bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental study of core MHD behavior and a novel algorithm for rational surface detection based on profile reflectometry in EAST
Authors: YE 叶 Kaixuan 凯萱 , ZHOU 周 Zhen 振 , ZHANG 张 Tao 涛 , MA 马 Jiuyang 九阳 , WANG 王 Yumin 嵎民 , LI 李 Gongshun 恭顺 , GENG 耿 Kangning 康宁 , WU 吴 Mingfu 茗甫 , WEN 文 Fei 斐 , HUANG 黄 Jia 佳 , ZHANG 张 Yang 洋 , SHAO 邵 Linming 林明 , YANG 杨 Shuqi 书琪 , ZHONG 钟 Fubin 富彬 , GAO 高 Shanlu 善露 , YU 喻 Lin 琳 , ZHOU 周 Ziqiang 子强 , XIANG 向 Haoming 皓明 , HAN 韩 Xiang 翔 , ZHANG 张 Shoubiao 寿彪 , LI 李 Guoqiang 国强 , GAO 高 Xiang 翔 , Team the EAST
Published: November 2023

Microwave reflectometry is a powerful diagnostic that can measure the density profile and localized turbulence with high spatial and temporal resolution and will be used in ITER, so understanding the influence of plasma perturbations on the reflect signal is important. The characteristics of the reflect signal from profile reflectometry, the time-of-flight (TOF) signal associated with the MHD instabilities, are investigated in EAST. Using a 1D full-wave simulation code by the Finite-DifferenceTime-Domain (FDTD) method, it is well validated that the local density flattening could induce the discontinuity of the simulated TOF signal and an obvious change of reflect amplitude. Experimental TOF signals under different types of MHD instabilities (sawtooth, sawtooth precursors and tearing mode) are studied in detail and show agreement with the simulation. Two new improved algorithms for detecting and localizing the radial positions of the low-order rational surface, the cross-correlation and gradient threshold (CGT) method and the 2D convolutional neural network approach (CNN) are presented for the first time. It is concluded that TOF signal analysis from profile reflectometry can provide a straightforward and localized measurement of the plasma perturbation from the edge to the core simultaneously and may be a complement or correction to the q-profile control, which will be beneficial for the advanced tokamak operation.
The effect of top-down attention on empathy fatigue
Authors: Shao Min , Li Lingxiao , Li Xiong , Wei Zilong , Wang Junyao , Hong Mingyu , Liu Xiaocui , Meng Jing
Published: November 2023

Prolonged exposure to others’ suffering can lead to empathy fatigue, especially when individuals struggle to effectively regulate their empathic capacity. Shifting active attention away from emotional components toward cognitive components of others’ suffering is an effective strategy for mitigating empathy fatigue. This research investigated how top-down attentional manipulation modulates empathy fatigue in both auditory (Study 1) and visual (Study 2) modalities. Participants completed two tasks in both studies: (i) the attention to cognitive empathy task (A-C task) and (ii) the attention to emotional empathy task (A-E task). Each task included three blocks (Time Block 1, Time Block 2, and Time Block 3) designed to induce empathy fatigue. Study 1 revealed that the A-C task reduced empathy fatigue and N1 amplitudes than the A-E task in Time Block 3, indicating that attention to cognitive empathy might decrease auditory empathy fatigue. Study 2 indicates that the A-C task caused a longer N2 latency than the A-E task, signifying a decelerated emotional empathic response when attention was on cognitive empathy in the visual modality. Overall, prioritizing cognitive empathy seems to conserve mental resources and reduce empathy fatigue. This research documented the relationship between top-down attention and empathy fatigue and the possible neural mechanism.
Human Capital and Financial Development: Firm-Level Interactions and Macroeconomic Implications
Authors: Allub Lian , Gomes Pedro , Kuehn Zoë
Published: November 2023

Capital-skill complementarity in production implies non-trivial interactions between the availability of human capital and financial constraints. Firms that are constrained in their access to finance hire a lower proportion of skilled workers than do unconstrained firms. Conversely, a lack of human capital increases skilled wages, reducing firms’ desired capital intensity and thus loosening firms’ effective financial constraints. To assess the macroeconomic implications of such firm-level interactions, we build an occupational-choice model with capital-skill complementarity in production, which we calibrate to US data. We vary financial frictions, educational attainment and total factor productivity across countries, and we quantify how aggregate output, wage inequality and entrepreneurship are affected by financial market liberalizations and increases in educational attainment. For aggregate output, the joint effect of both factors is, on average, 30% larger than the sum of the individual effects. Taking the educational attainment of the population as given, in countries with a negligible share of tertiary-educated workers and low total factor productivity, financial development has only small effects on aggregate output.
The activator protein-1 complex governs a vascular degenerative transcriptional programme in smooth muscle cells to trigger aortic dissection and rupture
Authors: Luo Yongting , Luo Junjie , An Peng , Zhao Yuanfei , Zhao Wenting , Fang Zhou , Xia Yi , Zhu Lin , Xu Teng , Zhang Xu , Zhou Shuaishuai , Yang Mingyan , Li Jiayao , Zhu Junming , Liu Yongmin , Li Haiyang , Gong Ming , Liu Yuyong , Han Jie , Guo Huiyuan , Zhang Hongjia , Jiang Wenjian , Ren Fazheng
Published: November 2023

Background and Aims

Stanford type A aortic dissection (AD) is a degenerative aortic remodelling disease marked by an exceedingly high mortality without effective pharmacologic therapies. Smooth muscle cells (SMCs) lining tunica media adopt a range of states, and their transformation from contractile to synthetic phenotypes fundamentally triggers AD. However, the underlying pathomechanisms governing this population shift and subsequent AD, particularly at distinct disease temporal stages, remain elusive.

Methods

Ascending aortas from nine patients undergoing ascending aorta replacement and five individuals undergoing heart transplantation were subjected to single-cell RNA sequencing. The pathogenic targets governing the phenotypic switch of SMCs were identified by trajectory inference, functional scoring, single-cell regulatory network inference and clustering, regulon, and interactome analyses and confirmed using human ascending aortas, primary SMCs, and a β-aminopropionitrile monofumarate–induced AD model.

Results

The transcriptional profiles of 93 397 cells revealed a dynamic temporal-specific phenotypic transition and marked elevation of the activator protein-1 (AP-1) complex, actively enabling synthetic SMC expansion. Mechanistically, tumour necrosis factor signalling enhanced AP-1 transcriptional activity by dampening mitochondrial oxidative phosphorylation (OXPHOS). Targeting this axis with the OXPHOS enhancer coenzyme Q10 or AP-1-specific inhibitor T-5224 impedes phenotypic transition and aortic degeneration while improving survival by 42.88% (58.3%–83.3% for coenzyme Q10 treatment), 150.15% (33.3%–83.3% for 2-week T-5224), and 175.38% (33.3%–91.7% for 3-week T-5224) in the β-aminopropionitrile monofumarate–induced AD model.

Conclusions

This cross-sectional compendium of cellular atlas of human ascending aortas during AD progression provides previously unappreciated insights into a transcriptional programme permitting aortic degeneration, highlighting a translational proof of concept for an anti-remodelling intervention as an attractive strategy to manage temporal-specific AD by modulating the tumour necrosis factor–OXPHOS–AP-1 axis.
Association between electronic nicotine delivery systems use and risk of stroke: A systematic review and meta-analysis of observational studies with 822,162 participants
Authors: Awad K , Mohammed M , Banach M
Published: November 2023

Background

The use of electronic nicotine delivery systems (ENDS) is becoming increasingly prevalent. Yet, its association with risk of stroke is still uncertain and not well-established.

Purpose

To synthesize more conclusive evidence about the association between ENDS use and risk of stroke through a systematic review and meta-analysis of available observational studies.

Methods

PubMed, Scopus, and Web of Science databases were searched from inception until February 20, 2023, to identify observational studies (either cross sectional, cohort, or case-control studies) that assessed the association of ENDS use with risk of stroke compared with non-users. Adjusted risk estimates of stroke form each relevant study were extracted and pooled as odds ratio (OR) with 95% confidence interval (CI) under the random-effects meta-analysis model. We also performed a leave-one-out sensitivity analysis to evaluate the robustness of the combined result. The I2 statistic was used to quantify heterogeneity.

Results

Six studies (four cross-sectional and two prospective cohort studies) with a total of 822,162 participants (ENDS users=38,539 and non-users=783,623) matched our criteria and were included in this meta-analysis. The analysis revealed that ENDS use was associated with a statistically significant increased risk of stroke (OR: 1.48 [95% CI: 1.07 to 2.05]; I2: 82%; Figure 1A) compared with non-users. This result was sensitive (i.e., became statistically insignificant) to the removal of one study by Bricknell and co-authors l (OR: 1.44 [95% CI: 0.96 to 2.18]; I2: 85%; Figure 1B).

Conclusion

The usage of ENDS appears to be associated with a greater risk of stroke when compared with a lack of use. Further well-designed longitudinal investigations are needed to validate these findings and investigate the potential mechanisms implicated with this association.

Figure 1: (A) results of meta-analysis of the included studies that assessed the association of ENDS use with risk of stroke (B) results of the leave-one-out sensitivity analysis.
Long-term clinical outcomes of EVAR within IFU compared to outside IFU
Authors: Lee J P , Jang A Y , Won Y S , Yang T I , Kim J H , Shin Y H , Ahn C M , Ko Y G , Choi D H , Kang W C
Published: November 2023

Background

Endovascular aneurysm repair (EVAR) has been used worldwide to treat abdominal aortic aneurysm (AAA). Outcomes after EVAR between within instruction for use (IFU) and outside IFU are still controversial. We analyzed long term outcomes of EVAR within IFU compared to EVAR outside IFU and baseline clinical/anatomical characteristics that influence outcomes of EVAR.

Methods

We collected data from 766 patients (mean age 71.0 ± 12.5 years, male 90.2%) who underwent EVAR for infrarenal AAA between August 1997 and July 2021 at two centers in Korea. The primary endpoint was aneurysm related mortality (ARM) during follow up. The secondary outcomes were endoleak, reintervention and aneurysm sac enlargement.

Results

The mean AAA diameter is 59.0 ± 12.2 mm. The proportion of patients underwent EVAR outside IFU was 62.7% (n=466). Neck angle > 60 degree was the most common outside IFU criterion (n=210, 27.4%). The median clinical and imaging follow-up duration was 36.5 and 51.0 months, respectively. Total 110 patients (14.8%) had complications during follow up. The outside IFU group had more complications compare to the within IFU group (p=0.033). Overall mortality rate was 8.8% (n=60). ARM occurred in 0% of patients with EVAR within IFU and in 7 (1.5%) of patients with EVAR outside IFU (p=0.041), respectively. There was no significant difference in incidence of endoleak (28.5 vs. 23.1%, p=0.173), reintervention rate (8.4 vs. 9.3%, p=0.688) and aneurysm sac enlargement (23.6 vs. 23.4%, p=0.957) between patients underwent EVAR within IFU and outside IFU group. In multivariate analysis, proximal neck diameter > 28 mm was independent risk factor for ARM (HR, 9.132; 95% CI, 1.684 – 49.516, P=0.010). In addition, proximal neck angle > 60 degree was independent risk factor for endoleak (HR, 1.553; 95% CI, 1.042 – 2.314, P=0.031) and reintervention (HR, 2.297; 95% CI, 1.333 – 3.955, P=0.003). Neck length < 10 mm and neck diameter >28 mm were risk factors for aneurysm sac enlargement (HR, 4.363; 95% CI, 1.252 – 15.211, P=0.021 and HR, 3.148; 95% CI, 1.261 – 7.859, P=0.014). Age over 75 was also a risk factor for endoleak (HR, 2.491; 95% CI, 1.666 – 3.726, P=0.000) and aneurysm sac enlargement (HR, 3.150; 95% CI, 1.536 – 6.458, P=0.002).

Conclusions

Our study showed EVAR outside IFU is associated higher ARM compared to EVAR within IFU. In addition, neck angulation was risk factor for endoleak and reintervention. Clinicians should be caution when they perform EVAR outside IFU and select optimal patient for successful EVAR.
LIGHT/TNFSF14 levels in carotid atherosclerotic plaques are associated with symptomatic cerebrovascular disease
Authors: Shami A , Edsfeldt A , Nilsson J , Goncalves I
Published: November 2023

Background

Plaque rupture is the underlying cause of most cardiovascular events, such as stroke and myocardial infarction. Co-stimulatory molecules, the immune checkpoints, are emerging as strong candidates to battle atherosclerosis progression. The co-stimulatory molecule LIGHT (tumour necrosis factor 14; TNFSF14) exists in foam cell-rich regions of atherosclerotic plaques, but whether it has a driving role in promoting a high-risk plaque phenotype is not known.

Purpose

This study investigates the association between intra-plaque LIGHT and plaque vulnerability.

Methods

Plaque levels of LIGHT/TNFSF14 were measured in homogenised carotid endarterectomy plaques by Proximity Extension Assay (PEA) in subjects from the Carotid Plaque Imaging Cohort (CPIP; N=201). Homogenates were further examined by multi-plex cytokine analysis and ELISA, and tissue plaque sections through histology/immunohistochemistry.

Results

Plaque levels of LIGHT were associated with the occurrence of pre-operative cerebrovascular symptoms (p=0.00014). Furthermore, LIGHT correlated strongly with the histological plaque vulnerability index (p=5x10-15): a ratio between the sum of destabilising versus stabilising plaque components (i.e. macrophages, intra-plaque haemorrhage and lipids versus smooth muscle cells and collagen) as well as with necrotic core size and the inflammatory cytokines interleukin(IL)-1β, IL-6, chemokine (C-C motif) ligand (CCL)-2, CCL4 and CCL5. Moreover, plaque LIGHT levels correlated with several components of the extracellular matrix turnover machinery, including cleaved collagen, the collagen cross-linking proteoglycans fibromodulin and lumican, the matricellular protein COMP (cartilage oligomeric matrix protein), and the remodelling regulator ADAMTS7 (a disintegrin and metalloproteinase with thrombospondin motifs-7). Levels also correlated with matrix metalloproteinases (MMPs) 1, 2, 9 and 10, and tissue inhibitor of metalloproteinase (TIMP)-1.

Conclusion

Expression of LIGHT in atherosclerotic plaques does not only correlate with markers of plaque destabilisation¸ but is also significantly elevated in plaques from symptomatic, compared to asymptomatic, patients. These results connect LIGHT content to a rupture-prone plaque phenotype and suggest the LIGHT signalling pathway as a potential therapeutic target to promote atherosclerotic plaque stability.
Intracoronary imaging of complex coronary artery lesions: A lesion-level analysis from SCAAR simulating the IMPROVE trial
Authors: Von Koch S , Koul S , Olivecrona G , Waksman R , Mohammad M , Erlinge D
Published: November 2023

Background

Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are two intracoronary imaging modalities which can be used to optimize stent implantation and expansion. The IMPROVE trial is an ongoing randomized study investigating the impact of IVUS on percutaneous coronary intervention (PCI) of complex lesions. We conducted a nationwide retrospective observational study simulating the IMPROVE trial.

Purpose

The aim of this study is to determine whether intracoronary imaging is associated with improved outcome after PCI of complex lesions.

Methods

Using the Swedish Coronary Angiography and Angioplasty registry (SCAAR) we identified complex lesions undergoing PCI between 1 January 2016 and 15 January 2022. Complex lesions were defined as (1) in-stent restenosis, (2) chronic total occlusions, (3) bifurcations and (4) lesions stented with a ≥ 28 mm stent. Lesions were stratified into two groups according to use of intracoronary imaging or not. The groups underwent propensity score (PS) matching to balance baseline demographics. Outcome was assessed with univariable cox regression models and Kaplan Meier estimates. The primary endpoint was target lesion revascularization (TLR) within 2-years assessed on lesion level where each patient could contribute with more than one lesion. Secondary endpoint included all-cause mortality analyzed on patient level.

Results

After PS-matching, two groups with 9,404 lesions each were formed. Baseline characteristics after PS matching did not show any significant demographic differences. The intracoronary imaging group contributed more often with more than one lesion. Intracoronary imaging was associated with significantly lower rates of TLR (hazard ratio (HR): 0.80 (95% confidence interval (CI): 0.67-0.94), p=0.008) and all-cause mortality (HR: 0.69 (95% CI 0.61-0.78), p<0.001).

Conclusion

In this study on complex lesions undergoing PCI, the use of intracoronary imaging was associated with an improved outcome. These results encourage intracoronary imaging when assessing complex lesions.Baseline characteristicsOutcome
High-sensitivity c-reactive protein to high-density lipoprotein cholesterol ratio and the risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention
Authors: Deng L D , Liang Y L , Xu Q X , Liu Y L , Liu J L , Deng J D , Li Z L , Han K H , Tian L T , Lu X L , Chen S C
Published: November 2023

Background

High-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) is a new biomarker, which is related to the incidence rate of coronary artery disease (CAD). The purpose of this study was to investigate the association between CHR and contrast-induced acute kidney injury (CI-AKI).

Methods

In this retrospective cross-sectional study, 10,917 patients underwent PCI. Diagnose CI-AKI according to KIDIGO standard. Univariate and multivariable logistic regression analysis were used to determine the relationship between CHR and CI-AKI, and further draw the receiver operating characteristic (ROC) curve of subjects to evaluate the clinical diagnostic performance of CHR on CI-AKI.

Results

1,037 patients (9.50%) developed CI-AKI after PCI. The subjects were 64.1 ± 11.1 years old, 2,511 were females (23.0%). Multivariate logistic regression analysis showed that the increase of CHR level was associated with the increase of CI-AKI incidence rate ([Q4 vs. Q1]: odds ratio (OR) = 1.89, 95% confidence interval (CI) [1.42 to 2.54], P < 0.001). Restrictive cubic spline analysis showed that CHR and CI-AKI were linear relationship. ROC analysis confirmed that CHR was a good predictor of CI-AKI (area under ROC curve =0.606, 95% CI [0.588 to 0.624]).

Conclusions

High CHR level is closely related to the increase of CI-AKI incidence, indicating that CHR may be an independent risk factor of CI-AKI.
A comprehensive network meta-analysis: comparison of long-term outcomes between intravascular ultrasound, optical coherence tomography, and angiography-guided stent implantation
Authors: Saylik F , Hayiroglu M I , Akbulut T , Cinar T
Published: November 2023

Background

Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided stent implantations are alternative techniques that are adjunct to angiography-guided (ANG) percutaneous coronary interventions in patients with coronary artery disease (CAD), especially for optimal stent deployment. We aimed to conduct a network meta-analysis including studies comparing those three techniques.

Methods

We searched PubMed, Scopus, and Cochrane libraries for eligible studies that compared IVUS, OCT, and angiography-guided stent implantation in patients with CAD. After excluding studies, which were irrelevant, duplicated, and had inappropriate results, 54 randomized, propensity-score matched, and observational studies with 232.181 patients were included in this meta-analysis.

Results

Number of studies compared ANG and IVUS was higher than the other two comparisons. Indirect evidence of network estimates between OCT and IVUS was higher than direct estimate (60% vs. 40%). Minimal parallelism and mean path length of each estimation was suitable with numbers low than 2 for both for comparisons. ANG had higher MACE (RR =1.30; 1.22-1.39, p<0.001), all cause-death (RR=1.45;1.30-1.61, p<0.001), cardiac death (RR=1.72;1.54-1.92, p<0.001), myocardial infarction (RR=1.34; 1.23-1.45, p<0.001), target lesion revascularization (RR=1.20; 1.13-1.26, p<0.001), and stent thrombosis (RR=1.58;1.34-1.85, p<0.001) risks compared to IVUS. There was no difference between OCT and IVUS regarding all outcomes. MACE (RR=1.51;1.26-1.81, p<0.001), cardiac death (RR=2.13;1.41-3.21, p<0.001), and myocardial infarction (RR=1.42;1.05-1.93, p<0.001) risks were higher in ANG groups than in OCT group. Highest benefit was established with OCT for MACE (p-score = 0.973), with IVUS for all-cause death (p-score= 0.792), with OCT for cardiac death (p-score=0.921), with OCT for myocardial infarction (p-score =0.823), with IVUS for target lesion revascularization (p-score=0.865), and with IVUS for stent thrombosis (p-score=0.930). Heterogeneity was appropriate for all outcomes (I2 <70%). There was no publication bias for all outcomes.

Conclusion

This comprehensive network meta-analysis indicated that angiography-guided stent implantation had higher risk of MACE, cardiac death, myocardial infarction, target lesion-revascularization, and stent thrombosis when compared to IVUS and had higher risk of MACE, cardiac death, and myocardial infarction than OCT.
Vascular healing of Combo plus stents in patients with acute coronary syndrome
Authors: Shishido K , Miyashita H , Yokoyama H , Yamashita T , Ochiai T , Yamaguchi M , Moriyama N , Tobita K , Matsumoto T , Mizuno S , Yamanaka F , Tanaka Y , Murakami M , Takahashi S , Saito S
Published: November 2023

Background

The Combo stent has an abluminal sirolimus-eluting coating composed of a biodegradable polymer to form a drug-eluting stent platform. Sirolimus release is completed in 30 days, and the biodegradable polymer disappears within 90 days. This dual therapy approach aims for neointimal suppression while retaining the endothelial progenitor cell–capturing prohealing benefits enabling rapid endothelialization. However, in patients with acute coronary syndrome (ACS), early vascular healing after COMBO stent implantation remains unknown.

Purpose

The aim of this study is to elucidate the early phase vascular responses in patients with ACS after COMBO stent implantation at 1 month and 6 months follow-up by using optical coherence tomography (OCT).

Methods

Twenty-eight patients who underwent primary percutaneous coronary intervention (PCI) for AMI with COMBO stent between March 2020 and July 2020 were examined. All patients received follow-up OCT at 1 and 6 months after primary PCI. For assessment of each strut, OCT images were analyzed at 1.0-mm intervals throughout the stented segment. The degree of strut coverage by OCT were measured both 1 month and 6 months.

Results

The neointimal thickness were 0.110 ± 0.036 mm at 1 months and 0.217 ±0.083 mm at 6 months (P< 0.001). The median rate of any covered struts was 40.2% at 1 month and 89.5% at 6 months (P< 0.001). The median rate of definite uncovered struts was 14.4% at 1 month and 0.7% at 6 months (P< 0.001). Major adverse cardiac events (MACE) were limited to two target vessel failure without target lesion revascularization. No definite or probable stent thrombosis was noted.

Conclusions

In patients with MI, the COMBO stent is associated with a high degree of neointimal strut coverage at 1 monthfs. Furthermore, almost complete vascular healing at 6 months is observed. These findings may have impact on the duration of dual anti-platelet therapy in patients with MI who underwent PCI using COMBO stent.
Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements
Authors: Soh M , Kim H , Lim H , Koh J
Published: November 2023

Background

Fractional flow reserve (FFR) is the most verified index to date in invasively evaluating lesion-specific myocardial ischemia. During FFR measurements, distal coronary pressure (Pd) can be influenced by hydrostatic pressure change resulted from the height difference (HD) between coronary ostium and location of distal pressure sensor. We aimed to investigate the impact of aorto-coronary HD on FFR measurement in each coronary artery.

Methods

We retrospectively analyzed 257 patients who underwent FFR measurement and coronary computed tomography angiography (CCTA) within a year. HD was measured by CCTA as the vertical distance between coronary ostium and a matched point of distal coronary pressure sensor identified on coronary angiography.

Results

The location of Pd sensor was higher in left anterior descending artery (LAD) (-4.47±1.33cm), whereas lower in left circumflex artery (LCX) (2.54±1.05cm) and right coronary artery (RCA) (2.05±1.25cm) than the coronary ostium. Compared with the original FFR values, corrected FFR by HD was higher in LAD (0.79±0.09, 0.82±0.09, P<0.05) and tended to be lower in LCX and RCA (0.87±0.07, 0.85±0.08, p=0.21; 0.87±0.10, 0.86±0.10, p=0.49, respectively). Based on FFR cut-off value of 0.8, the concordance rate between the FFR and corrected FFR was 77.8%, 92.5%, and 100% in LAD, LCX, and RCA, respectively.

Conclusion

During FFR measurements, HD between coronary ostium and distal pressure sensor may affect interpretation of disease severity and FFR-guided treatment decision of coronary artery disease.
Comparison of two angiography-based FFR techniques in NSTEMI Patients: A Multicenter Study
Authors: Skalidis I , Meier D , Luangphiphat O , Mauler-Wittwer S , Noirclerc N , Mahendiran T , Cagnina A , Collet C , Sonck J , De Bruyne B , Eeckhout E , Muller O , Fournier S
Published: November 2023

Background

Recently, non-invasive methods ("wire free") to functionally assess the hemodynamic severity of a coronary artery have emerged. FFRangio and QFR are angiography-based technologies that have been validated in patients with chronic and acute coronary syndrome compared to invasive FFR measurement. To date, no direct comparison between these two methods has been reported and they have never been prospectively evaluated in patients presenting exclusively with Non-ST Segment Elevation Myocardial Infarction (NSTEMI).

Methods

Patients with NSTEMI were prospectively included in this multicenter, single-arm, double-blinded study comparing FFR calculated by FFRangio and QFR - both calculated offline - to invasively-measured FFR (FFRinvasive). FFRinvasive was measured in all angiographically intermediate lesions (30%-70% stenosis) and was then compared to the average value measured by two blinded operators for each angio-based FFR modalities; FFRangio and QFR. The primary endpoints were the sensitivity and specificity of FFRangio and QFR relative to the reference standard FFRinvasive using a cutoff value of ≤0.80.

Results

Among 129 NSTEMI patients who were screened, 49 patients with 63 vessels in total underwent FFRinvasive measurements, had optimal angiographical views for FFRangio and QFR measurement, and were finally included in the study. The mean value of FFRinvasive was 0.83±0.3 with 22 (36%) being ≤0.80. The mean FFRangio was 0.83±0.1 with 20 (32%) being ≤0.80. FFRangio exhibited a sensitivity of 91%, a specificity of 100% and a diagnostic accuracy of 96.8%. The mean QFR was 0.82±0.3 with 20 (32%) being ≤0.80 and it showed sensitivity of 86.4%, specificity of 98.4% and diagnostic accuracy of 93.7%.The pearson correlation coefficient for FFRangio and QFR were r=0.91 and r=0.76, respectively.

Conclusion

To our knowledge, this multicenter study represents the first head-to-head comparison between these two non-invasive angiography-derived physiology assessment modalities. Both, FFRangio and QFR, that were performed by two operators, demonstrated great diagnostic performance which is slightly better compared to previous validation studies. Although, based on our study, FFRangioseems to have better sensitivity, further larger validation studies are required.Bland–Altman plotCorrelation for FFR and Angio-Based FFR
P2Y12 inhibitor loading time before elective PCI and the prevention of myocardial necrosis
Authors: Roule V , Beygui F , Cayla G , Range G , Motovska Z , Delarche N , Jourda F , Goube P , Guedeney P , Zeitouni M , El Kasty M , Laredo M , Vicaut E , Montalescot G , Silvain J
Published: November 2023

Background

There is dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is frequent and associated with poor outcome.

Purpose

We aimed to assess the impact of the P2Y12 inhibitor loading time (time from loading to PCI) on peri-procedural myocardial necrosis in the elective PCI population of the randomized ALPHEUS trial.

Methods

1809 patients of the ALPHEUS trial were divided into quartiles of loading time (0 to 0.2h, 0.2 to 1.7h, 1.7 to 4.1h and 4.1 to 24h). The ALPHEUS primary outcome was used (type 4 (a or b) myocardial infarction or major myocardial injury) as well as the main secondary outcome including minor myocardial injury. The risk of events was adjusted in a multivariate model.

Results

Patients in the first quartile group (Q1) presented higher rates of the primary outcome (p=0.01). When compared to Q1, incidences of the primary outcome decreased in patients with longer loading times (adjOR 0.70 [0.52.-0.95]; p=0.02 for Q2; adjOR 0.65 [0.48-0.88]; p<0.01 for Q3; adjOR 0.66 [0.49-0.89]; p<0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications and clinical ischemic events were rare and did not differ between groups.

Conclusion

In elective PCI for chronic coronary syndrome, administration of the loading dose of oral P2Y12 inhibitor at the time of PCI is associated with more frequent peri-procedural myocardial necrosis than an earlier administration.
Association between high platelet reactivity and early stent thrombosis in patients with drug-eluting stent implantation
Authors: Lim S , Hong S J , Kim J H , Cha J J , Joo H J , Park J H , Yu C W , Lim D S , Jeong Y H
Published: November 2023

Background

Stent thrombosis (ST) is a potentially fatal complication after percutaneous coronary intervention (PCI). The association between P2Y12 reaction unit (PRU) level and stent thrombosis occurrence is not fully elucidated.

Methods

Based on the multicenter, observational PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) registry of patients with drug-eluting stents (DES) implantation, a total of 11,714 patients with PRU values were identified. The independent predictors of early stent thrombosis (EST) were assessed. The primary outcome after EST was the composite of cardiac death, myocardial infarction and any revascularisation. Key secondary outcomes were all-cause death, cardiac death, myocardial infarction, and any revascularisation.

Results

EST, defined as definite ST in less than 1 month after index PCI, was identified in a total of 51 patients. The PRU value was significantly higher in the EST group (263.5 ± 70.8 vs. 217.5 ± 78.7, p<0.001). In multivariable analysis, having a PRU value of ≥252 (OR, 5.10; 95% CI, 1.58-16.46; p=0.006) and an ARU value of ≥414 (OR 4.85; 95% CI, 1.07-21.97; p=0.040) were significant predictors of EST. The use of first-generation DES (OR 3.56; 95% CI, 0.98-12.99; p=0.054) also posed a higher risk for EST occurrence with a borderline significance. Cumulative incidence of the primary composite outcome was significantly higher in patients with EST (HR 18.7; 95% CI 12.8-27.3; p<0.001).

Conclusion

In patients treated with clopidogrel after successful DES implantation, EST was associated with higher PRU values, and a greater rate of adverse outcomes, including all-cause death and MI.
Impact of heart failure severity and major bleeding events after percutaneous coronary intervention on subsequent major adverse cardiac events
Authors: Ikebe S , Ishi M , Otsuka Y , Nakamura T , Tsujita K , Matoba T , Kohro T , Oba Y , Kabutoya T , Imai Y , Kario K , Kiyosue A , Mizuno Y , Nochioka K , Nakayama M
Published: November 2023

Background

Heart failure (HF) is one of high bleeding risk after percutaneous coronary intervention (PCI). Furthermore, major bleeding events increase the risk of subsequent cardiovascular events. However, it is unknown whether HF severity and bleeding events are associated with major adverse cardiac events (MACE).

Purpose

The aim of this study was investigating the impact of HF severity or bleeding events on subsequent MACE.

Methods

Clinical Deep Data Accumulation System (CLIDAS), a multicenter database with 7 tertiary medical hospitals, was developed to collect data directly for patient characteristics, medications, laboratory test, physiological test, cardiac catheterization and PCI treatment in electronic medical records. This retrospective analysis included 7,160 patients with PCI between April 2014 and March 2020 and have completed 3-year follow-up. The patients were divided into two groups: HF with high BNP (HF-hBNP) (>100 pg/ml) (n=384) and non-HF-hBNP (HF with low BNP and non-HF) (n=6,776). Furthermore, both groups were re-classified into two groups according to presence of major bleeding events in 30 days: HF-hBNP with 30-day bleeding (n=14), without 30-day bleeding (n=370), non-HF-hBNP with 30-day bleeding (n=74) and without 30-day bleeding (n=6,702). Primary endpoint was defined as MACE.

Results

HF with high BNP was an independent risk factor of MACE (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.64-2.98) compared with non-HF. Among the HF-hBNP patients, MACE incidence tended to be increased by 30-day bleeding (p=0.075). In addition, among the non-HF-hBNP patients, the bleeding events increased the risk of MACE (p=0.003). The multivariable Cox regression model revealed that other three groups were associated with a high risk compared with non-HF-hBNP without 30-day bleeding group: non-HF-hBNP with 30-day bleeding (HR, 3.90; 95% CI, 1.59-9.54), HF-hBNP without 30-day bleeding (HR, 2.19; 95% CI, 1.56-3.07) and HF-hBNP with 30-day bleeding (HR, 8.33; 95% CI, 2.57-27.0).

Conclusion

The real-world database CLIDAS revealed that HF with high BNP and major bleeding events in 30 days might be associated with MACE. Those results suggest that management of HF and prevention of bleeding complication in early days after PCI could be important to prevent MACE.
Mortality after periprocedural myocardial injury and spontaneous myocardial infarction according to the levels of troponin increase: insights from a large PCI registry
Authors: Spirito A , Kamaleldin K , Sartori S , Vogel B , Feng Y , Baber U , Pileggi B , Johnson J , Sweeny J , Prakash K , Khera S , Kini A , Sharma S K , Dangas G , Mehran R
Published: November 2023

Background

Periprocedural myocardial injury and spontaneous myocardial infarction (MI) are potential complications in patients with coronary artery disease. The prognostic impact of periprocedural myocardial injury as compared to that of spontaneous MI has not been fully assessed.

Aim

To assess the impact on mortality of periprocedural myocardial injury and spontaneous MI according to thresholds of troponin increase proposed in expert consensus documents.

Methods

Among patients undergoing PCI at a large volume center, we included those presenting with: 1) chronic coronary syndrome (CCS) with normal (≤1x upper reference level [URL]) cardiac troponin I (cTnI) at baseline and after PCI (no myocardial events); 2) CCS with normal baseline cTnI and increased (>1 URL) cTnI in the 48 hours after PCI (periprocedural myocardial injury), and 3) type I MI (spontaneous MI). Patients with missing cTnI values, patients with CCS and increased baseline cTnI (>1 URL) and patients with unstable angina were excluded. Patients with periprocedural myocardial injury and spontaneous MI were stratified in 4 groups according to the cTnI peak value: 1-5, 5-35, 35-70, >70 times (x) above the URL. The risk of all-cause death at 1-year after PCI was assessed across the cTnI strata using the group with no myocardial events as reference. The conventional cTnI was measured with the Architect methodology (Abbott, Chicago, Illinois) and the URL was 0.4 ng/mL.

Results

Among patients undergoing PCI between 2012 and 2019, 7602 had no myocardial events, 913 had periprocedural myocardial injury and 2192 presented with spontaneous MI. CTnI peak was 1-5x, 5-35x, 35-70x, >70x above URL in 53%, 41%, 4%, 2% of patients with periprocedural myocardial injury, respectively, and in 24%, 38%, 11%, 26% of patients with spontaneous MI, respectively (Figure 1). Rate of all-cause death was 1.4% in patients with no myocardial events. The risk of all-cause death at 1-year was increased after periprocedural myocardial injury with a peak cTnI of 35-70x URL and tended to be higher with a peak cTnI >70x URL (Figure 2). Among patients with spontaneous MI, the risk of all-cause death was significantly higher in all cTnI strata (Figure 2). Adjusted results and p-value for comparisons between periprocedural myocardial injury and spontaneous MI will be presented at ESC 2023.

Conclusions

All-cause death at 1-year was not increased after periprocedural myocardial injury with a peak cTnI ≤35x URL. Periprocedural myocardial injury with cTnI peak >35x URL and spontaneous MI with any cTnI elevation were associated with a similar crude risk of all-cause death.Figure 2
Parsimonious versus extensive score: can we simplify bleeding risk stratification after percutaneous coronary intervention without losing specificity?
Authors: Woelders E C I , Onuma Y , Ninomiya K , O'leary N , Damman P , Peeters D A M , Van 'T Hof A W J , Serruys P W J C , Van Geuns R J M
Published: November 2023

Background/Introduction

Prediction of bleeding risk in patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) has been repeatedly attempted and resulted in multiple risk models. To promote the adoption and use of risk stratification among clinicians, a consortium in the South East of the Netherlands, the "ZON-HR", has created a simple binary variant of the existing logistic models. This model includes commonly available factors which can be incorporated into the PCI report to generate stratification. In this "parsimonious" model, high bleeding risk (HBR) is stratified according to: history of intracranial haemorrhage, previous spontaneous bleeding, Hb < 11 g/dL, eGFR< 30.

Purpose

We aimed to perform an external validation of our model for bleeding risk and to demonstrate its discriminative value in comparison with the PRECISE DAPT score, an acknowledged risk score.

Methods

We performed a post hoc analysis of the GLOBAL LEADERS trial, a multicenter randomized trial, comparing ticagrelor monotherapy after one month of DAPT with standard DAPT after PCI. We stratified the patients for HBR according to the ZON-HR or a PRECISE-DAPT score ≥ 25. Bleeding events one year after PCI were compared in the entire population and in subgroups for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), Ticagrelor monotherapy and DAPT.

Results

Of the 15968 patients included in GLOBAL LEADERS, 1059 patients were excluded due to missing variables required for either model. Among the 14909 patients, 17% had HBR according to the PRECISE DAPT score, 4% according to ZON-HR and 3% according to both. Bleeding events occurred in 8.5% and 13% of HBR defined by PRECISE DAPT or ZON-HR respectively. Patients with HBR according to both models showed 13% bleedings as opposed to 5% in non-HBR. Table 1 presents the sensitivity and specificity. Regression analysis (figure 1) demonstrated that patients with HBR according to either model have significantly more bleedings. This was also significant in all subgroups except for ACS patients receiving standard DAPT when the ZON-HR model was used.

Conclusion

The ZON-HR model is more conservative compared to the PRECISE DAPT score as depicted by the sensitivity and specificity. This can be explained by the larger number of risk factors used in the PRECISE DAPT score that cumulatively contributes to the sensitivity as opposed to the binary ZON-HR model which is more specific. However, the survival curves and hazard ratios showed good predictive value of both models for bleeding risk in the overall population.Table 1.Figure 1.
Transulnar artery approach in STEMI - Best alternative to radial?
Authors: Zafirovska Taleska B , Jovkovski A , Vasilev I , Taravari H , Kitanoski D , Petkoska D , Spiroski I , Kostov J , Kedev S
Published: November 2023

Background

Transulnar artery approach is a valuable alternative wrist access site for percutaneous coronary interventions. Currently published data about using transulnar approach (TUA) in the STEMI setting are missing. Due to its similarities with transradial approach (TRA), TUA in STEMI (ST segment elevation myocardial infarction) procedures can help in decreasing access site bleeding and vascular complications without sacrificing procedural success.

Purpose

To assess the success and safety of Transulnar access in STEMI.

Materials and Methods

In the period from March 2011 until December 2021, 8013 consecutive STEMI patients underwent primary PCI (percutaneous coronary intervention) in our center. All consecutive patients with transulnar approach (TUA) were included in a single center prospective registry of effectiveness and safety. The primary outcome was procedural success through ulnar access. We also examined clinical and procedure characteristics, access site bleeding and ischemic complications and failure mode of initial TUA.

Results

In this period, 172 STEMI patients (2.1%) underwent PPCI through transulnar approach. Mean age of patients was 60 ± 12 years with 27% females. All procedures were successfully performed through right TUA. There were no STEMI TUA cases with crossover to Transfemoral approach. In 150 patients (87%) TUA was the primary choice of puncture due to no palpable radial artery from previous radial artery occlusion. In 22 patients (12.7%) the reason for crossover from primary TRA to TUA were complex RA anomalies. Type 3 and 4 EASY Score hematoma was present in 4 patients (2.3%). 7% of patients had over 1 access site puncture. UA spasm was registered in 1.7%. Mean procedural time was 32±23 min and fluoroscopy time was 8.5±9.2 min. Ulnar artery anomalies were registered in 1% of patients.

There were no ulnar artery occlusions detected at discharge. There were no clinical or ischemic hand complications seen during clinical follow up.

Conclusion

Transulnar approach is safe and feasible alternative wrist access in the STEMI setting and can further decrease TFA crossover.
Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis
Authors: Wybraniec M , Cichon M , Kampka Z , Drabczyk M , Zielonka M , Wypych G , Grabka M , Mizia-Stec K
Published: November 2023

Background

Percutaneous pericardiocentesis (PP) belongs to life-saving procedures in cardiac tamponade, while it may also serve as diagnostic procedure in patients with recurrent pericardial effusion.

Purpose

The aim of the study was to evaluate the clinical characteristics and predictors of in-hospital mortality among patients subject to PP.

Methods

This single-center retrospective study comprised consecutive patients who underwent PP between 2011 and 2021 regardless of primary diagnosis. Among 132 456 patients screened, 208 patients were subject to PP [109 women, 52.4%; median age of 66 (58; 76) years] who underwent 231 procedures. Exclusion criteria involved data incompleteness regarding the etiology and outcome. The primary endpoint was in-hospital mortality.

Results

The most common indications for PP were neoplastic disease (23.1%), idiopathic effusion (14.42%), coronary artery perforation during percutaneous coronary intervention (PCI; 13.9%), viral pericarditis (11.1%), cardiac electronic device implantation (10.6%), catheter ablation (8.7%) and post-pericardiotomy syndrome (5.8%). Overall, iatrogenic cause was the most common indication for PP (41.8%). The median volume of pericardial fluid was 550 (330; 850) ml. In-hospital death was reported in 11 patients (5.3%). Univariate analysis revealed that in-hospital death was predicted by PCI-related etiology (p<0.0001), history of pulmonary embolism (p=0.007) and sudden cardiac arrest (p=0.032), lower pericardial drainage volume (p=0.037), right bundle branch block (p=0.007), cardiogenic shock (p=0.003), packed red blood cells transfusion (p=0.023). Logistic regression indicated that PCI-related etiology (OR 76.1, p<0.001), history of pulmonary embolism (OR 17.9, p=0.03) and recurrent/persistent cardiogenic shock in the course of in-hospital stay (OR 14.7, p=0.004) were independently associated with in-hospital mortality (AUC 0.895; Figure 1).

Conclusion

Iatrogenic etiology represents the most frequent indication for PP. PCI-related coronary perforation confers the greatest risk of in-hospital death.
Long term safety of paclitaxel coated balloon for de novo non-small coronary lesions
Authors: He X Q , Liu Y , Yin Z Y , Li F , Geuns R J , Garg S , Onuma Y , Serruys P , Gao C , Tao L
Published: November 2023

Background

The efficacy of drug-coated balloons (DCB) for treating de novo coronary stenoses in non-small lesions remains unclear.

Purpose

To evaluate the long-term efficacy of DCB to second-generation drug eluting stent (DES) in de novo, non-small coronary lesions.

Methods

Patients treated with paclitaxel-DCB were compared with patients from two second-generation drug eluting stent (DES) registries. Only patients having DES-only or DCB-only strategies were included; those with in-stent restenosis, a device diameter<2.5mm, DES bailout post-DCB treatment, or combined use of DES and DCB were excluded. The primary endpoint was a patient-oriented composite endpoint (PoCE) defined as all-cause death, any non-fatal myocardial infarction (MI), any stroke, and any revascularization at 2-year. Differences in the risk of PoCE between cohorts were compared and adjusted by inverse probability of treatment weighting (IPTW).

Results

The study included 6,284 patients with 5,399 treated with DES and 885 with DCB. The mean device diameters were 3.05 mm and 2.88 mm in the DES and DCB cohort, respectively. At 2-year follow-up, the primary endpoint occurred in 531 (9.8%) patients receiving DES and 92 (10.4%) patients treated with DCB (HRcrude:1.10, 95%CI:0.88-1.37, P=0.418; HRIPTW:1.08, 95%CI:0.79-1.47, P=0.639; Figure 1). All-cause death occurred in 230 (4.3%) patients in the DES group and 11 (1.2%) patients in the DCB group (HRIPTW:0.27, 95%CI: 0.12-0.57), any non-fatal MI occurred in 56 (1.0%) patients in the DES group and 13 (1.5%) patients in the DCB group (HRIPTW:0.94, 95%CI:0.39-2.25), any stroke occurred in 108 (2.0%) patients in the DES arm and 8 (0.9%) patients in the DCB group (HRIPTW:0.63, 95%CI: 0.29-1.39), and any repeat revascularization occurred in 199 (3.7%) patients in the DES arm and 69 (7.8%) patients in the DCB group (HRIPTW:2.10, 95%CI: 1.43-3.11).

Conclusion

We did not observe DCB to be associated with a higher rate of PoCE than DES in patients with de novo coronary lesions which were ≥2.5mm in diameter. However, DCB was associated with significantly lower mortality and significantly higher rates of repeat revascularization than DES.Figure 1