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Aims: The goals of this study were to develop a new technique that could pave the way for a quicker determination of CYP4F2 rs3093135 and CYP2C19 rs4244285 variants directly from a patient’s blood and to attempt to apply this technique in clinical practice. Patients & methods: The study included 144 consecutive patients admitted with ST elevation myocardial infarction. A blood-direct PCR and real-time PCR were used to detect variants of interest. Results & conclusion: Patients with bleeding events had the CYP2C19 GG (*1*1) variant more frequently than patients without bleeding events. The CYP4F2 TT variant was more frequently detected in patients with bleeding events 3 months after hospitalization.

Background: The NR3C2 gene encodes the mineralocorticoid receptor, which is present on cardiomyocytes. Prior studies reported an association between the presence of NR3C2 single-nucleotide polymorphisms (SNPs) and an increased cortisol production during a stress response such as acute myocardial infarction (AMI), which may lead to adverse cardiac remodeling. Objective: To study the impact of the NR3C2 rs2070950, rs4635799 and rs5522 gene polymorphisms on left ventricular (LV) remodeling, rhythm and conduction disorders in AMI patients. Methods: A cohort of 301 AMI patients who underwent revascularization was included. SNPs of the NR3C2 gene (rs2070950, rs4635799 and rs5522) were evaluated. A total of 127 AMI patients underwent transthoracic echocardiography follow-up after 72 h and 6 months. Results: The rs2070950 GG genotype and rs4635799 TT genotype were most common in patients who had LV end-diastolic volume increase < 20% and the same or increased LV ejection fraction, indicating a possible protective effect of these SNPs. The rs5522 TT genotype was associated with a higher frequency of arrhythmias, while the presence of at least one rs5522 C allele was associated with a lower risk of arrhythmias. Conclusion: SNPs of the NR3C2 gene appear to correlate with better ventricular remodeling and a reduced rate of arrhythmias post-AMI, possibly by limiting the deleterious effects of cortisol on cardiomyocytes.

The Coronavirus disease 2019 (COVID-19) pandemic has changed the way patients seek medical attention and how medical services are provided. We sought to compare characteristics, clinical course, and outcomes of patients presenting with acute myocardial infarction (AMI) during the pandemic compared with before it. This is a multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI in Lithuania from March 11, 2020 to April 20, 2020 compared with patients admitted with the same diagnosis during the same period in 2019. All patients underwent angiography. Six-month follow-up was obtained for all patients. A total of 269 patients were included in this study, 107 (40.8%) of whom presented during the pandemic. Median pain-to-door times were significantly longer (858 [quartile 1=360, quartile 3 = 2,600] vs 385.5 [200, 745] minutes, p

Introduction: The aim of this study was to evaluate the incidence rate of technical failure of graft patency while performing intra-operative angiography after coronary artery bypass grafting. Methods: This prospective pilot study included 50 patients with multi-vessel coronary artery disease who underwent coronary artery bypass grafting, in addition to intra-operative angiographic graft assessments, on open-chest. Overall, 144 grafts and 160 distal anastomoses were assessed in a hybrid operating room. Results: Intra-operative angiography allowed the identification of 23 angiographic defects (15.9% of all grafts) in 22 patients (44%): three graft defects (2% of all grafts), 17 anastomotic defects (10.6% of all distal anastomoses), and three target artery errors (1.8% of all grafted arteries). Ten re-interventions (43.4%) were performed based on the angiographic defects detected. During the follow-up period, computed tomography angiography of the attached grafts at a mean of 224 days (range, 80–318 days) showed that all repaired grafts were patent. During surgery, the total mean dose of radiation was 1.848 ± 0.54 mSv (range, 0.78–3.4 mSv) per patient and investigation time was 19.4 ± 4.94 minute (range, 9–31 minute). Conclusions: Intra-operative angiography is a powerful tool allowing the identification of graft defects, anastomotic defects and target vessel errors. Assuming relatively low level of exposure to radiation and short investigation time, intra-operative angiography could be included in routine practice as safe procedure improving surgery quality.

Background: There are very limited scientific data available on cardiac troponin I release after intermittent exercise. To know the different factors that mediate cTnI release after exercise is of concern for scientists. In this regard, our study is based on two major goals: 1) to evaluate the cTnI release in individuals during a sports match; and 2) to understand the impact of the status of the athlete (biological) on the release of individual cTnI. Methods: A total of 44 players, including “22 adult professional [PFP]: 24.2±4.5 years, 22 adult amateur [AFP]: 26.5±3.6 years” were involved in a match simulated as real. Successive observations of cTnI release were obtained at different settings such as at rest, pre-exercise, and instant-post-exercise at regular intervals of 3, 6, and then 24 h post-exercise. Results: From the obtained results it was observed that the individual highest values were vastly varied, with higher levels of cTnI release baseline and post-exercise for PFP players as compared to those of AFP (all p < 0.05). Moreover, the cTnI levels were increased (peak post: 0.024 [0.004-0.244] μg/L; p < 0.05). Additionally, the cTnI peak values surpassed the upper limit of reference in 77.3% of PFP (17 PFP). Conclusions: Our study data results affirm that the cTnI release is highly affected by the status of athletes. The cTnI release is enhanced by intermittent exercise.

Background and Objectives: Serum cortisol has been extensively studied for its role during acute myocardial infarction (AMI). Reports have been inconsistent, with high and low serum cortisol associated with various clinical outcomes. Several publications claim to have developed methods to evaluate cortisol activity by using elements of complete blood count with its differential. This study aims to compare the prognostic value of the cortisol index of Endobiogeny with serum cortisol in AMI patients, and to identify if the risk of mortality in AMI patients can be more precisely assessed by using both troponin I and cortisol index than troponin I alone. Materials and methods: This prospective study included 123 consecutive patients diagnosed with AMI. Diagnostic coronary angiography and revascularization was performed for all patients. Cortisol index was measured on admission, on discharge, and after 6 months. Two year follow-up for all patients was obtained. Results: Our study shows cortisol index peaks at 7–12 h after the onset of AMI, while serum cortisol peaked within 3 h from the onset of AMI. The cortisol index is elevated at admission, then significantly decreases at discharge, furthermore, the decline to its bottom most at 6 months is observed with mean values being constantly elevated. The cortisol index on admission correlated with 24-month mortality. We established combined cut-off values of cortisol index on admission &gt, 100 and troponin I &gt, 1.56 μg/las a prognosticator of poor outcomes for the 24-month period. Conclusions: The cortisol index derived from the global living systems theory of Endobiogeny is more predictive of mortality than serum cortisol. Moreover, a combined assessment of cortisol index and Troponin I during AMI offers more accurate risk stratification of mortality risk than troponin alone.

Objectives To assess whether instantaneous wave – free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG). Background Data suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency. Methods In iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome. Results In total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 – 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 – 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 – 0.96)) were occluded ( p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded ( p < 0.001). In terms of MACCE, no difference ( p = 1.0) was found between all 3 groups divided according to iFR value. Conclusions Instantaneous wave – free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period.

Aims To compare the safety and efficacy of edoxaban combined with P2Y12 inhibition following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF) presenting with an acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). Methods and results In this pre-specified sub-analysis of the ENTRUST-AF PCI trial, participants were randomly assigned 1:1 to edoxaban- or vitamin K antagonist (VKA)-based strategy and randomization was stratified by ACS (edoxaban n = 388, VKA n = 389) vs. CCS (edoxaban n = 363, VKA = 366). Participants received edoxaban 60 mg once-daily plus a P2Y12 inhibitor for 12 months, or VKA combined with a P2Y12 inhibitor and aspirin 100 mg (for 1-12 months). The primary bleeding endpoint at 12 months occurred in 59 (15.2%) vs. 79 (20.3%) ACS patients [hazard ratio (HR): 0.73, 95% confidence interval (CI): 0.59-1.02, P = 0.063], and in 69 (19.0%) vs. 73 (19.9%) CCS patients (HR: 0.94, 95%CI: 0.68-1.31, P = 0.708) with edoxaban- and VKA-based therapy, respectively [P for interaction (P-int) = 0.2741]. The main secondary endpoint (composite of CV death, myocardial infarction, stroke, systemic embolic events, or definite stent thrombosis) in ACS patients was 33 (8.5%) vs. 28 (7.2%) (HR: 1.16, 95%CI: 0.70-1.92), compared with 16 (4.4%) vs. 18 (4.9%) (HR: 0.91, 95%CI: 0.47-1.78) CCS patients with edoxaban and VKA-based therapy, respectively (P-int = 0.5573). Conclusions In patients with AF who underwent PCI, the edoxaban-based regimen, as compared with VKA-based regimen, provides consistent safety and similar efficacy for ischaemic events in patients with AF regardless of their clinical presentation. This work was supported and funded by Daiichi Sankyo. Vranckx, P (corresponding author), Hasselt Univ, Fac Med & Life Sci, Dept Cardiol & Crit Care Jessaziekenhuis Hasselt, Hasselt, Belgium. pascal.vranckx@iccuhasselt.be

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had a major impact on the behavior of patients, as well as on the delivery of healthcare services. With older and more medically vulnerable people tending to stay at home to avoid contracting the virus, it is unclear how the behavior of people with acute myocardial infarction (AMI) has changed. The aim of this study was to determine if delays in presentation and healthcare service delivery for AMI exist during the COVID-19 pandemic compared to the same period a year prior. Methods: In this single-center, retrospective study, we evaluated patients admitted with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during early months of the COVID-19 pandemic (March 11, 2020 to April 20, 2020) compared to patients admitted with same diagnosis during the same period a year prior. Results: There were 30 and 62 patients who presented with NSTEMI in the pandemic and pre-pandemic eras, respectively. The median pain-to-door time was significantly larger during the pandemic compared to pre-pandemic era (1,885 (880, 5,732) vs. 606 (388, 944) min, P < 0.0001). There was a significant delay in door-to-reperfusion time during the pandemic with a median time of 332 (182, 581) vs. 194 (92, 329) min (P = 0.0371). There were 24 (80%) and 25 (42%) patients who presented after 12 h of pain onset in pandemic and pre-pandemic eras, respectively (P = 0.0006). There were 47 and 60 patients who presented with STEMI during the pandemic timeframe of study and pre-pandemic timeframe, respectively. The median pain-to-door time during the pandemic was significantly larger than that of the pre-pandemic (620 (255, 1,500) vs. 349 (146, 659) min, P = 0.0141). There were 22 (47%) and 14 (24%) patients who presented after 12 h of pain onset in the pandemic and pre-pandemic eras, respectively (P = 0.0127). There was not a significant delay in door-to-reperfusion time (P = 0.9833). There were no differences in in-hospital death, stroke, or length of hospitalization between early and late presenters, as well as between pandemic and pre-pandemic eras. Conclusions: In conclusion, this study found that patients waited significantly longer during the pandemic to seek medical treatment for AMI compared to before the pandemic, and that pandemic-specific protocols may delay revascularization for NSTEMI patients. These findings resulted in more than a threefold increase from the onset of symptoms to revascularization increasing the risks for future complications such as left ventricular dysfunction and cardiovascular death. Efforts should be made to increase patients’ awareness regarding consequences of delayed presentation, and to find a balance between hospital evaluation strategies and goals of minimizing total ischemic time. Cardiol Res. 2020;11(6):386-391 doi: https://doi.org/10.14740/cr1175

Objectives: Recanalisation of chronic total occlusions (CTOs) in interventional cardiology is one of the most challenging and complex procedures. Currently, no data are available about the impact of BMI on success rates among CTO patients undergoing percutaneous coronary intervention. The aim of this study was to investigate the impact that BMI has on success rates, complications, and procedure characteristics among a large group of CTO patients who underwent percutaneous coronary intervention. Methods: The present study retrospectively included 420 patients who underwent percutaneous coronary intervention for at least one chronic total occlusion in the Hospital of the Lithuanian University of Health Sciences of Kaunas. All patients were grouped by their BMI level based on the World Health Organisation classification. Statistical analyses were performed using SPSS 20.0 software. The value of p 0.05). Conclusion: This retrospective study indicates that BMI has no impact on in-hospital outcomes in patients with chronic total occlusion after percutaneous coronary intervention.

The Cardiovalve (Cardiovalve Ltd., Or Yehuda, Israel) is a transcatheter mitral valve replacement (TMVR) system implanted through a fully percutaneous transseptal approach, which may overcome most of the limitations of current TMVR systems. The Cardiovalve is based on a low-profile design of 3

Nowadays it is believed that atherosclerotic plaque formation and coronary artery thrombosis are a result of a cascade of inflammatory processes. Leukocytes are one of the main mediators of the inflammation. We aimed to assess the correlation between leukocytes and long-term mortality in patients

Aims: The primary aim of this study was to estimate the agreement between Quantitative Flow Ratio (cQFR), a minimally invasive method to compute FFR value from coronary angiograms in accordance with individual speed of contrast flow within coronary artery (CA), in comparison with FFR, a gold standard method for assessment of functional significance of CA stenosis. The secondary aim was to assess the difference between cQFR and FFR on making a treatment decision. Methods and results:Sixty-two patients who have undergone coronary angiography revealing intermediate stenosis (lumen stenosis of 35-75%) by visual evaluation and for whom FFR measurements were performed between 1st January 2017 and 31st December 2018 have been prospectively included into our single centre study. Offline cQFR analyses were performed three times: at inclusion and repeated twice with the interval of three days. The level of significance was chosen p < 0.01. Excellent inner agreement of three cQFR analyses were found, r = 0.997, p < 0.001. Averaged cQFR values were compared to FFR values. In total, 69 lessons (49 Left Anterior Descending (LAD), 8 left circumflex (LCX) and 12 Right Coronary Artery (RCA)) were analysed. In the analyses of all lessons, a strong significant correlation coefficient between cQFR and FFR was found, r = 0.869, p < 0.001. After dividing lessons according to CA, following results have been found: LAD r = 0.899, p < 0.001; LCX r = 0.609, p = 0.109 and RCA r = 0.877, p < 0.001. The analyses of extracted LAD and RCA have shown strong significant correlation coefficients, while LCX did not significantly correlated, probably due to low number of cases in LCX sub-group. The secondary outcome was the agreement of clinical decision-making between cQFR and FFR. In the analyses of all lessons, strong significant correlations between cQFR and FFR have been found, r = 0.807, p < 0.001. Compared to FFR as a reference, cQFR ha. [...].

Background and Objectives: To assess the correlation between the degree of target coronary artery stenosis measured by instantaneous wave-free ratio (iFR) and the intraoperative transit time flow measurement (TTFM) of attached grafts as well as evaluate flow competition between the native coronary artery and the attached graft according to the severity of stenosis. Materials and Methods: In total, 89 grafts were subjected to intraoperative transit time flow measurement after coronary artery bypass grafting (CABG) in 25 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all coronary arteries with grafts. The coronary artery stenoses were divided into three groups based on the iFR value: iFR &lt, 0.86 (group 1), iFR 0.86&ndash, 0.90 (group 2), and iFR &gt, 0.90 (group 3). Results: The mean graft flow (MGF) was 46.9 &plusmn, 18.4 mL/min for group 1, 45.3 &plusmn, 20.9 mL/min for group 2, and 31.3 &plusmn, 18.5 mL/min for group 3. A statistically significant difference was confirmed between groups 1 and 3 (p = 0.002) and between groups 2 and 3 (p = 0.025). The pulsatility index (PI) was 2.49 &plusmn, 1.20 for group 1, 2.66 &plusmn, 2.13 for group 2, and 4.70 &plusmn, 3.66 for group 3. A statistically significant difference was found between groups 1 and 3 (p = 0.006) and between groups 2 and 3 (p = 0.032). Backward flow was detected in 7.5% of grafts for group 1, in 16.6% of grafts for group 2, and in 16% of grafts for group 3. A statistically significant difference was found between groups 1 and 2 (p = 0.025) and between groups 1 and 3 (p = 0.029). Conclusions: The iFR is a useful tool for predicting the impact of competitive flow observed between a native artery and an attached graft. The effect of competitive flow significantly increases when the graft is attached to a vessel with mild coronary stenosis. In a coronary artery where the iFR was not hemodynamically significant, the MGF was lower, the PI was higher, and a larger proportion of grafts with backward flow (BF) was detected compared to when there was significant stenosis (iFR &lt, 0.86).

Patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) frequently have suboptimal platelet inhibition in the early hours after the ticagrelor loading dose. It has been hypothesized that early loading dose administration optimizes platelet inhibition in PPCI and, therefore

Advances in stenting technology and procedural technique are changing the role of percutaneous coronary intervention (PCI) in the treatment of left main coronary artery (LMCA) disease. The location of the lesion in LMCA has a great influence on the stenting strategy. In many cases, the length of the

Inflammation plays a key role in the process of the formation of the atherosclerosis and in the pathogenesis of acute coronary syndrome. Myocardial necrosis induces the release of proinflammatory markers. It may even lead to tissue damage and eventually to the development of undesirable events such

Bifurcation percutaneous coronary intervention (PCI) remains a challenging frontier in interventional cardiology. In percutaneous coronary intervention for de novo coronary non-left main bifurcation lesions, the optimal technique for stenting is still a matter of discussion. We sought to determine

The GRACE score is a prospectively studied scoring system used for risk stratification of patients diagnosed with ACS to estimate their in-hospital and 6-month to 3-year mortality. The SYNTAX I score is used to estimate the burden and complexity of coronary artery disease (CAD). The SYNTAX I score

Most attempts to intervene on coronary chronic total occlusions fail because the wire cannot cross the occlusion. Three main strategies can be used to cross a CTO: antegrade wire escalation, antegrade dissection/re-entry and retrograde. The basic underlying principle of the hybrid approach (HA) is

We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary artery remodeling pattern and plaque components in 46 patients. We divided the patients into two groups according to the remodeling pattern as positive remodeling (PR, remodeling index>1.05) (n=18

Coronary plaque composition cannot be assessed accurately using gray-scale intravascular ultrasound (IVUS). Using virtual histology IVUS (VH-IVUS), a comparison of coronary plaque composition between acute coronary syndromes (ACS) and stable angina pectoris (SAP) was performed. Pre-intervention

Bioabsorbable stents - bioabsorbable vascular scaffolds (BVS) are a relatively new technology, which has many upsides when comparing it to metallic stents. After doing its function (revascularization) it also repairs the wall of the artery and then absorbs. It basically overcomes all of the

Stenting — it is a widespread procedure for patients that are suffering from coronary artery disease. Possibility to use drugs-covered stents, improved stenting safety and treatment efficiency. Using second generation Biolimus drugs-covered Stents A9 is associated reduced risk of stent thrombosis