bluuebunny/crossref_metadata_2025_split huggingface dataset:
PSRC1 rs599839 G allele may promote protection from coronary artery disease in a Madeira Island population
Authors: Sousa F , Mendonca M , Sa D , Temtem M , Santos M , Henriques E , Freitas S , Rodrigues M , Borges S , Guerra G , Drumond A , Sousa A C , Dos Reis R P 
Published: November 2023

Abstract

Previous research associates the PSRC1 gene on the chromosomal locus 1p13.3 with coronary artery disease (CAD). Specifically, the A wild allele of the PSRC1 rs599539 A&gt;G was identified as a risk allele for CAD, and the mutated G minor allele with a reduced risk of CAD. However, the underlying genetic mechanism is not yet fully understood and is controversial in other populations.

Aim
To investigate the association of rs599839 A&gt;G variant with CAD risk and lipid profile in a Portuguese population from Madeira Island.

Materials and Methods
We performed a case-control study including 3161 participants, 1724 patients with CAD (78.7% male) and 1437 controls (76.3% male). Coronary patients were recruited from the Madeira Central Hospital, and controls were from the normal population. PSRC1 was genotyped by TaqMan allelic discrimination assay (Applied Biosystems, 7300 Real-Time PCR). Pearson´s Chi-squared test evaluated the association between CAD-genotypes and the t Student test for genotypes-lipid levels.

Results
PSRC1 rs599839 A&gt;G variant was within Hardy -Weinberg equilibrium. The wild dominant model (AA+AG) conferred a trend for CAD risk (OR=1.16; p=0.414), and the mutated dominant model (GG+GA) presented slight protection for CAD susceptibility. However, the minor G (protector) allele was associated with low levels of total cholesterol (p=0.003) and LDL-cholesterol (p=0.004).

Conclusions
This finding is consistent with previous reports indicating a decrease in LDL-C and total cholesterol levels in carriers of the minor allele G of rs599839. Recent research refers that this allele could affect PSRC1 expression, resulting in lower levels of LDL cholesterol and reduced risk of CAD. In contrast, the A wild allele is associated with high LDL levels. PSRC1, lipid, and CAD risk is a complex topic involving genetic, epigenetic and environmental factors.
Optimal medical management vs. percutaneous coronary intervention for patients with stable angina: from nation-wide Korean Insurance data
Authors: Jo S H 
Published: November 2023

Abstract

Background
To investigate whether percutaneous coronary intervention (PCI) on top of optimal medical therapy (OMT) is superior to OMT only in patients with stable angina.

Methods
We enrolled patients with stable angina from 2005-2010 using the Korean national Insurance data. 68621 patients were candidate with stable angina and finally 5673 patients in PCI plus OMT and 5673 in OMT were selected with 1:1 propensity matching.

Results
Primary endpoint, a composite of myocardial infarction (MI), stroke, cardiac death and revascularization was significantly more common in PCI than in OMT group, 13.5/1000 vs. 11.5/1000 person year with HR, 1.182(1.059-1.319) (P=0.0027). Individual outcome rate of MI, revascularization and cardiac death was higher in PCI group then in OMT group , 2.9 vs. 2. (HR [1.376 1.085-1.744], p=0.0085), 30.3 vs. 8.1 (HR 3.638 [3.269-4.049], p&lt;0.001) and 4.8 vs 3.4/1000 person year (HR 1.397 [1.155-1.69], p=0.0006) respectively. No difference was found in stroke rate. In subgroup analysis same trend of more rate of event in PCI group was detected.

Conclusions
PCI was associated with higher rate of primary endpoint of MI, stroke, cardiac death as compared to OMT only in patients with stable angina.Primary endpoint between PCI vs. OMT
A predictors for 10-year mortality and clinical events in patients with chronic coronary total occlusion lesion
Authors: Kim K , Choi B G , Rha S W 
Published: November 2023

Abstract

Background
Despite advances in cardiovascular intervention techniques and devices, the treatment of patients with chronic coronary total occlusion CTO lesions is challenging yet. We evaluated predictors of 10-year mortality and clinical events in patients with CTO lesions in this study.

Methods
This study is a single-center, prospective, all-comer registry designed to reflect "real world" practice since 2001. Of a total of 1,672 consecutive patients were diagnosed with CTO lesions by coronary angiogram. The primary endpoints were all-cause death or major adverse cerebral, and cardiac events (MACCE) defined as the composite of all-cause death, myocardial infarction (MI), any coronary revascularization, and stroke up to 10 years. We derived for final results, from survival analysis by Kaplan-Meier and Cox-proportional regression analysis.

Results
In this study, males were 1,255 (75.1%), and the mean age was 65.2±10.9. Also, a total of 660 patients had received a successful PCI for CTO lesions at enrollment. A total of 267 patients was heart failure. Ten years of clinical follow, MACCE occurs in 407 cases (56.6%), all-cause death in 152 cases (18.5%), cardiac death in 87 cases (9.9%), myocardial infarction (MI) in 54 cases (7.7%), any revascularization of 251 cases (30.7%), and stroke of 41 cases (6.3%) by Kaplan-Meier analysis. In a multiple Cox-proportional regression analysis, a prior myocardial infarction, reduced LV ejection fraction less than 50%, chronic kidney disease, multi-vessel disease had increased a risk of MACCE and the use of statin, and aspirin had reduced a risk of MACCE. Also, an aging, prior MI, reduced LV ejection fraction less than 40%, and multi-vessel disease had increased a risk of all-cause death and the use of statin, and renin-angiotensin system inhibitors, nitrates, statin, and aspirin had reduced a risk of risk of all-cause death. However, PCI for CTO lesions could not reduce both of MACCE and all-cause death.

Conclusions
The study found that a prior myocardial infarction, reduced LV ejection fraction, chronic kidney disease, and multi-vessel disease were associated with an increased risk of MACCE, while the use of statins and aspirin reduced the risk of MACCE. Furthermore, PCI for CTO lesions did not reduce the incidence of MACCE or all-cause death. These findings highlight the need for further research and development of more effective treatment strategies for patients with CTO lesions.
Anatomic vs ischemia-driven strategies for percutaneous coronary revascularization in chronic coronary syndrome: a network meta-analysis
Authors: Giacobbe F , Valente E , Giannino G , Yip H C , Di Vita U , Carmagnola L , De Filippo O , Bruno F , Iannaccone M , Biondi Zoccai G , Gasparini M , Pocock S , Escaned J , De Ferrari G M , D'ascenzo F 
Published: November 2023

Abstract

Background
In patients with chronic coronary syndrome (CCS), percutaneous coronary intervention (PCI) stands out as an alternative to optimal medical therapy (OMT). The decision to perform a PCI may be driven either by angiographic evaluation or ischemia assessment, thus depicting different potential strategies which have not yet been compared.

Purpose
To compare different strategies of percutaneous revascularization (angiography, non-invasive ischemia and coronary physiology (FFR or iFR) guided) in order to identify a potential benefit of PCI depending on the guidance chosen in CCS.

Methods
Randomized controlled trials (RCTs) comparing OMT vs. PCI-angio guided or vs. PCI guided by non-invasive or invasive ischemia assessment were included and compared via network metanalysis. Major adverse clinical events (MACE), as defined by each included trial, were the primary end point, while cardiovascular (CV) death, myocardial infarction and subsequent revascularization the secondary ones.

Results
18 studies, encompassing 17512 patients, were included followed up for a weighted mean of 3,5 years. PCI guided by non-invasive assessment of ischemia entailed a reduced risk of myocardial infarction compared with OMT (HR 0.61:0.37-0.94, CI 95%). This strategy ranked best in preventing CV death. In addition, PCI guided by ischemia defined either invasively or not was associated with a reduced risk of MACE as compared with OMT. iFR and FFR guided approaches showed the highest probability of performing best. Finally, physiology guided PCI ranked best in reducing subsequent urgent revascularizations.

Conclusions
For patients with CCS, ischemia-guided PCI, either by invasive or noninvasive assessment, resulted in a reduced risk of MACE as compared with OMT. PCI guided by a non-invasive assessment of ischemia reduced risk of myocardial infarction compared to OMT, while PCI guided by iFR or FFR showed the highest probability of reducing the need of subsequent revascularization. These strategies showed the highest probability of reducing MACE and CV death.Bar plot of best treatmentPRISMA diagram and Network Plot
Association between quantitative flow ratio and non-target-vessel-related events before planned staged percutaneous coronary intervention in patients with acute coronary syndrome
Authors: Baer S , Kavaliauskaite R , Otsuka T , Ueki Y , Haener J D , Siontis G C M , Lanz J , Praz F , Pilgrim T , Stortecky S , Losdat S , Windecker S , Raeber L 
Published: November 2023

Abstract

Introduction
The optimal timepoint of non-target-vessel (non-TV) percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative Flow Ratio (QFR) is a novel, non-invasive, vasodilator-free method to assess the hemodynamic significance of coronary stenoses.

Purpose
We aimed to investigate the association between non-TV QFR and non-TV-related events occurring prior to planned staged PCI (sPCI), to derive first conceptual knowledge, whether QFR could be useful to determine the optimal timepoint of sPCI.

Methods
Between 2009-2017, all ACS patients scheduled to undergo out-of-hospital sPCI within 6 months from index PCI at Bern University Hospital, Switzerland, were eligible for QFR measurement. The primary endpoint was non-TV myocardial infarction (MI) and urgent (unplanned) non-target-vessel PCI occurring before planned sPCI. QFR was measured using the index presentation angiogram in the non-TV planned for sPCI. The association between lowest QFR per patient (per 0.1) and the occurrence of the primary endpoint was assessed with a multivariable Cox proportional hazards regression including a penalized spline term for QFR and the variables age, sex, diabetes mellitus, renal failure, and diameter stenosis (DS%) (per 5%).

Results
Out of 8657 ACS patients, 1432 were scheduled to undergo sPCI, and 1093 patients (1262 vessels) were analyzed by QFR. At baseline, mean QFR was 0.73±0.17 and mean DS% 54.8±11.2%. sPCI was planned with median 28 days after the index PCI. In multivariable analysis (1018 patients, 51 events), there was no independent association between QFR and the primary endpoint (HR 0.87, 95% CI 0.69-1.05, p=0.125; QFR non-linear p=0.648).

Conclusions
In this cohort study of ACS patients scheduled to undergo out-of-hospital sPCI within median 28 days, QFR did not emerge as a predictor of non-TV events prior to planned sPCI. Thus, this study does not support the concept, that QFR would be helpful to determine the optimal timepoint of sPCI.Figure 1.Primary endpointTable 1.Cox model primary endpoint
Clinical outcomes of deferred lesions by IVUS versus FFR-guided treatment decision: the FLAVOUR trial substudy
Authors: Lee J M , Kim H , Hong D , Nam C W , Doh J H , Lee B K , Kim W , Kang J , Ahn S G , Yoon M H , Kim U , Shin E S , Koo B K , Wang J , Hahn J Y 
Published: November 2023

Abstract

Background
There is limited data regarding the safety of deferral of percutaneous coronary intervention (PCI) based on intravascular ultrasound (IVUS) findings. Current study sought to compare the prognosis between deferred lesions based on IVUS and FFR (fractional flow reserve)-guided treatment decision.

Methods
Study population was derived from FLAVOUR trial which is a multinational, open-label, randomized, and non-inferiority trial that compared 2-year clinical outcomes between IVUS and FFR-guided treatment decision using predefined criteria. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients into those with or without deferred lesion. Vessel-oriented composite outcomes (VOCO) (cardiac death, target-vessel myocardial infarction, or target-vessel revascularization) in deferred vessels and patient-oriented composite outcomes (POCO) (death, myocardial infarction, or any revascularization) in patients with deferred lesion were compared between IVUS and FFR group.

Results
A total of 1682 patients and 1820 vessels were analyzed. At 2 years, there is no difference in cumulative incidence of VOCO in deferred vessels between IVUS and FFR groups (3.8% vs. 4.1%; hazard ratio [HR] 0.91; 95% confidence interval [CI] 0.47-1.75; P=0.771). The risk of VOCO was comparable between deferred and revascularized vessels following both IVUS (3.8% vs. 3.5%; HR 1.09; 95% CI 0.54-2.19; P=0.813) and FFR-guided treatment decision (4.1% vs. 3.6%; HR 1.14; 95% CI 0.56-2.32; P=0.715). In comparison of POCO in patients with deferred lesion, there was no significant difference between IVUS and FFR groups (6.2% vs. 5.9%; HR 1.05; 95% CI 0.61-1.80; P=0.856).

Conclusion
In patients with intermediate coronary artery stenosis, deferral of PCI based on IVUS-guided treatment decision showed comparable risk of clinical events with FFR-guided treatment decision.
High resting coronary flow velocity and reduced coronary flow velocity reserve independently predict worse survival in diabetic patients without inducible ischemia and normal left ventricular function
Authors: Meola L , Cortigiani L , Ciampi Q , Gaibazzi N , Rigo F , Wierzbowska-Drabik K , Rodriguez-Zanella H , Bovenzi F M , Picano E 
Published: November 2023

Abstract

Background
High resting coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery (LAD) can be easily assessed with transthoracic echocardiography (TTE) and is a predictor of worse survival.

Purpose
In this study, we sought to assess the relationship between resting CFV, coronary flow velocity reserve (CFVR), and outcome in patients without inducible regional wall motion abnormality during stress echo (SE).

Methods
In a prospective multicenter study design, we enrolled 6,887 patients (age 65±11 years, 3,838 men, 1,963 diabetics), with left ventricular ejection fraction (LVEF) ≥50% referred for SE. Recruitment (years 2004-2022) involved 7 accredited laboratories, with inter-observer variability &lt;10% for CFV measurement at study entry. Baseline peak diastolic CFV (abnormal value &gt;32 cm/s) was obtained by pulsed-wave Doppler in mid-distal LAD. Coronary flow velocity reserve (CFVR, abnormal value ≤2.0) was assessed with dipyridamole. All-cause death was the only end-point.

Results
The mean CFV of LAD was 30±11 cm/s. The mean CFVR was 2.37±0.58. During a median follow-up of 6.0±4.2, 1,015 (15%) patients died. At Cox analysis, resting CFV &gt;32 cm/s independently predicted mortality together with CFVR &lt;2, age, diabetes, previous myocardial infarction, history of coronary surgery and LVEF. Resting CFV allowed effective risk stratification either in diabetics and nondiabetics although the difference in survival based on resting CFV was more marked in the former (Figure). In addition, it added significant (p&lt;0.0001) prognostic information to CFVR result in the diabetic, but not in the non-diabetic population (Figure).

Conclusion
High resting CFV with TTE in mid-distal LAD predicts worse survival in patients without inducible ischemia. The value is independent and additive to CFVR in diabetic patients. The combination of high resting CFV-low CFVR is associated with worse survival.
Functional Syntax score based on quantitative flow ratio vs. anatomical Syntax score
Authors: Gkini K P , Terentes-Printzios D , Oikonomou D , Dima I , Gardikioti V , Aznaouridis K , Tsioufis K , Vlachopoulos C 
Published: November 2023

Abstract

Background/Introduction
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score takes into consideration only the anatomy of the coronary network, while the Functional Syntax Score based on Quantitative Flow Ratio (FSSQFR) combines all the information derived from both anatomy and physiology of coronary arteries.

Purpose
To investigate the level of agreement between anatomical SYNTAX Score I (SS) and FSSQFR and its possible impact on risk re-stratification of patients and on revascularization options.

Methods
We performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single Greek center. A total of 410 patients with accountable FSSQFR were included. The latter was counted by summing the individual points only of physiologically signiﬁcant lesions (vessel QFR ≤0.8). Patients were divided into low-, intermediate- and high risk according to SS and FSS with the same cutoff. The primary endpoint was the estimation of the predictive value of FSSQFR for the composite outcome of cardiovascular death, myocardial infarction and ischemia-driven revascularization at follow-up.

Results
FSSQFR and SS were estimated for all patients. After calculating the FSSQFR, 12% (48/410) of study patients changed the risk group. Most of them moved from higher-risk group by SS to lower-risk group and only three of them presented the opposite movement. Moreover, 5.9% (24/410) of patients, for whom coronary artery bypass grafting would be recommended according to SS, converted to favor percutaneous coronary intervention after FSSQFR calculation. After a median 30.2 (25.7-33.7) months follow-up period, the cumulative incidence of a composite of cardiac death, myocardial infarction or ischemia-driven revascularization was 4.6%, 10.7%, and 24.1%, in the low, intermediate, and high FSSQFR group correspondingly (log-rank P&lt;0.001) (Figure 1). After multivariate regression analysis, FSSQFR was an independent predictor of the primary endpoint after adjustment for age, gender, smoking, and hypertension (adjusted OR: 1.08 [95% CI, 1.05–1.12]; P&lt;0.001). The area under the curve for FSSQFR to predict the 2-year composite endpoint was higher than that of the classic anatomic SYNTAX score (0.711 vs. 0.706; p&lt;0.001) (Figure 2).

Conclusions
In our study, FSSQFR found to be an independent predictor of higher cardiovascular adverse events. Also, compared with SS, FSSQFR signiﬁcantly improved risk classiﬁcation of patients with coronary disease widening the possible therapeutic options.
Cost-effectiveness analysis of PCI in focal and diffuse coronary artery disease
Authors: Munhoz D M , Hlatky M , Collison D , Berry C , Oldroy K , Mizukami T , Sakai K , Storozhenko T , Seki R , Bouisset F , Sonck J , De Bruyne B , Collet C 
Published: November 2023

Abstract

Aims
The pattern of CAD predicts angina relief after PCI. Our aim was to evaluate the cost-effectiveness of PCI in diffuse coronary artery disease (CAD) to deferral from PCI in these patients.

Methods
This is a sub-analysis of the TARGET-FFR randomized clinical trial (NCT03259815). The pullback pressure gradient (PPG) was calculated to differentiate focal from diffuse CAD.
Healthcare resource use associated with the index hospitalization and with follow-up outpatient visits, medications, was recorded prospectively. We did not discount costs because of the limited follow-up period. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS).
Quality-adjusted life-years (QALYs) were derived from health-related quality of life and survival during the 3-month time horizon of the trial. Quality-of-life indexes (utilities) were evaluated at baseline and 3 months with the European Quality of Life–5 Dimensions (EQ-5D) instrument with UK weights scaled from 0 (death) to 1 (perfect health). The overall QALYs for each patient were estimated as the area under the curve determined by the utility values at baseline and 3 months. We computed confidence intervals for differences in costs and QALYs and in the incremental cost-effectiveness rate (ICER) using the bootstrap technique with the percentile method with 10 000 replications. A Markov model was used to simulate deferral of diffuse disease from PCI and not using PPG to select treatment. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty.

Results
Patients who underwent PCI for focal CAD had higher EQ-5D index values at follow-up (0.89 ± 0.18 vs 0.76 ± 0.28, p=0.004) and higher QALYs after 3 months follow-up (0.19 ± 0.06 vs 0.21 ± 0.04, p=0.022). Mean cumulative costs were £1574.3 ± 230.5 and significantly higher in patients treated for diffuse CAD as compared to patients treated for focal CAD (£1697 ± 293.4 vs £1393 ± 264.3; p&lt;0.001). The ICER was £7746/QALY (95% CI 5024 – 11007). PCI in focal CAD saved £1522.2/QALY when compared to PCI in diffuse CAD (£7009.2 ± 1919.4 /QALY vs. £8531.4±2753.4 /QALY, p&lt; 0.001). Deferring 30% of the diffuse CAD patients from PCI to optimized medical therapy would save £673.8/QALY (£7072.2 ± 1730.147 /QALY vs. £7746 ± 1943.5/QALY, p&lt; 0.001).

Conclusion
PCI is more cost-effective in focal than diffuse CAD. Treatment of diffuse CAD results in worst QALYs and costlier procedures. Every 5% of the diffuse CAD patients that were deferred from PCI saved aproximately £100/QALY. Further trials are needed to determine if the cost-effectiveness of PCI can be improved by deferring patients with diffuse CAD.Quality of life in focal and diffuse CADCost-effectiveness focal vs diffuse CAD
High sensitivity cardiac troponin I in response to handgrip in women with signs and symptoms of ischemia with no obstructive coronary arteries
Authors: Wei J , Iribarren A , Nelson M D , Cook-Wiens G , Mastali M , Samuels B , Azarbal B , Anderson R D , Handberg E M , Pepine C J , Van Eyk J E , Bairey Merz C N 
Published: November 2023

Abstract

Background
Women with signs and symptoms of ischemia and no obstructive coronary arteries (INOCA) are suspected to have myocardial ischemia, ∼10% have prior myocardial scar often in the absence of acute myocardial infarction (AMI) diagnosis and the development of heart failure with preserved ejection fraction (HFpEF) is relatively frequent. The mechanisms contributing to AMI and HFpEF progression are poorly understood in INOCA.

Purpose
To compare clinical, invasive, and high sensitivity cardiac troponin I (hsTnI) parameters in women with INOCA at rest and in response to isometric handgrip exercise.

Methods
Women with suspected INOCA underwent cannulation of the coronary sinus (CS), handgrip exercise testing and serial CS plasma sampling before, after 3 minutes of isometric handgrip stress at 30% of maximal voluntary contraction, and after 5 minutes of recovery. hsTnI was measured using a commercial immunoassay (R-PLEX, Meso Scale Discovery, Rockville, MD) and compared using t-tests.

Results
A total of 54 women with complete invasive data were included with a mean age of 53 ± 10 years, mean body mass index 28 ± 7 kg/m2. 20 women (37% of the cohort) had detectable CS hsTnI from baseline. Among these women, median values were elevated in response to handgrip (Figure) (baseline median 33.75 (IQR 18.12-67.75) pg/mL vs peak handgrip median 56.23 (IQR 32.84-97.83) pg/mL, signed rank p=0.0007, baseline vs recovery median 52.35 (IQR 32.59-106.27) pg/mL, signed rank p=0.0002).

Conclusion
Among women with INOCA, handgrip stress leads to an increase in hsTnI in more than a third, demonstrating objective evidence of myocardial injury. More work is needed to better understand contribution of coronary microvascular dysfunction to HFpEF progression.