Decreased plasma levels of microRNA-223 (miR-223), predominantly of platelet origin, were proposed as a surrogate marker of efficacy of antiplatelet therapy. However, higher on-treatment platelet reactivity was associated with lower plasma miR-223 in patients with coronary artery disease (CAD) on dual antiplatelet therapy (DAPT) including clopidogrel and aspirin. Our aim was to compare plasma miR-223 and platelet reactivity in CAD patients on DAPT with newer P2Y12 antagonists vs. clopidogrel. We studied 21 men with CAD admitted to our centre owing to a non-ST-elevation acute coronary syndrome, and with an uncomplicated hospital course. From the day of admission, the patients were receiving either clopidogrel (n = 11) or prasugrel/ticagrelor (n = 10) in addition to aspirin. Before discharge, miR-223 expression in plasma was estimated by quantitative polymerase chain reaction using the comparative Ct method relative to miR-16 as an endogenous control. Multiple electrode aggregometry was used to assess platelet aggregation in response to adenosine diphosphate (ADP). ADP-induced platelet reactivity was decreased in the patients treated with prasugrel or ticagrelor compared with those on clopidogrel (mean ± SD: 139 ± 71 vs. 313 ± 162 arbitrary units [AU]*min, p = 0.006), due to a more potent antiplatelet activity of the novel P2Y12 antagonists. Consequently, six out of seven patients in the lower tertile of the ADP-induced platelet aggregation were treated with the newer P2Y12 blockers, whereas six out of seven patients in the upper tertile were on clopidogrel. Plasma miR-223 was elevated with decreasing platelet reactivity (Spearman's rho = -0.52; p = 0.015 for trend), being significantly higher in the lower tertile of the ADP-induced platelet aggregation (median [range]: 1.06 [0.25-2.31]) vs. the upper tertile (0.20 [0.13-2.30]) (p = 0.04). In conclusion, our preliminary results argue against the notion of low plasma miR-223 as a marker of platelet responsiveness to DAPT. On the contrary, more potent platelet inhibition associated mainly with newer P2Y12 antagonists appears to coincide with higher miR-223 relative to the subjects with attenuated responsiveness to DAPT.

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The radial approach (RA) is the most common in invasive cardiology, but depending on the clinical situation, the femoral approach (FA) and brachial approach (BA) are also used. The BA is associated with the highest odds of complications so it is used mainly if a first-choice approach fails. The aim of the study was to assess clinical outcomes after invasive cardiology procedures stratified by the use of the RA, FA, and BA, with a focus on access site-related complications, quality of life (QoL), and patients’ perspective. A total of 250 procedures (RA: 98; FA: 99; BA: 53) performed between 2013 and 2020 were retrospectively analyzed. Puncture site-related complications, vascular events, patient preferences, and QoL were assessed by the analysis of medical records and telephone follow-up using a proprietary questionnaire and the modified EQ-5D-3L questionnaire. Patients from the RA group received the smallest volume of contrast during a percutaneous coronary interventions (PCI) procedure (RA vs. FA vs. BA: 180 (150–240) ml vs. 200 (180–270) ml vs. 190 (100–200) ml, p = 0.045). The access site was changed most frequently in the procedures initiated from the RA (p < 0.04). Overall puncture site-related complications, especially local hematomas, occurred most commonly in the BA group (7.1, 14.1, and 24.5% for RA, FA, and BA, respectively, p = 0.01). During the index procedure, the access site was changed most frequently in procedures initiated from the RA (19.7, 8.5 and 0%, p = 0.04). The RA was indicated as an approach preferred by the patient for a hypothetical next procedure (87.9, 55.4, and 70.0% for subjects preferring the same approach out of patients who underwent a procedure by the RA, FA, and BA, respectively, p < 0.001). For the RA and FA, the prevalence of moderate or extreme access site-related problems in self-care decreased significantly (RA: p < 0.01, FA: p < 0.05) within 1 month after the index procedure (RA: 18.1, 4.2, and 1.4%; FA: 20.7, 11.1, and 9.6% periprocedurally, after 1 and 6 months, respectively). In contrast, for the BA these percentages were higher and a significant improvement (p < 0.05) was delayed until 6 months (54.6, 36.4, and 18.2% periprocedurally, after 1 and 6 months, respectively). In conclusion, compared to the BA and FA, the RA appears to be not only the safest, mainly due to the lowest risk of puncture site-related complications after coronary procedures but also represents a preferable approach from the patient’s perspective. Although overall post-procedural QoL outcomes did not differ significantly according to the access site, nevertheless, the BA was associated with more frequent self-care problems whose improvement was delayed until more than one month after the index procedure.

Objective-Safety and feasibility evaluation of intracoronary temperature measurements in patients with acute coronary syndromes (ACS) using a catheter based thermography system. Methods and Results-Thermography was performed in 40 patients with ACS. A 3.5-F thermography catheter containing 5 thermocouples measuring vessel wall temperature, and 1 thermocouple measuring blood temperature (accuracy 0.05°C) was used. Gradient (⌬Tmax) between blood temperature (T bl ) and the maximum wall temperature during pullback was measured. The device showed satisfactory safety in ACS. [1][2][3] In these studies catheters with a single sensor were used and measurements were taken at several points of the culprit lesion and adjacent segments. 1-3 Multisensor catheters and measurements at multiple sites along the vessel provide a possibility of building a detailed thermal map of the vessel. 4 In the present study we used a novel intracoronary thermography system to assess the safety and feasibility of thermographic measurements and to analyze thermal maps of the culprit artery in patients with ACS. Methods Study PopulationPatients admitted to the Department of Hemodynamics and Angiocardiography of the Jagiellonian University Hospital for emergent percutaneous coronary intervention (PCI) on a 24-hour basis was enrolled in the study. Entry criteria were: acute myocardial infarction within 12 hours of chest pain onset or unstable angina pectoris class IIIB or IIIC in Braunwald's classification. Patients with TIMI 3 flow in the infarct-related artery were selected for the study and the reference diameter of segments for thermographic measurements had to be 2.5 to 4.0 mm. Patients with cardiogenic shock, significant rhythm or conduction disorders, co-morbid states, especially chronic inflammatory and neoplastic condition, pregnancy, under medication with corticosteroids or nonsteroid anti-inflammatory drugs except for aspirin were excluded from the study. Angiographic exclusion criteria were tortuous vessels or blood clot in the culprit artery.The study was approved by the Institutional Review Board of the Jagiellonian University and each patient provided written informed consent. Intracoronary Thermographic SystemThe intracoronary thermography system (Volcano Corporation, Rancho Cordova, Calif) was designed for the measurement and graphic recording of vessel wall and blood temperature. Measurements were taken using a 3.5-F catheter tipped with a 19.4-mm self-expanding basket with 5 nitinol arms. Nitinol has elastic properties ensuring that basket arms are in contact with all segments of the wall, if the vessel has a diameter of 2.5 to 4.0 mm. The catheter, compatible with guides 6-F or larger, was used to insert the folded basket over a long 0.014Ј guide wire. The basket could easily be expanded when positioned at the distal vessel segment. Five thermocouples placed on each nitinol arms to measure the vessel wall temperature and one central thermocouple measuring the blood temperature transformed the heat energy into electric signal...

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