Investigating the expression level of miR-17-3p, miR-101-3p, miR-335-3p, and miR-296-3p in the peripheral blood of patients with acute myocardial infarction.

The role of inflammation has been proven in acute myocardial infarction (AMI) pathogenesis. Due to the effect of NLRP3 gene expression in the inflammation process of MI, we aimed to explore the expression changes and diagnostic power of four inflammation-related miRNAs including miR-17-3p, miR-101-3p, miR-335-3p, miR-296-3p and their potential target, NLRP3, in ST-segment elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) patients as two major classes of AMI. The expression level of these genes were evaluated in 300 participants equally divided into three groups of STEMI, NSTEMI, and control using quantitative real-time PCR. The expression level of NLRP3 was upregulated in STEMI and NSTEMI patients compared to control subjects. Besides, the expression levels of miR-17-3p, miR-101-3p, and miR-296-3p were significantly downregulated in STEMI and NSTEMI patients compared to controls. The increased expression of NLRP3 had a very strong inverse correlation with miR-17-3p in patients with STEMI and with miR-101-3p in the STEMI and NSTEMI patients. ROC curve analysis showed that the expression level of miR-17-3p had the highest diagnostic power for discrimination between STEMI patients and controls. Remarkably, the combination of all markers resulted in a higher AUC. In summary, there is a significant association between the expression levels of miR-17-3p, miR-101-3p, miR-335-3p, miR-296-3p, and NLRP3 and the incidence of AMI. Although the miR-17-3p expression level has the highest diagnostic power to distinguish between STEMI patients and control subjects, the combination of these miRNAs and NLRP3 could serve as a novel potential diagnostic biomarker of STEMI.

The Association Between Hematologic Indices With TIMI Flow In STEMI Patients Who Undergo primary percutaneous coronary intervention.

BACKGROUND: The Primary Percutaneous Coronary Intervention (PPCI) is the preferred therapeutic strategy for patients who experienced ST-Elevation Myocardial Infarction (STEMI). OBJECTIVE: We aimed to evaluate the association of hematological indices, including hemoglobin level, platelets, White Blood Cells (WBCs) count, and MPV before PPCI with the TIMI grade flow after PPCI. METHODS: STEMI patients who experienced PPCI were included in the present retrospective crosssectional study. Then participants were divided into three groups based on their post-procedural TIMI flow grades. Demographic data and hematologic indices of patients before PPCI were collected and their association with the TIMI grade flow after PPCI was evaluated. To compare the quantitative and qualitative variables, chi-square and t-tests were performed, respectively. RESULTS: We found that elevated levels of hemoglobin and decreased levels of MPV had a significant association with an advanced grade of TIMI flow. Interestingly, in the normal range, there was a significant association between higher platelet count and TIMI-flow grade 1. Besides, TIMI flow grades 2 and 3 had a significant association with low and moderate platelets count, respectively. CONCLUSION: In conclusion, evaluating MPV, platelets, and hemoglobin levels before PPCI as easy and accessible parameters may be able to identify high-risk STEMI patients undergoing PPCI.

Visual-Functional Mismatch Between Coronary Angiography, Fractional Flow Reserve, and Quantitative Coronary Angiography.

Anatomical and functional mismatches are not uncommon in the assessment of coronary lesions. The aim of this study was to identify clinical and lesion-specific factors affecting angiographic, anatomical, and functional mismatch in intermediate coronary lesions. In patients who underwent coronary angiography for clinical reasons, fractional flow reserve (FFR), and quantitative coronary angiography (QCA) analyses for intermediate stenotic lesions were performed simultaneously. Mismatches between the measured values were analyzed. A total of 95 intermediate lesions were assessed simultaneously by visual angiography, FFR, and QCA. The visual-FFR mismatch was found in 40% of the lesions while reverse visual-FFR mismatch was determined in nearly 14% of the lesions. Mismatch and reverse mismatch between FFR and QCA parameters were observed in 10 and 23% of the lesions. FFR value was significant in 32% of the lesions while visually significant stenosis was shown in 61% of the lesions. Among the visual-FFR reverse mismatch group, the prevalence of culprit lesions within the left anterior descending (LAD) was significantly higher than other vessels (p value < 0.02). There were high frequencies of angiographic, QCA, and functional mismatches in analyses of intermediate coronary lesions. LAD lesions showed the highest mismatch. Angiographic or QCA estimation of lesion severity has consistently resulted in inappropriate stenting of functionally nonsignificant lesions or undertreatment of significant lesions based on FFR.

Angina induced by 5-fluorouracil infusion in a patient with normal coronaries.

This article reviews the occurrence of angina in patients treated with 5-fluorouracil (5-FU) without significant coronary artery disease. We present a case followed by a review of the literature. A 43-year-old man with a history of colon cancer developed typical angina during intravenous infusion of 5-FU. His electrocardiogram (ECG) showed tall T waves during his angina episode. His angina and ECG changes reoccurred during a second 5-FU infusion. His coronary angiography was normal. This case is consistent with a rare occurrence of 5-FU-induced angina despite normal coronaries. Physician should be aware of this important side effect of 5-FU infusion.

Carotid artery stenting: a single-center experience.

BACKGROUND: Carotid artery stenting is now used as an alternative to surgical endarterectomy. This study was done to assess the feasibility, safety, and immediate and late clinical outcomes in patients undergoing carotid stenting. METHODS: Between July 2008 and December 2009, a total of 40 patients (20 male, mean age: 65 ± 11 years, 19 symptomatic, and 90% high risk for endarterectomy) underwent carotid artery stenting with different embolic protection devices and carotid stents. Thirty-seven patients had coronary artery disease. Technical success rate, stroke/death/myocardial infarction rate at 30 days, access-site complications, and contrast-induced nephropathy were assessed. For the evaluation of the influence of experience in carotid artery stenting on complications, the patients were divided into two groups: Group 1 included the first 20 treated patients and Group 2 comprised the remainder of the patients. RESULTS: The overall technical success rate was 100%. The cumulative in-hospital stroke death rate was 7.5% (n = 3: 2 deaths and 1 major stroke). Complications were more frequent in Group 1 (2/20, 10%; 2 deaths) than in Group 2 (1/20, 5%; 1 major stroke), but this was not statistically significant (p value = 0.09). No access-site complications occurred, and mild contrast-induced nephropathy occurred in 3 patients (7.5%). No major stroke or neurological deaths occurred during a mean follow-up of 12 months. CONCLUSION: Carotid stenting seemed feasible and relatively safe in our experience. Advanced experience in carotid artery stenting appears to confer an acceptable peri-procedural stroke-death rate.

Extrinsic compression of left main coronary artery by the pulmonary trunk secondary to pulmonary hypertension documented using 64-slice multidetector computed tomography coronary angiography.

Compression of left main coronary artery (LMCA) secondary to pulmonary trunk dilatation is a newly recognized entity that has been associated with severe pulmonary hypertension. In this paper we present a case of extrinsic compression of LMCA caused by dilated pulmonary trunk secondary to pulmonary hypertension documented using 64-slice multidetector computed tomography (MDCT) coronary angiography. This case is followed by a review of the literature.

Isolated noncompaction of left ventricular myocardium with an unusual presentation of angina pectoris.

A 45-year-old man presented to the hospital with typical chest pain compatible with myocardial infarction. An electrocardiogram showed left bundle branch block. The patient underwent urgent coronary angiography, which revealed no significant coronary artery disease. Echocardiography showed noncompaction of the left ventricular myocardium. This unusual case of angina occurring in a patient with isolated noncompaction of the left ventricle is discussed with a review of the literature.

Percutaneous treatment of spontaneous left main coronary artery dissection extending to the left anterior descending and circumflex arteries possibly triggered by thrombolytic therapy.

Spontaneous coronary artery dissection is a rare cause of myocardial infarction and the role of thrombolytic therapy in this setting is not known. A case of acute ST elevation myocardial infarction is presented, with initial positive response to thrombolytic therapy and subsequent marked worsening of ST elevation due to extensive dissection, possibly triggered by thrombolytic therapy, which was successfully treated with percutaneous coronary intervention.