bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and prediction of periprocedural myocardial infarction in elective PCI: the ALPHEUS-MI sub-study
Authors: Montalescot G , Georges J L , Bellemain-Appaix A , Hauguel-Moreau M , Le Breton H , Saint-Etienne C , Caussin C , Montsegu J , Cayla G , Beygui F , Range G , Motovska Z , Portal J J , Vicaut E , Silvain J 
Published: November 2023

Abstract

Background
PCI-related myocardial infarction (MI) or injury are frequent events that have been shown to be associated with long-term ischemic outcomes and mortality. Determinants of these events with the validated definition of PCI-related myocardial infarction (MI) or injury are not well documented in contemporary elective PCI.

Methods
The ALPHEUS-MI study is a prespecified analysis of the ALPHEUS randomized trial conducted in 49 centers of two European countries which recruited 1910 patients with chronic coronary syndrome undergoing elective PCI. We analyzed the rate and predictors of periprocedural myocardial necrosis using the primary and secondary endpoint of the ALPHEUS trial (3rd and 4th universal definition of MI) and the ARC2/SCAI definitions. Multivariable model including patient’s demographic, angiographic and procedural characteristics were performed for each definition to determine predictors of periprocedural events.
Findings : The primary endpoint of the ALPHEUS trial (type 4a MI or major myocardial injury) occurred in 35.85% of the patients (3rd universal definition of MI); the secondary endpoint of the ALPHEUS trial (type 4a MI and any myocardial injury) occurred in 77.21% of the patients (4th universal definition of MI); significant periprocedural myocardial injury occurred in 3.24% of the patients (ARC2/SCAI definition) and periprocedural MI (ARC2/SCAI definition) in 2.02% of the patients. The rate of events followed a stepwise increase according to the number of high-risk features with all definitions (figure). High risk features were characterized by patients’ characteristics, the complexity of the coronary lesion (anatomy and atheroma burden) and the complexity of the PCI procedure itself. The only common predictor of MI or myocardial injury present with the 4 definitions was the total length of stent implanted (&gt;60mm) ; adjOR 3.23 (2.49-4.18) p&lt;0,001 (type 4a MI/major injury 3rd UDMI ) , adjOR 3.82 (2.51-5.8) p&lt;0,001 (type 4a MI/any injury 4th UDMI) , adjOR 2.2 (1.24-3.91) p=0,007 (myocardial injury ARC2/SCAI) and adjOR 6.0 (3.04-11.9) p&lt;0,001 (MI ARC2/SCAI).

Conclusion
Whatever definition of type 4aMI and myocardial injury, the strongest predictor of myocardial necrosis seems to be the length of stent implanted which reflects both the severity of atheroma burden and the complexity of PCI.
Intravascular ultrasonography guided percuatneous coronary intervention with everolimus-eluting stents or bypass surgery for multivessel coronary artery disease: post-hoc analysis of the BEST study
Authors: Lee J , Kim H , Choi Y , Ahn J M , Kang D Y , Kim M J , Park D W , Park S J 
Published: November 2023

Abstract

Background
Previous studies suggested that intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) improved clinical outcomes compared with coronary angiography (CAG)-guided PCI in complex coronary artery disease.

Objectives
We compared long-term clinical outcomes of IVUS-guided PCI with everolimus-eluting stent and coronary-artery bypass grafting (CABG) in multivessel coronary disease (MVD).

Methods
Among 880 patients with MVD enrolled in the BEST Extended Follow-up study, 333 patients underwent IVUS-guided PCI and 131 patients underwent CAG-guided PCI, which were compared with 401patients underwent CABG. The primary endpoint was the composite of death from any cause, myocardial infarction, or target-vessel revascularization during a median follow-up of 11.8 years (interquartile range, 10.6 to 12.5 years).

Results
During an extended follow-up, primary endpoint occurred in 75 patients (22.8%) in the IVUS-guided PCI group, in 58 patients (44.38%) in the CAG-guided PCI group, and in 95 patients (24.0%) in the CABG group. Compared with the CABG group, the IVUS-guided PCI group had a similar rate of primary endpoint (adjusted hazard ratio [HR], 1.013; 95% confidence interval [CI], 0.747-1.374; P=0.93), whereas the CAG-guided PCI group had a significantly higher risk of clinical events (adjusted HR, 2.231; 95% CI, 1.582-3.145; P&lt;0.001). Similarly, whereas the IVUS-guided PCI group had similar rate (adjusted HR, 0.845; 95% CI, 0.605-1.181; P=0.324), the CAG guided PCI group had the significantly higher rate of the safety composite of death, stroke and myocardial infarction (adjusted HR, 2.016; 95% CI, 1.405-2.895; P&lt;0.001) compared with the CABG group. However, both IVUS- and CAG-guided PCI groups had significantly higher rate of any repeat revascularization than CABG group. Conclusions In patients with MVD, IVUS-guided PCI appeared to be an safe and effective alternative to CABG. This study advocated the routine use of intravascular imaging during PCI for MVD.KM curve of outcomesPrimary and secondary outcome
Effects on re-endothelialisation with Bydureon treatment add on to insulin versus insulin alone, both in combination with metformin in type 2 diabetic subjects: Rebuild study
Authors: Santos-Pardo I , Witt N , Nystrom T 
Published: November 2023

Abstract

Background
Patients with type 2 diabetes (T2D) have a higher risk of in-stent restenosis and stent thrombosis following a percutaneous coronary intervention1. The key mechanism for preventing these events after stenting is a restored and well-functioning neo-endothelium2. Several large, randomized trials have shown cardioprotective effect of Glucagon Like Pepetide-1 receptor (GLP-1R) agonists therapy lowering the risk of major adverse cardiovascular events. In addition, activation of GLP-1R has been suggested to induce several effects on the vasculature3 that may reduce not only the risk of atherosclerosis progression, but even the risk of stent failure following an angioplasty.

Purpose
To evaluate the potential beneficial effect of the GLP-1R agonist Bydureon in the endothelialisation of modern drug-eluting stents (DES) in patients with T2D.

Methods
38 subjects with T2D and coronary artery disease who were eligible for revascularisation with implantation of DES were included and randomized to either treatment with Bydureon (once weekly) over the standard treatment, or to standard treatment alone. After 12 weeks, a new coronary angiography was performed to evaluate the coverage of the DES and the presence of neo-atherosclerosis by optical coherence tomography. The main outcome was the percentage of stent coverage at 12 weeks. Descriptive data is shown as median (percentile 25th- 75th).

Results
The two groups were well balanced regarding baseline clinical characteristics (Table). Neo-intimal coverage could be assessed in all 33 subjects that completed follow-up. DES coverage was 95% (88.7-98.5%) in the Bydureon group and 91.4% (88.8-98.5%) in the Control group (p=0.692). There were no significant differences between groups neither in the thickness of neo-intima (0.2 mm in both groups, p=0.471), nor the maximal in-stent obstruction by neo-intima (15.5% in Bydureon group vs 14.7% in Control group, p= 0.801). Weight decrease was greater in Bydureon group compared to Control group (-7.8 kg vs +0.14 kg, p=0.014), and so was also HbA1c reduction (-11.4 mmol/mol vs -4.7 mmol/mol, p=0.001). No significant differences were detected on the rate of target lesion revascularisation between groups (p=0.224).

Conclusion
Twelve weeks treatment with Bydureon did not lead to a significantly better stent coverage in patients with T2D. No significant differences in the occurrence of neo-atherosclerosis were detected between groups.Table:Baseline clinical characteristicsImage:Diagram of Methods and Results
Impact of repeat revascularization within 5 years on 10-year mortality after percutaneous or surgical revascularization
Authors: Wang R , Lunardi M , Hara H , Gao C , Ono M , Davierwala P , Geuns R J , Kappetein A P , Head S J , Thuijs D J F M , Tao L , Garg S , Onuma Y , Wijns W , Serruys P W 
Published: November 2023

Abstract

Background
The SYNTAX trial demonstrated negative impact of repeat revascularization (RR) on 5-year outcomes following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD). We aimed to investigate the impact of RR within 5 years, on 10-year mortality in patients with 3VD and/or LMCAD after PCI or CABG.

Methods
The SYNTAXES study evaluated the vital status out to 10 years of patients with 3VD and/or LMCAD. Patients were stratified by RR within 5 years and randomized treatment. The association between RR within 5 years and 10-year mortality was assessed.

Results
A total of 330 (220 RR after initial PCI and 110 RR after initial CABG) out of 1800 patients (18.3%) underwent RR within 5 years from initial revascularization. RR occurred more frequently after initial PCI than after initial CABG (25.9% vs 13.7%, p&lt;0.001). Overall, 10-year mortality was comparable between patients undergoing RR and those not (28.2% vs 26.1%, adjusted HR: 1.17, 95% CI: 0.93-1.48,
p=0.187). Among patients requiring RR, those who underwent PCI as initial revascularization had a higher risk of 10-year mortality compared to initial CABG (33.5% vs 17.6%, adjusted HR: 2.09, 95% CI: 1.21-3.61, p=0.008).

Conclusions
In the SYNTAXES study, RR within 5 years had no impact on 10-year all-cause death in the population overall. Among patients requiring any repeat procedures, 10-year mortality was higher after initial treatment with PCI than after CABG. These exploratory findings should be investigated with larger populations in future studies.Graphic Abstract
Association of liver dysfunction with outcomes after percutaneous coronary intervention - a systematic review and meta-analysis
Authors: Caldonazo T , Kirov H , Pompeu Sa M , Tasoudis P , Shanaah A , Haji D , Doenst T 
Published: November 2023

Abstract

Background
Liver dysfunction is currently receiving renewed attention as a major risk factor in patients undergoing cardiac surgery, including surgical treatment of coronary artery disease (CAD). Since percutaneous coronary intervention (PCI) for CAD treatment is much less invasive, the influence of liver dysfunction on outcomes after PCI may not be relevant.

Purpose
To assess the association of liver dysfunction with PCI outcomes.

Methods
We systematically searched three libraries (MEDLINE, Web of Science and The Cochrane Library) selecting all studies including patients with liver dysfunction who underwent PCI. A meta-analysis of studies comparing outcomes in patients with and without liver dysfunction who underwent PCI was performed. Primary outcome was short-term mortality. Secondary outcomes were major adverse cardiovascular events (MACE), bleeding and acute kidney injury. Random-effects model was performed.

Results
Five studies were selected and the data from 10,710,317 patients were included in the final analysis. Included studies were published between 2015 and 2021, all were observational risk-adjusted cohort studies, and two were national databases. In comparison with the absence of liver dysfunction, patients with liver dysfunction were associated with higher short-term mortality (OR, odds ratio: 2.97, 95% CI, confidence interval: 1.23-7.18, p=0.02), higher MACE (OR 1.42, 95%CI 1.08-1.87, p=0.01), and higher bleeding rates (OR 2.23, 95%CI 1.65-3.00, p&lt;0.01). There was no significant difference regarding acute kidney injury (OR 1.20, 95%CI 0.50-2.87, p=0.69).

Conclusions
The analysis suggests that liver dysfunction is a major risk factor in patients undergoing PCI. It is independently associated with higher risk of short-term mortality and also with an increased occurrence of MACE and bleeding, without significantly affecting renal function.
The triglyceride-glucose index might be a better indicator for predicting poor cardiovascular outcomes in chronic coronary syndrome
Authors: Erdogan A , Inan D , Genc O , Yildiz U , Genc D , Demirtola A Y S E I , Cetin I , Guler Y , Tekin A L I F , Bartucu S , Guler A , Karagoz A 
Published: November 2023

Abstract

Background
Abnormal glucose, and lipid metabolism all play major roles in the process of atherogenesis and are thus substantial risk factors for the development of coronary artery disease.

Purpose
We sought to investigate whether the triglyceride-glucose index (TyG) and the Atherogenic Index of Plasma (AIP), surrogates for atherosclerosis, are linked to major adverse cardiovascular events (MACE) in patients with Chronic Coronary Syndrome (CCS).

Methods and Results
Seven hundred ten-five consecutive patients with intermediate risk for CCS who presented to the outpatient clinic between June 2020 and August 2022 were included retrospectively. MACE included non-fatal myocardial infarction, heart failure, cerebrovascular events, non-cardiac mortality, and cardiac mortality. The composite of MACE was determined to be the primary outcome at follow-up after discharge. Secondary outcomes were defined as each individual parameter of MACE. For the primary outcome's time-to-event analysis, the Kaplan-Meier plots, and Cox proportional hazard models were done.The overall population’s median age was 55 years, with males accounting for 58%. The median follow-up time was 17 months. On multivariate cox regression analysis, age, hypertension, Coronary Artery Disease-Reporting and Data System score, and TyG index were found to be independent predictors of the primary outcome. The primary outcome rate was higher in individuals with high TyG than in those with low TyG (18.7% vs 3.8%, p&lt;0.001). Likewise, patients with high TyG had statistically higher rates of cerebrovascular events, heart failure, non-fatal MI, non-cardiac mortality, and cardiac mortality than the latter.

Conclusion
We found that the TyG might predict poor cardiovascular outcomes in CCS patients.Table 1Figure 1
Post-menopause women show increased levels in risk prediction scores with age as dependent variable
Authors: Dannenberg L , Chavez-Talavera O , Kielb J , Glugla S , Shahjerdi K , Saffak S , Weber J , Baensch L , Riek S , Celik A , Neizel-Wittke M , Zeus T , Kelm M , Polzin A 
Published: November 2023

Abstract

Background
Men and women differ in outcome after percutaneous coronary intervention (PCI). However, frequently used scores for ischemic risk prediction in patients with cardiovascular disease do not include sex related factors. In this study, we aimed to analyze sex related differences in risk score prediction in patients after PCI in dependence from age-determined menopause.

Methods
In this mono-center analysis, we compared frequently used risk prediction scores for post PCI patients (GRACE [Global Registry of Acute Coronary Events], PRECISE-DAPT [PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy], NCDR-mortality and PARIS [Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients]-thrombotic score) in male versus female post PCI patients in dependence from menopause (age determined) and age itself. Three-year follow-up was conducted to assess the incidence of MACCE (major adverse cerebro- and cardiovascular events) including all-cause mortality, myocardial infarction and stroke. Receiver operating characteristic (ROC) analysis was conducted to analyze predictive capacity of each score.

Results
1,001 patients post PCI were included (38% chronic coronary syndrome [CCS], 61% acute coronary syndrome [ACS]). Out of these, 765 were male and 306 were female. Women were slightly older (68.1±11.5 vs. 73.3±11.3 years, p&lt;0.0001). Male and female patients did not differ in achieved levels of risk score below the age of 55. In contrast, in the subgroups &gt;55 years, GRACE, PD-DAPT and NCDR Mortality scores were higher in woman compared to men (GRACE – 120.5±27.89 vs. 128.5±29.97, p&lt;0.0001; PD-DAPT – 26.46±13.13 vs. 30.66±12.76, p&lt;0.001; NCDR Mortality – 345.79±18.33 vs. 40.8±20.62, p&lt;0.0001). Interestingly, PARIS thrombotic score was reduced (4.02±2.28 vs. 3.6±2.3, p=0.027). After Propensity score matching for age, GRACE, PD-DAPT and NCDR Mortality did no longer differ whereby PARIS thrombotic was reduced in female patients in this analysis as well. ROC revealed a moderate predictive capacity for MACCE for all scores in this post PCI cohort with a numerically higher predictive capacity for women (GRACEAUC – 0.625 vs. 0.662; PD-DAPTAUC 0.589 vs. 0.660, NCDR-mortalityAUC 0.625 vs. 0.667; PARIS-thromboticAUC 0.594 vs. 0.638).

Conclusion
In this single center analysis of post PCI patients with ACS and CCS, we could reveal that the GRACE, PD-DAPT and NCDR-mortality risk scores show higher values in post-menopause women compared to men whereby the PARIS-thrombotic score was reduced. We revealed age as major driver for this discrepancy. Moreover, women showed a numerically higher predictive accuracy for the occurrence of MACCE in line with the demonstrated worse outcome after PCI in several cohorts.
Synergistic adverse impact of diabetes and chronic kidney disease on cardiovascular mortality in patients underwent percutaneous coronary intervention
Authors: Moriya S , Iwata H , Chikata Y , Funamizu T , Doi S , Endo H , Okai I , Wada H , Naito R , Ogita M , Dohi T , Okazaki S , Miyauchi K , Daida H , Minamino T 
Published: November 2023

Abstract

Background
Diabetes and chronic kidney disease (CKD) are frequently complicated each other. While approximately 40% of patients have diabetes among those with CKD, it is the most major (40-50%) and clinically important complication of diabetic patients which critically effects on their quality of life and outcomes. Moreover, numerous previous evidence has indicated the adverse prognostic impact by each of diabetes and CKD particularly in the secondary prevention of patients with established coronary artery disease (CAD). Nevertheless, to date, limited data is available regarding the synergistic impact of these two major risk factors on outcomes of patients with CAD.

Purpose
We studied the synergistic adverse effects of diabetes and chronic kidney disease on cardiovascular mortality in patients undergoing percutaneous coronary intervention (PCI).

Methods
This study is a part of a single-center prospective registry database of patients underwent PCI, which launched at 1984. A total of 4880 patients who underwent their first PCI (index PCI) at our university hospital between 2000 and 2018 were enrolled for the study. Participants were divided into 4 groups by the presence or absence of CKD and DM: DM−/CKD− (n=2028, 41.6%), DM+/CKD− (n=1411, 28.9%), DM−/CKD+ (n=754, 15.5%), and DM+/CKD+ (n=687, 14.1%). The endpoint was set as cardiovascular-related death (CV death). The median follow-up duration was 5.2 years since PCI procedure.

Results
During follow-up, 288 (5.9%) CV deaths were identified, in which 79.1% had DM or CKD. Unadjusted Kaplan-Meier curves showed patients with DM+/CKD+ had a significantly higher cumulative incidence of CV death compared to those with DM-/CKD- (log-rank p&lt;0.0001) and DM-/CKD+ (p=0.03) (Figure 1). Moreover, multivariate Cox-proportional hazard analysis set DM-/CKD- as a reference and adjusted by age, gender, body mass index, hemoglobin, ejection fraction, acute coronary syndrome, statin and smoking history showed significantly increased risk of having both of diabetes and CKD (Hazard ratio (HR) and 95% confidence interval (CI) of DM and CKD: 3.1,: 1.9-5.1, p&lt;0.0001) than having each of these (HR and 95% CI of DM alone: 1.2, 0.7-2.0, p=0.5, and of CKD alone: 1.8, 1.1-3.0, p=0.02 (Figure 2).

Conclusions
Findings in the present study indicated that CKD is a significant risk for CV death in patients following PCI, while only DM without CKD was not a significant risk factor in this population. Moreover, the risk for CV death was synergistically increased, when a patient had both of DM and CKD, compared to having each of these.Kaplan-Meier curves in CV deathAdjusted Cox hazard model in CV death
Iron deficiency and association with mortality in patients with coronary artery disease
Authors: Corballis N , Merinopoulos I , Gunawardena T , Tsampasian V , Bhalraam U , Fish J , Eccleshall S , Vassiliou V , Reinhold J 
Published: November 2023

Abstract

Background
Iron is essential for a number of metabolic and physiological processes and the role of iron deficiency (ID) as an adverse prognostic indicator in heart failure is well established. The suitability of the international guideline definition for prognosticating adverse events in heart failure has recently been brought into question due to the inclusion of ferritin, given its reduced specificity during intercurrent inflammation. As inflammation plays an active role in coronary disease, and acute coronary syndromes in particular, we sought to further explore whether ID according to the current guideline definition or alternative definitions without reliance on ferritin is a predictor of clinical outcomes in patients with coronary artery disease.

Purpose
The aims are to assess whether a)ID is associated with increased all-cause mortality in patients with coronary artery disease requiring percutaneous coronary intervention (PCI) and b) whether different definitions of ID have a stronger association with mortality in these patients.

Methods
All patients in a UK PCI registry who had full iron studies within thirty days of their index procedure were included. ID was defined according to three different criteria: 1) International guideline criteria (ferritin &lt;100 ng/ml or transferrin saturations (TSATs) &lt;20% if ferritin 100-299 ng/ml), 2) TSATs &lt;20%, or 3) serum iron &lt;13μmol/L. Mortality data was obtained from Hospital Episodes Statistics. Ethical approval was obtained from the Northwest Haydock Research Committee.

Results
Some 390 patients were included in this analysis. The mean age was 72.5 (62-86) and 33.0% were female. 28.7% of patients presented with a STEMI, 39.7% with an acute coronary syndrome and 31.5% had stable angina.
ID according to the serum iron and TSAT definitions were associated with increased all-cause mortality, HR 1.61 (CI 1.07-2.41), p=0.02 and HR 1.64 (CI 1.13-2.37), p=0.009 respectively. However, ID as determined by the international guideline definition was not predictive of increased all-cause mortality, HR 0.99 (CI 0.69-1.42), p=0.97.

Conclusions
Here we show that ID, defined by serum iron and TSATs but not by the current guideline definition of ID, is associated with increased all-cause mortality in patients with coronary artery disease, undergoing PCI. A randomised controlled trial into treating ID in patients with coronary disease is warranted to determine whether intravenous iron replacement is beneficial in this patient group. The current study supports the growing evidence that alternatives to the current guideline definition of ID may be better suited to identify patients with adverse prognosis and who, in turn, may benefit most from intravenous iron replacement therapy.