Optimal long term antithrombotic treatment in high-risk chronic coronary syndrome (CCS) patients remains uncertain. Both ticagrelor (60 mg BID) and low-dose rivaroxaban (2.5 mg BID) in addition to low-dose aspirin resulted in significant reductions in major cardiovascular events in high-risk patients at the expense of increased bleeding risk. We aimed to compare the effects of both strategies on bleeding time, fibrin clot lysis time and inflammatory biomarkers in CCS patients with history of acute coronary syndrome. Twenty aspirin-treated patients were recruited into a randomized crossover study to receive ticagrelor 60 mg BID in 1 week and rivaroxaban 2.5 mg BID in the other with a 2-week washout period in between. Outcome measures were determined at the start and end of each treatment week. Two-way ANOVA was used to determine difference in treatment effect. Data are presented as mean ± SD. At baseline, there was no significant difference in any studied outcome measure. Bleeding time was significantly longer with ticagrelor compared to rivaroxaban (Ticagrelor: 897 ± 481secs vs. Rivaroxaban: 440 ± 184 secs; p = .0001). Fibrin clot lysis time was not impacted by ticagrelor but significantly dropped post treatment with rivaroxaban (Ticagrelor: 5743 ± 2590 secs vs. Rivaroxaban: 4309 ± 2308 secs; p = .0049). Neither treatment had an impact on levels of high-sensitivity CRP or white cell count. In conclusion, ticagrelor 60 mg BID has greater impact on bleeding time compared to rivaroxaban 2.5 mg BID. Whereas rivaroxaban, positively modulates fibrin clots, rendering them more prone to lysis.

Background:The study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates. Methods:A single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI. Results:The median age of the patients was 71 years (interquartile range: [IQR] 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.16-2.61, P = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, P = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, P = 0.007) were independently associated with the TVF-or-mortality outcome. Conclusions:Patients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population.

Objectives. To determine the one-year and five-year occurrence and prognosticators of major adverse cardiac events (MACE: composition of all-cause death, myocardial infarction, target vessel revascularization, and vessel thrombosis), mortality, and target lesion revascularization (TLR) in patients with in-stent restenosis (ISR) treated with drug-eluting balloons (DEBs). Background. DEBs have become an emerging therapeutic option for ISR. We report the results of a single-center retrospective study on the treatment of ISR with DEB. Methods. 94 consecutive patients with ISR treated with the paclitaxel-eluting balloon were retrospectively studied between August 2011 and December 2019. Results. The one-year MACE rate was 11.8%, and the five-year MACE rate was 39.8%. The one-year mortality was 5.3%, and the five-year mortality rate was 21.5%. The one-year TLR rate was 4.3%, and the five-year rate was 18.7%. The univariable-Cox proportional hazard models for TLR showed lesion length, and the number of DEBs per vessel is associated with adverse outcomes with H.R. of 1.038 (1.007–1.069) and 4.7 (1.6–13.8), respectively. Conclusion. Our data indicate that at one year, DEBs provide an effective alternative to stenting for in-stent restenosis. Our five-year data, representing one of the longest-term follow-ups of DEB use, demonstrate high rates of MACE. The high five-year MACE reflects all-cause mortality in a high-risk population. This is offset by a reasonable five-year rate of TLR, indicating that DEB provides both short-term and long-term benefits in ISR.

BACKGROUND:Ostial left anterior descending (LAD) artery lesions are a critical area for coronary stenting, given that the location subtends a large area of the myocardium and can also be more technically challenging. It remains controversial whether crossover stenting of ostial LAD back into the left-main (LM) is advantageous over stenting the ostium alone.METHODS:To evaluate the long-term clinical outcomes of stenting ostial LAD lesions, we retrospectively reviewed all ostial LAD lesions cases at QEII Health Science Centre between 2008 and 2018. Specifically, we compared the outcomes in those patients that had left main stent crossover vs. ostial stenting (OS) alone.RESULTS:The total number of patients included in the study was 175, with 25 patients (14%) having a crossover to the LM and 150 (86%) having OS. There were more patients with previous CABG (24%) in the crossover group compared to the OS group (9.2%) (P = 0.042). The one-year MACE was not significantly different between CO vs. OS (13.3% (10.5-16.1) vs. 12% (5.5-18.5)). The five-year MACE was numerically higher, although statistically not significant, in CO vs. OS (19.3 (15.9-22.7) vs. 25.9 (16.6-35.2)).CONCLUSION:This study shows that percutaneous intervention provides reasonable long-term outcomes and low rates of repeat revascularization for isolated ostial LAD lesions, with no noticeable difference in outcomes with crossover stenting into the LM vs. OS alone. A larger, prospective study may be required to determine the optimal strategy for treating ostial LAD lesions.

In-stent restenosis (ISR) after Drug-Eluting Stent (DES) still exists, and its prevalence is not negligible due to the large population of patients treated with DES. Different tissue patterns have been described using Optical Coherent Tomography (OCT). Assessment of OCT characteristics of stent failure and evaluate the demographics, clinical features, the extent of coronary artery disease and technical and procedural outcomes for patients presenting with stent failure are the goals of this study.

Ostial left anterior descending (LAD) artery lesions are a critical area for coronary stenting given that the location subtends a large area of myocardium and can also be more technically challenging. It remains controversial as to whether crossover stenting of ostial LAD back into the left main is

Background: Ostial left anterior descending (LAD) artery lesions are a critical area for coronary stenting given that the location subtends a large area of myocardium and can also be more technically challenging. Stent struts protrusion into the left main and incomplete coverage of the ostium are not uncommon and may lead to increased risk of restenosis and stent thrombosis and worse long-term outcomes. To further evaluate the procedural techniques, acute and long-term clinical outcomes, a retrospective study of all patients that had stenting of the ostial LAD at the QEII Health Science Centre from 2008 to 2018 were included in the study. The clinical details, procedure techniques and patient demographics were retrieved from the CVIS database and each case was reviewed angiographically. The primary goal was to define the patient characteristics and procedural details for patients with ostial LAD lesions. Long-term outcomes including all-cause mortality, target lesion revascularization (TLR), target vessel revascularization (TVR) and instent restenosis (ISR) were determined for the cohort. A total of 177 patients were included in the study. The mean age was 64 with majority of the interventions being in males (78%). 16% of patients had two vessel disease and 4.5% with three vessel disease. The mean stent diameter was 3.17mm and stent length of 19.17mm. Mean number of stents used were 1.54 for each lesion. Drug eluting stents were used in 88% of cases. 14% had a crossover of the stent back into the left main. IVUS /OCT was used in 25.2% of the cases. The acute procedural success was 98.9%. The acute procedural mortality was 0.6%. The mean follow-up period was 50 months (+/- 34); during which the all-cause mortality, TLR, TVR was 10.7%, 4.5% and 6.2%, respectively. Instent restenosis of more than 50% occurred in 5% of patients. The present study shows that for isolated ostial LAD lesions, percutaneous intervention is safe, feasible and effective strategy. The results suggest that the outcomes for ostial LAD lesions are favourable and comparable to other lesion sites. However, a larger, prospective study may be required to compare it against alternative revascularization strategies.

Despite advancements in stent technology and PCI techniques, in-stent restenosis (ISR) remains a concern. OCT provides an ample amount of data to characterize mechanisms of ISR. Multiple studies showed poor correlation between OCT findings and histological findings in pathological specimen studies. The purpose of this study is to characterize the OCT morphological features of ISR to neo-atherosclerosis (NA) versus neo-intimal hyperplasia (NI) and then study the utility of automated tools for identification of these plaque morphologies. All patients with ISR and OCT image obtained at the QEII health science center in Halifax were included in our study. All OCT images were analysed visually according to homogeneousity, back scatter and lumen characteristics by an expert observer and the mechanism of ISR were categorized as NA vs. NI. Subsequently, image analysis and RGB coding, using imaging software along with supervised machine learning tools, was utilized to test different classification algorithms and predictive models for ISR mechanism. For the purpose of this study we only selected patients characterized as having NA vs. NI as pathogenesis for ISR by visual assessment and compared them to the classification according to automated supervised machine learning. A total of 60 patients with OCT images available for analysis. 48 patients visually characterized with NA or NI were included in this analysis. There was significant difference between the groups in terms of tissue characteristics with 50% of plaques in NI are homogeneous versus 3.6% in NA (P= 0.001). High backscatter occurred in 100% of NI, but there was low backscatter in 78% of NA. Lumen shape was mainly regular in NI compared to irregular in NA (100% versus 14.3% p < 0.000). Plaque rupture was present in 64.3% of NA. There was no significant difference between of the groups in terms of diabetes, hypertension or dyslipidemia. However, there were more current smokers in the NA cohort compared to NI (57% versus 20% P=0.01). Using supervised machine learning techniques, tissue characteristics, backscatter and lumen shape were predictive for the pathogenesis of ISR with 97.9% accuracy. The positive predictive value for the model was 95% for NA versus 100% for NI. There are distinct morphological characteristics for pathogenesis of ISR. These distinct characteristics could be used as predictive models for identification of ISR pathogenesis. Future studies and validation are needed to determine whether automated imaging techniques may help predict the long-term outcomes for ISR with various treatments, according to tissue type.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

BACKGROUND AND AIMS:Lecithin:cholesterol acyltransferase (LCAT), a key enzyme in high-density lipoprotein (HDL) metabolism and reverse cholesterol transport (RCT), has been associated with atheroprotection. However, its relation to plaque characteristics has not been confirmed to date. We aimed to determine the relationship between plasma LCAT mass concentration and plaque burden in a multi-center imaging study. METHODS:Two hundred sixty-seven patients with angiographically proven coronary artery disease (CAD) underwent intravascular ultrasonography (IVUS) imaging. Ninety-six patients without CAD served as controls for biochemistry assessments. RESULTS:Plasma LCAT mass concentration was higher in CAD patients as compared to controls (8.94 ± 2.51 μg/mL vs. 7.89 ± 2.99 μg/mL, p = 0.003), while cholesterol esterification rate (CER) was downregulated (253.6 ± 83.9 μM/2 h vs. 315.3 ± 115.0 μM/2 h, p<0.0001). Both parameters correlated inversely with total atheroma volume (r = -0.14, p = 0.027 and r = -0.14, p = 0.024, respectively), while only LCAT mass was found to be a significant predictor of atheroma volume (β-coefficient -0.18, p = 0.0047) when tested in a stepwise linear regression model against known CAD risk factors as predictor variables. Accordingly, patients with LCAT mass in the highest quartile had significantly less atheroma burden than those in the lower quartiles (39.7 ± 10.7% vs. 45.4 ± 10.4%, p = 0.0014 for highest vs. lowest quartile of LCAT mass). CONCLUSIONS:Plasma LCAT mass concentration is upregulated in CAD patients and inversely related to plaque volume, suggesting atheroprotective effects. LCAT mass concentration outperformed LCAT activity in risk prediction models for atheroma burden, suggesting that LCAT mass is a key variable in atheroprotection. Further studies assessing LCAT as a therapeutic target in cardiovascular disease are warranted.

Background: To determine whether pre-activation of the cardiac catheterization lab by Emergency Health Services (EHS) with a single call system in the field was associated with reduced time to reperfusion in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).Methods: Consecutive STEMI patients identified by EHS and subsequently taken to the Queen Elizabeth II Health Sciences Center (QEIIHSC) for PPCI between February 1, 2011 and January 30, 2013 were examined. Patients who had pre-activation of the catheterization lab from the field (pre-act group) after the acquisition of the LifeNet (R) system (Physio Control, Redmond Washington) were compared to those who had usual activation (routine group) prior to the acquisition of the LifeNet (R) system, for outcomes including treatment timeline data and mortality.Results: 271 patients were included in the analysis, 149 patients in the pre-act group and 122 patients in the routine group. Door-to-device (DTD) times of less than 90 min were achieved more frequently in the Pre-act group (91.9% vs. 62.2%; P < 0.001). DTD time was shorter in the Pre-act group (48 min IQR: 38 to 63 min vs. 78 min IQR: 64-101 min; p = 0.001) as was first medical contact-to-device (FMCTD) time (91 min IQR: 78 to 106 min vs. 115 min IQR: 90 to 139 min; P < 0.001). False activation of the catheterization lab was infrequent (1.3%).Conclusions: Implementation of catheterization lab pre-activation using the LifeNet (R) system was associated with more efficient reperfusion times as measured by reduced FMCTD and DTD times without excess false activation rates. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Both the metabolic syndrome (MetSyn) and microvascular dysfunction, as assessed by brachial artery hyperemic velocity-time integral (h_VTI), may predispose to cardiovascular disease (CVD). Thus, the purpose of this study was to determine whether the presence of MetSyn could predict future cardiovascular events, and to determine whether this was further influenced by reduced h_VTI.

Background: Existing criteria recommended by ACC/ESC for identifying patients with ST elevation myocardial infarction (STEMI) from the 12-lead ECG perform with high specificity (SP), but low sensitivity (SE). In our previous studies, we found that the SE of ischemia detection can be markedly improved without any loss of SP by calculating, from the 12-lead ECG, ST deviation in 3 "optimal" vessel-specific leads (VSLs). Our original VSLs, based on Delta ST body-surface potential maps (BSPMs), have been modified by using the more appropriate J-point BSPMs at peak ischemia (without subtraction of pre-occlusion distributions). The aim of the present study was to compare the performance of these new VSLs with that achieved by the STEMI criteria used in current practice.Methods: Two independent datasets of 12-lead ECGs were used: the STAFF DJ dataset acquired during ischemic episodes caused by balloon inflation in LAD (n = 35), RCA (n = 47), and LCx = 17) coronary arteries, and the Glasgow dataset comprising admission 12-lead ECGs of 116 patients who were hospitalized for chest pain and underwent contrast-enhanced cardiac MRI that confirmed AMI in 58 patients (50%).Results: We found that, in the STAFF III dataset, the detection of ischemic state by the STEMI criteria attained SE/SP of 60/97%, whereas SE/SP values of VSLs were 72/98%. In the Glasgow dataset, STEMI criteria yielded SE/SP of 43/98%, whereas the VSLs improved SE/SP to 60/98%. The most significant increase in diagnostic performance appeared in patients with LCx coronary artery occlusion: in STAFF. HI data (n = 17) SE achieved by STEMI criteria was improved by the VSLs from 35% to 71%; in Glasgow data (n = 12) SE of 31% achieved by STEMI criteria was improved by the VSLs to 69%.Conclusion: In our study population, existing ACC/ESC STEMI criteria complemented by the new VSLs yielded much improved sensitivity of ischemia detection without any detrimental effect on specificity. This finding needs to be corroborated on a larger chest-pain patient population with typical prevalence of acute ischemia presented to the emergency rooms. (C) 2015 Elsevier Inc. All rights reserved.

Introduction: In patients with ST Elevation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention (PPCI), the time from hospital arrival to balloon inflation (door-to-balloon time; DBT) is predictive of mortality. One strategy to shorten the DBT and facilitate timely reperfusion, is to activate the catheterization laboratory (cath lab) from the field, with direct transfer for PPCI.We evaluated whether the introduction of pre-hospital ECG and Emergency Room (ER) physician activation of the cath laboratory (Pre-activation) will result in a reduction in DBT and first medical contact to balloon time for patients undergoing PPCI.Methods and ResultsData was extracted retrospectively from the Cardiovascular Health Information System (CVIS) registry. Consecutive STEMI patients brought in by the Emergency Health Service (EHS) who underwent PPCI between 1st July, 2010 and 31st August, 2013 were included in the study. Patients with pre-hospital field activation of the cath lab (Pre-activation group) were compared to patients who had activation of the cath lab after evaluation in ER (ER group), over the same time interval.271 patients were included for analysis, of which 149 (54.9%) were in the Pre-activation group, and 122 (45.01 %) in the ER group. Median DBT was significantly shorter in the Pre-activation group as compared to the ER group (48 vs 78 minutes; p =0.001). Similarly, the first medical contact to balloon time was significantly shorter by 24 minutes in the Pre-activation group (91 minutes vs 115 minutes; p < 0.001). DBT < 90 minutes was achieved more frequently in the Pre-activation group (91.9%) as compared to the ER group (62.2 %, p < 0.001). In-hospital mortality was 2.7% in the Pre-activation group and 5.7% in the ER group, p= 0.314.Conclusion Introduction: In patients with ST Elevation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention (PPCI), the time from hospital arrival to balloon inflation (door-to-balloon time; DBT) is predictive of mortality. One strategy to shorten the DBT and facilitate timely reperfusion, is to activate the catheterization laboratory (cath lab) from the field, with direct transfer for PPCI. We evaluated whether the introduction of pre-hospital ECG and Emergency Room (ER) physician activation of the cath laboratory (Pre-activation) will result in a reduction in DBT and first medical contact to balloon time for patients undergoing PPCI. Methods and ResultsData was extracted retrospectively from the Cardiovascular Health Information System (CVIS) registry. Consecutive STEMI patients brought in by the Emergency Health Service (EHS) who underwent PPCI between 1st July, 2010 and 31st August, 2013 were included in the study. Patients with pre-hospital field activation of the cath lab (Pre-activation group) were compared to patients who had activation of the cath lab after evaluation in ER (ER group), over the same time interval.271 patients were included for analysis, of which 149 (54.9%) were in the Pre-activation group, and 122 (45.01 %) in the ER group. Median DBT was significantly shorter in the Pre-activation group as compared to the ER group (48 vs 78 minutes; p =0.001). Similarly, the first medical contact to balloon time was significantly shorter by 24 minutes in the Pre-activation group (91 minutes vs 115 minutes; p < 0.001). DBT < 90 minutes was achieved more frequently in the Pre-activation group (91.9%) as compared to the ER group (62.2 %, p < 0.001). In-hospital mortality was 2.7% in the Pre-activation group and 5.7% in the ER group, p= 0.314. Data was extracted retrospectively from the Cardiovascular Health Information System (CVIS) registry. Consecutive STEMI patients brought in by the Emergency Health Service (EHS) who underwent PPCI between 1st July, 2010 and 31st August, 2013 were included in the study. Patients with pre-hospital field activation of the cath lab (Pre-activation group) were compared to patients who had activation of the cath lab after evaluation in ER (ER group), over the same time interval. 271 patients were included for analysis, of which 149 (54.9%) were in the Pre-activation group, and 122 (45.01 %) in the ER group. Median DBT was significantly shorter in the Pre-activation group as compared to the ER group (48 vs 78 minutes; p =0.001). Similarly, the first medical contact to balloon time was significantly shorter by 24 minutes in the Pre-activation group (91 minutes vs 115 minutes; p < 0.001). DBT < 90 minutes was achieved more frequently in the Pre-activation group (91.9%) as compared to the ER group (62.2 %, p < 0.001). In-hospital mortality was 2.7% in the Pre-activation group and 5.7% in the ER group, p= 0.314. Conclusion

Introduction: The use of fractional flow reserve (FFR) derived from coronary pressure wire measurements for the assessment of coronary lesion severity has been well integrated in interventional practice for several years. Although prospective, randomized trial data validating the use of FFR measurements in clinical practice exist, few studies have reported retrospective analysis of the success and limitations of FFR in a real-world clinical setting. We sought to assess the rates of different management outcomes (medical therapy, PCI or CABG) following FFR measurements in an academic tertiary care centre in Atlantic Canada and the rate of revascularization of coronary lesions treated medically based on FFR and other clinical data.MethodsThe provincial CVIS database (Cardiovascular Information Management System, Philips Healthcare, Netherlands) was used to identify all patients that underwent FFR measurement from November 2007 to February 2013 in Halifax, Nova Scotia. Medical records, including coronary angiography reports, in-patient records, radiology reports, operative records and discharge summaries were reviewed for each study patient.Results1124 individual FFR measurements were performed in 927 patients (mean age 66 ± 11 years, 73% male, 67% acute coronary syndrome presentation). Left anterior descending territory vessels represented the majority of cases (56%) with left main assessment in only 6%. 670 pressure wire interrogated lesions were treated medically (average FFR 0.88 ± 0.06), 308 underwent PCI (FFR 0.74 ± 0.07) and 146 underwent CABG (FFR 0.73 ± 0.08). In the subgroup treated medically, only 21 interrogated lesions (3.1%) with mean FFR 0.86 ± 0.05 underwent subsequent revascularization within 1 year. Kaplan-Meyer 1-year freedom from revascularization curves for lesions treated medically following FFR interrogation are illustrated in Fig. 1.Conclusion Introduction: The use of fractional flow reserve (FFR) derived from coronary pressure wire measurements for the assessment of coronary lesion severity has been well integrated in interventional practice for several years. Although prospective, randomized trial data validating the use of FFR measurements in clinical practice exist, few studies have reported retrospective analysis of the success and limitations of FFR in a real-world clinical setting. We sought to assess the rates of different management outcomes (medical therapy, PCI or CABG) following FFR measurements in an academic tertiary care centre in Atlantic Canada and the rate of revascularization of coronary lesions treated medically based on FFR and other clinical data. MethodsThe provincial CVIS database (Cardiovascular Information Management System, Philips Healthcare, Netherlands) was used to identify all patients that underwent FFR measurement from November 2007 to February 2013 in Halifax, Nova Scotia. Medical records, including coronary angiography reports, in-patient records, radiology reports, operative records and discharge summaries were reviewed for each study patient. The provincial CVIS database (Cardiovascular Information Management System, Philips Healthcare, Netherlands) was used to identify all patients that underwent FFR measurement from November 2007 to February 2013 in Halifax, Nova Scotia. Medical records, including coronary angiography reports, in-patient records, radiology reports, operative records and discharge summaries were reviewed for each study patient. Results1124 individual FFR measurements were performed in 927 patients (mean age 66 ± 11 years, 73% male, 67% acute coronary syndrome presentation). Left anterior descending territory vessels represented the majority of cases (56%) with left main assessment in only 6%. 670 pressure wire interrogated lesions were treated medically (average FFR 0.88 ± 0.06), 308 underwent PCI (FFR 0.74 ± 0.07) and 146 underwent CABG (FFR 0.73 ± 0.08). In the subgroup treated medically, only 21 interrogated lesions (3.1%) with mean FFR 0.86 ± 0.05 underwent subsequent revascularization within 1 year. Kaplan-Meyer 1-year freedom from revascularization curves for lesions treated medically following FFR interrogation are illustrated in Fig. 1. 1124 individual FFR measurements were performed in 927 patients (mean age 66 ± 11 years, 73% male, 67% acute coronary syndrome presentation). Left anterior descending territory vessels represented the majority of cases (56%) with left main assessment in only 6%. 670 pressure wire interrogated lesions were treated medically (average FFR 0.88 ± 0.06), 308 underwent PCI (FFR 0.74 ± 0.07) and 146 underwent CABG (FFR 0.73 ± 0.08). In the subgroup treated medically, only 21 interrogated lesions (3.1%) with mean FFR 0.86 ± 0.05 underwent subsequent revascularization within 1 year. Kaplan-Meyer 1-year freedom from revascularization curves for lesions treated medically following FFR interrogation are illustrated in Fig. 1. Conclusion

OBJECTIVE:Numerous indexes of adiposity have been proposed and are currently in use in clinical practice and research. However, the correlation of these indexes with measures of vascular health remain poorly defined. This study investigated which measure of adiposity is most strongly associated with endothelial function. DESIGN AND METHODS:Data from the Firefighters And Their Endothelium (FATE) study was used. The relationships between three measures of vascular function: flow-mediated dilation (FMD), hyperemic velocity time integral (VTI), and hyperemic shear stress (HSS), and five measures of adiposity: BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body adiposity index (BAI) were tested. Univariate comparisons were made, and subsequently models adjusted for traditional risk factors were constructed. RESULTS:A total of 1,462 male firefighters (mean age 49 ± 9) without cardiovascular disease comprised the study population. No measure of adiposity correlated with FMD; all five measures of adiposity were negatively correlated with VTI and HSS (P values <0.0001), with WHtR most strongly correlated with VTI, and WC most strongly correlated with HSS (both P < 0.05). In models including all five measures of obesity simultaneously, BMI, WC, and WHtR were all predictive of HSS (all P values <0.05), and BMI and WHR were both predictive of VTI (P values <0.05). CONCLUSIONS:Anthropometric measures of adiposity may help refine estimations of atherosclerotic burden. BMI was most consistently associated with endothelial dysfunction, but measures of adiposity that reflect distribution of mass were additive.

Background: Coronary angioplasty via the radial approach is associated with a steeper learning curve compared to the femoral approach with increased procedural times noted. Recent randomised trials have suggested that the radial approach may offer a benefit with regards to mortality in primary PCI, and so is advocated as the default access site for primary PCI in many centres. Methods and Results: We compared procedural times in all patients who underwent PCI with STEMI via a radial approach over three years in a single large tertiary referral centre. Arrival to the cardiac catheter laboratory (CCL), puncture, sheath insertion and balloon times were prospectively recorded. There was no difference in patient baseline characteristics across the three years. A significant increase in the proportion and number of cases performed via the radial approach was noted (2009: n = 61, proportion via radial approach: 16.1%, 2010: n = 86, 28.2%, 2011: n = 135, 53.1%. P < 0.001). There was no change in median procedural times except in local to sheath time in 2010 (Table).Tabled 1Median Time (min)200920102011P valueCCL to local0:100:110:100.23Local to sheath0:020:010:020.01Sheath insertion to balloon0:160:180:180.14CCL to balloon0:290:330:310.08 Open table in a new tab Conclusion: We noted no clinically significant change in procedural times associated with the performance of radial PCI for STEMI despite a significant increase in procedures performed via the radial approach.