Circulating miR-320a as a Predictive Biomarker for Left Ventricular Remodelling in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention.

Restoration of epicardial coronary blood flow, achieved by early reperfusion with primary percutaneous coronary intervention (PPCI), is the guideline recommended to treat patients with ST-segment-elevation myocardial infarction (STEMI). However, despite successful blood restoration, increasing numbers of patients develop left ventricular adverse remodelling (LVAR) and heart failure. Therefore, reliable prognostic biomarkers for LVAR in STEMI are urgently needed. Our aim was to investigate the role of circulating microRNAs (miRNAs) and their association with LVAR in STEMI patients following the PPCI procedure. We analysed the expression of circulating miRNAs in blood samples of 56 patients collected at admission and after revascularization (at 3, 6, 12 and 24 h). The associations between miRNAs and left ventricular end diastolic volumes at 6 months were estimated to detect LVAR. miRNAs were also analysed in samples isolated from peripheral blood mononuclear cells (PBMCs) and human myocardium of failing hearts. Kinetic analysis of miRNAs showed a fast time-dependent increase in miR-133a, miR-133b, miR-193b, miR-499, and miR-320a in STEMI patients compared to controls. Moreover, the expression of miR-29a, miR-29b, miR-324, miR-208, miR-423, miR-522, and miR-545 was differentially expressed even before PPCI in STEMI. Furthermore, the increase in circulating miR-320a and the decrease in its expression in PBMCs were significantly associated with LVAR and correlated with the expression of miR-320a in human failing myocardium from ischaemic origin. In conclusion, we determined the time course expression of new circulating miRNAs in patients with STEMI treated with PPCI and we showed that miR-320a was positively associated with LVAR.

Revisión de los resultados de los principales subestudios del estudio RE-LY / Review of the principal RE-LY substudy results

Desde la publicación del estudio Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY), se ha publicado un total de 10 subanálisis de sus datos. La eficacia de dabigatrán a dosis de 110 y 150mg cada 12h comparado con warfarina para prevenir ictus y embolias sistémicas se ha analizado en diferentes contextos. Se han publicado los resultados que demuestran la superioridad de dabigatrán frente a warfarina en relación con el control de anticoagulación de los pacientes, si habían usado previamente warfarina o era la primera vez que la usaban, si habían tenido previamente un ictus o no, si se habían sometido a cardioversión eléctrica o farmacológica, si eran población japonesa, en diferentes franjas de edad de los pacientes y diferentes niveles de riesgo de sufrir un ictus. Además, se ha publicado un análisis farmacocinético de dabigatrán en la población incluida en el estudio RE-LY y dos análisis de coste-beneficio. Los resultados de todos estos estudios aportan más de 200 puntos de factor de impacto y respaldan la superioridad de dabigatrán frente a warfarina para prevenir ictus o embolias sistémicas (AU)

Since the initial publication of the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) study results, a total of 10 subanalyses of RE-LY data have been reported. In particular, the efficacy of administering 110 mg or 150 mg of dabigatran every 12 hours for preventing stroke and systemic embolism has been compared with that of warfarin in different clinical contexts. The study results demonstrate that dabigatran is superior to warfarin in terms of anticoagulation control, irrespective of whether patients had previously used warfarin or were taking it for the first time, whether or not they had previously had a stroke, and whether or not they had undergone electrical or pharmacologic cardioversion. Dabigatran was also found to be superior in Japanese patients, in different age groups and in patients with varying levels of stroke risk. In addition, a pharmacokinetic analysis of dabigatran in the RE-LY study population and two cost-benefit analyses have also been published. Together, these study results have achieved an equivalent impact factor of 200 and provide further evidence that dabigatran is superior to warfarin in the prevention of stroke and systemic embolism (AU)

Value of NT-ProBNP level and echocardiographic parameters in ST-segment elevation myocardial infarction treated by primary angioplasty: relationships between these variables and their usefulness as predictors of ventricular remodeling.

INTRODUCTION AND OBJECTIVES: To assess the value of N-terminal fragment of brain natriuretic peptide (NT-proBNP) measurement and echocardiography for predicting ventricular remodeling after myocardial infarction and to investigate relationships between the NT-proBNP level and echocardiographic parameters at discharge and in the medium term. METHODS: The study involved 159 patients with myocardial infarction treated by primary coronary angioplasty. The NT-proBNP level was measured on admission, at discharge and after 6 months. Echocardiography was performed at discharge and after 6 months. RESULTS: Overall, 31 patients (19.5%) demonstrated remodeling. At discharge, the variables associated with remodeling were: mitral inflow E-wave-to-A-wave velocity ratio (E/A), systolic mitral annulus velocity (Sm), early diastolic mitral annulus velocity (Em), the mitral inflow E wave to early diastolic mitral annulus velocity ratio (E/ Em), left atrial volume (LAV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and discharge NT-proBNP level. Only E/Em was an independent predictor of ventricular remodeling (odds ratio [OR]=1.143; 95% confidence interval [CI], 1.039-1.258; P=.006). At discharge, correlations were observed between the NT-proBNP level and LVEDV, LVESV, ejection fraction (EF) and E/Em. At 6 months, correlations with ventricular volumes and EF were unchanged, the correlation with E/Em was better (r=0.47 vs. r=0.69), and a modest correlation with LAV developed (r=0.43; P=.001). CONCLUSIONS: The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months.

NT-proBNP y variables ecocardiográficas en el infarto con elevación del ST tratado con angioplastia primaria: relación entre ambos y utilidad como predictores de remodelado ventricular / Value of NT-ProBNP Level and Echocardiographic parameters in ST-segment elevation myocardial infarction treated by primary angioplasty: relationships between these variables and their usefulness as predictors of ventricular remodeling

Introducción y objetivos. Estudiar el valor del fragmento aminoterminal del péptido natriurético cerebral (NT-proBNP) y del ecocardiograma para predecir remodelado tras infarto y relacionar el NT-proBNP con el ecocardiograma al alta y en fase crónica. Métodos. Estudiamos a 159 pacientes con infarto tratados con angioplastia primaria. Se determinó el NT-pro-BNP al ingreso, al alta y al sexto mes. Se hizo ecocardiograma al alta y al sexto mes. Resultados. Treinta y un pacientes (19,5%) sufrieron remodelado. Al alta se asociaron con remodelado: el cociente entre velocidades E y A del llenado mitral (E/A), la velocidad sistólica del anillo mitral (Sm), la velocidad diastólica precoz del anillo mitral (Em), el cociente entre onda E del llenado mitral y velocidad diastólica precoz del anillo mitral (E/Em), el volumen auricular izquierdo (VAI), los volúmenes telediastólico (VTD) y telesistólico (VTS) ventriculares izquierdos y el NT-proBNP al alta. De ellas, sólo el E/Em fue predictor independiente de remodelado (odds ratio [OR] = 1,143; intervalo de confianza [IC] del 95%, 1,039-1,258; p = 0,006). Al alta, el NT-pro-BNP se correlacionó con el VTD, el VTS, la fracción de eyección (FE) y el E/Em. Al sexto mes, había similar correlación con volúmenes ventriculares y FE, mejoró la correlación con el E/Em (r = 0,47 frente a r = 0,69) y apareció correlación modesta con el VAI (r = 0,43; p = 0,001). Conclusiones. El cociente E/Em es el mejor predictor ecocardiográfico de remodelado tras infarto. El NT-pro-BNP pierde valor predictor al considerarlo junto con el ecocardiograma. El NT-proBNP se correlaciona igualmente con volúmenes ventriculares y FE al alta y al sexto mes, mientras que la correlación con el cociente E/Em y el VAI es más relevante al sexto mes (AU)

Introduction and objectives. To assess the value of N-terminal fragment of brain natriuretic peptide (NT-proBNP) measurement and echocardiography for predicting ventricular remodeling after myocardial infarction and to investigate relationships between the NT-proBNP level and echocardiographic parameters at discharge and in the medium term. Methods. The study involved 159 patients with myocardial infarction treated by primary coronary angioplasty. The NT-proBNP level was measured on admission, at discharge and after 6 months. Echocardiography was performed at discharge and after 6 months. Results. Overall, 31 patients (19.5%) demonstrated remodeling. At discharge, the variables associated with remodeling were: mitral inflow E-wave-to-A-wave velocity ratio (E/A), systolic mitral annulus velocity (Sm), early diastolic mitral annulus velocity (Em), the mitral inflow E wave to early diastolic mitral annulus velocity ratio (E/ Em), left atrial volume (LAV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and discharge NT-proBNP level. Only E/Em was an independent predictor of ventricular remodeling (odds ratio [OR]=1.143; 95% confidence interval [CI], 1.039-1.258; P=.006). At discharge, correlations were observed between the NT-proBNP level and LVEDV, LVESV, ejection fraction (EF) and E/Em. At 6 months, correlations with ventricular volumes and EF were unchanged, the correlation with E/Em was better (r=0.47 vs. r=0.69), and a modest correlation with LAV developed (r=0.43; P=.001). Conclusions. The E/Em ratio was the best echocardiographic predictor of left ventricular remodeling after myocardial infarction. The NT-proBNP level had no additional predictive value over echocardiography. Correlations between the NT-proBNP level and ventricular volumes and EF at discharge and 6 months were similar, while correlations with E/Em and LAV were better at 6 months (AU)

[Percutaneous treatment of bifurcation lesions by crush T stenting: immediate and medium-term outcomes]. / Tratamiento de las lesiones bifurcadas mediante técnica de crush T stenting: resultados inmediatos y a medio plazo.

INTRODUCTION AND OBJECTIVES: Percutaneous coronary intervention for coronary bifurcations is usually associated with a low success rate, a high rate of complications, and a more frequent need for target lesion revascularization. The aim of this prospective study was to evaluate immediate and medium-term clinical and angiographic outcomes after the application of crush T stenting. METHODS: This approach to bifurcation stenting follows the same steps as modified T stenting. The only difference is that the side branch stent protrudes 3-4 mm into the main vessel from the carina. The aim is to ensure that the circumference of the side branch ostium is covered by the stent strut. RESULTS: Between December 2003 and February 2005, 82 patients were included in the study. The lesion involved the left main coronary artery in 53% of patients, the left anterior descending or diagonal coronary artery in 29%, the circumflex or marginal branch in 11%, and the right coronary artery or the posterior or posterolateral descending branch in 7%. Angiographic and clinical success was obtained in 100% and 96.4% of cases, respectively. Final dilatation was performed using a kissing balloon in 87%. Overall, 100% of patients were followed up clinically for 12 months and 77% were followed up angiographically for a mean of 8.7 (3.3) months. Target lesion revascularization was performed in 9 patients (10.8%). CONCLUSIONS: Treatment of coronary bifurcation lesions using the crush T stenting technique is safe and effective. It reduces both the restenosis rate and the major adverse cardiac event rate at one year.

Tratamiento de las lesiones bifurcadas mediante técnica de crush T stenting: resultados inmediatos y a medio plazo / Percutaneous treatment of bifurcation lesions by crush T stenting: immediate and medium- term outcomes

Introducción y objetivos. El tratamiento percutáneo de las lesiones bifurcadas se asocia con una menor tasa de éxito y una mayor frecuencia de complicaciones y de nueva revascularización de la lesión tratada. El objetivo de este estudio prospectivo fue evaluar los resultados clínicos y angiográficos iniciales y a medio plazo de la técnica de crush T stenting. Métodos. Este método de tratamiento percútaneo de las lesiones bifurcadas con implante de stents coronarios reproduce la técnica T stenting modificada con la diferencia de que el stent de la rama lateral protruye dentro de la rama principal a 3-4 mm de la carina. El propósito es asegurar que el ostium de la rama lateral es cubierto circunferencialmente con la malla de los stents. Resultados. Entre diciembre de 2003 y febrero de 2005 se incluyó a 82 pacientes en este estudio. La lesión afectaba al tronco coronario izquierdo en bifurcación en el 53%, a la arteria descendente anterior/diagonal en el 29%, a la arteria circunfleja/marginal en el 11% y a la coronaria derecha/descendente posterior-posterolateral en el 7%. Éxito angiográfico y clínico se obtuvo en el 100 y el 96,4%, respectivamente. Se realizó posdilatación con doble balón en el 87%. Se obtuvo seguimiento clínico a los 12 meses en el 100% y angiográfico en el 77%. El tiempo medio de seguimiento angiográfico fue 8,7 ± 3,3 meses. Se realizó una nueva revascularización de la lesión tratada en el 10,8%. Conclusiones. El tratamiento de las lesiones bifurcadas con técnica de crush T stenting es segura y efectiva, y presenta una baja tasa de eventos cardiacos mayores y de necesidad de nueva revascularización (AU)

Introduction and objectives. Percutaneous coronary intervention for coronary bifurcations is usually associated with a low success rate, a high rate of complications, and a more frequent need for target lesion revascularization. The aim of this prospective study was to evaluate immediate and medium-term clinical and angiographic outcomes after the application of crush T stenting. Methods. This approach to bifurcation stenting follows the same steps as modified T stenting. The only difference is that the side branch stent protrudes 3-4 mm into the main vessel from the carina. The aim is to ensure that the circumference of the side branch ostium is covered by the stent strut. Results. Between December 2003 and February 2005, 82 patients were included in the study. The lesion involved the left main coronary artery in 53% of patients, the left anterior descending or diagonal coronary artery in 29%, the circumflex or marginal branch in 11%, and the right coronary artery or the posterior or posterolateral descending branch in 7%. Angiographic and clinical success was obtained in 100% and 96.4% of cases, respectively. Final dilatation was performed using a kissing balloon in 87%. Overall, 100% of patients were followed up clinically for 12 months and 77% were followed up angiographically for a mean of 8.7 (3.3) months. Target lesion revascularization was performed in 9 patients (10.8%). Conclusions. Treatment of coronary bifurcation lesions using the crush T stenting technique is safe and effective. It reduces both the restenosis rate and the major adverse cardiac event rate at one year (AU)