bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomarkers for identification of high-risk coronary plaques in patients with suspected coronary artery disease
Authors: Pedersen G P , Dahl J D , Rasmussen L D R , Blavnsfeldt A B , Boettcher S B , Boettcher M B , Nyegaard M N , Nissen L N , Winther S W 
Published: November 2023

Abstract

Background
Patients with atherosclerotic plaques containing high-risk features have an increased likelihood of events and a worse prognosis. Whether elevated levels of biomarkers of ischemia e.g. TnI and inflammation e.g. high sensitive C-reactive protein (hsCRP) are associated with the presence of high-risk coronary atherosclerotic plaques (HRP) evaluated on coronary computed tomography angiography (CCTA) is not well described.

Objectives
To assess the association between 1) TnI and 2) hsCRP and quantified coronary plaque burden, luminal diameter stenosis and HRP in symptomatic patients with low/intermediate pre-test probability of obstructive coronary artery disease (CAD) referred to CCTA evaluation.

Methods
On enrolled patients (n=1,615), CCTA were analysed using a semiautomatic software for coronary artery plaque characterization. Patients with high (&gt;6 ng/L) and low (&lt;3 ng/L) TnI as well as high (&gt;2 mg/L) and low (&lt;1 mg/L) hsCRP were identified. Associations of high levels of TnI and hsCRP compared to low levels were investigated for the following: high plaque burden (defined as having total plaque volume above the 75th percentile on CCTA), presence of significant stenosis (defined as ≥50% luminal diameter stenosis on CCTA), and presence of HRP (defined as having a plaque with at least two risk features on CCTA).

Results
TnI and hsCRP were both positively correlated with total plaque burden (TnI rs=0.14, p&lt;0.001; hsCRP rs=0.08, p&lt;0.001). In multivariate logistic regression analyses, high TnI was when compared to low TnI associated with presence of stenosis (OR 1.43, 95% confidence interval (CI) 1.03-1.99, p=0.034), the presence of HRP (OR 1.79, 95% CI: 1.17– 2.74, p=0.008) and further the subtypes of HRP including low attenuation plaque (OR 1.93, 95% CI: 1.24–3.00, p=0.003) and positive remodelling (OR 1.51, 95% CI: 1.07–2.13, p=0.018). For high hsCRP levels, only the presence of stenosis and the HRP-subtype napkin ring sign correlated significantly.

Conclusion
In patients with suspected CAD TnI and hsCRP are associated with the presence of HRP features. These findings suggest that inflammatory and particularly ischemic biomarkers might improve early risk stratification and potentially also affect patient management.
ESC 0/1h-algorithm using the updated, biotin-resistant high-sensitivity cardiac troponin T assay
Authors: Twerenbold R , Boeddinghaus J , Nestelberger T , Puelacher C , Rubini Giemenez M , Guo L , Lopez Ayala P , Miro O , Martin-Sanchez F J , Morawiec B , Keller D , Mueller C 
Published: November 2023

Abstract

Background
For rapid and safe triage of patients with suspected non-ST-elevation myocardial infarction (NSTEMI), the European Society of Cardiology (ESC) recommends the use of a 0/1h-algorithm based on high-sensitivity cardiac troponin (hs-cTn) T or I. Recently, multiple widely used immuno-assays including hs-cTnT have been reported to interfere with high biotin concentrations, potentially leading to false-negative results. To address this major concern, an updated, biotin-resistant hs-cTnT assays has been developed by the manufacturer to replace its previous version.

Purpose
We aimed to assess and compare the clinical performance of the updated, biotin-resistant hs-cTnT Elecsys assay when using the original ESC hs-cTnT 0/1h-algorithm.

Methods
In a prospective international diagnostic study enrolling patients presenting with suspected NSTEMI to the emergency department (ED), hs-cTnT was serially measured at ED presentation and after one hour with the original, biotin-sensitive (hs-cTnT-original) and the updated, biotin-resistant hs-cTnT (hs-cTnT-updated) assay.
Patients presenting with STEMI were excluded. The final diagnosis was centrally adjudicated by two independent cardiologists using all available data including coronary angiography, echocardiography, follow-up data, and serial measurements of hs-cTn. We assessed the overall efficacy, rule-out safety and rule-in accuracy of the ESC hs-cTnT 0/1h-algorithm when using hs-cTnT-updated and compared it with the use of hs-cTnT-original.

Results
NSTEMI was the final diagnosis in 162 of 865 (19%) patients. The ESC 0/1h-algorithm using hs-cTnT-updated triaged 58% of patients towards "rule-out", 21% towards "rule-in", and 21% towards "observe" compared to 56%, 21% and 23% using hs-cTnT-original, respectively (Figure 1, p=ns). Only 6 patients were reclassified using hs-cTnT-updated. Safety of rule-out was very high using hs-cTnT-updated with a negative predictive value for NSTEMI of 100% (95% confidence interval (CI), 99.2-100%) and a sensitivity of 100% (95%CI, 97.7-100%) and was highly comparable to hs-cTnT-original (NPV 100% [95%CI 99.2-100], sensitivity 100% [95%CI, 97.7-100%], all p-values for comparison not significant). Of note, no NSTEMI-patient was missed by the ESC 0/1h-algorithm neither using hs-cTnT-updated nor original. Similarly, accuracy of rule-in was very high (positive predictive value 73.7% [95%CI, 66.8-79.6%], specificity 93.3% [95%CI, 91.2-94.9%]) and highly comparable to hs-cTnT-original (PPV 73.9% [95%CI 67.1-79.7%], specificity 93.2% [95%CI, 91.1-94.8%], all p-values for comparison not significant).

Conclusions
The safety and efficacy of the ESC 0/1h-algorithm using the novel updated, biotin-resistant hs-cTnT-assay is excellent and similar to the use of the original assay without the need to adjust the cutoffs to the new assay.Figure 1
A novel deep learning model for a coronary computed tomography angiography diagnosis of plaque erosion
Authors: Yuki H , Park S , Suzuki K , Kinoshita D , Niida T , Mcnulty I , Alexander B , Lee H , Nakamura S , Kakuta T , Ye J , Jang I K 
Published: November 2023

Abstract

Background
Plaque erosion is the underlying pathology in up to 50% of patients with non-ST-segment elevation acute coronary syndromes (ACS). Previous studies suggest that patients with erosion might be treated conservatively without stenting. Currently, a diagnosis of plaque erosion requires invasive intracoronary imaging.

Purpose
We sought to develop a deep learning (DL) model that enables an accurate diagnosis of plaque erosion using coronary computed tomography angiography (CTA).

Methods
A total of 532 coronary CTA scans (143 coronary CTA scans with plaque rupture, 113 with plaque erosion, and 276 with reference segment) from 395 patients were included to develop a model: 426 coronary CTA scans from 316 patients for training and internal validation, and 106 separate scans from 79 patients for test set validation. Among ACS patients, the diagnosis of plaque rupture or erosion identified by OCT was used as the ground truth, and the corresponding site on the CTA image matched with OCT image was determined to be the culprit lesion. A novel DL, Momentum Distillation Composite Transformer Attention (MD-CTA) model, was developed that can effectively process the whole CTA scans to diagnose plaque erosion.

Results
The novel DL model showed diagnostic performance in the five-fold cross-validation with an area under the receiver-operating characteristic curve (AUC) of 0.901 (0.873-0.930), a sensitivity of 81.2 (72.8-88.0), and a specificity of 86.6 (82.4-90.2), all of which were significantly higher than those of convolutional neural network (CNN) model with an AUC of 0.621 (0.567-0.675), the sensitivity of 59.8 (50.1-69.0), and specificity of 60.2 (54.5-65.7) in training validation. Similarly, in the test set validation, the AUC, sensitivity, and specificity of the MD-CTA model were 0.899 (0.841-0.957), 87.1 (70.2-96.4), and 85.3 (75.3-92.4), respectively, higher than those of 0.724 (0.622-0.826), 71.0 (52.0-85.8), and 68.0 (56.2-78.3) of the CNN model. At the slice level, the MD-CTA model was also superior in the five-fold cross-validation and the test set validation compared to the CCN model. This model significantly outperformed experienced cardiologists, especially for sensitivity.

Conclusions
The newly developed DL model enables an accurate CTA diagnosis of plaque erosion, which might enable the cardiologist to provide tailored therapy without invasive procedures. This algorithm might lead to a major shift in managing millions of patients with plaque erosion each year.Table 1Figure 1
The effect of PCI and post procedural TIMI flow on patients with late arrival STEMI
Authors: Tarabih M , Ovdat T , Karkabi B , Eitan A , Maguli B , Mahamid M , Shiran A 
Published: November 2023

Abstract

Introduction
Patients with ST-elevation myocardial infarction (STEMI) and late arrival (&gt;12h) may have worse outcome following percutaneous coronary intervention (PCI). A worse TIMI flow after PCI is associated with poor outcome. Our aim was to compare the TIMI flow after PCI and to find its effect on outcomes in patients with late-arrival STEMI Compared with that of patients presenting early (&lt;12h).

Methods
Data source was available for patients enrolled in the biennial acute coronary syndrome Israeli Surveys (ACSIS) during 2000-2021. TIMI flow data was reviewed in patients with late arrival STEMI (12-48h and &gt;48h) who underwent PCI. We analyzed its effect on clinical outcomes in patients with late-arrival STEMI compared with that of patients presenting early (&lt;12h).

Results
Available data regarding the time from symptom onset to hospital arrival was available in 6,466 patients with STEMI. Data regarding TIMI flow following primary PCI was available in 2,437/6466 (38%) patients. Pre procedural TIMI-0 flow in the infarct related artery (IRA) was present in 59% of patients, irrespective of time of presentation (Figure). The rate of TIMI-3 flow following PCI was similar in all groups, 89% in patients arriving 12-48h, 96% in those arriving &gt;48h after symptoms onset and 92% in patients presenting within 12h (p=0.632). Most importantly, PCI significantly reduced the rate of 30 days MACE only in those arriving less than 12 H from symptoms onset (Table).

Conclusions
In patients participating in the Israeli ACSIS registry, TIMI-3 flow after primary PCI was achievable in most STEMI patients, but PCI improved the outcome only in those arriving less than 12hour.
Quantitative flow ratio for non culprit lesions in ST elevation myocardial infarction and multi vessel disease - a direct comparison with fractional flow reserve
Authors: Memisevic N , Haertel F , Lauer B , Moebius-Winkler S , Schulze P C 
Published: November 2023

Abstract

Objectives
In acute myocardial infarction and multivessel disease (MVD), current guidelines recommend treatment of the culprit lesion followed by staged full revascularization of functionally relevant stenoses. We sought to analyze the hemodynamic relevance of intermediate stenoses using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population presenting with ST elevation myocardial infarction (STEMI) and MVD on index procedure.

Methods
We retrospectively analyzed 36 coronary lesions in 34 Patients presenting with STEMI and MVD from January 2017 to September 2022. 31 (86%) patients were male, mean age 63 ± 7, mean ejection fraction (EF %) 50 ± 8, arterial hypertension 30 (88%), diabetes 13 (38%). The non culprit lesion location was left anterior descending (LAD) in 24 (67%), circumflex artery (RCX) in 8 (22%) and right coronary artery (RCA) in 4 (11%). All patients received an invasive assessment of non culprit lesions using FFR within 3 months after STEMI. A QFR assessment of non culprit lesions in an acute invasive coronary angiography has been compared with FFR results in a staged procedure.

Results
QFR showed an excellent accuracy in ruling out functionally relevant stenosis with no false negative results (sensitivity 100% compared to FFR). Three coronary lesions (8,3%) were graded false positive (functionally relevant). Due to poor image acquisition, we were unable to perform QFR analysis in ten coronary lesions (28%). Overall specificity (56,5%) was lower than reported in previous trials. After excluding the lesions that could not be analyzed due to poor acquisition we achieved specificity of 81,2% (Fig. 1).
Concusion: QFR showed an excellent correlation with FFR (Fig. 1). Performing QFR in STEMI Patients with MVD could reduce the need of repeated invasive coronary angiographies and optimize the clinical therapy management in this high-risk population. Further studies on diagnostic performance and outcomes are needed.Fig. 1: Correlation plot
Incidence and pattern of repeat coronary revascularizations in patients with acute coronary syndromes treated with ticagrelor or prasugrel
Authors: Aytekin A , Scalamogna M , Coughlan J J , Lahu S , Ndrepepa G , Menichelli M , Mayer K , Joner M , Xhepa E , Kufner S , Laugwitz K L , Neumann F J , Schunkert H , Kastrati A , Cassese S 
Published: November 2023

Abstract

Background
The ISAR-REACT 5 randomized trial compared the efficacy and safety of ticagrelor and prasugrel in patients with acute coronary syndromes (ACS) managed invasively. Data are missing with regard to the effect of these antiplatelet agents on the repeat revascularization procedures.

Purpose
We sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of repeat coronary revascularizations in patients with ACS undergoing percutaneous coronary intervention (PCI).

Methods
This post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. Patients were divided into two groups as per assigned antiplatelet treatment. The primary outcome for this analysis was the incidence of repeat coronary revascularization (percutaneous or surgical) up to 12-month follow-up. Secondary outcomes were target vessel revascularization (TVR) and non-target vessel revascularization (NTVR). We also studied whether repeat revascularization procedures were urgent in nature.

Results
Among 3,377 ACS patients, 1,676 were assigned to ticagrelor and 1,701 to prasugrel group before receiving PCI. Compared with prasugrel, the incidence of repeat coronary revascularization at 12 months was significantly higher in patients treated with ticagrelor (hazard ratio [HR]=1.14; 95% confidence interval [CI] 1.01-1.29), mostly attributable to significantly more NTVR (HR=1.15 [1.01-1.32]) in this latter group. There were numerically more urgent repeat revascularizations in patients receiving ticagrelor compared with prasugrel (HR=1.32 [1.00-1.75]), mostly due to urgent NTVR (HR=1.62 [1.09-2.41]). The risk of TVR was not significantly different between treatment groups (HR=1.04 [0.76-1.44]).

Conclusions
In patients with ACS treated with PCI, ticagrelor is associated with significantly more repeat coronary revascularizations compared to prasugrel after 12 months, predominantly in remote coronary vessels.
Comparison of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in myocardial infarction patients with type 2 diabetes
Authors: Tjerkaski J , Ueda P , Alfredsson J , Erlinge D , Lindahl B , Mohammad M A , Omerovic E , Reitan C , Svensson P , Jernberg T 
Published: November 2023

Abstract

Background
Both sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to reduce the risk of adverse cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients with established atherosclerotic cardiovascular disease.

Purpose
The aim of this study was to assess the comparative effectiveness of SGLT2i and GLP1-RA in myocardial infarction (MI) patients with T2DM.

Methods
This observational cohort study included MI patients with T2DM who were treated with SGLT2i or GLP1-RA within 180 days of hospital discharge between 2013 and 2021. Data was acquired from the SWEDEHEART registry, a nationwide quality register. The co-primary endpoints of this study were a composite of MI, ischemic stroke and all-cause mortality (MACE) and a composite of heart failure hospitalisation (HHF) and all-cause mortality. Inverse probability of treatment weighting was used to adjust for differences in baseline covariates between the treatment groups.

Results
This study consisted of 617 patients who were treated with SGLT2i and 543 patients who were treated with GLP1-RA. We observed no statistically significant differences between SGLT2i and GLP1-RA concerning the risk of MACE (adjusted incidence rate 76 vs. 68 events per 1000 person-years; HR 1.09 [95% CI 0.85 - 1.40]) and the risk of HHF or all-cause mortality (adjusted incidence rate 52 vs. 50 events per 1000 person-years; HR 1.04 [95% CI 0.80 - 1.36]). Similarly, we did not observe any statistically significant differences between the treatment groups concerning the secondary outcomes of MI (adjusted incidence rate 63 vs. 53 events per 1000 person-years; HR 1.08 [95% CI 0.83 - 1.40]), stroke (adjusted incidence rate 7 vs. 6 events per 1000 person-years; HR 1.22 [95% CI 0.57 - 2.87]), HHF (adjusted incidence rate 45 vs. 38 events per 1000 person-years; HR 1.06 [95% CI 0.80 - 1.41]) and all-cause mortality (adjusted incidence rate 11 vs. 15 events per 1000 person-years; HR 1.06 [95% CI 0.63 - 1.82]).

Conclusions
There were no statistically significant differences between SGLT2i and GLP1-RA concerning the risk of recurrent ischemic events, HHF and all-cause mortality in this cohort of MI patients with T2DM.Cumulative incidence of events
Comparison of ticagrelor and prasugrel just before PCI in NSTE acute coronary syndromes, LIKE-ACCOAST analysis
Authors: Motovska Z , Jarkovsky J , Kovarik A , Mrozek J , Hlinomaz O , Precek J , Hromadka M , Zohor A , Kala P , Tomasov P , Cervinka P , Matejka J , Benesova K , Drabkova S 
Published: November 2023

Abstract

Background
Recommendations for the preference of prasugrel over ticagrelor just before PCI in NSTE ACS are based on limited and controversial evidence. Furthermore, prasugrel can’t be used in patients after a stroke/TIA, and the risk of bleeding in older and low-weight patients annuls its benefit.

Purpose
We aimed to add to the current evidence comparing the benefit of prasugrel and ticagrelor just before PCI (without pretreatment) in NSTE ACS patients.

Methods
The prasugrel population comprised the ACCOAST study non-pretreatment arm undergoing PCI (N 1372) (ref 1). The ticagrelor study population was selected from the long-term all-comers National Registry of Cardiovascular Surgery and Interventions: Module of Cardiovascular interventions of Institute of Health Information and Statistics of the Czech Republic (N 15126)who were 1) undergoing PCI for NSTE ACS, 2) received ticagrelor loading dose 180 mg just before the procedure, 3) fulfilled the inclusion and exclusion criteria of the ACCOAST trial (N 1370).
The endpoint (identically to the ACCOAST primary EP) was a composite of cardiovascular death, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa bailout seven days after PCI.
The data were matched to the structure of published ACCOAST no pre-treatment group using R with maic package, which provides a generalized workflow for the generation of subject weights to be used in Matching-Adjusted Indirect Comparison (MAIC) (Ref 3,4). In MAIC, unbiased comparison between outcomes of two trials is facilitated by weighting the subject-level outcomes of one trial with weights derived such that the weighted aggregate measures of the prognostic or effect modifying variables are equal to those of the sample in the comparator trial.

Results
The study population characteristics are presented in Table. We did not find any difference in the efficacy endpoint at seven and 30 days after PCI between the groups treated with prasugrel and ticagrelor (Figure).

Conclusion
Prasugrel and ticagrelor given just before PCI for NSTE ACS are equally effective in reducing ischemic risk.Table.Efficacy endpoint occurence.
Temporal trends and predictors of emergency department visits and hospital readmissions in angina and no obstructive coronary artery disease (ANOCA): a population-based study of 85,573 adults
Authors: Patel S , Fung M , Butalia S , Anderson T J 
Published: November 2023

Abstract

Background
Chest pain in patients with angina and no obstructive coronary artery disease (ANOCA) is a diagnostic and treatment challenge, resulting in a significant burden on healthcare resources. With increasing recognition of ANOCA, it is uncertain if the healthcare resource utilization of patients with ANOCA has changed over time. We aimed to determine whether emergency department (ED) visits and hospital readmissions in patients with ANOCA has changed over time and their predictors.

Methods
A retrospective population-based cohort of patients who had their first cardiac angiography for a chest pain syndrome in Alberta between 2002 and 2020 were extracted from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. A temporal trend analysis was performed to investigate the proportion of ED visits and hospital readmissions in ANOCA and obstructive coronary artery disease (CAD). The predictors of ED visits and readmissions were also analyzed.

Results
In our analysis, 85,573 patients were included (26% ANOCA, 31% female, mean age 62.1 ± 12.0 years, 65% ED visit≥1, 30% readmission). The percentage of patients with ANOCA and obstructive CAD having an ED visit ranged between 26.3% to 30.7% and 47.7% to 53.1%, respectively. The percentage of patients with ANOCA and obstructive CAD having readmission declined slightly over time, from 6.5% to 3.8% in ANOCA and 24.8% to 15.3% in obstructive CAD. Obstructive CAD was found to be the most significant predictor of both ED visits (OR=1.933, 95% CI=1.837–2.034), and readmissions (HR=2.638, 95% CI=2.518–2.764), with congestive heart failure (OR=1.302, 95% CI=1.125–1.507) , peripheral artery disease (OR=1.291, 95% CI=1.116–1.494), cerebrovascular disease (OR=1.382, 95% CI=1.224–1.559), myocardial infarction (vs stable angina (SA): OR=1.233, 95% CI=1.172–1.297), and unstable angina (vs SA: OR=1.564, 95% CI=1.466-1.668–0.89) also contributing to ED visits, and diabetes (HR=1.276, 95% CI=1.229–1.323) and stable angina (vs MI: HR=0.746, 95% CI=0.719–0.774; vs UA: HR=0.895, 95% CI=0.857–0.934) contributing to readmissions.

Conclusions
Emergency department visits for patients with ANOCA have remained stable over time, with a slight decline in hospital readmissions. Patients with ANOCA had fewer ED visits and readmissions than obstructive CAD patients, and no sex differences were observed in the utilization of healthcare resources. This study suggests that education and follow-up interventions are still needed for patients with ANOCA.Comparison of baseline characteristicsED visits & Readmission Temporal Trends