bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-sensitivity c-reactive protein to high-density lipoprotein cholesterol ratio and the risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention
Authors: Deng L D , Liang Y L , Xu Q X , Liu Y L , Liu J L , Deng J D , Li Z L , Han K H , Tian L T , Lu X L , Chen S C 
Published: November 2023

Abstract

Background
High-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) is a new biomarker, which is related to the incidence rate of coronary artery disease (CAD). The purpose of this study was to investigate the association between CHR and contrast-induced acute kidney injury (CI-AKI).

Methods
In this retrospective cross-sectional study, 10,917 patients underwent PCI. Diagnose CI-AKI according to KIDIGO standard. Univariate and multivariable logistic regression analysis were used to determine the relationship between CHR and CI-AKI, and further draw the receiver operating characteristic (ROC) curve of subjects to evaluate the clinical diagnostic performance of CHR on CI-AKI.

Results
1,037 patients (9.50%) developed CI-AKI after PCI. The subjects were 64.1 ± 11.1 years old, 2,511 were females (23.0%). Multivariate logistic regression analysis showed that the increase of CHR level was associated with the increase of CI-AKI incidence rate ([Q4 vs. Q1]: odds ratio (OR) = 1.89, 95% confidence interval (CI) [1.42 to 2.54], P &lt; 0.001). Restrictive cubic spline analysis showed that CHR and CI-AKI were linear relationship. ROC analysis confirmed that CHR was a good predictor of CI-AKI (area under ROC curve =0.606, 95% CI [0.588 to 0.624]).

Conclusions
High CHR level is closely related to the increase of CI-AKI incidence, indicating that CHR may be an independent risk factor of CI-AKI.
A comprehensive network meta-analysis: comparison of long-term outcomes between intravascular ultrasound, optical coherence tomography, and angiography-guided stent implantation
Authors: Saylik F , Hayiroglu M I , Akbulut T , Cinar T 
Published: November 2023

Abstract

Background
Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided stent implantations are alternative techniques that are adjunct to angiography-guided (ANG) percutaneous coronary interventions in patients with coronary artery disease (CAD), especially for optimal stent deployment. We aimed to conduct a network meta-analysis including studies comparing those three techniques.

Methods
We searched PubMed, Scopus, and Cochrane libraries for eligible studies that compared IVUS, OCT, and angiography-guided stent implantation in patients with CAD. After excluding studies, which were irrelevant, duplicated, and had inappropriate results, 54 randomized, propensity-score matched, and observational studies with 232.181 patients were included in this meta-analysis.

Results
Number of studies compared ANG and IVUS was higher than the other two comparisons. Indirect evidence of network estimates between OCT and IVUS was higher than direct estimate (60% vs. 40%). Minimal parallelism and mean path length of each estimation was suitable with numbers low than 2 for both for comparisons. ANG had higher MACE (RR =1.30; 1.22-1.39, p&lt;0.001), all cause-death (RR=1.45;1.30-1.61, p&lt;0.001), cardiac death (RR=1.72;1.54-1.92, p&lt;0.001), myocardial infarction (RR=1.34; 1.23-1.45, p&lt;0.001), target lesion revascularization (RR=1.20; 1.13-1.26, p&lt;0.001), and stent thrombosis (RR=1.58;1.34-1.85, p&lt;0.001) risks compared to IVUS. There was no difference between OCT and IVUS regarding all outcomes. MACE (RR=1.51;1.26-1.81, p&lt;0.001), cardiac death (RR=2.13;1.41-3.21, p&lt;0.001), and myocardial infarction (RR=1.42;1.05-1.93, p&lt;0.001) risks were higher in ANG groups than in OCT group. Highest benefit was established with OCT for MACE (p-score = 0.973), with IVUS for all-cause death (p-score= 0.792), with OCT for cardiac death (p-score=0.921), with OCT for myocardial infarction (p-score =0.823), with IVUS for target lesion revascularization (p-score=0.865), and with IVUS for stent thrombosis (p-score=0.930). Heterogeneity was appropriate for all outcomes (I2 &lt;70%). There was no publication bias for all outcomes.

Conclusion
This comprehensive network meta-analysis indicated that angiography-guided stent implantation had higher risk of MACE, cardiac death, myocardial infarction, target lesion-revascularization, and stent thrombosis when compared to IVUS and had higher risk of MACE, cardiac death, and myocardial infarction than OCT.
Vascular healing of Combo plus stents in patients with acute coronary syndrome
Authors: Shishido K , Miyashita H , Yokoyama H , Yamashita T , Ochiai T , Yamaguchi M , Moriyama N , Tobita K , Matsumoto T , Mizuno S , Yamanaka F , Tanaka Y , Murakami M , Takahashi S , Saito S 
Published: November 2023

Abstract

Background
The Combo stent has an abluminal sirolimus-eluting coating composed of a biodegradable polymer to form a drug-eluting stent platform. Sirolimus release is completed in 30 days, and the biodegradable polymer disappears within 90 days. This dual therapy approach aims for neointimal suppression while retaining the endothelial progenitor cell–capturing prohealing benefits enabling rapid endothelialization. However, in patients with acute coronary syndrome (ACS), early vascular healing after COMBO stent implantation remains unknown.

Purpose
The aim of this study is to elucidate the early phase vascular responses in patients with ACS after COMBO stent implantation at 1 month and 6 months follow-up by using optical coherence tomography (OCT).

Methods
Twenty-eight patients who underwent primary percutaneous coronary intervention (PCI) for AMI with COMBO stent between March 2020 and July 2020 were examined. All patients received follow-up OCT at 1 and 6 months after primary PCI. For assessment of each strut, OCT images were analyzed at 1.0-mm intervals throughout the stented segment. The degree of strut coverage by OCT were measured both 1 month and 6 months.

Results
The neointimal thickness were 0.110 ± 0.036 mm at 1 months and 0.217 ±0.083 mm at 6 months (P&lt; 0.001). The median rate of any covered struts was 40.2% at 1 month and 89.5% at 6 months (P&lt; 0.001). The median rate of definite uncovered struts was 14.4% at 1 month and 0.7% at 6 months (P&lt; 0.001). Major adverse cardiac events (MACE) were limited to two target vessel failure without target lesion revascularization. No definite or probable stent thrombosis was noted.

Conclusions
In patients with MI, the COMBO stent is associated with a high degree of neointimal strut coverage at 1 monthfs. Furthermore, almost complete vascular healing at 6 months is observed. These findings may have impact on the duration of dual anti-platelet therapy in patients with MI who underwent PCI using COMBO stent.
Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements
Authors: Soh M , Kim H , Lim H , Koh J 
Published: November 2023

Abstract

Background
Fractional flow reserve (FFR) is the most verified index to date in invasively evaluating lesion-specific myocardial ischemia. During FFR measurements, distal coronary pressure (Pd) can be influenced by hydrostatic pressure change resulted from the height difference (HD) between coronary ostium and location of distal pressure sensor. We aimed to investigate the impact of aorto-coronary HD on FFR measurement in each coronary artery.

Methods
We retrospectively analyzed 257 patients who underwent FFR measurement and coronary computed tomography angiography (CCTA) within a year. HD was measured by CCTA as the vertical distance between coronary ostium and a matched point of distal coronary pressure sensor identified on coronary angiography.

Results
The location of Pd sensor was higher in left anterior descending artery (LAD) (-4.47±1.33cm), whereas lower in left circumflex artery (LCX) (2.54±1.05cm) and right coronary artery (RCA) (2.05±1.25cm) than the coronary ostium. Compared with the original FFR values, corrected FFR by HD was higher in LAD (0.79±0.09, 0.82±0.09, P&lt;0.05) and tended to be lower in LCX and RCA (0.87±0.07, 0.85±0.08, p=0.21; 0.87±0.10, 0.86±0.10, p=0.49, respectively). Based on FFR cut-off value of 0.8, the concordance rate between the FFR and corrected FFR was 77.8%, 92.5%, and 100% in LAD, LCX, and RCA, respectively.

Conclusion
During FFR measurements, HD between coronary ostium and distal pressure sensor may affect interpretation of disease severity and FFR-guided treatment decision of coronary artery disease.
Comparison of two angiography-based FFR techniques in NSTEMI Patients: A Multicenter Study
Authors: Skalidis I , Meier D , Luangphiphat O , Mauler-Wittwer S , Noirclerc N , Mahendiran T , Cagnina A , Collet C , Sonck J , De Bruyne B , Eeckhout E , Muller O , Fournier S 
Published: November 2023

Abstract

Background
Recently, non-invasive methods ("wire free") to functionally assess the hemodynamic severity of a coronary artery have emerged. FFRangio and QFR are angiography-based technologies that have been validated in patients with chronic and acute coronary syndrome compared to invasive FFR measurement. To date, no direct comparison between these two methods has been reported and they have never been prospectively evaluated in patients presenting exclusively with Non-ST Segment Elevation Myocardial Infarction (NSTEMI).

Methods
Patients with NSTEMI were prospectively included in this multicenter, single-arm, double-blinded study comparing FFR calculated by FFRangio and QFR - both calculated offline - to invasively-measured FFR (FFRinvasive). FFRinvasive was measured in all angiographically intermediate lesions (30%-70% stenosis) and was then compared to the average value measured by two blinded operators for each angio-based FFR modalities; FFRangio and QFR. The primary endpoints were the sensitivity and specificity of FFRangio and QFR relative to the reference standard FFRinvasive using a cutoff value of ≤0.80.

Results
Among 129 NSTEMI patients who were screened, 49 patients with 63 vessels in total underwent FFRinvasive measurements, had optimal angiographical views for FFRangio and QFR measurement, and were finally included in the study. The mean value of FFRinvasive was 0.83±0.3 with 22 (36%) being ≤0.80. The mean FFRangio was 0.83±0.1 with 20 (32%) being ≤0.80. FFRangio exhibited a sensitivity of 91%, a specificity of 100% and a diagnostic accuracy of 96.8%. The mean QFR was 0.82±0.3 with 20 (32%) being ≤0.80 and it showed sensitivity of 86.4%, specificity of 98.4% and diagnostic accuracy of 93.7%.The pearson correlation coefficient for FFRangio and QFR were r=0.91 and r=0.76, respectively.

Conclusion
To our knowledge, this multicenter study represents the first head-to-head comparison between these two non-invasive angiography-derived physiology assessment modalities. Both, FFRangio and QFR, that were performed by two operators, demonstrated great diagnostic performance which is slightly better compared to previous validation studies. Although, based on our study, FFRangioseems to have better sensitivity, further larger validation studies are required.Bland–Altman plotCorrelation for FFR and Angio-Based FFR
P2Y12 inhibitor loading time before elective PCI and the prevention of myocardial necrosis
Authors: Roule V , Beygui F , Cayla G , Range G , Motovska Z , Delarche N , Jourda F , Goube P , Guedeney P , Zeitouni M , El Kasty M , Laredo M , Vicaut E , Montalescot G , Silvain J 
Published: November 2023

Abstract

Background
There is dated and conflicting data about the optimal timing of initiation of P2Y12 inhibitors in elective percutaneous coronary intervention (PCI). Peri-PCI myocardial necrosis is frequent and associated with poor outcome.

Purpose
We aimed to assess the impact of the P2Y12 inhibitor loading time (time from loading to PCI) on peri-procedural myocardial necrosis in the elective PCI population of the randomized ALPHEUS trial.

Methods
1809 patients of the ALPHEUS trial were divided into quartiles of loading time (0 to 0.2h, 0.2 to 1.7h, 1.7 to 4.1h and 4.1 to 24h). The ALPHEUS primary outcome was used (type 4 (a or b) myocardial infarction or major myocardial injury) as well as the main secondary outcome including minor myocardial injury. The risk of events was adjusted in a multivariate model.

Results
Patients in the first quartile group (Q1) presented higher rates of the primary outcome (p=0.01). When compared to Q1, incidences of the primary outcome decreased in patients with longer loading times (adjOR 0.70 [0.52.-0.95]; p=0.02 for Q2; adjOR 0.65 [0.48-0.88]; p&lt;0.01 for Q3; adjOR 0.66 [0.49-0.89]; p&lt;0.01 for Q4). Concordant results were found for the main secondary outcome. There was no interaction with the study drug allocated by randomization (clopidogrel or ticagrelor). Bleeding complications and clinical ischemic events were rare and did not differ between groups.

Conclusion
In elective PCI for chronic coronary syndrome, administration of the loading dose of oral P2Y12 inhibitor at the time of PCI is associated with more frequent peri-procedural myocardial necrosis than an earlier administration.
Association between high platelet reactivity and early stent thrombosis in patients with drug-eluting stent implantation
Authors: Lim S , Hong S J , Kim J H , Cha J J , Joo H J , Park J H , Yu C W , Lim D S , Jeong Y H 
Published: November 2023

Abstract

Background
Stent thrombosis (ST) is a potentially fatal complication after percutaneous coronary intervention (PCI). The association between P2Y12 reaction unit (PRU) level and stent thrombosis occurrence is not fully elucidated.

Methods
Based on the multicenter, observational PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) registry of patients with drug-eluting stents (DES) implantation, a total of 11,714 patients with PRU values were identified. The independent predictors of early stent thrombosis (EST) were assessed. The primary outcome after EST was the composite of cardiac death, myocardial infarction and any revascularisation. Key secondary outcomes were all-cause death, cardiac death, myocardial infarction, and any revascularisation.

Results
EST, defined as definite ST in less than 1 month after index PCI, was identified in a total of 51 patients. The PRU value was significantly higher in the EST group (263.5 ± 70.8 vs. 217.5 ± 78.7, p&lt;0.001). In multivariable analysis, having a PRU value of ≥252 (OR, 5.10; 95% CI, 1.58-16.46; p=0.006) and an ARU value of ≥414 (OR 4.85; 95% CI, 1.07-21.97; p=0.040) were significant predictors of EST. The use of first-generation DES (OR 3.56; 95% CI, 0.98-12.99; p=0.054) also posed a higher risk for EST occurrence with a borderline significance. Cumulative incidence of the primary composite outcome was significantly higher in patients with EST (HR 18.7; 95% CI 12.8-27.3; p&lt;0.001).

Conclusion
In patients treated with clopidogrel after successful DES implantation, EST was associated with higher PRU values, and a greater rate of adverse outcomes, including all-cause death and MI.
Impact of heart failure severity and major bleeding events after percutaneous coronary intervention on subsequent major adverse cardiac events
Authors: Ikebe S , Ishi M , Otsuka Y , Nakamura T , Tsujita K , Matoba T , Kohro T , Oba Y , Kabutoya T , Imai Y , Kario K , Kiyosue A , Mizuno Y , Nochioka K , Nakayama M 
Published: November 2023

Abstract

Background
Heart failure (HF) is one of high bleeding risk after percutaneous coronary intervention (PCI). Furthermore, major bleeding events increase the risk of subsequent cardiovascular events. However, it is unknown whether HF severity and bleeding events are associated with major adverse cardiac events (MACE).

Purpose
The aim of this study was investigating the impact of HF severity or bleeding events on subsequent MACE.

Methods
Clinical Deep Data Accumulation System (CLIDAS), a multicenter database with 7 tertiary medical hospitals, was developed to collect data directly for patient characteristics, medications, laboratory test, physiological test, cardiac catheterization and PCI treatment in electronic medical records. This retrospective analysis included 7,160 patients with PCI between April 2014 and March 2020 and have completed 3-year follow-up. The patients were divided into two groups: HF with high BNP (HF-hBNP) (&gt;100 pg/ml) (n=384) and non-HF-hBNP (HF with low BNP and non-HF) (n=6,776). Furthermore, both groups were re-classified into two groups according to presence of major bleeding events in 30 days: HF-hBNP with 30-day bleeding (n=14), without 30-day bleeding (n=370), non-HF-hBNP with 30-day bleeding (n=74) and without 30-day bleeding (n=6,702). Primary endpoint was defined as MACE.

Results
HF with high BNP was an independent risk factor of MACE (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.64-2.98) compared with non-HF. Among the HF-hBNP patients, MACE incidence tended to be increased by 30-day bleeding (p=0.075). In addition, among the non-HF-hBNP patients, the bleeding events increased the risk of MACE (p=0.003). The multivariable Cox regression model revealed that other three groups were associated with a high risk compared with non-HF-hBNP without 30-day bleeding group: non-HF-hBNP with 30-day bleeding (HR, 3.90; 95% CI, 1.59-9.54), HF-hBNP without 30-day bleeding (HR, 2.19; 95% CI, 1.56-3.07) and HF-hBNP with 30-day bleeding (HR, 8.33; 95% CI, 2.57-27.0).

Conclusion
The real-world database CLIDAS revealed that HF with high BNP and major bleeding events in 30 days might be associated with MACE. Those results suggest that management of HF and prevention of bleeding complication in early days after PCI could be important to prevent MACE.
Mortality after periprocedural myocardial injury and spontaneous myocardial infarction according to the levels of troponin increase: insights from a large PCI registry
Authors: Spirito A , Kamaleldin K , Sartori S , Vogel B , Feng Y , Baber U , Pileggi B , Johnson J , Sweeny J , Prakash K , Khera S , Kini A , Sharma S K , Dangas G , Mehran R 
Published: November 2023

Abstract

Background
Periprocedural myocardial injury and spontaneous myocardial infarction (MI) are potential complications in patients with coronary artery disease. The prognostic impact of periprocedural myocardial injury as compared to that of spontaneous MI has not been fully assessed.

Aim
To assess the impact on mortality of periprocedural myocardial injury and spontaneous MI according to thresholds of troponin increase proposed in expert consensus documents.

Methods
Among patients undergoing PCI at a large volume center, we included those presenting with: 1) chronic coronary syndrome (CCS) with normal (≤1x upper reference level [URL]) cardiac troponin I (cTnI) at baseline and after PCI (no myocardial events); 2) CCS with normal baseline cTnI and increased (&gt;1 URL) cTnI in the 48 hours after PCI (periprocedural myocardial injury), and 3) type I MI (spontaneous MI). Patients with missing cTnI values, patients with CCS and increased baseline cTnI (&gt;1 URL) and patients with unstable angina were excluded. Patients with periprocedural myocardial injury and spontaneous MI were stratified in 4 groups according to the cTnI peak value: 1-5, 5-35, 35-70, &gt;70 times (x) above the URL. The risk of all-cause death at 1-year after PCI was assessed across the cTnI strata using the group with no myocardial events as reference. The conventional cTnI was measured with the Architect methodology (Abbott, Chicago, Illinois) and the URL was 0.4 ng/mL.

Results
Among patients undergoing PCI between 2012 and 2019, 7602 had no myocardial events, 913 had periprocedural myocardial injury and 2192 presented with spontaneous MI. CTnI peak was 1-5x, 5-35x, 35-70x, &gt;70x above URL in 53%, 41%, 4%, 2% of patients with periprocedural myocardial injury, respectively, and in 24%, 38%, 11%, 26% of patients with spontaneous MI, respectively (Figure 1). Rate of all-cause death was 1.4% in patients with no myocardial events. The risk of all-cause death at 1-year was increased after periprocedural myocardial injury with a peak cTnI of 35-70x URL and tended to be higher with a peak cTnI &gt;70x URL (Figure 2). Among patients with spontaneous MI, the risk of all-cause death was significantly higher in all cTnI strata (Figure 2). Adjusted results and p-value for comparisons between periprocedural myocardial injury and spontaneous MI will be presented at ESC 2023.

Conclusions
All-cause death at 1-year was not increased after periprocedural myocardial injury with a peak cTnI ≤35x URL. Periprocedural myocardial injury with cTnI peak &gt;35x URL and spontaneous MI with any cTnI elevation were associated with a similar crude risk of all-cause death.Figure 2
Parsimonious versus extensive score: can we simplify bleeding risk stratification after percutaneous coronary intervention without losing specificity?
Authors: Woelders E C I , Onuma Y , Ninomiya K , O'leary N , Damman P , Peeters D A M , Van 'T Hof A W J , Serruys P W J C , Van Geuns R J M 
Published: November 2023

Abstract

Background/Introduction
Prediction of bleeding risk in patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) has been repeatedly attempted and resulted in multiple risk models. To promote the adoption and use of risk stratification among clinicians, a consortium in the South East of the Netherlands, the "ZON-HR", has created a simple binary variant of the existing logistic models. This model includes commonly available factors which can be incorporated into the PCI report to generate stratification. In this "parsimonious" model, high bleeding risk (HBR) is stratified according to: history of intracranial haemorrhage, previous spontaneous bleeding, Hb &lt; 11 g/dL, eGFR&lt; 30.

Purpose
We aimed to perform an external validation of our model for bleeding risk and to demonstrate its discriminative value in comparison with the PRECISE DAPT score, an acknowledged risk score.

Methods
We performed a post hoc analysis of the GLOBAL LEADERS trial, a multicenter randomized trial, comparing ticagrelor monotherapy after one month of DAPT with standard DAPT after PCI. We stratified the patients for HBR according to the ZON-HR or a PRECISE-DAPT score ≥ 25. Bleeding events one year after PCI were compared in the entire population and in subgroups for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), Ticagrelor monotherapy and DAPT.

Results
Of the 15968 patients included in GLOBAL LEADERS, 1059 patients were excluded due to missing variables required for either model. Among the 14909 patients, 17% had HBR according to the PRECISE DAPT score, 4% according to ZON-HR and 3% according to both. Bleeding events occurred in 8.5% and 13% of HBR defined by PRECISE DAPT or ZON-HR respectively. Patients with HBR according to both models showed 13% bleedings as opposed to 5% in non-HBR. Table 1 presents the sensitivity and specificity. Regression analysis (figure 1) demonstrated that patients with HBR according to either model have significantly more bleedings. This was also significant in all subgroups except for ACS patients receiving standard DAPT when the ZON-HR model was used.

Conclusion
The ZON-HR model is more conservative compared to the PRECISE DAPT score as depicted by the sensitivity and specificity. This can be explained by the larger number of risk factors used in the PRECISE DAPT score that cumulatively contributes to the sensitivity as opposed to the binary ZON-HR model which is more specific. However, the survival curves and hazard ratios showed good predictive value of both models for bleeding risk in the overall population.Table 1.Figure 1.