bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can machine learning improve risk prediction and individualise decision making between percutaneous and surgical revascularisation?
Authors: Ninomiya K , Kageyama S , Shiomi H , Masuda S , Kotoku N , Revaiah P , Kimura T , Onuma Y , Serruys P 
Published: November 2023

Abstract

Background/Introduction
In patients with three-vessel coronary artery disease (CAD) and/or left main (LM) CAD, individual risk prediction plays a key role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).

Purpose
The aim of this study was to assess whether these individualised revascularization decisions can be improved by applying machine learning (ML) algorithms and integrating clinical, biological, and anatomical factors.

Methods
The present study consisted of patients enrolled in the SYNTAX study, which is a randomized trial comparing PCI and CABG in patients with complex coronary artery disease. ML algorithms were used to develop a prognostic index for 5-year death, which was combined, in the second stage, with assigned treatment (PCI or CABG), and pre-specified effect-modifiers: disease type (3-vessel or LMCAD) and anatomical SYNTAX score. The model’s discriminative ability to predict the risk of 5-year death and treatment benefit between PCI and CABG was cross-validated in the SYNTAX trial (n=1800 patients) and externally validated in the CREDO-KYOTO registry (n=7362), and then compared to the original SYNTAX score II 2020 (SS2020).

Results
The gradient boosting ML model identified the top 10 prognostic factors at the time of decision making as: age, creatinine clearance, left ventricular ejection fraction, peripheral vascular disease, C-reactive protein, hemoglobin, HbA1c, glucose, systolic and diastolic pressure.
The ML model performed best for predicting 5-year all-cause death with C-indexes of 0.78 (95% CI 0.75-0.81) in cross-validation and 0.77 (95% CI 0.76-0.79) in external validation. The ML model discriminated 5-year mortality better than the SS2020 in the external validation cohort (vs C-index 0.72 for SS2020, p &lt;0.001) and identified heterogeneity in the treatment benefit of CABG versus PCI (Figure).

Conclusions
An ML-based approach for identifying individuals who benefit from CABG or PCI is feasible and effective. Implementation of this model in health care systems—trained to collect large numbers of parameters—may harmonize decision making.Figure
The impact of ticagrelor therapy on CABG-related bleeding in patients with STEMI managed with pPCI
Authors: Gulfidan A , Durmaz E , Cimci M , Karadag B , Incesu G , Soysal A U , Yalman H , Aygun A A , Miroglu M , Ceviker A , Dogramaci E , Karpuz M H 
Published: November 2023

Abstract

Background
Patients on double antiplatelet treatment who need early in-hospital coronary artery bypass grafting (CABG) are at high risk of major bleeding. However, recent studies have demonstrated that early CABG surgery within 7 days of discontinuation of p2Y12 inhibitors are safe with respect to bleeding events in patients with acute coronary syndrome.

Purpose
In this study, we aimed to investigate the impact of ticagrelor preloading on CABG related bleeding in patients with ST-segment elevation myocardial infarction (STEMI) initially managed with primary percutaneous coronary intervention (pPCI).

Methods
Patients with the diagnosis of STEMI who were managed with pPCI and underwent subsequent early (4-7 days following pPCI) or delayed (&gt; 7 days following pPCI) CABG surgery were included. All study patients were preloaded with ticagrelor 180 mg prior to pPCI procedure. Patients’ demographics, clinical variables and short-term cardiovascular outcomes were recorded.

Results
The study cohort included 98 patients. Fifty-four (54%) patients underwent early and 44(45%) patients underwent delayed CABG surgery. Left main coronary artery involvement and presence of chronic total occlusion in the non-infarct related artery were 26.5% and 25.5%. CABG-related bleeding occurred in 22 (22.4%) patients. There was no significant difference with respect to total ticagrelor dose and timing of the surgery between patients with or without CABG-related bleeding (p: 0.165 and p:0.142). Multivariate analyses demonstrated that only preoperative hemoglobin level was an independent predictor of CABG-related bleeding (OR:0.720, p: 0.034).There were three deaths within the 30 days of surgery, all occurring in patients with CABG-related bleeding. However, CABG-related bleeding was not associated with long-term cardiovascular events during the follow-up.

Conclusion
Our results indicated that discontinuation of ticagrelor therapy 3 days prior to surgery is sufficient to avoid CABG-related bleeding. Moreover, early CABG following STEMI does not increase the risk of long-term cardiovascular events.
Fibroblast growth factor 23 is a strong independent marker of poor outcome after an acute coronary syndrome
Authors: Kallmeyer A , Pello A , Canovas E , Acena A , Gonzalez-Casaus M L , Tarin N , Cristobal C , Gutierrez-Landaluce C , Huelmos A , Rodriguez-Valer A , Gonzalez Lorenzo O , Alonso J , Mahillo I , Lorenzo O , Tunon J 
Published: November 2023

Abstract
Our study aimed to assess the role of fibroblast growth factor 23 (FGF-23) as a prognostic marker after an acute coronary syndrome (ACS).
It was a prospective and multicentric study, performed at five tertiary hospitals in our city, which included 1,190 patients with ACS. FGF-23 plasma levels and other components of mineral metabolism (calcidiol, parathormone [PTH], klotho, and phosphate), lipids, troponin, high-sensitivity C-reactive protein, and N-terminal-pro-brain natriuretic peptide were measured at discharge. The primary outcome was a combination of acute ischemic events, heart failure (HF) and death. Secondary outcomes were the separate components of the primary outcome.
Median follow-up was 5.44 (3.03-7.46) years. 294 patients developed the primary outcome. Patients with FGF-23 less than median (which was settled in 110 RU/mL) were less frequently females, and were younger and had a lower load of cardiovascular risk factors. Besides, calcidiol and PTH levels were lower in patients with FGF-23 below the median.
Multivariable analysis showed that FGF-23 (HR 1.18 [1.08-1.29], p&lt;0.001), calcidiol (HR 0.86 [0.74-1.00], p=0.046), previous CAD or cerebrovascular accident, and hypertension were independent predictors of the primary outcome. The predictive power of FGF-23 was homogeneous across different subgroups of population. FGF-23 resulted an independent predictor of HF (HR 1.38 [1.22-1.57], p&lt;0.001), and death (HR 1.21 [1.07-1.37], p=0.002), but not of acute ischemic events. According to renal function, FGF-23 was an independent predictor for the primary outcome in patients with estimated glomerular filtration rate (eGFR) above 60 ml/min/1.73m2,, showing that the potential prognostic role of FGF-23 was not exclusively related to chronic kidney disease patients. Moreover, regarding the secondary outcomes, FGF-23 resulted an independent predictor of HF and death.
To sum up, FGF-23 seems to be a strong, independent, predictor of HF and death among patients with ACS. This effect is homogeneous across different subgroups of population and not limited to patients with CKD.
Effect of acute strenuous exercise on platelet aggregation, thrombin generation and fibrinolysis in patients with coronary artery disease
Authors: Kristiansen J , Grove E L , Sjurdarson T , Mohr M , Kristensen S D , Hvas A M 
Published: November 2023

Abstract

Introduction
Acute strenuous exercise may cause coronary thrombosis and sudden cardiac death.

Purpose
To investigate the effect of acute strenuous exercise on platelet aggregation, thrombin generation and fibrinolysis in patients with stable coronary artery disease (CAD) and healthy individuals.

Method
Patients with stable CAD (n=164) and healthy individuals (n=25) performed acute strenuous exercise on a cycle ergometer until exhaustion. Blood samples were taken at baseline (before exercise), immediately after and 2 hours after acute strenuous exercise.

Results
From baseline to immediately after strenuous exercise, TRAP-induced platelet aggregation increased significantly in CAD patients (Δ77 AU×min, 95% confidence interval (CI): 55;98, p&lt;0.001) and also in healthy individuals (Δ153 AU×min, 95%CI: 103;225, p&lt;0.001), and remained slightly elevated 2 hours after strenuous exercise in both groups (CAD patients: Δ53 AU×min, 95%CI: 27;80, p&lt;0.001; healthy individuals: Δ140 AU×min, 95%CI: 56;225, p=0.002). Thrombin generation was not affected immediately after exercise, but decreased after 2 hours in patients with CAD (endogenous thrombin potential: Δ-5%, 95%CI: -9;-2, p=0.004). Fibrin clot lysis time increased immediately after exercise (CAD patients: Δ10%, 95%CI: 3-16, p=0.003; healthy individuals: Δ30%, 95%CI: 16;46, p&lt;0.001), whilst plasminogen activator inhibitor-1 (PAI-1) decreased (CAD patients: Δ-17%, 95%CI: -33;-10, p&lt;0.001; healthy individuals: Δ-40%, 95%CI: -53;-25, p&lt;0.001). After 2 hours, an increased fibrinolysis was seen in both groups, expressed as a decrease in PAI-1 in both groups (CAD patients: Δ-41%, 95%CI: -46;-35 p&lt;0.001; healthy individuals: Δ-64%, 95%CI: -75;-46, p&lt;0.001) and a reduced fibrin clot lysis time in patients with CAD (Δ-18%, 95%CI: -24;-11, p&lt;0.001).

Conclusions
Acute strenuous exercise induced an immediate increase in platelet aggregation. Platelet aggregation remained slightly elevated after 2 hours while fibrinolysis was increased and thrombin generation slightly decreased indicating a more favourable haemostatic profile after 2 hours.
Premature coronary artery disease in all-comers undergoing first PCI
Authors: Pinxterhuis T H , Ploumen E H , Zocca P , Schotborgh C E , Anthonio R L , Roguin A , Danse P W , Benit E , Aminian A , Von Birgelen C 
Published: November 2023

Abstract

Background
The prevalence of coronary artery disease (CAD) increases with age, yet some individuals develop obstructive CAD at younger age.

Purpose
The present analysis aimed to assess differences in baseline risk profile and 3-year adverse event risk between patients undergoing percutaneous coronary intervention (PCI) for premature or non-premature CAD.

Methods
We pooled patient-level data of four randomized PCI trials in all-comers (TWENTE (clinicaltrials.gov: NCT01066650); DUTCH PEERS (NCT01331707); BIO-RESORT (NCT01674803); and BIONYX (NCT02508714)), who had no previous coronary revascularization (by PCI or coronary artery bypass surgery) or myocardial infarction (MI). Premature CAD was defined as CAD in men &lt;50 years and in women &lt;55 years, while non-premature CAD was classified as CAD in older patients. Main clinical endpoint was major adverse cardiac events (MACE), a composite of all-cause mortality, any MI, emergent coronary bypass surgery, or clinically indicated target lesion revascularization.

Results
Of all 6,171 PCI patients with first revascularizations, one out of seven (n=887, 14.4%) had premature CAD. These patients had lower rates of diabetes (10.6% vs. 16.6%, p&lt;0.001), hypertension (32.7% vs. 50.7%, p&lt;0.001), hypercholesterolemia (35.9% vs. 40.3%, p=0.012), and peripheral arterial disease (2.0% vs. 6.6%, p&lt;0.001). Yet, they were more often overweight (76.2% vs. 69.8%, p&lt;0.001), smoker (60.7% vs. 26.4%, p&lt;0.001), and had more often a family history of CAD (59.8% vs. 44.5%, p&lt;0.001). Patients with premature CAD suffered more often from acute ST-segment elevation MI and underwent less often treatment of calcified or bifurcated lesions (Table 1).
At 3-year follow-up, the main endpoint MACE did not differ significantly between patients with premature and non-premature CAD (6.6% vs. 9.4%; adj.HR:0.86, 95%-CI:0.65-1.16, p=0.33; Figure 1). All-cause mortality was lower in patients with premature CAD (0.8% vs. 4.4%; adj.HR:0.23, 95%-CI:0.10-0.52, p&lt;0.001). Yet, in patients with premature CAD the rate of repeated target vessel revascularization was higher than in patients with non-premature CAD (6.1% vs. 4.3%; adj.HR: 1.63, 95%-CI:1.18-2.26, p=0.003). In addition, their definite stent thrombosis risk was higher (1.0% vs. 0.5%; adj.HR:3.20, 95%-CI:1.39-7.38; p=0.006) than in patients with non-premature CAD.

Conclusions
One out of seven patients who were treated with PCI had premature CAD, and these patients had less complex risk profiles. Patients with premature CAD had higher risks for repeated revascularization and stent thrombosis, but the 3-year all-cause mortality risk was lower. In patients with premature CAD, long-term outcome after PCI might be improved by addressing modifiable risk factors such as smoking and overweight.Figure 1:Kaplan-Meier cumulative event
Impact of DM on clinical outcomes in patients with CAD diagnosed by CCTA
Authors: Kwon S U , Cho S W , Kwak J J , Doh J H , Namgung J 
Published: November 2023

Abstract

Background/Introduction
Diabetes mellitus (DM) is the most important risk factor for coronary artery disease (CAD) progression and prognosis. The DM patients with normal coronary artery on coronary CT angiography had good prognosis, however the prognosis of mild and moderate CAD was not fully elucidated.

Purpose
The aim of this study was to investigate the impact of DM on clinical outcomes in patients with mild and moderate CAD diagnosed by coronary CT angiography.

Methods
A total of 6014 patients underwent CCTA were prospectively enrolled and the 1126 patients with minimal and intermediate CAD were analyzed. Patients were categorized according to maximal severity of coronary artery stenosis: minimal CAD (31 to 50%) and intermediate CAD (51 to 70%). The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, coronary revascularization, or cardiac hospitalization.

Results
Nine hundred eighty-five patients had minimal CAD and 141 patients had intermediate CAD. The DM patients were 307 (31.2%) in the minimal CAD group and 52 (36.9%) in the intermediate CAD group. During the follow-up period (median 18.9 months [interquartile range: 7.8 to 34.6 months]), there is no significant difference of the risk of MACE between the non-DM and DM patients in the minimal CAD group (26.9% vs. 32.8%; adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.74-1.49; p=0.79). However, compared with the non-DM patients, the DM patients significantly increased the risk of MACE in the intermediate CAD group (36.5% vs. 63.2%; adjusted HR, 2.37; 95% CI, 1.18-4.77; p=0.02).

Conclusion
The prognosis of the DM patients was similar with the non-DM patients in the minimal CAD group. However, the DM patients had worse clinical outcomes compared with the non-DM patients in the intermediate CAD group.Study design and clinical outcomeKaplan-Meier curves of event rate for MA
No difference on angiographic features between women and men in patients with acute coronary syndrome: insights from the ADDICT-ICCU study
Authors: Guiraud-Chaumeil P , Lequipar A , Delmas C , Millischer D , Merat B , Grentzinger A , Lafont A , Gall E , Singh M , Clement A , El Beze N , Andrieu S , Pezel T , Henry P , Dillinger J G 
Published: November 2023

Abstract

Background
Previous studies have observed poorer outcomes in women with acute coronary syndrome (ACS). Angiographic features and angioplasty techniques to explain this difference between women and men have rarely been analyzed in recent studies.

Purpose
To analyze by a core laboratory angiographic finding, coronary artery disease (CAD) complexity and percutaneous intervention outcomes in women and men in patients with ACS.

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 ACS (n=379) with an independent angiographic core laboratory evaluation. The prevalence, location, and severity of CAD (lesion≥50%), the Syntax score, the residual Syntax score and the characteristics of percutaneous coronary intervention (PCI) were compared between women and men. The primary endpoint was Major Adverse Cardiac Events (MACE) defined by death, resuscitated cardiac arrest, or cardiogenic shock.

Results
Among the 379 patients with ACS (mean age: 63±13 years), 23% were women (n= 86) and 77% were men (n=286). Cardiovascular risk factors and CAD history were well balanced between women and men except for active smoking with less smokers in women (59% vs 81%, p&lt;0.001).
Regarding location of CAD (stenosis ≥50%), there was no significant difference between women and men: left anterior descending artery (56% vs 57%; p=0.90), circumflex (28% vs 39%; p=0.12) and right coronary artery (50% vs 48%; p=0.81). No difference was found for baseline Syntax score (7.98 vs 9.64; p=0.13). Women and men have a similar rate of multivessels disease (44% vs 50%; p=0.46) and 3 vessels disease (16% vs 20%; p=0.57).
Concerning PCI, Syntax score of the culprit lesion was significantly lower in women (4.5 vs 5.5, p=0.02). Women and men received a similar number of stents (2.3 vs 2.4; p=0.33). Stent length (28.9 vs. 30.3, p=0.43) or stent diameter (3.1 vs 3.2; p= 0.11) were not significantly different. Final TIMI 3 flow was found in 92.9% of women and 88.1% of men (p=0.23). The rate of procedural complications was low in both groups. At the end of the procedure, the residual Syntax score was similar in women and men (4.4 vs 5.4; p= 0.34).
The rate of in-hospital MACE was not different between women and men (4.7% vs 4.4%; p=0.91).

Conclusion
In this study with an independent angiographic core laboratory analysis of ACS patients, no difference between women and men regarding CAD severity or PCI outcomes was observed. Other reasons should be considered if a difference in prognosis exists between women and men.Angiographic features in Women and menAngiographic analysis by Core Laboratory
Uncertain meaning of early Q-wave in STEMI. Can we still rely on its relevance?
Authors: Pupiales Davila K , Gopar-Nieto R , Gonzalez-Pacheco H , Briseno-De La Cruz J L , Sierra-Lara Martinez J D , Araiza-Garaygordobil D , Patino-Gomez T A , Luna-Hernandez A , Baltazar-Cordero E , Arias-Mendoza A 
Published: November 2023

Abstract

Background
In patients with a first STEMI treated with invasive reperfusion strategy, early Q-waves do not predict a poor prognosis. The presence of a Q wave, although the common clinical misconception of its association with irreversible myocardial necrosis, should not necessarily change the reperfusion strategy, but hasten it.

Purpose
We aimed to examine if early Q-waves in patients in the emergency department of a tertiary center in the first 6 hours of chest pain, were associated with base demographics, in-hospital mortality, major adverse cardiovascular events, cardiac biomarkers, and cardiac imaging.

Methods
Retrospective cohort study of 1012 patients of which 251 had early Q-waves on their 12-lead ECG during the first 6 hours of chest pain. Q-waves were defined by the criteria of the Fourth Universal Definition of Myocardial Infarction. The cohort were the patients with Q-waves in ECG and compared each variable with its due statistical test.

Results
We found that age (54 vs 54, p=0.393), BMI (27.3 vs 27.4, p=0.683), diabetes (63 vs 196, p=0.266), smoking (118 vs 278, p=0.09), dyslipidemia (84 vs 195, p=0.152), hypertension (98 vs 258, p=0,747) and previous stroke (2 vs 10, p=0.42) were not associated with the presence of early Q-waves in our population.
There were no statistically significant differences within groups in global mortality (6% vs 14%, p=0.754), neither in cardiogenic shock (7% vs 15%, p =0.754), acute heart failure (8% vs 15%, p=0.390), acute pulmonary edema (2% vs 7%, p=0.749), stroke (0% vs 3%, p=0.292), atrial fibrillation and flutter (8% vs 12%, p=0.183), high degree AV block (15% vs 29%, p=0.273), ventricular tachycardia and fibrillation (18% vs 41%, p=0.522) and mayor bleeding (2% vs 3%, p=0.509).
Heart rate at admission was higher (p&lt;0.05) as well as the first determination of CK-MB (11.84 vs 8.48, p&lt;0.05). Interestingly, Q-waves were associated with greater likelihood of coronary occlusions, with a TIMI grade 0 before intervention (184 vs 458, p=0.044). There were no differences in reduced left ventricle ejection fraction (60.21 vs 60.96, p=0.06) or microvascular disease (76.38 vs 76.53, p=0.96) in cardiac magnetic resonance.

Conclusions
The presence of Q-wave at 6 first hours of chest pain was associated with higher cardiac biomarker expression and a greater incidence of coronary artery occlusion on cardiac catheterization. Early PCI should be directed as a first option to this group of patients, and this evidence might aim to perform it beyond the established 12-hour cutoff time.
The impact of smoking status on platelet reactivity and its association on clinical outcomes in east asian AMI patients with stent implantation
Authors: Song Z Y , Kim M H , Lee K M , Jin X , Yuan S L , Youk G S , Jung A H 
Published: November 2023

Abstract

Background
Smoking is one of the major risk factors as well as prognostic factors for cardiovascular disease including AMI.

Purpose
We sought to investigate the impact of smoking on major adverse cardiac and cerebrovascular events (MACCE) in AMI patient with stent implantation and also, we tried to confirm the issue’s of Smoker's paradox.

Methods
The multicenter PTRG-DES (Platelet function and geno Type-Related long-term proGnosis in DES-treated patients) consortium is a multicenter, real-world registry of patients who underwent PCI with DES and received DAPT of aspirin and clopidogrel in South Korea. We assessed PRUs as continuous and categorical measures. Additionally, the cutoff of HPR to ADP was defined as ≥ 252 PRU according to the time-dependent receiver-operating characteristic (ROC) curve analysis for East Asian patients. In this present analysis, smoking patients was defined according to data recorded at the time of admission. The primary outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE) were evaluated at 5-year follow-up.

Results
The 3,285 patients (28.0%) were smoker, and 4,001 patients (34.2%) were HPR patients. Smoker significantly increased the risk of death (HR=1.302 [95% CI: 1.019-1.664]), but did not increase the risk of MACCE. In smoking patients, HPR phenotype was significant association with MACCE (HR=1.532 [95% CI: 1.139-2.061]), death (HR=1.995 [95% CI: 1.335-2.983]), stent thrombosis (HR=3.986 [95% CI: 1.559-10.193]), in non-smoker patients, HPR was significantly associated with stent thrombosis (HR=3.018 [95% CI:1.591-5.726]).

Conclusion
Smoking was significantly associated with 5-year risks of all-cause death and MACCE. Smoking exaggerate HPR effect on MACCE. However, the smoker’s paradox was not observed in our study.