SummaryBackground: Estrogen favors endothelial function while acute tobacco use provokes dysfunction. Previous studies have not examined the effect of smoking one cigarette at different stages of the menstrual cycle.Hypothesis: Favorable actions of estrogen on endothelial function are transitorily abolished by smoking one cigarette.Methods: Brachial artery endothelium-dependent dilation was measured noninvasively before, 10 min, and 1 h after smoking in 17 healthy premenopausal women. Studies were done in the first 3 days (early stage) and repeated between Days 9 and 13 of the menstrual cycle (middle stage). Estradiol was measured after each study.Results: At basal conditions, women in the middle stage of their cycles, when estradiol was 20 times higher than in the early stage, had significantly more endothelial-dependent brachial dilatation. No difference in the marked depression caused by cigarette smoking was found between the two stages. One h recuperation was complete in both phases.Conclusion: Cigarette smoking abolishes the protection of circulating estrogen on endothelial function.

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BackgroundMyocardial revascularization failure (MRF) and Secondary revascularization (SR) are contemporary interventional cardiology challenges.AimTo investigate the characteristics, management, and prognosis of patients with myocardial revascularization failure (MRF) and need for secondary revascularization (SR) in contemporary practice.MethodsThe REVASEC study is a prospective registry (NCT03349385), which recruited patients with prior revascularization referred for coronary angiography at 19 centers. The primary endpoint is a patient‐oriented composite (POCE) at 1 year, including death, myocardial infarction, or repeat revascularization.ResultsA total of 869 patients previously revascularized by percutaneous intervention (83%) or surgery (17%) were recruited. MRF was found in 83.7% (41.1% stent/graft failure, 32.1% progression of coronary disease, and 10.5% residual disease). SR was performed in 70.1%, preferably by percutaneous intervention (95%). The POCE rate at 1 year was 14% in the overall cohort, with 6.4% all‐cause death. In the multivariate analysis, lower POCE rates were found in the groups without MRF (9.4%) and with disease progression (11%) compared with graft/stent failure (17%) and residual disease (18%), hazard ratio 0.67 (95% confidence interval: 0.45–0.99), p = 0.043. At 1 year, the SR group had less chronic persistent angina (19% vs. 34%, p < 0.001), but a higher rate of repeat revascularization (9% vs. 2.9%, p < 0.001).ConclusionMRF was found in 84% of patients with prior revascularization referred for coronary angiography. Stent/graft failure and residual coronary disease were associated with a worse prognosis. SR provided better symptom control at the expense of a higher rate of new revascularization

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