bluuebunny/crossref_metadata_2025_split huggingface dataset:
The triglyceride/HDL cholesterol ratio and TyG index to predict coronary artery calcium, epicardial fat and outcome in the general population
Authors: Chiappino S , Aimo A , Neglia D , Martini N , Della Latta D , Susini C , Piagneri V , Storti S , Passino C , Emdin M 
Published: October 2021

Abstract

Background
The ratio between triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) and the triglyceride-glucose (TyG) index predict the severity of coronary atherosclerosis and outcome in patients with chronic coronary syndrome. We investigated the relationship between TG/HDL-C and TyG and coronary artery calcium (CAC), the volume of the pro-atherogenic epicardial fat, and survival in a primary prevention setting.

Methods
Between May 2010 and October 2011, subjects aged between 45 and 75 years living in Montignoso (Tuscany, Italy) and free from known cardiovascular disease were invited to participate to a screening including a computed tomography (CT) scan.

Results
Study participants (n=1,382) were aged 61 years (interquartile interval 54–68), 45% were men, and their 10-year risk of death or myocardial infarction based on the Framingham risk score was 5% (2–10%). CAC and epicardial fat volume (EFV) increased significantly across quartiles of TG/HDL-C and TyG. The TG/HDL-C and TyG displayed weak correlations with CAC and stronger correlations with EFV. The TG/HDL-C and TyG did not predict CAC independently from other baseline variables, while they both independently predicted EFV. Over 10 years (9.5–10.5), 103 individuals died (8%), and 36 patients experienced the composite endpoint of cardiovascular death or urgent revascularization during 10.1 years (9.6–10.6). The risk of all-cause death and the composite cardiovascular endpoint increased with TG/HDL-C and TyG. TG/HDL-C and TyG were univariable predictors of all-cause death and the composite cardiovascular endpoint. Nonetheless, TG/HDL-C and TyG lost their prognostic value for the composite cardiovascular endpoint when adjusting for CAC.

Conclusions
In subjects from the general population, the TG/HDL-C and TyG predict CAC and EFV. TG/HDL-C and TyG are also predictive of cardiovascular death or urgent coronary revascularization, although not independently from CAC.

Funding Acknowledgement
Type of funding sources: None.
Electrocardiographic predictors of ventricular fibrillation in ST-segment elevation acute myocardial infarction
Authors: Martinez Gomez E , Nunez Sanchez I , Ramos Lopez N , Jeronimo Baza A , Ferrandez Escarabajal M , McInerney A , Ferrera Duran C , Noriega Sanz F J , Fernandez Ortiz A , Viana Tejedor A 
Published: October 2021

Abstract

Introduction
Ventricular fibrillation (VF) during ST-segment elevation myocardial infarction (STEMI) is a critical emergency that requires immediate action to recover sinus rhythm and prevent sudden death. The surface electrocardiogram (ECG) is an essential diagnostic tool performed during STEMI. Our objective was to identify markers on the ECG that might be useful as potential predictors of peri-infarct VF.

Methods
Data was obtained prospectively from consecutive patients with a STEMI diagnosis admitted to the Cardiology Acute Care Unit at a tertiary hospital from July-2019 to May-2020. In all cases, primary angioplasty was performed. Clinical and laboratory data and in-hospital complications were collected. Surface ECG parameters were evaluated at the time of diagnosis.

Results
Of a total of 93 patients included, 11 patients had peri-infarct VF (11.8%). No differences in age, sex or cardiovascular risk factors between groups were found.
The ECG at admission showed notable differences: the degree of maximum elevation of the ST segment in mm (STmax) and the sum of such elevation (STsum) in all leads were significantly higher in the VF group (Table). A receiver operating characteristics analysis was performed in order to evaluate the diagnostic capacity of STmax for VF (Figure). A cut off of 4 mm (4mV) in STmax demonstrated the highest sensitivity and specificity for predicting VF. Patients with ST elevation &gt;4mm in any lead had a 16 times greater probability of developing peri-infarct VF (OR 16.4, 95% CI 1.98–136.4; p=0.01). After adjusting for age, STsum also showed a significant association with peri-infarct VF. An STsum of &gt;12mm resulted in a 4 times greater risk of VF.

Conclusions
The surface ECG remains an essential tool in the evaluation of patients with STEMI. The maximum ST elevation and the sum of the ST elevation demonstrates a strong association with the development of peri-infarct VF. A ST elevation &gt;4mm in any lead is associated with a 16 times higher risk of developing VF.

Funding Acknowledgement
Type of funding sources: None. Table 1. Baseline demographics, electrocardiographic (ECG) and laboratory data in patients with and without ventricular fibrillation. CKD: chronic kidney disease. STmax: maximum elevation of the ST segment in the ECG measured in millivolts (mV). STsum: sum of all ST elevation on the 12 lead ECG. LVEF: left ventricular ejection fraction.Figure 1. Receiver operating characteristics (ROC) curve analysis to evaluate the diagnostic capacity of maximum ST elevation for the development of ventricular fibrillation in patients with infarction.
Ticagrelor or clopidogrel after acute coronary syndrome in the elderly: a propensity score matching analysis from 16 653 patients included in two large multinational registries
Authors: Bianco M , Careggio A , Biole' C , Quadri G , Quiros A , Raposeiras-Roubin S , Abu-Assi E , Kinnaird K , Spirito A , Templin C , Nunez-Gil I , De Ferrari G M , Varbella F , D'Ascenzo F , Cerrato E 
Published: October 2021

Abstract

Background
Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) has been suggested.

Purpose
We assessed the incidence of major bleeding (MB), reinfarction (REAMI), and all-cause death in elderly patients to evaluate the safety and efficacy of ticagrelor versus clopidogrel in a population at high risk of bleeding and ischemia treated with percutaneous coronary intervention (PCI).

Methods
RENAMI and BleeMACS, real-world registries of patients with ACS who underwent PCI and received dual antiplatelet therapy, were merged. The pooled cohort was divided into two groups, clopidogrel versus ticagrelor and propensity score matching (PSM) analysis performed. Statistical analysis considered two age groups (&lt;75 versus ≥75 years).
Endpoints were BARC 3–5 MB, REAMI and all-cause death at 1 year. Independent risk factors of MB were identified.

Results
The study included 16,653 patients (13,153 &lt;75 and 3,500 ≥75 years). Ticagrelor was underused in elderly patients (16.3% versus 20.8%, P&lt;0.001). Using PSM, two treatment groups of 1,566 patients were included in the final analysis. Ticagrelor appeared to prevent REAMI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.2–0.6; P&lt;0.001) and all-cause death (HR, 0.60; 95% CI, 0.4–0.9; P=0.026) irrespective of age. In patients ≥75 years, ticagrelor increased the incidence of MB compared with clopidogrel (HR, 1.49; 95% CI, 0.70–3.0; P=0.257) without statistical significance; ticagrelor was found to significantly reduce all-cause death (HR, 0.32; 95% CI, 0.1–0.8; P=0.012) and REAMI (HR, 0.25; 95% CI, 0.1–1.1, P=0.072) without statistical significance. Multiple Cox regression revealed that age (HR, 1.03; 95% CI, 1.02–1.05; P&lt;0.001) was an independent risk factor for bleeding, whereas hemoglobin level was inversely proportional to bleeding (HR, 0.80; 95% CI, 0.72–0.88; P&lt;0.001).

Conclusions
Ticagrelor did not significantly increase MB compared with clopidogrel in elderly patients hospitalized for ACS and treated with PCI, significantly improving 1-year survival. Further studies on elderly patients are required.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Astra Zeneca
Shockwave intravascular lithotripsy facilitated percutaneous coronary intervention in patients with calcified coronary artery disease: a systematic review and meta-analysis of observational studies
Authors: Kassimis G , Patoulias D , Theodoropoulos K , Papadopoulos C E , Davlouros P , Alexopoulos D , Sianos G , Ziakas A , Kanonidis I , Banning A 
Published: October 2021

Abstract

Background
Percutaneous coronary intervention (PCI) outcomes for patients with significant coronary artery calcification (CAC) have been consistently inferior compared to patients without significant CAC. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option for lesion modification of severely calcified plaques but supporting evidence on safety and efficacy of this technology is narrow. The aim of this study is to assess S-IVL safety and efficacy in patients with severe CAC undergoing PCI.

Methods
We systematically searched MEDLINE, ClinicalTrials.gov and the Cochrane Library to identify studies assessing the efficacy and safety of S-IVL in adult patients with calcified coronary artery disease undergoing PCI. We excluded those studies assessing the effect of S-IVL in patients with under-expanded coronary stents and/or in-stent restenosis.

Results
The largest meta-analysis to date was performed. All studies were observational since no relevant randomized controlled trials have been published so far. Nine studies were included in our qualitative synthesis, while 7 of them, in a total of 794 enrolled patients, were used in the quantitative synthesis. Frequency of peri-procedural outcomes of interest was low: a) coronary dissection: 2.52%, b) coronary perforation: 3.0%, c) MI: 3.51%. Relative frequency of 1-month MACE was 5.59% and cardiovascular death 1.01%. S-IVL resulted in a significant increase in the in-stent post-IVL minimum lumen diameter by 1.67 mm, a significant decrease in the in-stent post-IVL vessel diameter stenosis by 53.60%, and a significant increase in the in-stent post-IVL acute gain by 1.68 mm. OCT analysis confirmed a significant decrease in area stenosis post-IVL by 19.71% and calcium angle by 22.14o and a significant increase in lumen area by 1.62 mm2, without however affecting maximum calcium thickness. When we compared post-stent post-IVL vs. pre-stent post-IVL OCT results, we demonstrated a further significant decrease in area stenosis by 35.89% and in calcium angle by 20.33o, a significant increase in lumen area by 2.74 mm2 and a neutral effect on maximum calcium thickness.

Conclusion
Shockwave Intravascular lithotripsy offers a significant improvement in coronary lumen to facilitate stent delivery and deployment in severely calcified coronary arteries. Although S-IVL appears to be associated with a low incidence of complications and MACE based on our present findings, further evidence from RCTs and longer-term follow-up is required to advocate its routine use in patients with severe CAC.

Funding Acknowledgement
Type of funding sources: None.
Baseline troponin-T is powerful predictor of mortality after coronary bifurcation stenting
Authors: Vassilev D , Mileva N , Collet C , Sokolova K , Nikolov P , Karamfiloff K , Rigatelli G , Gil R 
Published: October 2021

Abstract

Introduction
Considerable progress has been made in the treatment of coronary bifurcation stenosis. Anatomical characteristics of the lesion, however, fail to give information about the functional significance of the bifurcation stenosis. There is no study that systematically establishes the baseline functional significance of coronary stenosis and its effect on procedural and clinical outcomes.

Methods
Patients with significant angiographically bifurcation lesions defined as diameter stenosis &gt;50% in main vessel and/or side branch were included. FFR was performed in main vessel (MV) and side branch (SB) before and after percutaneous coronary intervention (PCI). If FFR was ≤0.80 the lesion was considered functionally significant, and patients underwent PCI. For the group with FFR &gt;0.80 – intervention was deferred. All patients were followed-up for vital status every 3 months. Cox regression analysis was performed to identify independent predictors of all-cause and cardiovascular death. The local ethics committee approved the study and patients signed informed consent for participation into registry.

Results
For mean follow-up of 38±18 months (median 40, IQR 23–55 months) all-cause mortality was numerically lower: 8.5% (n=7/82) in deferred group and 12.6% in stented group (n=11/76, p=0.387). The cardiac mortality was also numerically lower, but statistically not significant (9.8%, n=8/82 vs. 11.5%, n=10/88, p=0.714). On multivariate model, independent predictors were mitral regurgitation &gt;1st degree – HR=1.778 (CI 1.100–2.874, p=0.019); dyslipidemia HR=0.765 (CI 0.594–0.985, p=0.038); hemoglobin concentration – HR=0.976 (CI 0.964–0.988, p&lt;0.001); pre-PCI serum troponin ≥0.010 ng/ml – HR=2.702 (CI 1.451–5.032, p=0.002). On multivariate analysis, the following factors were identified as independent predictors of cardiac mortality: age – HR=1.035 (CI 1.009–1.062, p=0.009); diabetes – HR=1.789 (CI 1.089–2.962, p=0.024); dyslipidemia treated with statin – HR=0.667 (CI 0.515–0.863, p=0.002); LV posterior wall thickness – HR=1.230 (CI 1.062–1.424, p=0.006); mitral regurgitation more than 1st degree – HR=1.763 (CI 1.065–2.917, p=0.027); troponin pre-PCI ≥0.010 ng/ml – HR=2.498 (CI 1.228–5.081, p=0.011); true bifurcation lesion – HR=1.820 (CI 1.026–3.229, p=0.040); SBBARI score &lt;10% – HR=1.715 (CI 1.049–2.804, p-0.031).

Conclusion
Baseline high-sensitive troponin T value is a strong predictor for both all cause and cardiac mortality in patients undergoing coronary bifurcation lesion PCI.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Alexandrovska University Hospital
Mid-term mortality after stenting of distal left main stenosis with regular, third generation drug eluting stent or dedicated bifurcation stent or surgery-registry based,all-comers data
Authors: Vassilev D , Zlatancheva G , Shumkova M , Nikolov P , Gil R 
Published: October 2021

Abstract

Background
Distal left main (LM) bifurcation lesions remain a challenge for interventional cardiologists and they are associated with significant morbidity and mortality. The aim of the current study was to identify predictors of cardiac mortality at mid-term follow up after PCI (DES vs. dedicated bifurcation stent) or CABG.

Methods
All patients with distal LM stenosis ≥50% were included in prospective registry starting from 01.2015. The exclusion criteria for registry are cardiogenic shock, a priory life expectancy duration &lt;1 year, lack of inform consent. All patients were prospectively followed about the alive status through the national security number data base. All deaths were deemed cardiac if proof otherwise (the data patient families or family's physicians were contacted through phone call about the reason of death)

Results
For three year follow up period (median 35 months, IQR 18–50) 303 patients were included. 220 patients were stented with 3rd generation DES, 43 with dedicated bifurcation stent BiOSS (Balton, Poland), and rest were sent for CABG. The mean age was 67±10 years, 72% were males, 37% diabetics, all with hypertension, 97% dyslipidemia, 15% PAD, 9% COPD, 16% carotid artery disease, previous MI 28%, previous PCI 50% - without significant difference between three groups. The frequency of acute coronary syndrome during admission was 11% - without difference in frequency between groups. The patient referred to CABG had significantly lower left ventricular EDV and ESV, more severe mitral regurgitation and kinetic disturbances, higher SYNTAX score and longer lesion length. On univariate COX regression analysis, the following factors were associated with mortality: age, NYHA class, GFR, baseline troponin, hemoglobin, LV EF, mitral regurgitation, kinetics disturbances, treatment with beta blockers, ACE inhibitors, statin, atrial fibrillation, SYNTAX score, lesion length. The type of treatment was not associated with differences in mortality (figure). On COX multiple regression survival analysis independent predictors of survival were: age (HR=1.036, CI 1.005–1.068, p=0.023); COPD (HR=2.313, CI 1.170–4.572, p=0.016); GFR (HR=0.988, CI 0.978–1.000, p=0.048); hemoglobin (HR=0.970, CI 0.955–0.986, p=0.000); left ventricular EF (HR=0.958, CI 0.832–0.985, p=0.003).

Conclusions
The type of treatment was not associated with mid-term mortality. Our data demonstrate that dedicated bifurcation stent could be used safely for distal LM stenosis treatment with similar safety as 3rd generation DES.

Funding Acknowledgement
Type of funding sources: None.
Software supported robotic PCI in coronary arteries – comparison from the ROBO.pci trial
Authors: Hofmann F J , Doerr O , Blachutzik F , Keranov S , Koehne A , Widmann L , Boeder N F , Elsaesser A , Hamm C , Nef H 
Published: October 2021

Abstract

Background
Robotic percutaneous coronary interventions (rPCI) have proven to be efficient and safe. The robotics software has recently been updated and now allows precise and fully controlled navigation of devices and wires to fit the various morphologic conditions of coronary arteries and calcified segments.

Objectives
In the present study we aimed to compare the different robotic wiring modalities supported by the new software.

Study design
rPCI performed using the updated robotics software was compared with rPCI using the manually executed wire positioning. Lesion crossing was performed with each method under identical circumstances, crossing the same lesion and measuring the wire times. Measurements were started at the ostium of the guiding catheter and were stopped at a pre-defined individual coronary anatomical landmark.

Results
Eleven consecutive patients with 11 lesions were enrolled in this trial. The mean age of patients was 63±6 years with typical cardiovascular comorbidities and 54% (6/11) presented with three-vessel disease. All patients underwent PCI in an elective setting with stable chronic coronary syndrome. The majority of lesions were located in the LCX (45%, 5/11) followed by the LAD (27%, 3/11) and the RCA (27%, 3/11). All lesions were de novo ACC/AHA grade B2/C lesions, and the procedure was performed by experienced (high-volume) interventional cardiologists. The lesion crossing times were not significantly different (manual crossing 15.00 [IQR: 40] sec vs. rPCI without software support 18.00 [IQR: 18] sec vs. rPCI with software support 13.00 [IQR: 47] sec; p=n.s.).

Summary
rPCI without software support tends to be slower than rPCI with software support. There was no statistical significance. rPCI was found to be safe and feasible and the new software tends to reduced procedural time, which could reduce operators' health risks and improve patients' outcomes. Further randomized controlled trials are needed to evaluate the long-term benefits.

Funding Acknowledgement
Type of funding sources: None.
Impact of nodular calcification on the outcomes of patients with acute coronary syndrome (ACS) treated with primary percutaneous coronary intervention (PCI)
Authors: Demuyakor A , Hu S , Koniaeva E , Liu M , Weng Z , Zhao C , Feng X , He L , Xu Y , Zeng M , Meng W , Yi B , Qin Y , Jia H , Bo Y 
Published: October 2021

Abstract

Background
Calcified plaque is thought to adversely impact clinical outcomes but the impact of nodular calcification after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) remains unclear.

Purpose
This study sought to explore the impact of nodular calcification on the outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes.

Methods
Five-hundred culprit plaque with calcification were analysed from 495 ACS patients in whom PCI was performed. Plaques were divided into nodular calcification group (n=238) and non-nodular calcification group (n=262). Calcification is defined as an area with low back-scattering signal and a sharp border. Nodular calcification was defined as a protruding mass with an irregular surface, high backscattering, and signal attenuation on optical coherence tomography (OCT).

Results
Patients with nodular calcification were older (p&lt;0.001) and had lower left ventricular ejection fraction (p=0.006) compared to patients with non-nodular calcification. Lesion length (31 (25.2, 38.5) vs. 29 (22.8, 34.1), p&lt;0.001) was longer in plaques with nodular calcification. A higher prevalence of superficial calcium (p&lt;0.001) was observed in plaques with nodular calcification compared with non-nodular calcification group. Minimum stent area (MSA) (5.0 (3.9, 6.3) vs. 5.4 (4.2, 6.7), p=0.011) and stent expansion (70 (62.7, 81.8) vs. 75 (65.2, 86.6), p=0.004) were significantly smaller in the nodular calcification group than in the non-nodular calcification group. Independent predictors of nodular calcification were age (p&lt;0.001) lesion length (p=0.002) and calcium depth (p&lt;0.001).

Conclusion
This study demonstrated that the presence of nodular calcification is associated with unfavourable outcomes with smaller minimum stent area and higher incidence of stent under expansion in patients with ACS treated with primary PCI.

Funding Acknowledgement
Type of funding sources: None.
A meta-analysis of randomized controlled studies comparing off-pump vs on-pump CABG in the elderly
Authors: Machado R J , Saraiva F A , Mancio J , Sousa P , Cerqueira R J , Barros A S , Lourenco A P , Leite-Moreira A F 
Published: October 2021

Abstract

Background
The increasing demand for coronary revascularization in the elderly has raised the interest in off-pump coronary artery bypass graft (CABG) as an option in these high-risk patients.

Purpose
We sought to investigate the differences between off-pump CABG (OPCAB) and on-pump CABG (ONCAB), among patients older than 60, in short and mid-term results throughout a meta-analysis of randomized clinical trials (RCTs).

Methods
A literature search was conducted using MEDLINE, ISI Web of Science and Cochrane Library (1960–2020). RCTs reporting mortality outcomes of OPCAB vs ONCAB within elderly patients (as prespecified or secondary analysis) were included. Data on myocardial infarction, stroke, repeat revascularization, renal failure and composite endpoints after CABG were also collected. Hazard ratio (HR) and variance for follow-up outcomes and frequencies or odds ratio (OR) for early endpoints were collected. Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI).

Results
Seven RCTs encompassing a total of 6,609 patients were included (3,303 OPCAB and 3,306 ONCAB, 50% were men). Five trials reported mortality during follow-up (6 months (2 studies) to 5 years). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95% CI: 0.88–1.17, p=0.82) and composite endpoint incidence (4 studies pooled HR: 0.98, 95% CI: 0.88–1.09, p=0.73) between OPCAB and ONCAB. At 30-days, no differences between groups were noted in mortality (5 studies pooled OR: 0.90, 95% CI: 0.62–1.31, p=0.59), early myocardial infarction (5 studies pooled OR: 0.95, 95% CI: 0.60–1.51, p=0.82) and renal complications (3 studies pooled OR: 0.74, 95% CI: 0.50–1.11, p=0.14). The need for early repeat revascularization was significantly higher in OPCAB (2 studies pooled OR: 2.58, 95% CI: 1.16–5.75, p=0.02), with higher percentage of incomplete revascularization among OPCAB in both trials included in this pooled result (34% in OPCAB vs 29% in ONCAB, p&lt;0.01). However, OPCAB showed a tendency for lower risk of early stroke (6 studies pooled OR: 0.70, 95% CI: 0.48–1.03, p=0.07).

Conclusions
Pooling data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. However, OPCAB was associated with a higher risk of early repeat revascularization and there was a trend for reduced early stroke risk. Further randomized studies, specifically designed to include elderly patients, are needed to establish the better CABG strategy.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP and FSE-Social European Fund; Fundação para a Ciência e Tecnologia Early and Mid-term Results