bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacodynamic comparison of optimal platelet reactivity by multiple platelet function tests in Korean acute coronary syndrome patients with half-dose ticagrelor or prasugrel treatment
Authors: Kim M.H , Jin C.D , Song K , Lee G.M , Moon H.Y , Jo Y.S , Yoon C.H , Cho Y.R , Park J.S , Lim K.H 
Published: November 2020

Abstract

Background
East Asians treated with potent P2Y12 inhibitors, prasugrel or ticagrelor exhibit more potent platelet inhibition than clopidogrel. Whether half-dose de-escalation strategy would improve optimal platelet reactivity at maintenance in East Asian patients with acute coronary syndrome (ACS) remains uncertain.

Method
In de-escalation strategy single center study, eligible Korean ACS patients (n=96) were assigned to receive standard-dose ticagrelor (n=33), prasugrel (n=28), followed by half-dose reduction at 1 month for maintenance, and clopidogrel (n=35) as control. Platelet reactivity was measured by VerifyNow, light transmittance aggregometry (LTA) and multiple electrode aggregometry (MEA). The investigators aim to compare optimal platelet reactivity status (OPR, defined as 85–208 P2Y12 reaction unit [PRU] for VerifyNow (VN), 16%–47% for LTA and 19–46 U for MEA) among 3 different platelet function tests at 3 months post PCI.

Results
At 3 months, ticagrelor achieved significantly lower PRU (17 [6–51] vs. 95 [61–151] vs. 172 [111–204]) than prasugrel and clopidogrel, resulting OPR rate 10% vs. 57.7% vs. 60.0%, respectively. Similar results were observed at LTA method (2% [0–12] in ticagrelor vs. 18% [13–22] in prasugrel vs. 18% [11–30] in clopidogrel), with OPR rate 11.8% vs. 69.2% vs. 50.0%, respectively. However, platelet reactivity was similar by MEA method (16 [13–20] in ticagrelor vs. 17 [13–22] in prasugrel vs. 19 [14–28] in clopidogrel), with OPR rate 33.3% vs. 40.0% vs. 42.0%, respectively (all p&gt;0.005). Among the three tests, resulting higher correlation between VN and LTA (r=0.745), MEA and LTA vs. MEA and VN showed lower correlations (r=0.412 and r=0.303). (Fig.)

Conclusion
In Korean ACS patients with half-dose de-escalation strategy after 1 month, OPR rate in ticagrelor is still rare during 3-month treatment by VN and LTA methods, however, prasugrel appears comparable to clopidogrel. VN/LTA might overestimate platelet function than MEA or MEA underestimate OPR rate than VN/LTA.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): National Research Foundation of Korea
Sheathless guiding catheter versus “slender” sheath/guiding catheter combination in acute coronary syndrome: a propensity-matched analysis of two downsized devices
Authors: Isawa T , Horie K , Honda T 
Published: November 2020

Abstract

Purpose
We investigated the differences between a sheathless guiding catheter and a Glidesheath slender/guiding catheter combination regarding access-site complications in percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).

Methods
We enrolled consecutive 1108 patients undergoing transradial primary PCI for ACS at our hospital using either a 7.5-Fr sheathless guiding catheter (Sheathless group) or a 7-Fr Glidesheath slender/7-Fr guiding catheter combination (Glidesheath group); 1:1 propensity score matching was performed, and 718 subjects (359 in each group) were included in the propensity-matched sample.

Results
Compared with the Sheathless group, the Glidesheath group had significantly less frequent ultrasound-diagnosed radial artery occlusion at 30 days (Sheathless: 4.7% vs. Glidesheath: 1.4%, p=0.015). No significant differences were observed in severe radial spasm (Sheathless: 1.4% vs. Glidesheath: 2.0%, p=0.77) or access-site bleeding (Sheathless: 9.8% vs. Glidesheath: 8.6%, p=0.70).

Conclusion
Thus, 7-Fr Glidesheath slender/7-Fr guiding catheter combination is clearly more advantageous than 7.5-Fr sheathless guiding catheters for decreased risk of radial artery occlusion in transradial PCI for ACS.
“Sheathless” vs. “Glidesheath slender”

Funding Acknowledgement
Type of funding source: None
Complete versus culprit-only PCI in patients with STEMI and multivessel disease: a systematic review and meta-analysis of randomized controlled trials
Authors: Levett J.Y , Windle S.B , Filion K.B , Cabaussel J , Eisenberg M.J 
Published: November 2020

Abstract

Background
Approximately half of patients with ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (CAD) during primary percutaneous coronary intervention (PCI).

Purpose
To compare the risks of major cardiovascular outcomes and procedural complications in patients with STEMI and multivessel CAD randomized to complete revascularization versus culprit-only PCI.

Methods
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing complete to culprit-only PCI, identified via a systematic search of MEDLINE, Embase, and the Cochrane Libraries. Count data were pooled using DerSimonian and Laird random-effects models with inverse variance weighting to obtain relative risks (RRs) and corresponding 95% confidence intervals (CIs).

Results
A total of 8 RCTs (n=6,632) were included, with mean/median follow-up times ranging from 6 to 36 months. Compared to culprit-only PCI, complete PCI was associated with a substantial reduction in MACE (12.6% vs. 22.0%), repeat myocardial infarction (4.5% vs. 6.9%), and repeat revascularization (3.3% vs. 12.1%) (Table 1). Complete PCI may also improve all-cause and cardiovascular mortality, but estimates were accompanied by wide 95% CIs. Findings for stroke, major bleeding, and contrast-induced AKI were inconclusive.

Conclusion
Complete revascularization appears to confer benefit over culprit-only PCI in patients with STEMI and multivessel CAD, and should be considered a first-line strategy in these patients.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Mr. Levett is supported by a Dr. Clarke K. McLeod Memorial Scholarship, funded through the McGill University Faculty of Medicine Research Bursary Program. Dr. Filion is supported by a Junior 2 Research Scholar award from the Fonds de recherche du Québec – Santé and a William Dawson Scholar award from McGill University.
Gender in non- ST elevation myocardial infarction and unstable angina: is there any equality?
Authors: Lopes J , Saleiro C , Campos D , Sousa J , Puga L , Gomes A , Ribeiro J , Lourenco C , Silva J , Goncalves L 
Published: November 2020

Abstract

Background
Historically, women (W) with acute coronary syndrome (ACS) have worse outcomes compared with men (M). This fact may occur due to gender-specific differences in the presentation and management of patients (P), which were mainly observed in studies dealing with ST-segment elevation infarction (STEMI). There seems to be a gap of knowledge in gender-specific differences in non- ST elevation myocardial infarction (NSTEMI) and unstable angina (UA).

Purpose
Assess gender-specific differences in presentation, treatment and outcomes in NSTEMI and UA patients.

Methods
A retrospective cohort study from consecutive ACS patients enrolled in a multicentre national registry from October 2010 to December 2018 was conducted, identifying 11394 P admitted with NSTEMI or UA. Demographic, clinical and treatment variables were compared between male gender and female gender P.
A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints: mortality at 1-year (1y) and cardiovascular (CV) hospitalization at 1-year.

Results
A total 11394 P were included, 8145 M (71.5%) and 3249 W (28.5%), mean age of 68±13. W, comparing with M, had higher age (72±12 vs 66±13, p=0.001), higher prevalence of hypertension (85% vs 72%, p=0.001) and diabetes (41% vs 34%, p=0.001) and longer time from symptoms to hospital admission (360 minutes vs 297 minutes, p=0.001). Chest pain was less frequent as first symptom in W (85.6% vs 91.3%, p=0.001). In medical treatment, W had higher chance of not having administration of a loading dose of P2Y12 inhibitor (22.1% vs 18.1, p=0.001) and of being medicated with clopidogrel (85.7% vs 82.1%, p=0.002). At discharge, W were less frequently medicated with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (82.6% vs 84.4, p=0.028). Coronary angiography was less frequently performed in W (77.3% vs 85.7%, p=0.001). Coronary artery disease was less frequently found in the female gender (12.4% vs 4.8%, p=0.001).
In-hospital mortality was higher in W (2.9% vs 2.1%), but in the multivariate analysis the female gender was not an independent predictor of in-hospital mortality (OR 1.05 [0.67- 1.65], p=0.823). 1-year mortality was higher in W (9.2% vs 7.3%) and 1-year CV hospitalization was higher in M (16.8% vs 14.4%). After adjusting for covariates in Cox regression analysis, difference was still significant for mortality (HR= 1.274 [1.038 - 1.564], p=0.02) and hospitalization (HR = 0.852 [0.726- 0.998], p=0.047).

Conclusion
In this NSTEMI and UA cohort, there are important gender-specific differences in comorbidities, diagnosis, management and outcomes. Gender was an independent predictor of 1-year mortality and 1-year CV hospitalization, but not an independent predictor for in-hospital mortality.

Funding Acknowledgement
Type of funding source: None
Clinical assessment and angiographic finding in patients with non ST-elevation myocardial infarction
Authors: Elbeyali M 
Published: November 2020

Abstract

Background
Non ST-elevation myocardial infarction is considered the intermediate form of acute coronary syndrome between unstable angina and ST-elevation myocardial infarction. Blockage either occurs in a minor coronary artery or causes partial obstruction of a major coronary artery. The rate of NSTEMI has increased to be 50% of all acute coronary syndrome.

Purpose
To compare some demographic, clinical risk assessments and angiographic data among high, intermediate and low risk NSTEMI patients.

Methods
We classified one hundred twenty (120) NSTEMI patients into 3groups by GRACE risk score (high risk group &gt;140, intermediate risk group from 109 to 140 and low risk group ≤108). The patients were evaluated by personal history taking, risk factors, clinical examination, ECG, laboratory investigations, echocardiography and percutaneous coronary intervention.

Results
We found that low risk group percentage was 47.5%, intermediate risk group percentage was 32.5% and high-risk group percentage was 20%. As regarding culprit lesion, LAD represent most affected artery (48.3% of patients).Recurrent ischemia and MI represent the highest percentage of major adverse cardiac event (MACE) among studied groups. All patients with LM disease have a MACE while 41.2% of MACE patients have significant LAD lesion. As time of intervention delayed the incidence of MACE increases among different groups. High risk group has significantly high percentage of type C lesion and TIMI 0/1 while type A lesion and TIMI III lesion highest among low risk patients. As regarding contour of the lesion, the irregularity increases as the clinical risk increases. Also as regarding occlusion of culprit artery, the incidence of total occlusion increases as the clinical risk increases.

Conclusions
We recommend selection of high-risk NSTEMI patient to direct them for early invasive therapy. Very high-risk directed for immediate revascularization like STEMI patient. NSTEMI considered precursors to STEMI and an early warning signal that aggressive medical intervention needed.
Association between time to intervention

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University budget
Complete revascularization of non-culprit lesions in stemi is associated with improved myocardial salvage and reduced microvascular obstruction: a cardiac magnetic resonance study
Authors: Calvo M , Guzman J , Perez P , Ortega L.G , Mendieta G , Lorenzatti D , Perez N , Gavara J , Marcos Garces V , Brugaletta S , Sabate M , Bodi V , Ortiz Perez J.T 
Published: November 2020

Abstract

Background
The COMPLETE trial showed that routine and complete Percutaneous Coronary Intervention (PCI) of non-infarct related artery (non-IRA) lesions in STEMI was associated with a significant reduction in the rates of death or new myocardial infarction. However, whether this benefit is related to improved myocardial salvage and left ventricular (LV) function is unknown.

Methods
We prospectively included 465 patients with first STEMI reperfused by primary PCI. Late gadolinium-enhanced Cardiac Magnetic Resonance (CMR) was obtained during admission to measure the area at risk (AAR), IRA-infarct size (IS) as % LV mass, and myocardial salvage index (MSI) as % of AAR. The study was repeated in 392 of them at 6 months follow-up to compute LV volumes and ejection fraction (EF).

Results
Patients with three-vessel disease had larger IS than those with two or single vessel disease (25.4±14.5% vs 19.0±13.1% vs 19.0±12.8% LV mass respectively, p&lt;0.05), despite no differences in AAR (33±11% LV mass for all). Accordingly, MSI decreased progressively for one, two or three-vessel disease (42.4±31.4 vs 41.5±30.6 vs 25.1±31.3% AAR respectively, p&lt;0.01). The number of myocardial segments with microvascular obstruction (MVO) was also higher for three-vessel disease (1.9±1.9) than for two (1.1±1.7) or single-vessel disease (1.2±1.8), p&lt;0.05. Mean follow-up EF also decreased progressively with the number of vessels involved (50.7±9.4, 49.1±11.4 and, 44.4±11.2% respectively, p&lt;0.01). A total of 183 patients had multivessel disease. Among them, those with complete revascularization (n=51) had larger MSI (46.4±35.2 vs 34.5±29.3% AAR, p&lt;0.04) and were less likely to have MVO phenomenon (28.6 vs 49.2%, p&lt;0.05). However, no significant differences in the change in EF was observed between both groups (ΔEF:+4.4±6.2 vs +4.3±6.2%, p=0.985 for the interaction).

Conclusion
The presence and extent of multivessel disease influence myocardial salvage and MVO following primary PCI in STEMI. Improvement in myocardial salvage in the IRA territory and a reduction in microvascular obstruction may mediate the beneficial effects of complete revascularization.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundaciό La Marato TV3 2015303132, FIS PI15/00531. Partially funded with FEDER funds.
The clinical significance and prognostic value of early second peak of hs-troponin t in patients successfully treated with primary pci
Authors: Ohtaroglu K , Durmaz E , Karadag B , Raimoglu U , Mutlu D , Tokdil H , Karaca O , Polat F , Ozmen E , Koca D , Incesu G , Ongen Z 
Published: November 2020

Abstract

Background
It was previously demonstrated that in patients with ST segment elevation myocardial infarction (STEMI) high-sensitive troponin-T (Hs-cTnT) makes two peaks. However, the clinical significance of the second peak (early vs late) in patients undergoing successful primary percutaneous intervention (pPCI) is not known. We investigated the role of early second peak on clinical outcomes.

Methods
Patients who underwent successful pPCI were included. Baseline characteristics, angiographic variables and kinetics of Hs-cTnT levels following pPCI were recorded. Second peak of Hs-cTnT was defined as re-elevation of troponin levels above plateau levels. The second peak of Hs-cTnT is defined as early second peak, if re-elevation is detected earlier than 72 hours after the diagnosis and late second peak, when re-elevation is detected later than 72 hours.

Results
We included 250 patients divided into two groups; patients with early second peak as group 1 (n=118) and rest of the patients as group 2 (n=132). Baseline characteristics and comorbidities were similar. Peak level of Hs-cTnT, Hs-CRP and pro-BNP levels were significantly lower in group 1 patients. Left ventricular ejection fraction was higher in group 1 patients (47.48±7.7 vs 43.80±9.3, p-value: 0.001). There was no significant difference with respect to new-onset heart failure (24% vs %28, p: 0.503) between groups however cardiac mortality was significantly lower in group 1 patients (%2 vs %11, p: 0.007).

Conclusion
The early second peak of Hs-cTnT in patients with STEMI is associated with successful reperfusion and predictors of better clinical outcome. Moreover, early second peak of Hs-cTnT is associated with decreased cardiac mortality and has a potential to be used as a marker of good prognosis.

Funding Acknowledgement
Type of funding source: None
Clinical practice and outcomes in elderly STEMI patients undergoing PCI with new generation DES – data from a large worldwide registry
Authors: Roguin A 
Published: November 2020

Abstract

Background
The best treatment option for elderly patients with acute myocardial infarction (MI) remains unclear.

Purpose
We aimed to determine clinical practice and outcomes of PCI with a new generation DES in patients with ST-elevated MI (STEMI), aged ≥80 years included in a one of the largest real-world PCI registries.

Methods
e-Ultimaster is a prospective, world-wide, multi-centre registry that enrolled 36,671 patients with coronary artery disease, treated with a thin strut sirolimus-eluting stent with abluminal bioresorbable polymer coating, across 50 countries. 34,538 patients who completed 1-year follow-up or who died were included in the analysis. The primary endpoint was 1-year target lesion failure (TLF: cardiac death, target vessel (TV) MI, clinically driven (CD) target lesion revascularization (TLR)). An Clinical Event Committee adjudicated all endpoint-related adverse events.

Results
6863 presented with STEMI at baseline (19.9%). Mean age of STEMI patients was 61.0±11.7 years, with 78.8% males. Diabetes was present in 20.9% and hypertension in 52.4%.
Of 6863 STEMI patients, 430 patients (6.2%) were aged ≥80 years, with 46.5% females compared to 19.5% females in the younger group. Patients in the older group had more comorbidities (hypertension and renal impairment) and more often took oral anticoagulant medication (9.2% vs 3.9%; p&lt;0.001). At discharge 94.9% of older STEMI patients were on dual antiplatelet therapy (DAPT) as compared to 97.6% of younger STEMI patients (p=0.002). Older STEMI patients more often took clopidogrel as second antiplatelet agent (54.7% vs 39.8%; p&lt;0.001) and were less often on prasurgrel (2.3%vs 10.9%; p&lt;0.001) and ticagrelor (41.2% vs 48.1%; p=0.005).
STEMI patients in the older group more often had multivessel disease (52.1 vs 45.8%; p=0.01), treatment of the left main artery (4.7 vs 1.4%; p&lt;0.001) and more calcified lesions (18.8 vs 11.2%; p&lt;0.001). Other lesion characteristics were similar between the two groups. Preferred access approach was radial and was alike in the two groups (87.0 vs 84.0%; p=0.10)
In-hospital mortality was more frequent in older STEMI patients (2.3% vs 0.8%; p=0.003). More bleedings were observed in older vs younger STEMI patients at discharge.
One-year TLF was significantly higher in older age group (7.0% vs 3.0%; p&lt;0.01), mainly driven by increased rates of cardiac death. All-cause mortality and bleedings were also more frequent in older STEMI patients. No differences were observed in revascularization or ST rates (1.4 vs 1.1%; p=0.48).

Conclusions
In elderly patients with STEMI, in-hospital mortality rates as well as bleeding rates were higher as compared to younger patients, while 1-year rates of revascularization and ST did not differ between the groups.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Terumo Europe
Effect of transradial ECG guided immediate intervention on culprit lesion with a single guiding catheter on door to balloon time
Authors: Guo G.J.C , Wang W.G.Z , Liu L.Z.J , Li L.H.D , Niu N.D , Gan G.S.J 
Published: November 2020

Abstract

Objective
There is limited literature on procedure of primary PCI in catheterization laboratory. This study was designed to assess the impact of electrocardiogram-guided immediate intervention on culprit lesion with a single guiding catheter in ST-elevation myocardial infarction (STEMI) patients on door-to-balloon (D2B) time and clinical outcomes.

Methods
In this prospective, randomized single center study, 560 patients with STEMI who underwent primary PCI from February 2017 to July 2019 were randomized into two groups. In single catheter group, a single guiding catheter (MAC3.5 or JL 3.5 guiding catheter) was used to perform angiogram and PCI of culprit vessel, followed by contralateral angiography (n=280). In contral group, 280 patients underwent primary PCI after complete diagnostic angiography. The primary evaluation was D2B time and second endpoint include catheterization laboratory-to-balloon (C2B) time, major adverse cardiac events (MACE) at 30 days. This trial was registered with ClinicalTrials.gov, NCT03272451.

Results
Baseline characteristics were not different between the two groups. The median D2B time (54.83 [IQR 40.00–68.0] min versus 58.32 [IQR 44.12–78.40] min, P=0.007), C2B time (16.91 [IQR 13.88–21.42] min versus 23.80 [IQR 18.92–28.52] min, P&lt;0.001), total procedural time (45.17 [34.06–59.48] min versus 48.51 [37.04–64.60] min, P=0.012) and fluoroscopy time (9.70 [6.50–14.15] min versus 11.26 [8.01–14.27] min, P=0.025)were significantly shorter in single catheter group Compared with control group. The proportion of patients achieving D2B time within 60 minutes increased significantly in the single catheter group (61.79% vs. 52.14%, P=0.021). The rate of radial perforation was significantly reduced in single catheter group (0.71% vs. 3.21%, P=0.033). The total number of catheters was significantly less in single catheter group (1.18±0.54 vs. 2.23±0.60, p&lt;0.001). There was no significant difference in the MACE at 30 days (2.5% vs. 4.64%, P=0.172) between the 2 groups.

Conclusion
ECG-guided immediate intervention on culprit lesion with a single guiding catheter in STEMI patients can reduce D2B time, C2B time, procedural time and fluoroscopy time.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Capital's Funds for Health Improvement and Research