bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between intracoronary versus intravenous bolus injection of tirofiban on infarct size during primary PCI in patients with acute anterior ST segment elevation myocardial infarction
Authors: Osman M , Yassen I , Elhefny E.H.A.B 
Published: November 2020

Abstract

Background
The latest guidelines considered glycoprotein IIb/IIIa inhibitors (GPI) as a bailout strategy in selected situations in patients presented with acute ST segment elevation myocardial infarction (STEMI) however, did not recommend route of administration over another and did not correlate it to infarct size. Infarct size correlates generally with prognosis following acute myocardial infarction and Reduction in infarct size can boost clinical outcomes and decrease rate of heart failure hospitalization.

Purpose
To evaluate intracoronary vs intravenous use of tirofiban on reduction of infarct size in STEMI treated with primary PCI.

Methods
Between February, 2018, and October, 2019, one hundred patients presented within 6 hours of anterior STEMI undergoing primary PCI after exclusion of (rescue PCI, TIMI flow less than II post PCI, Previous MI, Stent thrombosis, Previous CABG, Significant left main occlusion, Pulmonary edema and Cardiogenic shock).
Group (A): 50 patients who were treated by intracoronary bolus infusion of tirofiban followed by IV maintenance dose infusion of tirofiban.
Group (B): 50 patients who were treated by intravenous bolus infusion of tirofiban followed by IV maintenance dose infusion of tirofiban.
Primary endpoint: Infarct size was assessed 1 month after randomization by SPECT.
Secondary endpoint: Major adverse cardiovascular events (MACE) during hospital stay (cardiac death, MI, stroke or target vessel revascularization), heart failure and bleeding.

Results
Patients randomized to intracoronary tirofiban compared with intravenous tirofiban had a significant decrease in the primary end point of infarct size (mean [SD], 14.46% [7.79%] vs 18.06% [7.83%]; P=0.02). Also associated with lower incidence of heart failure (number [%], 8 [16%] vs 17 [34%]; P=0.037). There were no significant differences in any of the MACE or bleeding between the randomized groups at 30 days.

Conclusions
In patients with anterior STEMI presenting early after symptom onset, intracoronary tirofiban administration when compared to intravenous route during primary PCI resulted in infarction size reduction and lower heart failure incidence mainly driven by enhanced left ventricular systolic function however no distinction between two strategies on MACE or bleeding risk.
Results

Funding Acknowledgement
Type of funding source: None
Incidence and risk factors for major bleeding among patients undergoing percutaneous coronary intervention: findings from the Norwegian coronary stent trial (NORSTENT)
Authors: Samuelsen P , Eggen A.E , Steigen T , Wilsgaard T , Kristensen A , Skogsholm A , Holme E , Van Den Heuvel C , Nordrehaug J.E , Bendz B , Nilsen D.W.T , Bonaa K.H 
Published: November 2020

Abstract

Introduction
Bleeding is a concern after percutaneous coronary intervention (PCI) and subsequent dual antiplatelet therapy (DAPT).

Purpose
We herein report the incidence and risk factors for major bleeding in the Norwegian Coronary Stent Trial (NORSTENT).

Materials and methods
NORSTENT was a randomized, double blind, pragmatic randomized trial among patients with acute coronary syndrome or stable coronary disease undergoing PCI during 2008–11. The patients (N=9,013) were randomized to receive either a drug eluting stent or a bare metal stent, and were treated with at least 9 months of DAPT. The patients were followed for a median of five years, with BARC 3–5 major bleeding as one of the safety endpoints. We estimated cumulative incidence by a competing risks model and risk factors through cause-specific Cox models.

Results
The 12-month cumulative incidence of major bleeding was 2.3%. Independent risk factors for major bleeding were chronic kidney disease (CKD), underweight (&lt;60 kilograms), diabetes mellitus, and advanced age (&gt;80 years). A myocardial infarction (MI) or PCI during follow-up increased the risk of major bleeding (HR = 1.7, 95% CI 1–3-2.2).

Conclusions
The 12-month cumulative incidence of major bleeding in NORSTENT was higher than reported in previous, explanatory trials. This analysis strengthens the role of CKD, advanced age, and underweight as risk factors for major bleeding among patients receiving DAPT after PCI. The presence of diabetes mellitus or recurrent MI among patients is furthermore a signal of increased bleeding risk.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Northern Norway Regional Health Authority (Helse Nord RHF)
Efficacy of fractional flow reserve-guided percutaneous coronary intervention for patients with angina pectoris: a network meta-analysis
Authors: Shinohara H , Kodera S , Kiyosue A , Ando J , Morita H , Komuro I 
Published: November 2020

Abstract

Background
Evaluation of hemodynamic parameters, such as fractional flow reserve (FFR), is recommended before percutaneous coronary intervention (PCI) for patients with angina pectoris (AP). However, the advantage of FFR-guided PCI has not been fully established. A network meta-analysis (NMA) synthesizes the results of studies on multiple competing interventions. Moreover, no NMA has evaluated randomized controlled trials for AP to compare FFR-guided PCI and other treatments. To clarify whether FFR-guided PCI improves the prognosis in patients with AP, we performed this study.

Methods
Multiple databases were searched for studies published from 2000 to 2018. The search terms were based on Medical Subject Headings and keywords including “angioplasty”, “coronary artery bypass”, “percutaneous coronary intervention”, “coronary disease”, and “randomized controlled trial”. And an NMA was performed to compare outcomes of FFR-guided PCI, non-FFR-guided PCI, coronary artery bypass grafting (CABG), and medical treatment (MT) for AP based on estimated odds ratios (ORs). The primary endpoint was all-cause mortality. The secondary endpoints were the occurrence of MI. Treatments were ranked by the surface under the cumulative ranking curve.

Results
The study included 18,093 patients from 15 randomized controlled trials. No evidence of inconsistency was observed among the studies. The NMA showed that the all-cause mortality of FFR-guided PCI was not significantly different from that of the other treatment groups (CABG: OR, 1.1; 95% confidence interval [CI], 0.67–1.7; non-FFR-guided PCI: OR, 0.85; 95% CI, 0.53–1.4; and MT: OR, 0.83; 95% CI, 0.52–1.3). The NMA for myocardial infarction, which included 13,548 patients from 11 randomized controlled trials, showed that FFR-guided PCI tended to reduce the occurrence of myocardial infarction compared with MT (OR, 0.60; 95% CI, 0.36–1.0). According to the surface under the cumulative ranking curve, CABG was the best treatment, followed by FFR-guided PCI, non-FFR-guided PCI, and MT.

Conclusions
FFR-guided PCI for AP showed no significant prognostic improvement compared with non-FFR-guided PCI, CABG, and MT. CABG was the best treatment for AP, followed by FFR-guided PCI, non-FFR-guided PCI, and MT.
Network plot and interval plot

Funding Acknowledgement
Type of funding source: None
Impact of complete revascularization for acute myocardial infarction with multivessel coronary artery disease in diabetes mellitus patients
Authors: Kang J , Park K.W , Rhee T.M , Lee H.S , Ki Y.J , Han J.K , Yang H.M , Kang H.J , Koo B.K , Kim H.S 
Published: November 2020

Abstract

Background
Clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with Diabetes Mellitus (DM) patient.

Objectives
We sought to compare prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM.

Methods
A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on angiographic image. The primary endpoints of this study was patient oriented composite outcome (POCO) defined as a composite of all cause death, any myocardial infarction, and any revascularization within 3 years.

Results
Overall, 3-year POCO were significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the non-DM group but not in the DM group (POCO: 11.7% vs. 23.2%, p&lt;0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (HR 0.52, 95% CI 0.38–0.71) only in the non-DM group.

Conclusion
In AMI patients with multivessel disease, CR may be ineffective in improving clinical outcomes in patients with DM.

Funding Acknowledgement
Type of funding source: None
Looking for ischemia in patients with stable atypical chest pain: useful or useless?
Authors: Cosmi D , Mariottoni B , Cosmi F 
Published: November 2020

Abstract

Introduction
Patients with stable atypical chest pain (SACP) represent more than half of those with chest pain who require an outpatient evaluation. It's not clear if in these patients the prognosis is linked more to the optimal control of risk factors and to the research and treatment of any unfavorable anatomical alterations (common trunk obstruction, proximal involvement of VAT, multivessel disease with systolic dysfunction of the left ventricle) rather than to ischemia assessment with functional tests.

Methods
In the past 20 years we have evaluated the lifestyles of 40,422 outpatient patients. 9% (3,638) had a history of stable chest pain with no history of previous cardiovascular events. In the 1,322 patients (36%) with non-anginal chest pain, no diagnostic examination was performed after the electrocardiogram (ECG) and the echocardiogram. 462 patients (13%) had typical chest pain, and 422 of them performed a coronary angiography.
The other 1,854 (51%) patients with SACP underwent functional testing for ischemia (exercise ECG, ecostress, nuclear stress testing). They were also stratified according to the presence of 4 main modifiable lifestyles (cigarette smoking, diet, physical activity, obesity) and the 3 main cardiovascular risk factors (hypercholesterolemia, hypertension, diabetes).

Results
In the SACP group, the search for ischemia was positive in 192 patients (10.4%); 178 of them underwent coronary angiography, which demonstrated the presence of lesions with indication to revascularization to improve the prognosis, according to the ESC 2018 guidelines (Class IA), in 21 patients (11.7%). In the remaining 1,662 patients functional tests were negative.
We performed one-year follow-up. Major coronary events (fatal and non-fatal infarction, sudden death) occurred in 22 patients (1.3%) with negative stress tests and at least 3 risk factors or bad lifestyles (especially smoking, diabetes, high LDL). In patients with positive stress tests, there were 3 events, (1.5%), that occurred among patients with at least 3 risk factors, too. No events occurred in patients with fewer than 3 risk factors or lifestyles in either group.

Conclusions
In patients with SACP and negative functional test the risk of major coronary events remains 1.3% at 1 year of follow-up; the events occurr in patients with 3 or more factors or lifestyle at risk (especially smoking, diabetes, elevated LDL). The prognosis is similar to those with positive ischemia research.
The improvement of the outcomes should be entrusted more to a close control of the risk factors, to an optimal improvement of the lifestyles and to an anatomical evaluation (coronary CT) for the evaluation of those lesions that improve the prognosis rather than the search for ischemia which appears futile from a diagnostic and prognostic point of view as well as a source of economic waste.

Funding Acknowledgement
Type of funding source: None
Prognostic value of hybrid cardiac perfusion SPECT/CT for patients with coronary artery disease after coronary artery bypass grafting
Authors: Fukushima Y , Ishii Y , Kiriyama T , Nitta T , Kumita S 
Published: November 2020

Abstract

Introduction
Patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) occasionally experience recurrent myocardial ischemia. Because of their severe CAD and its complicated hemodynamics, conventional cardiac perfusion SPECT often cannot reveal the severity and prognosis solely. Hybrid cardiac SPECT/CT imaging simultaneously shows myocardial ischemia distribution, coronary artery lesion distribution, and their relationship, and this modality may enable detailed interpretation and risk stratification for such patients.

Aim
This study aimed to assess the prognostic value of hybrid cardiac SPECT/CT for patients with CAD and suspected myocardial ischemia after CABG.

Methods
A total of 201 consecutive patients, registered between April 2016 and September 2018, with suspected recurrent angina pectoris after CABG requiring examinations for myocardial ischemia were included in this study. Among these, 135 patients who underwent cardiac perfusion SPECT, cardiac CT, and hybrid cardiac SPECT/CT imaging were analyzed. In the SPECT-only analysis, SDS was calculated, and the patients were divided into none-to-mild (SDS &lt;4) and moderate-to-severe ischemia (SDS ≥4) groups. In the SPECT/CT analysis, the patients were divided into a matched group (SPECT reversible accumulation defects [SDS ≥2] along coronary arteries with significant lesions) and an unmatched group (accumulation defects not coincided with coronary artery territories or no significant stenoses in the corresponding coronary arteries). All patients were observed from the time of these tests for the occurrence of major adverse cardiac events (MACE), and the prognostic performances of these analyses were compared.

Results
In the SPECT-only analysis, 62 were in the none-to-mild group and 73 were in the moderate-to-severe group. In the SPECT/CT analysis, 61 were in the matched group and 74 were in the unmatched group. Within the follow-up period of 29±8 months, 15 patients experienced MACE. The patients' prognoses were clearly stratified by hybrid SPECT/CT analysis (matched: 13/61, 21.3% vs. unmatched: 2/74, 2.7%) compared with SPECT-only analysis (moderate-to-severe: 11/73, 15.0% vs. none-to-mild: 4/62, 6.5%). The hybrid cardiac SPECT/CT analysis was more strongly associated with the occurrence of MACE compared with SPECT-only analysis (p=0.008 vs. p=0.04, respectively).

Conclusions
Hybrid cardiac SPECT/CT imaging can have higher prognostic value compared with stand-alone cardiac perfusion SPECT for patients with CAD after CABG.

Funding Acknowledgement
Type of funding source: None
Percutaneous coronary intervention in spontaneous coronary artery dissection: a case-control study
Authors: Kotecha D , Premawardhana A.D.P.E , Garcia-Guimaraes M , Pellegrini D , Wood A.D , Maas A , Van Geuns R , Alfonso F , Adlam D 
Published: November 2020

Abstract

Background
Spontaneous Coronary Artery Dissection (SCAD) is an important cause of acute coronary syndrome particularly in young-middle aged women. Revascularisation is challenging due to an underlying disrupted and friable coronary vessel wall leading to widely reported worse outcomes than for atherosclerotic coronary disease. Therefore, a conservative approach where possible is favoured however in some cases haemodynamic instability, ongoing ischaemia and reduced distal flow mandates consideration of revascularisation.

Purpose
To compare SCAD survivors managed with PCI or conservatively in terms of presentation characteristics, complications and long-term outcomes.

Methodology and results
226 angiographically confirmed SCAD survivors (95% female,47±9.7yrs) who underwent PCI were compared in a case control study with two hundred and twenty-five angiographically confirmed SCAD survivors (92% female, 49±9.9yrs) who were conservatively managed. Patients were recruited from UK, Spanish and Dutch SCAD registries and both groups were well matched in terms of baseline demographics.
Those treated with PCI were more likely to present with proximal SCAD (30.8% vs 7.6% P&lt;0.01) and ST elevation myocardial infarction (STEMI) or cardiac arrest with reduced flow (32.3% vs 6.3% P&lt;0.01). Intervention was performed with stents in 72.4%, plain old balloon angioplasty in 21.1% and wiring in 6.4% of cases and more often for multi-segment disease (40.8% vs 26.3% P&lt;0.01). In cases with initial reduced flow undergoing PCI an improvement in flow was seen in 83%.
Analysis of UK PCI cases (n=144) reveal complications in 56 (38.8%). However, when assessed for significance defined by a reduction in flow in a proximal/mid vessel, stent extension into left main stem, iatrogenic dissection requiring PCI and CABG as a consequence of PCI only 13 cases (9%) met criteria. Iatrogenic dissection accounts for the majority (76.9%). SCAD lesion length was associated with presence of complications (P=0.025). There was a non-significant trend towards major adverse cardiovascular events (MACE) occurring more frequently in those undergoing PCI (18% vs 11% P=0.067) driven by revascularisation (5% vs 1% P=0.036). Median follow up was 2.7 years.

Conclusions
PCI in SCAD is often performed in higher risk patients; in those presenting with reduced flow, the majority demonstrate improvement. Importantly whilst overall complication rates were similar to those widely reported, clinically significant complications were low. Multivariate modelling will reveal factors associated with complications to aid future decision making in this challenging patient group.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation
Association between hypercoagulability and microvascular dysfunction in patients with acute myocardial infarction
Authors: Kang M.G , Kim K.H , Bae J.S , Ahn J.H , Park H.W , Park Y.W , Hwang S.J , Hwang J.Y , Koh J.S , Jeong Y.H 
Published: November 2020

Abstract

Background
Microvascular dysfunction (MVD) following percutaneous coronary intervention (PCI) can increase the risk of adverse clinical outcomes, which partly may be related with thromboembolic microvascular obstruction. This study was sought to determine whether hypercoagulability is linked with MVD post-PCI in patients with acute myocardial infarction (AMI).

Methods
Hypercoagulability was determined with thrombin-induced platelet-fibrin clot strength (maximal amplitude [MAthrombin] ≥68 mm evaluated by thromboelastography). Microvascular function was assessed by invasive physiological index after PCI (MVD: index of microcirculatory resistance [IMR] ≥40 U). Major adverse cardiovascular events (MACE) was defined as the incidence of death or rehospitalization for heart failure post-PCI.

Results
Among AMI patients (n=116), 46 patients (39.7%) met the criteria of hypercoagulability and 27 patients (23.3%) had a MVD. Level of IMR showed a significant correlation with MAthrombin value (r=0.313; p=0.001). Prevalence of MVD was increased proportionally according to the quartile scale of MAthrombin (3.6% vs. 21.9% vs. 25.9% vs. 41.4%; p for trend = 0.009). Hypercoagulability significantly increased the predictive value for MVD occurrence (odds ratio: 4.35; 95% confidence interval: 1.74 to 10.89; p=0.001). During the follow-up post-PCI of 40.9 months (IQR: 19.8 to 59.4 months), MVD and hypercoagulability were both associated with MACE (hazard ratio: 5.86 and 2.28 respectively). Patients with both MVD and hypercoagulability showed an increased risk for MACE compared with the others (18.2% vs. 5.3%; adjusted hazard ratio: 4.50; 95% confidence interval: 1.26 to 16.12; Log rank p=0.011) (Figure).

Conclusion
This is the first analysis to demonstrate that baseline hypercoagulability is an independent determinant of post-PCI MVD in AMI patients. Combining the measurements of hypercoagulability and MVD may enhance risk stratification and deserves further study.
Long-term outcomes

Funding Acknowledgement
Type of funding source: None
Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism
Authors: Jeronimo Baza A , Salazar C , Perez Vyzcaino M.J , Nombela L , Jimenez Quevedo P , Nunez I , Salinas P , Mejia H , Escaned J , Fernandez Ortiz A , Ferrandez Escarabajal M , Martinez Gomez E , Ramos Lopez N , Gonzalo N 
Published: November 2020

Abstract

Introduction
Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet.

Purpose
To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients.

Methods
40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period.

Results
Patients with ACS-E were younger (28% vs 10% were &lt;45 years old, p&lt;0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p&lt;0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p&lt;0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p&lt;0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p&lt;0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p&lt;0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p&lt;0.001).

Conclusions
ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E.

Funding Acknowledgement
Type of funding source: None