bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rotational atherectomy: assessment of the effectiveness and safety
Authors: Borges-Rosa J , Grine M , Oliveira-Santos M , Delgado-Silva J , Matos V , Costa M , Goncalves L 
Published: October 2022

Abstract

Background
Rotational atherectomy (RA) enables percutaneous coronary intervention (PCI) for complex and calcified coronary lesions, despite limited data regarding long-term outcomes.

Purpose
We aimed to characterize success rate, safety, and long-term outcomes with this technique in a single-centre with over a decade of experience.

Methods
We retrospectively analysed all cases of RA performed in a single-centre between January 2009 and December 2020. Angiographic success was defined as the presence of less than 30% residual stenosis and grade 3 TIMI (thrombolysis in myocardial infarction) flow. Complications included coronary perforation or dissection, burr entrapment, wire fracture, slow flow/no-reflow, side branch occlusion, peri-procedural myocardial infarction (MI), or death. Long-term major adverse cardiovascular (CV) events (MACE) included CV and all-cause death, MI, and target vessel revascularization.

Results
Of the total of 14,527 PCI performed, 410 procedures (2.8%) included RA. Most patients were male (74.0%) with mean age of 72.3±9.3 years. There was high prevalence of hypertension (85.65%) and dyslipidaemia (74.2%) which increased significantly over time (p trend=0.008 and p trend&lt;0.001, respectively). One-third presented with acute coronary syndrome, most patients had multivessel disease (38.4% two-vessel, 32.7% three-vessel), and 12.2% had significant left main disease. Over time there was an increase in disease complexity, reflected by the proportion of type B2/C lesions (p trend =0.003) and median SYNTAX score (p trend =0.003). The utilization of transradial access increased over time (p trend =0.003) and maximum burr size was ≤1.50 mm in most cases (88.0%), with smaller sizes over time. Overall angiographic success rate was 96.6% without significant variation over time while complications (9.0%) showed a temporal decline (p trend=0.029) (Figure 1). Most frequent complications were coronary dissection (n=17) and burr entrapment (n=6). After a median follow-up of 40 (16–76) months, MACE occurred in 27.7% of patients, mainly due to CV death. At one year of follow-up, MACE, all-cause mortality and target vessel revascularization occurred in 12.1%, 6.4%, and 5.6%, respectively, without variation over time.

Conclusions
RA is an effective and safe technique, with a declining rate of peri-procedural complications along with technical developments. The rate of long-term events is concordant with the CV risk profile and coronary lesion complexity.

Funding Acknowledgement
Type of funding sources: None.
Pathological analysis of struts coverage after second- and third-generation drug-eluting stents implantation for duration of dual anti-platelets therapy; an autopsy study
Authors: Aihara K , Torii S , Nakamura N , Nakazawa G , Ikari Y 
Published: October 2022

Abstract

Background
Strut coverage of drug-eluting stents (DES) is one of the important factors for the duration of dual anti-platelets therapy (DAPT) after percutaneous coronary intervention. Several studies have reported percent coverage of struts assessed by optical coherence tomography (OCT), however, the timing of endothelial coverage of the latest second- and third-generation DES has not been revealed histologically.

Methods and results
From CVHills stent autopsy registry of 171 stented lesions, a total of 56 lesions from 39 autopsy cases with less than 370 days after second- and/or third-generation DES implantation was evaluated histologically. The lesions were stratified by duration: 1–30 days (n=39), 31–60 days (n=4), 61–90 days (n=5), 91–180 days (n=2), and 181–370 days (n=6), and percent coverage of struts, which was defined as neointimal coverage overlying with endothelial cells, was evaluated for each lesion. In addition, difference of coverage within 90 days after implantation between second-generation DES with circumferentially coated polymer and third-generation DES with abluminally coated polymer was also evaluated.
Percent strut coverage increased with time [1–30 days vs. 31–60 days vs. 61–90 days vs. 91–180 days vs. 181–370 days: median (interquartile range) 0.0% (0.0–0.3), 6.3% (1.0–11.7), 16.7% (8.0–32.6), 64.2% (55.6–72.9), and 86.5% (63.5–92.5), respectively, p&lt;0.0001]. When the coverage at the earlier time point was compared between second- and third-generation DES, prevalence of coverage with &gt;25% per section was higher in third-generation DES and the difference was more obvious in 61–90 days after stent implantation (0.0 vs. 1.0%, p=0.15 in 1–30 days, 7.7 vs. 14.3%, p=0.65 in 31–60 days, and 10.0 vs. 36.3%, p=0.04 in 61–90 days).

Conclusions
The current pathological analysis has demonstrated that the process of endothelial strut coverage in second- and third-generation DES proceeds over time, however, the speed was slower than reported in the previous studies evaluated with OCT. Furthermore, endothelial strut coverage of third-generation DES was faster than that of second-generation DES, suggesting a positive roll of abluminal coating on healthy endothelial coverage and safety de-escalation of DAPT at earlier timepoint.

Funding Acknowledgement
Type of funding sources: None.
Microscopic evaluation of mechanical burr degradation mechanisms after rotational atherectomy
Authors: Zimoch W J , Gronostajski Z , Kaszuba M , Reczuch K 
Published: October 2022

Abstract

Background
Rotational atherectomy is a highly effective technique to facilitate percutaneous intervention on highly calcified coronary lesions. In some cases, despite numerous passages of the burr, successful crossing of the lesion is impossible. Empirical evidence shows that burr replacement is usually successful, therefore suggesting possible mechanical wear of the tool, however this hypothesis was never tested.

Aims
The aim of this study was to asses the possible mechanisms of mechanical burr degradation after rotational atherectomy in scanning electron microscope.

Methods
Burrs after the procedure were cleaned and examined in the scanning electron microscope. In order to facilitate the quantification of possible changes burrs were divided into 7 areas in which the analysis was carried out separately according to preestablished protocol. There were several methods applied to determine the degree of tool wear. The first one was to count the number of pull-outs of the diamond coating. Secondly we used image analysis to determine the dark phase share in the particular areas, which corresponds to the amount of the diamond phase. Finally we compared new burrs with used ones to asses weather any signs of mechanical wear of the tool were visible. Examples of burr division and applied methods are presented in Figure 1.

Results
We included 13 burrs into our analysis, 2 new ones and 11 that were used for various amount of time during the procedure (24 to 540 seconds, mean 132 seconds). Except for one area there were no differences between new and used burrs in regard of studied parameters. Results are presented in Table 1.

Conclusions
Our study showed no signs of mechanical wear of rotablation burrs during the procedure. Further studies are needed to evaluate other possible causes of burr's loss of grinding properties such as covering by biological particles etc.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Wrocław Medical University
Shockwave intravascular lithotripsy (IVL) for calcified coronary lesions; a real world multicentre European study with long term follow up
Authors: Raja W , Testa L , Popolo Rubbio A , Cortese B , Wassef N , Raju P , Sharma V , Choudhury A , Hailan A , Lelasi A , Mastrangelo A , Bartorelli A , Basavarajaiah S 
Published: October 2022

Abstract

Background
The presence of calcium in atherosclerotic plaques is a challenge for successful angioplasty and is an independent risk factor for restenosis and stent thrombosis. Despite conventional tools (non-compliant, scoring and cutting balloons and rotational atherectomy), cracking calcium can still be challenging and incomplete. Intra-vascular lithotripsy (IVL) has shown promising results, although long-term data on safety and efficacy from real-world is lacking.

Purpose
This study was undertaken to report long-term outcomes following use of IVL from a European multi-centre experience.

Methods
This was a multicentre, retrospective observational study in which we enrolled all patients treated with shockwave lithotripsy from November 2018 to June 2021. Procedural success, complications and in hospital events were evaluated. The clinical outcomes during follow-up included cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularisation (TLR), and major adverse cardiac event (MACE) (composite of cardiac death, TVMI, and TVR).

Result
A total of 272 patients were treated with IVL, with a mean age of 72 9.1 years and 78.5% (n=216) were male. Forty percent (n=110) were diabetic while 16% (n=45) had chronic kidney disease. Acute coronary syndrome was the presentation in 36% (n=99) while 51% (n=141) had stable angina. De novo lesions accounted for 78% (n=215) of the cases and the remainder were in-stent restenosis (21%; n=58). The LAD was the commonest artery treated 50% (n=139) followed by RCA 24% (n=68). Intracoronary imaging was performed in 33% of cases. Upfront IVL strategy was adopted in 37% (n=101) while 63% (n=171) were bail out procedures due to inadequate pre dilatation. Adjuvant rotational atherectomy was used on 31 (11.4%) cases. Procedural success was achieved in 96% (260) cases with major complications in 8 cases (perforation requiring covered stent in 3 patients) but there was no in-hospital mortality. Clinical outcomes over the median follow up of 641 days are shown in the table.

Conclusion
This is the largest multicentre registry with long term follow up. It has demonstrated that IVL appears to be safe with high success rates, low rates of complication and no in-hospital mortality. The long-term follow-up show promising results with low rates of hard-endpoints and revascularization rates.

Funding Acknowledgement
Type of funding sources: None.
CT-FFR in predicting future cardiovascular events
Authors: Smolka S , Fava A , Moshage M , Marwan M , Desai M Y , Achenbach S 
Published: October 2022

Abstract

Background
Computational fluid dynamics offer a non-invasive way for functional assessment of coronary stenosis in CT-FFR. Currently, minimal FFR thresholds used for determining ischemia were established in invasive coronary angiography. It remains unknown whether minimal absolute CT-FFR values are the most adequate tool for predicting future cardiovascular events.

Methods
This analysis enrolled 605 of 767 consecutive patients with suspected CAD undergoing CCTA from 2005 to 2007. Of the 161 (21%) patients excluded, image artifacts were the most common cause (97), followed by software error (43) and chronic total occlusion in (15). CT-FFR was measured using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany) by an experienced observer. CT-FFR values were measured at the proximal and distal end of each coronary segment and the maximum drop in CT-FFR (ΔFFR) over one segment recorded, respectively. Follow up data included major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction, cardiovascular death) and revascularization (PCI or CABG).

Results
This study included 605 patients (60±11 years, 61.2% men) with minimal CT-FFR 0.81±0.14. Mean ΔFFR was 0.13±0.11. MACE occurred in 24 (4.0%) cases, revascularization in 66 (10.9%) during a median follow up of 2823 days (7–8 years). The area under the Receiver operator characteristic (ROC) curve was 0.887 for revascularization during follow up and 0.608 for MACE during follow up. AUC for the combined end point of MACE and revascularization was 0.806.

Conclusion
Maximum drop in CT-FFR (ΔFFR) is a good predictor for future revascularization but less useful in predicting MACE. This underlines the current use of CT-FFR in guiding treatment decisions.

Funding Acknowledgement
Type of funding sources: None.
Predictors of no-reflow in patients with myocardial infarction and ST-segment elevation treated with primary angioplasty
Authors: Cordero A , Escribano D , Monteagudo M , Zuazola P , Frutos A , Bertomeu-Gonzalez V 
Published: October 2022

Abstract

Introduction
The no-reflow phenomenon is a serious complication of coronary intervention, especially in primary angioplasty and effective preventive measures are unknown.

Methods
Retrospective study of all patients treated by primary angioplasty in a single center through 4 years. We define no-reflow as the absence of flow immediately after stent angioplasty. The variables associated with this phenomenon were analyzed using binary logistic regression. The delay to primary angioplasty was calculated as the sum of the time to the first medical contact, activation, transfer until arterial puncture.

Results
We included 1453 patients, mean age 64.1 years, 21% women, 16.1% Killip &gt;1. The mean delay to primary angioplasty was 180 minutes (interquartile range 125–323). No-reflow was recorded in 81 (5.57%) patients and these patients had a higher mean age (69.37±12.51 vs. 63.76±13.52; p&lt;0.001), higher delay to primary angioplasty (770.93±2056.91 vs. 348.80±749.73; p&lt;0.001), presentation with Killip grade &gt;1 (29.0% 15.36%; p=0.002), in addition to lower systolic blood pressure (121.18±28.63 vs. 113.37±28.22; p=0.021). Regarding coronary angiography, patients who developed no-reflow presented more frequently TIMI-0 (88.89% vs. 70.32%; p&lt;0.001) and a tendency to being the left anterior descending the culprit vessel (46.91% vs. 36.88, p=0.07). In 59.3% of the patients who presented no-reflow, a final TIMI 3 was achieved, with the measurements carried out, compared to (94.9%) of the patients who did not have no-reflow (p&lt;0.001).
Multivariate analysis identified the following variables associated with no-reflow: age (OR: 1.03 95% CI 1.01–1.05; p=0.008), delay to primary angioplasty &gt;120 min (OR: 2.70, 95% CI 1.21–6.00; p=0.015), initial TIMI-0 (OR: 3.22, 95% CI 1.57–6.58; p=0.001). In fact, patients aged &gt;40 had a very low incidence of no-reflow (1.72%), regardless of delay to primary angioplasty; however, in patients &gt;70 years of age, the incidence was much higher (figure)
Hospital mortality was 9.25% (125 patients) and was almost 4 times higher in patients who presented no-reflow (23.68% vs. 8.39%; p&lt;0.001). Adjusted for age, sex, delay to primary angioplasty diabetes and final TIMI flow, the no-reflow phenomenon was associated with higher hospital mortality (OR: 2.34 95% CI 1.02 4.25; p=0.030)

Conclusions
The no-reflow phenomenon has a low incidence but high mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty. Age, delay to primary angioplasty and initial TIMI 0 flow are the main predictors of no-reflow.

Funding Acknowledgement
Type of funding sources: None.
Impact of body mass index on outcomes in patients undergoing percutaneous coronary intervention for in-stent restenosis
Authors: Jones D , Sartori S , Cao D , Nicolas J , Spirito A , Beerkens F , Edens M , Synder C , Dangas G , Mehran R 
Published: October 2022

Abstract

Background
Recent advances in drug eluting stents (DES) design have significantly decreased the rates of in-stent restenosis (ISR). Nonetheless, ISR remains a major problem, affecting 5–10% of patients undergoing percutaneous coronary intervention (PCI). Furthermore, PCI for ISR is often a poor prognostic factor for outcomes after the procedure. Historically, obese patients tended to have better outcomes when undergoing PCI, however it is unclear if this trend continues for the same population undergoing PCI for ISR.

Purpose
Investigate the outcomes of patients undergoing PCI for ISR in the overweight and normal weight population.

Methods
All patients undergoing PCI with DES implantation at a tertiary care center from January 2012 to December 2019 were included. Normal weight was defined as a body mass index (BMI) greater than or equal to 18.5 kg/m2 and less than 25 kg/m2, while overweight was defined as a BMI greater than or equal to 25 kg/m2. Patients with BMI &lt;18.5 kg/m2, underwent PCI for acute myocardial infarction (MI), or received a bare metal stent (BMS) were excluded. The primary outcome was major events (MACE), a composite of all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR) up to one year after PCI. Secondary outcomes included individual components of the primary endpoint.

Results
Out of 16,234 patients with available data on BMI, 12,444 (76.7%) were overweight and 3,790 (23.3%) were normal weight. Among overweight patients, 2,879 (23.1%) underwent PCI for ISR versus 815 (21.5%) of normal weight patients. Regardless of BMI status, patients undergoing PCI for ISR had higher rates of co-morbidities such as hypertension, hyperlipidemia, and diabetes mellitus than non-ISR counterparts. At one year post PCI, both overweight and normal weight patients undergoing PCI for ISR had increased risk of MACE (overweight: 18.4% vs. 6.7%; HR 2.83; 95% CI 2.50–3.20; normal weight: 18.8% vs. 7.8%, HR 2.43, 95% CI 1.95–3.04) when compared to non-ISR counterparts, mostly driven by TVR (overweight: 16% vs. 4.6%; HR 3.58; 95% CI 3.11–4.13; normal weight: 15.2% vs. 4.1%; HR 3.69; 95% CI 2.80–4.86). However, only overweight patients undergoing PCI for ISR had higher risk of all cause mortality (2.2% vs. 1.5%; HR 1.42; 95% CI 1.03–1.95) and MI (3.0% vs. 1.3%, HR 2.22; 95% CI 1.64–2.99) when compared to non-ISR counterparts (Figure 1).

Conclusions
PCI for ISR was associated with increased risk of MACE, irrespective of body weight. The risks of all-cause mortality and MI in ISR vs non-ISR patients only reached statistical significance in overweight patients.

Funding Acknowledgement
Type of funding sources: None.
Peri-interventional ischemic stroke after coronary angiography: a large-scale nationwide cohort analysis from 2006 to 2020
Authors: Bay B , Gossling A , Remmel M , Koester L , Blaum C M , Becher P M , Zengin-Sahm E , Rimmele D L , Clemmensen P , Seiffert M , Blankenberg S , Brunner F J , Waldeyer C 
Published: October 2022

Abstract

Background
Ischemic stroke after coronary angiography is a life-threatening complication, leading to high mortality and long-term sequelae in surviving patients. Contemporary data from a European nationwide perspective are however lacking.

Purpose
We aimed to investigate the incidence, temporal trends, and outcome of ischemic stroke complicating coronary angiography in a German nationwide cohort.

Methods
A retrospective analysis of healthcare records from 2006–2020 based on ICD-10 and OPS codes obtained from the German Federal Statistical Office was carried out. Patients ≥18 years of age hospitalized for coronary angiography (both diagnostic and percutaneous interventions) were included in this analysis. Ischemic stroke events as well as co-morbidities were identified using ICD-10 and OPS codes. The outcome of interest was in-hospital mortality. Multivariable logistic regressions were computed for the association of ischemic stroke with in-hospital mortality adjusting for age, gender, hypertension, hyperlipoproteinemia, and diabetes mellitus.

Results
Overall 5,098,751 cases of patients undergoing coronary angiography (mean age 68.7±11.4 years; 28.0% female) between 2006 and 2020 were included. Ischemic stroke occurred in 3,808 (0.07%) patients. In comparison, individuals who suffered from peri-interventional ischemic stroke were older (70.8±11.1 vs. 68.7±11.4; p&lt;0.001), more likely female (33.4% vs. 27.9%; p&lt;0.001), and differed significantly according to their clinical characteristics (see Table 1). Patients with ischemic stroke had a significantly longer in-hospital stay (18.3±15.5 vs. 6.4±8.0 days; p&lt;0.001), and higher rates of in-hospital mortality (18.0% vs. 3.2%; p&lt;0.001) compared to patients without ischemic stroke. After multivariable adjustment, ischemic stroke remained independently associated with a higher risk of in-hospital mortality with an Odds ratio of 6.5 (95% Confidence Interval: 5.9, 7.1; p&lt;0.001). Also, incidence of peri-interventional stroke increased gradually from 0.03% in 2006 to 0.12% in 2020 (see Figure 1).

Conclusion
In a contemporary nationwide cohort of patients hospitalized for coronary angiography spanning 15 years, the incidence of ischemic stroke remained low, although a gradual increase from 2006 to 2020 was documented. The occurrence of ischemic stroke was independently associated with a markedly increased risk of in-hospital mortality. These findings might be helpful in evaluating patients undergoing coronary angiography and to reduce the high mortality and morbidity associated with this complication in future.

Funding Acknowledgement
Type of funding sources: None.
Direct stenting versus stenting after predilatation in STEMI patients with high thrombus burden: a subanalysis from the randomized COMPARE CRUSH trial
Authors: Vogel R F , Delewi R , Wilschut J M , Lemmert M E , Diletti R , Nuis R J , Paradies V , Alexopoulos D , Zijlstra F , Montalescot G , Angiolillo D J , Krucoff M W , Van Mieghem N M , Smits P C , Vlachojannis G J 
Published: October 2022

Abstract

Background/Introduction
Direct stenting has been proposed to reduce vessel wall damage and distal embolization in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, studies comparing direct stenting with stenting after predilatation have shown mixed results so far. Patients presenting with high thrombus burden in the culprit lesion represent a subgroup of STEMI patients that may particularly benefit from direct stenting, as high thrombus burden is associated with suboptimal reperfusion and poor clinical outcomes.

Purpose
We sought to determine the efficacy of direct stenting compared with stenting after predilatation in STEMI patients presenting with high thrombus burden.

Methods
The randomized COMPARE CRUSH trial assessed the efficacy of pre-hospital administration of crushed versus integral prasugrel tablets in patients presenting with STEMI planned for primary PCI. We assessed Thrombolysis In Myocardial Infarction (TIMI) flow, corrected TIMI frame count (cTFC) and myocardial blush grade at the end of primary PCI, as well as the occurrence of complete (≥70%) ST-segment resolution 1 hour post-PCI in STEMI patients presenting with high thrombus burden in the culprit lesion (defined as a TIMI thrombus grade ≥3).

Results
A total of 417 STEMI patients were included in the current analysis of which 336 (81%) presented with high thrombus burden on initial angiography with 144 patients (43%) being treated with direct stenting. Patients undergoing direct stenting exhibited significantly lower cTFC post-PCI compared with stenting after predilatation (16 [12–24] vs. 20 [13–29], p=0.02). Moreover, direct stenting patients more frequently exhibited complete ST-segment resolution 1 hour post-PCI compared with stenting after predilatation (72% vs. 59%, OR 1.82 [95% CI, 1.11–2.99], p=0.02). In contrast, we found no differences in the occurrence of TIMI 3 flow (DS 92% vs. 92%, OR 1.02 [0.47–2.22], p=0.97) or myocardial blush grade 3 (DS 63% vs. 54%, OR 1.45 [95% CI, 0.83–2.52], p=0.19) post-PCI between groups.

Conclusion
STEMI patients presenting with high thrombus burden treated with direct stenting showed improved markers of early myocardial reperfusion compared with patients treated with stenting after predilatation, indicating that a direct stenting strategy may benefit the subgroup of STEMI patients that present with high thrombus burden. Randomized trials are warranted to further investigate whether the potential benefits of direct stenting outweigh potential hazards over the long-term.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Daiichi-Sankyo and Shanghai MicroPort Medical