No abstract is provided for this article.
IntroductionCoronary angioplasty with stenting has revolutionized the treatment of coronary artery disease. This article describes the history of coronary angioplasty and stenting, reviews the contemporary stents and recommendations and highlights the on-going work and potential future directions.
Production of specific immunoglobulin (Ig)E is the characteristic abnormality of atopy. IgE is produced by B lymphocytes under the influence of interleukin (IL)4 and IL-13. IgE binds to high-affinity IgE receptors (Fc«RI) on mast cells to induce degranulation and mediator synthesis. IL-4 enhances the activation of Fc«RI to augment the production of cytokines and lipid mediators. These receptors may also be expressed on other cells such as basophils, monocytes and eosinophils. IgE may also activate low-affinity IgE receptors (Fc«RII or CD23) that are expressed on B lymphocytes, T lymphocytes, macrophages and airway smooth muscle cells. CD23 expression is enhanced by IL-4. Recently, a humanised murine monoclonal antibody (E25) directed against IgE has demonstrated a reduction in early and late responses to inhaled allergen and eosinophil counts in induced sputum, and reduced airway hyperresponsiveness. There is a profound reduction in circulating IgE, which may be due to switching-off IgE production from B cells. In patients with severe asthma who require oral steroids there is a significant reduction in oral steroid requirements, and several patients are able to completely withdraw oral steroids in comparison with a placebo. E25 may also reduce signalling through CD23 as IgE levels are lowered and this might explain its efficacy in chronic asthma, through an inhibitory effect on T lymphocytes, macrophages, eosinophils and airway smooth muscle.
Resveratrol has shown promising anti-inflammatory effects in airway disease models but poor pharmacokinetics and potency impede its therapeutic application. Recently, its methoxylated analogues have emerged as candidates with improved pharmacological properties. This study investigated the anti-inflammatory effects of these analogues, namely isorhapontigenin, pinostilbene and pterostilbene. A549 cells were stimulated with 1 ng/mL IL-1β and the effect on IL-6 and CXCL8 release measured using ELISA (n=4-6). Their effect on NF-κB activation was assessed using A549 cells stably transfected with NF-κB luciferase reporter gene (n=4). For IL-6 release, the IC<sub>50</sub> value of pinostilbene tended to be lower but only isorhapontigenin was significantly more potent than resveratrol. Isorhapontigenin and pterostilbene inhibited CXCL8 release with lower IC<sub>50</sub> values than resveratrol (Table 1). Resveratrol analogues, but not resveratrol, repressed NF- κB transcriptional activity (Table 1) and were more efficacious than dexamethasone which inhibited this response by ∼60% at 10 µM. This study identified analogues with superior anti-inflammatory effects than resveratrol and greater inhibition of NF-κB activity than dexamethasone. Their development as novel anti-inflammatory agents in airway inflammation is warranted.
Aim Covid-19 has had a dramatic impact on the healthcare systems globally. Despite efforts to maintain systems of cardiovascular care during the pandemic, public health responses to the virus have contributed to adverse cardiovascular outcomes. Herein, we summarize current evidence detailing the impact of Covid-19 on interventional cardiology. Methods According to PRISMA criteria, a systematic review was performed through Medline, Embase, and Cochrane databases, to identify reports on the impact of Covid-19 on interventional cardiovascular procedures. We identified 50 published studies that met the prespecified inclusion and exclusion criteria. Results In the acute setting, several datasets report a reduction of acute coronary syndrome (ACS) admission by 40% globally (−40%, 95% CI 37–43 from the National Health Service hospital trusts in England). Most surveys and registries reported a numerically higher impact on NSTEMI/unstable angina cases compared to STEMI (−42%, 95% CI 38–46 and −23%, 95% CI 16–30 respectively, from the National Health Service hospital trusts in England). In STEMI care pathways, several studies report increased delays between symptom onset and first medical contact (105 min, 95% CI 45–222 during the pandemic vs 71 min, 95% CI 30–180 before it, p&lt;0.001, from the National STEMI registry in Spain), with a subsequent increased duration of the ischaemic period (200 min, 95% CI 140–332 during the pandemic vs 233 min, 95% CI 150–375 before it, p&lt;0.001, from the National STEMI registry in Spain). Importantly, hospital “door-to-balloon” times were unchanged. Most studies suggest similar in-hospital mortality for STEMI during the pandemic compared to historic controls (1.7% vs 1.8%, p=0.67 from British National Institute of Cardiovascular Outcomes Research database). An increased incidence of mechanical complications were observed (41.2% vs 19.6%, p=0.030, from an Italian monocentric experience). In the United States (New York city), overall mortality from ischemic heart diseases depicted a 2-fold increase during the pandemic (relative change 2.39, 95% CI 1.39–4.09). Of note, in the same city home deaths increased from 35/day in 2013–2017 to 200/day during the pandemic. These data suggest that ACS incidence has not decreased, but more likely patients presenting ischemic symptoms may have not contacted health care services, and have died at home. Conclusions The Covid-19 pandemic has adversely impacted outcomes in patients with ischemic heart disease (IHD). The diagnosis and treatment of IHD should be designated a health system priority that remains intact during pandemic events as the magnitude of harm induced by its interruption is substantial. Funding Acknowledgement Type of funding sources: None.
OBJECTIVES We aimed to identify periprocedural quantitative coronary angiographic (QCA) variables that have predictive value on long-term angiographic results and to construct multivariate models using these variables for postprocedural prognosis. BACKGROUND Coronary stent implantation has reduced the restenosis rate significantly as compared with balloon angioplasty in short de novo lesions in coronary arteries >3 mm in size. Although the postprocedural minimal luminal diameter (MLD) is known to have significant bearing on long-term angiographic results, no practically useful model exists for prediction of angiographic outcome based on the periprocedural QCA variables. METHODS The QCA data from patients who underwent Palmaz-Schatz stent implantation for short (<15 mm) de novo lesions in coronary arteries >3 mm and completed six months of angiographic follow-up in the four prospective clinical trials (BENESTENT I, BENESTENT II pilot, BENESTENT II and MUSIC) were pooled. Multiple models were constructed using multivariate analysis. The Hosmer-Lemeshow goodness-of-fit test was used to identify the model of best fit, and this model was used to construct a reference chart for prediction of angiographic outcome on the basis of periprocedural QCA variables. RESULTS Univariate analysis performed using QCA variables revealed that vessel size, MLD before and after the procedure, reference area before and after the procedure, minimal luminal cross-sectional area before and after the procedure, diameter stenosis after the procedure, area of plaque after the procedure and area stenosis after the procedure were significant predictors of angiographic outcome. Using multivariate analysis, the Hosmer-Lemeshow goodness-of-fit test showed that the model containing percent diameter stenosis after the procedure and vessel size best fit the data. A reference chart was then developed to calculate the expected restenosis rate. CONCLUSIONS Restenosis rate after stent implantation for short lesions can be predicted using the variables percent diameter stenosis after the procedure and vessel size. This meta-analysis indicates that the concept of “the bigger the better” holds true for coronary stent implantation. Applicability of the model beyond short lesions should be tested.
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