bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microvascular functional assessment using microvascular resistance reserve in patients undergoing elective fractional flow reserve-guided percutaneous coronary intervention
Authors: Hada M , Usui E , Kanaji Y , Nagamine T , Ueno H , Setoguchi M , Tahara T , Mineo T , Yonetsu T , Sasano T , Kakuta T 
Published: October 2024

Abstract

Background
Microvascular resistance reserve (MRR) has been proposed as an index for coronary microvascular function. However, the determinants of MRR and the prevalence of coexistent coronary microvascular dysfunction (CMD) in patients with obstructive coronary disease remains elusive. We sought to assess the prevalence of CMD and determinants for MRR.

Methods
We retrospectively investigated 703 physiologically significant (FFR≤0.80) chronic lesions in our institutional physiological registry. All patients underwent pre-PCI physiological assessment including FFR, CFR and MRR. CMD was defined with MRR&lt;2.1. The characteristics and physiological findings were compared between CMD and non-CMD. The predicting factors for CMD were investigated.

Results
In a total cohort, FFR, CFR and MRR were 0.70(0.6-0.75), 1.82 (1.27-2.80) and 3.20 (2.22-4.30), respectively. CMD was observed in 142 (20.2%) vessels. Older age (71[65-77] vs 69[62-75], p=0.007), female patients (24.6% vs 14.4%, p=0.005) and non-LAD culprit lesions (42.3% vs 32.4%, p=0.014) were significantly more frequent in CMD. Furthermore, CMD group was significantly associated with the history of hemodialysis and heart failure (10.6% vs 3.6%, p=0.001, 38.0% vs 31.0%, p=0.015 respectively). FFR and CFR were lower in CMD than non-CMD (0.67[0.60-0.73] vs 0.70[0.61-0.76], p&lt;0.001, 1.03[0.82-1.21] vs 2.16[1.56-3.00], p&lt;0.001, respectively).
In multiple linear regression analysis, low FFR, non-LAD lesion, older age, female and history of hemodialysis were significant predictors for the presence of CMD.

Conclusion
The prevalence of coexistent CMD in patients undergoing PCI was 20.2%, when defined as MRR≤2.1. Non-LAD lesion location, older age, women, history of hemodialysis, and FFR were significantly associated with the presence of CMD.
Short versus conventional DAPT in patients undergoing PCI with ultra-thin DES by renal function: an analysis from the HOST-IDEA trial
Authors: Han J , Lee S D , Hwang D , Yang S , Park S H , Yun J P , Kang J , Yang H M , Kang H J , Koo B K , Kim H S 
Published: October 2024

Abstract

Background
Patients with impaired renal function are known to have an elevated risk of both ischemic and bleeding events following percutaneous coronary intervention (PCI). However, there is insufficient data available on the optimal duration of dual antiplatelet therapy (DAPT), especially with the latest generation of drug-eluting stent (DES)s.

Objective
We investigated to assess the efficacy and safety of abbreviated duration of DAPT in patients undergoing PCI with 3rd generation DESs based on their renal function.

Methods
In this prespecified subgroup analysis of the HOST-IDEA trial, a total of randomized 1997 patients with available baseline estimated glomerular filtration rate (eGFR) were categorized into three groups: high eGFR (&gt;90 mL/min), intermediate eGFR (60 to 90 mL/min), and low eGFR (&lt;60 mL/min). The primary outcome assessed during the 1-year follow-up period was net adverse clinical events (NACE). Ischemic and bleeding endpoints were also evaluated.

Results
Compared to intermediate or high eGFR groups, the low eGFR group resulted in significantly worse outcomes (P &lt; 0.001). 3-6 month DAPT was associated with similar risk of NACE across all eGFR groups (High eGFR: HR: 0.91; 95% CI: 0.38-2.20; Intermediate eGFR: HR: 0.76; CI: 0.33-1.73; Low eGFR: HR: 0.99; CI: 0.51-1.92). There was also no significant difference in target lesion failure (HR: 0.95; CI: 0.32-2.83, HR: 0.77; CI: 0.29-2.06, and HR: 1.14; CI: 0.47-2.75) and major bleeding (HR: 0.84; CI: 0.19-3.74, HR: 0.59 CI: 0.14-2.48; and HR 0.83 CI: 0.34-2.05) among all stratified eGFR groups. This effect was also consistent in patients of end stage of renal disease (eGFR &lt;15 mL/min).

Conclusions
In patients undergoing PCI with third generation DESs, short DAPT was comparable to conventional DAPT regardless of their baseline renal function.
Clinical outcome based on functional complete revascularization in patients with three-vessel coronary artery disease: The FAME 3 Trial
Authors: Otsuki H , Takahashi K , Kobayashi Y , Zimmermann F , Minten L , Takahashi T , Woo J , Yeung A , Pijls N , De Bruyne B , Fearon W 
Published: October 2024

Abstract

Background
Anatomic complete revascularization after angiography-guided percutaneous coronary intervention (PCI) is associated with improved clinical outcomes. The impact of functional complete revascularization (PCI of all fractional flow reserve (FFR) positive lesions) in patients with 3-vessel coronary artery disease (3VD) amenable to PCI or coronary artery bypass grafting (CABG) is unknown.

Purpose
To investigate the clinical impact of functional complete revascularization after FFR-guided PCI in the FAME 3 trial

Methods
The FAME 3 trial is a multicenter, international, randomized study comparing FFR-guided PCI with CABG in patients with angiographic 3VD. This pre-specified sub-study evaluated the impact of functional complete revascularization after PCI on the primary endpoint of death, myocardial infarction (MI), or stroke at 3 years. The degree of functional complete revascularization was quantified by calculating the residual functional SYNTAX score (rFSS), defined as the residual anatomic SYNTAX score based on post-PCI angiography minus any FFR-negative deferred lesions.

Results
Of the 757 patients treated with FFR-guided PCI, the rFSS could be calculated by the core laboratory in 81% (n=601). Among the angiographically significant lesions, PCI was deferred based on FFR in 17% (51 % of patients had deferral of at least one lesion). The patients were divided into two groups according to acceptable functional complete revascularization: rFSS 0-8 (63%) and functional incomplete revascularization: rFSS&gt;8 (37%). The cumulative incidence of death, MI, or stroke at 3 years was significantly lower in patients with rFSS 0-8 (9% vs. 17%, Hazard ratio[HR]:0.5, 95% confidence interval[CI]:0.3-0.8, p=0.006) compared with rFSS&gt;8. In comparison with the CABG arm, the patients with rFSS 0-8 had similar outcome (HR:0.97, 95%CI:0.6-1.5, p=0.87), while in those with rFSS &gt;8 outcome was worse (HR:1.9, 95%CI: 1.3-2.8, p=0.002) (Figure). There was no difference in death, MI or stroke in CABG patients with or without anatomic complete revascularization. In a multivariate-adjusted model, rFSS&gt;8 showed a significant association with death, MI or stroke at three years (adjusted HR: 1.83, 95% CI: 1.09-3.09, p=0.02).

Conclusions
Acceptable functional complete revascularization with FFR-guided PCI in patients with 3VD is an independent predictor of death, MI or stroke at three years and can be achieved in 63% of patients resulting in similar outcomes compared with CABG.
Impact of moderate to severe anemia on clinical outcomes in patients with atrial fibrillation and coronary artery disease requiring percutaneous coronary intervention
Authors: Abe K , Kitahara H , Tanabe Y , Yamazaki T , Hiraga T , Kobayashi Y 
Published: October 2024

Abstract

Background
In patients with coronary artery disease undergoing percutaneous coronary intervention (PCI), anemia is one of the important risk factors for thrombotic events as well as bleeding events. In patients with atrial fibrillation (AF), on the other hand, a similar relationship between anemia and the increased risks of mortality, cardiovascular events, or bleeding events has been reported.

Purpose
The purpose of this study was to evaluate the impact of anemia on clinical outcomes in patients with AF undergoing PCI, who required intensive antithrombotic therapy with a combination of anticoagulants and antiplatelet agents, using a multicenter registry database.

Methods
Patients with AF undergoing PCI at 15 institutions between January 2015 and March 2021 were included in this analysis. Based on the baseline hemoglobin levels, moderate to severe anemia was defined as hemoglobin levels &lt;11 g/dL, and mild anemia was defined as hemoglobin levels 11-12.9 g/dL for men and 11-11.9 g/dL for women. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, stent thrombosis, and stroke) and major bleeding events (BARC 3 or 5), were compared among patients with moderate/severe anemia, mild anemia, and no anemia.

Results
In a total of 746 enrolled patients, 119 (16.0%) and 168 (22.5%) patients presented with moderate/severe and mild anemia. The incidence of MACE (22.5%, 11.0%, and 9.1%, log-rank p&lt;0.001) as well as major bleeding events (10.7%, 6.5%, and 2.7%, log-rank p&lt;0.001) was the highest in the moderate/severe anemia group compared with the mild and no anemia groups (Figure 1). In multivariable Cox regression analyses, moderate/severe anemia (p=0.008), severe chronic kidney disease (p=0.019), and acute coronary syndrome (p=0.049) were independently associated with MACE. For major bleeding events, moderate/severe anemia (p=0.031) and platelet count (p=0.021) were independent predictors.

Conclusions
Moderate/severe anemia was significantly associated with the higher incidence of MACE as well as major bleeding events compared with mild and no anemia in AF patients undergoing PCI.Figure 1
The effect of kaolin on postprocedural radial artery compression - randomized comparison
Authors: Bernat I , Jirous S , Horak D , Buchnerova A , Lerchner T , Rokytova R , Rokyta R 
Published: October 2024

Abstract

Background
Mechanical compression is a standard method of postprocedural radial artery hemostasis. We investigated the use of this method and its combination with kaolin impragnated gauze patch as a new method of hemostasis.

Methods
We randomized 712 consecutive patients (pts) from our same day discharge program (age 66±8 years, 76% males) after coronary angiography (69%) and intervention (31%) from the proximal (PRA) and distal radial (DRA) approaches. Compression was performed by mechanical inflatable device with or without kaolin gauze : 241 versus (vs) 241 patients in proximal groups and 115 vs 115 pts in distal groups were compared. Postprocedural proximal radial artery patency was evaluated by reverse Barbeau test with finger oximetry testing. Time to hemostasis and access site complications were analyzed.

Results
Baseline characteristics were similar in all four groups - proximal with kaolin (PK+) and without kaolin (PK-), distal with kaolin (DK+) and without kaolin (DK-). Mean compression time was 57±20 min in PK+ vs 83±19 min in PK- groups (p&lt;0.001) and 48±12 min in DK+ vs 63±12 min in DK- groups (p&lt;0.001). In parallel, compression times were shorter in the distal groups compared to the corresponding proximal groups: (DK+ vs PK+; DK- vs PK-; both p&lt;0.001). Postprocedural EASY grade II (&lt;10cm) and III (&gt; 10cm) hematomas occured more often in PRA (4,7% and 0,8%) in comparison with DRA (1,7% and 0%; p=0,03). There were no other local complications including the absence of proximal radial artery occlusion.

Conclusions
The use of kaolin in combination with mechanical radial artery compression was associated with shorter compression time in both PRA and DRA compared to mechanical compression alone. DRA was associated with an overall lower incidence of hematomas and also shorter compression time compared to the same PRA groups. No proximal radial artery occlusion was detected in our analysis.
Ultrasonographic and functional evaluation of forearm circulation with occluded radial artery
Authors: Lewandowski P , Zuk A , Slomski T , Pluta M , Ramotowski B , Maciejewski P , Budaj A 
Published: October 2024

Abstract

Introduction
The transradial approach (TRA) has gained popularity in cardiology procedures. This study aims to evaluate forearm and hand arterial circulation in radial artery (RA) occlusion (RAO) patients after coronary angiography (CAG) and percutaneous coronary interventions (PCI). The ulnar (UA) and anterior interosseous artery (AIA) can compensate for RAO.

Methods
A prospective, observational study was conducted on 40 RAO patients after CAG/PCI. Ultrasonographic and functional evaluation (Barbeau test) of collateral circulation through AIA or UA were performed. Statistical analyses were applied to evaluate various Doppler ultrasound parameters and the anatomical characteristics of the RAO.

Results
The RAO group mean age was 71.22 ± 9.99 years, and 45% were male. RA, UA, and AIA showed significant differences in peak systolic velocity, end-diastolic velocity, arterial diameter, total flow volume, and stroke volume (p &lt; 0.01). Pulse quality over RA and UA also differed significantly (p &lt; 0.0001). Blood flow direction in the distal RA segment divided patients into an antegrade flow group (50%) from AIA and a retrograde flow group (50%) from UA. The Barbeau test results varied among RAO patients, with type D being the most common. Anatomical locations of RAO included the anatomical snuffbox (10%), wrist (60%), and forearm (30%). The logistic regression model revealed that the Barbeau test results on Finger 2 (p=0.0006, OR=0.1398) and Finger 4 (p=0.004, OR 0.2843) were significant predictors for the occurrence of antegrade or retrograde blood flow in the distal RA when RAO occurred. Furthermore, when the RA was occluded, the study revealed that a palpable pulse over the RA was still possible in 15% of cases.

Conclusion
Ultrasonographic evaluation and the Barbeau test can assess collateral circulation and predict blood flow patterns in RAO patients. Further research is needed to validate these findings, explore additional factors influencing collateral circulation and access route selection, and investigate the clinical implications of different RAO anatomical locations in cardiology procedures.Radial Artery OcclusionThe pulse quality over RA/UA with RAO
Prognostic impact of intravascular imaging in percutaneous coronary intervention according to atherothrombotic risk
Authors: Ha J , Hong D , Lee J M , Park T K , Choi K H , Hahn J Y , Song Y B , Lee S H , Lee J Y , Shin D S , Lee S Y , Gwon H C , Choi S H , Yang J H , Kim S M 
Published: October 2024

Abstract

Background
Recent randomized controlled trials support intravascular imaging-guided PCI to improve patient prognosis, however, future risk of clinical events in patient with coronary artery disease is not solely determined by lesion characteristics or how these lesions are treated.

Objectives
Current study investigated whether the effects of intravascular imaging in complex percutaneous coronary invention (PCI) would differ according to atherothrombotic risks.

Methods
This study was post-hoc analysis of the RENOVATE-COMPLEX-PCI trial that compared intravascular imaging-guided PCI with angiography-guided PCI in patients with complex coronary artery lesions. Study population was stratified according to atherothrombotic risk assessed by Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) (a sum of age≥75 years, diabetes mellitus, hypertension, smoking, peripheral arterial disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction) into low-risk (TRS-2P&lt;3) or high-risk (TRS-2P≥3) groups. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel related myocardial infarction, or clinically driven target vessel revascularization.

Results
Among the total patients, 1,247 were low-risk and 392 were high-risk. The risk of TVF was significantly higher in the high-risk group than the low-risk group (15.5% vs. 7.2%; hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.51–3.00; P&lt;0.001). The benefits of intravascular imaging-guided PCI over angiography-guided PCI did not differ between the low-risk group (5.6% vs. 10.4%; HR, 0.56; 95% CI, 0.36–0.86) and the high-risk group (14.1% vs. 18.5%; HR, 0.71; 95% CI, 0.41–1.24) without significant interaction (interaction P=0.496).

Conclusions
Although patients with high atherothrombotic risk had significantly worse clinical outcome than those with low atherothrombotic risk, the prognostic impact of intravascular imaging-guided PCI compared with angiography-guided PCI was similarly observed in both low and high future atherothrombotic risk groups.Structured Graphical Abstract
Influence of acute kidney injury and chronic kidney disease on 3-year clinical outcomes in patients with AMI treated by contemporary PCI and optimal medical therapy; insights from J-MINUET study
Authors: Ozaki Y , Nakao K , Kimura K , Ako J , Noguchi T , Suwa S , Shimizu W , Kawashima N , Niwa Y , Miyajima K , Yoshiki Y , Takahashi H , Muramatsu T , Izawa H , Ishihara M 
Published: October 2024

Abstract

Background
The influence of acute kidney injury (AKI) and chronic kidney disease (CKD) on long-term outcomes following AMI in the era of modern primary PCI with optimal-medical-therapy (OMT) is still in debate.

Methods
A total of 3,281 patients with acute myocardial infarction (AMI) were enrolled in the J-MINUET registry with primary PCI of 93.1% in STEMI Consecutive patients hospitalized within 48 h of onset of AMI at 28 Japanese medical institutions were enrolled in the J-MINUET study (UMIN000010037). AKI was defined as an increase in serum-creatinine ≥0.3mg/dL or ≥50% within-48h during-hospitalization. CKD was defined as estimated glomerular filtration-rate [eGFR]&lt;60mL/min/1.73m2. Major adverse cardiac event (MACE) was defined as a composite of all-cause death, cardiac-failure, MI and stroke. Patients were divided into 4 groups based on the presence or absence of CKD and the occurrence or non-occurrence of AKI. The parameters were assessed by the Cox proportional hazards model. Differences were considered statistically significant at P&lt;0.05.

Results
Of the 3,281 patients with AMI, 3220 patients had complete data set. The average age was 69±13 years old and 75.3% of the patients were male. Of the 3220 patients, 1375 patients had CKD (42.7%) and AKI occurred in 365 patients (11.3%) during the initial hospital stay. AKI more frequently occurred in 305 CKD patients (22.2%) than 60 non-CKD patients (3.3%) (p&lt;0.0001). A total of 898 MACE occurred (27.4%) during follow-up period (median of 768days). Kaplan-Meier curves illustrated event-free survival for MACE over 3 years stratified by the 4 groups (Figure).

Conclusions
While both CKD without AKI and non-CKD with AKI showed similar effect on the incidence of MACE, the worst clinical outcome was observed in patients having AKI on pre-existed CKD.
The acute procedural results and subsequent clinical outcomes after CTO-PCI: main-analysis of the japanese CTO-PCI expert registry
Authors: Matsuda H , Tsuchikane E , Tanaka H , Oikawa Y , Kawasaki T , Igarashi Y 
Published: October 2024

Abstract

Background
The prospective and nonrandomized registry by Japanese Board of chronic total occlusion (CTO) experts has been finished. The large-scale clinical data related with acute procedural results and subsequent clinical outcomes after CTO-percutaneous coronary intervention (PCI) has received limited study.

Objectives
The aim of this study was to make clear the procedural results comparing the different primary CTO-PCI approaches and the clinical outcomes after successful CTO-PCI.

Methods
Between January 2014 and December 2022, a total of 11,674 CTO-PCI patients were consecutively enrolled in this registry. We compared the acute procedural results between 2 groups; primary antegrade approach (PAA) versus primary retrograde approach (PRA), following the intention-to-treat principle. The key outcome of interest was a technical success that was defined as successful stent implantation, residual diameter stenosis &lt;30% within the treated segment, and restoration of TIMI grade 3 flow. The clinical outcomes after achieving technical success of CTO-PCI were assessed in terms of major adverse clinical events (MACE) that were composed of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Moreover, the technical failed factors were also investigated with multivariate analyses.

Results
Of overall, the technical success rate was 91.9%, but there were significant differences between PAA and PRA groups in terms of the success rate (93.2% vs 88.3%; p &lt; 0.001). The success rates of switching strategy to final antegrade approach after retrograde failure were very low among both groups (PAA; 55.8%, PRA; 68.1%). Of retrograde success group, the successful channel tracking tended to using septal and graft route (70.8% vs 56.0%; p &lt; 0.001). Severe calcification and tortuosity of CTO lesion were stronger predictors of failed CTO-PCI than the other factors of J-CTO score. Also, The median follow-up duration was 446.7±613.4 days. At 1 year, the clinical incidence of MACE was 9.4%. The individual components of MACE were also shown lower rates (All-cause death; 2.6%, MI; 0.8%, TLR; 6.3%).

Conclusions
In this large cohort of Japanese CTO-PCI registry, CTO-PCI by highly experienced specialists achieved a high technical success rate and clinical impacts. Retrograde approach has been a key to technical success of CTO-PCI in this study.
Concomitant left atrial appendage occlusion and transcatheter aortic valve replacement among patients with atrial fibrillation: an updated systematic review and meta-analysis
Authors: Andrade N , Cumming H S , Katsuyama E S , Fernandes J M , Pinheiro R P S , Pereira V J , Gomes W F 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) is a prevalent arrhythmia in patients undergoing transcatheter aortic valve replacement (TAVR). Left atrial appendage occlusion (LAAO) has emerged as a viable strategy to prevent stroke in selected patients with AF. While both devices can be implanted simultaneously during a single procedure, the safety and efficacy of this approach remain uncertain.

Purpose
This study aims to evaluate the efficacy and safety of concomitant LAAO in patients with AF and aortic valve disease undergoing TAVR.

Methods
We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies that compared concomitant TAVR and LAAO with isolated TAVR. The study's primary outcomes were all-cause mortality, stroke or transient ischemic attack (TIA), and major bleeding. We established a minimum follow-up time of six months.

Results
Three studies met our eligibility criteria, including one randomized controlled trial and two observational studies. The meta-analysis included 570 patients, 249 (44%) who underwent LAAO and TAVR, with a mean follow-up of 16.3 months. In the overall population, there was no significant difference between the groups in all-cause mortality (relative risk [RR] 0.95; 95% confidence interval [CI] 0.67-1.35; p = 0.78; figure 1A), major bleeding (RR 1.15; 95% CI 0.75-1.77; p = 0.51; 1B), and stroke or TIA (RR 0.70; 95% CI 0.33-1.45; p = 0.33; figure 1C).

Conclusion
In conclusion, concomitant LAAO and TAVR did not demonstrate discernible clinical differences compared to isolated TAVR in patients with AF and aortic valve disease. We recommend that this therapeutic approach be individualized until more robust data become available.