bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radial versus femoral access for coronary angiography and interventions: a systematic review and meta-analysis of randomized trials
Authors: Chiarito M , Cao D , Nicolas J , Roumeliotis A , Power D , Chandiramani R , Goel R , Claessen B.E , Ferrante G , Stefanini G.G , Mehran R , Dangas G 
Published: November 2020

Abstract

Background
The presence of any benefits associated with radial or femoral access among patients undergoing coronary angiography and percutaneous coronary interventions (PCI) is still debated.

Purpose
Our aim is to provide a comprehensive quantitative appraisal of the effects of access site on the risks of stroke, myocardial infarction, and major bleeding in patients undergoing coronary angiography with or without PCI.

Methods
In January 2020, we searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access for coronary angiography with or without subsequent PCI. Odds ratios (OR) were used as metric of choice for treatment effects with random-effects models. Co-primary efficacy endpoints were stroke and myocardial infarction. Primary safety endpoint was major bleeding. Secondary endpoints were all cause mortality and vascular complications. Heterogeneity was assessed with the I-squared index. This study is registered with PROSPERO.

Results
We identified 31 trials, including 30,414 patients. Risks of stroke (OR 1.11, 95% CI 0.76–1.64, I2=0%) and myocardial infarction (OR 0.90, 95% CI 0.79–1.03, I2=0%) were comparable between radial and femoral access. Radial access was associated with a reduction for the risk of major bleeding as compared to femoral access (OR 0.53, 95% CI 0.42–0.67, I2=3.3%) with a number needed to treat of 92. Findings were consistent regardless clinical features and procedure performed, with the only exception of an increased benefit of the radial access in patients with chronic coronary syndrome (p forinteraction=0.005). The risk for all-cause mortality (OR 0.73, 95% CI 0.61–0.89, I2=0%) and vascular complication (OR 0.32, 95% CI 0.23–0.44, I2=16.7%) was significantly lower in the radial compared to femoral access group.

Conclusions
In patients undergoing coronary angiography with or without PCI, radial compared to femoral access did not reduce the risk of stroke and myocardial infarction, with no impact on the effect estimates of clinical presentation, age, gender, or subsequent PCI. Whereas, radial access is associated with a significant risk reduction of major bleeding as compared to femoral access. The benefit favoring radial access is of important clinical relevance in view of the relatively low number needed to treat to prevent a major bleeding and the significant impact on mortality.

Funding Acknowledgement
Type of funding source: None
Side branch long lesion with main vessel vulnerable plaques by optical coherence tomography predict target-vessel myocardial infarction after provisional stenting in patients with coronary bifurcation
Authors: Chen S.L 
Published: November 2020

Abstract

Background
Provisional side branch (SB) stenting is correlated with target-vessel myocardial infarction (TVMI) in patients with coronary bifurcation lesions. However, the underlying mechanisms remain unknown.

Objectives
We aimed to determine the correlation of SB lesion length with vulnerable plaques using optical coherence tomography (OCT) and TVMI in patients with coronary bifurcation lesions treated by a provisional approach.

Methods
A total of 405 patients with 405 bifurcation lesions who underwent pre-PCI OCT imaging of both main vessel (MV) and SB was prospectively enrolled. Patients were defined as Long-SB lesion (SB lesion length ≥10 mm) and Short-SB lesion (SB lesion length &lt;10 mm) groups according to quantitative coronary analysis and were also stratified by the presence of vulnerable plaques based on OCT findings. The primary endpoint was the occurrence of TVMI after provisional stenting at one-year follow-up.

Results
178 (43.9%) patients had long SB lesions. Vulnerable plaques predominantly localized in the main vessel (MV) and more frequently in the Long-SB lesion group (42.7%) compared to 24.2% in the Short-SB lesion group (p&lt;0.001). At one-year follow-up after provisional stenting, there were 31 (8.1%) TVMIs, with 11.8% in the Long-SB lesion group and 4.4% in the Short-SB lesion group (p=0.009), leading to significant difference in target lesion failure between two groups (15.2% vs. 6.6%, p=0.007). The rate of cardiac death, revascularization, and stent thrombosis was comparable between study groups. By multivariate regression analysis, long SB lesion length (p=0.011), presence of vulnerable plaques in the polygon of confluence (p=0.001), and true coronary bifurcation lesions (p=0.004) were three independent factors of TVMI.

Conclusions
Long-SB lesion length with MV vulnerable plaques predict increased TVMI after provisional stenting in patients with true coronary bifurcation lesions. Further study is warranted to identify the better stenting techniques for coronary bifurcation lesions with long lesion in the SB
Kaplan-Meier survival curve

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): NSFC
Differential diagnosis and intervention for braid-like coronary artery – case series analysis based on intracoronary artery imaging
Authors: Leng W.X , Gao L.J 
Published: November 2020

Abstract

Background
Case reports on braid-like coronary arteries, often diagnosed as Woven Coronary Artery, are accumulating. However, the diversity of manifestation of such lesions has caused great confusion.

Methods
Consecutive patients admitted to Fuwai hospital with braid-like lesions on coronary angiography (CAG) were included. Intracoronary optical coherence tomography (OCT) was performed to verify the lesion nature. Major cardiovascular events were recorded in 12 months when a control CAG was recommended.

Results
From January 2018 to June 2019, braid-like lesions were identified in 6 patients (5 male) with average age of 45.3 years. All patients were transferred from lower-level hospitals. Five patients were current heavy smokers, and 4 patients had an old anterior myocardial infarction history. The braid-like segments were found in right coronary artery of 4 patients and in left anterior descending artery of the other 2 patients. Of these 6 braid-like lesions, 3 were culprit of coronary adverse events, and the other 3 lacked relevant history or documented inducible ischemia. The OCT images of all lesions were consistent with recanalization of organized thrombi, which consisted of septa that divided the lumen into multiple small cavities communicating with each other with significant stenosis. These structures had smooth inner borders with traces of intraluminal thrombi, but no separate 3-layered structure could be defined. Drug eluting stents were successfully implanted in all braid-like lesions. All patients were event free for 12 months, and 3 patients received control CAGs which showed stents patent.

Conclusions
Most cases of braid-like coronary artery may be recanalization of organized thrombi rather than Woven Coronary Artery. Smoking may be a potential risk factor. Percutaneous stent implantation may be challenging but benificial in selected patients. The underlying cause of the forming of such thrombotic lesions remained unclear.
Imagings before and after intervention

Funding Acknowledgement
Type of funding source: None
Similar degree of intimal coverage and apposition among drug-eluting stents with persistent, absorbable or without polymer at 1 and 6 months after implantation
Authors: Calvo Fernandez A , Negrete A , Tizon-Marcos H , Millan R , Salvatella N , De La Torre J.M , Diez J.L , Ivern C , Gomez-Lara J , Vaquerizo B 
Published: November 2020

Abstract

Background
Despite technological advances in drug-eluting stents (DES) design, delayed vascular healing is still a problem, triggered by the polymers among others. This may induce restenosis and thrombosis. The development of biodegradable polymers and DES without polymer is thought to improve the vascular response and enhance earlier neointimal healing. Optical coherence tomography (OCT) is the best intracoronary imaging tool to evaluate endothelial coverage after stent implantation.

Purpose
We aimed to quantitatively assess the differences on intimal coverage between biodegradable-polymer, durable-polymer and without-polymer DES at 1 and 6-month follow-up OCT.

Methods
A total of 94 patients with de novo coronary lesions were treated with DES: 26% were treated with Biolimus A9 (BA9) stent without polymer, 30% were treated with Everolimus DES with biodegradable polymer (EESb) and 44% with Everolimus DES with persistent polymer (EESp). OCT analysis was performed blindly at an independent Core Lab at three stages: implantation, after one month and after six months.
The primary endpoint was to compare neointimal coverage and apposition of these three different types of DES with OCT at one and six months after implantation.

Results
A total of 16034 struts were analysed (24% BA9, 29% EESb and 47% EESp). No significant differences were found among the groups regarding baseline clinical characteristics. When studying the strut coverage, it is remarkable the relatively low percentage of early neointimal coverage with no significant differences among stents one month after implantation (84–87%). After six months, there was better coverage in the three stent groups compared with one month (p&lt;0.001). The stents without polymer had better neointimal coverage at six months compared with the stents with persistent polymer (99% vs 92%, p=0.0002). No significant differences were found in the strut apposition after one or six months among the three stent types. However, the rate of apposition was higher after six months compared with one month in all stent groups (p=0,001). No significant differences were found in the neointimal hyperplasia at one month among the three stent groups. At six months there was a higher hyperplasia in the stent without polymer compared to the stent with persistent polymer (164μm vs 92μm, p=0,003). The degree of hyperplasia after six months was higher compared to one month in all groups (p=0,001).

Conclusions
The new-generation DES with biodegradable-polymer or without polymer showed relatively poor early neointimal coverage and similar to the last generation durable-polymer EES. According to these results, DAPT may not be shortened in any of the three DES types studied.

Funding Acknowledgement
Type of funding source: None
Differential impact of target vessel on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment
Authors: Takashima H , Ohashi H , Ando H , Suzuki A , Sakurai S , Nakano Y , Sawada H , Fujimoto M , Naito K , Tanabe S , Suzuki W , Waseda K , Amano T 
Published: November 2020

Abstract

Background
Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel.

Method
This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results
In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p&lt;0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p&lt;0.001, LCX; r=0.771, p&lt;0.001, RCA; r=0.769, p&lt;0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p&lt;0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p&lt;0.01 for LAD compared to LCX, p&lt;0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p&lt;0.05 for among 3 vessels).

Conclusion
RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice.

Funding Acknowledgement
Type of funding source: None
The impact of myocardial volume assessed with cardiac computed tomography on the prediction of coronary lesion ischemia
Authors: Matsuda J 
Published: November 2020

Abstract

Background
Angiographical stenosis assessed by quantitative coronary angiography (QCA) is correlated with fractional flow reserve (FFR). However, there is discrepancy between severity assessed by QCA and functional ischemia assessed by FFR in non-negligible proportion.

Purpose
We sought to investigate the incremental predictive value of left ventricular myocardial mass (LVM) assessed by computed tomography (CT) in addition to QCA for a significant ischemia.

Methods
A total of 177 angiographically intermediate lesions which underwent FFR measurement and cardiac CT were investigated. FFR was measured with pressure-sensor wire during the hyperemia. LVM of the subtended territory to the lesion was measured with use of proprietary off-line software. Having FFR≤0.80 was considered a significant ischemia and the predictors of FFR≤0.80 was determined.

Results
FFR ≤0.80 was detected in 83 (46.9%) lesions. Left anterior descending (LAD) lesion (P=0.013), Male (P=0.013), younger age (P&lt;0.001), small diameter stenosis (DS) (P=0.003), long lesion length (LL) (P=0.003), small minimal lesion diameter (MLD) (P&lt;0.001) and large LVM (P&lt;0.001) were associated with FFR ≤0.80. In multivariate analysis, LAD (OR 2.36; 95% CI 1.05–5.32, P&lt;0.001), MLD (OR 0.080; 95% CI 0.030–0.21, P&lt;0.001) and LVM (OR 1.05; 95% CI 1.03–1.08, P&lt;0.001) independently predicted FFR ≤0.80. Receiver-operating characteristics (ROC) analysis showed the area under the curve (AUC) was improved by combining multiple factors (DS alone, AUC = 0.63 vs DS + LAD, AUC = 0.71: P=0.029) (DS + LAD, vs DS + LAD + LVM, AUC = 0.79: P=0.0071) (Figure).

Conclusion
Myocardial volume of subtended region was associated with myocardial ischemia independent of anatomical stenosis and LAD location.

Funding Acknowledgement
Type of funding source: None
Characterization of plaque features exhibiting physiological mismatch between fractional flow reserve and resting index: near-infrared spectroscopy imaging analysis
Authors: Murai K , Kataoka Y , Hosoda H , Nakashima T , Honda S , Fujino M , Nakao K , Yoneda S , Otsuka F , Nishihira K , Kanaya T , Asaumi Y , Noguchi T , Yasuda S 
Published: November 2020

Abstract

Background
In addition to fractional flow reserve (FFR), resting indexes (RI) have been shown as another physiological measure to evaluate myocardial ischemia. Despite the clinical usefulness of RI without the use of intravenous vasodilatory agent, discrepancy between FFR and RI infrequently occurs. Whether this physiological mismatch is derived by specific plaque feature remains unknown.

Purpose
To characterize coronary plaques associated with coronary physiological mismatch.

Methods
We analyzed 59 coronary arteries (LAD/RCA/LCX=49/4/6) with FFR≤0.80 in 57 stable CAD subjects receiving PCI. Following measurement of FFR and RI, culprit lesion was evaluated by near-infrared spectroscopy and intravascular ultrasound (NIRS/IVUS). The analyzed vessels were stratified according to FFR and RI values: FFR≤0.75+RI&gt;0.89 (n=6: physiological mismatch), FFR&gt;0.75+RI&gt;0.89 (n=6), FFR≤0.75+RI≤0.89 (n=33) and FFR&gt;0.75+RI≤0.89 (n=14).

Results
The median values of percent diameter stenosis, FFR and RI were 51%, 0.75 and 0.87, respectively. Physiological mismatch was observed in 10.1% (=6/59) of analyzed vessels. On IVUS imaging, maximum percent plaque area was greater than 70% in all groups (p=0.29). Furthermore, there were no significant differences in angiographic and IVUS-derived minimum lumen area across 4 groups (Table). However, culprit lesions exhibiting physiological mismatch contained a substantially larger amount of lipid plaque, reflected by a higher maximum 4-mm lipid-core burned index (maxLCBI4mm: p=0.04) on NIRS imaging (Table). Multivariate analysis demonstrated maxLCBI4mm as the only plaque feature associated with physiological mismatch (odds ratio=1.010, 95% CI: 1.001–1.019, p=0.02).

Conclusion
Plaque feature associated with coronary physiological mismatch was the extent of lipidic materials but not the quantity of coronary atheroma. Since the accumulation of lipidic plaque component is caused by endothelial dysfunction, this vascular substrate could impair baseline vasomotion, thereby causing a lower FFR despite preserved RI value. Evaluation of lipidic burden may be a potential option to avoid unnecessary deferral of revascularization in subjects with normal RI value.
maxLCBI4mm in each group

Funding Acknowledgement
Type of funding source: None
Impact of periprocedural myocardial infarction on 10-year mortality after percutaneous coronary intervention or coronary artery bypass grafting for multivessel or left main coronary artery disease
Authors: Hara H , Takahashi K , Ono M , Gao C , Wang R , Kappetein P , Mohr F , Mack M , Holmes D , Morice M , Davierwala P , Head S , Thuijs D , Onuma Y , Serruys P 
Published: November 2020

Abstract

Background
Periprocedural myocardial infarction (PMI) occurs frequently after both percutaneous coronary intervention (PCI) and bypass grafting surgery (CABG) in patients with complex coronary artery disease (CAD), and PMI has been shown to have a detrimental impact on mortality. On the other hand, long-term impact of PMI on mortality has not been fully evaluated.

Purpose
This study aimed to assess the impact of PMI according to SCAI definition on 10-year all-cause death in patients with complex CAD.

Methods
The SYNTAX Extended Survival (SYNTAXES) study evaluated vital status up to 10 years in 1800 patients with de novo three-vessel disease and/or left main coronary artery disease randomized to treatment with CABG or PCI in the SYNTAX trial. Blood was sampled for creatine kinase (CK) pre- and post-revascularisation, and the cardiac specific MB iso-enzyme (CK-MB) was determined only if the CK ratio ≥2 x the upper limit of normal (ULN). If the CK ratio &lt;2 ULN, CK-MB assessment was not mandated. In this analysis, patients with at least one blood sampling within 48 hours of the procedure were included. PMI was defined as follows; peak CK-MB measured within 48 hours of the procedure ≥10 x ULN, or ≥5 x ULN with new Q-waves in 2 contiguous leads or new persistent left bundle branch block.

Results
Of 1800 patients, 1679 (93.2%) patients were included. Of 877 patients treated with PCI, PMI occurred in 26 patients (3.0%), whereas 14 (1.7%) PMIs were observed in 802 patients treated with CABG. Compared with patients without PMI, patients with PMI presented with unstable angina more frequently (45.0% vs. 28.7, p=0.033), and had a higher rate of bifurcation lesion (87.5% vs. 72.5, p=0.046). PMI was associated with a higher all-cause mortality at 10 years compared with no PMI (55.3% vs. 25.4%; Log-rank p&lt;0.001, Figure), which was mainly driven by a high mortality rate within 1 year. In patients undergoing PCI, the mortality rates were significantly higher in patients with PMI not only within 1 year (Log-rank p&lt;0.001) but also beyond one year (Log-rank p=0.016), compare to patients without PMI (Figure). On the other hand, in patients undergoing CABG, a higher mortality rate in patients with PMI was observed until 1 year (Log-rank p&lt;0.001), but the impact of PMI on mortality beyond one year after CABG subsided (Log-rank p=0.308) (Figure 1).

Conclusion
PMI was associated with a poor prognosis at 10 years. The impact of PMI on mortality was strong within one year. Of note, the impact of PMI on mortality persisted beyond 1 year only in patients undergoing PCI. Patients who were treated with PCI and suffered PMI need careful follow-up beyond one year after revascularization.
Figure 1

Funding Acknowledgement
Type of funding source: None