bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of COVID-19 patients with STEMI undergoing primary PCI
Authors: Kleczynski P , Niewiara L , Kulbat A , Kaczynski M , Pawlowski T , Socha` S , Rakowski T , Gil R , Bartus S , Legutko J 
Published: October 2022

Abstract

Introduction and aim
Coronavirus disease (COVID-19) has substantial impact on acute myocardial infarction (AMI) clinical course and outcome.
In Poland during early phase of COVID-19 pandemic a network of dedicated hospitals was set to treat SARS-Cov2 positive patients. There is scarce data on STEMI patients outcome treated in this setting.
Our aim was to compare outcomes of STEMI patients treated with primary PCI in hospitals dedicated to treat COVID-19 and referral high volume haemodynamic centres.

Methods
Study was a retrospective analysis of 115 consecutive COVID-19 patients with STEMI, treated with primary PCI, admitted to 4 high volume centres (2 referral hospitals and 2 COVID dedicated sites) in southern Poland between May 2020 and November 2021. Data was obtained from patients' electronic medical records.

Results
Detailed characteristics are presented in Table 1 and 2. In general in all hospitals, patients were similar in terms of age (median 69 y.o., IQR: 60–73), with similar profile of comorbidities. All patients used acetylsalicylic acid and unfractioned heparin.
In referral centres, as compared with COVID-19 dedicated sites, there was a higher use of mechanical thrombectomy (p&lt;0.001) and adenosine (p&lt;0.001). Overall mortality rate was higher in COVID-19 centres (50% vs 25%, p=0.008). Detailed results are presented in Table 3.

Conclusions
There is a significantly higher mortality in COVID patients who develop STEMI than in patients with STEMI who were tested positive on admission.
Patients in COVID-19 hospitals had higher levels of CRP and NT-proBNP at baseline.
There are substantial differences in treatment of patients in referral centres and COVID dedicated hospitals.

Funding Acknowledgement
Type of funding sources: None.
Changes in cardiovascular risk factors in patients undergoing first time coronary revascularization from 2003–2020, A nationwide population study
Authors: Pham M , Christensen D M , Kristensen A T , Clausen C S , Gislason G H , Olsen N T 
Published: October 2022

Abstract

Introduction
Current knowledge of cardiovascular risk factors is primarily based on older studies that may not reflect current populations. Monitoring risk factors may influence decisions about prevention and treatment of ischemic heart disease. We hypothesize that the prevalence of traditional risk factors in patients undergoing first-time coronary revascularization has changed over time.

Purpose
We examined the proportion of patients with traditional cardiovascular risk factors from year 2003–2020 in patients undergoing first-time coronary revascularization.

Methods
We identified all adults undergoing first-time coronary revascularization (percutaneous intervention and bypass grafting) from 2003–2020 using Danish nationwide registries. Risk factors were defined as either medical prescriptions or diagnosis prior to first-time revascularization. We calculated the proportion of individual risk factors per year with associated 95% CI, and calculated the trend using chi-squared test for trend in proportion.

Results
We identified 152,692 patients who underwent first-time coronary revascularization. 78.5% of the patients underwent percutaneous coronary intervention and 21.5% underwent coronary artery bypass grafting, 73.8% were male, mean age 65 (SD 11.5), and 67.9% had at least 1 risk factor at first-time revascularization.
Figure 1 shows the trends in risk factors from 2003 to 2020.
From 2003–2005 to 2018–2020, the proportion of patients with at least 1 risk factors changed from 70.9 to 64.0%, hypertension changed from 41.4 to 36.0%, hypercholesterolemia decreased from 47.6 to 43.6%, aspirin use decreased from 52.4 to 32.06%, diabetes increased from 11.7 to 15.8%, chronic kidney disease increased from 2.4 to 4.4%, and chronic obstructive pulmonary disease increased from 4.95 to 4.96% (p-value for trend &lt;0.001 for all risk factors, except chronic obstructive pulmonary disease (p-value 0.96)).

Conclusion
We assessed the temporal trends in coronary risk factors over a 17-year period in patients undergoing first-time coronary revascularization. We found a large decrease in the proportion of patients with any risk factor, hypertension, hypercholesterolemia, and aspirin use, and an increase in diabetes and chronic kidney disease. The proportion of patients with chronic obstructive pulmonary disease was unchanged.

Funding Acknowledgement
Type of funding sources: None.
Clinical outcomes of percutaneous coronary intervention and rotational atherectomy using second generation drug eluting stents: a Korean multicentre analysis
Authors: Kim K , Lee K , Jung J , Choi I , Lee J , Lee J , Lee S , Lee P , Lee S , Yoo K , Yun K , Lee H , Her S 
Published: October 2022

Abstract

Background
The aim of this study was to compare the clinical outcomes of different second generation drug-eluting stents (DES) in patients with calcified coronary lesions who underwent percutaneous coronary intervention using rotational atherectomy.

Methods
This study was based on a multicentre registry which enrolled patients with calcified coronary artery disease who received RA during between January 2010 and October 2019 from 9 tertiary centres in Korea. The primary outcome was target-vessel failure (TVF), defined as the compositae of cardiac death, target-vessel myocardial infarction (MI), and target-vessel revascularisation (TVR). The secondary outcomes were all-cause death, cardiac death, target vessel MI, TVR, cardiovascular accident, stent thrombosis, and total bleeding.

Results
540 patients who underwent PCI after RA were enrolled and followed up for a median period of 16.1 months. From this registry, 439 patients who were treated using second generation DES were selected for further analysis. They were divided into four groups based on the characteristics of the stents used during the procedure. [Group I cobalt-chromium sirolimus eluting stent (CoCr-SES): Ultimaster 48 & Orsiro 30, Group II platinum-chromium everolimus eluting stent (PtCr-EES): Synergy 93 & Promus 70, Group III cobalt-chromium everolimus eluting stent (CoCr-EES): Xience 105, Group IV zotarolimus eluting stent (ZES): Resolute 93] There was no inter-group difference in procedural success rates, and the primary outcome of TVF showed no difference across the four groups (I: 10.3%, II: 13.5%, III: 13.3%, IV: 15.1%, log-rank p=0.922). Even after multivariate Cox regression analysis, there was no significant difference in TVF, or the secondary outcomes of all-cause death, cardiac death, target vessel MI, TVR, cardiovascular accident, stent thrombosis, and total bleeding.

Conclusions
There was no difference in procedural success rates and clinical outcomes between four different types of second-generation DES (CoCr-SES, PtCr-EES, CoCr-EES, ZES) in patients who underwent PCI using RA.

Funding Acknowledgement
Type of funding sources: None.
Results of percutaneous treatment of the left main coronary artery in elderly patients
Authors: Gallo Fernandez I , Pastor Wulf D , Lopez Baizan J , Serrano Criado M , Gonzalez Manzanares R , Flores Vergara G , Duenas Perez G , Ojeda Pineda S , Romero Moreno M , Pan Alvarez-Ossorio M , Hildago Lesmes F J 
Published: October 2022

Abstract

Introduction and objectives
Surgical revascularization of the left main (LM) coronary lesions has been the most accepted strategy. However, elderly and frailty patients are not represented in the specific trials that compared surgical versus percutaneous revascularization. Conservative treatment does not seem to be a feasible option due to high major cardiac adverse event rate at short term follow-up. The objective of the study was to analyze the results of percutaneous treatment of the LM in elderly patients who were not candidates for surgical revascularization due to high surgical risk or medical decision.

Methods
We performed an unicentric, retrospective and descriptive study. We included patients aged 75 years or older who presented with an LM lesion (isolated or associated with other coronary lesions) between between 2017 and 2021 underwent percutaneous treatment.

Results
During this time period, a total of 140 patients who met the inclusion criteria were treated in our center. The mean age was 81±4 years and 64% (89 patients) were male. Acute coronary syndrome was the clinical presentation in 59% of patients. Seventy-five patients (54%) met criteria of frailty or high comorbidity. The use of nonsteroidal anti-inflammatory drugs were predominated risk factor associated (94 patients, 67%). Immediate success of the procedure was obtained in 97%, with an in-hospital mortality of 7%. The remaining variables are described in Figure 1. With a median follow-up of 19 months, 29 adverse cardiac events (20%) were recorded: 3 (2%) patients suffered a nonfatal myocardial infarction, 7 (5%) patients required a new revascularization, and 19 (14%) patients died of cardiac causes. However, up to 11% (15 patients) died of non-cardiac causes at follow-up (Figure 1 and 2a). A non-significant trend was found for a worse prognosis in terms of survival in frail patients (HR: 1.6 (0.76–3.3), p: 0.212) (Figure 2b).

Conclusions
Percutaneous treatment of left main coronary artery in elderly patients with multiple associated comorbidities could be considered a feasible option in this special population. The rate of cardiac events at follow-up seems acceptable.

Funding Acknowledgement
Type of funding sources: None.
Impact of the ISCHEMIA randomized clinical trial on the management of patients with chronic coronary syndrome
Authors: Spagnolo M , Laudani C , Occhipinti G , Agnello F , Legnazzi M , Scalia L , Mauro M S , Rochira C , Finocchiaro S , Greco A , Capodanno D 
Published: October 2022

Abstract

Background
In the ISCHEMIA trial, patients with chronic coronary syndromes (CCS) and moderate or severe ischemia had no significant difference in combined ischemic events with an initial invasive compared with a conservative strategy [1]. Coronary computed tomography angiography (CCTA) was part of the pre-randomization workup of ISCHEMIA and is gaining popularity over ischemia testing or initial invasive coronary angiography (ICA) as the initial diagnostic strategy for CCS [2].

Purpose
To analyse whether the results of the ISCHEMIA trial had a sizeable impact on the diagnostic algorithm for CCS by analysing trends in referral to ICA and/or revascularization.

Methods
ICAs performed in CCS patients between November 2019 and February 2022 at a high-volume centre were analysed. Two groups were defined based on procedure date: i) pre-ISCHEMIA, including ICAs performed before March 2020 (date of trial publication); ii) post-ISCHEMIA, including ICAs performed ≥3 months (i.e., blanking period) after trial publication. The primary outcome was the incidence of referral to ICA by CCTA. Secondary objectives included referral to ICA or revascularization by ischemia testing, referral to revascularization by CCTA, and referral by CCTA to ICA that did not require further intervention.

Results
A total of 2,365 patients qualified for the analysis, of which 487 (20.6%) and 1878 (79.4%) in the pre-ISCHEMIA and post-ISCHEMIA groups, respectively. There were no notable differences in baseline characteristics between groups. The primary outcome occurred more frequently in the post-ISCHEMIA group (73.5% vs 32.5%, p&lt;0.01). Referral to ICA by ischemia testing was lower in the post-ISCHEMIA group (31.6%, vs 52.5% p&lt;0.01), while referral for revascularization by CCTA was more frequent (8.3% vs 12.0% p&lt;0.01). There were no significant differences in referral to revascularization by ischemia testing (3.4% vs 3.0%, p=0.73) and referral by CCTA to ICA that did not require further intervention (60.3% vs 60.8%, p=0.90).

Conclusions
At two years from publication, the ISCHEMIA trial seems to have impacted significantly on the decision-making algorithm for patients with CCS. The frequency of referral to ICA and revascularization by CCTA considerably increased, paralleled by decreased referral to ICA by ischemia testing.

Funding Acknowledgement
Type of funding sources: None.
Clinical features and lipid profiles of plaque erosion over lipid rich plaque versus fibrous plaque
Authors: Sekimoto T , Mori H , Koba S , Suzuki H , Shinke T 
Published: October 2022

Abstract

Backgrounds and aims
Plaque erosion (PE) which is one of the most common causes of acute coronary syndrome (ACS) can occur over fibrous plaque or lipid-rich plaque (LRP) according to pathological reports. Whereas in plaque rupture (PR) the main cause of ACS, underlying plaque is basically LRP with thin fibrous cap. We aimed to investigate the clinical features and lipid profiles of PE with or without LRP in comparison to PR.

Methods
A total of 165 statin-naïve patients with ACS who underwent percutaneous coronary intervention using optical coherence tomography and met the criteria for PR or PE were included. LRP was defined as a plaque with lipid having the maximal lipid arc (&gt;180°). Culprit lesions were categorized into the PR, PE with/without LRP [PE(LRP), PE(Fibrous), respectively).

Results
The prevalence of PR, PE(LRP), and PE(Fibrous) was 104 (63.0%), 42 (25.5%), and 19 (11.5%), respectively. Patients with PR and PE(LRP) had significantly higher peak creatine kinase (1338, 1733, 214 U/L, respectively, P&lt;0.01) and more prevalence of ST-elevation myocardial infarction (71.2, 78.6, 21.1%, respectively, P&lt;0.01) than PE(Fibrous).
Overall, the levels of the various lipid profiles were mostly comparable between PE(Lipid) and PR but different in PE(Fibrous). The levels of small-dense low-density lipoprotein cholesterol was significantly greater in PR and PE(LRP) than in PE(Fibrous) (39.0, 36.6, 25.7 mg/dL, respectively, P=0.02).

Conclusion
PE(LRP) had substantially different clinical features and lipid profiles compared to PE(Fibrous) showing some similarity to those of PR.

Funding Acknowledgement
Type of funding sources: None.
Fractional flow reserve versus angiography guided revascularization for patients with multivessel coronary artery disease: a systematic review and meta-analysis of randomized controlled trials
Authors: Goel S , Slomovich S , Edris S , Park W J , Agarwal C , Hooda A , Krishnamoorthy P M , Gidwani U , Sharma S , Kini A 
Published: October 2022

Abstract

Background
Recently published randomized controlled trials (RCT) have questioned the utility of Fraction Flow Reserve (FFR) to guide revascularization in patients with multivessel coronary artery disease (CAD) as compared to Angiography

Purpose
This current analysis aimed to compare the clinical outcomes associated with FFR guided versus standard angiography-guided revascularization for patients with multivessel CAD using a large number of randomized patients with stable CAD and acute coronary syndrome (ACS)

Methods
We conducted an electronic database search of all published data for RCT that compared FFR versus Angiography for patients with multivessel CAD and reported on subsequent mortality, cardiac death, myocardial infarction, revascularization, and other outcomes of interest. Event rates were compared using a forest plot of odds ratios using a fixed-effects model assuming interstudy heterogeneity.

Results
Eleven RCT (n=6052; FFR = 3043, Angiography = 3027) were included in the final analysis. Mean follow-up period was 1.7 years. In our analysis, FFR guided revascularization as compared to angiography guided revascularization alone was not associated with any significant reduction in overall mortality (OR = 1.10, 95% CI = 0.83–1.47, P=0.47, I2=0), cardiac mortality (OR = 0.95, 95% CI = 0.63–1.45, P=0.42, I2=0), all revascularization (OR = 0.96, 95% CI = 0.80–1.14, P=0.17, I2=31%) or myocardial infarction (OR = 0.99, 95% CI = 0.79–1.23, P=0.33, I2=12%). There was also no difference between two groups in terms of major adverse cardiac or cerebrovascular event [MACCE] (OR = 1.13, 95% CI = 0.90–1.42, P=0.39, I2=5%), major adverse cardiac event [MACE] (OR = 0.86, 95% CI = 0.70–1.07, P=0.55, I2=0), stroke/TIA (OR = 1.61, 95% CI = 0.92–2.82, P=0.36, I2=8%) or target lesion revascularization [TLR] (OR = 0.86, 95% CI = 0.44–1.67, P=0.71, I2=0). Furthermore, sensitivity analysis was conducted to include only studies with ACS patients and studies which used CABG only for revascularization. However, there was no difference between the two groups for any of the above outcomes

Conclusion
There is no difference in clinical outcomes in patients undergoing FFR-guided versus angiography guided revascularization for multivessel CAD

Funding Acknowledgement
Type of funding sources: None.
Comparison of quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) during daily routine in the catheterization laboratory
Authors: Antoniadis M , Stader J , Ussat M , Wachter R , Jurisch D , Lavall D , Metze M , Neef M , Baum P , Spies C , Laufs U , Lenk K 
Published: October 2022

Abstract

Background
The prognosis of patients with coronary artery disease (CAD) depends strongly on the hemodynamic relevance of the stenosis. The gold standard is the invasive evaluation of the stenosis using Fractional Flow Reserve (FFR), instantaneous wave-free ratio (iFR) or Resting Full-Cycle Ratio (RFR). The use of invasive procedures remains low due to procedural factors and costs. Quantitative Flow Ratio (QFR) is a novel, software-based method to evaluate the physiology of coronary lesions during cardiac catheterization. Computing a three-dimensional model of the vessel based on two angiographic recordings and analyzing the fluid dynamics of the contrast medium flow, the software computes the FFR. In the setting of clinical studies, it has been demonstrated that QFR is feasible and correlates well with FFR. The aim of this study is to compare feasibility and reliability of QFR with established measurements of the iFR or RFR in daily routine.

Methods
Patients with an indication for an invasive coronary angiography and a stenosis of 30 to 90% were simultaneously assessed using QFR and iFR/RFR in a routine setting. The QFR-computation was performed online by a certified expert with QAngio XA 3D 3.2. The following outcome parameters were analyzed: time to result, volume of applicated contrast medium, applicated dose area product, result of the evaluation. The results have been registered for both methods, respectively.

Results
102 coronary arteries were analyzed using QFR and iFR or RFR. QFR shows a good correlation (r=0.753, AUC=0.922) and accuracy (agreement 89.22%, sensitivity 95.83%, specificity 83.33%, PPV 83.64%, NPV 95.74%). The data show that QFR delivers significantly faster results and reduces the procedure related applicated radiation dose from in median 598.8 cGy cm2 to 306.75 cG ycm2 (p&lt;0.001). The study shows no significant difference regarding the amount of contrast medium used.

Conclusion
QFR has a good diagnostic agreement and can reduce procedure length and applicated radiation dose. Thereby QFR could increase the use of physiologically guided coronary interventions in daily routine.

Funding Acknowledgement
Type of funding sources: None.
Cardioprotective effect of empagliflozin in acute myocardial infarction: the role of ketone bodies availability
Authors: Badimon J J , Santos-Gallego C G , Requena-Ibanez J A , Picatoste B , Fardman B , Ishikawa K , Mazurek R , Pieper M , Fuster V 
Published: October 2022

Abstract

Background
The cardio-renal benefits of SGLT2i have been clearly established by clinical trials. Of interest, despite not having any effect on the incidence of classic atherothrombotic events (MI and strokes), patients receiving SGLT2i treatment had a higher chance of surviving myocardial infarction (MI).

Purpose
We aim to evaluate the cardioprotective potential of empagliflozin on acute myocardial infarction.
We postulate that the benefits of SGLT2-I are mediated via an increase in circulating ketone bodies (KBs) induced by SGLT2i, and its preferential myocardial utilization energetically benefits the heart to better withstand an ischemic event.

Methods
The study was undertaken in our non-diabetic porcine model of ischemia/reperfusion. Animals were allocated to either one-week pre-treatment with empagliflozin or placebo before MI-induction. A third group received IV infusion of KBs at the time of the MI- induction to serve as positive-control. The acute effects of the treatments were studied 24 hours after MI-induction by Cardiac Magnetic Resonance (CMR). Immediately post-CMR, animals were sacrificed and heart samples collected for molecular analysis.

Results
(see Table and Figure): Despite similar initial ischemic injury (area at risk) in all groups, empagliflozin was associated with a significantly higher myocardial salvage (MSI 23.7±9.7 vs 4.5±3.6%, p&lt;0.001) and better preserved cardiac function (LVEF 41.3±3.1 vs 33±5.5%, p&lt;0.009) compared with placebo. The infusion of KBs replicated in part the beneficial profile of the empagliflozin group (MSI 16.7±8.8 and LVEF 39.1±3.6%). Histological analysis showed less cardiomyocyte apoptosis and less oxidative stress

Conclusions
To the best of our knowledge, this is the first study evaluating in vivo the cardioprotective potential of a SGLT2 inhibitor in a well-stablished porcine translational model. Furthermore, effects are evaluated using the gold standard for visualization and quantification of MI, Cardiac Magnetic Resonance (CMR). Three are the main conclusions:
1. One-week treatment with empagliflozin raises circulating KBs levels and confers significant cardio-protection during a myocardial infarction. Acute post-MI benefits (greater myocardial salvage and better preserved cardiac function) are already seen within 24 hours as compared with placebo.
2. Periprocedural IV infusion of KBs induces similar benefits than the SGLT2-I group.
3. These observations strongly support our hypothesis that SGLT2 inhibition is associated with increased circulating KBs and its selective use as preferential myocardial source of energy as a potential mechanism of action involved in the cardio-renal benefits observed with SGLT2i.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology. Research Fellowship Grant.