bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive role of intracoronary electrocardiography for procedural success in patients with ST-elevation myocardial infarction developing coronary no-reflow
Authors: Ozkaya Ibis A N , Sunman H , Kalkan K , Tunca C , Tas A , Ozkan M T , Erol N I , Tulmac M 
Published: November 2023

Abstract

Background
The no-reflow phenomenon (NRP) is associated with increased mortality and development of heart failure in patients with ST-segment elevation myocardial infarction (STEMI). Although there is no definitive method for NRP treatment in current guidelines, methods to predict the success of procedures with NRP are also limited. There is a need for a practical, real-time method for predicting the outcome of procedures in NRP patients. Intracoronary electrocardiography (ic-ECG) which is simple, cost-effective, and a bedside indicator of myocardial ischemia, is proposed as a potential solution in this study.

Purpose
The aim of this study was to examine the potential of ic-ECG in predicting the success of primary percutaneous intervention (pPCI) in patients with STEMI and the development of coronary no-reflow.

Methods
This was a prospective investigation that included 71 patients diagnosed with acute anterior STEMI and underwent pPCI between November 2021 and May 2022. The patients were separated into two groups based on the Thrombolysis in Myocardial Infarction (TIMI) flow grade criteria, with those having a grade of less than 3 defined as NRP. The NRP group was further analyzed to determine the relationship between the percentage of ST-segment resolution (STR) in the ic-ECG records taken during pPCI and short-term major adverse cardiovascular events rates and left ventricular ejection fraction (LVEF) recovery status.

Results
A total of 71 patients, with a mean age of 56.8 years and 76.1% of them being male, were included in the study. Of these patients, 26 were found to have developed NRP, while TIMI-3 flow was observed in 45 patients. In the NRP group, various parameters were found to be associated with LVEF recovery, such as peak troponin value (6267.8±2488.4 ng/ml vs 3244.6±3183 ng/ml, p=0.013) basal low-density lipoprotein cholesterol (LDL-C) (138.8±29.9 mg/dl vs 104.5±40 mg/dl, p=0.021), total cholesterol value (222.7±69.2 mg/dl vs 167.5±44.5 mg/dl, p=0.024), and ic-ECG STR level (21±22.3% vs 65.5±17%, p&lt;0.001). The results of the multivariate analysis and subsequent ROC analysis showed that an ic-ECG STR ratio greater than 42% (sensitivity 100%, specificity 84.6%) was an independent predictive factor for LVEF improvement (Table 1).

Conclusions
The results showed that the STR rate measured by ic-ECG was significantly associated with LVEF recovery and was an independent predictive factor for LVEF recovery with a sensitivity of 100% and specificity of 84.6%. The study highlights the usefulness of ic-ECG in predicting pPCI success in NRP patients and supports its integration into clinical practice.
Single stent versus two stent strategy in primary PCI for unprotected LM occlusion
Authors: Tantawy M , Fouad A 
Published: November 2023

Abstract

Background
Acute MI due to left main coronary artery (LMCA) occlusion carry the highest anatomical risk for morbidity and mortality during primary PCI. Although several clinical trials compared different PCI techniques and strategies for LMCA, still special populations and different clinical scenarios have lack of evidence about ideal approaches.

Purpose
We aim to compare provisional stenting versus two stent upfront technique in acute MI due to LMCA occlusion regarding short term clinical outcomes.

Methods
This was a prospective observational study from three large centers within the period from February 2019 to Feb 2023. Patients with acute STEMI due to LMCA occlusion who are candidates for primary PCI were included and was assigned to two groups according to operator discretion. Group I (provisional stenting) versus group II (upfront two stent strategy). Our primary outcome was MACE within 30 days and secondary Outcomes were angiographic outcomes after intervention including TIMI flow, CTFC and myocardial blush.

Results
A total of 62 patients met our inclusion criteria, mean age (62.64±8.61), 24.6% women. Thirty-eight patients in group I undergone provisional stenting and twenty-four patients in group II undergone two stent strategy. MACE was significantly higher in the two-stent strategy group (61.62% vs 40.34%, P&lt;0.001] compared with provisional stenting group. the IV epinephrine group. Angiographic outcomes were significantly better in provisional stenting group by the end of the procedure. There was marked increase in patients who achieved postprocedural TIMI III and TMPG III in group I by 22% and 18% respectively in comparison with two stent strategy group.

Conclusion
Our observational study concluded that provisional stenting carries better short-term outcomes in acute MI intervention due to unprotected LMCA occlusion. Clinical studies are needy in this specific population.Study flow chartFigure I
Outcomes of chronic total occlussion recanalization in patients with prior bypass-surgery: an updated systematic review and meta-analysis of real world registries
Authors: Romeo F , Moroni F , Del Buono M G , Damonte J I , Chiabrando J G , Azzalini L 
Published: November 2023

Abstract

Background
Recanalization of chronic total occlusion (CTO) coronary lesions by percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) is still considered a challenging scenario due to the complexity of coronary lesions as well as the requirement of CTO PCI advanced techniques. The aim of this study is to compare clinical outcomes of patients undergoing CTO PCI with and without CABG surgery.

Methods
We conducted a systematic review and meta-analysis of observational studies that compared in-hospital outcomes of CTO PCI in patients with vs. without prior CABG published in Medline from inception until December 2022. The results are synthesized in a quantitative manner with random effects models. Categorical variables were compared using the chi-square test, whereas continuous variables were compared using a 2-sample Student's t-test. Statistical heterogeneity was assessed by I2 statistics: I2 statistic &gt;50% was considered substantial, and I2 &gt;75% was considered considerable. The Review Manager Software version 5.3.5. (The Cochrane Collaboration, 2014) was used to calculate summary statistics (odds ratios [ORs] with 95% confidence intervals [CIs]).

Results
Eleven observational studies with a total of 35,666 patients were included, of whom 7,005 patients had a history of CABG. Prior CABG patients were older, (68.1 ± 9.0 vs. 64.1 ± 10.7 years; p &lt; 0.001), and had more complex coronary lesions (J-CTO score: 3.2 ± 1.4 vs. 2.5 ± 1.4; p &lt; 0.001). Prior CABG was associated with lower technical success (66.6% vs. 78.5%; OR 0.53 [95% CI: 0.43 to 0.65]; p &lt; 0.00001, I2 = 84%) as well as lower procedural success (OR 0.64 [95% CI: 0.57 to 0.71]; p &lt; 0.00001, I2 = 0%) as compared with patients with no prior CABG (Figure 1A and Figure 1B). Prior CABG patients had a higher incidence of in-hospital mortality (0.7% vs. 0.4%; OR: 2.00 [95% CI: 1.32 to 3.05]; p = 0.001, I2 = 9%, Figure 2A), coronary perforation (3.7% vs. 2.3%; OR: 1.64 [95% CI: 1.15 to 2.33]; p &lt; 0.006, I2 = 74%, Figure 2B), and myocardial infarction (1.7% vs. 0.7%; OR: 2.57 [95% CI: 1.73 to 3.81]; p &lt; 0.00001, I2 = 12%), but a lower incidence of cardiac tamponade (0.2% vs. 0.9%; OR: 0.36 [95% CI: 0.17 to 0.77]; p = 0.09, I2 = 0%, Figure 2C) compared with those without prior CABG. Both groups had a similar incidence of acute cerebrovascular events (0.2% vs. 0.1%; OR: 1.70 [95% CI: 0.75 to 3.88]; p = 0.21, I2 = 0%), major bleeding (1.4% vs. 1.2%; OR: 1.24 [95% CI: 0.96 to 1.61]; p = 0.09, I2 = 0%) and vascular complications (1.4% vs. 0.9%; OR: 1.50 [95% CI: 0.93 to 2.41]; p = 0.10, I2 = 0%).

Conclusion
Prior CABG patients undergoing CTO PCI presented a higher risk of in-hospital mortality and perioperative procedural complications although the risk of tamponade was lower.Figure 1A and Figure 1BFigure 2A, 2B and 2C
Impact of procedure-related increase in plasma creatinine after transcatheter aortic valve implantation: a nationwide study
Authors: Petersen J , Fosbol E , Bager L G V , Strange J E , Carlson N , Schou M , Kober L , Ostergaard L 
Published: November 2023

Abstract

Background
In patients undergoing transcatheter aortic valve implantation (TAVI), the impact of plasma creatinine (PCreat) increase on the prognosis and on future kidney function is sparsely examined and data from large, nationwide cohorts are warranted.

Purpose
To examine the long-term risk of dialysis treatment, mortality, and major adverse kidney event according to PCreat level increments in the periprocedural setting of TAVI.

Methods
With Danish nationwide registries, we identified all patients undergoing TAVI from 2014–2021. According to two PCreat blood samples (the latest measured value between 365–7 days prior to TAVI and the highest measured value within 21 days after TAVI), patients were classified according to percent increase in PCreat: 1) &lt;25%, 2) 25–49%, and 3) ≥50%. With a maximum of one year of follow-up, we used Aalen-Johanson estimator to examine the cumulative incidence frequency (CIF) of first-time dialysis treatment and major adverse kidney event and Kaplan-Meier estimates to assess all-cause mortality. Major adverse kidney event was defined as either of three: initiation of dialysis treatment, mortality, or an admission with a diagnosis code of acute kidney injury. Adjusted rates of outcomes were assessed, using multivariable Cox analysis, with patients with &lt;25% PCreat increase serving as reference.

Results
We identified 4,029 patients undergoing a first-time TAVI procedure (57.0% male, median age 81 year); 3,343 (83.0%) patients with &lt;25% PCreat increase, 462 (11.5%) with 25–49% PCreat increase, and 224 (5.6%) with ≥50% PCreat increase. Compared with &lt;25% PCreat increase, the adjusted one-year rate of dialysis treatment showed no statistical difference in patients with 25-49% PCreat increase (hazard ratio [HR] 1.52 [95%CI, 0.74–3.11]), while patients with ≥50% PCreat increase had an increased associated one-year rate of dialysis treatment (HR 3.62 [95%CI, 1.90–6.90]) (Figure). The adjusted one-year rate of mortality was increased in both patients with 25-49% PCreat increase (HR 1.78 [95%CI, 1.29–2.45]) and ≥50% PCreat increase (HR 2.87 [95%CI, 1.97–4.18]). The adjusted one-year rate of major adverse kidney event was increased in both patients with 25-49% PCreat increase (HR 1.69 [95%CI, 1.25–2.28]) and ≥50% PCreat increase (HR 3.03 [95%CI, 2.17–4.23]).

Conclusion
In patients undergoing TAVI, a PCreat increase of ≥25% was associated with increased one-year rates of mortality and major adverse kidney event, while an increase ≥50% carried a more than threefold increased rate of incident dialysis treatment and increased rates of mortality and major adverse kidney event.
Valve-in-valve transcatheter aortic valve implantation for degenerative stentless versus stented surgical bioprostheses
Authors: Steul J , Abdel-Wahab M , Stankowski T , Haussig S , Woitek F , Gasior T , Crusius L , Knorr L , Mueller F , Kiefer P , Kappert U , Holzhey D , Linke A , Mangner N 
Published: November 2023

Abstract

Introduction
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a viable and less-invasive alternative to open heart surgery in selected patients with bioprosthetic valve dysfunction. Most ViV-TAVI procedures have been performed in failing stented bioprosthetic valves; stentless bioprostheses lack fluoroscopic markers and could be more challenging for transcatheter therapy. Data on more recent patients applying Valve Academic Research Consortium (VARC)-3 defined outcomes are scarce; thus, we compared patient characteristics, procedural outcomes, and 1-year outcomes of patients with stentless (SL) versus stented (ST) aortic bioprosthetic device failure undergoing ViV-TAVI.

Methods
Patients undergoing ViV-TAVI between 2007 and 2022 (53% of cases after 2015) at 3 German centres were included in this analysis. The 1-year mortality was the primary outcome measure, secondary outcomes included VARC-3 defined technical and device success and early safety.

Results
Overall, 43 (11.8%) SL and 313 (88.2%) ST ViV-TAVI were included. Patients were comparable with regard to age (SL: 77 (74; 82) vs. ST: 78 (75; 83), p=0.08), sex (male: SL 70% vs. ST 56%, p=0.08), clinically relevant baseline comorbidities and surgical risk (STS PROM SL 10.0 (4.8; 12.5) % vs. ST 9.4 (4.5; 11.3) %, p=0.62). Aortic regurgitation was the mode of failure in 33% of SL vs. 8% in ST (p&lt;0.01). The rate of self-expanding TAVI prostheses was 86% and 76% in SL and ST, respectively (p=0.15). The rates of technical success (SL: 84% vs ST: 80%, p=0.55), device success (SL: 67% vs ST: 54%, p=0.11), and early safety (SL: 74% vs ST: 62%, p=0.30) were comparable between groups. There were higher rates of mild/moderate residual aortic regurgitation in SL (77.5% vs. 35%, p&lt;0.01), whereas the remaining mean gradient was higher in ST (11.2 (6.0; 15.5) mmHg vs. 17.0 (11.0; 22.0) mmHg, p&lt;0.01). The 30-day mortality rate (SL: 7.0% vs. ST: 2.6%, p=0.14) and Kaplan-Meier estimated 1-year mortality rates (SL: 9.3% vs. ST: 8.2%, p=0.63) were comparable between groups.

Conclusion
Both SL and ST ViV-TAVI have comparable short-term outcomes according to VARC-3- defined endpoints and similar low rates of 1-year all-cause mortality. However, against the background of a relevant rate of residual aortic regurgitation in SL and increased gradients in ST, long-term studies are of utmost importance to determine the clinical relevance of those factors.
Self-expanding or balloon-expandable transcatheter aortic valve replacement in a German comparison
Authors: Oettinger V , Hilgendorf I , Wolf D , Rilinger J , Stachon P , Kaier K , Zehender M , Westermann D , Von Zur Muehlen C 
Published: November 2023

Abstract

Background
Studies demonstrated that results for self-expanding vs balloon-expandable transcatheter aortic valve replacement (TAVR) are similar, with larger subgroup analyzes missing.

Methods
We identified 46,243 self-expanding (SE) and balloon-expandable (BE) transfemoral TAVR for aortic stenosis in German hospitals in 2019 or 2020. Both in-hospital outcomes as well as subgroups for in-hospital mortality were analyzed.

Results
Regarding baseline characteristics, the logistic EuroSCORE was higher in SE (SE 13.6% - BE 12.7%; p&lt;0.001), which also applied to age (SE 81.6a - BE 80.0a; p&lt;0.001). There was a comparable in-hospital mortality rate in both groups (BE 2.37% - SE 2.35%; p=0.916). Risk adjusted in-hospital mortality was also not significantly different (OR=0.98, p=0.799). The SE group presented a significantly lower risk of major bleeding events (OR=0.83, p=0.006), however, there was a significantly higher risk of stroke (OR=1.38, p&lt;0.001), risk of delirium (OR=1.15, p=0.001) as well as risk of permanent pacemaker implantation (OR=1.29, p&lt;0.001). No difference has been found for acute kidney injury, mechanical ventilation &gt;48h, length of hospital stay, and reimbursement. In addition, the subgroups showed no significant differences for in-hospital mortality regarding age, logistic EuroSCORE, gender, heart failure NYHA III/IV, previous coronary artery bypass graft, peripheral vascular disease, chronic obstructive pulmonary disease, pulmonary hypertension, renal disease GFR &lt;30ml/min or diabetes mellitus.

Conclusion
Self-expanding or balloon-expandable TAVR did not show significant differences for in-hospital mortality in a subgroup analysis in Germany.
Analyzing current German transcatheter and surgical aortic valve replacement practices in pure aortic regurgitation
Authors: Oettinger V , Hilgendorf I , Wolf D , Kaier K , Stachon P , Heidenreich A , Zehender M , Westermann D , Von Zur Muehlen C 
Published: November 2023

Abstract

Background
In Germany, the use of transcatheter aortic valve replacement (TAVR) for treating pure aortic regurgitation is still not regular practice.

Purpose
Therefore, the current development of TAVR in aortic regurgitation is to be investigated.

Methods
In 2018–2020, 4,025 surgical aortic valve replacements (SAVR), 50 transapical, 329 balloon-expandable transfemoral, and 457 self-expanding transfemoral TAVR in pure aortic regurgitation were studied using multivariable logistic and linear regressions.

Results
The TAVR groups had a higher age than SAVR (76.0-77.3a vs 62.8a) and logistic EuroSCORE (17.7-19.1 vs 4.9%). Unadjusted in-hospital mortality was highest in transapical TAVR (6.0%), followed by SAVR (5.7%), and it was lowest in transfemoral TAVR, with self-expanding procedures (2.4%) showing significantly lower in-hospital mortality than balloon-expandable (5.2%; p=0.039). After risk adjustment, we saw a significant association with lower mortality rates for balloon-expandable as well as self-expanding transfemoral TAVR vs SAVR (balloon-expandable: OR=0.50, p=0.031; self-expanding: OR=0.20, p&lt;0.001). In the same way, we found that other examined outcomes were significantly in favor of TAVR: stroke (balloon-expandable: OR=0.17, p&lt;0.001; self-expanding: OR=0.17, p&lt;0.001), major bleeding (balloon-expandable: OR=0.04, p&lt;0.001; self-expanding: OR=0.03, p&lt;0.001), delirium (balloon-expandable: OR=0.19, p&lt;0.001; self-expanding: OR=0.16, p&lt;0.001), mechanical ventilation &gt;48h (balloon-expandable: OR=0.09, p&lt;0.001; self-expanding: OR=0.06, p&lt;0.001), and length of hospital stay (balloon-expandable: Coefficient=-6.88d, p&lt;0.001; self-expanding: Coefficient=-7.22d, p&lt;0.001).

Conclusion
Despite lower procedure volumes in TAVR vs SAVR for pure aortic regurgitation, we see lower rates of in-hospital mortality and complications, suggesting that TAVR can be used successfully in selected patients with aortic regurgitation.
Protecting the vulnerable during a crisis - TAVR during the COVID-19 pandemic
Authors: Zaka A , Mridha N , Abtahi J , Anderson S , Murdoch D 
Published: November 2023

Abstract

Introduction
The coronavirus (COVID-19) pandemic has been challenging for healthcare systems globally. Patients with symptomatic severe aortic stenosis awaiting transcatheter aortic valve replacement (TAVR) are a vulnerable, elderly subset of patients often with multiple comorbidities. Untreated severe aortic stenosis (AS) is associated with a poor prognosis. It is uncertain if population-based strategies to mitigate COVID-19 spread such as delaying elective procedures and virtual consultations have resulted in increased morbidity or mortality in this subset of patients. Position statements guiding TAVR during the COVID-19 pandemic have suggested fewer and shorter hospital admissions. We evaluated the available literature and performed a systematic review and meta-analysis assessing the impact of the COVID-19 pandemic on referral times, hospital stays and mortality in patients awaiting TAVR.

Methods
This systematic review and meta-analysis (CRD42022379840) is reported according to PRISMA guidelines. A comprehensive search strategy with computer- based search was performed using PubMed, Ovid MEDLINE, EMBASE and Cochrane databases. No time limit to start date was applied, and the search was conducted up to 28 November 2022. Only studies with available comparative data to pre-COVID 19 cohorts were included.

Results
Eleven studies satisfied our inclusion criteria, with a pooled analysis of 79785 TAVR patients. Patients undergoing TAVR in the COVID-19 era were associated with a modest risk of all-cause mortality (unadjusted RR: 1.41, 95% CI 0.97-2.06) however this was not statistically significant (Figure 1) and substantial heterogeneity was observed (p&lt;0.01 and i2 = 84%). Patients undergoing TAVR in the COVID-19 cohort trended towards shorter average lengths of stay and time from referral to procedure than TAVR patients prior to the pandemic (mean difference -0.37, 95% CI -0.93 – 0.19 and mean difference -25.43, 95% CI -52.31 to 1.44 respectively), however this was not significant.

Conclusion
This systematic review suggested a trend towards increased all-cause mortality in TAVR patients in the COVID-19 era. Furthermore, the available data trended towards shorter times from referral to TAVR and a shorter average length of stay, consistent with published recommendations from European and Asian expert consensus papers. Our data did not reach statistical significance and showed significant heterogeneity, likely reflecting widespread institutional variations during the pandemic. As the COVID-19 dynamic changes, further data is required to help characterise and optimise patient care in this vulnerable patient group.
Quantitative fluid overload in severe aortic stenosis refines cardiac damage and associates with worse outcomes
Authors: Halavina K , Koschutnik M , Dona C , Mascherbauer K , Heitzinger G , Dannenberg V , Hofer F , Winter M P , Treibel T A , Mascherbauer J , Goliasch G , Hengstenberg C , Kammerlander A A , Bartko P E , Nitsche C 
Published: November 2023

Abstract

Background
Cardiac decompensation in aortic stenosis (AS) involves extra-valvular cardiac damage (CD) and progressive fluid overload (FO). FO can be objectively quantified using bioimpedance spectroscopy (BIS).

Objectives
We aimed to assess the prognostic value of FO beyond established CD markers to guide risk stratification.

Methods
Consecutive patients with severe AS scheduled for transcatheter aortic valve implantation (TAVI) underwent prospective risk assessment with BIS and echocardiography. FO by BIS was defined as ≥1.0L (0.0L=euvolemia). The extent of CD was assessed by echocardiography according to an established staging classification. Right-sided CD (rCD) was defined as pulmonary vasculature/tricuspid/right ventricular CD. Heart failure hospitalization (HHF) and/or death served as primary endpoint.

Results
In total, 880 patients (81±7y/o, 47% female) undergoing TAVI were included. 360 (41%) had FO. Clinical examination in patients with FO was unremarkable for congestion signs in &gt;50%. A quarter had FO but no rCD (FO+/rCD-). FO+/rCD+ had the highest CD markers, including NT-proBNP levels.
After 2.4±1.0 years of follow-up, 236 patients (27%) had reached the primary endpoint (29 HHF, 194 deaths, 13 both). Quantitatively, every 1.0L increase in BIS was associated with a 12% increase in event hazard (adjHR 1.12, 95% CI 1.05-1.20, P=0.001). FO provided incremental prognostic value to traditional risk markers (NT-proBNP, EuroSCORE-II, CD on echocardiography). Stratification according to FO and rCD yielded worse outcomes for FO+/rCD+ and FO+/rCD-, but not FO-/rCD+, compared to FO-/rCD-.

Conclusion
Quantitative FO in patients with severe AS improves risk prediction of worse post-interventional outcomes compared to traditional risk assessment.