bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical outcomes of drug coated balloon in coronary lesions: 3-year follow-up of CAGE FREE Registry
Authors: Wang R , Yang W , Liu J , Mou F , Liu Y , Zhou J , Yin Z , Wang Q , Yuan M , Li F , Li C , Gao C , Tao L 
Published: November 2023

Abstract

Background
Intervention with drug-coated balloons (DCB) is based on a leave-nothing-behind concept and has been recommended as the first-line treatment modality for in-stent restenosis (ISR) and small-vessel disease. However, DCB treated for de novo lesions and comparison between DCB treatment for de novo lesions and ISR has not been fully elucidated.

Purpose
To report and compare 3-year clinical outcomes between DCB treatment for ISR and de novo disease, and identify the risk factors of adverse events after DCB intervention.

Methods
The study population was derived from the CAGE FREE Registry, which was a prospective, dedicated DCB treated all-comers registry in ISR and/or de novo lesions. The primary outcome was vessel-oriented composite endpoint (VoCE) at 3 years, defined as a composite of vessel-related cardiac death, vessel-related myocardial infarction (MI), and target vessel revascularization (TVR).

Results
A total of 2473 consecutive patients with 2804 lesions were enrolled. DCB treated in 1478 patients with 1669 de novo lesions and 995 ISR patients with 1135 lesions. The median duration of follow-up was 2.5 years (IQR 1.8-3.2) overall. At 3 years, the rate of VoCE was 12.1% (vessel-related cardiac death: 3.0%, vessel-related MI: 2.2%, and TVR: 7.8%) in the overall cohort. Patients with ISR treated with DCB had a higher rate of 3-year VoCE than those with de novo lesions (16.8% vs. 8.9%, HR: 2.00, 95%CI: 1.56-2.57, p&lt;0.001), with the HR remaining significant after adjustment (IPTW adjusted HR: 1.79, 95%CI: 1.37-2.35). In terms of procedure-related factors, TIMI flow after PCI less than grade 3 and residual stenosis more than 25% were independent risk factors of 3-year VoCE for patients with de novo lesions. In patients with ISR, residual stenosis more than 25% had a higher risk of 3-year VoCE, whereas TIMI flow after PCI less than grade 3 only had a trend.

Conclusion
Patients with ISR treated with DCB had a higher rate of 3-year VoCE than those with de novo lesions. DCB appears to be an attractive alternative treatment for de novo coronary lesions. Residual stenosis ≤25% combined with TIMI flow grade 3 should be attempted after DCB angioplasty.Kaplan Meier curve for 3-year VoCE
Comparison among ultra-thin coronary stents: a network metanalysis
Authors: Marengo G , Bruno F , De Filippo O , D'ascenzo F , De Ferrari G M 
Published: November 2023

Abstract

Background
Ultrathin-struts drug eluting stents (DESs) have been related to potential improvement in stent-related outcomes compared to thicker-struts DES. However, comparison among different ultrathin devices are lacking.

Methods
All Randomized Controlled Trials (RCTs) comparing ultrathin (strut thickness &lt; 70 µm) vs thicker struts DES in an all-comers population were included. Target lesion failure (TLF), as defined by included trials, at one year follow up was the primary endpoint. Cardiovascular (CV) death, myocardial infarction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) were the secondary ones. Arms of included trials were compared by means of Network Meta Analysis (NMA).

Results
Nine studies encompassing 20081 patients were included: Orsiro DESs were evaluated in 7 arms with 8086 patients, MiStent in one arm (703 patients) and Supraflex in one arm with 720 patients. At one year follow up, no significant differences were noted for TLF. In particular, Orsiro was associated with similar risk of TLF compared with Supraflex (RR 1.7; CI 0.59 - 1.78) and with Xience (RR 0.98; CI 0.71 - 1.35), being the one with the highest probability of performing best. Orsiro stent was the one with the highest probability of performing best also for MI and TLR.

Conclusions
Ultrathin DES are all associated with a comparable risk of TLF as compared with second generation, thicker struts DES. As for the risk of repeat revascularization and of TLF, Orsiro was the one with the highest probability of performing best, either compared with other ultrathin DES or with thicker-struts devices.TLR: RRs among different devices
The effects of statins on cardiovascular and inflammatory biomarkers in primary prevention: A systematic review and meta-analysis
Authors: He W B , Ko H T K , Curtis A J , Zoungas S , Woods R L , Tonkin A , Neumann J T , Turner S L , Hopper I 
Published: November 2023

Abstract

Background
Statins are well-established for their treatment of cardiovascular disease (CVD) due to their cholesterol-lowering effects and potential anti-inflammatory properties. Although previous systematic reviews demonstrate that statins reduce inflammatory biomarkers in the secondary prevention of CVD, none examine their effects on cardiac and inflammatory biomarkers in a primary prevention setting.

Aims and Methods
We conducted a systematic review and meta-analysis to examine the effects of statins on cardiovascular and inflammatory biomarkers among individuals without established CVD. The biomarkers included are: cardiac troponin, N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), soluble E-selectin (sE-selectin) and endothelin-1 (ET-1). A literature search was performed through Ovid MEDLINE, Embase and CINAHL Plus for randomized controlled trials (RCTs) published up to June 2021.

Results
Overall, 35 RCTs with 26,521 participants were included in our meta-analysis. Data was pooled using random effects models presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Combining 36 effect sizes from 29 RCTs, statin use resulted in a significant reduction in CRP levels (SMD -0.61; 95% CI -0.91, -0.32; P&lt;0.001). This reduction was observed for both hydrophilic (SMD -0.39; 95% CI -0.62, -0.16; P&lt;0.001) and lipophilic statins (SMD -0.65; 95% CI -1.01, -0.29; P&lt;0.001). There were no significant changes in serum concentrations of cardiac troponin, NT-proBNP, TNF-α, IL-6, sVCAM, sICAM, sE-selectin and ET-1.

Conclusions
This meta-analysis demonstrates the effect of statins in reducing serum CRP concentrations in the context of CVD primary prevention, with no significant changes in the other cardiac and inflammatory biomarkers studied. The meta-analysis highlights the need for further high quality, large-scale trials evaluating the effects of statins on cardiac and inflammatory biomarkers in primary prevention.Figure 1.Effect of statins on CRP
Coronary artery disease in cardiac amyloidosis
Authors: Dona C , Rettl R , Binder C , Schrutka L , Dalos D , Camuz Ligios L , Kain R , Loewe C , Hengstenberg C , Badr-Eslam R , Bergler-Klein J , Kastner J , Kammerlander A A , Duca F 
Published: November 2023

Abstract

Background
Cardiac amyloidosis is an important disease causing significant morbidity and mortality. Due to the ageing society as well as better diagnostic tools such as 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy (DPD scan), cardiac amyloidosis has increased in prevalence, however, the coexistence, as well as the differences in presentation with coronary artery disease (CAD), has not yet been discovered.

Purpose
The purpose of the study is to evaluate the prevalence of CAD in patients with cardiac amyloidosis, to assess differences in late gadolinium enhancement (LGE) in cardiac MRI, and to assess differences in symptoms such as dyspnea.

Materials and Methods
We retrospectively assessed all patients with cardiac amyloidosis at our center and screened for an evaluation of coronary artery disease with coronary angiography, coronary CT, or myocardial scintigraphy. In all patients, who underwent cardiac MRI we assessed the pattern of LGE using the cardiac left ventricular segmentation model published by the AHA [1].

Results
295 patients (27% female, 74 ± 11 years) with cardiac amyloidosis (26% AL-amyloidosis, 74% ATTR-amyloidosis) were retrospectively assessed. Of those, 205 (69%) had a CAD evaluation. In 69 patients (34%), significant CAD was present, 10 patients (5%) had undergone CABG and 48 patients (23%) had received a PCI in the past. In patients with CAD, 3 patients (4%) suffered from NYHA IV and 51 patients (74%) were symptomatic with NYHA II or NYHA III. There were no significant differences to patients without CAD (p=0.252).
In 153 patients (75%), cardiac MRI was performed. In 7% of the patients, no LGE was obvious, in 84%, a diffuse circular subendocardial to transmural LGE with basoapical gradient, typical for cardiac amyloidosis, could be observed. In 6% of the cases, a subendocardial pattern typical for post-ischemic changes could be observed; in 56% of the patients, a previous myocardial infarction was known. In the remaining 3%, LGE in the insertion points could be observed.

Conclusion
With 34%, CAD is highly prevalent in patients with cardiac amyloidosis. In 28%, a coronary intervention (surgical or interventional) was performed, making coronary interventions in patients with cardiac amyloidosis a feasible option. Cardiac MRI in patients with concomitant CAD and cardiac amyloidosis often shows the typical diffuse LGE, therefore, visualization of postischemic changes in these patients is difficult. Furthermore, symptoms do not differ between patients with CAD and no CAD.
A specific molecular signature of extra-vesicles (EVs) was associated with cardiometabolic risk profile and atherosclerotic burden in patients with chronic coronary syndrome: a pilot study
Authors: Ragusa R , Rocchiccioli S , Scholte A , Neglia D , Caselli C 
Published: November 2023

Abstract

Background
microRNAs (miRs) are pivotal regulators of mRNA and protein expression. They critically contribute to cardiovascular pathophysiology and circulate in the blood using extra-vesicles (EVs) as delivery carrier. The role of EV-associated miRs in atherosclerotic cardiovascular disease, however, is unclear.

Purpose
The aim of this study was to detect Coronary Artery Disease (CAD)-related miRs carried by EVs in stable patients with Chronic Coronary Syndrome (CCS). In particular we aimed to assess whether a specific miRs signature is associated with the cardiometabolic risk profile and coronary atherosclerotic burden and plaque features, as evaluated by coronary computed tomography angiography (CTA) in these patients.

Methods
miRs with known effects in the cardiovascular system were analysed by real time-PCR in EVs isolated from CCS patients by density gradient centrifugation (n=21). All patients underwent coronary CTA to assess total, calcified, and noncalcified plaque volume (PV). Obstructive CAD was defined as the presence of stenoses &gt;50% in at least one of the main coronary vessels.

Results
All CCS patients (n=21) were statin users and had coronary atherosclerosis documented by coronary CTA. Among the 25 miRs tested, 7 were detected within EVs and 4 of them, miR-145-5p, miR-30e5-p, miR-126-5p, miR-375, were significantly related with cardiometabolic profile, showing an alternative association with glucose and insulin, a positive correlation with HDL-Cholesterol and a negative correlation with triglycerides, BMI and waist circumference. No association was observed with Total-Cholesterol and LDL-Cholesterol (Figure1). These miRs were also not associated with the presence of obstructive CAD, but were significantly related with total, calcified, and noncalcified PVs (Figure1).

Conclusions
In CCS patients, among the 25 miRs studied and out of the 7 EV-associated, only 4 miRs were related with a specific cardiometabolic risk profile, characterized by insulin-resistance, obesity, high triglyceride and low HDL-Cholesterol levels. They were also associated with an increased coronary atherosclerotic burden. These results suggest a potential involvement of specific EV-associated miRs in molecular mechanisms of residual atherosclerotic risk.Figure 1
Abscence of high lipoprotein(a) levels is and independent predictor of acute myocardial infarction without coronary lesions
Authors: Kallmeyer A , Pello Lazaro A M , Blanco Colio L , Acena A , Gonzalez Lorenzo O , Tarin N , Cristobal C , Gutierrez-Landaluce C , Huelmos A , Lumpuy-Castillo J , Lopez Castillo M , Alonso J , Egido J , Lorenzo O , Tunon J 
Published: November 2023

Abstract
Ministry of Science.
The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the probability of developing MINOCA. Moreover, the relationship between MINOCA and the plasma levels of other proatherogenic and proinflammatory molecules such as Interleukin-18 (IL18) and proprotein convertase subtilisin/kexin type 9 has not been studied. We conducted a prospective, multicenter study involving 1042 patients with acute myocardial infarction (AMI). Seventy-six patients had no significant coronary lesions. All patients underwent plasma analysis on admission. MINOCA patients were younger (57 (47–68) vs. 61 (52–72) years; p = 0.010), more frequently female (44.7% vs. 21.0%; p &lt; 0.001), and had lower rates of diabetes and of Lp(a) &gt; 60 mg/dL (9.2% vs. 19.8%; p = 0.037) than those with coronary lesions; moreover, High Density Lipoprotein cholesterol (HDL-c) levels were higher in MINOCA patients. The absence of Lp(a) &gt; 60 mg/dL and of diabetes were independent predictors of MINOCA, as well as female sex, high HDL-c levels, and younger age. IL-18 and PCSK9 levels were not predictors of MINOCA. During a follow-up of 5.23 (2.89, 7.37) years, the independent predictors of the primary outcome (acute ischemic events or death) in the whole sample were Lp(a) &gt; 60 mg/dL, older age, low estimated Glomerular Filtration rate (eGFR), hypertension, previous heart failure (HF), coronary artery bypass graft, use of insulin, and no therapy with acetylsalicylic acid. In conclusion, in AMI patients, the absence of high Lp(a) levels, as well high HDL-c levels, were independent predictors of the inexistence of coronary artery disease. High Lp (a) levels were also an independent predictor of ischemic events or death.
Circulating NETosis markers in NSTEMI and predicting of 1-year cardiac death
Authors: Munteanu M , Popovici M , Ivanov V , Popovici I , Ciobanu L , Popovici I , Cobet V 
Published: November 2023

Abstract

Aim
Evaluation of serum levels of markers having reliable link to NETosis phenomenon in patients with NSTEMI as well as their predictive value on 1-year cardiac death.

Material and methods
The study was undergone in 123 patients with NSTEMI without diabetes mellitus exposed to angioplasty. The admission serum level of 7 markers having specific (myeloperoxidase (MPO), metalloproteinase 8 (MMP8), neutrophil elastase (NE)) or less specific (selectin E (SE), ICAM-1, IL-8 and phospholipase A2 (PhA2)) pathogenic relation to NETosis have been determined using ELISA technic. Control markers have been assayed in 40 healthy persons. Post-infarction cardiac death rate was appreciated during 12 moths, and the inherent prediction value of these markers has been estimated using hazard ratio CI (95%).

Results
The revealed highest incremental variation of markers from control was characteristic for specific markers of NETosis: MYO by 156% (77,6±13,8 vs 30,4±5,5 U/ml), NE by 114% (35,9±6,2 vs 16,8±3,6 ng/ml) and MMP8 by 83% (53,8±9,4 vs 29,5±5,4 ng/ml). The other markers increased significantly, but in a lower range, 49-71%. The 1-year mortality rate reached a level of 18% (22 patients). The predictive value of studied markers according to risk of cardiac death for 1 year was also highest among direct markers of NETosis: MYO, HR 3,16 CI (1,98-5,25, p&lt;0,01), NE, HR 2,73 CI (1,44-4,16, p&lt;0,01) and MMP8 HR 2,38 CI (1,13-3,89, p&lt;0,01).

Conclusion
A markedly increased admission serum level of MYO, NE and MMP8 (83-156%) in patients with NSTEMI justifies the pathogenetic role of NETosis as well as the diagnostical importance of these markers. Likewise, these markers quite highly predict 1-year cardiac death, and therefore could be useful in post-infarction prognosis.
The effect of sodium-glucose co-transporter-2 inhibitors following anterior ST-segment elevation myocardial infarction
Authors: Incesu G , Tokdil H , Tekin A M , Raimoglu U , Mutlu D , Yalman H , Yurtseven E , Durmaz E , Karadag B , Karpuz M H 
Published: November 2023

Abstract

Background
Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been clearly demonstrated to be associated with lower rate of new-onset heart failure(HF) in patients under risk of HF. In addition, due to lower rehospitalisation and better functional status in HF patients, SGLT-2 inhibitors have became the cornerstone of treatment regardless of the diabetes status. New-onset HF is very common in survivors of anterior ST-segment elevation myocardial infarction(STEMI) and requires preventive strategies, however the role of SGLT-2 inhibition in this population is not well established yet.

Purpose
In this study, we aimed to demonstrate the role of the SGLT-2 inhibitors in patients with anterior STEMI.

Methods
We prospectively enrolled patients with diabetes mellitus who had anterior STEMI, which was managed with primary percutaneous coronary intervention. Patients with previous myocardial infarction, heart failure, under SGLT-2 inhibitor treatment and chronic kidney disease were excluded. Patients were divided into two groups according to SGLT-2 inhibitor treatment; group 1 patients treated with empaglifosine or dapaglifosine and group 2 received other classes of diabetes medicine. Comorbidities regarding smoking history (p: 0.871), hypertension (p: 0.064), previous cerebrovascular accident(p: 0,348) and coronary artery disease(p: 0.201) were comparable between groups. Presence of multivessel coronary artery disease (p: 0.259) and left main coronary artery involvement (p: 0.062) were also similar between groups. Glucose level on admission was similar (p: 0.782) between groups, however HBa1C level was significantly higher in group 1(p: &lt;0.001). Left ventricular ejection fraction which was calculated prior to hospital discharge was also similar between groups(p: 0.297). Mean follow-up duration was 12 months and new-onset heart failure was significantly lower in group 1 patients(p:&lt;0.001). In line with the rate of new onset-heart failure, pro-BNP levels at the 12th month visit were lower in group 1 patients (p: 0.042) which was similar during the STEMI hospitalization (p: 0.668). Multivariate analyses demonstrated that the use of SGLT-2 inhibitors independently associated with lower rate of new-onset HF.

Conclusion
Our results indicate that SGLT-2 inhibitors decrease the rate of new-onset heart failure during the follow-up in patients with previous myocardial infarction.Baseline characteristicsUnivariate and multivariate analysis
Abbreviated versus standard dual antiplatelet therapy time after PCI in high bleeding risk patients with acute coronary syndrome - a report from the SWEDEHEART registry
Authors: Haakansson A , Koul S , Omerovic E , Andersson J , Agewall S , James S , Mokhtari A , Van Der Pals J , Wester A , Szummer K , Jernberg T , Erlinge D , Mohammad M A 
Published: November 2023

Abstract

Background
The use of a short duration of dual antiplatelet therapy (DAPT) has become increasingly common in patients with high bleeding risk (HBR). This study aimed to evaluate outcomes for an abbreviated DAPT strategy compared to standard DAPT time strategy for high bleeding risk-patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI).

Methods
A total of 22310 patients from the SWEDEHEART-registry with at least one high bleeding risk criteria who underwent PCI for ACS in Sweden between January 1, 2013, until January 15, 2021, were enrolled. Patients were grouped according to their planned DAPT time at discharge: standard DAPT with 12 months of any P2Y12 inhibitor and aspirin or an abbreviated DAPT duration (&lt;6 months DAPT or 12-month single APT) and matched for intended P2Y12 inhibitor type (clopidogrel or prasugrel/ticagrelor). The primary outcome was net adverse clinical events (NACE) at one year defined as the first occurrence of cardiac mortality or hospitalization due to myocardial infarction, ischemic stroke or clinically significant bleeding. Major adverse cardiovascular events and the individual components of NACE were defined as secondary endpoints.

Results
No significant difference in NACE was observed between the abbreviated compared to standard DAPT time groups, Kaplan-Meier event rate: 12.9% (n = 584) vs 13.1% (n = 594) hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.88-1.11, p=0.83. No differences were observed for MACE (HR 1.08; 95% CI 0.94-1.25) or any of the elements of the primary composite outcome. The results were consistent in all HBR-subgroups.

Conclusion
For patients with a high bleeding risk undergoing PCI due to an ACS, an abbreviated DAPT strategy was associated with comparable rates of NACE and MACE as compared to a standard DAPT time strategy. The results add real-world evidence that abbreviated DAPT-regimes can be a viable treatment option for patients with ACS with a high bleeding risk.
Helicobacter pylori and pro-inflammatory protein biomarkers in myocardial infarction with and without obstructive coronary artery disease
Authors: Warme J , Sundqvist M , Hjort M , Svensson P , Lindahl B , Hofmann R , Tornvall P 
Published: November 2023

Abstract

Introduction
Myocardial infarction (MI) with (MI-CAD) and without (MINOCA) obstructive coronary artery disease affects different populations and may have separate pathophysiological mechanisms with greater inflammatory activity in MINOCA compared to MI-CAD. Helicobacter pylori (Hp) is the most common chronic infection globally. It can cause systemic inflammation and has been associated with cardiovascular disease (CVD). We aimed to investigate whether Hp infection is associated with concentrations of protein biomarkers of inflammation and CVD.

Methods
In a case-control study patients with MINOCA (n=99) in Sweden were included, complemented by subjects with MI-CAD (n=99) and controls (n=100) matched by age and sex. Protein biomarkers were measured with a proximity extension assay in plasma samples collected 3 months after MI. Seroprevalence of Hp and cytotoxin associated gene A (CagA) was determined using ELISA. The associations between protein levels and Hp status were studied with linear regression.

Results
The prevalence of Hp was 20.2%, 19.2% and 16.0% for MINOCA, MI-CAD and controls, respectively (p=0.73). Seven proteins were significantly associated with Hp in an adjusted model: tissue plasminogen activator (tPA), interleukin-6 (IL-6), myeloperoxidase (MPO), TNF-related activation-induced cytokine (TRANCE), pappalysin-1 (PAPPA), soluble urokinase plasminogen activator receptor (suPAR) and P-selectin glycoprotein ligand 1 (PSGL-1).

Conclusion
Hp infection was present in one in five patients with MI, irrespective of the presence of obstructive CAD. Proteins previously associated with MINOCA and MI-CAD were elevated in Hp positive subjects, suggesting that Hp might promote an inflammatory response and contribute to the development of MI with and without CAD.Forest plot of regression coefficients