Distal Versus Conventional Radial Access for Coronary Angiography and Intervention: The DISCO RADIAL Trial.

BACKGROUND: Currently, transradial access (TRA) is the recommended access for coronary procedures because of increased safety, with radial artery occlusion (RAO) being its most frequent complication, which will increasingly affect patients undergoing multiple procedures during their lifetimes. Recently, distal radial access (DRA) has emerged as a promising alternative access to minimize RAO risk. A large-scale, international, randomized trial comparing RAO with TRA and DRA is lacking. OBJECTIVES: The aim of this study was to assess the superiority of DRA compared with conventional TRA with respect to forearm RAO. METHODS: DISCO RADIAL (Distal vs Conventional Radial Access) was an international, multicenter, randomized controlled trial in which patients with indications for percutaneous coronary procedure using a 6-F Slender sheath were randomized to DRA or TRA with systematic implementation of best practices to reduce RAO. The primary endpoint was the incidence of forearm RAO assessed by vascular ultrasound at discharge. Secondary endpoints include crossover, hemostasis time, and access site-related complications. RESULTS: Overall, 657 patients underwent TRA, and 650 patients underwent DRA. Forearm RAO did not differ between groups (0.91% vs 0.31%; P = 0.29). Patent hemostasis was achieved in 94.4% of TRA patients. Crossover rates were higher with DRA (3.5% vs 7.4%; P = 0.002), and median hemostasis time was shorter (180 vs 153 minutes; P < 0.001). Radial artery spasm occurred more with DRA (2.7% vs 5.4%; P = 0.015). Overall bleeding events and vascular complications did not differ between groups. CONCLUSIONS: With the implementation of a rigorous hemostasis protocol, DRA and TRA have equally low RAO rates. DRA is associated with a higher crossover rate but a shorter hemostasis time

Influence of Fasting Status and Sample Preparation on Metabolic Biomarker Measurements in Postmenopausal Women

<div><p>Background</p><p>Epidemiologic data linking metabolic markers-such as insulin, insulin-like growth factors (IGFs)-and adipose tissue-derived factors with cancer are inconsistent. Between-study differences in blood collection protocols, in particular participant’s fasting status, may influence measurements.</p><p>Methods</p><p>We investigated the impact of fasting status and blood sample processing time on components of the insulin/IGF axis and in adipokines in a controlled feeding study of 45 healthy postmenopausal-women aged 50–75 years. Fasting blood samples were drawn (T0), after which subjects ate a standardized breakfast; subsequent blood draws were made at 1 hour (T1), 3 hours (T3), and 6 hours (T6) after breakfast. Serum samples were assayed for insulin, C-peptide, total- and free-IGF-I, IGF-binding protein [BP]-1 and -3, total and high molecular weight (HMW)-adiponectin, retinol binding protein-4, plasminogen activator inhibitor (PAI)-1, and resistin.</p><p>Results</p><p>Insulin and C-peptide levels followed similar postprandial trajectories; intra-class correlation coefficients [ICC] for insulin = 0.75, (95%CI:0.64–0.97) and C-peptide (ICC = 0.66, 95%CI:0.54–0.77) were similarly correlated in fasting (Spearman correlation, <i>r</i> = 0.78, 95%CI:0.64–0.88) and postprandial states (T1, <i>r</i> = 0.77 (95%CI: 0.62–0.87); T3,<i>r</i> = 0.78 (95%CI: 0.63–0.87); T6,<i>r</i> = 0.77 (95%CI: 0.61–0.87)). Free-IGF-I and IGFBP-1 levels were also affected by fasting status, whereas total-IGF-I and IGFBP-3 levels remained unchanged. Levels of adipokines were largely insensitive to fasting status and blood sample processing delays.</p><p>Conclusion</p><p>Several components of the insulin/IGF axis were significantly impacted by fasting state and in particular, C-peptide levels were substantially altered postprandially and in a similar manner to insulin.</p></div

Prognostic role of multiple biomarkers in stable patients undergoing fractional flow reserve-guided coronary angioplasty

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI), along with optimal medical therapy, improves clinical outcome by targeting ischemia-inducing stenosis. Yet, plaque progression or stent failure may cause recurring cardiac events. We assessed the potential prognostic role of different inflammatory biomarkers, known to be associated with plaque progression or stent failure, in patients undergoing FFR-guided PCI

Medians and median absolute deviation of serum (A) C-peptide, (B) insulin, (C) total IGF-1, (D) free-IGF-1, (E) IGFBP-1, and (F) IGFBP-3 after an overnight fast (T0), and 1 hour (T1), 3 hours (T3), and 6 hours (T6) after the research breakfast.

<p>Medians and median absolute deviation of serum (A) C-peptide, (B) insulin, (C) total IGF-1, (D) free-IGF-1, (E) IGFBP-1, and (F) IGFBP-3 after an overnight fast (T0), and 1 hour (T1), 3 hours (T3), and 6 hours (T6) after the research breakfast.</p

Spearman’s correlation matrix for the insulin/IGF-1 axis parameters and adipokines measured on blood samples collected 1 hour after the research breakfast (T1).

<p>Spearman’s correlation matrix for the insulin/IGF-1 axis parameters and adipokines measured on blood samples collected 1 hour after the research breakfast (T1).</p

Characteristics of study subjects.

<p>Characteristics of study subjects.</p