bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vivo evaluation of intravascular lithotripsy in a healthy porcine coronary model
Authors: Yin J , Wang R , Chen H , Shen L , Ge J 
Published: November 2023

Abstract

Objectives
In this study, we aimed to investigate the vascular response to an intravascular lithotripsy (IVL) shockwave balloon in a healthy porcine coronary artery model.

Background
IVL is a novel clinical technique for modifying heavily calcified atherosclerotic plaques.

Methods
A total of 24 porcine coronary arteries were treated with IVL or plain old balloon angioplasty (POBA). Histology, histomorphometry, quantitative coronary angiography analysis (QCA), and optical coherence tomography (OCT) were performed post-procedure and at 1-month follow-up (1M-FU).

Results
There was no significant difference in the late lumen loss and diameter stenosis (determined by QCA) and the minimal lumen area (evaluated by OCT) of the IVL and POBA groups at 1M-FU. Pathological analysis revealed that the lumen and neointima areas were similar between the two groups. However, the medial and adventitial layers were more prominent in the IVL than in the POBA group. The injury score and inflammation of the media and adventitia increased dramatically in the IVL group post-procedure and at 1M-FU. At 1M-FU, media fibrin deposition and adventitial fibrosis were also significantly increased in the IVL group. However, there was no significant difference in neointima fibrin deposition, endothelialization, and thrombosis between both groups. Layered separation of the media and adventitia was observed in the IVL group.

Conclusion
The findings indicate that the IVL balloon did not cause serious intimal hyperplasia and endothelial damage compared with the effects of POBA in the healthy coronary artery. However, shock waves may cause unique damage to the vascular media and adventitia in the coronary artery, which was not observed in the peripheral artery.Device introductionPathological image at 1M FU
Clinical outcomes of comparison between type-III cap and non-cap acute coronary syndrome patients in 3 year follow up
Authors: Yildiz B , Gunduz R , Ozgur S , Cizgici A Y , Ozdemir I H 
Published: November 2023

Abstract

Background
Coronary artery perforation(CAP) is potentially fatal complication of percutaneous coronary intervention(PCI) in acute coronary syndrome(ACS).There is no study in literature comparing long term clinical outcomes of type III-CAP-ACS and non-CAP-ACS patients.

Purpose
The aim of this study was to investigate in hospital- 1-year and 3-year clinical outcomes of type III-CAP during PCI in ACS patients.

Methods
Data from ACS patients who had type III-CAP during PCI from January 2010 to Jaunary 2020 at different high volume centers in Turkey were collected.A retrospective cohort of 43,791 patients who underwent PCI was used:120 patients with CAP and 43,671 case-control patients were evaluated.Propensity score matching was used to evaluate the association between differing CAP. Clinical angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively in 1-year and 3-year follow up.Multiple regressions were used to identify predictors of coronary perforation and its association with outcomes.

Results
The mean age of subjects was 66.5±11.9 years(61.8%males).Of all ACS patients were 247STEMI(37.9%), 216NSTEMI(33.2%) and 188UA(28.9%).Non significant differences were identified between the CAP and non-CAP groups in hospital follow-up for, cardiac death, major bleeding, and stent thrombosis except cerebrovascular event(p=0.003).At three year, differences remained different between myocardial infarction(MI)(p=0.038),coronary artery bypass graft(CABG)(p=0.001),stent thrombosis(ST)(p=0.002),major bleeding(p=0.029) and cerebrovascular event(CVE)(p=0.011)), was observed in the CAP/non-CAP group.Median follow-up of was 36 months.The all-cause mortality was 33.3% in CAP group versus 1.8% in non-CAP group at 1-year and 28.3% in CAP group versus 6.9% in non-CAP group at 3-years(p=0.001,p=0.001).

Conclusions
There was no significat difference between type-III-CAP and non-CAP group in hospital mortality.The procedural, clinical, 1 and 3-year outcomes of type III-CAP showed that relatively high risk of MI,CABG,CVE,ST and major bleeding under 1 and 3-year follow-up.Also, non-CAP ACS patients had better survival compared to type III CAP ACS patients in 3- year follow up.Figure 1Figure 2
Usefulness of canada acute coronary syndrome risk score for predicting no-/slow-reflow in ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Xie E , Li Q , Ye Z , Gao Y , Zheng J 
Published: November 2023

Abstract

Background
The no-/slow-reflow phenomenon following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) patients is associated with a poor prognosis. Early identification of high-risk patients of no-/slow-reflow is critical. This study sought to evaluate the predictive ability of the Canada Acute Coronary Syndrome (C-ACS) risk score for no-/slow-reflow in these patients.

Methods
STEMI patients who underwent primary PCI were consecutively enrolled and divided into three groups based on the C-ACS score: 0, 1, and ≥2. The C-ACS score was computed using the four clinical variables evaluated at admission (1 point for each): age ≥75 years, heart rate &gt;100 beats/min, systolic blood pressure &lt;100 mmHg, and Killip class &gt;1. No-/slow-reflow was defined as thrombolysis in myocardial infarction flow grade 0 to 2 after primary PCI. The predictive ability of the C-ACS score for no-/slow-reflow was evaluated by the receiver operating characteristic curve.

Results
Overall, 834 patients were enrolled, with 109 (13.1%) developing no-/slow-reflow. The incidence of no-/slow-reflow increased from the C-ACS 0 group to C-ACS ≥2 group (10.7% vs 17.7% vs 32.2%, respectively, p&lt;0.001). After multivariable adjustment, the C-ACS score was an independent predictor of no-/slow-reflow (odd ratio 2.623, 95% confidence interval 1.948-3.532, p&lt;0.001). Furthermore, the C-ACS score possessed good discrimination for no-/slow-reflow (area under the curve 0.707, 95% CI 0.653-0.762, p&lt;0.001). Further subgroup analyses indicated a significant interaction of C-ACS score with patient sex (p for interaction =0.011). The independent association between C-ACS score and no-/slow-reflow was only observed in male patients (odd ratio 3.061, 95% confidence interval 1.931-4.852, p&lt;0.001). During a median follow-up duration of 4.3 years, the C-ACS score was independently associated with major adverse cardiovascular events independently of the occurrence of no-/slow-reflow (p for interaction =0.212).

Conclusion
The C-ACS risk score could independently predict the no-/slow-reflow in STEMI patients undergoing primary PCI, particularly in male patients.
A pilot randomized controlled trial of novel reperfusion method in patients of acute st elevation myocardial infarction during primary percutaneous coronary intervention
Authors: He J , Yang Y X , Yang X C , Wang L F 
Published: November 2023

Abstract

Objectives
This study was conducted to explore the feasibility, clinical safety and potential effects of a novel reperfusion method, Volume-Controlled Reperfusion (VCR) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).

Background
Reperfusion injury is associated with larger infarct size (IS) and drawback of long-term overcome. Microvascular obstruction (MVO) as detected on late gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) is the most used index for assessment of reperfusion injury. To date, there is no feasible gradual reperfusion method in primary PCI setting. VCR is an original reperfusion method feasible in primary PCI for both accurate gradual reperfusion and intermittent flow.

Methods
A total of 60 patients with STEMI presenting within 12 h of symptom onset undergoing PPCI were randomized enrolled, 30 patients in VCR group and 30 patients in control group with routine PCI only. VCR was performed with the dual catheter technique, 10ml of artery blood diluted with10ml of heparin saline infused via manual aspiration catheter at speed of 20ml/min for 10 rounds after suspending the antegrade flow using a prophylactic inflated balloon. Then, routine PCI procedure as usual. The primary endpoint was major adverse cardiac events (MACE) during hospitalization, the main second endpoint was the MVO extent difference measured on day 5-7 post-procedure.

Results
Baseline characteristics were well matched between two groups. No major adverse cardiac events (MACE) found in-hospital or 30 days followed up. There were no complications associated with VCR procedure. 43 patients had LGE-CMR exam (22 in Control group, 21 in VCR group, among them, 14/22 were anterior wall control and 14/21 VCR). There was no significant difference in infarct size, MVO or CMR-LVEF in total patients between VCR and control. However, significant difference in CMR-LVEF was noted between control and VCR anterior wall subgroup (40.53 ± 7.39 vs50.55 ± 7.55; P=0.002), the average of MVO and MVO of infarct size were smaller in VCR group while no significant difference.

Conclusions
This is the pilot RCT study showed VCR method was feasibility and clinical safe among patients with acute STEMI during PPCI and 30 days followed up, indicated potential attenuate effect in reperfusion injury as well. Staged II study is needed to verify clinical benefit.VCR illustrationLGE-CMR figure
Physiological phenotype of coronary artery disease on short-term angina status in patients with CCS after PCI: perspective from PIONEER IV trial
Authors: He X Q , Wang B , Tsai T Y , Chennigahoshalli Revaiah P , Wykrzykowska J , Sharif F , Rosseel L , Reiber J , Onuma Y , Serruys P 
Published: November 2023

Abstract

Background
The hemodynamic impact of PCI on major epicardial conductance vessels is the results of a complex interplay between diffuseness and focality of coronary artery atherosclerosis. The pre-procedural identification of these two phenotypes (diffuseness vs. focality) may have important implication on the angina relief after PCI.

Purpose
The aim of this study was to determine the differential improvement in patient-reported outcomes after PCI in focal and diffuse CAD as deﬁned by the pullback pressure gradient index (PPGi) derived from angiography.

Methods
The PIONEER IV trial is a prospective, all-comers, multi-center trial, randomizing patients to PCI guided by angiography-derived physiology or usual care, with both arms using the Healing-Targeted Supreme sirolimus-eluting stent. Pre-procedural PPGi derived from angiography was documented. The 7-item Seattle Angina Questionnaire (SAQ-7) was administered at baseline and 30 days after PCI. The median PPG value was used to deﬁne focal and diffuse CAD. Residual angina was deﬁned as a SAQ-AF score ≤ 90.

Results
A total of 203 patients were analyzed, in which 105 patients with focal CAD and 98 diffuse. Focal disease had larger pre-procedure QFR and post-procedure QFR value than patients with diffuse disease (0.71 ± 0.13 vs 0.59 ± 0.19, P &lt; 0.001; 0.96 ± 0.04 vs 0.91 ± 0.08, P &lt; 0.001). The median of PPGi was 0.73 (Figure 1A). In the restricted cubic spline model, the risk of residual angina rises substantially when the pre-procedural PPGi was below 0.74 (Figure 1B). Patients with focal disease who underwent PCI for focal CAD had signiﬁcantly higher angina frequency score and quality of life score at follow-up than those with diffuse CAD (94.10 ± 11.58 vs 89.80 ± 16.31, P = 0.031; 75.77 ± 26.01 vs 67.17 ± 25.86, P=0.024; Figure 2). After PCI, residual angina was present in 35.0% but was signiﬁcantly less in those with treated focal CAD (26.7 % vs 43.9 %; P = 0.015; Figure 1C-D).

Conclusion
Residual angina after PCI was higher in patients with diffuse CAD, whereas patients with focal CAD reported greater improvement in angina and quality of life. Whether pre-procedural physiological phenotyping should alter the therapeutic decision making to perform PCI, and could influence the procedure planning warrants further study.Figure 1Figure 2
Successful ESC recommended LDL-C reduction after percutaneous coronary intervention: real-world data from the contemporary ZON-HR registry
Authors: Peeters D , Woelders E C I , Luijkx J J P , Winkler P J C , Damman P , Remkes W S , Van 'T Hof A W J , Van Geuns R J M 
Published: November 2023

Abstract

Background
Low density lipoprotein-cholesterol (LDL-C) reduction in patients who underwent percutaneous coronary intervention (PCI) is recommended by ESC guidelines to prevent secondary events. Lipid lowering treatment is indicated to reach a LDL-C of less than 1.4mmol/l in these very high risk patients. The ‘’Zuid-Oost Nederland Heart Registry’’ (ZON-HR) is a multicentre prospective registry designed to improve secondary prevention after PCI by a patient-tailored approach.

Purpose
Cholesterol management in patients after percutaneous coronary intervention (PCI) from the ZON-HR was evaluated.

Methods
Since November 2020 real-world data from 4628 patients who underwent PCI were collected in four hospitals. Patient characteristics, LDL-C values at baseline and after 30 days and medication at discharge were collected. The association between predefined variables and a LDL-C &lt;1.4 mmol/l was assessed in multivariable logistic regression.

Results
LDL-C at baseline and one-month follow-up was complete in 306 patients. This number is limited, because LDL-C was not routinely tested in every patient at baseline and during 30 day follow-up. Patients with a chronic coronary syndrome (CCS) undergoing PCI were significantly older compared to patients with ACS (66.8 vs 63.9 years)(table 1). After one month, the LDL-C value decreased significantly both in ACS as well as CCS patients. No significant differences in cholesterol lowering medication at discharge between CCS and ACS patients were observed. Statins (87.8%) were most frequent prescribed, with low numbers of new therapies (8.2% ezetimibe, 2.6% PCSK-9 inhibitor).
The goal LDL &lt;1.4 mmol/l was reached in 33% of patients. Lower LDL-C levels at baseline, ACS indication for PCI, and a combination of lipid lowering treatment were independent predictors for achieving the goal LDL-C &lt;1.4 (table 2).

Conclusion
Our contemporary registry reveals the following important observations: 1) LDL-C assessment at one month follow-up is performed in a minority of patients. 2) The LDL-C goal of 1.4 mmol/l is reached in a minority of patients. 3) Predictors for reaching the ESC recommended target include an ACS indication and combination lipid lowering treatment, emphasizing the importance of secondary prevention.Baseline characteristicsPredictors reaching LDL-C target value
Cerebral embolic protection in transcatheter aortic valve replacement with bicuspid aortic stenosis
Authors: Gupta A , Koren O , Patel V , Nagasaka T , Patel D , Golwala K , Chakravarty T , Al-Jilaihawi H , Nakamura M , Makkar R 
Published: November 2023

Abstract

Background
In the PROTECTED-TAVR randomized controlled trial, use of cerebral embolic protection device (CEPD) during transcatheter aortic valve replacement (TAVR) did not reduce procedural stroke. It is, however, not clear whether certain high-risk subgroups like young patients with bicuspid aortic stenosis may derive benefit from CEPD.

Purpose
This study aimed to determine the effectiveness of CEPD in preventing cerebrovascular events during TAVR in patients with severe bicuspid aortic stenosis.

Methods
We retrospectively analyzed 3505 patients who underwent transfemoral TAVR at a single center between 2016-2020 and identified 257 patients with bicuspid aortic valve stenosis. Baseline demographic, clinical, and procedural characteristics were stratified by CEPD use. We performed Cox Proportional Hazards regression analysis to examine whether the use of CEPD in patients was associated with a lower rate of cerebrovascular events (stroke or transient ischemic attack) after adjusting for baseline characteristics.

Results
Among 257 patients receiving TAVR for bicuspid aortic stenosis, median age was 74.7 years (IQR 66.9 – 83.2 years) and 62.6% were men. There were no significant differences in the baseline demographic and clinical characteristics between patients with (n=94) and without CEPD (n=163) (Figure 1a). In univariate analysis, there was no significant difference in rates of stroke or transient ischemic attack in-hospital or at 30-days (Figure 1b). In adjusted analysis, CEPD use (HR 1.55 [95% CI, 0.1-3.8)] was not associated with a decreased rate of stroke or transient ischemic attack.

Conclusion
These findings indicate that CEPD use is not associated with lower rates of cerebrovascular events in patients with bicuspid aortic stenosis and add to the growing body of evidence that questions the utility of CEPD during TAVR.Baseline Characteristics
Transcatheter aortic valve implantation in young patients: a propensity score-matched analysis
Authors: Baekke P S , Butt J , Bajoras V , Rosseel L , Bieliauskas G , Fosboel E , Soendergaard L , De Backer O 
Published: November 2023

Abstract

Objectives
The aim of this study was to assess the reasons for denial of surgical aortic valve replacement (SAVR) in young multimorbid patients referred to transcatheter aortic valve implantation (TAVI) and to evaluate the 3-year mortality post-TAVI in comparison with a matched background population.

Background
Data on young multimorbid patients undergoing TAVI is limited, and their prognosis remains unclear.

Methods
Retrospective data were collected on all consecutive patients ≤65 years with severe, symptomatic aortic stenosis treated with TAVI at 10 different centres in the period 2008 to 2018. Data on three-year vital status were collected. The TAVI population was compared with a 1:4 sex, age, and comorbidity-matched background population obtained from the Danish National Registries. Subgroup analyses included matching of specific comorbidities.

Results
The study population consisted of 459 TAVI patients and 1836 matched controls from the background population. The primary reasons for SAVR denial were prior cardiac surgery (35%), pulmonary disease (30%), frailty (23%), reduced left ventricular function (19%), renal failure (18%), malignancy/radiation (15%) and obesity (13%). Two-thirds (68%) had more than one reason for SAVR denial. The 3-year risk of mortality was 34% in the TAVI group compared with 3% in the pure sex and age-matched background population with a hazard ratio of 12.6 (CI: 6.2 – 25.6; P &lt; 0.0001). Subgroup analyses will be performed for patients with chronic heart failure, chronic pulmonary disease, chronic dialysis, prior cardiac surgery, prior stroke, and prior Hodgkin’s lymphoma.

Conclusion
Multimorbid patients aged ≤65 years treated with TAVI in the 2008-2018 period showed satisfactory procedural outcomes. However, mid-term outcomes reveal a poor prognosis with a 3-year mortality of 34%, primarily due to their pre-existing comorbidities.Study Profile
Edge-to-edge repaire and the incidence of silent cerebral embolic events
Authors: Cervinka P , Kvasnak M K , Cervinkova M C , Storchova B S 
Published: November 2023

Abstract

Background
Silent cerebral hits are present in the majority of patients (75-80%) undergoing TAVI. However, there is a lack of data on the rate of silent cerebral infarcts after percutaneous "edge-to-edge" procedure.

Purpose
To assess clinically overt stroke and silent cerebral embolic lesions detected by diffusion-weighted magnetic resonance imaging (DW-MRI) in patients after MitraClip implantation.

Methods and results
85 patients underwent MitraClip implantation at our institution within a period of May 2016 – January 2023. Of these, 53 patients (62%) underwent DW-MRI pre (&lt;24 hours) and post (24-48 hours) "edge-to-edge" procedure. No patients showed a significant decline in post-neurocognitive function (as assessed by the Montreal Cognitive Assessment [MoCA] score) compared with baseline. DW-MRI detected silent cerebral lesion in 11 patients (21%; 6 unilateral and 5 bilateral) after MitraClip implantation.

Conclusions
The rate of silent (assessed by DW-MRI) cerebral embolic events after MitraClip implantation was very low in our observational study (the largest study worldwide so far). Larger randomized trials including neuroimaging are needed to define the occurrence and consequences of cerebral damage during transcatheter treatment of mitral regurgitation. Future research is also needed to investigate the role of cerebrovasczlar protection devices during this procedure.
Embolization of percutaneous left atrial appendage closure devices: timing, management and associated clinical outcomes
Authors: Eppinger S , Piayda K , Rodes-Cabau J , Klein N , Sabir S A , Kim J S , Cook S , Kornowski R , Nielsen-Kudsk J E , Gupta D , Boersma L , Raeber L , Sievert K , Bertog S , Sievert H 
Published: November 2023

Abstract

Background
Percutaneous left atrial appendage occlusion (LAAO) is a good option to mitigate stroke risk in patients with atrial fibrillation. Device embolization is infrequent but a serious complication.

Objectives
We aim to describe timing, management and clinical outcomes of device embolization in an international multi-center registry.

Methods
Patient characteristics, imaging findings, procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes.

Results
Sixty-seven centers contributed data on 125 patients who underwent LAAO and experienced device embolization at an embolization rate between 0 and 3.9 % per 100 person-years. Device embolization within the first 24 hours post-procedural occurred in 69.4% of cases. The device was left in place in three (2.8%) patients, a percutaneous retrieval was attempted in 83 (76.1%) and surgery was preferred in 23 (21.1%) patients. In 27/83 (32.5%) patients with an initial percutaneous retrieval attempt a second, additional procedure was performed, which was associated with a high mortality (death first attempt: 2.7% vs. second attempt: 18.5%, p&lt;0.001[HS1] ). The primary outcome (bailout surgery, cardiogenic shock, and/or death) occurred in 43 (38.7%) patients. Major complications related to LAAO device embolization occurred in 39 (35.1%) patients.

Conclusions
The majority of device embolizations after LAAO occurs early. The percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was not successful.