Vía transradial en el tratamiento percutáneo del infarto agudo de miocardio con stents coronarios

Introducción y objetivo. El tratamiento del infarto agudo de miocardio (IAM) mediante intervención coronaria percutánea (ICP) con stent determina un excelente resultado clínico inmediato y un buen pronóstico. El objetivo de este estudio es comparar la seguridad y eficacia de la vía arterial radial (VAR) con la vía arterial femoral (VAF). Pacientes y método. Entre mayo de 2001 y junio de 2003, se incluyó en el estudio observacional a 162 pacientes consecutivos con IAM < 12 h tratados mediante implante percutáneo de stents. Por VAR se abordó a 103 pacientes y por VAF, a los 59 restantes. Se compararon el éxito del procedimiento, los acontecimientos cardíacos adversos mayores y la incidencia de complicaciones locales entre ambas vías. Resultados. En ambos grupos la duración de la fluoroscopia (22,4 ± 15,4 min frente a 24,5 ± 19,5 min), la frecuencia de éxitos inmediatos (el 96,1 frente al 94,9%) y el número de acontecimientos cardíacos adversos mayores (el 6,8 frente al 8,5%) fueron similares. En ningún caso se produjeron complicaciones locales por la VAR (0 frente a 5 pacientes por VAF; p = 0,007). Conclusiones. El éxito y la seguridad de la VAR en el tratamiento percutáneo con stents de pacientes con IAM son similares a los que se obtienen por VAF, pero la incidencia de complicaciones locales, especialmente hemorragia, es significativamente menor. Por tanto, la VAR podría ser la de elección en pacientes con riesgo elevado de hemorragia

Predicted Value of MicroRNAs, Vascular Endothelial Growth Factor, and Intermediate Monocytes in the Left Adverse Ventricular Remodeling in Revascularized ST-Segment Elevation Myocardial Infarction Patients.

Primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) improves the survival of patients; nevertheless, some patients develop left ventricular adverse remodeling (LVAR) a few months after the intervention. The main objective of this study was to characterize the role of pro-inflammatory cell populations, related cytokines, and microRNAs (miRNAs) released after PPCI as reliable prognostic biomarkers for LVAR in patients with STEMI. We evaluated the level of pro-inflammatory subsets, before and after revascularization, 1 and 6 months after PPCI, using flow cytometry. We also performed a miRNA microarray in isolated peripheral blood mononuclear cells (PBMCs) and examined the levels of 27 cytokines in patients' serum of patients by multiplex ELISA. We observed that the levels of classical and intermediate monocytes increased 6 h after PPCI in patients who developed LVAR later. Multivariate regression analysis and ROC curves indicated that intermediate monocytes, after PPCI, were the best monocyte subset that correlated with LVAR. Within the 27 evaluated cytokines evaluated, we found that the increase in the level of vascular endothelial growth factor (VEGF) correlated with LVAR. Furthermore, the microarray analysis of PBMCs determined that up to 1,209 miRNAs were differentially expressed 6 h after PPCI in LVAR patients, compared with those who did not develop LVAR. Using RT-qPCR we confirmed a significant increase in miR-16, miR-21-5p, and miR-29a-3p, suggested to modulate the expression of different cytokines, 6 h post-PPCI in LVAR patients. Interestingly, we determined that the combined analysis of the levels of the intermediate monocyte subpopulation, VEGF, and miRNAs gave a better association with LVAR appearance. Similarly, combined ROC analysis provided high accurate specificity and sensibility to identify STEMI patients who will develop LVAR. Our data suggest that the combined analysis of intermediate monocytes, VEGF, and miRNAs predicts LVAR in STEMI patients

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

This article belongs to the Special Issue Novel Biomarkers for Heart Disease.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.This research was funded by the Institute of Carlos III [grant numbers: PI18/01197; PI15/00203; CB16/11/00431]; the Spanish Ministry of Economy and Competitiveness [grant number: BFU2016-74932-C2]; and the Andalusia Government [grant number: PI-0313-2016]. This study was co-financed by FEDER Funds