bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of fat attenuation index of pericoronary adipose tissue surrounding left anterior descending artery on coronary computed tomography angiography
Authors: Sugiyama T , Kanaji Y , Hoshino M , Yamaguchi M , Hada M , Misawa T , Sumino Y , Nogami K , Ueno H , Kakuta T 
Published: November 2020

Abstract

Background
Recent studies reported the association between elevated fat attenuation index (FAI) of pericoronary adipose tissue (PCAT) on coronary computed tomography angiography (CTA) and worse cardiac outcomes.

Purpose
We investigated the prognostic value of increased FAI-defined coronary inflammation status in patients with coronary artery disease.

Methods
Three-hundred fifty-eight patients (127 acute coronary syndromes [ACS], 231 stable coronary artery disease) with left anterior descending artery (LAD) as a culprit vessel who underwent coronary CTA were retrospectively studied. The FAI defined as the mean CT attenuation value of PCAT (−190 to −30 Hounsfield Unit [HU]) was measured at the proximal 40-mm segment of LAD. All subjects were divided into two groups according to the median value of FAI in the LAD. The association between the incidence of major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, target and non-target vessel revascularization were evaluated.

Results
In a total of 358 patients, median FAI values surrounding the LAD was −71.46 (interquartile range, −77.10 to −66.34) HU. Thirty-eight patients (10.6%) experienced MACE during the follow-up period (median, 818 days). Kaplan-Meier analysis revealed that high FAI-LAD (&gt;−71.46 HU [median]) was significantly associated with the incidence of MACE (log-rank test, chi-square = 4.183, P=0.041) (Figure).

Conclusions
In patients with coronary artery disease with culprit LAD lesions, elevated FAI of PCAT surrounding the LAD was associated with worse clinical outcomes. Assessment of FAI may have a potential for potential for non-invasive risk-stratification by coronary CTA.
Kaplan-Meier analysis for MACE

Funding Acknowledgement
Type of funding source: None
Secondary prevention in coronary artery disease: a risk-guidance may be beneficial
Authors: Huynh Q , Nghiem S , Byrnes J , Scuffham P , Marwick T.H 
Published: November 2020

Abstract

Background
Assessment of secondary event risk is now recommended for all coronary artery disease (CAD) patients. Many risk calculators have been developed for this purpose. However, their contribution to secondary prevention of CAD is limited because it is unknown whether high-risk patients would benefit more from intensive management. This study sought to apply a previously developed risk score of secondary event to predict readmission in CAD patients, and determine if higher-risk patients benefit more from intensive medical and interventional therapies.

Methods
This State-wide longitudinal study included 19,940 patients admitted to a hospital in 2010 with CAD as the principal diagnosis. Patients were followed up till the end of 2015. A previously developed and validated risk score (PEGASUS-TIMI54) was used to estimate risks of future adverse events and stratify all patients into either low risk (score&lt;6) or high risk (score≥6) as previously recommended. The primary outcome was all-cause readmission. Secondary outcomes included all-cause mortality and days alive and out of hospital within five years of hospital discharge. Cox proportional hazards regression and linear regression were used for analysis.

Results
The high risk patients (n=6,573) had a significantly higher proportion of males and Indigenous people, had greater comorbidities, and were more likely to be readmitted or dead (all p&lt;0.001) than their counterparts in the low risk group (n=13,367). Beta-blocker (hazards ratio HR=0.87 [95% CI: 0.79–0.95]), ACEi/ARB (HR=0.68 [95% CI: 0.62–0.73]) and PCI (HR=0.91 [95% CI: 0.88–0.95]) were negatively associated with readmission, and showed a negative interaction (p&lt;0.001) with patients' predicted risks – implicating greater benefits for high-risk patients. CABG, on the contrary, was positively associated with readmission (HR=1.44 [95% CI: 1.15–1.80]) and showed a negative interaction (p&lt;0.001) with patients' predicted risks. This finding suggests that patients receiving CABG were more likely to be readmitted than those not receiving CABG, but this trend reduced for patients with higher risks. Analysis of secondary outcomes suggest that all medical and interventional therapies reduced mortality risks, with the strongest effect size for CABG (HR=0.34 [95% CI: 0.29–0.48]). There was a negative interaction of statins, PCI and CABG with patients' predicted risks, implicating greater survival benefits for patients with higher risks.

Conclusions
CAD patients can be effectively risk-stratified. The use of this information for a risk-guided strategy may maximize benefits for high-risk patients.

Funding Acknowledgement
Type of funding source: None
Twenty-year survival of patients with atherosclerotic non-obstructive coronary plaques
Authors: Hlinomaz O , Sabbah M , Jarkovsky J , Machal J 
Published: November 2020

Abstract

Background
Atherosclerotic non-obstructive coronary artery disease (NObCAD) is frequently observed in patients referred for coronary angiography. No available data exist for the long-term prognosis of NObCAD patients beyond 10 years.

Purpose
We sought to compare the 15- and 20-year survival among patients presenting with chronic stable angina who had smooth coronary vessels, NobCAD, and obstructive (ObCAD), on invasive coronary angiography.

Methods
Coronary angiography of 671 consecutive patients presented with suspected CAD were retrospectively evaluated from single center registry between January and December 1998 and linked to administrative databases for outcomes evaluation. No CAD, NobCAD, and ObCAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in epicardial coronary artery, respectively. The 15- and the 20-year survival rates were compared by Kaplan-Meier curve and multivariate Cox proportional hazards regression was used to identify significant independent predictors of mortality.

Results
Of 613 individuals (78.7% men with median age of 55.6 (51.0–65.2) years), 74 (12.1%) had normal coronary arteries, 42 (6.9%) had NobCAD, and 497 (81%) had ObCAD. The 15- and the 20-year survival rates were 89%, 66.7%, 62.4% and 79.7%, 54.7%, 42,5% in patients with normal, NobCAD, and ObCAD, respectively, (P=0.050 for no versus NobCAD; P=0.001 for no versus ObCAD at 20-year), These angiographic severity categories showed a strong gradient (P&lt;0.001) (Figure 1). At 15-year follow-up, both ObCAD (adjusted HR=2.42, 95% CI (1.21–4.85), p=0.013) and NobCAD patients (HR=2.65, 95% CI (1.15–6.11), p=0.023) showed higher mortality compared to no CAD group. Independent predictors of mortality were, obstructive CAD (HR=2.34, 95% CI (1.407–3.916), P=0.001 for no versus NobCAD; HR=1.93, 95% CI (1.0–3.72), P=0.050, for no versus obstructive CAD), and age at addmission (HR=1.06, 95% CI (1.04–1.07), P&lt;0.001).

Conclusion
The result of this analysis highlighted the less benign course of NobCAD that carries a mortality risk similar to patients with ObCAD at 15-and at 20-year follow-up. These findings support the need for aggressive anti-atherosclerotic drug therapy in such individuals and underscore the necessary efforts to improve the risk stratification and management of patients with non-obstructive CAD.

Funding Acknowledgement
Type of funding source: None
Circulating miR-133b and miR-21: potential non-invasive diagnostic biomarkers of coronary artery disease
Authors: Kumar D , Narang R , Sreenivas V , Rastogi V , Bhatia J , Saluja D , Srivastava K 
Published: November 2020

Abstract

Background
While coronary artery disease (CAD) has become a major threat worldwide, the timely biomarker-based early diagnosis of CAD remains a major unmet clinical challenge.

Purpose
We aimed towards assessing the level of circulatory microRNAs as candidates of novel biomarkers in early diagnosis of CAD.

Methods
A total of 147 subjects were recruited from Delhi and surrounding regions which includes 78 subjects with angiographically proven CAD, 15 pre-atherosclerotic normal coronary artery (NCA) subjects and 54 healthy individuals. Quantitative real-time PCR assays were performed using total RNA isolated from plasma of CAD patients and healthy individuals in order to measure the relative expression profiles of circulating miR-133b and miR-21. The severity level of the disease in each individual was assessed on the basis of number of diseased vessels involved and extent of stenosis.

Results
MiR-133b was found to be significantly downregulated (p&lt;0.05) by 4.6 fold whereas miR-21 was significantly upregulated (p&lt;0.05) by ∼2 fold in plasma samples of CAD patients as compared to healthy individuals. Importantly, both the miRNAs showed an association with disease severity as miR-133b was downregulated by 8.45 fold in acute coronary syndrome (ACS), 3.38 fold in Stable angina (SA) and 2.08 fold in NCA. MiR-21 was upregulated by 2.46 fold in ACS, 1.90 fold in SA and 1.12 fold in NCA. Moreover, miR-133b could significantly differentiate subjects with ST-elevation myocardial infarction (STEMI) from Non-STEMI. Both the miRNAs exhibited a noteworthy diagnostic potential as translated through an upstanding sensitivity and specificity. MiR-133b showed an area under the curve (AUC): 0.80 with 75.6% sensitivity and 76% specificity at recommended optimal cut-off point of 14.0 whereas, miR-21 showed and AUC value of 0.79 with 72.2% sensitivity and 69.4% specificity at optimal cut-off point of 5.59 as assessed by receiver operating characteristics (ROC) curve analysis.

Conclusions
The reduced expression of miR-133b and elevated expression level of miR-21 in plasma suggest their significant role in the pathophysiology as well as their implication towards the individual's susceptibility in developing CAD. Thus, we conclude that these two circulating miRNAs could be possible candidates of non-invasive biomarkers in the early prediction and diagnosis of CAD.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Department of Science and Technology, New Delhi, India; University Grant Commission (JRF/SRF Fellowship: Ref no. 22/12/2013(ii)EU-V
Diagnostic value of myocardial perfusion CT to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary disease
Authors: Hada M , Kanaji Y , Ueno H , Nogami K , Misawa T , Sumino Y , Yamaguchi M , Sugiyama T , Yonetsu T , Kakuta T 
Published: November 2020

Abstract

Background
The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of regional absolute coronary flow by CTP to detect microvascular dysfunction remains unknown.

Purpose
The aim of study is to assess the diagnostic value of preprocedural CTP to detect coexisting microvascular dysfunction with functionally significant epicardial stenosis in patients with chronic coronary syndromes.

Methods and results
Thirty-three chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR]&lt;0.80) who underwent noncomplicated PCI were investigated. In CTP analysis, regional myocardial blood flow (MBF) at rest (rest-MBF) and hyperemia (hyperemic-MBF) were evaluated semi-automatically. Clinical characteristics, pressure-temperature sensor-chipped wire-based information and CTP findings were compared between groups with and without microvascular dysfunction defined by the index of microcirculatory resistance (IMR) (IMR≥25, n=17, IMR&lt;25, n=16, respectively).
The determinants of coexistence of microvascular dysfunction and functional epicardial stenosis were determined. In invasive wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.57–0.72), 1.61 (1.00–1.98), and 26.7 (19.3–39.4) respectively.
In CTP analysis, rest and hyperemic-MBF and CFR derived from CTP (CFRCTP; calculated as hyperemic-MBF/rest-MBF) were 2.00 (1.31–2.35) ml/min/g, 4.03 (2.11–5.44) ml/min/g, and 2.09 (1.49–2.09) respectively.
In the lesions with IMR&gt;25, hyperemic-MBF was significantly lower than that in IMR&lt;25 (3.42 [1.89–4.34] vs 4.50 [3.44–5.99], p=0.031), although there was no significant difference in regional rest-MBF and CFRCTP (1.75 [1.31–2.24] vs 2.05 [1.35–2.46], p=0.439, and 1.83 [1.21–2.11] vs 2.61 [1.91–2.91], p=0.101 respectively). Receiver operating characteristic curve analysis of hyperemic-MBF detecting IMR&gt;25 showed area under the curve of 0.72 (0.54–0.90), sensitivity of 47% and specificity of 94%.

Conclusion
Quantitative assessment of absolute coronary flow by CTP may help detect coexisting microvascular dysfunction in patients with significant epicardial stenotic lesions.

Funding Acknowledgement
Type of funding source: None
Lack of statin therapy is associated with plaque instability in non-culprit non-ischemic lesions of diabetic patients – data from the COMBINE OCT-FFR study
Authors: Berta B , Roleder T , Hermanides R.S , Ijsselmuiden A.J.J , Alfonso F , Kauer F , Escaned J , De Luca G , Kennedy W , Wojakowski W , Kedhi E 
Published: November 2020

Abstract

Background
Effect of statin therapy on coronary plaque stabilisation and reducing adverse cardiovascular events is well known both in primary and secondary prevention. Nevertheless, there is a paucity of data presenting the impact of statins on plaque morphology as assessed by optical coherence tomography (OCT).

Purpose
The goal of this analysis was to evaluate the plaque morphology using OCT within non-culprit, non-ischaemic coronary lesions in diabetes mellitus (DM) patients with or without statin pre-treatment.

Methods
All patients of the COMBINE (FFR-OCT) trial underwent fractional flow reserve (FFR) measurement followed by OCT in FFR negative lesions. OCT recorded the presence of thin-cap fibroatheroma (TCFA), plaque rupture (PR), plaque erosion (PE) and calcified nodule (CN).

Results
From the 391 patients, 82 (21%) had no statin at baseline. OCT was performed in 463 lesions of which 96 lesions assessed in statin naive and 367 lesions in statin treated group. The median angiographic diameter stenosis was 50% and the median FFR value was 0.88 in both groups (p=0.953 and p=0.448, respectively). Myocardial infarction (MI) at presentation was 16.6% and did not differ between groups (p=0.380). Patients without statin pre-treatment were characterized by lower rate of known hypercholesterolemia (47.6% vs. 63.0%; p=0.011), male gender (52.4% vs. 65.7%; p=0.027), active smokers (8.5% vs. 22.3%; p=0.004) and previous MI (22.0% vs. 35.3%; p=0.022) as compared to patients with statin pre-treatment, respectively. The results of the qualitative OCT findings see in Table 1.

Conclusions
Non-ischemic lesions of DM patients without statin pre-treatment showed more vulnerable and instable plaque features like wider lipid arc, thinner fibrotic cap and a higher prevalence of lipid-rich plaque, TCFA and PR suggesting a stabilizing effect of statins on non-ischemic atherosclerotic lesions.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The trial is founded from the Department of Cardiology Zwolle Heart-centrum with support from a non-restricted grant from St Jude Medical (now Abbott)
Residual functional SYNTAX score by quantitative flow ratio and improvement of exercise capacity after revascularization in patients with stable ischemic heart disease
Authors: Lee S.H , Choi K.H , Lee J.M , Shin D , Kim H.K , Doh J.H , Nam C.W , Shin E.S , Park T.K , Yang J.H , Song Y.B , Hahn J.Y , Choi S.H , Koo B.K , Gwon H.C 
Published: November 2020

Abstract

Background
In patients with stable ischemic heart disease (SIHD), the efficacy of percutaneous coronary intervention (PCI) in improving exercise capacity has been under debate and the differential effect of PCI for exercise capacity, according to functional completeness of revascularization, has not been evaluated.

Purpose
This study aimed to evaluate the association between improvement in exercise capacity and functional completeness of revascularization, determined by residual functional SYNTAX score (rFSS), which is the sum of residual SYNTAX score of the vessels with post-PCI quantitative flow ratio (QFR)≤0.80.

Methods
Among patients enrolled in the QFR multicenter registry, 110 patients who underwent prespecified routine exercise treadmill tests before and after PCI were analyzed. Patients were classified into functional complete revascularization (CR) group (rFSS=0) and functional incomplete revascularization (IR) group (rFSS≥1). Increase of exercise time after PCI was compared between the 2 groups. Improvement of exercise capacity was defined as ≥10% increase of exercise time after PCI.

Results
Functional CR was achieved in 79 patients (71.8%), otherwise classified as functional IR in 31 patients (18.2%). There were no significant differences in baseline characteristics including medication profiles. Increase of exercise time was significantly associated with increase of 3-vessel QFR (r=0.198, P=0.038) and rFSS (r=−0.312, P&lt;0.001), but not with decrease of SYNTAX score (r=0.097, P=0.313). The rFSS showed significantly higher c-index to predict the improvement of exercise capacity after PCI than increase of 3-vessel QFR or decrease of SYNTAX score (0.722 vs. 0.627 vs. 0.492, respectively, P&lt;0.001). Patients with functional CR, defined by rFSS, showed significantly higher increase of exercise time than those with functional IR (97.7 sec vs. 12.5 sec, P&lt;0.001). Functional CR was an independent predictor of the improvement of exercise capacity after PCI (adjusted odds ratio 4.656, 95% CI 1.678–12.920, P=0.002).

Conclusions
Integrated anatomic and functional scoring system (rFSS) was significantly associated with improvement of exercise capacity after PCI. SIHD patients with functional CR, defined by rFSS, showed significantly higher exercise capacity after PCI than those with functional IR.
Summarizing Figure

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): SaeHan NK & D and Medis Corporation
Early aspirin discontinuation following acute coronary syndrome or percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials
Authors: Guedeney P , Mesnier J , Sorrentino S , Abcha F , Zeitouni M , Lattuca B , Silvain J , De Rosa S , Indolfi C , Collet J.P , Kerneis M , Montalescot G 
Published: November 2020

Abstract

Background
The respective ischemic and bleeding risks of early aspirin discontinuation following an acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI) remains uncertain.

Objectives
To evaluate the safety and efficacy of early aspirin discontinuation in ACS or PCI patients treated with P2Y12 inhibitors with or without anticoagulants.

Methods
We performed a review of randomized controlled trials (RCTs) comparing a P2Y12 inhibitor-based single antiplatelet strategy following early aspirin discontinuation to a strategy of sustained dual antiplatelet therapy (DAPT) in ACS or PCI patients requiring or not anticoagulation for another indication. The primary safety endpoint was major bleeding while non-major bleeding and all bleeding were secondary safety endpoints. The primary efficacy endpoint was all-cause mortality while secondary efficacy endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction (MI), definite stent thrombosis (ST) or any stroke. We estimated risk ratios (RR) and 95% confidence intervals (CI) using random effect models. The study is registered in PROSPERO (CRD42019139576).

Results
We included 9 RCTs comprising 40,621 patients.Compared to prolonged DAPT, major bleeding (2.2% vs. 2.8%; RR 0.68; 95% CI: 0.54 to 0.87; p=0.002; I2: 63%), non-major bleeding (5.0% vs. 6.1%; RR: 0.66; 95% CI: 0.47 to 0.94; p=0.02; I2:87%) and all bleeding (7.4% vs. 9.9%; RR: 0.65; 95% CI: 0.53 to 0.79; p&lt;0.0001; I2: 88%) were significantly reduced with early aspirin discontinuation (Figure 1), without significant difference for all-cause death (p=0.60), MACCE (p=0.60), MI (p=0.77), definite ST (p=0.63), and any stroke (p=0.59). Results were consistent in patients with or without anticoagulation, without significant interaction for any outcomes but MI (p=0.04).

Conclusions
In patients on DAPT after an ACS or a PCI, early aspirin discontinuation prevents bleeding events with no effect on the ischemic risk or mortality.
Figure 1. Central illustration

Funding Acknowledgement
Type of funding source: None
Efficacy and safety of low-dose rivaroxaban on top of aspirin in patients with polypharmacy and multimorbidity: an analysis from the COMPASS trial
Authors: Vanassche T , Verhamme P , Leong D , Bhatt D.L , Shestakovska O , Maggioni A.P , Fox K.A.A , Muehlhofer E , Connolly S , Yusuf S , Eikelboom J , Bosch J 
Published: November 2020

Abstract

Background
In patients with coronary or peripheral artery disease, intensified antithrombotic therapy with aspirin plus low dose rivaroxaban reduced cardiovascular outcomes compared with aspirin alone. Polypharmacy and multimorbidity are frequent in patients with vascular disease and are often perceived as barriers to more intensive pharmacotherapy by both patients and physicians.

Purpose
To report cardiovascular outcomes and the efficacy, safety, and net benefit of low dose rivaroxaban plus aspirin in patients with stable vascular disease by the number of concomitant cardiovascular drugs and by the number of comorbidities.

Methods
We reported ischemic events (cardiovascular death, stroke, or MI), major bleeding (ISTH modified criteria), and a prespecified net clinical outcome in participants from the randomised, double-blind COMPASS study by number of cardiovascular medications (0–2, 3, 4, 5–7) and by number of concomitant medical conditions. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone by category of number of medications and concomitant conditions and tested for interaction between polypharmacy and multimorbidity and antithrombotic regimen.

Results
Although patients with polypharmacy and multimorbidity have a higher risk of cardiovascular events (Figure) those who required many cardiovascular drugs derived the largest absolute reduction in the net clinical outcome when adding rivaroxaban on top of aspirin. The relative efficacy, safety, and net clinical benefit of adding low-dose rivaroxaban to aspirin in patients with stable vascular diseases were not affected by the number of cardiovascular drugs or by the number of comorbidities. Multimorbidity, but not polypharmacy, was related with a higher risk of major bleeding.

Conclusion
Addition of low-dose rivaroxaban conveyed a benefit irrespective of the number of concomitant drugs or comorbid conditions. Multiple comorbidities and/or polypharmacy should not dissuade the addition of low-dose rivaroxaban to aspirin in otherwise eligible patients.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): The COMPASS trial was funded by Bayer AG.