bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circulating intermediate monocytes increase after elective percutaneous coronary intervention
Authors: Merinopoulos I , Bhalraam U , Holmes T , Tsampasian V , Corballis N , Gunawardena T , Sawh C , Maart C , Wistow T , Ryding A , Eccleshall S , Smith J , Vassiliou V 
Published: November 2023

Abstract

Introduction
Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This study explores the changes in monocyte subset and humoral response after elective PCI.

Methods
In this prospective study we recruited patients undergoing elective PCI for stable angina due to de novo coronary artery disease, either with DES or DCB utilised at the discretion of the operator. We excluded patients with significant renal impairment or any significant inflammatory condition on immunosuppression. All patients provided written, informed consent. Patients had blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14+CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers.

Results
Some 30 patients were recruited in the study; two patients were lost to follow-up and two patients were excluded as they had raised baseline (pre-PCI) troponin; therefore 26 patients were included in analysis. Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI (Fig 1). The classical monocytes appeared to follow the opposite pattern to intermediate monocytes while the non-classical monocytes did not change significantly, suggesting that there was a shift from classical to intermediate monocytes and vice versa. Subgroup analysis showed that the intermediate monocytes remained significantly elevated in the DES group but not in the DCB group (Fig 2). Gene expression analysis of CD14+ leucocytes showed that IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remained elevated up to two weeks post PCI while IL6 and TNFα remained elevated till two months post PCI.

Conclusion
Intermediate monocytes, a highly proatherogenic monocyte subset, increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI and improve patient outcomes.Monocyte response after PCIMonocyte response after DCB(A) or DES(B)
Comparison of percutaneous coronary intervention versus medication in dialysis patients with coronary artery disease
Authors: Xie E , Ye Z , Li Y , Shen N , Gao Y , Zheng J 
Published: November 2023

Abstract

Background
There is a lack of evidence for the optimal management of dialysis patients complicated with coronary artery disease (CAD). Based on the favorable results from patients with normal or near-normal kidney function, percutaneous coronary intervention (PCI) has extended to patients on maintenance dialysis. However, it is unknown whether this extrapolation is accurate.

Purpose
We sought to investigate the benefits of PCI in dialysis patients with CAD.

Methods
Between January 2015 and June 2021, 455 617 consecutive cardiac catheterizations from 30 cardiac centers in China were reviewed retrospectively through medical records. Patients with normal coronary anatomy, those who did not receive dialysis therapy or received dialysis for less than 3 months, those who received coronary artery bypass grafting, repeat admissions, and those with less than one year of follow-up were excluded. Patients were followed up via telephone interviews or clinic visits until June 2022. The primary outcome of interest was 1-year all-cause mortality, and the secondary outcome of interest was 1-year cardiac death. Cox proportional hazards regression model was used to assess the association of PCI with outcomes. Inverse probability of treatment weighting was used to control for imbalances in patient characteristics.

Results
Of 1 119 patients who met the final criteria, 799 (71.4%) received PCI. The mean age was 61.9±10.6 years, and 828 (74.0%) were male. Compared with medically treated patients, patients in the PCI group were more likely to present with a high Gensini score, be with multivessel diseases, and receive dual antiplatelet and statin therapy. Overall, 201 (16.4%) all-cause deaths were documented, with 153 (13.7%) cardiac deaths. Patients treated with PCI experienced significantly lower cumulative rates of 1-year all-cause deaths (15.5% vs. 24.1%, log-rank p&lt;0.001) as well as cardiac deaths (11.5% vs. 19.1%, p&lt;0.001). Multivariate analyses showed that PCI was independently associated with a lower risk of either all-cause deaths (hazard ratio 0.48, 95% confidence interval 0.36-0.64, p&lt;0.001) or cardiac mortality (hazard ratio 0.45, 95% confidence interval 0.30-0.61, p&lt;0.001). These findings were further confirmed in the inverse probability of treatment weighting cohort.

Conclusion
This cohort study found that in real-world practice, among dialysis with CAD, use of PCI was associated with significantly lower risks for 1-year all-cause death or cardiac mortality compared with medical management. Further prospective studies are needed to confirm these findings.
Distal radial artery palpability and cannulation success for coronary procedures
Authors: Tsigkas G , Apostolos A , Moulias A , Papageorgiou A , Vasilagkos G , Pappelis K , Grapsas N , Aminian A , Sgueglia G , Davlouros P 
Published: November 2023

Abstract

Background
Distal transradial access (DRA) is increasingly performed for coronary angiography and interventions, due to lower incidence of radial artery occlusion, faster hemostasis and decreased local complications rate. However, higher rates of crossover to other access sites remains the major limitation of DRA and the optimal technique for achieving successful cannulation remains under investigation.

Purpose
Aim of our analysis is to explore whether a palpable distal radial artery is associated with higher successful cannulation.

Methods
We conducted a patient-level pooled analysis using data from two randomized-controlled trials (RCT) on DRA. All patients with available data on distal radial artery palpation and cannulation’s success were included in our analysis.

Results
A total of 435 patients were included in our analysis; 84 and 351 from the two studies, respectively. Demographic characteristics, pharmacotherapy details and procedural indications did not differ between the two groups (palpable versus non – palpable DRA), except BMI, which was significantly increased in non – palpable DRA group (27.3 versus 28.3 kg/m2, p=0.034). A palpable DRA was found in 313 (72%) patients. Successful cannulation did not significantly differ between the patients with a palpable and a non-palpable DRA (81.5% versus 80.3%, p=0.78) Furthermore, a multivariable analysis excluded any interactions with demographic characteristics, pharmacotherapy details and indications of procedure.

Conclusions
Our analysis showed that a non-palpable distal radial artery is not associated with lower cannulation success rates. Accordingly, the palpation of the DRA may not be required for achieving better cannulation results. As these findings have been obtained among experienced operators, further research is required to validate the generalizability of our results.
Platelet reactivity and activated clotting time predict haemorrhagic site complications in patients with chronic coronary syndromes undergoing percutaneous coronary intervention
Authors: Ramotowski B , Lewandowski P , Slomski T , Maciejewski P , Budaj A 
Published: November 2023

Abstract

Background/Introduction
Same-day discharge has become a standard of care for patients with chronic coronary syndromes (CCS) treated with ad hoc percutaneous coronary interventions (PCI). QuickClot Radial kaolin-based haemostatic device may shorten haemostasis time and reduce the incidence of vascular site complications. Besides unfractionated heparin (UFH) and aspirin (ASA), an ad hoc procedure demands a loading dose of clopidogrel. Dynamic changes in platelets and thrombotic activity may influence the outcomes at vascular sites. Rapid "point-of-care" testing measures the effects of anticoagulation but the optimal threshold during and after PCI still requires further research.

Purpose
We investigated the effect of a standard dose of UFH and a loading dose of clopidogrel measured with point-of-care devices: Hemochron activated clotting time device (ACT), VerifyNow P2Y12 test on on-site outcomes.

Methods
We conducted a prospective, observational study of consecutive patients with CCS who qualified for ad hoc PCI. Patients were on chronic ASA therapy, received 100 IU/kg UFH, and a 600 mg loading dose of clopidogrel. ACT was measured before and 10 min, 2 h, and 6 h after the administration of UFH and clopidogrel, respectively, and the VerifyNow P2Y12 test measured after 2 and 6 h. A QuickClot haemostatic pad with gradually released compression for up to 2 h was used in all patients. Ultrasonographic assessment of artery diameter and patency was performed before and 6 h after the procedure. Bleeding (BARC criteria) or local haematoma (EASY scale) were observed regularly until hospital discharge.

Results
Forty patients were enrolled in the study. The mean±SD age was 68.8±8.8 years, 30 (75%) patients were men, 13 (35%) had diabetes, 38 (95%) hypertension, 16 (40%) previous myocardial infarction, and 15 (37,5%) were active smokers. Patients received a median [interquartile range (IQR)] 8000 [7000-9000] IU of UFH and 600 mg of clopidogrel. All of the radial arteries remained patent during observation; local bleeding (BARC 2) was observed in 11 (27,5%) and haematomas (EASY 1 and 2) in 11 (27,5%) patients. Patients with bleeding had lower platelet activity measured with platelet reactivity units (PRU) after 2 h (122.5± 51 vs 158.7± 43, p= 0.04) and higher ACT (s) (216.9 ±40 vs. 184.6±28 s, p=0.006). An ACT &gt;196 s, measured 2 h after the procedure, predicted the occurrence of bleeding or haematoma (AUC 0.72; 95%CI 0.56-0.85, p=0.008).

Conclusion
Lower platelet activity and higher ACT after PCI were associated with higher risk of haemorrhagic site complications. "Point-of-care" measures post PCI in CCS patients may be clinically applicable.
The impact of underlying plaque characteristics following the novel resorbable magnesium scaffold implantation: an intravascular OCT assessment up to 12-months
Authors: Aytekin A , Seguchi M , Xhepa E , Haude M , Wlodarczak A , Van Der Schaaf R J , Torzewski J , Ferdinande B , Escaned J , Iglesias J F , Bennett J , Toth G , Toelg R , Garcia-Garcia H M , Joner M 
Published: November 2023

Abstract

Background
Second-generation resorbable magnesium scaffold (RMS) Magmaris showed favorable outcomes in clinical trials, especially regarding the incidence of scaffold thrombosis. The earlier studies reported a higher occurrence of scaffold recoil with this RMS owing to vessel constriction. This finding was shown to be more prominent in presence of underlying fibrous plaques rather than calcific and/or lipidic lesions. This suggest that sufficient radial force along with longer scaffolding time may improve the device performance. Against this background, DREAMS 3G was developed with stronger mechanical properties despite thinner struts by modifying the magnesium alloy of its predecessor. The first-in-man trial BIOMAG-I demonstrated promising results for the novel RMS with respect to clinical and angiographic outcomes at 6 months follow-up. Still, the data concerning the performance of DREAMS 3G scaffold up to 12-months are lacking.

Purpose
This study aims to assess the influence of the intravascular optical coherence tomography (OCT) -derived underlying plaque characteristics on mean lumen area (mm 2) in patients treated with DREAMS 3G at 6- and 12-months.

Methods
Patients enrolled in the BIOMAG-I trial and who underwent OCT imaging (i) at index-procedure, (ii) at 6-months and (iii) at 12-months follow-up were included in the current analysis. The acquired intravascular imaging data were evaluated every 1 mm on a quadrant basis to assess the presence of fibrous, calcific, or lipidic lesions. We calculated the proportions of each plaque feature per pullback, then assessed their correlation with the mean lumen area obtained at 6- and 12-months follow-up. In addition, we investigated the potential impact of scaffold edge dissection on the mean lumen area.

Results
Fifty-one patients and 52 lesions were evaluated in the current analysis. There was no significant correlation between the underlying plaque characteristic and mean lumen area at 6-months (p=0.767 for fibrous, p=0.761 for calcific, p=0.767 for lipid lesions). This trend was similar at 12 months follow-up (p=0.499 for fibrous, p=0.714 for calcific, p=0.569 for lipid lesions). Finally, the presence of edge dissection did not correlate with mean lumen area (p=0.559 and p=0.670 at 6- and 12-months follow-up, respectively).

Conclusion
The underlying plaque characteristics and the presence of edge dissection had no significant impact on the mean lumen area following DREAMS 3G implantation up to 12 months. These results suggest better device performance with the novel RMS irrespective of the underlying plaque characteristics.
Appropriate ischemic criteria for type 4a myocardial infarction: insights from the ALPHEUS trial
Authors: Roule V , Zeitouni M , Guedeney P , Beygui F , El Kasty M , Braik N , Bertin B , Brugier D , Range G , Motovska Z , Cayla G , Vicaut E , Montalescot G , Silvain J 
Published: November 2023

Abstract

Background
Different troponin thresholds have been proposed to define periprocedural myocardial injury based on post percutaneous coronary intervention (PCI) troponin increase only, whereas the definition of type 4a myocardial infarction (MI) needs the association of post procedural troponin and one ischemic criterion. These criteria which evolved from the 3rd to the 4th Universal Definition of Myocardial Infarction (UDMI) are frequently under-reported in studies on periprocedural MI.

Purpose
We aimed to describe rates of type 4a MI additional diagnostic criteria among the ranges of post PCI troponin elevation in the randomized ALPHEUS trial which compared ticagrelor to clopidogrel in high-risk elective PCI patients.

Methods
1698 patients with normal pre-PCI troponin values and centralized core laboratory angiogram analyzes were divided into 4 groups according to maximal post PCI troponin elevations (≤ 1x upper reference limit (URL) for group 1; &gt; 1xURL and ≤ 5xURL for group 2; &gt; 5xURL and &lt; 35xURL for group 3 and ≥ 35xURL for group 4). The type 4a MI additional criteria (ischaemic imaging changes, ischaemic ECG changes, chest pain and angiographic complications) as defined by the 3rd and 4th UDMI were reported and the different angiographic complications were detailed for each group.

Results
The most prevalent additional ischemic criterion was the presence of angiographic complications detected by the core laboratory. The rate of angiographic complications increased in a stepwise manner with higher post PCI troponin elevation (Figure). Interestingly, we found a similar rate of angiographic complications in patients without any increase in post PCI troponin and troponin elevations below the 5xURL threshold (8.4% and 9.9% respectively). Most angiographic complications were related to transient main branch dissection and/or thrombosis, and transient or permanent side branch occlusions (Table). ECG changes and chest pain ischemic criteria also increased in a stepwise manner and were rarely found below the 5-fold threshold increase, although they might be underreported.

Conclusion
When using a core laboratory, angiographic complications are found even in patients with no or minor troponin elevation. Above the 5 xURL threshold the rates of angiographic complications are 2 to 3-fold more frequent, and ECG changes and chest pain ischaemic criteria are likely to be present. Our findings support the use of angiographic core laboratory in clinical trial using periprocedural MI as an endpoint; similarly, chest pain -which disappeared from the 4th UDMI- should be reconsidered as a diagnostic ischemic criterion.
Cerebral embolic protection devices during transcatheter aortic valve implantation: a meta-analysis of randomised controlled trials
Authors: Reddy R K , Ahmad Y , Arnold A D , Howard J P 
Published: November 2023

Abstract

Background
Stroke is a feared complication of transcatheter aortic valve implantation (TAVI), which may be mitigated by embolic protection devices (EPDs).

Purpose
We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to test the effect of EPDs in TAVI.

Methods
All RCTs comparing EPDs with control during TAVI were systematically identified. Pre-specified primary endpoints were all stroke, disabling stroke, non-disabling stroke and all-cause mortality. Safety and neuroimaging parameters were assessed. Sensitivity analyses were stratified by EPD type. This study was prospectively registered.

Results
Eight trials randomising 4043 patients were included. There was no significant difference between EPDs and control for all stroke [RR 0.88, 95%CI 0.65–1.18, p=0.386, I2=0%], disabling stroke [RR 0.59, 95%CI 0.31–1.14, p=0.117, I2=0%], non-disabling stroke [RR 0.99, 95%CI 0.71–1.40, p=0.967, I2=0%] or all-cause mortality [RR 0.88, 95%CI 0.44–1.78, p=0.727, I2=0%]. There were no differences in safety endpoints of bleeding, vascular complications, or acute kidney injury. EPDs resulted in reduced cerebral lesion volume [SMD -0.55, 95%CI -0.91– -0.18, p=0.003, I2=63.6%], but no difference in number of patients with new lesions. The Sentinel EPD significantly reduced risk of disabling stroke [RR 0.42, 95%CI 0.20–0.88, p=0.022, I2=0%] but did not impact all stroke, non-disabling stroke or all-cause mortality.

Conclusion
The totality of randomised data for EPDs during TAVI demonstrated no safety concerns or significant differences in clinical endpoints, although total cerebral lesion volume was reduced. Analyses restricted to the Sentinel EPD demonstrated large, clinically meaningful reductions in disabling stroke. Ongoing RCTs may help validate these results.Effects of cerebral embolic protectionEffects of the Sentinel device
Mid-term outcomes in aortic stenosis patients treated with contemporary balloon expandable and self-expanding valves; does valve size have an impact on outcome?
Authors: Kalogeras K , Jabbour R , Pracon R , Kabir T , Shannon J , Duncan A , Oikonomou E , Katsianos E , Patel N , Cadiz S , Siasos G , Vavouranakis M , Davies S , Dalby M , Panoulas V 
Published: November 2023

Abstract

Background
No data currently exists comparing the performance of the contemporary iterations of balloon-expandable (BE) Edwards SAPIEN 3/Ultra and the self-expanding (SE) Medtronic Evolut PRO/R34 valves. In addition, no direct head to head comparisons of the aforementioned devices have been performed in patients with small annuli with the exception of small registries.

Purpose
Aim of the study was the head-to-head comparison of these transcatheter heart valves (THV) with emphasis on patients with small aortic annulus.

Methods
In this retrospective registry, peri-procedural outcomes and mid-term all-cause mortality were analyzed.

Results
1673 patients (917 SE vs. 756 BE) were followed-up for a median of 15 months. Baseline demographics were similar apart from worse left ventricle systolic function amongst SE patients and more extensive coronary artery disease amongst BE patients. 194 patients died (11.6%) during follow-up. SE and BE groups showed similar survival at one (92.6 vs. 90.6%) and three-years (80.3% vs. 85.2%), plog-rank=0.136.
Compared to the BE group, patients treated with SE device had lower peak (16.3±8mmHg SE vs. 21.9±8mmHg BE, p=0.001) and mean (8.8±5mmHg SE vs. 11.5±5mmHg BE, p=0.001) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation (PVR) post-operatively (5.6% vs. 0.7% for SE and BE valves respectively, p&lt;0.001).
In patients treated with small THV (≤26 for SE and ≤23mm for BE; N=284 for SE and N=260 for BE) survival was higher amongst patients treated with SE valves at both 1 (96.7% SE vs. 92.1% BE) and 3-years (91.8% SE vs. 82.2% BE), plog-rank=0.042.

Conclusions
Real-world comparison of the latest generation SE and BE devices demonstrated similar survival up to 3 years follow-up. Among patients with small aortic annulus, those treated with SE valves seem to demonstrate improved survival rates.36months survival rates
Acute ischemic stroke complicating tavi. predictors, outcomes, and treatment associated outcomes
Authors: Kheifets M , Kruchin B , Aviram I , Vaknin-Assa H , Barnea R , Findler M , Perl L , Witberg G , Codner P , Talmor-Barkan Y , Rephaeli G , Uriel E , Kornowski R , Levi A 
Published: November 2023

Abstract

Introduction
Despite the great strides made since the emergence of TAVI two decades ago, periprocedural ischemic stroke remains a major concern. The aims of this study were to describe the incidence, characteristic and outcomes of patients presenting with acute ischemic stroke complicating TAVI (AISCT), and to compare conservative therapy vs. neurointervention, in eligible patients.

Material and method
We analyzed consecutive TAVI procedures performed in our medical center between 2008 and 2021. Patients with and without AISCT were compared. Outcomes of neurointervention to treat AISCT were compared to conservative therapy. Primary outcomes were mortality at 1 and 3 year and neurologic disability status at 3 months.

Results and discussion
Of 1145 eligible patients who underwent TAVI between 2008-2019, 29 (2.5%) had AISCT within 30 days. All-cause mortality was significantly higher in the AISCT group in 30-days (13.8% vs. 2.9%, p&lt;0.01), 1-year (27.9% vs. 8.1%, p&lt;0.01), and 3-years (50.1% vs. 25.1%, p&lt;0.01), as compared to the AISCT negative group. Lower body mass index (OR- 1.11, 95%CI 1.01-1.21, p=0.03) prior ischemic stroke (OR- 2.80, 95%CI 1.23-6.01, p&lt;0.01) and frailty (OR- 2.98, 95%CI 1.27-6.49, p&lt;0.01) emerged as independent risk factors for stroke. Out of the 38 patients who suffered AISCT between 2008-2021, 7 underwent neurointervention. The majority of AISCT were observed within the first 24-hours following TAVI (p&lt;0.01). All-cause mortality following severe stroke was significantly higher (p&lt;0.01) compare to mild or moderate stroke. There were no significant differences in mortality between the two groups, however, patients with moderate severity stroke (NIHSS score 6-14) undergoing neurointervention enjoyed a higher rate of disability free survival at 3-months compared to patients treated conservatively. (100% compared to 50% respectively, p=NS).

Conclusion
AISCT was associated with increased morbidity and mortality. Neurointervention, as compared to conservative therapy, may improve disability status in patients with moderate or severe stroke.