Circulating irisin levels and coronary heart disease: association with future acute coronary syndrome and major adverse cardiovascular events.

INTRODUCTION: Irisin is a newly discovered myokine, associated with 'browning' of the white adipose tissue, obesity, insulin resistance and metabolic syndrome. The purpose of this study is to evaluate circulating irisin as a predictor of acute coronary syndromes (ACSs) and major adverse cardiovascular events (MACE). METHODS: Sub-study 1: a case-control study, nested within the Veteran's Affairs Normative Ageing Study, evaluating circulating irisin levels in 88 ACS cases and 158 age- and sampling year-matched controls, as a predictor of ACS. Sub-study 2: a prospective cohort study, where 103 participants with established coronary artery disease were stratified by circulating irisin levels at the time they received percutaneous coronary interventions (PCIs) and were followed for the development of MACE. RESULTS: Study 1: there was no association between irisin levels and ACS in otherwise healthy individuals (odds ratio: 1.00 95% confidence interval: (0.99-1.00)). Study 2: the incidence of MACE was significantly lower in the first irisin tertile compared with the second and third (incidence rate 0 vs 0.92 (0.51-1.61) vs 0.57 (0.28-1.14) events per 1000 person-days; P < 0.01). This was primarily driven by the lower incidence of unstable angina (incidence rate 0 vs 0.61 (0.31-1.22) vs 0.43 (0.19-0.96) per 1000 person-days; P = 0.01). CONCLUSION: This is the first study to date that demonstrates that, although circulating irisin levels do not predict the development of ACS in healthy individuals, increased irisin levels are associated with the development of MACE in patients with established coronary artery disease after PCI.

[Diagnostic efficacy of myocardial tomographic imaging in the detection of restenosis after coronary angioplasty]. / Eficacia diagnóstica de la tomogammagrafía miocárdica en la detección de reestenosis coronaria postangioplastia.

INTRODUCTION AND OBJECTIVES: To analyze the efficacy of single photon emission tomography (SPET) with 99mTc-compounds for the diagnosis of restenosis of previous percutaneous transluminal coronary angioplasty (PTCA). PATIENTS AND METHODS: Seventy-one patients (16 women, median age: 60 years, 35 with multivessel disease, 78 arteries with PTCA) with previous PTCA and with coronary angiography performed after scintigraphy were studied. 99mTc-SPET exercise (53 with MIBI and 18 with tetrofosmin) was performed, for clinical reasons, to all patients between one month and 4 years after PTCA. Intravenous dipyridamole was administered simultaneously to 16 patients who had insufficient exercise. RESULTS: SPET sensitivity, specificity, positive predictive values, negative predictive values and global values were all significantly higher than those obtained with exercise tests (80% vs 63%; p = 0.05; 83% vs 37%; p = 0.001; 91% vs 69%; p = 0.007; 64% vs 31%; p = 0.009, and 81% vs 55%; p = 0.0006, respectively). These results were significantly superior in patients with one vessel disease than in patients with multivessel disease. CONCLUSIONS: SPET exercise with 99mTc-compounds is a test with a high efficacy for the diagnosis of post-PTCA restenosis, mainly in patients with one vessel disease.

[Adult congenital anomalies of the coronary arteries described over 31 years of angiographic studies in the Asturias Principality: main angiographic and clinical characteristics]. / Anomalías congénitas de las arterias coronarias del adulto descritas en 31 años de estudios coronariográficos en el Principado de Asturias: principales características angiográficas y clínicas.

OBJECTIVE: The aim of this study was to determine the incidence of adult congenital anomalies of the coronary arteries over 31 years of angiographic studies, describing their angiographic and clinical characteristics. The results have been compared with the main series published. METHODS: The diagnostic angiographic reports done in the Principado de Asturias from 1968 to 1999 are reviewed. In those in which a congenital anomaly was diagnosed, the clinical report and the angiography were studied. The initial course of the anomaly was defined following angiographic criteria. RESULTS: Thirteen thousand five hundred reports were reviewed describing 75 patients with 75 anomalies (0.5%) including: anomalous origin of the left circumflex coronary artery (n = 24), coronary artery fistulae (n = 21), both coronary arteries arising from the left coronary sinus (n = 15), single coronary arteries (n = 6), both coronary arteries arising from the right coronary sinus (n = 2), separated origin of anterior descending and left circumflex coronary arteries (n = 3), anterior descending artery arising from the right coronary sinus (n = 2), and others (n = 1). Angiographic studies were done because of: angina (59%), dysnea (25%), atypical chest pain (7%), syncope (3%), dizziness (3%) and palpitations (3%). The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, anterior in the anterior descending arteries and retroaortic, septal and combined, in the left coronaries. CONCLUSIONS: Adult congenital anomalies of the coronary arteries are not very common and are usually casual findings of diagnostic angiographic studies. Left circumflex coronary artery anomalies are the most frequently diagnosed.

PTCA procedure for Shepherd's Crook right coronary artery lesion with a new long soft-tip 6F guiding catheter.

A new Cordis Long Brite Tip 6F guiding catheter (I.D. .064") is described. Because of its technical characteristics, this product provides greater balloon catheter support by means of deeper intubation of the right coronary artery (RCA). We present our experience with a Shepherd's Crook RCA lesion PTCA procedure.