bluuebunny/crossref_metadata_2025_split huggingface dataset:
The coronary angiography-derived index of microcirculatory resistance predicts perioperative myocardial injury in stable coronary artery disease patients undergoing PCI
Authors: Zhang B , Ma L 
Published: October 2024

Abstract

Background
Coronary microvascular dysfunction (CMD) assessed by the index of microcirculatory resistance (IMR) is associated with perioperative myocardial injury(PMI).The angiography-derived index of microcirculatory resistance (caIMR) is a novel and accurate alternative of IMR.

Objective
This study aims to evaluate the predictive value of caIMR on PMI in stable coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI).

Methods
Consecutive stable CAD patients undergoing elective PCI of a single lesion were recruited. caIMR were measured before and after revascularization.Total creatine kinase-MB (CK-MB) and high sensitivity Troponin T (hsTnT) levels were measured before and within 24 hours after PCI.

Results
A total of 65 patients were enrolled, twenty-six patients fulfilled the diagnostic criteria of PMI. Post-PCI caIMR values in the PMI group were significantly higher than those in the control group (27.02±3.70 vs. 15.91±3.43U, P&lt;0.001). Pearson correlation analysis demonstrated that increased post-PCI caIMR values have a significant positive correlation with peak hsTnT (r = 0.803, P&lt;0.001) and peak CK-MB (r = 0.512, P= 0.001). Multivariate logistic regression analysis showed the post-PCI caIMR was independent predictors of PMI(OR,1.731;95% CI:1.348-2.023; P&lt;0.001).The ROC analysis suggested that the best cutoff value of post-PCI caIMR was 25.17U to diagnose PMI(AUC=0.951, sensitivity 88.5%, specificity 97.1%%).

Conclusions
The post-PCI caIMR can accurately predict PMI in stable CAD patients receiving elective PCI, supporting its use in clinical practice.
A comprehensive approach combining FFR, CFR, and IMR in order to predict adverse cardiovascular events in patients with non-obstructive coronary artery disease
Authors: Yoshikawa H , Murai T , Hikita H , Kanno Y , Cho S , Ito A , Yano H , Hishikari K , Takahashi A , Yonetsu T , Sasano T 
Published: October 2024

Abstract

Background
Abnormal coronary circulation is linked to poor patient outcomes. The predictive values of comprehensive physiological assessments in patients with non-obstructive coronary artery disease (NOCAD) have not been fully investigated.

Objectives
The study aimed to evaluate the predictive value of a comprehensive approach that combines fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) in patients with NOCAD.

Methods
FFR, CFR, and IMR were measured in the left anterior descending artery of 226 patients with NOCAD. The primary endpoint was defined as adverse cardiovascular events including cardiovascular death, heart failure, coronary revascularization, cerebral infarction, and peripheral vascular events.

Results
Optimal cutoffs predicting the endpoint were 0.89 for FFR, 2.3 for CFR and 18.0U for IMR. Among the patients, 53 were negative for all indices, 80 positive for one, and 93 positive for two or three. During a median follow-up period of two years, 29 adverse events occurred, with the distribution as follows: 1 (1.9%) in patients with all negative indices, 5 (6.2%) in those with one positive index, and 23 (24.7%) in those with two or three positive indices. Kaplan-Meier curve analysis demonstrated significantly worse event-free survival in patients with an increasing number of positive indices (χ2=18.5, P&lt;0.001). The presence of two or three positive indices was an independent predictor of the endpoint (hazard ratio 7.280, p&lt;0.001).

Conclusions
Combining FFR, CFR, and IMR is an effective method for predicting cardiovascular events in patients with NOCAD.
Diastolic hyperemia-free ratio for the assessment of intermediate coronary artery stenosis in patients with hemodialysis
Authors: Nohara H , Egami Y , Abe M , Osuga M , Kawanami S , Kawamura A , Ukita K , Yasumoto K , Tsuda M , Okamoto N , Matsunaga Y , Yano M , Nishino M 
Published: October 2024

Abstract

Background
Diastolic hyperemia-free Ratio (DFR) is new resting index and uses a pragmatic definition by including areas below the average aortic pressure with negative slope. Hemodialysis (HD) exhibits left ventricular hypertrophy and impaired microcirculation. The relationship between DFR and fractional flow reserve (FFR) in the patients with HD has not been yet investigated.

Purpose
We aimed to compare the rate of physiological discordance between HD patients and non-HD patients, and to elucidate the best DFR cut-off value predicting less than 0.80 of FFR in HD patients.

Methods
We enrolled 761 consecutive patients (1033 vessels) who underwent both DFR and FFR in the intermediate coronary artery stenosis between July 2020 and December 2023 in our hospital. The cutoff values of DFR 0.89 or less and FFR 0.80 or less were used for the study. We compared the DFR values with FFR values between HD group and Non-HD group.

Results
HD group consisted of 110 patients and Non-HD group consisted of 651 patients. A good correlation between DFR and FFR was observed in HD group (R=0.780 ; p &lt; 0.0001) and Non-HD group (R=0.770 ; p &lt; 0.0001). The rate of physiological discordance between HD group and non-HD group was each 31.3% and 20.5% (p &lt; 0.01). Receiver operating characteristic curve showed that a suitable cut off value of DFR for equivalent FFR value of 0.80 was 0.84 in HD group and 0.89 in Non-HD group, respectively (Figure).

Conclusion
In the patients with HD, DFR may overestimate intermediate coronary artery stenosis and the suitable cut off value was 0.84.2024 ESC HD DFR Figure
Impact of fractional flow reserve measurement on angina frequency in the invasive arm of the ISCHEMIA trial
Authors: Singh A , Rodman J C S , Brown D L 
Published: October 2024

Abstract

Introduction
Fractional flow reserve (FFR) is an invasive, lesion-specific surrogate for myocardial ischemia. The use of FFR to guide lesion selection for revascularization is believed to improve outcomes compared to an angiographic approach because it allows categorization of lesions based on hemodynamic significance. Lesions that are not hemodynamically significant can be safely deferred while the revascularization of significant lesions has been reported to improve quality of life compared to medical therapy alone.

Purpose
To compare the outcomes of patients randomized to the invasive (INV) arm of the ISCHEMIA trial who underwent FFR during initial angiography with those whose treatment was guided by angiography alone.

Methods
The ISCHEMIA data set was obtained from the National Heart, Lung, and Blood Institute under a data use agreement. Subjects randomized to the INV arm who underwent FFR were compared to those who underwent angiography alone. Categorial variables were compared using the chi-squared or Fisher’s exact test. Continuous variables were compared using the student T-test or Wilcoxon rank sum test. Multivariable linear mixed effects regression was used to evaluate the association of FFR use on SAQ7 AF score as well as assess changes across five years of follow-up. Covariates included in the model were based on their univariate and clinical significance. All tests were two-sided and P&lt;0.05 was considered statistically significant.

Results
Of the 5,179 patients with chronic coronary syndromes and at least moderate ischemia on stress testing, 2588 were assigned to the INV strategy and 2210 had data available for analysis. Of these individuals, 410 (19%) had FFR performed during their diagnostic angiogram. Females comprised 24% of FFR patients and 24% of non-FFR patients (P=0.85). FFR patients were older than non-FFR patients (65.7 [8.7] years vs. 64.3 [9.6] years, P=0.006). The incidence of hypertension, diabetes, smoking, or prior MI at baseline did not differ between groups. Mean ejection fraction did not differ between groups. Fewer FFR patients had severe ischemia at baseline (45% vs. 52%) and more had mild or moderate ischemia (54% vs. 48%) (P=0.009). FFR patients had fewer native vessels with &gt;70% stenosis than non-FFR patients (1.0[0.9] vs. 1.5[1.0], P&lt;0.001), and less complex disease as assessed by the Duke jeopardy score (P&lt;0.001). On multivariable linear mixed effects regression, FFR was not associated with a significant change in the SAQ AF score (0.56 (-0.85 – 1.97; P=0.44)), after adjusting for other covariates. However, the SAQ7 AF score was 0.22 units less in those that underwent FFR compared to those that did not (95%CI=-0.44 – -0.01; P=0.043) when assessed over follow-up time.

Conclusion
ISCHEMIA patients randomized to an INV strategy who underwent physiologic assessment with FFR had no improvement in angina frequency compared to those who underwent angiography alone.
Coronary sinus reducer device for the treatment of refractory angina: a single center experience
Authors: Sobral Domingues M , Carvalho R , Certo Pereira J , Madeira S , Brito J , Raposo L , Teles R , Almeida M 
Published: October 2024

Abstract

Introduction
The coronary sinus Reducer emerged as a complementary therapy in patients with angina refractory to optimal medical therapy and not amenable to revascularization.

Aim
The aim of this study was to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina.

Methods and population
Twenty-six patients with refractory angina, objective evidence of myocardial ischemia attributable to the left coronary artery and deemed unsuitable for revascularization were treated with Reducer at a single center between April 2018 and January 2023. Safety endpoints were procedural success and complications. Efficacy endpoints, assessed at 6-month, were a reduction in Canadian Cardiovascular Society angina (CCS) class and a reduction in pharmacological antianginal therapy.

Results
Twenty-one (81%) patients had end-stage coronary artery disease without targets for further revascularization (13 had previous CABG ± PCI and 8 had only PCI) and 5 patients had microvascular disease without epicardial stenosis.
All procedures were performed via right jugular vein. The mean procedure and fluoroscopy duration were 66±29 and 19±8 minutes. Procedural success was achieved in all patients, with no device related complications. There was one cardiac tamponade, promptly treated with pericardiocentesis.
Regarding the efficacy endpoint, 21 patients (81%) had at least 1 grade reduction in CCS class, 13 patients (50%) had at least 2 class reductions, and 7 patients (28 %) became asymptomatic, with a mean reduction of CCS class of 1.4±0.9, from 2.6±0.5 to 1.2±0.9 (p=0.001) at 6-month follow-up. During this time frame, twelve patients (46%) withdrew or reduced the dose of at least one anti-anginal drug. The mean reduction of anti-anginal drugs was 0.54 ±0.86, from 3.5±1.02 to 2.9±1.07 (p=0.04).

Conclusion
In this real-world, single-center experience, implantation of Reducer was safe and associated with improvement of angina and reduction of anti-anginal drugs intake in patients with refractory angina unsuitable for revascularization.
The comparison of short-term dual antiplatelet therapy versus standard dual antiplatelet therapy in elderly patients with coronary artery disease who underwent percutaneous coronary intervention
Authors: Jin I 
Published: October 2024

Abstract

Introduction
Elderly patients are likely to have more underlying risk factors for bleeding and the bleeding risk increases with age although dual anti-platelet therapy (DAPT) is mandatory for patients who underwent percutaneous coronary intervention (PCI) for prevention of ischemic events. Therefore, elderly patients aged 75 or older are included as minor criteria for high bleeding risk, as defined by the Academic Research Consortium for High Bleeding Risk criteria. However, only limited data have been investigated of optimal duration of DAPT for patients aged 75 or older.

Purpose
The aim of this study is to evaluate optimal DAPT duration for elderly patients aged 75 and older.

Methods
We selected 1,571 patients aged 75 and older with coronary artery disease (CAD) from the pooled database among the 5 randomized controlled trials related to DAPT duration after PCI. DAPT was consisted of clopidogrel or ticagrelor in addition to aspirin. Short-term DAPT duration was defined as 1 to 3months, and standard DAPT duration was defined as 6 to 12months after PCI. Primary outcomes were net clinical adverse outcomes (NACE), composite of major cardiovascular and cerebrovascular adverse outcomes (MACCE) and TIMI major bleeding at 1 year. The inversed probability of treatment weighting (IPTW) analysis was performed to minimize selection bias effects of pooled database.

Results
The NACE was not significantly different between the short-term DAPT group (3.9%) and standard DAPT group (7.6%) (HR: 0.69, 95% CI: 0.46-1.04; p=0.076) (Figure A). Moreover, MACCE was not different in both groups. However, the significant reduction of bleeding risk was observed in short-term DAPT group (1.4%) than standard DAPT group (3.4%) (hazard ratio (HR): 0.40, 95% confidential interval (CI): 0.19-0.83; p=0.015) (Figure B). These results were consistent after multivariable Cox regression analysis and IPTW analysis.

Conclusions
Short-term DAPT duration (1 to 3months) was found to be superior to standard DAPT duration (6 to 12months) in terms of bleeding outcomes without the increased ischemic outcomes in patients aged 75 or older with CAD who underwent PCI.
Three decades of lipid-lowering therapy in type 2 diabetic patients with angiographically proven stable coronary artery disease
Authors: Vogel J , Ratz M , Elsner P , Plattner T , Vonbank A , Mader A , Larcher B , Leiherer A , Muendlein A , Frick M , Drexel H , Saely C H 
Published: October 2024

Abstract
Lipid-lowering therapy (LLT) is key to reducing the burden of macrovascular diabetes complications. Here, we aim to assess long-term trends in LLT and LDL-C levels among patients with type 2 diabetes (T2DM) with angiographically proven coronary artery disease (CAD).
We investigated T2DM patients (n=590), who were referred to elective coronary angiography and were diagnosed with CAD in one of three observational cohort studies (OS) spanning 25 years: OS1: 1999-2000 (n=190); OS2: 2005-2008 (n=241); OS3: 2022-2023 (n=159). These studies were conducted at the same cardiology unit of a tertiary care hospital in Central Europe.
The proportion of patients receiving statin therapy (C10AA and C10AB) increased significantly from 57.9% in OS1 to 64.3% in OS2 and 78.6% in OS3 (ptrend&lt;0.001). Further, there was an increase in patients receiving high-intensity statin therapy, rising from none in OS1 to 8.5% in OS2 and 73.4% in OS3 (ptrend&lt;0.001). The proportion of patients receiving more than one LLT compound also increased (OS1: 2.1%; OS2: 2.1%; OS3: 35.2%; ptrend&lt;0.001). Use of ezetimibe (C10AX09) increased (OS1: 0.0%; OS2: 1.2%; OS3: 39.0%; ptrend&lt;0.001) and fibrate use (C10AB) decreased (OS1: 5.3%; OS2: 3.3%; OS3: 0.6%; ptrend=0.015). Newly approved compounds (C10AX13 - C10AX16) were prescribed for 3.8% of patients in OS3. Among statin combination therapies, ezetimibe was predominantly used (93.5%). Mean LDL-C levels declined significantly from 123±38 mg/dL (OS1) to 115±39 mg/dL (OS2) and 77±38 mg/dL (OS3; ptrend&lt;0.001). However, only 2.2% of patients in OS1, 2.5% in OS2 and 32.1% in OS3 reached an LDL-C target of &lt;55 mg/dL (ptrend&lt;0.001).
This analysis suggests an upward trend in treatment intensity and a substantial improvement in LDL-C levels among T2DM patients with CAD. However, the majority of these patients still does not reach their LDL-C target.
Comparison of the prognosis between complete and incomplete revascularization among moderate to severe chronic kidney disease patients with acute coronary syndrome
Authors: Phoksiri A , Kuanprasert S , Pota P , Thonghong T , Suwannasom P 
Published: October 2024

Abstract

Background
Complete revascularization (CR) in acute coronary syndrome patients with multivessel disease (MVD) is recommended in current clinical practice guidelines. However, the benefit of CR in moderate to severe chronic kidney disease (CKD) patients remains controversial. We aimed to compare the clinical outcomes between complete and incomplete revascularization among moderate to severe CKD patients who presented with ACS.

Methods
Of 1,924 ACS patients who underwent percutaneous coronary intervention (PCI) in our center, 127 patients were CKD. CR was defined as residual SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score ≤ 3. The primary outcome was the patient oriented clinical outcome (POCO) at 1 year, including all-cause death, any myocardial infarction, any revascularization, and heart failure requiring hospitalization.

Results
The mean age of the patients was 73.89±9.07 years. The median estimated glomerular filtration rate (eGFR) was 32.56±10.68 ml per minute per 1.73 m2. The rate of POCO at 1 year was significantly lower in the CR group (16.3% vs 39.3%; HR 0.36; 95%CI, 0.16-0.81; p=0.014). The primary outcome was mainly driven by 1-year all-cause death which was significantly lower in the CR group (14.0% vs 39.3%; HR 0.32; 95%CI 0.13-0.76; p=0.017). The rate of initiation of renal replacement therapy was comparable (4.7% vs 2.4%; p=0.55).

Conclusion
CR with a target SYNTAX score ≤ 3 improved 1-year prognosis of POCO and all-cause death in ACS patients with moderate to severe CKD without increasing the rates of renal replacement therapy.1-year POCOPrespecified Subgroup Analysis of POCO
Impact of symptom-to-balloon time on long-term prognosis: a 3-year follow-up study in non-st-segment elevation myocardial infarction patients with complex lesions
Authors: Kim Y H , Her A Y , Rha S W , Choi C U , Choi B G , Hyun S J , Park S , Kang D O , Cho J R , Kim M W , Park J Y , Park S H , Jeong M H 
Published: October 2024

Abstract

Background
Because no data are available, we compared clinical outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI), stratified based on the presence of complex lesions, according to symptom-to-balloon time (SBT, &lt;48 h versus ≥48 h), undergoing newer-generation drug-eluting stents.

Methods
From the KAMIR (Korea Acute Myocardial Infarction Registry)-NIH dataset, a total of 4373 patients diagnosed with NSTEMI were enrolled and stratified into two groups: the complex group (2106 patients; SBT &lt;48 h, 1365; SBT ≥48 h, 741) and the non-complex group (2267 patients, SBT &lt;48 h, 1573; SBT ≥48 h, 694). The primary outcome was the 3-year all-cause death rate, and the secondary outcome was major adverse cardiac events (MACE), including cardiac death (CD), recurrent MI, and any repeat revascularization.

Results
The rates of all-cause death (adjusted hazard ratio [aHR], 0.656; p = 0.009) and cardiac death (aHR, 0.633; p = 0.037) in the complex group, and the rate of all-cause death (aHR, 0.773; p = 0.036) in the total study population, were significantly lower for patients with SBT &lt;48 h than for those with SBT ≥48 h. In the non-complex group, all clinical outcomes were not significantly different between the SBT &lt;48 h and SBT ≥48 h groups. In the SBT ≥48 h group, the complex group exhibits higher rates of all-cause death, any repeat revascularization, and MACE than those of the non-complex group

Conclusions
Reducing SBT was more effective in decreasing 3-year mortality in NSTEMI patients with a complex group compared to the non-complex group.
Incremental role of Cardio-Ankle Vascular Index in predicting ischemic threshold in patients with suspected coronary artery disease
Authors: Tunhasiriwet A , Krittanawong C , Hengrussamee K , Sukhum P , Yodwut C , Treesong M , Thiangtham S , Samut B , Wuttichaipradit C 
Published: October 2024

Abstract

Background
The Cardio-Ankle Vascular Index (CAVI) quantifies arterial stiffness and has emerged as a potential biomarker for cardiovascular disease and its associated risk factors. This study explores the prognostic utility of CAVI in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD). Additionally, it examines the relationship between global longitudinal strain (GLS) and the wall motion score index (WMSI) during both rest and stress echocardiography.

Methods
We conducted a retrospective analysis of patients with suspected CAD who underwent CAVI measurement and stress echocardiography within a three-month window. Coronary angiography was utilized to evaluate anatomical stenosis (&gt;50%). We used multivariate analysis to identify predictors of the ischemic threshold.

Results
In our cohort of 127 patients (average age 61.4 ± 9.1, 78% male), the prevalence of hypertension, dyslipidemia, and diabetes was 76%, 68% and 47% of patients, respectively. Prior coronary intervention and a history of myocardial infarction were showed significant prevalence at 33% and 9%, respectively. CAD distribution included absence in 15%, left main (LM) disease in 8%, proximal left anterior descending (LAD) artery disease in 38%, mid-to-distal LAD disease in 50%, left circumflex artery disease in 46%, and right coronary artery disease in 57%. A robust correlation between GLS and WMSI was observed both at rest and during peak stress (r=0.68 and r=0.57, p&lt;0.001, respectively). High CAVI (≥8.5), resting GLS in the LAD(&lt;-15.5%), and peak GLS during stress (&lt;-15.3%) emerged as significant ischemic threshold predictors in multivariate analysis (AUC = 0.82, p&lt;0.0001).

Conclusion
The correlation between WMSI and GLS provides valuable insights into cardiac mechanics. These findings underscore the clinical relevance of incorporating CAVI, GLS, and WMSI into routine assessments for patients with suspected CAD to enhance prognostic stratification.ROC for final predictive model