bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of coronary CT angiography on the hospital outcome among patients admitted with AMI undergoing revascularization procedures in theUS
Authors: Shoar S , Allencherril J 
Published: October 2024

Abstract

Background
Coronary CT angiography (CCTA) is gaining popularity as a diagnostic modality for risk stratification among patients hospitalized with acute myocardial infarction (AMI). However, its impact on the hospital outcomes among this population of patients remains to be determined.

Methods
Using national inpatient sample database, admission cases with a diagnosis of AMI who underwent revascularization procedures were identified from 2016-2020. The prevalence of CCTA was determined among the patient population and stratified based on the type of AMI (STEMI vs. NSTEMI) and revascularization procedure (PCI vs. CABG). Hospital outcomes were compared among the study strata.

Results
A total of 862,064 admission cases for STEMI and 3,586,944 admission cases for NSTEMI were identified out of which 661,958 cases underwent revascularization procedures. The utilization of CCTA was roughly 10 times higher among AMI cases undergoing PCI than those undergoing CABG (0.5% vs. 0.06%, p&lt;0.0001). Prior CCTA increased the odds of receiving PCI by 79.3 times and the odds of undergoing CABG by 2.8 times. Among STEMI patients undergoing PCI, prior CCTA was associated with a lower mortality rate and non-home disposition (13.8% vs. 21.2%, p&lt;0.0001) compared to no CCTA (3% vs. 5.5%, p=0.01). For NSTEMI patients undergoing PCI, CCTA was associated with a lower non-home disposition (16.5% vs. 20.6%, p=0.003) but not a significantly lower mortality rate. CCTA did not demonstrate any statistically significant differences for AMI patients undergoing CABG. On the other hand, CCTA increased the cost of hospitalization by $15,130.7 for STEMI patients undergoing PCI, length of stay (9 days) and hospital cost for STEMI patients undergoing CABG ($302,802), and total hospital cost for NSTEMI patients undergoing PCI by $8,705.

Conclusions
Using CCTA helps in risk stratifying AMI patients for revascularization procedures, allocating PCI to those admitted with STEMI and CABG to those with NSTEMI. Although CCTA reduces the risk of death and non-home disposition among STEMI patients undergoing PCI, it also increases hospital charges for patients receiving revascularization procedures.
Relationship between coronary artery calcium score and plaque vulnerability in patients with established coronary artery disease
Authors: Fujimoto D , Niida T , Kinoshita D , Suzuki K , Lee H , Mcnulty I , Kakuta T , Jang I K 
Published: October 2024

Abstract

Introduction
Coronary artery calcium (CAC) score is widely used for risk stratification. However, in patients with established coronary artery disease (CAD), its clinical implication and relationship with plaque vulnerability have not been fully investigated.

Purpose
We sought to investigate the relationship between CAC score and plaque vulnerability assessed by optical coherence tomography (OCT).

Methods
Patients with CAD who had both CAC score and OCT prior to percutaneous coronary intervention were included. The patients with a prior history of coronary revascularization were excluded. Patients were divided into five groups based on CAC score; CAC score of 0, 1-99, 100-399, 400-999, and over 1000. Vulnerable features in culprit plaque assessed by OCT were compared among these five groups.

Results
In 460 patients, the prevalence of lipid-rich plaque, macrophage, and cholesterol crystal significantly differed among the five groups: lowest in the patients with a CAC score of zero. The prevalence of thin-cap fibroatheroma (TCFA) tended to be lower in those with a CAC score of zero (Figure). In the two-group comparison between the group with a CAC score of zero and the other four groups, the prevalence of lipid-rich plaque (60.5 vs. 85.9%, p &lt; 0.001), macrophage (48.8 vs. 74.1%, p &lt; 0.001), TCFA (16.3 vs. 35.0%, p = 0.013), and cholesterol crystal (11.6 vs. 32.9%, p = 0.004) was significantly lower in the patients with CAC score of zero. No significant difference in vulnerable features was observed among the four groups with CAC scores &gt; 0. CAC score of zero was independently negatively associated with the lipid-rich plaque (odds ratio [OR] 0.246, p &lt; 0.001), macrophage (OR 0.348, p = 0.003), TCFA (OR 0.285, p = 0.006), and cholesterol crystal (OR 0.273, p = 0.010) after adjustment with patient characteristics.

Conclusion
This is the first study that investigated the relationship between CAC score and plaque vulnerability assessed by OCT in patients with known CAD. Patients with CAC score of zero have a significantly lower prevalence of vulnerable plaque features compared to those with CAC score &gt; 0.
Impact of the distribution of calcification around the left main coronary artery bifurcation on prognosis after percutaneous coronary intervention
Authors: Sasaki K , Sawayama Y , Ikuta A , Osakada K , Kubo S , Tada T , Tanaka H , Fuku Y , Kadota K 
Published: October 2024

Abstract

Backgrounds
The presence of true bifurcation lesions (TBL) by Medina classification at the left main coronary artery (LMCA) bifurcation is known to be associated with cardiovascular events after percutaneous coronary intervention (PCI). However, the prognostic impact of the distribution of calcification at LMCA bifurcation has not been adequately investigated.

Methods
This retrospective study consisted of consecutive patients who were implanted with a second or subsequent generation drug-eluting stent for LMCA bifurcation at a single center from 2014 to 2018. We excluded patients with a protected LMCA and those in whom calcification or stenosis of the LMCA bifurcation could not be assessed. With reference to the Medina classification, the region was divided into three segments (LM, LAD, and LCX). Each segment was assigned a value of 0 (for less than moderate calcification) or 1 (for more than moderate calcification) and expressed as calc (X.X.X). Calc (1.1.1), calc (1.0.1), and calc (0.1.1) were defined as true bifurcation calcification (TBC). The primary endpoint was 3-year target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization.

Results
Of 498 patients in this analysis, the mean age was 73 years, males accounted for 78% overall, acute coronary syndrome 31% overall, and TBL 42% overall. Moderate or severe calcification at any site around the LMCA bifurcation was observed in 184 (37%). In order of frequency, calc (1.1.0) in 70 (14%), calc (1.1.1) in 58 (12%), calc (0.1.0) in 43 (9%), calc (0.1.1) in 11 (2%), and calc (1.0.1) in 2 (0.4%), while calc (1.0.1) and calc (1. 0.0) were not present. TBC accounted for 14% overall. Patients with TBC at LMCA bifurcation had a higher incidence of 3-year TLF (Log-rank P &lt;0.001; Figure1). Multivariable logistic regression, including age, acute coronary syndrome, maintenance hemodialysis, SYNTAX score ≥33, TBL, and TBC in the model as covariates, TBC was significantly associated with the primary endpoint (adjusted odds ratio 3.4, 95% confidence interval 1.6-7.2, P=0.013). In contrast, a significant association between TBL and the primary endpoint was not observed (adjusted odds ratio 1.5, 95% confidence interval 0.8-2.8, p=0.206).

Conclusion
Even after adjusting the presence of TBL at LMCA bifurcation, the presence of TBC at LMCA bifurcation was significantly associated with the 3-year TLF.
The Belgian registry on coronary function testing (BELmicro registry): study population and prevalence of coronary vascular dysfunction
Authors: Bringmans T , Benedetti A , Zivelonghi C , Vanhaverbeke M , Mathieu F D , Palmers P J , Coussement P , De Wilder K , Coeman M , Demeure F , Kersemans M , Collet C B , Kayaert P , Van Mieghem C , Segers V F M 
Published: October 2024

Abstract

Background
Coronary function tests (CFT) play a pivotal role in the diagnosis of coronary vascular dysfunction and in providing patients with tailored therapy.

Aims
To describe baseline characteristics and prevalence of coronary microvascular dysfunction (CMD) and coronary vasospasm in a real-world population of patients undergoing CFT.

Methods
The Belgian registry on coronary function testing (BELmicro registry) is a prospective, observational registry that includes 14 centers in Belgium. All patients undergoing clinically indicated CFT were included. Baseline characteristics, CFT data, and clinical outcomes were collected.

Results
Between October 2021 and September 2023, 449 patients were enrolled. The mean age was 65 ± 10 years, and 47.4% of patients were male. Fifty-nine percent of patients had hypertension, 18.7% diabetes, 69.5% hypercholesterolemia, and 40.1% smoking habit. On coronary angiography, the presence of coronary stenosis ≥ 50% was detected in 20.3% of patients. A microvascular physiology assessment was performed in 95.5% of patients, a vasoreactivity test in 28.5%, and both in 24.0%. CMD was diagnosed in 23.6% of patients. Definite epicardial vasospasm was diagnosed in 27.3% of patients, and microvascular spasm in 14.1%. The rates of severe complications were 0.7% for the microvascular physiology assessment and 0% for the vasoreactivity test.

Conclusion
Participants in the BELmicro registry represent a real-world population of patients, characterized by a high burden of cardiovascular risk factors. Both CMD and coronary vasospasm were frequent. CFT in daily clinical practice was feasible with a low rate of complications.Visual summaryScatter plot of measurements
Prognostic role of post-percutaneous coronary intervention quantitative flow ratio
Authors: Oikonomou D , Terentes-Printzios D , Gkini K P , Gardikioti V , Aznaouridis K , Dima I , Tsioufis K , Vlachopoulos C 
Published: October 2024

Abstract

Background/Introduction
Accumulated evidence supports the prognostic value of post–percutaneous coronary intervention (PCI) physiological measurement. Quantitative Flow Ratio (QFR) is a well-studied angiography-based method for functional assessment.

Purpose
To investigate the possible prognostic implications of post-PCI QFR in patients undergoing revascularization.

Methods
We performed offline QFR analysis in all-comers undergoing PCI in a single center. A cut-off value of 0.8 was used to classify patients in high post-PCI QFR group (&gt;0.8) and low post-PCI QFR group (≤0.8). Patients with at least one vessel with post-PCI QFR ≤0.8 were classified in the low post-PCI QFR group. Primary endpoint was the composite outcome of death, myocardial infraction, ischemia-driven revascularization, and heart failure-related hospitalization.

Results
We included 297 patients in the study. Mean age was 64 (±11) years and 81% of patients were male. Number of patients presented with chronic coronary syndrome was comparable to that of patients presented with acute coronary syndrome (52.9 vs 47.1 %, respectively). Patients in the low post-PCI QFR group had more often diabetes mellitus, lower left ventricular ejection fraction (LVEF) and higher SYNTAX score compared to patients in the high post-PCI QFR group. Median follow-up period was 29 (26-34) months. After adjusting for covariates, low post-PCI QFR was independently associated with higher rate of the composite outcome (HR: 2.22 95% CI 1.01-4.88, p=0.047).

Conclusions
In our study, patients with lower post-PCI value were independently associated with higher risk of cardiovascular adverse events.
Physiological disease pattern as assessed by PPGI in vessels with FFR and iFR discordance
Authors: Chenniganahosahalli Revaiah P , Tsung-Ying T , Miyashita K , Tobe A , Xingqiang H , Biscaglia S , Escaned J , Patel M , Onuma Y , Serruys P W 
Published: October 2024

Abstract

Background
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) disagree on the hemodynamic significance of a coronary lesion in≈20% of cases. It is unclear whether the physiological pattern of disease is an influencing factor for this. This study assessed whether the physiological pattern of coronary artery disease (CAD) as assessed by angiography derived pullback pressure gradient index (PPGI) influences discordance between FFR and iFR measurement.

Methods and results
This study is a centralized off-line analysis by an independent academic core laboratory (CORRIB Core lab) of a prospective cohort of 444 vessels with both pressure wire-instantaneous wave free ratio (PW-iFR) and pressure wire-fractional flow reserve (PW-FFR) measurements. The study population consisted of a patients presenting with chronic coronary syndrome and having at least one epicardial coronary artery lesion with a 40% to 90% diameter stenosis by visual assessment on invasive coronary angiography. Three-hundred and ninety vessels (355 patients; mean age, 68±10 years; 70% men) with combined FFR, iFR, QFR and angiography derived PPGI were included. QFR was calculated using the QAngio XA 3D 2.1 software package (Medis Medical Imaging System BV, Leiden, The Netherlands). PPGI was calculated using the QFR 2.1.38.2 Research Edition software package. Cut points for hemodynamic significance were FFR ≤0.80 and iFR ≤0.89, respectively. Vessels were classified into FFR+/iFR+ (n=103; 26.4%), FFR-/iFR+ (n=27; 6.9%), FFR+/iFR- (n=38; 9.7%), and FFR-/iFR- (n=222; 57%) groups.. Median FFR, iFR, and QFR were 0.84 (0.77-0.90), 0.92 (0.88-0.97), and 0.83 (0.73-0.90) respectively. FFR disagreed with iFR in 16.7% (65 of 390). The Median PPGI was 0.75 (0.67-0.85). Vessels with PPGI ≥0.75 was considered to have predominantly focal disease pattern and vessels with PPGI &lt;0.75 was considered to have predominantly diffuse disease pattern. The physiological pattern of disease was classified according to the angiography derived pullback pressure gradient index (PPGI) as predominantly physiologically focal (n=209; 53.6%) or predominantly physiologically diffuse (n=181; 46.4%). The median PPGI was significantly lower in FFR-/iFR+ vessels as compared to FFR+/iFR- vessels [0.65(0.60-0.69) vs 0.82(0.75-0.85), p&lt;0.001). The physiological pattern of disease was the influencing factor relating to FFR/iFR discordance: predominantly physiologically focal was significantly associated with FFR+/iFR- (76.3% [29 of 38]), and predominantly physiologically diffuse was significantly associated with FFR-/iFR+ (96.3% [26 of 27]; P&lt;0.001 for pattern of disease between FFR+/iFR- and FFR-/iFR+ groups).

Conclusions
The physiological pattern of coronary artery disease was an important influencing factor for FFR/iFR discordance.
The impact of hydrostatic pressure on fractional flow reserve in saphenous vein grafts
Authors: Hoek R , Porouchani S , De Winter R W , Somsen Y B O , Van Diemen P A , Jukema R A , Twisk J W , Wilgenhof A , Verouden N J , Danad I , Nap A , Knaapen P 
Published: October 2024

Abstract

Background
Intracoronary physiological measurements can be subject to the influence of hydrostatic pressure. Saphenous vein grafts (SVGs) diverge in origin and trajectory from native coronary arteries, which may increase the susceptibility of fractional flow reserve (FFR) measurements to be impacted by the hydrostatic pressures. The precise impact of SVG anatomy on physiological pressure indices remains unknown at present.

Purpose
We sought to study the impact of SVG anatomy on FFR.

Methods
Included were symptomatic patients with prior coronary artery bypass grafting and at least one non-occluded SVG, who underwent coronary computed tomography angiography (CCTA) preceding invasive coronary angiography. SVG course and height excursion were reconstructed based on the CCTA images. Similarly to native coronary arteries, the impact of hydrostatic pressure on FFR was calculated by adding 0.077 mmHg to the distal coronary pressure for every millimeter height difference in a supine position between the SVG ostium and the position of the pressure wire tip.

Results
In total, 74 patients (mean age 71 ± 7 years; 85% male) with 87 SVGs were included. A total of 76 SVGs underwent interrogation by FFR. The height difference between SVG ostium and pressure wire tip position was largest for single SVGs to the circumflex artery (Cx; - 55.1 ± 17.0 mm), followed by sequential SVGs to the Cx (- 53.1 ± 17.7 mm) and to the right coronary artery (RCA; - 36.7 ± 21.6 mm). Corrected FFR was significantly lower as compared to uncorrected FFR in single SVGs to the Cx (0.85 ± 0.17 vs. 0.90 ± 0.18), and sequential SVGs to the Cx (0.92 ± 0.14 vs. 0.96 ± 0.15) and the RCA (0.82 ± 0.20 vs. 0.85 ± 0.21) (P&lt;0.001 for all).

Conclusions
Hydrostatic pressure related to the course anatomy of SVGs notably affects FFR values, resulting in an overestimation of FFR in SVGs to the Cx and sequential SVGs to the RCA. In these SVGs, FFR values near the cutoff value should be interpreted cautiously.
One-year results from the REDUCER-I multi-center real-world clinical trial of the treatment of refractory angina with the coronary sinus Reducer
Authors: Verheye S , Van De Hoef T , De Silva R , Van Kuijk J P , Byrne J , Montorfano M , Buschmann E , Dupont M , Banai S 
Published: October 2024

Abstract

Background/Introduction
Patients with refractory angina have chronic symptoms due to reversible ischemia which are inadequately controlled with optimal medical therapy or interventional treatments. These patients suffer from a poor quality of life and place a significant strain on the health care system due to their frequent rehospitalizations. The coronary sinus (CS) Reducer is a stainless-steel hour-glass shaped mesh stent that creates a focal narrowing in the lumen of the CS resulting in improved microvascular resistance and redistribution of myocardial blood flow.

Purpose
The COSIRA randomized controlled trial showed the Reducer is a safe and effective treatment for refractory angina with patients having significant improvements in Canadian Cardiovascular Society (CCS) class and other measures of quality of life. The REDUCER-I post-market study evaluated the long-term outcomes with the Reducer in a large and challenging ‘real-world’ cohort.

Methods
REDUCER-I is a multicenter, non-randomized study conducted across 26 medical centers in Europe. At one year, device effectiveness was assessed by improvement in CCS grade as compared to baseline and device safety was assessed by Major Adverse Cardiac Events (MACE). Secondary endpoints included six-minute walk tests, EQ-5D-5L tests, and Seattle Angina Questionnaires (SAQ). Subjects were followed at 30 days, 6 months, and annually through five years.

Results
The as-treated population includes a total of 371 patients who received a Reducer implant (78.7% (292/371) male, 47.2% (175/371) diabetic, 73.9% (274/371) post-revascularization). The one-year Kaplan-Meier overall MACE rate post-implant was 7.1% (95% CI [4.9, 10.4]). There were nine deaths within the first 365 days, one death was due to unknown causes and eight deaths were adjudicated to as not being device- or procedure-related. At 12 months, 70.0% (205/293) of patients improved by ≥1 CCS class. At baseline, 72.2% (232/363) of patients were CCS class III/IV and this proportion decreased to 18.1% (54/298) at 12 months (P&lt;0.0001). The patients’ baseline six-minute walk distance was 327.5±116.1m which improved by a mean of 30.8±81.8m at 12 months (p&lt;.0001). In the year prior to Reducer implant, 33.3% (88/264) of the patients had at least one visit to the emergency department compared to 11.7% (31/264) in the year after Reducer implant (p&lt;.0001). The significant improvements in CCS class and SAQ-QoL were sustained through 3 years (Figure).

Conclusion
In this 12-month analysis of the REDUCER-I study, patients with refractory angina treated with the CS Reducer had low MACE rates and showed significant and sustained improvements in angina, QoL, functional capacity, and need for rehospitalization.
Sodium-glucose cotransporter 2 inhibitor attenuates left ventricular dysfunction in post-myocardial infarction in rats via reducing cardiac mitochondrial impairment
Authors: Attachaipanich T , Apaijai N , Maneechote C , Piriyakuntorn C , Sripusanapan A , Kongkaew A , Thanyaratsarun T , Chattipakorn S C , Chattipakorn N 
Published: October 2024

Abstract

Background
Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a class of antidiabetic drugs that has demonstrated cardiovascular benefits in heart failure patients, regardless of diabetic status. Although current evidence regarding the role of SGLT2i in myocardial infarction (MI) is still limited, a recent randomized study reported the favorable effects of dapagliflozin on cardiometabolic outcomes in post-MI patients. Nevertheless, the evidence of the underlying mechanism of SGLT2i in post-MI is still unclear.

Purpose
We aimed to investigate the cardioprotective effects and cellular mechanisms of SGLT2i in post-MI rats.

Methods
72 male Wistar rats were divided into two groups: the MI group, which underwent surgery involving permanent ligation of the left anterior descending coronary artery to induce MI (n=58), and the sham group, which underwent a sham operation (n=14). One-week post-surgery, echocardiography was performed. For inclusion in the MI group, only rats exhibiting anterior wall akinesia and a left ventricular ejection fraction (LVEF) &lt; 50% were considered. Subsequently, MI rats were stratified into three groups to receive different interventions: 1) MI+VEH (distilled water, PO, n=13), 2) MI+DAPA (dapagliflozin, 1 mg/kg, PO, n=11), and 3) MI+ENA (enalapril, 10 mg/kg, PO, n=14). After 8 weeks of treatment, echocardiography was performed again. Then, the rats were sacrificed, and heart tissues were used to determine mitochondrial function and protein expressions.

Results
After 8 weeks of treatment, the MI+VEH group exhibited a decrease in LVEF compared to the sham group (Fig. 1A). The MI+VEH group was associated with cardiac mitochondrial dysfunction, as indicated by increased mitochondrial oxidative stress, mitochondrial membrane depolarization, and mitochondrial swelling, and impaired mitochondrial biogenesis, as indicated by decreasing peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) expressions (Fig. 1B-F). Treatment with dapagliflozin and enalapril effectively attenuated left ventricular (LV) systolic dysfunction, reversed mitochondrial dysfunction, and restored mitochondrial biogenesis induced by MI (Fig. 1A-F).

Conclusion
SGLT2i could attenuate LV dysfunction and restore mitochondrial dysfunction in post-MI rats. These findings demonstrate SGLT2i as a novel cardioprotection against post-MI complications.