bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of coronary revascularization on coronary flow capacity assessed by serial transthoracic echocardiographic findings in patients with chronic coronary syndrome
Authors: Ueno H , Hoshino M , Sakamoto T , Matsuda K , Nogami K , Nagamine T , Hanyu Y , Hada M , Usui E , Yonetsu T , Sasano T , Kakuta T 
Published: November 2023

Abstract

Background
Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease. This study evaluated the effects of revascularization (PCI) on CFC assessed by serial transthoracic doppler echocardiography (TDE) examinations before and after elective PCI.

Methods
A total of 177 patients with chronic coronary syndrome underwent stress TDE examinations of left anterior descending arteries (LAD) before and after PCI to assess changes in CFC. Resting and hyperemic diastolic peak velocity (hDPV) was used to calculate CFR. Using previously reported thresholds for ischemia and normal perfusion, vessels were stratified in four CFC categories: severely reduced, moderately reduced, minimally reduced CFC, and normal flow. The association between CFC increase and pre-procedural TDE parameters was studied.

Results
After PCI, fractional flow reserve (FFR) values improved in all cases (0.70, (0.62 - 0.74), P &lt; 0.001), although 74 cases (41.8%) showed CFC decrease. Pre-PCI lower FFR, lower resting Pd/Pa, lower CFR, and lower hDPV were significant predictors for CFC increase after PCI. Lower baseline CFC, particularly in ischemic CFC defined as a composite of moderately, and severely reduced CFC was a predictor of CFC increase (P &lt; 0.01). On multivariable analysis, pre-PCI lower hDPV, and pre-PCI ischemic CFC were independent factors predicting CFC-improvement, while pre-PCI wire-based physiological data including FFR were not significantly associated with CFC improvement.

Conclusions
About a half of successful LAD PCI resulted in an increase in CFC. Preprocedural TDE-derived parameters including hDPV and CFC may help identification of lesions that benefit from revascularization with respect to an increase in coronary flow capacity. Further studies are needed to elucidate the effect of CFC improvement on prognosis.Effect of preprocedural CFC after PCI
Predictors of successful post-PCI optimization in vessels with post-PCI fractional flow reserve &lt;0.90: findings from the FFR REACT trial
Authors: Neleman T , Ziedses Des Plantes A C , Scoccia A , Groenland F T W , Van Zandvoort L J C , Ligthart J M R , Witberg K T , Boersma H , Nuis R J , Den Dekker W K , Diletti R , Wilschut J , Van Mieghem N M , Daemen J 
Published: November 2023

Abstract

Introduction
Recent studies demonstrated a strong relation between suboptimal post-PCI fractional flow reserve (FFR) and clinical outcome. The feasibility of post-PCI FFR optimization and its impact on future clinical outcome remains topic of debate.

Purpose
The aim of the present substudy of the FFR REACT trial was to identify predictors of 1) absolute FFR increase following optimization and 2) successful functional optimization (final FFR ≥0.90).

Methods
The FFR REACT trial was a single-center, investigator initiated, randomized controlled trial including patients with (un)stable angina or non-ST segment elevation myocardial infarction and angiographically successful PCI. Following a post-PCI FFR &lt;0.90, patients were randomized to intravascular ultrasound (IVUS)-guided optimization according to a dedicated optimization protocol (intervention arm) or no further treatment (control arm). In case of PCI optimization, FFR and IVUS were repeated to evaluate the optimization result. The present analysis included all patients randomized to IVUS-guided optimization, who actually underwent PCI optimization, and who had pre- and post-optimization FFR values available. We performed multivariate linear and logistic regression models to identify predictors of absolute FFR increase and FFR ≥0.90 following optimization.

Results
A total of 145 patients were allocated to the IVUS-guided optimization arm with 152 vessels having a post-PCI FFR &lt;0.90 (mean post-PCI FFR: 0.83±0.05), of which 104 vessels (68.4%) underwent additional treatment after IVUS evaluation. Paired FFR measurements (pre- and post-optimization) were available in 100/104 optimized vessels. The mean absolute change in FFR was 0.03±0.06 (p&lt;0.001), and 20/100 (20%) vessels achieved a final FFR ≥0.90.
Both left anterior descending arteries (LAD) (mean change = -0.033, 95%CI -0.055- -0.010, p=0.004) and higher post-PCI FFR values (mean change per 0.01 unit increase = -0.005, 95%CI -0.007 - -0.004, p&lt;0.001) were associated with lower changes in FFR following optimization.
Independent predictors of achieving a final FFR ≥0.90 were higher post-PCI FFR values (OR 1.26 per 0.01 unit increase, 95%CI 1.06-1.51, p=0.009) and non-LAD vessels (OR 5.72, 95%CI 1.73-18.94, p=0.004).

Conclusions
Within the FFR REACT trial, we observed that the likelihood of improvement in final FFR values was driven by the initial post-PCI FFR values (before optimization) and the location of the target vessel, with non-LAD lesion location being a significant predictor of FFR increase.
Impact of myocardial bridge defined by computed tomographic coronary angiography on fractional flow reserve 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
Myocardial bridge (MB) is a common anomaly of epicardial coronary artery that courses through myocardium. MB can be identified by computed tomographic coronary angiography (CTCA) or invasive coronary angiography (ICA). However, its relevance to coronary physiological parameters remains unknown.

Purpose
This observational study aimed to explore how MBs affect physiological parameters in patients with chronic coronary syndrome before and after revascularization.

Methods
We investigated 172 consecutive patients who underwent preprocedural CTCA and elective fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in left anterior descending artery (LAD). We compared patient characteristics, angiographic, and pre- and post-PCI physiological parameters in patients with versus without MB.

Results
We identified MB in 70 (40.7%) and 23 (13.3%) patients by CTCA and ICA, respectively. CTCA detected the presence of MB with a sensitivity of 100% and a specificity of 33% when ICA-defined MB was regarded as a reference standard. Longer MB (adjusted odds ratio 1.18 [95% confidence interval 1.05-1.33], P &lt; 0.01) and smaller left ventricular myocardial mass volume in whole LAD territory (adjusted odds ratio 0.93 [95% confidence interval 0.89-0.98], P&lt;0.01) were associated with ICA detectability of MB. Older age and higher frequency of diabetes mellitus were observed in patients with MB compared with those without MB. Pre-PCI FFR values were not associated with a presence of MB regardless of either CTCA- or ICA-defined MB. On the other hand, post-PCI FFR values were significantly lower in patients with versus without MB by CTCA (0.82 [0.80-0.86] vs. 0.86 [0.82-0.89], P&lt;0.01), while no significant difference was observed in post-PCI FFR between patients with and without ICA-defined MB (0.82 [0.81-0.84 vs. 0.84 [0.80-0.88], P=0.08). Multivariable linear regression analysis revealed that a presence of CTCA-defined long MB (≥25mm) (adjusted β coefficient = -0.040, P&lt;0.01) and greater myocardial mass volume in whole LAD territory (adjusted β coefficient = -0.0004, P&lt;0.01) were independently associated with lower post-PCI FFR.

Conclusion
A presence of MB was an independent predictor of lower post-PCI FFR after successful and elective PCI for LAD.
Bivalirudin versus Heparin in ST and non-ST-segment elevation myocardial infarction
Authors: Omerovic E 
Published: November 2023

Abstract

Background
The registry-based randomized VALIDATE-SWEDEHEART trial compared bivalirudin vs. heparin in patients undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI). It showed no difference in the composite primary endpoint of death, MI, or major bleeding at 180 days.

Methods
Analysis of primary and secondary endpoints at two years of follow-up was prespecified in the study protocol. We report here the study results for the extended follow-up time.

Results
In total, 6006 patients were enrolled, 3005 with ST-segment elevation MI (STEMI) and 3001 with Non-STEMI (NSTEMI), representing 70% of all eligible patients with these diagnoses during the course of the study. The primary endpoint occurred in 14.0% (421 of 3004) in the bivalirudin group compared with 14.3% (429 of 3002) in the heparin group (hazard ratio [HR] 0.97; 95% confidence interval [CI], 0.85 – 1.11; P=0.70) at one year and in 16.7% (503 of 3004) compared with 17.1% (514 of 3002), (HR 0.97; 95% CI, 0.96 – 1.10; P=0.66) at two years (Figure 1). The primary outcome at two years was consistent across all prespecified subgroups, including risk groups with high age, gender, chronic renal failure, diabetes mellitus, and smokers (Figure 2).

Conclusions
Till two-years follow-up there were no differences in endpoints between patients with MI undergoing PCI and allocated to bivalirudin compared with those allocated to heparin.Figure 1Figure 2
Very long-term prognostic value of clinical SYNTAX score in patients undergoing percutaneous coronary intervention for left main coronary artery disease
Authors: Lee J , Jung M , Kwak H , Chang E , Jung J , Rhee E , Park Y , Park B , Kim H , Kim N , Jang S , Bae M , Yang D , Park H , Cho Y 
Published: November 2023

Abstract

Background
Recently, long-term prognostic value of SYNTAX score (SS) has been validated in patients with left main coronary artery disease (LMCA). However, the ability of clinical SYNTAX score (CSS) to predict very long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) for LMCA has not been fully investigated yet.

Purpose
We aimed to validate the impact of CSS on very long-term outcomes in patients undergoing PCI for LMCA.

Methods
Between June 2006 and December 2012, 279 patients underwent unprotected LMCA PCI were analyzed. The SS for each patient was calculated by scoring all coronary lesions using SS algorithm. CSS was calculated by multiplying the SS to an ACEF score (age/left ventricular ejection fraction + 1 if serum creatinine&gt;2mg/dL). Major adverse cardiac events (MACEs) were defined as death, non-fatal myocardial infarction, and revascularizations. Mean follow-up duration was 2,529±1664 days.

Results
The CSS (26.8±11.9 versus 39.9±26.1, p&lt;0.001) as well as SS (23.2±6.9 versus 25.8±7.9, p=0.003) was significantly higher in patients with MACEs. Area under the curve for MACEs (0.672 versus 0.599, p=0.0023) and mortality (0.744 versus 0.626, p&lt;0.0001) of CSS was significantly higher compared with those of SS (Figure 1). The CSS significantly improved the reclassification and the integrated discrimination of patients compared to SS. Log CSS was an independent predictor for MACEs (hazard ratio [HR] 5.37, 95% confidence interval [CI] 1.98 – 14.61; p = 0.006) and mortality (HR 11.69, 95% CI 3.30 – 41.31; p &lt; 0.001). When patients were categorized into 3 groups according to tertiles of CSS (Low CSS ≤ 22, 22 &lt; Mid CSS ≤ 34, High CSS &gt; 34), patients in the highest CSS tertile had significantly higher rates of MACEs (log-rank p&lt;0.001) and mortality (log-rank p&lt;0.001) compared with those in the lower 2 tertiles (Figure 2). The highest CSS tertile was an independent predictor for MACEs (HR 2.33, 95% CI 1.42 – 3.82; p = 0.001) and mortality (HR 5.66, 95% CI 2.20 – 14.57; p &lt; 0.001).

Conclusions
The CSS is useful to predict very long-term clinical outcome in patients underwent unprotected LMCA PCI.
Feasibility and efficacy of a novel 6 french sheathless guiding catheter equipped with peel-off type external dilator for PCI with distal radial approach - a Japanese multicenter study
Authors: Yamada T , Izumikawa T , Taniguchi N , Hata T , Nakajima S , Takahashi A 
Published: November 2023

Abstract

Introduction
Recently, distal radial access has emerged as a promising alternative access to minimize access site complications.

Objectives
The aim of this study was to evaluate feasibility and efficacy of a novel 6-Fr sheathless guiding catheter system equipped with peel off type outer dilator for the patients who underwent percutaneous coronary intervention through distal radial artery.

Methods
Between Oct 2018 and January 2023, a total of 168 patients including 27 patients with ST elevation myocardial infarction underwent percutaneous coronary intervention using a 6-Fr novel sheathless guiding catheter in 2 Japanese hospitals with distal radial approach. The guiding catheter system include a 6-Fr guiding catheter and an inner and outer (peel-off type)dilater to prevent potential vascular damage during passage of the tip of the catheter. After puncture of the distal radial artery with 22 gause needle, a 0.025 inch guidewire with 220 cm length was inserted. Then, a seathless guiding catheter system equipped with both inner and outer sheath was advanced through skin surface for dilatation of puncture point. After peeling off the outer sheath, the catheter with inner sheath was advanced. Hemostatic method complies compression with a hemostatic pad and elastic bandage for 3 hours. Procedural success, bleeding complication and radial occlusion examined using Doppler ultrasound at discharge was accessed.

Results
Mean age of the patients was 72.1 ± 11.3 years old and 114 patients were male. Procedural success was 100 % with no patient requiring conversion to conventional radial access. The culprit lesion was located in the right coronary artery in 45 patients, the left anterior descending artery in 86 patients, the left circumflex artery in 21 patients, and the left main trunk in 12 patients. Doppler ultrasound examination of the distal radial artery at 1-day follow-up was available in all patients, with 2 patients (1.2%) was found to have radial artery occlusion. One patient (0.6%) presented forearm hematoma equivalent to EASY hematoma classification I and 4 patients (2.4%) showed dorsum hematoma.

Conclusions
The current study demonstrated that the use of a novel sheathless guiding catheter with outer dilator for distal radial approach in PCI was feasible and may contribute further reduction of procedure-related complications.peel-off type outer dilaterinsertion procedure
The effect of heparin dose on radial artery occlusion in patients undergoing coronary procedures via distal radial access: a sub-analysis of a randomized trial
Authors: Tsigkas G , Apostolos A , Papageorgiou A , Moulias A , Vasilagkos G , Papanikolaou A , Katechis S , Koufou E , Koros R , Trigka A , Travlos C , Chamakioti M , Bozika M , Nastouli K M , Davlouros P 
Published: November 2023

Abstract

Background
Radial artery occlusion (RAO) is the most common complication following coronary catheterization. Several measures have been taken to prevent RAO, including increasing the dose of unfractionated heparin (UFH) and using a distal radial artery (DRA) approach. However, the effect of a higher dose of UFH on RAO incidence in the DRA approach remains unclear.

Purpose
This study aims to investigate the impact of heparin dose (50IU/kg or ≥70IU/kg) after DRA approach on RAO incidence.

Methods
Data were obtained from a previous randomized controlled trial comparing distal to conventional radial access regarding RAO. Patients having undergone DRA access were stratified into two groups based on heparin dose received. A Pearson chi-square test was used to compare RAO incidence between the groups, and a multivariate logistic regression analysis was performed, considering baseline and periprocedural details.

Results
Data on RAO incidence and heparin dose were available for 768 patients, and 379 catheterized via DRA. A total of 234 patients received ≥70IU/kg heparin dose and the rest 145 received 50IU/kg. A higher dose of UFH was not associated with a lower incidence of RAO (3.3% vs. 3.4%, p=0.957). Multivariate logistic regression analysis showed that the use of 5-Fr sheaths (odds ratio [OR]: 0.044, 95% CI: 0.003-0.755), a lower number of diagnostic catheters (OR: 2.47, 95% CI: 1.250-4.878), and a shorter total procedure time (OR: 1.034, 95% CI: 1.011-1.059) were significantly associated with lower rates of RAO.

Conclusions
Our analysis indicates that a higher dose of UFH (≥70IU/kg) did not reduce RAO incidence in DRA access. Further studies with larger sample sizes are necessary to confirm these findings.
Right and left radial access for coronary angiography and percutaneous coronary intervention after coronary artery bypass graft surgery: no need to go down
Authors: Cutz M , Pina Y , Castillo G 
Published: November 2023

Abstract

Introduction
Currently is estimated that at least 90% of the coronary studies are performed through the radial access. However, in patients with prior coronary artery bypass graft surgery (CABG) the femoral access continues to be widely used due to an easier and more successful graft engagement. Evidence of the efficacy and security of the radial approach use in this population is both scarce and controversial.

Purpose
We aimed to compare radial (right and left) versus femoral access to perform coronary angiography (CA) and/or percutaneous coronary intervention (PCI) after CABG.

Methods
In this comparative historical cohort study conducted at a national reference center, all CA and PCI performed from January 2012 to October 2022 were eligible for review. Electronic and physical records were examined for demographic and interventional data. Groups were classified for comparison as CA plus PCI, CA only and PCI only.

Results
We identified 563 patients; radial access was used in 227 (40%). In CA plus PCI group, in only one case existed failure to cannulate bypass grafts by the initial chosen access (from right radial access [RRA] to the left internal mammary artery [LIMA]). The crossover rate for any cause other than graft cannulation failure was 11.3% with right radial access (p = 0.002), 4.2% with left radial access (p = 0.28) and 0% with the femoral route. Fluoroscopy time was greater in RRA compared to femoral, nevertheless left radial access (LRA) had lower fluoroscopy time and contrast volume compared to RRA and femoral access. In the CA only group, failure to cannulate bypass grafts occurred exclusively when the LIMA had to be cannulated from the RRA (8.3% p=0.001); with a crossover rate for any cause other than graft cannulation failure was greater in the radial access compared to femoral (RRA 18.1% p &lt; 0.001; LRA 4.2% p = 0.002; femoral 0.5% P=0.001), LRA had greater fluoroscopy time but the femoral access had greater contrast volume use in relation with a higher number of venous bypass grafts [143.64 mL (±69.36), p = 0.01]. There were 15 cases of PCI only, were fluoroscopy time and contrast volume were greater in LRA (N= 2 none were for treatment of LIMA) and lower in RRA compared to LRA and femoral access. Vascular complications were infrequent in all groups, being minor bleeding in the femoral access the most frequent, with no statistical significance.

Conclusion
Right and left radial access are feasible to perform coronary angiography and PCI after CABG, compared to the femoral route are associated with less contrast volume despite a greater crossover rate. This analysis suggests that the LRA should be preferred over the RRA when angiography of the LIMA is needed.
Ultrasound guided trans-radial access in the cardiac catheterisation laboratory: a systematic review and meta-analysis
Authors: Hamilton G W , Sharma V , Yeoh J , Yudi M , Raman J , Clark D J , Farouque O 
Published: November 2023

Abstract

Background
Although ultrasound (US) guidance for vascular access is now widely considered standard of care (1,2), its use for trans-radial access (TRA) in the cardiac catheterization laboratory is uncommon. There is a perception that US guidance offers no clinically relevant benefit over traditional palpation guided TRA, and this notion has been amplified by the inconsistent findings of individual studies.

Purpose
To evaluate the utility of US guidance for TRA when performed specifically for cardiac catheterisation.

Methods
A systematic review of MEDLINE, EMBASE and the Cochrane Library identified studies comparing US to palpation guided TRA for cardiac catheterization. Event rates and calculated risk ratios (RR) were pooled for meta-analysis. Access failure was the primary outcome, defined as an inability to insert a sheath into the radial artery with the initial access strategy (US or palpation guided). Random effects modelling was used for analysis.

Results
Of the 977 studies screened, 5 were included with a total of 1,918 patients (961 US-guided and 964 palpation-guided, Table 1). The majority of procedures were elective. US guidance significantly lowered the risk of access failure (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.21 – 0.97), with moderate heterogeneity (I^2 = 51.2%) (Figure 1). There was a strong trend to improved first pass success with US (RR 1.29, 95% CI 1.00 – 1.66, I^2 = 83.8%), though no differences were found in rates of difficult access (RR 0.29, 95% CI 0.07 - 1.18, I^2 = 88.3%). Salvage US guidance was successful in 30/41 (73.2%) patients following failed palpation guided TRA. No differences were found in already low complication rates including radial artery spasm (RR 0.92, 95% CI 0.52 – 1.62, I^2 = 34.8%) and bleeding (RR 0.92, 95% CI 0.40 – 2.11, I^2 = 0.0%). No studies evaluated patient-reported outcome measures.

Conclusions
US guidance improves TRA success in the cardiac catheterisation laboratory. Further investigation is necessary to determine whether routine, selective, or salvage use of US confers the most radial artery protection, patient satisfaction, and overall clinical benefit. Future studies should have standardised outcome measures including femoral crossover rates and patient reported outcome measures