Arya Atherosclerosis
Volume:19 Issue: 6, Nov-Dec 2023

The generation of reactive oxygen species, which is induced by the activation of the xanthine oxidase (XO) enzymatic system, is one of the primary causes of ischemia-reperfusion injury for an ischemic heart. Allopurinol, as an XO inhibitor, plays an inhibitory role in free radical production in ST-elevation myocardial infarction (STEMI) patients. The aim of this study is to evaluate the impact of allopurinol pre-treatment on post-revascularization outcomes in patients admitted with STEMI Ninety patients with acute STEMI were enrolled in this randomized double-blind clinical trial and divided into two equal groups. The allopurinol group received a 600 mg allopurinol loading dose before the emergency PCI, and the control group received a placebo medication of the same shape. Thrombolysis in Myocardial Infarction (TIMI) flow, ECG changes, troponin level, and the occurrence of major cardiac events (MACE) during a 1-month follow-up were assessed. In the end, 81 patients were analyzed. The mean age of the patients was 59.52(11.31) and 61.3(9.25) in the allopurinol and control groups, respectively (p = 0.49). The troponin level 48 hours after the PCI and ST-elevation regression showed no significant difference between the groups [(p = 0.25) and (p = 0.21), respectively]. TIMI flow had improved in the allopurinol group compared to the placebo (p = 0.02). The PCI success rate was 78.6% and 61.5% in the case and control groups, respectively (p = 0.09). MACE and other clinical outcomes were similar between the groups (p > 0.05). This study revealed that allopurinol pre-treatment could improve TIMI flow in patients undergoing primary or rescue PCI in an acute STEMI setting.

This study aimed to investigate the frequency of asymptomatic intracranial and extracranial artery stenosis in healthy volunteers in Kerman, Iran, in 2019 using Doppler ultrasound imaging. This cross-sectional study was conducted on healthy volunteers in Kerman in 2019 following a public elicitation. After the general examination, 138 healthy volunteers who had no history of any disease and were not treated with any medication underwent cerebrovascular evaluation with Doppler ultrasound. Demographic information, history of addiction, and sonographic findings were recorded in a checklist and then analyzed using SPSS 22. Stenosis was found in 14.4% of volunteers. The mean age of participants was 45.8±10.12 years, and 74 (54%) of them were male. In volunteers with stenosis, a significant correlation was found between age (P = 0.03) and addiction (P = 0.04) with the involved artery. There was also a significant correlation between addiction and intracranial and extracranial artery stenosis (P = 0.04). Logistic regression analysis showed a significant relationship between being female, addiction, and age with stenosis, as well as between addiction and intracranial artery stenosis (P <0.05). The majority of healthy residents of Kerman have asymptomatic cerebrovascular stenosis, and this is more prevalent in the elderly, addicts, and women.

In recent years, transradial cardiac catheterization has become the preferred method. However, it can result in a significant complication known as radial artery occlusion (RAO). The medical management of RAO remains controversial, especially with the emergence of novel oral anticoagulants. Nevertheless, there is limited data on the use of these agents for treating RAO, which is the focus of this study using apixaban. This pilot double-blinded randomized clinical trial involved 30 patients who developed RAO following transradial coronary angiography. The patients were randomly assigned to receive either apixaban (2.5 mg twice daily) or a conservative approach for 30 days. Doppler ultrasonography was performed at baseline and at the end of the intervention to assess radial artery diameter and the resolution of arterial patency. Demographic, medical, medication, and clinical characteristics were collected. The mean age of the studied population was 59.43±12.14 years, and the majority were males (60%). Radial artery resolution was observed in 21 (70%) patients, independent of medication use. There was no significant association between resolution and age (P-value=0.62), gender (P-value=0.74), body mass index (P-value=0.23), smoking (P-value=0.64), diabetes (P-value=0.999), hypertension (P-value=0.74), statins (P-value=0.999), antiplatelet therapy (P-value=0.999), length of angiography (P-value=0.216), or follow-up arterial diameter (P-value=0.304). Recanalization occurred in 13 (86.7%) cases in the apixaban treatment group, compared to 8 (53.3%) individuals in the control group, indicating a significant difference (P-value=0.046). The study findings suggest no demographic, medical, medication, or clinical factors were associated with arterial recanalization. However, a one-month treatment with apixaban at a dose of 2.5 mg twice daily appeared to be effective.

The prevention and control of dyslipidemia, as an important risk factor for cardiovascular diseases (CVDs), is a priority for the healthcare system to reduce the burden of these diseases. The purpose of this protocol is to outline the key steps of the first Iranian Dyslipidemia Clinical Practice Guideline development, which can be used by other researchers as a guide to design a standard, comprehensive, evidence-based, and local context-based guideline. This guideline will be developed and reported according to the format of the World Health Organization (WHO) Handbook for Guideline Development. All members of the guideline development team will sign the declaration-of-competing-interests (DOI) forms. The development of the authors’ guideline will be supported by five groups: the steering committee (SC), the Guideline Developing Group (GDG), the systematic review (evidence synthesis) group, and the external review group. The authors will also establish a patient advisory group to inform guideline development by patients’ values and preferences. The SC and GDG will determine the scope of the guideline and will design PICO questions. The systematic review group will systematically search Embase, PubMed, Scopus, Web of Sciences, Cochrane Library, and Google Scholar from inception. The systematic review group will assess the risk of bias and create evidence summaries using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations of this guideline will be divided into strong recommendations and weak or conditional recommendations or suggestions. This clinical practice guideline will provide clinicians and healthcare professionals with new evidence-based recommendations for the diagnosis, management, and treatment of dyslipidemia in children and adults.

Primary percutaneous coronary intervention (PPCI) is the gold standard approach to restore blood flow in ST-segment elevation myocardial infarction (STEMI); however, the no-reflow phenomenon as a potential complication of PPCI can worsen the outcomes. It has been hypothesized that adjunctive prophylactic intracoronary infusion of low-dose fibrinolytic might improve the PPCI outcomes; however, this theory is a matter of debate. The current study aims to investigate the value of adjunctive prophylactic intracoronary low-dose alteplase to prevent the no-reflow phenomenon in patients with STEMI. This case-control study was conducted on 80 STEMI patients who underwent PPCI. The patients were assigned into the case group who were intervened by 10 mg adjunctive intracoronary alteplase immediately at the end of the balloon angioplasty (n=40) and controls (n=40) who underwent conventional PPCI only. The angioplasty-associated outcomes including final TIMI score, need for no-reflow treatment, ST-segment resolution, post-PPCI complications, and death were compared between the groups. Alteplase use was accompanied by significantly improved final TIMI flow scores (P-value<0.001) and fewer requirements for no-reflow treatments (P-value<0.001); however, it did not improve the ST-segment resolution (P-value=0.491). The mortality rate and post-angioplasty complications did not differ between the groups (P-value>0.05). Based on the findings of this study, adjunctive infusion of low-dose intracoronary alteplase during PPCI could not efficiently prevent the no-reflow phenomenon. Although the final TIMI flow and need for post-stenting no-reflow treatment improved, ST-segment resolution did not occur dramatically. Given that, this approach requires further investigations and should be considered cautiously.

The accurate incidence of different cardiovascular consequences of COVID-19 in the pediatric population has been inadequately defined due to ongoing genotype changes in the virus. Although COVID-19 is known to increase inflammatory markers associated with atrial arrhythmias, the contemporary literature has poorly described new onset arrhythmias as a complication in previously healthy neonates with COVID-19.

A twenty-day-old female term neonate, born by caesarean section with immediate cry, developed labored breathing, cyanosis, and tachycardia after having close contact with a confirmed case of COVID-19. The neonate developed atrial flutter, which was refractory to cardioversion and drugs, namely Amiodarone, Flecainide, and Propranolol. The authors treated the neonate with IVIG. This is the first reported case of atrial flutter in the neonatal period secondary to COVID-19.

Since the start of the SARS-CoV-2 pandemic, all attention and concerns have been mainly on respiratory manifestations and complications. The cardiovascular complications and treatment have been neglected. This case reports tachyarrhythmia (Atrial Flutter) as an unusual presentation of acute COVID-19 in the neonatal population and shows the role of IVIG in the treatment of refractory arrhythmias.

Various studies indicate that air pollution poses an environmental threat to public health, particularly cardiovascular disease (CVD) 1, 2. While the impact of air pollution on an individual scale is relatively low compared to other significant risk factors for cardiovascular diseases, the large number of people affected can result in a substantial increase in the total mortality of the population. Consequently, the effect of air pollution on cardiovascular disease is regarded as a serious issue in public health 3.