BACKGROUND:Coronary artery vasospasm (CAV) is a major cause of myocardial ischemia in patients without obstructive coronary disease. Its detection remains challenging due to the lack of biomarkers. We investigated circulating microRNAs (miRNAs) as potential biomarkers for CAV. METHODS:The ANFIBIO study is a prospective, multicenter cohort study that enrolled consecutive patients presenting with chest pain of presumed coronary origin (ClinicalTrials.gov identifier: NCT05374694). Patients were referred for invasive physiological evaluation. For this substudy, only those who underwent a coronary vasospasm test were included (n=70). Circulating miRNA profiling was performed using RT-qPCR. RESULTS:The mean age of participants was 66.5 years and 40.0% were women. The prevalence of hypertension, dyslipidemia, and diabetes mellitus was 72.9%, 61.4% and 20.0%, respectively. Patients with CAV showed a higher use of oral nitrates. Notably, most individuals with undetectable plasma levels of miR-502-5p exhibited CAV (60%). Accordingly, detectability was used as the primary representation of miR-502-5p in further analyses. Adding miR-502-5p to a clinical model (age, sex, smoking status, nitrate use and transferrin concentration) was associated with a numerically higher AUC (0.74-0.81) and improved reclassification metrics (NRI=0.533; IDI=0.079). CONCLUSIONS:In this cohort, plasma miR-502-5p was associated with CAV and showed exploratory incremental value when added to a clinical model. These findings should be considered hypothesis-generating and require further validation in larger and independent cohorts.

Resumo Fundamento A caracterização fisiológica abrangente dos endotipos coronários permanece limitada, especialmente na disfunção epicárdica. Objetivos Descrever os perfis hemodinâmicos em todo o espectro de endotipos coronários e explorar possíveis ligações com a isquemia. Métodos Pacientes com suspeita de síndromes coronárias crônicas submetidos à avaliação fisiológica invasiva no Projeto ANFIBIO (NCT05374694) foram classificados de acordo com a reserva de fluxo fracionada [(RFF)≤0,80] e o índice de resistência microcirculatória [(IRM) ≥25] na artéria descendente anterior esquerda em quatro grupos: índices normais, disfunção epicárdica isolada, disfunção microvascular isolada e disfunção combinada. Os índices de pressão, fluxo e resistência coronários foram comparados entre os grupos. Resultados Um total de 130 pacientes foram finalmente incluídos. Uma diminuição gradual no fluxo coronário hiperêmico [(Qcor) em mL/min; índices normais: 387±192, epicárdico isolado: 278±153, microvascular isolado: 130±41, combinados: 96±33; p<0,001] e um aumento progressivo na resistência coronária total [(RTotal) em unidades Wood (WU); índices normais: 238±139, epicárdico isolado: 373±167, microvascular isolado: 694±210, combinado: 999±342; p<0,001] foram observados à medida que mais compartimentos estavam envolvidos. Além disso, a disfunção epicárdica foi associada principalmente à redução da pressão coronária distal (Pd) e ao aumento da resistência epicárdica [(REpi) em WU; índices normais: 25±18, epicárdico isolado: 145±113, microvascular isolado: 66±34, combinados: 389±282; p<0,001], enquanto a disfunção microvascular foi caracterizada por Pd preservado, mas Qcor acentuadamente diminuído e resistência microvascular aumentada [(RMicro) em WU; índices normais: 213±124, epicárdico isolado: 228±73, microvascular isolado: 628±195, combinados: 610±137; p<0,001. A disfunção combinada compartilha mecanismos de disfunção epicárdica e microvascular. Conclusões Os endotipos coronários exibem padrões hemodinâmicos distintos com mecanismos isquêmicos específicos relacionados à pressão e ao fluxo. A avaliação fisiológica integrada é essencial para a caracterização precisa do endotipo e para estratégias terapêuticas personalizadas.

BACKGROUND AND AIMS:Circulating microRNAs (miRNAs) may represent promising candidate biomarkers of chronic coronary syndrome (CCS). Nevertheless, their relationship with patterns of coronary dysfunction remains underexplored. This study aims to identify plasma miRNA profiles associated with macrovascular and/or microvascular patterns of coronary dysfunction. METHODS:Prospective, multicenter cohort study that enrolled consecutive patients with chest pain of presumed coronary origin who were referred for invasive physiological evaluation, which included measurement of fractional flow reserve (FFR) and the index of microcirculatory resistance (IMR). Based on FFR and IMR values, patients were categorized into four groups: normal coronary indices; isolated microvascular dysfunction; isolated macrovascular dysfunction; and combined macrovascular and microvascular dysfunction. miRNA profiling was performed using RT-qPCR. An unsupervised hierarchical clustering approach was applied to identify miRNA-based clusters (miRNotypes). RESULTS:128 patients were included and were distributed across study groups as follows: 37.5% normal coronary indices, 23.4% isolated microvascular dysfunction, 19.5% isolated macrovascular dysfunction; and 19.5% combined macro- and microvascular dysfunction. Plasma miRNA profiles in patients with isolated macrovascular dysfunction differed significantly from those with normal indices and microvascular dysfunction. miR-21-5p and miR-92a-3p were independently associated with coronary macrovascular dysfunction. Incorporating a 3-miRNA signature (miR-17-5p, miR-21-5p, miR-92a-3p) was associated with improved reclassification metrics when added to a clinical model (IDI = 0.082, p-value = 0.002; NRI = 0.576, p-value<0.001). Unsupervised clustering revealed three distinct plasma miRNotypes associated with specific patterns of coronary dysfunction. CONCLUSIONS:In patients with suspected CCS, circulating miRNA profiles differ between patterns of coronary involvement. Plasma miRNA-based molecular phenotyping could potentially complement existing clinical tools aiding in the identification of coronary macrovascular dysfunction.

Background: Comprehensive physiological characterization of coronary endotypes remains limited, especially in epicardial dysfunction. Objectives: To describe hemodynamic profiles across the full spectrum of coronary endotypes and explore potential links with ischemia. Methods: Patients with suspected chronic coronary syndromes who underwent invasive physiological assessment in the ANFIBIO Project (NCT05374694) were classified according to fractional flow reserve [(FFR)<= 0.80] and index of microcirculatory resistance [(IMR)>= 25] in the left anterior descending artery into four groups: normal indices, isolated epicardial, isolated microvascular, and combined dysfunction. Coronary pressure, flow, and resistance indices were compared between groups. Results: A total of 130 patients were finally included. A gradual decrease in hyperemic coronary flow [(Q(cor)) in mL/min; normal indices: 387 +/- 192, isolated epicardial: 278 +/- 153, isolated microvascular: 130 +/- 41, combined: 96 +/- 33; p<0.001] and a progressive increase in total coronary resistance [(R-Total) in Wood units (WU); normal indices: 238 +/- 139, isolated epicardial: 373 +/- 167, isolated microvascular: 694 +/- 210, combined: 999 +/- 342; p<0.001] were observed as more compartments were involved. Also, epicardial dysfunction was primarily associated with reduced distal coronary pressure (Pd) and elevated epicardial resistance [(R-Epi) in WU; normal indices: 25 +/- 18, isolated epicardial: 145 +/- 113, isolated microvascular: 66 +/- 34, combined: 389 +/- 282; p<0.001], whereas microvascular dysfunction was characterized by preserved Pd but markedly decreased Q(cor) and increased microvascular resistance [(R-Micro) in WU; normal indices: 213 +/- 124, isolated epicardial: 228 +/- 73, isolated microvascular: 628 +/- 195, combined: 610 +/- 137; p<0.001]. Combined dysfunction shares mechanisms of both epicardial and microvascular dysfunction. Conclusions: Coronary endotypes exhibit distinct hemodynamic patterns with specific pressure-and flow-related ischemic mechanisms. Integrated physiological assessment is essential for accurate endotype characterization and personalized therapeutic strategies.

BACKGROUND:Distal radial access (DRA) is a promising alternative to conventional transradial access for coronary procedures, offering fewer vascular complications, shorter hemostasis, and greater patient comfort. However, the predictors of DRA failure remain insufficiently defined. This study aimed to evaluate the feasibility, safety, and predictors of DRA failure in an all-comer population and to develop an evidence-based strategy to optimize procedural success. METHODS:A prospective multicenter cohort included 1387 patients who underwent 1454 coronary procedures through DRA between August 2020 and September 2024. Multivariate logistic regression and conditional inference trees (CITs) were used to identify and visualize independent predictors of failure. RESULTS:DRA was successful in 96.5% of cases, with 99% of coronary procedures completed through the initial access. Access-related complications were infrequent (2.5%), including 0.8% inhospital radial artery occlusion. Weak distal radial pulse was the strongest independent predictor of failure (odds ratio: 10.07, 95% confidence interval: 5.22-20.21; P  < 0.001), while preprocedural ultrasound (US) evaluation, US-guided puncture, right-sided access, and operator experience independently predicted success. US guidance markedly improved outcomes in patients with weak pulses (98.2% vs. 61.0%; P  < 0.001). The learning curve plateaued after 60 cases. CONCLUSION:DRA is a safe, feasible, and effective access strategy for coronary procedures in an all-comer population. The success of the procedure depends on the strength of the arterial pulse, the US guidance, and the experience of the operator. The CIT-derived evidence-based framework provides a practical and reproducible approach to optimize access-site selection and improve procedural outcomes.

RESUMEN Introducción y objetivos: Actualmente, el acceso radial distal (ARD) para procedimientos coronarios es una alternativa al acceso radial convencional, con algunas ventajas descritas principalmente en términos de complicaciones relacionadas con el acceso. A pesar de la evidencia, pocos centros han establecido el ARD como acceso sistemático para procedimientos coronarios. El objetivo de esta cohorte prospectiva es presentar la experiencia inicial en nuestro centro con el ARD en pacientes con indicación de procedimientos coronarios en cualquier escenario clínico. Métodos: Se incluyeron 1.000 procedimientos de ARD (943 pacientes) realizados en un único centro de agosto de 2020 a noviembre de 2023. El estudio fue realizado con pacientes en cualquier escenario clínico. Se recomendó la valoración por ultrasonido del trayecto de la arteria radial antes y después del procedimiento, así como la punción ecoguiada. El objetivo principal fue el éxito del ARD. Como objetivos secundarios se consideraron el éxito del procedimiento coronario, el desempeño del ARD y las complicaciones relacionadas con el acceso. Resultados: El éxito del ARD fue del 97,4% (n = 974) y el éxito del procedimiento coronario fue del 96,9% (n = 969). El tiempo de acceso del ARD fue de 40 segundos [rango intercuartílico, 30-60]. Se realizaron procedimientos diagnósticos en el 64% (n = 644) e intervencionismo coronario percutáneo (ICP) en el 36% (n = 356), incluyendo ICP primario en el 13% (n = 128) de los pacientes. La valoración por ultrasonido antes del procedimiento se llevó a cabo en el 83% (n = 830) y la punción ecoguiada en el 85% (n = 848). La incidencia de complicaciones relacionadas con el acceso fue del 2,9% (n = 29). Conclusiones: Este estudio muestra la viabilidad y la seguridad del ARD principalmente guiado por ultrasonido para los procedimientos coronarios en cualquier escenario clínico, con un alto porcentaje de éxito del acceso y de éxito del procedimiento, además de una baja incidencia de complicaciones relacionadas con el acceso. El estudio fue registrado en ClinicalTrials.gov (NTC06165406).

Background Conventional transradial access in women is associated with a lower success rate and a higher incidence of spasm compared to men. To date, the effect of sex on the performance of distal radial access (DRA) has not been fully elucidated. The aim of this study was to assess the impact of sex on catheterization success and other performance parameters of DRA procedures. Methods This is a prospective three-center observational study. From August 2020 to September 2022, data from all consecutive patients who underwent DRA for coronary procedures were collected. Results A total of 868 procedures were registered and stratified into two groups according to sex: women (n = 258) and men (n = 610). Female patients had less favorable baseline characteristics than male patients in terms of absent or weak pulse (29% vs. 17%; P < 0.001), distal radial diameter (2.2 ± 0.3 vs. 2.4 ± 0.4 mm; P < 0.001) and proximal radial diameter (2.5 ± 0.7 vs. 2.7 ± 0.7 mm; P = 0.001). No differences in success rates were found in women compared to men (94.2% vs. 96.6%; P = 0.135), with a higher presence of arterial spasm in women (5.8% vs. 3.0%; P = 0.044). The preprocedural ultrasound evaluation was the only predictor of DRA success [odds ratio = 20.0 (4.739–83.333); P < 0.001]. Conclusion In patients undergoing coronary procedures, the success rate of DRA was high regardless of sex, with a higher incidence of arterial spasm in women.

Introduction and objectives: Distal radial access (DRA) for coronary procedures is currently recognized as an alternative to conventional transradial access, with documented advantages primarily related to access-related complications. However, widespread adoption of DRA as the default approach remains limited. Therefore, this prospective cohort study aimed to present our initial experience with DRA for coronary procedures in any clinical settings. Methods: From August 2020 to November 2023, we included 1000 DRA procedures (943 patients) conducted at a single center. The study enrolled a diverse patient population. We recommended pre- and postprocedural ultrasound evaluations of the radial artery course, with ultrasound-guided DRA puncture. The primary endpoint was DRA success, while secondary endpoints included coronary procedure success, DRA performance metrics, and the incidence of access-related complications. Results: The DRA success rate was 97.4% (n = 974), with coronary procedure success at 96.9% (n = 969). The median DRA time was 40 [interquartile range, 30-60] seconds. Diagnostic procedures accounted for 64% (n = 644) of cases, while 36% (n = 356) involved percutaneous coronary intervention (PCI), including primary PCI in 13% (n = 128). Pre-procedure ultrasound evaluation and ultrasound-guided DRA were performed in 83% (n = 830) and 85% (n = 848) of cases, respectively. Access-related complications occurred in 2.9% (n = 29). Conclusions: This study shows the safety and feasibility of DRA for coronary procedures, particularly when performed under ultrasound guidance in a diverse patient population. High rates of successful access and coronary procedure outcomes were observed, together with a low incidence of access-related complications. The study was registered on ClinicalTrials.gov (NTC06165406).

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83–2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64–1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4–13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.

Key Points Question What is the effect of P2Y12 inhibition, a proposed therapeutic target and preventive strategy, on clinical outcomes in critically ill patients hospitalized for COVID-19? Findings In this randomized clinical trial that included 949 participants, use of a P2Y12 inhibitor did not result in a greater number of days alive and free of cardiovascular or respiratory organ support up to day 21 of the index hospitalization. Meaning These data do not support routine use of a P2Y12 inhibitor in critically ill patients hospitalized for COVID-19.

BACKGROUND:MicroRNAs (miRNAs) are noncoding RNAs involved in post-transcriptional genetic regulation with a proposed role in intercellular communication. miRNAs are considered promising biomarkers in ischemic heart disease. Invasive physiological evaluation allows a precise assessment of each affected coronary compartment. Although some studies have associated the expression of circulating miRNAs with invasive physiological indexes, their global relationship with coronary compartments has not been assessed. Here, we will evaluate circulating miRNAs profiles according to the coronary pattern of the vascular compartment affectation. STUDY AND DESIGN:This is an investigator-initiated, multicentre, descriptive study to be conducted at three centres in Spain (NCT05374694). The study will include one hundred consecutive patients older than 18 years with chest pain of presumed coronary cause undergoing invasive physiological evaluation, including fractional flow reserve (FFR) and index of microvascular resistance (IMR). Patients will be initially classified into four groups, according to FFR and IMR: macrovascular and microvascular affectation (FFR≤0.80 / IMR≥25), isolated macrovascular affectation (FFR≤0.80 / IMR<25), isolated microvascular affectation (FFR>0.80 / IMR ≥25) and normal coronary indexes (FFR>0.80 / IMR<25). Patients with isolated microvascular affectation or normal indexes will also undergo the acetylcholine test and may be reclassified as a fifth group in the presence of spasm. A panel of miRNAs previously associated with molecular mechanisms linked to chronic coronary syndrome will be analysed using RT-qPCR. CONCLUSIONS:The results of this study will identify miRNA profiles associated with patterns of coronary affectation and will contribute to a better understanding of the mechanistic pathways of coronary pathology.

Introduction Distal radial access for coronary procedures decreases hemostasis time, prevents radial occlusion, and improves patient comfort compared to conventional transradial access. Initially described for left distal radial access (lDRA), the right distal radial access (rDRA) is feasible. However, there are no comparative studies to date. This study aimed to evaluate the impact of the access site on vascular access and procedural performance. Methods From August 2020 to October 2021, coronary procedures performed through distal radial access were prospectively recorded. After propensity score matching, the rDRA and lDRA were compared. The primary endpoint was the proportion of approach success. The secondary endpoints included access time, coronary procedural success, radial spasm, exposition to ionizing radiation, patient comfort, and vascular access-related complications. Results From a total of 385 procedures in 382 patients, after a propensity score matching, 182 procedures were compared between the rDRA and lDRA. There were no differences in the baseline characteristics between the groups. Compared to the lDRA, the rDRA presented similar approach success (96.7% vs. 96.7%, p=1.0), less access time (39 (25–60) sec vs. 50 (29–90) sec, p=0.018), comparable coronary procedural success after sheath placement (100% vs. 100%, p=1.000), and not statistically significant radial spasm (2.19% vs. 6.59%, p=0.148). No differences in dose-area product (32 (20–56.2) Gy.m2 vs. 32.3 (19.4–46.3) Gy.m2; p=0.472) and fluoroscopy time (4.4 (2.5–9.1) min vs. 4.3 (2.4–7.5) min, p=0.251) were detected between the groups. No vascular access-related complications were observed in any group. Conclusions The rDRA, compared to the lDRA, had the same proportion of approach success and procedural performance, with a slight reduction in access time for patients undergoing coronary procedures.

Resumo Fundamento Os limiares de corte para a “relação do ciclo completo de repouso” (RFR) oscilam em diferentes séries, sugerindo que as características da população podem influenciá-los. Da mesma forma, foram documentados preditores de discordância entre a RFR e a reserva de fluxo fracionado (FFR). O Estudo RECOPA, mostrou que a capacidade diagnóstica está reduzida na “zona cinzenta” da RFR, tornando necessária a realização de FFR para descartar ou confirmar isquemia. Objetivos Determinar os preditores de discordância, integrar as informações que eles fornecem em um índice clínico-fisiológico: a “RFR Ajustada”, e comparar sua concordância com o FFR. Métodos Usando dados do Estudo RECOPA, os preditores de discordância em relação à FFR foram determinados na “zona cinzenta” da RFR (0,86 a 0,92) para construir um índice (“RFR Ajustada”) que pesaria a RFR juntamente com os preditores de discordância e avaliar sua concordância com a FFR. Resultados Foram avaliadas 156 lesões em 141 pacientes. Os preditores de discordância foram: doença renal crônica, cardiopatia isquêmica prévia, lesões não envolvendo a artéria descendente anterior esquerda e síndrome coronariana aguda. Embora limitada, a “RFR Ajustada” melhorou a capacidade diagnóstica em comparação com a RFR na “zona cinzenta” (AUC-RFR = 0,651 versus AUC-“RFR Ajustada” = 0,749), mostrando também uma melhora em todos os índices diagnósticos quando foram estabelecidos limiares de corte otimizados (sensibilidade: 59% a 68%; especificidade: 62% a 75%; acurácia diagnóstica: 60% a 71%; razão de verossimilhança positiva: 1,51 a 2,34; razão de verossimilhança negativa: 0,64 a 0,37). Conclusões Ajustar a RFR integrando as informações fornecidas pelos preditores de discordância para obter a “RFR Ajustada” melhorou a capacidade diagnóstica em nossa população. Mais estudos são necessários para avaliar se os índices clínico-fisiológicos melhoram a capacidade diagnóstica da RFR ou de outros índices coronarianos.

Ischemic cardiovascular diseases have a high incidence and high mortality worldwide. Therapeutic advances in the last decades have reduced cardiovascular mortality, with antithrombotic therapy being the cornerstone of medical treatment. Yet, currently used antithrombotic agents carry an inherent risk of bleeding associated with adverse cardiovascular outcomes and mortality. Advances in understanding the pathophysiology of thrombus formation have led to the discovery of new targets and the development of new anticoagulants and antiplatelet agents aimed at preventing thrombus stabilization and growth while preserving hemostasis. In the following review, we will comment on the key limitation of the currently used antithrombotic regimes in ischemic heart disease and ischemic stroke and provide an in-depth and state-of-the-art overview of the emerging anticoagulant and antiplatelet agents in the pipeline with the potential to improve clinical outcomes.

Background Cutoff thresholds for the “resting full-cycle ratio” (RFR) oscillate in different series, suggesting that population characteristics may influence them. Likewise, predictors of discordance between the RFR and fractional flow reserve (FFR) have been documented. The RECOPA Study showed that diagnostic capacity is reduced in the RFR “grey zone”, requiring the performance of FFR to rule out or confirm ischemia. Objectives To determine predictors of discordance, integrate the information they provide in a clinical-physiological index, the “Adjusted RFR”, and compare its agreement with the FFR. Methods Using data from the RECOPA Study, predictors of discordance with respect to FFR were determined in the RFR “grey zone” (0.86 to 0.92) to construct an index (“Adjusted RFR”) that would weigh RFR together with predictors of discordance and evaluate its agreement with FFR. Results A total of 156 lesions were evaluated in 141 patients. Predictors of discordance were: chronic kidney disease, previous ischemic heart disease, lesions not involving the anterior descending artery, and acute coronary syndrome. Though limited, the “Adjusted RFR” improved the diagnostic capacity compared to the RFR in the “grey zone” (AUC-RFR = 0.651 versus AUC-“Adjusted RFR” = 0.749), also showing an improvement in all diagnostic indices when optimal cutoff thresholds were established (sensitivity: 59% to 68%; specificity: 62% to 75%; diagnostic accuracy: 60% to 71%; positive likelihood ratio: 1.51 to 2.34; negative likelihood ratio: 0.64 to 0.37). Conclusions Adjusting the RFR by integrating the information provided by predictors of discordance to obtain the “Adjusted RFR” improved the diagnostic capacity in our population. Further studies are required to evaluate whether clinical-physiological indices improve the diagnostic capacity of RFR or other coronary indices.

Hyponatraemia is common in patients with acute heart failure (HF). Aims: To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid‐range ejection fraction (HFmrEF).

Remote ischemic conditioning (RIC) and the GLP-1 analog exenatide activate different cardioprotective pathways and may have additive effects on infarct size (IS). Here, we aimed to assess the efficacy of RIC as compared with sham procedure, and of exenatide, as compared with placebo, and the interaction between both, to reduce IS in humans. We designed a two-by-two factorial, randomized controlled, blinded, multicenter, clinical trial. Patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention (PPCI) within 6 h of symptoms were randomized to RIC or sham procedure and exenatide or matching placebo. The primary outcome was IS measured by late gadolinium enhancement in cardiac magnetic resonance performed 3–7 days after PPCI. The secondary outcomes were myocardial salvage index, transmurality index, left ventricular ejection fraction and relative microvascular obstruction volume. A total of 378 patients were randomly allocated, and after applying exclusion criteria, 222 patients were available for analysis. There were no significant interactions between the two randomization factors on the primary or secondary outcomes. IS was similar between groups for the RIC (24 ± 11.8% in the RIC group vs 23.7 ± 10.9% in the sham group, P = 0.827) and the exenatide hypotheses (25.1 ± 11.5% in the exenatide group vs 22.5 ± 10.9% in the placebo group, P = 0.092). There were no effects with either RIC or exenatide on the secondary outcomes. Unexpected adverse events or side effects of RIC and exenatide were not observed. In conclusion, neither RIC nor exenatide, or its combination, were able to reduce IS in STEMI patients when administered as an adjunct to PPCI.

Coronary heart disease is common in heart failure (HF). Our aim was to determine the impact of ischemic etiology on prognosis among men and women with HF. This study is a prospective national multicenter registry. The primary endpoint was 12-month mortality. Patients with HF and ischemic heart disease were stratified according to sex. A total of 1830 patients were enrolled of which 756 (41.3%) were women. Ischemic etiology was more common in men (446 (41.6%)) than in women (167 (22.2%)). Among patients with ischemic HF, diabetes was more frequent in women than in men. Ischemic etiology was not associated with higher mortality risk, and this was true for women (Hazard Ratio [HR] 1.51, 95% Confidence Interval [CI] 0.98–2.32; p = 0.61) and men (HR 1.14, 95% CI 0.81–1.61; p = 0.46), p-value for interaction: 0.067. Mortality/readmission risk in ischemic HF increased in men with previous readmissions (HR 1.15, 95% CI 1.02–1.29; p = 0.022), chronic obstructive pulmonary disease (HR1.20, 95% CI 1.02–1.41; p = 0.026) and in women with diabetes (HR 2.23, 95% CI 1.05–4.47; p = 0.035). Ischemic etiology was not associated with mortality in HF patients. In ischemic HF, the variables associated with a poor prognosis were diabetes in women and previous readmissions and chronic obstructive pulmonary disease in men.

Background. The resting full‐cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods. Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR “grey zone” in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results. A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; P<0.001) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the “grey zone” (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions. Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use.