Significance of microRNA-targeted ErbB signaling pathway genes in cardiomyocyte differentiation.

OBJECTIVE(S): Cardiomyocyte differentiation is a complex process that follows the progression of gene expression alterations. The ErbB signaling pathway is necessary for various stages of cardiac development. We aimed to identify potential microRNAs targeting the ErbB signaling pathway genes by in silico approaches. METHODS: Small RNA-sequencing data were obtained from GSE108021 for cardiomyocyte differentiation. Differentially expressed miRNAs were acquired via the DESeq2 package. Signaling pathways and gene ontology processes for the identified miRNAs were determined and the targeted genes of those miRNAs affecting the ErbB signaling pathway were determined. RESULTS: Results revealed highly differentially expressed miRNAs were common between the differentiation stages and they targeted the genes involved in the ErbB signaling pathway as follows: let-7g-5p targets both CDKN1A and NRAS, while let-7c-5p and let-7d-5p hit CDKN1A and NRAS exclusively. let-7 family members targeted MAPK8 and ABL2. GSK3B was targeted by miR-199a-5p and miR-214-3p, and ERBB4 was targeted by miR-199b-3p and miR-653-5p. miR-214-3p, miR-199b-3p, miR-1277-5p, miR-21-5p, and miR-21-3p targeted CBL, mTOR, Jun, JNKK, and GRB1, respectively. MAPK8 was targeted by miR-214-3p, and ABL2 was targeted by miR-125b-5p and miR-1277-5p, too. CONCLUSION: We determined miRNAs and their target genes in the ErbB signaling pathway in cardiomyocyte development and consequently heart pathophysiology progression.

Tenascin-C as a noninvasive biomarker of coronary artery disease.

BACKGROUND: Coronary artery disease (CAD), is the leading cause of mortality and morbidity worldwide. Tenascin-C (TNC) with high expression levels in inflammatory and cardiovascular diseases, leads to the rupture of atherosclerotic plaques. The origin of plaque destabilization can be associated to endothelial dysfunction. Given the high prevalence of CAD, finding valuable biomarkers for its early detection is of great interest. Using serum samples from patients with CAD and individuals without CAD, we assessed the efficacy of TNC expression levels in serum exosomes and during endothelial cell differentiation as a noninvasive biomarker of CAD. METHODS: TNC expression was analyzed using the RNA-sequencing data sets of 6 CAD and 6 normal samples of blood exosomes and endothelial differentiation transitions. Additionally, TNC expression was investigated in the serum samples of patients with CAD and individuals without CAD via qRT-PCR. ROC curve analysis was employed to test the suitability of TNC expression alterations as a CAD biomarker. RESULTS: TNC exhibited higher expression in the exosomes of the CAD samples than in those of the non-CAD samples. During endothelial differentiation, TNC expression was upregulated and then consistently downregulated in mature endothelial cells. Moreover, TNC was significantly upregulated in the serum of the CAD group (P = 0.02), with an AUC of 0.744 for the expression level (95% confidence interval, 0.582 to 0.907; P = 0.011). Hence its expression level can be discriminated CAD from non-CAD samples. DISCUSSION: Our study is the first to confirm that altered TNC expression is associated with pathological CAD conditions in Iranian patients. The expression of TNC is involved in endothelial differentiation and CAD development. Accordingly, TNC can serve as a valuable noninvasive biomarker with potential application in CAD diagnosis.

Downregulation of Talin-1 is associated with the increased expression of miR-182-5p and miR-9-5p in coronary artery disease.

BACKGROUND: Evidence indicates that the dysregulation of extracellular matrix (ECM) components can lead to cardiovascular diseases. The Talin-1 (TLN1) gene is a major component of the ECM, and it mediates integrin adhesion to the ECM. In this study, we aimed to determine microRNAs (miRs) that regulate the expression of TLN1 and determine expression alterations in TLN1 and its targeting miRs in coronary artery disease (CAD). METHODS: Data sets of CAD and normal samples of blood exosomes were downloaded, and TLN1 was chosen as one of the genes with differential expressions in an in silico analysis. Next, miR-182-5p and miR-9-5p, which have a binding site on 3´-UTR of TLN1, were selected using bioinformatics tools. Then, the miR target site was cloned in the psiCHECK-2 vector, and direct interaction between the miR target site and the TLN1 3'-UTR putative target site was investigated by luciferase assay. The expression of miR-182-5p, miR-9-5p, and TLN1 in the serum samples of CAD and non-CAD individuals was assessed via a real-time quantitative polymerase chain reaction. RESULTS: Our data revealed that miR-182-5p directly regulated the expression of TLN1. Moreover, miR-182-5p and miR-9-5p were significantly upregulated in the CAD group. Hence, both bioinformatics and experimental analyses determined the downregulated expression of TLN1 in the CAD samples. CONCLUSIONS: Our findings demonstrated that miR-182-5p and miR-9-5p could play significant roles in TLN1 regulation and participate in CAD development by targeting TLN1. These findings introduce novel biomarkers with a potential role in CAD pathogenesis.

Diagnostic accuracy of two-dimensional coronary angiographic-derived fractional flow reserve-Preliminary results.

AIM: Noninvasive fractional flow reserve (NiFFR) is an emerging method for evaluating the functional significance of a coronary lesion during diagnostic coronary angiography (CAG). The method relies on the computational flow dynamics and the three-dimensional (3D) reconstruction of the vessel extracted from CAG. In the present study, we sought to evaluate the diagnostic performance and applicability of 2D-based NiFFR. METHODS: In this prospective observational study, we evaluated 2D-based NiFFR in 279 candidates for invasive CAG and invasive fractional flow reserve (FFR). NiFFR was calculated via two methods: variable NiFFR, in which the contrast transport time was extracted from the angiographic view, and fixed NiFFR, in which a prespecified frame count was applied. RESULTS: The final analysis was performed on 245 patients (250 lesions). Variable NiFFR had an area under the receiver operating characteristic curve of 81.5%, an accuracy of 80.0%, a sensitivity of 82.2%, a specificity of 82.2%, a negative predictive value of 91.4%, and a positive predictive value of 63.6%. The mean difference between FFR and NiFFR was -0.0244 ±.0616 (p ≤.0001). A pressure wire-free hybrid strategy was possible in 68.8% of our population with variable NiFFR. CONCLUSIONS: Our 2D-based NiFFR yielded results comparable to those derived from 3D-based software. Our findings should; however, be confirmed in larger trials.

Mitral valve resistance determines hemodynamic consequences of severe rheumatic mitral stenosis and immediate outcomes of percutaneous valvuloplasty.

INTRODUCTION: The mitral valve area (MVA) poorly reflects the hemodynamic status of (MS). In this study, we compared the MVA with mitral valve resistance (MVR) with regard to the determination of hemodynamic consequences of MS and the immediate outcomes of percutaneous balloon mitral valvuloplasty (PBMV). METHODS: In a prospective study, 36 patients with severe rheumatic MS with left ventricular ejection fraction (LVEF) >50% were evaluated. They underwent transthoracic echocardiography (TTE) and catheterization. The MVA was measured by two-dimensional planimetry and pressure half-time (PHT), and the MVR was calculated using the equation: 1333 × transmitral pressure gradient mean transmitral diastolic flow rate. RESULTS: The patients' mean age was 47.8±10.5 years. MVR ≥140.6 dynes·s/cm5 detected systolic pulmonary arterial pressure (sPAP) >55 mm Hg with a sensitivity of 100% and a specificity of 74%. The sensitivity and specificity of MVA<0.75 cm2 to discriminate elevated sPAP were 81% and 89%, respectively. PHT ≥323.5 mseconds had a sensitivity of 78% and a specificity of 96% to detect an elevated sPAP. To predict a successful PBMV, preprocedural MVR ≥106.1 dynes·s/cm5 had a sensitivity of 100% and a specificity of 67% (area under the curve [AUC]=0.763; 95% confidence interval [CI]=0.520-1.006; P=.034); preprocedural MVA <0.95 cm2 had a sensitivity of 78% and a specificity of 73% (AUC=0.730; 95% CI=0.503-0.956; P=.065); and preprocedural PHT ≥210.5 mseconds had a sensitivity of 73% and a specificity of 78% (AUC=0.707; 95% CI=0.474-0.941; P=.095). CONCLUSIONS: MVR seems to be more accurate than MVA in determining the hemodynamic consequences of severe MS as determined by sPAP. In addition, preprocedural MVR detected successful PBMVs.

The usefulness of cardiopulmonary exercise testing in assessment of patients with suspected coronary artery disease.

OBJECTIVE: The aim of this study is to assess different parameters of cardiopulmonary exercise testing that can predict the development of myocardial ischaemia in patients with suspected coronary artery disease (CAD) and to identify the parameters which have more correlation with myocardial ischaemia. STUDY DESIGN: Cross-sectional study. METHODS: In this study, a total of 31 men (mean age 57.23±11.09 years) with suggestive symptoms of CAD underwent an exercise stress test with breath-by-breath gas exchange analysis, followed by coronary angiography as the gold standard for diagnosing CAD. RESULTS: The ventilation versus CO2 output (VE/VCO2) peak was significantly different between patients with negative and positive angiography results. Receiver operator characteristic analysis showed an area under the curve of 0.73 for VE/VCO2 peak with diagnostic threshold equal to 35 (95% CI 0.54 to 0.9; p=0.05). Exercise stress testing had sensitivity and specificity of 75% and 40%, respectively. CONCLUSIONS: A change in ventilatory efficiency assessed using the VE/VCO2 peak has the predictive ability to identify exercise-induced myocardial ischaemia. The present study has provided additional evidence of the potential clinical value of cardiopulmonary exercise testing in the diagnosis of CAD.

Associations between low serum levels of ANRIL and some common gene SNPs in Iranian patients with premature coronary artery disease.

Coronary artery disease (CAD) is the major cause of mortality in the world. Premature development of CAD can be attributed to women under 55 and men under 45. Many genetic factors play a part in premature CAD. Among them, ANRIL, a long noncoding RNA is located at the 9p21 risk locus, and its expression seems to be correlated with CAD. In the current study, premature CAD and control blood samples, with and without Type 2 Diabetes (T2D), were genotyped for six SNPs at the 9p21 locus. Additionally, ANRIL serum expression was assessed in both groups using real-time PCR. It was performed using different primers targeting exons 1, 5-6, and 19. The χ2 test for association, along with t-tests and ANOVA, was employed for statistical analysis. In this study, we did not find any significant correlation between premature coronary artery disease and rs10757274, rs2383206, rs2383207, rs496892, rs10757278 and rs10738605. However, a lower ANRIL expression was correlated with each SNP risk genotype. Despite the correlation between lower ANRIL expression and CAD, Type 2 diabetes was associated with higher ANRIL expression. Altogether, the correlation between ANRIL expression and the genotypes of the studied SNPs indicated that genetic variants, even those in intronic regions, affect long noncoding RNA expression levels. In conclusion, we recommend combining genetic variants with expression analysis when developing screening strategies for families with premature CAD. To prevent the devastating outcomes of CAD in young adults, it is crucial to discover noninvasive genetic-based screening tests.

Effect of garlic powder tablet on carotid intima-media thickness in patients with coronary artery disease: a preliminary randomized controlled trial.

BACKGROUND/OBJECTIVES: This study was designed to investigate whether garlic powder tablets in adjunct to conventional medical treatment could have an effect on carotid intima-media thickness (CIMT) and plasma lipoproteins and lipids in patients with coronary artery disease (CAD). SUBJECTS/METHODS: A randomized, placebo-controlled, clinical trial was conducted on 56 patients with CAD between the ages of 25 and 75 years. The patients were randomly divided into two groups: garlic group (n = 27), receiving garlic powder tablet (1200 µg allicin/tab) twice daily and the placebo group (n = 29), receiving placebo for 3 months. The rate of atherosclerosis progression was measured by B-mode ultrasonography as the increase in CIMT. RESULTS: After 3 months of taking garlic tablets, CIMT values had minor variations (0.009 ± 0.007 mm reduction from baseline), while in the placebo group, an increase in CIMT values was observed (0.04 ± 0.01 mm increase from baseline). After 3 months of treatment, mean CIMT difference from baseline was significantly differ between the two groups (p < 0.001). Plasma lipids and lipoproteins (total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, Apolipoprotein A1 and Apolipoprotein B) did not differ between the two groups. CONCLUSIONS: The results suggest that dry garlic powder tablet is superior to placebo in prevention of CIMT progression in patients with CAD and may be considered as an adjunct treatment for atherosclerosis.

Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry.

OBJECTIVE: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. METHODS: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. RESULTS: A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients' health status improved significantly only in successful group. CONCLUSIONS: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success.

Bioinformatics Analysis to Find Novel Biomarkers for Coronary Heart Disease.

Background: Coronary heart disease (CHD), a major cause of death worldwide, is defined as a narrowing or blockage of the coronary arteries that supply oxygen and blood to the heart. We aimed to find potential biomarkers for coronary artery disease, by comparing the expression profile of blood exosomes of both normal and CHD samples. Methods: Datasets of 6 CHD and 6 normal samples of blood exosomes were downloaded, and differentially expressed RNAs, with adjusted P<0.01 and log2FoldChange≥1 were achieved. Moreover, gene ontology (GO) and pathway analysis were accomplished by PANTHER database for datasets. Results: Our data analysis found 119 differentially expressed genes between two datasets. By comparing transcriptome profiles, we candidate the highest downregulated gene, ACSBG1, and the highest upregulated one, DEFA4, as specific biomarkers for CHD. Furthermore, GO and pathway analysis depicted that aforementioned differentially expressed genes are mostly involved in different molecular metabolic process, inflammation, immune system process and response to stimulus pathways which all cause cardiovascular diseases. Conclusion: We have provided new potential biomarkers for CHD, though experimental validation is still needed to confirm the suitability of the candidate genes for early detection of CHD.

Cardiac Reverse Remodeling After Transcatheter Patent Ductus Arteriosus Closure in Adults.

Whereas most patent ductus arteriosus (PDAs) are identified and treated in the childhood, and the long term outcome studies have approved the outstanding results (positive cardiac reverse remodeling) in these group of patients, the outcome of percutaneous PDA closure in adults is not comprehensible. The aim of this retrospective cohort study which consecutively recruited 121 adult patients (age >16 years) who underwent the transcatheter closure (TCC) of PDAs between 2012 and 2018 is, evaluation at least 1-year follow-up of adult patients after PDA closure and compare the hemodynamic and the cardiac reverse remodeling findings with the previous studies in adults and children.

Role of stent oversizing in patients undergoing primary percutaneous coronary intervention. An open-labeled randomized controlled trial.

BACKGROUND: In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI. METHODS: Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III. RESULTS: The study population was comprised of 122 patients, allocated to the oversized group (N.=61) and the non-oversized group (N.=61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05±55.12 vs. 64.64±23.28; P=0.056). The troponin ratio, CK-MB ratio, and 6-month follow-up outcome - defined as target lesion revascularization, heart failure, and cardiovascular death - were comparable between the 2 groups. CONCLUSIONS: Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.

Effects of the COVID-19 Pandemic on the Management of Patients With ST-elevation Myocardial Infarction in a Tertiary Cardiovascular Center.

BACKGROUND: In the Coronavirus Disease 2019 (COVID-19) pandemic, the appropriate reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS: This retrospective single-center study consecutively enrolled patients who presented with STEMI and scheduled for primary percutaneous coronary intervention (PPCI) during the outbreak of COVID-19. Due to the delay in the reporting of the polymerase chain reaction test results, our postprocedural triage regarding COVID-19, followed by the isolation strategy, was based on lung computerized tomography scan results. RESULTS: Forty-eight patients with STEMI referred to our center. PPCI was done for 44 (91%) of these patients. The mean symptom-to-device time was 490.93 ± 454.608 minutes, and the mean first medical contact-to-device time was and 154.12 ± 36.27 minutes. Nine (18%) patients with STEMI were diagnosed as having typical/indeterminate features indicating COVID-19 involvement. During hospitalization, 1 (2.0%) patient died of cardiogenic shock. The study population was followed for 35.9 ± 12.7 days. Two patients expired in another centers due to COVID-19. No cardiac catheterization laboratory staff members were infected by COVID-19 during the study period. CONCLUSIONS: Our small report indicates that by taking the recommended safety measures and using appropriate PPE, we can continue PPCI as the main reperfusion strategy safely and effectively.

The significance of coronary artery calcium score as a predictor of coronary artery stenosis in individuals referred for CT angiography.

Introduction: Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings inpatients with suspected CAD. Methods: From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected. Results: A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients(5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS <100 group, and 67.0% in CACS >100 group (P < 0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], P = 0.006), CACS (OR= 4.31 [2.33-7.98], P < 0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], P = 0.027) were independent predictors of obstructive CAD. Conclusion: We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.

Association between the risks of contrast-induced nephropathy after diagnostic or interventional coronary management and the transradial and transfemoral access approaches.

Introduction: The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA). Methods: Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI. Results: Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P= 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P= 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study. Conclusion: The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.

Left ventricular end-diastolic pressure-guided hydration for the prevention of contrast-induced acute kidney injury in patients with stable ischemic heart disease: the LAKESIDE trial.

OBJECTIVES: Contrast-induced acute kidney injury (CI-AKI) is a serious complication in patients undergoing diagnostic cardiac angiography or percutaneous coronary intervention. We aimed to evaluate the preventive effects of left ventricular end-diastolic pressure (LVEDP)-guided hydration for the prevention of CI-AKI in patients with chronic kidney disease undergoing cardiac catheterization. METHODS: This prospective randomized single-blind clinical trial enrolled 114 eligible patients with an estimated glomerular filtration rate (eGFR) of 15 < eGFR ≤ 60 mL/min/1.73 m2 [according to the level-modified Modification of Diet in Renal Disease formula (MDRD)] and stable ischemic heart disease undergoing coronary procedures. The patients were randomly allocated 1:1 into the LVEDP-guided hydration group (n = 57) or the standard hydration group (n = 57). CI-AKI was defined as a greater than 25% or greater than 0.5 mg/dL (44.2 mmol/L) increase in the serum creatinine concentration compared with the baseline value. Hydration with 0.9% sodium chloride at a rate of 1 mL/kg/h (0.5 mL/kg/h if left ventricular ejection fraction < 40%) within 12 h was given to all the patients in both groups before the procedure. In the LVEDP-guided group, the hydration infusion rate was adjusted according to the LVEDP level during and after the procedure. RESULTS: The incidence of CI-AKI was 7.01% (4/57) in the LVEDP-guided group vs 3.84% (2/52) in the standard hydration group (summary odds ratio 0.53, 95% CI 0.093-3.022; P = 0.463). Major adverse cardiac events, hemodialysis, or related deaths occurred in neither of the groups during hospitalization or the 30-day follow-up. CONCLUSIONS: In the present study, LVEDP-guided fluid administration, by comparison with standard hydration, failed to offer protection against the risk of CI-AKI in patients with renal insufficiency undergoing coronary angiography with or without percutaneous coronary intervention.

Comparison between rosuvastatin and atorvastatin for the prevention of contrast-induced nephropathy in patients with STEMI undergoing primary percutaneous coronary intervention.

Introduction: There is some controversy over the efficacy of statins for the prevention of contrastinduced nephropathy (CIN). There have also been reports on varying efficacies of different statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of CIN was assessed. Methods: This single-blind randomized clinical trial was performed on 495 random patients with myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI. Results: The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There was no significant difference between rosuvastatin group compared with atorvastatin group, regarding the CIN grading (P = 0.14). Conclusion: Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the prevention of CIN.

Intracoronary versus Intravenous eptifibatide during percutaneous coronary intervention for acute ST-segment elevation myocardial infarction; a randomized controlled trial.

Although aspirin and clopidogrel seem to be quite enough during low risk percutaneous coronary intervention (PCI), the combination may need some reinforcement in complex situations such as primary PCI. By modifying the route and also the duration of administration, glycoprotein IIb/IIIa inhibitors might be a viable option. The aim of this study is to compare the benefits and disadvantages of three different methods of administration of eptifibatide in primary PCI population. Primary PCI candidates were randomized in three groups on which three different methods of administration of eptifibitide were tested: intravenous bolus injection followed by 12-h infusion (IV-IV), intracoronary bolus injection followed by intravenous infusion (IC-IV) and, only intracoronary bolus injection (IC). 99 patients were included in the present study. There was no significant difference among the three groups regarding all cause in hospital and one month mortality (p value = 0.99), re-myocardial infarction (p value = 0.89), post-PCI TIMI flow grade 3 (p value = 0.97), ST segment resolution (p value = 0.77) and peak troponin levels (p value = 0.82). The comparison of vascular access and major bleeding complications were not possible due to low events rate. By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure.

Coronary Slow Flow Phenomenon Clinical Findings and Predictors.

BACKGROUND: In some patients with chest pain, selective coronary angiography reveals slow contrast agent passage through the epicardial coronary arteries in the absence of stenosis. This phenomenon has been designated the slow coronary flow (SCF) phenomenon. OBJECTIVES: In this study, we aimed to describe the demographic and clinical findings and presence of common atherosclerosis risk factors in patients with the SCF phenomenon. PATIENTS AND METHODS: Between October 2014 and March 2015, demographic data, clinical histories, atherosclerosis risk factors, and laboratory and angiographic findings were recorded for all consecutive patients scheduled for coronary angiography and diagnosed with the SCF phenomenon, as well as a control group (patients with normal epicardial coronary arteries; NECA). SCF was diagnosed based on the thrombolysis in myocardial infarction frame count (TFC). A TFC > 27 indicated a diagnosis of SCF phenomenon. RESULTS: Among the 3600 patients scheduled for selective coronary angiography, 75 (2%) met the SCF criteria. SCF and NECA patients did not exhibit statistically significant differences in traditional risk factors except for hypertension, which was more prevalent in SCF than NECA patients (52% versus 31%, P = 0.008). A multivariable analysis indicated a low body mass index, presence of hypertension, low high-density lipoprotein cholesterol (HDL-c) level, and high hemoglobin level as independent predictors of the SCF phenomenon; of these, hypertension was the strongest predictor (odds ratio = 6.3, 95% confidence interval: 2.2 - 17.9, P = 0.001). CONCLUSIONS: The SCF phenomenon is relatively frequent, particularly among patients with acute coronary syndrome who are scheduled for coronary angiography. Hypertension, a low HDL-c level, and high hemoglobin level can be considered independent predictors of this phenomenon.

The Effects of Side Branch Predilation During Provisional Stenting of Coronary Bifurcation Lesions: A Double-Blind Randomized Controlled Trial.

BACKGROUND: There is a paucity of data regarding the role of side branch (SB) predilation during the provisional stenting of bifurcation lesions. OBJECTIVES: The present study aimed to assess the effects of SB predilation on the outcomes of true bifurcation interventions. PATIENTS AND METHODS: Sixty patients with true bifurcation lesions according to the Medina classification were included in the study and randomly assigned to receive SB predilation before stenting the main branch (n = 30) or no predilation as the control group (n = 30). RESULTS: There was a trend toward the higher occurrence of dissection in the predilated ostial lesions of the SB compared to the non-predilated group (16.7% vs. 0, P = 0.07). Performance of the SB predilation was not associated with improved flow of the SB or fewer degrees of ostial stenosis after stenting the main branch, the need to rewire, rewiring time, or the rate of use of the final kissing balloon dilation and double stents procedures. CONCLUSIONS: Routine predilation of the SB in provisional stenting of true bifurcation lesions seems to be ineffective and might be associated with some undesirable consequences. Still, there are some complex ostial lesions of the SB which could benefit from predilation.