Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome.

OBJECTIVE: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS). METHODS: Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. RESULTS: Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD. CONCLUSION: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.

Prognostic Value of the Neutrophil-Lymphocyte Ratio in Patients With ST-Elevated Acute Myocardial Infarction.

The predictive value of leukocyte counts has been reported in patients with acute myocardial infarction (AMI). We aimed to evaluate the predictive value of the total leukocyte count and neutrophil-lymphocyte (N/L) ratio for mortality due to AMI. A total of 522 patients with acute ST-elevated MI were included in the study. The study population was divided into tertiles based on admission N/L ratio values. High (n = 174) and low N/L (n = 348) ratio groups were defined as patients having values in the third tertile (>5.77) and lower 2 tertiles (≤ 5.77), respectively. The high N/L ratio group had a significantly higher incidence of in-hospital cardiovascular mortality (13.8% vs 4.6%, P < .001). An N/L ratio >5.77 was found to be an independent predictor of in-hospital cardiovascular mortality (hazard ratio: 3.78, 95% confidence interval: 1.71-8.30, P = .001). A high N/L ratio is a strong and independent predictor of in-hospital cardiovascular mortality of AMI with ST elevation.

The association between serum uric acid level and heart failure and mortality in the early period of ST-elevation acute myocardial infarction.

OBJECTIVES: Uric acid (UA) is a strong marker of cardiovascular disease. Therefore, we aimed to determine the relationship between serum UA levels and cardiovascular events in patients in the early period of their acute myocardial infarction. STUDY DESIGN: This retrospective study included 586 consecutive patients with ST-elevated myocardial infarction (STEMI) who were admitted to the hospital between March 2010 and February 2012. The study population was divided into two groups; the first group included hyperuricemic patients (n=107; uric acid level >6 mg/dl in women and >7 mg/dl in men), and the second group included patients with normal UA level (n=479). Multivariate analysis was used to demonstrate the predictive value of UA levels in groups. RESULTS: Patients in the hyperuricemic group were older (median 66 years vs. 60 years, p=0.001), and the ratio of female patients was higher (35.5% vs. 16.9%, p=0.001). Patients with hyperuricemia had a significantly higher incidence of in-hospital cardiovascular mortality than the normal group (15.9% vs. 3.1%, p<0.001). Advanced heart failure (class ≥ 3) was more frequent among hyperuricemic patients (17.8% vs. 8.8%, p=0.006). Age ≥ 70 years, chest pain duration >6 hours and hyperuricemia (hazard ratio (HR): 1.83, 95% confidence interval: 1.02-3.27; p=0.041) were found to be independent predictors of advanced heart failure. Hyperuricemia was found to be an independent predictor of in-hospital cardiovascular mortality in multivariate analyses (HR: 5.32, 95% confidence interval: 2.46-11.49; p=0.001). CONCLUSION: This study showed that a high serum UA level is an independent predictor of cardiovascular mortality and morbidity during the in-hospital period of STEMI.

Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction.

BACKGROUND: Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). MATERIAL AND METHODS: The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). RESULTS: Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR >144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16-4.0, p=0.014). CONCLUSIONS: This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI.

Contrast-induced nephropathy: preventive and protective effects of melatonin.

Infusion of contrast agents increases osmotic load, viscosity, hypoxemia of the renal medulla and renal free radical production through post-ischemic oxidative stress. The present experimental study sought to determine whether melatonin, because of its anti-oxidant properties might have a preventive and protective role against the development of contrast-induced nephropathy (CIN). Twenty-four adult male rats were divided into four experimental groups: healthy control rats (CR), rats with CIN (CINR), rats with CIN pretreated with melatonin (CINR1M), and rats with CIN pre- and post-treated with melatonin (CINR2M). In CINR, both serum creatinine (Cr) level and fractional excretion of sodium (FE-Na) significantly increased, whereas Cr clearance decreased at post-CIN compared with pre-CIN period. Rats in CINR1M did not show any improvement in renal function. Cr clearance decreased, whereas both serum Cr level and FE-Na increased in rats pretreated with melatonin. In contrast, significant improvements were observed in CINR2M. Serum Cr and Cr clearance did not change, whereas FE-Na significantly reduced in rats pre- and post-treated with melatonin. In conclusion, the present experimental study clearly demonstrated the preventive and protective role of melatonin against the development of CIN.

Loratidine improves ischemic parameters of exercise stress test in patients with acute myocardial infarction.

BACKGROUND: This study sought to determine whether adding an anti-histaminic medication, loratidine, to anti-ischemic treatment would ameliorate or improve ischemic parameters induced by exercise stress test in patients who suffered an acute myocardial infarction. METHODS: Twenty stable patients with acute inferior myocardial infarction who had a positive EST were randomly allocated into 2 groups, A and B. Patients in group A and B received a 10 mg loratidine tablet added daily to their anti-ischemic regimen for 7 days during the second and third week post-event, respectively. At the end of each period they underwent an exercise stress test (EST). Exercise parameters in each group were then compared before and after loratidine therapy. RESULTS: Both groups showed improvements in exercise parameters after loratidine therapy compared to basal EST results. ST(max) ( group A: 1.9 +/- 0.74 vs 0.9 +/- 1.29 mm, P = .046; group B: 2.5 +/- 0.71 vs 1.4 +/- 1.17 mm, P = .041), ST(lead) ( group A: 3.4 +/- 1.08 vs 1.5 +/- 2.12, P = .027; group B: 4.6 +/- 1.71 vs 2.22 +/- 2.25, P = .011), ST(total) ( group A: 4.7 +/- 2.18 vs 2.1 +/- 3.11 mm, P = .024; group B: 7.9 +/- 2.92 vs 3.33 +/- 3.81 mm, P = .005). CONCLUSION: Our study revealed that loratidine, a histamine-1 receptor blocker, improves ischemic parameters of EST when given as additive therapy to a routine anti-ischemic regimen during the sub-acute phase of myocardial infarction.