bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of FFRCT in patients with stable chest pain – a 3-year follow-up of the ADVANCE-DK registry
Authors: Madsen K T , Noergaard B L , Oevrehus K A , Parner E , Jensen J M , Grove E L , Fairbairn T A , Nieman K , Patel M , Rogers C , Mickley H , Rohold A , Boetker H E , Leipsic J , Sand N P R 
Published: October 2022

Abstract

Introduction
The short-term safety of using coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) to guide downstream testing after CTA is well documented. Whether the prognostic information provided by FFRCT can be extended to sustained follow-up and to patients with a high degree of coronary artery calcification (CAC) is unknown.

Purpose
To evaluate the association between FFRCT and clinical outcomes in new onset stable symptomatic patients with coronary stenosis up to 3 years after CTA index testing.

Methods
Multicenter 3-year follow-up study of 900 patients from the Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care (ADVANCE) registry at three Danish sites, the “ADVANCE-DK Registry”. All patients had at least one ≥30% coronary stenosis by CTA and underwent subsequent core laboratory FFRCT analysis by HeartFlow. The criterium for an abnormal FFRCT test result was an FFRCT value ≤0.80 (2 cm distal to stenosis). High CAC was defined as a CAC score ≥400. The primary endpoint (PE) was a composite of all-cause death and spontaneous myocardial infarction (MI). The secondary endpoint (SE) was a composite of cardiovascular (CV) death and spontaneous MI. Events were adjudicated by an independent clinical committee.

Results
Patient characteristics are given in Table 1. Coronary stenosis ≥50% was present in 750 (83%) patients. In total 36 patients suffered a PE (all-cause death, n=24; MI, n=12) and 22 an SE (CV death, n=10; MI, n=12). An abnormal vs a normal FFRCT test result was associated with an increased risk of the PE and of the SE both overall and in patients with high CAC; PE (all), 6.6% vs 2.1%, relative risk (RR): 3.1; 95% CI: 1.6–6.3, p&lt;0.001, SE (all), 5.0% vs 0.6%, RR: 8.7; 95% CI: non assessable, p&lt;0.001, PE (high CAC), 9.0% vs 2.2%, RR: 4.1; 85% CI: 1.4–11.8, p=0.001, and SE (high CAC), 6.6% vs 0.5%, RR: 12.0; 95% CI: non assessable, p=0.01, respectively, Figure 1. The observed increased risk in patients with an abnormal vs a normal FFRCT test result persisted after adjustment for degree of stenosis by CCTA (&lt; / ≥50%) and amount of CAC (&lt; / ≥400): PE, adjusted RR: 2.5; 95% CI: 1.2–5.2, p=0.02, and SE, adjusted RR: 8.0; 95% CI: 2.1–30.2, p=0.002.

Conclusion
Patients with stable chest pain, stenosis by CTA and a normal FFRCT test result have a low risk of adverse outcomes during 3 years of follow-up. An abnormal FFRCT identifies patients at increased risk of death or spontaneous MI. These associations are consistent in patients with high levels of CAC.

Funding Acknowledgement
Type of funding sources: None.
Prognostic role of functional syntax score based on quantitative flow ratio
Authors: Gkini K P , Terentes-Printzios D , Oikonomou D , Aznaouridis K , Dima I , Gardikioti V , Tsioufis K , Vlachopoulos C 
Published: October 2022

Abstract

Background/Introduction
The quantitative flow ratio (QFR) based functional Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score (FSSQFR) takes into consideration not only the anatomy but also the physiology of coronary arteries.

Purpose
To investigate the prognostic value of the FSSQFR.

Methods
We performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single center. FSSQFR was counted by summing the individual scores only in ischemia-producing lesions (vessel QFR ≤0.8). Patients were divided into low-, intermediate- and high risk according to SS and FSS with the same cutoff. The primary endpoint was the estimation of the predictive value of FSSQFR for the composite outcome of death, myocardial infarction, ischemia-driven revascularization, stroke, hospitalization for heart failure, and life-threatening arrhythmias.

Results
410 patients were included in this study. Baseline characteristics of the population displayed in Table 1. FSSQFR and SS were estimated for all patients. According to SS, 26.6% of patients were high risk, 36.6% were intermediate risk and 36.8% were low cardiovascular risk. After calculating FSSQFR, risk stratification changed in 10% of the study population, more specifically 21.2%, 36.6%, and 42.2% of patients were classified as high-, intermediate- and low-risk respectively. 5% (n=20) of the patients for whom coronary artery bypass grafting would be recommended according to SS, converted in favor of percutaneous coronary intervention after FSSQFR calculation. After a median 30.2 (25.7–33.7) months follow-up period multivariate regression analysis showed FSSQFR was an independent predictor of primary endpoint after adjustment for age, gender, BMI, and hypertension (adjusted OR: 1.03 [95% CI, 1.01–1.06]; P=0.012). The Kaplan-Meier estimate for the primary endpoint was 15%, 18.7%, and 32.2% in the low, intermediate, and high FSSQFR group, respectively (log-rank P=0.001; Figure 1A) and cardiac death was 2.3%, 8.7%, and 12.6% in the low, intermediate, and high FSSQFR group, respectively (log-rank P=0.003; Figure 1B).

Conclusions
In our study, FSSQFR showed discordance with classical anatomical SS leading to risk re-stratification of patients with coronary disease and possible alternative treatment strategy and also was found to be an independent predictor of higher cardiovascular adverse events.

Funding Acknowledgement
Type of funding sources: None.
Assessment of absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis
Authors: Gallinoro E , Paolisso P , Vanderheyden M , Esposito G , Bertolone D T , Mileva N , Bermpeis K , Belmonte M , De Colle C , Candreva A , Penicka M , Collet C , Sonck J , De Bruyne B , Barbato E 
Published: October 2022

Abstract

Introduction
The development of left ventricular hypertrophy in patients with severe aortic stenosis (AS) is accompanied by adaptive coronary flow regulation, both in epicardial and microvascular compartment, which ultimately lead to a chronic ischemic insult even in the absence of obstructive coronary artery disease. Intracoronary continuous thermodilution of saline through a dedicated infusion catheter is a novel tool that allows to measure absolute coronary flow and microvascular resistance at rest and during hyperemia and to calculate both coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR)

Purpose
We aimed to assess absolute coronary flow, microvascular resistance, CFR and MRR in patients with AS, by continuous intracoronary thermodilution, comparing these hemodynamic findings with a propensity-score matched contemporary cohort of patients without AS.

Methods
Absolute coronary blood flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and compared to 15 controls matched for age, gender, diabetes mellitus and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac-CT.

Results
Patients with AS presented a significantly positive LV remodeling with lower global longitudinal strain and higher global work index compared to controls (p&lt;0.02). Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS. Compared to matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (86 [66–107] ml/min vs 68 [52–75] ml/min, p=0.036), resulting, in lower CFR (2.30±0.69 vs 2.89±0.77, p=0.005) and MRR (2.73±0.74 vs 3.53±0.95, p=0.005) in the AS cohort compared to controls (Figure 1). No differences were found in hyperemic flow and resting and hyperemic resistances. Interestingly, hyperemic myocardial perfusion (calculated as the ratio between the absolute coronary flow in the LAD and the mass subtended by the vessel, expressed in mL/min/g), but not resting, was significantly lower in the AS group (1.9 [1.5–2.5] ml/min/g vs 2.3 [2–3.1] ml/min/g p=0.036).

Conclusions
In patients with severe aortic stenosis and non-obstructive coronary artery disease, with the progression of LVH, the compensatory mechanism of increased resting flow maintains an adequate perfusion at rest, but not during hyperemia (Figure 2). As consequence, both CFR and MRR are significantly impaired.

Funding Acknowledgement
Type of funding sources: None.
Thermodilution-derived coronary absolute flow and resistance in patients with different INOCA endotypes
Authors: Smits P M , Laforgia P L , Sijbring M , Den Ruijter H M , Smits P C , Paradies V 
Published: October 2022

Abstract

Background
Thermodilution-derived measurement of absolute coronary flow and resistance has been recently validated by using a dedicated microcatheter and a pressure-temperature guidewire. Coronary absolute flow (AbsF) and derived absolute resistance (AbsR) can give precious information about the microcirculation in patients with ischemia and non-obstructive coronary artery disease (INOCA). The correlation with different INOCA endotypes has been so far poorly investigated.

Methods
108 INOCA patients underwent a complete evaluation of underwent coronary function testing, including acetylcholine (ACH) provocation testing, adenosine testing (CFR/IMR) and functional assessment of the left anterior descending artery using thermodilution-derived measurement of AbsF and AbsR.

Results
Among 108 INOCA patients, 64% showed coronary microvascular dysfunction (CMD) with positive ACH reaction (ACH+) and/or abnormal CFR/IMR (CFR/IMR+), of whom 38% presenting with an isolated structural component (CFR/IMR+) and 62% with an isolated vasospastic component (ACH+).
Among ACH+ patients, epicardial vasospastic angina was detected in 28.2% of the patients.
AbsF was found significantly lower in ACH+ patients than in ACH− patients (0.174±0.09 vs 0.2019±0.09, p=0.03). Similarly, a trend of higher AbsR values was found in ACH+ patients as compared to ACH− (612.5±226.5 vs 524.5±171.2, p=0.07, Fig. 1A). AbsF was found significantly lower in patients with coronary microvascular dysfunction (CMD) than in patients without either vasospastic or structural component of CMD (0.172±0.06 vs 0.202±0.09, p=0.05) and AbsR showed a trend towards higher values in patients with CMD than patients without CMD. (609.3±208.8 vs 557.7±193.1, p=0.08, Fig. 1B) AbsF and AbsR did not differ in patients with and without abnormal adenosine testing only: AbsF (0.176±0.06 vs 0.197±0.09, p=0.31) and AbsR 589.8±183.0 vs 565.2±190.2, p=0.27). A modest correlation was found between AbsQ and IMR (r: −0.2: p: 0.05, Fig. 2).

Conclusion
Coronary vasomotor dysfunction is highly prevalent in INOCA patients and a complete coronary function evaluation, including provocative test should be performed. Continuous thermodilution is safe and easily implemented in INOCA patients and provide new insights in the assessment of INOCA endotypes with high reproducibility. The exact diagnostic and prognostic value of these measurements, and their optimal cutoff, should be assessed in future studies.

Funding Acknowledgement
Type of funding sources: None.
Post-occlusive reactive hyperaemia can objectify the occurrence of vasospasm induced ischemia during acetylcholine provocation testing
Authors: Feenstra R G T , Woudstra J , Bijloo I , Eringa E C , De Winter R J , Van De Hoef T P , Appelman Y , Beijk M A M , Piek J J 
Published: October 2022

Abstract

Introduction
Acetylcholine (ACh) spasm provocation testing together with the diagnostic criteria published by the Coronary Vasomotor Disorders International Study Group (COVADIS) are considered the gold standard for the diagnosis of coronary vasospasm in contemporary clinical practice. In 20–29% of patients undergoing vasospasm provocation an equivocal test result occurs when these criteria are only partially met and poses a diagnostic dilemma. Post-occlusive reactive hyperaemia is a marker of acute myocardial ischemia and could serve as an added objective diagnostic criterium for the diagnosis of acetylcholine induced vasospasm.

Purpose
The aim of this study is therefore to evaluate the occurrence of post-occlusive reactive hyperaemia in the equivocal, positive and negative test result that follows acetylcholine vasospasm provocation.

Methods
66 patients with angina and non-obstructive coronary artery disease on angiography (ANOCA) who underwent the entire ACh spasm provocation testing protocol were included in this analysis. After each ACh dose angiography was performed and when vasospasm occurred 200 μg nitro-glycerine was administered intracoronary. Definitions and diagnostic criteria for CAS were in line with those used by the COVADIS working group to diagnose epicardial and microvascular vasospasm. An equivocal test result was defined as the induction of recognisable angina without ischemic ECG changes, in reaction to ACh. Doppler flow was continuously measured during the procedure. Changes in flow due to ACh mediated vasodilation quickly return to baseline values due to its short-half life. Therefore, the occurrence of post-ischemic reactive hyperaemia was assessed by the extended time to return to baseline flow, the so called “flow recovery time”.

Results
We analysed the flow recovery time in 21 patients with epicardial vasospasm, in 16 with microvascular spasm, in 14 with an equivocal test result and in 15 with a negative test result. Mean age of the entire study population was 56±11 years and 86% were female. In reaction to dose 1 to 3 flow recovery time was similar between all diagnostic endotypes. In reaction to the fourth dose flow recovery time was extended in the epicardial, microvascular and equivocal test result compared to the negative test result indicative of post-ischemic reactive hyperaemia.

Conclusion
Post-occlusive reactive hyperaemia occurs in patients with an equivocal test result similar to patients with microvascular vasospasm and epicardial vasospasm. These findings indicate the occurrence of acetylcholine induced vasospasm in the equivocal test result and these patients may benefit from medical treatment.

Funding Acknowledgement
Type of funding sources: None.
Validation and diagnostic performance of a fast on-site deep learning-based CT-FFR algorithm
Authors: Giannopoulos A , Keller L K , Sepulcri D S , Boehm R B , Garefa C G , Tsinaridis A T , Sager D S , Venugopal P V , Mitra J M , Ghose S G , Pack J D P , Davis C L D , Edic P M E , Kaufmann P A K , Buechel R R B 
Published: October 2022

Abstract

Background/Introduction
CT-based fractional flow reserve (CT-FFR) has been extensively studied and established as a valuable tool for clinical decision making over the past decade. Nevertheless, clinical implementation has not been systematically adopted due to economic and technical reasons. Among the latter, the turn-around time for the computation and analysis' results potentially plays an important role.

Purpose
To evaluate the feasibility and diagnostic accuracy of CT-FFR computed on-site with a novel, deep learning-based algorithm using invasive hemodynamic indices as the reference standard.

Methods
Sixty-one patients who underwent clinically indicated coronary computed tomography angiography and invasive FFR (iFFR) and/or instantaneous wave-free ratio (iFR) measurements were retrospectively included. CT-FFR analysis was performed in 77 arteries using an on-site prototype software based on deep learning algorithms for coronary anatomy segmentation and prediction of the pressure drop under rest and hyperemia. The diagnostic performance of CT-FFR to detect hemodynamic significant lesions was assessed using iFFR (≤0.8) and/or iFR (≤0.89) as the standard of reference (60 patients with iFFR, 11 patients with iFR, and 3 patients with both) and the receiver operating characteristic area under the curve (AUC) was calculated. Furthermore, correlation analysis and Bland-Altman (BA) analysis was performed. Time for analysis including processing and manual edits to the lumen segmentation was recorded.

Results
CT-FFR analysis was successful in 59 (97%) patients and 74 (96%) arteries. In 74 arteries, 31 of 74 coronary lesions were invasively found to be hemodynamically significant. Total mean time for per patient CT-FFR analysis was 7 minutes and 55 seconds. Compared with invasive indices, per-lesion sensitivity and specificity of CT-FFR were 90%, and 98%, respectively. The AUC of CT-FFR vs. invasive indices for hemodynamic significance was 0.94, (95% confidence interval: 0.86–0.98). Compared to iFFR, CT-FFR correlated well (r=0.77) with only a very small bias (0.02) and narrow BA limits of agreement (−0.14 to 0.17). The per-lesion accuracy, sensitivity and specificity vs. iFFR were 96%, 93%, and 100%, respectively.

Conclusion
A novel deep learning-based CT-FFR algorithm yields excellent diagnostic accuracy compared to invasive hemodynamic indices to detect lesion-specific ischemia and offers the potential to be readily implemented into clinical practice given that it can be performed fast and on-site.

Funding Acknowledgement
Type of funding sources: None.
Bleeding in patients undergoing percutaneous coronary intervention: factors associated with procedural outcomes and major bleeding complications
Authors: Bimal T , Bhuiyan M , Fishbein J , Gandotra P , Selim S , Ong L , Gruberg L 
Published: October 2022

Abstract

Background
Bleeding complications are infrequent in patients undergoing percutaneous coronary interventions (PCI), however they are associated with a poor outcome and increased mortality and morbidity rates.

Purpose
To assess bleeding complications in patients undergoing PCI adjusting for other factors such as estimated glomerular filtration rate (eGFR), sex, left ventricular ejection fraction (EF), ST-segment elevation myocardial infarction (STEMI), intra-aortic balloon pump (IABP) and/or Impella, age, and prior coronary artery bypass graft (CABG).

Methods
Data was collected for quality control on all patients that underwent PCI between 2010 and 2018 at 6 tertiary care hospitals in our system. Outcomes were classified and reported in accordance with the Bleeding Academic Research Consortium (BARC) criteria. BARC Type 4 (CABG-related) and BARC Type 5 (fatal) bleeds were excluded. Major bleeding was defined as BARC Type ≥3. Major adverse cardiac and cerebrovascular events (MACCE) was the combined endpoint of hospital death; post procedural myocardial infarction; cerebrovascular events (ischemic and hemorrhagic) and major bleeding complications. Due to the clustering of patients within hospitals, hierarchical generalized linear mixed models were used. Due to the high intraclass correlation of procedures within patients, only the first procedure within the study period was selected from each patient for analysis.

Results
A total of 25,647 patients underwent PCI during the time period. Baseline and procedural characteristics are shown in the Table. Patients with major bleeding (BARC ≥3) differed significantly from patients with BARC &lt;3 bleeding complications. By multivariate analysis, age (OR: 1.15, CI: 1.1–1.2), femoral site (OR: 1.5, CI: 1.2–1.8), CKD (OR: 1.7, CI: 1.4–2.0), STEMI (OR: 3.3, CI: 2.8–4.0), prior cardiogenic shock (OR: 5.8, CI: 4.1–8.3), and use of IABP/Impella (OR: 5.5, CI: 4.4–6.9) were associated withBARC ≥3 (Figure).

Conclusion
In large contemporary dataset of patients undergoing PCI: 1) patients with BARC ≥3 bleeding complications were significantly different from those having BARC&lt;3 bleeding complications; 2) femoral access, chronic kidney disease, STEMI on presentation and the use of mechanical circulatory devices were associated with major bleeding complications; and 3) male patients had significantly lower odds of major bleeding complications.

Funding Acknowledgement
Type of funding sources: None.
Drug-eluting balloons and drug-eluting stents in the treatment of small vessel coronary artery disease: a systematic review and metanalysis of long-term clinical and angiographic outcomes
Authors: Murphy G , Durand R , McCaughey C , Naughton A , Heron E , Pearson I 
Published: October 2022

Abstract

Introduction
Coronary artery disease is a leading cause of mortality and morbidity worldwide. For those undergoing PCI, there are 20–30% with disease of the small coronary arteries on presentation [1]. Small coronary artery disease asserts a significant risk factor for adverse events. It is often diffuse and multi-vessel on presentation and confers higher rates of major adverse cardiac events, (MACE) and target lesion failure after intervention [2,3]. Best practice guidelines on the management of SvCAD interventions remain limited.
Drug-eluting balloons are a novel therapy, which has shown promise in treating in-stent restenosis (ISR), however their use in small coronary arteries when compared to drug-eluting stents remains unclear.

Purpose
This systematic review and meta-analysis compare long-term outcomes (&gt;1 year), of drug-eluting balloons (DEB), vs. drug-eluting stents (DES), in the treatment of small coronary artery disease (&lt;3mm).

Methods
A systematic review was completed within PRISMA guidelines. The primary outcome was non-inferiority of DEB Vs. DES in major adverse cardiac events (MACE). Secondary outcomes include all-cause mortality, MI, vessel thrombosis, major bleeding and target vessel revascularization at one, two and three years follow-up. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and Random effect model. Odds ratios (OR), were presented with a 95% confidence interval (CI).

Result
Of 4661 articles, four RCTs were included (1414 patients). DEB demonstrated reduced rates of non-fatal MI at one year, OR 0.44 (95% CI 0.2, 0.94) and Basket-2 small reported a significant reduction in two-year bleeding rates OR 0.3 (95% CI 0.1, 0.91). DEBs were non-inferior to DES for all other outcomes.

Conclusion
Long duration follow-up of DEB and DES use in small coronary arteries demonstrates DEB to be non-inferior to DES in all outcomes across all years of follow-up. There was a significant reduction in rates of non-fatal MI at one year in the DEB arm and a reduction in major bleeding episodes at two years in the Basket Small 2 trial. These data highlight the potential utility and long-term safety of novel DEBs in small coronary artery disease revascularization.

Funding Acknowledgement
Type of funding sources: None.
Deferred stent implantation in patients with ST segment elevation myocardial infarction with high thrombus burden
Authors: Mohamady M A S 
Published: October 2022

Abstract

Background
Recent guidelines recommend against deferred stenting as a routine strategy in STEMI patients.

Objectives
Current study aimed to assess whether deferred stenting strategy in primary PCI might reduce angiographic or in-hospital major adverse cardiac events in comparison to immediate stenting.

Methods
one hundred patients of STEMI with high thrombus burden divided equally into; 50 patients (group 1) treated with immediate stenting and 50 patients (group 2) treated with deferred stenting. Procedural angiographic events were the primary endpoints, while in hospital MACE were designed as secondary endpoints.

Results
patients of deferred stenting group had statistically significant reduction of distal embolization, slow flow and no reflow (P value = 0.016). In contrast, deferred strategy didn't improve the short term clinical outcomes. Composite of MACEs was statistically significant in the deferred stenting group (20%) versus only (6%) in the immediate stenting group (P value = 0.037).

Conclusion
Deferred stenting in patients with STEMI those with high thrombotic burden improves only the angiographic outcomes but could not improve the short term clinical outcomes in comparison to immediate stenting. Deferred stenting shouldn't be used as a routine strategy in STEMI patients.

Funding Acknowledgement
Type of funding sources: None.