bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impacts of illicit drug use on coronary angiographic findings in a multicenter registry of patients with acute coronary syndrome
Authors: Lequipar A , Pezel T , Delmas C , Trimaille A , Boccara F , Roubille F , Lafont A , Gall E , El Beze N , Guiraud-Chaumeil P , Singh M , Gerbaud E , Picard F , Henry P , Dillinger J G 
Published: November 2023

Abstract

Background
Although illicit drug use may induce acute coronary syndrome (ACS), its impacts on coronary angiographic characteristics and the coronary artery disease (CAD) burden are a matter of debate.

Purpose
To assess the association between illicit drugs use and coronary angiographic findings in a multicenter patients with ACS.

Methods
From April 7 to 22, 2021, the Addiction in Intensive Cardiac Care Unit (ADDICT-ICCU) study included prospectively 1,499 patients admitted to ICCUs with a systematic urine multidrug test in 39 ICCUs across France. This prespecified study focuses on patients admitted for ACS with an angiography analysed by an independent Angiographic Core Laboratory. Patients with history of coronary artery bypass graft surgery were excluded. We compared coronary angiographic findings between illicit drugs users and others for the following parameters: the prevalence, location, type, and severity of CAD obstruction (stenosis≥50%), SYNTAX score, residual SYNTAX score, and the characteristics of percutaneous coronary intervention (PCI).

Results
Among the 283 patients with ACS (62±13 years, 77% men), 38 (13.4%) had a positive test for illicit drugs (cannabis: 12%, cocaine: 1.1%, MDMA: 0.7%). Drug users were younger than other patients (51±12 vs 64±12 years, p&lt;0.001), but there were no significant difference in sex ratio (89.5% vs 75.5%, p=0.088). There was no significant difference in the rate of STEMI (52.6% vs 45.7%, p=0.535) and NTSEMI (47.4% vs 54.3%, p=0.535) between drug users and others. Regarding the CAD burden, drug users had significantly less obstructive coronary lesions (1.6±1.1 vs 2.2±1.4, p=0.012), less multivessel obstructive CAD (31% vs 61%, p=0.001), and a trend for a lower initial SYNTAX score (8.3±7.8 vs 10.8±8.4; p=0.084) compared to others. Concerning culprit lesion, drug users had less bifurcation lesions (p=0.008), a trend for more left anterior descending (LAD) artery lesions (p=0.091), a higher thrombus burden score (p=0.057), and less lesions above 20 mm (p=0.183).

Conclusion
In patients with ACS, recent illicit drug use is associated with less number of significant lesions and less multivessel CAD. Concerning culprit lesions, illicit drugs use is associated with less bifurcation lesions, with a trend for more LAD lesions and a higher thrombus burden score.ACS analysed with Core LaboratoryAngiographic findings according to drug
Clinical efficacy of permanent internal mammary artery occlusion in chronic coronary artery disease: a double-blind, randomized, sham-controlled trial
Authors: Bigler M R , Kieninger-Graefitsch A , Tschannen C , Grossenbacher R , Seiler C 
Published: November 2023

Abstract

Introduction
Natural internal mammary artery (IMA) bypasses to the coronary circulation have been shown to act as extracardiac sources of myocardial blood supply, which has been found augmented by right IMA device occlusion. The goal of this randomized, sham-controlled trial was to test the efficacy of permanent right or left IMA device occlusion on symptoms of chronic coronary artery disease (CAD), on coronary artery occlusive blood supply, as well as on myocardial ischemia.

Methods
This was a prospective superiority trial in 100 patients with chronic CAD randomly allocated (1:1) to IMA permanent vascular device occlusion (verum group) or to IMA sham intervention (placebo group). The primary study endpoint was the change in treadmill exercise time (DET in seconds, s) during 6 weeks of follow-up after trial intervention. Secondary study endpoints were the changes in simultaneously obtained collateral flow index (CFI), and angina pectoris during a 1-minute proximal balloon occlusion of the coronary artery of interest. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure.

Results
In the verum and placebo group, exercise time changed from 398±176s to from 421±198s in the verum group (p=0.1745), and from 426±162s to 430±166s in the placebo group (p=0.55); DET was +23±116s and +4±120s, respectively (p=0.44). CFI change during follow-up was +0.022±0.061 in the verum and -0.039±0.072 in the placebo group (p&lt;0.0001). Angina pectoris at follow-up during the coronary balloon occlusion for CFI measurement had decreased or disappeared in 20/48 patients of the verum group, and in 10/47 patients of the placebo group (p=0.0336).

Conclusion
Permanent IMA device occlusion tends to augment treadmill exercise time in response to heightened coronary artery occlusive blood supply, the fact of which is reflected by mitigated signs of myocardial ischemia.
CSL112 (apolipoprotein A-I [human]) reduces the elevation in neutrophil-lymphocyte ratio (NLR) induced by acute myocardial infarction
Authors: Kingwell B , Duffy D , Clementi R , Velkoska E , Feaster J , Gibson C M 
Published: November 2023

Abstract

Background
CSL112 (apolipoprotein A-I [human]) is a novel therapy designed to reduce the risk of recurrent cardiovascular events following acute myocardial infarction (AMI). Preclinical data suggest that apolipoprotein A-I has anti-inflammatory properties which might contribute to atherosclerotic plaque stabilization (1). The neutrophil-lymphocyte ratio (NLR) is a clinically accessible measure of inflammatory status and predicts incident cardiovascular events in large outcome trials (2). It is unknown whether CSL112 can reduce inflammation as measured by the NLR.

Purpose
To evaluate whether infusion of CSL112 inhibits post-AMI inflammation as measured by NLR.

Methods
In a Phase 2 multicenter, double-blind study, 83 AMI patients with stage 3 chronic kidney disease were randomized 2:1 to receive 4 infusions of either 6 g CSL112 (n=55) or saline placebo (n=28) each separated by one week. The first infusion delivered on protocol Day 1 occurred 12h to 7d after presentation (mean 83 h). Blood samples were drawn prior to each infusion on Days 1, 8, 15 and 22 as well as at both Day 29 and 60 post the first infusion. Leukocyte data were available for up to 75 participants across the 6 sampling timepoints and neutrophil and lymphocyte counts were measured at the central laboratory. NLR was calculated and found to be non-normal in distribution and so analyses were performed on Loge transformed data. A mixed model repeated measures (MMRM) analysis was used to compare change from baseline (Day 1) in LogeNLR, neutrophil count and lymphocyte count between treatment groups (CSL112 6g versus Placebo) at the other 5 timepoints. An analysis of covariance (ANCOVA) was used to assess the effect of time from index MI to first infusion on change from baseline (Day 1) in LogeNLR at Day 8.

Results
The LogeNLR increased after AMI (between Day 1 and Day 8) with placebo treatment, whereas CSL112 infusion given after the Day 1 blood sample resulted in a decline (p=0.012; Fig 1, left panel, mean±SD). This effect of CSL112 was driven by reduction in neutrophil count (p=0.002; Fig 1, right panel) with lymphocyte levels remaining stable (p=0.537). Importantly, the magnitude of the effect of CSL112 to reduce NLR was greater if the timing of administration was closer to the index MI (treatment X time interaction and treatment effect both p=0.008).

Conclusion
CSL112 inhibits post-AMI elevation in NLR and this effect is maximized when infusion occurs early after presentation. It remains to be determined whether these anti-inflammatory effects of CSL112, in conjunction with previously demonstrated enhancement in cholesterol efflux capacity, will improve cardiovascular outcomes (3).Fig 1: Change in LogeNLR from baseline
Pretreatment with parenteral anticoagulation in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
Authors: Albuquerque F , Gomes D , Ferreira J , De Araujo Goncalves P , Felix Oliveira A , Campante Teles R , De Sousa Almeida M 
Published: November 2023

Abstract

Background and Aim
According to ESC guidelines, parenteral anticoagulation is recommended for all patients presenting with ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PPCI). However, no specific recommendations are made regarding the timing of administration. In fact, whether upstream anticoagulation improves clinical outcomes in STEMI patients is not well established. We conducted a systematic review and meta-analysis of current evidence on parenteral anticoagulation timing for patients presenting with STEMI.

Methods
We performed a systematic search of electronic databases (PubMed, CENTRAL and Scopus) until December 2022. Studies were considered eligible if they a) compared upstream anticoagulation with administration at the catheterization lab; and b) enrolled patients with STEMI undergoing PPCI. Studies comparing different anticoagulants were excluded from the analysis. Random-effects meta-analyses were performed. Efficacy outcomes included TIMI flow-grade pre- and post-PPCI, in-hospital cardiogenic shock (CS) and 30-day all-cause mortality. Safety outcome was defined as major in-hospital bleeding events.

Results
Overall, 9 studies were included (all non-randomized), with a total of 69,571 patients (30,693 in the pretreatment arm). In all but one, anticoagulation strategy was exclusively based on unfractionated heparin. Pretreatment was associated with a significant reduction in the incidence of 30-day all-cause mortality (OR 0.61; 95% CI 0.47-0.80; p&lt;0.001) and in-hospital CS (OR 0.69; 95% CI 0.59-0.81; p&lt;0.001). Upstream anticoagulation was also associated with a significant increase of spontaneous reperfusion of the culprit artery before PPCI (pre-PPCI TIMI &gt; 0: OR 1.47; 95% CI 1.35-1.60; p&lt;0.001) and TIMI flow ≥ 2 after coronary intervention (OR 1.28; 95% CI 1.05-1.56; p=0.016). Regarding safety outcomes, pretreatment was not associated with an increase of in-hospital major bleeding (OR 1.01; 95% CI 0.70-1.44; p=0.970). Multiple sensitivity analyses, including propensity-matched populations, showed consistent results.

Conclusions
Upstream anticoagulation was associated with a significant lower risk of 30-day all-cause mortality, incidence of in-hospital cardiogenic shock and improved reperfusion of culprit artery. These benefits were not accompanied by an increased risk of major bleeding, suggesting an overall clinical benefit of early anticoagulation in patients presenting with STEMI. These results require confirmation in a randomized clinical trial.
Ticagrelor versus clopidogrel for complex percutaneous coronary intervention in chronic coronary syndrome: a post-hoc analysis of the ALPHEUS study
Authors: Lattuca B , Mazeau C , Guedeney P , Kala P , Nejjari M , Morel O , Leclercq F , Payot L , Beygui F , Range G , Motovska Z , Vicaut E , Collet J P , Montalescot G , Silvain J 
Published: November 2023

Abstract

Background
Whether ticagrelor utilization in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) could prevent type 4 myocardial infarction (MI) or myocardial injury as compared to clopidogrel is unknown.

Purposes
To evaluate the frequency and outcomes of complex PCI in stable coronary patients and the efficacy of ticagrelor versus clopidogrel in these patients randomized in the ALPHEUS trial.

Methods
All PCI procedures were blindly reviewed by two core laboratory readers and classified as complex if they had at least one of the following criteria: stent length ≥60 mm, two-stent bifurcation, use of atherectomy, left main, bypass graft, chronic total occlusion, use of guide catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b MI and major myocardial injury, defined by the 3rd and 4th universal definition of MI, during the 48h after PCI. Angiographic complications and the composite of death, MI, stroke at 48 hours and at 30 days were also evaluated. We compared the event rates in the randomized groups according to the presence or not of complex PCI criteria and evaluated the interaction with the randomization to ticagrelor or clopidogrel.

Results
Among the 1866 patients randomized, 910 (48.3%) PCI were classified as complex PCI and 956 (51.7%) as not complex. Multiple criteria of complex PCI were found in 14.4% (2 criteria) and 9.1% (≥3 criteria) of the patients. The primary endpoint was more frequent in complex PCI than in the not-complex PCI (45.6% vs 26.6%; p&lt;0.001) driven by higher rates of type 4MI and angiographic complications (12.2% vs 4.8 %; p&lt;0.001 and 19.3% vs 8.6%; p&lt;0.05, respectively). The composite of death, MI, stroke at 48 hours (12.7% vs 5.1 %; p&lt;0.05) and at 30 days (13.4% vs 5.3%; p&lt;0.05) were also more frequent in complex PCI. No interaction was found between the complexity of PCI and the randomized treatment for the primary endpoint (p for interaction = 0.35) nor the secondary endpoints.

Conclusions
Complex PCI patients have higher rates of periprocedural and cardiovascular events which are not reduced by ticagrelor as compared with clopidogrel.
Association of LDL cholesterol levels and all cause mortality in a real world analysis using data from an international network
Authors: Costa L , Scudeler T L S , Nunes R A B N 
Published: November 2023

Abstract

Background
Current cholesterol guidelines have recommended low low-density lipoprotein cholesterol (LDL-C) treatment targets for secondary prevention of cardiovascular disease. However, recent studies have suggested that very low or very high levels of LDL-C may be associated with increased mortality and other adverse outcomes. The association between LDL-C levels and mortality remains to be determined.

Methods and Results
This cohort study included data from a large multinational electronic health record network (TriNetX) of patients aged 18 years or older with coronary artery disease. LDL-C levels were divided into 4 categories: &lt;30 (cohort 1), 30-50 (cohort 2), 50-70 (cohort 3), and 70-100 (cohort 4). Deaths were ascertained by linkage to death records in the last 10 years before the analysis. Five-year Kaplan-Meier curves and hazard ratios were calculated. We identified 1,136,600 patients, of whom 36,060 had LDL-C &lt;30 mg/dL, 282,500 had LDL-C &lt;50 mg/dL, 255,964 had LDL-C 50-70 mg/dL and 596,136 had LDL-C 70-100 mg/dL. Comparative analyzes were performed on the cohorts (cohort 1 vs. cohort 2, cohort 2 vs. cohort 3, and cohort 3 vs. cohort 4) after propensity score matching. After adjustment, individuals of cohort 2 (n = 36,004), compared with those of cohort 1 (n = 36,004), had higher all-cause mortality (HR 1.086; CI 95% 1.064-1.109, p &lt;0.0001), individuals of cohort 3 (n = 244,908), compared to those of cohort 2 (n = 270,359), had higher risk of all-cause mortality (HR 1.063; 95% CI 1.055-1.1071, p &lt;0.0001), and induviduals of cohort 4 (n = 254,465), compared with those of cohort 3 (n = 254,465), had lower risk of all-cause mortality (HR 0.937; CI 95% 0.929-0.944, p &lt;0.0001).

Conclusions
Lower LDL-C levels are associated with a reduced risk of all-cause mortality in patients with coronary artery disease.
Efficacy and safety of under-dose non-vitamin K antagonist oral anticoagulant with atrial fibrillation undergoing PCI: Insights from a nationwide population-based cohort study
Authors: Youk G S , Choi S Y , Jung A H , Choi S Y , Yuan S L , Song Z Y , Lee K M , Kim M H 
Published: November 2023

Abstract

Background
The under-dose non-vitamin K antagonist oral anticoagulants (NOACs) are required according to clinical conditions for patients with atrial fibrillation (AF). We aimed to assess the comparative effectiveness and safety of standard-dose and under-dose NOACs undergoing PCI.

Methods
We studied the retrospective nonrandomized observational cohort of oral anticoagulant native nonvalvular patients with atrial fibrillation treated NOACs (rivaroxaban, dabigatran, apixaban, or edoxaban) from January 2013 to December 2017, based on the Korean Health Insurance Review and Assessment database. We performed head-to-head comparisons of standard-dose and under-dose NOACs.

Results
We studied standard-dose and under-dose NOACs were 1,095 and 2,136, respectively (Rivaroxaban, 500 vs 782; Dabigatran, 233 vs 709; Apixaban, 244 vs 430; Edoxaban, 118 vs 214). Compared with standard-dose NOACs, low-dose NOACs were associated with lower risk of major bleeding in AF patients with PCI(Rivaroxaban, HR=0.72[0.58∼0.85]; Dabigatran, HR=0.73[0.60-0.86]; Apixaban, HR=0.82[0.69-0.95]; Edoxaban, HR=0.85[0.72-0.98]. Also, the ischemic stroke was significantly different for standard-dose and under-dose NOACs in AF patients with PCI (Rivaroxaban, HR=0.67[0.54-0.80]; Dabigatran, HR=0.68[0.55-0.81]; Apixaban, HR=0.69[0.56-0.82]; Edoxaban, HR=0.70[0.57-0.83]).

Conclusions
In this nonrandomized Asian cohort study, NOACs(rivaroxaban, dabigatran, apixaban, or edoxaban) were associated with lower risk of major bleeding and ischemic stroke for standard-dose and under-dose NOACs in AF patients with PCI.Table 1.Clinical outcomes
Association of revascularization with mortality in ischemic left ventricular dysfunction
Authors: Tao M , Liu Y , Radakrishnan A , Al-Sadawi M , Masson R , Rahman T , Mann N , Pyo R 
Published: November 2023

Abstract

Background
Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). The purpose of this meta-analysis is to evaluate the association of coronary revascularization with mortality in patients with ischemic LV dysfunction.

Methods
A literature search was conducted for studies reporting on all-cause mortality after revascularization with PCI or CABG compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status.

Results
A total of 21 studies with 6062 participants (2838 revascularized, 3224 on OMT) met inclusion criteria. Mean follow-up was 37 months (11-68 months), mean LV ejection fraction (EF) was 29%, mean age was 61, 85% of patients were male.
Revascularization was significantly associated with lower all-cause mortality compared to patients on OMT (OR 0.57, 95% CI 0.46-0.71; p&lt;0.01). The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Heterogeneity between subgroups was low and test for subgroup difference was not statistically significant by EF cutoff of 35% or by revascularization method (p=0.43, I2=0%; p=0.12, I2=59.7%).
Subgroup analysis by viability demonstrated that revascularization was significantly associated with lower all-cause mortality compared to OMT for patients with viability and mixed cohorts with or without viability, but not patients without viability (OR 0.47, 95% CI 0.33-0.66; p&lt;0.01; OR 0.57, 95% CI 0.38-0.84; p&lt;0.01; OR 0.73, 95% CI 0.51-1.02; p=0.07). The effect size was larger in the subgroup with viable myocardium compared to mixed patients with viable or non-viable myocardium (Z=4.33 vs 2.79).

Conclusions
Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of all-cause mortality in patients without evidence of viable myocardium.
Percutaneous coronary intervention and medical therapy versus medical therapy alone in chronic coronary syndrome: A hierarchical win-ratio analysis from SCAAR
Authors: Von Koch S , Koul S , Erlinge D , Mohammad M 
Published: November 2023

Abstract

Background
Revascularization of patients with chronic coronary syndrome (CCS) using percutaneous coronary intervention (PCI) is frequently done. However, the role of a PCI in this subgroup of patients with coronary artery disease remains controversial.

Purpose
The objective is to determine whether PCI plus medical therapy is associated with better outcomes for patients with CCS, compared to medical therapy only.

Methods
We conducted a population-based nationwide observational study. Using the Swedish Coronary Angiography and Angioplasty registry (SCAAR) we identified all patients with CCS undergoing coronary angiography between 2010-2020. Patients with obstructive coronary artery disease, defined as having at least one stenosis with ≥50% luminal obstruction were included. Patients were stratified into two groups according to their received treatment with PCI plus medical therapy or medical therapy only. Propensity score (PS) matching was used to match the two groups on their baseline characteristics. Outcome was assessed with win-ratio and the primary endpoint was net adverse clinical event (NACE) within 5-years. In the win-ratio analysis, the components of NACE were ranked (1) all-cause mortality, (2) stroke, (3) bleeding and (4) myocardial infarction. Subgroup analysis was also performed.

Results
After propensity score matching, two groups comprising 16,937 patients each, were formed. Baseline characteristics were comparable between the two groups (Table 1). However, patients who underwent PCI were more likely to receive dual antiplatelet therapy with aspirin and a P2Y12 inhibitor, while those treated with medical therapy were more commonly prescribed nitrates. Additionally, statins were prescribed more frequently to patients treated with PCI. The hierarchical outcome analysis showed no statistically significant difference between the two groups (win-ratio: 0.98; 95% confidence interval: 0.94-1.02; p=0.345). Subgroup analyses of men, women, patients aged 75 years and older, diabetic patients, and non-diabetic patients showed no significant differences in outcome between the two groups.

Conclusion
In this study, which aimed to assess the outcomes of patients with CCS using a hierarchical approach, revascularization with PCI did not result in better outcomes when compared to medical therapy alone. These findings suggest that for patients with CCS, medical therapy may be just as effective as PCI in improving outcomes.Baseline characteristicsWin-ratio