bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantification of calcium volume by coronary CT compared to OCT
Authors: Monizzi G , Sonck J , Nagumo S , Buytaert D , Van Hoe L , Grancini L , Bartorelli A.L , De Bruyne B , Andreini D , Collet C 
Published: November 2020

Abstract

Background
Coronary artery calcifications are frequently observed in patients referred for cardiac catheterization. Using OCT, the calcified volume can be determined. CT is a sensitive non-invasive tool to detect coronary artery calcifications and may be useful to guide percutaneous coronary intervention.

Purpose
The aim of the study was to investigate the accuracy of CT-derived calcium volume with OCT as a reference in patients undergoing PCI.

Methods
66 calcified plaques (32 vessels) from 31 patients undergoing OCT-guided PCI with coronary CT angiography acquired as a standard of care were included. Coronary CT angiography and OCT images were matched using fiduciary points. Calcified plaques were reconstructed in three dimensions to calculate calcium volume. A Passing-Bablok regression analysis and the Bland-Altman method were used to assess agreement between imaging modalities.

Results
27 left anterior descending arteries and 5 right coronary arteries were analyzed. Median calcium volume by CT angiography and OCT were 18.23 mm 3 [IQR 8.09, 36.48] and 10.03 mm 3 [IQR 3.6, 22.88]. The Passing-Bablok analysis showed a proportional difference without a systematic difference (Coefficient A 0.08, 95% CI: −1.37 to 1.21, Coefficient B 1.61, 95% CI: 1.45 to 1.84); with a mean difference of 9.69 mm3 (LOA −10.2 mm 3 to 29.6 mm 3). No significant differences were observed for MLA: median value for CT 2.84 mm2 [IQR 2.03, 3.74] and for OCT 2.55 mm2 [IQR 1.91, 4.43].

Conclusions
Coronary CT angiography volumetric calcium evaluation overestimates calcium volume by 60% compared to OCT. Accounting for CT overestimation may allow for appropriate interpretation of calcific burden in the non-invasive setting. Coronary CT angiography may emerge as a tool to quantify calcium burden for invasive procedural planning.
Calcium burden comparison CT vs OCT

Funding Acknowledgement
Type of funding source: None
Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?
Authors: Arbas Redondo E , Tebar Marquez D , Poveda Pinedo I.D , Dalmau Gonzalez-Gallarza R , Valbuena Lopez S.C , Guzman Martinez G , Terol Espinosa De Los Monteros B , Rosillo Rodriguez S.O , Lopez Fernandez T , Lopez Sendon J.L 
Published: November 2020

Abstract

Introduction
Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques.

Purpose
To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner.

Methods
Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected.

Results
We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization.

Conclusions
In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose.

Funding Acknowledgement
Type of funding source: None
Clinical implications of post-stent optical coherence tomographic findings after drug-eluting stent implantation: severe malapposition and thrombotic events
Authors: Kim B.G , Kachel M , Kim J.S , Guagliumi G , Milewski K , Hong S.J , Ahn C.M , Shin D.H , Kim B.K , Ko Y.G , Choi D.H , Jang Y.S 
Published: November 2020

Abstract

Background
The clinical implications of optical coherence tomography (OCT) assessment following percutaneous coronary intervention are controversial.

Purpose
We sought to evaluate the impact of post-stent OCT findings, including significant malapposition, on long-term clinical outcomes.

Methods
A total of 1,290 patients with 1,348 lesions, in which OCT was performed immediately post-stent, were consecutively enrolled in the prospective OCT registry. Post-stent OCT findings were assessed to identify predictors of device-oriented clinical end points (DoCE), including cardiac death, target vessel-related myocardial infarction (MI), stent thrombosis, and target lesion revascularization (TLR). We also looked for significant malapposition criteria that may be associated with thrombotic events such as cardiac death, target vessel-related MI, and stent thrombosis.

Results
Incidences of stent edge dissection, tissue prolapse, thrombus, and malapposition after intervention were not associated with occurrence of adverse thrombotic events. However, patients with significant malapposition [total malapposition volume (TMV) ≥7.0 mm3 or TMV/stent volume ≥4.1%] exhibited more frequent thrombotic events. In multivariate analysis, smaller minimal stent area (MSA) was identified as an independent predictor for DoCE (hazard ratio [HR], 1.21 [1.01–1.45]; P=0.037). Malapposition with TMV ≥7.0 mm3 was found to be an independent predictor of thrombotic events (HR, 4.62 [1.29–16.47]; P=0.018).

Conclusions
Although most high-resolution OCT findings were not associated with clinical outcome, smaller MSA was associated with DoCE, driven mainly by TLR, and significant malapposition with TMV ≥7.0 mm3 was associated with more thrombotic events after drug-eluting stent implantation.
Kaplan-Meier curve

Funding Acknowledgement
Type of funding source: None
Three-year outcomes after deferral of revascularization based on instantaneous wave-free ratio or fractional flow reserve: insights from the J-CONFIRM Registry
Authors: Kuramitsu S , Matsuo H , Takashima H , Yokoi H , Tanaka N 
Published: November 2020

Abstract

Background
The safety of deferral of revascularization based on instantaneous wave-free ratio (iFR) is established in randomized controlled trials. However, there is little data regarding long-term outcomes after deferral of revascularization based on iFR in real-world practice.

Purpose
We sought to assess clinical outcomes after deferral of revascularization based on iFR in clinical practice as compared with those based on fractional flow reserve (FFR).

Methods
This is a post hoc analysis of the J-CONFIRM registry (long-term outcomes of Japanese patients with deferral of coronary intervention based on fractional flow reserve in multicenter registry), in which 1262 patients with 1447 lesions deferred the revascularization based on FFR. Of these, both FFR and iFR were measured in 399 patients with 452 lesions. The patients were classified into the two groups: the iFR group (iFR &gt;0.89; 308 patients with 348 lesions) and the FFR group (FFR &gt;0.80; 740 patients with 855 lesions). The primary study endpoint was the 3-year target vessel failure (TVF) including cardiac death, target-vessel related myocardial infarction (TVMI), and clinically driven target vessel revascularization (CDTVR).

Results
Mean iFR was 0.96±0.04 in the iFR group. Mean FFR was significantly lower in the iFR group than in the FFR group (0.87±0.05 vs. 0.89±0.05, p=0.002). The iFR group included 35 lesions (11.4%) with FFR ≤0.80. At 3 years, the rate of TVF on a lesion basis were not significantly different between the iFR and FFR groups (8.8% vs. 6.1%, p=0.10), whereas CDTVR rate was significantly higher in the iFR group than in the FFR group (8.5% vs. 5.3%, p=0.044). Cardiac death and TVMI on a patient basis rarely occurred in both groups during the 3-year follow-up (0.33% vs. 0.77%, p=0.47; 0.66% vs. 0.56%, p=0.85, respectively).

Conclusion
At 3 years, TVF rate in deferred lesions was numerically higher in the iFR group than in the FFR group, driven by a higher rate of CDTVR. However, cardiac death and TVMI was very rare in both groups, highlighting the safety of both iFR- and FFR-based deferral of revascularization in daily practice.

Funding Acknowledgement
Type of funding source: None
Mortality benefit with remote ischemic preconditioning in STEMI: a frequentist and Bayesian meta-analysis of randomized controlled trials
Authors: Shariff M , Pedreira Vaz I , Doshi R , Adalja D , Krishnan A , Kumar A 
Published: November 2020

Abstract

Introduction
Myocardial infarction related morbidity and mortality remains substantial despite perpetual improvement in patient care. Remote ischemic preconditioning among patients with myocardial infarction has exhibited to improve surrogate markers of ischemia. However, its effect on all-cause mortality is not well established.

Purpose
An updated frequentist and Bayesian meta-analysis of randomised control trials [RCTs] investigating remote ischemic preconditioning among patients with ST segment elevation myocardial infarction [STEMI] and its effect on all-cause mortality.

Methods
A systematic search across PubMed, EMBASE and Cochrane databases was performed. The inclusion criteria was RCTs comparing remote ischemic preconditioning with standard treatment juxtaposed to standard treatment alone among patients with STEMI and reporting all-cause mortality. Data extraction was carried out by two independent authors and looked for reproducibility. Inverse variance method with Paule-Mandel estimator for tau2 and Hartung-Knapp adjustment was used to calculate Risk Ratio with 95% confidence interval. Heterogeneity was assessed using I2 statistics. We estimated the robustness of our pooled effect size using Bayesian meta-analysis. A weakly informative prior [normal (0, 1) for intercept and uniform (0, 2) for standard deviation] and 20000 iterations [10000 warm-up + 10000 sampling] were used for Bayesian meta-analysis. We used meta ( ) and brm ( ) package in R for frequentist and Bayesian meta-analysis, respectively. All statistical analysis was carried out using R statistical software version 3.6.2. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results
Five RCTs comprising a total of 6043 patients [3010 intervention and 3033 controls] were included in the final analysis. The largest included RCT was the CONDI-2/ERIC-PPCI 2019 trial. Remote ischemic preconditioning among patients with STEMI had no effect on all-cause mortality at follow-up [RR=0.70, 95% confidence interval = 0.26–1.87, I2=60%] [Figure 1, Panel A]. Similar results were obtained from hierarchical Bayesian meta-analysis [RR=0.55, 95% credibility interval = 0.23–1.38] [Figure 1, Panel B]. Low certainty of evidence as per GARDE, reports no benefit of remote ischemic preconditioning in reducing the risk of all-cause mortality in STEMI.

Conclusion
Remote ischemic preconditioning among patients with STEMI has no effect on all-cause mortality at follow-up.
Figure 1

Funding Acknowledgement
Type of funding source: None
Conversion and outcome of dual antiplatelet therapy after bleeding in patients with acute coronary syndrome
Authors: Ye Z.S , Huang R , Wang J.I.E 
Published: November 2020

Abstract

Objective
To explore the conversion and outcome of antiplatelet therapy in patients with acute coronary syndrome (ACS) who have suffered bleeding after receiving aspirin combined with ticagrelor.

Methods
Patients who diagnosed with ACS and given aspirin 100 mg once daily combined with ticagrelor 90 mg twice daily for dual antiplatelet therapy (DAPT) were selected. The patients were divided into bleeding group and non-bleeding group according to whether bleeding events occurred within one year after DAPT. The bleeding group was divided into the next four groups according to the converted antiplatelet treatment strategy decided by the doctor and the patient. Patients in group A to D were treated with ticagrelor 90mg twice a day plus aspirin 0–50mgonce a day, ticagrelor 60mg twice a day plus aspirin 100mgonce a day, clopidogrel 75mgonce a day plus aspirin 100mg once a day and ticagrelor 90mg twice a day plus aspirin 100mg once a day, respectively. All patients were followed up for 1 year after DAPT. The primary outcome is change of bleeding degree by BARC. The secondary outcomes includes BARC bleeding, all-cause mortality and MACE.

Results
A total of 752 cases were enrolled, including 250 in the bleeding group and 502 in the non-bleeding group. The bleeding group was divided into four treatment groups, which were 63, 43, 38 and 95 cases among A, B, C and D group. There was a significant difference in the improvement of bleeding among the four groups. To be noted, patients in group A has the highest improvement rate of hemorrhage (65.1% vs 62.8% vs 47.4% vs 24.2%, P&lt;0.01). There were no significant differences in the incidence of MACE and all-cause mortality (P&gt;0.05). The incidence of major MACE in patients in the bleeding group was 14.4%, which was higher than that in the non-bleeding group (9.2%, P=0.03).The result of multivariate logistic regression analysis showed that female (OR=5.18, 95% CI: 1.61–16.65, P=0.006), low body weight (OR=7.73, 95% CI: 2.46–24.49, P&lt;0.001) and low AA-induced maximum platelet aggregation rate (OR=2.72, 95% CI:1.09–6.84, P=0.033) were independent risk factors for hemorrhage.

Conclusion
Patients with acute coronary syndrome who have suffered bleeding after receiving aspirin combined with ticagrelor were at a higher risk of MACE than those who did not. Low-dose aspirin (0–50mg/d) combined with ticagrelor or even ticagrelor alone has the best effect on reducing bleeding without increasing the risk of ischemia. Female, low body mass and low AA-induced maximum platelet aggregation rate are independent risk factors for bleeding.

Funding Acknowledgement
Type of funding source: None
Relation of multi-vessel coronary artery disease to response to aspirin
Authors: Shiyovich A , Sasson L , Lev E , Solodky A , Kornowski R , Perl L 
Published: November 2020

Abstract

Background
Multi-vessel coronary artery disease (MV-CAD) is correlated with worse outcomes compared with single-vessel CAD (SV-CAD), potentially attributed to more advanced atherosclerotic disease in other vascular beds, greater endothelial dysfunction, thrombin activation and possibly greater platelet reactivity.

Objectives
The aim of the current study was to evaluate the association between MV-CAD and high on-aspirin platelet reactivity (HAPR) in patients with stable CAD treated with aspirin.

Methods
Patients with known stable CAD, who were taking aspirin (75–100 mg qd) regularly for at least one month, and had undergone coronary angiography at least 3 months prior to the test, were enrolled. Blood was drawn from the participants and sent for platelet function testing. MV-CAD was defined as &gt;50% stenosis in ≥2 separate major coronary territories per coronary angiography. HAPR was defined as aspirin reaction units (ARU) &gt;550.

Results
Overall 507 patients were analyzed; age 66.7±11.2, 17.9% women, 223 (44%) had MV-CAD. Mean ARU was significantly higher among patients with MV-CAD vs. SV-CAD (460±68 vs. 440±55, p&lt;0.001, respectively). Furthermore, the rate of HAPR was significantly higher among patients with MV-CAD (figure 1). In a multivariate analysis adjusted for potential confounders, MV-CAD was found to be a strong independent predictor of HAPR [OR=1.8 (95% CI1.05–4.7), p=0.014]. In a reverse analysis, HAPR was associated with a higher number of coronary vessels involved (1.95±0.65 vs. 1.45±0.57, p&lt;0.01) and a strong independent predictor of MVD (OR-2.44, CI 1.83–25.6, p=0.015).

Conclusions
MV-CAD is significantly associated with HAPR. This could potentially explain, in part, the increased risk and/or worse outcomes in patients with MV-CAD and implies considering intensive anti-thrombotic therapy among these patients.

Funding Acknowledgement
Type of funding source: None
Optimal antiplatelet therapy in out-hospital cardiac arrest with mild therapeutic hypothermia
Authors: Jimenez Britez G , Freixa X , Sabate M , Diaz M , Hernandez-Enriquez M 
Published: November 2020

Abstract

Background
Out-of-Hospital Cardiac Arrest (OHCA) and Mild therapeutic hypothermia (MTH) has been linked to an increased risk of Stent Thrombosis (ST) in comatose survivors who underwent percutaneous coronary intervention (PCI). There is no formal recommendation about which antiplatelet regimen should be used in patients with Acute Coronary Syndrome (ACS) after OHCA

Methods
Prospective, single center study.
We compared antiplatelet efficacy of clopidogrel and ticagrelor at different time points after primary PCI in OHCA patients underwent MTH with 2 systems (VerifyNow®) and light transmission aggregometry.
With the system (VerifyNow®) the results were expressed in P2Y12 reaction units (PRU) in response to ADP-prostaglandin E1.
With the aggregometry in vitro platelet aggregation was measured in response to ADP (20 lmol/L at 37 C). The main result was the percentage of maximal platelet aggregation

Results
24 consecutive OHCA patients were included in our hospital.
We confirmed that residual platelet activity was higher with clopidogrel than with ticagrelor, expressed by PRU, 2 h after loading dose (229±56 vs. 180±30, p&lt;0.014), 6h after loading dose during MTH (203±45 vs. 135±51, p&lt;0.004), 24h after loading dose during MTH (188±52 vs. 58±64, p&lt;0.0001), after warming (200±55 vs. 27±24, p&lt;0.0001) and 24 h after warming (201±57 vs. 31±24, p&lt;0.0001).
With the aggregometry we observed higher percentajes of maximal platelet aggregation in response to ADP with clopidogrel than ticagrelor since 6 hs after loading dose. 2 h after loading dose (44±17 vs. 36±23, p: 0.439), 6h after loading dose during MTH (42±13 vs. 24±20, p&lt;0.02), 24h after loading dose during MTH (26±20 vs. 9.5±6.5, p&lt;0.005), after warming (26±16 vs. 12±8, p&lt;0.02)..

Conclusion
In this study, we observed a lower antiplatelet efficacy of clopidogrel compared with ticagrelor in patients with OHCA after PCI with MHT. This decrease in antiplatelet efficacy persists after the warming. Similarly to other settings, ticagrelor might be a valid alternative to clopidogrel in those patients

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministerio de Economía y Competitividad. Instituto Carlos III, Fondo Investigaciόn Sanitaria. Spain
Triple therapy in the elderly patients and women – results from the MUNICH triple cohort in patients with AF undergoing PCI
Authors: Riesinger L , Strobl C.S , Mehr M , Kellnar A , Opitz K , Siebermair J , Rassaf T , Massberg S , Wakili R 
Published: November 2020

Abstract

Introduction
Approximately 20% of patients with atrial fibrillation (AF) are suffering from coronary artery disease (CAD), requiring percutaneous coronary intervention (PCI) and stenting over time. These patients are in need of a so-called “triple therapy” (TT) for prevention of stent thrombosis and stroke. Prospective and randomized trials examined risk for bleeding in TT and compared it to a dual regimen, but in majority excluded elderly patients. Moreover, in all to date presented triple therapy trials women represent a minority of included patients (mostly &lt;30%). This raises the question, why female and elderly patients are underrepresented and these groups have a different outcome then younger and male patients, when treated with a guideline recommended TT.

Methods
The objective of our retrospective cohort study was to determine the number of women and elderly patients with the indication for TT and to evaluate the differences in medical treatment. Furthermore, we evaluated safety, represented by bleeding (BARC ≥2 bleedings) and efficacy endpoints (composite clinical endpoint: all-cause-death, myocardial infarction, stent thrombosis, stroke and other systemic thromboembolism) in women vs. men, and elderly vs. younger patients. Moreover, we investigated the influence of NOAC (new oral anticoagulant) vs. VKA (vitamin K antagonist) treatment. Follow-ups were performed via phone-calls or in-hospital visits.

Results
In total, we included 928 patients with AF, that underwent PCI and stenting. Mean follow-up was 464 days. 627 patients were &lt;80 years old (mean age: 72±7 years), 301 were ≥80 years old (mean age: 84±4 years). Only 27.9% of all patients were female. The number of men and women receiving TT was comparable (83.0% vs. 82.2%, p=0.78), while in the younger group significantly more patients received TT (537 (85.6%) vs. 228 (74.7%) (p&lt;0.001). The incidence of BARC ≥2 bleedings in patients with TT was not significantly different in younger vs. older patients and in men vs. women. Also, the incidence of the composite clinical endpoint did not differ significantly in both comparisons.

Conclusion
In our real-life cohort female sex represents around a quarter of TT patients in line with large RCTs. But, unlike the large RCTs, 1/3 of our included patients were older then 80 years and seem to be underrepresented in randomized TT trials.
TT seems to be safe in elderly as well as in female patients. As they both represent an important group, future trials should focus more on including a well balanced patient cohort to improve the applicability of the results.

Funding Acknowledgement
Type of funding source: None