bluuebunny/crossref_metadata_2025_split huggingface dataset:
Side branch closure in patients undergoing coronary bifurcation stenting with or without side branch predilatation
Authors: Vassilev D , Mileva N , Panayotov P , Rigatelli G , Gil R 
Published: November 2023

Abstract

Background
Considerable progress in the treatment of coronary bifurcation lesions has been achieved. Side branch pre-dilatation (SPPD) is a technique that is generally not recommended by the latest guidelines and consensus statements. The main reason is the risk of side branch (SB) dissection or vessel closure.

Aim
The aim of the current study is to explore the rates of SB closure in patients undergoing bifurcation PCI with or without SB pre-dilatation.

Methods
All patients with coronary bifurcation lesions treated between 2012 and 2022 were included in the prospective registry. For the current analysis, only patients with stable or unstable angina were included, with follow-up of at least two years. Patients with STEMI and left main stenosis were excluded. Propensity Score Matching (PSM) was performed to equalize the effects of the following characteristics: age, sex, diabetes, smoking, hypertension, dyslipidemia, renal failure, cancer, COPD, atrial fibrillation, left ventricular ejection fraction, and SYNTAX score. SB closure was defined as SB ostial stenosis ≥99% with TIMI 0-1 flow.

Results
832 patients from the registry covered the criteria for the current analysis. After PSM, 324 matched couples remained, and 648 patients were analyzed. The demographic characteristics of SBP(+) and SBP (-) were well balanced, with no differences between groups – age 68±10 years, 71% males, 40% smokers, 47% with diabetes, 26% with previous MI, 53% with previous PCI, 4% after CABG, 12% with peripheral arterial disease, 13% with COPD, 32% with renal failure, 23% AFib, LVEF 55±10%. Patient with SBP(+) wad more CTOs (17% vs. 9%, p=0.003), longer lesions (42±21mm vs. 36±20mm, p&lt;0.001) and more severe SB stenoses (68%±25% vs. 41%±31%, p&lt;0.001). Among true bifurcation stenoses (Medina xx1 – 63%, 410/648), 88% were predilated.
SB closure was non-significantly different in groups with SBPD and SBnPD (3.6% vs. 2.2%, p=0.272). Acute SB closure after stenting occurred at similar rates in SBPD and SBnPD groups (3.6% vs. 2.7%, p=0.505), without difference in rates of MI if SB was closed or not (n=10/17, 59% vs. n=227/631, 36%, p=0.058). The rate of periprocedural MI was not significantly different between groups with and without SB closure – 52% vs. 34%, p=0.066. At the end of the procedure, only 7 SBs were closed, 2 in the SBPD group and 5 in the SBnPD group (p=0.461).

Conclusions
The rates of final SB closure were numerically lower (but not significantly different) when SBPD was performed. SB closure did not translate into worse clinical outcomes.
Trends and outcomes of intravascular imaging in patients undergoing percutaneous coronary intervention for coronary chronic total occlusion: a 5-year retrospective analysis
Authors: Moras E , Gandhi K , Isath A , Wu L , Casso Dominguez A 
Published: November 2023

Abstract

Background
Elderly patients with coronary chronic total occlusions (CTO) represent a vulnerable population with comorbid conditions and complex coronary anatomy. Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). There is limited data on its impact in patients undergoing percutaneous coronary intervention (PCI) for coronary CTO.

Purpose
We aimed to identify the trends in utilization of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in patients undergoing single vessel (SV) - CTO PCI and its impact on clinical outcomes.

Methods
We queried the Nationwide Inpatient Sample database to identify hospitalizations for SV PCI between 2016 – 2020. Patients with CTO were identified using the ICD-10 diagnosis code. The use of IVUS and OCT was identified using the ICD-10 codes. We compared utilization of IVUS-OCT for SV-CTO PCI to those without and studied the impact of their utilization on clinical outcomes. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary outcomes included in-hospital mortality, re-infarction, stroke and post-procedural AKI. Outcomes were compared using univariate and multivariate logistic regression analysis.

Results
A total of 135,745 weighted hospitalizations for SV CTO-PCI were identified of which 13,610 (10%) utilized IVUS/OCT (mean age 66+/-12, 26.5 % females). Hospitalizations were stratified by patient age into a younger cohort &lt;75 years (mean age 61 ± 9 years) and an older cohort ≥75 years (mean age 81 + 4). Male sex, Caucasians, and admissions to a large urban hospital were associated with higher IVUS/OCT use in both cohorts (p &lt; 0.001). The use of IVUS/OCT was associated with significantly lower MACCE (aOR 0.73, 95% CI 0.6 - 0.8, p &lt; 0.001) and lower incidence of re-infarction in both cohorts (OR 0.6, 95% CI 0.5-0.6, p&lt;0.001 for both cohorts). In-hospital mortality was significantly lower in both cohorts utilizing intravascular imaging (OR 0.8, 95% CI 0.7-1.0, p&lt;0.05 for age ≥75 years and OR 0.6, 95% CI 0.5-0.7, p &lt;0.001) for age &lt; 75). Overall, the rates of stroke and length of stay (4 + 5 days) were comparable but associated with higher hospitalization costs (153k-170k vs 110k-120k, p &lt; 0.001). In patients undergoing CTO-PCI, there was an increasing trend towards the utilization of IVUS and OCT over the study period.

Conclusion
The use of IVUS/OCT guidance for CTO-PCI was associated with a significant reduction in MACCE, re-infarction and in hospital mortality regardless of age. There was a significant increase in the utilization of IVUS and OCT for the study period in all groups.
Predictors of residual lipid content detected by near-infrared spectroscopy after elective stenting in patients with chronic coronary syndrome
Authors: Usui E , Sakamoto T , Matsuda K , Nogami K , Ueno H , Hanyu Y , Nagamine T , Hada M , Hoshino M , Kakuta T 
Published: November 2023

Abstract

Backgrounds
Residual lipid-rich plaque (LRP) in stented segments assessed by near-infrared spectroscopy (NIRS) immediately after percutaneous coronary intervention (PCI) is reportedly associated with target lesion failure. However, morphological determinants of residual LRP after elective PCI remains unknown.

Purpose
This single-center observational study aimed to explore morphological and procedural predictors of residual LRP after electing PCI.

Methods
We investigated 340 consecutive patients who underwent elective NIRS-intravascular ultrasound-guided PCI for de novo coronary lesions. Lesions requiring balloon dilatation or debulking before NIRS imaging, requiring ≥2 remote stent deployment in the vessel, being treated with drug-coated balloon, and having insufficient NIRS imaging were excluded. Maximum lipid core burden index in 4mm (maxLCBI4mm) in culprit segment both before and after PCI was assessed by NIRS. Residual LRP was defined as post-PCI maxLCBI4mm in stented lesions &gt;200. Baseline clinical and morphological findings were compared between lesions with versus without residual LRP. Multivariable logistic regression analysis was performed to determine predictors of residual LRP.

Results
A total of 236 de novo lesions in 223 patients were included in the final dataset. After PCI, residual LRP was observed in 69 (29%) lesions. Patients with residual LRP tended to be older than those without residual LRP. Pre-PCI maxLCBI4mm in culprit lesions, plaque burden, and remodeling index were greater in lesions with residual LRP. Post-PCI minimum stent area and expansion index tended to be smaller in lesions with residual LRP. In a multivariable analysis, pre-PCI maxLCBI4mm (per 10, adjusted odds ratio [OR]:1.04; 95% confidence interval [CI]: 1.02 to 1.05; p&lt;0.01) and stent expansion index (per 10%, adjusted OR: 0.80; 95%CI: 0.64 to 0.99; p=0.047) were independently predictive of residual LRP.

Conclusions
In patients undergoing elective PCI, greater pre-PCI maxLCBI4mm and smaller stent expansion were associated with post-PCI residual LRP.
Association between myocardial bridge with transthoracic doppler echocardiography-defined physiological indices and fractional flow reserve before and after elective percutaneous coronary intervention
Authors: Sakamoto T , Usui E , Hoshino M , Hada M , Hanyu Y , Nagamine T , Ueno H , Nogami K , Matsuda K , Yonetsu T , Sasano T , Kakuta T 
Published: November 2023

Abstract

Background
A myocardial bridge (MB) is a coronary variant in which an epicardial coronary artery courses through myocardium. MB can be identified by computed tomographic coronary angiography (CTCA) or invasive coronary angiography (ICA), which is known to be common in left anterior descending artery (LAD). Transthoracic Doppler echocardiography (TDE) noninvasively provides coronary flow information.

Purpose
We aimed to investigate the physiological impact of myocardial bridge on coronary flow dynamics assessed by adenosine-induced stress-TDE before and after elective percutaneous coronary intervention (PCI).

Methods
We examined 93 consecutive patients treated with fractional flow reserve (FFR)-guided elective PCI who underwent pre-PCI CTCA and pre- and post-PCI stress-TDE. We compared patient characteristics, angiographic, physiological data, and stress-TDE-defined coronary flow parameters in patients with versus without MB.

Results
We identified MB in 40 (43.0%) and 15 (16.1%) patients by CTCA and ICA, respectively. All MBs diagnosed by ICA were identified by CTCA. Longer MB was associated with the detectability by ICA. Older age and higher frequency of diabetes mellitus were observed in patients with CTCA-defined MB compared with those without. Pre-PCI FFR was similar in patients with versus without CTCA-defined MB (0.69 [0.61-0.73] vs. 0.69 [0.61-0.75], P=0.92), while post-PCI FFR was significantly lower in patients with versus without CTCA-defined MB (0.82 [0.78-0.86] vs. 0.84 [0.82-0.88], P=0.01). Pre- and Post- PCI hyperemic systolic peak flow velocity (SPV) by stress-TDE was higher in patients with versus without MB by CTCA (36 [26-43] m/s vs. 30 [23-34] m/s, P=0.03 and 38 [32-52] m/s vs. 33 [20-39] m/s, P=0.02, respectively). Pre-PCI hyperemic diastolic peak flow velocity (DPV) by stress-TDE was not significantly different between the 2 groups (49 [39-64] m/s vs. 45 [34-55] m/s, P=0.12), while post-PCI hyperemic DPV was higher in patients with versus without CTCA-defined MB (73 [60-85] m/s vs. 63 [50-81] m/s, P=0.03).

Conclusion
In patients undergoing elective PCI for LAD, a presence of CTCA-defined MB was associated with higher pre- and post-PCI hyperemic SPV and an acceleration of hyperemic DPV after the PCI. Impact of systolic compression by MB on hyperemic DPV at the distal segment accelerated by the treatment of upstream stenosis may lead to lower post-PCI FFR compared with patients without MB.
A novel scoring system devised by an international large-scale coronary bifurcation registry to guide the optimal choice between the 1- and 2-stent strategy: the BIFURCAT Two-Stent (BTS) score
Authors: Jang A Y , Oh P C , Kim M S , Lee K H , Lee J P , Won Y S , Koo B K , Han S H 
Published: November 2023

Abstract

Background and Aims
Previous studies used predefined criteria to evaluate the outcomes of two stents over one stent. We sought to devise a scoring system based on data-driven criteria for the guiding the optimal choice between two approaches.

Methods
We analyzed an international coronary bifurcation cohort with 2nd-generation drug-eluting stents, the combined insights from the unified RAIN and COBIS bifurcation registries (BIFURCAT) registry. The primary endpoint was major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target lesion failure.

Results
We analyzed 5333 patients (mean age: 66.2 years; male: 76%; 1-stent: 82%). We found one clinical and five angiographic factors associated with lower MACE risk when two stents were implanted compared with one. We assigned one point per each component the patient was positive for and defined this as the BIFURCAT Two-Stent (BTS) score. The 2-stent strategy was associated with significantly higher MACE rate in the total patient cohort (HR: 1.49; 95% CI: 1.19-1.87; P&lt;0.001) and BTS score&lt;4 (HR: 2.04; 95% CI: 1.64-2.56; P&lt;0.001). However, the two stents had a lower chance of MACE in BTS score≥4 (HR: 0.56; 95% CI: 0.35-0.89; P=0.014) with or without adjustment for baseline and procedural characteristics and antiplatelet therapy.

Conclusions
Approximately 80% of the patients had low (&lt;4) BTS score that showed favorable outcomes with the 1-stent strategy. However, those with high BTS scores (≥4) proved favorable outcomes with the 2-stent strategy. The BTS score may be able to guide interventionists to select an optimal stenting strategy in bifurcation lesions.
Optical coherence tomography assessment of dissection following Drug-Coated Balloon treatment in de-novo small vessel disease
Authors: Ninomiya K , Huang J , Masuda S , Ding D , Tu S , Dijkstra J , Reimers B , Colombo A , Onuma Y 
Published: November 2023

Abstract

Background/Introduction
Several studies have shown either favorable or unfavorable effects of dissection following drug-coated balloon (DCB) angioplasty. However, there is no established method to precisely assess the extent of dissection during DCB treatment and the relationship between dissection and late lumen gain (LLG) remains unclear.

Purpose
The aim of this study is to develop a new method to quantify the dissection and investigate the impact of dissection volume on angiographic outcomes.

Methods
The present study consisted of patients enrolled in the randomized TRANSFORM-I trial, comparing novel Magic TouchTM sirolimus coated-balloon with SeQuent Please NeoTM paclitaxel coated balloon (PCB) in patients with de-novo small vessel coronary artery disease.
One-hundred lesions in 98 patients were investigated with OCT after pre-dilatation to assess the dissection. A customized software (QCU-CMS, Leiden) precisely quantifies the dissection and lumen volumes separated by a common boundary connecting the two edges of the intimal fracture. Quantitative OCT analysis of dissection volume is derived from cross-sectional slices with a thickness of 200 microns. Tissue composition analysis, using OCT-Deep Learning (DL) (Pulse, Shanghai), at the starting site of the dissection was performed to elucidate the mechanisms triggering the dissection.

Results
The dissection was found in 96% (96/100) of the treated lesions. The median dissection volume was 1.98 (0.57 – 3.89)mm3. The median maximal dissection arc was 113 degree.
The tissue composition analysis showed that the dissection occurs at the thinnest site (320 μm) of fibrous intima (83%) (Figure). The 6-month angiographic outcomes of TRANSFORM-I will be presented at the late breaking session by then the mechanistic determinant of late loss and gain will have been examined in details.

Conclusions
Quantitative OCT analysis of dissection demonstrated that dissection occurs during DCB treatment. Final results with 6-month outcome, relationship between the dissection volume and late lumen loss (LLL) or LLG will be presented at the time of congress.Figure
Increased in-hospital complication risk in women undergoing chronic total occlusion recanalization
Authors: Hamzaraj K , Holzgruber M , Kastrati L , Graf S , Gyoengyoesi M , Lang I , Hengstenberg C , Aschauer S , Distelmaier K , Frey B , Toma A 
Published: November 2023

Abstract

Introduction
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is a complex procedure that requires advanced operator skills and dedicated devices. Despite increasing success rates of up to 95% in experienced centers, in-hospital complications associated with CTO PCI remain high, and predictors of short-term outcomes and complications are yet scarce. Female sex is often observed to be correlated with in-hospital complications in complex interventions, but current evidence related to CTO PCI is ambiguous and inconclusive. Our aim was to investigate the potential impact of sex on individual and composite in-hospital complications associated with CTO PCI.

Methods
We prospectively included patients undergoing CTO PCI at our university-affiliated tertiary care center over four years (2018-2021). In this analysis, we compared comprehensive baseline characteristics and angiographic parameters between men and women and estimated their correlation with a composite endpoint of in-hospital complications using adjusted logistic regression analysis. We presented group differences related to individual component in-hospital complications.

Results
Out of 271 patients undergoing antegrade or retrograde CTO PCI, 222 (81.9%) were men, and 49 (18.9%) were women. Compared with men, women were older (67 ±11 vs. 72±12 years, P=.005) and had less prior PCI (65.8% vs. 44.9%, P=.006). Both groups had comparable angiographic complexity. Overall MACCE was 2.6%, and any in-hospital complication occurred in 8 women (16.3%) and 15 men (6.8%). Univariate analysis showed that sex, J-CTO score, and proximal cap ambiguity were correlated with the primary composite endpoint. By adjusted multivariate analysis, sex was independently associated with any in-hospital complication (OR=.334; CI .129 to .864; P=.024). The results were numerically driven by major bleeding, acute kidney injury, and MACCE.

Conclusion
Our findings suggest that women undergoing CTO PCI are at an increased risk of any in-hospital complication, regardless of clinical severity. Further studies are needed to confirm this finding and explain potential gender disparities in patients undergoing CTO PCI.Clinical and angiography characteristicsIn-hospital complications
Percutaneous coronary intervention versus optimal medical therapy for chronic total occlusion: an updated meta-analysis of randomized controlled trials comparing clinical and health status outcomes
Authors: Gandhi K , Moras E , Isath A , Correa A , Mahmood K , Casso Dominguez A , Tamis-Holland J 
Published: November 2023

Abstract

Background
The prevalence of coronary chronic total occlusion (CTO) varies widely from 18-52% in patients with stable ischemic heart disease. Despite recent advances in operator techniques and improving operator experience, percutaneous coronary intervention (PCI) for CTO still poses a major challenge. While several observational studies have demonstrated superior outcomes for CTO-PCI, the overall benefit of CTO intervention remains controversial.

Purpose
We aimed to compare the clinical endpoints and health status outcomes in all randomized controlled trials (RCT's) to evaluate safety and efficacy of PCI as compared to optimal medical therapy (OMT).

Methods
We queried PubMed/MEDLINE, Cochrane Library and EMBASE for RCT’s that compared CTO-PCI with OMT. The primary endpoint was all-cause mortality. Secondary outcomes included cardiac mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), target vessel revascularization (TLR), stent thrombosis, left ventricle ejection fraction (LVEF) changes and health status outcomes. Risk ratios (RR’s) and their corresponding 95% confidence intervals (CIs) were calculated using the random-effects model.

Results
We included a total of 6 RCT’s (1890 total patients, mean age 61.8±3.6, and 84.6 % male) Follow-up ranged from 4 to 48 months. All-cause mortality and cardiac mortality were comparable between CTO-PCI and OMT groups (RR 0.83; 95% CI 0.47 – 1.48; p = 0.53 and RR 0.98; 95% CI 0.24 – 4.07; p = 0.98, respectively). There was no significant difference between PCI or medical therapy with regards to MACCE (RR 0.85; 95% CI 0.50 – 1.45; p = 0.55) and TLR at follow-up (RR 0.50, 95% CI 0.24 – 1.06; p = 0.07). Moreover, the risk for MI (RR 1.36; 95% CI 0.91 – 2.-2; p = 0.13), stent thrombosis (RR 1.74; 95% CI 0.36 – 8.40; p = 0.49), and stroke at follow-up (RR 0.57; 95% CI 0.24 – 1.38; p = 0.21) was comparable between the two groups. Health status outcomes such as angina frequency (RR 4.05; 95% CI –1.95 – 10.05; p = 0.19), physical limitations (RR 3.83; 95% CI –0.75 – 8.41; p = 0.10), quality of life (RR 6.25; 95% CI –1.54 – 14.03; p = 0.12), and treatment satisfaction (RR 2.60; 95% CI –1.15 – 6.35; p = 0.17), were comparable between the two groups.

Conclusion
Pooled data from RCT does not support an advantage to CTO PCI in terms of a reduction in cardiovascular events or improved quality of life. Further adequately powered and long-term trials are required to identify the best management strategy for patients with coronary CTO.Figure 1Figure 2
Prognostic implications of iron deficiency and supplementation in patients undergoing valvular heart surgery
Authors: Tse Y K , Ren Q W , Wu M Z , Huang J Y , Leung C K L , Li H L , Tse H F , Yiu K H 
Published: November 2023

Abstract

Background
Iron deficiency is common in patients with cardiovascular diseases, present in up to 60% of patients with coronary artery disease, heart failure, or pulmonary hypertension. Its role in valvular heart disease, including its prevalence, determinants, and prognostic implications, remains unclear.

Purpose
The present study aimed to evaluate the prognostic significance of iron deficiency in patients undergoing valvular heart surgery.

Methods
Pre-operative haematology and iron profiles were retrospectively collected in all patients undergoing valvular heart surgery in Hong Kong between 2010 and 2021. Iron deficiency was defined referencing the ESC 2021 guidelines as a ferritin level &lt;100 ng/mL or a transferrin saturation &lt;20% with a ferritin level of 100 to 299 ng/mL. Logistic regression analyses were conducted to determine variables associated with guideline-defined iron deficiency. Stepwise Cox proportional hazards regression was applied to identify predictors of 5-year mortality. The impact of iron supplementation on outcomes was estimated in iron-deficient patients, modelled by inverse probability of treatment-weighted logistic regression.

Results
Our study included 578 patients; the median age was 62 (interquartile range 54-70) years, and 47.4% were males. Iron deficiency was present in 324 (56.1%) patients. Independent correlates of iron deficiency were age, male sex, diabetes mellitus, atrial fibrillation, heart failure, diuretics and warfarin use, aortic stenosis, and tricuspid regurgitation (Table 1).
Death from any cause occurred in 99 patients over five years of follow-up, of which 45 were due to cardiovascular events. Iron deficiency was associated with a two- to three-fold excess risk of all-cause (hazard ratio [HR] 1.89, 95% CI 1.23-2.90; P = 0.004) and cardiovascular mortality (HR 2.84, 95% CI 1.23-2.90; P = 0.004). Results were consistent in multivariable models incorporating comorbidities, medications, type of valvular intervention, and cardiac surgery risk-scoring systems, even after adjustment for haemoglobin levels (Table 2). For individual components of the guideline criteria, transferrin saturation &lt;20% and ferritin &lt;300 ng/mL were associated with worse all-cause and cardiovascular mortality.
Among 324 patients with iron deficiency, 61 (18.8%) received iron supplementation before valvular surgery. Iron supplementation was associated with a 58% lower risk of death in multivariable models with IPTW (HR 0.42; 95% CI, 0.19–0.99; P = 0.047).

Conclusions
In patients undergoing valvular surgery, iron deficiency is associated with worse survival. This elevated risk may be mitigated by iron supplementation before valvular surgery.Table 1Table 2