bluuebunny/crossref_metadata_2025 huggingface dataset:
Elderly patients are hyperresponsive to potent P2Y12 inhibitors
Authors: Mutschlechner D , Tscharre M , Wadowski P , Lee S , Pultar J , Weikert C , Panzer S , Gremmel T
Published: October 2024

Background

Aging has recently been associated with increased basal platelet activation and adenosine diphosphate (ADP) hyperreactivity on the one hand, but decreased platelet response to thrombin receptor stimulation on the other hand in individuals without antiplatelet therapy. In the current study, we investigated platelet response to agonist stimulation in elderly patients (70 years or older) on dual antiplatelet therapy with potent P2Y12 inhibitors.

Methods

Platelet aggregation in response to arachidonic acid (AA), ADP, collagen, the protease-activated receptor (PAR)-1 agonist SFLLRN and the PAR-4 agonist AYPGKF was assessed by multiple electrode aggregometry in 79 prasugrel- and 77 ticagrelor-treated patients 3 days after acute percutaneous coronary intervention.

Results

In the overall study population (n=156), patients aged ≥70 years (n=33) had lower platelet aggregation in response to AA, ADP and SFLLRN than younger patients (all p<0.05). In prasugrel-treated patients (n=79), those aged ≥70 years (n=13) showed significantly lower platelet aggregation in response to all agonists compared to younger patients (all p<0.05). In contrast, in ticagrelor-treated patients (n=77), those aged ≥70 years (n=20) only had significantly lower ADP-inducible platelet aggregation than younger patients (p=0.03), whereas platelet aggregation in response to AA, collagen, SFLLRN and AYPGKF was similar between elderly and younger patients on ticagrelor (all p>0.05). Among patients aged ≥70 years, prasugrel-treated patients showed significantly lower platelet aggregation in response to AA, collagen and AYPGKF than those receiving ticagrelor (all p<0.05).

Conclusion

Patients aged ≥70 years on potent P2Y12 inhibitors exhibit increased inhibition of ADP-inducible platelet aggregation. In addition, elderly patients on prasugrel show a significantly lower response to AA, collagen, SFLLRN and AYPGKF than younger patients.Platelet aggregation prasugrel patientsPlatelet aggregation ticagrelor patients
Effects of rivaroxaban on vascular endothelial function and circulating endothelial progenitor cells: a randomized controlled trial
Authors: Lin M , Wong C K , Chan K Y , Tsui F , Au K W , Choo A , Tam C C , Tse H F
Published: October 2024

Background

Combination of low dose rivaroxaban with aspirin was shown to reduce major adverse cardiovascular events when compared to aspirin monotherapy in COMPASS trial. The beneficial effect of rivaroxaban beyond factor Xa inhibition remains unknown.

Purpose

This randomized controlled trial explored the effects of rivaroxaban on vascular endothelial function and circulating endothelial progenitor cells in patients with stable atherosclerotic disease.

Methods

An investigator-initiated, investigator-blinded, single-center randomized clinical trial was conducted from May 2021 to August 2023. 142 patients were randomized in 1:1 ratio to receive rivaroxaban 2.5mg twice daily plus aspirin 100mg once daily (Treatment Group) or aspirin 100mg once daily (Control Group) and had follow-up for 3 months. The primary outcome was change of flow mediated dilation (FMD) from baseline to 3-month follow-up. Key secondary outcomes included change of circulating endothelial progenitor cells (CD45+/34+/133+, CD45+/34+/KDR+), platelet activation marker (CD41+/62p+), inflammatory marker (CD14+/11b+) and thrombo-inflammatory maker (CD14+/42b+) measured by flow cytometry, as well as platelet function (aspirin reaction unit, ARU) measured by blood biochemistry. Intention-to-treat analysis was performed with analysis of covariance (ANCOVA) and P < 0.05 was considered statistically significant.

Results

Overall, 142 patients were enrolled in the study. One patient was excluded from analysis due to protocol deviation. Among the remaining 141 patients (78.8% male and mean age 69±9 years), there were 71 in Treatment Group and 70 in Control Group. The recruited patients had a high prevalence of cardiovascular comorbidities including 76.6% with hypertension, 50.4% with hyperlipidemia, 45.4% with diabetes, and 92.2% with percutaneous coronary intervention. At 3 months, Treatment Group had greater FMD improvements (+2.18±5.66% vs +1.57±5.07%, P=0.03), and more reduction in platelet activation marker (-0.33±13.55% vs +5.78±21.60%, P=0.01). There was no significant change in circulating endothelial progenitor cells, inflammatory marker, thrombo-inflammatory maker, and platelet function. Minor bleeding occurred in 2 patients (2.82%) in Treatment Group and none in Control Group (P>0.05).

Conclusion

In patients with stable atherosclerotic disease, addition of rivaroxaban to aspirin was well tolerated, and it improved vascular endothelial function and reduced platelet activation.
Inclisiran-containing low-density lipoprotein cholesterol reduction effectively stabilizes atherosclerotic plaques
Authors: Kokina B , Trusinskis K , Lapsovs M , Karantajere M , Knoka E , Caunite L , Jegere S , Narbute I , Sondore D , Grave A , Kumsars I , Erglis A
Published: October 2024

Background/Introduction

Near-infrared spectroscopy (NIRS) allows to quantify lipid composition of coronary artery lesions. High plaque lipid content has been associated with increased adverse cardiovascular event risk.

Purpose

Aim of this study was to evaluate atherosclerotic plaque lipid content reduction in association with low-density lipoprotein (LDL-C) lowering on the background of intensive hypolipidaemic therapy.

Methods

NIRS investigation was performed in stable coronary artery disease patients having 20-50% stenosis in the proximal or middle third of a coronary artery. Segment of interest was repeatedly evaluated after 15 months. Lipid-rich plaques (LRPs) were defined as lesions with maximum lipid-core burden index within 4 mm (maxLCBI4 mm) >250. Study participants were taking high-intensity statin (atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg) with or without ezetimibe for a run-in period of 4-6 weeks. Afterwards, in patients not achieving LDL-C level <1.8 mmol/l, add-on inclisiran was started. Baseline LDL-C was defined as the level at the time of initiation of optimal lipid-lowering therapy. Statistical significance level of 0.05 was set.

Results

Data of 36 patients was analyzed. Mean baseline maxLCBI4 mm was 203.9, reduced by 39.8% (-81.1, 95%CI -129.2 to -33.0) at 15-month follow-up (P=0.003). In 15 patients LRPs were detected with mean baseline maxLCBI4 mm 363.5, which was decreased by 35.8% (-130.3, 95%CI -235.0 to -25.7) (P=0.020). Mean LDL-C level at baseline was 2.5 mmol/l among all participants, lowered by 32.0% (-0.8, 95%CI -1.1 to -0.5) after 15 months of treatment (P<0.001). 19 patients received inclisiran in addition to high-dose statin and optional ezetimibe therapy. In 24 patients achieving LDL-C target <1.8 mmol/l at 15-month follow-up, a significant maxLCBI4 mm reduction from 208.5 by 48.4% (-101.0, 95%CI -169.3 to -32.7) was established (P=0.010). Among those having LDL-C >1.8 mmol/l, maxLCBI4 mm reduction from 194.7 by 21.2% (-41.25, 95%CI -94.7 to 12.2) was observed, however the change was not statistically significant (P=0.114).

Conclusion

LDL-C lowering with high-intensity hypolipidaemic therapy, including escalation to proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition, demonstrated atherosclerotic plaque stabilization by NIRS-detected lipid content decrease.
Clinical outcomes of risk score-guided dual antiplatelet therapy in patients with acute coronary syndrome who underwent percutaneous coronary intervention
Authors: Hyun D , Lim Y , Oh S , Ahn J H , Lee S H , Cho K H , Kim M C , Hong Y J , Kim J H , Ahn Y , Jeong M H , Sim D S
Published: October 2024

Objective

We aimed to investigate the effect of risk score-guided dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) from real-world clinical practice in Korea.

Methods

984 patients with ACS undergoing PCI with bioabsorbable-polymer everolimus eluting stent were enrolled from 20 hospitals in the multicenter, observational study. The analysis was conducted on 834 patients who took medications according to risk score-guided DAPT and were follow-up after 1 year. GRACE score and PRECISE-DAPT score were used for risk score-guided DAPT and medication for antiplatelets was conducted as follow (Figure 1).

Results

The mean age was 64.0 ± 10.5 years, 77.6% were men. 43.7% had acute myocardial infarction, 62.5% hypertension and 37.6% diabetes. Multivessel and left main artery disease were about in 56.2%. Trans-radial PCI was performed in 76.3%. Aspirin was taken in almost all patients (99.1%) and clopidogrel was most frequently prescribed as a DAPT (clopidogrel 64.9%, Ticagrelor 28.1%, prasugrel 6.6%). All-cause mortality and NACE (consisting of all-cause mortality, myocardial infarction, revascularization, stent thrombosis, stroke, and major/minor bleeding) were 1.2%, and 5.4% respectively at 1 year. Stent thrombosis was occurred only in 4 patients (0.5%). Bleeding complications were developed in 19 case (2.3%). Among the bleeding sites, the access site was the most common 7 (0.8%), followed by the gastrointestinal tract 4 (0.5%). Major bleeding was occurred (BARC types 3 to 5 bleeding) in 3 cases (0.4%) and BARC type 2 was most common (1.2%) (Figure 2 and Table 1).

Conclusion

Bleeding complications and ischemic events were very low in real-world patients with ACS undergoing PCI during 1 year follow-up, when the management was performed according to the risk scoring-guided DAPT.Figure 1Figure 2 and Table 1
A randomized controlled trial of an eight-week cardiac rehabilitation home verse hospital exercise programme for post coronary cardiac bypass patients
Authors: Taktoni M , Morg Thow M T , Seenan C S
Published: October 2024

Background

The prevalence and morbidity and mortality rates of coronary heart disease (CHD) continue to increase towards epidemic proportions in the Kingdom of Saudi Arabia (KSA). Despite the advances in Cardiac surgery, currently there are no established out-patient phase program of Cardiac Rehabilitation (CR) for CHD participants in KSA.

Aim of the study

To evaluate the effectiveness of a home-based CR (Home CR) program using individualized exercise (Physiotools-R) and out-patient phase of CR (Hospital CR) program compared to standard care of home instructions on physical function, physiological and psychological status, body composition and the quality of life of the CHD participants post Coronary Artery Bypass Graft (CABG) surgery.

Methods

73 participants post-CABG surgery were randomly assigned to one of three groups: Hospital CR group (n=25), Home CR group (n=24) and Control group (n=24). Outcome measures include Incremental Shuttle Walk Test (ISWT), Metabolic Equivalent Tasks (METs), Psychosocial outcomes and body composition were recorded at baseline, eight weeks of CR intervention, and after four weeks of observation follow up. Intervention: Hospital CR program comprised of group based Aerobic Circuit Training, home based structured individualized exercise program. Each programme had 2 hours’ sessions, 3 times a week for 8 weeks, followed by four weeks of observation follow-up. The control group followed standard care comprised usual advice on post-operation precautions.

Results

Post intervention, there was an increase in mean ISWT score from baseline in both the home-based cardiac rehabilitation and outpatient-based cardiac rehabilitation groups (66 [0.58] m and 71 [9.19] m, respectively). No difference was observed in the control group. At the 4-week follow-up, both intervention groups showed statistically significant improvements in all outcome measures (ISWT, metabolic equivalence tasks, HADS-A, HADS-D, and Short Form-36) compared with baseline (all P < .001). The home-based cardiac rehabilitation group showed statistically continuous improvement compared with the outpatient-based cardiac rehabilitation group. The control group did not show any significant changes across time in outcome measures

Conclusion

Home-based CR is as effective as hospital-based CR at improving exercise capacity in patients following CABG surgery. Home-based CR appears to be more effective at maintaining these improvements with no further input in the longer term.
Drug-coated balloon for de-novo coronary artery lesions exceeding 2.5 mm in diameter: optical coherence tomography analysis and clinical follow-up
Authors: Guo L , Zhang B , Liu Y , Lv H
Published: October 2024

Objective

To investigate the precise changes in the lumen and lesions, and clinical outcomes after DCB treatment for de-novo coronary lesions exceeding 2.5 mm in diameter through a detailed analysis of OCT.

Methods

This is a prospective study including 53 consecutive patients with 55 de-novo coronary lesions, who underwent DCB angioplasty-only between January 2021 and April 2022. Quantitative coronary angiography (QCA) and OCT were performed before percutaneous coronary interventions (PCI), immediately after PCI, and at 6-9 months follow-up after PCI. Target lesion failure (TLF) was the primary endpoint of the present study. Multivariate logistic regression analysis was performed to identify the predictors or risks for late lumen enlargement (LLE).

Results

A total of 52 patients were successfully treated with DCB. The median follow-up was 7 months, and the incidence of TLF was 7.5%. After the DCB procedure, 43 patients had their scheduled angiographic and OCT examination. QCA demonstrated that the late lumen loss was -0.79 ± 0.28 mm. OCT demonstrated LLE in 79.1% and dissection healing in 65.1% of lesions. After multivariable logistic analysis, type B dissection (odds ratio [OR] 2.92, 95% confidence interval [CI] 1.34-7.41, p = 0.037) was found to be a predictor of LLE, but lipid plaque (OR 0.09, 95% CI 0.01-0.63, p = 0.015) was a risk of LLE.

Conclusions

This is the first and largest prospective study to assess the outcomes of DCB treatment for de-novo coronary lesions exceeding 2.5 mm in diameter and the detection of significant vessel enlargement and dissection healing guide by OCT. DCB could be a novel, safe and effective treatment for de-novo coronary lesions exceeding 2.5 mm in diameter through a detailed analysis of OCT.Representative coronary angiography (CAGRepresentative optical coherence tomogra
Relation of apolipoprotein C3 to risk of major adverse cardiovascular events and death after acute coronary syndrome on a background of optimized statin treatment
Authors: Schwartz G G , Reijnders E , Szarek M , Jukema W J , Bhatt D L , Bittner V A , Fazio S , Garon G , Goodman S G , Harrington R A , Stevanovic I , White H D , Cobbaert C , Steg P G
Published: October 2024

Background

Apolipoprotein C3 (ApoC3), a component of triglyceride-rich lipoproteins and some low-density lipoprotein and high-density lipoprotein particles, has been shown to predict incident coronary heart disease (CHD) and major adverse cardiovascular events (MACE). However, it is unknown whether ApoC3 predicts risk in patients with acute coronary syndrome (ACS) receiving contemporary therapies including optimized statin treatment, and if any such association is independent of apolipoprotein B (ApoB) levels.

Purpose

We assessed the association of ApoC3 with first MACE (CHD death, nonfatal myocardial infarction, fatal or nonfatal ischaemic stroke, or hospitalization for unstable angina) and all-cause death in patients with recent ACS treated with high-intensity or maximum-tolerated statin and blinded PCSK9 inhibitor (alirocumab, ALI) or placebo (PBO).

Methods

ApoC3 was measured by mass spectrometry at baseline (n=11,956) and after 4 months (M4; n=11,176) of treatment with ALI or PBO in the ODYSSEY OUTCOMES trial (which had 18,924 total participants). In continuous and spline analyses adjusted for treatment group and ApoB, we assessed the association of baseline ApoC3 with risk of MACE and death. In the ALI group we determined association of change in ApoC3 from baseline to M4 with risk of MACE and death after M4 in a model adjusted for baseline ApoC3 and ApoB, and the change in ApoB from baseline to M4.

Results

Median (Q1, Q3) baseline ApoC3 concentration was in a normal range [85 (65, 113) mg/L]. Continuous ApoC3 was not related to MACE (p=0.50) or death (p=0.51); spline analysis showed a slight curvilinear association of baseline ApoC3 with risk of MACE and death, but no clinically meaningful relationship (Figure). Findings were similar in the PBO group alone, and without adjustment for ApoB (data not shown). At M4, the median (Q1, Q3) change from baseline in ApoC3 was -10 (-27, -5; p<0.0001) mg/L with ALI and 2 (-14, 18; P = NS) mg/L with PBO. Overall, ALI significantly reduced the incidence of MACE (10.1% vs 12.1%; p=0.0006) and death (3.5% vs 4.2%; p=0.045) compared with PBO among those with available baseline ApoC3. However, the change in ApoC3 on treatment with ALI did not predict the risk of MACE or death after M4. Findings were qualitatively similar without adjustment for ApoB or its change.

Conclusion

In a cohort with recent ACS receiving optimized statin therapy and with median baseline ApoC3 in a normal range, ApoC3 did not provide clinically meaningful prediction of cardiovascular events or death. A modest reduction of ApoC3 by ALI did not associate with subsequent risk of MACE or death. It remains uncertain whether targeted therapies producing larger reductions in ApoC3 from higher baseline levels will affect cardiovascular risk.
Comparing predictive risk to actual presence of coronary atherosclerosis on coronary computed tomography angiography: a retrospective cohort analysis
Authors: Playford E , Stewart S , Hoyne G , Strange G , Dwivedi G , Hamilton-Craig C , Figtree G , Playford D
Published: October 2024

Background

There is limited data supporting the ability of cardiovascular risk scores (CVRS) to accurately predict asymptomatic coronary artery disease (CAD).

Purpose

To examine the predictive accuracy of CVRS in detecting presence and extent of atherosclerosis, determined by coronary computed tomography angiography (CCTA).

Methods

Asymptomatic individuals without known CAD, undergoing a screening CCTA with available CVRS data, were examined retrospectively. Natural language processing of the CCTA report data extracted the coronary artery calcium score (CACS) and the extent and severity of coronary plaque (low, moderate, or extensive, using a modified CAD-RADS 2.0 classification). Normal was defined as both zero plaque and zero CACS. CVRS was categorized as high (>15%), moderate (10-15%), low (1-9%) and "zero" (<1%) risk.

Results

828 individuals (median age 58.6, IQR=52.0, 65.3 years, 57% male) met inclusion criteria, and a zero, low, moderate, and high CVRS was identified in 13, 483, 113 and 219 individuals, respectively. Any degree of atherosclerosis was found in 548 scans (67% male). However, of the 137 males and 68 females with extensive atherosclerosis, 47 (34%) and 38 (56%) respectively had a low CVRS classification. Overall, 23% of males and 31% of females had CAD predicted by CVRS, with little to no agreement between CVRS and atherosclerosis burden (Cohen’s kappa: males, κ=0.149; females, κ=0.096).

Conclusions

In asymptomatic individuals without known CAD, CVRS does not reliably predict the presence and extent of CAD, and severe disease may be present in apparently low CVRS.Graphical AbstractFigure
Analysis of risk factors in high-risk plaque in acute coronary syndrome based on LASSO regression
Authors: Gao J , Bai M N , Wang J X , Li X W , Wang J X , Wang Y H , Liu Y
Published: October 2024

Background

The CLIMA Study (Relationship between OCT Coronary Plaque Morphology and Clinical Outcome) put forward the concept of High-risk plaque (HRP) and demonstrated that HRP were correlated with the high risk of major coronary events[1, 2]. HRP were defined as the presence of four simultaneous characteristics: minimum lumen area (MLA) <3.5mm2, fibrous cap thickness (FCT) <75 μm, lipid arc circumferential extension >180°, and the presence of macrophage infiltration. Early prediction of HRP formation are of great significance for the prevention and treatment of Acute Coronary Syndrome (ACS), but there are no relevant studies.

Purpose

To identify the risk factors related to OCT HRP in ACS and establish risk prediction model for HRPs in ACS.

Methods

A prospective observational cohort study was carried out on the patients with ACS from September 2019 to August 2022. A total of 169 patients were divided into OCT HRP (n=55) and OCT non-HRP (n=114) groups. Clinical information, laboratory examination and the OCT characteristics of the patients were collected. LASSO regression was used to screen variables, and multivariate logistic regression was used to establish risk prediction model. A nomogram was formulated, use the ROC curve to evaluate the discrimination of the model and the Bootstrap method to internally validate the model.

Results

The most frequently observed HRP characteristic was Lipid plague>180°(147 patients），followed by MLA<3.5mm2(141 patients), macrophages(127 patients), FCT<75μm(64 patients). The LASSO regression model was used to screen variables and construct an HRP risk factor model. This final model included age, BMI≥25, TC, LDL-C and Log NT-proBNP. The model is well differentiated (AUC 0.780, 95%CI 0.705-0.855) and calibrated. Decision Curve Analysis shows that the model has good net benefits.

Conclusion

This prediction model can accurately predict the risk of OCT HRP in patients with ACS, and is expected to assist clinicians in diagnosis and prevention of plaque stability.
Differential prognostic significance of platelet reactivity based on ischemic risk after percutaneous coronary intervention
Authors: Jeon K , Jeong Y H , Youn T J , Chae I H , Kim B K , Joo H J , Chang K , Park Y , Song Y B , Lee S Y , Kim H S , Kim M H , Lim D S , Shin E S , Suh J W
Published: October 2024

Background

High platelet reactivity (HPR) in patients underwent percutaneous coronary intervention (PCI) is a potential risk factor of adverse cardiovascular events. It is not well understood in which patients HPR is particularly clinically important.

Purpose

We aimed to elucidate the prognostic value of high platelet reactivity (HPR), across varying levels of ischemic risk categorized by the CHADS-P2A2RC score in a large registry.

Methods

We retrospectively analyzed 11,714 patients who underwent PCI in the PTRG-DES registry. Ischemic risk was stratified using the CHADS-P2A2RC score into low (score ≤ 1), moderate (score 2–3), and high (score ≥ 4) groups. HPR was defined as a P2Y12 Reaction Unit (PRU) value ≥252. The incidence of major adverse cardiac and cerebrovascular events (MACCE) during 5- year follow-up was the primary outcome.

Results

During the median follow-up of 37.6 months (IQR, 12.0–60.8), a total of 709 MACCEs (6.1%) (392 deaths [3.3%], 172 non-fatal MI [1.5%], 62 ST [0.5%] and 181 non-fatal stroke [1.5%]), and 324 cases of major bleeding (2.8%) occurred. The high-risk group has the highest incidence of MACCE during 5-year follow-up unadjusted HR of 4.206, 95% CI 3.204–5.521. Among the 2,577 low-risk patients, HPR did not significantly affect MACCE incidence (HR 1.366, 95% CI 0.798–2.336, p=0.253). In the moderate-risk cohort of 5,417 patients, HPR conferred a modest increase in MACCE risk (HR 1.289, 95% CI 1.008–1.649, p=0.043). Notably, the high-risk group demonstrated a significant association between HPR and MACCE (HR 1.385, 95% CI 1.135–1.692, p<0.001).

Conclusion

HPR is a potent risk factor of long-term outcomes following PCI, especially in patients with a high ischemic risk based on CHADS-P2A2RC scoring. The results highlight the varying impact of platelet reactivity depending on the level of ischemic risk, indicating the importance of tailored antiplatelet therapy in high-risk group to improve clinical outcomes.
Microdosing of alteplase leads to thrombolysis in an in vitro flow model of cardiac microvascular obstruction
Authors: Milusev A , Roesch Y , Wolint P , Kuster Y , Ulmer J , Raeber L , Weisskopf M , Cesarovic N , Obrist D
Published: October 2024

Background

Cardiac microvascular obstruction (MVO) is a frequent injury of the myocardial microcirculation after successful recanalisation of the occluded coronary artery in myocardial infarction. At least in part, MVO is caused by embolised microthrombi of less than 200 µm diameter [1]. MVO leads to hypoperfusion of the myocardium and negatively affects patient outcomes. However, there is no effective treatment for MVO [2, 3]. Thrombolytic drugs are a promising approach, but they are difficult to deliver to the MVO area, and an increased risk of bleeding limits their use. In a previous study using an in vitro fluidic multi-scale model for MVO [4, 5], it was shown that controlled flow infusion (CFI) with a novel drug-delivering catheter could be used to effectively deliver highly concentrated intracoronary microdoses of a thrombolytic drug to the MVO area [6]. We now aim to investigate how such locally administered drug microdoses can induce thrombolysis as a possible therapeutic approach for MVO treatment.

Methods

A microfluidic chip (Fig.1) was used to study thrombolysis under flow using different microdoses of the thrombolytic drug alteplase. The chip consists of a tapered straight channel, which traps injected porcine microthrombi without causing complete channel occlusion (Fig. 1A). To mimic intracoronary CFI (consisting of temporary balloon occlusion of a coronary vessel for 90 seconds while drug is injected distally through a catheter) in vitro, microthrombi were incubated (without flow) directly in the chip for 90 seconds with various microdoses of alteplase (Fig. 2A, C). The chip was subsequently perfused with porcine plasma for 25 min (matched for physiological shear stress of 30 dyn/cm²). Conventional intravenous (IV) drug infusion (10 mg dose) resulting in a low systemic alteplase concentration, was mimicked by perfusing microthrombi with porcine plasma containing 2 µg/ml alteplase (Fig. 2B, C).

Results

Thrombolysis after CFI was concentration dependent, with the lowest microdose (0.3 mg) achieving 24% lysis of the thrombus area and the highest microdose (1.5 mg) achieving 60% lysis. In contrast, conventional IV drug infusion (corresponding to 10 mg alteplase IV dose) only achieved 10% lysis and was not significantly higher than the control perfused with pure porcine plasma.

Conclusion

Our findings suggest that intracoronary CFI is more efficient at achieving porcine microthrombus lysis than the current standard of IV bolus infusion (2 µg/ml alteplase in the circulating blood). Intracoronary CFI microdosing of fibrinolytic drugs using a drug-delivering catheter is a promising therapeutic approach for treating embolising MVO with a reduced systemic drug burden. Importantly, our intracoronary CFI approach achieves locally 6–40 times higher drug concentrations than a conventional IV drug infusion while reducing the total drug dose 60–300 times (Fig. 2C).
Impact of coronary revascularization on clinical outcomes of post-acute myocardial infarction patients with left ventricular thrombus
Authors: Leow A S T , Seah A W J , Goh F Q , Tan B Y Q , Yeo L L L , Kong W K F , Poh K K , Yip J W L , Wong R C C , Chai P , Yeo T C , Chan M Y Y , Sia C H
Published: October 2024

Background

Left ventricular thrombus (LVT) is an uncommon, but dangerous complication seen in post-acute myocardial infarction (AMI). With advances in percutaneous coronary intervention (PCI) techniques, the incidence of post-AMI LVT has declined in the contemporary era. However, a minority of patients do not undergo coronary revascularisation due to medical contraindications or patient preference. This study aimed to evaluate the clinical characteristics and outcomes of post-AMI LVT patients treated with and without coronary revascularisation.

Methods

This was a retrospective study of 263 consecutive post-AMI patients diagnosed with LVT from November 2012 to January 2021, retrieved from a echocardiography database. Patients were stratified by the presence or absence of revascularisation treatment. Baseline clinical characteristics, treatment and outcomes data were collected and analysed.

Results

The median follow-up duration was 2.9 years (IQR: 0.9 – 4.7). A majority of post-AMI LVT patients underwent revascularisation via PCI (71.5%, n = 188), CABG (4.2%, n = 11) or thrombolysis (0.4%, n = 1). Unrevascularised patients (24.0%, n = 63) were older (p <0.001), more likely to be female (p <0.001), and had more co-morbidities such as previous stroke (p <0.001), heart failure (p = 0.001), chronic kidney disease (p = 0.020), and malignancy (p = 0.021). More unrevascularised patient had NSTEMI (p < 0.001), and significantly fewer were treated with triple therapy (p < 0.001). Incidence of LVT resolution was lower (p < 0.001) while all-cause mortality was higher (p < 0.001) for unrevascularised patients on univariate survival analyses. On multivariable Cox regression, revascularisation status was not an independent predictor of LVT resolution, bleeding, stroke, or all-cause mortality outcomes.

Conclusion

While unrevascularised post-AMI LVT patients had poorer outcomes compared to revascularised patients overall, revascularisation status itself was not independently associated with poorer clinical outcomes. Optimising medical therapy such as triple therapy remains a key treatment goal for post-AMI LVT patients.
Effect of empagliflozin on no-reflow in patients with st elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Nasef M A , Saber M , Gomaa Y , Kamal D
Published: October 2024

Background

Primary percutaneous coronary intervention (PPCI) restores myocardial tissue perfusion successfully in over 90 % of ST-elevation myocardial infarction (STEMI) patients .However there remains a small proportion of patients who exhibit no-reflow.(1) Empagliflozin is a sodium glucose co-transporter 2 (SGLT2) inhibitor that acts as a powerful anti-oxidant and has beneficial effects on endothelial function and reducing burden of ischemia in-vitro.(2)

Aim and Objectives: To Assess the effect of Empagliflozin preloading in non-diabetic STEMI patients before PPCI on procedural, in-hospital outcomes and short-term Major Adverse Cardiovascular events (MACE) in a single tertiary center.

Patients and Methods: The study was carried out on 200 non-diabetic STEMI patients presenting to our university hospital within the first 8 hours of symptom onset. Patients were randomised into 2 groups , the intervention group received 10mg Empagliflozin before PPCI with the standard medical therapy while the control group received only the standard medical therapy. Patients were assessed for demographic data, risk factors, procedural outcomes, clinical and in-hospital outcomes, and short-term MACE up to 1 month.

Results: Our study found a significant difference between the intervention and control groups regarding contrast volume with a mean of 131 ml in the intervention group and 144 ml in control group with a p value of 0.009, incidence of no-reflow with 34.5% in the control group and only 18.2% in the intervention group and a p value of 0.014 and myocardial blush grade (MBG) were 84.1% of the patients in intervention group had MBG III after PCI while only 65.5% of the patients in the control group showed the same results with a p value of 0.019. Also, there was a significant difference in St-segment resolution post PCI as 59.1% of patients in the intervention group had complete ST segment resolution and only 39.1% of the patients in the control group had complete resolution with a p-value of 0.027, and total MACE in the first month which affected 44.8% of the patients in the control group and only 28.4% of those in the intervention group with a p-value of 0.024.

Conclusion

Our study showed that pre-loading of STEMI patients with Empagliflozin resulted in improvement in procedural outcomes, decreasing the incidence of coronary no-reflow, improvement in patient’s course during hospital stay and short-term MACE. Improvement in MACE was mainly due to reduced HF hospitalisations and anginal symptoms.
Symptoms and ASCVD score fail to identify majority of the patients at risk of first myocardial infarction
Authors: Mueller A , Konje S K , Barman N B , Argulian E A , Maslov P M , Namdarizandi V M , Leipsic J L , Tomey M T , Narula J N , Ahmadi A A
Published: October 2024

Background

Cardiovascular disease screening has long relied on the presence of symptoms like chest pain or on the Atherosclerotic Cardiovascular Disease (ASCVD) risk score, which is typically initiated at age 40. However, current research suggests that the ASCVD risk score may not incorporate a comprehensive range of factors and should be started earlier. Furthermore, the absence of symptoms such as angina in some patients prior to acute coronary syndrome (ACS) casts doubt on the reliability of symptom-based screening methods.

Purpose

This study aimed to evaluate the effectiveness of the ASCVD risk score and chest pain as predictors for ACS.

Methods

We retrospectively analyzed the data of all patients of 65 or younger who presented with their first ACS event in a single US center from January 2020 to January 2024. We collected the demographic and clinical data, including age, sex, lipid panel, blood pressure, medical history, onset of symptoms, and calculated their individual ASCVD risk score. We explored whether these patients, if assessed one week before their ACS event, would have been identified as at risk and thus prescribed lipid lowering or recommended for further diagnostic tests.

Results

Among 166 patients presenting with ACS, 64 (39%) were considered low risk with an ASCVD risk score of <5 or too low to calculate. 20 (12%) patients were assessed as borderline risk with an estimated risk score of 5-7.5%. In the intermediate risk category, 20 patients (12%) had a score of 7.5% -10% and 42 patients (25%) were estimated to have a score of >10 to <20%. 14 patients (8%) fell in the high-risk category, and lastly 6 patients had an LDL that was above 190 mg/dl.

Regarding symptoms of chest pain or shortness of breath, 14 patients (8%) did not experience any symptoms prior to their presentation, 98 (59%) patients experienced their first episode of symptoms within 48 hours, 19 patients (11%) within 2 days to a week, 10 patients (6%) had CP leading up to their event from a week to a month, 6 patients (4%) in the range of a month to 3 months and 19 patients (11%) had symptoms longer than 3 months prior to their presentation. To summarize if there were seen 1 week prior to their first ACS events, 51% of them were not recommended for statin therapy based on their ASCVD risk score and 67% of patients either had no chest pain until the event or chest pain within 48hrs of onset of their ACS and consequently would not have been routinely screened for coronary artery disease (CAD) by any anatomical or functional methods.

Conclusion(s)

ASCVD risk score and symptoms fail to identify majority of patient below 65 years of age with their first MI. Given high prevalence of CAD and associated mortality, improved screening tools, in addition to symptomatology or risk scores, would be more effective in identifying individuals at risk.
Circulating beta-hydroxybutyrate levels are associated with major adverse clinical events in patients with acute myocardial infarction
Authors: Dai Y , Xie L , Zhang Y , He Y , Liu H , Kong S , Chen W , Li H , Zhan Y , Tan N , Duan C , He P , Xue L , Liu Y
Published: October 2024

Background

Acute myocardial infarction (AMI) is associated with high mortality, and effective biomarkers are required for the risk stratification of patients with AMI. In cardiovascular diseases, circulating levels of ketone bodies (KB) such as beta-hydroxybutyrate (BHB) and acetoacetate are altered. However, the relationship between circulating KB levels and major adverse clinical events (MACE) in patients with ST-elevation myocardial infarction (STEMI) is unknown.

Methods

Patients with STEMI undergoing percutaneous coronary intervention (PCI) between January 2010 to June 2020 were enrolled, and divided into T1 (< 0.09 mmol/L, n=219), T2 (0.09-0.28 mmol/L, n=202), and T3 (> 0.28 mmol/L, n=211) tertiles according to the circulating BHB levels within 24 h of admission. The primary endpoint was in-hospital MACE, including all-cause mortality, stroke, recurrence of AMI, or target vessel revascularization.

Results

The incidence of in-hospital MACE in the T3 group (20.9%) was significantly higher than in the T1 group (10.5%) and T2 group (14.9%) (P=0.012). Multivariate logistic regression analysis showed that elevated circulating BHB levels were associated with an increased risk of all-cause mortality and MACE during hospitalization (OR = 1.41, 95% CI = 1.08-1.85, P = 0.012). During follow-up period, multivariate Cox regression analyses showed that elevated circulating BHB levels were associated with higher all-cause mortality and MACE (OR = 1.36, 95% CI = 1.19-1.56, P < 0.001). The impact of BHB on MACE were similar for all the subgroups.

Conclusion

Elevated circulating BHB levels within 24 h of admission were associated with an increased risk of MACE in patients with STEMI undergoing PCI, and could be a promising prognosis biomarker.
To evaluate coronary microvascular obstruction by myocardial contrast echocardiography and its influence on prognosis in patients with ST-segment elevation myocardial infarction
Authors: Gao J , Dou J , Wang S F , Wang J X , Liu Y
Published: October 2024

Background

The goal of primary PCI (pPCI) is not only to restore epicardial coronary blood flow quickly but also to provide continuous myocardial tissue level reperfusion through coronary microcirculation. However, the incidence of coronary microvascular obstruction (MVO) after pPCI is as high as 50%-60%, which is closely related to the occurrence of heart failure and increased mortality of patients. Myocardial contrast echocardiography (MCE) is a new noninvasive technique for real-time observation of myocardial microcirculation perfusion in a specific imaging mode. At present, there are few studies on the application of MCE in the evaluation of coronary MVO in STEMI patients in China.

Purpose

To evaluate coronary MVO by MCE and its influencing factors and prognosis value after pPCI in patients with STEMI.

Methods

Patients with STEMI who received pPCI from October 2020 to June 2023 in the CCU were enrolled. MCE examination was performed on the 5th to 7th day after pPCI. The patients were divided into the MVO group and Non-MVO group. Major adverse cardiovascular events (MACE) were observed by 6-month follow-up after STEMI onset. Multiple Logistic regression analysis was used to analyze the risk factors for MVO, Multiple Cox regression analysis of the risk factors for MACE and Kaplan-Meier survival curve to compare the cumulative event-free survival of the two groups.

Results

A total of 98 patients were included in the analysis. The age was 59.88±11.71 years old, and 76(77.55%) were male. MCE examination showed 52 cases in the MVO group and 46 cases in the Non-MVO group. The incidence of MVO was 53.1% (52/98). There were 15 patients with MACE during follow-up. The results of stepwise Multivariate Logistic regression analysis showed that the peak value of cardiac troponin T (cTnT) (OR=1.354,95%CI 1.103-1.661, P=0.004) and without thrombus aspiration (TA) were independent risk factors for MVO (OR=5.588,95%CI 1.915-16.308, P=0.002). Multivariate Cox regression analysis indicated that female (HR=2.891, 95%CI 1.027-8.135, P=0.044), left ventricular ejection fraction (LVEF) <40% (HR=9.960, 95%CI 3.370-29.435, P<0.001) and MVO (HR=5.759,95%CI 1.279-25.935, P=0.023) were independent risk factors for MACE. Kaplan-Meier survival curve showed that the cumulative event-free survival rate in the Non-MVO group was higher than that in the MVO group, and the difference was statistically significant (P=0.0047).

Conclusion

The incidence of coronary MVO was higher in STEMI patients after pPCI, the peak value of cTnT and without TA were independent risk factors of MVO. The independent risk factors for MACE were female, LVEF < 40%, and MVO.
Remote ischemic peri-conditioning suppressed cardiac sympathetic nerve activity especially in the non-culprit lesion in patients with acute myocardial infarction
Authors: Kondo T , Watanabe T , Yamada T , Morita T , Kawasaki M , Kikuchi A , Kawai T , Nishimoto Y , Seo M , Nakamura J , Fujita T , Taniichi M , Chang Y , Fukunami M
Published: October 2024

Background

Remote ischemic periconditioning (RIPC) has demonstrated cardioprotective effects and improved clinical outcomes as an adjunct to emergent percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). However, it remains to be elucidated whether RIPC affects the cardiac sympathetic nerve activity in patients with AMI.

Purpose

The purpose of this study is to investigate the effect of RIPC on cardiac sympathetic nerve activity (CSNA) in the culprit and non-culprit lesion respectively in patients with AMI.

Methods

We randomly assigned 157 patients with suspected AMI undergoing emergent PCI to receive transient limb ischemia (by inflating a cuff at 200 mmHg for 4×5 minutes: RIPC group, n=77) or no procedure (control group, n=80). After excluding inappropriate patients such as those with other diagnosis than AMI, we analyzed 122 patients (62 patients in RIPC and 60 in control group). CSNA was assessed in the culprit and non-culprit lesion respectively by the cardiac MIBG SPECT imaging.

Results

Patients in RIPC and control group had similar demographic and clinical characteristics at baseline. Patients in RIPC group tended to show higher late uptake only in the non-culprit lesion at discharge. At 1 year after discharge, patients in RIPC group demonstrated significantly higher late uptake (p=0.021) and lower washout rate (p=0.013) than those in control group in the non-culprit lesion. Regarding the culprit lesion, only washout rate tended to be lower in RIPC group at 1 year after discharge.

Conclusion(s): Remote ischemic peri-conditioning showed suppressive effect on cardiac sympathetic nerve activity especially in the non-culprit lesion in patients with acute myocardial infarction.SPECT parameters in RIPC and control
C-reactive protein after discharge and infarct size in patients with ST segment elevation myocardial infarction
Authors: Zhou Y , Madsen J M , Bo Kunkel J , Loenborg J T , Engstroem T
Published: October 2024

Background

C-reactive protein (CRP) peaks at 2 days in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and can predict final infarct size. It is, however, unknown whether CRP level after discharge, indicative of prolonged inflammation, plays a prognostic role in myocardial damage.

Purpose

To investigate the prevalence of high CRP level within 3 months after discharge in patients with STEMI and its association with myocardial damage.

Methods

In the current study, all patients were identified through the xx database and treated with timely PCI at xx hospital from 2011 to 2014. Blood samples were retrieved within 3 months after discharge. High CRP level was defined as CRP >=3 mg/L. Only patients with a cardiac magnetic resonance (CMR) at baseline or follow-up were recruited. The primary outcome was final infarct size. Multiple regression was performed to adjust for potential confounders using any baseline variable with P<0.10 for the difference between groups.

Results

Of the 1603 patients from xx, 273 patients had CRP measured following discharge and at least one CMR measured. Of them, 200 (73.3%) had high CRP level after discharge. There was no difference in period from PCI to CRP testing between patients with high CRP and those with low CRP [11 days, interquartile range (IQR) (4, 40) vs. 21 days, IQR (4, 42), P=0.31]. Patients with high CRP level showed larger final infarct size [12.5% left ventricle (LV) vs. 7.0% LV, P <0.001] and larger acute infarct size [15.2% LV vs. 10.6% LV, p=0.004] compared with those with low CRP level. Patients with high CRP level also had lower final myocardial salvage index (MSI) (0.67 vs. 0.75, P=0.003) and lower acute MSI (0.47 vs. 0.61, P=0.006). The results persisted after adjusting for potential confounders in multiple regression.

Conclusions

A large proportion of patients with STEMI undergoing PCI persisted high CRP within 3 months after discharge. High CRP level after discharge was associated with larger acute and final infarct size as well as lower acute and final MSI level.
Clinical significance of 12-lead electrocardiogram QRS scores on admission in ST-segment elevation myocardial infarction
Authors: Tsutsumi K , Okada K , Hanajima Y , Kirigaya H , Horii M , Kirigaya J , Nakahashi H , Minamimoto Y , Gohbara M , Kimura Y , Matsushita K , Kosuge M , Ebina T , Sugano T , Hibi K
Published: October 2024

Background

A QRS scoring system by 12-lead electrocardiography (ECG) is a quick and simple method to evaluate degree and extension of myocardial infarction. Previous studies have shown that high QRS scores (≥5) at hospitalization (before reperfusion) related to impaired myocardial reperfusion during percutaneous coronary intervention (PCI) and subsequent poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI) (Figure 1). However, the pathogenesis and associated factors with high QRS scores remain poorly defined. Therefore, this study aimed to explore clinical and lesion characteristics associated with QRS scores at hospitalization in patients with STEMI.

Methods

This retrospective observational study enrolled 138 broad anterior-wall STEMI patients who underwent PCI in the proximal left anterior descending artery and achieved reperfusion within 3 hours of onset. Patients were divided by QRS scores at hospitalization into low (<5: n=97) and high (≥5: n=41) QRS-scores, and clinical and lesion characteristics were compared between the 2 groups. Lesion characteristics were evaluated by intravascular ultrasound (IVUS).

Results

Despite early phase of STEMI, QRS scores at hospitalization varied (3 [2-5] points). Clinical characteristics, including onset-to-door time (66 [41-101] min vs. 55 [42-76] min) and onset-to-reperfusion time (112 [88-145] min vs. 106 [81-120] min), were comparable between patients with low and high QRS-scores. In contrast, significantly higher percentages of lipid plaques, plaque rupture and large thrombus were seen at the culprit lesion sites in patients with high versus low QRS scores (Figure 2). As a result, patients with high QRS scores had higher incidence of no-reflow phenomenon during PCI (36.6% vs. 12.6%, p<0.05) and larger infarct size assessed by peak CK values (5333 [3307-7443] IU/l vs. 1941 [759-3559], p<0.05) compared with those with low QRS-scores.

Conclusions

High QRS scores at hospitalization were associated with vulnerable lesion characteristics, as well as impaired coronary reperfusion and large infarct size. Although the exact mechanisms of the associations require future studies, QRS scores may help risk stratification before reperfusion and prognostic prediction after reperfusion.Figure 1.Figure 2.