bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk stratification in unprotected left main coronary disease: do we have the tools?
Authors: Ventura Gomes R , Oliveira A , Goncalves M , Madeira S , Vale N , Brito J , Leal S , Raposo L , Araujo Goncalves P , Mesquita Gabriel H , Campante Teles R , Sousa Almeida M 
Published: November 2020

Abstract

Introduction
The evolution of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) techniques made the choice of the optimal revascularization strategy of unprotected left main coronary disease (ULMD) challenging. Scoring systems are useful tools for the decision-making process and for risk stratification.

Purpose
To evaluate 1) the performance of the SYNTAX score I (SSI) and II (SSII) and Euroscore II (EII) in risk stratification and 2) the outcome predictors of patients (pts) with ULMD, according to the treatment strategy chosen (PCI or CABG).

Methods
Retrospective single centre cohort study of 440 consecutive pts (age 68±11 years; 76.6% male) with significant ULMD (defined as left main coronary artery stenosis &gt;50%, with no patent arterial or venous bypass graft to left anterior descending artery), who were submitted to PCI (n=135) or CABG (n=307), between January 2006 and December 2018. Median follow-up (FU) was 4.0±1.8 years.
The primary outcome was a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and target lesion revascularization (TLR).

Results
During the FU period, there were 112 (25.5%) CV deaths, 26 (5,9%) non-fatal MI and 53 (12.0%) TLR.
Multivariate analysis of pts submitted to PCI showed that SSII and anatomical complete revascularization were independent predictors of the primary outcome (HR 1.045, CI 1.015–1.075, p=0.003 and HR 3,014, CI 1.655–5.489, p&lt;0.0001, respectively). The 63 pts submitted to PCI, who had a SSII favoring CABG, had slightly more adverse events (42.9% vs 41.7%, p=0.889).
In the CABG cohort, only SSII was an independent predictor of the outcome by multivariate analysis (HR 1.061, CI 1.035–1.086, p&lt;0.0001).
The ROC curve analysis for all cohort presented no discriminative capacity for SSI (AUC 0.538, CI 0.482–0.593, p=0.186) and a weak discrimination for SSII (AUC 0.659, CI 0.605–0.713, p&lt;0.0001) and EII (AUC 0.653, CI 0.599–0.707, p&lt;0.0001; Figure 1). The difference between SSII and EII was not statistically significant (DeLong test p=0.828). Similar results were found when analysing the CAGB group, however, in PCI cohort, SII and EII showed an acceptable discriminative capacity (AUC 0.722, CI 0.636–0.809, p&lt;0.0001 and AUC 0.700, CI 0.610–0.791, p&lt;0.0001, respectively).

Conclusion
In a real-world ULMD population, the most common risk scores, mainly those integrating anatomical and clinical features, presented a very modest role in the risk stratification, both in chronic and acute coronary syndromes. However, in pts with ULMD submitted to PCI, those risk scores had a more significant role in the risk stratification of these pts.
Figure 1. SSI, SSII, EII ROC curves for all cohort

Funding Acknowledgement
Type of funding source: None
Distal radial approach via anatomical snuffbox is associated with higer rate of radial spasm and greater patient discomfort
Authors: Kozinski L , Dabrowska-Kugacka A , Orzalkiewicz Z 
Published: November 2020

Abstract

Background/Introduction
Conventional transradial approach (c-TRA) at the wrist is considered as the default strategy for catheter-based procedures providing less serious access-related complications and better patients' comfort than transfemoral route. A novel distal transradial artery approach (d-TRA) via the anatomical snuffbox has been proposed recently as an noteworthy alternative. It is hypothesised that d-TRA may provide additional benefits without losing the efficacy of c-TRA.

Purpose
To assess consecutive patients' comfort undergoing coronary angiography or intervention by novel d-TRA in comparison with c-TRA.

Methods
In a span of 4 months, out of 465 caucasian subjects, 400 patients were included in a prospective, single-center, randomized (1:1) distAl vs traditioNal Transradial Access for coRonary procEdures Study (ANTARES). Hemodynamic instability, ST-elevation myocardial infarction, forearm artery occlusion or prior radial access failure were the exclusion criteria. An artery was punctured with anterior wall modified Seldinger technique, and standard 5F or 6F vascular sheaths were used.
Pain/discomfort when access gaining, radial spasm, early (within 24 hours) postprocedural local neuropathy (thumb numbness) were the analyzed parameters determining patients' comfort in both groups.

Results
Baseline characteristics of patients were matched.

Conclusion(s)
Coronary procedures performed in consecutive patients via novel d-TRA are associated with worse patient's comfort determined by higer rate of radial spasm and early postprocedural local neuropathy, and greater pain/discomfort when access gaining, in comparison with c-TRA.

Funding Acknowledgement
Type of funding source: None
One-year outcomes of percutaneous coronary intervention in native coronary arteries versus bypass grafts in patients with prior coronary artery bypass graft surgery
Authors: Abdelrahman A , Debski M , More R , Eichhofer J , Patel B 
Published: November 2020

Abstract

Background
Patients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native versus graft PCI after CABG.

Methods
We performed a retrospective study in a tertiary reference cardiac centre of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Major adverse cardiac events (MACE) included death or myocardial infarction (MI) or revascularization. All outcomes were assessed at 1-year after each index procedure.

Results
A total of 445 PCI were performed in 410 patients (209 had native PCI and 201 had graft PCI). The groups of patients with native vessel PCI and graft PCI were statistically comparable regarding their baseline characteristics. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.818, 95% confidence interval [CI] 1.148–2.878).

Conclusion
Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.
MACE outcomes

Funding Acknowledgement
Type of funding source: None
Optimal timing of delayed percutaneous coronary intervention in stable patients with ST-segment elevation myocardial infarction
Authors: Zhao Q , Xu H , Lv J , Zhao Y , Yang Y 
Published: November 2020

Abstract

Background
There is ongoing controversy and limited data about the optimal timing to perform delayed percutaneous coronary intervention (PCI) in stable ST-segment elevation myocardial infarction (STEMI) patients who have missed opportunities for acute reperfusion therapy and are in absence of ongoing ischemia.

Purpose
To evaluate the effects of timing of delayed PCI on short- and long-term safety outcomes in stable STEMI patients.

Methods
A cohort of 3,048 stable STEMI patients without acute reperfusion therapy who underwent delayed PCI were included in the study. Procedural timing was stratified into three groups: &lt;3d, 3–7d, &gt;7d. Primary outcomes were 30-day and 12-month major adverse cardiac events (MACE), a composite of death and reinfarction. Multivariate logistic and Cox regression models were performed.

Results
After multivariate adjustment, restricted cubic splines revealed a monotonic decrease in the risk of MACE with prolonged procedural timing (Figure-1). Delayed PCI on 3–7d and &gt;7d were strongly associated with lower risks of MACE at 30 days (3–7d: Hazard ratio (HR) 0.43 [95% Confidence interval (CI) 0.18–0.99], P=0.046; &gt;7d: HR 0.40 [95% CI 0.19–0.87], P=0.020) and 12 months (3–7d: HR 0.49 [95% CI 0.25–0.95], P=0.036; &gt;7d: HR 0.42 [95% CI 0.22–0.77], P=0.006) compared with that on &lt;3d. Delayed PCI on &gt;7d also showed improvement in 12-month mortality (HR 0.45 [95% CI 0.22–0.91], P=0.026) over that on &lt;3d, whereas procedure on 3–7d did not (HR 0.52 [95% CI 0.24–1.11], P=0.091). MI location and cardiac function had significant interactions with procedural timing for 12-month MACE (P-interaction=0.141 and 0.137). Procedural timing had more significant effects on MACE in patients with anterior MI or cardiac insufficiency.

Conclusion
Delayed PCI over a week after symptom onset had significant improvement in short- and long-term safety in stable STEMI patients especially with anterior MI or cardiac insufficiency. Decision-making on optimal timing should identify the high-risk individuals and balance between ischemic benefits and safety.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Twelfth Five-year Science and Technology Support Projects by Ministry of Science and Technology of China.
Impact of new generations drug-eluting stents overlap on six-month clinical outcomes in patients with acute anterior STEMI treated with primary PCI
Authors: Elakabawi K , Shah S.A , Fadlullah H , Yuan Z.Y , Guo N 
Published: November 2020

Abstract

Background
Stent overlap has been associated with adverse outcomes. However, data regarding the impact of new generations drug-eluting stents (DES) overlap in the context of ST-segment elevation myocardial infarction (STEMI) are limited.

Objective
To compare the 6-moth clinical outcomes of patients with and without new generations DES overlap implanted during primary PCI for anterior STEMI.

Methods
We evaluated a total of 1078 consecutive anterior STEMI patients who underwent primary PCI with deployment of new generations DES. The patients were divided according to the presence or absence of stent overlap into 2 groups; overlapping-stents group (n=388) and single-stent group (n=690). We compared the rates of cardiac mortality, major adverse cardiovascular events (MACEs; composite of death, reinfarction, ischemia-driven target vessel revascularization (TVR), definite stent thrombosis (ST), and stroke) between the 2 groups.

Results
There was a non-significant trend toward increased in-hospital mortality in the overlapping-stents group related to a significant higher rate of cardiogenic shock [9.5% versus 6.1%, respectively; P=0.037] and post-procedural suboptimal TIMI flow [26.3% versus 19.4%, respectively; P=0.009] as compared to the single-stent group. Yet, there were no significant differences between the 2 groups in the incidence of 6-month cardiac death: [18 (4.6%) and 21 (3%); P=0.173], MACEs: [35 (9%) and 49 (7.1%); P=0.259], reinfarction: [14 (3.6%) and 22 (3.2%); P=713], TVR: [17 (4.4%) and 28 (4.1%); P=0.799], and definite ST: [14 (3.6%) and 19 (2.8%); P=0.434], respectively.

Conclusion
The use of multiple overlapping new generations DES, if needed, is relatively safe and acceptable in the context of primary PCI for STEMI patients.

Funding Acknowledgement
Type of funding source: None
Long-term safety and performance of a novel conical bioresorbable vascular scaffold: insights from in-vitro and in-vivo studies
Authors: Ma Q , Du Y , Wang J.L , Wu S.J , Zhao Y.X , Zhou Y.J 
Published: November 2020

Abstract

Background
The phenomenon of size-mismatches between cylindrical stents and tapered vessels is not uncommon in current endovascular interventions which is associated with poor clinical outcomes.

Purpose
The aim of the present study was to evaluate the mechanical properties of the novel conic BRS and to validate its performance with the support of optical coherence tomography (OCT), quantitative coronary angiography (QCA) and histology up to 2 years in a porcine model.

Methods
We produced the conical BRS with the four-axis 3D printing system, with a computer-controlled rotational axis (the 4th axis) in addition to the 3 axes of traditional 3D printing systems.
Mechanical properties were evaluated by recoil and radial strength, cyclic fatigability testing.
Twelve swine that received 12 conic BRS were evaluated by OCT, QCA and histology post-implantation and at 12 and 24 months.

Results
The in vitro study showed no fractures after accelerated cycle testing over time (at 3.8×108 cycles).
The recoil rate of the scaffolds after plate compress test was 14.3±0.61%.
There was no significant peri-operative complications.
By OCT, 60±21 struts per BRS were recognizable by 2 years. Quantitative coronary angiography showed late luminal loss and percent diameter stenosis were 0.02±0.52 mm and 0.50±16.90% at 2-year follow-up.
Histopathological analysis demonstrated mild vessel injuries, inflammatory cell infiltration around struts at 1 and 2 years follow ups.

Conclusions
The conical BRS showed optimal performance and has the potential to improve clinical outcome.
OCT and histological images

Funding Acknowledgement
Type of funding source: None
Impact of diabetes mellitus on 2-year outcomes of Absorb BVS compared to Xience EES: a pooled analysis of the COMPARE-ABSORB and AIDA trial
Authors: Gao C , Kerkmeijer L , Tijssen R.Y.G , Kraak R , Tijssen J , Onuma Y , Chevalier B , West N , Morice M.C , De Winter R , Smits P , Wykrzykowska J.J , Van Geuns R.J 
Published: November 2020

Abstract

Background and purpose
Diabetes mellitus (DM) is associated with increased risk of cardiovascular events after percutaneous coronary intervention (PCI). To evaluate the impact of Absorb bioresorbable vascular scaffold (BVS) in patients with DM, we aimed to compare the 2-year outcomes of Absorb BVS versus 2nd generation drug eluting stents Xience (EES) by pooling diabetic patients treated with BVS or EES from two large, randomized controlled trial.

Methods
Patients with medically-treated DM and treated by Absorb BVS in the COMPARE-ABSORB and AIDA trial were pooled for analysis. The primary efficacy outcomes measure was target lesion failure (cardiac death, target-vessel myocardial infarction or target lesion revascularization), and the primary safety outcome measure was device thrombosis at 2-year follow-up.

Results
Out of a total 3515 enrolled subjects in the two trials, 913 were diabetics. Compared with the non-diabetic patients, those with DM were older, more often to have a history of hypercholesterolemia, chronic renal failure, stroke, hypertension, heart failure, peripheral vascular disease and previous PCI. At 2-years, target lesion failure occurred in 10.8% of BVS DM patients and 7.6% of EES DM patients (adjusted HR 1.43, 95% CI: 0.87–2.34, P=0.115). The 2-year rates of cardiac death (2.4% vs 1.6%, P=0.385), TV-MI (5% vs 1.6%, P=0.123) and TLR (7.8% vs 5.8%, P=0.416) showed not significant difference. The 2-year incidence of definite device thrombosis was 3.2% in Absorb BVS versus 0.7% in Xience EES (adjusted HR 4.77, 95% CI: 1.01–22.43, P=0.048).

Conclusion
This pooling of the diabetic patients from two large scale RCTs compared BVS versus 2nd generation DES, showed an increased rate of device thrombosis in BVS-treated patients at 2 years.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
The in vivo comparison of first versus second generation bioresorbable technologies early after implantation in the porcine coronary in stent restenosis model
Authors: Kachel M , Janas A , Jelonek M , Kazmierczak P , Buszman P.E , Fernandez C , Lukasik K , Milewski K , Buszman P.P 
Published: November 2020

Abstract

Background
Second generation bioresorbable scaffold (BRS) technologies with thinner struts were developed to overcome thrombotic and restenotic events when compared to first generation

Purpose
Herein we compare vascular response and scaffold recoil of first generation BRS (Absorb, BVS, 150 micron) with second generation (Meres 100, MRS, 100 micron) in the porcine model of coronary in stent restenosis model

Methods
In total 11 BRS and 13 MRS similar scaffolds were implanted in 12 domestic swine, with 110% overstretch under Optical coherence tomography guidance. Animals were followed up for 2, 7 and 28 days (8 scaffolds for each period). At terminal follow up comprehensive evaluation with OCT was performed and tissues harvested for pathology

Results
Arterial injury expressed as overstretch was similar among groups. There were no differences at 2 and 7 days with regards to lumen area (LA), neointimal area (NA) stent areas (SA) and %AS. At 28 days SA and NA were lower in the MRS group when compared to BRS (SA: 5,1 vs. 8,8 mm2, p=0,01; NA: 1,94 vs. 3.36 mm2; p=0,01). Arterial healing was similar at 28 days between MRS and BRS as expressed by embedded and covered struts (100 vs 100%, p=1,0), however at 7 days there were more uncovered struts in the MRS (43% vs 12%, p=0,01).

Conclusions
Second generation MRS have proven improved vascular response in porcine coronary model with regard to lesser neointimal hyperplasia. Thinner struts however caused recoil when compared to thicker ones at early follow-up point. Further BRS material and design improvements are necessary to achieve metallic stent - like properties.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Center for Research and Development
Cardiovascular outcomes of concurrent TAVR and PCI compared to TAVR alone using the U.S. national inpatient sample: 2011–2014
Authors: Byer M , Celli D , Zarrabian B , Colombo R 
Published: November 2020

Abstract

Introduction
The high concurrent prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) inevitably forces experts to face a pressing decision whether to revascularize and replace the aortic valve at the same time. While current recommendations support combined transaortic valve replacement (TAVR) and percutaneous coronary intervention (PCI) for treatment of ostial/proximal lesions, or in unstable patients, less clear indications exist for patients not fulfilling this pattern. The population undergoing concomitant TAVR and PCI can be clinically challenging and thus it is important to further characterize prognosis and major cardiovascular outcomes in this cohort.

Purpose
To assess the likelihood of major cardiovascular events in patients undergoing TAVR with PCI during the same hospital admission compared to those with TAVR only. As well as to have a better understanding of the risks and possible benefits of a combined procedure and thus aid in clinical decision-making.

Methods
This study used the National Inpatient Sample (NIS) of patients undergoing a TAVR from 2011 to 2014. The NIS is a stratified systematic random sample of 20% hospital admissions in the United States. Internal Classification of Diseases Ninth Revision-Clinical Modification procedure codes were used to identify all patients that underwent a PCI and/or TAVR during the same admission. Patients aged greater than 50 years were included. Outcomes of interest included all-cause in-hospital mortality, new TIA/ischemic stroke, cardiogenic shock, cardiac arrest, hemopericardium, and length of stay. Multivariate logistic regression was used to adjust for patient and procedural confounders.

Results
Among the 33,652 patients who underwent TAVR between 2011 and 2014, 1,179 underwent a PCI during the same hospital admission. The adjusted odds of all-cause in-hospital mortality was 3.05 (95% CI 1.95–4.75) in those with a TAVR+PCI compared to TAVR only. The adjusted odds of cardiac arrest and cardiogenic shock was 2.50 (95% CI: 1.48–4.22) and 4.85 (95% CI 3.05–7.7), respectively. Furthermore, the odds of a new TIA/ischemic stroke during the same admission was 0.86 (95% CI 0.35–2.07) and odds of hemopericardium was 3.13 (95% CI: 0.71–13.70).

Conclusion
Concomitant PCI and TAVR during the same hospitalization was associated with higher all-cause in-hospital mortality, increased length of stay, cardiogenic shock, and cardiac arrest but does not appear to increase the likelihood of stroke/TIA. While this suggest worse outcomes in the cohort undergoing both procedures, the initial indications for these patients to receive a PCI might predispose them to these outcomes.

Funding Acknowledgement
Type of funding source: None
Safety and feasibility of a systematic transradial-access program for percutaneous coronary intervention in chronic total occlusions
Authors: Trejo Velasco B , Diego-Nieto A , Nunez J.C , Gonzalez-Ferreiro R , Herrero-Garibi J , Rodriguez-Collado J , Sanchez P.L , Cruz-Gonzalez I , Martin-Moreiras J 
Published: November 2020

Abstract

Aims
To evaluate the safety and feasibility of a transradial-access PCI program in CTO and its impact on angiographic and clinical results and in-hospital stay length.

Methods
Retrospective single-centre cohort-study including 237 consecutive patients undergoing CTO-PCI. From November 2018 onwards, a transradial-access program and all first-attempt CTO-PCI procedures were systematically performed via the radial artery. 47 patients included in the transradial-access CTO-PCI program were compared to a historical cohort of 190 CTO-PCI patients, employing transfemoral access mainly: n=150 (78.9%).

Results
Mean age was 66.9±11.4 and 199 (83.9%) patients were male, Table 1. Mean J-CTO score (2.5±1.1) was similar in both groups. Successful revascularization was achieved in 208 (87.8%) cases overall, without differences between both cohorts. No differences in periprocedural complications between both groups existed, but in-hospital complications were numerically lower in the transradial cohort (4.3% vs 13.7%, p=0.072). Mean hospital-stay was lower in the transradial-access group (0.89±1.4 vs 2.2±3.2 days, p&lt;0,001). Same-day discharge was successfully accomplished in 56% of elective patients in the transradial-access program, Figure 1.

Conclusion
A transradial program for CTO-PCI is safe and effective in most CTO. Adoption of a transradial protocol for CTO-PCI allows same-day hospital discharge in over half of elective procedures and reduces in-hospital stay length.
Figure 1. Same-day discharge in both cohorts

Funding Acknowledgement
Type of funding source: None