bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of age at the time of the first ST-elevation myocardial infarction on 10-year outcomes. A sub-analysis from the EXAMINATION EXTEND trial
Authors: Arevalos Rivas V , Spione F , Gabani R , Ortega-Paz L , Gomez-Lara J , Jimenez-Diaz V A , Jimenez M , Jimenez-Quevedo P , Diletti R , Pineda J , Campo G , Silvestro A , Maristany J , Sabate M , Brugaletta S 
Published: October 2022

Abstract

Background
The aim of this post-hoc sub analysis of the EXAMINATION-EXTEND study was to analyze 10-year outcomes according to the age of the patient at the time of the first STEMI.

Methods
Out of 1498 STEMI patients included in the EXAMINATION-EXTEND study, those with a previous history of atherosclerotic cardiovascular disease (coronary ischemic event, ischemic stroke, or previous coronary revascularization) were excluded for this analysis. The remaining 1375 patients were divided into three age groups: &lt;55, 55–65 and &gt;65 years. The primary endpoint was 10-year patient oriented composite endpoint (POCE) of all-cause death, any myocardial infarction (MI), or any revascularization. Secondary endpoints included the individual components of the primary endpoint, cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularization (TLR), and stent thrombosis. The association between age and endpoints was adjusted for baseline confounders.

Results
At 10-year follow-up, patients &lt;55 years (Adjusted hazard ratio [HR]: 0.42, 95% CI: 0.33–0.53, p=0.001), and 55–65 years (Adjusted HR: 0.44, 95% IC: 0.35–0.56, p=0.001) showed lower risk of POCE compared with those &gt;65 years, led by a lower incidence of all-cause death (&lt;55: 5.8% vs. 55–65: 11.3% vs. &gt;65 years: 40.67%, p=0.001). Cardiac death was more prevalent in the older group (&lt;55: 3.5% vs. 55–65: 5.5% vs. &gt;65 years: 21.3%, p=0.001). There were not significant differences in the incidence of TVMI, TLR and stent thrombosis among the different age groups. In the landmark analyses, between 5 and 10-year follow-up, young patients exhibited higher incidence of any revascularization (&lt;55: 7.4% vs. 55–65: 4.9% vs. &gt;65 years: 1.7%, p=0.001) and a trend towards a higher incidence of any MI (&lt;55: 5.2% vs. 55–65: 3.6% vs. &gt;65 years: 1.5%, p=0.064). No differences were found in any other endpoints.

Conclusions
In patients with a first STEMI, advanced age was associated with high rates of POCE at 10-year follow-up, in particular, due to all-cause and cardiac death. Conversely, patients who presented at younger age exhibited a high risk of revascularization at long-term follow-up.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular
Ten years survival benefit of CABG or PCI based on individual prediction
Authors: Serruys P W , Gao C , Ninomiya K , Hara H , Garg S , Onuma Y , Kappetein A P , Mohr F W , Mack M 
Published: October 2022

Abstract

Background
To compare the observed and individual predicted mortalities according to the SYNTAX score II 2020 (SSII-2020) in the all-comers SYNTAX population, and retrospectively assess the appropriateness of revascularization with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three vessel disease (3VD) and/or left main disease (LMCAD).

Methods
Internal and external validation of the SSII-2020 to predict 10-year all-cause death was performed in the respective randomized and registry SYNTAX populations. Differences in individual predicted mortalities following CABG or PCI were ranked and displayed with the observed mortalities. The proportions of screened patients deriving a survival benefit from CABG or PCI were determined retrospectively.

Results
A total of 2602 participants (as-treated population) were included in the randomized and registry cohorts. In the randomized cohort, all-cause mortality at 10 years, as an average treatment effect, was 23.8% (199/865) with CABG and 28.6% (249/901) with PCI, with a differential survival benefit of 4.6% (95% CI: 0.58% to 8.7%, log-rank p value=0.023). In the CABG and PCI registries, mortalities were 27.8% (167/644) and 55.4% (99/192), respectively. Calibration and discrimination of the SSII-2020 was helpful in CABG and PCI patients in the randomized and registry cohorts. In the PCI registry, the SSII-2020 underestimated mortality since specific comorbidities that entail high mortality are not included in the formula (C-index: 0.72, intercept: 0.38, slope: 0.66), whilst in the CABG registry, it predicted mortality with a helpful calibration and discrimination (C-index: 0.70, intercept: 0.00, slope: 0.76). The proportions of patients with a predicted survival benefit following CABG and PCI were respectively 78.3% (1383/1766) and 21.7% (383/1766) in the randomized cohort, and 82.4% (2143/2602) and 17.7% (459/2602) in the whole SYNTAX trial population.

Conclusion
In the randomized and registry cohort of this all-comers population with 3VD and/or LMCAD, there was reasonable agreement between the individual predicted and observed mortalities after CABG or PCI, such that the predicted 10-year survival benefit might be helpful in determining the appropriateness of each modality of revascularization.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The SYNTAX Extended Survival study was supported by the German Foundation of Heart Research (Frankfurt am Main, Germany). The SYNTAX trial, during 0-5 years follow-up, was funded by Boston Scientific Corporation (Marlborough, MA, USA). Both sponsors had no role in the study design, data collection, data analyses, and interpretation of the study data, nor were involved in the decision to publish the final manuscript. The principal investigators and authors had complete scientific freedom.
Prevention of radial artery spasm during coronary angiography with transdermal glyceryl trinitrate patches: the NURSE-TTS trial
Authors: Doundoulakis I , Kalamakidou I , Koliastasis L , Samara M , Papazisis G , Tsiachris D , Tsioufis K , Economou F 
Published: October 2022

Abstract

Background/Introduction
One of the most common complications encountered during transradial procedures is radial artery (RA) spasm, whereas its management remains a challenge.

Purpose
We hypothesized that in patients undergoing cardiac catheterization via the RA, the use of transdermal nitroglycerin (NTG) patches applied to skin over the RA puncture site may prevent the occurrence of radial artery spasm.

Methods
NURSE-TTS (Nitrate Use to Obtain Radial Spasm Embarrassment) is a parallel-group, randomized, double-blind, placebo-controlled trial evaluating the impact of transdermal NTG application to RA spasm prevention. 146 patients were consecutively enrolled from February 2021 to December 2021 from an experienced center in Greece and underwent diagnostic coronary angiography. The primary endpoint was the exerting force of the RA measured by the dynamometer in Newton.

Results
The primary endpoint of the dynamometer measurements was found to be significantly different between the two groups. The treatment group's mean force was 5.95±2.60 and 7.21±2.82 for the placebo group respectively (p=0.007). The multivariate analysis confirmed that NTG patches affected radial spasm (treatment group p=0,010, 95% CI: −2,038, −0,282; age p=0,010, 95% CI: −0,099, −0,014; male gender p=0,011, 95% CI: −2,612, −0,349; CKD p=0,044, 95% CI: 0,064,0,951).

Conclusions
This is the first prospective randomized study demonstrating that the application of transdermal NTG 10mg on skin for 30 minutes before coronary angiography resulted in lower exerting force of the cannulated radial artery thus lower arterial spasm.

Funding Acknowledgement
Type of funding sources: None.
Low burr-to-artery ratio predict stent underexpansion in patients with high OCT based calcium score underwent rotablator atherectomy
Authors: Wongpraparut N , Chongthaveepol S 
Published: October 2022

Abstract

Background
Stent under-expansion is the potent predictor for stent thrombosis.

Purpose
We aim to determine the incidence of stent under-expansion and its predictors in patient who undergoing rotational atherectomy (RA) assisted percutaneous coronary intervention (PCI) assessed by optical coherence tomography (OCT).

Method
The study included 83 consecutive patients who undergoing OCT guidance RA assisted PCI during January 2016 through September 2020. Baseline clinical characteristics and intracoronary imaging data were recorded. Stent under-expansion was defined as the minimal stent area divided by average of proximal and distal reference lumen area &lt;80%.

Results
Majority of patients (83%) had OCT based calcium score 3–4. The incidence of stent under-expansion was 9.6%. Comparing between the patient with optimized stent expansion and stent under-expansion, patients with stent under-expansion has older age (79.1±6 vs 69.8±10.4, p=0.015), higher calcium thickness (1.01±0.83 vs 0.65±0.22, p&lt;0.001), longer calcium length (18.68±1.88 vs 12.69±5.33, p&lt;0.001). and lower burr to artery ratio (0.53±0.09 vs 0.65±0.09, p&lt;0.001). The optimal cut-off values of burr to artery ratio &lt;0.54 predict stent under-expansion.

Conclusion
In the patients with high OCT based calcium score underwent RA assisted PCI, burr to artery ratio&lt;0.54 is a predictor for stent underexpansion.

Funding Acknowledgement
Type of funding sources: None.
Coronary perforation incidence and temporal trends (COPIT): systematic review and meta-analysis
Authors: Mikhail P , Howden N , Monjur M , Said C , Jeyaprakash P , Bland A , Collison D , McCartney P , Adamson C , Morrow A , Carrick D , McEntegart M , Ford T 
Published: October 2022

Abstract

Background
Despite advancements in Percutaneous Coronary Intervention (PCI) technology and techniques, iatrogenic coronary artery perforation (CAP) remains a dreaded potential complication within the cardiac catheterisation laboratory. Data detailing the incidence of coronary perforation during PCI has previously been obtained from relatively small datasets. A swell of large data published in recent times provides invaluable information regarding PCI related CAP.

Purpose
COPIT is a systematic review and meta-analysis targeted at detailing the incidence, outcomes, etiology and treatment modalities of PCI related CAP including evaluation of temporal trends since the inception of PCI to contemporary practice. Additionally, COPIT provides hypothesis generating data regarding predictors of CAP during PCI.

Methods
A prospective systematic review and meta-analysis using MEDLINE and EMBASE via the OVID interface (PROSPERO ID: CRD42020207881) was performed according to the PRISMA guidelines. Identified relevant studies were used in a pre-specified sensitivity analysis to detail incidence, outcomes, etiology, treatment modalities and risk factors of PCI complicated by CAP. Studies limited to PCI in high risk populations only such as CTO-PCI or rotational atherectomy only were excluded.

Results
67 studies met eligibility criteria detailing 5,568,191 PCIs over a 38-year period (1982–2020). The pooled incidence of CAP was 0.39% (95% CI: 0.34–0.45%) with no change in incidence over that time. Approximately 1 in 5 perforations led to cardiac tamponade (21.1%). Ellis 3 perforations are increasing in frequency and account for 43% of all perforations. Mortality due to perforation occurs in 7.5% of all CAP (95% CI 6.7% - 8.4%) but has declined over the studied period. Meta-regression suggested that female gender, hypertension, chronic kidney disease and previous coronary bypass grafting were all associated with higher incidence of CAP. Coronary perforation was most frequently caused by distal wire exit (37%) followed by balloon dilation catheters (28%). Covered stents were used to treat 25% of perforations, with emergency cardiac surgery needed in 17%.

Conclusion
Coronary perforations occurs in approximately 1 in 250 all-comer PCI procedures. A tendency towards increase in coronary perforations is likely reflective of contemporary trends towards high pressure post-dilatation with 1:1 vessel sizing as well as an ageing population with increasingly complex, calcific coronary disease. However, reduction in CAP related mortality suggests earlier recognition and effective treatment with transcatheter techniques.

Funding Acknowledgement
Type of funding sources: None.
Prevalence and prognostic implications of the no-reflow phenomenon in patients undergoing primary percutaneous coronary intervention in a university center in a middle-income country
Authors: Godinez Cordova L B , Gonzalez-Pacheco H , Gopar-Nieto R , Eid-Lidt G , Briseno-De La Cruz J L , Araiza-Garaygordobil D , Mendoza-Garcia S , Altamirano-Castillo A , Ontiveros-Mercado H , Arias-Mendoza A 
Published: October 2022

Abstract

Background
No-reflow (TIMI flow ≤2) during primary PCI for STEMI occurs in 7–25% of cases, indicates poor myocardial tissue perfusion, and is associated with a poor outcome. (1–3) The incidence in our hospital is unknow.

Purpose
To analyse the prevalence of no-reflow and the 30-day mortality in our hospital.

Methods
We analysed the database of a teaching hospital and identified 2463 patients who underwent primary PCI from January 2006 to December 2021. No-reflow was defined as post-PCI TIMI flow ≤2, in the absence of post-procedural significant (≥25%) residual stenosis, abrupt vessel closure, dissection, perforation, thrombus of the original target lesion, or epicardial spasm. The outcome measure was 30-day mortality.

Results
Of total of 2050 patients, no-reflow phenomenon was found in 413 (16.8%) patients, and it was associated with significantly higher 30-day mortality (16.7% vs. 4.29%; p = &lt;0.001). Patients with no-reflow were older (60 [53–69.5] vs. 59 [51–66]; p=0.001), with a higher delay in onset of symptom to emergency department arrival (270 min vs. 247 min; p=0.001) but had similar door to balloon time (75 min vs. 80 min; p=0.434). No-reflow patients also had had fewer previous myocardial infarction (11.6 vs. 18.4; p=0.001), lower systolic blood pressure (128 mm Hg vs. 132 mm Hg; p = &lt;0.001) and a Killip class &gt;1 (37% vs. 26.4%; p = &lt;0.001). No-reflow patients were more likely to have an anterior myocardial infarction (55.4% vs. 47.8; p=0.005), initial TIMI flow 0 (76% vs. 68%; p = &lt;0.001) and TMP 0 (14.1% vs. 4.5%; p = &lt;0.001).

Conclusion
No-reflow occurred in 16.8% of STEMI patients undergoing primary PCI and was more likely with older age, delayed presentation, anterior myocardial infarction and Killip class &gt;1. No-reflow was associated with a higher mortality at 30-day follow-up.

Funding Acknowledgement
Type of funding sources: None.
Clinical and angiographic outcomes following percutaneous treatment of non-occlusive vs. chronically total occluded coronary lesions
Authors: Aytekin A , Cassese S , Kufner S , Ndrepepa G , Voll F , Rheude T , Seguchi M , Coughlan J J , Pinieck S , Joner M , Fusaro M , Kastrati A , Xhepa E 
Published: October 2022

Abstract

Background
Recent advancements in recanalization techniques, introduction of dedicated equipment and elaboration of systematic algorithmic approaches have significantly improved procedural success of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures. However, despite their undisputable merits in terms of procedural success, direct comparisons of mid-term clinical and angiographic outcomes following CTO and non-CTO-PCI are missing.

Purpose
The aim of this study was to assess the clinical and angiographic outcomes of patients undergoing successful CTO-PCI as compared to a propensity matched cohort of patients undergoing PCI of non-occlusive coronary lesions.

Methods
All consecutive patients undergoing successful CTO recanalization procedures at our center between 2015 and 2018 were included (N=453; 472 lesions). For matching purposes, all patients undergoing non-CTO-PCI present in our database were included (N=14733; 23458 lesions). A 1-to-1 nearest neighbour matching using baseline clinical and angiographic variables was performed to identify one patient undergoing non-CTO-PCI (N=453; 472 vessels) for each patient undergoing CTO-PCI (N=453; 472 vessels). Surveillance angiography was scheduled at 6–9 months and clinical follow-up was performed up to 12 months. The primary clinical endpoint of interest was the incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR). The secondary angiographic endpoint was in-segment binary restenosis.

Results
Patients undergoing CTO-PCI displayed a tendency towards higher degrees of binary restenosis at surveillance angiography as compared to those undergoing non-CTO-PCI (CTO vs. non-CTO: 30.5% vs. 24.0%; P=0.058), despite not meeting statistical significance. Of note, the incidence of occlusive restenosis was low and comparable between groups (2.2% vs. 1.4%; P=0.603). At 12 months follow-up, MACE occurred in 83 patients (19.7%) in the CTO-PCI and 59 patients (14.1%) in the non-CTO-PCI group (hazard ratio [HR] = 1.44; 95% confidence interval [CI]: 1.03–2.01; P=0.033). TLR rates were significantly higher following CTO- as compared to non-CTO-PCI (17.2% vs. 10.3%; HR=1.72 [1.18–2.51], P=0.005). The incidence of all-cause death (2.6% vs. 3.3%; P=0.548) and MI (0.5% vs. 1.4%; P=0.177) was not significantly different between the groups.

Conclusion
In this large, propensity-matched comparison of clinical and angiographic outcomes following CTO- vs. non-CTO-PCI, we found CTO-PCI to be associated with a higher MACE rate at 12 months, primarily driven by significantly higher TLR rates. The incidence of occlusive restenosis was low and comparable between groups.

Funding Acknowledgement
Type of funding sources: None.
Radiofrequency thermal balloon angioplasty of vulnerable atherosclerotic plaque accompanied by delta-aminolevulinic acid photodynamic therapy and catheter-based samarium-153 brachytherapy
Authors: Mehrad H , Mokhtari Soureh A 
Published: October 2022

Abstract

Background
The balloon angioplasty methods that are currently in use, cause to inflammation and subsequent neoatherosclerosis.

Purpose
The aim of this study was to evaluate the effect of combined photodynamic therapy and brachytherapy on inflammation and intimal hyperplasia reduction after radiofrequency thermal balloon angioplasty of carotid artery in an animal model of thin fibrous cap atheromatous plaque, wherein a high resolution diagnostic ultrasound is adjuncted with angioplasty and combination therapy system, with a goal of increased safety.

Methods
Briefly, New Zealand white rabbits were submitted to carotid artery vulnerable atherosclerotic plaque by primary intravascular balloon injury followed by a 1.5% cholesterol-rich diet for eight weeks. Histopathology results showed the formation of advanced atherosclerosis with a foam cell-rich atheromatous plaque, resulted in severe stenosis (&gt;70%) in all of the rabbits' arteries. Then treatment group underwent B-mode ultrasound-guided radiofrequency thermal balloon angioplasty followed by catheter-based samarium-153 brachytherapy (153Sm, 18 Gy, β particles) and photosensitizer delta-aminolevulinic acid (delta-ALA)-mediated fiber optic catheter-based polarized light-emitting diodes (LEDs) violet light (λ±Δλ = 405±5 nm, E/A = 120 J/cm2) photodynamic therapy.

Results
Results from ultrasonography and histopathology showed a significant reduction in the mean value for macrophages, lymphocytes, mast cells, foam cells and hyperplastic vascular smooth muscle cells density after angioplasty in the treatment group compared with the other groups (p&lt;0.05).

Conclusion
Apoptotic effect of brachytherapy in combination with cytotoxic and anti-inflammatory effect of delta-ALA photodynamic therapy on immune cells and hyperplastic vascular smooth muscle cells, can cause to reduce the neoatherosclerosis in the intimal layer. These findings provide the basis for developing of combined brachytherapy and photodynamic therapy for a successful clinical application in the inhibition of neoatherosclerosis after radiofrequency thermal balloon angioplasty.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mehrad Research Lab
Coronary angioplasty or medical treatment in patients with aortic stenosis and coronary artery disease undergoing transcatheter aortic valve implantation: a real world analysis
Authors: Belo Nunes R , Da Costa L M A , Cantarelli M J , Castello Junior H , Oliveira G B F , Avezum Junior A 
Published: October 2022

Abstract

Backgroud
Patients undergoing transcatheter aortic valve implantation (TAVI) due to severe aortic stenosis have a high prevalence of coronary artery disease (CAD). As many of them have high surgical risk, CAD treatment in this group usually has been carried out with optimal medical treatment alone or associated with percutaneous coronary intervention (PCI). However, the best approach in this scenario is not well established.

Purpose
We aimed to compare the incidences of major adverse cardiovascular outcomes in patients with aortic stenosis and chronic CAD treated with medical treatment alone or medical treatment plus PCI before or during TAVI, using data from a large multinational electronic health record network (TriNetX).

Methods
Patients aged ≥18 years with severe aortic stenosis and CAD who underwent TAVI in the last 10 years before the analysis were considered eligible. Patients who underwent PCI before or during TAVI were named the PCI-TAVI group and no coronary intervention patients were named isolated TAVI group. Patients with a past history of acute coronary syndrome, stroke or coronary artery bypass graft before TAVI were excluded from the analysis. The primary outcome was major adverse cardiovascular events (MACE) including the composite of death, unstable angina or myocardial infarction and ischemic stroke. We used propensity score matching to balance the cohorts. The 5-year cumulative incidences for MACE, Kaplan Meier curves and hazard ratios were calculated.

Results
We identified 13,171 patients undergoing isolated TAVI and 1,884 patients undergoing TAVI and PCI. Using propensity score matching, 1,884 patients in each group were compared. The 5-year incidence of MACE was 23.1% in the isolated TAVI group vs 24.7% in the PCI-TAVI group. The probability of survival without MACE was not significantly different between the isolated TAVI group vs PCI-TAVI group (47.4% vs 50.3%, Log-rank test p=0.718) (Figure 1). The hazard ratio (HR) between the 2 groups was also not significant (HR 1.027, CI 95% 0.89–1.18).

Conclusions
In a real-world cohort of patients with severe aortic stenosis and chronic coronary artery disease, the 5-year probability of major adverse cardiovascular events was not different between patients undergoing isolated TAVI versus patients undergoing PCI before or during TAVI.

Funding Acknowledgement
Type of funding sources: None.