bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distal versus conventional transradial access for coronary angiography: a pooled analysis from the randomized RAPID trial
Authors: Stiermaier T , Gruenewaelder M , Paetz T , Rawish E , Joost A , Meusel M , Marquetand C , Kurz T , Schmidt T , Frerker C , Fuernau G , Eitel I 
Published: October 2024

Abstract

Background
Transradial access (TRA) is the recommended approach for coronary procedures considering safety benefits over femoral access with radial artery occlusion (RAO) being the most frequent complication. Although usually not clinically significant, the presence of RAO affects potential future procedures and medical treatments. Distal TRA (dTRA) has been suggested to reduce the risk of postprocedural RAO compared to conventional TRA (cTRA) with, however, inconsistent results in clinical trials.

Purpose
This study aimed to compare the efficacy and safety of dTRA versus cTRA in patients undergoing diagnostic coronary angiography.

Methods
The RAPID trial is a single-center, open-label, 2x2 factorial, randomized study of patients undergoing coronary angiography through a 6-F radial access. The trial was stopped early by the data and safety monitoring board after the second pre-planned interim analysis and inclusion of 600 participants. Patients were randomized to dTRA or cTRA with further stratification according to periprocedural heparin use and preexisting oral anticoagulation. The primary endpoints were the incidence of RAO assessed by vascular ultrasound and puncture-site related bleedings.

Results
The final study population consisted of 298 patients randomized to dTRA and 302 patients to cTRA. Periprocedural heparin was administered in 382 patients (63.7%) and percutaneous coronary intervention was performed in 161 cases (26.8%) without differences between the study groups (p=0.700 and p=0.465; respectively).
Distal TRA was associated with a significantly increased number of puncture attempts (2.4 ± 2.0 versus 1.5 ± 1.2; p&lt;0.001) and failed punctures leading to access site crossover (11.7% versus 5.0%; p=0.003). Consequently, the total procedure time was longer in the dTRA group (30 min versus 25 min; p=0.004) without increasing fluoroscopy time (p=0.320), dose area product (p=0.245), or contrast volume (p=0.884). Patent hemostasis was achieved in 91.7% of patients with cTRA. The rates of RAO (16.1% versus 15.6%, p=0.855) and puncture-site related bleedings (6.7% versus 8.3%; p=0.466) were similar in both groups.

Conclusions
According to this study, dTRA does not reduce the risk of RAO or bleeding events compared to cTRA.
Simulation training for invasive cardiovascular procedures: the Heart-SIMS-1 study
Authors: Santos M , Guerreiro C , Lobo B , Marinho A , Rosa J , Santos E , Costa M , Goncalves L , Cacao R , Capinha J , Carvalho P , Pires De Morais G , Silva Marques J , Khokhar A 
Published: October 2024

Abstract

Introduction
Interventional cardiology training has a long learning curve and exposes patients and clinicians to undesirable procedural risks. We aim to assess whether mentored simulation-based training with three dimensional (3D) printed models can improve the procedural skills and safety performance of beginners in coronary diagnostic procedures.

Methods
Twenty-nine final-year medical students from a single centre were lectured in the basic principles of invasive coronary angiography (ICA) for one-hour, and then randomized to conventional training or simulation training. Conventional training (n=15) consisted in watching a 20-minute video demonstrating all ICA steps in a 3D-printed coronary simulator. Simulation training (n=14) offered the same explanations in a hands-on training session with the 3D-printed model, in pairs, for 20 minutes. The co-primary endpoint was efficacy and safety of performing a simulated ICA in the 3D-printed simulator, installed under sterile drapes, in a conventional angiography suite. Efficacy and safety were graded by a blinded investigator using a pre-specified performance checklist, including the identification of procedural "red flags", graded 0-100%. The secondary endpoint was theoretical knowledge, assessed in a 25-question multiple-choice quiz, graded 0-100%.

Results
All participants completed the training and evaluation phases. Both elements of the co-primary endpoint were superior in the simulation group: efficacy score of 91.5 ± 3.8 vs 64.6 ± 8.3% and safety score 100.0 (100.0-100.0) vs 62.5 (20.8-79.2) %, p&lt;0.001. The median number of "red flags" were 2 (1-4) in conventional and 0 (0-0) in simulation training recipients (p&lt;0.001). Secondary endpoint was higher in simulation training: 85.7 ± 9.0 vs 76.8 ± 12.7% (p=0.039).

Conclusion
Mentored simulation-based training of medical students in ICA with 3D-printed models resulted in improved performance regarding efficacy, procedural safety, and theoretical knowledge.ResultsSimulation and evaluation setup
Peri-procedural complications in patients with chronic thromboembolic pulmonary hypertension who underwent balloon pulmonary angioplasty
Authors: Staal D P , Van Leusden F J , Van Thor M C J , Rensing B J M W , Van Kuijk J P , Mulder B J M , Van Den Heuvel D , Boerman S , Mager J J , Post M C 
Published: October 2024

Abstract

Background
Complication rate in patients with chronic thrombo-embolic pulmonary hypertension (CTEPH) who undergo balloon pulmonary angioplasty (BPA) is high, especially in patients with compromised pulmonary hemodynamics.

Purpose
Here we describe complications based on the new definition in a cohort of CTEPH patients who underwent BPA.

Methods
All patients with CTEPH who completed BPA treatments before September 15th 2023 were selected from the CTEPH database. Peri-procedural complications were collected and classified according to the 2023 consensus paper on BPA in CTEPH patients. Complications were analyzed in subgroups of patients with pulmonary vascular resistance (PVR) or &gt;6.6 WU and mean pulmonary artery pressure (mPAP) or &gt;45 mmHg at first BPA.

Results
In total, 87 patients (63.2% women; mean age 61.1±14.0 years; 62.1% on dual PH targeted medical therapy) underwent 426 (mean 4.9±1.6 per patient) BPAs. Non-severe complications occurred in 59 (13.8%) of the interventions; in 47.1% of the patients; 64.4% were thoracic, and 35.6% were non-thoracic complications. The thoracic complications were mostly mild (71.1%) or moderate (28.9%), and none were severe. Patients with a PVR &gt;6.6 WU (n=8) underwent more BPA-procedures (6.6±1.5 versus 4.6±1.5, p=0.002), had more overall complications (87.5% versus 40.6% of patients, p=0.020), and more thoracic complications (17.0% vs 6.8% of BPAs, p=0.013) than patients with PVR 6.6 WU. Patients with mPAP &gt;45 mmHg (n=13) also had more BPA-procedures (6.5±1.7 versus 4.6±1.4, p&lt;0.001), more overall complications (76.9% versus 43.5% of patients, p=0.027) and more thoracic complications (14.1% versus 7.9% of BPAs, p=0.039) than patients with mPAP 45 mmHg.

Conclusions
Complications occurred in 13.8% of BPA procedures and were mostly mild. Patients with increased pulmonary hemodynamics at baseline suffered more (thoracic) complications.Overview complications
Very short-term effects of single dose of proprotein convertase subtilisin kexin 9 inhibitor therapy before percutaneous coronary intervention
Authors: Kataoka T , Uzui H , Morishita T , Nomura R , Tsuji T , Shimizu T , Mukai M , Sato Y , Miyoshi M , Yamaguchi J , Ikeda H , Tama N , Hasegawa K , Ishida K , Tada H 
Published: October 2024

Abstract

Introduction
Several pioneering studies have reported that continuous administration of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor reduces cardiovascular events and plaque volume on intravascular ultrasound and increase the thickness of the fibrous-cap on optical coherence tomography after 52-76 weeks.[1,2] However, the effect of PCSK9 inhibitors in very short period of time has not adequately been evaluated.

Purpose
This study aimed to investigate the effect of the single dose of PCSK9 inhibitor in regard to serial change of plaque composition in very short period with near-infrared spectroscopy with intravascular ultrasound (NIRS-IVUS).

Methods
This prospective, single arm, single-center, interventional study included 27 consecutive coronary artery disease patients (silent myocardial ischemia and stable angina) who performed NIRS-IVUS at the time of coronary angiography for diagnosis between June 2021 and August 2023. Maximal lipid-core burden index over any 4-mm segment (max-LCBI4mm) and total lipid-core burden index (T-LCBI) at the target lesions were assessed with NIRS-IVUS and they were administered evolocumab 420mg. After 2 to 6 weeks, percutaneous coronary intervention (PCI) was performed on a standby basis and repeat NIRS-IVUS were performed at PCI.

Results
The median max-LCBI4mm showed a significant decrease from 387 to 315 (IQR: 268 to 572 and IQR: 221 to 488, respectively; p = 0.02) in a lesion-wise analysis. The median T-LCBI also showed a significant decrease from 160 to 117 (IQR: 105 to 263 and IQR: 65 to 226, respectively; p = 0.02). Minimum lumen area and minimum lumen diameter showed no significant changes.

Conclusions
Single dose of PCSK9 inhibitor therapy before PCI resulted in significant degression of lipid core plaques identified by NIRS at the target lesion in very short period of time.Changes of max-LCBI4mmChanges of T-LCBI
Association between stent implantation results and target vessel failure after IVUS-Guided PCI: A FLAVOUR substudy
Authors: Tu S , Wang Z , Yang S , Wu P , Ding D , Zhang J , Hu X , Liu X , Shi H , Yu W , Qu X , Sun Y , Wijns W , Wang J , Koo B 
Published: October 2024

Abstract

Background
Despite substantial advancements in coronary stent systems and implantation techniques, target vessel failure (TVF) remains a clinical issue to be addressed.

Purpose
We used deep learning algorithms for automatic stent analysis of intravascular ultrasound (IVUS) data to identify stent implantation characteristics associated with TVF.

Methods
In patients from the IVUS-guided group of the FLAVOUR trial who had undergone successful stenting, validated deep learning algorithms were applied to IVUS images to delineate plaque and stent strut for the quantification of stent expansion, apposition, and residual plaque burden. Stent overexpansion was defined as stent area exceeding 120% of the hypothetical healthy lumen area. Murray law-based quantitative flow ratio (μQFR) was also assessed from angiographic images. The primary endpoint was TVF at 2 years, defined as a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target vessel revascularization.

Results
A total of 459 vessels in 441 patients were included, with TVF events occurred in 15 vessels (3.3%) during the 2-year follow-up. Stent analysis was performed in 687,379 stent struts from 70,369 IVUS image frames of the interrogated vessels with the assistance of specific deep learning algorithms. On vessel-level multivariate analysis adjusting for procedural covariates, stent overexpansion length &gt;5 mm (hazard ratio, 4.57; 95% confidence interval [CI], 1.31 to 15.92; P=0.017), residual plaque burden at proximal stent edge &gt;50% (hazard ratio, 3.34; 95% CI, 1.19 to 9.33; P=0.022), and post-PCI μQFR &lt;0.90 (hazard ratio, 5.09; 95% CI, 1.62 to 15.97; P=0.005) were more likely to be present in vessels with TVF events than in those without.

Conclusions
Besides the established indexes of post-procedural residual plaque burden and low μQFR, deep learning-powered IVUS stent overexpansion was significantly associated with increased risk of TVF.Suboptimal stenting results and TVF
Serial optical coherence tomography assessment of coronary atherosclerosis and long-term clinical outcomes
Authors: Yamaji K , Watanabe H , Taniwaki M , Akashi R , Kubo S , Ohira H , Numasawa Y , Arikawa M , Iwama M , Kitai T , Tada T , Yamaji Y , Daidoji H , Ono K , Kimura T 
Published: October 2024

Abstract

Background
The impact of high-risk coronary artery plaques identified using optical coherence tomography (OCT) on late luminal narrowing and clinical events remains poorly understood.

Methods
This multicenter prospective study included 176 patients who underwent percutaneous coronary intervention (PCI) and serial OCT at baseline and 1-year follow-up to investigate non-target regions with angiographically intermediate stenosis. The primary outcome measure was luminal narrowing within the matched regions of interest in the non-target regions over a 1-year period. The secondary outcome measures included all-cause death, cardiac death, nonfatal myocardial infarction, and ischemia-driven coronary artery revascularization within 3 years.

Results
At 1 year after PCI, the coronary artery lumen area in non-target regions significantly decreased from 6.06 (95% confidence interval [CI], 5.60–6.53) to 5.88 (95% CI, 5.41–6.35) mm2, with a difference of -0.18 (95% CI, -0.22 to -0.14 mm2; P&lt;0.001). This decrease was pronounced in thin-cap fibroatheromas (TCFAs), thick-cap fibroatheromas, mixed plaques, and fibrous plaques. The prevalence of TCFAs decreased from 3.4% to 3.3% (P&lt;0.001), whereas that of thick-cap fibroatheromas also decreased from 35% to 33% (P&lt;0.001). Patients with TCFA had a significantly higher risk of ischemia-driven non-target vessel revascularization (hazard ratio [HR], 2.42; 95% CI, 1.03–5.71; P=0.04), primarily due to revascularization in the imaged region. The higher prevalence of fibroatheroma was associated with a numerically increased risk of imaged region revascularization (HR per 10%, 1.38; 95% CI, 0.97–1.97; P=0.07). The prevalence of coronary artery calcium significantly increased from 31% at baseline to 34% at 1-year follow-up (P&lt;0.001), accompanied by a significant increase in calcium thickness and angle. Diabetes and current smoking habits were independently associated with increasing calcium prevalence. No significant association was observed between the prevalence of coronary artery calcium and clinical outcomes within 3 years.

Conclusions
Coronary artery lumen area significantly decreased over a 1-year interval, particularly in TCFAs, thick-cap fibroatheromas, mixed plaques, and fibrous plaques. Although no significant association was noted between coronary artery calcium prevalence and clinical outcomes within 3 years, the interaction between calcium progression and long-term clinical events necessitates further investigation.
Coronary stent edge segments as determinant of clinical outcomes: An OCTOBER Trial Substudy
Authors: Bulow Rasmussen S H , Neghabat O , Andreasen L N , Laanmets P , Kumsars I , Bennett J , Olsen N T , Dijkstra J , Christiansen E H , Holm N R 
Published: October 2024

Abstract

Background
Small lumen dimensions and high plaque burden in stent edge segments are known risk factors for subsequent clinical events after percutaneous coronary intervention (PCI). The evidence using intravascular optical coherence tomography is scarce.

Purpose
This study aimed to characterize edge segments after PCI and the relation to clinical outcomes in the randomized OCTOBER trial on bifurcation PCI optimized using optical coherence tomography.

Methods
This is a predefined substudy of the OCTOBER Trial. Edge segments were analysed in detail for degree of stenosis and plaque composition using a dedicated software. Data was planned to be analysed using multi-level cox regression analysis, but descriptive statistics was applied due to very low event rates after OCT-guided PCI. Main endpoints were OCT-detected edge residual stenosis, lipid plaque, calcification, and dissections.
Post PCI coronary angiography was analysed for diameter stenosis, edge segment length and minimal lumen diameter. Patients with cardiac events were diagnosed with angiography duringt the two-year follow-up period.

Results
A total of 597 patients were treated with OCT-guided PCI. Analysable final OCT scans with no additional treatment was available for 505 patients in the main vessel and for the side branch in 289 cases. At deadline for abstract submission 242 scans with 474 edges were analysed and included in preliminary results.Lesions with ≥30% diameter stenosis was found in 20% of proximal edges, 24% of distal edges and 37% of side branch (SB) edges. A plaque burdenOCT ≥180° was found in 74% of proximal edges, 48% of distal edges, and 52% of SB edges. A lipid plaque wafound in 35%, 11% and 14%, dissections in 15%, 6% and 12%, and ≥180° calcium was found in 7%, 4% and 4% of edges respectively.
Six patients (1%) of the total OCT-guided population had an edge-related event during the median two-year follow-up. Only two of these 6 patients had post-procedural OCT-scans of the event-related edge, thus 4 of the cases were effectively angiographic guided.

Conclusion
Only a small fraction of edge segments in the OCTOBER Trial were left with residual edge disease exceeding protocol thresholds. This resulted in historically very low rate of edge related events. No evaluation of a stent edge by OCT in otherwise OCT guided patients appeared to be the main predictor of edge related events. Final results are presented at ESC 2024.
Intracoronary nicardipine to induce hypaeremia
Authors: Viscusi M M , Seki R , Leone A , Bertolone D T , Mizukami T , Mahendiran T , Belmonte M , Sonck J , Collet C , De Bruyne B 
Published: October 2024

Abstract

Background
Several pharmacological agents and routes of administration have been used to induce transient maximal hyperaemia, but most suffer from shortcomings that limit their clinical usage. Nicardipine, a dihydropyridine calcium channel blocker, has been proposed as a coronary hyperaemic agent with the advantage of not causing any adverse effects.

Purpose
We compared intracoronary (IC) nicardipine with IC papaverine for obtaining fractional flow reserve (FFR) and pullback pressure gradient (PPG).

Methods and results
This is a prospective, single-center study enrolling stable patients presenting with intermediate coronary artery disease (CAD) undergoing invasive functional assessment. The lowest FFR, duration of the hyperemic plateau, and PPG were assessed after IC nicardipine (400 µg to the left coronary or 300 µg to the right coronary artery) and IC papaverine (12 mg to the left coronary artery and 8 mg to the right coronary artery).

Results
Overall, 107 patients with 108 vessels (216 FFR and 216 PPG paired measurements) were analyzed. The correlation in FFR between nicardipine and papaverine was r = 0.95 (95% CI 0.92 to 0.96, p &lt; 0.001) with a mean difference of 0.02 FFR units (limit of the agreement [LOA]: -0.04 to 0.08). Similarly, the correlation in PPG between nicardipine and papaverine was r = 0.86 (95% CI 0.71 to 0.93, p &lt; 0.001) with a mean difference of 0.01 PPG units (limit of the agreement [LOA]: -0.14 to 0.17). The hyperaemic plateau was significantly longer with nicardipine (101.4 ± 62.1 s nicardipine vs 41.5 ± 14.3 s papaverine, p &lt; 0.001). No significant differences were observed in the magnitude of changes in blood pressure and heart rate (p=NS). No complications occurred with the administration of IC nicardipine or papaverine.

Conclusion
FFR and PPG values obtained following nicardipine administration exhibited excellent agreement with those obtained using papaverine. Moreover, the hyperaemic response induced by nicardipine led to a significantly prolonged steady state in comparison to papaverine. Given its widespread availability, cost-effectiveness, safety profile and frequent utilization in clinical settings, nicardipine emerges as the optimal vasodilator for coronary physiology testing.FFR by Nicardipine vs PapaverinePPG by Nicardipine vs Papaverine
Coronary microvascular dysfunction in heart failure: observations from the MICRO registry
Authors: Velollari O , Olschweski M , Kresoja K P , Herzog J , Brandt M , Schnitzler K , Knorr M , Wenzel P , Lurz P , Gori T 
Published: October 2024

Abstract

Background
Heart failure (HF) is one of the leading causes of hospitalization in the elderly. Coronary microvascular dysfunction (CMD), among other risk factors, is linked to the pathogenesis and clinical manifestations of HF.

Purpose
This abstract aims to summarize key findings from a comprehensive analysis of CMD in subgroups of HF, shedding light on its association with hemodynamic parameters.

Methods
Patients experiencing recurrent angina (CCS II-IV) and no relevant epicardial stenosis were enrolled in a prospective registry (MICRO). Epicardial and microvascular responses (pressure, resistance and flow) were assessed at rest and during adenosine and acetylcholine testing. The impact of an elevated left ventricular end-diastolic pressure (LVEDP) in the absence of clinical signs of HF was also investigated.

Results
Overall, 188 patients (63% (118) women, mean age 65±11 years) with angina and no epicardial stenosis were enrolled. Patients with HF (n=26) displayed lower hyperemic flow in response to endothelium-independent adenosine (5.2±3.1 vs. 7.3±4.4; P=0.004), lower coronary flow reserve (2.9±1.5 vs. 4.4±1.1; P&lt;0.001) and microvascular resistance reserve (3.3±2.1 vs. 5.2±2.7; P&lt;0.001), and increased microvascular resistance during adenosine-induced hyperemia (25±21 vs. 17±11; P=0.045). An increased LVEDP without clinical signs of HF was not associated with a lower coronary flow reserve (4.3±1.9 vs. 2.6±1.2; P=0.006) or microvascular resistance reserve (4.9±2.1 vs. 2.8±1.7; P=0.004). Microvascular resistance during acetylcholine (endothelium-dependent)-induced hyperemia was lower in HF patients (36.2±23.5 vs. 57.4±37.8; P=0.018).

Conclusion(s)
Patients with heart failure displayed signs of impaired microvascular endothelium-independent responses while endothelium-dependent reactivity appears to be maintained. An elevated LVEDP without clinical HF was not associated with impaired coronary microvascular function.