randomized trial substudy
Authors: Borges F K , Guerra-Farfan E , Bhandari M , Patel A , Slobogean G , Feibel R J , Sancheti P K , Tiboni M E , Balaguer-Castro M , Tandon V , Sigamani A , Harvey V , Balasubramanian K , Vincent J , Devereaux P J
Published: November 2023

Background

Myocardial injury after a hip fracture is common and has a poor prognosis. Patients with a hip fracture and myocardial injury may benefit from accelerated surgery to remove the physiological stress associated with the myocardial injury.

Purpose

To determine if accelerated surgery is superior to standard-care on the 90-day risk of vascular outcomes and death in patients with a hip fracture who presented with an elevated cardiac biomarker/enzyme at hospital arrival.

Methods

The HIP ATTACK-1 trial was a randomized controlled trial designed to determine whether accelerated surgery for hip fracture was superior to standard-care in reducing death or major complications. This substudy includes 1392/2970 patients with a cardiac biomarker/enzyme measurement (>99.9% had a troponin measurement) at hospital arrival. The primary outcome was all-cause mortality. The secondary composite outcome included all-cause mortality, myocardial infarction, stroke, and congestive heart failure at 90-days after randomization.

Results

322/1392 (23%) patients had a troponin elevation at hospital arrival. Among patients with troponin elevation, median time from hip fracture diagnosis to surgery was 6 h (IQR 5–13) in the accelerated-care group and 29 h (IQR 19–52) in the standard-care group. Patients with an increased troponin had lower risk of mortality with accelerated surgery compared to standard-care (17/163 [10%] versus 36/159 [23%]; HR 0.43 [95% CI 0.24–0.77]); and lower risk of the composite outcome (23/163 [14%] versus 47/159 [30%]; HR 0.43 [CI 95% 0.26-0.72]).

Conclusion

One in 5 patients with hip fracture present with myocardial injury. Accelerated surgery demonstrated a lower risk of mortality and major cardiovascular outcomes compared with standard-care.
Effect of a restrictive vs. liberal blood transfusion strategy among patients with acute myocardial infarction and anemia according to heart failure. A subgroup analysis of the REALITY trial
Authors: Ducrocq G , Cachanado M , Simon T , Puymirat E , Lemesle G , Lattuca B , Ariza-Sole A , Silvain J , Ferrari E , Gonzalez Juanatey J R , Martinez Selles M , Calvo G , Steg P G
Published: November 2023

Background/Introduction

The optimal Red Blood Cell (RBC) transfusion strategy in patients with acute myocardial infarction (MI) and anemia remains debated. In REALITY, the largest randomized trial to date in this population (n=666), a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days, but did not achieve non-inferiority at 1 year.

One of the main concerns with RBC transfusion is the risk of fluid overload and acute heart failure (HF). Therefore, the balance of benefit and risk of transfusions strategies may differ between patients with and without heart failure.

Purpose

We aimed to evaluate the potential interaction between HF and RBC transfusion on outcomes in REALITY.

Methods

HF was defined as either a history of heart failure or Killip class > 1 at randomization (data available for 658 patients). All events until day 30, including HF, were adjudicated by a Critical Event Committee blinded to the transfusion arm and hemoglobin levels. The primary clinical outcome was MACE at 30 days. Secondary endpoints included MACE at one year, individual components of MACE and new onset of heart failure at 30 days and 1 year.

Results

Among 658 patients, 311 (47.3 %) had HF. HF patients had a higher rate of MACE and a higher rate of new HF than patients without HF at 30 day and at 1 year (Fig 1). There was no interaction between HF and the effect of randomized assignment on the primary outcome or on new HF. In contrast, a liberal strategy was associated with increased all-cause death at 30 days and at 1 year in patients with HF but not in pts without HF (interaction p = 0.0088 and p = 0.049 respectively, Fig 1).

Conclusion(s)

Heart failure is frequent in MI patients with anemia (nearly half of the patients) and is associated with higher risks of MACE and of HF. While no interaction was observed between HF and transfusion strategies on the primary outcome of MACE, a liberal transfusion strategy was associated with higher all-cause mortality than a restrictive strategy both at 30-days and 1 year. The mechanism of this interaction deserves further investigation.
Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death
Authors: Pezel T , Dillinger J G , Toupin S , Mirailles R , Logeart D , Cohen-Solal A , Goncalves T , Lequipar A , Gall E , Ah-Sing T , Hamzi L , Lima J , Bousson V , Henry P
Published: November 2023

Background

Although the left atrioventricular coupling index (LACI) measured by cardiovascular magnetic resonance (CMR) is a strong predictor of cardiovascular events, the availability to CMR remains limited in clinical routine. Therefore, it would be useful to validate LACI assessment using other imaging methods such as computed tomography (CT). However, the feasibility of LACI measurement using cardiac CT and its prognostic value are not established.

Purpose

We aimed to investigate the prognostic value of the LACI assessed by cardiac CT, to predict the occurrence of cardiovascular death in consecutive patients without known CVD referred for coronary CT angiography (CCTA).

Methods

Between 2010 and 2020, we conducted a single-center study with all consecutive patients without known CVD referred for CCTA. LACI was defined as the ratio of LA to LV end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association of LACI with the primary outcome after adjustment for traditional risk factors and CCTA findings.

Results

In 1,444 patients (70±12 years, 43% men), 92 (6.4%) patients experienced all-cause death, including 67 (4.3%) patients with cardiovascular death after a median (IQR) follow-up of 6.8 (5.9-9.1) years. After adjustment for risk factors and CCTA findings, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI, 1.05-1.09] per 1% increment, p<0.001), and all-cause death (adjusted HR, 1.05 [95% CI, 1.03-1.07] per 1% increment, p<0.001). After adjustment, a LACI ≥25% showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C-statistic improvement: 0.27; NRI=0.826; IDI=0.209, all p<0.001; LR-test p<0.001).

Conclusions

LACI measured by CCTA is independently associated with cardiovascular death and all-cause death in patients without known CVD referred for CCTA, with an incremental prognostic value over traditional risk factors and CCTA findings.LACI measurement using CCTASurvival curves stratified by LACI value
Non-invasive pressure volume loops derived by cardiovascular magnetic resonance: association between area at risk or infarct size and cardiac hemodynamics at 2-6 days after myocardial infarction
Authors: Lav T , Nordlund D , Jablonowski R , Khoshnood A , Ekelund U , Atar D , Erlinge D , Engblom H , Arheden H
Published: November 2023

Background

A novel non-invasive method for generation of pressure volume loops (PV-loops) using brachial blood pressure and cardiovascular magnetic resonance (CMR) imaging has recently been presented and validated (1). The non-invasive nature of this method enables calculation of PV-loops in large patient cohorts previously not feasible due to the need of invasive measurements.

Purpose

The purpose of the present study was to investigate how cardiac hemodynamics assessed by PV-loop variables such as stroke work, potential energy, contractility and ventriculoarterial coupling is related to myocardium at risk and infarct size in a cohort of patients with acute myocardial infarction (MI).

Method

A total of 100 patients with ST-elevation MI (STEMI) were included from the SOCCER, MITOCARE and CHILL-MI trials (2-4). The CHILL-MI cohort (n = 11) was prone to a stricter selection criterion than the SOCCER cohort, including first-time myocardial infarction and no comorbidities. All patients underwent a CMR examination at 2-6 days after MI. Non-invasive PV-loops were generated by combining volumetric CMR data and brachial sphygmomanometric pressure measurements using a recently validated method (1). Maximal elastance (Emax, translated to contractility), stroke work, potential energy and ventriculoarterial coupling (Ea/Emax) were measured from the PV-loops. Myocardium at risk and infarct size were assessed using contrast-enhanced steady state free precession and late gadolinium enhancement images, respectively.

Results

Contractility, ventriculoarterial coupling, stroke work and potential energy all correlated to myocardium at risk (Emax: r²=0.25, Ea/Emax: r²=0.36, stroke work: r²=0.21, potential energy: r²=0.10) and infarct size (Emax: r²=0.29, Ea/Emax: r²=0.41, stroke work: r²=0.25, potential energy: r²=0.15) as shown in Figure 1. Furthermore, contractility showed a stronger correlation to myocardium at risk (Emax: r²=0.77) than to infarct size (Emax: r²=0.37) for the CHILL-MI patients as shown in Figure 2.

Conclusion

Non-invasive CMR derived PV-loop parameters can be used to assess cardiac hemodynamics early after STEMI showing that increased myocardium at risk and infarct size are both associated with an increased ventriculoarterial coupling and potential energy, and a decreased contractility and stroke work. To what extent these hemodynamic parameters provide incremental prognostic information compared to conventional parameters such as ejection fraction and left ventricular dimensions after STEMI remains to be determined.Figure 1Figure 2
Cholesterol-Years and the risk of the first MI
Authors: Dyrbus K , Niedziela J , Banach M , Trzeciak P , Jankowski P , Legutko J , Wita K , Gasior M
Published: November 2023

Background

Low-density lipoprotein cholesterol (LDL-C) has been determined as one of the causal factors of Atherosclerotic Cardiovascular Disease (ASCVD). The term "cholesterol-years" represents the cumulative exposure of the arterial wall to LDL-C during the lifetime, and is measured by multiplication of patient’s age, and LDL-C level. According to the theory, exceeding a certain number of "cholesterol-years" increases the risk of myocardial infarction (MI) [1]. So far, there are no studies that assess the effect of "cholesterol-years" on the risk of the first MI.

Purpose

We aimed to determine whether "cholesterol-years", as an indicator of cumulative exposure to LDL-C, is associated with the risk of development of the first MI in Polish patients.

Method

Data were extracted from patients from years 2016-2022, who were participants of the Polish Registry of Acute Coronary Syndromes (PL-ACS), a national, multicenter, ongoing, prospective observational registry that includes all patients hospitalized with the acute coronary syndrome (ACS) in Poland. The study group consisted of patients who had not previously been treated with lipid-lowering therapy, with first MI, and had the available data for LDL-C. The association between the "cholesterol-years" and the occurrence of the first MI was assessed using the Spearman’s correlation. All continuous variables were presented as mean (SD), and categorical variables were shown as absolute numbers and percentages.

Results

The studied group constituted 35,747 patients, with the mean age of 66.5 years, of whom 36% were women. 25,6% of patients had diabetes, 70,8% arterial hypertension, and 62.6% were past-or-present smokers. In patients with the first myocardial infarction, there is a significant linear correlation between cholesterol-years and the age at which the first myocardial infarction occurs. In our observation, exceeding 6,000 "cholesterol-years" at the age of 40 increases the risk of the first myocardial infarction.

Conclusion

In the large, real-world population, the risk of the first myocardial infarction was linearly correlated with the number of "cholesterol-years", which supports the "cholesterol-years" theory of the risk of development of the first MI.Baseline Characteristics of PatientsCholesterol-years in the study group
Cardiomyocyte-specific beta3-adrenergic receptor expression reduces infarct size inhibiting the autophagic flux in mice
Authors: Fernandez Tocino M , Pun-Garcia A , Gomez M , Clemente-Moragon A , Cadiz L , Oliver E , Ibanez B
Published: November 2023

Background

Since the discovery of β3-adrenergic receptor (β3AR), the third class of β-adrenergic receptors, expression in in both cardiomyocytes and endothelial cells of the cardiovascular system, it has come to the focus due to it´s possible implication in cardiovascular diseases. Although it´s expression is low compared to β1 and β2 subtypes (1), its been demonstrated that β3AR agonists have a cardioprotective effect in ischemia/reperfusion (IR) injury though inhibition of mitochondrial pore opening (2).

Purpose

In this project we determined the cellular origin of the β3AR cardioprotection and its role on cellular autophagic machinery.

Methods

Mice with overexpression of the β3AR in cardiomyocytes or endothelial cells and their control littermates were subjected to left coronary artery occlusion for 45 min followed reperfusion after 24h and 7days. Left ventricular function was assessed by echocardiography at day 7. Then, heart samples were collected at baseline and 24h and 7 days after IRI. Mitochondrial number were analyzed by transmission electron microscopy. Proteins related to autophagy signaling pathways were measured by western blot and RT-qPCR.

Results

Cardiomyocyte-specific β3AR overexpression protects the heart upon IR injury, reduced cardiac fibrosis which improved cardiac function and maintained heart mass. Studying the effects at baseline to understand the molecular mechanisms of cardioprotection, we found that β3AR overexpression in cardiomyocytes showed a reduction in autophagy markers such as LC3B and Parkin, meaning there is an alteration in the autophagic flux.

Conclusions

Cardiomyocyte-specific overexpression of β3-adrenergic receptor reduces infarct size and protects the heart affecting the autophagy machinery. Our results shed light on the role of the β3AR in the mitochondrial quality control system, offering evidence of its potential use as a target to decrease IR injury in patients with acute myocardial infarction.
Thrombotic profile of East Asian and Western ACS patients and relationship to cardiovascular outcomes
Authors: Suh J W , Memstas V , Gue Y X , Cho H Y , Lee W , Kang S H , Gorog D A
Published: November 2023

Background

East Asian patients compared to Westerners, have a lower risk of ischemic heart disease and a higher risk of bleeding with antithrombotic medications. The underlying mechanisms are incompletely understood. Genetic differences may underlie lower coagulant and inflammation levels in EA compared to W populations.

Objectives

We sought to compare thrombotic profiles of East Asian and Western patients with myocardial infarction (MI) and relate these to cardiovascular outcomes.

Methods

In a 2 centre, prospective, observational study in the U.K. and Korea, blood samples from patients (n=515) with ST- or non-ST-elevation MI (STEMI and NSTEMI) were assessed using the Global Thrombosis Test, measuring thrombotic occlusion (OT) and endogenous fibrinolysis (LT) times. In STEMI patients, blood samples were taken immediately upon arrival, whilst in NSTEMI patients, blood samples were taken after DAPT loading. Patients were followed for 1 year for major adverse cardiovascular events and major bleeding.

Results

Major adverse cardiovascular events occurred significantly more frequently in Western than in East Asian patients (6.27% vs. 1.92%, p=0.014), driven by a higher rate of cardiovascular death (3.53% vs. 0.38%, p=0.01), with minimal major bleeding events (0.39% vs. 0.38%, p=1.0). East Asian patients showed reduced platelet reactivity (longer OT) compared to Western patients (646s [470-818] vs. 436s [320-580], p<0.001), with similar LT. In STEMI, OT (588s [440-759] vs. 361s [274-462], p<0.001) and LT (1854s [1389-2729] vs. 1338s [1104-1788], p<0.001) were longer in East Asian patients than Westerners. In NSTEMI, OT was longer (OT 734s [541-866] vs. 580s [474-712], p<0.001) and LT shorter (1519s [1058-2508] vs. 1898s [1614-2806], p=0.004) in East Asian than Western patients. While OT was unrelated, LT was a strong independent predictor of MACE after adjustment for risk factors (HR 3.70, 95% CI 1.43-9.57, p=0.007), predominantly in Western patients, and more so in STEMI than NSTEMI.

Conclusion

East Asian patients exhibit different global thrombotic profiles to Westerners, associated with a lower rate of cardiovascular events. The lower platelet reactivity in East Asian STEMI patients, even before antiplatelet therapy, may explain contribute to the lower risk of subsequent adverse ischaemic events.
Antiplatelet therapy and prognosis at the onset of stent thrombosis
Authors: Matsuoka Y , Sotomi Y , Hikoso S , Nakatani D , Okada K , Dohi T , Kida H , Sunaga A , Tsujimura T , Kikuchi A , Tanaka A , Kosugi S , Ichibori Y , Ishihara T , Sakata Y
Published: November 2023

Background/Introduction

Antiplatelet therapy is the standard therapy after stent implantation. Stent thrombosis (ST) has dramatically decreased by appropriate antiplatelet therapy and advancement in stent technology, but remains a life-threatening event if it occurs. Some patients develop ST even under intensive antiplatelet therapy (dual antiplatelet therapy; DAPT). The association of prognosis of ST and antiplatelet therapy at the onset of ST is unclear.

Purpose

We aimed to investigate the association of prognosis and antiplatelet therapy at the onset of ST.

Methods

We used the database of Long-term Outcomes following Occurrence of Stent Thrombosis registry, a multicenter, retrospective, observational study (Long ST registry). Definite ST cases from January 2008 to December 2017 were enrolled, and long-term clinical outcomes were investigated.

Results

A total of 187 patients (male: 86.1%, median age at the time of ST: 69.0) were eligible. Ninety patients were under DAPT at the onset of ST (DAPT group), whereas 97 patients were under single antiplatelet therapy or no antiplatelet therapy (non-DAPT group). The median follow-up duration was 1054.0 (inter-quartile range, 239.5 – 1850.0) days. Findings of intravascular ultra sounds at the time of ST were similar between two groups. Patients in DAPT group were independently associated with higher incidence of major adverse cardiac events (MACE: a composite of cardiovascular death, nonfatal myocardial infarction, and target lesion revascularization) than in non-DAPT group (adjusted hazard ratio: 2.36, 95% confidence interval [1.27 - 4.34], P value = 0.006).

Conclusion

Patients who developed ST under DAPT were independently associated with a higher incidence of MACE than patients under single or no antiplatelet therapy.
Intensity of dual antiplatelet therapy based on thrombotic and bleeding risks after coronary stenting
Authors: Kim J S , Jeong Y H , Ahn J H , Kang M G , Koh J S , Park Y W , Hwang S J , Hwang J Y , Park Y H , Hwang K W , Lee S H , Lee S Y , Choi J H , Kim S H , Lim J H
Published: November 2023

Background/Introduction

High thrombotic risk (HTR) features are associated with higher ischemic rate, which may be mitigated by potent antiplatelet therapy. However, concomitant high bleeding risk (HBR) may be present, making it unclear whether the intensity of antiplatelet therapy should be prioritized.

Purpose

This study investigated the prognostic implications of HTR and HBR strata according to intensity of antiplatelet therapy (indicated by platelet reactivity) after coronary stenting.

Methods

HTR was defined as having at least one of the three risk factors: 1) index presentation with acute coronary syndrome; 2) complex coronary artery disease and stenting; and 3) guideline-directed clinical ischemic risk factors. HBR was determined according to presence of Academic Research Consortium (ARC)-HBR criteria. In addition, high platelet reactivity (HPR) was decided depending on the level of platelet reactivity (> 208 P2Y12 reaction unit measured by VerifyNow assay).

Results

Among 4,550 patients, HTR features were observed in 3,973 patients (87.3%) and 1,451 (31.9%) met the ARC-HBR criteria. HPR phenotype (n=2563, 56.3%) significantly increased the risk of 4-year ischemic events (adjusted hazard ratio [HRadj]: 1.40; 95% confidence interval [CI]: 1.15-1.70; P=0.001). Among patients who met the ARC-HBR criteria, HPR was not associated with the rate of ischemic events, regardless of HTR features. In cases of non-HBR patients, HPR phenotype increased ischemic events only in patients with HTR feature(s), which risk proportionally increased according to the number of HTR features (HRadj: 0.67, 1.47 and 1.58; 95% CI: 0.22-2.08, 0.94-2.29 and 1.09-2.28 in 0 [9.2%], 1 [31.2%] and ≥2 [27.7%] HTR features). In HBR patients, the risk of major bleeding was not increased by the level of antiplatelet effect.

Conclusion

HPR phenotype was significantly associated with the risk of ischemic events after coronary stenting, which proportionally increased according to the number of HTR features only if the ARC-HBR criteria were not present. These observations suggested that when concordant, bleeding risk, more than ischemic risk, should inform decision-making on the intensity of antiplatelet therapy.KM curve and HR forest plot for MACCEKM curve and HR forest plot for NACE
The association between the hsCRP/BMI ratio and cardiovascular prognosis in CAD patients
Authors: Yang J I E , Zhang K U O , Wang Y U A N , Tang Y I D A
Published: November 2023

Background

Some researchers have explored the influence of hsCRP on cardiovascular outcomes stratified by BMI in subjects with known CAD. However, it is unclear whether a novel composite biomarker, the high-sensitivity C-reactive protein (hsCRP)-to-BMI ratio (CBR), is associated with poor prognosis in patients who underwent percutaneous coronary intervention (PCI).

Aim

We conducted the present study to evaluate the association between the CBR and poor prognosis in CAD patients undergoing percutaneous coronary intervention (PCI).

Methods

A total of 9,810 patients were prospectively included in the present study. All the participants were classified into 3 groups based on their CBR levels: tertile 1 (CBR ≤ 0.04, n = 3,270), tertile 2 (0.04 < CBR ≤ 0.11, n = 3,270) and tertile 3 (CBR > 0.11, n = 3,270). The primary outcome was defined as major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause mortality, myocardial infarction (MI), stroke, and target vessel revascularization (TVR).

Results

During a mean follow-up of 26.7 months, a total of 1022 MACCEs, 122 all-cause deaths, 392 nonfatal MIs, 156 strokes and 461 TVRs were recorded. The outcomes of Kaplan–Meier analysis showed that the incidences of MACCE and MI increased with high tertiles of the CBR (MACCE: 8.8% vs. 10.3% vs. 12.1%, log-rank P < 0.001; myocardial infarction: 3.3% vs. 4.1% vs. 4.7%, log-rank P = 0.018). Cox regression analysis showed that the CBR was independently associated with long-term MACCEs and MI.

Conclusion

The hsCRP to BMI ratio is independently associated with long-term MACCE and MI in CAD patients undergoing DES implantation.
Synergistic effect of Interleukin-1beta and cholesterol efflux capacity on outcomes in acute myocardial infarction patients
Authors: Materne C , Silvain J , Zeitouni M , Guedeney P , Galier S , Guillas I , Lhomme M , Frisdal E , Vicaut E , Lesnik P , Collet J P , Le Goff W , Montalescot G , Kerneis M , Guerin M
Published: November 2023

Background

Low cholesterol efflux capacity and elevated levels of Interleukin-1ß (IL-1ß) are both associated with residual cardiovascular risk in patients with acute myocardial infarction (MI) and may be used as new biomarkers to identify patients at higher cardiovascular risk. Both pathways are currently evaluated as new therapeutic targets in ongoing clinical trials.

Objectives

We evaluated potential synergetic effect of cholesterol efflux capacity and IL-1ß on recurrent major cardiovascular events (MACE) at one-year in patients with acute ST-segment elevation MI who underwent primary percutaneous coronary intervention.

Methods

Cholesterol efflux capacity and IL-1ß were measured among 2012 ST-segment elevation MI patients enrolled in a prospective cohort. The association of these biomarkers with the primary outcome of MACE (MI, Stroke, or cardiovascular death) was evaluated at one-year follow-up using a multivariate-cox proportional regression analysis. In addition, in-vitro analysis of anti-atherogenic properties of HDL particles was also performed.

Results

Patients with both, a reduced cholesterol efflux capacity and an elevated level of IL-1b, exhibited the highest risk of recurrent MACE at one year compared to patients with both high cholesterol efflux capacity and low IL-1b (adjusted HR: 3.28; 95% CI: 1.83 to 5.89, p<0.0001) (Figure). In this high-risk subgroup, patients exhibited HDL particles defective for ABCA1-dependent efflux capacity with enhanced pro-inflammatory activity as a potential explanation for our clinical findings.

Conclusion

Defective cholesterol efflux capacity and elevated IL-1β increase synergistically the residual cardiovascular risk in MI patients.
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition with evolocumab decreases myocardial inflammation in individuals with acute coronary syndrome (ACS)
Authors: Ziogos E , Harb T , Valenta I , Vavuranakis M A , Williams M S , Blaha M J , Jones S R , Schindler T H , Gerstenblith G , Leucker T M
Published: November 2023

Background/Introduction

Although inflammation is commonly present and often beneficial in the period following tissue injury, prolonged inflammation may impair healing and repair following acute ischemic injury. In addition to its impact on cholesterol metabolism PCSK9 is elevated in patients with inflammatory diseases and is thought to be a pro-inflammatory mediator. The presence and early trajectory of myocardial inflammation, and the impact of PCSK9 inhibition on that trajectory, in patients with an acute myocardial infarction have not been characterized.

Purpose

Our goals were to assess myocardial inflammation in patients with an acute myocardial infarction using 18F-FDG-PET scans obtained at the time of hospitalization for the infarction and at 30-days following the infarction and the impact of PCSK9 inhibition with evolocumab on inflammation in a placebo-controlled, randomized trial.

Methods

Fifty-five participants from the Evolocumab in Acute Coronary Syndrome trials, with a NSTEMI and a troponin-I of > 5 ng/ml or with a STEMI were randomized to placebo (n=30) or to 420 mg SQ of evolocumab (n=25) within 24 hours of admission. 18F-FDG-PET scans were performed within five days (2 [1-4]) of randomization and at 30 days. The myocardial mean Standardized Uptake Value (SUV) in the two randomized groups at baseline and the changes from baseline to 30 days were compared. All participants received guideline-directed therapies for acute infarction.

Results

Mean±SD age of the cohort was 57±13 years, 22% were African American, and 36% were women. There were no significant differences in demographic or clinical characteristics between the two groups. Mean SUV at baseline did not differ between the placebo (2.4±0.5) and the evolocumab (2.7±0.7) groups, p=0.25 for the between groups comparison. Mean SUV decreased in both groups, from 2.4±0.5 to 2.1±0.7 in the placebo group (p=0.05) and from 2.7±0.7 to 1.9±0.5 in the evolocumab group (p <0.0001), and the decrease was less in the placebo group, p=0.039 for the between groups comparison. The percent-change in the placebo group (-10.4%±36%) was also less than the percent change in the evolocumab group (-26.7%±20%), p = 0.04 for the between groups comparison. In addition, the percent of participants in whom the mean SUV units decreased was lower in the placebo group (60%) than in the evolocumab group (88%,), p=0.03 for the between groups comparison.

Conclusion

Myocardial inflammation assessed using 18F-FDG-PET decreases but is still present 30 days following an acute myocardial infarction. PCSK9 inhibition with evolocumab given within the first 24 hours of admission improves resolution of the inflammation. In addition to its marked impact on lipid levels, PCSK9 inhibition has significant anti-inflammatory effects in the early post-infarction setting.
Plaque progression is dependent on the local hemodynamics (time-averaged wall shear stress and TSVI) in combination with the plaque phenotype
Authors: Wentzel J J , De Nisco G , Hartman E , Mazzi V , Chiastra C , Gallo D , Daemen J , Morbiducci U
Published: November 2023

Objective

To investigate the predictive power of TSVI for plaque growth in human coronary arteries in plaques with different phenotypes.

Methods

38 non-stented, non-culprit coronary arteries (MPACT study) were imaged with near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) at the baseline and after 12 months [2]. Coronary reconstructions were based on fusion of the multimodality imaging and used as input for computational fluid dynamics. Vessel-specific flow was measured using Doppler wire and used as input to calculate TAWSS and TSVI [2]. The coronary arteries were subdivided into 1.5 mmx45º sectors and the TAWSS and TSVI were classified as low, mid and high based on the range per vessel. Per sector the plaque growth was quantified as plaque burden (Plaque area/total vessel area*100%) change over time (ΔPAV). Based on the NIRS and OCT data, the sectors were characterized as lipid rich plaque (wall thickness>0.5 mm & NIRS+, lipid rich(OCT)) or plaque without lipid (wall thickness >0.5 mm & NIRS-, fibrous (OCT)) or plaque free wall (wall thickness <0.5 mm &NIRS-, PFW (OCT)). The effect of TAWSS, TSVI and the combination with plaque phenotype on plaque progression was evaluated using Linear Mixed Model in SPSS.

Results

TSVI at baseline was significantly associated with PAV increase, with high PAV for high TSVI (p<0.001). A clear trend emerged for TAWSS, with high PAV for low TAWSS at baseline (Figure 1B). The highest plaque progression at 1-year follow-up was observed for lipid rich plaques (both based on NIRS and OCT) exposed to either low TAWSS or high TSVI (figure 2). Also in the PFW sectors clear plaque progression was observed dependent on either TAWSS or TSVI.

Conclusion

Lipid rich regions exposed to either low TAWSS or high TSVI are at the highest risk for plaque progression. These data suggest that although TAWSS and TSVI have a different mechanism of action on the endothelium, but both actions are involved in plaque progression.Figure 1Figure 2
Calcification of different cardiac structures shown by cardiac CT: how important are lipids?
Authors: Miranda I , Passos M , Gerardo F , Mateus C , Lopes J , Fialho I , Santos P , Loureiro J , Augusto J
Published: November 2023

Background

The relationship between dyslipidemia and atherosclerotic plaque as a risk factor for coronary artery disease is well-established. However, the involvement of lipids in the development of valve and aortic calcification beyond coronary disease is yet to be understood.

Objective

To evaluate the involvement of lipids in the calcification of various cardiac structures as measured by cardiac CT.

Methods

In this single-center study, we analyzed data from 316 consecutive patients who underwent cardiac CT scans between January 2018 and December 2019. Patients with poor imaging quality, constrictive pericarditis, prosthetic valves and/or devices were excluded. The calcium score of various cardiac structures, including coronary arteries (CA), mitral valve (MV), aortic valve (AoV), ascending aorta (AAo), and aortic arch (AAc), was calculated using the Agatston method from non-contrast ECG-gated CT. These scores were then combined to derive the valvular (VA=MV+AoV), total cardiac (TC=CA+VA), total vascular (TV=AAo+AAc), and total cardiovascular (TCV=TC+TV) calcium scores. We then collected data regarding lipid values (total cholesterol, LDL and HDL cholesterol and triglycerides).

Results

275 CT scans were suitable for analysis, 142 were male (52%), with a mean age of 60±12 years (range 26–93 years). A total of 183 (66.7%) patients presented calcification in at least one location. Patients with calcification on any of the prespecified locations had higher prevalence of hypertension, dyslipidemia and type 2 diabetes mellitus (DM) than those without any calcium (p<0.05). The best regression models (using backwards conditional input method) showed that age was a significant predictor of calcification in all locations (and combinations of locations, p<0.05 for all) and HDL cholesterol was a part of these models across all calcifications types, being significant for TC score (p=0.010) and TCV score (p=0.024, see Figure). Patients above the fourth quartile (Q4) of TCV had significantly lower HDL cholesterol levels (47±12 vs 53±16mg/dL, p=0.007). Of note, total cholesterol, LDL cholesterol and triglycerides were not significant predictors of calcification in any location.

Conclusion

Calcification across the cardiovascular system is consistently associated with low HDL cholesterol levels, which extends beyond the traditional association with coronary disease. The calcification effect of HDL is found to be more significant than other lipids, however, the specific contribution of HDL subtypes is not yet fully understood.
Variability of time to healing of Spontaneous Coronary Artery Dissection assessed through coronary CT angiography
Authors: Zilio F , Mochen M , Muraglia S , Borghesi M , Zucchelli F , Todaro D , Bonvicini E , Morat F , Dallago M , Casagranda G , Bonmassari R
Published: November 2023

Background

Spontaneous coronary artery dissection (SCAD) results from a spontaneous, non-traumatic, and non-iatrogenic separation of the coronary arterial wall by intramural hematoma caused by intimal tear or spontaneous hemorrhage that is unrelated to atherosclerosis. SCAD is an important cause of myocardial infarction particularly in young to middle-aged women. Natural history of this condition is poorly understood: spontaneous healing has been demonstrated through coronary angiography in the vast majority of patients at long term follow up, but the timing of healing is still not clear. Nowadays, Coronary CT angiography (CCTA) is emerging as a noninvasive option to evaluate SCAD healing at least for coronary arteries with diameter ≥2mm and could help in understanding the natural history of this condition.

Methods

In this single-centre, retrospective study, patients affected by SCAD between 2017 and 2022 were included. Patients with SCAD involving coronary arteries with diameter ≥2mm who did not undergo percutaneous coronary intervention (PCI) and underwent to at least one CCTA during follow up were evaluated with regard to evolution of SCAD and time to healing.

Results

Among 93 patients for whom diagnosis of SCAD was posed by coronary angiography, 33 conservatively managed patients (84.8% female, mean age 51.8±12.3 years) underwent to at least one CCTA during follow up. At a median time of 49 days (IQR 13 to 82 days), a complete healing of SCAD was demonstrated in 6 patients (18.2%), while most of the patients showed a stability or partial healing and 1 patient (3.0%) an extension of SCAD. During further follow up, of 10 patients who did not show a significant healing at the first CCTA, 4 patients showed a complete healing, while 6 patients showed a stability of SCAD extension or only partial healing at the longest available CCTA follow up (median follow up 191 days, IQR 96 to 249 days). As regards clinical events, no death, myocardial infarctions, or target vessel PCIs were reported during follow up.

Conclusion

Spontaneous healing is commonly seen in SCAD and can be demonstrated by CCTA. However, the timing of complete healing is largely variable between individuals: therefore, studies focusing factors impacting natural history of SCAD are needed.
Association of admission blood glucose to albumin ratio and clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention
Authors: Zhen C , Zeng L , Lin Z , Lin Z , Tan N , Liu Y , He P
Published: November 2023

Background

It is unclear whether admission blood glucose to albumin ratio (AAR) predicts clinical adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).

Purpose

Here, we explored the predictive value of AAR.

Methods

Patients diagnosed with STEMI undergoing PCI between January 2010 and February 2020 were enrolled. The patients were classified into three groups according to AAR quantiles. In-hospital all-cause mortality was regarded as the primary outcome. Logistic regression, Kaplan-Meier analysis and Cox proportional hazard regression were mainly used to estimate outcomes.

Results

Among the 3,224 enrolled patients, 130 (3.9%) of them suffered in-hospital all-cause mortality and 181 (5.4%) experienced major adverse cardiac events (MACEs). After the adjustment, multivariate analysis demonstrated that an increase in AAR was associated with the increased risk of in-hospital all-cause mortality (adjusted OR: 2.72, 95% CI: 1.47–5.03, p = 0.001) and MACEs (adjusted OR: 1.91, 95% CI: 1.18–3.10, p = 0.009), as well as for long-term all-cause mortality (adjusted HR: 1.64, 95% CI: 1.19–2.28, p = 0.003) and MACEs (adjusted HR: 1.58, 95% CI: 1.16–2.14, p= 0.003). ROC analysis indicated that AAR could accurately predict in-hospital all-cause mortality (AUC = 0.718, 95% CI: 0.675–0.761) and MACEs (AUC = 0.672, 95% CI: 0.631–0.712).

Conclusions

AAR is a novel and convenient independent predictor of all-cause mortality and MACEs both at the in-hospital and long-term levels in STEMI patients receiving PCI.ROC curve of AARKaplan–Meier survival curves
The importance of evaluation for living alone among acute myocardial infarction patients
Authors: Fukumoto D , Kanda D , Ohmure K , Sonoda T , Anzaki K , Ikeda Y , Ohishi M
Published: November 2023

Background

Assessment of the mortality risk in acute myocardial infarction (AMI) patients is crucial when making medical decisions because AMI is an important public health issue and a major cause of death worldwide. The Global Registry of Acute Coronary Events (GRACE) risk score is useful for estimating in-hospital mortality at the time of admission and is in wide use. On the other hand, in the rapidly aging societies of the modern era, social isolation and absence of support are important welfare issues. Among them, living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease.

Purpose

The purpose of this study was to investigate the association between living alone and cardiac deaths in AMI patients after percutaneous coronary intervention (PCI), and to determine whether this association was independent of GRACE risk score as a score that is widely used in clinical settings.

Methods

This study was a retrospective cohort study, investigating 277 consecutive AMI patients who underwent successful revascularization of the culprit lesion by primary PCI. Associations between cardiac deaths after PCI and baseline characteristics including living alone and GRACE risk score were assessed. Furthermore, this study also assessed nutritional status using the Geriatric Nutritional Risk Index (GNRI).

Results

Median duration of follow-up was 1153 days (IQR, 560–1566 days). In this population, median age was 69 years (IQR, 59–77 years), and 198 patients (71%) were male. Eighty-three patients (30%) were living alone. Thirty patients died after PCI, including 20 cardiac deaths. Patients living alone showed higher incidences of cardiac deaths compared with patients not living alone (14% vs. 4%, p=0.004). The proportion of males differed significantly between living alone and not living alone groups (p=0.004). GNRI was significantly lower in the living alone group than in the not living alone group (p<0.001 and p=0.048). GRACE risk score was significantly higher in the living alone group (median, 140; IQR, 107–170) than in the not living alone group (median, 127; IQR, 103–149; p=0.038). Multivariate Cox proportional hazards regression analysis models showed living alone (hazard ratio [HR], 4.17; 95% confidence interval [CI], 1.60–10.84; p=0.003), GNRI (HR, 0.94; 95%CI, 0.91-0.98; p=0.003), and GRACE risk score (HR, 1.03; 95%CI, 1.01-1.04; p<0.001) were significantly associated with cardiac death after PCI. A comparison of p values for the interaction of GRACE risk score and either living alone and GNRI were p=0.082 and p=0.244, respectively.

Conclusions

The current study revealed that living alone represents an independent risk factor for cardiac deaths in AMI patients after PCI, separate from GRACE risk score. Evaluation of living arrangements may provide more information regarding prognosis for AMI patients.