bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fractional flow reserve and instantaneous wave-free ratio discordance in patients with severe aortic valve stenosis
Authors: Yamanaka F , Shishido K , Yokota S , Moriyama N , Mashimo Y , Hayashi T , Miyashita H , Yokoyama H , Tobita K , Mizuno S , Tanaka Y , Murakami M , Takahashi S , Tsujita K , Saito S 
Published: November 2020

Abstract

Background
It has been reported that discordance between fractional flow reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) could occur in up to 20% of cases. However, there are no reports regarding discordance between FFR and iFR in patients with severe aortic valve stenosis (AS).

Purpose
We aimed to investigate the discordance between FFR and iFR in patients with severe AS.

Methods
Severe AS was defined as an aortic-valve area of ≤1.0 cm2, a mean aortic-valve gradient of 40mmHg or more, or a peak aortic-jet velocity of 4.0 m/s or more. Intermediate coronary artery stenosis was defined as 30% to 70% stenosis (visual estimation). FFR and iFR were calculated in 4 quadrants based on values of FFR ≤0.8 and iFR ≤0.89 (positive discordance; low FFR and high iFR, negative discordance; high FFR and low iFR).

Results
We examined consecutive 140 patients (164 intermediate coronary artery stenosis vessels). Mean FFR and iFR ± standard deviation was 0.82±0.09 and 0.82±0.14, respectively. The discordance was observed in 48 vessels (29.3%). In the discordant group, most of cases were negative discordance (45 cases, 93.6%). Binary logistic regression analysis showed that left anterior descending artery (Hazard Ratio 3.80; 1.55 to 9.31, p=0.0036) was independently associated with negative discordance.

Conclusions
In patients with severe AS, the discordance between FFR and iFR could be observed in 29.3% of the vessels, mostly negative discordance. The left anterior descending artery is an independent predictor for negative discordance.

Funding Acknowledgement
Type of funding source: None
The Gly82Ser polymorphism in the receptor for advanced glycation end products is associated with increased risk for coronary events in the general population
Authors: Grauen Larsen H , Sjogren M , Engstrom G , Nilsson P.M , Orho-Melander M , Nilsson J , Melander O , Schiopu A 
Published: November 2020

Abstract

Background/Introduction
Activation of the receptor for advanced glycation end products (RAGE) by AGEs and various immune mediators has pro-inflammatory and pro-atherogenic effects. RAGE also exists in a soluble form, sRAGE, that acts as a decoy receptor for RAGE ligands. Low plasma sRAGE has previously been found to be associated with a higher risk for major adverse coronary events (MACE) in the population.

Purpose
The purpose of our study was to examine the causality of the association, by exploring whether genetic variants that influence sRAGE are associated with atherosclerosis progression and incident MACE and mortality in the population.

Methods
We performed a genome-wide association study (GWAS) in 4192 individuals from a randomly selected subgroup of a population-based cohort. Subsequently, we explored the associations between the identified single nucleotide polymorphims (SNPs) associated with plasma sRAGE levels, baseline intima media thickness (IMT) and IMT progression in the common carotid artery during a median follow-up of 16.5 years. Further, we analyzed the prospective relationships between the sRAGE-associated SNPs, incident MACE and mortality in the entire population-based cohort of 29245 individuals. The median follow-up time from baseline was 21.2 years for MACE and 21.6 years for total mortality (time to event or end of follow-up).

Results
We found the minor alleles of two single nucleotide polymorphisms (SNPs), rs2070600 and rs204993, to be independently associated with lower plasma sRAGE. While rs204993 is a silent intronic mutation, rs2070600 is known to cause a Gly82Ser polymorphism in the ligand binding domain, enhancing RAGE propensity for activation. In Cox regression analyses, we found an association between the minor T (vs. C) allele of rs2070600 and increased risk for first-time MACE [HR 1.12 (1.02–1.23); P=0.023]. The association was independent of traditional cardiovascular risk factors, blood pressure-lowering medication and lipid-lowering medication at baseline. rs204993 was not associated with MACE. Neither SNP was associated with carotid IMT at baseline or with IMT progression. We did not identify any relationships with total mortality.

Conclusions
We demonstrate for the first time an independent link between a genetic RAGE determinant and the risk for MACE in the population. Despite both identified SNPs being associated with lower sRAGE levels, only the functional rs2070600 mutation was associated with MACE, suggesting that the link is probably due to the enhancement of RAGE function rather than to the sRAGE lowering effect.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): This study was supported by grants from the Swedish Research Council and the Swedish Heart and Lung foundation.
Indoleamine 2,3 dioxygenase (IDO) as a new predictor for advance coronary artery diseases
Authors: Wongpraparut N , Pengchata P , Piyophirapong S , Pongakasira R , Maneechotesuwan K 
Published: November 2020

Abstract

Background
Indoleamine 2,3 dioxygenase (IDO), the rate-limiting enzyme in in the kynurenine (Kyn) pathway of tryptophan (Trp) degradation, is modulated by inflammation and regarded as a key molecule driving immunotolerance and immunosuppressive mechanisms. This response accelerates the resolution of inflamed tissues to protect them against collateral damage and facilitate tissue healing. A growing body of evidence indicates that IDO-mediated Trp metabolism is involved directly or indirectly in atherogenesis. Little is known about IDO activity in patients with active coronary artery disease (CAD).

Purpose
We hypothesized that IDO activity as reflected by Kyn/Trp ratio and Kyn levels correlated with coronary artery disease (CAD) severity and predicted 1-year major adverse cardiac events (MACE).

Method
We prospectively enrolled the patients whom underwent coronary angiography in our institute. We excluded the patients whom might have other non-cardiac causes of elevated inflammatory biomarkers such as rheumatoid arthritis, allergic asthma, and so on. Measurements of IDO, hs-troponin and hs-CRP levels were performed at baseline and IDO activity was monitored every 6 month at interval. Baseline demographic, coronary angiogram/interventions data were recorded. Significant CAD defined as &gt;70% stenosis in major epicardial vessel. Patients were followed up for 1-year. MACE were pre-specified.

Results
Three-hundred and five patients were enrolled. Ninety-eight patients (32%) presented with acute coronary syndrome. There was a significant difference in IDO, kynurenine, and hs-troponin between patients with and without significant CAD (Table 1). In addition, baseline IDO activity, kynurenine and hs-troponin levels were significantly higher in significant CAD patients with 3-vessel, 2-vessel and 1-vessel involvements than those with insignificant CAD; (0.17 vs 0.14 vs 0.14 vs 0.04, p&lt;0.01), (5.8 vs 4.5 vs 5.1 vs 2.9 μM/g, p&lt;0.01) and (18.2 vs 12.4 vs 12.7 vs 11.1 mg/dL, p&lt;0.001), respectively. Preliminary data in 287 patients with completion of 1-year follow up showed that 1-year mortality was 2.9%. In comparison between patients who survived and death, it demonstrated markedly higher baseline kynurenine (5.12 vs 0.54 μM/g, p&lt;0.03) and IDO (0.15 vs 0.01, p&lt;0.02) in the patients without 1-year mortality.

Conclusion
Immunometabolic response mediated through IDO function were enhanced in patients with CAD and correlated with the severity and extent of the disease. Patient with inadequate IDO response had a higher 1-year mortality.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The Siriraj grant for research development and medical education of the Faculty of Medicine Siriraj Hospital
Acute coronary syndrome patients with two minor high-bleeding risk criteria have the same bleeding rate that patients with one major criteria
Authors: Cordero A , Garcia-Acuna J.M , Rodriguez-Manero M , Cid B , Alvarez Alvarez B , Agra-Bermejo R , Escribano D , Bertomeu-Gonzalez V , Moreno-Arribas J , Zuazola P , Gonzalez-Juanatey J.R 
Published: November 2020

Abstract

Background
In 2019 the Academic Research Consortium of high-bleeding risk (ARC-HBR) proposed a new and binary definition of high-bleeding risk (HBR) patients based on the presence of 1 major or 2 minor criteria.

Methods
Prospective study of all consecutive patients admitted for ACS in two different centers. We analyzed bleeding incidence in patients with 1 major criteria (1MC) vs. 2 minor criteria (2mC) using the 2019 ARC-HBR consensus. Bleeding events were collected according those fitting definitions 3 or 5 of the BARC consortium.

Results
We included 8,724 patients included and 40.9% we classified as HBR; 20.9% for 1MC and 20.0% for 2mC. In-hospital mayor bleeding rate was 8.6%; no-HBR patients had 0.3%, 2mC 15.1% and 1MC 29.7% (p&lt;0.001 for the comparison). In contrast, the statistically highest in-hospital mortality was observed in patients with 2mC (11.4%), followed by patients with 1MC (8.0%) and no-HBR patients (2.0%).
During follow-up (median time 57.8 months) all-cause mortality rate was 21.0% and cardiovascular dead 14.2%. The incidence of post-discharge major bleeding was 10.5%. No-HBR patients had the lowest bleeding rate (7.4%) and no difference was observed in patients with 1MC (14.6%) or 2mC (15.8%) (figure). The multivariate analysis, adjusted by age, gender, medical treatment, atrial fibrillation and revascularization and considering all-cause mortality as competing risk, showed independent association of 1MC (sHR: 1.46, 95% 1.22–1.75) and 2mC (sHR: 1.31, 95% CI 1.05–1.63) with post-discharge major bleeding.

Conclusions
HBR patients according to the 2019 ARC-HBR containing 2mC or 1MC are at similar and higher risk of in-hospital or post-discharge bleeding events

Funding Acknowledgement
Type of funding source: None
Characteristics and outcome in foreign-born vs Sweden-born patients with myocardial infarction
Authors: Zwackman S , Karlsson J.-E , Sederholm Lawesson S , Jernberg T , Leosdottir M , Eriksson M , Alfredsson J 
Published: November 2020

Abstract

Introduction
Immigration is increasing in most European countries. Little is known about differences in baseline characteristics and outcome between foreign-born and native patients with myocardial infarction (MI).

Purpose
To investigate differences in baseline characteristics and one-year mortality after an MI, based on region of birth.

Methods
We included 194 498 MI patients (36% women) between 2005 and 2016 from the SWEDEHEART registry and compared them according to region of birth: Sweden (Sw, n=166020), Other Nordic countries (No, n=10856), EU countries except Nordic (EU, (n=6301), Non-EU Europe (non EU, n=4779), Asia (n=4927), Africa (n=669), S America (n=567) and N America (n=379). One-year mortality was assessed using a Cox regression model (pairwise with Swedish-born as reference) and in a second model adjusting for age and sex. Data are presented as hazard ratios (HR) with 95% confidence intervals (CI).

Results
There was an increased proportion of foreign-born patients over time (12.8 to 16.7%).
We observed substantial differences in risk factors and comorbidity according to region of birth (lowest vs highest value) in age (mean) (58 vs 72 year, African vs Sw. born), smoking (19 vs 39%, Sw. vs Asian born), history of diabetes (20 vs 36%, African vs Sw. born), hypertension (40 vs 59%, born in African vs No.), MI (17 vs 23%, S America vs EU born) stroke (9 vs 20%, born in S American vs No.), low income (28% vs 56%, Sw. vs Asian born) and low level of education (27 vs 49%, born in Africa vs No.). One-year mortality according to region of birth was 15.4% for patients born in Sweden, 14.0% for patients born in other Nordic countries, 12.8% in EU, 9.6% for non-EU Europe, 6.3% for Asia, 8.4% for Africa, 6.7% for S America and 15.0% for N America. After adjustment for age and sex, the only significant differences were higher mortality in patients born in other Nordic countries (HR 1.1, 95% CI: 1.01–1.12), non-EU Europe (HR=1.12, 95% CI: 1.02–1.23) and Africa (HR=1.68, 95% CI: 1.29–2.19) compared to patients born in Sweden.

Conclusions
We observed increased rate of foreign-born MI patients, with differences in risk profile, comorbidity, education and financial resources according to region of birth, which may impact on observed differences in outcome. Equal access to care pose a challenge which may merit a more comprehensive and individualised approach to cardiac care. Future analyses should explore differences in treatment based on region of birth and potential association with outcome.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Kamprad Family for Entrepeneurship, Research and Charity; The County Council of Östergötland, Sweden; Medical Research Council of Southeast Sweden
Clinical characteristics and prognosis in patients with premature coronary artery disease of different genders after intervention
Authors: Tang X.F , Yao Y , Jia S.D , Liu Y , Xu B , Yuan J.Q 
Published: November 2020

Abstract

Objective
To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders.

Methods
From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up.

Results
Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P&lt;0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P&gt;0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P&lt;0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P&lt;0.001; HR=1.758, 95% CI: 1.365–2.264, P&lt;0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002).

Conclusion
The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China
Quality and clinical outcomes of primary percutaneous coronary intervention after ST-segment elevation myocardial infarction: a population density analysis of a Japanese nationwide registry
Authors: Yamaji K , Kohsaka S , Inohara T , Numasawa Y , Ishii H , Amano T , Ikari Y 
Published: November 2020

Abstract

Background
Despite progress in acute myocardial infarction (MI) treatment, data on geographical disparities in its care remain limited.

Purpose
We aimed to assess the discrepancy by population density (PD) on the quality and clinical outcomes of patients with primary percutaneous coronary intervention (PCI) after ST-segment elevation MI (STEMI).

Methods
The J-PCI registry is a prospective procedural registry conducted by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) to assure the quality of delivered care. Between January 2014 and December 2018, 209,521 patients underwent PCI for STEMI in 1,126 institutes. Population of administrative municipal-level districts was determined through the complete population census. The patients were divided into tertiles according to the PD of the PCI institution location (low: &lt;951.7/km2, n=69,797; middle: 951.7–4,729.7/km2, n=69,750; high: ≥4,729.7/km2, n=69,974).

Results
Patients treated in high PD administrative districts were younger (low: 69.1±12.9, middle: 68.7±12.9, high: 68.0±13.1) and likely to be male (low: 75.6%, middle: 76.0%, high: 76.6%). No significant correlation was observed between PD and door-to-balloon time (DTB: regression coefficients: 0.036 per 1000 people/km2, 95% CI: −0.232 to 0.304, P=0.79). Patients treated in low PD areas had higher crude in-hospital mortality rates than those treated in high PD areas (low: 2.89%, middle: 2.60%, high: 2.38%; P&lt;0.001). Moreover, PD and in-hospital mortality had a significantly inverse association, before and after adjusting for baseline characteristics (crude odds ratio [OR]: 0.983 per 1,000/km2, 95% confidence interval [CI]: 0.973–0.992, P&lt;0001; adjusted OR: 0.980 per 1,000/km2, 95% CI: 0.964–0.996, P=0.01, respectively). Higher PD districts had more operators per institute (low: 6, interquartile range [IQR] 3–10; middle: 7, IQR 3–13; high: 8, IQR 5–13, P&lt;0.001), suggesting an inverse association with in-hospital mortality (OR: 0.992, 95% CI: 0.986–0.999, P=0.03).

Conclusions
Marked geographical inequality was observed in immediate case fatality; patients treated in population-dense areas had a lower in-hospital mortality than those treated in less dense areas. Variation in the number of operators per institute, rather than traditional quality indicators (e.g. DTB) may explain the difference in in-hospital mortality.

Funding Acknowledgement
Type of funding source: None
Impact of age on the obesity paradox in acute coronary syndrome: a nationwide analysis
Authors: Narasimhan B , Ho K , Wu L , Amreia M , Isath A , Bhatia K , Shah A , Kantharia B 
Published: November 2020

Abstract

Background
The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients.

Methods
A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model.

Results
In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p&lt;0.001) with significantly lower 30-day readmission rates as well (p&lt;0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p&lt;0.001).

Conclusion
In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age.

Funding Acknowledgement
Type of funding source: None
The efficacy of a PCSK9 inhibitor for the plaque stabilization in the non-culprit lesion of ACS patients by using near-infrared intravascular ultrasonography
Authors: Wakana N , Zen K , Yanishi K , Nakanishi N , Nakamura T , Yamada H , Matoba S 
Published: November 2020

Abstract

Background and purpose
In acute coronary syndrome (ACS) patients, major cardiovascular events during follow-up were equally attributable to recurrence at the site of culprit lesions and to non-culprit lesions, and mostly occurred within one year. Recent studies showed that Proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor significantly reduces the risk of cardiovascular events. However, the rigorous effects of PCSK9 inhibitor in patients with ACS, especially for the stabilization of plaque in the non-culprit lesions has not been identified. The purpose of this study was to evaluate the efficacy of a PCSK9 inhibitor for the plaque stabilization in the non-culprit lesion of ACS patients.

Methods
We retrospectively analyzed the 10 ACS patients (STEMI:5 cases, NSTEMI:1 case, and UAP:4 cases) who had non-culprit lesions and were injected with a PCSK9 inhibitor. We analyzed 11 non-culprit lesions before and after PSCK9 injections by using a near-infrared intravascular ultrasonography (NIRS-IVUS).

Results
The follow up intervals were 229.4±82.9 days. Major cardiovascular events did not occur in all patients. The serum low-density lipoprotein (LDL) cholesterol levels were significantly decreased form 128±36.7 mg/dl to 26.7±7.4 mg/dl (P&lt;0.01; Figure 1A). There were no significant changes in percent atheroma volume before and after PCSK9 injections. However, the max lipid core burden index (LCBI) were significantly improved from 392.5±155.8 to 209.4±116 (P&lt;0.01; Figure 1B). Although the lesion characteristics did not change in the images, by IVUS, the LCBI of the lesion was significantly decreased after PCSK9 injections. This study suggested that NIRS-IVUS had the possibility of detection for the slight changes in the plaque characteristics, which could not be detected by only an IVUS.

Conclusion
This study suggested that the plaque morphology can be altered by the aggressive lipid lowering therapy by using a PCSK9 inhibitor, and NIRS-IVUS can detect these plaque stabilizations of non-culprit lesion in ACS patients.
The authors have no financial conflicts of interest to disclose concerning the presentation.
Figure 1

Funding Acknowledgement
Type of funding source: None