Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia: The Randomized RAIN-FLOW Study.

Background ST-segment-elevation myocardial infarction complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have been shown to improve the Thrombolysis in Myocardial Infarction flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 mL/min via a dedicated microcatheter causes (flow-mediated) hyperemia. The objective is to compare the efficacy of pharmacologic versus flow-mediated hyperemia in patients with ST-segment-elevation myocardial infarction complicated with no reflow. Methods and Results In the RAIN-FLOW (Treatment of Slow-Flow After Primary Percutaneous Coronary Intervention With Flow-Mediated Hyperemia) study, 67 patients with ST-segment-elevation myocardial infarction and no reflow were randomized to receive either pharmacologic-mediated hyperemia with intracoronary adenosine or nitroprusside (n=30) versus flow-mediated hyperemia (n=37). The angiographic corrected Thrombolysis in Myocardial Infarction frame count and the minimal microcirculatory resistance, as assessed with intracoronary pressure-thermistor wire, dedicated microcatheter, and thermodilution techniques, were compared after study interventions. Both Thrombolysis in Myocardial Infarction frame count(40.2±23.1 versus 39.2±20.7; P=0.858) and minimal microcirculatory resistance (753.6±661.5 versus 993.3±740.8 Wood units; P=0.174) were similar between groups. Thrombolysis in Myocardial Infarction 3 flow was observed in 26.7% versus 27.0% (P=0.899). Flow-mediated hyperemia showed 2 different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In-hospital death and nonfatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow-mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in patients with ST-segment-elevation myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04685941.

High and low on-treatment platelet reactivity to P2Y12 inhibitors in a contemporary cohort of acute coronary syndrome patients undergoing percutaneous coronary intervention.

INTRODUCTION: There is compelling evidence supporting the association between high on-treatment platelet reactivity (HPR) and low on-treatment platelet reactivity (LPR) to clopidogrel with atherothrombotic and bleeding events, respectively. However, it is uncertain if current cutoff values should be used in prasugrel- or ticagrelor-treated subjects. The objective of this analysis was to evaluate the pharmacodynamic (PD) efficacy of P2Y12 antagonists in a contemporary real-world population. MATERIALS AND METHODS: This PD study included 988 patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) and receiving dual therapy with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor). Platelet function was assessed at day 1 and day 30 post-PCI by VerifyNow P2Y12 assay, multiple electrode aggregometry and vasodilator-stimulated phosphoprotein (VASP) assay. RESULTS: Clopidogrel-treated patients (n = 324) had greater platelet reactivity than those receiving ticagrelor (n = 469) or prasugrel (n = 195) at both time points (p < 0.001 for all comparisons). No difference between ticagrelor and prasugrel was observed at day 1 with the VerifyNow P2Y12 assay (51.5 ±â€¯2.8 vs. 42.7 ±â€¯3.5 PRUs; p = 0.298), whereas ticagrelor achieved greater platelet inhibition at day 30 (48.1 ±â€¯2.5 vs. 89.2 ±â€¯4.2 PRUs; p < 0.001). Similar results were obtained with the VASP assay. Both prasugrel and ticagrelor had markedly lower HPR rates than clopidogrel and very high rates of LPR at both time points. CONCLUSIONS: Prasugrel and ticagrelor displayed more potent and consistent PD effects than clopidogrel in ACS patients undergoing PCI, with a trend towards greater platelet inhibition with ticagrelor during the maintenance phase of therapy compared to prasugrel.

Role of New Antiplatelet Drugs on Cardiovascular Disease: Update on Cangrelor.

Dual therapy with a P2Y12 receptor antagonist in addition to aspirin is the antiplatelet treatment of choice in patients with acute coronary syndromes or undergoing percutaneous coronary intervention (PCI). However, available oral P2Y12 antagonists have several limitations, mostly due to their pharmacological profile, which can affect outcomes in certain clinical settings. Cangrelor is an intravenous, direct-acting, potent P2Y12 inhibitor with rapid onset and offset of action, which has been recently approved for clinical use in patients undergoing PCI. In clinical trials, cangrelor has demonstrated greater efficacy than clopidogrel with a favorable safety profile among PCI patients not receiving pretreatment with oral P2Y12 antagonists. However, its definitive role in contemporary practice is yet to be determined. This review aims to provide a comprehensive overview of the current status of knowledge on cangrelor, focusing on its pharmacological properties, clinical development, and the potential applications of this newly available agent.

Global risk score for choosing the best revascularization strategy in patients with unprotected left main stenosis.

BACKGROUND: Coronary artery bypass graft (CABG) is recommended for patients with unprotected left main stenosis (ULMS). Percutaneous coronary intervention (PCI) is only recommended in specific anatomic conditions as in patients with low/mid SYNTAX score (SS). The aim of this study was to assess if the clinical and anatomic global risk classification (GRC) can enhance the indication of both revascularization therapies. METHODS: A total of 407 patients with ULMS treated with CABG (n = 285) or PCI (n = 122) were prospectively collected. The decision to treat with CABG or PCI was dependent on patient and physician's choice. Patients with ST-elevation myocardial infarction, shock, or valve disease were excluded. Clinical follow-up was obtained at 3 years. RESULTS: Patients with low GRC (n = 151) treated with CABG vs those with PCI had similar cardiac mortality (5.9% vs 0%, respectively; P=.17) and major adverse cardiac events (MACE; 18.5% vs 12.5%, respectively; P=.40). Patients classified as mid GRC (n = 175) had similar cardiac death (11.1% vs 10.3%; P=.85) and MACE rates (20.7% vs 22.4%; P=.92) with CABG or PCI, respectively. Patients with high GRC (n = 81) treated with CABG had numerically fewer cardiac deaths (16.3% vs 28.1%; P=.16) and lower MACE rates (24.5% vs 40.6%; P=.048) than with PCI. Statistical models using the GRC as a predictor of cardiac death showed better goodness-of-fit than the SS. CONCLUSION: Patients with low/mid GRC have similar mid-term outcomes with either CABG or PCI; patients with high GRC seem to benefit from CABG. Although further investigations are required, GRC is a better predictor of outcomes than SS.

Regulatory volume decrease in Leishmania mexicana: effect of anti-microtubule drugs

The trypanosomatid cytoskeleton is responsible for the parasite's shape and it is modulated throughout the different stages of the parasite's life cycle. When parasites are exposed to media with reduced osmolarity, they initially swell, but subsequently undergo compensatory shrinking referred to as regulatory volume decrease (RVD). We studied the effects of anti-microtubule (Mt) drugs on the proliferation of Leishmania mexicana promastigotes and their capacity to undergo RVD. All of the drugs tested exerted antiproliferative effects of varying magnitudes [ansamitocin P3 (AP3)> trifluoperazine > taxol > rhizoxin > chlorpromazine]. No direct relationship was found between antiproliferative drug treatment and RVD. Similarly, Mt stability was not affected by drug treatment. Ansamitocin P3, which is effective at nanomolar concentrations, blocked amastigote-promastigote differentiation and was the only drug that impeded RVD, as measured by light dispersion. AP3 induced 2 kinetoplasts (Kt) 1 nucleus cells that had numerous flagella-associated Kts throughout the cell. These results suggest that the dramatic morphological changes induced by AP3 alter the spatial organisation and directionality of the Mts that are necessary for the parasite's hypotonic stress-induced shape change, as well as its recovery.

Genetic association analysis of inositol polyphosphate phosphatase-like 1 (INPPL1, SHIP2) variants with essential hypertension.

BACKGROUND: Inositol polyphosphate phosphatase-like 1 (INPPL1, SHIP2) is a negative regulator of insulin signalling and has previously been found to be associated with hypertension, obesity and type 2 diabetes in a cohort of families with diabetes in the UK presenting features of metabolic syndrome. In particular, a haplotype of three genetic polymorphisms (rs2276047, rs9886 and an insertion/deletion polymorphism in intron 1) was found to be strongly associated with increased susceptibility to hypertension. OBJECTIVE AND METHODS: To assess if INPPL1 variants play a direct role in the development of essential hypertension, we genotyped the three previously associated INPPL1 polymorphisms in a cohort of 712 families with severe hypertension from the BRIGHT study transmission disequilibrium test cohort. RESULTS: We found no evidence of significant association between hypertension and any of the three INPPL1 polymorphisms or haplotypes (p>0.1). CONCLUSION: These results suggest that INPPL1 variants may be involved in mechanisms causing hypertension in metabolic syndrome patients specifically.

Optimizacion del proceso de embriogenesis somatica en variedades venezolanas de caña de azucar / Improvement of somatic embryogenesis in sugarcane venezuelan cultivars

En muchas variedades de caña de azúcar, se induce un alto porcentaje de callo embriogénico (70 %), al cultivar ôin vitroö explantes de hojas jóvenes en un medio constituido por las sales de Murashige y Skoog ,y 13 M de ácido 2,4 diclorofenoxiacético (2,4-D). Sin embargo, en las variedades venezolanas V78-1 y V75-6 el porcentaje de callo embriogénico producido en estas condiciones,es menor (30 %). Con el fin de optimizar el proceso de embriogénesis somática en estas dos variedades, se indujo la formación de callo embriogénico utilizando diferentes medios: Medio C3 (13 M de 2,4-D); Medio C7 (31.5 M de 2,4-D); Medio Cd (30 M de Dicamba) y medio C5BA (22.5 M de 2,4-D y 22.2 M de Benciladenina). Después de 45 días, en el medio Cd se observó el mayor porcentaje de calloembriogénico para ambas variedades (90 %). La capacidad morfogenética de estos callos, quedó evidenciada al ser transferidos al medio de regeneración (sin hormonas), donde a los cuatro días ya se observaba la formación de plantas a partir de los embriones somáticos obtenidos en el medio Cd, mientras que los embriones provenientes de los medios C3, C7 y C5BA, comenzaban a desarrollar plantas a los ocho días.