bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischemic stroke in France: are younger women at higher risk than men?
Authors: Alami O , Alami M 
Published: October 2022

Abstract

Introduction
Recent studies suggested that younger women were more likely to suffer from an ischemic stroke than men of the same age.

Purpose
Our aim is to confirm whether younger women in France are more exposed to ischemic strokes.

Methods
We compared male and female one-year hospitalization numbers for ischemic stroke in different age groups in France. We also used the French population data by sex and similar age group. Chi-square Tests of Homogeneity were used to assess statistical significance of the differences among men and women hospitalization numbers for each age group.

Results
Women in the age group 15–24 y-o experienced more ischemic strokes than men (151 hospitalizations for women vs 113 for men; p=0,0088). In the 25–34 y-o group, no differences were found between men and women (385 hospitalizations for men vs 370 for women; p=0,3497). In the 35–44 y-o group, women experienced less ischemic strokes than men (906 hospitalizations for women vs 1200 for men; p&lt;0,0001). Women older than 85 y-o also had significantly more hospitalizations than men (15143 vs 6950; p=0,0073). All the other age groups showed a significative male predominance.

Conclusion
Younger women (15–24 y-o) are at higher risk of ischemic strokes than men of the same age in France. As far as ischemic stroke incidence is rising among young adults in France, an urgent awareness should be raised and further studies should focus on the possible etiologies.

Funding Acknowledgement
Type of funding sources: None.
Incidence of heart failure after acute coronary syndrome in multivessel patients a subanalysis of the coralys registry
Authors: Marengo G , D'Ascenzo F , De Filippo O , Bruno F 
Published: October 2022

Abstract

Introduction
Potential protective role of complete revascularization for development of Heart Failure (HF) after an Acute Coronary Syndrome (ACS) remains to be elucidated.

Methods
CORALYS is a multicenter, retrospective, observational registry enrolling consecutive patients admitted for ACS and treated with PCI. Patients with known history of HF or reduced left ventricular ejection fraction (LVEF) before index admission were excluded. The composite of first hospitalization for HF or cardiovascular (CV) death was the primary endpoint, while its single components along with all-cause death were the secondary ones. Complete vs. non complete revascularization (CR vs. non-CR) strategies were compared with Inverse Probability Treatment Weighting (IPTW) across all patients and for those admitted for STEMI and NSTEMI ACS and with Ejection Fraction (EF) at discharge above or below 50%.

Results
Out of 14699 patients, 5054 presented with multivessel disease. Of them, 1473 (29.2%) underwent CR. Over 5 years follow up, complete revascularization reduced the primary combined endpoint (9.2% vs. 16.2%, p&lt;0.001) and the secondary endpoints of HF hospitalization (6.3% vs. 11.7%, p&lt;0.001), CV death (3.7% vs. 6.6%, p&lt;0.001), and all-cause death (9.3% vs. 14.9%, p&lt;0.001). These results remained consistent according to ACS presentation with STEMI or NSTEMI (respectively with an incidence of the primary end point of 5.4% vs. 8.8%, p&lt;0.001; and of 7.4% vs. 13.2%, p&lt;0.001) and according to EF at discharge ≥ or &lt;50% (respectively the primary end point occurred in 3.7% vs. 8.5%, p&lt;0.001; and 10.9% vs. 15.9%, p=0.003).

Conclusions
Complete revascularization after ACS reduces risk of CV death and of hospitalizations for HF, providing another explanation of the prognostic role of CR apart from prevention of recurrent infarctions and a clear therapeutic strategy.

Funding Acknowledgement
Type of funding sources: None.
The vascular response to ultrathin biodegradable polymer sirolimus-eluting stent at 2-weeks and 1-year follow up in patients with ST-elevation myocardial infarction
Authors: Oishi Y , Tsujita H , Arai T , Sakai R , Sato S , Tanaka H , Ogura K , Masaki R , Kondo S , Tsukamoto S , Higuchi S , Sumida A , Matsumoto H , Shinke T 
Published: October 2022

Abstract

Background
Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, the details of vascular response in very early and chronic phase have not been systematically addressed.

Objective and method
We exploratory investigate early and chronic vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT).
Consecutive twenty-four patients with STEMI who underwent FD-OCT after primary PCI and were eligible for follow-up FD-OCT at 2 weeks and 1 year after implantation were enrolled between June 2018 and August 2020.
OCT was performed immediately after PCI, at 2-weeks (2W) and 1-year (1Y) after the primary PCI. Struts were recorded as uncovered if any part was visibly exposed in the lumen or covered if a layer of tissue covered all reflecting surfaces. Struts of stents that are smaller than 3.0mm of diameter with more than 80μm between the center reflection and the adjacent vessel surface were recorded as malapposed. The reduction of atherothrombotic protrusion burden within the stent was also assessed.

Results
Twenty-four patients (age 64.9±11.4 years, male 83.3%) were enrolled.
The percentage of uncovered struts significantly decreased from post-PCI to 2W follow-up and from 2W follow-up to 1Y follow-up (62±20% post-PCI versus 27±11% at 2W follow up, p&lt;0.0001 and 2W follow-up versus 3.3±3.3% at 1Y follow up, p&lt;0.0001). Malapposed struts also decreased from post-PCI to 2W follow-up (4.1±3.6% post-PCI versus 1.5±2.2% at 2W follow-up, p&lt;0.0001), but no significant difference was shown between 2W follow-up and 1Y follow-up (2W follow-up versus 1.0±2.3 at 1Y follow up, p=0.12). The average protrusion area of athero-thrombotic burden decreased (0.57±0.32 at post-PCI versus 0.42±0.22 mm2 at 2W follow up, p&lt;0.0001) and its volume showed similar tendency (16.6±10.7 at post-PCI versus 12.9±8.23 mm3 at 2W follow up, p=0.0011). Thrombus was shown in all patients at post-PCI, but two patients (8.0%) showed it at 1Y follow-up.

Conclusion(s)
This study elucidated very early and chronic vascular responses following ultrathin strut BP-SES implantation in STEMI patients by FD-OCT. It showed resolution of athero-thrombotic materials in very early phase and favorable progression of strut coverage in very early and chronic phase.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic accuracy of instantaneous wave-free ratio at rest and during dobutamine provocation to assess myocardial bridging relevance
Authors: Aleksandric S , Al-Lamee R , Djordjevic-Dikic A , Giga V , Tesic M , Banovic M , Zobenica V , Vukcevic V , Tomasevic M , Stojkovic S , Orlic D , Nedeljkovic M , Stankovic G , Davies J , Beleslin B 
Published: October 2022

Abstract

Background
Diastolic fractional flow reserve (d-FFR) during dobutamine provocation (DOB) was found to be a more reliable physiological index for the functional assessment of myocardial bridging (MB). However, d-FFR calculation is complicated and time-consuming, and therefore several authors have suggested the use of instantaneous wave-free ratio (iFR) to overcome these issues.

Purpose
The aim of our study was to assess diagnostic performance of d-FFR and iFR at rest and during DOB with exercise-induced myocardial ischemia as reference.

Methods
Twenty-four symptomatic patients (17 males, mean age 58±8 years) with MB and systolic compression ≥50% diameter stenosis on the left anterior descending (LAD) artery were included. Exercise stress-echocardiography test (SE), and both d-FFR and iFR in the distal segment of LAD at rest and peak DOB (30–50μg/kg/min), were performed in all patients. Optimal cut-off values and diagnostic performance of resting and hyperemic d-FFR and iFR were assessed using SE.

Results
Exercise-SE was positive for myocardial ischemia in 7/24 patients (29%). The area-under-the-receiver-operating-characteristic curve (ROC-AUC) for exercise-induced myocardial ischemia was 0.64 (95% CI: 0.400–0.885) for resting d-FFR, 0.62 (95% CI: 0.378–0.866) for resting iFR, 1.000 (95% CI: 0.999–1.000) for d-FFR at peak DOB, and 0.96 (95% CI: 0.895–1.000) for iFR at peak DOB. No significant difference in ROC-AUC was observed between d-FFR and iFR at peak DOB (p=0.243). The best cut-off value for both d-FFR and iFR at peak DOB was &lt;0.76 with similar sensitivity and negative predictive values (100 vs. 100% for both), but lower specificity and positive predictive value for iFR in identifying MB associated with exercise-induced ischemia (94% vs. 82%; 88% vs. 70%, respectively). Compared with exercise-induced myocardial ischemia, the diagnostic accuracy of d-FFR and iFR at peak DOB was 96% (kappa=0.903, p&lt;0.001) and 88% (kappa=0.731, p&lt;0.001), respectively.

Conclusions
iFR during DOB provocation showed similar diagnostic accuracy as d-FFR to identify the functionally significant MB when compared with exercise-induced myocardial ischemia.

Funding Acknowledgement
Type of funding sources: None.
Consenting practices in interventional cardiology: an analysis from the European Association of Percutaneous Cardiovascular Interventions (EAPCI)
Authors: Rajkumar C A , Bello O , McInerney A , Tilsted H H , Johnson V , Fovino L N , Fitzsimons D , Al-Lamee R , Byrne R 
Published: October 2022

Abstract

Background
Consenting practices in interventional cardiology vary across different procedures, operators, centres and nations.

Purpose
In order to define best practice for obtaining informed patient consent, it is first necessary to understand how consenting practice differs.

Methods
An online survey of 20 questions was sent to all members of the European Association of Percutaneous Cardiovascular Interventions, addressing consenting practices in elective and emergency scenarios.

Results
We received 483 responses from 74 countries. The majority of respondents (77%) were European operators. Responses were received from consultant cardiologists (n=370), fellows in training (n=55), allied health professionals (n=36) and others (n=21).
Across all respondents, in elective practice, 427 (88.4%) operators obtain written consent for every procedure, the remainder (9.5%) obtain verbal consent only. Consent is obtained by the consultant or fellow who directly performs the procedure in 56.9% cases. For coronary angiography, pre-emptive consent for possible additional procedures (pressure wire and PCI) is taken by operators in all cases (58.6%), some cases (30.6%) and never (11.0%). Prior to interventional therapies, written information detailing the risk of the procedure is provided in every case by 63.8% of operators, sometimes by 25.1% of operators, and is never provided by 11.0% of operators.
In emergency settings, where patients are conscious and have capacity to consent, 274 (56.7%) of respondents obtain written consent, 155 (33.1%) obtain verbal consent only and 52 (10.8%) stated that a consent process was not required. Where consciousness and capacity are impaired, 218 (45.1%) always, 118 (24.4%) sometimes and 145 (30%) never document a written capacity and best interests' assessment.
When asked to rate the overall quality of consenting practices in their own institution, 279 (57.8%) stated these were “excellent” or “above average”, 165 (34.2%) were “average” and 39 operators described consenting practices in their institution as “below average” or “poor”.

Conclusions
Diversity in consenting practice spans elective and emergency procedures. These results suggest that there is substantial variation in the understanding of the rationale, legal requirement, and perceived best practices for consent. Further work should consider the merits of standardisation of consent processes across Europe.

Funding Acknowledgement
Type of funding sources: None.
Impact of vessel morphology on computed tomography derived fractional flow reserve (FFRCT) in normal coronary artery disease: a novel marker for the predictor of FFRCT changes
Authors: Tsugu T , Tanaka K , Nagatomo Y , Belsack D , Argacha J F , Cosysns B , De Maeseneer M , De Mey J 
Published: October 2022

Abstract

Background
Computed tomography (CT) derived fractional flow reserve (FFRCT) decreases continuously from the proximal to the distal segments of the vessel even in normal coronary arteries. It has been empirically proved that the degree of FFRCT decline varies based on vessel morphology even in the same vessel length.

Purpose
To investigate the vessel morphological factors that influence FFRCT in normal coronary arteries.

Methods
A total of 1402 outpatients with suspected CAD who underwent CT angiography (CTA) with FFRCT analysis between January 2017 and October 2021 were evaluated. Among them, 234 consecutive patients who underwent both CT angiography including FFRCT and invasive coronary angiography, resulting in &lt;20% stenosis in right coronary artery (RCA) were evaluated. RCA vessels from ostium to just proximal site of the posterior descending branch were analysed and divided into two groups according to distal FFRCT: FFRCT &gt;0.80 (n=219) and FFRCT ≤0.80 (n=15). FFRCT was measured at proximal and distal segments of the RCA. Vessel morphology (vessel length, lumen diameter and volume, and plaque volume) and left ventricular mass were assessed. The ratio of lumen volume and vessel length was defined as the V/L ratio.

Results
Whereas vessel length was almost the same between FFRCT &gt;0.80 and ≤0.80 (&gt;0.80 vs. ≤0.80, 115.9±17.3 vs. 119.6±28.7 mm), lumen volume (1135.2±369.3 vs. 906.2±362.6 mm3, p&lt;0.05) and V/L ratio (9.8±2.6 vs. 7.5±2.3, p&lt;0.01) were significantly higher in FFRCT &gt;0.80. Distal FFRCT correlated with plaque-related parameters [low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque (CP)] and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). Among all vessel-related parameters, V/L ratio showed the highest correlation with distal FFRCT (r=0.44, p&lt;0.0001) (Figure 1). Multivariable analysis showed that CP volume was the strongest predictor of distal FFRCT (β-coefficient = −0.38, p&lt;0.0001), followed by V/L ratio (β-coefficient = 0.95, p=0.007). V/L ratio was the strongest predictor of a distal FFRCT ≤0.80 (cut-off 8.2, AUC 0.73, sensitivity 66.7%, specificity 69.3%, 95% CI 0.60–0.86) (Figure 2).

Conclusions
Our study findings suggest that the V/L ratio can be a measure to predict subclinical coronary perfusion disturbance.

Funding Acknowledgement
Type of funding sources: None.
Ten-year trends of clinical outcomes after percutaneous coronary intervention
Authors: Choi J H , Lee S H , Kim H Y , Choi J M 
Published: October 2022

Abstract

Objectives
Mortality following percutaneous coronary intervention (PCI) is a key quality measurement in clinical practice. This study investigated the 10-year trends of mortality following PCI in an unselected nationwide cohort.

Design
Retrospective cohort study.

Setting
A nationwide study in South Korea.

Participants
PCI claim data from 2006 to 2015 of the National Health Insurance Service and the Statistics of Korea.

Measures
1-year cardiovascular or non-cardiovascular death.

Results
In total, 437,436 patients were included. The annual number of PCI increased from 32,098 to 51,990 over the decade studied (p&lt;0.001). Patients were divided into quartile subgroups according to clinical score for predicting 1-year all-cause death. The proportion of patients in the high-risk quartiles increased, whereas those in the low-risk quartiles decreased (p&lt;0.001). The 1-year cumulative incidence rate of all-cause death did not change in the population with risk scores in the 1st (0.9% to 0.8%) and 2nd (1.3% to 1.3%) quartiles, whereas it increased in the population with risk scores in the 3rd (3.4% to 5.1%) and 4th (15.5% to 19.4%) quartiles (p&lt;0.001). Compared to year 2006, the mean survival time in year 2015 was shorter by 0, 3.3, and 12.4 days in patients with risk scores in the 1st or 2nd, 3rd, 4th quartiles, respectively. These findings were also consistent for cardiovascular or non-cardiovascular deaths.

Conclusion
The number, proportion, and the overall risk of patients with a high risk for mortality after PCI increased over the decade in Korea.

Funding Acknowledgement
Type of funding sources: None.
Default distal radial approach for all coronary procedures – a prospective study
Authors: Pati P K , Arstall M , Pati A 
Published: October 2022

Abstract

Background
Radial artery approach for coronary interventions has substantially improved the outcome especially in acute coronary syndrome patients. However, radial artery occlusion is the achilles' heel of such an approach.

Purpose
To obviate such problems, distal radial artery (DRA) approach is evolving but technical challenge is the small size of the artery. We looked at the feasibility, safety and advantages of it.

Methods
Patient population included any patient requiring a diagnostic or percutaneous coronary interventions (PCI) in our catheterization laoratory from March 2020 to March 2022. A primary operator performed all procedures as default, if the patient had a palpable DRA. After local anaesthesia infiltration, using seldinger technique and micropuncture kit, 5 to 7F hydrophilic sheaths were introduced and a cocktail of verapamil and heparin was given routinely. Sheaths were removed immediately after procedure but dedicated side specific compression devices were used but removed 45 min after diagnostic and 2 hours after PCI. Clinical patency of radial artery was assessed at discharge and follow up.

Results
A total of 682 procedures were performed (50% were diagnostic). Out of all PCIs 59% were for ACS). Elective PCIs included very complex cases including PCI for bifurcation, left main and rota assisted complex PCIs. 651 patients had right distal radial approach and 28 had left. Mean age of patients were 66.8±12.9 years (26 to 97). Females constituted 218 (32%). Mean time from 1st needle puncure to successful vascular access took 1.2±0.8 min (20 sec to 6 min). Average attempts to obtain successful vascular access was 1.3±0.7 (1 to7 attempts). There were 15 failures (2%) to obtain DRA access requiring change over to 6 ipsilateral radial, 2 ulnar, 4 contralateral distal radial, 2 femoral and 1 brachial access. Interestingly, in 5 different occaisions previous procedure related occluded radial arteries were recanalized through this access. Most importantly, no case of radial artery occlusion was encountered at discharge or at follow up by clinical examinations. No other vascular complications were encountered except mild transient bruising in 6 cases and early small hematoma in 3 cases. Patient's comfort, nursing staffs' satisfaction and trend towards early discharges were also noticed. There was a distinct improvement in obtaining faster access with lower failure rates by the operator after initial 90, especially after 150 procedures.

Conclusions
A default approach through distal radial artery in anatomical snuff box for all coronary interventions is feasible, safe and possibly superior to conventional radial access with better patient comfort and caring staff's satisfaction. Though learning curve is longer and more challenging, success rates were much higher and vascular access was faster after initial phase. Clinically radial artry occlusion was not seen but needs further study and more objective evidence.

Funding Acknowledgement
Type of funding sources: None.
Effect of aspirin discontinuation according to individualised patient bleeding and ischemic risks after PCI: a TWILIGHT trial sub-analysis
Authors: Mendieta Badimon G , Mehta S , Baber U , Collier T , Dangas G , Sharma S K , Cohen D J , Angiolillo D , Briguori C , Escaned J , Gabriel Steg P , Huber K , Michael Gibson C , Pocock S , Mehran R 
Published: October 2022

Abstract

Background
The TWILIGHT trial demonstrated a reduction in BARC 2, 3 or 5 (BARC-235) bleeding without an increase in ischemic events at 1-year in high-risk PCI patients randomized to placebo or aspirin (ASA) on a background of ticagrelor 3-months after PCI. However, the effect of ASA discontinuation according to baseline risk of bleeding and ischemic events remain unclear.

Purpose
To a) develop separate models to predict the risk of bleeding and ischemic events, and b) to assess treatment effect of ASA discontinuation across the risk strata.

Methods
Using the TWILIGHT patient database (N=7,119), two multivariable models, one for BARC-235 bleeding and one for CV death, nonfatal MI or nonfatal ischemic stroke (ischemic endpoint) were developed, and their predictive capacity was assessed. The effect of randomized treatment on bleeding and ischemic events across different patient risk-group categories as determined by the risk scores was investigated.

Results
At 1-year, 350 (5.4%) patients experienced a BARC-235 bleeding event and 258 (3.6%) experienced an ischemic event. Independent predictors of BARC-235 included haemoglobin levels at index PCI, proton-pump inhibitor non-use at discharge, age, liver disease and active smoking (c-statistic 0.64). Independent predictors of the ischemic outcome included a positive troponin ACS, prior CABG, diabetes, age, peripheral artery disease, prior PCI, a history of congestive heart failure, active smoking, the level of index PCI complexity, and prior MI (c-statistic 0.71). The risk of a BARC-235 almost doubled between patients in lower versus higher bleeding risk categories (4.3% versus 7.9%) and ischemic risk more than tripled between patients in lower versus higher ischemic risk categories (2.0% versus 7.0%) (see Figure 1). There was no evidence of a differential treatment effect for dual antiplatelet therapy versus ticagrelor monotherapy across the different risk categories of bleeding (interaction P=0.54) and ischemic risk (interaction P=0.95) (Table 1).

Conclusion
Individual patient bleeding and ischemic risks after PCI can both be readily characterised with good discrimination. The effect of ASA discontinuation in preventing bleeding in ticagrelor-treated patients was consistent regardless of baseline bleeding risk. There was no evidence for increased ischemic events with ASA discontinuation according to baseline ischemic risk.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZenecaIcahn School of Medicine at Mount Sinai