bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation of microchannel identified by optical coherence tomography to clinical, angiography and other plaque morphological characteristics in ST-segment Elevation myocardial infarction patients
Authors: Wang J , Dai J , Fang C , Yu B 
Published: November 2020

Abstract

Background
Previous studies have suggested that Microchannel (MC) is associated with plaque progression and vulnerability. Optical coherence tomography (OCT) could provide a chance to directly visualize plaque neovascularization in vivo.

Methods
1268 STEMI patients who underwent OCT examination of culprit lesion were included and divided into MC group (the culprit plaque with MC, n=560) and no-MC group (the culprit plaque without MC, n=708). MC was defined as a no-signal tubuloluminal structure on the cross-sectional optical coherence tomographic image. Clinical, angiography and other plaque morphological characteristics were compared between the two groups. Logistic regression analysis was used to identify independent predictors of MC in overall. In addition, the difference of predictors on MC was found in plaque rupture (PR) and plaque erosion (PE).

Results
Significant differences between MC group and no-MC group were found in the frequency of thin-cap fibroatheroma (74.6% vs 64.4%, p&lt;0.001), lipid plaque (91.8% vs 82.9%, p&lt;0.001), lipid core length (13.7±6.5mm vs 12.6±6.3mm, p=0.006) and the minimal lumen area (MLA, 1.95±0.98mm2 vs 2.10±1.58mm2, p=0.046). In MC group, the other vulnerable plaque morphological characteristics, such as macrophage (88.8% vs 75.1%, p&lt;0.001), cholesterol crystal (39.6% vs 32.9%, p=0.013), spotty calcification (38.6% vs 29.5%, p&lt;0.001) were more frequent. And compared with MLA the more locations of the culprit lesion in MC group was proximal (proximal, 47.3% vs 38.1%, at MLA, 38.2% vs 44.2%, distal, 14.5% vs 17.7%, p=0.004).The difference of Hemoglobin (Hb, 147.5±16.9g/L vs 144.1±18.2g/L, p&lt;0.001), lipidemia (TC, 188.7±43.6mmol/L vs 180.8±40.0mmol/L, p&lt;0.001, LDL-C, 121.5±37.4mmol/L vs 115.7±36.8mmol/L, p=0.005, and TC/HDL, 4.0±1.6 vs 3.8±1.0, p&lt;0.001), and hypertension (50.7% vs 44.2%, p=0.021) between 2 groups was statistically significant. Multivariable logistic regression models showed 7 independent parameters associated with MC in culprit plaque of overall: hypertension, Hb, TC, MLA, lesion location (compared with MLA), lipid core length, macrophage, spotty calcification. In addition, Hb, TC and MLA were common predictors of MC in PR and PE, however, the predictive effect of MLA on MC was opposite in PR [OR (95% CI)=1.266 (1.095–1.463), p=0.001] and PE [OR (95% CI)=0.742 (0.597–0.922), p=0.007].

Conclusions
MC in culprit plaque is associated with more lipid (especially cholesterol), higher Hb, hypertension, lesion location (compared with MLA) and the other vulnerable plaque morphological characteristics. The predictors of MC were different in plaque rupture and plaque erosion.
Flow chart

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Natural Science Foundation of China (81827806, 81801861); National Key R&D Program of China (2016YFC1301100)
Comparison of FFR with iFR and QFR in assessment of intermediate coronary artery disease in patients with severe aortic stenosis
Authors: Kleczynski P , Dziewierz A , Rzeszutko L , Dudek D , Legutko J 
Published: November 2020

Abstract

Background
The functional assessment of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) has been barely examined so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR), quantitative flow ratio (QFR) and fractional flow reserve (FFR) in patients with severe AS.

Methods
The functional significance of 416 coronary lesions was investigated with iFR, FFR and QFR measurements in 221 AS patients. The iFR-FFR and QFR-FFR diagnostic agreement has been tested using the conventional 0.80 FFR cut-off.

Results
Mean value of FFR was 0.85±0.07; iFR – 0.90±0.04; QFR – 0.84±0.07. The correlation between iFR and FFR was good (r=0.83, p&lt;0.001) and QFR and FFR was goot too (r=0.77, p&lt;0.001), as well as the area under the curve at ROC curve analysis 0,995 (0,983 to 0,999, p&lt;0.001) for iFR and 0,988 (0,972 to 0,996, p&lt;0.001) for QFR. However, using the standard iFR 0.89 and QFR 0.8 threshold, the diagnostic accuracy of iFR was 100% sensitivity and 90.26% specificity and for QFR – 100% and 92.21%, respectively. According to ROC analysis, the best iFR cut-off in predicting FFR ≤0.8 was 0.88 (J=0.94), the best QFR cut-off value was 0.80 (J=0.92).

Conclusions
In the presence of severe AS, iFR and QFR had good agreement with FFR values for assessment of borderline coronary lesions. However, iFR threshold for predicting FFR below 0.8 may be different from a standard value of 0.89.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre
Comparison of two simple treatment algorithms for iatrogenic femoral artery pseudoaneurysm: ultrasound guided manual compression vs. ultrasound guided thrombin injection
Authors: Stern M , Oezaslan G , Sansone R , Baasen S , Heiss C , Kelm M , Busch L 
Published: November 2020

Abstract

Background
Postcatheterization femoral pseudoaneurysm (PSA) is a common access site related complication after endovascular procedures with potentially deleterious effect on patient outcome. There is still lack of consensus about the optimal treatment.

Objective
We analyze the incidence of PSA in a large cohort of patients undergoing state of the art procedures in current cardiology, identify independent risk factors for PSA formation and assess our experience in PSA treatment comparing two simple treatment algorithms: ultrasound guided manual compression vs. ultrasound guided thrombin injection as a first line treatment.

Methods and results
In this single-centre, retrospective study 29.802 patients from January 2013 to May 2018 underwent femoral artery catheterization. Sheath removal was carried out according to standard operating procedures of the clinic. In 228 patients, a PSA was diagnosed. Thus, overall incidence of PSA amounted to 0.8%.
Of 228 patients with a PSA, 117 (51%) patients were primarily treated with ultrasound guided manual compression with an overall success rate of 34% at next day follow up. All other patients (n=111, 49%) were primarily treated with ultrasound guided thrombin injection with an overall success rate of 99% at next day follow up. Low rates of periprocedural complications were noted with either hemostasis technique.
Analysis of laboratory characteristics revealed that efficacy of ultrasound guided manual compression is dependent on INR whereas efficacy of ultrasound guided thrombin injection is independent of INR (p=0.0253). There was also a higher rate of significant hemoglobin drop with ultrasound guided manual compression versus ultrasound guided thrombin injection (0.78 mg/dl ± 0.09 vs 0.26 mg/dl ± 0.08, p=0.038). Time to mobilization was significantly shorter after ultrasound guided thrombin injection (UGTI: mean time 23.4 h ± 3.1 h, UGMC: mean time 27.1 h ± 10.2 h, p=0.0002).
Multivariate logistic regression analysis revealed that female gender, age (&gt;75 years), oral anticoagulation and anemia are independent risk factors for PSA formation.

Conclusions
Almost 0.8% of patients undergoing cardiac catheterization via femoral access acquire PSA, for which independent risk factors could be identified. Interventional cardiologist operated ultrasound guided thrombin injection is highly effective and safe as a first line treatment and reduces blood loss compared to ultrasound guided manual compression.

Funding Acknowledgement
Type of funding source: None
Prognostic impact of gender and young age in patients with acute myocardial infarction undergoing primary PCI
Authors: Radomirovic M , Milasinovic D , Mehmedbegovic Z , Pavlovic A , Zaharijev S , Zobenica V , Jelic D , Tesic M , Ivanovic B , Stankovic G , Vukcevic V , Asanin M 
Published: November 2020

Abstract

Background
Previous studies showed higher unadjusted mortality rates in female patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). However, after adjusting for differences in baseline characteristics, including age, female gender was not consistently associated with higher mortality.

Purpose
Our aim was to investigate the impact of gender on short- and long-term mortality in patients aged 18 to 55 years with AMI undergoing primary PCI.

Methods
We included 11 288 patients admitted for primary PCI during 2009–2019, from a prospectively kept, electronic registry of a high-volume tertiary center. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard. Median follow up was 1 507 days.

Results
3 505 patients were younger than 55 years (31%). In this age group, 18.9% were female patients (n=661). Baseline characteristics were similar for females vs. males below the age of 55 years, including similar reperfusion times (338 min. vs. 341 min., p=0.8), with only exceptions being a higher rate of previous hypertension (64% vs. 58%, p=0.002) and stroke (3.6% vs. 2.2%, p=0.049), as well as lower ejection fraction (48% vs. 51%, p&lt;0.001), in female patients. MINOCA (Myocardial Infarction with Nonobstructive Coronary Arteries) was more frequently present in female vs. male patients aged ≤55 years (10.1% vs. 5.0%, p&lt;0.001). In the overall population, crude mortality was higher in female patients at 30 days (9.8% vs. 6.0%, p&lt;0.001) and 5 years (38.4% vs. 30.2%, p&lt;0.001). In younger patients (≤55 years), mortality rates were low and similar between the sexes at both 30 days (3.6% in females vs. 2.5% in males, p=0.136) and 5 years (14.5% vs. 13.4%, p=0.58). On the contrary, in patients aged &gt;55 years, crude mortality was higher in female patients at both 30 days (11.3% vs. 7.9%, p&lt;0.001) and 5 years (43.9% vs. 39.4%, p=0.02), albeit mainly driven by the differences in baseline characteristics between the sexes in this older age group (adjusted HR for female sex 1.220, CI95% 0.920–0.617, p=0.17, at 30 days; and adjusted HR 1.033, CI95% 0.908–0.175, p=0.62, at 5 years).

Conclusion
Differences in crude mortality rates between sexes in patients with AMI admitted for primary PCI appear to be mainly dependent on age, with similar rates of both short- and long-term mortality in younger patients (≤55 years). The observed excess in mortality in older (&gt;55 years) female vs. male patients could be explained by the differences in baseline clinical characteristics.

Funding Acknowledgement
Type of funding source: None
Comparison of two iterations of the zotarolimus-eluting stents: an analysis of all-comer patients from two consecutive randomised clinical trials
Authors: Buiten R.A , Ploumen E.H , Zocca P , Jessurun G.A.J , Schotborgh C.E , Roguin A , Danse P.W , Benit E , Aminian A , Scholte M , Hartmann M , Van Houwelingen K.G , Doggen C.J.M , Linssen G.C.M , Von Birgelen C 
Published: November 2020

Abstract

Background
The newest iteration of the durable polymer zotarolimus-eluting stents (ZES) is designed with thin swaged shape composite-wire struts (inner platinum–iridium core and outer cobalt–chromium layer). It is of interest to compare the clinical performance of this novel device with its predecessor in all-comers.

Purpose
The purpose of the present study is to assess 2-year clinical outcome in all-comer patients who were treated with the novel ZES versus the previous iteration ZES.

Methods
We did a post-hoc analysis of clinical outcome data of 2374 patients who were treated with the novel or the previous generation ZES (only nominal stent diameters that were available for both devices) in two consecutive large-scale randomised all-comer trials. A total of 1201 trial participants were treated with the novel ZES, and 1173 were treated with the previous generation ZES. The main outcome parameter target vessel failure is a composite of safety (cardiac death, target vessel myocardial infarction) and efficacy (target vessel revascularisation). Clinical outcome data were analysed with Kaplan-Meier methods and hazard ratios were computed with Cox regression analysis. An additional analysis was done in a subgroup of patients who presented with chronic coronary syndromes.

Results
The mean age of the study population was 63.9±10.9 years, 611 (25.7%) were female and 1669 (70.3%) presented with acute coronary syndromes. Two-year follow-up was available in 2346 (98.8%) participants. After 2 years, there was no significant difference between stent-groups in the rates of target vessel failure (7.2% vs. 8.3%, HR 0.85, 95% CI 0.64–1.14, p-logrank = 0.28; Figure 1) or its individual components. Peri-procedural myocardial infarction occurred less often in patients treated with the novel ZES (0.7% vs. 2.1%, p-logrank &lt;0.01), and definite-or-probable stent thrombosis rates were low in both ZES groups (0.3% vs. 0.8%, p-logrank = 0.15). In a subgroup of 705 patients with chronic coronary syndromes, the rate of target vessel myocardial infarction tended to be lower with novel ZES (1.8% vs. 4.2%, p-logrank = 0.05).

Conclusions
The novel ZES showed similar 2-year clinical outcomes as compared to its predecessor. Furthermore, there was a positive safety signal regarding the incidence of target vessel myocardial infarction and a particularly low stent thrombosis rates with the novel ZES.
Figure 1. Target vessel failure at 2 years

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Thoraxcentrum Twente has received institutional research grants provided by Abbott Vascular, Biotronik, Boston Scientific and Medtronic. The present analysis received no funding.
Two-year clinical performance of Absorb BVS compared to Xience EES in ST-segment elevation myocardial infarction: a pooled analysis of AIDA and COMPARE-ABSORB trials
Authors: Kerkmeijer L.S.M , Chao G , Tijssen R , Gori T , Kraak R.P , Tijssen J.G.P , Onuma Y , Chevalier B , De Winter R.J , Smits P , Van Geuns R.J , Wykrzykowska J.J 
Published: November 2020

Abstract

Introduction
Bioresorbable vascular scaffolds (BVS) use appears theoretically attractive in patients presenting with ST-segment elevation myocardial infarction (STEMI) as acute lesions are generally composed of soft plaques, in which optimal BVS deployment and expansion is easier to achieve. Furthermore, those patients are generally younger and would benefit longer from the promise of vascular restoration therapy.

Purpose
In this patient level pooled analysis of two clinical trials, we evaluated the clinical outcomes of Absorb BVS versus Xience everolimus-eluting stent (EES) in STEMI patients at 2-year follow-up.

Methods
We performed an individual patient-level pooled analysis of the AIDA and COMPARE-ABSORB trials in which 3515 patient were randomly assigned to Absorb BVS (n=1772) or Xience EES (n=1743). Clinical outcomes in STEMI patients were analyzed by randomized treatment assignment cumulative through 2 years. 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
350 (19.8%) STEMI patients were allocated to Absorb BVS versus 328 (18.8%) to Xience EES. The mean age of patient presenting with STEMI was 60 years old, 76.0% were males and 15.3% had diabetes mellitus. At 2-years target lesion failure occurred in 8.4% of BVS STEMI patients and 6.2% of EES STEMI patients (p=0.253). The 2-year rates of cardiac death (2.6% vs 1.6%, p=0.332), TV-MI (4.7% vs 2.5%) and TLR (6.8% vs 4.1%) were not significantly different. The 2-year incidence of definite device thrombosis was 4.7% in Absorb BVS versus 1.8% in Xience EES (p=0.045).

Conclusion
In the present patient-level pooled analysis of the AIDA and COMPARE-Absorb trials, BVS was associated with increased rates of device thrombosis in STEMI patients compared to Xience EES.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Abbott
Intracoronary imaging reduces target vessel failure in primary percutaneous coronary intervention
Authors: Ho C , Yeung Y.K , Leung C , Lee P.H , So T.C , Chiang M.C.S , Wong M.H , Tsang C.F , Chui S.F , Chan K.C , Wong C.Y , Fu C.L , Lee K.Y , Chan K.T 
Published: November 2020

Abstract

Background
Intracoronary imaging during percutaneous coronary intervention (PCI) allows better delineation of lesion characteristics and more accurate vessel sizing compared with angiogram alone. However, the benefit and safety of its use in primary percutaneous coronary intervention (PPCI) is uncertain.

Purpose
To determine whether the use of intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT)/ optical frequency domain imaging (OFDI) in PPCI is associated with better outcome.

Method
From Jan 2014 to Dec 2018, all patients with PPCI performed in our hospital were retrospectively studied. Baseline and procedural characteristics of angiographic-guided versus imaging-guided PCI were analyzed. Primary endpoint was target vessel failure, and procedural outcomes were contrast volume, number of stents implanted, mean stent length and diameter and use of post-dilatation. Safety outcomes were post-operative acute kidney injury (AKI), need for renal replacement therapy (RRT) and occurrence of no/slow reflow.

Results
A total of 408 patients were included, of which 223 (54.7%) used IVUS (n=176 80.3%) or OCT/OFDI (n=44 19.7%) during the procedure. Baseline and procedural characteristics were similar between both groups except more patients had history of PCI (12.6% vs 4.3% p=0.004) and left-main/ bifurcation lesions (12.6% vs 2.7% p&lt;0.001). Intra-coronary imaging was associated with less target vessel failure during a median follow up of 22 months (Hazard ratio (HR): 0.59; 95% Confidence interval (CI): 0.36–0.97; p=0.036). Patients who had intra-coronary imaging during PPCI received more post-dilatation (77.1% vs 55.1% p&lt;0.001), had longer (53mm vs 42mm p&lt;0.001) and more stents (2 vs 1.67 p=0.003) implanted but had more contrast injected (151.2ml vs 130.6ml p=0.002). There was no statistically significant difference in mean stent diameter (3.07mm vs 3.02mm p=0.53), occurrence of slow/now reflow (15.3% vs 18.4% p=0.409), incidence of AKI (7.2% vs 10.8% p=0.197) or need for RRT (3.1% vs 5.4% p=0.254) between both groups.

Conclusion
Use of intra-vascular imaging during PPCI was associated with less target vessel failure, longer and more stents implanted and more frequent use of post-dilatation. Further prospective randomized controlled trial is suggested to confirm this benefit.

Funding Acknowledgement
Type of funding source: None
Right ventricular rather than left ventricular systolic dysfunction predicts outcome in patients undergoing transcatheter aortic valve implantation: insights from cardiac magnetic resonance imaging
Authors: Koschutnik M , Nitsche C , Dona C , Dannenberg V , Kammerlander A.A , Aschauer S , Goliasch G , Siller-Matula J , Winter M.P , Andreas M , Loewe C , Hengstenberg C , Mascherbauer J 
Published: November 2020

Abstract

Background
Right ventricular (RV) function is strongly associated with outcome in heart failure. Whether it also adds important prognostic information in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown.

Methods
We consecutively enrolled patients with severe aortic stenosis (AS) scheduled for TAVI and preprocedural cardiac magnetic resonance (CMR) imaging. Kaplan-Meier estimates and multivariate Cox regression analyses were used to identify factors associated with outcome. A composite of heart failure hospitalization and/or cardiovascular death was selected as primary study endpoint.

Results
423 consecutive patients (80.7±7.3 years; 48% female) were prospectively included, 201 (48%) underwent CMR imaging. 55 (27%) patients presented with RV systolic dysfunction (RVSD) defined by RV ejection fraction (RVEF) &lt;45%. RVSD was associated with male sex (69 vs. 40%; p&lt;0.001), New York Heart Association (NYHA) functional status (NYHA ≥ III: 89 vs. 57%; p&lt;0.001), NT-proBNP serum levels (9365 vs. 2715 pg/mL; p&lt;0.001), and history of atrial fibrillation (AF: 51 vs. 30%; p=0.005). On CMR, RVSD was associated with left ventricular (LV) volumes (end-diastolic: 187 vs. 137 mL, end-systolic: 119 vs. 53 mL; p&lt;0.001) and EF (39 vs. 64%; p&lt;0.001).
A total of 51 events (37 deaths, 14 hospitalizations for heart failure) occurred during follow-up (9.8±9 months). While LVSD (LVEF &lt;50%) was not significantly associated with outcome (HR 0.83, 95% CI: 0.33 – 2.11; p=0.694), RVSD showed a strong and independent association with event-free survival by multivariate Cox regression analysis (HR 2.47, 95% CI: 1.07–5.73; p=0.035), which was adjusted for all relevant CMR parameters (LV volumes and EF), cardiovascular risk factors (sex, NYHA, AF, diabetes mellitus type II, use of diuretics), and routine biomarkers (NT-proBNP, creatinine).

Conclusions
RVSD rather than LVSD, as determined on CMR, is an important predictor of outcome in patients undergoing TAVI. RV function might thus add useful prognostic information on top of established risk factors.
Figure 1. Kaplan-Meier survival curves

Funding Acknowledgement
Type of funding source: None
Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation
Authors: Berkovitch A , Segev A , Finkelstein A , Kornowski R , Danenberg H , Fefer P , Vaknin Assa H , Konigstein M , Perlman G , Maor E , Orvin K , Steinvil A , Shuvy M , Guetta V , Barbash I.M 
Published: November 2020

Abstract

Background
Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients.

Methods
We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented.

Results
Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value&lt;0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value&lt;0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank&lt;0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p&lt;0.001 compared to those having an elective procedure.

Conclusions
Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis.
Kaplan-Meier's survival analysis

Funding Acknowledgement
Type of funding source: None