Molecular inflammation and oxidative stress are shared mechanisms involved in both myocardial infarction and periodontitis.

BACKGROUND AND OBJECTIVE: Our aims were to improve the understanding of the pathogenic relationship between cardiovascular diseases and periodontitis and to generate new perspectives in the prevention and treatment of acute myocardial infarction (AMI) and periodontitis. The present study evaluates possible differences in inflammation, oxidative stress, and autophagy markers among subject suffering AMI, periodontitis, or both, to explore possible common pathogenic mechanisms. MATERIAL AND METHODS: A total of 260 subjects were enrolled in the study: 106 subjects that survived to a first AMI (AMI group) and 154 subjects had no cardiac events in their clinical record (control group). A questionnaire was used to assess age, height, weight, blood pressure, and heart rate. The clinical probing depth, clinical attachment loss, number of remaining teeth, and average number of sites with bleeding on probing were assessed. Lipid peroxidation and protein levels of phosphorylated AMP-activated protein kinase (p-AMPK) and microtubule-associated proteins 1A/1B-light chain 3-II (LC3-II) were determined in isolated peripheral blood mononuclear cells by thiobarbituric acid reactive substances (TBARS) assay and Western blot, respectively. Plasma levels of interleukin-1ß were determined using a commercial ELISA kit. All the obtained variables were compared between subjects suffering an AMI with or without periodontitis and control subject periodontal healthy or with periodontitis. RESULTS: A higher proportion of subjects suffering AMI + periodontitis than only AMI (without periodontitis) was found. Higher levels of TBARS were found in subjects with periodontitis than in subjects without periodontitis in both AMI and control subjects. Positive correlations between IL-1ß levels and TBARS and between IL-1ß levels and LC3-II were found only in control subjects. CONCLUSION: Results from the present study are consistent with the suggestion of periodontitis as a potential risk factor for AMI. Periodontitis association with circulating lipid peroxides in both AMI and control subjects were found. The absence of differences in IL-1ß levels between AMI subjects (only AMI vs AMI + periodontitis) suggests that oxidative stress could be the main pathogenic link between AMI and periodontitis.

Could NLRP3-Inflammasome Be a Cardiovascular Risk Biomarker in Acute Myocardial Infarction Patients?

Conventional cardiovascular risk factors (CVRFs) are accepted to identify asymptomatic individuals with high risk of acute myocardial infarction (AMI). However, AMI affects many patients previously classified at low risk. New biomarkers are needed to improve risk prediction. We propose to evaluate the NLRP3-inflammasome complex as a potential conventional cardiovascular risk (CVR) indicator in healthy males and post-AMI patients and compare both groups by known CVRFs. We included 109 men with no history of cardiovascular disease (controls) and 150 AMI patients attending a cardiac rehabilitation program. AMI patients had higher mean of body mass index (BMI) and waist circumference than the controls. However, high percentages of the controls had a high BMI and a waist circumference >95 cm. The controls also had higher systolic blood pressure (p > 0.001), total and low-density lipoprotein cholesterol, dietary nutrient, and calorific intake. Fuster BEWAT score (FBS) correlated more closely than Framingham risk score (FRS) with most CVRF, groups. However, only the FBS showed a correlation with inflammasome cytokine interleukin 1ß (IL-1ß). Several CVRFs were significantly better in AMI patients; however, this group also had higher mRNA expression of the inflammasome gene NLRP3 and lower expression of the autophagy gene MAP-LC3. The controls had high levels of CVRF, probably reflecting unhealthy lifestyle. FBS reflects the efficiency of strategies to induce lifestyle changes such as cardiac rehabilitation programs, and could provide a sensitive evaluation CVR. These results lead to the hypothesis that NLRP3-inflammasome and associated IL-1ß release have potential as CVR biomarkers, particularly in post-AMI patients with otherwise low risk scores. Antioxid. Redox Signal. 27, 269-275.

Lack of correlation between the optimal glycaemic control and coronary micro vascular dysfunction in patients with diabetes mellitus: a cross sectional study.

BACKGROUND: Coronary microvascular dysfunction (CMD) is associated with cardiovascular events in type 2 diabetes mellitus (T2DM). Optimal glycaemic control does not always preclude future events. We sought to assess the effect of the current target of HBA1c level on the coronary microcirculatory function and identify predictive factors for CMD in T2DM patients. METHODS: We studied 100 patients with T2DM and 214 patients without T2DM. All of them with a history of chest pain, non-obstructive angiograms and a direct assessment of coronary blood flow increase in response to adenosine and acetylcholine coronary infusion, for evaluation of endothelial independent and dependent CMD. Patients with T2DM were categorized as having optimal (HbA1c < 7%) vs. suboptimal (HbA1c ≥ 7%) glycaemic control at the time of catheterization. RESULTS: Baseline characteristics and coronary endothelial function parameters differed significantly between T2DM patients and control group. The prevalence of endothelial independent CMD (29.8 vs. 39.6%, p = 0.40) and dependent CMD (61.7 vs. 62.2%, p = 1.00) were similar in patients with optimal vs. suboptimal glycaemic control. Age (OR 1.10; CI 95% 1.04-1.18; p < 0.001) and female gender (OR 3.87; CI 95% 1.45-11.4; p < 0.01) were significantly associated with endothelial independent CMD whereas glomerular filtrate (OR 0.97; CI 95% 0.95-0.99; p < 0.05) was significantly associated with endothelial dependent CMD. The optimal glycaemic control was not associated with endothelial independent (OR 0.60, CI 95% 0.23-1.46; p 0.26) or dependent CMD (OR 0.99, CI 95% 0.43-2.24; p = 0.98). CONCLUSIONS: The current target of HBA1c level does not predict a better coronary microcirculatory function in T2DM patients. The appropriate strategy for prevention of CMD in T2DM patients remains to be addressed.

Revascularización endovascular carotídea realizada por un equipo multidisciplinar: primera experiencia en España / Endovascular carotid revascularization performed by a multidisciplinary team: first experience in Spain

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Bioresorbable vascular scaffold collapse causes subacute thrombosis.

We report a subacute bioresorbable scaffold thrombosis caused by stent collapse into a heavily calcified lesion.

Abordaje de las lesiones bifurcadas con stent liberador de everolimus: comparación entre estrategias simple y compleja con T-stenting / Approach to coronary bifurcation lesions using the everolimus-eluting stent: comparison between a simple strategy and a complex strategy with T-stenting

Introducción y objetivos. El abordaje de las lesiones en bifurcación se puede realizar con estrategia simple o compleja. La estrategia compleja no se ha mostrado superior a la simple con stents farmacoactivos de primera generación. Sin embargo, hasta ahora no se ha definido la mejor estrategia con los stents farmacoactivos de segunda generación. Métodos. Estudio prospectivo aleatorizado de comparación de la estrategia simple frente a la compleja mediante T-stenting en la revascularización de las lesiones en bifurcación con el uso de stent farmacoactivo liberador de everolimus. Se realizó un seguimiento clínico y angiográfico a los 9 meses. Resultados. Se incluyeron 70 lesiones de 69 pacientes, a los que se aleatorizó a estrategia simple (34 lesiones de 33 pacientes) o compleja (36 lesiones de 36 pacientes). El 85,6% de las lesiones en bifurcación fueron verdaderas. La tasa de crossover fue del 17,1%. La tasa total de reestenosis binaria fue del 12,1%, sin diferencias entre grupos de estrategia. La reestenosis del ramo lateral mostró en la estrategia simple tendencia a ser superior que en la compleja (el 10,7 frente al 0%) en el análisis por intención de tratar, pero no en el análisis por protocolo (el 5,9 frente al 4,2%). La tasa de eventos cardiacos adversos (muerte cardiaca, infarto de miocardio y nueva revascularización) fue del 9,2%, sin diferencias entre grupos. No hubo ningún caso de trombosis del stent. Conclusiones. No parece que la estrategia compleja aporte ventajas clínicas o angiográficas respecto a la simple en la revascularización de lesiones en bifurcación con stent farmacoactivo de segunda generación liberador de everolimus (AU)

Introduction and objectives: Coronary bifurcation lesions can be approached using a simple or a complex strategy. In clinical trials with first-generation drug-eluting stents, the complex strategy was not superior to the simple approach. However, to date, the best strategy when using second-generation drug-eluting stents has not been defined. Methods: We performed a prospective randomized study comparing a simple vs a complex strategy involving T-stenting for the percutaneous revascularization of bifurcation lesions using the everolimuseluting stent. Angiographic and clinical follow-up were performed at 9 months. Results: We included 70 lesions in 69 patients, who were randomized to the simple (34 lesions, 33 patients) or complex strategy (36 lesions and patients). In all, 85.6% of the lesions included were true bifurcations. The crossover rate was 17.1%. The binary restenosis rate was 12.1%, with no differences between the groups. Side branch restenosis tended to be higher with the simple strategy in the intention to treat analysis (10.7% vs 0%) but not in the per protocol analysis (5.9% vs 4.2%). The incidence of major adverse cardiac events (cardiac death, myocardial infarction, and target vessel revascularization) was 9.2%, with no differences between groups. There were no cases of stent thrombosis. Conclusions: According to the clinical and angiographic findings, the complex strategy was not significantly superior to the simple approach in the revascularization of bifurcation lesions with secondgeneration everolimus-drug eluting stents (AU)

Approach to coronary bifurcation lesions using the everolimus-eluting stent: comparison between a simple strategy and a complex strategy with T-stenting.

INTRODUCTION AND OBJECTIVES: Coronary bifurcation lesions can be approached using a simple or a complex strategy. In clinical trials with first-generation drug-eluting stents, the complex strategy was not superior to the simple approach. However, to date, the best strategy when using second-generation drug-eluting stents has not been defined. METHODS: We performed a prospective randomized study comparing a simple vs a complex strategy involving T-stenting for the percutaneous revascularization of bifurcation lesions using the everolimus-eluting stent. Angiographic and clinical follow-up were performed at 9 months. RESULTS: We included 70 lesions in 69 patients, who were randomized to the simple (34 lesions, 33 patients) or complex strategy (36 lesions and patients). In all, 85.6% of the lesions included were true bifurcations. The crossover rate was 17.1%. The binary restenosis rate was 12.1%, with no differences between the groups. Side branch restenosis tended to be higher with the simple strategy in the intention to treat analysis (10.7% vs 0%) but not in the per protocol analysis (5.9% vs 4.2%). The incidence of major adverse cardiac events (cardiac death, myocardial infarction, and target vessel revascularization) was 9.2%, with no differences between groups. There were no cases of stent thrombosis. CONCLUSIONS: According to the clinical and angiographic findings, the complex strategy was not significantly superior to the simple approach in the revascularization of bifurcation lesions with second-generation everolimus-drug eluting stents.

Stenting intra y extracraneal múltiple en un solo acto / Multiple intra- and extra-cranial stenting in one single act

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[Relationship between coronary flow and viability in patients with myocardial infarction submitted to revascularization with stent. Assessment by Doppler guidewire]. / Relación entre flujo coronario y viabilidad en pacientes con infarto que reciben angioplastia con stent. Análisis con guía intracoronaria Doppler.

UNLABELLED: Introduction and objectives. Intracoronary Doppler guidewire measurement provides information about the state of the myocardial microcirculation. Our aim was to assess the relationship between the pattern of coronary flow and myocardial viability. Patients and method. The study included 19 patients who had had a recent myocardial infarction (< 1 month), who underwent percutaneous revascularization of the responsible vessel, and who agreed to angiographic follow-up. Patients were divided into two groups according to the extent of the akinetic area observed at follow-up responsible (149 [40] days) in the myocardial region supplied by the responsible artery: one group (n=11) had preserved regional contractility (i.e., an akinetic area less than 30%); the other group (n=8) had impaired regional contractility (i.e., an akinetic area equal to or greater than 30%). Coronary flow in the artery was responsible assessed after revascularization and at follow-up using the Doppler guidewire method. RESULTS: After revascularization, patients with preserved regional contractility had a higher diastolic deceleration half-time than those with impaired regional contractility (628 [188] ms vs 376 [131] ms, P=.02). At follow-up, the difference in coronary flow between the groups had disappeared. Patients in whom regional contractility was preserved demonstrated a significant increase in coronary flow reserve at follow-up (1,8 [0,5] vs 2,3 [0,5], P=.01). CONCLUSIONS: After timely revascularization (within one month) of the vessel responsible for a myocardial infarction, the pattern of coronary flow observed in patients with viable myocardium differed from that in those with non-viable myocardium. The differences disappeared during follow-up.

Relación entre flujo coronario y viabilidad en pacientes con infarto que reciben angioplastia con stent. Análisis con guía intracoronaria Doppler / Relationship between coronary flow and viability in patients with myocardial infarction submitted to revascularization with stent. Assessment by doppler guidewire

Introducción y objetivos. La guía intracoronaria Doppler suministra información sobre el estado de la microcirculación miocárdica. Nuestro objetivo fue evaluar la relación entre las características del flujo coronario en la arteria causante del infarto y el mantenimiento de viabilidad miocárdica. Pacientes y método. Se incluyó a 19 pacientes con infarto reciente (1 mes), revascularización percutánea de la arteria causante y disposición para una revaluación angiográfica en el seguimiento. Los pacientes se dividieron en 2 grupos, según la extensión de acinesia en el territorio de la arteria causante del infarto en el seguimiento (149 +/- 40 días): grupo con contractilidad regional preservada (n = 11, con un porcentaje de acinesia = 30%). Tras la revascularización, y en el control de seguimiento, se analizó el flujo coronario en la arteria causante del infarto con guía Doppler. Resultados. Los pacientes con contractilidad regional preservada presentaron, después de la revascularización, un mayor tiempo de hemidesaceleración diastólico (628 ± 188 frente a 376 +/- 131 ms; p = 0,02). En el control de seguimiento, las diferencias en el patrón de flujo coronario entre los dos grupos desaparecen. Además, en el seguimento se produce un aumento significativo de la reserva coronaria únicamente en el grupo con contractilidad preservada (1,8 +/- 0,5 frente a 2,3 +/- 0,5; p = 0,01). Conclusiones. Tras revascularización de la arteria causante de un infarto reciente hay un patrón diferencial de flujo coronario entre los pacientes con y sin viabilidad. Estas diferencias desaparecen en el seguimiento

Introduction and objectives. Intracoronary Doppler guidewire measurement provides information about the state of the myocardial microcirculation. Our aim was to assess the relationship between the pattern of coronary flow and myocardial viability. Patients and method. The study included 19 patients who had had a recent myocardial infarction (< 1 month), who underwent percutaneous revascularization of the responsible vessel, and who agreed to angiographic follow-up. Patients were divided into two groups according to the extent of the akinetic area observed at follow-up responsible (149 [40] days) in the myocardial region supplied by the responsible artery: one group (n=11) had preserved regional contractility (i.e., an akinetic area less than 30%); the other group (n=8) had impaired regional contractility (i.e., an akinetic area equal to or greater than 30%). Coronary flow in the artery was responsible assessed after revascularization and at follow-up using the Doppler guidewire method. Results. After revascularization, patients with preserved regional contractility had a higher diastolic deceleration half-time than those with impaired regional contractility (628 [188] ms vs 376 [131] ms, P=.02). At follow-up, the difference in coronary flow between the groups had disappeared. Patients in whom regional contractility was preserved demonstrated a significant increase in coronary flow reserve at follow-up (1,8 [0,5] vs 2,3 [0,5], P=.01). Conclusions. After timely revascularization (within one month) of the vessel responsible for a myocardial infarction, the pattern of coronary flow observed in patients with viable myocardium differed from that in those with non-viable myocardium. The differences disappeared during follow-up

Assessment of the efficacy of phentolamine to prevent radial artery spasm during cardiac catheterization procedures: a randomized study comparing phentolamine vs. verapamil.

The objective of this study was to evaluate phentolamine as radial artery spasmolytic in transradial catheterization procedures. Radial artery spasm is a relatively frequent complication during transradial approach, causing patient discomfort or even making it impossible to continue the procedure. As radial artery spasm is mediated by the stimulation of alpha-adrenoreceptors, the use of the alpha-blocker phentolamine could make sense as spasmolytic. We designed a randomized double-blind study to compare phentolamine vs. verapamil, the standard spasmolytic agent. Five hundred patients (250 in each arm) submitted to a transradial cardiac catheterization were consecutively included and randomly assigned to receive 2.5 mg of verapamil or 2.5 mg of phentolamine after sheath insertion. Both vasodilator agents induced a significant radial artery diameter increase (from 2.22 +/- 0.53 to 2.48 +/- 0.57 mm, P < 0.001 for verapamil, and from 2.20 +/- 0.53 to 2.45 +/- 0.53 mm, P < 0.001 for phentolamine). However, verapamil was more efficacious to prevent radial artery spasm (13.2% compared with 23.2% in phentolamine-treated patients; P = 0.004). Follow-up (20 +/- 18 days) evaluation of the radial artery patency by plestismography and pulse oximetry showed no differences between the two groups in the rate of radial occlusion (3.0% vs. 3.2% in verapamil and phentolamine treated patients, respectively). Phentolamine was an effective radial vasodilator agent, although it showed less ability to prevent radial artery spasm than verapamil. Radial artery occlusion rate was almost identical for both vasodilators. Thus, phentolamine could be a valid alternative to verapamil as a radial artery spasmolytic agent.

[Radial artery spasm in transradial cardiac catheterization. Assessment of factors related to its occurrence, and of its consequences during follow-up]. / Espasmo radial en el cateterismo cardíaco transradial. Análisis de los factores asociados con su aparición y de sus consecuencias tras el procedimiento.

INTRODUCTION AND OBJECTIVES: Radial artery spasm is the most frequent complication of transradial cardiac catheterization. It causes patient discomfort and reduces the procedure's success rate. The aims of this study were to identify variables associated with this complication, such as clinical parameters, angiographic characteristics of the radial artery and factors related to the procedure, and to analyze the clinical consequences of spasm, both generally and for radial artery patency, during follow-up. PATIENTS AND METHOD: The study included 637 patients who were undergoing transradial cardiac catheterization. Radial artery spasm was recorded using a scale that reflected the presence of pain and the technical difficulty of the procedure. RESULTS: Radial artery spasm was reported in 127 patients (20.2%). Multivariate analysis showed that the variables associated with radial artery spasm were radial artery anatomical anomalies (odds ratio [OR]=5.1; 95% confidence interval [95% CI]: 2.1-11.4), use of >size-3 catheters (OR=3.0; 95% CI: 1.9-4.7), moderate-to-severe pain during radial artery cannulation (OR=2.6; 95% CI: 1.4-4.9), the use of phentolamine as a spasmolytic (OR=1.8; 95% CI: 1.1-2.9), and postvasodilation radial artery diameter (OR=0.98; 95% CI: 0.98-0.99). At follow-up [20 (18) days], severe pain in the forearm was more frequent in patients who presented with radial artery spasm (12.4% vs 5.3%), but there was no significant difference in the radial artery occlusion rate (4.5% vs 2.2%). CONCLUSION: Radial artery spasm during transradial catheterization mainly depends on radial artery characteristics and procedural variables. At follow-up, radial artery spasm was associated with more frequent severe pain in the forearm, but the radial artery occlusion rate was not increased.

Espasmo radial en el cateterismo cardíaco transradial. Análisis de los factores asociados con su aparición y de sus consecuencias tras el procedimiento / Radial artery spasm in transradial cardiac catheterization. Assessment of factors related to its occurrence, and of its consequences during follow-up

Introducción y objetivos. El espasmo radial es la complicación más frecuente en el cateterismo cardíaco transradial y ocasiona un procedimiento más doloroso para el paciente, con una menor tasa de éxito. El objetivo es analizar los factores que se asocian con el espasmo radial durante el cateterismo cardíaco (variables clínicas, características angiográficas de la arteria radial y variables del procedimiento), así como sus consecuencias (clínicas y de permeabilidad de la arteria radial) en el seguimiento. Pacientes y método. Se ha incluido a 637 pacientes en los que se realizó un cateterismo cardíaco por vía radial. El espasmo radial se registró según una escala que valora las molestias del paciente y las dificultades técnicas. Resultados. Se produjo espasmo radial en 127 pacientes(20,2%). El análisis multivariable mostró que las variables relacionadas con el espasmo radial fueron: una anomalía anatómica radial (odds ratio [OR] = 5,1; intervalo de confianza [IC] del 95%, 2,1-11,4), el empleo > 3 catéteres(OR = 3,0; IC del 95%, 1,9-4,7), el dolor moderado-intenso en la canulación radial (OR = 2,6; IC del 95%,1,4-4,9), la utilización de fentolamina como vasodilatador(OR = 1,8; IC del 95%, 1,1-2,9) y el diámetro radial tras el empleo del vasodilatador (OR = 0,98; IC del 95%, 0,98-0,99). Durante el seguimiento (20 ± 18 días), los pacientes con espasmo radial presentaron un mayor porcentaje de dolor moderado-intenso en el antebrazo (el 12,4 frente al 5,3%), pero sin diferencias significativas en la tasa de oclusión radial (el 4,5 frente al 2,2%).Conclusión. La aparición del espasmo radial tiene un componente multifactorial en el que predominan las características de la arteria y las variables del procedimiento. Durante el seguimiento, el espasmo no condicionó una mayor tasa de oclusión radial, aunque sí de persistencia de dolor importante en el antebrazo (AU)

Introduction and objectives. Radial artery spasm is the most frequent complication of transradial cardiac catheterization. It causes patient discomfort and reduces the procedure’s success rate. The aims of this study were to identify variables associated with this complication, such as clinical parameters, angiographic characteristics of the radial artery and factors related to the procedure, and to analyze the clinical consequences of spasm, both generally and for radial artery patency, during follow-up. Patients and method. The study included 637 patients who were undergoing transradial cardiac catheterization. Radial artery spasm was recorded using a scale that reflected the presence of pain and the technical difficulty of the procedure. Results. Radial artery spasm was reported in 127 patients(20.2%). Multivariate analysis showed that the variables associated with radial artery spasm were radial artery anatomical anomalies (odds ratio [OR]=5.1; 95%confidence interval [95% CI]: 2.1-11.4), use of > size-3catheters (OR=3.0; 95% CI: 1.9-4.7), moderate-to-severe pain during radial artery cannulation (OR=2.6; 95%CI: 1.4-4.9), the use of phentolamine as a spasmolytic(OR=1.8; 95% CI: 1.1-2.9), and post vaso dilation radial artery diameter (OR=0.98; 95% CI: 0.98-0.99). At follow up[20 (18) days], severe pain in the forearm was more frequent in patients who presented with radial artery spasm (12.4% vs 5.3%), but there was no significant difference in the radial artery occlusion rate (4.5% vs2.2%). Conclusion. Radial artery spasm during transradial catheterization mainly depends on radial artery characteristics and procedural variables. At follow-up, radial artery spasm was associated with more frequent severe pain in the forearm, but the radial artery occlusion rate was not increased (AU)

[Value of gated-SPECT in defining the post-revascularization prognosis of patients with ischemic cardiomyopathy]. / Valor del gated-SPECT para definir el pronóstico tras la revascularización en una población con cardiopatía isquémica.

INTRODUCTION AND OBJECTIVES: Gated-SPECT simultaneously evaluates perfusion and ventricular function and could provide important prognostic information in ischemic cardiomyopathy. Our aim was to study the value of gated-SPECT performed before revascularization in a cardioischemic population to predict the outcome of revascularization. METHODS: One hundred and ten patients who had undergone percutaneous (n = 100) or surgical revascularization were included. Patients underwent sestamibi gated-SPECT before revascularization. After revascularization, they were followed-up for at least 12 months (mean 23.7 months, maximum 44 months). We recorded deaths and a combined clinical event of death, non-fatal infarction, and hospital re-admission for cardiac reasons. We analyzed the prognostic value of clinical, angiographic, and gated-SPECT variables. RESULTS: During follow-up, there were 14 deaths (6.4%/ year) and 36 cases of combined events (16.5%/year). Multivariate analysis showed that depressed gated-SPECT ejection fraction (threshold 0.30) was the only variable independently related to death (OR = 4.8; 95%CI, 1.6-14.6) and combined event (OR = 2.5; 95%CI, 1.2-4.8). Survival analysis showed that patients with ejection fraction < or = 0.30% had a significantly shorter period of time free of death (33 months [28-38] versus 42 months [40-44]; p = 0.002) and combined events (28 months [23-32] versus 36 months [33-39]; p = 0.007). CONCLUSIONS: Gated-SPECT, due to the information it provides about left ventricular function, predicts the prognosis of patients after coronary revascularization.

[Could fractional flow reserve guide therapeutic strategy in acute coronary syndrome?]. / ¿Puede la reserva fraccional del flujo guiar la estrategia terapéutica en el síndrome coronario agudo?

Fractional flow reserve, as determined with a pressure-wire, was validated in the assessment of the functional severity of intermediate lesions in a population with stable ischemic cardiopathy. The value of pressure-wire analysis in acute coronary syndrome is unknown. We report two patients with acute coronary syndrome, in which the therapeutic approach was guided by the fractional flow reserve. We discuss the utility of this tool in this context.

Simultaneous intracoronary pressure and Doppler guidewires to assess coronary stenosis: if one is enough, are two too much?

We report a potential source of erroneous estimation of stenosis severity by pressure guidewire assessment. Simultaneous introduction of pressure and Doppler guidewires can lead to an overestimation of stenosis pressure gradient in the evaluation of intermediate stenosis.