bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the treatment strategy following intracoronary pressure wire in a contemporaneous real-life cohort of patients with intermediate coronary stenosis. Results from a nationwide registry
Authors: Rodriguez Leor O , Toledano B , Lopez Palop R , Rivero F , Brugaletta S , Linares J A , Puigfel M , Sadaba M , Vaquerizo B , Rondan J , Gomez I , Saez R , Planas A , Lozano F , Perez De Prado A 
Published: October 2022

Abstract

Background
Intracoronary pressure wire is useful to guide revascularization in patients with coronary artery disease.

Aims
To evaluate changes in diagnosis (coronary artery disease extent), treatment strategy and clinical results after intracoronary pressure wire study in real-life patients with intermediate coronary artery stenosis.

Methods
Observational, prospective and multicenter registry of patients in whom pressure wire was performed. The extent of coronary artery disease and the treatment strategy based on clinical and angiographic criteria were recorded before and after intracoronary pressure wire guidance. 12-month incidence of MACE (cardiovascular death, non-fatal myocardial infarction or new revascularization of the target lesion) was assessed.

Results
1414 patients with 1781 lesions were included. Complications related to the procedure were reported in 42 patients (3.0%). The extent of coronary artery disease changed in 771 patients (54.5%).
Figure 1 shows extent of coronary artery disease based on coronary angiographic analysis and following intracoronary pressure wire study. Figure 2A shows the extent of coronary artery disease based on coronary angiographic analysis and its reclassification following intracoronary pressure wire study. Figure 2B shows the extent of coronary artery disease following pressure wire study and its classification when only considering the coronary angiographic analysis.
Figure 2 shows change in treatment strategy following intracoronary pressure wire study. There was a change in treatment strategy in 779 patients (55.1%) (18.0% if medical treatment; 68.8% if PCI; 58.9% if surgery (p&lt;0.001 for PCI vs medical treatment; p=0.041 for PCI vs CABG; p&lt;0.001 for medical treatment vs CABG). In patients with PCI as the initial strategy, the change in strategy was associated with a lower rate of MACE (4.6% vs 8.2%, p=0.034).

Conclusions
The use of intracoronary pressure wire was safe and led to the reclassification of the extent of coronary disease and change in the treatment strategy in more than half of the cases, especially in patients with PCI as initial treatment.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The registry was endorsed by the Intracoronary Diagnostic Techniques Working Group of the Interventional Cardiology Association of the Spanish Society of Cardiology. The study was supported by an unconditional grant from Philips-Volcano, Abbott Vascular, and Boston Scientific. The sponsors did not have access to the database or the final results until the preparation of this abstract. None of them participated in the preparation or review of this abstract.
Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients
Authors: Burger P , Dorresteijn J , Fiolet A , Koudstaal S , Eikelboom J , Nidorf S , Thompson P , Cornel J , Budgeon C , Steg P , Cramer M , Teraa M , Bhatt D , Visseren F , Mosterd A 
Published: October 2022

Abstract

Background
Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model.

Purpose
This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile.

Methods
The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to &lt;1.4 mmol/L, and systolic blood pressure (SBP) reduction to &lt;130 mmHg.

Results
Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+.

Conclusion
The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD.

Funding Acknowledgement
Type of funding sources: None.
Coronary plaque characteristics associated with major adverse cardiovascular events in atherosclerotic patients and lesions – a systematic review and meta-analysis
Authors: Gallone G , Bellettini M , Bruno F , Scudeler L , De Filippo O , Iannaccone M , Baldetti L , Kwon-Koo B , Pontone G , Depaoli A , Libby P , Stone G W , Narula J , De Ferrari G M , D'Ascenzo F 
Published: October 2022

Abstract

Background
The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non-flow-limiting lesion remains uncertain.

Purpose
We performed a systematic review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE).

Methods
We systematically reviewed MEDLINE, EMBASE, and the Cochrane database for studies evaluating the association of CPC with patient-level and lesion-level MACE. CPCs included high plaque burden, low minimal lumen area, thin cap fibroatheroma, high lipid core burden index, low attenuation plaque, spotty calcification, napkin ring sign, or positive remodelling.

Results
Thirty studies (21 retrospective, 9 prospective) with 30,369 patients were included. CPCs were evaluated by invasive intravascular techniques in 9 studies (optical coherence tomography=4, intravascular ultrasound imaging=3, near-infrared spectroscopy intravascular ultrasound imaging=2) and by coronary computed tomography angiography (CCTA) in 21 studies. CPCs significantly predicted patient-level and lesion-level MACE in both unadjusted and adjusted analyses. For each CPC, the risks were higher for lesion-level (HR range 3.2–16.8) as compared with patient-level MACE (HR range 1.8–4.1). Accuracy was modest to good for most CPCs at the patient-level (AUC for MACE ranging between 0.53 and 0.84) and moderate to good for most CPCs at the lesion-level (AUC for MACE ranging between 0.71 and 0.83). Plaques with more than one CPC had the highest accuracy for lesion-level MACE (AUC 0.87, 95% CI 0.84–0.90). The pooled sensitivities of CPCs for lesion-level MACE ranged between 40% and 63% and specificities between 73% and 98%. As the pooled prevalence of CPCs among plaques was low (3% to 28%), the estimated positive predictive values for lesion-level MACE were modest (range 1% to 26%).

Conclusions
CCTA and intravascular imaging characterization of CPCs identifies high-risk atherosclerotic plaques that place lesions and patients at risk for future MACE, albeit with modest sensitivity and positive predictive value (PROSPERO identifier: CRD42021251810).

Funding Acknowledgement
Type of funding sources: None.
Ten-year prognostic impact of acute heart failure in STEMI patients: a prospective cohort study
Authors: Kozhukhov S , Parkhomenko A , Irkin O , Lutay Y A , Dovganych N 
Published: October 2022

Abstract

Background
Cardio-vascular death (CVD) in patients with acute myocardial infarction (AMI) significantly decreased due to reperfusion and advances in pharmacotherapy. Acute heart failure (AHF) remains a common and unfavorable AMI-related complication.

Aim
To determine the incidence and prognostic value of Killip Class II–IV of AHF in long term follow-up of patients with ST-elevation myocardial infarction (STEMI).

Methods
All patients with STEMI were admitted to our emergency cardiology department during 1995–2011. CVD up to ten years after STEMI was the main outcome endpoint. We compared CVD in patients with and without AHF, and revascularization. Survival curve was generated by the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression.

Results
Prospective cohort study includes 1625 STEMI patients; the mean age of the patients was 54.4±0.3 years, time from symptom onset was 5.0±0.2 hour, 1497 were men (92.1%), and 899 patients (55.5%) were revascularized (TLT – 632 (38.9%), PCI – 267 (16.4%), including 159 patients with stent implantation (9.8%). 412 patients had AHF - Killip Class II–IV (25.4%) during first 24 hours. Ten-year survival after STEMI was 85%; survival exceeded 88% in patients without AHF, but was 75% for those with AHF. Among patients who underwent revascularisation ten-year survival was 82.9% for patients in group with AHF, and was 87.1% for those without AHF. In multivariable Cox regression, age ≥65 years, female gender and HF were the predictive factors for CVD. Kaplan-Meier survival curves demonstrated higher incidence of CVD in AHF patients in compare with those without AHF in long-term follow-up (Figure 1).

Conclusion
According to the study AMI care is associated with high rates of long term survival, ten-year rates exceed 85%. AHF during first 24 hour in patients with STEMI worsens the prognosis, but reperfusion therapy increases survival. Further efforts to improve survival should be directed to patients with AHF and low revascularization rate that are associated with poor survival after AMI.

Funding Acknowledgement
Type of funding sources: None.
Correlation between NSTE-ACS risk scores with Syntax: can we predict coronary lesion complexity before angiography?
Authors: Maltes S , Paiva M S , Madeira S , Teles R C , Almeida M S , Mendes M 
Published: October 2022

Abstract

Background and aim
Standard single antiplatelet regimen (SAPT) is currently recommended before invasive risk stratification in non-ST elevation acute coronary syndromes (NSTE-ACS). However, there are subsets in whom dual antiplatelet therapy (DAPT) may be more protective according to the coronary anatomy and revascularization strategy. We aimed to identify pre-procedural predictors of coronary artery complexity that may be helpful in selecting an individualized antiplatelet regimen.

Methodology
Retrospective single-center study including patients with NSTE-ACS performing coronary angiography between January 2020 and July 2021. Clinical variables and classical NSTE-ACS risk scores (TIMI, GRACE and HEART) were captured and SYNTAX 1 score was calculated. Patients were divided into low (0–22), moderate (23–32) and high (≥33) SYNTAX score. Multivariate logistic regression analysis was performed to determine predictors of anatomical complexity (defined as significant left main disease [stenosis ≥50%] or SYNTAX ≥33).

Results
A total of 448 patients were included (mean age 67±13 years; 74% males; 85% with NSTE-myocardial infarction). Overall, 350 (78%), 63 (14%) and 35 (8%) patients had a low, moderate or high-SYNTAX score, respectively. Thirty-one (7%) patients had significant left main disease.
At multivariate analysis (adjusted for age, diabetes, renal function, GRACE and TIMI scores), the HEART score (hazard ratio 2.3, 95% confidence interval 1.5–3.3, p&lt;0.001) predicted a high anatomical complexity. When performing ROC curve analysis, the HEART score had a high discriminative ability in identifying those with complex coronary anatomy (area under the curve 0.79, 95% CI 0.72–0.86, p&lt;0.001) (Figure 1) – a score &gt;7 showed a sensitivity of 76% and specificity of 75% in identifying such patients.

Conclusion
In this cohort of NSTE-ACS patients, the HEART score was an independent predictors of complex coronary anatomies. These results suggest that those with high (&gt;7) HEART score may merit from SAPT as opposed to DAPT, given the high probability of complex lesions amenable to CABG.

Funding Acknowledgement
Type of funding sources: None.
Complications in acute coronary syndrome with contemporary care, and predictors of high risk
Authors: Nilsson T , Mokhtari A , Ekelund U 
Published: October 2022

Abstract

Introduction
With the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly.
However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds.

Purpose
The aim of this study was to map the complications in contemporary ACS patients, and to explore the possibility of creating simple decision rules for risk assessment.

Methods
This observational study included 26547 chest pain patients ≥18 years at five Swedish emergency departments (ED) from the ESC-TROP trial. Complications were defined as the following within 30 days: Death, cardiac arrest, cardiogenic shock, respiratory failure, ventricular arrythmia, high-degree AV-block that required a pacemaker, and mechanical complications such as ventricular septum defects (VSD). Logistic regression including age, sex, history of myocardial infarction, hypertension, hypercholesterolemia, angina pectoris, diabetes mellitus was used to identify factors predicting high risk of complications.

Results
Of all 26547 patients, 2463 (9.3%) were diagnosed with ACS, and 146 of these (5.9%) suffered any complication within 30 days. Mean age was higher in patients with (78.9 years) than without (69.4 years) complications, and more were female (39.7% vs 33.1%).
Seventy-nine (3.2%) patients died, 33 (1.3%) had cardiac arrest, 10 (0.4%) cardiogenic shock, 20 (0.9%) respiratory failure, 6 (0.2%) ventricular arrythmia, 13 (0.5%) high-degree AV block, and 2 (&lt;0.1%) VSD. More than 40% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 78 (53%) of the patients with complications underwent coronary angiography and 62 were revascularized (PCI or CABG). Sixty-two patients (42%) were managed without coronary angiography and 6 (4%) had palliative care from the start. Only age &gt;80 years (OR 4.8, p&lt;0.001) appeared to be a significant factor for increased risk of complications.

Conclusion
With current care, serious complications occurred in only 6 out of 100 ACS patients, and the complications were often present already at the ED. Many patients with complications were not admitted to the CCU/ICU and did not undergo coronary angiography.
Algorithms to improve the identification of ACS patients with a need of high-level monitoring could help optimize the use of hospital resources.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ALF research grantSwedish Research Council
The impact of age on the 99th percentile of cardiac troponin
Authors: Hasselbalch R , Strandkjaer N , Kristensen J , Joergensen N , Kock T O , Rye Ostrowski S , Vesterager Pedersen O B , Torp-Pedersen C , Bundgaard H , Bor V , Afzal S , Kamstrup P , Dahl M , Hilsted L , Iversen K I 
Published: October 2022

Abstract

Introduction
The 99th percentile upper reference limit (URL) of cardiac troponin (cTn) is diagnostic cutoff for myocardial infarction (MI). Several factors are known to lead to an increase in cTn including sex, kidney function, left ventricular function and various comorbidities. Similarly, studies have shown that cTn concentration of patients increase with age. However, the impact of age on the concentration of cTn in healthy individuals is unclear as several studies of healthy populations showed little to no impact of age.

Purpose
To determine the effect of age on the URL of cTn for the Danish population.

Methods
We invited active and retired blood donors with the aim of including 250 participants of each sex in each of four age groups, &lt;50, 50–60, 60–70 and &gt;70 years, for a total of about 2000 participants. cTn levels were measured by 4 cTn assays (Siemens Atellica and Vista cTnI, Roche cTnT and Abbott Alinity cTnI). The age specific URL were calculated using the non-parametric method. Quantile regression for the 99th percentile was adjusted for sex and creatinine concentration.

Results
A total of 2287 participants were sampled in the study, of which 4 (0.2%) were excluded due to a history of heart disease and 7 (0.3%) were excluded due to insufficient plasma for screening biomarkers. The median age was 58.6 (IQR 48.2–69.7), and 52.6% were female. Figure 1 shows the distribution of cTn concentrations in age intervals. There was a significant increase in cTn with age for all assays (all p&lt;0.001). After adjusting for sex and creatinine concentration, increasing age was only significantly associated with cTnT (0.40 ng/L increase per year, p=0.03). Figure 2 panel A shows the age specific URL for each assay, where we observed a significant difference for cTnT with the URL increasing from 15.8 ng/L (90% CI 12.4–33.9 ng/L) for participants &lt;50 years to 37.6 ng/L (90% CI 34.6–41.5 ng/L) for participants &gt;70 years. The proportion of participants with concentrations above the manufacturers URL increased with age for cTnT from 1.5% in participants &lt;50 years to 25.6% for participants &gt;70 years (p&lt;0.001), figure 2 panel B. This changed little when removing participants with decreased kidney function (eGFR &lt;60 mL/min/1.73 m2) as 24.3% of the remaining participants &gt;70 years had a cTnT above the URL.

Conclusions
The concentration of cTn increased with age for all assays. This was clearest for cTnT in which the 99th percentiles of participants were significantly different for participants age &gt;70 years of whom a quarter had cTnT levels above the level for myocardial injury according to the manufacturer's URL.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): HelsefondenMauritzen La Fountaine Foundation
Elements of Long-Term Care That Promote Quality of Life for Indigenous and First Nations Peoples: A Mixed Methods Systematic Review
Authors: Brooks Deborah , Johnston Sandra , Parker Christina , Cox Leonie , Brodie Melissa , Radbourne Catherine , MacAndrew Margaret 
Published: October 2022

Abstract

Background and Objectives
Little is known about elements of long-term care (LTC) that promote quality of life (QoL) for older Indigenous and First Nations peoples. This systematic review aimed to extend understanding of those deemed most important.

Research Design and Methods
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic database and hand-searching were used to find published and unpublished qualitative studies and textual reports. A convergent integrated approach was used to synthesize data, according to the Joanna Briggs Institute methodology for mixed methods systematic reviews.

Results
Included papers (11 qualitative; seven reports) explored views and experiences of Indigenous residents, families, and LTC staff from North America (8), South Africa (1), Norway (1), New Zealand (1), and Australia (7). Elements of care included: (a) codesigning and collaborating with Indigenous and First Nations communities and organizations to promote culturally safe care; (b) embedding trauma-informed care policies and practices, and staff training to deliver culturally safe services; (c) being respectful of individual needs, and upholding cultural, spiritual and religious beliefs, traditional activities and practices; (d) promoting connection to culture and sense of belonging through sustained connection with family, kin, and Indigenous and First Nations communities.

Discussion and Implications
This review identifies elements or models of care that promote QoL for Indigenous and First Nations peoples in LTC. While included papers were mostly from the United States and Australia, the congruence of elements promoting QoL was evident across all population groups. Findings may be used to inform standards specific to the care of Indigenous and First Nations peoples.
Identification of Implementation Strategies Using the CFIR-ERIC Matching Tool to Mitigate Barriers in a Primary Care Model for Older Veterans
Authors: Shin Marlena H , Montano Anna-Rae L , Adjognon Omonyêlé L , Harvey Kimberly L L , Solimeo Samantha L , Sullivan Jennifer L 
Published: October 2022

AbstractBackground and ObjectivesAs the proportion of the U.S. population over 65 and living with complex chronic conditions grows, understanding how to strengthen the implementation of age-sensitive primary care models for older adults, such as the Veterans Health Administration’s Geriatric Patient-Aligned Care Teams (GeriPACT), is critical. However, little is known about which implementation strategies can best help to mitigate barriers to adopting these models. We aimed to identify barriers to GeriPACT implementation and strategies to address these barriers using the Consolidated Framework for Implementation Research–Expert Recommendations for Implementing Change (CFIR-ERIC) Matching Tool.Research Design and MethodsWe conducted a content analysis of qualitative responses obtained from a web-based survey sent to GeriPACT members. Using a matrix approach, we grouped similar responses into key barrier categories. After mapping barriers to CFIR, we used the Tool to identify recommended strategies.ResultsAcross 53 Veterans Health Administration hospitals, 32% of team members (n = 197) responded to our open-ended question about barriers to GeriPACT care. Barriers identified include Available Resources, Networks & Communication, Design Quality & Packaging, Knowledge & Beliefs, Leadership Engagement, and Relative Priority. The Tool recommended 12 Level 1 (e.g., conduct educational meetings) and 24 Level 2 ERIC strategies (e.g., facilitation). Several strategies (e.g., conduct local consensus discussions) cut across multiple barriers.Discussion and ImplicationsStrategies identified by the Tool can inform on-going development of the GeriPACT model’s effective implementation and sustainment. Incorporating cross-cutting implementation strategies that mitigate multiple barriers at once may further support these next steps.