bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interdisciplinary rendez-vous approach in endovascular stroke treatment a new concept to accelerate mechanical thrombectomy in primary stroke centers
Authors: Braun H , Knez A , Krug N , Auerbach H M , Bodenberger S , Eglseder B , Wunderlich S , Boy S , Zimmer C , Henninger J , Maegerlein C 
Published: November 2023

Abstract

Background/Introduction
Prompt endovascular treatment of patients with stroke due to intracranial Large Vessel Occlusion (LVO) is a major challenge especially in rural areas because neurointerventionalists are usually not available. As a result, treatment is delayed, and clinical outcomes are worse compared with patients primarily treated in comprehensive stroke centers (CSC).

Purpose
To address this problem, we present a new concept in which interdisciplinary, on-site endovascular treatment is performed in a Primary Stroke Center (PSC) by a team of interventional cardiologists and neuroradiologists: the Rendez-Vous approach.

Methods
Twenty-seven patients with LVO who underwent interdisciplinary thrombectomy on-site at the PSC as part of the Rendez-Vous concept were compared with 72 patients who were transferred from a PSCs to the CSC for thrombectomy when diagnosed with LVO in terms of temporal sequences and clinical outcomes. The crucial aspect of the concept is that the patient is not transferred for the intervention but is treated on site and the cardiologist actively starts the intervention while the neurointerventionalist rushes to the site as soon as possible.

Results
Patients treated on-site at the PSC as part of the Rendez-Vous approach were managed as successfully and without an increase in complication rates compared with patients treated secondarily at a CSC (91.7% successful interventions in Rendez-Vous vs. 87.3% in control group, p=0.57). The time from diagnosis of LVO to groin puncture was reduced by 68.3 minutes with the Rendez-Vous concept (p&lt;0.01). Regarding the clinical outcome, a functionally independent status was achieved in 37.0 % in the Rendez-Vous group and in 19.4% in the control group (p=0.012).

Conclusion
Interdisciplinary teamwork between cardiology and interventional neuroradiology in rural PSCs leads to shorter times to successful reperfusion in patients with severe ischemic stroke due to LVO. This has a potentially positive impact on the clinical outcome of stroke patients and should be considered as a possible care concept in similar stroke networks.Rendez-Vous concept in stroke management
Risks of cardiovascular events after acute ischemic stroke and intra-cranial hemorrhage
Authors: Chao T , Lip G Y H , Chen S A 
Published: November 2023

Abstract

Background
The occurrence of acute ischemic stroke and intra-cranial hemorrhage (ICH) would result in severe stress for patients which may trigger cardiovascular (CV) events. In the present study, we aimed to report and compare the risks of CV events of patients who experienced ischemic stroke and ICH. Also, we analyzed the associations between the severities of stroke/ICH and risks of CV events.

Methods
A total of 413,000 and 131,313 patients who experienced acute ischemic stroke and ICH and did not have past history of acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and ventricular arrhythmia (VA) were identified from the Taiwan National Health Insurance Research Database, respectively. Risks of CV events within 90 days after stroke and ICH were analyzed and compared.

Results
There were 2.77% and 1.75% of patients who suffered from CV events after ischemic stroke and ICH, respectively. The risks of AMI (odds ratio [OR] 0.702, 95%CI 0.618-0.798), HF (OR 0.708, 95%CI 0.661-0.759), AF (OR 0.534, 95%CI 0.502-0.569) and any events (OR 0.626, 95%CI 0.598-0.655) were lower for patients with ICH compared to those with ischemic stroke (Figure 1). For patients with acute ICH, the risks of CV events expect for AF significantly increased from mild to severe ICH (Figure 2). For patients with acute ischemic stroke, all the risks of CV events were higher among patients with severe stroke.

Conclusions
When managing patients with acute ischemic stroke and ICH, the risks of acute CV events should also be kept in mind. The impacts of acute CV events on the long-term prognosis of these patients deserve a further study.
Agreement between direct Fick and bolus thermodilution measurements of cardiac output during right heart catheterisation and the impact on haemodynamic classifications
Authors: Hamilton G W , Fletcher L , Harley W , Azzopardi R , Fulcher J , Chan R K , Horrigan M 
Published: November 2023

Abstract

Background/Introduction
When measuring cardiac output (CO) during right heart catheterisation (RHC), both direct Fick (DF) and bolus thermodilution (TD) methods are endorsed by pulmonary hypertension (PH) guidelines (1). Agreement between these techniques in contemporary practice is not well understood, nor are the diagnostic consequences of disagreement.

Purpose
To investigate the real-world agreement between DF and TD techniques for measuring CO during contemporary RHC, and evaluate the impact of disagreement on patients’ haemodynamic classification.

Methods
This was a single-centre study including 182 patients who had CO measured simultaneously by DF and TD methods during RHC. Oxygen consumption (VO2) was measured with an indirect calorimeter. The primary outcome was the agreement between DF and TD derived CO using Bland-Altman analysis. Secondary outcomes included the impact of specific clinical variables on CO agreement, and the frequency of disagreement in determining patients’ haemodynamic classification.

Results
Disagreement between DF and TD measures of CO was noted, with the DF technique tending to overestimate CO relative to the TD measurement (median DF-CO 5.42 L/min [interquartile range (IQR) 3.90 – 7.41] vs median TD-CO 4.10 L/min [IQR 3.47 – 5.10], p&lt;0.001). For CO values between 3-7 L/min, the error between DF and TD measurements ranged from -4.75% to +44.5%, and limits of agreement were between -69.9% and +101% (Figure 1). Disagreement was increased by 19.2% in patients with at least moderate-to-severe tricuspid regurgitation, and by 16.0% in those with irregular heart rhythms (Table1). The agreement between DF and TD derived pulmonary vascular resistance (PVR) was equally poor. Nonetheless, in 86.3% of patients, the techniques agreed in classifying the PVR as abnormally elevated (&gt; 2 Wood Units), with disagreement occurring more frequently in patients with less severe PH.

Conclusions
In this real-world study there was poor agreement between DF and TD derived CO, resulting in more than 10% of patients having discrepant haemodynamic classifications. This data highlight that both methods should be utilised in clinical practice, particularly in borderline cases or when the haemodynamic assessment influences treatment eligibility or operative risk assessment. The two techniques should not be used interchangeably for serial surveillance, and the impact of our findings on invasive assessments of valvular pathologies needs further investigation.
Impact of intravascular ultrasound parameters on revascularization decision in grey zone fractional flow reserve: data from IRIS FFR registry
Authors: Kang D Y , Lee J M , Ahn J M , Park Y S , Choi Y , Lee J H , Kim M J , Park D W , Park S J 
Published: November 2023

Abstract

Background
The optimal revascularization strategy for coronary stenosis with grey-zone fractional flow reserve (FFR) value (0.75-0.80) is still debated. This study investigated the prognostic impact of the lesion characteristics measured by intravascular ultrasound (IVUS) in grey-zone FFR.

Methods
A total of 734 native coronary stenoses with grey-zone FFR in 734 patients from the prospective multicenter IRIS-FFR registry were simultaneously evaluated by IVUS. The primary outcome was a composite of cardiac death, myocardial infarction and target vessel revascularization.

Results
Among the 734 patients, revascularization was deferred for 293 patients and performed for 441. During a median follow-up of 4.4 years, the primary outcome occurred in 31 (10.6%) patients in deferred group and 42 (9.5%) in performed group. With the best cut-off values of 2.62 mm2 (area under curve 0.64) and 75% (area under curve 0.63), respectively, the minimal lumen area (MLA) and plaque burden (PB) at the MLA site were significant predictors of the primary outcome in the deferred group, whereas they were not predictive in the performed group. Revascularization performed group showed lower incidence rate of the primary outcome than deferral group in 348 patients with smaller MLA (&lt;2.62 mm2) and larger PB (&gt;75%) (19.3% vs. 36.8%, hazard ratio 0.58, 95% confidence interval [CI] 0.34-0.91, P=0.017), whereas other patients showed similar incidence rate of primary outcome between two groups (15.7% vs. 19.8%, hazard ratio 0.78, 95% CI 0.47-1.31, P=0.35).

Conclusions
For coronary stenoses with grey-zone FFR and smaller MLA and larger PB measured by IVUS, revascularization was associated with better clinical outcomes than deferral. The incorporation of FFR and IVUS may improve the revascularization decision in native coronary stenoses with grey-zone FFR.
Preliminary results of the feasibility and precision of optical coherence tomography guided and robotic-assisted PCI (Robo-OCT) study
Authors: Rilinger J , Jeuck M , Heidt T , Hartikainen T S , Westermann D , Von Zur Muehlen C 
Published: November 2023

Abstract

Background/Introduction
Optical coherence tomography (OCT) allows high resolution characterisation of coronary lesions as well as optimization of stent implantation and detection of stent-related mechanical problems leading to restenosis. Robotic assisted PCI (R-PCI) additionally enables highly precise stent positioning. Therefore, the combination of OCT with R-PCI might further improve outcome of PCI – based on a highly individualized planning of the PCI procedure, highly precise conduction of the procedure, quality assessment of stent placement, and in parallel protection of the personnel.

Purpose
Analyse the technical feasibility and safety of R-PCI and OCT.

Methods
We report preliminary data of our ongoing feasibility study of combining R-PCI with OCT (DRKS-Nr. DRKS00024995). In this pilot study, first the technical feasibility and safety of a joint application of OCT and R-PCI were investigated. Moreover, R-PCI success and quality were evaluated by post-PCI OCT imaging.

Results
In the eight patients treated so far, a technical success rate of 100% was achieved. However, as the mechanics of the cassettes device drive damage the sensitive OCT catheter, manual insertion of the OCT catheter via the passive drive had to be performed in all cases. Rate of complications (MACE: cardiac death, cerebrovascular event (stroke), documented myocardial infarction, target lesion repeated revascularization (PCI and/or CABG), dissection or occlusion) was 0%.
Post-PCI OCT showed neither major (≥60 degrees of the circumference of the vessel at site of dissection and/or ≥3 mm in length) nor minor (&lt;60 degrees of the circumference of the vessel and &lt; 3 mm in length) edge dissections (both 0%). Furthermore, the rate of untreated reference segments (focal disease with untreated Mean Lumen Area (MLA) &lt; 4.5 mm2 within 5 mm from the proximal and/or distal stent edges) was 0%.

Conclusion
Preliminary results of the Robo-OCT feasibility study showed a high technical success rate of the combination of OCT with robotic assisted PCI without any complications or vessel injuries proven by OCT.
Long-term association of post stent fractional flow reserve with clinical events
Authors: Hwang D , Chung J , Lee J M , Lee H J , Nam C W , Shin E S , Doh J H , Matsuo A , Matsuo H , Chen S L , Kakuta T , Koo B K 
Published: November 2023

Abstract

Background
Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) is associated with procedural factors in the stented segment and residual disease in the non-stented segment. Even the prognostic value of post-PCI FFR has been reported, its long-term clinical relevance has not been thoroughly investigated.

Purpose
We sought to investigate the long-term prognostic value of post-PCI FFR and its relative significance on future events in stented and non-stented segments.

Methods
The International Post-PCI FFR extended registry (NCT04684043) followed the 2,200 patients who underwent PCI and measured post-PCI FFR between June 2011 and May 2018. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (TVMI), and target vessel revascularization (TVR) at 5 years. The secondary outcomes were a composite of cardiac death or TVMI at 5 years.

Results
The median value of post-PCI FFR of target vessels was 0.89 (IQR 0.84-0.93). The optimal cut-off value of post-PCI FFR for predicting TVF was 0.81, and that for predicting cardiac death or TVMI was 0.76, respectively. The cumulative incidence of TVF was significantly higher in the low post-PCI group (20.5%) than in the high post-PCI FFR group (10.3%) (adjusted hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.56-2.86, p&lt;0.001). The cumulative incidence of cardiac death or TVMI was also significantly higher in the low post-PCI FFR group (7.3%) than in the high post-PCI FFR group (3.2%) (adjusted HR 2.34, 95% CI 1.12-4.91, p=0.024). Landmark analysis at 2 years showed that the impact of post-PCI FFR on TVF was consistently found during the first 2 years (adjusted HR of low post-PCI FFR 2.22, 95% CI 1.54-3.21, p&lt;0.001) and thereafter (adjusted HR of low post-PCI FFR 1.96, 95% CI 1.14-3.36, p&lt;0.001). However, the impact of post-PCI FFR on cardiac death or TVMI was more significant after 2 years of follow-up (adjusted HR of low post-PCI FFR 2.01, 95% CI 0.66-6.11, p=0.217 for the first 2 years and adjusted HR of low-post PCI FFR 2.81, 95% CI 1.04-7.60, p=0.042). The cumulative incidence of TVR was 9.5% for 5 years, and 61.0% of TVRs occurred in the stented segment. However, the proportion of TVRs in the non-stented segment increased along with the decrease of post-PCI FFR (35.3% in post-PCI FFR more than 0.90, 34.1% in post-PCI FFR 0.81-0.90, 43.8% in post-PCI FFR 0.71-0.80, and 66.7% in post-PCI FFR 0.70 and less than 0.70, p-for trend&lt;0.001).

Conclusions
The long-term outcome results of the Internation Post-PCI FFR Extended registry showed that the prognostic impact of post-PCI FFR on TVF was consistently found along with the follow-up. However, that of post-PCI FFR on cardiac death or TVMI was more prominent during the late period of follow-up. In addition, clinical event distribution was different according to post-PCI FFR values.
New criteria to identify patients at higher risk for cardiovascular complications after percutaneous coronary intervention
Authors: Brener S J , Spirito A , Sharma A , Cao D , Sartori S , Zhang Z , Nicolas J , Pivato C A , Cohen R , Baber U , Sweeny J , Sharma S K , Dangas G , Kini A , Mehran R 
Published: November 2023

Abstract
A universal definition to identify patients at higher risk of complications after percutaneous coronary intervention (PCI) is lacking. We aimed to validate a recently developed score to identify patients at increased risk of all-cause death after PCI. All consecutive patients from a large PCI registry not presenting with ST-elevation myocardial infarction or cardiogenic shock were included. Each patient was assigned a score obtained by summing the points associated with the following variables: age &gt;80 years (3 points), dialysis (6 points), left ventricular ejection fraction &lt;30% (2 points), and multivessel PCI (2 points). Patients were stratified in 3 groups: low risk (score 0), intermediate risk (score 2 to 3), or high risk (score ≥4). The primary outcome was all-cause death, and the secondary outcomes were major adverse cardiovascular events and major bleeding. Events were assessed at 1 year after PCI. Between January 2014 and December 2019, 12,689 patients underwent PCI. Compared with the 9,884 patients at low risk, those at intermediate and high risk had a fourfold (hazard ratio 3.99, 95% confidence interval 2.95 to 5.38) and ninefold (hazard ratio 9.55, 95% confidence interval 6.89 to 13.2) higher hazard for all-cause death at 1 year, respectively. The score had a good predictive value for all-cause death at 1 year (area under the curve 0.70). The risk of major adverse cardiovascular events and major bleeding increased consistently from the low- to the high-risk group. In conclusion, in patients who underwent PCI for stable ischemic heart disease or non−ST-elevation acute coronary syndrome, a score based on 4 variables well predicted the risk of all-cause death at 1 year.Derivation of risk scoreAll-cause death rate at 1 year
Incidence and determinants of non-radial vascular approach for coronary angiography among heart transplant recipients
Authors: Procopi N , Guedeney P , Zeitouni M , Kerneis M , Barthelemy O , Le Feuvre C , Silvain J , Berman E , Coutance G , Varnous S , Leprince P , Lebreton G , Collet J P , Montalescot G , Helft G 
Published: November 2023

Abstract

Background
Repeated coronary angiograms may be required among heart transplant (HT) recipients to detect coronary allograft vasculopathy (CAV), exposing to higher risk of non-radial vascular approach over time.

Objective
To describe the incidence and determinants of non-radial vascular approach in this specific population in a large HT center.

Methods
Consecutive HT recipients undergoing coronary angiography between October 2020 to November 2022 at our Hospital, the largest French HT center, were included and all previous coronary angiograms performed after heart transplantation were retrospectively reviewed. A radial vascular approach has systematically been the first-line approach for coronary angiography in the last two decades. Coronary angiography is routinely performed one year after heart transplantation and every couple of years thereafter or more frequently in case of CAV progression or clinical indication. Determinants of non-radial vascular approach were assessed using multivariate logistic regression analyses, which included the individual mean number of coronary angiographies per year after heart transplantation to account for disparities in follow-up between the two groups.

Results
A total of 326 patients were included during the period of interest, with a median number of 4 (1-7) coronary angiographies performed over a median duration of 7.0 (1.8-13.1) years (Table 1). A non-radial approach was used in 108 (33.1%) patients, after a median delay from HT of 3.0 (1.0 - 8.4) years (Figure 1). Independent determinants of non-radial approach were female sex (Odds Ratio [OR] 2.18, 95% confidence interval [CI] 1.06 – 4.50), older age at the time of HT (OR 0.98 95%CI 0.96-0.99), post-transplantation dialysis (OR 7.34, 95%CI 2.41 – 22.30) and the development of type 3 CAV according to the International Society Heart and Lung Transplantation (ISHLT) classification (OR 2.01, 95%CI 1.20 – 3.35. Severe complications related to the vascular approach remained rare.

Conclusions
Non-radial vascular approach remains frequent among HT recipients.
In a center of high HT volume and high radial access volume, non-radial vascular approach is used in one out of three HT recipients with multifactorial reasons.
Lipid lowering treatment after percutaneous coronary intervention: data from the large contemporary ZON-HR registry
Authors: Peeters D A M , Woelders E C I , Luijkx J J P , Winkler P J C , Damman P , Remkes W S , Van 'T Hof A W J , Van Geuns R J M 
Published: November 2023

Abstract

Background
Low density lipoprotein-C (LDL-C) reduction in patients who underwent percutaneous coronary intervention (PCI) is recommended by ESC guidelines to prevent ischemic events. This is mainly achieved by secondary prevention with lipid lowering treatment. The ‘’Zuid-Oost Nederland Heart Registry’’ (ZON-HR) is a multicentre prospective registry designed to improve secondary prevention after PCI by a patient-tailored approach.

Purpose
To describe the use of lipid lowering treatment in patients who underwent PCI in the ZON-HR.

Methods
Since November 2020 data from all 4628 patients who underwent PCI were included in four hospitals. Patient characteristics, LDL-C values at baseline and medication at discharge were collected. The association between predefined variables and lipid lowering treatment was assessed with multivariable logistic regression.

Results
LDL-C at baseline was available in 2325 patients. The mean age was 67.8 year and 73.5% was male (table 1). ACS patients had a significantly higher baseline LDL-C value compared with CCS patients (2.81 mmol/l vs 2.45 mmol/l). However, even in CCS patients LDL-C values were &gt;2 mmol/L. There was a different pattern in lipid lowering treatment at discharge after ACS or CCS. Statins were prescribed significantly more frequent in ACS patients, while ezetimibe was prescribed significantly more frequent in CCS patients compared to ACS patients. Mono and combination therapy was prescribed more often in ACS patients compared to CCS patients.
Increasing age and CCS indication for PCI were predictors for not receiving any lipid lowering medication at discharge. Also, patients with a higher LDL-C baseline value had a smaller chance to receive lipid lowering medication at discharge.

Conclusion
LDL-C reduction is the cornerstone of secondary prevention after PCI for CCS and ACS. 8.9% of ACS and 18.2% of CCS patients receive no lipid lowering treatment. Also, patients with scheduled PCI (CCS) had LDL-C values above target. Age and CCS are independent predictors for not receiving lipid lowering treatment. ZON-HR will develop and integrate initiatives to improve lipid lowering secondary prevention.Baseline characteristicsPredictors lipid lowering medication