bluuebunny/crossref_metadata_2025_split huggingface dataset:
How many CCS- and ACS-patients might reach the newly recommended LDL-C-target &lt;55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population
Authors: Gitt A.K , Horack M , Lautsch D , Zahn R , Ferrieres J 
Published: November 2020

Abstract

Background
The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from &lt;70mg/dl to &lt;55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target.

Methods
The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended &lt;55mg/dl target.

Results
A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C &lt;55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal.

Conclusion
Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of &lt;55 mg/dl from less than 20% to more than 90% of the population.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD
Identification of the high-risk patient in primary percutaneous coronary intervention: development and validation of a novel predictive index
Authors: Blake S , Proscia C , Eleuteri A , Groves D , Stables R.H 
Published: November 2020

Abstract

Background
Primary percutaneous coronary intervention (PPCI) is the best treatment for patients with ST elevation myocardial infarction (STEMI). Several risk scores have been created to help risk-stratify these patients but few of these can be calculated in-lab, during the acute event. Development of a score that could be applied during PPCI could aid operators' decisions regarding adjunctive therapies and post-procedural surveillance which could improve patient outcomes. This study aimed to develop a simple, practical risk model that could be applied during PPCI to identify high-risk patients.

Methods
Demographic, clinical and outcome data were collected for all patients, as part of the HEAT-PPCI trial, who underwent PPCI for suspected STEMI between February 2012 and November 2013 at our hospital. Independent predictors of the composite outcome of 28-day mortality or severe impairment of LV function (ejection fraction ≤35%) were identified using multiple logistic regression. A risk model was fitted and internal validation was performed by bootstrapping. External validation was performed on a separate cohort of patients with STEMI.

Results
The derivation cohort included 1271 patients, with 131/1271 = 10.3% experiencing the composite outcome of 28-day mortality or poor LV function. Three variables were required to predict the outcome: age (OR:2.07, 95% CI 1.55 to 2.78), location of the culprit artery (OR:6.16, 95% CI 4.00 to 9.47), myocardial blush grade post-PPCI (OR:2.32, 95% CI 1.39 to 3.88). External validation was performed on 324 patients undergoing PPCI from a different centre. The model showed good discrimination on ROC-curve analysis (c statistic 0.79, 95% CI 0.75 to 0.83) and performed well on external validation (c statistic 0.87, 95% CI 0.72 to 0.95). Accuracy of the risk model on the validation data was improved by simple recalibration. The model was used to create a risk prediction chart that can be used in-lab during PPCI (Figure 1).

Conclusions
We have developed a risk model that accurately predicts 28-day mortality or poor LV function following STEMI using age, culprit location and myocardial blush grade. The model can assist operators in identifying high-risk patients during PPCI.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): National Health Service, UK
Compliance with guideline-directed basic pharmacotherapy and late adverse events in patients with stable coronary artery disease after isolated surgical revascularization
Authors: Yepanchintseva O , Mikhaliev K , Shklianka I , Zharinov O , Todurov B 
Published: November 2020

Abstract

Background
Long-term basic pharmacotherapy may have a major impact upon clinical course and survival in patients with stable coronary artery diseases (CAD) after isolated coronary artery bypass grafting (CABG).

Purpose
To determine the role of compliance with guideline-directed basic pharmacotherapy in the prevention of late major adverse clinical events (MAEs) in patients with stable CAD after isolated CABG at 3-year follow-up.

Methods
A single-centre study included 576 patients with stable CAD, consecutively enrolled for isolated CABG during the period 2011–2017. Follow-up median was 34 months (interquartile range 13–60 months). Two (0.3%) patients died early after CABG, thus 574 (99.7%) patients were followed post-discharge. At 3-year follow-up, data on MAEs were available in 251 patients, mean age (61±9) years, 218 (86.9%) males. Among them, MAEs occurred in 55 (21.9%) cases.

Results
Basic CAD pharmacotherapy after CABG was comparable in MAEs vs. no-MAEs groups, with the vast majority of patients receiving guideline-recommended therapy at discharge, namely angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-II receptors blockers (ARBs) (79.6% vs. 88.8%, respectively; p=0.109), statins (98.1% vs. 99.0%, respectively; p=0.619) and antiplatelet drugs (98.1% vs. 99.5%, respectively; p=0.327). At 3-year follow-up, MAEs group, as opposed to no-MAEs group, was characterized by the lower usage of ACEI/ARBs (68.5% vs. 87.2%, respectively; p=0.001) and statins (59.3% vs. 86.7%, respectively; p&lt;0.001), as well as triple basic CAD therapy (ACEI or ARBs/statins/antiplatelet drugs: 35.2% vs. 70.4%, respectively; p&lt;0.001).

Conclusion
At 3-year follow-up, MAEs in patients with stable CAD after isolated CABG were associated with more frequent discontinuation of previously prescribed guideline-directed basic pharmacotherapy, namely ACEI/ARBs and statins, as well as triple basic CAD therapy.

Funding Acknowledgement
Type of funding source: None
Chronic total occlusion (CTO) revascularization a comparison from Japanese and European expert CTO operators registries
Authors: Takeshi S , Gerald S Werner W.G , Muramatsu T.M , Giunta G.R , Ribeiro R.M , Sumitsuji A.S , Okada N.O , Sianos S.G , Puglisi P.S , Pieri P.P , Tsuchikane E.T , Galassi G.A 
Published: November 2020

Abstract

Background
Development of different strategies and devices improved CTO revascularization. However, technical and procedural success might be influenced by several factors including geographical expertise.

Methods
A total of 4412 CTO coronary treated lesions (Japan 1531 Europe 2881) (mean age 64.5±10.7, male 85.2%, JCTO score 2.09±1.24) were analyzed in European and Japanese registries during the year 2016. The primary endpoint was to assess technical success rate of CTO-PCI cases and procedural outcomes.

Results
Primary Antegrade approach and success rate were 71.5% and 90.8% respectively in Japan while 77.0% and 94.1%, respectively in Europe, (p&lt;0001). Primary Retrograde approach and success rate were 28.5% and 84.0% respectively in Japan, while 22.6% and 69.2%, in Europe (p&lt;0001). There were no differences in technical success rate between Japan and Europe (89.9% vs 88.5%, p=0.13). Procedural time was higher in Japan than in Europe 156.3±1.8 vs 107.1±1.3 mins (p&lt;0.001), but contrast media volume resulted the opposite 209.6±3.2 ml vs 267.5±2.4 ml, (p&lt;0.001). Procedural complications were higher in Japan than Europe (death: 0.4% vs 0.07%, p=0.024, myocardial infarction: 1.2% vs 0.57% p=0.045, coronary artery occlusion: 0.26% vs 0.07% p=0.026, coronary perforation: 4.22% vs 3.04% p=0.045). A multivariate analysis showed that independent predictors of failed procedure were both for Japan and Europe unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length&gt;20mm.

Conclusions
Technical success rate was similar between Japan and Europe, but more retrograde approach was common in Japan. Unsuccessful retrograde crossing channel, severe lesion calcification and occlusion length&gt;20mm were independent predictors of failed procedures for both countries. Procedural complications were higher in Japan probably because of longer procedural time and higher frequency of retrograde approach.

Funding Acknowledgement
Type of funding source: None
Prasugrel versus ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention; a meta-analysis of randomized controlled trials
Authors: Rodriguez Z , Valdecanas A , Palileo N 
Published: November 2020

Abstract

Background
Dual antiplatelet therapy (DAPT) with ASA and a P2Y12 inhibitor is the cornerstone of anti-thrombotic therapy for patients undergoing PCI. The 2014 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines on myocardial revascularization recommend DAPT with prasugrel or ticagrelor over clopidogrel, however, a comparison between the efficacy in reducing all cause mortality and major bleeding of prasugrel versus ticagrelor is sparse.

Objectives
To perform a meta-analysis of randomized controlled trials (RCT) in the determination of the efficacy and safety of prasugrel as compared to ticagrelor among ACS patients undergoing PCI.

Methods
Extensive search of PubMed, Cochrane Library, Ovid, EMBASE, Google scholar, Medline and Herdin was done up to November 2019. Studies were limited to RCTs comparing ticagrelor vs. prasugrel among acute coronary syndrome (ACS) patients undergoing PCI. Outcome measures include all-cause mortality and major bleeding. Statistical analysis was done using Review manager V5.3.

Results
Thirteen RCTs with 6086 patients were included in this study. Pooled analysis using random effects model showed no difference in reduction of all-cause mortality between prasugrel versus ticagrelor (92 vs 107, RR of 0.77, 95% CI of 0.58–1.02, p-value of 0.07, I2 of 0%). Likewise, major bleeding (using BARC and TIMI as defined by the Bleeding Academic Research Consortium scale and Thrombolysis in Myocardial Infarction definitio) was similar between prasugrel and ticagrelor (91 vs 111, RR of 0.83, 95% CI of 0.63–1.09, p-value of 0.18, I2 of 0%).

Conclusion
There were no significant differences in the reduction of all cause mortality and major bleeding among ACS patients undergoing PCI receiving prasugrel versus ticagrelor. Our study may support the equal recommendation of both P2Y12 inhibitors as in the above guidelines.

Funding Acknowledgement
Type of funding source: None
Patterns of revascularization in stable ischemic heart disease in the pre-ISCHEMIA era
Authors: Albuquerque F , Brizido C , Madeira S , Teles R , Raposo L , Gabriel H , Leal S , Goncalves M , Brito J , Goncalves P , Almeida M , Mendes M 
Published: November 2020

Abstract

Introduction
New evidence on the role of myocardial revascularization in stable ischemic heart disease (SIHD), recently presented, showed that revascularization guided by the presence of moderate-to severe ischemia relieves angina more effectively than optimal medical therapy (OMT), without a significant benefit in hard clinical endpoints.

Aim
To assess the representativeness of the ISCHEMIA trial in a real-world population and compare management strategies between patients who fulfill the eligibility criteria of the trial (Group 1, G1) and those who do not (Group 2, G2).

Methods and population
Single centre retrospective analysis including all consecutive patients referred to coronary angiography (CA) for SIHD from January 2018 to December 2019. Patients were stratified in two groups (G1 and G2) according to the ISCHEMIA trial inclusion and exclusion criteria. G1 was compared with G2 and with a subset of G2 with obstructive coronary artery disease (CAD), defined as ≥70% luminal stenosis in at least one coronary artery or &gt;50% for the left main.

Results
A total of 1020 patients underwent CA, of whom only 124 (12.2%) would have been eligible for the ISCHEMIA trial (G1). Overall, there were no significant differences in baseline characteristics between the two groups. G1 patients had more extensive and severe disease, presenting more frequently with proximal left anterior descending (LAD) involvement (26.6% vs 10.4%; p&lt;0.001), two vessel disease without proximal LAD stenosis (23.4% vs 10.3%; p&lt;0.001) and three vessel disease (18.5% vs 5.9%; p&lt;0.001). These patients had higher rates of revascularization, both CABG (25.8% vs 10.8%, p&lt;0.001) and PCI (56.5% vs 39.5%, p&lt;0.001). However, when comparing G1 with the subset of G2 patients with obstructive CAD, G1 patients had higher rates of CABG (26.8% vs 17.8%, p=0.034) but there were no differences on the rates of PCI (58.0% vs 56.9%, p=0.916).

Conclusions
Patients included in the ISCHEMIA trial are underrepresented in a real-world population of SIHD patients referred to coronary angiography. PCI rates were similar among patients with at least one significant coronary artery stenosis, regardless of previous evidence or severity of ischemia. Our findings underline the need for further refinement in criteria for revascularization in SIHD.

Funding Acknowledgement
Type of funding source: None
Transfusion requirements in cardiac Surgery III (TRICS III), Ticagrelor Substudy
Authors: Alraddadi H , Belley-Cote E , Shehata N , Mazer D , Whitlock R.P 
Published: November 2020

Abstract

Background
Ticagrelor, in addition to aspirin, has been demonstrated to reduce morbidity and mortality in patients with acute coronary syndrome compared to clopidogrel with aspirin. The treatment effect appeared to be maintained in the subgroup of patients who underwent urgent surgical revascularization. However, the risk of postoperative bleeding in these patients has not been well described.

Research question
We aimed to establish the effect of ticagrelor exposure within 7 days before surgery on blood loss as measured by postoperative chest tube output and blood product use.

Method
In a nested cohort study of patients enrolled in the Transfusion Requirements in Cardiac Surgery III (TRICS III) trial, we compared chest tube output and blood product use in patients based on their preoperative exposure to ticagrelor ≤3 days versus &gt;3 days before surgery.

Results
Of the 5243 patients in TRICS III, 87 patients were exposed to ticagrelor within 7 days with a mean age of 78 years (SD 6) and 74% were male. Patients exposed to ticagrelor 3 days or less before surgery bled a median of 730 ml (IQR 295, 2195) postoperatively in the first 24 hours postoperatively, compared to 518 ml (IQR 350, 1000) for those for whom ticagrelor was held for more than 3 days. We log-transformed the data and found that recent ticagrelor exposure (≤3 days) was associated with significantly more blood loss compared to no exposure for more than 3 days (P-value: 0.01).
69.6% of patients in the recent exposure group received at least one red blood cell transfusion versus 54.7% in patients exposed to ticagrelor more than 3 days pre-operatively (p-value: 0.214). Platelet and fresh frozen plasma transfusion were 52.2% vs 15.6% (p-value 0.001), and 39.1% vs 9.4% (p-value 0.003), respectively, for ticagrelor exposure ≤3 days compared to &gt;3 days.
Cryoprecipitate use was 17.4% in the ≤3 days group and 3.1% in the &gt;3 days group (p-value 0.04). Only 1 patient in each group received prothrombin complex concentrate (PCC) transfusion. And 1 patient with exposure ≤3 days received Factor VII.

Conclusion
Exposure to ticagrelor within 3 days of surgery is associated with an increased risk of postoperative bleeding as assessed by greater chest tube output at 24 hours and more patients requiring blood product transfusion. A ticagrelor-reversing agent may improve the outcomes of patients who have been recently exposed to ticagrelor and require urgent cardiac surgery.

Funding Acknowledgement
Type of funding source: None
Heparins crossover in percutaneous coronary intervention: is it a real issue in real-world practice?
Authors: Li Y , Weng H.Y , Zhang L , Jiang J , Zhang Y , Li J.P 
Published: November 2020

Abstract

Background/Introduction
Current guidelines do not recommend heparins crossover in percutaneous coronary intervention (PCI) between unfractionated heparin (UFH) and low molecular weight heparin (LMWH), which is only based on the post-randomization crossovers analysis of SYNERGY trial. However, in real-world practice, heparins crossover is common.

Purpose
To evaluate bleeding complications in patients who underwent PCI using periprocedural crossover of heparin therapy.

Methods
From January 2015 to December 2019, all consecutive patients who underwent PCI in our hospital were retrospectively enrolled in this analysis. The primary outcome was a hemoglobin drop ≥3g/dl within 72 hours after the procedure.

Results
A total of 5,001 patients, including 4,487 (89.72%) with heparins crossover. As shown in figure 1, after a 1:4 ratio of propensity score matching of age, gender, prior medical history, vital signs, body mass index, puncture site, coronary lesion number, stent number, baseline hemoglobin and platelet counts, 539 with crossover and 165 without were matched. There was no difference of the incident of bleeding (1.67% vs. 0.61%, P=0.562) and thrombocytopenia (1.86% vs. 1.82%, P=0.562) between the two groups. In multivariate adjusted logistic regression models, there was no significant association with heparins crossover and bleeding (odds ratio: 0.36; 95% CI, 0.05–2.85) or thrombocytopenia (odds ratio: 0.95; 95% CI, 0.26–3.53).

Conclusion(s)
In this real-world retrospective analysis of a single center, the periprocedural heparins crossover was not associated with increased bleeding or thrombocytopenia risk.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Youth clinical research project of Peking University First Hospital
Clinical features and prognosis of acute myocardial infarction due to coronary artery embolism
Authors: Hata R , Shimada T , Shima Y , Okabe K , Ohya M , Miura K , Murai R , Amano H , Kubo S , Tada T , Tanaka H , Fuku Y , Goto T , Kadota K 
Published: November 2020

Abstract

Background
Coronary artery embolism (CE) is one of the important causes of acute coronary syndrome (ACS). The feature of CE is that angiographic evidence of coronary artery embolism and thrombosis without atherosclerotic components. However, the prevalence of CE remains unknown because of the diffifulty to diagnose in the acute settings. A recent retrospective analysis suggested that up to 3% of ACS cases may result from CE.

Purpose
The aim of this study was to elucidate the prevalence, clinical features and long-term outcomes including all-cause and cardiac death.

Methods
We analysed the consecutive 2695 patients with first AMI performed coronary intervention between January 2004 and July 2017. CE was diagnosed by clinical histories and angiographic findings. We retrospectively evaluated the clinical and lesion characteristics and outcomes including all-cause and cardiac death.

Results
The prevalence of CE was 2.0% (n=55; CE group and n=2640; non-CE group), including 8 (15%) patients with multivessel CE. The CE group had higher average age (70.8±14.9 vs. 68.4±12.6, p&lt;0.01), prevalence of female (54% vs. 27%, p&lt;0.01), lower prevalence of smoking (34% vs. 62%, p&lt;0.01). The common causes with CE were atrial fibrillation (47%), and malignant tumor (9%), and cardiomyopathy (5%), and patent foramen ovale (4%). Only 20% of patients with CE were treated with anti-coagulant therapy. The rate of distal infarction site (defined as #4, #8, #14–15) was significantly higher in CE group than non-CE group (54.0% vs. 4.9%, p&lt;0.01). During median follow-up of 53.6 [32.6–77.3] months, CE and thromboembolism recurred in 5 patients (CE: 1 patient, stroke 4 patients). The 4-year incidence of all-cause death was significantly higher in the CE group, but cardiac death was not significantly different between the groups (28.8% vs. 14.8%, p=0.03; 12.8% vs. 5.1%, p=0.11).

Conclusion
Compared with non-CE group, the prevalence of distal infarction site was significantly higher in the CE group, and the incidence of cardiac death is not significantly different.

Funding Acknowledgement
Type of funding source: None
Galectin-3 predicts cardiovascular events in patients with type-2 diabetes
Authors: Lorenzo-Almoros A , Pello A , Acena A , Martinez-Milla J , Tarin N , Cristobal C , Blanco-Colio L.M , Martin-Ventura J.L , Huelmos A , Gutierrez-Landaluce C , Lopez-Castillo M , Alonso J , Egido J , Lorenzo O , Tunon J 
Published: November 2020

Abstract

Introduction
Type-2 diabetes mellitus (T2DM) is associated with early and severe atherosclerosis. However, few biomarkers can predict cardiovascular events in this population.

Methods
We followed 964 patients with coronary artery disease (CAD), assessing at baseline galectin-3, monocyte chemoattractant protein-1 (MCP-1) and N-terminal fragment of brain natriuretic peptide (NT-proBNP) plasma levels. Secondary outcomes were acute ischemia and heart failure or death. Primary outcome was the combination of the secondary outcomes.

Results
Male patients were 75.0% in T2DM and 76.6% in the non-T2DM subgroup (p=0.609). Age was 61.0 (54–72) and 60.0 (51–71) years, respectively (p=0.092). 232 patients had T2DM. Patients with T2DM showed higher MCP-1 [144 (113–195) vs. 133 (105–173) pg/ml, p=0.006] and galectin-3 [8.3 (6.5–10.5) vs. 7.8 (5.9–9.8) ng/ml, p=0.049] levels.
Median follow-up was 5.39 years (2.81- 6.92). Galectin-3 levels were associated with increased risk of the primary outcome in T2DM patients [HR 1.57 (1.07–2.30); p=0.022], along with a history of cerebrovascular events. Treatment with clopidogrel was associated with lower risk. In contrast, NT-proBNP and MCP-1, but not galectin-3, were related to increased risk of the event in non-diabetic patients [HR 1.21 (1.04–1.42); p=0.017 and HR 1.23 (1.05–1.44); p=0.012, respectively], along with male sex and age.
Galectin-3 was also the only biomarker that predicted the development of acute ischemic events and heart failure or death in T2DM patients, while in non-diabetics MCP-1 and NT-proBNP, respectively, predicted these events.

Conclusion
In CAD patients, cardiovascular events are predicted by galectin-3 plasma levels in patients with T2DM, and by MCP-1 and NT-proBNP in those without T2DM.
Effect of Gal-3 on the primary endpoint

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Insituto de Salud Carlos III