bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic value of coronary flow reserve assessment by dynamic 99mTc-MIBI SPECT-CZT gamma camera for the detection of coronary artery disease
Authors: Cygulska K M , Blaszczyk M , Kasprzak J D , Wejner-Mik P , Frynas-Jonczyk K , Plachcinska A , Kusmierek J , Cichocki P , Lipiec P 
Published: October 2021

Abstract

Background
Coronary flow reserve (CFR) obtained by dynamic acquisition of myocardial blood flow using 99mTc-MIBI SPECT-CZT gamma camera may be useful to diagnose myocardial perfusion defects in patients with coronary artery disease (CAD).

Purpose
To assess the feasibility and diagnostic value of SPECT-derived CFR in patients with suspected of confirmed CAD.

Methods
The study group comprised 55 patients (pts) (43.6% females, mean age 64.6±8.4 years) with suspected CAD who were referred for scheduled coronary angiography. All pts underwent myocardial perfusion study with solid-state CZT nuclear camera (dipyridamole stress protocol) to calculate myocardial blood flow reserve. We measured total CFR, as well as CFR in three coronary territories: left anterior descending artery (LAD CFR), right coronary artery (RCA CFR) and left circumflex artery (LCx CFR).

Results
On coronary angiography 27 pts were found to have significant CAD (at least one major coronary artery ≥70% narrowed). Mean total CFR in pts with CAD was lower than in pts without CAD (1.73±0.59 vs 2.09±0.56, respectively, p=0.02). Similar differences were noted in LAD territory (1.47±0.57 vs 2.00±0.57; respectively, p=0.004) and RCA territory (1.55±0.54 vs 2.01±0.62; respectively, p=0.03). However, the differences in LCx CFR between CAD and no-CAD group did not reach statistical significance. Modest, but significant correlations were detected between LAD CFR and the percentage of LAD stenosis (r=−0.3; p=0.02). Total CFR has acceptable diagnostic value for detecting significant CAD (AUC=0.672; p=0.03). The criterion with the highest diagnostic accuracy was CFR &lt;1.8 – its sensitivity was 63%, specificity 71.4%, and overall accuracy 67%. In analysis of coronary territories the highest diagnostic value was achieved for CFR LAD (AUC=0.744; p=0.007).

Conclusions
SPECT-derived CFR provides acceptable diagnostic accuracy for the detection of significant CAD.

Funding Acknowledgement
Type of funding sources: None.
Coronary angiography in patients with native or prosthetic aortic-valve endocarditis: outcomes and implications for myocardial revascularisation
Authors: Berger T , Siepe M , Dees D , Fagu A , Pingpoh C , Kondov S , Zeh W , Beyersdorf F.-J , Rylski B , Schroefel H , Czerny M , Neumann F.-J , Hochholzer W , Kreibich M 
Published: October 2021

Abstract

Background
Coronary angiography (CA) remains the cornerstone of the preoperative assessments before open-heart surgery to detect or rule out coronary artery disease (CAD). Preoperative CA is currently not recommended in patients with active infective aortic valve endocarditis, but may help to reduce the risk of perioperative myocardial infarction.

Purpose
This study aimed to evaluate the risks and benefits of preoperative CA in selected patients before aortic valve replacement to treat active infective endocarditis of the aortic valve and to assess the incidence and relevance of CAD.

Methods
Sixty-five patients with native or prosthetic aortic-valve endocarditis underwent preoperative diagnostic CA between 03/2008 and 09/2020. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the CA data. We evaluated the intraoperative data, and clinical outcomes after CA and after surgery. Patients were selected according to the site, size and mobility of vegetations of the underlying active infective process.

Results
CA revealed CAD in the majority of patients (n=34; 52%): one-vessel disease n=17 (26%), two-vessel disease n=6 (9%), and three-vessel disease n=11 (17%). Coronary sclerosis without hemodynamic significance were detected in 23 patients (35%). Sixteen patients had a previous history of CAD. We observed no adverse events following preoperative diagnostic CA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischaemia. Surgery was performed 3 [IQR 1; 5] days after CA. During surgical aortic-valve replacement, concomitant coronary artery bypass grafting was performed in 19 patients (29%). Postoperative in-hospital mortality was 12% (n=8) and the new-onset disabling-stroke incidence was 2% (n=1). Neither stroke nor visceral or lower body ischemia due to embolism were observed in any patient after surgery.

Conclusions
By weighing risks and benefits of CA together as a team, no adverse clinical outcomes but significant clinical implications could be identified in patients with active infective aortic valve endocarditis. Concomitant surgical myocardial revascularization was frequent and may well have contributed to favorable clinical outcome. Therefore, active infective endocarditis of the aortic valve per se should not be regarded as an absolute contraindication for CA.

Funding Acknowledgement
Type of funding sources: None.
Comparing loading strategies of P2Y12 inhibitors in patients undergoing elective PCI: a network meta-analysis
Authors: Gupta R , Malik A , Vadhar S , Briasoulis A , Vyas A , Patel N 
Published: October 2021

Abstract

Introduction
Effective platelet inhibition prior to elective percutaneous coronary intervention (PCI) reduces the risk of ischemic complications. Newer P2Y12 inhibitors are preferred agents over clopidogrel for patients presenting with acute coronary syndrome. However, the comparative efficacy and safety of them over clopidogrel in elective PCI is unclear. Our objective was to perform a network meta-analysis and assess that from randomized controlled trials (RCT).

Methods
We conducted a systematic review of RCTs up to and including November 2020. The endpoints of interest were overall mortality, rates of myocardial infarction (MI), stroke, revascularization and major bleeding. Random effects model using frequentist approach was used to perform a network meta-analysis using R software.

Results
5 trials with total of 5,194 patients were included in our analysis. For ischemic outcomes including MI, Stroke and revascularization, prasugrel had the most favorable trend. However, clopidogrel had the highest probability of being most effective for major bleeding and all-cause mortality. None of these trends were statistically significant due to lack of power for each individual outcome (Figure 1).

Conclusion
Prasugrel and ticagrelor seem to show better efficacy in preventing MI and stroke. However, their effects are marginal and do not translate into improved overall mortality and bleeding. Therefore, in this lower risk population presenting for elective PCI, clopidogrel remains a reasonable P2Y12 inhibitor choice in lower risk population.

Funding Acknowledgement
Type of funding sources: None. Results
A meta-analysis of randomised controlled trials investigating the impact of colchicine on major adverse cardiovascular events in acute coronary syndrome
Authors: Blake N , Alonso A , Rai H , Colleran R , Giacoppo D , Byrne R A ,   Cardiovascular Research Institute (CVRI), Dublin
Published: October 2021

Abstract

Background/Introduction
Colchicine has been shown to reduce inflammation and has a potential to stabilise atherosclerotic plaques. Prior meta-analyses on the topic suggest its role in reducing components of major adverse cardiovascular events (MACE).

Purpose
The aim of the present meta-analysis was to delineate the effect of colchicine on post-PCI (percutaneous intervention) MACE among acute coronary syndrome (ACS) patients.

Methods
We included randomised controlled trials (RCTs) comparing colchicine to placebo in ACS patients undergoing PCI. To identify potentially relevant trials a PUBMED search was undertaken using the MESH terms “colchicine” and “cardiovascular system”. Eligible RCTs published up to November 2020 were included. Our search strategy also included presentations from the proceedings of international meetings. The primary endpoint was MACE. However, definitions of MACE varied between included studies. Study level odds ratios (ORs) and 95% confidence intervals (CI) of MACE were pooled using the Mantel-Haenszel method and random effects model. Forest plots were generated using Review Manager (RevMan) 5.4 software.

Results
Our initial search identified 1,049 articles for potential inclusion. Of them, 4 RCTs were found to be eligible: COPS, COLCHICINE-PCI, COLCOT time-to-Initiation (TTI) 0–3 days and PODCAST-PCI.
A pool of 2,709 patients were randomly allocated to treatment with either colchicine (n=1,367) or placebo (n=1,342). Patients received colchicine either prior to angiography or within 3 days post-procedure. Follow up duration ranged from 30 days to 3 years during which MACE were recorded. Mean age of the whole analysed cohort was 60.3±10.5 years. 73% were male. 51% had history of hypertension, 26% had diabetes mellitus, 38% were current smokers. There were 89 events in the colchicine group as opposed to 133 events in the placebo group. The risk of post-PCI MACE was lower in patients treated with colchicine as compared with placebo (OR 0.63, 95% CI 0.48–0.84, p=0.001) (see figure 1). Heterogeneity was not detectable (I2=0).

Conclusions
Our results indicate lower risk of MACE in patients treated with colchicine. This indicates a potential use of colchicine in patients undergoing PCI in an ACS setting. Further investigations in larger cohorts are warranted to test this effect.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Platelet reactivity and bleeding outcomes in female patients presenting with ST-segment elevation myocardial infarction: a COMPARE CRUSH substudy
Authors: Vogel R F , Vlachojannis G J , Wilschut J M , Lemmert M E , Diletti R , Nuis R J , Paradies V , Alexopoulos D , Zijlstra F , Montalescot G , Angiolillo D J , Krucoff M W , Van Mieghem N M , Smits P C , Delewi R 
Published: October 2021

Abstract

Background/Introduction
Females presenting with ST-segment elevation myocardial infarction (STEMI) are characterized by an increased risk of bleeding after primary percutaneous coronary intervention (pPCI) compared with males. The reason for increased bleeding rates is multifactorial, including age, comorbidities, vessel anatomy and possible differences in platelet biology. Data about platelet reactivity levels in females versus males presenting with STEMI is scarce.

Purpose
Investigation of gender-driven variances in platelet reactivity and bleeding outcomes in STEMI patients planned to undergo pPCI.

Methods
The COMPARE CRUSH trial was a randomized multicenter ambulance trial assessing the effect of prehospital administration of P2Y12 inhibitor loading dose with crushed versus integral prasugrel tablets in STEMI patients. We assessed the occurrence of high platelet reactivity (HPR), predictors of HPR at baseline and bleeding outcomes between females and males. Blood samples were analyzed at four prespecified time points using VerifyNow.

Results
The COMPARE CRUSH trial included 633 STEMI patients in the period between November 2017 and March 2020. Females more frequently exhibited HPR at baseline than males (76% vs. 41%, odds ratio (OR), 4.58 [95% CI, 2.52 to 8.32], p&lt;0.01). Moreover, female sex was a strong, independent predictor for HPR at baseline (OR, 4.93 [95% CI, 2.30 to 10.57], p&lt;0.01). HPR rates at other time points were not significantly different between females and males. The risk of bleeding within the first 48 hours was significantly increased in females (OR, 6.02 [95% CI, 2.58 to 14.08], p&lt;0.01), but after adjustment for baseline characteristics this increased risk was no longer statistically significant (OR, 2.61 [95% CI, 0.73 to 9.32], p=0.14).

Conclusion
Female sex is an independent predictor for occurrence of HPR at baseline in STEMI patients. However, females exhibit a stronger platelet inhibition effect by oral P2Y12 inhibitors than males, which may contribute to an increased bleeding risk. A more tailored antiplatelet therapy approach should be considered for female STEMI patients to reduce bleeding risk.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Unrestricted grants from Daiichi-Sankyo and Shanghai MicroPort Medical.
The age-specific prognostic impact of the platelet-to-lymphocyte ratio on long-term outcome after acute coronary syndrome
Authors: Kazem N , Hofer F , Koller L , Hammer A , Hofbauer T , Hengstenberg C , Niessner A , Sulzgruber P 
Published: October 2021

Abstract

Background
Personalized risk stratification within the ageing society after ACS remains scarce. With increasing general life expectancy, easily applicable age-specific strategies for the prediction of fatal adverse events are in urgent need. Increased platelet activity together with inflammatory activation play a key role during ACS.

Objective
We aimed to evaluate the age-specific prognostic potential of the platelet to lymphocyte ratio (PLR) on long-term cardiovascular mortality after ACS.

Methods
Patients presenting with ACS admitted to a tertiary care centre with a high-volume cardiac catheterization unit between December 1996 and January 2010 were recruited within a clinical registry including assessment of peripheral blood samples. The impact of the PLR on survival was assessed by Cox-regression hazard analysis.

Results
We included a total of 681 patients with a median age of 64 years (IQR:45–84). 200 (29.4%) individuals died during the median follow-up time of 8.5 years. A strong and independent association of the PLR with cardiovascular mortality was found in the total study population (adjusted [adj.] hazard ratio [HR] per one standard deviation [1-SD] of 1.52 [95% CI: 1.18–1.96; p&lt;0.001). After stratification in individuals &lt;65 years (n=339) and ≥65 years (n=342), a prognostic effect of the PLR on cardiovascular mortality was solely observed in elderly patients ≥65 years (adj. HR per 1-SD of 1.32 [95% CI: 1.01–1.74]; p=0.045), but not in their younger counterparts &lt;65 years (adj. HR per 1-SD of 1.08 [95% CI: 0.60–1.93]; p=0.804).

Conclusion
The present investigation highlights a strong and independent age-specific association of the PLR with cardiovascular mortality in patients with ACS. The PLR only allows to identify patients ≥65 years at high risk for fatal events after ACS – even from a long-term perspective.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Vienna Effect of PLR stratified by age
Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction
Authors: Ocal L , Keskin M , Cersit S , Eren H , Cakmak E O , Cakir H , Dogan S , Ozturk B , Kaya A , Turkmen M M 
Published: October 2021

Abstract

Background
Inflammatory markers are significantly associated with cardiovascular disease and many markers have been used as predictor in patients with STEMI. This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI).

Method
A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention in a tertiary heart center were enrolled in the study. SII was calculated using the following formula: Platelet × Neutrophil/Lymphocyte ratio. The patients were stratified into four quartiles (Q) according to admission SII level. In-hospital and 3-year outcomes were compared between the four groups (Q1–4)

Results
In-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events, and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. ROC analysis showed that the best cut-off value of the Systemic Immune-Inflammatory Index to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity (AUC: 0.75; 95% CI: 0.69–0.81; p&lt;0.001). Kaplan Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6%, 96.9%, 91.6% and 81.0% respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had independent risk of death compared to Q1.

Conclusion
SII, a novel inflammatory index, had a better prediction of in-hospital and long-term outcomes than traditional risk factors in patients with STEMI.

Funding Acknowledgement
Type of funding sources: None.
The total amount of CRP within the first 72 h after STEMI is crucial for the outcome
Authors: Garlichs C , Ries W , Torzewski J , Pfluecke C D , Darius H , Heigl F , Ince H , Mitzner S , Nordbeck P , Butter C , Sheriff A ,   CAMI-1 Investigators
Published: October 2021

Abstract

Background
The CAMI-1 study dealt with the depletion of CRP by apheresis in patients with acute myocardial infarction (AMI). CRP, the prototype human acute phase protein, has been known as a marker of poor prognosis in AMI and independently predicts 30-day mortality.

Methods
66 STEMI patients were enrolled following complete coronary revascularization (2–12 h after AMI). 32 patients received CRP apheresis, whereas 34 patients treated by standard protocols served as controls. CRP apheresis started 24±12 h and 48±12 h after onset of symptoms. A specific CRP adsorber removed ≤79% of the original CRP. 6000 ml of plasma was treated via peripheral venous access. Primary endpoint was myocardial infarction size as determined by Cardiac Magnetic Resonance Imaging (CMR) 3–9 days after STEMI.

Results
Aphereses sessions were well tolerated with no relevant side effects. The expected peak CRP level after AMI can be calculated precisely with 2–3 CRP quantifications during the first 24h after the onset of symptoms (CRP gradient). The regression coefficient for this analysis is 0.91. This mathematical step allows for the comparison of the CRP-apheresis group and the controls on the basis of their individual CRP gradients. The mean CRP gradient does not differ between both groups, whereas the mean area under the curve (AUC) of CRP within the first 72 h after AMI does. Thus, there was no bias in CRP kinetics between the two groups. The AUC of CRP is a significant indicator for infarct size (p=0.002), LVEF (p&lt;0.001), circumferential strain (p&lt;0.001), longitudinal strain (p=0.021). Therefore, the aphereses patients performed significantly better at all endpoints than the controls. The CRP apheresis significantly reduced myocardial damage by a reduction of the AUC of CRP. To our surprise, two apheresis patients had an infarct size of 0%.

Conclusions
For the first time we find an unequivocal association between myocardial infarct size and the AUC of CRP. The results show a significant beneficial effect of CRP apheresis on myocardial infarction size and wall motion. Selective CRP apheresis is now being further evaluated as a therapeutic approach in the treatment of acute myocardial infarction in a registry (CAMI registry).

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pentracor GmbH
Iron deficiency – a factor in left ventricular ejection fraction depression post-myocardial infarction
Authors: Dias Claudio F , Carias M , Rocha R , Picarra B , Neves D , Trinca M 
Published: October 2021

Abstract

Introduction
Iron deficiency was shown to affect functional capacity and ejection fraction in patients with heart failure and reduced ejection fraction. Myocardial infarction is an important cause of reduced left ventricular ejection fraction (LVEF). Moreover, there is some evidence of the iron deficiency as a factor to predict cardiovascular and non-cardiovascular mortality.

Purpose
Evaluate the presence of iron deficiency in patients with acute coronary syndromes (ACS) admitted to the intensive cardiac care unit and its eventual association with LVEF and mortality.

Population and methods
We performed a prospective study in which ACS patients were divided into groups according to the presence or absence of iron deficiency. We collected demographic data, comorbidities, as well as determination of troponin I, haemoglobin and criteria for absolute and functional iron deficiency (ID) and other data related to the use of mechanical ventilation, need for aminergic support, LVEF and death.

Results
From 148 patients we included 78 patients who met the criteria for being analysed. 49 patients had iron deficiency (51% had absolute iron deficiency and 49% had relative iron deficiency). There were no differences between groups in terms of myocardial infarction with or without ST segment elevation (p=0.609 and p=0.329, respectively), hypertension (p=0.926), diabetes (p=0.882), obesity (p=0.343), dyslipidaemia (p=0.482), smoking (p=0.876), valvular heart disease (p=0.888), acute and chronic renal failure (p=0.800 and p=0.888, respectively) and LVEF (p=0.886). There were no differences in need for aminergic support (p=0.984), ventilation (p=0.315) and death (p=0.704).
We found that in the sub-population of patients without anaemia (Hb&gt;12g/dL), the proportion of patients with depressed LVEF (inferior to 50%) and relative iron deficiency was significantly higher than those with preserved LVEF (48.1 vs 13.8%, p=0.005). Furthermore, we also found that in this sub-population, patients with myocardial infarction without ST segment elevation had higher proportion of absolute iron deficiency (45.0 vs 19.4%, p=0.043).

Conclusion
Our study showed that the prevalence of iron deficiency in ACS patients is 62.9% (n=49). Moreover, in patients without anaemia, this results seems to point out that the presence of iron deficiency may be related with LVEF, at least during the acute event. Further studies with a higher sample size are warranted to either establish or discard this association. Furthermore, a follow-up of this patients can further enlighten us as to the role of iron deficiency in long term LVEF and mortality.

Funding Acknowledgement
Type of funding sources: None.
Impact of lipoprotein(a) as a residual risk on long-term cardiovascular outcomes in patients with acute coronary syndrome treated with statin
Authors: Takahashi D T , Wada H W , Ogita M O , Yasuda K Y , Nishio R N , Takeuchi M T , Takahashi N T , Yatsu S Y , Sonoda T S , Shitara J S , Suwa S S , Dohi T D , Miyauchi K M , Daida H D , Minamino T M 
Published: October 2021

Abstract

Background
It is still uncertain that lipoprotein(a) [Lp(a)] concentration could be a residual risk for cardiovascular events among patients with acute coronary syndrome (ACS).

Purpose
The aim of the present study is to evaluate the impact of Lp(a) on long-term cardiovascular outcomes in patients with ACS treated with statins.

Methods
We studied 1758 consecutive ACS patients who underwent emergency percutaneous coronary intervention (PCI). We finally enrolled 1131 patients who had data of Lp(a) and were treated with statin. They were divided into two groups according to Lp(a) levels (15.0mg/dL). Primary endpoint was major adverse cardiac events (MACE), composite of all-cause death and myocardial infarction.

Results
The cumulative incidence of MACE was significantly higher in the high Lp(a) group than in the low Lp(a) group. After adjustment for other risk factors, the high Lp(a) group had a significantly higher risk of MACE compared with the low Lp(a) group (HR 1.59, 95% CI 1.01–2.48, p=0.04). Multivariate Cox hazard analysis also showed that increasing Lp(a) was associated with worse clinical outcomes (HR 1.33 per log Lp(a) 1 increase, 95% CI 1.05–1.69, p=0.02).

Conclusions
Elevated levels of Lp(a) is significantly associated with long-term cardiovascular outcomes among ACS patients treated with statin.

Funding Acknowledgement
Type of funding sources: None.