bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation
Authors: Haemmerle P , Eick C , Bauer A , Rizas K.D , Coslovsky M , Krisai P , Vesin J.M , Beer J , Moschovitis G , Bonati L.H , Sticherling C , Conen D , Osswald S , Kuehne M , Zuern C.S 
Published: November 2020

Abstract

Introduction
The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system.

Purpose
We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes.

Methods
We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes.

Results
At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI &lt;15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI&lt;15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN&lt;70ms and MHR&lt;80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure).

Conclusions
Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation
Patterns of coronary vascular involvement in patients with heart failure due to cardiac amyloidosis
Authors: Yacob O , Beyene S , Melaku G , Hideo-Kajita A , Kuku K , Brathwaite E , Wilson V , Ozaki Y , Dan K , Sheikh F , Mohammed S , Garcia-Garcia H 
Published: November 2020

Abstract

Background
Amyloidosis is a group of protein-folding disorders characterised by organ deposits, derived from one of several amyloidogenic precursor proteins. The involvement of coronary arteries has been previously described in amyloidosis, however the pattern of the disease in the coronaries is still unknown.

Purpose
The aim of this study is to characterise the pattern and severity of coronary artery lesions in cardiac amyloidosis.

Methods
We retrospectively compared patients with heart failure who tested positive (i.e. biopsy or gene tests – HF/CA+) against those that tested negative (HF/CA−) for cardiac amyloidosis. Groups were compared demographically and angiographically for qualitative and quantitative variables to determine patterns of involvement in the major epicardial coronary vessels.

Results
In total, 110 heart failure patients were included in the study, of whom 55 were HF/CA+ patients (88 lesions) and 55 were HF/CA− patients (66 lesions). Despite the advanced age in the HF/CA+, (74.53±11.02 vs 54.11±15.08; p=0.05), severe calcification was reported in HF/CA− group (4.5% vs to 0.0%; p=0.018). The HF/CA+ group also had fewer ostial lesions (3.4% vs. 15.15%, p=0.0095), reduced TIMI flow grade (83% vs 76%; p=0.21) and a higher TIMI frame count (30±12 Vs 27±11 frames; p=0.06). In the HF/CA+ group, compared to women, men had a significant number of tandem lesions (14.55% vs 0.0%, p=0.02). Men trended to have more ulcerations in comparison to women (9.09% vs 0.0%; p=0.15).

Conclusion
Overall, patients with HF/CA+ were older but found to have lesser calcified lesions, ostial involvement and a reduced anterograde blood flow. This is the first report outlining the coronary lesions in patients with HF/CA+.

Funding Acknowledgement
Type of funding source: None
Bioresorbable scaffold versus drug coated balloon for treatment of in-stent-restenosis – long-term outcomes of the randomized ABSORB-ISR trial
Authors: Bossard M , Attinger A , Wolfrum M , Moccetti F , Zasada W , Mehmann B , Kobza R , Toggweiler S , Cuculi F 
Published: November 2020

Abstract

Background
Observational studies showed promising results after treatment of coronary instent-restenosis (ISR) using the everolimus-eluting bioresorbable vascular scaffold (BVS) Absorb®.

Purpose
We compared long-term outcomes after treatment of ISR with BVS versus the paclitaxel-eluting drug coated balloon (PE-DCB) SeQuent® Please, which is commonly used for treatment of ISR.

Methods
This was randomized-controlled trial of Absorb® BVS versus SeQuent® Please PE-DCB in an all-comers population with clinically relevant ISR. The patients were randomized in a 1:1 fashion. The angiographic primary endpoint was late lumen loss (LLL) at 9 months. Clinical follow-ups (FU) up to 48 months were conducted.

Results
Totally, 53 patients and lesions were enrolled. The mean age was 66.7±9.8 years, 23 (43.4%) had an acute coronary syndrome (ACS) and 16 (30.2%) were diabetic. PCI was successful in all patients. After 9 months, the mean LLL did not significantly differ between patients treated with BVS versus PE-DCB (median 0.41 (interquartile range (IQR) 0.15; 1.23)mm versus 0.27 (IQR 0.13; 0.66)mm, p=0.86). Moreover, mean lumen area on optical coherence tomography (OCT) did not significantly differ (median 5.47 (IQR 4.44; 7.69)mm2 versus 6.70 (IQR 5.00; 7.82)mm2, p=0.24). Rates of significant ISR (angiographic stenosis &gt;70%) were similar with BVS versus PE-DCB (7 (30.4%) versus 6 (27.3%), p=0.81). The target vessel revascularization rates were 9 (33.3%) versus 9 (34.6%) using the BVS versus PE-DCB (p=0.72), also highlighted in the Figure below). No stent/ scaffold thrombosis occurred during FU. The study was prematurely stopped due to withdrawal of the Absorb® BVS in September 2017.

Conclusions
In this randomized pilot study, we found no significant difference in angiographic, OCT and clinical endpoints after treatment of ISR lesions using the Absorb BVS versus SeQuent® Please PE-DCB during long-term follow-up (≥48months). However, rates of target vessel revascularization were very high in both groups (&gt;30%).
TVR and TLF with BVS or PE-DCB for ISR

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott Vascular
Safety and efficacy of different arterial pressure bandages following percutaneous coronary interventions from radial access: preliminary data of the RAD-PRESS trial
Authors: Nemeth B , Nowotta F , Ruzsa Z , Szuk T , Becker D , Merkely B , Edes I.F 
Published: November 2020

Abstract

Background
The overwhelming majority of diagnostic coronary angiographies and percutaneous coronary interventions (PCIs) are performed via radial access as recommended by the current European revascularization guidelines. Using dedicated pressure bandages for the radial access site in high-volume centres can be a significant part of the budget of catheterization laboratories, therefore we developed a cost-effective pressure bandage utilizing wrapped empty glass vials of intravenous medications. Furthermore, compression time of the radial puncture site following PCI is a predictor of radial artery occlusion, therefore shortening the period of compression to as short as possible is feasible.

Purpose
Our aim was to validate efficacy and safety of our cost-effective pressure bandage by comparing it to two dedicated devices, as well as reducing length of compression to as short as possible.

Methods
We designed the RAD-PRESS trial, major inclusion criteria of which were first puncture of a radial artery with a diameter greater than 1.8mm, PCI performed as per guidelines utilizing a 6 French guiding catheter and age below 80 years. Patients were then randomized to receive one of three pressure bandages: the glass vial, Seal-One or the gold standard TR-band. Release of pressure was performed as fast as possible in 10-minute steps, and guided by pulse oximetry. Hematoma formation was thoroughly checked for all patients and categorized using the Easy scale. Radial artery patency was investigated by ultrasound 24 hours after final removal of the bandage. The data of 40 patients of every group was analysed.

Results
Population characteristics were similar among the groups. Length of compression time (126±10, 142±11 and 144±11 mins for Vial, Seal-One and TR-band, respectively, p&gt;0.05), hematoma formation (Easy Grade 1 in 17.5%, 15.0% and 10.0%, Easy Grade 2 in 5.0%, 7.5% and 7.5% for Vial, Seal-One and TR-band, respectively, all p&gt;0.05) were not significantly different among the groups. Radial artery occlusion occurred in only 2 patients (Vial and TR-Band groups), accounting for 1.7% of the cases.

Conclusions
The cost-effective wrapped vial strategy to compress the radial puncture site was comparable to both Seal-One and the gold standard TR-band regarding safety and efficacy. Furthermore, compression time could be safely shortened to approximately 2.5 hours.

Funding Acknowledgement
Type of funding source: None
Impact of intraprocedural stent thrombosis on outcomes of percutaneous coronary intervention: a meta-analysis
Authors: Aggarwal A , Jain A , Kohli V 
Published: November 2020

Abstract

Background
Intraprocedural stent thrombosis (IPST), defined as the development of occlusive or nonocclusive new thrombus in or adjacent to a recently implanted stent before completion of PCI. IPST even though a rare entity, yet is associated with worse prognosis amongst all intraprocedural thrombotic events.

Purpose
Data regarding the impact of IPST is scarce and needs further investigation.

Methods
We performed literature search of all published full-length articles that studied and compared data on patients with IPST and with no IPST during PCI. We calculated odds ratios via the random effects model for 30 day and 1 year outcomes.

Results
Our literature search yielded 3 studies (1 retrospective, 2 observational post-hoc analysis) relevant to the meta-analysis. Total 19272 patients were included. IPST occurred in 159 patients (0.8%). At 30 days, IPST was associated with statistically significant higher all-cause mortality (OR 10.79, 95% CI [6.31, 18.45] p&lt;0.00001), MI (OR 4.82, 95% CI [2.39, 9.73] p&lt;0.0001), target vessel revascularization (TVR) (OR 6.70, 95% CI [3.38, 13.29] p&lt;0.00001), definite stent thrombosis (OR 10.44, 95% CI [5.87, 18.58] p&lt;0.00001), definite or probable stent thrombosis (OR 9.28), 95% CI [5.54, 15.56] p&lt;0.00001) and death or MI or TVR (OR 7.20], 95% CI [4.10, 12.64] p&lt;0.00001), than those without IPST. At one year, results remained statistically significant for higher mortality (OR 4.27, 95% CI [1.92, 9.49] p=0.0004) and death or MI or TVR (OR 2.91, 95% CI [1.58, 5.36] p=0.0006) in patients with IPST.

Conclusions
IPST even though is a rare occurrence, is associated with more adverse ischemic events, including higher mortality at 30 days and 1 year.

Funding Acknowledgement
Type of funding source: None
Four-year results of the AIDA trial: comparison of Absorb bioresorbable scaffold with Xience everolimus-eluting metallic stent in daily clinical practice
Authors: Kerkmeijer L.S.M , Tijssen R.Y.G , Kraak R.P , Hofma S.H , Arkenbout E.K , Van Der Schaaf R.J , Weevers A.P.J , Tijssen J.G.P , Piek J.J , Henriques J.P.S , De Winter R.J , Wykrzykowska J.J 
Published: November 2020

Abstract

Aims
Absorb bioresorbable scaffold (BRS) related events were noticed between 1 and 3 years – the approximate time of active scaffold bioresorption. This resulted in the recommendation for 3 year DAPT after Absorb BRS implantation. We aimed to evaluate the safety and efficacy of the Absorb BRS in comparison with Xience everolimus-eluting stent (EES) at 4 years follow-up in large unselected population. In addition, we aimed to assess the value of prolonged DAPT against scaffold thrombosis.

Methods
AIDA was an investigator-initiated, non-inferiority, multicenter, randomized, all-comers trial. Target vessel failure (a composite of cardiac death, target-vessel myocardial infarction and target-vessel revascularization) and device thrombosis at 4-year follow-up are the primary focus of this analysis. During the trial recommendation for DAPT was changed to up to 3-years post Absorb BVS implantation. Whether this adaption influenced the results after Absorb BVS will be assessed.

Results
Between August 2013 and December 2015, 1,845 patients were enrolled, of whom 924 were randomized to treatment with Absorb BRS and 921 to Xience EES. The baseline characteristics in the two study arms were well balanced. Of all patients, 18% had diabetes mellitus, more than 50% presented with ACS and the median SYNTAX score was 11. In the Absorb BRS arm, 97% of lesions were predilated and in 74% post-dilatation was performed. Four-year clinical outcomes are currently being adjudicated by an independent clinical event committee. The results will be available at EuroPCR 2020.

Conclusions
Absorb BRS is associated with higher rates of scaffold thrombosis throughout 3-year of follow-up. The performance of Absorb BRS beyond 3-years, in comparison with the Xience EES, in a large unselected population will be presented. (ClinicalTrials.gov Identifier: NCT01858077)

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
Radiation exposure in interventional cardiology: relationship between patient radiation dose, demographic characteristics and procedural factors
Authors: McCaughey C , Kumar R , Kumar J , Matiullah S 
Published: November 2020

Abstract

Introduction
There has been a significant increase in Interventional Cardiology (IC) procedures over last few decades across the globe. The introduction of newer techniques and procedure types in IC has contributed to an overall increase in radiation exposure to both operators and patients alike. Unlike diagnostic imaging, IC procedures are heterogeneous and vary in their complexity based on a myriad of factors, such as patient disease characteristics, anatomy, nature of lesions and operator technique.

Purpose
The aim of the study is to evaluate the demographic and procedural characteristics associated with increased radiation dose. Limited studies exist on the impact of demographic and procedural characteristics on cumulative radiation dose.

Methods
Single-centre retrospective observational study of elective Percutaneous Coronary Intervention (PCI) patients from October 2018 to December 2018 in a 24/7 Irish pPCI centre. Patient level data including weight, height, demographic and procedural characteristics were collected for 65 consecutive elective PCI cases. Radiation exposure metrics, including Kerma Area Product (Pka), Reference Air Kerma (Ka,r) and Fluoroscopy Time (FT), were also collected. A Mann-Whitney U Test was used to assess for differences in radiation exposure between groups and a multivariate regression analysis was performed in order to identify those variables which contributed to radiation exposure.

Results
Median total radiation exposure for our cohort was (Q1–3) -Pka 109 (61–154) Gy·cm2, Ka,r 1746 (1,082–2,530)mGy and FT 16 (10–25)mins. Males (n=48) had a significantly higher radiation exposure Pka 126 (84–171) vs 56 (27–114)Gy·cm2 p=0.001; Ka,r 2094 (1256–2936) mGy p=0.006) than females. Those who underwent femoral access had significantly lower radiation exposure (Pka 50 (38–77) vs 114 (63–158) Gy·cm2 p=0.019; Ka,r (897 (725–1094) vs 2020 (1092–2618) mGy; p=0.018) when compared to radial access. Increasing body mass index (BMI) (p=0.03), multi vessel PCI (p=0.001) and the use of a “sheathless” technique (p=0.029) were associated with increasing radiation exposure (r2=0.630 Pka; Ka,r r2=0.611). Stent characteristics and all other clinical risk factors (HTN, smoking, DM, renal impairment, previous PCI) had no significant impact on radiation exposure.

Conclusion
Radiation exposure during IC in our cohort was within the range of most European Diagnostic Reference Levels (DRL's). Increased BMI and male gender were associated with increased radiation exposure. Procedural characteristics such as radial access, multi vessel PCI and the use of sheathless technique were independently associated with increasing radiation exposure. We recommend dose documentation of all procedures for these patients to avoid radiation hazards; with periodic assessment of statistical dose recording and planned follow up.
Regression analysis

Funding Acknowledgement
Type of funding source: None
Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: a meta-analysis of randomized controlled trial
Authors: Bajraktari G , Bytyci I , Henein M.Y , Alfonso F , Ahmed A , Jashari H , Bhatt D.L 
Published: November 2020

Abstract

Background
The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesion had a reduced risk of major adverse cardiac events (MACE: cardiovascular mortality, myocardial infarction, or ischemia-driven revascularization), but not of cardiovascular or total mortality.

Aim
To assess the efficacy of complete revascularization for cardiovascular or total mortality reduction by meta-analysis of all available randomized controlled trials (RCTs) including the COMPLETE trial.

Methods
PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n=3420) vs. only culprit lesion (n=3613) PCI for a median 28.7 months follow-up. Random effect risk ratios were used for efficacy and safety outcomes.

Results
Complete revascularization reduced the risk of MACE (10.4% vs. 16.6%; RR=0.59, 95% CI: 0.47 to 0.74, p&lt;0.0001), CV mortality (2.87% vs. 3.72%; RR=0.73, 95% CI: 0.56 to 0.95, p=0.02), reinfarction (5.1% vs. 7.1%; RR=0.67, 95% CI: 0.52 to 0.86, p=0.002), urgent revascularization (7.92% vs. 17.4%; RR=0.47, 95% CI: 0.30 to 0.73, p&lt;0.001), and CV hospitalization (8.68% vs. 11.4%; RR=0.65, 95% CI: 0.44to 0.96, p=0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy.

Conclusion
The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes.

Funding Acknowledgement
Type of funding source: None
Impact of a CTO in a non-infarct-related artery on long-term mortality in patients undergoing primary PCI
Authors: Milasinovic D , Mladenovic D.J , Jelic D , Mehmedbegovic Z , Radomirovic M , Zobenica V , Pavlovic A , Vratonjic J , Vukcevic V , Asanin M , Stankovic G 
Published: November 2020

Abstract

Background
Previous studies showed increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery, but long-term data are scarce.

Purpose
Our aim was to assess all-cause mortality during 5 years follow-up in patients with a remaining nonculprit CTO after being treated with primary PCI.

Methods
The study included 9504 patients admitted for primary PCI during 2009–2019, with available baseline angiography, from an electronic, prospective registry of a high-volume catheterization laboratory. Kaplan Meier cumulative mortality curves for non-culprit CTO vs. no CTO were compared with the log-rank test, with landmarks set at 30 days and then annually up to 5 years follow-up. Adjusted Cox regression models were constructed to assess 30-day and 5-year mortality risk of a non-culprit CTO. Median follow-up was 1507 days.

Results
Nonculprit CTO was present in 13.2% of patients (n=1253). Presence of a nonculprit CTO was associated with older age (64 vs. 61, p&lt;0.001), more frequent history of cardiovascular disease including prior MI (33% vs. 14%, p&lt;0.001), stroke (10.3% vs. 5.9%, p&lt;0.001) and CABG (10.5% vs. 1.5%, p&lt;0.001), higher rates of renal failure (10.7% vs. 4.8%, p&lt;0.001), as well as more often Killip class 2–4 on admission (29% vs. 16%, p&lt;0.001) and a lower ejection fraction (40% vs. 47%, p&lt;0.001). Crude mortality rates were significantly increased in patients with a nonculprit CTO vs. no CTO, at both 30 days (15.7% vs. 5.6%, p&lt;0.001) and 5 years (54.6% vs. 27.9%, p&lt;0.001). After adjusting for the observed baseline differences, nonculprit CTO was still associated with an elevated mortality risk at both 30-days (HR 1.5, CI95% 1.1–1.9, p=0.007) and 5 years (HR 1.6, CI95% 1.4–1.9, p&lt;0.001). Landmark analyses showed continuously increasing risk of mortality in the presence of a nonculprit CTO, as compared with primary PCI-treated patients with no CTO (30 days to 1 year 11.4% vs. 4.9%, p&lt;0.001; 1st to 2nd year of follow-up 6.3% vs. 3.4%, p&lt;0.001; 2nd to 3rd year 6.2% vs. 2.8%, p&lt;0.001; 3rd to 4th year 7.4% vs. 3.0%, p&lt;0.001; and 4th to 5th year 5.2% vs. 3.6%, p=0.1).

Conclusions
Presence of a nonculprit CTO is independently associated with 5-year mortality after primary PCI. Importantly, the mortality risk increases continuously with an average annual absolute difference of 3%, in patients with a nonculprit CTO vs. those with no CTO.
Nonculprit CTO vs. no CTO

Funding Acknowledgement
Type of funding source: None