bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in acute coronary syndromes: a never ending same old story or sign for improvement
Authors: Radovanovic D , Schoenenberger-Berzins R , Roffi M , Pedrazzini G , Eberli F , Erne P , Rickli H 
Published: October 2022

Abstract

Introduction
We previously described sex differences in baseline characteristics, interventional therapy and mortality in patients admitted for acute coronary syndromes (ASC) in Swiss hospitals and enrolled in the AMIS Plus registry between 1997 and 2006 (1). This present analysis aimed to reassess whether anything changed over the last 15 years.

Method
All AMIS Plus patients enrolled between 2007 and 2021 were included. Baseline characteristics, therapy and outcome were analysed according to sex and age groups. Multivariate analyses were performed to assess independent predictors of in-hospital mortality.

Results
Among 42,471 patients, 10,825 (25.5%) were women. Women were still older (71.6±12.6y vs. 64.2±12.6y for men), had more comorbidities (Charlson Comorbidity Index&gt;1: 26.5% vs. 21.7%), were less likely to receive drug therapy (e.g., P2Y12 inhibitors 83.3% vs. 89.2% or statins 73.0% vs. 78.5%) and underwent percutaneous coronary intervention (PCI) less frequently (OR 0.77; 95% CI 0.73–0.83). These findings paralleled our observations for the period 1997–2006. However, the increase in PCI use over the years, particularly in women, led to a marked decrease in differences between men and women with respect to revascularization, from 16.6% in 2006 down to 2.0% in 2020. Unadjusted in-hospital mortality was higher in women (OR 1.55; 95% CI 1.41–1.70), but this significance disappeared after adjustment for baseline differences (OR 1.07; (95% CI 0.96–1.20)). However, in women under the age of 50 years, crude mortality (3.1% versus 1.6%) was significantly higher than in same-aged men; adjusted OR 1.78 (95% CI 0.99–3.20).

Conclusions
Sex differences in the baseline characteristics of ACS patients and the use of evidence-based drugs persisted but the sex gap in PCI access slowly but surely diminished. Female sex per se was not an independent predictor of in-hospital mortality in the overall population but it showed a strong trend among patients younger than 50 years of age.

Funding Acknowledgement
Type of funding sources: None.
Associations between DAPT score and long-term mortality post PCI
Authors: Tan M , Dinh D , Gayed D , Liang D , Brennan A , Duffy S , Clark D , Ajani A , Oqueli E , Roberts L , Reid C , Freeman M , Chandrasekhar J 
Published: October 2022

Abstract

Introduction
The dual antiplatelet therapy (DAPT) score was developed to identify patients more likely to derive benefit (score ≥2) or harm (score &lt;2) from DAPT beyond 1-year post PCI. There is no study which looked at the DAPT score and long term outcomes post PCI in Australia.

Purpose
We sought to examine long-term mortality after PCI by the DAPT score in patients treated with DAPT per local guidelines.

Methods
We examined data from the MIG PCI database from 2005 to 2018 in whom the DAPT score could be derived and grouped them as score ≥2 or &lt;2. Long-term mortality was assessed from National Death Index linkage. The primary endpoint was long-term mortality examined using survival analysis. Secondary endpoints included 30-day ischaemic outcomes and in-hospital major bleeding.

Results
Out of 27,740 patients in the study, 9,401 (33.9%) had DAPT score ≥2. They were younger and included more females and higher prevalence of renal impairment. DAPT score ≥2 patients had higher in-hospital major bleeding, 30-day mortality, MI and target vessel revascularisation. DAPT score ≥2 patients had lower long-term survival to 12 years (p&lt;0.001 for all).

Conclusion
A third of all-comer PCI patients had DAPT score ≥2 with greater short-term risk of ischaemic and bleeding outcomes, as well as long-term mortality. Theoretically, those with DAPT score ≥2 would benefit from longer duration of DAPT as ischaemic risk outweighs bleeding risk. However, given our finding of increased short-term bleeding risk and long-term mortality, dynamic bleeding risk assessment should be undertaken to guide pharmacotherapy strategies.

Funding Acknowledgement
Type of funding sources: None.
Effects of intravenous lysine acetylsalicylate versus oral aspirin on platelet responsiveness in patients with ST-segment elevation myocardial infarction
Authors: Vivas D , Jimenez J , Martin-Asenjo R , Bernardo E , Ortega-Pozzi A , Gomez-Polo J C , Moreno G , Vilacosta I , Perez-Villacastin J , Fernandez-Ortiz A 
Published: October 2022

Abstract

Background
Prasugrel and ticagrelor, new P2Y12-ADP receptor antagonists, are associated with greater pharmacodynamic inhibition and reduction of cardiovascular events in patients with an acute coronary syndrome. However, evidence is lacked about the effects of achieving faster and stronger cyclooxygenase inhibition with intravenous lysine acetylsalicylate (LA) compared to oral aspirin on prasugrel inhibited platelets in patients with an ST-segment elevation myocardial infarction (STEMI).

Methods
This is a prospective, randomized, multicenter, open platelet function study conducted. STEMI patients were randomly assigned to receive a loading dose (LD) of intravenous LA 450mg plus oral ticagrelor 180mg, or LD of aspirin 300mg plus ticagrelor 180mg orally. Platelet function was evaluated at baseline, 30 min, 1h, and 24h using multiple electrode aggregometry and vasodilator-stimulated phosphoprotein phosphorylation (VASP). The primary endpoint of the study is the inhibition of platelet aggregation after arachidonic acid (AA) 1.5mM at 30 min. Secondary endopoints are the inhibition of platelet aggregation after AA baseline and at 1h, and 24h, and measurement of aggregation with other platelet test (ADP, collagen and VASP).

Results
A total of 32 STEMI patients were randomized (16 LA, 16 aspirin). The inhibition of platelet aggregation after AA 1.5 mM at 30 min was greater in subjects treated with LA compared with aspirin: 166 vs. 412 respectively, p=0.001. This differential effect was observed at 1 hour (p=0.01), but not at 24 hours. Subjects treated with LA presented less variability and faster and greater inhibition of platelet aggregation with AA compared with aspirin (Figure 1).

Conclusions
The administration of intravenous LA resulted in a significantly reduction of platelet reactivity compared to oral aspirin on ticagrelor inhibited platelets in patients with STEMI. Loading dose of LA achieves an earlier platelet inhibition, and with less variability than aspirin.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the CTU-SCReN (Clinical Trial Unit – Spanish Clinical Research Network) from San Carlos University Hospital (Madrid, Spain), financed by the ISCII (Project PI16/00191)
Positive predictive value of the crusade score for bleeding events in patients with acute coronary syndromes on dual antiplatelet therapy with acetylsalicylic acid and clopidogrel
Authors: Monteiro J J , Chemba J M , Carvalho P , Carvalho C , Bernardo M , Moreira I , Ribeiro H , Moreira J I 
Published: October 2022

Abstract

Introduction
Crusade score (CS) quantifies intrahospital major bleeding (IHMB) risk in patients admitted with acute coronary syndrome (ACS). Hemorrhagic risk after ACS increases with age, although, it's not considered in score estimation.

Purpose
Evaluate CS ability to predict IHBM risk according to different patient ages (higher or lower than 75 years) admitted with ACS diagnosis and submitted to double antiagreggation therapy with acetylsalicylic acid and Clopidogrel.

Methods
A retrospective study based on the Portuguese National Registry of ACS, including patients (pts) hospitalized with ACS and treated with double antiagreggation therapy with acetylsalicylic acid (AAS) and clopidogrel between October 2010 and January 2021 (n=8401). Were excluded patients submitted to coronary artery bypass grafting, with ticagrelor or prasugrel switch to clopidogrel during hospitalization.
Patients were divided into two groups according to their age (above or below 75 years) and then subdivided in 5 groups according to CS category of IHBM risk estimation: very low (CS ≤20, 3,1% risk predicted by the score), low (21 ≤ CS≤30, 5,5%), moderate (31 ≤ CS≤40, 8,6%), high (41 ≤ CS≤50, 11,9%) and very high risk (CS≥51, 19,5%). Then, the incidence of IHMB observed in each group during hospitalization (mean 5 days) was compared to the IHBM risk predicted by the CS.

Results
The IHMB rate was 1.78%, significantly lower than predicted by the Crusade score (7.1%, p&lt;0.001). Bleeding rates in each group of patients (above or below 75 years and according to CS calculation are depicted in Figure 1. CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years (see Figure 2).

Conclusion
As shown in different literature, crusade score overestimate bleeding risk after ACS compared to real-life cohorts. Despite the same trend observed in our cohort of patients, in this retrospective study, CS revealed more power to predict IHMB in the prespecified group of patients older than 75 years, than in the group of patients younger than 75 years in patients submitted to double antiaggregation with AAS and clopidogrel.

Funding Acknowledgement
Type of funding sources: None.
Perioperative risk and benefit of antiplatelet therapy in patients undergoing non-cardiac surgery within 1 year after percutaneous coronary intervention with second-generation drug-eluting stents
Authors: Lee S , Kim C , Kim H , Ahn S G , Cho S , Park J K , Moon J Y , Won H , Suh Y , Cho J R , Cho Y H , Oh S J , Lee B K , Kime J S 
Published: October 2022

Abstract

Background
Antiplatelet therapy (APT) in patients undergoing non-cardiac surgery (NCS) after percutaneous coronary intervention (PCI) is still on debate due to its opposite effects which are to prevent from cardiovascular events and to cause bleeding. There is no apparent consensus on how to determine perioperative APT strategy within 1 year after PCI. Therefore, we investigated the risk and benefit of APT in NCS within 1 year after PCI.

Methods
Patients undergoing NCS after PCI with second-generation drug-eluting stents are retrospectively included from multicenter cohort of 8 medical centers in Korea. Perioperative clinical event within 30 days after NCS was recorded. Net adverse clinical event (NACE) including all cause death, major adverse cardiac event (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and major bleeding were evaluated. To overcome bias, propensity score covariate adjustment was performed using logistic regression analysis to generate propensity scores for patients of both APT strategies.

Results
Total 1130 patients (median age 69 years, female 30.5%) undergoing NCS within 1 year after PCI were eligible in the cohort. Study population included 55.1% patients suffered from ACS and 22.5% underwent complex PCI. NCS included 45.8% intermediate-to-high risk surgery and 10.7% urgent or emergent surgery. APT was continued during NCS in 62.7% of the patients. More patients continued DAPT (48% vs. 32%, p&lt;0.001) among the patients who underwent NCS within 6 months after PCI than those who underwent NCS after 6 months. There were 49 NACE (4.3%), 16 MACE (1.4%) and 23 major bleeding events (2.0%), respectively. Continuing APT was associated with a lower risk of NACE (Adjusted hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.27–0.89; p=0.020)) and MACE (Adjusted HR, 0.35; 95 CI, 0.12–0.96; p=0.042). Subgroup analysis showed a tendency that continuing APT might be favorable than discontinuing APT in terms of MACE in patients who were diagnosed with ACS, underwent complex PCI, or underwent NCS within 6 months after PCI.

Conclusions
About two thirds of the patients were continuing APT during NCS. Our findings may support a careful consideration of APT continuation for some of the patients who are undergoing NCS within 1 year after PCI.

Funding Acknowledgement
Type of funding sources: None.
Mitral annulus strain by 3D echo reveals regional annular dysfunction in Barlow's disease
Authors: Aguilera H M , Persson R M , Haaverstad R , Skallerud B , Prot V , Urheim S 
Published: October 2022

Abstract

Background
Barlow's disease (BD) provides both diagnostic and therapeutic challenges. Annular dilation is typically seen in BD, however, data on regional deformation is lacking.

Purpose
We hypothesized that mitral annulus dilates non-homogenously during ventricular systole in BD. A method to calculate annular regional strain was developed and applied in a subset of BD patients and healthy controls.

Methods
Ten patients with BD and late systolic mitral regurgitation and nine healthy controls were studied. For each subject, the mitral annulus was segmented throughout the cardiac cycle using 3D echocardiography. Twelve evenly distributed geometrical points were annotated along the annular perimeter, enabling the creation of periodic degree-3 spline curves parameterized by arc length at each discrete time-frame. The motion of the mitral annulus was then acquired by assuming that heterogeneity in annular strain is small and finding the point-wise map that minimized the total displacement between the consecutive curves. Then, the end-diastolic annular curve was divided into 200 evenly distributed points around the annular perimeter, and the point-wise mapping was implemented to create a continuous movement of the discretized annulus throughout the cycle. Annular strain was then calculated for each individual line segment. The method presented herein is validated by comparing the strain between sonomicrometric crystals in pigs and the method described above. The timescale was normalized from ED (end-diastole) to mitral valve opening for each individual. The regional strains of the annulus were calculated with the ED configuration as reference.

Results
Hemodynamic data are presented in Table 1. In BD annulus area increased from 16.6±3.2 to 21.7±4.2 cm2 at end-diastole and peak systole, respectively (p&lt;0.001). In controls, annulus area at end-diastole and end-systole was 9.6±2.2 cm2 and 9.2±1.8 cm2, respectively (NS). Figure 1 demonstrates non-homogenous regional strain at peak systole, with the most severe deformation in the posteromedial region. In healthy controls, peak systolic strain was similar in all segments.

Conclusions
In the present study, we have applied a novel non-invasive method to demonstrate non-homogenous deformation of the mitral annulus in Barlow patients. On average, the most severe deformation was seen in the posteromedial region. This finding may reveal further insight into the mechanisms of late systolic mitral regurgitation in BD as well as the design of annuloplasty in the future.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Trond Mohn Foundation
Ticagrelor or prasugrel in patients with acute coronary syndrome and prior myocardial infarction
Authors: Scalamogna M , Lahu S , Ndrepepa G , Mayer K , Gewalt S , Menichelli M , Bernlochner I , Joner M , Xhepa E , Kufner S , Laugwitz K L , Neumann F J , Schunkert H , Kastrati A , Cassese S 
Published: October 2022

Abstract

Objectives
To investigate the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) and prior myocardial infarction (MI).

Background
The efficacy and safety of ticagrelor versus prasugrel in ACS patients with prior MI remains unstudied.

Methods
Patients with ACS scheduled for an invasive strategy and randomized to ticagrelor or prasugrel in the ISAR-REACT 5 trial with available information concerning prior MI were included in the present analysis. The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Endpoints were assessed 12 months after randomization.

Results
A total of 4,015 patients were included in this analysis (prior MI= 631 patients; no prior MI = 3,384 patients). As compared to patients without prior MI, the primary endpoint occurred more frequently in patients with prior MI (12.6% vs. 7.2%; hazard ratio [HR] = 1.78, 95% confidence interval [CI] 1.38–2.29; p= &lt;0.001) without significant difference in terms of secondary endpoint between groups (5.8% vs. 5.7%; HR=1.02 [0.71–1.45]; p=0.921). Patients with prior MI randomized to ticagrelor versus prasugrel displayed higher risk for primary (HR=1.62 [1.03–2.55]) but not secondary endpoint (HR=1.28 [0.56–2.91]). Patients without prior MI randomized to ticagrelor or prasugrel displayed no significant difference in terms of primary (HR=1.28 [0.99–1.65]) or secondary endpoints (HR=1.13 [0.82–1.55]). There was no treatment assignment-by-prior MI status interaction with respect to the primary (p for interaction = 0.373) and the secondary (p for interaction= 0.786) endpoints.

Conclusions
Patients with ACS and prior MI are at higher risk for recurrent ischemic but not bleeding events. The history of MI does not affect the relative efficacy and safety of ticagrelor versus prasugrel in patients with ACS.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
Abbreviated dual antiplatelet therapy after PCI in patients at high bleeding risk: a collaborative meta-analysis of randomized trials
Authors: Costa F , Montalto C , Bhatt D , Steg P G , Feres F , Cao D , Micari A , Stone G , Mehran R , Valgimigli M 
Published: October 2022

Abstract

Aims
The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. We appraised an abbreviated compared with a more prolonged DAPT regimen in this setting by using the totality of existing evidence.

Methods and results
A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated (i.e., short [3 months] or very-short [1 month]) with standard (≥6 months) DAPT in HBR patients. Six trials with 8,409 patients were included. Major or clinically relevant non-major bleeding (MCRB) and major adverse cardiovascular events (MACE) were the co-primary safety and efficacy endpoints. MCRB was lower with abbreviated compared to standard DAPT (risk ratio [RR] 0.63, 95% CI 0.41–0.95; I2=74%). No difference in terms of MACE (RR 1.03, 95% CI 0.89–1.20; I2=0%) all-cause death, cardiovascular death, stent thrombosis or myocardial infarction were observed. Network meta-analysis showed short or very-short DAPT to have the highest probability to prevent bleeding in HBR patients.

Conclusion
Abbreviated DAPT reduced bleeding without apparent increase in ischemic events in HBR patients undergoing PCI. Three-month or one-month DAPT courses appeared similarly effective to optimize the trade-off for ischemia and bleeding in this population.

Funding Acknowledgement
Type of funding sources: None.
Procedural and long-term outcomes of stent post dilatation during primary percutaneous coronary interventions
Authors: El Amrawy A , Zaki A , Sadaka M , Wagdy S 
Published: October 2022

Abstract

Background
The role of stent post dilatation (SPD) during primary percutaneous intervention (PPCI) is controversial. Currently there are no clear guidelines or consensus regarding when to perform SPD and it is left to the operator decision.

Purpose
The aim of this study was to evaluate the procedural and long terms outcomes of SPD during PPCI.

Methods
We collected retrospectively data of 614 STEMI patients who presented to two tertiary centers during one year period. All patients underwent PPCI. We excluded patients with cardiogenic shock, prior CABG, severe LM disease. Patients were divided into two groups according to SPD procedure. Group 1: who had SPD included 424 patients (69.1%). Group 2: no SPD included 190 patients (30.9%). Both groups were well matched with regard to demographic data and lesion characteristics. Procedural outcomes and clinical outcomes at one year were collected.

Results
SPD patients had significantly higher incidence of no reflow during the procedure (33.7% in group 1 vs. 21.6% in group 2, P=0.026), but the final TIMI flow was similar between two groups. Also, there was no significant difference between two groups regarding other procedural outcomes as dissection, perforation, or cardiac death. After one year follow up SPD patients had significantly higher incidence of reinfarction (5.6% of group 1 vs. 1.5% in group 2, P=0.03) and significantly more target vessel revascularization (TVR) (16.7% in group 1 vs. 4.7% in group 2 P&lt;0.001). There was no significant difference between the two groups regarding the incidence cerebrovascular stroke (CVS), heart failure or cardiac death.

Conclusion
Our study shows that SPD during PPCI is associated with an increased risk of procedural no reflow and increased risk of reinfarction as well as need for TVR after 1 year follow up. Finally, SPD did not improve clinical outcomes after 1 year follow up. Nonetheless, large-scale randomized trials are required to establish the role of SPD during PPCI.

Funding Acknowledgement
Type of funding sources: None.
Intracoronary Imaging in left main stent percutaneous coronary intervention has a clear survival benefit particularly in more complex patients
Authors: Khan K , Abdulelah Z , Murad S , Hsu Y U K A I , Leung J , Shahid F , Khan S 
Published: October 2022

Abstract

Background
Left Main Stem Disease (LMS) is prognostically important coronary artery disease that is managed either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI). Use of intracoronary imaging (ICI) modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve outcomes with PCI revascularization.
The primary objective of this study was to evaluate the impact of ICI on outcomes following LMS PCI.

Methods
Retrospective observation study of 498 (5.1% of all PCI cases) patients who had undergone LMS PCI at our tertiary primary PCI centre hospital over a 11-year period between July 2010-July 2021. Data was collected from electronic medical records. Follow-up was also obtained through linkage with the Office of National Statistics.

Results
The mean age at the time of enrolment was 70.7±11.5 years. Majority of the patients were male 351 (70.5%). 353 (70.9%) of cases had acute coronary syndrome (ACS) presentation while the remainder were elective procedures. Mean follow-up duration was 3.75±3.06 years. Survival calculated by Kaplan-Meier was 70%. 87 patients (17.5%) deceased during first year of enrolment. 344 (69.1%) patients had ICI, with IVUS in 316 (63.5%) and OCT in 28 (5.6%) patients. IVUS comprised 91.9% of ICI procedures. Protected LMS (OR 0.175, 95% CI: 0.037–0.833, P-value=0.029) and the use of left ventricular mechanical support device (OR 0.324, 95% CI: 0.122–0.859, P-value=0.024) were associated with decreased odds of undergoing an ICI.
Patients undergoing ICI had significantly better survival compared to those without ICI (HR: 0.54, P&lt;0.001). Moreover, OCT showed significantly better survival compared with IVUS (HR: 0.181, P=0.017). Use of ICI was associated with better survival in patients who had Rotablation (HR: 0.455, 95% CI: 0.232–0.892, P=0.022), ACS (HR: 0.523, 95% CI: 0.383–0.714, P&lt;0.001) or comorbidities of diabetes and stroke (HR: 0.551, 95% CI: 0.337–0.807, P=0.002).

Conclusion
ICI in LMS PCI has a significant survival benefit in our dataset. This is especially the case in patients presenting with ACS, those with comorbidities of Diabetes mellitus and stroke and those undergoing rotablation.

Funding Acknowledgement
Type of funding sources: None.