bluuebunny/crossref_metadata_2025_split huggingface dataset:
The clinical outcome of fractional flow reserve based coronary revascularization strategy of the patients on hemodialysis
Authors: Hirobe K , Otsuki H , Inagaki Y , Anaka K , Nakao M , Arashi H , Yamaguchi J , Hagiwara N 
Published: October 2021

Abstract

Background
The optimal coronary revascularization strategy for the patients on hemodialysis is yet to be determined. In the real-world practice, we sometimes encounter the rapid deterioration after percutaneous coronary intervention (PCI) to angiographically intermediate but functionally significant stenosis. According to the fractional flow reserve (FFR) based revascularization strategy, the clinical outcome of the deferred lesions is reported to be almost equivalent to that of the lesions received PCI. However, whether the relationship also applies to hemodialysis patients is unclear.

Purpose
To assess the clinical outcome of the lesions for which revascularization strategy was determined by FFR in patients with hemodialysis.

Methods
Consecutive 147 vessels in 120 patients with hemodialysis whose revascularization strategy was decided according to the FFR were enrolled in this study. We compared the clinical outcomes of the deferred group (FFR ≥0.80, 87 vessels, 78 patients) with the PCI group (FFR&lt;0.80, 60 vessels, 42 patients). The primary endpoint of this study was target vessel failure (TVF) defined as a composite of TV revascularization and myocardial infarction evaluated by per-vessel analysis. The secondary endpoint was major adverse cardiovascular events (MACE) defined as all cause death, myocardial infarction, urgent revascularization evaluated by per-patient analysis.

Results
The median follow-up period was 2.3 years (interquartile range, 1.5–4.0 years). The beseline characteristics of the lesions and patients were well balanced between the 2 treatment groups except for the distribution of target vessels and FFR value. The cumulative TVF rate was not significantly different between the deferred group and PCI group (2-year event rate 26.7% vs. 17.7%; Log-rank p=0.23). The risk of MACE was also not significantly different between two groups (2-year event rate 35% vs. 30%; Log-rank p=0.48).

Conclusion
The clinical outcome of the lesions/patients for which received revascularization based on FFR was equivalent to the deferred lesions/patients even in the patients on hemodialysis (2,129/3,000).

Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
Microvascular dysfunction in patients with angina and non-obstructive coronary artery disease – preliminary data from a single center registry
Authors: Banai A , Lupu L , Borohovitz A , Levi E , Banai S , Konigstein M 
Published: October 2021

Abstract

Introduction
About 50% of patients referred for coronary angiography because of angina and/or myocardial ischemia are found to have non-obstructive coronary artery disease (CAD). The role of microvascular dysfunction as the cause of angina or ischemia is becoming increasingly recognized.

Purpose
Our aim was to describe coronary physiology and microvascular function in patients with angina and ischemia and non-obstructive CAD (ANOCA/INOCA).

Methods
Patients with angina, referred for coronary angiography and found to have non-obstructive CAD enter a prospective registry and undergo invasive coronary physiology evaluation. Fractional flow reserve (FFR), coronary flow reserve (CFR), index of myocardial resistance (IMR) and resistive reserve ratio (RRR) are recorded. Patients with obstructive CAD (≥50% diameter stenosis and/or FFR≤0.8), acute coronary syndrome and/or hemodynamic instability are excluded. Microvascular dysfunction is considered significant if either CFR&lt;2.5, IMR≥25 and/or RRR≤3.5.

Results
58 patients with ANOCA or INOCA were studied. Mean age was 64.8±10.4 and 65.5% were females. Hyperlipidemia, hypertension, and obesity were the most frequent cardiovascular risk factors (65.5%, 55.1% and 39%, respectively), and approximately 25% had known ischemic heart disease with a previous percutaneous coronary intervention. Microvascular dysfunction was found in 29 (52.7%) of the patients. 10 (18.2%) had CFR&lt;2.5, 20 (34.5%), had IMR≥25, and 27 (50%) had RRR≤3.5. Among patients with IMR≥25, mean CFR and RRR were 2.1±0.5 and 2.4±6.8, respectively.

Conclusion
Microvascular dysfunction is present in approximately half of the patients with angina and/or ischemia referred for coronary angiography and found to have non-obstructive CAD.

Funding Acknowledgement
Type of funding sources: None.
Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry
Authors: De La Torre Hernandez J M , Ferreiro J L , Lopez Palop R , Ojeda S , Marti D , Avanzas P , Linares J A , Diego A , Amat I J , Telleria M , Cid B , Otaegui I , Lozano I , Pinar E , Perez De Prado A ,   PACO-PCI (EPIC-15) registry
Published: October 2021

Abstract

Background
The strategy of antithrombotic therapy in patients with atrial fibrillation (AF) after revascularization with drug-eluting stents continues to be debated. The evidence in elderly population in this scenario is particularly scarce.

Purpose
We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with AF after revascularization with drug-eluting stents.

Methods
Retrospective registry in 20 centers including consecutive patients over 75 years with AF treated with drug-eluting stents. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months.

Results
Out of 41,000 patients undergoing PCI 1,249 patients (81.1±4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p=0.04) but less MACCE (8.7% vs. 13.6%, p=0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p=0.03) and similar MACCE (9.8% vs. 9.4%, p=0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates.

Conclusions
Despite advanced age TAT prevails, but prolonged durations or use of VKA are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bristol-Myers-Squibb/Pfizer
Utility and safety of the MANTA device for access site closure after removal of the mechanical hemodynamic support device Impella on the intensive care unit
Authors: Burkart P , Bossard M , Moccetti F , Hess S , Jeyarasa M , Madanchi M , Cioffi G , Seiler T , Wolfrum M , Hakimi M , Seelos R , Toggweiler S , Attinger-Toller A , Kobza R , Cuculi F 
Published: October 2021

Abstract

Background
The percutaneously implanted hemodynamic mechanical support devices Impella are commonly used in patients at risk for or with cardiogenic shock (CS). Impella removal after hemodynamic stabilization on the intensive care unit (ICU) remains a major challenge and is prone to high rates of bleeding and vascular complications.

Purpose
It is unknown if the use of the novel large-bore access closure device MANTA® is safe and facilitates access management compared to manual compression.

Methods
Between January 2017 and December 2020, 172 CS patients were treated with an Impella® device at our centre. Of those, in 89 patients the Impella® was removed on the ICU and access site management occurred with either MANTA® device or manual compression. The criteria for MANTA® 14 french device deployment included: (i) femoral artery Diameter &gt;6mm and (ii) absence of significant peripheral arterial disease (PAD). Bleeding and vascular access site complications were assessed and adjudicated according to the Valve Academic Research Consortium-2 (VARC-2) criteria.

Results
Among the 89 included patients, Impella® removal was performed using the MANTA® device in 31 cases and manual compression in 58 cases. Mean age was 66±11 years, and 50 (56.2%) patients had a CS classified as Society for Cardiovascular Angiography and Interventions (SCAI) D or higher due to myocardial infarction. Median support time was 40 (IQR 24; 69) hours. Baseline characteristics are displayed in Table 1. Immediate haemostasis was more frequently achieved by MANTA® device compared to manual compression (p=0.034). Moreover, we observed significantly less overall (2 (6.5%) vs. 22 (37.9%), p=0.001) and minor bleedings (1 (3.2%) vs. 15 (25.9%), p=0.006) with the MANTA® device when compared to manual compression. Of note, there were no significant differences in vascular complications between the two groups (Table 2).

Conclusions
In patients requiring Impella® support and residing on ICU, the MANTA® device, compared to standard of care manual compression, seems to be a safe and effective option for access site management, especially with regards to the reduction of bleeding events. However, physicians should carefully assess the vascular anatomy and degree of calcification prior to deployment of the MANTA® device. Nevertheless, more prospective data is necessary for evaluating the optimal access closure among CS patients treated with a percutaneously implanted Impella® device.

Funding Acknowledgement
Type of funding sources: None. Table 1. Baseline demographicsTable 2. Outcomes
Clinical outcomes in percutaneous coronary interventions with polymer-free vs. durable-polymer stents: a metanalysis of randomized clinical trials
Authors: Escribano D , Cordero A , Bertomeu-Gonzalez V , Moreno-Arribas J , Monteagudo M , Lopez Ayala J M , Perez-Berbell P , Quintanilla M , Zuazola P 
Published: October 2021

Abstract

Background
Polymer-free (PF) stents were designed as an alternative to durable-polymer (DP) drug-eluting stents to minimize the time on dual antiplatelet treatment for patients at high-risk of bleeding. Nonetheless, the efficacy and safety of PF vs. DP stents in patients undergoing percutaneous coronary intervention (PCI) remain controversial.

Methods
We performed a metanalysis with currently available studies that assessed the effect of PF-stents vs. DP-stents after performing a systematic search. The endpoints analyzed were all-cause death, myocardial infarction, target lesion revascularization (TLR) and probable or definite stent thrombosis. The raw numbers of incident end-points reported in each study were used. We performed analyses in short and long term (&lt;1 or &gt;1 year follow-up) studies.

Results
We included 12464 patients from 8 studies (5 short-term and 3 long-term): 6723 treated with PF-stents and 5741 with DP stents. Females represented 23.3% (n=3284) and 33.7% (n=4202) were included in the setting of acute coronary syndromes. As shown in the figure, PF-stents were associated to lower incidence of all-cause mortality (HR: 0.91 95% CI 0.84–0.98; p=0.016) and TLR (HR: 0.88 95% CI 0.80–0.96; p=0.003). No differences were observed in the risk of cardiovascular death (HR: 0.96 95% CI 0.86–1.06 p=0.415), myocardial infarction (HR: 0.90 95% CI 0.80–1.01; p=0.061) or probable-definite stent thrombosis (HR: 0.92 95% CI 0.74–1.14; p=0.447). Finally, no differences in the primary end-point (HR: 0.92 95% CI 0.83–1.03; p=0.143) were detected with PF-stents vs. DP-stents. No significant heterogenicity was observed in any of the endpoints, except for the incidence of stent thrombosis.

Conclusions
Under current PCI techniques the use of PF-stent might be associated to better outcomes, especially in terms of all-cause mortality and TLR.

Funding Acknowledgement
Type of funding sources: None.
Localization of the femoral artery bifurcation: hips don't lie – in at least 97% of cases
Authors: Uehlein S , Smolka S , Arnold M , Marwan M , Achenbach S 
Published: October 2021

Abstract

Background
The most common vascular access for structural cardiac interventions such as transcatheter aortic valve implantation (TAVI) is the common femoral artery (CFA). Depending on the procedure CFA puncture has to be performed not only unilaterally, but also bilaterally. Since incorrect localization of femoral access can lead to severe vascular complications, specific knowledge about the exact position of the CFA bifuraction is helpful. Such information might be systematically obtained from pre-TAVI CT scans.

Methods
We performed a retroperspective analysis of consecutive contrast-enhanced pre-TAVI CT angiography data sets (n=1000) to determine the CFA bifurcation localization relative to the femoral head and the correlation to contralateral CFA bifurcation location.

Results
The site of the CFA bifurcation was in 67.2% below the femoral head (−−), in 24.3% within the lower third of the femoral head (−), in 7.4% in the mid (0) and in 1.2% within the upper third (+) of the femoral head. Bifurcations above (++) the femoral head were not detected. CFA bifurcations below the femoral head showed the highest prevalence within men and women in all age groups (50–59, 60–69, 70–79, 80–89, 90–99 years). Bilateral agreement of CFA bifurcations was observed in only 69.3% and was independent of one-sided hip replacement (agreement 72.7%) or two-sided hip replacement (agreement 78.7%). A congruent contralateral left CFA bifurcation below the femoral head could be predicted in 80.6%, whereas CFA bifurcations within the lower and upper margins of the femoral head were congruent in only 65.7% (of these, 49.2% for the lower third, 29.7% for the mid and 36.4% for the upper third).

Conclusion
In conclusion, punctures within the upper third of the femoral head will provide an ideal puncture site in at least 97% of cases, independent of age, sex, or previous hip replacement.

Funding Acknowledgement
Type of funding sources: None.
Impact of doppler velocity index after transcatheter aortic valve replacement using Sapien-3 valve – a single centre experience
Authors: Lak H , Sammour Y , Chawla S , Svensson L G , Yun J , Harb S , Reed G W , Puri R , Jaber W , Krishnaswamy A , Kapadia S 
Published: October 2021

Abstract

Background
Little is known about the hemodynamic performance of Edwards Sapien-3 (S3) valve after Transcatheter Aortic Valve Replacement (TAVR). Doppler velocity index (DVI) is a better indicator of prosthetic valve function as it is independent of valve size and flow, unlike mean gradient and peak velocity which are flow-dependent.

Methods
In this study, we compare outcomes based on differences in DVI among a consecutive series of patients who underwent S3 TAVR between April 2015 and December 2018. Our institutional review board approved the study and informed consents were obtained from the subjects.

Results
Among 921 patients who had follow-up echocardiograms within 30 days after TAVR, 60.8% had DVI ≤0.5, while 39.2% had DVI &gt;0.5. The median 30-day DVI was 0.47 with a standard deviation of 0.11 and mean 0.49 and interquartile range 0.41–0.55. The baseline clinical and procedural characteristics were similar between both groups with the exception of less post-dilation (36.8% vs. 47.4%; p=0.001) and greater implantation depth (2.59±1.99 vs. 2.31±1.9mm; p=0.031) with DVI ≤0.5. The rates of aortic valve calcification, pre dilation, pre-TAVR aortic regurgitation (AR) were similar. At baseline, there were no differences between both groups in mean or peak gradients or aortic velocity time integral (VTI). At 1 year, mean gradients were higher with DVI ≤0.5 (12.7±5.6 vs. 11.1±4.6 mmHg; p=0.001). DVI ≤0.5 was associated with higher peak gradients (24.2±10.2 vs. 21.4±8.7 mmHg; p=0.002), and aortic VTI (51.4±13.5 vs. 46.8±12.2 cm; p&lt;0.001) at 1 year, especially with the 26mm and 29mm prostheses. Compared with DVI&gt;0.5 group, patients in DVI&lt;0.5 group had lower baseline left ventricular ejection fraction (LVEF) (54.5±12.2% vs. 58.9±11.2%; p&lt;0.001), higher left ventricular end-diastolic volume index (LVEDVi) (54.3±20.9 vs. 49.4±17.4 ml/m2; p=0.001), higher LV end-systolic volume index (LVESVi) (25.2±16.5 vs. 21.3±12.7 ml/m2; p=0.001), and similar LV mass index (110.7±31.9 vs. 106.9±32.7 g/m2; p=0.134). 1-year mortality rates among patients who had DVI ≤0.5 compared to DVI &gt;0.5 were lower (6.6% vs. 10.6%; log-rank p=0.033), however no difference was noted at both 2 years (17.3% vs. 20.1%; log-rank p=0.151), and 3 years after TAVR (30.7% vs. 31.2%; log-rank p=0.333).

Conclusions
DVI&lt;0.5 was associated with higher peak gradients and lower baseline LVEF. DVI &lt;0.5 group patients had lower 1-year mortality but similar mortality at 2 and 3-years of follow up.

Funding Acknowledgement
Type of funding sources: None. Figure 1. All-cause SurvivalFigure 2. Hemodynamic Data
Clinical and echocardiographic parameters associated with left ventricular recovery after TAVI
Authors: Tiosano S , Maor E , Berkovitch A , Fefer P , Feinberg M , Vatury O , Barbash I M , Guetta V , Segev A 
Published: October 2021

Abstract

Introduction
The relationship between severe Aortic Stenosis (AS) and Left Ventricular (LV) dysfunction is well established. However, there is a paucity of data regarding LV functional recovery after TAVI.

Purpose
To study the clinical and echocardiographic parameters associated with LV functional recovery after TAVI.

Methods
We evaluated all patients who underwent TAVI between 2009–2020 in a tertiary medical center. We included patients with pre-procedural LV Ejection Fraction (LVEF) of 40% and below. All patients had baseline and in-hospital post-procedural echo, and their clinical characteristics were recorded in a designated TAVI registry. LV functional recovery was defined as an absolute increase in at least 10% in LVEF post-procedurally. No LV recovery was defined as an absolute change of up to ±10% in post-procedure LVEF, and LVEF deterioration was defined as an absolute decrease of more than 10% in post-procedural LVEF compared to baseline. Univariate analysis consisting clinical and echocardiographic factors for LV functional recovery was performed, followed by logistic regression adjusting for confounders.

Results
Out of 1,349 consecutive TAVI patients, 100 (7.4%) had LVEF of 40% or less. There were 69 (69%) men with a mean age of 82±8 years, and average BMI of 27±4 kg/m2. Prior coronary artery disease and hypertension were present in 34 (34%) and 21 (21%) of patients, respectively. Out of these 100 patients, 32 (32%) had achieved LV functional recovery and no patient had experienced LVEF deterioration (FIGURE). Mean Left Ventricular End Systolic Diameter (LVESD) was 3.79 and 4.43 in the LV functional recovery and no LV recovery groups, respectively. Mean aortic pressure gradient was higher among patients who had LV functional recovery compared to no LV recovery (45.9 vs. 31.5 mmHg, respectively). Multivariable analysis revealed parameters that were independently associated with LV functional recovery: Coronary artery disease – OR 5.29 (95% CI 1.59–20.44), LVESD – OR 0.87 (95% CI 0.8–0.95) for each 1 mm increment and mean aortic pressure gradient – OR 1.91 (95% CI 1.21–3.28) per each 10 mmHg increment.

Conclusion
In patients with severe AS and LV dysfunction undergoing TAVI, the presence of coronary artery disease, increased aortic pressure gradient and reduced LVESD were associated with early LV functional recovery.

Funding Acknowledgement
Type of funding sources: None. Figure 1
National prevalence and outcomes of different mitral valve interventions for mitral regurgitation among patients with cardiogenic shock: an analysis of the national readmission database 2010–2018
Authors: Aldrugh S , Kakouros N , Qureshi W 
Published: October 2021

Abstract

Background
Prevalence and outcome data of mitral valve (MV) interventions for severe mitral regurgitation (MR) in the setting of cardiogenic shock (CS) is limited.

Purpose
Our aim is to study the national prevalence, mortality, and outcomes of three mitral valve interventions (transcatheter mitral valve (MitraClip), surgical mitral valve repair (sMVR), and surgical mitral valve replacement (sMVr)) in patients with severe MR and CS, and how they compare to a non-invasive medical approach to management.

Methods
Patients with concomitant severe MR and CS were included for the years 2010 - 2018 from the national readmission database. We compared the national prevalence, in hospital mortality, readmission rate, and outcomes of patients who were treated either medically (non-invasive), or underwent an invasive approach with MitraClip, sMVR, or sMVr using one-way ANOVA and logistic regression.

Results
A total of 106,015 patients (68±13 years, 42% women) with severe MR and CS were identified. Of these, 88,696 (84%) were treated medically, while 607 (0.6%) underwent MitraClip, 4,528 (4%) underwent sMVR, and 12,184 (12%) underwent sMVr. Majority of patients in all four groups had a high Elixhauser comorbidity score of &gt;6. In-hospital mortality rate was 31% in the medical therapy group, 14% and 17% in the sMVR and sMVr groups subsequently, and 26% in the MitraClip group (p&lt;0.001). The median cost of hospitalization was significantly higher in the MitraClip group ($400,087) compared to the other groups (medical=$140,282, sMVR =$290,456, and sMVr =$353,688, p&lt;0.001). Readmission rates were significantly lower in the sMVR (0.7%) and sMVr (1%) groups compared to the medical therapy (4%) and MitraClip (6%) groups (p&lt;0.001). MitraClip was associated with a higher use of Impella (Odds Ratio (OR) 2.6; 95% Confidence Interval (CI) 1.8–3.8, p&lt;0.001), intra-aortic balloon pump (IABP) (OR 3.8; 95% CI 2.9–5.1, p&lt;0.001), and vasopressors (OR 1.6; 95% CI 1.1–1.7, p&lt;0.001) than sMVR or sMVr. Extracorporeal membrane oxygenation (ECMO) use was more common in sMVR (OR 2.9, 95% CI 2.5–3.4, p&lt;0.001) and sMVr (OR 2.0,95% CI 1.8–2.2, p&lt;0.001) than in MitraClip. In terms of complications, MitraClip was associated with a higher rate of vascular complications (OR 4.2; 95% CI 1.4–12.8, p&lt;0.001); while both sMVR and sMVr had higher association with significant post-operative bleeding (OR 2.3; 95% CI 1.9–2.8, p&lt;0.001) and (OR 2.1; 95% CI 1.9–2.4, p&lt;0.001) respectively.

Conclusion
Majority of patients in this cohort with severe MR and CS were treated either medically or underwent surgical MV replacement. Although MitraClip improved hospital mortality over medical therapy, it was associated with a higher mortality risk, readmission rate, and cost of hospitalization when compared to sMVR and sMVr.

Funding Acknowledgement
Type of funding sources: None.