bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive value of d-dimer for plaque rupture, thrombus and worse clinical outcomes in acute coronary syndrome from TACTICS registry
Authors: Sato C , Wakabayashi K , Nishikura T , Kobayashi N , Kondo S , Sugiyama T , Kakuta T , Suwa S , Mori H , Kimura S , Higuma T , Yonetsu T , Mizukami T , Yamamoto M , Shinke T 
Published: November 2023

Abstract

Background
Acute coronary syndrome (ACS) mainly occurs by the rupture of lipid plaques with platelet aggregation. D-dimer (DD) is a primary degradation product and circulating marker of fibrinolysis. The use of DD helps to diagnose thrombosis. The serum DD level may indicate a thrombus within coronary artery in patients with ACS.

Purpose
The present study determined the association of serum DD level on admission with a thrombus within culprit lesion and ACS mechanism assessed by optical coherence tomography (OCT), and clinical outcomes.

Methods and Results
Tokyo/ Kanagawa/ Chiba/ Shizuoka/ Ibaraki active OCT applications for ACS (TACTICS) registry includes 695 consecutive ACS patients who underwent emergent PCI with OCT guidance. Of those, the information of serum DD level was available in 653 cases. Those patients were divided into two groups according to serum DD level on admission: high DD group(≧0.73 μg/ml, n= 328) and low DD group(＜0.73 μg/ml, n= 325). Comparison of type of plaque morphology and thrombus are shown in Figure. ACS patients with high DD level had poor long-term outcomes.

Conclusion
High serum DD level was associated with red-thrombus, plaque rupture, and worse prognosis in ACS. The simple test of DD may give us useful information in clinical practice for ACS.
Biological profiling in the spectrum of acute coronary syndrome: characterizing patients from MINOCA to NSTEMI with different features of the culprit plaque
Authors: D'aiello A , Pedicino D , Bonanni A , Vinci R , Severino A , Ponzo M , Conte C , Cribari F , Filomia S , Brecciaroli M , Grimaldi M C , Montone R A , Massetti M , Crea F , Liuzzo G 
Published: November 2023

Abstract

Background
In the last two decades, the development of procedures and tools such as coronary angiography and optical coherence tomography (OCT) have made it possible to highlight several aspects of acute coronary syndromes (ACS), identifying multiple subgroups such as patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) and ruptured fibrous cap (RFC) or intact fibrous cap (IFC) culprit lesions. The aim of the study is to better characterize the ACS spectrum by evaluating the biological profile of non-characterized NTSEMI, RFC-NSTEMI, IFC-NSTEMI, and MINOCA patients.

Methods
We enrolled 56 consecutive patients presenting with ACS, specifically 16 patients with non-characterized NSTEMI, 12 patients with RFC-NSTEMI, 8 patients with IFC-NSTEMI, and 20 patients with MINOCA. Biological samples were collected and stored. We performed gene expression analysis through qRT-PCR technique for 21 genes.

Results
Our data displayed several differences in gene expression levels involved in inflammation, cellular adhesion, extracellular matrix turnover, and oxidative stress between the groups under examination. We observed no significant difference between non-characterized NSTEMI and MINOCA for all the studied genes. Alongside, MINOCA displayed significantly lower levels of the following genes than RFC and IFC patients: CD44, GPX1, ICAM1, PLA2G7, SOD1, and VEGFA. Furthermore, when compared with IFC patients, MINOCA showed lower levels of EDN1, LGALS8, MMP1, and TNF, and non-characterized NSTEMI showed a lower gene expression of CD31, ICAM1, and PI16. Finally, CD44, EDN1, GPX1, LGALS8, NOS3, SOD1, TFRC, and VEGFA were more expressed in RFC and IFC compared to non-characterized NSTEMI patients.

Conclusions
Our preliminary data, besides exploring new pathways in MINOCA patients, reflects the need for characterization and patients’ stratifications in the clinical management of ACS, since no differences were observed between non-characterized NSTEMI and MINOCA. This result may indicate that a one size fits all approach is not the most suitable since a plaque could be an innocent bystander and should be treated accordingly. A precision medicine approach that recognizes the presence of obstructive plaque and defines the type of culprit plaque (i.e., RFC or IFC) could identify better treatment, for a tailored therapy, allowing better prognosis and quality of life.Figure
Incremental value of physiological indices to predict high-risk plaque detected by NIRS-IVUS
Authors: Kakehi K , Yamada N , Onishi K , Sugimoto K , Funauchi Y , Takase T , Ueno M , Mathumura K , Nakazawa G 
Published: November 2023

Abstract

Background
The vulnerable plaque are called high-risk plaques (HRPs), and coronary computed tomography angiography (CCTA) studies have revealed the following characteristics: (1) lesion plaque density on CT≦30HU (2) positive remodeling, (3) The presence of spotty calcification, (4) ΔFractional Flow Reserve derived from CCTA (FFRCT) or Δ Quantitative Flow Reserve (QFR)≧0.06 has been cited as a feature of these lesions.
Therefore, identification of HRPs in non-culprit lesion is important to reduce future cardiovascular events.

Purpose
The purpose of the study was to determine whether HRP is predictable by incremental values of physiological indices in non-culprit lesions of ACS subjects.

Methods
A total of 137 non-culprit coronary lesions in 31 ACS subjects were retrospectively evaluated by CCTA, FFRCT, QFR and NIRS-IVUS imaging. Each coronary artery was divided into 30mm long segments beginning at the ostium to evaluate lesion vulnerability. By NIRS imaging, plaque with 4-mm maximum lipid-core burden index (maxLCBI4mm) ≥400 was defined as HRP. The relationship between HRP detected by NIRS and CCTA-derived plaque features, delta (Δ) FFRCT, and ΔQFR was evaluated.

Results
CT density, positive remodeling, diameter stenosis, ΔFFRCT, and ΔQFR were significantly associated with HRP, respectively (P&lt;0.05). On multivariable analysis, CT density (OR; 0.95, 95%CI 0.91-0.99, P=0.0001), diameter stenosis (OR; 1.05, 95%CI 1.00-1.10, P=0.03) and ΔQFR (OR; 2119483 , 95%CI 1.75-2561856632475.6, P=0.03) independently predicted HRP, but not ΔFFRCT. ROC analysis for predicting HRP showed greater accuracy with incremental ΔQFR values in the model of CT density and diameter stenosis (AUC 0.93, P&lt;0.0001).

Conclusion
HRP detected by NIRS may be predicted with greater accuracy by integrating QFR values with the assessment of CCTA-derived plaque features.figure1figure2
Impact of coronary physiological phenotypes on the immediate angiography-derived hemodynamic results of percutaneous coronary intervention
Authors: Wang B , Tsai T Y , Hery X Q , Kotoku N O Z O M I , Garg S C O T , Ninomiya K A I , Kageyama S H I G E , Masuda S H I N , Revaiah P C , Reiber J O H A N , Collet C A R L O S , Escaned J A V I E R , Biscaglia S I M O N E , Onuma Y O S H I , Serruys P W 
Published: November 2023

Abstract

Background
Angiography-based technologies can evaluate the physiological phenotypes of coronary artery disease (CAD) and the functional results of percutaneous coronary intervention (PCI), however, few studies have combined these to assess CAD pre- and post-PCI.

Purpose
We investigated the impact of physiological phenotypes of CAD on immediate post-PCI angiography-derived functional indices.

Methods
We analyzed 1004 vessels from three ongoing trials. Pre-PCI physiological phenotypes were characterized according to the angiography-derived pullback pressure gradient index (PPGi) as focal (≥0.66) or diffuse (&lt;0.66). Local disease severity was assessed by instantaneous quantitative flow reserve (QFR) gradient per unit length (dQFR/ds) with a dQFR/ds≥0.025/mm, a "major" gradient. Post-PCI, epicardial and microvasculature functions were assessed using QFR and the index of microcirculatory resistance (angio-IMR), respectively.

Results
Pre-PCI, 327(35.81%) vessels had a PPGi&lt;0.66, whilst 121 (13.25%) had a dQFR/ds&lt;0.025 (Figure1, panel A). Post-PCI, a QFR&lt;0.91 and IMR≥25 occurred in 247 (24.6%) and 310 (30.9%) vessels, respectively (Figure2, panel B). A post-PCI QFR&lt;0.91 was associated with a lower PPGi (Odds ratio [OR]:1.31[1.17-1.47], p&lt;0.001, Figure 1, panel C) but not a dQFR/ds (OR:0.99[0.96-1.02], p=0.453). A post-PCI IMR&lt;25 was not associated with PPGi or dQFR/ds. Worsening in the IMR post-PCI was significantly associated with lower PPGi (1.31[1.16-1.48], p&lt;0.001, Figure 1, panel D) and higher dQFR/ds (1.08[1.02-1.14], p=0.008, Figure 1, panel E) pre-PCI. Higher PPGi was associated with a higher odds ratio of achieving the optimal result (OR per 0.1 increase 1.25, [1.13-1.38], p&lt;0.001, Figure 1, panel F). Multivariable analysis identified PPGi as an independent predictor of a post-PCI QFR≥0.91 and an optimal outcome (QFR≥0.91 and IMR&lt;25, Figure2).

Conclusion
the phenotype of CAD pre-PCI can help predict functional outcome post-PCI, and therefore angiography-derived assessment has an important role in determining treatment strategy and outcome.Figure 1Figure 2
Differential outcomes in FFR-guided versus angiography-guided revascularization strategy according to target non-infarct related vessels: from FRAME-AMI trial
Authors: Jeon H S , Lee J H , Lee J W , Youn Y J , Lee J M , Hahn J Y , Ahn S G 
Published: November 2023

Abstract

Background
Incomplete revascularization of non-infarct related arteries (IRA) leads to worse outcomes in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease (MVD). Outcomes of fractional flow reserve (FFR)- and angiography-guided percutaneous coronary intervention (PCI) for non-IRA may differ according to their location between the anterior descending artery (LAD) and non-LAD.

Aims
We investigated the impact of FFR- versus angiography-guided PCI on clinical outcomes according to the location of non-IRA (LAD versus non-LAD) in AMI patients with MVD.

Methods
This trial was a pre-specified post-hoc analysis of the FRAME-AMI study, an investigator-initiated, randomized, open-label, multicenter trial at 14 sites in Korea. In the FRAME-AMI trial, PCI was performed for non-IRA in 64.1% (FFR £0.80) and 97.1% (diameter stenosis of &gt;50%) in FFR-guided PCI and angiography-guided PCI groups, respectively. We grouped the patients into four according to treatment strategy (FFR versus angiography) and location of non-IRA (LAD vs. non-LAD). The primary endpoint was a composite of time to death, MI, or repeat revascularization.

Results
Patients with non-IRA involving LAD and non-LAD were 55.0% and 45.0%, respectively. The proportion of performed PCI (82.2% vs. 78.3%, p=0.242) and the rate of the primary outcome (9.4% vs. 11.5%, p=0.421) were similar between LAD and non-LAD. Among patients with non-IRA involving LAD, the FFR-guided group had a fewer events rate of the primary outcome than the angiography-guided group (5.7% vs. 14.3%, p=0.010). Among those with non-IRA not involving LAD, the FFR-guided group tended to the lower incidence of the primary outcome compared to the angiography-guided group (7.4% vs. 14.5%, p=0.081). However, the effect of the interaction between LAD and non-LAD on the primary outcome was not found (p for interaction 0.667).

Conclusions
In AMI patients with MVD, FFR-directed PCI for non-IRA was superior to angiography-guided PCI regardless of the location of non-IRA. The benefit of an FFR-directed revascularization strategy for non-IRA is likely enhanced in LAD.
In-hospital prognosis of recreational drug use in patients with acute ST-elevation myocardial infarction: insights from the ADDICT-ICCU study
Authors: Clement A , Pezel T , Ramonatxo A , Roule V , Picard F , Swedsky F , Amri N , Maitre-Ballesteros L , Coppens A , Bouali N , Guiraud-Chaumeil P , Gall E , Lequipar A , Henry P , Dillinger J G 
Published: November 2023

Abstract

Background
Although recreational drug use may induce ST-elevated myocardial infarction (STEMI), its prevalence in patients hospitalized in intensive cardiac care units (ICCUs), as well as its short-term cardiovascular consequences, remains unknown.

Purpose
To assess the prevalence of recreational drug use and its prognosis for in-hospital major adverse cardiac events (MACEs) in patients with STEMI.

Methods
From April 7 to 22, 2021, the Addiction in Intensive Cardiac Care Unit (ADDICT-ICCU) study included prospectively 1575 patients admitted to ICCUs with a systematic urine multidrug test in 39 ICCUs across France. This prespecified study focuses on patients admitted for STEMI. The following recreational drugs were detected within two hours after admission to the ICCU: i) tetrahydrocannabinol including cannabis and marijuana; ii) cocaine; iii) amphetamines; iv) MDMA; and v) heroin and other opioids. Administration of morphine for pain sedation during the initial management of patients was recorded, and their urine test for opioids was considered negative. The primary endpoint was MACEs defined by death, resuscitated cardiac arrest, or cardiogenic shock.

Results
Among the 325 patients with STEMI (age 62±13 years, 79% men), 41 (12.6%) had a positive test (cannabis: 88%, opioids: 37%, cocaine: 10%, MDMA: 5%). The prevalence of drug use increased to 34% in patients under 50 years of age. Recreational drug users were more frequently men (93% vs. 77%, p=0.02), younger (50±12 years vs. 63±13 years, p&lt;0.001), and more active smokers (78% vs. 34%, p&lt;0.001). Multiple drug use was reported in 16 cases (39%). Of the 41 patients with recreational drug use, 22 (54%) self-reported the use of recreational drugs on admission. During hospitalization, 17 MACEs occurred (5.2%), including 6 deaths (1.8%), 10 cardiogenic shocks (3.1%), and 7 cardiac arrest events (2.2%). Ventricular arrhythmia was more frequent in recreational drug users (9.8% vs. 1.4%, p=0.01). Use of recreational drugs was associated with more MACEs after adjustment for comorbidities (OR=13.6; 95%CI: 3.6-57.3).

Conclusion
In patients with STEMI, recreational drug use is prevalent, especially in patients under 50 years of age, and is independently associated with an increase of MACEs with more ventricular arrhythmia.Prevalence of recreational drug usePrognosis of recreational drug use
Adherence to guideline-directed medical therapy and 3-year clinical outcome following acute myocardial infarction
Authors: Hyun D , Lee S H , Choi J , Yoon C H , Cha K S , Oh S K , Seong I W , Jeong M H , Choi J H 
Published: November 2023

Abstract

Aims
Despite the well-established clinical benefits and strong recommendations in clinical guidelines, adherence to guideline-directed medical therapy (GDMT) is known to be insufficient. We investigated the adherence to GDMT and its impact on the 3-year clinical outcomes in patients with acute myocardial infarction (AMI).

Methods and results
Source data were obtained from KAMIR-NIH, a Korean multicenter observational registry. GDMT was defined according to the ACC/AHA class I recommendations. Adherence to GDMT was assessed at discharge and every year thereafter. The differences in clinical characteristics between patients receiving and those not receiving GDMT were adjusted using propensity score matching (PSM) or inverse probability of treatment weighting (IPTW). The primary endpoint was major adverse cardiovascular events (MACE), which was a composite of all-cause death and non-fatal MACE, including MI, revascularization, or stroke. Of 12,815 patients, GDMT adherence was 70.2% at discharge, and decreased gradually into 54.6% at 3-year. GDMT at discharge was associated with lower MACE risk in the unadjusted analysis (HR=0.51, 95%CI=0.47–0.55, p&lt;0.001) and also in the PSM- or IPTW-adjusted analyses (HR=0.77, 95%CI=0.69–0.86; HR=0.79, 95%CI=0.72–0.86; p&lt;0.001, all). These findings were replicated in the 1-year or 2-year landmark analyses (HR=0.58 to 0.82, p&lt;0.01, all).

Conclusion
Adherence to GDMT was suboptimal among patients with AMI in Korea. As the adherence to GDMT was associated with a lower incidence of MACE during 3-year follow-up, the maintenance of long-term GDMT might be crucial for patients with AMI.Structured Graphical Abstract
Checkpoint nano-degrader to transiently promote efferocytosis in acute myocardial infarction
Authors: Gao J , Ge J U N B O 
Published: November 2023

Abstract
The efferocytosis of apoptotic cardiomyocytes (CMs) after acute myocardial infarction (AMI) is required for inflammation resolution and cardiac repair. However, this process would be impaired by the elevated CD47 presentation on apoptotic CMs. Herein, we developed CD47 density-controlled senescent RBC-mimetic liposome (RLP) as a nano-degrader to promote receptor signal-regulatory protein alpha (SIRPα) mediated internalization and transiently inhibit CD47-SIRPα axis. We demonstrated that RLP modified with Ly6G antibody hitchhiked neutrophiles and was released to macrophages in the border area of the infarct heart, which was subsequently internalized through SIRPα and degraded in lysosome. CD47-SIRPα axis blockade consequently promoted the efferocytosis of apoptotic CMs and lead to decreased infarct area and anti-inflammatory microenvironment for improved cardiac remodeling. This nano-degrader from senescent RBC-mimetic liposome presents a practical membrane protein degradation strategy to transiently inhibit CD47-SIRPα axis and boost apoptotic CMs efferocytosis.
One-month dual antiplatelet therapy following stent implantation in patients with acute coronary syndromes and high bleeding risk
Authors: Pivato C A , Musto C , Paolucci L , Testa L , Pacchioni A , Briguori C , Esposito G , Lucisano L , De Luca L , Latini A C , Regazzoli D , Sardella G , Indolfi C , Condorelli G , Stefanini G G 
Published: November 2023

Abstract

Background/introduction
There is a paucity of data regarding the safety of a one-month dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) presenting with acute coronary syndromes (ACS).

Purpose
We aimed to compare the clinical outcomes of patients at HBR with ACS or chronic coronary syndromes (CCS) treated with PCI using bioresorbable-polymer everolimus-eluting stent followed by one-month DAPT.

Methods
This is a pre-specified sub-analysis of the POEM trial, an interventional, prospective, multicenter, single-arm trial, that evaluated the safety of PCI with bioresorbable-polymer everolimus-eluting stent followed by one-month DAPT in patients with HBR against an objective performance criterion (OPC). The OPC was derived from the reported 1-year primary endpoint rate of 9.4% observed in the LEADERS FREE trial. According to the POEM protocol, patients were treated with one-month DAPT. In case of need for anticoagulation, patients received an oral anticoagulant in addition to a P2Y12 inhibitor for one month, followed by oral anticoagulation only after that. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months.

Results
263 (59.4%) patients with CCS and 180 (40.6%) patients with ACS were included. Most of the HBR inclusion criteria were comparable between the two groups, Figure 1. At one year, the rates of the primary outcome were 4.3% (95% CI, 2.4-7.6%) and 5.7% (95% CI, 3.1-10.3%) among patients with CCS and ACS, respectively. Both 1-sided 97.5% upper confidence limits of the risk difference between the primary outcome and the prespecified OPC of 9.4% were below the non-inferiority margin of 3.85 % (CCS: -1.8 %; ACS: 0.9 %), Figure 2. No significant difference was evident between CCS and ACS patients for each isolated component of the primary endpoint (cardiac death: 1.7% vs. 2.0%, p= 0.857; myocardial infarction: 3.9% vs. 3.1%, p= 0.934; definite/probable stent thrombosis: 1.2% vs. 0.8%, p= 0.689). The risk for Bleeding Academic Research Consortium (BARC) type 1-5 or type 3-5 bleedings was also similar between CCS and ACS patients (4.3% vs. 5.2%, p=0.677, and 1.6% vs. 2.9%, p=0.351, respectively).

Conclusions
Among HBR patients with ACS who underwent PCI with BP-EES, a one-month DAPT strategy is associated with a similar risk of ischemic and bleeding events compared to those with CCS. These findings support the hypothesis that DAPT should be tailored to patients’ bleeding risk profiles and that a one-month strategy might be safely applied also in a particular setting of ACS.Figure 1.HBR inclusion criteria.Figure 2.Primary endpoint analysis.
Incremental value of a CCTA-derived AI-based ischemia algorithm over standard CCTA interpretation for coronary ischemia in patients with suspected coronary artery disease
Authors: Nabeta T , Bar S , Maaniitty T , Min J K , Earls J P , Bax J J , Saraste A , Knuuti J 
Published: November 2023

Abstract

Background
Coronary computed tomography angiography (CCTA) is a widely used non-invasive test to diagnose coronary artery stenosis in patients with suspected coronary artery disease (CAD). Positive predictive value for ischemia has been suboptimal using clinical reading. A novel AI-based ischemia algorithm applying machine learning that considers an array of atherosclerotic and vascular morphology features from CCTA images has been suggested to improve the diagnostic performance for ischemia.

Purpose
This study aims to evaluate the incremental diagnostic performance of CCTA derived AI-based ischemia algorithm in evaluating myocardial ischemia.

Methods
Patients with suspected CAD referred for CCTA at Turku University Hospital from February 2007 to December 2016 were analysed. The AI-based ischemia algorithm was calculated by analysts blinded for patient characteristics and clinical outcomes using typically-acquired CCTA images. In diagnostic reading significant stenosis defined by a stenosis &gt; 50% on CCTA. The reference standard was ischemia detected by stress 15O-H2O positron emission tomography (PET).

Results
A total of 1445 patients (mean age 63 ± 9 years, 46% male) were included in this analysis. Myocardial ischemia by PET was detected in 384 (27%) patients while the other patients had either normal PET or had non-obstructive CAD by CCTA. A positive AI-based ischemia algorithm was found in 431 (30%) patients. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the AI-based ischemia algorithm for the assessment of myocardial ischemia were 83%, 74%, 86%, 66%, and 90%, respectively. Compared with diagnostic reading of CCTA (area under the receiver operating characteristic curve [AUC], 0.853; 95%CI 0.832-0.874), the model including clinical reading and AI-based ischemia algorithm demonstrated superior discrimination of myocardial ischemia (AUC 0.883; 95%CI 0.863-0.904, p-value &lt;0.001). (Figure)

Conclusions
A novel AI-based ischemia algorithm derived from CCTA improves diagnostic accuracy compared with clinical reading of CCTA in assessing myocardial ischemia by PET perfusion imaging in patients with suspected CAD.Figure