MicroRNA-copy number variations in coronary artery disease patients with or without type 2 diabetes mellitus.

BACKGROUND: An important cause of Coronary Artery Disease (CAD) is Type 2 Diabetes Mellitus (T2DM). The aim of this study was the evaluation of copy number variations (CNVs) of hsa-miR-93, hsa-miR-122, hsa-miR-192 in CAD patients with or without T2DM. METHODS: CNVs of three micro-RNAs in 50 CAD patients and 50 non-CAD subjects both with and without diabetes were evaluated by real-time PCR and compared in three comparison groups namely 1, 2 and 3 (including comparison between CAD and non-CAD, diabetic CAD and non-diabetic CAD and between diabetic CAD and diabetic non-CAD subjects, respectively). RESULTS: There were significant differences in CNVs of hsa-miR-93 between cases and controls in comparison groups 1 and 3 (p = .0310 and .0232, respectively), for hsa-miR-122 in all comparison groups, and for hsa-miR-192 in comparison group 3 (p = .0181). CONCLUSION: We showed the association of these microRNA-CNVs with CAD, T2DM or both simultaneously.

A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score.

Total occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach. This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach. A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97-23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95-17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46-7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28-6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08-6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03-6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate. Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0-8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.

The non-hyperemic coronary pressure notch as an indicator of the physiologic significance of coronary artery stenosis.

Myocardial fractional flow reserve (FFR) is a new index of the functional significance of intermediate coronary stenoses that is calculated from pressure measurements made during coronary arteriography. The aim of this study was to evaluate the correlation between non-hyperemic coronary pressure dicrotic notch and fractional flow reserve (FFR). A consecutive of 114 patients (73 men and 41 women) was enrolled in this study. Data were shown as means ± SD. Statistical analyses were performed with SPSS software. The statistical significance of differences was determined by chi-square analysis with Yates correction. Significance was defined as P< 0.05. Positive dicrortic notch was observed in 97 patients (85%). Significant association was detected between coronary pressure notch (dicrotic notch), and FFR as loss of the dicrotic notch was detected in 93.8% (15/16) of patients with FFR less than 0.75 (P=0.001). Upon ROC curve, a cutoff FFR value of approximately 0.75 demonstrated sensivity and specifity of 93.8% and 98%, respectively for loss of the dicrotic notch. The positive predictive value for loss of the dicrotic notch was 88.2%. Our study demonstrated loss of non-hyperemic coronary pressure diacrotic notch correlates significantly with FFR and may predict an FFR < 0.75 with high accuracy. In patients with functionally significant coronary stenosis, loss of non-hyperemic diacrotic notch appears to be a useful index of the functional severity of the stenoses and the need for coronary revascularization.

Evaluation of effective factors in success rate of intervention on CTO.

UNLABELLED: Chronic total occlusion (CTO) intervention is still a challenging problem. The aim of this study is to determine factors that affect PCI results. METHOD AND RESULTS: The study was conducted on 72 patients in two centers. CTO angioplasty was done by the antegrade approach from the femoral and/or radial approach. The role of age, gender, anatomical variations such as calcification, length of the lesion, proximal bending, retrograde filling and occluded coronary artery (LAD, CCK or RCA), and wires were assessed. The success rate was 79.6%, and presence of calcification was an important factor in CTO PCI. Operator's experience, use of appropriate equipment and calcification are important factors in predicting a successful PCI.

Comparison between Intracoronary Abciximab and Intravenous Eptifibatide Administration during Primary Percutaneous Coronary Intervention of Acute ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Administration of glycoprotein IIb/IIIa inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. METHODS: A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab (0.25 µg/kg) bolus or two boluses of intravenous Eptifibatide (0.180 µg/kg) each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution (STR), and post-procedural thrombolysis in myocardial infarction (TIMI) grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect (arrhythmia) and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. RESULTS: Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.61). The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI (µmol/L/hr), was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 (interquartile range [IQR], 3006.0 to 11112.0) versus 7,294 (IQR, 3795.5 to 11803.5); p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively (p value = 0.87). No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. CONCLUSION: The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI.

Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients.

BACKGROUND: There is evidence that opium addiction has immunosuppressant effects. Coronary artery disease (CAD) is a condition resulted from atherosclerosis which is dependent on the immune response. PURPOSE: To evaluate plasma levels of interleukin-6 and interleukin-1Ra in 30 patients with three-vessel coronary artery disease, ejection fraction of more than 35% and to evaluate their changes after prognostic treadmill test in 15 opium addicted and 15 non-addicted patients. METHODS: The participants underwent prognostic treadmill test and plasma levels of interleukin-6 (IL-6) and interleukin-1Ra (IL-1Ra) were evaluated with ELISA method before, just after and 4 hours after the test. RESULTS: IL-1Ra (2183 pg/ml) tended to decrease over time in the opium addicted group (1372 pg/ml after prognostic treadmill test and 1034 pg/ml 4 hours after that), although such decrease did not reach the statistical significance. IL-1Ra levels were significantly higher in opium addicted than in non addicted patients. Opium addiction had no significant effect on IL-6 changes. CONCLUSION: Consumption of opium in CAD patients is associated with higher IL-1Ra levels.

Traumatic coronary artery fistula closure with stent graft.

We present a rare case of a symptomatic acquired large coronary fistula and aneurysm secondary to chest trauma that was successfully closed using stent graft. This case is followed by review of the literature.

Iatrogenic left main artery dissection: A catastrophic complication.

Iatrogenic left main artery (LM) dissection is a catastrophic complication of coronary angiography and angioplasty that requires prompt management using stenting. Although LM dissection can be prevented, it cannot always be avoided and has a reported incidence rate of 0.02%. In the present report, a case of iatrogenic LM dissection that was successfully treated with multiple stents is presented and followed by a brief review of the literature.

Evaluation of asymptomatic peripheral arterial disease by ankle- brachial index in patients with concomitant coronary arterial disease.

BACKGROUND: Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD) improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. OBJECTIVES: The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. METHODS: Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3) with a documented coronary arterial disease. RESULTS: Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. CONCLUSIONS: It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units.

BACKGROUND: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs). This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. METHODS: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27%) were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. RESULTS: Mean (± standard deviation) hospitalization duration was 3.04 (±0.71) days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602). The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205). Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699). Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. CONCLUSION: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization costs, and the lack of cardiovascular complications in patients observed at 1-month follow-up after discharge, it is recommended that appropriate evaluations be performed in emergency units to prevent unnecessary admissions.

Extrinsic compression of left main coronary artery by the pulmonary trunk secondary to pulmonary hypertension documented using 64-slice multidetector computed tomography coronary angiography.

Compression of left main coronary artery (LMCA) secondary to pulmonary trunk dilatation is a newly recognized entity that has been associated with severe pulmonary hypertension. In this paper we present a case of extrinsic compression of LMCA caused by dilated pulmonary trunk secondary to pulmonary hypertension documented using 64-slice multidetector computed tomography (MDCT) coronary angiography. This case is followed by a review of the literature.

Percutaneous treatment of spontaneous left main coronary artery dissection extending to the left anterior descending and circumflex arteries possibly triggered by thrombolytic therapy.

Spontaneous coronary artery dissection is a rare cause of myocardial infarction and the role of thrombolytic therapy in this setting is not known. A case of acute ST elevation myocardial infarction is presented, with initial positive response to thrombolytic therapy and subsequent marked worsening of ST elevation due to extensive dissection, possibly triggered by thrombolytic therapy, which was successfully treated with percutaneous coronary intervention.