bluuebunny/crossref_metadata_2025_split huggingface dataset:
471 IMPACT OF COMPLETE REVASCULARIZATION ON DEVELOPMENT OF HEART FAILURE IN PATIENTS WITH ACUTE CORONARY SYNDROME AND MULTIVESSEL DISEASE
Authors: Bruno Francesco , Marengo Giorgio , Filippo Ovidio De , Wanha Wojciech , Leonardi Sergio , Rubin Sergio Raposeiras , Fabris Enrico , Giannino Giuseppe , Truffa Alessandra , Gaibazzi Nicola , Ielasi Alfonso , Sardella Gennaro , Gallone Guglielmo , Cortese Bernardo , Montalto Claudio , Ugo Fabrizio , Barbieri Lucia , Morici Nuccia , Mancone Massimo , Campo Gianluca , Sinagra Gianfranco , D´ascenzo Fabrizio , De Ferrari Gaetano Maria 
Published: December 2022

Abstract

Background
The impact of complete revascularization (CR) on survival and occurrence of heart failure (HF) after ACS is still unsettled. Goal of this study was to evaluate the impact of CR on HF hospitalization and adverse outcomes in patients with ACS and multivessel coronary artery disease undergoing PCI.

Methods
Consecutive ACS patients with multivessel disease from the CORALYS registry were included. First hospitalization for HF or cardiovascular (CV) death was the primary endpoint. Patients were stratified according to CR.

Results
Of 14699 patients in the CORALYS registry, 5054 had multivessel disease. 1473 (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary endpoint (adjusted HR 0.66, 95% CI 0.51-0.85), first HF hospitalization (adj HR 0.67, 95% CI 0.49-0.90), CV death (adj HR 0.56, 95% CI 0.38-0.84) and all-cause death (adj HR 0.74, 95% CI 0.56-0.97). The results were consistent in the matched population and in the IPTW analysis. The benefit of CR was consistent across ACS presentations (HR 0.59, 95% CI 0.39-0.89 for STEMI and HR 0.71, 95% CI 0.50-0.99 for NSTE-ACS) and in patients with LVEF&gt;40% (HR 0.52; 95% CI 0.37-0.72), while no significant benefit was observed in patients with LVEF≤40% (HR 0.77; 95% CI 0.37-1.10, p for interaction 0.04).

Conclusions
In patients with ACS and multivessel disease, CR reduced the risk of first hospitalization for HF and CV death, as well as first HF hospitalization, CV and overall death. When feasible, CR should be performed in all patients with ACS to reduce the incidence of HF and death. Future studies are needed to assess the evidence of CR in patients with depressed LVEF.
1140 CLINICAL OUTCOME OF FRACTIONAL FLOW RESERVE GUIDED REVASCULARIZATION STRATEGY OF CORONARY LESIONS: THE HALE-BOPP STUDY
Authors: Caglioni Serena , Campo Gianluca , Gallo Francesco , Scoccia Alessandra , Durante Alessandro , Tedeschi Delio , Verdoliva Sebastiano , Cortese Bernardo , Bilotta Ferruccio , Watkins Stuart , Ielasi Alfonso , Valentini Giuliano , Arena Marco , Mele Daniela , Pavasini Rita , Serenelli Matteo , Pompei Graziella , Scala Antonella , Gibiino Federico , Scollo Ennio , D´aniello Emanuele , Biscaglia Simone , Barbato Emanuele , Tebaldi Matteo 
Published: December 2022

Abstract

Background
There are currently some doubts about the efficacy of fractional flow reserve (FFR)-guided revascularization in different clinical settings.

Aim
To evaluate the long-term outcome of an FFR-deferred strategy in daily practice.

Methods
The Clinical Outcome of FFR-guided Revascularization Strategy of Coronary Lesions (HALE-BOPP) is an investigator-initiated, multicenter, international prospective study consecutively enrolling patients who underwent FFR measurement on at least one vessel. According to decision-making workflow and treatment, vessels were classified in three subgroups: i) angio-revascularized, ii) FFR-revascularized, iii) FFR-deferred. The primary endpoint was the occurrence of target vessel failure (TVF, cardiac death, target vessel myocardial infarction and ischemia-driven target vessel revascularization). The analysis is carried out at vessel- and patient-level.

Results
Overall, 1305 patients with 2422 diseased vessels fulfilled criteria for the present analysis. Wire-related pitfalls and transient adenosine-related side effects occurred in 0.8% (95%CI 0.4%-0.1%) and 3.3% (95% 2.5%-4.3%) of cases, respectively. In FFR-deferred vessels the overall incidence rate of TVF was 0.024% (95%CI 0.019-0.031) lesion/year. After a median follow-up of 3.5 years, the occurrence of TVF was 6%, 7% and 11.7% in FFR-deferred, FFR-revascularized and angio-revascularized vessels, respectively. As compared to angio-revascularized vessels, FFR-guided vessels (both FFR-revascularized and FFR-deferred vessels) showed a lower TVF incidence rate lesion/year (0.029, 95%CI 0.024-0.034 vs. 0.049, 95%CI 0.040-0.061 respectively, p= 0.0001). This was consistent after correction for confounding factors and across subgroups of clinical interest. Patient-level analysis confirmed the lower occurrence of TVF in negative-FFR vs. positive-FFR subgroups.

Conclusions
In a large prospective observational study, FFR-based strategy for the deferral of coronary lesions is reliable and safe and associated with good long-term outcome.
773 CONTRAST-ENHANCED EXCIMER LASER CORONARY ANGIOPLASTY IN THE TREATMENT OF HEAVILY CALCIFIED LESIONS: A STEPWISE APPROACH
Authors: Caminiti Rodolfo , Vetta Giampaolo , Parlavecchio Antonio , Mazzone Paolo , Giacchi Giuseppe , Sacchetta Giorgio , Della Rocca Domenico Giovanni , Magnocavallo Michele , Virga Vittorio , Costa Francesco , Di Bella Gianluca , Carerj Scipione , Contarini Marco , Vizzari Giampiero , Micari Antonio 
Published: December 2022

Abstract

Introduction
The treatment of heavily calcified lesions is a challenge for the interventional cardiologist. The Excimer laser coronary atherectomy (ELCA) is a plaque modification tool and the main mechanism of action seems to be the photomechanical delivering acoustic pressure with a mechanical disruption of the plaque in front of the catheter tip.

Objective
To evaluate the effectiveness of the contrast-enhanced ELCA by a stepwise approach, with incremental frequency/fluency in the treatment of calcified lesions in different contexts.

Methods
We retrospectively enrolled consecutively all patients undergoing contrast-enhanced ELCA-assisted PCIs between 2018 and 2021 at the Cardiology Unit of “Umberto I” Hospital of Syracuse (Italy).
The frequency/fluency ELCA profile used with a stepwise approach were 50/50, 60/60, 70/70 and 80/80. ELCA technical success was defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. Procedural success was defined as &lt;30% residual stenosis after laser and adjunctive therapy. Clinical success requested procedural success with absence of major adverse cardiac events at hospital discharge. Major adverse cardiac events included death of all causes, myocardial infarction, need for target lesion revascularization, tamponade, and life-threatening arrhythmias.

Results
We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI. 58% of the patients had acute coronary syndrome and 42% had chronic coronary syndrome. The left anterior descending artery was the target vessel in 42.1% of cases, the right coronary artery in 26.3%, the circumflex in 10.5%, and the left main artery in 2.3%. The main indication for ELCA was intrastent restenosis (56.2%). The median stenosis was 90% (80% – 90%).
The ELCA catheter tip was 0.9 mm and 1.4 mm was employed in the 89.5% and 10.5% of cases respectively. The most used frequency/fluency profile was 70/70 (39.5%) followed by 60/60 (31.6%), 50/50 (15.8%) and 80/80 (13.2%). Use of contrast-enhanced ELCA was associated with high technical success rate (97.4%), procedural success rate (93.7%), and clinical success rate (97.1%).

Conclusions
In Conclusion, the contrast-enhanced ELCA seems to be a safe and effective treatment for management of calcified lesions.
89 GUIDE EXTENSION CATHETER: INDICATION, USE AND RESULTS IN A LARGE SERIES OF COMPLEX PERCUTANEOUS CORONARY INTERVENTIONS
Authors: Cappannoli Luigi , Marchetta Michele , Ausiello Davide , Romagnoli Enrico , Burzotta Francesco , Cristina Aurigemma , Giambusso Nicole , Fulco Linda , Vergallo Rocco , D´amario Domenico , Leone Antonio Maria , Antonio Montone Rocco , Buffon Antonino , Crea Filippo , Trani Carlo 
Published: December 2022

Abstract

Aims
The guide extension catheter (GEC) is a helpful tool to increase catheter support when facing complex percutaneous coronary intervention (PCI) in unfavorable coronary anatomies. The aim of this study was to describe indication, efficacy, and safety of the GEC in a high-volume center.

Methods and results
From 2014 to 2021, we retrospectively identified and analyzed 351 interventional cases in which GEC was used to complete the procedure. The endpoints of the study were PCI success, procedural success and device failure. GEC use increased over the years and was more frequently used by radial approach (92.1%) in elective setting (90.6%) and using the 6F size (95.3%). The GEC was mostly implemented as bail-out strategy (75.9%) with the aim to improve back-up (89.6%), less frequently to optimize catheter alignment or obtain selective coronary cannulation (10.4%). Intracoronary advancement was performed using the guidewire in 1.3% of cases, after positioning of a second “buddy” wire in 23.2%, with support of a deflated balloon at the distal tip in 12.2%, or with anchoring technique in 63.3%. Mean coronary deep intubation depth was 38.8±23.9mm. Vessel and lesion characteristics are reported in Table I.
Overall, PCI success rate was 92.5%, while procedural success (PCI success without in hospital adverse event) was 88.6%. GEC was successfully used in 92.7% of patients with no device-dependent severe adverse events; in particular, failures were related to inability to cross the target lesion in 4.5% or to device–related complication in 2.85% of cases.

Conclusions
This large real-world registry on GEC use in complex PCI confirms the GEC as a valid and safe tool to increase backup support and overcome the limits of conventional technique during complex PCI.
1068 THE IMPACT OF COMMISSURAL ALIGNMENT ON CORONARY ARTERY ACCESS: A META ANALYSIS
Authors: Carabetta Nicole , Boccuto Fabiola , Panuccio Giuseppe , Canino Giovanni , Indolfi Ciro , Rosa Salvatore De 
Published: December 2022

Abstract

Background
The use of TAVR has been spreading out globally due to its favorable safety profile and the excellent efficacy data from randomized controlled trials. With the growing number of treated patients, the attention is rising around specific issues, such as the treatment of intercurrent coronary artery disease. Commissural alignment of transcatheter heart valves (THV) has the potential to reduce the impact of the prosthesis on accessibility of coronary ostia, as misalignment of the neo-commissures could be responsible for partial overlap with coronary artery ostia. However, no definitive evidence is available, despite multiple trials have addressed this issue.

Methods
The aim of this meta-analysis was to investigate the impact of the commissural alignment on coronary filling. We examined the techniques of commissural alignment and their impact on coronary access and coronary overlap. Eligible studies were searched for on Pubmed and SCOPUS and selected using the PRISMA guidelines. The primary endpoint is a composite of severe coronary overlap and failure of transcatheter coronary access. Odds Ratio were used as the metric for comparison between the groups. A random effects meta-analysis was selected as the calculation model.

Results
Six studies with a total of 1213 patients were included in this analysis. Of these patients, 757 patients underwent TAVR with commissural alignment and 456 underwent TAVR without commissural alignment. The composite endpoint of coronary overlap and failure of coronary access occurred in 118 patients undergoing TAVR with commissural alignment and in 124 patients without commissural alignment (OR=0.20, 95% CI 0.08-0.48; p= 0.0003).

Conclusions
Commissural alignment was associated with significantly lower rates of commissure-to-coronary-ostia overlap and failure of coronary access. Therefore, a modified insertion technique could reduce coronary overlap and coronary occlusion, particularly in supra-annular valves. Commissural alignment performed during TAVR could therefore have an important role in coronary re-access and re-intervention especially in younger patients.
683 TWO IS BETTER THAN ONE!
Authors: Circhetta Simone , Ricottini Elisabetta , Nusca Annunziata , Melfi Rosetta , Mangiacapra Fabio , Gallo Paolo , Cocco Nino , Rinaldi Raffaele , Cammalleri Valeria , Bernardini Federico , Nobile Edoardo , Filippis Aurelio De , Viscusi Michele Mattia , Grigioni Francesco , Paolo Ussia Gian 
Published: December 2022

Abstract
Patients suffering from atrial fibrillation (AF) and severe aortic stenosis thus undergoing transcatheter aortic valve implantation (TAVI) have a worse prognosis than those in sinus rhythm. One of the reasons of this is related to the augmented bleeding risk associated with oral anticoagulation (OAC). Left atrial appendage occlusion (LAAO) represents a therapeutic choice to avoid this drug intake and to reduce this kind of adverse outcome. So, a combined procedure of TAVI and LAAO could be an option for TAVI candidates with AF to omit the need for OAC.
The clinical case concerns an 85-year-old man with hypertension and dyslipidemia with a history of recent syncope and permanent atrial fibrillation in therapy with antithrombotic drug. Brain MRI performed during hospitalization showed numerous hemosiderin deposits with microhemorrhagic foci thus contraindicating oral anticoagulation. Severe aortic stenosis has also been found to the transthoracic echocardiogram with a mean gradient of 35 mmHg and confirmed by transesophageal echocardiogram with a planimetric area of 0.8 sq.cm.
Furthermore, given the finding of significative left circumflex artery disease, after Heart Team discussion and the execution of CT scan that demonstrated the feasibility of transcatheter approach, it was decided to perform in a single session percutaneous coronary intervention (PCI) plus TAVI plus left atrial appendage closure (LAAO).
This kind of approach allowed a quick recovery to the patient after a short period of hospitalization. After six months from interventional procedure his NYHA (New York Heart Association Functional Classification) status improved abutting on I/II class.
As described above, it can be deduced that combined approach (TAVI+LAAO) is feasible for certain kind of patients thus avoiding surgical approach and long hospitalization. Furthermore, multimodality imaging is of critical importance to plan a complex procedure and an accurate step-by-step pre-procedural strategical planning is the key for procedural success.
273 CORONARY ARTERIES ANEURYSMS: CASE-BASED DISCUSSION
Authors: Di Caccamo Leandro , Vadalá Giuseppe , Alaimo Chiara , Di Fazio Luca , Ferraiuoli Giovanni , Buccheri Giancarlo , Sucato Vincenzo , Corrado Egle , Novo Giuseppina , Galassi Alfredo Ruggero 
Published: December 2022

Abstract
Coronary artery aneurysm (CAA) is an abnormal dilatation of a coronary artery segment; when its diameter is bigger than 20 mm or it is more than four times bigger as compared to the normal vessel size, the coronary artery aneurysm is defined as Giant. However, there are multiple definition of Giant CAA and miss a standardized classification. The reported prevalence of coronary aneurysms in the population underwent coronary angiography, ranges from 0.3% to 5% and often CAA are found in patient with aneurysms in other sites as ascending or abdominal aorta. In half of the cases an atherosclerotic etiology could be recognized; often CAA is found in the context of acute coronary syndrome. Seldom CAA is found at the autopsy of patient died for sudden cardiac death. Up today very few data exist about CAA management and their prognostic relevance; moreover, CAA treatment is not still clearly codified but rather case-based. Indeed, up today there are not published dedicated studies on which is the best medical therapy in example with antiplatelets or anticoagulant agents rather than an interventional approach, by endovascular or surgical technique. In this review, through two clinical cases, it will be described the current evidence about diagnostic tools and treatment options of CAAs.
1050 ULTRASOUND GUIDED CANNULATION OF FEMORAL ARTERY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: Di Costanzo Assunta , Sorrentino Sabato , Panarello Alessandra , Spinali Martina , Bellantoni Antonio , Boccuto Fabiola , Mariani Andrea , Manzo Rachele , Molaro Maddalena Immobile , Polimeni Alberto , Spaccarotella Carmen , Mongiardo Annalisa , Esposito Giovanni , Indolfi Ciro 
Published: December 2022

Abstract

Background
Vascular access complications are a significant source of morbidity and mortality after transcatheter aortic valve replacement (TAVR). Ultrasound-guided cannulation (UGC) of central veins or arteries is a widely used approach for patients undergoing invasive procedures. Whether UGC significantly decreases the risk of vascular access complications also for large-bore access procedures, such as TAVR, lacks evidence

Objectives
in this study, we aimed to evaluate the benefits of routine use of UGC in patients undergoing TAVR.

Methods
Data were retrospectively collected from two high-volume TAVR centers from September 2009 to March 2022. UGC was performed using a two-dimensional ultrasound short-axis views, while manual palpation, fluoroscopy, or contralateral angiography were used for the other patients. The odds ratio (OR) for vascular complications was calculated using a multivariate logistic regression model including as dependent variables all relevant baseline and procedural characteristics (forward stepwise selection process). Vascular complications were adjudicated according to the Valve Academic Research Consortium definitions 3.

Results
Out of 874 patients included in the study, UGC access was performed in 177 subjects. Overall mean age was 80.2±5.8 years old, 60% of patients were females, 35.5% had diabetes, 61.4% had dyslipidemia, and 27.8% had chronic kidney disease, with a mean left ventricular ejection fraction of 52.7±9.7%. Looking at the procedural variables Euroscore II was 5.8±5.4, second and third valves generation have been used in 85% of the cases, while suture-based closure devices in 84% of subjects. After adjustment for clinical and procedural variables, routinely use of UGC was associated with a lower rate of total [Odds Ratio (OR): 0.38; 95% confidence interval (CI) 0.15% to 0.95%)] and major vascular complications [Odds Ratio (OR): 0.21; 95% confidence interval (CI) 0.05% to 0.75%)], while no differences were observed for minor vascular complications.

Conclusions
Routinely use of UGC significantly decreases the risk of vascular complications in patients undergoing TAVR. However, a dedicated randomized clinical trial assessing the safety and efficacy of this approach is warranted to confirm our results in this high-risk population.
457 CORONARY ROTATIONAL ATHERECTOMY AFTER TAVI: A PROCEDURAL CHALLENGE
Authors: Motta Silvia Crescenzia , Scalia Lorenzo , Barbanti Marco , Tamburino Corrado 
Published: December 2022

Abstract

Background
Selective cannulation must be ensured especially in patient with coronary artery disease (CAD). Commissural alignment in self-expanding transcatheter heart valve (THV) is fundamental to facilitate subsequent coronary reaccess.

Clinical Scenario
A man of 84 years old, suffering from hypertension, dyslipidemia, diabetes mellitus, third stage of chronic kidney disease and obesity was admitted in our hospital for treatment. He had angina and dyspnea with a third NYHA class. The echocardiogram showed severer aortic stenosis with mean gradient of 48 mmHg and aortic valve area of 0.6cmq with preserved ejection fraction. He was eligible for transfemoral transcatheter aortic valve implantation (TAVI) and he had intermediate risk score. The preprocedural coronary angiogram revealed subocclusive and severe calcified lesion on mid circumflex artery.

Methods
The Acurate NEO 2 size L THV was chosen and was planned to implant the bioprosthesis with commissural orientation correlated to the native commeasures, selecting at the CT scan the projection of cusp overlap (right and left coronary cusp on the right of the screen). The delivery catheter was inserted into the introducer sheath with its flush port facing the six o’clock position and the after crossing the aortic arch and native annulus, the handle of the delivery catheter was torqued clockwise until 1 of the Acurate NEO 2 commissural posts faced the commissural of the aortic root. The final angiogram showed optimal position and orientation of the THV without paravalvular leak. The patient was discharged the next day with a mean gradient of 9mmHg. One month after TAVI, elective PCI was performed. We’ve prepared the lesion with rotational atherectomy, due to severe calcification. Three forward advancements of rotating abrasive burr was performed and subsequently one DES was implanted. The angiogram check showed excellent result with TIMI 3 flow.

Conclusion
The Acurate Neo 2 supra-annular valve platform provides a successful coronary cannulation. Coronary rotational atherectomy for severe calcified lesions after TAVI with Acurate Neo 2 is a feasible strategy
659 LEFT ATRIAL MYXOMA IN A PATIENT PRESENTING WITH ACUTE CORONARY SYNDROME: IS EMBOLISM THE PATHOPHYSIOLOGICAL MECHANISM?
Authors: Oliva Carlo-agostino , Falcone Stefania , Morello Matteo , Ghiringhelli Sergio , Provasoli Stefano , Tamborini Claudio , De Ponti Roberto 
Published: December 2022

Abstract

Background
Cardiac myxomas, though uncommon, do represent the most frequent primary cardiac neoplasms in human beings. Their clinical presentation is mainly due to flow obstruction, cytokines hyperincretion or embolism. Coronary embolism related to the tumor is a rare finding. Here we describe the case of a left atrial cardiac myxoma with an acute coronary syndrome presentation.

Case presentation
A 71 year-old woman referred for chest pain, nausea and vomit. On the previous few months she had developed exertional dyspnea and fatigue. No prior history of cardiovascular diseases was reported. The 12-lead ECG showed no significant alterations. Troponin T values were elevated (224 ng/L, normal assay threshold &lt;14 ng/L). Transthoracic echocardiogram displayed left apical akynesia and a bulky left atrial mass protruding through the mitral valve in systole. Coronary angiography showed complete distal occlusion of the left anterior descending (LAD) coronary artery. Thromboaspiration allowed for the retrieval of small-sized non-thrombotic material in the culprit vessel, without angiographic signs of atherosclerotic disease, thus hinting at the embolic nature of LAD occlusion. The patient was then referred to the surgical theatre for removal of the atrial mass, which showed a 4.3×3.4×3.2 cm translucid, lobulated and gelatinous neoformation attached to the interatrial septum via a 1.5×1.2 cm stalk. The mass was surgically removed and the interatrial septum was repaired with a pericardium patch. Hystology was consistent with left atrial myxoma. The hospitalization course was uneventful.

Conclusion
We reported a case of acute coronary syndrome due to left atrial myxoma. Coronary embolization induced by a cardiac myxoma is rare; however, it should be suspected in patients presenting with myocardial infarction without adjunctive coronary risk factors.