Gender differences in the distal radial artery diameter for the snuffbox approach

Background: Recently, interventional cardiologists have been increasingly interested in snuffbox approach for coronary angiography (CAG) and percutaneous coronary intervention (PCI). However, there is lack of data regarding distal radial artery (RA) diameter according to gender. Therefore, the aim herein was to investigate gender differences in the diameter of distal RA diameter. Methods: Left snuffbox approach was done in 117 patients who had planned CAG or PCI for suspected myocardial ischemia between 1 December 2017 and 28 February 2018 at the Chonnam National University Hospital, Gwangju, Korea. Left RA angiography was achieved from 101 patients. Among 101 individuals, 69 (68.3%) men and 32 (31.7%) women were enrolled. There was no significant difference in systolic and diastolic blood pressure, body mass index, left ventricular systolic function, or patients with acute coronary syndrome in either group. Results: The average diameter of distal RA was 2.57 mm in all patients. Women had a significantly smaller diameter of distal RA than men (2.40 mm vs. 2.65 mm, p = 0.016). Nevertheless, CAG via snuffbox approach by 6 Fr sheath was successfully performed in all 117 patients. Regarding success rate of the distal RA approach, women had a lower success rate (32/38) compared with men (72/79), but not significantly (84.2% vs. 91.1%, p = 0.264). Conclusions: Females has a significantly smaller distal RA diameter compared to males. Moreover, the success rate of the distal RA approach tends to be higher in men than in women

Subclinical vascular inflammation in subjects with normal weight obesity and its association with body Fat: an 18 F-FDG-PET/CT study

BACKGROUND: Although body mass index (BMI) is the most widely accepted parameter for defining obesity, recent studies have indicated a unique set of patients who exhibit normal BMI and excess body fat (BF), which is termed as normal weight obesity (NWO). Increased BF is an established risk factor for atherosclerosis. However, it is unclear whether NWO subjects already have a higher degree of vascular inflammation compared to normal weight lean (NWL) subjects; moreover, the association of BF with vascular inflammation in normal weight subjects is largely unknown. METHODS: NWO and NWL subjects (n = 82 in each group) without any history of significant vascular disease were identified from a 3-year database of consecutively recruited patients undergoing (18) F-fluorodeoxyglucose positron emission tomography/computed tomography ((18) F-FDG-PET/CT) at a self-referred Healthcare Promotion Program. The degree of subclinical vascular inflammation was evaluated using the mean and maximum target-to-background ratios (TBRmean and TBRmax) of the carotid artery, which were measured by (18) F-FDG-PET/CT (a noninvasive tool for assessing vascular inflammation). RESULTS: We found that metabolically dysregulation was greater in NWO subjects than in NWL subjects, with a significantly higher blood pressure, higher fasting glucose level, and worse lipid profile. Moreover, NWO subjects exhibited higher TBR than NWL subjects (TBRmean: 1.33 ± 0.16 versus 1.45 ± 0.19, p < 0.001; TBRmax: 1.52 ± 0.23 versus 1.67 ± 0.25, p < 0.001). TBR was significantly associated with total BF (TBRmean: r = 0.267, p = 0.001; TBRmax: r = 0.289, p < 0.001), age (TBRmean: r = 0.170, p = 0.029; TBRmax: r = 0.165, p = 0.035), BMI (TBRmean: r = 0.184, p = 0.018; TBRmax: r = 0.206, p = 0.008), and fasting glucose level (TBRmean: r = 0.157, p = 0.044; TBRmax: r = 0.182, p = 0.020). In multiple linear regression analysis, BF was an independent determinant of TBRmean and TBRmax, after adjusting for age, BMI, and fasting glucose level (TBRmean: regression coefficient = 0.020, p = 0.008; TBRmax: regression coefficient = 0.028, p = 0.005). Compared to NWL, NWO was also independently associated with elevated TBRmax values, after adjusting for confounding factors (odds ratio = 2.887, 95% confidence interval 1.206–6.914, p = 0.017). CONCLUSIONS: NWO is associated with a higher degree of subclinical vascular inflammation, of which BF is a major contributing factor. These results warrant investigations for subclinical atherosclerosis in NWO patients

Efficacy and safety of drug-eluting stents in elderly patients: A meta-analysis of randomized trials

Background: Current guidelines recommend newer generation drug-eluting stents (DES) over bare-metal stents (BMS) in patients with ischemic heart disease. However, there is no age-specific recommendation in elderly patients.Methods: Meta-analysis was performed of 6 randomized studies enrolling 5,042 elderly patients who underwent percutaneous coronary intervention (PCI) with stent implantation (DES, n = 2,579; BMS, n = 2,463).Results: Combined data indicated a significant reduction in major adverse cardiovascular events (MACEs) with use of DES (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.44–0.71, p &lt; 0.001). Moreover, use of DES was associated with a significantly lower incidence of myocardial infarction (OR 0.54, 95% CI 0.36–0.81, p = 0.003) and repeat revascularization (OR 0.44, 95% CI 0.31–0.62, p &lt; 0.001), was compared to that with the use of BMS. Stent thrombosis and bleeding complication rates were not significantly different between groups. In a subgroup meta-analysis, short duration (1 or 6 months) dual antiplatelet therapy (DAPT) was associated with a significantly lower MACE rate (OR 0.49, 95% CI 0.34–0.80; p = 0.003) in elderly patients who underwent PCI with everolimuseluting stent implantation, compared with that using long duration DAPT.Conclusions: This meta-analysis provides clinically relevant evidence that DES rather than BMS should be selected for elderly patients