bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of FFR measured after DES implantation with clinical parameters and long-term clinical outcome
Authors: Csanadi B , Fulop G , Szoke S , Szonyi T , Dekany G , Pinter T , Takacs P , Abdelkrim A , Beres A , Fontos G , Andreka P , Nyolczas N , Piroth Z 
Published: October 2022

Abstract

Introduction
The role of fractional flow reserve (FFR) measured directly after drug eluting stent (DES) implantation (post-PCI FFR) is not clear in predicting major adverse cardiac events (MACE), and it is not known which clinical parameters affect post-PCI FFR.

Aim
We aimed to clarify the relationship between post-PCI FFR and clinical parameters, post-PCI FFR and long-term MACE and determine the best post-PCI FFR cut-off in MACE prediction.

Method
Patients who underwent post-PCI (DES) FFR measurement at our center between March 2009 and January 2021 were included. We examined the relationship between post-PCI FFR and gender, age, hypertension, diabetes mellitus, hyperlipidemia, indication (acute (ACS) vs. chronic coronary syndrome (CCS)), stent diameter, in-stent restenosis vs de novo lesion category, proximal vs. non-proximal lesion location, LAD (vs. non-LAD) location, and pre-PCI FFR. We sought to determine the correlation between post-PCI FFR and target vessel-related MACE (cardiovascular death (CVD), non-fatal myocardial infarction (MI), recurrent revascularization (TVR)). Optimal cut-off was determined by ROC curves.

Results
Post-PCI FFR measurement was performed in 500 coronary arteries of 434 patients. LAD location (0.86 vs. non-LAD 0.91, p&lt;0.001), male gender (0.87 vs. 0.89, p=0.001), younger age (p=0.0215), smaller stent diameter (p=0.0028) and lower pre-PCI FFR (p=0.0006) proved to be independent predictors of lower post-PCI FFR, no other parameter showed a significant correlation with post-PCI FFR. During a median follow-up of 37 months, 24 CVD, 15 MI and 47 TVR occurred. Follow-up was complete in 96.2% of patients. There was a significant inverse correlation between post-PCI FFR and MACE (p&lt;0.001). Diabetes mellitus (p=0.0024) and in-stent restenosis (0.0356) were also independent predictors of MACE. The best post-PCI FFR cut-off for the total patient population, LAD and non-LAD lesions were 0.83 (p&lt;0.0001), 0.83 (p&lt;0.0001), and 0.88 (p=0.0091), respectively.

Conclusion
LAD location, male gender, younger age, smaller stent diameter and lower pre-PCI FFR value result in lower post-PCI FFR. There is no significant difference between post-PCI FFR measured in ACS vs. CCS. FFR measured after PCI, diabetes mellitus and in-stent restenosis are significant predictors of MACE-free long-term survival. The best post-PCI FFR cut-off to predict MACE was 0.83 for the whole patient population and for LAD and 0.88 for non-LAD lesions.

Funding Acknowledgement
Type of funding sources: None.
Comparison of outcomes between a single long stent and overlapping stents in long coronary artery lesion: a meta-analysis of the current literature
Authors: Saylik F , Cinar T , Selcuk M , Cicek V , Hayiroglu M I , Orhan A L 
Published: October 2022

Abstract

Background
There is no consensus for the treatment of diffuse coronary artery lesions with a single long stent (SLS) or with overlapping of two or more stents (OLS). In this review, we aimed to compare the outcomes between these two approaches by performing a meta-analysis based on the literature.

Methods
We searched MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library for eligible studies. In total, 12 studies (n=6414) that included the outcomes in the follow-up period were included in this meta-analysis.

Results
Patients with OLS had higher risk of cardiac death and target lesion revascularization (TLR) than those with SLS (RR: 1.51, confidence interval: 1.03–2.21, p=0.03, I2=0% and RR: 1.64, confidence interval: 1.02–2.65, p=0.04, I2=38%, respectively). Fluoroscopy time was prolonged in OLS group compared to SLS group (SMD: 0.35, confidence interval: 0.25–0.46, p&lt;0.01, I2=0%). Contrast volume usage was higher in the OLS group, but there was significant heterogeneity in pooled analysis (I2=95%). In subgroup analysis, there were no differences with respect to outcomes between the studies reported before and after the year 2015.

Conclusion
This was the first meta-analysis to indicate that cardiac death and TLR were higher and fluoroscopy time was longer in the OLS group than in the SLS group.

Funding Acknowledgement
Type of funding sources: None.
Association of body mass index with long-term outcomes after elective and semi-urgent percutaneous coronary intervention
Authors: Ho J S Y , Soh R Y H , Djohan A H , Sim H W , Loh P H , Yeo T C , Tan H C , Chan M Y , Sia C H 
Published: October 2022

Abstract

Background
While obesity is associated with cardiovascular mortality and morbidity, patients with higher body mass index (BMI) may have better outcomes post-percutaneous coronary intervention (PCI). This “obesity paradox” is controversial and needs clarification.

Purpose
We aimed to investigate the relationship between BMI and outcomes post-PCI in an Asian cohort.

Methods
A retrospective cohort study was performed on consecutive patients who underwent semi-urgent PCI for non-ST elevation myocardial infraction or unstable angina, and elective PCI for stable angina from January 2014 to December 2015 in a tertiary centre. Patients were underweight (BMI &lt;18.5), normal weight (BMI 18.5–22.9), overweight (BMI 23–24.9), pre-obese (BMI 25–29.9) or obese (BMI ≥30), according to the WHO Asian classification. The primary endpoint was all-cause mortality. The secondary outcomes were subsequent events of stroke or transient ischemic attack, myocardial infarction (MI) and congestive cardiac failure (CCF).

Results
1,610 patients were followed up for 3.71 (±0.97) years, 19.7% were female and mean age was 62.1 years (Table 1). BMI showed a U-shaped relationship with the incidence of death (p&lt;0.001), MI (p=0.005), and CCF (p&lt;0.001) (Figure 1A), which was also shown on Kaplan Meier analysis (Figures 1B-E). With reference to normal weight patients on multivariable Cox analysis, overweight (adjusted HR 0.64, 95% CI 0.42–0.97) and pre-obese (adjusted HR 0.55, 95% CI 0.38–0.80) patients had lower mortality. Underweight patients had higher risk (adjusted HR 2.12, 95% CI 1.01–4.46), while pre-obese patients had lower risk of MI (adjusted HR 0.56, 95% CI 0.34–0.92) compared to normal weight patients. Underweight and obese patients had higher risk of CCF (underweight: adjusted HR 3.05, 95% CI 1.45–6.42; obese: adjusted HR 1.86, 95% CI 1.03–3.35) compared to normal weight patients.

Conclusion
Patients at the lower and upper extremes of BMI demonstrated higher risk of mortality, MI and CCF post-PCI.

Funding Acknowledgement
Type of funding sources: None.
Angiographic derived physiological assessment after intervention for predicting 2-year vessel-oriented composite endpoints in Multivessel TALENT trial
Authors: Kageyama S , Serruys P W , Masuda S , Ninomiya K , Kotoku N , Onuma Y 
Published: October 2022

Abstract

Aims
The purpose of the study is to assess the treatment results in the first 200 patients in the ongoing Multivessel TALENT trial and to predict the vessel-oriented endpoint by assessing the quantitative flow ratio (QFR) post PCI in a central independent core laboratory.

Methods
In this prospective, randomized, 1:1 balanced, multi-centre, open-label trial, de novo multivessel coronary artery disease patients without left main disease are assigned to the sirolimus-eluting stent or everolimus-eluting stent arm. The percutaneous coronary intervention (PCI) is planned based on functional lesion evaluation by QFR provided by the Core laboratory and the PCI has to be optimized by intravascular imaging, optimal pharmacological treatment and prasugrel monotherapy.

Results
Mean age of the population was 66.6±14.7 years, and 78.1% of them were male. This population consists of 17.4% unstable angina and of 31.8% diabetic patients. Anatomical SYNTAX score was 18.8±9.1. Total 458 lesions were treated from September 2020 to December 2021. Left anterior descending artery accounts for 40.3%, bifurcation lesion was present in 40.8%, total occlusion in 4.2%. The average stent diameter and total stent length were 3.0±0.4mm and 38.7±22.4mm, respectively. Intravascular imaging was used in 92.8% of treated vessels (intravascular ultrasound 56.5%, optical coherent tomography 36.3%). Pre-PCI QFR was analysable in 435 vessels (0.59±0.21), and 5.5% of them were treated even though the pre-PCI QFR values were more than 0.8. Post-PCI QFR has been so far analysed in 303 vessels (0.93±0.11) and 79.5% of them achieved a post-PCI QFR equal or superior to 0.91. Based on the previous study [1], Two-year vessel-oriented composite endpoint (VOCE) was estimated to become 5.4% in the present study population (3.7% in the patient group that achieved post PCI QFR equal or superior to 0.91, while 12% in the patients who could not reach the threshold), which was almost equal to what is expected in the power calculation.

Conclusions
In the Multivessel TALENT trial, the large majority of the vessels treated (94.5%) complied with the hemodynamic criteria of recommended PCI as provided by the QFRs of the Core laboratory. Favourable post-PCI QFR (≥0.91) obtained in 80% of the patients let expected a favourable VOCE outcome of 5.4%.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The National University of Ireland Galway
Impact of left ventricular ejection fraction on 10-year mortality after percutaneous coronary intervention or coronary artery bypass grafting
Authors: Masuda S , Ninomiya K , Kageyama S , Kotoku N , Mack M J , Kappetein A P , Morice M C , Onuma Y , Serruys P W 
Published: October 2022

Abstract

Backgrounds
The impact on vital prognosis at very long-term of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with reduced ejection fraction (EF) remains to be elucidated.

Objective
To investigate the impact of left ventricular ejection fraction (LVEF) on 10-year mortality after PCI and CABG in the SYNTAX trial.

Methods
In the SYNTAXES study, 1,800 randomized patients were categorized into three groups according to the current guidelines; (1) reduced EF (rEF; LVEF ≤40%), (2) mildly reduced EF (mrEF; LVEF 41–49%), (3) preserved EF (pEF; LVEF ≥50%). The primary endpoint was 10-year all-cause mortality. Event rate up to 10 years was estimated according to the Kaplan-Meier method, and the log-rank test was performed to examine the differences among LVEF subgroups. The SYNTAX score 2020 (SS-2020) was compared between the patients with reduced (LVEF &lt;50%) and preserved EF (LVEF ≥50%) in order to better refine their respective personalized vital prognosis and assess in cross-validation the value of the risk score.

Results
The population was stratified as rEF (n=168), mrEF (n=179), and pEF (n=1453). Ten-year all-cause mortality were 44.0% vs. 31.8% vs. 22.6% (P&lt;0.001), in patients with rEF, mrEF and pEF, respectively. The significant interaction was not identified between LVEF classification and treatment (P interaction = 0.183). In patients with rEF, there was a tendency toward higher mortality in PCI group than CABG (52.9% vs 39.6%, P=0.054), and no significant differences in patients with mrEF (36.0% vs. 28.6%, P=0.273) and pEF (23.9% vs. 22.2%, P=0.275). According to the SS-2020, PCI was a relatively safe modality of revascularization in 37.8% of the patients with reduced EF (LVEF &lt;50%). In the population with preserved EF (LVEF ≥50%), the proportion of patients eligible to PCI with predicted equipoise in mortality with CABG was 57.5%.

Conclusion
LVEF could an important factor for determining the revascularization treatment in patients presenting with complex coronary artery disease. Calculation of individualized 10-year prognosis using the SS-2020 may be a viable option in decision-making.

Funding Acknowledgement
Type of funding sources: None.
Reperfusion strategy and late clinical outcomes of patients with ST-elevation myocardial infarction (STEMI) in the absence of standard modifiable risk factors (SMuRFs)
Authors: Jamal J , Idris H , Faour A , Yang W , McLean A , Burgess S , Shugman I , Oloughlin A , Leung D , Mussap C J , Juergens C P , Lo S , French J K 
Published: October 2022

Abstract

Introduction
There is growing evidence that patients presenting with STEMI in the absence of standard modifiable cardiovascular risk factors (SMuRFs; smoking, hypertension, hypercholesterolemia, diabetes) have poorer outcomes compared to those with atleast one SMuRF. It has been hypothesised that this may be in part due to decreased administration of pharmacotherapies in the post-infarct period due to perceived low risk. Long term outcomes of patients without SMuRFs based on reperfusion strategy received during the index admission have not been investigated.

Purpose
We sought to analyse late clinical outcomes of STEMI patients with and without SMuRFs based on reperfusion strategy received during the index admission.

Methods
All patients who underwent PCI between 2003 and 2014 were identified from a PCI centre STEMI database. Late clinical outcomes of patients with and without SMuRFs were analysed overall and based on reperfusion strategy [primary PCI (pPCI) vs pharmaco-invasive PCI (PI-PCI)]. Propensity matching was used to account for differences in baseline characteristics between the groups.

Results
Amongst 2,091 STEMI patients, 531 (25%) had no SMuRFs (51% pPCI, 49% PI-PCI) and 1560 (75%) had ≥1 SMuRF (52% pPCI, 48% PI-PCI). Unadjusted late mortality in SMuRF-less patients was 13.4% (18.8% pPCI, 7.7% PI-PCI) and for those with ≥1 SMuRF was 9.7% (11.0% pPCI, 8.4% PI-PCI). After propensity-matching clinical and angiographic characteristics, 5 year mortality rates were significantly higher for patients without SMuRFs compared to those with SMuRFs [HR 1.36, CI: 1.03–1.81, p=0.031]. This difference was attenuated for patients who underwent pPCI [HR 1.72, CI: 1.22–2.43, p=0.002]. Interestingly, this discrepancy was not observed amongst individuals who underwent pharmaco-invasive PCI [HR 1.13, CI: 0.53–1.48, p=0.638], as SMuRF-less patients had similar mortality rates to their counterparts. Long term rates of reinfarction, stent thrombosis and target vessel revascularisation were similar between the groups. Additionally, there was no significant difference in rates of stroke and major bleeding amongst all 4 subgroups.

Conclusion
Patients presenting with STEMI in the absence of SMuRFs have increased overall late mortality compared to those with at least one SMuRF. However, this difference was not observed in patients who underwent a pharmaco-invasive strategy, whereby patients without SMuRFs had similar outcomes to those with SMuRFs after adjusting for confounders. Our findings suggest the use of a pharmaco-invasive strategy in appropriate SMuRF-less patients presenting with STEMI.

Funding Acknowledgement
Type of funding sources: None.
Heparin pre-treatment in patients with ST elevation myocardial infarction: a cohort study investigating the effects on coronary artery occlusion, mortality, and bleeding
Authors: Emilsson O L , Bergman S , Mohammad M , Rylance R , Olivecrona G , Gotberg M , Erlinge D , Koul S 
Published: October 2022

Abstract

Background
Unfractionated heparin (UFH) is often administered before arrival at the cath lab in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, large studies regarding the clinical impacts of UFH pre-treatment are scarce.

Purpose
To investigate if pre-treatment with heparin affects total coronary artery occlusion at angiography, mortality at 30 days, and major bleeding during hospitalization in patients with STEMI undergoing primary PCI.

Methods
The study population was extracted from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and consisted of unique patients with a first STEMI event undergoing PCI during the study period 2008 to 2016. Patients receiving UFH pre-treatment were compared with patients not receiving UFH pre-treatment. To obtain relative risks of the outcomes adjusted Poisson regression models with robust standard errors were used. In the adjusted models, we included age, sex, smoking status, year, comorbidities (as specified under tables 1 and 2), and anti-thrombotic treatment (as specified under tables 1 and 2). To obtain absolute risk differences, analyses of propensity score (PS) matched groups were performed. PS was based on the same variables as in the adjusted Poisson regression, and a caliper of 0.02 was used.

Results
A total of 41,631 patients were included in the study population (median age: 67 years; 71% male), with 16,026 receiving pre-treatment with UFH and 25,605 not receiving UFH pre-treatment. The adjusted Poisson model revealed that UFH pre-treatment was associated with an 11% relative risk reduction of coronary artery occlusion (95% confidence interval (CI): 9%; 12%), and an 13% (95% CI: 2%; 23%) reduced relative risk of mortality. For bleeding, no statistically significant difference was found. In the PS-matched analysis (median age: 67 years, 71% male), the absolute risk differences were for coronary artery occlusion 8.3% (95% CI: 7.1%; 9.5%) in favour of UFH pre-treatment, and for mortality 0.5% (−0.1%; 1.2%), with a modest trend in favour of UFH pre-treatment. For bleeding, no statistically significant difference was found.

Conclusion
UFH pre-treatment was associated with a reduction in coronary artery occlusion at presentation at the cath lab in patients with STEMI, the number needed to treat being 13, without increasing the risk of bleeding. Regarding mortality, a reduced relative risk was found in the adjusted regression analysis, but the absolute risk difference was small and not statistically significant in the PS-matched analysis. Due to the retrospective study design, residual confounding cannot be excluded.

Funding Acknowledgement
Type of funding sources: None.
Robotic-assisted PCI – insights from a monocenter registry
Authors: Rilinger J , Heidt T , Bode C , Von Zur Muehlen C 
Published: October 2022

Abstract

Background
Robotics in interventional cardiology is a rapidly evolving technique, which is still in an early phase of development and clinical application. Beside the pivotal studies, there is limited real world data on success rates and safety of this new technology.

Purpose
To investigate the success rate as well as the safety profile of robotic-assisted percutaneous coronary intervention (R-PCI) and compare it with manual PCI (M-PCI).

Methods
We report preliminary data of our ongoing, prospective FRiK registry, started in mid 2021. This registry focuses on success rates and safety, radiation dose of patients and personnel, long-term outcome (after 6, 12 and 24 months), as well as on economic aspects and the learning curve of the interventionalists. Moreover, the R-PCI is compared with the M-PCI in these categories.

Results
So far, 51 patients (age 69 (62–80) years, BMI 28.4 (25.2–32) kg/m2, 74.5% male), received R-PCI. PCI success rate was 100%, with 15% requiring manual assistance (Figure 1). Rate of complications (myocardial infarction after PCI, dissection, stent thrombosis, pericardial effusion, target lesion revascularization and MACE (major adverse cardiovascular events) was 0%.
Compared with 41 M-PCI patients (Table 1), treated by the same interventionalists, there was a higher median procedural time (diagnostic and intervention) 106 (82–127) min vs. 71 (54–93) min (p&lt;0.001) and fluoroscopy time 20.3 (14.8–28.5) min vs. 14.8 (10.4–22.4) min (p=0.012) in R-PCI patients. However, there was no significant difference between the dose-area product 4662.4 (3019.4–6399.2) cGy cm2 vs. 4193.9 (2759.9–6254.3) cGy cm2 (p=0.487) and contrast volume use 200 (150–280) ml vs. 180 (145–255) ml (p=0.587).

Conclusion
Preliminary results of R-PCI showed a high success rate, low rates for need of manual assistance, and a very high safety profile without any complications. The dose-area product and contrast volume use were comparable between R-PCI and M-PCI, whereas R-PCI showed a longer procedural and fluoroscopy time. Future steps will include a larger number of cases and definitions of patient cases with optimal eligibility for R-PCI.

Funding Acknowledgement
Type of funding sources: None.
Vascular access in complex high-risk but indicated percutaneous coronary interventions (CHiP) types, trends, and outcomes
Authors: Al Shamkhani W , Rashid M , Mamas M A 
Published: October 2022

Abstract

Background
Radial access improves the safety of PCI; however, its role in Complex, High-risk but indicated Percutaneous coronary interventions (CHiP) remains poorly studied.

Objectives
To examine CHiP types, clinical and procedural characteristics and clinical outcomes according to vascular access.

Methods
Data was obtained from the British Cardiovascular Intervention Society. We compared the baseline characteristics of 125,662 CHiP procedures performed electively between 2006 and 2017 stratified by access site. Multivariate regression analyses was used to investigate the access site specific odds for in-hospital death, bleeding, and major cardiovascular and cerebral events (MACCE).

Results
Overall, 61,825 CHiP procedures (49.2%) were performed via transradial access (TRA) and 63,837 (50.8%) via trans-femoral access (TFA). TRA use increased over time (14.6% in 2006 to 78.4% in 2017). The patients who had PCI through TRA were older (Median age: TRA, 71.2 vs TFA, 70.2 years). Cardiovascular risks were more prevalent in the TRA than TFA (stroke: 5.3 vs 4.3%; hypertension: 67.4 vs 64.3%; peripheral vascular disease: 7.2 vs 6.7%; smoking: 9.6 vs 8.9% respectively; p&lt;0.001 for all). TRA patients had higher rates of multi-vessel PCI than TFA (two or more vessel PCI: 27.2 vs 24.2% respectively; p&lt;0.001) and longer lesions (median stent length: 24mm vs 23mm). TFA group had higher rates of diabetes (26.6 vs 25.8%), previous myocardial infarction (44.2 vs 40.2%), previous PCI (38.7 vs 37.1%), heart failure (10.3 vs 9.3%), respectively (p&lt;0.001 for all) suggesting operators' tendency to choose TFA in patients with greater cardiometabolic burden. TRA adoption was more prevalent in most CHiP types (elderly (54%), chronic renal failure (55.7%), poor LV function (51.4%), left main PCI (51.2%), treatment for severe vascular calcifications (53.1%)). Following adjustment for differences in clinical and procedural characteristics, TFA was independently associated with increased odds for mortality (aOR: 1.4 (1.1–1.8), p=0.004), bleeding (aOR: 2.9 (2.4–3.5), p&lt;0.001), and MACCE (aOR: 1.2 (1.1–1.3), p&lt;0.001).

Conclusion
Over the 12 years, TRA has become the predominant access site used in CHiP PCI and is associated with significantly lower mortality, major bleeding and MACCE odds than TFA. Addressing the cardiometabolic burden-treatment paradox by preferentially selecting TRA as the baseline cardiovascular burden increases may potentially improve CHiP clinical outcomes.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): An unrestricted educational grant from Abbott supports Warkaa Shamkhani's salary. However, the company had no role in the study design, manuscript preparation, or access to the manuscript's contents before submission. The authors are solely responsible for this study design and conduct and all analysis, drafting, and editing of the manuscript and its final content.