bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic value of the ESC quality indicators in patients with acute myocardial infarction: a systematic review
Authors: Perello-Bordoy A , Masso-Van Roessel A , Mas-Llado C , Ramis-Barcelo M F , Vives-Borras M , Pons J , Peral V , Rossello X 
Published: October 2021

Abstract

Background
Quality indicators (QIs) provide a mechanism for measuring opportunities to improve cardiovascular care and outcomes. To help improving quality of care in patients with acute myocardial infarction (AMI), the European Society of Cardiology (ESC) set 20 QIs to evaluate several dimensions of care. These 20 QIs are organized in 3 areas and 7 domain defined in structural, performance measures including patient's feedback and outcomes. Several registries have reported their performance using real-world data, and some of them reported their prognostic value. For this purpose, we systematically reviewed the literature evaluating the 2017 ESC ACVC set of QIs in previous observational studies, with the aim to summarise their prognostic value.

Methods
A systematic review of PubMed and Web of Science was conducted including all original articles reporting the use of the ESC QIs in AMI patients. Inclusion criteria were studies providing original data, and studies evaluating the 2017 ESC ACVC set of QIs in patients with AMI (STEMI or NSTEMI). The main exclusion criterion was for non-original articles and studies evaluating a different set of QIs. Adjusted estimates (odds or hazard ratio) for the association between QIs and mortality were used to report the prognostic value of QIs.

Results
Among de 220 screened citations, 9 studies met the inclusion criteria after full-text review. Among these 9 studies, there were 11 different cohorts. Patients were recruited from 3 different continents (31 countries) between 2003 and 2018. The association between QIs and mortality have been reported in three cohorts: EPICOR, FAST-MI and MINAP. EPICOR evaluated this association for 15 QIs and 2-year mortality, whereas FAST-MI evaluated the relationship for 11 QIs and 30-day mortality, and MINAP for 9 QIs and 3-year mortality. In general, higher compliance was associated with better prognosis in most QIs (Figure 1). The association between mortality and some QIs (1.3, 3.1, 3.2, and QI 6) was not reported in any study, and their prognostic value is therefore unknown to date. Composite QIs, which combine individual indicators from domains 1–6 to summarise the multiple dimensions of quality of care, were associated with mortality in all comparisons (7.1 was tested in the 3 studies, whereas 7.2 was only tested in EPICOR).

Conclusions
Our review has shown a consistent association between higher attainment of QIs and decreased mortality in the three cohorts that evaluated this association. These data support the use of QIs as a useful tool for assessing quality of care across centres and countries. There is a need to design registries and surveys specifically assessing QIs to have a more accurate picture about the implementation of ESC QIs.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Percutaneous coronary intervention in patients with peripheral artery disease and adverse cardiovascular adverse event and bleeding
Authors: Kang M G , Kim K H , Park H W , Koh J S , Hwang S J , Hwang J Y , Park J R 
Published: October 2021

Abstract

Background
Peripheral artery disease (PAD) increase the risk of comorbidity and mortality in coronary artery disease (CAD).

Objectives
We evaluate influence of PAD on prognosis in patients undergoing percutaneous coronary intervention (PCI).

Methods
We analyzed all consecutive patients included in our dedicated local registry for PCI between January 2011 and December 2016. Presence of PAD was defined by decreased ankle-brachial index (&lt;0.9). Major adverse cardiovascular event (MACE) was defined as a composite of cardiovascular death, non-fatal myocardial infarct, revascularization, and ischemic stroke. Major bleeding was defined as Bleeding Academic Research Consortium 3 or 5.

Results
Among the 4,747 patients who underwent the PCI, 12.9% (n=610) of PAD were identified. Old age (&gt;60 years), renal dysfunction, reduced ejection fraction, and presence of PAD were predictors with both MACE and major bleeding event. Among them, presence of PAD was an independent risk factor of MACE and major bleeding (MACE, HR 8.26, 95% CI 2.33- 29.41, p=0.036; major bleeding, HR 3.11, 95% CI 1.10–10.63, p=0.040, respectively). The MACE and major bleeding rate at 5-year was significantly increased in patients with PAD (MACE, 30.0% vs. 15.8%, log rank test p&lt;0.001; major bleeding, 6.7 vs. 3.6%, log rank test p=0.003, respectively) (Figure).

Conclusion
Presence of PAD was strongly associated with higher rate of long-term MACE and major bleeding. These findings could have a clinical relevance in requiring individualized pharmacologic strategies to reduce the burden of cardiovascular disease.

Funding Acknowledgement
Type of funding sources: None.
Predictive value of the left ventricular function in coronary artery disease: should we tailor risk-stratification for men and women?
Authors: Molenaar M , Bouma B J , Isgum I , Verouden N J , Selder J L , Chamuleau S A J , Schuuring M J 
Published: October 2021

Abstract

Introduction
Left ventricular function (LVF) is a well-known recognized predictor of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and is recommended in all CAD patients by the guidelines of the European Society of Cardiology. As non-obstructive CAD is more common among women, the predictive value of LVF might differ between men and women.

Purpose
The aim of this study is to evaluate sex-related differences in the predictive value of LVF in patients with suspected or documented CAD.

Methods
Patients with suspected or documented CAD who underwent transthoracic echocardiography (TTE) with LVF assessment in a tertiary center between 2014 and 2021 were included. LVF was classified with left ventricular ejection fraction (LVEF) as normal (≥52%) or impaired (LVEF &lt;52%). MACE were defined as death, heart failure (HF), acute coronary syndrome (ACS) and stroke. Time-to-first-event analysis was performed with Kaplan-Meier survival analysis and multivariate Cox proportional hazard analysis adjusting for age as covariate.

Results
In total, 1763 patients were included of which 59% were men (age 65±12 years) and 41% were women (age 65±13 years). 225 (22%) men and 100 (14%) women had impaired LVF (p&lt;0.001). Median follow-up time was 1.9 years (1.2–3.8); median event-free survival for men and women was 1.6 years (1.0–3.3) and 1.6 years (1.0–3.0), respectively (p=0.8). MACE and deaths were reported in 422 patients (23% of men, 25% of women) and 15 patients (12% of men, 10% of women), respectively. Impaired LVF was associated with a significantly higher risk of MACE in both men (HR 1.3, 95% CI: 1.2–1.4, p&lt;0.005) and women (HR 1.2, 95% CI: 1.0–1.3, p=0.02).

Conclusions
Impaired LVF was more common in men with suspected or documented CAD. In patients with impaired LVF, the predictive value of LVF is similar for both men and women.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Amsterdam UMC, Amsterdam MACE_men_women
High plasma levels of soluble LOX-1 portends poor survival in acute coronary syndromes beyond GRACE 2.0: a multicentre prospective cohort study
Authors: Kraler S , Obeid S , Liberale L , Von Eckardstein A , Wenzl F A , Paneni F , Matter C , Muller O , Raeber L , Mach F , Akhmedov A , Luescher T F 
Published: October 2021

Abstract

Background
While inflammatory states and dyslipidemias confer a dismal prognosis following myocardial ischaemia, the role of the lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) which sits at the confluence of these conditions remains elusive. Given soluble LOX-1' (sLOX-1) pivotal role in inflammatory processes underlying atherosclerotic plaque progression, we sought to study its prognostic utility on the risk of adverse events in acute coronary syndromes (ACS).

Purpose
Hence, we aimed to investigate whether sLOX-1 is an independent predictor of all-cause death at one year beyond traditional and emerging risk factors for poor survival following ACS.

Methods
2678 ACS patients were recruited in the prospective, multicentre SPUM-ACS trial, of which 2525 completed follow-up at one year. Major adverse cardiovascular events, including death from any cause, were adjudicated by an independent clinical endpoint committee. By employing high-sensitive enzyme-linked immunosorbent assay, sLOX-1 was assessed in the plasma at the time of presentation in ACS and age-matched chronic coronary syndrome (CCS) patients. Kaplan-Meier survival analysis and Cox proportional hazard regression models, adjusted for baseline variables and the GRACE 2.0 score, were used to study the predictive utility of sLOX-1.

Results
At the time of presentation, ACS patients, specifically those with ST-segment elevation ACS, had significantly elevated sLOX-1 levels as compared to patients with CCS (median, 35.40 vs. 2.00 pg/ml, P&lt;0.0001). Patients in the upper sLOX-1 tertile were at heightened risk for both death from any cause (crude HR 1.785, 95% CI 1.083–2.941, P&lt;0.05; adjusted HR 2.035, 95% CI 1.176–3.519, P&lt;0.05) and CV death (crude HR 2.447, 95% CI 1.285–4.663, P&lt;0.01; adjusted HR 2.383, 95% CI 1.206–4.710, P&lt;0.05) compared to those in the first tertile. Importantly, sLOX-1 remained an independent predictor of all-cause death after adjustment for known risk factors of adverse outcome and the GRACE 2.0 score (adjusted + GRACE 2.0 HR 1.896, 95% CI 1.034–3.476, P&lt;0.05).

Conclusions
Plasma sLOX-1 is elevated in ACS patients and predicts poor survival independent of both traditional and emerging risk factors and provides prognostic information beyond GRACE 2.0.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationFoundation for Cardiovascular Research - Zurich Heart House
Relationship of the degree of coronary lesion and serum adipokine levels in patients with myocardial infarction
Authors: Belik E , Gruzdeva O V , Dyleva Y U A , Naumov D Y U , Barbarash O L 
Published: October 2021

Abstract

The role of adipokines in the development of myocardial infarction (MI) is being actively discussed. It is of interest to determine the association between the degree of coronary lesion and serum levels of the studied parameters, as well as the prognostic role of these factors in relation to the risk of developing an unfavorable outcome of MI, which is important for choosing the tactics of a therapeutic strategy.

Aims
Identification of the presence and characteristics of the relationship of the degree of coronary lesions with the levels of adiponectin and leptin in the blood serum of patients with MI.

Materials and methods
The study included 119 patients with ST-segment elevation MI who signed voluntary informed consent. Depending on the degree of coronary lesion, patients were divided into 3 groups by the SYNTAX Score: 47 moderate (≤22, Group 1), 42 severe (23–31, Group 2) and 30 extremely severe (≥32, Group 3). The concentrations of adiponectin and leptin was determined in blood serum by ELISA on the 1st and 12th days of hospitalization (BioVendor, USA). Statistical analysis was performed using Statistica 9.0.

Results
The concentrations of the studied parameters in the blood serum of patients on the 1st day of hospitalization were: adiponectin 7.72 (6.5; 13.0) μg/ml, leptin 7.48 (5.98; 12.5) ng/ml. On the 12th day, there was an increase in the level of adiponectin by 1.5 times and a decrease in leptin by 1.6 times. Correlation analysis revealed significant dependences of the degree of coronary lesion according to the SYNTAX Score with the serum adiponectin level both on the 1st (r=−0.48; p=0.01) and on the 12th day (r=−0.44; p=0.02), and leptin level on the 1st (r=0.35; p=0.01) and 12th days (r=0.37; p=0.01).

Conclusions
The results of this study indicate a relationship between the degree of coronary lesion, assessed by the SYNTAX Score, and the serum adipokine profile in patients with MI. Based on the data obtained, it can be concluded that the studied markers are capable of reflecting the degree of coronary artery disease already on the 1st day of myocardial infarction and the possibility of using the risk of developing myocardial infarction as biomarkers.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic performance of fractional flow reserve derived from computed tomography in the stented coronary arteries
Authors: Toba T , Otake H , Roy A , Choi G , Gobi N , Schaap M , Takahashi Y , Fukuyama Y , Nakano S , Tanimura K , Matsuoka Y , Kawamori H , Taylor C , Ken-Ichi K 
Published: October 2021

Abstract

Background
The current system of HeartFlow fractional flow reserve derived from computed tomography (FFRCT) is not available for stented coronary arteries. However, the latest version of HeartFlow FFRCT has the potential of rendering an accurate assessment for stented coronary arteries.

Objectives
To evaluate the feasibility of FFRCT for the stented coronary arteries.

Methods
We retrospectively enrolled patients with a history of coronary stent implantation who underwent invasive fractional flow reserve (FFR) for the stented coronary arteries within 3 months after coronary computed tomographic angiography (cCTA). As a subgroup analysis, we analyzed optical coherence tomography (OCT) images in patients who underwent OCT for stented vessels. OCT was performed as a part of the Kobe University Hospital OCT registry, which is a single-centre registry of consecutive patients who underwent OCT for the coronary arteries. The diagnostic performance of HeartFlow FFRCT for stented vessels was evaluated by comparing with that of cCTA alone. Minimum lumen area (MLA) within stent segments derived from cCTA was also compared with MLA derived from optical coherence tomography (OCT).

Results
A total of 30 vessels in 23 patients were studied. The diagnostic accuracy, sensitivity, specificity, positive and negative predictive value of FFRCT for myocardial ischemia using invasive FFR as a reference standard was 73.3%, 88.9%, 67.7%, 53.3% and 93.3%, respectively. FFRCT provided superior diagnostic performance than cCTA alone (p=0.016). FFRCT was significantly correlated with the invasive FFR (r=0.620, p&lt;0.001), and Bland-Altman plot showed a mean bias of −0.041 with 95% limit of agreement of −0.173 to 0.092 (Figure 1). Among a total of 30 studied vessels, OCT was available for 25 vessels. MLA derived from cCTA correlated significantly with that derived from OCT (r=0.695, p&lt;0.001), and Bland-Altman plot showed a mean bias of −0.32 mm2 with 95% limit of agreement of −2.89 to 2.25 mm2 (Figure 2).

Conclusions
The latest version of the HeartFlow FFRCT has the potential to be available for stented coronary arteries. Further investigation is required to elaborate our results.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Is there a real difference in approach between women and men with non-ST-segment elevation myocardial infarction? Insights from a multicentre national registry
Authors: Cabral M , Fernandes S , Santos L G , Carvalho M , Carvalho R , Santos B , Loureiro M F , Morais J 
Published: October 2021

Abstract

In patients with non-ST-elevation myocardial infarction (NSTEMI), the early invasive strategy has shown benefit in morbidity and mortality, especially in intermediate-to-high risk patients. However, women still seem to have a lower revascularization rate, regardless of the risk.
The aim of this study is to describe our clinical practice reality about the performance of the invasive strategy between genders among NSTEMI patients, in Portugal.
The authors performed a retrospective analysis of patients admitted with NSTEMI included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and February 2021. A propensity score matching included baseline characteristics and previous history was applied. Comparison tests and log-rank test were performed. A p-value less than 0.05 was considered statistically significant.
A total of 11858 patients with NSTEMI were included, of which 71.3% (n=8450) were men. After the propensity score performing, 4458 patients were analysed, 50.0% (n=2229) men. Table 1 shows the most important baseline characteristics.
The authors found a significant delay in hospital admission after the onset of symptoms in women (median of 6 hours and 48 minutes) compared to men (median of 5 hours) (p&lt;0.01). Grace score was higher in males (mean 153 points) than in females (mean 145 points) (p&lt;0.01).
The cardiac catheterization was performed in 82.9% (n=3695) of the patients, with no difference between genders (p-value=0.19), as shown in table 2. Among those who underwent cardiac catheterisation, the presence of significant stenosis and coronary occlusion was greater in males, for almost all localizations. The absence of obstructive coronary lesions was more common in females (p-value&lt;0.01).
During hospitalization, sustained ventricular tachycardia was more prevalent in males (p-value =0.01), with no significant difference for other complications or in-hospital mortality.
A 1-year follow-up of 2351 patients (1184 men and 1163 women) was analysed, with survival of 91.2% (n=1080) in men and 91.0% (n=1056) in women, with no significant difference (p-value=0.80).
In conclusion, we observed that women are admitted to the hospital later than men and have a lower Grace score at admission. However, the standardized analysis of the groups allows us to infer that the invasive strategy does not seem to be less frequent or late in women, as observed in other populations. A more recent analysis, including risk groups, would be interesting to clarify the results.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular thrombus and anticoagulation: how long should we treat?
Authors: Lorente Ros A , Alonso Salinas G L , Monteagudo J M , Rajjoub Al-Mahdi E , Vieitez Florez J M , Abellas Sequeiros M , Sanmartin M , Fernandez Golfin C , Zamorano J L 
Published: October 2021

Abstract

Background
Left ventricular thrombus (LVT) is a potential complication of acute myocardial infarction and is associated with a high rate of thromboembolic events. With the advent of more potent antithrombotic medications and quicker reperfusion strategies, the incidence of LVT has been reduced. However, current guidelines recommendations are based on older evidence and some aspects of the treatment are being questioned, such as the optimal duration of anticoagulation.

Purpose
To determine how length of anticoagulation influences the risk of thromboembolic events and mortality in a tertiary-care cardiac center with primary percutaneous coronary intervention (PCI) capability.

Methods
A cohort of consecutive cases of patients with IVT diagnosed by transthoracic echocardiography between 2014 and 2020 was retrospectively analyzed.

Results
A total of 72 cases of LVT were identified. Etiology was ischemic cardiomyopathy in 60 (82.0%) patients and 13 (20.0%) were female. LVT was diagnosed in the setting of acute myocardial infarction in 23 (32.0%) of cases. Prolonged anticoagulation regimes were significantly associated with fewer systemic thromboembolic events (21.4% vs 6.1%; p=0.04), without a significant effect on mortality (Figure 1).

Conclusion
Clinical manifestations and epidemiology of LVT has recently changed after the advent of improved treatments. In our cohort, an indefinite anticoagulation strategy was significantly associated with fewer thromboembolic events, suggesting that future investigations should clarify these issues.

Funding Acknowledgement
Type of funding sources: None.
Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy
Authors: Gallinoro E , Monizzi G , Candreva A , Sonck J , Mileva N , Mastrangelo A , Andreini D , Bartorelli A L , Galli S , Nagumo S , Munhoz D , Barbato E , De Bruyne B , Collet C 
Published: October 2021

Abstract

Background
Percutaneous coronary interventions (PCI) in calcified coronary artery lesions is associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using dedicated calcium modifying techniques such as RA or IVL has been advocated. Studies comparing these technologies are lacking.

Objectives
To compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either rotational atherectomy (RA) or intravascular lithotripsy (IVL).

Methods
Patients undergoing either RA- or IVL-assisted PCI from two European centers were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post- PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad, calculated as the difference between the vFFR at the proximal minus distal edge of the stent). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥0.90.

Results
From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0,65±0,13 RA and 0,67±0,11 IVL). After PCI, in-stent pressure gradient was significantly lower in the IVL group (0.032±0.026 vs 0.043±0.026 in the RA group, p=0.024). The proportion of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; p=0.669)

Conclusions
Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL.

Funding Acknowledgement
Type of funding sources: None. In stent gradients after RA and IVL