Comparison of Frequency of Silent Cerebral Infarction After Coronary Angiography and Stenting With Transradial Versus Transfemoral Approaches.

Silent cerebral infarction (SCI) can be seen after coronary procedures. We investigated whether vascular access sites have an impact on the risk of SCI. A total of 255 consecutive patients who underwent diagnostic or interventional coronary procedures through transfemoral (n = 126 patients) or transradial (n = 129 patients) approach were evaluated. Neuron-specific enolase (NSE) levels were studied before and 12 hours after the procedure. Elevation of greater than 12 ng/ml was considered as SCI. Patients were mainly men (60%) with a mean age of 62 years. SCI was observed in 74 of 255 patients (29%). It was significantly more prevalent among transradial group. Elevation of NSE was observed in 36% of transradial group (n = 47) and 21% of the transfemoral group (n = 27) (p = 0.008). Patients with SCI were more likely to have male sexuality, hyperlipidemia, history of smoking, and previous myocardial infarction. Multivariate analysis demonstrated that patients who underwent coronary procedures through transradial approach were 2.1 times more likely to have an SCI than patients with transfemoral approach (95% confidence interval [CI] 1.205 to 3.666; p = 0.008). Other independent predictors of NSE elevation were previous myocardial infarction (odds ratio 8.6; 95% CI 4.209 to 17.572; p <0.001) and smoking history (odds ratio 7.251; 95% CI 3.855 to 13.639; p <0.001). The present study suggests that transradial coronary procedures carry higher risk of SCI when compared with transfemoral route.

Prevention of minor myocardial injury after elective percutaneous coronary intervention: comparison of ticagrelor versus clopidogrel.

BACKGROUND: Elective percutaneous coronary intervention (ePCI) may cause minor elevation of cardiac enzymes, so-called minor myocardial injury (MMI) which can be due to different pathophysiological mechanism (e.g. distal embolisation, side branch occlusion, increased platelet activation triggered by the intracoronary metallic stents). We aimed to compare the effectiveness of ticagrelor versus clopidogrel for the prevention of MMI and major adverse clinical events (MACEs) after ePCI. METHODS: Study population consisted of two groups of patients based on the treatment: Group I, receiving clopidogrel (n = 104), Group II, receiving ticagrelor (n = 96). Cardiac troponin I (cTnI), CK-MB were studied before and 12 hours after the procedure. Elevation of cTnI greater than 0.06 ng/ml was considered as MMI. All patients were also evaluated for the MACEs (death, myocardial infarction, stroke and transient ischaemic attack). RESULTS: Fifty-two of 200 patients (26%) had MMI after the procedure. The minor myocardial injury was significantly more prevalent in clopidogrel group than that of ticagrelor group (33% vs. 19%, p = .03). Myocardial infarction (MI) and MACEs were significantly higher in the clopidogrel group (15% vs. 6%, for MI, p = .04; 16% vs. 6%, for MACEs, p = .03, respectively). Multivariate analysis demonstrated antiplatelet treatment, saphenous graft intervention, type-C lesion as independent predictors of MMI. CONCLUSIONS: Present study showed that the combination of ticagrelor and aspirin was more effective than combination of clopidogrel and aspirin in decreasing MMI and MACEs after elective stenting.