bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study
Authors: Yeh J.S , Hsu C.Y , Huang C.Y , Chen W.T , Hsieh Y.C , Chien L.N 
Published: November 2020

Abstract

Aims
To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI).

Methods and results
We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1).

Conclusions
Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI.
Figure 1

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University
The effect of SGLT2 inhibitors on silent myocardial ischemia
Authors: Kadro W , Al Turkmani M , Kadro K , Kadro M.Y , Rigali D , Pietro G , Hamid M , Mathew S 
Published: November 2020

Abstract

Background
In large cardiovascular (CV) outcome trials, sodium-glucose co-transporter 2 (SGLT2) inhibitors reduced the development of heart failure (HF) in patients with type 2 diabetes (T2DM). Also it reduced CV death and worsening HF events in HFrEF patients. It is unknown whether SGLT2 inhibitors work through glucose-dependent mechanism or it could have other effects not related to glucose on cardiovascular morbidity and mortality in diabetic patients. Its effect on silent ambulatory myocardial ischemia (SAMI) has not been reported yet. In this study we report the effect of SGLT2 inhibitors on (SAMI). Treating silent myocardial ischemia has a prognostic effect and may improve long term mortality of chronic ischemic heart disease (CIHD).

Methods
We enrolled 44 type 2 diabetic patients with proven stable coronary artery disease (CAD) and at least one episode of on silent ambulatory myocardial ischemia (SAMI) on ambulatory ECG monitoring. All of them were receiving optimal therapy for CIHD and type 2 DM. 22 patients were randomized to receive Dapagliflozin 5mg qd and the other 22 patients received placebo. Ambulatory monitoring was repeated after 4 to 6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, HgbA1c level, and baseline serum cholesterol levels. Holters were read by a blinded cardiologist.

Results
The Dapagliflozin group experienced a significant reduction in the number of episodes of ST-segment depression compared with the placebo group. ST-segment depression completely resolved in 8 of 22 patients (36%) in the Dapagliflozin group versus 3 of 22 (13%) in the placebo group and the Dapagliflozin group exhibited a highly significant reduction in (SAMI) (P&lt;0.001). By logistic regression, treatment with Dapagliflozin was an independent predictor of (SAMI) resolution.

Conclusions
Therapy with SGLT2 inhibitors in type2 DM patients results in reduction or resolution of (SAMI) recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG. A larger study is required to confirm this theory and to see the effect of SAMI reduction on long term mortality of CIHD in diabetics. Possible mechanisms for this beneficial effects of SGLT2i includes: Reduction in oxygen supply-demand mismatch, improvement in cardiac microvascular function, modulation of cardiac energy metabolism, reduction in glucotoxicity, reduction in sympathetic nervous system activation and reduction in blood pressure.

Funding Acknowledgement
Type of funding source: None
Pharmacological preconditioning by Nicorandil in prevention of ischaemic myocardial injury during an elective percutaneous coronary intervention
Authors: Soboleva G , Gostishev R.V , Rogoza A.N , Kotkina T.I , Samko A.N , Soboleva T.V , Karpov Y.A 
Published: November 2020

Abstract

Introduction
Elective percutaneous coronary intervention (PCI) is accompanied by intraoperative ischemic myocardial injury (IIMI) up to 30% of the cases despite successfully performed procedure. Pharmacological preconditioning can prevent IIMI; Nicorandil is considered promising for this purpose.

Purpose
To study the possibility of pharmacological preconditioning by oral Nicorandil to ptevent ischaemic myocardial injury and 4a type myocardial infarction (MI) in patients with a stable form of coronary artery disease (CAD) before PCI.

Material and methods
182 patients with CAD and indications for PCI were randomized into two groups: Nicorandil treatment group (additionally to β-blockers and a calcium channel blockers, n=90) and the control group (β-blockers and a calcium channel blockers, n=92). Nicorandil per os was prescribed 2 days before the PCI (30 mg/day); on the day of PCI – 2 hours before intervention (20 mg), 6–12 hours after PCI – 10 mg. The analysis of hs-Troponin I (hs-Tr) and creatine phosphokinase-MB (CK-MB)was carried out before PCI and 24, 72 hours after the procedure. The diagnosis of MI 4a type was established according to fourth universal definition. Double antiplatelet therapy was prescribed to all patients.

Results
Clinical profile (age, BMI, BP, creatinin clearance, LDL-cholesterol, glucose) of the patient groups were comparable by the basic parameters. The rate of hs-Tr after 24 hours has approached the 99th percentile from the upper limit of normal in 146 patients (80%). The increment of mean level of hs-Tr 24 hours after PCI has not distinguish statistically between the Nicorandil and the control group (364 vs 725 pg/ml, p=0,1). Mean of CK-MB increment in the control group has approached 2,5 ng/ml vs 0,5 ng/ml in the Nicorandil group (p=0.06). Among women (n=61), the increment of hs-Tr in 24 hours after PCI was statistically significantly lower (287 vs 1135 pg/ml, p=0,04) in the Nicorandil group compared to the control group. MI 4a type was detected in 12% of patients in the control group, and it decreased to 3% of patients in the Nicorandil group (p=0,05), it was observed in 21% in women in the control group and in 3% in the Nicorandil group.

Conclusion
Nicorandil treatment using before PCI decreases the risk of MI 4a in patients with a stable CAD due to the realization of pharmacological preconditioning.

Funding Acknowledgement
Type of funding source: None
Clinical outcomes of percutaneous coronary intervention in coronary allograft vasculopathy from single center experience
Authors: Cia Mendioroz X , Oteo Dominguez J.F , Leon Aliz E , Vilches-Soria S , Arellano Serrano C , Garcia-Touchard A , Fernandez Diaz J.A , Caraballo Gomez M.A , Goicolea Ruigomez J , Segovia Cubero J 
Published: November 2020

Abstract

Background/Introduction
Cardiac allograft vasculopathy (CAV) is a leading cause of morbidity and mortality of heart transplant recipients. Percutaneous coronary intervention (PCI) is an alternative to medical treatment, however long-term data from large multicenter studies are scarce.

Purpose
To review clinical characteristics and outcomes of CAV undergoing PCI in our heart transplant series.

Methods
We analysed retrospectively 52 heart transplant recipients with CAV who underwent PCI from 2004 to 2020. Surveillance angiography was performed in 90% of stents. Stent restenosis (SR), stent thrombosis (ST), target lesion revascularization (TLR) and patient survival are reported.

Results
During study period, 124 lesions were treated. Primary success was obtained in 99% of lesions. Mean angiographic follow up was 37±47 months. A total of 31 (25%) stents presented events during follow-up: 24 SR, 7 ST. There were no differences between bare-metal stent (BMS) and drug-eluting stent (DES). We performed 16 (12.9%) TLR. There was no association between clinical and lesion-related features and TLR. Post-PCI survival was 75.3% at 5 and 55.7% at 10 years.. Cytomegalovirus (CMV) infection before development of CAV decreased survival in univariable analysis (p&lt;0.016).

Conclusions
PCI with stent in CAV can be performed with high rates of primary success and low rate of complications, similar to non-transplant patients. Our series suggest that CMV infection can have negative impact in post-PCI survival, but further studies are needed.

Funding Acknowledgement
Type of funding source: None
Prediction of medium term mortality in diabetics with complex ischemic heart disease after first isolated coronary artery bypass grafting: comparison of FREEDOM, SYNTAX II and our formula
Authors: Ostojic M , Arnautovic N , Nezic D , Borzanovic M , Ragus T , Nikolic A , Micovic S , Otasevic P , Djokic D , Ivanovic I , Stanetic B , Kovacevic-Preradovic T , Tasic N , Djajic V , Bojic M 
Published: November 2020

Abstract

Background
Controversies exist how to predict medium term mortality (Mt) in diabetics (DM) with 3 vessel (3VD) and/or left main (LM) disease undergoing myocardial revascularization ranging from Syntax Score II (SSII) where DM was not predicative variable up to FREEDOM formula which was derived, just from population with DM (without LM), having DM patients (Pts) requirement of insulin as one of predicative variable.

Purpose
To compare predicative power of SSII, FREEDOM and formula developed in our institution in Pts post first isolated CABG with 3VD and/or LM with DM.

Methods
From our prospective data base of 2455 consecutive pts who had the first isolated CABG in the period 01/2012–12/2014 with complex Ischemic Heart Disease with 100% follow up of 4 years all-cause Mt we created by random sampling Training (1321; Mt:10.4%; DM 511; Mt:13.3%) and Validation (1134; Mt:10.0%; DM 414; Mt: 11.8%) sets. After deriving predicative formula (Cox regression) from training population we validated FREEDOM, SSII and Our Formula in 414 pts with DM from the Validation set.

Results
Characteristics of pts, our formula, predicating power by C Statistics, Calibration plots and Brier scores are presented in Picture 1.

Conclusions
FREEDOM formula designed just for DM pts with complex Ischemic Heart Disease without LM had the smallest standard error in the estimate, but moderate C statistics as Syntax Score II and our formula which may be used for pts with and without DM and 3VD and/or LM.
Picture 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of education, science and technology development, Republic of Serbia
FREEDOM formula: external validation of diabetics treated by coronary artery bypass grafting in single large volume cardio-surgical center
Authors: Arnautovic N , Ostojic M , Nezic D , Borzanovic M , Nikolic A , Ragus T , Micovic S , Otasevic P , Djokic D , Ivanovic I , Stanetic B , Kovacevic-Preradovic T , Djajic V , Tasic N , Bojic M 
Published: November 2020

Abstract

Background
Freedom formula (FF) was derived very recently to assist in decision making by Heart Team in patients (Pts) with diabetes (DM) who are in need for myocardial revascularization (Percutaneous Coronary Intervention or Coronary artery bypass grafting (CABG)) due to complex ischemic Heart disease (but without left main steam disease (LM)). In external validation moderate C statistics values were obtained.

Purpose
To validate FF predictive value in Pts with DM and more complex patients (three vessel (3VD) and/or LM as well lower left ventricular ejection fraction (LVEF)) than in FREEDOM population.

Methods
From our prospective data base of 2455 consecutive pts who had the first isolated CABG in the period 01/2012–12/2014 with 3VD and/or LM with 100% follow up of 4 years All-cause Mortality (Mt) we retrieved 925 pts with DM.

Results
DM was present in 925 Pts (Mt: 12.6%). On insulin were 318 (34.3%; Mt 14.5%). We analysed the predicative value of FF in the whole group (925) of pts with DM as well as in subgroups with LM (294) and without LM (631; most similar to original Freedom population), separately. Characteristics of pts, Freedom formula, predicating power by C Statistics, Calibration plots and Brier scores are presented in Picture 1.

Conclusions
Our external validation of FF was almost identical as previous published one. Furthermore, the FF may be of value even in pts with LM disease and other vessels involved. Of note our pts as seen by combined LVEF, ClCr and LM were sicker than pts in FREEDOM.
Picture 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of education, science and technological development, Republic of Serbia
Expression of adiponectin and il-6 by local fat depots of the heart: relationship with the main risk factors for cardiovascular diseases
Authors: Gruzdeva O.V , Belik E , Dyleva Y.U.A , Borodkina D.A , Uchasova E.G , Sinitsky M.Y.U , Brel N.K , Karetnikova V.N , Bychkova E.E , Barbarash O.L 
Published: November 2020

Abstract

Introduction
Previous studies have identified a number of pro-inflammatory and other markers potentially associated with atherogenesis, which are also expressed and produced by adipose tissue. Atherosclerosis is a multifactorial disease, in the development of which both unmodifiable factors (gender, age) and modifiable factors (smoking, dyslipidemia) contribute, and further study of the pathogenetic relationships of adipocytokines and CVD risk factors is necessary.

Purpose
To evaluate the features of the expression of adiponectin and IL-6 in the epicardial (EAT), perivascular (PVAT), subcutaneous adipose tissue (SAT) and its relationship with the main risk factors for CVD.

Materials and methods
The study included 84 patients with stable coronary artery disease (CAD) who were planning coronary artery bypass grafting (CABG). During the operation, adipose tissue (AT) biopsy samples were obtained. The expression of adiponectin and IL-6 genes was evaluated by the method of quantitative polymerase reaction in real time (PCR) depending on the presence or absence of CVD risk factors.

Results
It was found that adipocytes of EAT are characterized by the lowest expression of the adiponectin gene against the background of the maximum - IL-6. In men, the adiponectin mRNA level in EAT and PVAT is reduced (2.5 and 2.8 times). The expression of IL-6 in male patients is higher in SAT (3 times) and lower in PVAT than in women. The presence of dyslipidemia is associated with a decrease in the expression of both adiponectin in EAT and PVAT (2.7 and 3.6 times), and IL-6 in PVAT (2.3 times). People with arterial hypertension (AH) have lower levels of adiponectin in EAT and PVAT (2 and 1.8 times) with high levels of IL-6 in SAT and EAT (8 and 10.4 times). With an increase in the experience of hypertension for more than 20 years, adiponectin expression decreases in all types of AT with an increase in IL-6 in PVAT (2 times) and a decrease in SAT. Smoking is associated with increased adiponectin mRNA levels. Patients 51–59 years old are characterized by high expression of IL-6 in EAT and PVAT in comparison with parameters of other age groups.

Conclusions
The revealed decrease in the expression of adiponectin in EAT against the background of an increase in pro-inflammatory IL-6 can enhance atherogenesis, and in combination with risk factors such as male sex, the presence of dyslipidemia and hypertension contribute to the progression of coronary artery disease.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Russian Scientific Foundation no. 17-75-20026
Long term outcomes of single versus multi-vessel coronary artery disease in patient with diabetes undergoing PCI
Authors: Omair M , Dinh D.D , Brennan A.B , Farouque O.F , Duffy S.D , Ajani A.J , Andrianopoulos N.A , Koshy A.K , Yudi M.Y , Clark D.C 
Published: November 2020

Abstract

Background
Long-term outcomes of PCI in diabetics with single vessel disease (SVD) are less well known. We aimed to assess the long-term mortality of patients with diabetes with SVD compared to MVD undergoing PCI.

Methods
We included 7,506 consecutive patients with DM undergoing PCI from 34,784 patients in the Melbourne Interventional Group registry (2005–2018).

Results
4,889 (65%) of DM had MVD. Compared to SVD, MVD were older (67±11 vs. 64±11 years), with higher rates of hypertension, insulin dependence, renal impairment, left ventricular ejection fraction &lt;45% and cardiogenic shock (all p&lt;0.001). Patients with MVD had significantly higher rates of stent thrombosis, unplanned CABG and major bleeding (all p&lt;0.001). Unadjusted mortality rates in hospital, at 30 days and long-term (mean 5.4±3 years) were higher in MVD (4.1 vs 1.4%, 4.9% vs 1.9%, 26% vs 16.4%; all p&lt;0.001). Cox proportional hazard modelling found MVD as an independent predictor of long-term mortality (HR 1.7, 95% CI 1.5–1.9, p&lt;0.001). Long term mortality was similar for SVD diabetes and MVD non-diabetes (HR 1.29, 95% CI 1.13–1.48 vs 1.26, 95% 1.16–1.37), which was also evident on Kaplan-Meier curve.

Conclusion
DM with SVD undergoing PCI had a lower long-term mortality. However, the mortality beyond 5 years in SVD increases, mandating aggressive risk factor control and close clinical follow-up.
Kaplan-Meier curve

Funding Acknowledgement
Type of funding source: None
Acute coronary syndromes in chronic kidney disease patients: the good, the bad or the ugly?
Authors: Saleiro C , De Campos D , Lopes J , Teixeira R , Sousa J.P , Gomes A.R.M , Puga L , Costa M , Goncalves L 
Published: November 2020

Abstract

Background
Patients with chronic kidney disease (CKD) are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, current aggressiveness of therapeutic strategies may minimize the course of the disease.

Aim
To assess the prognostic impact of optimized medical treatment in a CKD population with acute coronary syndrome (ACS).

Methods
355 ACS patients admitted to a single coronary care with CKD who were discharged from hospital were included. Those with end-stage renal disease were excluded. Three groups were created based on the KDIGO classification: Group A (Stage 3A, eGFR [estimated glomerular filtration rate] 45–59mL/min/1.73 m2) N=190; Group B (Stage 3B, eGFR 30–44mL/min/1.73 m2) N=113; and Group C (Stage 3B, eGFR 15–29mL/min/1.73 m2) N=52. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The median of follow-up was 32 (IQ 15–70) months.

Results
Groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, left ventricular (LV) systolic function, peak troponin, multivessel disease, treatment option (PCI, CABG or OMT) and medical therapy at discharge. More advance renal failure patients had a higher prevalence of diabetes mellitus (DM), a lower haemoglobin, a higher NT-proBNP and were less likely to receive ACE inhibitors/angiotensin II antagonist at discharge. 170 patients met the primary outcome. Kaplan-Meyer curves showed decreased survival with worse renal function (Group A 68% vs Group B 57% vs Group C 37%, Log Rank P=0.006 – Figure 1). After adjustment for age, DM, haemoglobin, NT-proBNP, LV systolic function and ACE inhibitors/angiotensin II antagonist at discharge, eGFR was not associated with increased death (HR 1.00, 95% CI 0.98–1.01). In this model, only age (HR 1.04, 95% CI 1.01–1.07), haemoglobin (HR 0.86, 95% CI 0.979–0.94), Nt-proBNP (HR 1.00, 95% CI 1.00–1.00) and impaired LV function (LV ejection fraction 40–49%: HR 2.95, 95% CI 1.89–4.81; LV ejection fraction &lt;40%: HR 2.15, 95% CI 1.44–3.21) remained associated with the outcome.

Conclusion
The worse outcome attributed to CKD after an ACS seems to be related not the eGFR itself but to associated comorbidities such as age, anaemia, fluid overload and impaired LV function. The fact that some of these comorbidities may be altered by intensive therapy indicates that CKD patients should also be candidates to optimized medical treatment.

Funding Acknowledgement
Type of funding source: None
Moment of truth for aspirin use in variant angina: a meta-analysis
Authors: Sousa J.P , Puga L , Lopes J , Saleiro C , Gomes R , Lourenco C , Goncalves L 
Published: November 2020

Abstract

Background
Aspirin has been a mainstay of antiplatelet therapy for coronary artery disease (CAD). However, in the context of variant angina (VA), high-dose aspirin was reported to exacerbate coronary spasms. Consequently, the value of traditional low-dose aspirin in VA, especially if not associated with atherosclerotic CAD, may be disputed.

Purpose
To perform a meta-analysis aimed at evaluating the extent to which low-dose aspirin therapy influences cardiovascular (CV) prognosis in VA.

Methods
We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar for studies addressing the long-term impact of low-dose aspirin on main CV outcomes of VA patients, published up until February 1, 2020. The primary endpoint was all-cause mortality, whereas secondary endpoints included CV mortality, acute coronary syndrome (ACS) events, revascularization procedures and hospital admissions for angina. The subgroup of patients with no significant epicardial CAD was further investigated separately, underneath similar outcomes. Study-specific odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model.

Results
One prospective multicenter and two retrospective single-center studies, encompassing 1652 and 1164 patients, respectively, were regarded as eligible for quantitative evaluation. Median follow-up ranged between 12 and 52.1 months. 1284 patients were allocated to the aspirin arm and 2770 had no epicardial CAD. Absolute number of events for each endpoint may be reported as follows: all-cause mortality, 33; CV mortality, 11; ACS, 57; revascularization, 14; hospital admission for angina, 218. Aspirin was not found to reduce neither all-cause mortality (OR 0.78, 95% CI 0.38–1.58, p=0.49, i2=0%), nor CV mortality (OR 0.98, 95% CI 0.30–3.25, p=0.98, i2=0%), nor ACS events (OR 1.44, 95% CI 0.51–4.10, p=0.49, i2=47%), nor revascularization procedures (OR 2.06, 95% CI 0.63–6.75, p=0.23, i2=0%), nor hospital admissions for angina (OR 1.60, 95% CI 0.67–3.80, p=0.29, i2=86%). Likewise, this comprehensively neutral effect held true in those with VA and no significant atherosclerotic CAD (OR 1.04, 95% CI 0.28–3.92, p=0.95, i2=0%, for CV mortality; OR 1.29, 95% CI 0.19–8.94, p=0.79, i2=33%, for revascularization; OR 1.73, 95% CI 0.81–3.73, p=0.16, i2=75%, for hospital admission for angina).

Conclusion
Even though scarce, currently available evidence suggests that low-dose aspirin is not effective in shrinking major adverse cardiovascular events in VA patients, particularly in those with no epicardial CAD. On the other hand, lower doses of aspirin may avoid the menace of clinically significant coronary spasms.

Funding Acknowledgement
Type of funding source: None