1,721,792 research outputs found
Revascularization based on coronary computed tomography angiography and novel antiplatelet therapy in coronary artery disease
No full textInvasive coronary angiography (ICA) is the cornerstone of cardiology and has revolutionized the diagnosis and treatment of coronary artery disease (CAD). Its history can be traced back to the early 20th century, with evolution through a series of experimental advances, technological breakthroughs, and clinical applications (1). Although ICA remains the gold standard for visualising the coronary anatomy, coronary computed tomography angiography (CCTA) has evolved into a non-invasive imaging modality that plays a pivotal role in the management of CAD in contemporary clinical practice (2). Current clinical guidelines, including those from the European Society of Cardiology (ESC) and the American College of Cardiology (ACC), have recommended CCTA as the first-line diagnostic test in patients with an intermediate pre-test probability of obstructive CAD (3,4). Its high sensitivity and negative predictive value make it a powerful tool for excluding significant coronary artery stenoses, reducing the need for ICA in many patients. In those without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque, that can be monitored for progression/regression following preventative therapy and provide risk stratification (2). Furthermore, FFR-CT has become increasingly integrated into the management of CAD, enhancing patient care and optimizing revascularization strategies by providing anatomical and functional assessment in one modality (5). Coronary revascularisation, whether percutaneous or surgical, aims not simply to address coronary artery obstruction but to improve clinical outcomes. Previous randomized controlled trials (RCTs) have shown that the anatomical SYNTAX score plays an essential role in risk stratification and is associated with clinical outcomes; notably the treatment effects observed in RCTs often achieved the basis of treatment guidelines, but despite the wide range of treatment effects between patients the focus has been on the average treatment effect. The optimal revascularization strategy should be individualized, considering both the severity of CAD and factors affecting the patient's prognosis. Additionally, as the first-line test for investigating CAD is moving from ICA to CCTA, it is essential to investigate the feasibility and long-term prognosis of revascularization strategies based on CCTA. Optimal medical therapy is essential to improve clinical outcomes regardless of the modality of revascularization. In recent years, the approach to short dual antiplatelet therapy (DAPT) after coronary artery stent deployment has evolved significantly. The latest ESC guidelines recommend tailoring the duration of DAPT based on patient risk profiles, balancing the risk of bleeding against thrombotic events (6). This shift is an essential step in optimizing post-stenting treatment and improving long-term clinical outcomes while preventing ischemic events, and reducing bleeding events
What is the cornerstone of decision making in patients requiring myocardial revascularisation? - Personalized evidence based medicine –
No full textThis thesis aims to enhance personalized decision-making for myocardial revascularization in patients with coronary artery disease (CAD), by identifying individual treatment responses across a heterogeneous population.
Part 1 evaluates diagnostic tools guiding revascularization, particularly the diagnostic performance of various angiography-derived fractional flow reserve (FFR) software in a prospective cohort. It also introduces the pull-back pressure gradient (PPG) index as a novel physiological metric to predict percutaneous coronary intervention (PCI) outcomes.
Part 2 reviews subgroup analyses from the SYNTAX trial, which compared PCI and coronary artery bypass grafting (CABG) in patients with complex CAD. These analyses uncover treatment effect heterogeneity based on clinical and lesion characteristics, emphasizing the importance of considering multifactorial interactions in revascularization strategy.
Part 3 investigates the applicability of the SYNTAX Score II 2020 (SSII-2020) in real-world settings using non-randomized registry data. The analysis explores differences between randomized and registry populations, estimating appropriate treatment allocations and highlighting practical considerations in applying SSII-2020 to diverse patient populations.
Part 4 develops an individualized decision-support tool using machine learning, integrating clinical, anatomical, and biomarker data to predict long-term mortality and treatment benefit from PCI or CABG in complex CAD.
Part 5 explores device-specific strategies, focusing on bioresorbable scaffolds (BRS) and drug-coated balloons (DCB) as alternatives to drug-eluting stents (DES). It addresses their potential benefits and limitations, and the challenge of identifying patients most likely to benefit from these novel technologies.
Collectively, this work contributes to the advancement of precision medicine in coronary revascularization through diagnostic refinement, prognostic modeling, and individualized treatment selection
Periprocedural anatomical and physiological assessment of myocardial revascularisation
No full textThe goal of coronary revascularisation, whether via stenting or bypass grafting, is not merely to address coronary artery obstructions but also to improve clinical outcomes. Functional assessment of coronary stenoses has become the standard of care to evaluate the significance of coronary flow-limitation, and to justify revascularisation in contemporary practice. Imaging- derived physiological assessment based on invasive coronary angiography (ICA) or coronary computed tomographic angiography (CCTA) is an alternative to wire-based pressure measurements, and offers the benefits of being less invasive, more cost-effective, and having a shorter procedure time. In patients with complex coronary artery disease (CAD), the decision by the Heart Team between either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is aided using an objective risk model such as the SYNTAX Score Ⅱ 2020, which facilitates an individual assessment of the short- and long-term risk benefit with each treatment modality (1). Optimal medical therapy after revascularisation is associated with long-term survival benefit (2)
Advance in planning and treatment of patients with complex coronary artery disease: From invasive coronary angiography to coronary computed tomography angiography and machine learning
No full text[No abstract available
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Characterizing Pathophysiological Patterns of Coronary Artery Disease Among Individuals With Elevated Lipoprotein(a)
No full textDispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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