bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimal extra-cardiac atherosclerosis in people <50 years with sudden cardiac death due to coronary disease
Authors: Paratz E , Fahy L , Nehme Z , Pflaumer A , Stub D , La Gerche A
Published: October 2024

Background

The association between severe coronary artery disease and widespread atherosclerosis in younger individuals remains uncertain.

Purpose

To characterise the association between severe (fatal) coronary disease and extra-cardiac atherosclerosis in a population of young and middle-aged individuals.

Methods

Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019-23, autopsy-proven to be due to coronary artery disease, were identified using the state-wide EndUCD registry. The presence of extra-coronary atherosclerosis greater than modified American Heart Association class III was documented in five arterial beds (intra-cerebral vessels, carotid arteries, aorta, renal and femoral arteries).

Results

Of 3,044 individuals who experienced SCD, 372 were due to coronary artery disease and 71 of these (19.1%) had extra-coronary plaque. Plaque was identified in aorta (68/372 patients, 18.3%), carotid arteries (11/372, 3.0%), iliofemoral arteries (11/372, 3.0%), intracerebral arteries (4/157 patients who underwent examination of the brain, 2.6%) and renal arteries (7/372 patients, 1.9%). 51 patients (13.7%) had plaque in ≥2 arterial beds in addition to their coronary disease. Predictors of extra-coronary plaque were older age (median 47.7 vs 44.4 years, p<0.0001), hypertension (32.3% vs 18.9%, p=0.013), and previous percutaneous coronary intervention (9.9% vs 3.0%, p=0.01). Patients with extra-coronary plaque had higher rates of cardiomegaly (68.8% vs 51.1%, p=0.01), cardiac fibrosis indicative of previous myocardial infarction (49.3% vs 31.9%, p=0.006) and multi-vessel coronary disease (73.5% vs 55.6%, p=0.007).

Conclusion

Only 1 in 5 people aged 1-50 years experiencing SCD from a coronary cause exhibit extra-coronary plaque. This limits the utility of screening for carotid or aortic plaque to predict coronary atherosclerosis. Individuals with extra-coronary plaque had a higher burden of cardiovascular risk factors and more established coronary disease.
Elevated risk for stroke in genetically predisposed bicuspid aortic valve disease: evidences from a mendelian randomization study
Authors: Lu F W , Wu B T , Feng B Q , Shu X H , Wang Y S , Ge J B
Published: October 2024

Background

Patients with bicuspid aortic valve (BAV) have been recognized to have an elevated risk for stroke. However, the exact causal association between BAV and stroke remains elusive due to stroke-related comorbidities, residual confounding bias and sample size limitations of observational studies.

Purpose

To identify the causal relationship between genetically predisposed BAV and 15 cardiovascular diseases (CVDs), and whether calcific aortic valve stenosis (CAVS) or atrial fibrillation (AF) could serve as the mediator on the pathway from BAV to stroke by mendelian randomization (MR) approach.

Methods

Uncorrelated (r² < 0.001) and genome-wide significant (P < 5×10^-8) single nucleotide polymorphisms were extracted from the largest genome-wide association study statistics (2,236 patients and 11,604 controls) of BAV by Gehlen et al. Summary-level statistics for 15 CVDs were obtained from the UK Biobank study, FinnGen study, HERMES consortium, CARDIoGRAMplusC4D consortium and GIGASTROKE consortium. We used 2-sample MR to estimate the causal association between BAV and 15 CVDs, evaluated 12 potential mediators and mediated proportions within 2-step MR framework. Inverse variance weighted was utilized as primary MR analyses method. Results for each outcome from different sources were pooled using the random effect meta-analysis. False discovery rate (FDR) was calculated by Benjamini-Hochberg method to account for multiple comparisons.

Results

Genetically predicted per log-odds liability increase of BAV was significantly associated with aortic aneurysm (OR, 1.26; 95% CI, 1.13-1.40; FDR-adjusted P = 3.54 × 10^-4), any stroke (OR, 1.06; 95% CI, 1.02-1.09; FDR-adjusted P = 0.004), ischemic stroke (IS) (OR, 1.17; 95% CI, 1.03-1.11; FDR-adjusted P = 0.001) and cardioembolic stroke (CES) (OR, 1.15; 95% CI, 1.06-1.25; FDR-adjusted P = 0.004). No significant association were observed between BAV and another 11 CVD outcomes. Instead of CAVS, genetic liability to AF mediated the total effect of BAV on any stroke (proportion mediated = 13.2% [95% CI, 3.1% - 23.2%]), IS (proportion mediated = 10.8% [95% CI, 2.5% - 19.1%]) and CES (proportion mediated = 21.5% [95% CI, 5.3% - 37.7%]).

Conclusions

Genetically predisposed BAV is associated with a higher risk of any stroke, IS and CES, which could be mediated by AF. This study implies the pathophysiological processes from BAV towards stroke and highlights the clinical significance of AF intervention in reducing the incidence of stroke for BAV patients.Causal association between BAV and CVDs
Global longitudinal strain predicts clinical outcome in patients after acute ischemic stroke without left ventricular dysfunction
Authors: Mihalovic M , Mikulenka P , Linkova H , Knize T , Vichova T , Stetkarova I , Tousek P
Published: October 2024

Background

Global longitudinal strain (GLS) is a sensitive marker of myocardial dysfunction that could help predict adverse outcomes.

Purpose

We assessed whether GLS can help predict adverse clinical outcomes in patients after acute ischemic stroke (AIS).

Methods

Patients without LV dysfunction after AIS were divided into groups according to abnormal GLS (≤15.9%) or normal GLS (≥16%). Blood samples were obtained to determine levels of high-sensitive troponin I (hs-cTnI). Clinical data, functional outcome, and all-cause mortality at 1 year were compared between groups. National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc).

Results

In our study, between 8/2020-8/2022 155 enrolled patients after AIS had echocardiographic examination, due to image quality or LV dysfunction, GLS was assessed in 110 patients with normal LV function, 28 patients (25.6%) had abnormal GLS. After a year follow-up, the overall mortality was more common in patients with abnormal GLS compared to patients with normal GLS (hazard ratio [HR] 2.9610, 95% confidence interval [CI] 0.9015 to 9.7255, p =0.074) and was significant when comparing mean values (p<0.001) (Fig. 1A). The Kaplan-Meier survival curve accentuated a significantly elevated all-cause mortality among patients with abnormal GLS (Fig 2). Moreover, abnormal GLS was associated with positive hs-cTnI (Fig. 1B), and was connected with unfavorable functional outcome evaluated by mRS at 90 days (Fig. 1C). At last, severe stroke (NIHSS >15) was not significantly associated with abnormal GLS (HR 2.2121, 95% CI 0.7091 to 6.9009, p = 0.1714)

Conclusion

In patients after AIS, abnormal GLS could be helpful predictor for clinical events and subclinical myocardial injury.
Single centre experience using vessel Fractional Flow Reserve (vFFR) and diagnostic performance compared with invasive Fractional Flow Reserve (FFR)
Authors: Traynor B , Duncan A , Lolait C , Mccann H , Mahon N , Galvin J , O'neill J , Keelan P , Srinivas P , Casserly I , Blake G
Published: October 2024

Background

Fractional flow reserve (FFR) is a diagnostic gold standard in the functional assessment of coronary artery stenoses (1). Alternative invasive and non-invasive methods have been developed in an attempt to avoid limitations associated with FFR including added procedural risk, patient discomfort, time and cost. Vessel fractional flow reserve (vFFR) is a novel software using two angiographic projections to generate a 3D vessel reconstruction which has shown high diagnostic accuracy in predicting a positive FFR (2-4).

Methods

All patients undergoing coronary angiography between 01/10/2022 and 08/03/2023, where FFR was performed, were assessed. Patients were included where images met requirements necessary to use vFFR software. vFFR measurements were taken retrospectively by a single investigator and not used to inform patient care. Data were expressed as mean +/- standard deviation and %. The correlation of vFFR to FFR was compared using Pearson’s correlation coefficient. Receiving operator characteristic (ROC) area under the curve (AUC) analysis was used to determine diagnostic performance. Statistical analysis was performed using SPSS v27.

Results

28 of 37 patients and 32 of 44 vessels were included and analysed with vFFR software. Excluded vessels were unsuitable due to insufficient frame rate or projection angulation during angiography. Mean age was 63 +/- 3.8 years and 75% of patients were male. Of 32 vessels assessed, 20 were LAD, 5 RCA, 5 LCx and 2 LMS. 29 of 32 vFFR values agreed with positive or negative FFR. Positive vFFR values were seen in all 15 vessels with positive FFR. 3 vessels received a positive vFFR where FFR values were negative. Mean vFFR was 0.76 +/- 0.1 and mean FFR was 0.81 +/- 0.09. vFFR correlated significantly with FFR (R=0.777, p<0.001). vFFR demonstrated good diagnostic accuracy in discriminating "positive" (>0.8) and "negative" (≤0.8) FFR with an AUC of 0.758 (95% CI 0.61-0.91, p<0.01).

Conclusion

vFFR correlated significantly with FFR and all positive FFR values also received positive vFFR values. vFFR demonstrated good diagnostic accuracy in predicting a positive FFR result. Thus, these data support a strategy of using a negative vFFR to avoid further testing.Pearson correlation of vFFR to invFFRROC curve: vFFR predicting invFFR
Distal versus conventional transradial access for coronary angiography: a pooled analysis from the randomized RAPID trial
Authors: Stiermaier T , Gruenewaelder M , Paetz T , Rawish E , Joost A , Meusel M , Marquetand C , Kurz T , Schmidt T , Frerker C , Fuernau G , Eitel I
Published: October 2024

Background

Transradial access (TRA) is the recommended approach for coronary procedures considering safety benefits over femoral access with radial artery occlusion (RAO) being the most frequent complication. Although usually not clinically significant, the presence of RAO affects potential future procedures and medical treatments. Distal TRA (dTRA) has been suggested to reduce the risk of postprocedural RAO compared to conventional TRA (cTRA) with, however, inconsistent results in clinical trials.

Purpose

This study aimed to compare the efficacy and safety of dTRA versus cTRA in patients undergoing diagnostic coronary angiography.

Methods

The RAPID trial is a single-center, open-label, 2x2 factorial, randomized study of patients undergoing coronary angiography through a 6-F radial access. The trial was stopped early by the data and safety monitoring board after the second pre-planned interim analysis and inclusion of 600 participants. Patients were randomized to dTRA or cTRA with further stratification according to periprocedural heparin use and preexisting oral anticoagulation. The primary endpoints were the incidence of RAO assessed by vascular ultrasound and puncture-site related bleedings.

Results

The final study population consisted of 298 patients randomized to dTRA and 302 patients to cTRA. Periprocedural heparin was administered in 382 patients (63.7%) and percutaneous coronary intervention was performed in 161 cases (26.8%) without differences between the study groups (p=0.700 and p=0.465; respectively).

Distal TRA was associated with a significantly increased number of puncture attempts (2.4 ± 2.0 versus 1.5 ± 1.2; p<0.001) and failed punctures leading to access site crossover (11.7% versus 5.0%; p=0.003). Consequently, the total procedure time was longer in the dTRA group (30 min versus 25 min; p=0.004) without increasing fluoroscopy time (p=0.320), dose area product (p=0.245), or contrast volume (p=0.884). Patent hemostasis was achieved in 91.7% of patients with cTRA. The rates of RAO (16.1% versus 15.6%, p=0.855) and puncture-site related bleedings (6.7% versus 8.3%; p=0.466) were similar in both groups.

Conclusions

According to this study, dTRA does not reduce the risk of RAO or bleeding events compared to cTRA.
Simulation training for invasive cardiovascular procedures: the Heart-SIMS-1 study
Authors: Santos M , Guerreiro C , Lobo B , Marinho A , Rosa J , Santos E , Costa M , Goncalves L , Cacao R , Capinha J , Carvalho P , Pires De Morais G , Silva Marques J , Khokhar A
Published: October 2024

Introduction

Interventional cardiology training has a long learning curve and exposes patients and clinicians to undesirable procedural risks. We aim to assess whether mentored simulation-based training with three dimensional (3D) printed models can improve the procedural skills and safety performance of beginners in coronary diagnostic procedures.

Methods

Twenty-nine final-year medical students from a single centre were lectured in the basic principles of invasive coronary angiography (ICA) for one-hour, and then randomized to conventional training or simulation training. Conventional training (n=15) consisted in watching a 20-minute video demonstrating all ICA steps in a 3D-printed coronary simulator. Simulation training (n=14) offered the same explanations in a hands-on training session with the 3D-printed model, in pairs, for 20 minutes. The co-primary endpoint was efficacy and safety of performing a simulated ICA in the 3D-printed simulator, installed under sterile drapes, in a conventional angiography suite. Efficacy and safety were graded by a blinded investigator using a pre-specified performance checklist, including the identification of procedural "red flags", graded 0-100%. The secondary endpoint was theoretical knowledge, assessed in a 25-question multiple-choice quiz, graded 0-100%.

Results

All participants completed the training and evaluation phases. Both elements of the co-primary endpoint were superior in the simulation group: efficacy score of 91.5 ± 3.8 vs 64.6 ± 8.3% and safety score 100.0 (100.0-100.0) vs 62.5 (20.8-79.2) %, p<0.001. The median number of "red flags" were 2 (1-4) in conventional and 0 (0-0) in simulation training recipients (p<0.001). Secondary endpoint was higher in simulation training: 85.7 ± 9.0 vs 76.8 ± 12.7% (p=0.039).

Conclusion

Mentored simulation-based training of medical students in ICA with 3D-printed models resulted in improved performance regarding efficacy, procedural safety, and theoretical knowledge.ResultsSimulation and evaluation setup
Peri-procedural complications in patients with chronic thromboembolic pulmonary hypertension who underwent balloon pulmonary angioplasty
Authors: Staal D P , Van Leusden F J , Van Thor M C J , Rensing B J M W , Van Kuijk J P , Mulder B J M , Van Den Heuvel D , Boerman S , Mager J J , Post M C
Published: October 2024

Background

Complication rate in patients with chronic thrombo-embolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA) is high, especially in patients with compromised pulmonary hemodynamics.

Purpose

Here we describe complications based on the new definition in a cohort of CTEPH patients who underwent BPA.

Methods

All patients with CTEPH who completed BPA treatments before September 15th 2023 were selected from the CTEPH database. Peri-procedural complications were collected and classified according to the 2023 consensus paper on BPA in CTEPH patients. Complications were analyzed in subgroups of patients with pulmonary vascular resistance (PVR) or >6.6 WU and mean pulmonary artery pressure (mPAP) or >45 mmHg at first BPA.

Results

In total, 87 patients (63.2% women; mean age 61.1±14.0 years; 62.1% on dual PH targeted medical therapy) underwent 426 (mean 4.9±1.6 per patient) BPAs. Non-severe complications occurred in 59 (13.8%) of the interventions; in 47.1% of the patients; 64.4% were thoracic, and 35.6% were non-thoracic complications. The thoracic complications were mostly mild (71.1%) or moderate (28.9%), and none were severe. Patients with a PVR >6.6 WU (n=8) underwent more BPA-procedures (6.6±1.5 versus 4.6±1.5, p=0.002), had more overall complications (87.5% versus 40.6% of patients, p=0.020), and more thoracic complications (17.0% vs 6.8% of BPAs, p=0.013) than patients with PVR 6.6 WU. Patients with mPAP >45 mmHg (n=13) also had more BPA-procedures (6.5±1.7 versus 4.6±1.4, p<0.001), more overall complications (76.9% versus 43.5% of patients, p=0.027) and more thoracic complications (14.1% versus 7.9% of BPAs, p=0.039) than patients with mPAP 45 mmHg.

Conclusions

Complications occurred in 13.8% of BPA procedures and were mostly mild. Patients with increased pulmonary hemodynamics at baseline suffered more (thoracic) complications.Overview complications
Very short-term effects of single dose of proprotein convertase subtilisin kexin 9 inhibitor therapy before percutaneous coronary intervention
Authors: Kataoka T , Uzui H , Morishita T , Nomura R , Tsuji T , Shimizu T , Mukai M , Sato Y , Miyoshi M , Yamaguchi J , Ikeda H , Tama N , Hasegawa K , Ishida K , Tada H
Published: October 2024

Introduction

Several pioneering studies have reported that continuous administration of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor reduces cardiovascular events and plaque volume on intravascular ultrasound and increase the thickness of the fibrous-cap on optical coherence tomography after 52-76 weeks.[1,2] However, the effect of PCSK9 inhibitors in very short period of time has not adequately been evaluated.

Purpose

This study aimed to investigate the effect of the single dose of PCSK9 inhibitor in regard to serial change of plaque composition in very short period with near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS).

Methods

This prospective, single arm, single-center, interventional study included 27 consecutive coronary artery disease patients (silent myocardial ischemia and stable angina) who performed NIRS-IVUS at the time of coronary angiography for diagnosis between June 2021 and August 2023. Maximal lipid-core burden index over any 4-mm segment (max-LCBI4mm) and total lipid-core burden index (T-LCBI) at the target lesions were assessed with NIRS-IVUS and they were administered evolocumab 420mg. After 2 to 6 weeks, percutaneous coronary intervention (PCI) was performed on a standby basis and repeat NIRS-IVUS were performed at PCI.

Results

The median max-LCBI4mm showed a significant decrease from 387 to 315 (IQR: 268 to 572 and IQR: 221 to 488, respectively; p = 0.02) in a lesion-wise analysis. The median T-LCBI also showed a significant decrease from 160 to 117 (IQR: 105 to 263 and IQR: 65 to 226, respectively; p = 0.02). Minimum lumen area and minimum lumen diameter showed no significant changes.

Conclusions

Single dose of PCSK9 inhibitor therapy before PCI resulted in significant degression of lipid core plaques identified by NIRS at the target lesion in very short period of time.Changes of max-LCBI4mmChanges of T-LCBI
Association between stent implantation results and target vessel failure after IVUS-Guided PCI: A FLAVOUR substudy
Authors: Tu S , Wang Z , Yang S , Wu P , Ding D , Zhang J , Hu X , Liu X , Shi H , Yu W , Qu X , Sun Y , Wijns W , Wang J , Koo B
Published: October 2024

Background

Despite substantial advancements in coronary stent systems and implantation techniques, target vessel failure (TVF) remains a clinical issue to be addressed.

Purpose

We used deep learning algorithms for automatic stent analysis of intravascular ultrasound (IVUS) data to identify stent implantation characteristics associated with TVF.

Methods

In patients from the IVUS-guided group of the FLAVOUR trial who had undergone successful stenting, validated deep learning algorithms were applied to IVUS images to delineate plaque and stent strut for the quantification of stent expansion, apposition, and residual plaque burden. Stent overexpansion was defined as stent area exceeding 120% of the hypothetical healthy lumen area. Murray law-based quantitative flow ratio (μQFR) was also assessed from angiographic images. The primary endpoint was TVF at 2 years, defined as a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization.

Results

A total of 459 vessels in 441 patients were included, with TVF events occurred in 15 vessels (3.3%) during the 2-year follow-up. Stent analysis was performed in 687,379 stent struts from 70,369 IVUS image frames of the interrogated vessels with the assistance of specific deep learning algorithms. On vessel-level multivariate analysis adjusting for procedural covariates, stent overexpansion length >5 mm (hazard ratio, 4.57; 95% confidence interval [CI], 1.31 to 15.92; P=0.017), residual plaque burden at proximal stent edge >50% (hazard ratio, 3.34; 95% CI, 1.19 to 9.33; P=0.022), and post-PCI μQFR <0.90 (hazard ratio, 5.09; 95% CI, 1.62 to 15.97; P=0.005) were more likely to be present in vessels with TVF events than in those without.

Conclusions

Besides the established indexes of post-procedural residual plaque burden and low μQFR, deep learning-powered IVUS stent overexpansion was significantly associated with increased risk of TVF.Suboptimal stenting results and TVF
Serial optical coherence tomography assessment of coronary atherosclerosis and long-term clinical outcomes
Authors: Yamaji K , Watanabe H , Taniwaki M , Akashi R , Kubo S , Ohira H , Numasawa Y , Arikawa M , Iwama M , Kitai T , Tada T , Yamaji Y , Daidoji H , Ono K , Kimura T
Published: October 2024

Background

The impact of high-risk coronary artery plaques identified using optical coherence tomography (OCT) on late luminal narrowing and clinical events remains poorly understood.

Methods

This multicenter prospective study included 176 patients who underwent percutaneous coronary intervention (PCI) and serial OCT at baseline and 1-year follow-up to investigate non-target regions with angiographically intermediate stenosis. The primary outcome measure was luminal narrowing within the matched regions of interest in the non-target regions over a 1-year period. The secondary outcome measures included all-cause death, cardiac death, nonfatal myocardial infarction, and ischemia-driven coronary artery revascularization within 3 years.

Results

At 1 year after PCI, the coronary artery lumen area in non-target regions significantly decreased from 6.06 (95% confidence interval [CI], 5.60–6.53) to 5.88 (95% CI, 5.41–6.35) mm2, with a difference of -0.18 (95% CI, -0.22 to -0.14 mm2; P<0.001). This decrease was pronounced in thin-cap fibroatheromas (TCFAs), thick-cap fibroatheromas, mixed plaques, and fibrous plaques. The prevalence of TCFAs decreased from 3.4% to 3.3% (P<0.001), whereas that of thick-cap fibroatheromas also decreased from 35% to 33% (P<0.001). Patients with TCFA had a significantly higher risk of ischemia-driven non-target vessel revascularization (hazard ratio [HR], 2.42; 95% CI, 1.03–5.71; P=0.04), primarily due to revascularization in the imaged region. The higher prevalence of fibroatheroma was associated with a numerically increased risk of imaged region revascularization (HR per 10%, 1.38; 95% CI, 0.97–1.97; P=0.07). The prevalence of coronary artery calcium significantly increased from 31% at baseline to 34% at 1-year follow-up (P<0.001), accompanied by a significant increase in calcium thickness and angle. Diabetes and current smoking habits were independently associated with increasing calcium prevalence. No significant association was observed between the prevalence of coronary artery calcium and clinical outcomes within 3 years.

Conclusions

Coronary artery lumen area significantly decreased over a 1-year interval, particularly in TCFAs, thick-cap fibroatheromas, mixed plaques, and fibrous plaques. Although no significant association was noted between coronary artery calcium prevalence and clinical outcomes within 3 years, the interaction between calcium progression and long-term clinical events necessitates further investigation.
Coronary stent edge segments as determinant of clinical outcomes: An OCTOBER Trial Substudy
Authors: Bulow Rasmussen S H , Neghabat O , Andreasen L N , Laanmets P , Kumsars I , Bennett J , Olsen N T , Dijkstra J , Christiansen E H , Holm N R
Published: October 2024

Background

Small lumen dimensions and high plaque burden in stent edge segments are known risk factors for subsequent clinical events after percutaneous coronary intervention (PCI). The evidence using intravascular optical coherence tomography is scarce.

Purpose

This study aimed to characterize edge segments after PCI and the relation to clinical outcomes in the randomized OCTOBER trial on bifurcation PCI optimized using optical coherence tomography.

Methods

This is a predefined substudy of the OCTOBER Trial. Edge segments were analysed in detail for degree of stenosis and plaque composition using a dedicated software. Data was planned to be analysed using multi-level cox regression analysis, but descriptive statistics was applied due to very low event rates after OCT-guided PCI. Main endpoints were OCT-detected edge residual stenosis, lipid plaque, calcification, and dissections.

Post PCI coronary angiography was analysed for diameter stenosis, edge segment length and minimal lumen diameter. Patients with cardiac events were diagnosed with angiography duringt the two-year follow-up period.

Results

A total of 597 patients were treated with OCT-guided PCI. Analysable final OCT scans with no additional treatment was available for 505 patients in the main vessel and for the side branch in 289 cases. At deadline for abstract submission 242 scans with 474 edges were analysed and included in preliminary results.Lesions with ≥30% diameter stenosis was found in 20% of proximal edges, 24% of distal edges and 37% of side branch (SB) edges. A plaque burdenOCT ≥180° was found in 74% of proximal edges, 48% of distal edges, and 52% of SB edges. A lipid plaque wafound in 35%, 11% and 14%, dissections in 15%, 6% and 12%, and ≥180° calcium was found in 7%, 4% and 4% of edges respectively.

Six patients (1%) of the total OCT-guided population had an edge-related event during the median two-year follow-up. Only two of these 6 patients had post-procedural OCT-scans of the event-related edge, thus 4 of the cases were effectively angiographic guided.

Conclusion

Only a small fraction of edge segments in the OCTOBER Trial were left with residual edge disease exceeding protocol thresholds. This resulted in historically very low rate of edge related events. No evaluation of a stent edge by OCT in otherwise OCT guided patients appeared to be the main predictor of edge related events. Final results are presented at ESC 2024.
Intracoronary nicardipine to induce hypaeremia
Authors: Viscusi M M , Seki R , Leone A , Bertolone D T , Mizukami T , Mahendiran T , Belmonte M , Sonck J , Collet C , De Bruyne B
Published: October 2024

Background

Several pharmacological agents and routes of administration have been used to induce transient maximal hyperaemia, but most suffer from shortcomings that limit their clinical usage. Nicardipine, a dihydropyridine calcium channel blocker, has been proposed as a coronary hyperaemic agent with the advantage of not causing any adverse effects.

Purpose

We compared intracoronary (IC) nicardipine with IC papaverine for obtaining fractional flow reserve (FFR) and pullback pressure gradient (PPG).

Methods and results

This is a prospective, single-center study enrolling stable patients presenting with intermediate coronary artery disease (CAD) undergoing invasive functional assessment. The lowest FFR, duration of the hyperemic plateau, and PPG were assessed after IC nicardipine (400 µg to the left coronary or 300 µg to the right coronary artery) and IC papaverine (12 mg to the left coronary artery and 8 mg to the right coronary artery).

Results

Overall, 107 patients with 108 vessels (216 FFR and 216 PPG paired measurements) were analyzed. The correlation in FFR between nicardipine and papaverine was r = 0.95 (95% CI 0.92 to 0.96, p < 0.001) with a mean difference of 0.02 FFR units (limit of the agreement [LOA]: -0.04 to 0.08). Similarly, the correlation in PPG between nicardipine and papaverine was r = 0.86 (95% CI 0.71 to 0.93, p < 0.001) with a mean difference of 0.01 PPG units (limit of the agreement [LOA]: -0.14 to 0.17). The hyperaemic plateau was significantly longer with nicardipine (101.4 ± 62.1 s nicardipine vs 41.5 ± 14.3 s papaverine, p < 0.001). No significant differences were observed in the magnitude of changes in blood pressure and heart rate (p=NS). No complications occurred with the administration of IC nicardipine or papaverine.

Conclusion

FFR and PPG values obtained following nicardipine administration exhibited excellent agreement with those obtained using papaverine. Moreover, the hyperaemic response induced by nicardipine led to a significantly prolonged steady state in comparison to papaverine. Given its widespread availability, cost-effectiveness, safety profile and frequent utilization in clinical settings, nicardipine emerges as the optimal vasodilator for coronary physiology testing.FFR by Nicardipine vs PapaverinePPG by Nicardipine vs Papaverine
Coronary microvascular dysfunction in heart failure: observations from the MICRO registry
Authors: Velollari O , Olschweski M , Kresoja K P , Herzog J , Brandt M , Schnitzler K , Knorr M , Wenzel P , Lurz P , Gori T
Published: October 2024

Background

Heart failure (HF) is one of the leading causes of hospitalization in the elderly. Coronary microvascular dysfunction (CMD), among other risk factors, is linked to the pathogenesis and clinical manifestations of HF.

Purpose

This abstract aims to summarize key findings from a comprehensive analysis of CMD in subgroups of HF, shedding light on its association with hemodynamic parameters.

Methods

Patients experiencing recurrent angina (CCS II-IV) and no relevant epicardial stenosis were enrolled in a prospective registry (MICRO). Epicardial and microvascular responses (pressure, resistance and flow) were assessed at rest and during adenosine and acetylcholine testing. The impact of an elevated left ventricular end-diastolic pressure (LVEDP) in the absence of clinical signs of HF was also investigated.

Results

Overall, 188 patients (63% (118) women, mean age 65±11 years) with angina and no epicardial stenosis were enrolled. Patients with HF (n=26) displayed lower hyperemic flow in response to endothelium-independent adenosine (5.2±3.1 vs. 7.3±4.4; P=0.004), lower coronary flow reserve (2.9±1.5 vs. 4.4±1.1; P<0.001) and microvascular resistance reserve (3.3±2.1 vs. 5.2±2.7; P<0.001), and increased microvascular resistance during adenosine-induced hyperemia (25±21 vs. 17±11; P=0.045). An increased LVEDP without clinical signs of HF was not associated with a lower coronary flow reserve (4.3±1.9 vs. 2.6±1.2; P=0.006) or microvascular resistance reserve (4.9±2.1 vs. 2.8±1.7; P=0.004). Microvascular resistance during acetylcholine (endothelium-dependent)-induced hyperemia was lower in HF patients (36.2±23.5 vs. 57.4±37.8; P=0.018).

Conclusion(s)

Patients with heart failure displayed signs of impaired microvascular endothelium-independent responses while endothelium-dependent reactivity appears to be maintained. An elevated LVEDP without clinical HF was not associated with impaired coronary microvascular function.
Assessment of structural and functional microvascular dysfunction using microvascular resistance reserve versus invasive exercise stress testing
Authors: Rahoual G , Procopi N , Beaupre F , Martinez C , Michon M , Sulman D , Guedeney P , Hammoudi N , Vicaut E , Hatem S , Kerneis M , Silvain J , Collet J P , Montalescot G , Zeitouni M
Published: October 2024

Background

Coronary microvascular dysfunction is an heterogenous entity with structural dysfunction present in about 60% of cases. Although Coronary Flow Reserve (CFR) is commonly used for diagnosis, this index is nonspecific to the microvasculature. The effectiveness of the recently introduced Microvascular Resistance Reserve (MRR) and absolute microvascular resistance (Rµ) in identifying microvascular dysfunction endotypes remains uncertain.

Objective

To evaluate whether MRR and hyperemic Rµ assessment are effective in dichotomizing functional and structural microvascular dysfunction as compared with Rµ and coronary blood flow (Q) monitoring during exercise.

Methods

Rµ and MRR were first assessed using continuous thermodilution with saline infusion at 10 mL/min (rest) and 20 mL/min (hyperemia) in the left anterior descending artery of consecutive patients with Angina and Non-Obstructive Coronary Arteries. An MRR<2.3 was considered the cutoff for coronary microvascular dysfunction. Q and Rµ were assessed during subsequent stress testing with an incremental workload of 30 watts every two minutes, using a dedicated supine cycling ergometer.

Results

Coronary microvascular dysfunction was observed in 36.6% of the participants with suspected Angina with Non-Obstructive Coronary Artery disease (11 out of 30). Median hyperemic Rµ was 561 [381; 684] Wood Unit (WU) among patients with microvascular dysfunction. Participants with structural dysfunction (MRR<2.3 and hyperemic Rµ>561WU), had a resting Rµ similar to participants without CMD (1286±410 versus 1231±291 WU) but exhibited both impaired reduction of Rµ (139 [64; 288] versus 191 [74; 317] WU per 30 watts) and increase of Q during exercise (20 [1; 37.5] versus 52 [15.5; 92.0] mL/min per 30 watts). Patients with functional dysfunction (MRR<2.3 and hyperemic Rµ<561WU) had lower resting Rµ (672±219 WU) and higher resting Q (152±39 versus 84±24 mL/min) with a similar increase of Q during exercise (55 [30.5; 103.0] than participants without CMD. Mean N-terminal pro B-type natriuretic peptide level was higher in the structural group (425±563 ng/L) as compared to the functional and normal groups (86±10 ng/L and 50±80 ng/L respectively).

Conclusion

The use of MRR combined to hyperemic Rµ, derived from continuous intracoronary thermodilution, enables the assessment of coronary microvascular dysfunction with an accurate distinction between functional and structural endotypes.Microvascular hemodynamic adaptationNTpBNP level
Assessment of TIMI frame count pre- and post- intracoronary acetylcholine administration in patients with angina and non-obstructive coronary arteries (ANOCA)
Authors: Holdermann H , Bekeredjian R , Ong P
Published: October 2024

Background

Patients with Angina and unobstructed coronary arteries (ANOCA) represent a diagnostic challenge. Current ESC guidelines on the management of patients with chronic coronary syndrome recommend intracoronary spasm testing and coronary spasm represents a frequent diagnosis in such patients. Previous studies have shown that coronary artery flow assessments during acetylcholine testing frequently show non-uniform results.

Purpose

The aim of the present study was to assess changes in TIMI Frame Count (a quantitative method for the assessment of coronary artery flow) pre- and post- intracoronary acetylcholine testing in patients with ANOCA.

Methods

From 2007 to 2018, a total of 141 consecutive patients (51.8% female, mean age 61 ± 13.2 years) were included in the study. Among them, 63 patients (45%) presented with myocardial infarction with unobstructed coronary arteries, while 78 patients (55%) presented with stable angina and unobstructed coronaries. Following diagnostic angiography, all patients underwent intracoronary acetylcholine testing using a standardized protocol. TIMI frame count (TFC) was measured both for LAD and LCX before and after ACh injection, and post nitroglycerine injection. All counted frames were adjusted to a frame rate of 30 frames per second (fps). Furthermore, TFC of the LAD was divided by 1.7 to obtain the corrected TFC (cTFC).

Results

Of all 141 patients, coronary spasm was found in 98 patients (70%) during ACh testing (44% epicardial and 56% microvascular spasm). In the spasm cohort, the median cTFC in the LAD pre-ACh was 21.8 fps (quartiles: 16.3 – 30.0), decreased to 12.9 fps (8.8 - 19.2) post-ACh, and increased to 15.9 fps (10.6 - 21.3) post-nitro. The difference in the LAD between pre-ACh and post-ACh was statistically significant (p < 0.001). In the LCX the median TFC was 26.5 fps (15.0 – 40.5) pre-ACh, decreased to 16.0 fps (11.5 - 28.5) post-ACh and reached 24.0 fps (15.5 - 33.3) post-nitro. Again, this reduction from pre-ACh to post-ACh was statistically significant (p < 0.001). In the negative spasm cohort median cTFC for the LAD was 22.9 fps (16.0 – 18.2) pre-Ach, 15.3 fps (9.4 – 24.7) post-ACh and 15.8 fps (10.6 - 24.7) post-nitro, TFC for LCX was 24.0 fps (18.0 - 36.0) pre-ACh, 18.0 fps (12.0 – 33.0) post-ACh and 24.0 fps (12.0 – 34.0) post-nitro. The change in cTFC/TFC pre-ACh compared to post-ACh was statistically significant for both coronary arteries (LAD, p=0.012; LCX p=0.005, Table 1). Interestingly, in the spasm cohort 22% of LAD and 32% of LCX vessels showed higher TFC post-ACh compared to pre-ACh (Figure 1).

Conclusions

In patients with ANOCA and coronary spasm assessment of TIMI frame count reveals a hetereogeneous response. The majority of cases shows a decrease in TFC suggesting an increase in flow despite coronary spasm. This interesting finding allows speculations about the presence of coronary shunts.Figure 1
Comparing predictive accuracy: systolic blood pressure to left ventricular end-diastolic pressure ratio versus TIMI score for short-term mortality after primary percutaneous coronary intervention
Authors: Yaqoob N , Kumar R , Sial J , Saghir T , Karim M
Published: October 2024

Objective

Aim of this study was to evaluate the predictive performance of systolic blood pressure (SBP) to left ventricular end-diastolic pressure (LVEDP) ratio for the prediction of in-hospital and short-term mortality in a contemporary cohort of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center.

Methods

This study included a consecutive series of patients diagnosed with STEMI who underwent primary PCI. The SBP/LVEDP ratio and TIMI (Thrombolysis in Myocardial Infarction) score were calculated, and their ability to predict in-hospital and short-term mortality was evaluated by analyzing the area under the curve (AUC) on the receiver operating characteristics (ROC) curve.

Results

This study involved 977 patients, with 780 (79.8%) being male and a mean age of 55.6±11.5 years. Among them, 191 (19.5%) had an SBP/LVEDP ≤5.4. The in-hospital mortality rate was 4.3% (42), and the short-term all-cause mortality rate after a mean follow-up of 5.9±2.4 months was 15% (140). Patients with SBP/LVEDP ≤5.4 had higher in-hospital mortality rates (14.1% vs. 1.9%; p<0.001) and short-term mortality rates (35.1% vs. 9.8%; p<0.001) compared to those with SBP/LVEDP >5.4. The AUCs of SBP/LVEDP and TIMI for predicting in-hospital mortality were 0.766 [0.681-0.851] and 0.787 [0.713-0.861], respectively. For short-term mortality, the AUCs of SBP/LVEDP and TIMI were 0.731 [0.682-0.780] and 0.736 [0.690-0.782], respectively.

Conclusion

In conclusion, SBP/LVEDP showed sufficiently high predictive power comparable to the TIMI risk score. SBP/LVEDP is a readily available ratio that can rapidly provide valuable prognostic information during primary PCI.operating characteristics curveComparative distribution
Ten-year comparative long-term outcomes of PCI versus CABG in multi-vessel coronary artery disease
Authors: Fu Y T , Sung S H
Published: October 2024

Background

While coronary artery bypass grafting (CABG) is the standard treatment for patients with multi-vessel coronary artery disease (CAD), percutaneous coronary intervention (PCI) has been an alternative approach. The study aims to evaluate the long-term outcomes of PCI versus CABG in treating patients with CAD.

Methods

A total of 9569 patients with CAD (age 68.60±12.24 years, 81.7% men) who underwent PCI (n=7429) or CABG (n=1635) were retrospectively recruited from January 2000 to December 2014 at a tertiary medical center. Propensity score-matched analysis were conducted. The primary outcome was all-cause mortality during a 10-year follow-up duration.

Results

During a median follow-up duration of 6.97±4.54 years, there were 1634 deaths. Crudely, there was no difference in 10-year mortality between PCI and CABG groups (26.3% vs. 23.02%; P= 0.135). After accounting for age, renal function, previous myocardial infarction, and heart failure, the 10-year survival rate remained similar between the two groups. The subgroup analysis showed inferior outcomes with PCI than CABG if any bare-mental stent (BMS) was used (10-year risk of mortality 36.1% vs. 24.7%; P= 0.032). In addition, CABG was also associated with better survival than PCI in diabetic subjects (10-year risk of mortality 24.9% vs. 30.9%, P=0.086). In contrast, PCI demonstrated superior long-term benefits in subjects with left main (LM) and single-vessel disease, whereas CABG showed better long-term outcomes for individuals with left main (LM) and multivessel disease.

Conclusions

PCI demonstrated comparable long-term outcomes with CABG in treating subjects with CAD when purely drug-eluting stents were used. Any use of BMS is not encouraged to treat patients with left main or multivessel CAD. In contrast, PCI was related to superior long-term survival among patients with LM and single-vessel disease.
Comparative clinical outcomes of amphilimus-eluting stents in diabetic versus non-diabetic patients
Authors: Kim J H , Lim S , Cha J J , Joo H J , Park J H , Hong S J , Yu C W , Lim D S
Published: October 2024

Background

Patients with diabetes mellitus (DM) are at an increased risk of experiencing adverse events following percutaneous coronary intervention (PCI). The Cre8 EVO stent, which releases a formulation of sirolimus with an amphiphilic carrier from laser-dug wells, has demonstrated clinical benefits specifically in diabetic populations. We aimed to explore the impact of DM on clinical outcomes in a large, real-world registry of all-comer patients treated with Cre8 and Cre8 EVO stents.

Methods

We did an investigator-initiated, prospective, single-arm observational trial at 28 sites in South Korea. The primary endpoint was a composite of cardiac death, target vessel-related myocardial infarction (MI), and clinically-driven repeat revascularization at 12 months. All-cause mortality was a key secondary endpoint.

Results

A total of 2,045 patients (66.0 ± 11.5 years of age; 76.2% male) were analyzed. Diabetic patients (n = 774; 37.8%) were more likely to be older, female, and have hypertension, dyslipidemia, or chronic kidney disease. There were 39 cases of primary events, 17 (2.5%) in the DM group and 22 (1.9%) in the non-DM group (hazard ratio, 1.34; 95% confidence interval, 0.74–2.41; log-rank p = 0.33). Overall, the primary endpoint occurred in 2.1% of patients, with a cardiac death rate of 0.4%, a target vessel-related MI rate of 0.3%, and a clinically driven TLR rate of 1.8%. Among the secondary endpoints, the DM group exhibited a significantly higher all-cause mortality rate compared to the non-DM group (2.0% vs. 0.9%; hazard ratio, 2.20; 95% confidence interval, 1.04–4.65).

Conclusion

In this real-world registry, diabetic patients treated with amphilimus-eluting stents demonstrated excellent safety and effectiveness at 12 months, with a similar occurrence of MACE compared to non-diabetics. These results underscore the potential for amphilimus-eluting stents to become a preferred option for PCI in diabetic patients, prompting further investigation into their long-term benefits and mechanisms of action.
Comparison of clinical outcomes in diabetic and non-diabetic patients undergoing coronary bifurcation stenting
Authors: Lim S , Hong S J , Kim J H , Cha J J , Joo H J , Park J H , Yu C W , Lim D S
Published: October 2024

Background

Diabetes mellitus (DM) is a well-known risk factor for cardiovascular diseases, including coronary artery diseases (CAD). Due to poor post-intervention outcomes, bypass surgery is often recommended in preference to percutaneous coronary intervention (PCI) in DM patients with complex scenarios, such as bifurcation lesions.

Methods

In this retrospective, multicentre, observational, real-world registry of 2,648 patients with coronary bifurcation lesions undergoing PCI with 2nd-generation drug-eluting stents (DES), the effect of DM on cardiovascular outcomes was analysed. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, and stroke, at 5 years. The adjusted outcomes were compared using 1:1 propensity score (PS) matching.

Results

Overall, DM patients were more likely to be older, female, and have hypertension or chronic kidney disease. In the PS-matched cohort, the cumulative incidence of the primary outcome was numerically higher in the DM group, but without statistical significance (7.9% vs. 5.5%, log-rank p=0.276). Secondary outcomes including all-cause mortality (5.5% vs. 3.9%, log-rank p=0.090) and cardiac mortality (3.2% vs. 1.8%, log-rank p=0.060) were also comparable between the two groups.

Conclusion

For patients with coronary bifurcation lesions undergoing contemporary PCI, the outcomes were comparable for DM and non-DM patients. Bifurcation PCI can thus be successfully performed in diabetic patients with 2nd-generation DES.