AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/032
On behalf of the Korea Acute Myocardial Infarction Registry - National Institute of Health (KAMIR-NIH) Investigators 1Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, School of Medicine, Daejeon, Korea
2Chonnam National University Hospital, Chonnam National University, School of Medicine, Gwangju, Republic of Korea 3Kyungpook National University Hospital, Kyungpook National University, School of Medicine, Daegu, Republic of Korea 4Yeungnam University Hospital, Daegu, Republic of Korea
5Kyunghee University College of Medicine, Seoul, Republic of Korea
6Seoul National University Hospital, Seoul National University, School of Medicine, Seoul, Republic of Korea
7Chungbuk National University Hospital, Chungbuk National University, School of Medicine, Cheongju, Republic of Korea 8Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
*Corresponding Author: N, Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, School of Medicine, Daejeon, Korea
Citation: Kye T. Ahn., Seok-Woo Seong., Kim M., Jin-Ok Jeong., Seon-Ah Jin. et al. (2020) Impact of thrombus aspiration one-year cardiac mortality during primary PCI in STEMI patients with total occlusion; from Korea Acute Myocardial Infarction Registry National Institute of Health. J Clinical Cardiology and Cardiovascular Interventions, 3(3); DOI:10.31579/2641-0419/032
Copyright: © 2020 Seok-Woo Seong. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 28 November 2019 | Accepted: 27 January 2020 | Published: 04 February 2020
Keywords: thrombus aspiration; myocardial infarction; percutaneous coronary intervention
Background: The clinical impact of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. We investigated to evaluate whether TA during primary PCI reduces one-year mortality.
Methods: From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3749 patients with STEMI who were undergoing primary PCI within 12 hours (60.8±12.9 years, 18.7% women) and shown pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow 0, 1 in coronary angiography were enrolled between November 2011 and November 2015 during one-year follow up. The patients were divided into two groups according to TA during primary PCI: PCI with TA (n=1630) and PCI alone (n=2119). The primary end-point was major adverse cardiac events (MACE), defined as the composite of cardiovascular death (CVD), stroke or recurrent MI at one-year. The secondary efficacy end-point were all-cause of mortality and CVD at one-year.
Results: PCI with TA did not reduce the risk of MACE (OR: 0.598, 95% CI: 0.737-1.160, p=0.499), all-cause mortality (OR: 0.898, 95% CI: 0.705-1.144, p=0.383) and CVD (OR: 0.893, 95% CI: 0.683-1.168, p=0.408) in all patients during one-year follow up. The trend did not change after propensity score matching. In subgroup analysis, there was no efficacy of clinical outcome during one-year follow up.
Conclusions: Primary PCI with TA did not reduce MACE and all-cause mortality among patients with STEMI and pre-procedural TIMI flow 0,1 during one-year follow up.
Manual thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) reduces thrombus burden and improves markers of myocardial reperfusion in patients with acute ST-elevation myocardial infarction (STEMI) [1,2]. However, its clinical benefit has been a contentious point of debate. The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) trial [3] and other several studies [4-6] showed a mortality reduction with TA. In contrast, 2 recent multi-center randomized trials, the Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) [7] and the Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE) [8,9] failed to show a significant reduction in clinical events including mortality.
There remain unanswered questions on the efficacy of PCI with TA including whether PCI with TA truly is of clinical benefit and which subgroups may or may not benefit from the procedure. In the present study, we sought to evaluate clinical impact of TA during primary PCI in STEMI patients with pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow 0, 1
2. Materials and Methods
2.1 Study design and population
The study population was derived from the Korea Acute Myocardial Infarction Registry-National Institutes of Health (KAMIR-NIH) between November 2011 and November 2015. The KAMIR-NIH is a prospective, multicenter, web-based observational cohort study to develop the prognostic and surveillance index of Korean patients with acute myocardial infarction (AMI) from 20 centers in Korea and has been performed to support by a grant of Korea Centers for Disease Control and Prevention since November 2011. Trained study coordinators at each participating institution collected the data using a standardized format. Standardized definitions of all variables were determined by the steering committee board of KAMIR-NIH.
We analyzed a total of 13516 patients with AMI undergoing primary PCI.
Inclusion criteria for the current study are as follows
We therefore enrolled a total of patients in the current study. The study flow diagram is shown in Figure. 1. The current study was approved by the Institutional Review Board (IRB) of our medical institution. All patients proved written, informed consent for participant in the registry.
The primary efficacy end-point was one-year major adverse cardiac events (MACE), defined as the cardiovascular death (CVD), myocardial infarction (MI) or stroke. one-year all cause of mortality. The secondary efficacy end-points were one-year all cause of mortality and CVD. The incidence of “definite” stent thrombosis was recorded according to the Academic Research Consortium of Circulatory System Devices Panel Meeting, an advisory committee to the US Food and Drug Administration (FDA) in 2006.
2.4 Statistical analysis
Continuous variables were expressed as mean ± SD (SD: standard deviation) or the median and interquartile range, and they were compared using the independent t test or Mann-Whitney U test between the two groups. Categorical variables were compared with Pearson’s Chi-square or Fisher’s exact tests between the two groups. Multivariate logistic regression analysis was performed to identify an independent predictors of clinical outcomes. Clinical variables were included this analysis for adjustment. All statistical tests were 2-tailed, and a p value < 0.05 was considered statistically significant. Statistical analysis was done using the SPSS version 18.0 (SPSS, Inc., Chicago, IL).
To adjust for the bias inherent to the decision of choosing PCI alone or PCI with TA group, propensity scores were used. Matching was performed using "many-to-one” individual matching between PCI alone and PCI with TA groups.
3.1 Baseline characteristics
A total of 3749 patients were enrolled in the current study. Enrolled patients were divided into 2 groups according to use of TA during PCI: PCI with TA group (n=1630) and PCI alone group (n=2119). TA during PCI were performed in 43.7 percent of total patients.
Patients in PCI with TA group were younger and higher BMI. In laboratory data, Creatinine clearance, HDL level were significantly higher in PCI with TA group. In hemodynamic and procedural characteristics, more patients of PCI with TA group were with lower Killip class, door to balloon time and heart rate admission. PCI with TA group had more right coronary artery disease as the infarct-related vessel. Many more cases of single vessel diseases existed and more culprit only PCI was done in PCI with TA group. Glycoprotein IIb/IIIa inhibitor was more used in 29.3 percent of patients of PCI with TA group than PCI alone group. After propensity-score matching, there is no significant differences in clinical variable. But level of HDL and CK-MB were higher in PCI with TA group. Many more cases of transfemoral vascular approach in PCI alone group. Also glycoprotein IIb/IIIa inhibitor was more used in PCI with TA group than PCI alone group after propensity-score matching.
3.2 Clinical outcomes in all patients
Unadjusted and adjusted one-year clinical outcome before and after propensity matching are shown in table 1.
Adjust included various clinical Variables including age, sex, BMI, heart rate at admission, SBP at admission, HDL, Creatine clearance, Hemoglobin, symptom balloon time (min), index procedure (culprit only PCI vs. Multi-vessel PCI), use of statin, beta-blocker, RAS blocker, Glycoprotein IIb/IIIa inhibitor, LVEF, .
MACE and all-cause mortality were occurred in 435(11.6%) and 271(7.2%) patients during one-year follow up. With respect to the primary efficacy outcome, there was no significant difference in the incidence of MACE between PCI alone and PCI with TA group (8.4% vs. 7.9%, unadjusted Odd ratio (OR) with 95% confidence interval (CI) 0.925 [0.737-1.160], p value=0.499 for TA use). Also, after propensity-score matching, there were no significant differences in the incidence of one-year MACE between the two group (8.2 % vs. 8.2%, adjusted OR with 95% CI 1.187 [0.863-1.633], p value=0.291 for TA use). The secondary efficacy outcome, CVD and all-cause mortality were not different between the two groups. Also, after propensity-score matching, there were no significant differences in the incidence of one-year CVD and all-cause mortality between the two groups. (CVD; 6.0 % vs. 5.8%, adjusted OR with 95% CI 1.222 [0.778-1.920], p value=0.523 for TA use, all-cause mortality; 7.3 % vs. 7.1%, adjusted OR with 95% CI 1.130 [0.776-1.647], p value=0.523 for TA use)
3.3 Clinical outcomes in subgroup
Subgroup analysis of composite of CVD, recurrent MI and stroke in propensity score matching patient.
Subgroup analysis suggests that the impact of PCI with TA did not clinically relevant in mortality of all patient with PCI at one-year. So, PCI wih TA was no efficacy of clinical outcome at one-year in subgroup analysis.
Our study was conducted to determine if PCI with TA expected to be effective in patients with total occlusion of coronary artery could reduce cardiac mortality in Korean patients with STEMI.The major finding of our study is that thrombus aspiration of patients with STEMI who were underwent primary PCI within 12 hours, pre-procedural TIMI flow 0,1 did not reduce the risk of the adverse clinical outcomes at one-year. Moreover, There was no efficacy of clinical outcome when subgroup analysis between the PCI with TA and PCI alone.
The result of our study was corresponded well with several large-scale trials. [7-9,14,15] In randomized clinical trial of Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE), routine thrombus aspiration before PCI did not reduce 30-day mortality, and rate of death from any cause or the composite of death from any cause, re-hospitalization for myocardial infarction, or stent thrombosis at 1 year [8,9]. The Trial of Routine Aspiration Thrombectomy with PCI versus PCI Alone in Patients with STEMI (TOTAL) also pointed out that the thrombus aspiration did not significantly improve cardiovascular mortality in 180 days. Rather, the TOTAL trial found that the risk of stroke in the patients treated thrombus aspiration was significantly higher within 30 days. [7]
However, the previous several reports disagreed with our findings. In TAPAS trial [3], 1-year cardiac death was reduced in TA group (HR:1.93; 95% CI [1.11-3.37], p=0.020). Burzotta et al. [6] showed in individual patients-data pooled analysis of randomized studies that thrombectomy significantly improved the clinical outcome in patients with STEMI undergoing mechanical reperfusion. Also Cistopoulos et al. [2] documented that the use of manual thrombectomy devices is associated with significant improvements in ST-segment resolution, Myocardial Blush Grade (MBG) 3, TIMI grade 3 flow as well as clinical parameters (43% reduction in mortality, p=0.04) in patients undergoing primary PCI.
A few KAMIR data demonstrated that TA showed clinical benefit only in special subgroups. Hachinohe et al. [16] compared clinical outcomes between PCI with TA and PCI alone group. Although TA was not enhanced clinical outcomes in all patients, TA for LAD occlusion and use of GP IIb/IIIa inhibitor with TA showed an improvement of 12-month MACE. Sim et al. [17] also reported that manual TA during primary PCI was not improved clinical outcomes at 12 month, and it may become clinically relevant with longer total ischemic time, forming a U-shaped relationship.
The use of glycoprotein IIb/IIIa inhibitor and manual thrombectomy had debates in some studies. [6,16,18,19] In Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction (INFUSE-AMI) trial, an intracoronary bolus of the glycoprotein IIb/IIIa inhibitor abciximab was effective in reducing the infarct size, whereas thrombectomy by means of manual aspiration was not. Reduced embolization and improved myocardial perfusion may improve clinical outcomes. Similar result also report based on Korean patients that manual TA was not associated with reduced infarct size assessed by cardiac computed tomography [20]. TA may not be a safe procedure and distal embolization including cerebral embolization can occur [7,15]. Coronary thrombus material triggers thrombotic, inflammatory, vasoconstrictor, and other pathways, and evacuating a portion of the thrombus and plaque material addresses only a part of the pathophysiological problem. Disrupting thrombus formation pharmacologically may be more effective [8].
Recently, on the basis of the results of the INFUSE-AMI, TASTE and TOTAL trial, The ACC/AHA guidelines 2015 have been revised that the usefulness of selective and bail-out aspiration thrombectomy in patients undergoing primary PCI is not well established (Class IIB, level of evidence C). Also, routine aspiration thrombectomy before primary PCI is not useful (Class III, level of evidence A) [21]. Routine thrombus aspiration is not recommended (Class III, level of evidence A), but in cases of large residual thrombus burden after opening the vessel with a guide wire or a balloon, thrombus aspiration may be considered in ESC guideline 2017. [22]
Although our study is analyzed only based on one-year events, our results didn’t show any benefit of TA during PCI. Moreover, TA in patients with long ischemic time or TA with concomitant use of Glycoprotein IIb/IIIa inhibitor were not enhanced clinical outcomes. There results implied the probability that TA might be performed in patients with larger burden of thrombus or in patients with higher risks, and resulted in worse clinical outcomes.
Types of thrombus can affect mortality during PCI. Some studies have focused on the macroscopic appearance of the aspirated material, subdividing into white (fibrin-rich) and red (erythrocyte-rich) thrombus. White thrombus was typically found in patients with a small thrombus burden and a short ischemic time. By contrast, red thrombus tended to be aspirated from late-presenting patients who had a higher risk of distal embolization and cardiac mortality. [23] In our study, we could net analyze the type of thrombus.
This study has several limitations. First, although this study was conducted in the patients with MI registered with the KAMIR-NIH and statistical adjustment was performed, some confounding factors may still exist. Second, we used TIMI flow grade, but it is a subjective one based on gross examination and there was no information about other markers of myocardial perfusion such as corrected TIMI frame count, myocardial brush grade which are known to more precisely associate with prognosis. [24,25] Third, as we analyzed only about one-year events, our study might be underpowered to demonstrate the clinical usefulness of TA in STEMI patients.
Our study shows that routine thrombus aspiration during primary PCI as compared with PCI alone did not reduce MACE and all-cause mortality among patients with STEMI and pre-procedural TIMI flow 0,1 at one-year.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
