BackgroundWith the wide clinical application of angiography, contrast-enhanced nephropathy (CIN) has become the third-leading cause of acute kidney injury (AKI). Remote ischemic preconditioning (RIPC) is a non-fatal ischemia-reperfusion injury that can provide protection against lethal ischemia-reperfusion. This study aimed to assess the effect of RIPC on CIN in elderly patients with non-ST-elevation myocardial infarction (NSTEMI).Material/MethodsPatients were randomly divided into 2 groups with 119 patients in each group treated with interventional therapy. Patients in the RIPC group received distal ischemic preconditioning 2 h before contrast exposure, while patients in the control group received a sham RIPC procedure. Incidence of CIN was the primary outcome. Changes in creatinine, NGAL, and KIM-1 after contrast administration were secondary outcomes.ResultsCIN occurred in a total of 27 (12.3%) patients, including 12 (10.1%) in the RIPC group and 15 (15.1%) in the control group (P=0.329). RIPC treatment significantly reduced the levels of NGAL (P=0.024) and KIM-1 (P=0.007) at 12 h after contrast administration, suggesting RIPC treatment reduces sub-clinical renal damage. Subgroup analysis revealed that significant reduction of KIM-1 and NGAL by RIPC, mainly occurring in patients with a Mehran risk score of 6–10.ConclusionsAlthough RIPC did not significantly reduce CIN incidence in elderly patients with NSTEMI, the application of more sensitive biomarkers – NGAL and KIM-1 – indicated a reduction of sub-clinical renal damage by RIPC, especially in the early stage of injury. As a simple and well-tolerated method, RIPC may be a potentially feasible option to prevent CIN.

New thoughts are warranted to develop efficient diagnosis and optimal therapeutics to combat unstable angina (UA)/myocardial infarction (MI). Therefore, the gene data of patients with UA or MI were used in this study to identify the optimal pathways which can provide comprehensive information for UA/MI development. Differentially expressed genes (DEGs) between UA and MI were detected using LIMMA package, and pathway enrichment analysis was conducted for the DEGs, based on the DAVID tool, to detect the significant pathways. Then, differential co-expression network (DCN) and sub-DCN for the DEGs were constructed. Subsequently, informative pathways were extracted using guilt-by-association (GBA) principle relying on the area under the curve (AUC), and the pathway categories with AUC >0.8 were defined as the informative pathways. Finally, we selected the optimal pathways based on the traditional pathway analysis and the sub-DCN-based-GBA pathway prediction method. A total of 203 and 266 DEGs were identified from the expression profile of blood of MI samples comparing with UAs in the time-point 1 and time-point 2 groups. Moreover, 7 and 10 informative pathway terms were identified based on AUC>0.8. Significantly, cytokine-cytokine receptor interaction, as well as MAPK signaling pathway were the common optimal pathways in the two groups. Calcium signaling pathway was unique to the whole blood of patients with acute coronary syndrome (ACS) taken at 30 days post-ACS. In conclusion, the optimal pathways (MAPK signaling pathway, cytokine-cytokine receptor interaction, and calcium signaling pathway) might play important roles in the progression of UA/MI.

Objective We aimed to assess the impact of using enhanced stent visualization (ESV) systems on contrast media volume and radiation dose in percutaneous coronary intervention (PCI), especially for patients with chronic kidney disease (CKD). Background Coronary heart disease (CHD) is associated with chronic kidney disease (CKD) as they share the similar pathological pathway. In addition, the iodinated contrast media used for angiography is a risk factor for contrast-associated acute kidney injury (CA-AKI), which could aggravate the progression of CKD. We hypothesized that ESV systems have the potential to reduce the use of contrast media as well as radiation dose, however, few study reported the impact on contrast media with use of ESV systems. Methods We retrospectively collected 124 patients with acute coronary syndromes underwent PCI from May 2020 to July 2021. Patients were divided into ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters including contrast media volume, radiation exposure (in Air Kerma), number of cines, cine frames, fluoroscopy and procedure time were recorded and analyzed. Results Groups were comparable for patient characteristics. A significant reduction in contrast media volume (174.7 ± 29.6 ml vs. 132.6 ± 22.3ml, p = 0.0001), radiation exposure (907.62 ± 534.94 mGy vs. 1316.11 ± 768.14 mGy, p = 0.002) and procedure time (53.06 ± 21.20 min vs. 72.00 ± 30.55min, p = 0.01) with the use of ESV systems. Similar results were observed in the subgroup analysis for the patients with CKD. Conclusion This study suggested that the use of ESV is associated with reduced contrast media usage, radiation dose and procedure time during PCI. The same results were observed in subgroup analysis in patients with CKD, which is of great significance in decreasing the occurrence of contrast-induced nephropathy and mitigating the progression of CKD and CHD.

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Objective: We aimed to assess the impact of using enhanced stent visualization (ESV) systems on contrast media volume and radiation dose in percutaneous coronary intervention (PCI), especially for patients with chronic kidney disease (CKD). Background: Coronary heart disease (CHD) is associated with chronic kidney disease (CKD) as they share the similar pathological pathway. In addition, the iodinated contrast media used for angiography is a risk factor for contrast-associated acute kidney injury (CA-AKI), which could aggravate the progression of CKD. We hypothesized that ESV systems have the potential to reduce the use of contrast media as well as radiation dose, however, few study reported the impact on contrast media with use of ESV systems. Methods: We retrospectively collected 124 patients with acute coronary syndromes underwent PCI from May 2020 to July 2021. Patients were divided into ESV-guided group (n = 64) and angiography-guided group (n = 60). Procedural parameters including contrast media volume, radiation exposure (in Air Kerma), number of cines, cine frames, fluoroscopy and procedure time were recorded and analyzed.Results: Groups were comparable for patient characteristics. A significant reduction in contrast media volume (179.41 ± 16.76 ml vs. 114.5 ± 13.56ml, p = 0.0001), radiation exposure (693.99 ± 351.04 mGy vs. 1439.45 ± 973.01 mGy, p = 0.001) and procedure time (47.75 ± 15.43 min vs. 65.88 ± 23.81 min, p = 0.029) with the use of ESV systems. Similar results were observed in the subgroup analysis for the patients with CKD.Conclusion: This study suggested that the use of ESV is associated with reduced contrast media usage, radiation dose and procedure time during PCI. The same results were observed in subgroup analysis in patients with CKD, which is of great significance in decreasing the occurrence of contrast-induced nephropathy and mitigating the progression of CKD and CHD.