bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice of P2Y12 inhibitor and clinical outcomes in the AUGUSTUS study: support for an individualised approach
Authors: Storey R , Alexander J.H , Wojdyla D.M , Mehran R , Vora A.N , Goodman S.G , Aronson R , Windecker S , Granger C.B , Lopes R.D 
Published: November 2020

Abstract

Background
AUGUSTUS randomized patients with atrial fibrillation and ACS and/or PCI to apixaban or VKA and aspirin or placebo for 6 months on background P2Y12 inhibitor.

Purpose
To characterise the clinical outcomes in patients receiving clopidogrel or ticagrelor.

Methods
Patients enrolled in AUGUSTUS (n=4614) were grouped by P2Y12 inhibitor at randomization. Baseline characteristics were compared among groups. Rates of ISTH major or CRNM bleeding, definite/probable stent thrombosis (ST), stroke, MI, and death or ischaemic event were quantified and treatment groups were compared according to treatment with clopidogrel or ticagrelor.

Results
At randomization, patients were treated with clopidogrel (n=4165), ticagrelor (n=280), prasugrel (n=51) or no P2Y12 inhibitor (n=118). Median ages were 71, 69, 66 and 72 years (P&lt;0.001). Ticagrelor and prasugrel were more commonly used in PCI-managed ACS (53% and 55%) whilst clopidogrel or no P2Y12 inhibitor was more common in medically-managed ACS (25% and 36%); elective PCI was the index event in 37–41% for each group. Irrespective of P2Y12 inhibitor used, bleeding risk was lower with apixaban vs. VKA and higher with aspirin vs. placebo (Table). ST rate was lowest but major/CRNM bleeding rate highest with ticagrelor + aspirin vs ticagrelor without aspirin or clopidogrel with or without aspirin.

Conclusions
Apixaban is safer than VKA regardless of P2Y12 inhibitor used. Dropping aspirin reduces bleeding but is associated with numerically higher ST rates regardless of P2Y12 inhibitor used. These data support current recommendations for preferential use of NOAC vs. VKA and individualised choice of P2Y12 inhibitor and timing of aspirin cessation after PCI according to the patient's risks of bleeding and stent thrombosis.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bristol-Myers Squibb/Pfizer
Retrospective comparison of Resting Full-cycle Ratio (RFR) and Fractional Flow Reserve (FFR) in a coronary artery disease cohort
Authors: Wienemann H , Mauri V , Baldus S , Halbach M 
Published: November 2020

Abstract

Background
The fractional flow reserve (FFR) is the gold standard for the assessment of the physiological severity of coronary artery disease. Measurement of FFR requires administration of a vasodilator (commonly adenosine) to achieve maximum hyperemia. The development of resting indices that do not require the administration of adenosine is of great importance. A novel hyperemia-free resting index is the “resting full cycle ratio” (RFR), which corresponds to the lowest pressure distal to the stenosis in relation to the aortic pressure during the entire cardiac cycle. The aim of the present study was to examine the diagnostic accuracy of RFR compared to FFR.

Methods
The study included consecutive patients undergoing pressure wire studies for standard indications at our university hospital from March 9, 2015 to February 15, 2019. Lesions with FFR ≤0.80 were classified as functionally significant. The RFR values were calculated retrospectively from the curves of the FFR measurements, using a point in time before adenosine administration, so that non-hyperemic resting conditions were present.

Results
A total of 635 patients with 733 coronary lesions were investigated using FFR. The average age of the subjects was 68.1±10.7 years. 459 (72.3%) were male. The distribution of the lesions was as follows: LAD: 444 (60.5%), RCA: 140 (19.1%), RCX: 127 (17.3%), RIM: 12 (1.6), LM: 6 (0.9%) and bypasses: 4 (0.5). Overall, the FFR and RFR values were 0.841±0.08 and 0.91±0.06. The RFR showed a significant correlation with the FFR (Table 1). Diagnostic accuracy of the RFR compared to the FFR was highest at a cut-off value of 0.89. This could be demonstrated using the receiver operating characteristic curve (Picture 1).
In 408 measurements, coronary stenoses that were not hemodynamically relevant were found (FFR&gt;0.8 and RFR&gt;0.89). 164 measurements showed hemodynamically relevant coronary stenoses (FFR ≤0.8 and RFR ≤0.89). In 66 lesions, the FFR measurement showed hemodynamic relevance and the RFR measurement did not, whereas in 95 patients the RFR measurement showed hemodynamic relevance and the FFR values were normal.

Conclusions
The RFR as a new resting index has a significant correlation with the FFR after adenosine administration. In 22% of the measurements, a different therapeutic decision would have been made based on the RFR vs. the FFR. A randomized study should therefore investigate whether a RFR-guided approach is non-inferior to a FFR-guided approach in terms of avoiding cardiovascular complications.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Laboratories
The effect of preloading statins prior to primary reperfusion on in-hospital mortality risk in a contemporary large-scale cohort of patients with ST-elevation myocardial infarction
Authors: Fu R , Song C.X , Li X.D , Yang Y.J 
Published: November 2020

Abstract

Background
The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation.

Objective
To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI.

Methods
We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment.

Results
A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p&lt;0.0001).

Conclusions
The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences
Twenty-year trends in clinical outcome of randomized controlled trial for coronary intervention: systematic review and meta-regression analysis of 46 randomized controlled trials
Authors: Asano T , Ono M , Saito A , Kanie T , Takaoka T , Komiyama N 
Published: November 2020

Abstract

Aim
The technology of percutaneous coronary intervention (PCI) has been developed after the advent of coronary stent. However, the impact of the technological development on clinical outcomes is still unclear, whereas a remarkable improvement of clinical outcomes after PCI has not been observed in the trials comparing to medical therapy or coronary bypass graft. The current analysis aims to investigate trends in clinical outcomes after PCI after the emargence of coronary stent, using the randomized controlled trials (RCTs) comparing coronary stents.

Methods and results
We performed a systematic review of RCTs investigating coronary stents in non-specific population (excluding the trials particularly enrolling diabetic or myocardial infarction etc.) conducted between 1996 and 2015 (publication between 1997 and 2019) with independent clinical event adjudication. The random-effect meta-regression analysis including 90 arms with 94,831 patients in 46 RCTs was performed investigating the 20-year trends in clinical outcomes such as death, cardiac death, myocardial infarction, target lesion revascularization (TLR) and stent thrombosis at one and five years after the index procedure. The sensitivity analysis was performed by limiting to 20 all comer trials. In the meta-regression analysis, we did not observe significant change in the incidences of cardiac death and myocardial infarction after PCI over 20 years (P values for cardiac death: 0.666 at one year, 0.256 at five years and P values for myocardial infarction: 0.121 at one year, 0.376 at five years; R2 for cardiac death: &lt;0.01 at one year and five years and R2 for myocardial infarction: &lt;0.01 at one year and five years), whereas the incidences of clinically indicated TLR (P value &lt;0.001, R2 = 0.40 at one year, P value = 0.002, R2 = 0.22 at five years) and stent thrombosis were decreased steeply in the first decade and slightly in the second decade (P value = 0.040, R2 = 0.09 at one year; P value = 0.017, R2 = 0.17 at five year). The sencitivity analysis limiting all-comer population revealed the consistent results.

Conclusion
The development of PCI had an impact on the 20-year trends in TLR and ST, despite there were no trends in the cardiac death and myocardial infarction.
Trends in the incidence of the outcomes

Funding Acknowledgement
Type of funding source: None
Aggressive therapy to prevent contrast-induced kidney damage during percutaneous coronary interventions
Authors: Safyanova O.E , Repin A.N 
Published: November 2020

Abstract

Introduction
In the era of the development of medical technology percutaneous coronary intervention (PCI) has become the most common method of surgical treatment of coronary arteries in patients with coronary heart disease (CHD). Contrast-induced nephropathy (CIN) is a harbinger of chronic renal failure. The recommendations for myocardial revascularization for the prevention of CIN recommend the use of statin treatment. The choice of the optimal statin, the duration of its administration and the effectiveness of loading doses of statins in preventing CIN still remain unresolved topical issues.
The purpose of research work: 1) to evaluate the effectiveness of the prevention of contrast-induced kidney damage when using a loading dose of statins; 2) to study the possibility of early diagnosis of renal damage by examining serum creatinine levels, calculating the glomerular filtration rate (GFR) and the index of a new biomarker of cystatin C.

Material and methods
All patients with CHD, hemodynamically significant stenosis of the coronary arteries were sent to elective endovascular myocardial revascularization. All patients underwent: general clinical examination, a serial study of biochemical blood analysis parameters: creatinine, c-reactive protein (CRP), cystatin C level, GFR. Using the envelope method, the patients were divided into two groups. Patients of the first group were prescribed atorvastatin at a dose of 80 mg for 7 days: 3 days before PCI and 4 days after it. The second group included patients who were treated with rosuvastatin at a dose of 40 mg for 7 days: 3 days before PCI and 4 days after PCI.

Conclusion
The incidence of CI AKI in patients with planned PCI during the administration of high doses of rosuvastatin was less frequent compared with loading therapy with atorvastatin, respectively 3.33% and 12.12%. On average, an increase in the concentration of serum creatinine to the maximum level in patients receiving atorvastatin was higher than in the second group with loading therapy of rosuvastatin (14.3% versus 8.1%, p=0.024).
The decrease in GFR calculated by the formula CKD-Epi was detected 48 and 72 hours after PCI. At the same time, a study of plasma cystatin C showed a decrease in renal function 12 and 24 hours after surgery with the introduction of a contrast agent. This biomarker is an effective marker for early detection of renal failure, even with normal creatinine levels. The anti-inflammatory effect was evaluated by a highly sensitive CRP. In patients with CHD after PCI during therapy with rosuvastatin it was significantly stronger compared with the group of patients using atorvastatin. Thus, the use of rosuvastatin in order to prevent CI of AKI during CPI in patients with CHD seems to be preferable in comparison with atorvastatin due to a more pronounced nephroprotective and anti-inflammatory effect.
Aggressive statin therapy

Funding Acknowledgement
Type of funding source: None
Elevated TG/HDL-C ratio is an independent predictor of outcome and it is associated with CAD progression in patients with stable coronary artery disease
Authors: Caselli C , Rocchiccioli S , Smit J.M , Ragusa R , Rosendael R , Buechel R , Teresinska A , Pizzi M.N , Magnacca M , Campolo J , Knuuti J , Parodi O , Pelosi G , Scholte A.J , Neglia D 
Published: November 2020

Abstract

Background
Elevated TG/HDL-C ratio is associated with CVD outcomes in high-risk populations presenting for coronary angiography, but studies were limited in gender-specific populations or in pts with ACS.

Purpose
Aim of this study was to evaluate the prognostic role of TG/HDL-C levels and their association with CAD progression in pts with suspected stable CAD.

Methods
TG/HDL-C ratio was calculated in 545 pts (60±9yrs,330males) with symptoms of stable CAD enrolled in the EVINCI study. 490 pts underwent coronary CTA to assess the presence of CAD (&gt;50%stenosis) and entered a clinical follow up (4.5±0.9yrs). The CVD outcome measure included all cause mortality, non fatal MI, hospitalization for unstable angina or HF. After 6±1yrs, during the SMARTool study, a second CTA was obtained in 171 EVINCI pts and a CTA risk score (based on plaque extent, severity, composition, and location) was calculated at enrolment and at follow up to assess CAD progression (ΔCTA score).

Results
Pts were divided according to TG/HDL-C quartiles: IQ (&lt;1.32), IIQ (1.32–2.03), IIIQ (2.04–3.33), and IVQ (&gt;3.33). As reported in Table, the frequency of male, diabetes, metabolic syndrome and obesity increased among quartiles. Glucidic biomarkers progressively increased from quartile I to IV, while LDL-C decreased. The prevalence of obstructive CAD at CTA did not differ among groups. The CVD endpoint occurred in 7% of pts. At multivariable analyses, high TG/HDL-C ratio (IVQ) was associated with the outcome endpoint independently from presence of obstructive CAD and treatment (HR 3.477, 95% CI 1.181–10.239, P=0.0237). CTA score was significantly higher in pts in IVQ compared to IQ at both SMARTool enrolment and follow up (Figure1). A significantly higher ΔCTA score was observed in pts in III-IVQ compared with those in I-IIQ (Figure2).

Conclusion
Elevated TG/HDL-C ratio is an independent predictor of outcome and it is associated with CAD progression in patients with stable CAD.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): “EValuation of INtegrated Cardiac Imaging” - EVINCI [GA number: 222915]; “Simulation Modeling of coronary ARTery disease: a tool for clinical decision support - SMARTool” [GA number: 689068]
Non-alcoholic fatty liver disease fibrosis score predicts cardiovascular mortality in post percutaneous coronary intervention patients: a 5-years results from observational registry
Authors: Lee D , Kim J 
Published: November 2020

Abstract

Background and aims
The nonalcoholic fatty liver disease fibrosis score (NFS) is comprised of metabolic risk indicators that may accurately predict residual cardiovascular risk in patients with CAD.

Method
This is a nested case control study of the post PCI registry from single tertiary hospital. Among 5589 patients who underwent PCI from 2010 through 2014, previously diagnosed 1510 NAFLD patients and 296 consecutive NAFLD patients who had undergone both PCI and ultrasonography of abdomen within 1 year between the tests were enrolled. (median age, 64y (IQR 55–73)). We applied the NFS to the patients at baseline, using validated NFS cut-offs and 201 patients with higher NFS, defined as NFS &gt;0.67 at PCI, were 1:1 matched with controls, based on propensity scores for higher NFS &gt;0.67.

Results
Higher NFS (NFS &gt;0.67) was more prevalent in patients with left ventricle (LV) dysfuction (LVEF at PCI &lt;40%) than in those without (81.0% vs 33.6%, p&lt;0.001). Baseline higher NFS was significantly associated with LV dysfunction (adjusted OR 1.86, 95% CI 1.36 to 2.55, p&lt;0.001), and baseline higher NFS and persistent higher NFS at 1 year after PCI were independent predictor of a 5-years CV death, after adjustment for LVEF (adjusted HR 1.42, 95% CI 1.03 to 1.95, p=0.023; adjusted HR 1.52, 95% CI 1.08 to 2.64, p=0.033).

Conclusion
With a longitudinal assessment of the association between NAFLD status by NFS and the risk of CV death, we found post-PCI patients with persistent higher NFS were at higher risk of CV death compared with those without.
KM rates of CV death according to NFS

Funding Acknowledgement
Type of funding source: None
Coronary artery fistulas: a single-center case series
Authors: Cardoso Torres S , Vasconcelos M , Resende C.X , Diogo P , Pinto R , Proenca T , Carvalho J.M , Calvao J , Amador F , Costa C , Cruz C , Moreira J , Pinho P , Silva J.C , Maciel M.J 
Published: November 2020

Abstract

Introduction
Coronary artery fistulas (CAFs) are rare anomalous connections between a coronary artery and a major vessel or cardiac chamber. Currently they are being increasingly encountered due to the more widespread use of various imaging modalities and coronary angiography. Although the vast majority of CAFs are incidentally diagnosed and have no clinical relevance, they can cause significant morbidity such as myocardial infarction, congestive heart failure and endocarditis.

Methods
A consecutive series of 55867 coronary arteriograms performed in our Cardiology Department from 2007 to 2019 was retrospectively investigated for the presence of coronary artery fistulas. Patients clinical, angiographic and therapeutic data up to november 2019 were analyzed. Data were obtained from medical records of hospital stay and subsequent consultations.

Results
We identified 50 patients who were diagnosed with one or more CAFs, with ages between 5 and 85 years (mean 59 years). 62% (n=31) were males.
The great majority of patients had a single fistula (n=34, 68%), 11 patients had two fistulas (22%), 1 patient had 3 fistulas (2%) and 4 patients had multiple fistulas (8%).
CAFs arose more frequently from the left anterior descending artery (n=27), followed by the right coronary (n=18), left circumflex (n=15), left main (n=5) and intermediate artery (n=2). The most frequent drainage site was the pulmonary artery (n=38).
The majority of CAFs were incidentally found (n=32; 64%) and thought to have no significance for the patients' clinical status. As for the rest of the patients, CAFs were diagnosed during evaluation of: a heart murmur (n=7); exertional chest pain with no associated significant atherosclerotic coronary artery disease (n=7); exertional dyspnea (n=2); positive exercise stress test (n=1); NSTEMI and cardiac arrest (n=1).
Regarding treatment, watchful waiting was the main approach (n=40; 80%). 3 patients had their CAFs closed during surgery for another heart condition (CABG/aortic valve replacement). In 1 patient, heart surgery was specifically conducted for fistula closure. 6 patients (12%) underwent fistula transcatheter closure.

Conclusion
CAFs are rare coronary anomalies and the majority has no clinical relevance, so watchful waiting is the commonest approach. When they are hemodynamically significant or symptoms/complications arise, surgical or transcatheter closure should be considered. This study describes the angiographic, clinical and therapeutic data of CAFs detected along the last 12 years in a single tertiary care center catheterization laboratory.

Funding Acknowledgement
Type of funding source: None