bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antiplatelet therapy and prognosis at the onset of stent thrombosis
Authors: Matsuoka Y , Sotomi Y , Hikoso S , Nakatani D , Okada K , Dohi T , Kida H , Sunaga A , Tsujimura T , Kikuchi A , Tanaka A , Kosugi S , Ichibori Y , Ishihara T , Sakata Y 
Published: November 2023

Abstract

Background/Introduction
Antiplatelet therapy is the standard therapy after stent implantation. Stent thrombosis (ST) has dramatically decreased by appropriate antiplatelet therapy and advancement in stent technology, but remains a life-threatening event if it occurs. Some patients develop ST even under intensive antiplatelet therapy (dual antiplatelet therapy; DAPT). The association of prognosis of ST and antiplatelet therapy at the onset of ST is unclear.

Purpose
We aimed to investigate the association of prognosis and antiplatelet therapy at the onset of ST.

Methods
We used the database of Long-term Outcomes following Occurrence of Stent Thrombosis registry, a multicenter, retrospective, observational study (Long ST registry). Definite ST cases from January 2008 to December 2017 were enrolled, and long-term clinical outcomes were investigated.

Results
A total of 187 patients (male: 86.1%, median age at the time of ST: 69.0) were eligible. Ninety patients were under DAPT at the onset of ST (DAPT group), whereas 97 patients were under single antiplatelet therapy or no antiplatelet therapy (non-DAPT group). The median follow-up duration was 1054.0 (inter-quartile range, 239.5 – 1850.0) days. Findings of intravascular ultra sounds at the time of ST were similar between two groups. Patients in DAPT group were independently associated with higher incidence of major adverse cardiac events (MACE: a composite of cardiovascular death, nonfatal myocardial infarction, and target lesion revascularization) than in non-DAPT group (adjusted hazard ratio: 2.36, 95% confidence interval [1.27 - 4.34], P value = 0.006).

Conclusion
Patients who developed ST under DAPT were independently associated with a higher incidence of MACE than patients under single or no antiplatelet therapy.
Intensity of dual antiplatelet therapy based on thrombotic and bleeding risks after coronary stenting
Authors: Kim J S , Jeong Y H , Ahn J H , Kang M G , Koh J S , Park Y W , Hwang S J , Hwang J Y , Park Y H , Hwang K W , Lee S H , Lee S Y , Choi J H , Kim S H , Lim J H 
Published: November 2023

Abstract

Background/Introduction
High thrombotic risk (HTR) features are associated with higher ischemic rate, which may be mitigated by potent antiplatelet therapy. However, concomitant high bleeding risk (HBR) may be present, making it unclear whether the intensity of antiplatelet therapy should be prioritized.

Purpose
This study investigated the prognostic implications of HTR and HBR strata according to intensity of antiplatelet therapy (indicated by platelet reactivity) after coronary stenting.

Methods
HTR was defined as having at least one of the three risk factors: 1) index presentation with acute coronary syndrome; 2) complex coronary artery disease and stenting; and 3) guideline-directed clinical ischemic risk factors. HBR was determined according to presence of Academic Research Consortium (ARC)-HBR criteria. In addition, high platelet reactivity (HPR) was decided depending on the level of platelet reactivity (&gt; 208 P2Y12 reaction unit measured by VerifyNow assay).

Results
Among 4,550 patients, HTR features were observed in 3,973 patients (87.3%) and 1,451 (31.9%) met the ARC-HBR criteria. HPR phenotype (n=2563, 56.3%) significantly increased the risk of 4-year ischemic events (adjusted hazard ratio [HRadj]: 1.40; 95% confidence interval [CI]: 1.15-1.70; P=0.001). Among patients who met the ARC-HBR criteria, HPR was not associated with the rate of ischemic events, regardless of HTR features. In cases of non-HBR patients, HPR phenotype increased ischemic events only in patients with HTR feature(s), which risk proportionally increased according to the number of HTR features (HRadj: 0.67, 1.47 and 1.58; 95% CI: 0.22-2.08, 0.94-2.29 and 1.09-2.28 in 0 [9.2%], 1 [31.2%] and ≥2 [27.7%] HTR features). In HBR patients, the risk of major bleeding was not increased by the level of antiplatelet effect.

Conclusion
HPR phenotype was significantly associated with the risk of ischemic events after coronary stenting, which proportionally increased according to the number of HTR features only if the ARC-HBR criteria were not present. These observations suggested that when concordant, bleeding risk, more than ischemic risk, should inform decision-making on the intensity of antiplatelet therapy.KM curve and HR forest plot for MACCEKM curve and HR forest plot for NACE
The association between the hsCRP/BMI ratio and cardiovascular prognosis in CAD patients
Authors: Yang J I E , Zhang K U O , Wang Y U A N , Tang Y I D A 
Published: November 2023

Abstract

Background
Some researchers have explored the influence of hsCRP on cardiovascular outcomes stratified by BMI in subjects with known CAD. However, it is unclear whether a novel composite biomarker, the high-sensitivity C-reactive protein (hsCRP)-to-BMI ratio (CBR), is associated with poor prognosis in patients who underwent percutaneous coronary intervention (PCI).

Aim
We conducted the present study to evaluate the association between the CBR and poor prognosis in CAD patients undergoing percutaneous coronary intervention (PCI).

Methods
A total of 9,810 patients were prospectively included in the present study. All the participants were classified into 3 groups based on their CBR levels: tertile 1 (CBR ≤ 0.04, n = 3,270), tertile 2 (0.04 &lt; CBR ≤ 0.11, n = 3,270) and tertile 3 (CBR &gt; 0.11, n = 3,270). The primary outcome was defined as major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause mortality, myocardial infarction (MI), stroke, and target vessel revascularization (TVR).

Results
During a mean follow-up of 26.7 months, a total of 1022 MACCEs, 122 all-cause deaths, 392 nonfatal MIs, 156 strokes and 461 TVRs were recorded. The outcomes of Kaplan–Meier analysis showed that the incidences of MACCE and MI increased with high tertiles of the CBR (MACCE: 8.8% vs. 10.3% vs. 12.1%, log-rank P &lt; 0.001; myocardial infarction: 3.3% vs. 4.1% vs. 4.7%, log-rank P = 0.018). Cox regression analysis showed that the CBR was independently associated with long-term MACCEs and MI.

Conclusion
The hsCRP to BMI ratio is independently associated with long-term MACCE and MI in CAD patients undergoing DES implantation.
Synergistic effect of Interleukin-1beta and cholesterol efflux capacity on outcomes in acute myocardial infarction patients
Authors: Materne C , Silvain J , Zeitouni M , Guedeney P , Galier S , Guillas I , Lhomme M , Frisdal E , Vicaut E , Lesnik P , Collet J P , Le Goff W , Montalescot G , Kerneis M , Guerin M 
Published: November 2023

Abstract

Background
Low cholesterol efflux capacity and elevated levels of Interleukin-1ß (IL-1ß) are both associated with residual cardiovascular risk in patients with acute myocardial infarction (MI) and may be used as new biomarkers to identify patients at higher cardiovascular risk. Both pathways are currently evaluated as new therapeutic targets in ongoing clinical trials.

Objectives
We evaluated potential synergetic effect of cholesterol efflux capacity and IL-1ß on recurrent major cardiovascular events (MACE) at one-year in patients with acute ST-segment elevation MI who underwent primary percutaneous coronary intervention.

Methods
Cholesterol efflux capacity and IL-1ß were measured among 2012 ST-segment elevation MI patients enrolled in a prospective cohort. The association of these biomarkers with the primary outcome of MACE (MI, Stroke, or cardiovascular death) was evaluated at one-year follow-up using a multivariate-cox proportional regression analysis. In addition, in-vitro analysis of anti-atherogenic properties of HDL particles was also performed.

Results
Patients with both, a reduced cholesterol efflux capacity and an elevated level of IL-1b, exhibited the highest risk of recurrent MACE at one year compared to patients with both high cholesterol efflux capacity and low IL-1b (adjusted HR: 3.28; 95% CI: 1.83 to 5.89, p&lt;0.0001) (Figure). In this high-risk subgroup, patients exhibited HDL particles defective for ABCA1-dependent efflux capacity with enhanced pro-inflammatory activity as a potential explanation for our clinical findings.

Conclusion
Defective cholesterol efflux capacity and elevated IL-1β increase synergistically the residual cardiovascular risk in MI patients.
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition with evolocumab decreases myocardial inflammation in individuals with acute coronary syndrome (ACS)
Authors: Ziogos E , Harb T , Valenta I , Vavuranakis M A , Williams M S , Blaha M J , Jones S R , Schindler T H , Gerstenblith G , Leucker T M 
Published: November 2023

Abstract

Background/Introduction
Although inflammation is commonly present and often beneficial in the period following tissue injury, prolonged inflammation may impair healing and repair following acute ischemic injury. In addition to its impact on cholesterol metabolism PCSK9 is elevated in patients with inflammatory diseases and is thought to be a pro-inflammatory mediator. The presence and early trajectory of myocardial inflammation, and the impact of PCSK9 inhibition on that trajectory, in patients with an acute myocardial infarction have not been characterized.

Purpose
Our goals were to assess myocardial inflammation in patients with an acute myocardial infarction using 18F-FDG-PET scans obtained at the time of hospitalization for the infarction and at 30-days following the infarction and the impact of PCSK9 inhibition with evolocumab on inflammation in a placebo-controlled, randomized trial.

Methods
Fifty-five participants from the Evolocumab in Acute Coronary Syndrome trials, with a NSTEMI and a troponin-I of &gt; 5 ng/ml or with a STEMI were randomized to placebo (n=30) or to 420 mg SQ of evolocumab (n=25) within 24 hours of admission. 18F-FDG-PET scans were performed within five days (2 [1-4]) of randomization and at 30 days. The myocardial mean Standardized Uptake Value (SUV) in the two randomized groups at baseline and the changes from baseline to 30 days were compared. All participants received guideline-directed therapies for acute infarction.

Results
Mean±SD age of the cohort was 57±13 years, 22% were African American, and 36% were women. There were no significant differences in demographic or clinical characteristics between the two groups. Mean SUV at baseline did not differ between the placebo (2.4±0.5) and the evolocumab (2.7±0.7) groups, p=0.25 for the between groups comparison. Mean SUV decreased in both groups, from 2.4±0.5 to 2.1±0.7 in the placebo group (p=0.05) and from 2.7±0.7 to 1.9±0.5 in the evolocumab group (p &lt;0.0001), and the decrease was less in the placebo group, p=0.039 for the between groups comparison. The percent-change in the placebo group (-10.4%±36%) was also less than the percent change in the evolocumab group (-26.7%±20%), p = 0.04 for the between groups comparison. In addition, the percent of participants in whom the mean SUV units decreased was lower in the placebo group (60%) than in the evolocumab group (88%,), p=0.03 for the between groups comparison.

Conclusion
Myocardial inflammation assessed using 18F-FDG-PET decreases but is still present 30 days following an acute myocardial infarction. PCSK9 inhibition with evolocumab given within the first 24 hours of admission improves resolution of the inflammation. In addition to its marked impact on lipid levels, PCSK9 inhibition has significant anti-inflammatory effects in the early post-infarction setting.
Plaque progression is dependent on the local hemodynamics (time-averaged wall shear stress and TSVI) in combination with the plaque phenotype
Authors: Wentzel J J , De Nisco G , Hartman E , Mazzi V , Chiastra C , Gallo D , Daemen J , Morbiducci U 
Published: November 2023

Abstract

Objective
To investigate the predictive power of TSVI for plaque growth in human coronary arteries in plaques with different phenotypes.

Methods
38 non-stented, non-culprit coronary arteries (MPACT study) were imaged with near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) at the baseline and after 12 months [2]. Coronary reconstructions were based on fusion of the multimodality imaging and used as input for computational fluid dynamics. Vessel-specific flow was measured using Doppler wire and used as input to calculate TAWSS and TSVI [2]. The coronary arteries were subdivided into 1.5 mmx45º sectors and the TAWSS and TSVI were classified as low, mid and high based on the range per vessel. Per sector the plaque growth was quantified as plaque burden (Plaque area/total vessel area*100%) change over time (ΔPAV). Based on the NIRS and OCT data, the sectors were characterized as lipid rich plaque (wall thickness&gt;0.5 mm & NIRS+, lipid rich(OCT)) or plaque without lipid (wall thickness &gt;0.5 mm & NIRS-, fibrous (OCT)) or plaque free wall (wall thickness &lt;0.5 mm &NIRS-, PFW (OCT)). The effect of TAWSS, TSVI and the combination with plaque phenotype on plaque progression was evaluated using Linear Mixed Model in SPSS.

Results
TSVI at baseline was significantly associated with PAV increase, with high PAV for high TSVI (p&lt;0.001). A clear trend emerged for TAWSS, with high PAV for low TAWSS at baseline (Figure 1B). The highest plaque progression at 1-year follow-up was observed for lipid rich plaques (both based on NIRS and OCT) exposed to either low TAWSS or high TSVI (figure 2). Also in the PFW sectors clear plaque progression was observed dependent on either TAWSS or TSVI.

Conclusion
Lipid rich regions exposed to either low TAWSS or high TSVI are at the highest risk for plaque progression. These data suggest that although TAWSS and TSVI have a different mechanism of action on the endothelium, but both actions are involved in plaque progression.Figure 1Figure 2
Calcification of different cardiac structures shown by cardiac CT: how important are lipids?
Authors: Miranda I , Passos M , Gerardo F , Mateus C , Lopes J , Fialho I , Santos P , Loureiro J , Augusto J 
Published: November 2023

Abstract

Background
The relationship between dyslipidemia and atherosclerotic plaque as a risk factor for coronary artery disease is well-established. However, the involvement of lipids in the development of valve and aortic calcification beyond coronary disease is yet to be understood.

Objective
To evaluate the involvement of lipids in the calcification of various cardiac structures as measured by cardiac CT.

Methods
In this single-center study, we analyzed data from 316 consecutive patients who underwent cardiac CT scans between January 2018 and December 2019. Patients with poor imaging quality, constrictive pericarditis, prosthetic valves and/or devices were excluded. The calcium score of various cardiac structures, including coronary arteries (CA), mitral valve (MV), aortic valve (AoV), ascending aorta (AAo), and aortic arch (AAc), was calculated using the Agatston method from non-contrast ECG-gated CT. These scores were then combined to derive the valvular (VA=MV+AoV), total cardiac (TC=CA+VA), total vascular (TV=AAo+AAc), and total cardiovascular (TCV=TC+TV) calcium scores. We then collected data regarding lipid values (total cholesterol, LDL and HDL cholesterol and triglycerides).

Results
275 CT scans were suitable for analysis, 142 were male (52%), with a mean age of 60±12 years (range 26–93 years). A total of 183 (66.7%) patients presented calcification in at least one location. Patients with calcification on any of the prespecified locations had higher prevalence of hypertension, dyslipidemia and type 2 diabetes mellitus (DM) than those without any calcium (p&lt;0.05). The best regression models (using backwards conditional input method) showed that age was a significant predictor of calcification in all locations (and combinations of locations, p&lt;0.05 for all) and HDL cholesterol was a part of these models across all calcifications types, being significant for TC score (p=0.010) and TCV score (p=0.024, see Figure). Patients above the fourth quartile (Q4) of TCV had significantly lower HDL cholesterol levels (47±12 vs 53±16mg/dL, p=0.007). Of note, total cholesterol, LDL cholesterol and triglycerides were not significant predictors of calcification in any location.

Conclusion
Calcification across the cardiovascular system is consistently associated with low HDL cholesterol levels, which extends beyond the traditional association with coronary disease. The calcification effect of HDL is found to be more significant than other lipids, however, the specific contribution of HDL subtypes is not yet fully understood.
Variability of time to healing of Spontaneous Coronary Artery Dissection assessed through coronary CT angiography
Authors: Zilio F , Mochen M , Muraglia S , Borghesi M , Zucchelli F , Todaro D , Bonvicini E , Morat F , Dallago M , Casagranda G , Bonmassari R 
Published: November 2023

Abstract

Background
Spontaneous coronary artery dissection (SCAD) results from a spontaneous, non-traumatic, and non-iatrogenic separation of the coronary arterial wall by intramural hematoma caused by intimal tear or spontaneous hemorrhage that is unrelated to atherosclerosis. SCAD is an important cause of myocardial infarction particularly in young to middle-aged women. Natural history of this condition is poorly understood: spontaneous healing has been demonstrated through coronary angiography in the vast majority of patients at long term follow up, but the timing of healing is still not clear. Nowadays, Coronary CT angiography (CCTA) is emerging as a noninvasive option to evaluate SCAD healing at least for coronary arteries with diameter ≥2mm and could help in understanding the natural history of this condition.

Methods
In this single-centre, retrospective study, patients affected by SCAD between 2017 and 2022 were included. Patients with SCAD involving coronary arteries with diameter ≥2mm who did not undergo percutaneous coronary intervention (PCI) and underwent to at least one CCTA during follow up were evaluated with regard to evolution of SCAD and time to healing.

Results
Among 93 patients for whom diagnosis of SCAD was posed by coronary angiography, 33 conservatively managed patients (84.8% female, mean age 51.8±12.3 years) underwent to at least one CCTA during follow up. At a median time of 49 days (IQR 13 to 82 days), a complete healing of SCAD was demonstrated in 6 patients (18.2%), while most of the patients showed a stability or partial healing and 1 patient (3.0%) an extension of SCAD. During further follow up, of 10 patients who did not show a significant healing at the first CCTA, 4 patients showed a complete healing, while 6 patients showed a stability of SCAD extension or only partial healing at the longest available CCTA follow up (median follow up 191 days, IQR 96 to 249 days). As regards clinical events, no death, myocardial infarctions, or target vessel PCIs were reported during follow up.

Conclusion
Spontaneous healing is commonly seen in SCAD and can be demonstrated by CCTA. However, the timing of complete healing is largely variable between individuals: therefore, studies focusing factors impacting natural history of SCAD are needed.
Association of admission blood glucose to albumin ratio and clinical outcomes in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention
Authors: Zhen C , Zeng L , Lin Z , Lin Z , Tan N , Liu Y , He P 
Published: November 2023

Abstract

Background
It is unclear whether admission blood glucose to albumin ratio (AAR) predicts clinical adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).

Purpose
Here, we explored the predictive value of AAR.

Methods
Patients diagnosed with STEMI undergoing PCI between January 2010 and February 2020 were enrolled. The patients were classified into three groups according to AAR quantiles. In-hospital all-cause mortality was regarded as the primary outcome. Logistic regression, Kaplan-Meier analysis and Cox proportional hazard regression were mainly used to estimate outcomes.

Results
Among the 3,224 enrolled patients, 130 (3.9%) of them suffered in-hospital all-cause mortality and 181 (5.4%) experienced major adverse cardiac events (MACEs). After the adjustment, multivariate analysis demonstrated that an increase in AAR was associated with the increased risk of in-hospital all-cause mortality (adjusted OR: 2.72, 95% CI: 1.47–5.03, p = 0.001) and MACEs (adjusted OR: 1.91, 95% CI: 1.18–3.10, p = 0.009), as well as for long-term all-cause mortality (adjusted HR: 1.64, 95% CI: 1.19–2.28, p = 0.003) and MACEs (adjusted HR: 1.58, 95% CI: 1.16–2.14, p= 0.003). ROC analysis indicated that AAR could accurately predict in-hospital all-cause mortality (AUC = 0.718, 95% CI: 0.675–0.761) and MACEs (AUC = 0.672, 95% CI: 0.631–0.712).

Conclusions
AAR is a novel and convenient independent predictor of all-cause mortality and MACEs both at the in-hospital and long-term levels in STEMI patients receiving PCI.ROC curve of AARKaplan–Meier survival curves