bluuebunny/crossref_metadata_2025_split huggingface dataset:
Residual quantitative flow ratio to estimate post-intervention fractional flow reserve
Authors: Van Diemen P A , De Winter R W , Schumacher S P , Bom M J , Driessen R S , Everaars H , Jukema R , Van Rossum A C , Nap A , Verouden N J , Opolski M , Danad I , Knaapen P 
Published: October 2021

Abstract

Objective
To assess the performance of residual quantitative flow ratio (QFR) to estimate post percutaneous coronary intervention (PCI) fractional flow reserve (FFR).

Background
QFR computes FFR based on invasive coronary angiography (ICA) images. Residual QFR is a novel tool that assesses the functional outcome of an intervention by estimating post-PCI FFR.

Methods
Residual QFR analyses, using pre-PCI ICA images, were attempted in 159 vessels with post-PCI FFR measurements. QFR lesion location was matched with the treated segment to allow virtual removal of the lesion similar to the performed PCI and computation of residual QFR (Picture 1: case example of residual QFR analysis). A post-PCI FFR &lt;0.90 was used to define a suboptimal PCI result.

Results
Residual QFR computation was successful in 128 (81%) vessels. Median residual QFR was higher than post-PCI FFR (0.96 interquartile range (IQR): 0.91–0.99 vs. 0.91 IQR: 0.86–0.96, p&lt;0.001). A moderate correlation and agreement was observed between residual QFR and post-PCI FFR (Spearman correlation coefficient=0.56 and Intraclass correlation coefficient=0.47, p&lt;0.001 for both). Following PCI, an FFR &lt;0.90 was observed in 54 (42%) vessels. Specificity, positive predictive value, sensitivity, and negative predictive value of residual QFR for determining a suboptimal PCI result were 96% (95% confidence interval (CI): 87–99%), 89% (95% CI: 72–96%), 44% (95% CI: 31–59%), and 70% (95% CI: 65–75%), respectively. Overall, residual QFR had an accuracy of 74% (95% CI: 66–82%) and an area under the receiver operating characteristic curve of 0.79 for assessing a post PCI FFR &lt;0.90.

Conclusion
A moderate correlation and agreement between residual QFR and post-PCI FFR was observed. Residual QFR ≥0.90 does not necessarily commensurate with an optimal PCI result. However, residual QFR &lt;0.90 is a good indicator of a post-PCI FFR &lt;0.90 and might therefore be utilized to determine PCI location in order to obtain a satisfactory PCI result (Picture 2: central illustration).

Funding Acknowledgement
Type of funding sources: None. Case example of residual QFR analysisCentral illustration
Clinical profile and in hospital mortality of invasively managed patients with suspicion of acute coronary syndrome during the COVID-19 pandemic
Authors: Michalski B , Peruga J Z , Plewka M , Kupczynska K , Szymczyk E , Kasprzak J D 
Published: October 2021

Abstract

Background
The pandemic of COVID-19 significantly changed the treatment of patients with suspicion of ACS and COVID-19 infection. Access to cardiology department and possibility of invasive diagnosis and treatment of ACS are still significantly impaired.

Aim
Our aim was to evaluate the characteristic and prognosis of patients with suspicion of ACS and COVID-19 infection.

Materials and methods
Our department of cardiology was transformed for Covid unit and was dedicated for diagnosis and treatment of patients with suspicion of ACS. COVID-19 confirmed cases were defined by a positive SARS-CoV-2 polymerase chain reaction (PCR) test. From 14th of October 2020 to 14th of March we performed 39 coronary angiographies. We included 39 patients (27 men) with mean age 69±8.5. In that group 11 patients had NSTEMI, 10 patients had STEMI, 2 patients Tako-Tsubo and 16 unstable angina. All patients underwent coronary angiography, and in 27 patients we performed PCI.

Results
In hospital mortality rate was 35% (14 patients). Cardiac arrest was present in 3 (8%) patients and cardiogenic shock in 4 (10%) patients. The rate of NSTEMI was higher in patients who died 7 vs 4 (p=NS) and STEMI were comparable in both groups 4 vs 6, (p=ns). The IL 6 levels in patients who died were 389±278pg/mL, in compare to 101±93pg/mL (p=0.3) who survived. Independent predictors of death were: sex with the OR=1,1 (95% CI: 0.6–2.4), p=0,03 and IL-6 level on admission OR=1,4 (95% CI: 0.6–2.4), p=0,04. There were no statistically significant differences regarding age, left ventricle ejection fraction, CRP levels and oxygen saturation od admission.

Conclusion
This study confirms the higher risk of death in patients with ACS and SARS-CoV-2. In the multivariable analysis only sex and Il-6 level on admission were the independent risk factors of the in hospital death. Further investigations of the underlying physiopathological relations between COVID-19 and ACS are needed.

Funding Acknowledgement
Type of funding sources: None.
Reference values for intracoronary doppler flow velocity-derived hyperaemic microvascular resistance index
Authors: Feenstra R G T , Seitz A , Boerhout C K M , De Winter R J , Ong P , Beijk M A M , Piek J J , Sechtem U , Van De Hoef T P 
Published: October 2021

Abstract

Background
Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.

Objective
We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index in a cohort of ANOCA patients with no structural pathophysiological alterations in the coronary circulation.

Methods
The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) &gt;2.5, and had either (1) tested negatively for spasm provocation (n=12) or (2) tested positively with only angina at rest (n=29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.

Results
In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8–1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6–2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.

Conclusion
In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A &gt;2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.

Funding Acknowledgement
Type of funding sources: None. Example of HMR measurement
The relationship between adverse outcomes and a full spectrum of ejection fraction in patients without acute myocardial infarction undergoing percutaneous coronary intervention
Authors: Liu Y L , Song J S , Wang W W , Tang Y T 
Published: October 2021

Abstract

Background
There is insufficient study evaluating how the risk of adverse cardiovascular outcomes varies across the full range of LVEF in patients undergoing percutaneous coronary intervention (PCI). A more comprehensive evaluation could provide further understanding of prognosis and support the management of these patients.

Purpose
The present study aimed to assess the association between left ventricular ejection fraction (LVEF) and major adverse cardiovascular events (MACE) in patients with coronary artery diseases undergoing PCI.

Methods
A consecutive series of 9475 patients without acute myocardial infarction (AMI) undergoing PCI were enrolled into the study and followed up for a median 2.4 years. Patients were stratified into 8 groups by 5% intervals: under 40%, 40–45%, 45–50%, 50–55%, 55–60%, 60–65%, 65–70%, and over 70%. MACE, consisting of cardiac death, myocardial infarction, stent thrombosis, and revascularization, was evaluated as the outcome.

Results
MACE occurred in 594 (6.3%) patients. The MACE rates decreased before LVEF under 65% while increased after LVEF over 70%, showing a U-shaped pattern. The 65–70% group showed the lowest rate of MACE (4.5%). Consistently, in the Cox regression, the association between LVEF and MACE presented as a U-shaped pattern regardless of different age and sex groups, and after adjusted for clinical and procedural covariables. The LVEF categories lower than 65% or higher than 70% were independent predictors of MACE, compared with 65–70% group (Hazard ratios 1.311 to 2.657, all P value &gt;0.05). Similar trend was also observed in restricted mean survival time analysis.

Conclusions
LVEF and MACE displayed a U-shaped association and patients with LVEF of 65–70% showed the lowest risk of MACE. The present study provided an insight into how the MACE risk changed in a wide spectrum of LVEF in patients without AMI undergoing PCI, which might improve preprocedural evaluation.

Funding Acknowledgement
Type of funding sources: None.
In-hospital clinical outcomes of percutaneous coronary intervention for patients deemed ineligible for surgical revascularization
Authors: Farag M , Ibrahem A , Al-Atta A , Abdalwahab A , Egred M 
Published: October 2021

Abstract

Background
Ineligibility for surgical revascularization remains subjective with limited data. Coronary artery bypass graft surgery (CABG)-ineligible patients usually have a high prevalence of risk factors and complex coronary disease, which lead to worse clinical outcomes.

Aim
We aimed to evaluate CABG surgical ineligibility reasons and in-hospital percutaneous coronary intervention (PCI) outcomes at a large tertiary centre.

Methods
Anonymized, prospectively collected data from the institutional electronic records between April 2013 and November 2020 were analysed retrospectively. All patients who were formally turned down for CABG and had PCI were included.

Results
There were 473 patients in total. Perceived frailty of the patient with associated comorbidities and/or the quality of distal coronary arteries were the main documented reasons for surgical ineligibility in 52.4% of patients. Mean age was 72±11 years, mean body mass index was 29±6 kg/m2 and 69.8% were male. Stable angina constituted 216 patients (45.7%) and 257 patients (54.3%) had acute coronary syndromes. Mean hospital stay was 4±5 days. Procedural success was documented in 457 out of 473 patients (96.6%). PCI adjunctive tools included coronary imaging in 97 patients (20.5%), rotational atherectomy in 96 patients (20.3%), laser atherectomy in 12 patients (2.5%), lithotripsy in 3 patients (0.6%) and physiological assessments in 34 patients (7.2%). In-hospital major adverse cardiac events were experienced in 32 patients (6.8%), death in 12 patients (2.5%), myocardial infarction in 21 patients (4.4%), ischaemic stroke in 1 patient (0.2%), coronary perforation in 7 patients (1.5%), repeat target vessel revascularization in 6 patients (1.3%), major access-site bleeding in 2 patients (0.4%), aortic dissection in 1 patient (0.2%) and new acute kidney injury requiring dialysis in 1 patient (0.2%).

Conclusions
PCI in surgically ineligible patients is generally safe and effective. The process of determining suitability for surgical revascularization remains complex in the real-world.

Funding Acknowledgement
Type of funding sources: None.
Unprotected left main coronary artery stenting: true vs. non true bifurcation lesions; a single-centre experience
Authors: Santucci A , Scavelli F , Jacoangeli F , Mattei C , Sclafani R , Notaristefano S , Bordoni E , Aimi A , Cavallini C 
Published: October 2021

Abstract

Aims
We investigated the impact of bifurcation lesions involving a side branch lesion combined with a main branch stenosis on clinical outcomes after percutaneous coronary intervention (PCI) on unprotected left main coronary artery (ULM).

Methods and results
We defined “true” bifurcation lesions as significant (&gt;50%) side branch stenosis associated with a significant main branch lesion, either proximal or distal, according to the Medina classification (1.1.1, 1.0.1 or 0.1.1 lesions). “Non true” lesions were defined by absence of significant side lesions, or significant side lesions without concomitant main branch stenosis. We compared patients with “non-true” bifurcation lesions (N=132; 56%) with those with “true” bifurcation lesions (N=105; 44%) in their 12-month incidence of target vessel failure (TVF) (composite of (i) cardiac death related to target vessel; (ii) myocardial infarction related to target vessel, or (iii) ischemia-driven target vessel revascularization), death from any cause, target lesion revascularization (TLR) and stent thrombosis (ST). TVF occurred in 56 patients (24%) (figure 1). Patients with “true” bifurcation lesions had a significantly higher risk of TVF than those with “non-true” bifurcation lesions (HR 2.39; 95% CI 1.39–4.11, P=0.002). “True” bifurcation lesions were also associated with a higher risk of all cause of death (HR, 2.54; 95% CI, 1.09–5.94; P=0.031) and TLR (HR, 2.33; 95% CI, 1.1–4.94, P=0.027). 'True' bifurcation lesions, diabetes mellitus, as well as cardiogenic shock, were independently associated with an increased risk of TVF (figure 2). Of note, the SYNTAX score I was not identified as an independent predictor of TVF. The stenting strategy (1 vs 2 stents) did not show any significant association with the outcome.

Conclusions
Patients with ULM and “true” bifurcation lesions who undergo PCI have a worse clinical outcome than those with “non-true” bifurcation lesions.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Kaplan-Meier curves for TVFFigure 2. Independent predictors of TVF
Prognostic impact of coronary artery disease severity and revascularization in TAVI patients
Authors: Silva G , Espada Guerreiro C , Goncalves Teixeira P , Queiros P , Ribeiro Da Silva M , Ferreira D , Brandao M , Sampaio F , Rodrigues A , Braga P , Fontes-Carvalho R 
Published: October 2021

Abstract

Background
Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis. In patients who undergo surgical aortic valve replacement, the presence of CAD and the need for CABG adversely influences short- and long-term outcomes. However, the impact of concomitant CAD and its revascularization in patients undergoing transcatheter aortic valve implantation (TAVI) is still a matter of debate.

Purpose
The aim of this study was to evaluate the prognostic impact of CAD severity in 1-year all-cause mortality of patients undergoing TAVI and whether prior complete or incomplete reasonable revascularization can improve prognosis after TAVI.

Methods and results
Retrospective analysis of a total of 575 patients (51,3% female, mean age 79,7±7,7 years) who underwent TAVI from August 2007 to November 2018. 50,3% of patients had significant CAD (at least one stenosis &gt;50%) which 54,2% of these had history of prior revascularization (64,8% complete or incomplete reasonable revascularization and 35,2% incomplete revascularization).
Pre-TAVI CAD severity was defined by the SYNTAX Score (SS) and reasonable revascularization by the residual SYNTAX Score (rSS). Patients without history of revascularization were stratified into 3 groups: no CAD (SS=0); nonsevere CAD (SS between 1 and 22); and severe CAD (SS ≥23); Patients who had undergone revascularization prior to TAVI were separated into 2 categories based on their residual SS: complete or incomplete reasonable revascularization (rSS&lt;8) and incomplete revascularization (rSS≥8). The primary end point was an all-cause mortality. 1 year, patients with severe CAD had significantly higher rates of mortality (no CAD: 9,8%, nonsevere CAD: 12,6%, severe CAD: 38,9%; P=0.001) without significant differences between patients with no CAD and nonsevere CAD (p=1,00). Patients with high rSS had significantly higher rates of mortality comparing to no CAD or rSS&lt;8 (no CAD: 9,8%, rSS&lt;8: 8,6%; rSS≥8: 28,0%, p=0.001).

Conclusions
In our study, only the presence of severe CAD (SS≥23) prior to TAVI was associated with increased 1-year all-cause mortality. In patients with previous history of revascularization, a complete/reasonable revascularization (lower rSS) was associated with lower long-term mortality, which may attenuate the association of severe CAD and mortality and therefore improve the prognosis of these patients.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho Figure 1. Prognostic Impact of CAD severityFigure 2. Prognostic Impact of Revascularization
Anticoagulant profile of supplementary-dose enoxaparin in patients undergoing prolonged percutaneous coronary intervention
Authors: Liu Z , Chen Q , Li J , Zhu X , Xu L , Wu W 
Published: October 2021

Abstract

Background
Enoxaparin 0.75 mg/kg, with either a staged-dose regimen (0.5+0.25 mg/dl) or a single-dose regimen (0.75 mg/dl) achieves target anticoagulation for 90 min in patients undergoing percutaneous coronary intervention (PCI). In patients with prolonged procedures (&gt;90 min), a supplementary-dose enoxaparin (0.375 mg/kg) needs to be given at 90 min to maintain target anticoagulation for additional 90 min. However, the actual anticoagulant profile of this supplementary-dose regimen remains unknown because it is recommended only based on pharmacokinetic simulations.

Purpose
This study directly assessed the anticoagulant profile of supplementary-dose enoxaparin (0.375 mg/kg) in troponin-negative patients undergoing prolonged elective trans-radial PCI who received a total dose of enoxaparin 0.75 mg/kg during the first 90 min of their procedures.

Methods
In 33 patients with prolonged procedures, 15 patients received enoxaparin 0.5 mg/kg at the beginning of coronary angiography and additional enoxaparin 0.25 mg/kg before PCI (Staged-dose regimen); while, 18 patients received enoxaparin 0.75 mg/kg at the beginning of coronary angiography without additional dose before PCI (Single-dose regimen). A supplementary-dose enoxaparin (0.375 mg/kg) was administered at 90 min after the first dose was given, and every 90 min thereafter until the end of PCI. Anti-Xa levels were assessed at 0 min (immediately before), 10 min and 90 min after each supplementary dose was given (S_0min, S_10min, and S_90min, respectively). Target anticoagulation was defined as anti-Xa level of 0.5–1.8 IU/ml.

Results
In patients who received only one supplementary dose (n=28), the anti-Xa levels were S1_0min: 0.87±0.19 IU/ml, S1_10min: 1.44±0.21 IU/ml, and S1_90min: 1.10±0.21 IU/ml. In patients who received two supplementary doses (n=5), the anti-Xa levels were S1_0min: 0.86±0.07 IU/ml, S1_10min: 1.27±0.27 IU/ml, and S1_90min: 1.03±0.23 IU/ml, as well as S2_0min: 1.03±0.23 IU/ml, S2_10min: 1.56±0.28 IU/ml, and S2_90min: 1.28±0.18 IU/ml, respectively. No patient received more than two doses of supplementary enoxaparin. All anti-Xa levels were within the range of target anticoagulation except for two patients receiving one supplementary dose (S1_10min: 1.96 IU/ml and 1.81 IU/ml, respectively) and another one receiving two supplementary doses (S2_10min: 1.87 IU/ml).

Conclusions
In patients undergoing prolonged PCI who received a total dose of enoxaparin 0.75 mg/kg during the first 90 min of their procedures, a supplementary-dose enoxaparin (0.375 mg/kg), which was administered at 90 min and every 90 min thereafter, maintained target anticoagulation for additional 90 min each time it was given.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Peking Union Medical College Hospital (PUMCH) Science Fund for Junior Faculty
Correlation of Seattle Angina Questionnaire score and post-procedural outcomes in patients undergoing multi-vessel coronary intervention
Authors: Johal G , Kyaw H , Farhan S , Gedela M , Hooda A , Goel S , Iruvanti S , Sartori S , Mehran R , Kini A , Sharma S 
Published: October 2021

Abstract

Introduction
The Seattle Angina Questionnaire (SAQ) score has been used to assess angina severity in patients undergoing coronary intervention. However, assessment of clinical outcomes using the SAQ score in those with multi-vessel disease (MVD) requiring multiple interventions has not been determined.

Purpose
To analyse patient-reported outcomes over time among individuals undergoing multiple staged interventions using serial SAQ scores.

Methods
We performed a retrospective analysis of 531 consecutive elective patients who underwent multi-vessel coronary intervention from January 1, 2015, to December 31, 2018, at a single academic centre. We used a short-form version of the SAQ score calculator that is built into our hospital electronic medical record. Trained clinical staff administered the SAQ at the point of care before each procedure. We divided the baseline SAQ scores into three groups [Group 1: &lt;50, Group 2: 50–66, Group 3: ≥67] and analysed the correlation between the scores and patient-reported angina symptoms before the final staged intervention. Post index procedural outcomes, including myocardial infarction, congestive heart failure, post-procedural bleeding, and blood transfusion were reported.

Results
In all, 531 patients met inclusion and exclusion criteria. Patients' mean age was 65.66±10.30 years, and 78.3% of patients were males. Group 1 had an increased prevalence of diabetes (59.3% vs. 49.4% and 44%), prior coronary artery bypass surgery (CABG) (24.7% vs. 17.2% and 11.4%), a lower haemoglobin value (12.88±1.56 vs. 13.06±1.7 and 13.33±1.56) compared with group 2 and group 3. The rate of in-stent restenosis (ISR) was 18.7%, 11.5% and 8.6% in group 1, 2, and 3, respectively. Summary SAQ-7 values between interventions had improved significantly in group 1 (22.30±21.35) and group 2 (10.45±17.77), while group 3 failed to show any meaningful change (−1.09±14.79) (P&lt;0.0001). [Table 1] The post-index-procedural outcomes were not statistically different among the three groups. In group 1, women (adjusted odds ratio [aOR]: 3.96; 95% confidence interval [CI]: 2.44 to 6.45; p&lt;0.0001) and prior CABG patients (aOR: 2.03; 95% CI: 1.27 to 3.24; p=0.0031) had higher odds of SAQ-7 improvement between index and staged intervention.

Conclusion
The lowest baseline SAQ group had a significant improvement of SAQ score between the index and a staged intervention. The study demonstrated that serial SAQ scores could be used as a surrogate to measure patient-reported outcomes in those with MVD undergoing multiple interventions.

Funding Acknowledgement
Type of funding sources: None.