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Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients
Abstract Objective The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as...
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| Published in: | Journal of cardiology 2016-03, Vol.67 (3), p.248-253 |
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| creator | Schaaf, Mathieu Julien, MD Mewton, Nathan, MD, PhD Rioufol, Gilles, MD, PhD Angoulvant, Denis, MD, PhD Cayla, Guillaume, MD, PhD Delarche, Nicolas, MD Jouve, Bernard, MD Guerin, Patrice, MD, PhD Vanzetto, Gerald, MD, PhD Coste, Pierre, MD, PhD Morel, Olivier, MD, PhD Roubille, François, MD, PhD Elbaz, Meyer, MD, PhD Roth, Olivier, MD Prunier, Fabrice, MD, PhD Cung, Thien Tri, MD Piot, Christophe, MD, PhD Sanchez, Ingrid, MD Bonnefoy-Cudraz, Eric, MD, PhD Revel, Didier, MD Giraud, Céline, MSc Croisille, Pierre, MD, PhD Ovize, Michel, MD, PhD |
| description | Abstract Objective The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). Methods In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72 h after admission. Results A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95 ± 0.02 vs. 2.97 ± 0.02, respectively; p = 0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32 ± 17 g vs. 21 ± 17 g, respectively; p = 0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p = 0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. Conclusion Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size. |
| doi_str_mv | 10.1016/j.jjcc.2015.05.008 |
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| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_01850352v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0914508715001586</els_id><sourcerecordid>1769619879</sourcerecordid><originalsourceid>FETCH-LOGICAL-c649t-ab18531568c1b5a8bb442c6269e9393af0a4d9fcc80cb3998256e9a9f2de85153</originalsourceid><addsrcrecordid>eNp9UsGKFDEQDaK4s6s_4EFy1EOPSXcnnYAIy7C6AyMu7HgO6XT1TtqeZEzSI-t9_9s0s-7Bg1BQIbz3ilevEHpDyZISyj8My2EwZlkSypYkFxHP0IKKhhd1U4nnaEEkrQtGRHOGzmMcCOFECv4SnZWcUi4FXaCHmwDFzWqNtbuz_i7ow84avF1_XeN-9L-wdTjtAJtpPASbsPHBOx3usQ4JcrOuHydwBuL81MEkHO1vyGod3lsT_FHHzNUB-zamMJlkvZtFb7dXecRBJwsuxVfoRa_HCK8f-wX6_vlqu7ouNt--rFeXm8LwWqZCt1SwijIuDG2ZFm1b16XhJZcgK1npnui6k70xgpi2klKUjIPUsi87EIyy6gK9P-nu9KiyoX22ory26vpyo-Y_kgeQipVHmrHvTthD8D8niEntbTQwjtqBn6KiDZecStHIDC1P0Gw4xgD9kzYlao5KDWqOSs1RKZKLiEx6-6g_tXvonih_s8mAjycA5I0cLQQVjZ133dkAJqnO2__rf_qHbkbrrNHjD7iHOPgpuLxrRVUsFVG387HMt0IZySqCV38AObO6WQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1769619879</pqid></control><display><type>article</type><title>Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><source>ScienceDirect Freedom Collection</source><creator>Schaaf, Mathieu Julien, MD ; Mewton, Nathan, MD, PhD ; Rioufol, Gilles, MD, PhD ; Angoulvant, Denis, MD, PhD ; Cayla, Guillaume, MD, PhD ; Delarche, Nicolas, MD ; Jouve, Bernard, MD ; Guerin, Patrice, MD, PhD ; Vanzetto, Gerald, MD, PhD ; Coste, Pierre, MD, PhD ; Morel, Olivier, MD, PhD ; Roubille, François, MD, PhD ; Elbaz, Meyer, MD, PhD ; Roth, Olivier, MD ; Prunier, Fabrice, MD, PhD ; Cung, Thien Tri, MD ; Piot, Christophe, MD, PhD ; Sanchez, Ingrid, MD ; Bonnefoy-Cudraz, Eric, MD, PhD ; Revel, Didier, MD ; Giraud, Céline, MSc ; Croisille, Pierre, MD, PhD ; Ovize, Michel, MD, PhD</creator><creatorcontrib>Schaaf, Mathieu Julien, MD ; Mewton, Nathan, MD, PhD ; Rioufol, Gilles, MD, PhD ; Angoulvant, Denis, MD, PhD ; Cayla, Guillaume, MD, PhD ; Delarche, Nicolas, MD ; Jouve, Bernard, MD ; Guerin, Patrice, MD, PhD ; Vanzetto, Gerald, MD, PhD ; Coste, Pierre, MD, PhD ; Morel, Olivier, MD, PhD ; Roubille, François, MD, PhD ; Elbaz, Meyer, MD, PhD ; Roth, Olivier, MD ; Prunier, Fabrice, MD, PhD ; Cung, Thien Tri, MD ; Piot, Christophe, MD, PhD ; Sanchez, Ingrid, MD ; Bonnefoy-Cudraz, Eric, MD, PhD ; Revel, Didier, MD ; Giraud, Céline, MSc ; Croisille, Pierre, MD, PhD ; Ovize, Michel, MD, PhD</creatorcontrib><description>Abstract Objective The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). Methods In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72 h after admission. Results A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95 ± 0.02 vs. 2.97 ± 0.02, respectively; p = 0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32 ± 17 g vs. 21 ± 17 g, respectively; p = 0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p = 0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. Conclusion Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.</description><identifier>ISSN: 0914-5087</identifier><identifier>EISSN: 1876-4738</identifier><identifier>DOI: 10.1016/j.jjcc.2015.05.008</identifier><identifier>PMID: 26116981</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Aged ; Cardiovascular ; Coronary Angiography - methods ; Coronary Circulation ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Embolism - etiology ; Embolism - pathology ; Female ; Humans ; Life Sciences ; Magnetic resonance imaging ; Male ; Microvascular obstruction ; Microvessels - pathology ; Middle Aged ; Myocardial delayed enhancement ; Myocardial infarction ; Myocardial Infarction - complications ; Myocardial Infarction - pathology ; Myocardial Infarction - surgery ; Percutaneous Coronary Intervention ; Preoperative Period ; Prospective Studies</subject><ispartof>Journal of cardiology, 2016-03, Vol.67 (3), p.248-253</ispartof><rights>2015</rights><rights>Copyright © 2015. Published by Elsevier Ltd.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c649t-ab18531568c1b5a8bb442c6269e9393af0a4d9fcc80cb3998256e9a9f2de85153</citedby><cites>FETCH-LOGICAL-c649t-ab18531568c1b5a8bb442c6269e9393af0a4d9fcc80cb3998256e9a9f2de85153</cites><orcidid>0000-0002-2841-2459 ; 0000-0002-5288-9687 ; 0000-0002-2146-9874</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26116981$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01850352$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Schaaf, Mathieu Julien, MD</creatorcontrib><creatorcontrib>Mewton, Nathan, MD, PhD</creatorcontrib><creatorcontrib>Rioufol, Gilles, MD, PhD</creatorcontrib><creatorcontrib>Angoulvant, Denis, MD, PhD</creatorcontrib><creatorcontrib>Cayla, Guillaume, MD, PhD</creatorcontrib><creatorcontrib>Delarche, Nicolas, MD</creatorcontrib><creatorcontrib>Jouve, Bernard, MD</creatorcontrib><creatorcontrib>Guerin, Patrice, MD, PhD</creatorcontrib><creatorcontrib>Vanzetto, Gerald, MD, PhD</creatorcontrib><creatorcontrib>Coste, Pierre, MD, PhD</creatorcontrib><creatorcontrib>Morel, Olivier, MD, PhD</creatorcontrib><creatorcontrib>Roubille, François, MD, PhD</creatorcontrib><creatorcontrib>Elbaz, Meyer, MD, PhD</creatorcontrib><creatorcontrib>Roth, Olivier, MD</creatorcontrib><creatorcontrib>Prunier, Fabrice, MD, PhD</creatorcontrib><creatorcontrib>Cung, Thien Tri, MD</creatorcontrib><creatorcontrib>Piot, Christophe, MD, PhD</creatorcontrib><creatorcontrib>Sanchez, Ingrid, MD</creatorcontrib><creatorcontrib>Bonnefoy-Cudraz, Eric, MD, PhD</creatorcontrib><creatorcontrib>Revel, Didier, MD</creatorcontrib><creatorcontrib>Giraud, Céline, MSc</creatorcontrib><creatorcontrib>Croisille, Pierre, MD, PhD</creatorcontrib><creatorcontrib>Ovize, Michel, MD, PhD</creatorcontrib><title>Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients</title><title>Journal of cardiology</title><addtitle>J Cardiol</addtitle><description>Abstract Objective The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). Methods In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72 h after admission. Results A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95 ± 0.02 vs. 2.97 ± 0.02, respectively; p = 0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32 ± 17 g vs. 21 ± 17 g, respectively; p = 0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p = 0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. Conclusion Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.</description><subject>Aged</subject><subject>Cardiovascular</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Circulation</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Embolism - etiology</subject><subject>Embolism - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Microvascular obstruction</subject><subject>Microvessels - pathology</subject><subject>Middle Aged</subject><subject>Myocardial delayed enhancement</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - pathology</subject><subject>Myocardial Infarction - 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methods</topic><topic>Coronary Circulation</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Embolism - etiology</topic><topic>Embolism - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Microvascular obstruction</topic><topic>Microvessels - pathology</topic><topic>Middle Aged</topic><topic>Myocardial delayed enhancement</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - pathology</topic><topic>Myocardial Infarction - surgery</topic><topic>Percutaneous Coronary Intervention</topic><topic>Preoperative Period</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schaaf, Mathieu Julien, MD</creatorcontrib><creatorcontrib>Mewton, Nathan, MD, PhD</creatorcontrib><creatorcontrib>Rioufol, Gilles, MD, PhD</creatorcontrib><creatorcontrib>Angoulvant, Denis, MD, PhD</creatorcontrib><creatorcontrib>Cayla, Guillaume, MD, PhD</creatorcontrib><creatorcontrib>Delarche, Nicolas, MD</creatorcontrib><creatorcontrib>Jouve, Bernard, MD</creatorcontrib><creatorcontrib>Guerin, Patrice, MD, PhD</creatorcontrib><creatorcontrib>Vanzetto, Gerald, MD, PhD</creatorcontrib><creatorcontrib>Coste, Pierre, MD, PhD</creatorcontrib><creatorcontrib>Morel, Olivier, MD, PhD</creatorcontrib><creatorcontrib>Roubille, François, MD, PhD</creatorcontrib><creatorcontrib>Elbaz, Meyer, MD, PhD</creatorcontrib><creatorcontrib>Roth, Olivier, MD</creatorcontrib><creatorcontrib>Prunier, Fabrice, MD, PhD</creatorcontrib><creatorcontrib>Cung, Thien Tri, MD</creatorcontrib><creatorcontrib>Piot, Christophe, MD, PhD</creatorcontrib><creatorcontrib>Sanchez, Ingrid, MD</creatorcontrib><creatorcontrib>Bonnefoy-Cudraz, Eric, MD, PhD</creatorcontrib><creatorcontrib>Revel, Didier, MD</creatorcontrib><creatorcontrib>Giraud, Céline, MSc</creatorcontrib><creatorcontrib>Croisille, Pierre, MD, PhD</creatorcontrib><creatorcontrib>Ovize, Michel, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schaaf, Mathieu Julien, MD</au><au>Mewton, Nathan, MD, PhD</au><au>Rioufol, Gilles, MD, PhD</au><au>Angoulvant, Denis, MD, PhD</au><au>Cayla, Guillaume, MD, PhD</au><au>Delarche, Nicolas, MD</au><au>Jouve, Bernard, MD</au><au>Guerin, Patrice, MD, PhD</au><au>Vanzetto, Gerald, MD, PhD</au><au>Coste, Pierre, MD, PhD</au><au>Morel, Olivier, MD, PhD</au><au>Roubille, François, MD, PhD</au><au>Elbaz, Meyer, MD, PhD</au><au>Roth, Olivier, MD</au><au>Prunier, Fabrice, MD, PhD</au><au>Cung, Thien Tri, MD</au><au>Piot, Christophe, MD, PhD</au><au>Sanchez, Ingrid, MD</au><au>Bonnefoy-Cudraz, Eric, MD, PhD</au><au>Revel, Didier, MD</au><au>Giraud, Céline, MSc</au><au>Croisille, Pierre, MD, PhD</au><au>Ovize, Michel, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients</atitle><jtitle>Journal of cardiology</jtitle><addtitle>J Cardiol</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>67</volume><issue>3</issue><spage>248</spage><epage>253</epage><pages>248-253</pages><issn>0914-5087</issn><eissn>1876-4738</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract Objective The influence of initial-thrombolysis in myocardial infarction (i-TIMI) coronary flow in the culprit coronary artery on myocardial infarct and microvascular obstruction (MVO) size is unclear. We assessed the impact on infarct size of i-TIMI flow in the culprit coronary artery, as well as on MVO incidence and size, by contrast-enhanced cardiac magnetic resonance (ce-CMR). Methods In a prospective, multicenter study, pre-percutaneous coronary intervention (PCI) coronary occlusion was defined by an i-TIMI flow ≤1, and patency was defined by an i-TIMI flow ≥2. Infarct size, as well as MVO presence and size, were measured on ce-CMR 72 h after admission. Results A total of 140 patients presenting with ST-elevated myocardial infarction referred for primary PCI were included. There was no significant difference in final post-PCI TIMI flow between the groups (2.95 ± 0.02 vs. 2.97 ± 0.02, respectively; p = 0.44). In the i-TIMI flow ≤1 group, infarct size was significantly larger (32 ± 17 g vs. 21 ± 17 g, respectively; p = 0.002), MVO was significantly more frequent (74% vs. 53%, respectively; p = 0.012), and MVO size was significantly larger [1.3 IQR (0; 7.1) vs. 0 IQR (0; 1.6)], compared to in the i-TIMI ≥2 patient group. Conclusion Initial angiographic TIMI flow in the culprit coronary artery prior to any PCI predicted final infarct size and MVO size: the better was the i-TIMI flow, the smaller were the infarct and MVO size.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>26116981</pmid><doi>10.1016/j.jjcc.2015.05.008</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-2841-2459</orcidid><orcidid>https://orcid.org/0000-0002-5288-9687</orcidid><orcidid>https://orcid.org/0000-0002-2146-9874</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of cardiology, 2016-03, Vol.67 (3), p.248-253 |
| issn | 0914-5087 1876-4738 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_01850352v1 |
| source | BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS; ScienceDirect Freedom Collection |
| subjects | Aged Cardiovascular Coronary Angiography - methods Coronary Circulation Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Embolism - etiology Embolism - pathology Female Humans Life Sciences Magnetic resonance imaging Male Microvascular obstruction Microvessels - pathology Middle Aged Myocardial delayed enhancement Myocardial infarction Myocardial Infarction - complications Myocardial Infarction - pathology Myocardial Infarction - surgery Percutaneous Coronary Intervention Preoperative Period Prospective Studies |
| title | Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T10%3A46%3A55IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_hal_p&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Pre-PCI%20angiographic%20TIMI%20flow%20in%20the%20culprit%20coronary%20artery%20influences%20infarct%20size%20and%20microvascular%20obstruction%20in%20STEMI%20patients&rft.jtitle=Journal%20of%20cardiology&rft.au=Schaaf,%20Mathieu%20Julien,%20MD&rft.date=2016-03-01&rft.volume=67&rft.issue=3&rft.spage=248&rft.epage=253&rft.pages=248-253&rft.issn=0914-5087&rft.eissn=1876-4738&rft_id=info:doi/10.1016/j.jjcc.2015.05.008&rft_dat=%3Cproquest_hal_p%3E1769619879%3C/proquest_hal_p%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c649t-ab18531568c1b5a8bb442c6269e9393af0a4d9fcc80cb3998256e9a9f2de85153%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1769619879&rft_id=info:pmid/26116981&rfr_iscdi=true |