bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor prognosis of patients with acute coronary syndrome presenting optical coherence tomography-defined calcified nodule at culprit lesions after emergent percutaneous coronary intervention
Authors: Hada M , Kakuta T , Sugiyama T , Usui E , Kimura S , Mizukami T , Yamamoto M , Kondo S , Wakabayashi K , Suwa S , Kobayashi N , Higuma T , Mori H , Yonetsu T , Shinke T 
Published: November 2023

Abstract

Background
Optical coherence tomography (OCT) enables the diagnosis of underlying causes of acute coronary syndrome (ACS). Calcified nodule (CN) is reported to be a rare but important cause of ACS, although its prognostic impact on clinical outcomes after emergent percutaneous coronary intervention (EPCI) remains undetermined. TACTICS registry is an investigator-initiated, prospective, multicenter, observational study to be conducted at 22 hospitals in Japan to clarify the prevalence of underlying causes of ACS defined by OCT (plaque rupture [PR], plaque erosion [PE] and CN) and its impact on clinical outcomes, and assess the feasibility of OCT-guided emergent PCI (UMIN-CTR, ID 000039050).

Purpose
This study aimed to clarify the prevalence of CN at the culprit lesions in ACS patients and its prognostication after EPCI in a large prospective registry.

Methods
We assessed 702 patients enrolled in TACTICS registry who underwent OCT assessment of the culprit lesion during EPCI. Advanced chronic kidney disease (CKD) was defined as those with creatinine clearance &lt;30 ml/min/1.73m2. The prevalence of OCT-defined CN and occurrence of MACE, defined as a composite of cardiovascular death, myocardial infarction, heart failure, or ischemia-driven unplanned revascularization at 1 year were compared between patients with and without advanced CKD.

Result
Patients with advanced CKD was found in 5.4% of a total cohort. The prevalence of CN was 3.0% in patients with non-advanced CKD and 21.1% in those with advanced CKD (p&lt;0.001). In advanced CKD, MACE occurred most frequently in patients with CN (87.5%), followed by plaque rupture (11.8%) and plaque erosion (10.0%) (p&lt;0.001). In Cox hazard analysis, CN was a significant predictor for MACE in advanced CKD (hazard ratio [HR], 12.94 (3.31-50.67), p&lt;0.001). In contrast, CN was not significant predictor for MACE in non-advanced CKD (HR1.931 (0.706-5.281), p=0.200).

Conclusion
CN is significantly more frequently found at the culprit lesions of ACS in advanced CKD patients. CN was associated with poor outcome in advanced CKD patients.
Road map fusion imaging in PCI reduces contrast medium exposure irrespective of investigator's experience level
Authors: Phinicarides R P , Quast C Q , Afzal S A , Veulemans V V , Klein K K , Berisha N B , Leuders P L , Erkens R E , Jung C J , Boenner F B , Kelm M K , Zeus T Z , Polzin A P 
Published: November 2023

Abstract

Background/Introduction
Dynamic Coronary Roadmap (DCR) is a software tool that creates a real-time dynamic coronary artery overlay on the fluoroscopic image. Its efficacy in significantly reducing contrast medium use during percutaneous coronary interventions (PCI) has already been shown.

Purpose
The purpose of this study is to investigate whether the positive effects of DCR persist irrespective of the investigator’s experience level.

Methods
In this sub-analysis of a monocentric, open-label, randomized trial, 130 patients with hemodynamically relevant coronary type A and B lesions were randomized (1:1 ratio) and conducted with or without DCR software. PCI was randomly allocated and performed by an investigator with high (A) or medium (B) experience level.

Results
Overall, the primary endpoint contrast medium use was significantly reduced by both investigators in the +DCR group (Investigator A: –DCR 68.62 +/- 23.86ml vs. +DCR 43.39 +/- 21.91ml; Investigator B: –DCR 70.80 +/- 31.77ml vs. +DCR 29.46 +/- 12.26ml, p &lt; 0.0001). With the software, Investigator B used significantly less contrast medium than Investigator A (p = 0.0468). The DCR software is not accompanied by increased radiation exposure for the patients or the teams. On the contrary, the dose area product was reduced by both investigators but was significantly reduced with DCR in the highly experienced investigator (Investigator A: –DCR 2415.25 +/- 1413.30 cGycm² vs. +DCR 1727.17 +/- 1148.69 cGycm², p = 0.0284). Fluoroscopy time was not different between investigators. Procedural success was 100%. Serious in-hospital adverse events were not observed. One patient of Investigator A suffered from post-procedural acute kidney injury in the –DCR group.

Conclusion(s)
DCR significantly reduces contrast medium use during PCI irrespective of the investigator’s experience level. Efficacy and safety do not differ between investigators’ experience levels. Whether these excellent results can also be translated into more complex lesion settings has to be evaluated in future trials.Operating principle of DCRPrimary and secondary endpoints
Impact of revascularization on non-flow limiting lesions
Authors: Boerhout C K M , Van De Hoef T P , Piek J J 
Published: November 2023

Abstract

Background
Physiology-guided decision-making markedly improves outcomes in patients with coronary artery disease (CAD). The fractional flow reserve (FFR) and the coronary flow reserve (CFR) can be used to estimate the reduction in myocardial blood flow by a stenosis and both were validated against non-invasive modalities to identify ischemia. Nevertheless, discordance between FFR and CFR in stenosis classification occurs in 30-40%. Recent studies showed that patients with non-flow limiting lesions (abnormal FFR, normal CFR) deferred from revascularization had similar outcomes to those vessels that underwent revascularization.
However, the direct impact of revascularization in these vessels remains unclear.

Purpose
We aimed to identify the impact of revascularization in vessels with non-flow limiting lesions (abnormal FFR and normal CFR).

Methods
We selected those patients with non-flow limiting lesions from the global ILIAS Registry, a comprehensive pooled data set of patients whom underwent clinically indicated coronary angiography and complete physiological assessment. The primary outcomes consist of the composite endpoints of MACE and TVF at 5-year follow-up.

Results
A total of N=526 patients were included in the current analysis. Mean age was 64±10 and 74% were men. The mean FFR was 0.79±0.09 and the mean CFR 2.38±1.12. Of these, 53% (N=276) underwent revascularization and (47%) had no revascularization of the target vessel during the index procedure. Both groups had a similarly increased risk for MACE and TVF at 5-years (HR 2.4 [95% CI 1.6 – 3.5] and HR 2.2 [95% CI 1.5 – 3.4] respectively, p&lt;0.005 for both, and p=0.787 for the difference between both).

Conclusions
We found that revascularization did not impact the association between non-flow limiting lesions and MACE or TVF at 5-year follow-up. Although these results should be interpreted with caution, it indicates the need for a more inclusive assessment of coronary hemodynamic when considering revascularization therapy.Figure 1
Clinical outcomes of physiology-guided coronary revascularization in patients undergoing TAVR
Authors: Matsuo Y , Wada T , Nishi T , Kuwabara K , Tanaka A 
Published: November 2023

Abstract

Background
Coronary artery disease frequently coexists with severe aortic valve stenosis (AS). Although an fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in native coronary artery has been shown to be associated with better clinical outcomes as compared with an angiography-guided PCI, it is unknown whether this applies to severe AS patients.

Purpose
The purpose of this study was to compare the outcomes of different revascularization strategies between FFR-guided and angiography-guided PCI in AS patients undergoing transcatheter aortic valve replacement (TAVR).

Methods
In this retrospective analysis, we included 401 patients with severe AS undergoing TAVR who had coexisting coronary artery disease at invasive coronary angiography. A total of 156 patients was considered to have significant coronary artery lesions (&gt;50% of diameter stenosis) due to the visual estimation. Patients were divided into 2 groups: physiology-guided (n=96, PCI performed in case of FFR ≤0.80 or diameter stenosis ≥90%) and angiography-guided PCI (n=60, PCI performed based on angiographic evaluation). Patients were clinically followed up and evaluated for the occurrence of major adverse cardiac and cerebrovascular event (MACCE; defined as a composite of death, non-fatal myocardial infarction, target vessel failure, and cerebrovascular accident) and major bleeding event defined as ≥VARC-3 type 2.

Results
Most lesions (62/96; 65%) in the physiology-guided group had negative results and were deferred. During a median follow-up of 743 [from 400 to 1,186] days, physiology-guided group had a significantly lower rate of MACCE compared with the angiography-guided groups (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.20-0.83; P&lt;0.01). In addition, physiology-guided group showed a lower major bleeding event rate compared with the angiography-guided group (adjusted HR, 0.12; 95% CI, 0.04-0.40; P&lt;0.01).

Conclusion
Physiology-guided PCI resulted in better clinical outcomes and lower bleeding events than angiography-guided PCI in patients with AS undergoing TAVR.
Incremental prognostic value of metabolic dysfunction-associated fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease
Authors: Nishihara T , Miyoshi T , Nakashima M , Miki T , Osawa K , Yoshida M , Toda H , Nakamura K , Ito H 
Published: November 2023

Abstract

Background
Fatty liver caused by nutritional metabolic disorders regardless of other chronic liver diseases has been proposed as a new liver disease concept, metabolic dysfunction-associated fatty liver disease (MAFLD). With the alteration from non-alcoholic fatty liver disease to MAFLD, MAFLD can be recognized as higher CVD risk. However, the association of MAFLD with adverse coronary CT angiography (CCTA) findings, such as the presence of obstructive and high-risk plaque, and cardiovascular events has not been fully elucidated.

Purpose
This study was aimed to investigate additional risk stratification benefits of MAFLD diagnosed by hepatic steatosis assessed during CCTA in patients with suspected coronary artery disease (CAD).

Methods
A total of 2289 patients without a history of CAD who underwent CCTA in our institute from August 2011 and December 2016 were enrolled. Hepatic steatosis, defined on CT as a hepatic-to-spleen attenuation ratio of &lt;1.0, was examined just before the evaluation of CCTA. Adverse CCTA findings were defined as obstructive and/or high-risk plaque. The major adverse cardiovascular events (MACE) were composite coronary events including cardiovascular death, acute coronary syndrome, and late coronary revascularization. The incremental predictive value of MAFLD was evaluated using the global chi-square values and C-statistic.

Results
Among 2289 patients (60% men, mean age 68 years), MAFLD was identified in 382 (17%) patients. The presence of adverse CCTA findings in patients with MAFLD was significantly greater than that in patients without MAFLD (40% and 35%, p=0.039). During a median follow-up of 4.4 years, 103 (4.4%) MACE were observed. In the multivariate Cox regression analysis, MAFLD was significantly associated with MACE in a model included traditional risk factors and adverse CCTA findings (HR 1.73, 95%CI 1.10–2.72, P = 0.017). The Kaplan–Meier analysis showed that patients with both MAFLD and adverse CCTA findings had highest event rates compared with patients without MAFLD or adverse CTA findings (log rank test, p=0.004). By adding MAFLD to a prediction model including adverse CCTA findings, the global chi-square values and C-statistic significantly increased from 80.6 to 86.2 (P = 0.017) and 0.72 to 0.74 (P = 0.044), respectively.

Conclusions
MAFLD concurrently assessed during CCTA enables more accurate detection of patients at higher risk of MACE In patients with suspected stable CAD.
Impact of transfusion on platelet aggregation and biomarkers in myocardial infarction patients with anemia: an ancillary study of the randomized REALITY trial
Authors: Silvain J , Lattuca B , Puymirat E , Ducrocq G , Dillinger J G , Lhermusier T , Cachanado M , Drouet E , Abergel H , Danchin N , Montalescot G , Simon T , Steg P G 
Published: November 2023

Abstract

Importance
Higher rates of thrombotic events have been reported in patients with myocardial infarction (MI) requiring blood transfusion. The impact of transfusion strategies on biomarkers of thrombosis and inflammation is still unknown.

Objective
Compare the impact of a liberal vs a restrictive transfusion strategy in anemic MI patients on P2Y12 mediated platelet reactivity and biomarkers of thrombosis and inflammation.
Design and Setting: Prespecified ancillary study of the multicentric randomized REALITY trial, performed in 6 French centers between February 2018 and September 2019 (Figure). Patients randomized to a liberal (hemoglobin ≤10g/dL) or a restrictive (hemoglobin ≤8g/dL) transfusion strategy had platelet reactivity measured at baseline and after randomization.
Participants: One hundred anemic acute MI patients from the REALITY trial (666 randomized patients).
Measurements: Measurements of platelet reactivity included a centralized blinded VASP-PRI assay and PRU measured locally using encrypted VerifyNow assay. Biomarkers of thrombosis (P-selectin, PAI-1, vWF) and inflammation (TNF-α) were also measured. The primary endpoint was the change in the VASP-PRI (difference from baseline and post randomization) between the two randomized groups.

Results
Among 100 patients included (n=50 in each group), the most frequent P2Y12 inhibitors used was clopidogrel (48%) while 16% of the patients did not receive any P2Y12 inhibitors. Transfused patients received on average 2.4±1.6 units of packed red blood cells. We found no differences between groups in change in P2Y12-mediated platelet aggregation before and after randomization, measured either by the VASP PRI (difference 4.3%; 95% CI (-5.4% to 14.1%)) or by the PRU (difference 23.5; 95% CI (-20.8 to 67.8)). Similar results were found in transfused patients (n=71) regardless of the randomized group, VASP PRI (difference 1.6%; 95% CI (-6.7% to 10.0%)) or PRU (difference -17.6; 95% CI (-41.0 to 5.7)). We did not find an impact of transfusion strategy or transfusion itself in the levels of P-selectin, PAI-1, vWF and TNF-α.

Conclusion and Relevance
A liberal or a restrictive transfusion strategy does not impact platelet reactivity and biomarkers in MI patients with anemia, supporting the lack of clinically relevant difference in thrombotic risk between both strategies.
Vitamin D status and 12-year mortality risk after myocardial infarction
Authors: Cruijsen E , Van Pijkeren C S , Evers I , Visseren F L J , Geleijnse J M 
Published: November 2023

Abstract

Introduction
Vitamin D deficiency has been associated with an increased risk of cardiovascular disease (CVD) mortality in healthy populations. Whether this association is also present in patients with established CVD is not yet clear.

Purpose
We examined the association of serum 25-hydroxyvitamin D [25(OH)D] as an indicator of vitamin D status with 12-year risk of CVD and all-cause mortality in post-myocardial infarction (MI) patients.

Methods
A prospective analysis was carried out in 4,479 Dutch patients from the Alpha Omega Cohort (aged 60-80 y) who had an MI ≤10 y prior to study enrolment. Non-fasting venous blood was sampled at baseline (2002-2006) for the assessment of 25(OH)D using LC-MS/MS. Patients were followed for cause-specific mortality through December 2018. Hazard ratios (HRs) for CVD and all-cause mortality were obtained in sex-specific 25(OH)D tertiles using Cox regression models, adjusted for age, education, physical activity, smoking status, alcohol intake, adherence to dietary guidelines (i.e. 2015 Dutch Healthy Diet index [DHD15]), prevalent diabetes and kidney function (eGFR). Restricted cubic splines (RCS) analysis was performed for continuous associations, using median 25(OH)D as the reference.

Results
Patients were 69.0 ± 5.6 y old, 78% was male, 17% were current smokers, 18% had diabetes and 8% used vitamin-D containing supplements. A total of 2,091 deaths occurred during a median follow-up period of 12.4 y (49,529 person-years), including 924 from CVD as a primary or contributing cause. Median 25(OH)D was 21.3 ng/mL, and tertile cut-offs were 18.3 and 26.2 ng/mL for males and 15.2 and 22.0 ng/mL for females. Of the cohort, 44% were vitamin D deficient (&lt;20 ng/mL). Lower risks of CVD mortality were observed in the mid tertile (HR: 0.76, 95%CI:0.65-0.88) and upper tertile (HR: 0.67, 95%CI:0.57-0.79) of 25(OH)D, compared to the lower tertile. RCS showed a roughly linear association (P-non-linearity = 0.08), with a 11% lower risk of CVD mortality per 5 ng/mL-increment in 25(OH)D (HR: 0.89, 95%CI: 0.86-0.93). Inverse associations were more pronounced in patients with a higher calcium intake (&gt;845 g/d; 0.87, 95%CI:0.96-0.98; per 5 ng/mL) and in patients who were more physically active (HR: 0.88, 95%CI: 0.83-0.93; per 5 ng/mL). Exclusion of 378 vitamin D supplement users did not materially change the associations. For all-cause mortality, multivariable HRs were 0.74 (95%CI: 0.67-0.82) in the mid tertile, and 0.65 (95%CI: 0.58-0.73) in the upper tertile, compared to the lower tertile.

Conclusion
A low vitamin D serum concentration is related to a higher risk of recurrent CVD and all-cause mortality in patients with coronary artery disease. Causality remains to be determined preferably in a clinical trial to evaluate the effect of oral suppletion of vitamin D on recurrent CVD and mortality risk in these patients.
Treatment of microvascular angina with the coronary sinus reducer: a first experience
Authors: Gnan E , Cioffi G M , Bossard M , Madanchi M , Majcen I , Zhi Y , Gjergjizi V , Seiler T , Cuculi F , Attinger A 
Published: November 2023

Abstract
The Coronary Sinus Reducer (CSR) is an hourglass-shaped device approved for the treatment of refractory angina. Its percutaneous implantation in the coronary sinus leads to a retrograde increase in venous pressure, which is thought to improve capillary recruitment and perfusion to the ischemic myocardium. No data is however available on the use of the CSR to treat microvascular angina, an increasingly recognized but still poorly understood condition. In this preliminary study, we evaluated the efficacy of the CSR in a small cohort of patients with non-obstructive disease.
We screened consecutive patients from the prospective COMPLEX registry that received a CSR for refractory angina between June 2018 and November 2022. Inclusion criteria were the absence of obstructive coronary artery disease (&lt;50% narrowing in all coronary arteries, or a negative intracoronary fractional flow reserve test) and no prior history of revascularization. Endpoints were angina and dyspnea symptoms, evaluated with the Canadian Cardiovascular Society (CCS) and the New York Hearth Association (NYHA) scores respectively, procedural success rate, and major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, cardiovascular death, acute coronary syndromes (ACS) and heart failure (HF) hospitalizations.
We ultimately enrolled 8 patients; 6 (75%) were females and mean age was 67.8±9.9 years. Their baseline characteristics are further depicted in table 1. Microvascular dysfunction was invasively confirmed in 5 (62.5%) patients; mean index of microvascular resistance (IMR) was 32.8±15.7 and mean coronary flow reserve (CFR) was 1.7±0.7. In one patient, reduced global CFR (1.4) was evident on cardiac magnetic resonance examination. At baseline, mean CCS class was 2.9±0.6, NYHA class 2±0.9, and number of antianginal drugs 2.6±1.6. Procedural success was 100%, with only one patient experiencing a procedure-related complication (sternocleidomastoid muscle hematoma requiring no intervention). At a median follow-up of 647.5 days (IQR 132-732), mean CCS class was 1.5±0.8, NYHA class 1.9±0.9 and number of antianginal drugs 1.9±1.1. All patients improved by ≥1 CCS class and 3 (37.5%) by ≥2 CCS classes. No MACE was observed.
To the best of our knowledge, we present the first report of CSR implantation for the treatment of microvascular angina. Our positive results are particularly promising given the paucity of treatment options currently available for the condition, but larger studies are needed to confirm these findings.table 1figure 1
Optimal antiplatelet therapy for patients after antiplatelet therapy-induced gastrointestinal bleeding: when to resume?
Authors: Huang R , Xiao B , Ye Z S , Cheng R , Han Z , Wu S S , Wang G X , Li Z Y , Liang T , Zhang S T 
Published: November 2023

Abstract

Background
Adjusting antiplatelet strategies after antiplatelet-associated gastrointestinal bleeding (GIB) is a complex clinical challenge. there is no uniform answer to the question of when it is safe to restart antiplatelet therapy after GIB.

Objective
To assess the risk of outcomes at different times of resumption of antiplatelet therapy and explored the optimal time to resume therapy.

Methods
The study analyzed consecutive patients with antiplatelet-associated GIB from our hospital information system between October 2019 and June 2022. The primary outcomes were recurrent bleeding, major adverse cardiovascular and cerebrovascular events (MACE), and all-cause death. Multivariate-adjusted Cox proportional hazards models were used to evaluate the risks of these outcomes. The receiver operating characteristic curve was used to find the optimal time to resume treatment.

Results
Of the 617 patients with GIB after antiplatelet therapy successfully followed up, the median follow-up was 246 (interquartile range: 120–466) days, The mean age was 68.38 ± 10.68 years, 70.99% were male, and the age-adjusted Charlson comorbidity index score was 7.16 ± 1.96 points. Most patients (87.36%) interrupted therapy after GIB and 45.22% resumed within 90 days, of which 35.13% resumed within 7 days and 64.87% resumed after 7 days. Resumption therapy had a low risk of recurrent bleeding (uninterrupted as a reference: HR 0.32, 95% CI 0.15–0.67, p = 0.003), MACE (no resumption as a reference: HR 0.66, 95% CI 0.45–0.98, p = 0.037), and all-cause death (no resumption as a reference: HR 0.18, 95% CI 0.08–0.40, p＜0.001). And resuming therapy within 7 days had a lower risk of MACE (HR 0.18, 95% CI 0.08–0.44, p＜0.001) than after 7 days without a significantly higher risk of re-bleeding. The optimal time point for resuming therapy in this study was 9 days.

Conclusion
Resuming antiplatelet therapy after GIB provides a higher net clinical benefit. Early resumption of antiplatelet therapy (&lt;7 days) significantly reduces the risk of MACE events. Although the risk of re-bleeding is increased, it is not statistically significant and has good clinical benefit. After analyzing the composite endpoint events, 9 days might be the optimal time to resume therapy for the antiplatelet population, especially for the single antiplatelet population. Our study provides new clinical data for the antiplatelet population after GIB to help physicians make better clinical decisions.