Decrease in circulating microRNA-24 is associated with increase in neointimal hyperplasia: optical coherence tomography analysis

Abstract

Intervention / Peripheral circulation 995 in DES than that in BMS. Because the incidences of thrombosis at the site of ISA and MIH with 2nd generation DES were significantly lower than those with 1st generation DES, the use of 2nd generation DES might lead to favorable outcome. Purpose: Biomarkers predicting the presence of Thin-Cap Fibroatheroma (TCFA), the primary type of vulnerable plaque, have not been established. Recently , High-Mobility Group Box 1 (HMGB1), a damage-associated molecular pattern molecule derived from necrotic cells and activated macrophages, has been shown to contribute to the progression of atherosclerosis. The aim of this study was to assess whether circulating serum HMGB1 can predict the presence of TCFA as determined by Optical Coherence Tomography (OCT). Methods: Forty-eight patients (69±9 years, 39 males) with 40 stable and 8 unstable angina pectoris were enrolled. Culprit lesion morphology was assessed by OCT and Intravascular Ultrasound (IVUS) before Percutaneous Coronary Intervention (PCI). By OCT, the TCFA was defined as a plaque with lipid contents in >90° and with thinnest part of the fibrous cap measuring <65μm. Cross-sectional vessel, lumen, plaque area, and remodeling index were measured using IVUS. Circulating serum levels of HMGB1 and high sensitive C-Reactive Protein (hsCRP) were measured before PCI and compared with plaque characteristics. Serum HMGB1 levels were categorized into low (lowest tertile), intermediate (middle tertile), and high (highest tertile) groups. Results: Nineteen patients with TCFA and 29 patients without TCFA were identified. Levels of HMGB1 were significantly higher in patients with TCFA than those without TCFA (9.64±5.52 vs. 5.95±3.68 ng/mL; p = 0.008). There were no significant differences in hsCRP levels between patients with and without TCFA. Levels of HMGB1, but not hsCRP, correlated inversely with fibrous cap thickness (r =-0.30, p = 0.04) and positively with remodeling index (r = 0.45, p = 0.001). The frequency of TCFA was 13, 50, and 56% in low, intermediate, and high HMGB1 group, respectively (p = 0.024). Multivariate logistic regression analysis showed that HMGB1 level was the independent factor associated with TCFA existence (odds ratio, 1.19; 95% confidence interval, 1.02 to 1.40; p = 0.032). The area under the receiver-operating characteristics curve for HMGB1 level for prediction of TCFA was 0.73 (p = 0.008). The optimal cutoff value of HMGB1 for predicting TCFA was 6.40 ng/mL (sensitivity 74%, specificity 62%). Conclusions: Higher serum HMGB1 level was associated with the presence of TCFA, thinner fibrous cap thickness, and greater remodeling index at coronary culprit lesions. These findings suggest that circulating HMGB1 may be a useful marker reflecting the plaque vulnerability. Purpose: A large amount of literature suggests that coronary angiography (CA) and percutaneous coronary interventions (PCI) performed by radial route are associated with higher radiation doses to patient. RAY'ACT is a nationwide, mul-ticentre, French survey aimed at evaluating current practices for patient radiation protection (RP) in French non-university public hospitals. The purpose of this study was to compare RP parameters during CAs and PCIs performed via radial and femoral routes. Methods: RP parameters from 31,066/33,931 (91%) CAs and 25,356/27,823 (91%) PCIs performed at 44 centres during 2010, and routinely registered in professional software were retrospectively analyzed. Extreme values were validated and/or corrected by centres. Dose Area Product (DAP in Gy.cm 2) and Fluoroscopy time (FT in min), presented as median [quartiles], were compared between procedures performed by radial and femoral routes. Arterial access was missing for 286 CAs and 359 PCIs. Results: Radial route was used in 21 726/30 780 CAs (71%, range of centres 8%-93%) and in 17,134/24,997 PCIs (68%, range 6%-94%). Compared to femoral route, FT was higher in CAs and PCIs performed by radial route (3.5 min [2.1-6.5] vs 3.8 [2.3-6.3] for CA, and 10.1 min [6.2-16.7] vs 10.4 [6.9-16.0] for PCI, respectively, all p<0.01). Conversely, DAP was lower in procedures performed by radial route (26.8 Gy cm 2 [15.1-44.5] vs 28.1 [16.4-46.9] by femoral route for CA, and 55.6 Gy cm 2 [32.1-92.1] vs 59.4 [34.6-99.9] for PCI, respectively, all p<0.001). The difference in DAP remained significant (p<0.01) after adjustment on age, sex, BMI, emergency procedure, left ventriculography. A significant interaction was found between DAP and the volume of the centre for radial route (p<0.001). DAP was significantly higher by radial than by femoral route in centres with low volume for radial route (34.2 Gy cm 2 vs 26.6 for CA, 78.1 vs 76.1 for PCI; p<0.01), and lower in high-volume centres (24.1 Gy cm 2 vs 25.3 for CA, 50.8 vs 54.2 for PCI; p<0.01). Conclusions: In this nationwide multicentre survey, radial route was used predominantly for CA and PCI, and was associated with lower radiation doses to patient than the femoral route. Radial route delivered higher radiation doses only in low-volume centres for radial route. Purpose: Older thrombus is an independent predictor of mortality in patients with acute myocardial infarction (AMI) undergoing thrombus aspiration during primary percutaneous coronary intervention (PCI). We aimed at assessing the relationship between age of thrombus aspirates and optical signal characteristics of residual thrombus at the culprit site by optical coherence tomography (OCT). Methods: Manual thrombectomy immediately followed by OCT pullback was performed in 67 patients with AMI. Thrombi were classified in 4 stages based on histology composition: early (<1 day), lytic (1-3 days), infiltrating (4-7 days), and organized (>7 days). OCT signals of residual thrombi, including peak intensity , mean intensity, attenuation, and backscattering were evaluated semi-automatically with a dedicated software. Results: Peak intensity significantly decreased from stage 1 to stage 4 (median 6.87 [IQR 6.54-7.06], 6.72 [6.52-6.89], 6.52 [6.26-6.59], and 6.42 [6.29-6.64] respectively, P < 0.001), while attenuation increased, peaking at lytic and infiltrating stage (median 0.50 [-0.60-1.34], 2.08 [1.16-2.68], 2.06 [1.78-2.65], and 0.48 [0.42-1.23] respectively, P < 0.001). No correlation was observed with mean intensity (P = 0.131) and backscattering (P = 0.070). (Figure) Thrombus age and OCT signals Conclusions: In patients with AMI treated with primary PCI and manual thrombectomy, thrombus age is significantly associated with peak intensity and attenuation of residual thrombus as detected by OCT. Purpose: MicroRNAs (miRNAs) can be detected in circulating blood and may be useful as biomarkers for cardiovascular disease. miRNAs are critically involved in many biological processes in neointimal hyperplasia after coronary stenting. The objectives of the present study are to determine whether miRNAs can be used as a novel biomarker for in-stent restenosis (ISR) and to investigate associations between changes in miRNAs and optical coherence tomography (OCT) (C7XR Fourier-Domain System) characteristics. Methods: Angina patients (n=253) requiring biolimus-eluting stent implantation with 9-month OCT follow-up were prospectively analyzed. An operator who was blinded to patient information performed measurements with digitized images with cross-sections spaced at 1 mm intervals (Ilumien Offline review workstation, Ver D.O 2, MA, USA). All measured vessel areas at each cross-section were added and then divided by the number of total cross-sections in order to obtain the average vessel volume per unit area. Percent neointima volume (NV%) was calculated by dividing neointima volume with stent volume. Baseline and 9-month follow-up serum samples from participating patients were analyzed for miRNA-17,-24,