bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of copeptin, miRNA-499 and miRNA-208 as new biomarkers for early detection of acute coronary syndrome
Authors: El-Deek S , Meki A.R , Hassan A , Gaber M , Mohamed O 
Published: November 2020

Abstract

Introduction
Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide. Despite being the gold standard biomarkers, cTn and CK-MB have a major drawback as they are less sensitive in the first 3 hours of the onset of symptom. So, there is still a need for novel biomarkers, which can reliably rule in or rule out this disease immediately on admission.

Aim of the work
To evaluate the role of copeptin, miRNA-499 and miRNA-208 as novel biomarkers for early detection of unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) Patients and Methods: A total of 65 patients presenting within 4 h of onset of chest pain suggestive of ACS were enrolled in the study. They included 23 UA, 42 NSTEMI. Also 25 apparently healthy controls were included. Blood samples (first set within the first 3 hours and second set at 6 hours) were taken for estimation of copeptin by ELISA and miRNA-499 and miRNA-208 expression levels by real time PCR.

Results
Copeptin, miRNA-499 and miRNA-208 expression levels were significantly increased in UA and NSTEMI patients compared to controls (P&lt;0.001 each). Also these biomarkers were significantly increased in NSTEMT compared to UA (P&lt;0.001 each). They also significantly elevated in UA and NSTEMI patient in the first 3 hours who had negative cardiac troponin (p&lt;0.001 each). ROC curve analysis revealed that the area under curve (AUC) for prediction of ACS was 0.96 for copeptin, 0.97 for miRNA-499 and 0.0.97 for miRNA-208. Interestingly, combining copeptin with miRNA-499 and miRNA-210 significantly improved the diagnostic value by increasing the AUC to 0.98, P&lt;0.001. The sensitivity and specificity within the first 3 hours were 90%, 86% for copeptin, 95%, 94% for miRNA-499 and 93%, 98% for miRNA-208. The sensitivity and specificity were 81% and 86% for cardiac troponin within 6 hours. There was a positive correlation between copeptin and miRNA-499 and miRNA-208 (r=0.75, P&lt;0.001 and r=0.76, P&lt;0.001 respectively) Also, there was a positive correlation between these biomarkers and cTn (r=0.7. P&lt;0.001, r=0.64, P&lt;0.001 and r=0.68, P&lt;0.001 respectively).

Conclusions
Copeptin, miRNA-499 and miRNA-208 expression might be novel biomarkers as they are associated with UA and NSTEMI presented in the first 3 hours of onset of pain. The combination of copeptin and miRNA with cTn accelerate the diagnosis of ACS and avoiding the gray zone of cTn. Copeptin and miRNAs representing a potential aid in early diagnosis as they have different pathogenesis and site of liberation.

Funding Acknowledgement
Type of funding source: None
Influence of caffeine intake on intravenous adenosine-induced fractional flow reserve
Authors: Ishibuchi K , Fujii K , Otsuji S , Takiuchi S , Hasegawa K , Tamaru H , Ishii R , Yasuda S , Nakabayashi S , Yamamoto W , Kusumoto H , Taniguchi Y , Kakishita M , Shimatani Y , Higashino Y 
Published: November 2020

Abstract

Background
This study evaluated whether caffeine abstention is required before fractional flow reserve (FFR) measurement by intravenous adenosine triphosphate (ATP) administration in Japanese patients.

Methods and results
This study was a subanalysis of a previously published study and a total of 208 intermediate lesions that underwent FFR measurements were enrolled for this analysis. Hyperemia was induced by continuous intravenous ATP infusion at 150μg/kg/min (IVATP150) and 210μg/kg/min (IVATP210), and by intracoronary administration of nicorandil 2mg (ICNIC2mg) as a reference standard. The degree of change in the FFR value both after IVATP150 and after IVATP210, as compared with the FFR value after ICNIC2mg was similar between the caffeine and non-caffeine groups (−0.04±0.05 vs. −0.04±0.07, and 0.00±0.02 vs. 0.01±0.02, respectively). In patients who consumed caffeine before the FFR measurement, the degree of FFR change was independent of the time interval (&lt;12 hours, 12–24 hours, and 24–48 hours) between caffeine intake and catheterization both after IVATP150 and ICNIC2mg and after IVATP210 and ICNIC2mg.

Conclusion
When compared with the FFR value after ICNIC2mg, the degree of change in the FFR value both after IVATP150 and after IVATP210 remained similar regardless of caffeine intake. Strict caffeine abstention before intravenous ATP-induced FFR measurement may not be required in clinical practice.

Funding Acknowledgement
Type of funding source: None
Coronary artery echo-attenuated plaques in acute coronary syndromes: a serial intravascular ultrasound imaging study
Authors: Scherer D.J , Shishikura D , Andrews J , Di Giovanni G , Jones S , Honda S , Butters J , Kataoka Y , Nicholls S.J 
Published: November 2020

Abstract

Background
Echo attenuation of atherosclerotic plaque (EAP) identified with intravascular ultrasound (IVUS) has been shown to correlate with vulnerable plaque morphologies and their presence is predictive of future cardiovascular events. EAP have predominantly been assessed at a single time point and their natural history in the immediate post acute coronary syndrome (ACS) period remains unknown. We aimed to assess this and whether their presence correlated with a more modifiable plaque composition in the immediate post-ACS setting.

Methods
Serial IVUS imaging was performed in non-culprit vessels of 270 patients undergoing angiogram for ACS and at 3 month follow up. IVUS analysis of plaque burden and EAP was performed.

Results
Baseline characteristics are described in Table 1. EAP were present at baseline in 62 patients (23%) with these patients more likely to be male (89.1% vs. 76.7%, p=0.03) but no differences in other atherosclerotic risk factors. There was no difference in baseline plaque burden between patients with EAP and those without (Percent atheroma volume [PAV] 38.9% vs. 37.8%, p=0.32). At follow up IVUS change in PAV was not statistically significantly different between patients with baseline EAP and those without (ΔPAV 0.09% vs. −0.36%, p=0.43), and neither was there a difference in the frequency of plaque regressors (42.7% vs 50%, p=0.31). EAP had resolved in 25 patients (40%) within 3 months at the follow up IVUS. Despite contemporary post-ACS therapy 18 patients who had not had EAP present at baseline (9%) developed new EAP at the follow up IVUS.

Conclusion
EAP were present in a quarter of ACS patients and were not associated with baseline plaque burden or a more modifiable plaque phenotype. In the setting of contemporary ACS treatments the natural history of high risk IVUS plaque characteristics such as EAP is dynamic with significant change even over a 3 month period in the post ACS setting.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Royal Adelaide Hospital Research Fund AR Clarkson Scholarship
Association between body mass index and 1-year outcome after acute myocardial infarction
Authors: Kim D.W 
Published: November 2020

Abstract

Background
Beneficial effects of overweight and obesity on mortality after acute myocardial infarction (AMI) have been described as “Body Mass Index (BMI) paradox”. However, the effects of BMI is still on debate. We analyzed the association between BMI and 1-year major cardiocerebrovascular events (MACCE) after AMI.

Methods and findings
Among 13,104 AMI patients registered in an Institute of Health in Korea between November 2011 and December 2015, 10,568 patients who eligible for this study were classified into 3 groups according to BMI (Group I; &lt;22 kg/m2, 22 ≤ Group II &lt;26 kg/m2, Group III; ≥26 kg/m2). The primary end point was a composite of cardiac death (CD), myocardial infarction (MI), target vessel revascularization (TVR), and cerebrovascular events at 1 year. Over the median follow-up of 12 months, the composite of primary end point occurred more frequently in the Group I patients than in the Group III patients (primary endpoint: adjusted hazard ratio [aHR], 1.290; 95% confidence interval [CI] 1.024 to 1.625, p=0.031). Especially, cardiac death in MACCE components played a major role in this effect (aHR, 1.548; 95% confidence interval [CI] 1.128 to 2.124, p=0.007).
Conclusions Higher BMI appeared to be good prognostic factor on 1-year MACCE after AMI. This result suggests that higher BMI or obesity might confer a protective advantage over the life-quality after AMI.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research of Korea Centers for Disease Control and Prevention and the Korea Health Technology R&D Project, Ministry of Health & Welfare (HI13C1527), Republic of Korea.
Comparison of prasugrel and ticagrelor for patient with acute coronary syndrome: a systematic review and meta-analysis
Authors: Fong L.C.W , Lee N , Yan A.T , Ng M.Y 
Published: November 2020

Abstract

Background
Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial.

Purpose
To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year.

Methods
Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs.

Results
411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11).

Conclusion
Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively.
Figure 1. Primary Objective

Funding Acknowledgement
Type of funding source: None
Long-term adherence to low-dose aspirin therapy for cardiovascular prevention in routine clinical practice in United Kingdom and Germany
Authors: Vora P , Soriano-Gabarro M , Russel B , Morgan Stewart H 
Published: November 2020

Abstract

Background
Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). However, adherence to therapy is likely an important factor for these benefits to be seen and non-adherence is associated with sub-optimal outcomes.

Purpose
To assess the long-term adherence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population

Methods
This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network Database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Adherence was calculated using medication possession ratio (MPR) which is number of days of medication supplied within the refill interval divided by number of days in the refill interval. Long term adherence was divided in three categories namely patients with ≤2 years, 2-≤5 years, and 5-≤10 years of follow-up.

Results
The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years of follow-up was 88% and 80% for secondary CVD prevention, respectively; 84% and 74% for 2-≤5 years; and 75% and 59% for 5-≤10 years, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years was 76% and 75% for potential primary CVD prevention; 65% and 66% for 2-≤5 years; 49% and 49% for 5-≤10 years, respectively (Figure).

Conclusion
The long-term adherence to low dose aspirin was quite high with more than half the patients being adherent to their treatment. Overall, the adherence was higher in secondary compared to primary CVD prevention. The estimates for adherence might be underestimated due to potential over the counter use of low-dose aspirin.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Bayer AG
Prevalence of myocardial viability and ischemic burden in chronic total occluded coronary artery disease
Authors: Yang X , Tian J.F , Zhang L.J , Dong W , Li J.N , Li J.H , Han Y , Zuo H.J , He Y , Mi H.Z , Song X.T 
Published: November 2020

Abstract

Aims
We assessed the viable myocardium status and investigated the relationship between collaterals with the ischemia burden and myocardial viability utilizing cardiac magnetic resonance imaging (CMR) and adenosine stress single-photon emission computed tomography (SPECT).

Methods and results
150 consecutive patients with at least one native CTO artery, as confirmed by coronary arteriography or coronary CT angiography, were prospectively recruited. SPECT examination was accepted by only 50 patients while declined by the other 100 patients for reasons such as financial problems. Of all segments in the 173 CTO artery territories, only 10.4% exhibited transmural myocardial infarction and 60.2% showed no late gadolinium enhancement. Among 50 patients who completed SPECT examination, 36 patients showed inducible perfusion defect in CTO territory, and the proportion of the ischemic area of 42% patients was over 10%.

Conclusion
Most patients with CTO had different degrees of myocardial infarction detected by CMR, but only a minority of them showed transmural infarction and cardiac function in patients with transmural infarction declined compared to those without transmural infarction. Approximately half of CTO patients exhibited inducible ischemia in CTO territory. Based on this, a large proportion of patients potentially benefit from CTO-PCI.
Figure 1. Relationship between WMSI, LVE

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Beijing Municipal Education Commission Science and Technology Plan for 2020, Capital Health Development Research Project (no. 2018-2-2063)
Impact of hinge motion on stent edge restenosis after new generation drug-eluting-stent implantation in RCA
Authors: Jimba T , Ikutomi M , Nishijyo D , Yamasaki M , Shindou A , Mochida K , Yanagisawa T , Sato T , Matsushita M , Onishi S , Yamasaki M 
Published: November 2020

Abstract

Background
Edge restenosis still occurs after stent implantation, even by using new generation drug-eluting stents (DES) considered to have favorable biomechanical properties. Mechanical stress imposed on the stent edge are thought to be aggravated by hinge motion at a point between the stented and unstented segments, inducing chronic local inflammation and neointimal overgrowth.

Purpose
The aim of this study was to investigate the association between the development of edge restenosis and hinge motion in right coronary artery (RCA) where the excessive vessel movement is commonly observed.

Methods
Among consecutive 650 lesions in RCA where new generation DESs were implanted between 2009 and 2019, 427 serial lesions with sets of angiographies at baseline and follow-up (6–18 month) were included. In addition to conventional quantitative angiography analysis, hinge angle at stent edges was measured (Fig. 1). All the appropriate data for intravascular imaging were analyzed for both stent edges and reference segments.

Results
Binary restenosis occurred in 43 lesions, and 39 of them were referred to re-intervention. Fifty five percent of them were related to stent edges (15 at proximal and 9 at distal edges). Classical risk factors including diabetes and hemodialysis were more prevalent in the restenosis group (p&lt;0.05). Hinge angle was statistically larger in edge restenosis group than body restenosis or no restenosis group (17.3° vs 11.6° vs 10.6°, p&lt;0.001, Fig. 2). In per-edge analysis, hinge angle, dissection and residual plaque ratio were the independent predictors for binary restenosis (Table 1) with the optimal cut-off value of hinge angle 11.5°. The coexistence of excessive hinge angle and residual plaque burden had an amplified effect on the angiographic stenotic progression at stent edge (p for interaction &lt;0.001) and the incidents of binary restenosis (16.7% vs 1.7% p&lt;0.01, Figs. 3,4).

Conclusion
Substantial stress determined by angulation at the stent edge and its interaction with residual plaque can be considered as one of the plausible mechanisms for edge restenosis. For tortuous RCA lesions, it would be important to decide the stent-landing zone for minimizing hinge motion and optimize the future stent design.

Funding Acknowledgement
Type of funding source: None
Hybrid coronary revascularization with endoscopic closed-chest arterial coronary bypass technique (endo-CABG)
Authors: Claessens J , Van Genechten S , Kaya A , Yilmaz A 
Published: November 2020

Abstract

Introduction
Treatment of three-vessel coronary disease in minimally invasive manner could be complex in some cases. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) gives good patency rates which outlive vein grafts. The hybrid approach, combination of PCI with minimally invasive endoscopic coronary artery bypass graft (endo-CABG), might be a valuable option for treatment of multivessel coronary disease. Hereby we describe our series of patients undergoing arterial revascularization of the anterior and/or lateral wall combined with PCI of the right coronary artery or a marginal branch.

Methods
From March 2013 until December 2019, 208 patients (82.2% males, mean age: 66.69±10.44 years) underwent hybrid coronary revascularization for multivessel disease. Patients with multivessel disease suitable for hybrid approach were accepted at the heart team. All patients received total arterial revascularisation by endo-CABG. The PCI was prior or after the endo-CABG. There was no discontinuation of dual platelet therapy. Uni or bilateral internal mammary artery (IMA) harvesting was performed through three 5mm endoscopic ports in the 2nd, 3rd and 4th intercostal space. Cardiopulmonary bypass was established using a minimally invasive extracorporeal circulation (MiECC) with groin cannulation. Transthoracic aortic cross-clamping was followed by antegrade administration of a single shot cold mixed blood cardioplegia. A utility port of three centimeter was used for direct vision anastomosis.

Results
The procedure was successful in all patients, requiring no conversion to full sternotomy. Mean cross-clamping and cardiopulmonary bypass times were 44.38±28.33 and 91.75±37.97 minutes, respectively, with a mean of 2.1±0.91 bypasses for each patient. All patients received total arterial revascularization. The mean ICU and hospital length of stay were 62.5±39.74 hours and 8.80±4.64 days, respectively. Average postoperative blood loss over 24 hours was 555.20±859.19 mL. There were 8 re-interventions on the target vessels (3.8%) and 2 patients suffered from a stroke (1%). The 30-day mortality rate was 0.5%.

Conclusion
Minimally invasive hybrid arterial coronary revascularization is a safe and valuable alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. The endo-CABG is a safe and feasible technique without compromising operative morbidity and providing good postoperative results.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital