Dual antiplatelet therapy before coronary artery bypass grafting in patients with myocardial infarction: a prospective cohort study.

BACKGROUND: Dual antiplatelet therapy (DAPT) in patients with MI who are candidates for early coronary artery bypass grafting (CABG) can affect intraoperative and postoperative outcomes. Therefore, the aim of this study was to evaluate the effect of DAPT up to the day before CABG on the outcomes during and after surgery in patients with MI. METHODS: In this prospective cohort study, 224 CABG candidate patients with and without MI were divided into two groups: (A) patients without MI who were treated with aspirin 80 mg/day before surgery (noMI-aspirin group; n = 124) and (B) patients with MI who were treated with aspirin 80 mg/day before surgery and clopidogrel (Plavix brand) at a dose of 75 mg/day (MI-DAPT group; n = 120). Dual or mono-antiplatelet therapy continued until the day before surgery. Patients were followed to assess in-hospital and 6-months outcomes. RESULTS: The in-hospital mortality in MI-DAPT group was similar with noMI-aspirin group (OR 4.2; 95% CI 0.9-20.5; p = 0.071). The prevalence of CVA (p = 0.098), duration of hospital stay (p = 0.109), postoperative ejection fraction level (p = 0.693), diastolic dysfunction grade (p = 0.651) and postoperative PAP level (p = 0.0364) did not show difference between two groups. No mild or severe bleeding was observed in the patients. Six-month follow up showed that number of readmissions (p = 0.801), number of cases requiring angiography (p = 0.100), cases requiring re-PCI (p = 0.156), need for re-CABG (p > 0.999) and CVA (p > 0.999) did not differ between the two groups. During the 6-month follow-up, out-hospital mortality did not differ significantly between the two groups (p = 0.446). CONCLUSIONS: A 6-month follow-up showed that DAPT with aspirin and clopidogrel before CABG in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. Therefore, DAPT is recommended in the preoperative period for these patients.

Performance of Manchester Acute Coronary Syndromes decision rules in acute coronary syndrome: a systematic review and meta-analysis.

Multiple decision-aiding models are available to help physicians identify acute coronary syndrome (ACS) and accelerate the decision-making process in emergency departments (EDs). This study evaluated the diagnostic performance of the Manchester Acute Coronary Syndrome (MACS) rule and its derivations, enhancing the evidence for their clinical use. A systematic review and meta-analysis was performed. Medline, Embase, Scopus, and Web of Science were searched from inception until October 2023 for studies including adult ED patients with suspected cardiac chest pain and inconclusive findings requiring ACS risk-stratification. The predictive value of MACS, Troponin-only MACS (T-MACS), or History and Electrocardiogram-only MACS (HE-MACS) decision aids for diagnosing acute myocardial infarction (AMI) and 30-day major adverse cardiac outcomes (MACEs) among patients admitted to ED with chest pain suspected of ACS. Overall sensitivity and specificity were synthesized using the 'Diagma' package in STATA statistical software. Applicability and risk of bias assessment were performed using the QUADAS-2 tool. For AMI detection, MACS has a sensitivity of 99% [confidence interval (CI): 97-100], specificity of 19% (CI: 10-32), and AUC of 0.816 (CI: 0.720-0.885). T-MACS shows a sensitivity of 98% (CI: 98-99), specificity of 35% (CI: 29-42), and AUC of 0.859 (CI: 0.824-0.887). HE-MACS exhibits a sensitivity of 99% (CI: 98-100), specificity of 9% (CI: 3-21), and AUC of 0.787 (CI: 0.647-0.882). For MACE detection, MACS demonstrates a sensitivity of 98% (CI: 94-100), specificity of 22% (CI: 10-42), and AUC of 0.804 (CI: 0.659-0.897). T-MACS displays a sensitivity of 96% (CI: 94-98), specificity of 36% (CI: 30-43), and AUC of 0.792 (CI: 0.748-0.830). HE-MACS maintains a sensitivity of 99% (CI: 97-99), specificity of 10% (CI 6-16), and AUC of 0.713 (CI: 0.625-0.787). Of all the MACS models, T-MACS displayed the highest overall accuracy due to its high sensitivity and significantly superior specificity. T-MACS exhibits very good diagnostic performance in predicting both AMI and MACE. This makes it a highly promising tool for managing patients with acute chest pain.

Differences in gender and outcomes following isolated coronary artery bypass graft (CABG) surgery.

BACKGROUND: Gender impacts pre-, intra-, and postoperative parameters and outcomes following coronary artery bypass graft (CABG) with conflicting results. This study aimed to identify differences in preoperative, intraoperative, and postoperative parameters. It also seeks to compare the postoperative complications and mortality between two genders who had CABG surgery. METHOD: This prospective observational study included patients who had isolated CABG and were divided based on gender. Demographic information, underlying comorbidities, drug history, clinical and laboratory data at the time of referral, operative characteristics, postoperative variables, and mortality outcomes were tracked during hospitalization and six months after discharge. RESULTS: Three hundred twenty patients were enrolled in the study during its duration. 71% were male. Women were older (62.40±9.03 vs. 59.99±9.81 years, p= 0.011) and had more dyslipidemia (p=0.003), hypertension (p=0.000), and diabetes (p=0.001), whereas men admitted with more myocardial infarction (MI) (p=0.011) and had lower Ejection fraction (EF) (p=0.001). They also had lower EF post-surgery (p <0.001) and six months after discharge (p = 0.006). However, the number of vessels involved was not different between genders (p=0.589), but the number of grafts was higher in men (p=0.008).There was no statistically significant difference in overall mortality rates between the two groups (4.42% and 6.38% in men and women, respectively, p= 0.464). CONCLUSIONS: The women had more underlying comorbidities than men. Furthermore, there were some differences in the intra-operative parameters and postoperative complications between the two genders, but there was no difference in postoperative mortality in our setting.

The value of Coronary Artery Disease - Reporting and Data System (CAD-RADS) in Outcome Prediction of CAD Patients; a Systematic Review and Meta-analysis.

Introduction: Coronary computed tomographic angiography (CCTA) reporting has traditionally been operator-dependent, and no precise classification is broadly used for reporting Coronary Artery Disease (CAD) severity. The Coronary Artery Disease Reporting and Data Systems (CAD-RADS) was introduced to address the inconsistent CCTA reports. This systematic review with meta-analysis aimed to comprehensively appraise all available studies and draw conclusions on the prognostic value of the CAD-RADS classification system in CAD patients. Method: Online databases of PubMed, Embase, Scopus, and Web of Science were searched until September 19th, 2022, for studies on the value of CAD-RADS categorization for outcome prediction of CAD patients. Results: 16 articles were included in this systematic review, 14 of which had assessed the value of CAD-RADS in the prediction of major adverse cardiovascular events (MACE) and 3 articles investigated the outcome of all-cause mortality. Our analysis demonstrated that all original CAD-RADS categories can be a predictor of MACE [Hazard ratios (HR) ranged from 3.39 to 8.63] and all categories, except CAD-RADS 1, can be a predictor of all-cause mortality (HRs ranged from 1.50 to 3.09). Moreover, higher CAD-RADS categories were associated with an increased hazard ratio for unfavorable outcomes among CAD patients (p for MACE = 0.007 and p for all-cause mortality = 0.018). Conclusion: The evidence demonstrated that the CAD-RADS classification system can be used to predict incidence of MACE and all-cause mortality. This indicates that the implementation of CAD-RADS into clinical practice, besides enhancing the communication between physicians and improving patient care, can also guide physicians in risk assessment of the patients and predicting their prognosis.

HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis.

Introduction: Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient. Method: The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality. Results: 25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality. Conclusion: The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.

Associations between short-term exposure to fine particulate matter and acute myocardial infarction: A case-crossover study.

BACKGROUND: Previous studies evaluated the impact of particle matters (PM) on the risk of acute myocardial infarction (AMI) based on local registries. HYPOTHESIS: This study aimed to evaluate possible short term effect of air pollutants on occurrence of AMI based on a specific case report sheet that was designed for this purpose. METHODS: AMI was documented among 982 patients who referred to the emergency departments in Tehran, Iran, between July 2017 to March 2019. For each patient, case period was defined as 24 hour period preceding the time of emergency admission and referent periods were defined as the corresponding time in 1, 2, and 3 weeks before the admission. The associations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM2 .5 ) and particulate matter with an aerodynamic diameter ≤10 µm (PM10 ) with AMI were analyzed using conditional logistic regression in a case-crossover design. RESULT: Increase in PM2.5 and PM10 was significantly associated with the occurrence of AMI with and without adjustment for the temperature and humidity. In the adjusted model each 10 µg/m3 increase of PM10 and PM2.5 in case periods was significantly associated with increase myocardial infarction events (95% CI = 1.041-1.099, OR = 1.069 and 95% CI = 1.073-1.196, and OR = 1.133, respectively). Subgroup analysis showed that increase in PM10 did not increase AMI events in diabetic subgroup, but in all other subgroups PM10 and PM2 .5 concentration showed positive associations with increased AMI events. CONCLUSION: Acute exposure to ambient air pollution was associated with increased risk of AMI irrespective of temperature and humidity.

Risk Factors of Readmission in COVID-19 Patients; a Retrospective 6-Month Cohort Study.

Introduction: The available literature regarding the rate of readmission of COVID-19 patients after discharge is rather scarce. Thus, the aim in the current study was to evaluate the readmission rate of COVID-19 patients and the components affecting it, including clinical symptoms and relevant laboratory findings. Methods: In this retrospective cohort study, COVID-19 patients who were discharged from Imam Hossein hospital, Tehran, Iran, were followed for six months. Data regarding their readmission status were collected through phone calls with COVID-19 patients or their relatives, as well as hospital registry systems. Eventually, the relationship between demographic and clinical characteristics and readmission rate was assessed. Results: 614 patients were entered to the present study (mean age 58.7±27.2 years; 51.5% male). 53 patients were readmitted (8.6%), of which 47 patients (7.6%) had a readmission during the first 30 days after discharge. The reasons for readmission were relapse of COVID-19 symptoms and its pulmonary complications in 40 patients (6.5%), COVID-19 related cardiovascular complications in eight patients (1.3%), and non-COVID-19 related causes in five patients (0.8%). Older age (OR=1.04; 95% CI: 1.01, 1.06; p=0.002) and increased mean arterial pressure during the first admission (OR=1.04; 95% CI: 1.01, 1.08; p=0.022) were found to be independent prognostic factors for the readmission of COVID-19 patients. Conclusion: Readmission is relatively frequent in COVID-19 patients. Lack of adequate hospital space may be the reason behind the early discharge of COVID-19 patients. Hence, to reduce readmission rate, extra care should be directed towards the discharge of older or hypertensive patients.

Six-Month Follow-up of COVID-19 Patients: Mortality and Related Factors.

BACKGROUND: Currently, there is lack of evidence regarding the long-term follow-up of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to present a 6-month follow-up of COVID-19 patients who were discharged from hospital after their recovery. METHODS: This retrospective cohort study was performed to assess the six-month follow-up of COVID-19 patients who were discharged from the hospital between February 18 and July 20, 2020. The primary outcome was 6-month all-cause mortality. RESULTS: Data related to 614 patients were included to this study. Of these 614 patients, 48 patients died (7.8%). The cause of death in 26 patients (54.2%) was the relapse of COVID-19. Also, 44.2% of deaths happened in the first week after discharge and 74.4% in the first month. Risk factors of all-cause mortality included increase in age (odds ratio [OR]=1.09; P<0.001), increase in neutrophil percentage (OR=1.05; P=0.009) and increase in heart rate (OR=1.06; P=0.002) on the first admission. However, the risk of all-cause death was lower in patients who had higher levels of hematocrit (OR=0.93; P=0.021), oxygen saturation (OR=0.90; P=0.001) and mean arterial pressure (OR=0.93; P=0.001). In addition, increase in age (OR=1.11; P<0.001) was an independent risk factor for COVID-19-related death, while higher levels of lymphocyte percentage (OR=0.96; P=0.048), mean arterial pressure (OR=0.93; P=0.006) and arterial oxygen saturation (OR=0.91; P=0.009) were protective factors against COVID-19-related deaths during the 6-month period after discharge. CONCLUSION: Death is relatively common in COVID-19 patients after their discharge from hospital. In light of our findings, we suggest that elderly patients who experience a decrease in their mean arterial pressure, oxygen saturation and lymphocyte count during their hospitalization, should be discharged cautiously. In addition, we recommend that one-month follow-up of discharged patients should be take place, and urgent return to hospital should be advised when the first signs of COVID-19 relapse are observed.

Is cardiac Troponin I Considered as A Predictor of In-hospital Mortality among COVID-19 Patients? A Retrospective Cohort Study.

OBJECTIVE: To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their in-hospital mortality as a cardiac biomarker. METHODS: The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat one positive polymerase chain reaction (PCR) test in Tehran, Iran from February 2020 to early June 2020. The on admission troponin I level divided into two groups of ≤0.03ng/mL (normal) and >0.03ng/mL (abnormal). The adjusted COX-regression model was used to determine the relationship between the studied variables and patient's in-hospital mortality. RESULTS: In this study, the median age of subjects was 65 years (54.8% men) and 29.53% of them had abnormal troponin I levels. Besides, the in-hospital mortality rate among patients with abnormal troponin I levels was found to be 51.56%; whereas, patients with normal levels exhibited 18.82% mortality. Also, the multivariable analysis indicated that the risk of death among hospitalized COVID-19 patients displaying abnormal troponin I levels was 67% higher than those with normal troponin I levels (Hazard ratio=1.67, 95% confidence interval=1.08-2.56, p=0.019). CONCLUSION: It seems that troponin I is one of the important factors related to in-hospital mortality of COVID-19 patients. Next, due to the high prevalence of cardiac complications in these patients, it is highly suggested to monitor and control cardiac biomarkers along with other clinical factors upon the patient's arrival at the hospital.

Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study.

BACKGROUND: Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality. METHODS: In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn't present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR). RESULTS: Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p <0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p <0.001), supraventricular arrhythmia (RR = 1.632; p <0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p <0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients. CONCLUSION: Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality.

A Randomized Double Blind Placebo Controlled Trial Examining the Effects of Pentoxifylline on Contrast Induced Nephropathy Reduction after Percutaneous Coronary Intervention in High Risk Candidates.

Contrast-induced nephropathy (CIN) (known as contrast-induced acute kidney injury) occurs as a result of acute worsening of renal function following a procedure with administration of iodine contrasts agent and remains a substantial concern in clinical practices. The purpose of this study is to investigate the preventive effect of Pentoxifylline supplementation on reduction of CIN occurrence after percutaneous coronary intervention among patients who were high risk of CIN according to Mehran score. In randomized, double-blind clinical trial patients who undergo coronary angiography with Mehran Score ≥ 11 consisted of our population. Patients in a ratio 1:1, divided into two groups received saline 0.9% plus N-acetyl cysteine and Pentoxifylline 400 mg three times per day 24 h before angiography until 48 h after angiography. In control group, the patients received placebo instead of PTX in a same manner as the control group. The endpoint was the incidence of CIN defined as creatinine increase of 0.5 mg/dL within 2 days after contrast. There were no significant differences in baseline characteristics. CIN occurred in 3 (5.5%) and 4 (7.3%) patients of the both groups (Pentoxifylline and control), respectively (p = 0.69; incidence odds ratio 1.36; 95% CI 0.29-6.38). No significant differences were seen in secondary outcome measures and changes in the level of creatinine (p = 0.54). In high-risk patients undergoing coronary angiography pentoxifylline supplementation had protection effect against contrast-induced nephropathy greater than placebo based hydration, but, not supported by our data.

Intravenous Amiodarone versus Digoxin in Atrial Fibrillation Rate Control; a Clinical Trial.

INTRODUCTION: Treatment of rapid ventricular response arterial fibrillation (rapid AF) varies depending on the decision of the in-charge physician, condition of the patient, availability of the drug, and the treatment protocol of the hospital. The present study was designed aiming to compare IV digoxin and amiodarone in controlling the heart rate of patients presenting to emergency department with rapid AF and relative contraindication for first line drug in this regard. METHOD: In the present clinical trial, patients presented to the ED with rapid AF and relative contraindication for calcium channel blockers and beta-blockers were treated with either IV amiodarone or IV digoxin and compared regarding success rate and complication using SPSS version 22. P < 0.05 was considered as statistically significant. RESULTS: 84 patients were randomly allocated to either amiodarone or digoxin treatment groups of 42 (53.6% male). The mean age of the studied patients was 61.8 ± 11.14 years (38 - 79). No significant difference was present regarding baseline characteristics. The rate of treatment failure was 21.4% (9 cases) in amiodarone and 59.5% (25 cases) in digoxin groups (p < 0.001). The mean onset of action was 56.66 ± 39.52 minutes (10 - 180) in amiodarone receivers and 135.38 ± 110.41 minutes (25 - 540) in digoxin group (p < 0.001). None of the patients showed any adverse outcomes of hypotension, bradycardia, and rhythm control. CONCLUSION: Based on the findings of the present study, rapid AF patients with relative contraindication for calcium channel blockers or beta-blockers who had received amiodarone experienced both higher (about 2 times) treatment success and a more rapid (about 2.5 times) response compared to those who received IV digoxin.

Relationship between metabolic syndrome and angiographic severity of coronary artery disease.

BACKGROUND: There are a few literature data on the correlation between metabolic syndrome (MetS) and coronary disease among Iranian population. This study aimed to find relationship between MetS and severity of coronary artery disease (CAD) in presence of diabetes. METHODS: Total of 192 patients were consecutively enrolled in the study who were admitted to coronary care unit because of acute coronary syndrome (ACS) and then underwent coronary angiography. MetS was defined by Iranian criteria. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between MetS and angiographic CAD severity or clinical presentation was compared between them after adjusting for diabetes. RESULTS: Individuals with MetS (n = 125) had a higher prevalence of ST-elevation myocardial infarction (71% vs 30%, P < 0.001), multi-vessel disease (50% vs. 34%, P = 0.003), decreased ejection fraction (P = 0.001) and more severe angiographic stenosis based on both modified Gensini (P = 0.081) and syntax (P = 0.008) scores, compared to those without MetS. Syntax score showed statistically significant difference between two groups before (P = 0.021) and after adjustment for diabetes (P = 0.005). CONCLUSION: MetS was related to the severity of CAD both clinically and by angiographic scores but diabetes was a challenging factor and may independently increase the severity of CAD.

Association between metabolic syndrome and coronary heart disease in patients on hemodialysis.

BACKGROUND: The metabolic syndrome (MeS) is a common risk factor for coronary heart disease (CHD) in the general population. OBJECTIVES: We examined the association between MeS and its risk in terms of CHD in patients on hemodialysis (HD). PATIENTS AND METHODS: This study was conducted on 300 patients on HD in six HD centers during March 2012. Patients were divided in two groups regarding presence of MeS. The rate of CHD were evaluated in each group and compared with each other. RESULTS: A total of 300 patients on HD, 173 males and 127 females with mean age of 61.7 ± 14.2, were enrolled in the study. Prevalence of MeS was 50.3%; hypertension, 83.7%; diabetes mellitus, 52%; high triglyceride level, 34%, low HDL cholesterol, 48.3%; and abdominal obesity, 41.3%. During the study, the CHD was more frequent in patients with MeS (27.8%) than was in those without MeS (14.1%) (P = 0.004). In addition, stroke happened more frequently in the MeS group than in those without MeS (30.5% vs. 17.4%; P = 0.008). The mean number of criteria for MeS was not significantly associated with mortality causes (CHD, 2.7 ± 1.3; stroke, 2.8 ± 0.9; other causes, 2.9 ± 1.3 P = 0.78). However, hypertension (89.3%) and diabetes mellitus (53.8%) were associated with increased risk for mortality. In the group of MeS, CHD were not significantly associated with serum albumin, calcium, phosphate, blood urea nitrogen, creatinine, ferritin, C-reactive protein, and KT/V; but there was significant association with white blood cells count (P < 0.0002). CONCLUSIONS: These findings suggested MeS might be an important risk factor for CHD, but not for mortality due to CHD in patients on HD.

Comparison of the effects of simultaneous administration of vitamin C and omega-3 fatty acids on lipoproteins, apo A-I, apo B, and malondialdehyde in hyperlipidemic patients.

BACKGROUND: Control of hyperlipidemia is vital in patients with cardiovascular disease (CVD). Omega-3 fatty acids (n-3FAs) have desirable effects on serum triglyceride (TG) levels, thrombosis, and arrhythmia, but lead to increases in serum low-density lipoprotein (LDL) and apo-B as well. OBJECTIVE: To determine and compare the effects of administration of n-3FAs, vitamin C (VitC) and n-3FAs + VitC on the serum levels of LDL, apoB, other serum lipids, and malondialdehyde (MDA). The present study was performed in Tehran University of Medical Sciences from 2000 to 2001. DESIGN: In a double-blind, placebo trial of parallel design, 68 hyperlipidemic patients [total cholesterol (TC) and TG greater than 200 mg/dL] were randomly assigned to receive daily 500 mg VitC, 1 g n-3FAs, 500 mg VitC + 1 g n-3FAs, or placebo (control) for 10 weeks. Fasting blood samples were collected at the beginning and at the end of the period. TG, TC, LDL-cholesterol-C (LDL-C), and high-density lipoprotein-cholesterol (HDL-C) were measured enzymatically, VitC and MDA colorimetrically, and apo-B and apo-A-I immunoturbidometrically. The pattern of food consumption, socio-economic, and anthropometric indices were determined; there was no significant change in these indices during the study. RESULTS: There was a significant difference in the blood VitC level at the end of the study in comparison to the initial value in the VitC (p = 0.001) and VitC + n-3FAs (p = 0.027) groups. Similarly, the serum TG level at the end of study was significantly different from the initial value in the n-3FAs group (p = 0.002) and also from the final value in the control group (p = 0.013). In the VitC group, there was a significant decrease in TC (p = 0.004), apo-B (p = 0.005), and MDA (p = 0.015) at the end of study as compared to the respective initial values. There was also a significant increase in blood VitC compared to the control value (p = 0.018) and a significant decrease in MDA compared to the n-3FAs group (p = 0.034). At the end of study, in the n-3FAs group, there was a significant (p = 0.04) and a marginally significant decrease (p = 0.05), respectively, in TG/HDL and apo-B levels as compared to the initial values, and the TG/HDL ratio showed a significant decrease as compared to the control group (p = 0.047). CONCLUSION: Simultaneous administration of n-3FAs and VitC had no beneficial effects on the lipid profile of hyperlipidemic patients, but 1 g purified n-3FAs daily for 10 weeks is a beneficial supplement for decreasing TG without any increase in LDL-C, apo-B or MDA. Administration of 500 mg VitC for more than 10 weeks might decrease significantly TC and apo-B in hyperlipidemic patients.

Short-Term Outcome of Discharged Low-Risk Chest Pain without Provoke Ischemia Study.

INTRODUCTION: Chest pain is a common problem in patients referring to emergency units. The present study was undertaken to evaluate the short-term outcome of patients presenting with a low risk chest pain and discharging without provoke ischemia study during emergency department admission. METHODS: In the present prospective cohort study, patients with low-risk chest pain, referring to the emergency department of Imam Hossein Hospital, Tehran, during the first half of 2012, were evaluated. All the patients underwent electrocardiogram (ECG) and cardiac enzyme tests, including cardiac isoenzymes creatine kinase MB and troponin I. One week after referring to the emergency department, the patients underwent an exercise test and were followed for a month. Data were analyzed with chi-squared test at a significant level of P<0.05. RESULTS: A total of 252 patients were included. The mean and standard deviation of patient ages was 56±7.7 years (47.5% male). The results of exercise tests for 47 (26.3%) subjects were positive [32 (28.8%) patients in the 41-60 year age group and 15 (22.7%) over 60 years of age].The angiography examination results of 5 patients (2.8%) were abnormal. There were no significant relationships between the age and gender and the results of exercise test and angiography (P>0.05). During the one-month follow-up no cases of mortality, cardiac problems, or referring again to the hospital were recorded. CONCLUSION: Based on the results of the present study, prevalence of cardiac etiology in patients with low risk chest pain was 2.8% and one-month follow-up did not reveal any complications or serious problems in such cases.

Relationship between dietary approaches to stop hypertension score and presence or absence of coronary heart diseases in patients referring to Imam Hossein Hospital, Tehran, Iran.

BACKGROUND: The dietary approaches to stop hypertension (DASH) dietary pattern reduces blood pressure. However, there is little information about the relationship between DASH and coronary heart diseases. This study aimed to assess the relationship between a DASH-style diet adherence score and coronary heart diseases (CHD) in patients referring for coronary angiography. METHODS: In this study, 201 adults (102 males, 99 females) within the age range of 40-80 years who referred for coronary angiography were selected. Diet was evaluated using a validated food frequency questionnaire. DASH score was calculated based on 8 food components (fruits, vegetables, whole grains, nuts and legumes, low fat dairy, red/processed meats, soft drinks/sweets, and sodium). The relationship between DASH score and CHD was assessed using logistic regression analysis. RESULTS: Mean of DASH score was 23.99 ± 4.41. Individuals in the highest quartile of DASH score were less likely to have CHD [odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.16-0.86]. However, after adjustment for gender or smoking, there was little evidence that coronary heart disease was associated with DASH diet score. There was a significant negative correlation between DASH score and diastolic blood pressure (P ≤ 0.05). CONCLUSION: In conclusion, having a diet similar to DASH plan was not independently related to CHD in this study. This might indicate that having a healthy dietary pattern, such as DASH pattern, is highly related to gender (dietary pattern is healthier in women than men) or smoking habit (non-smokers have healthier dietary pattern compared to smokers).

Differences in cardiovascular disease risk factors associated with maximum and mean carotid intima-media thickness among hemodialysis patients.

INTRODUCTION: Carotid intima-media thickness (CIMT) could be used as a surrogate marker of atherosclerosis in hemodialysis patients. Since different mechanisms are involved in the atheroma formation and arterial wall thickness, we assessed the relationship between the maximum and the mean CIMT with different cardiovascular risk factors in dialysis patients. MATERIALS AND METHODS: The mean and the maximum CIMT were measured using a B-mode ultrasonography in 75 hemodialysis patients, and the correlation between CIMT and cardiovascular risk factors were assessed. RESULTS: The mean and maximum CIMT measurements were 0.5 mm (range, 0.2 mm to 1 mm) and 3.4 mm (1.4 mm to 5.6 mm), respectively. Among all the studied variables, age (P = .04, r = 0.238), HS-CRP (P = .01, r = 0.284), mean arterial blood pressure (P = .003, r = 0.343), and DM (P = .02) had significant correlations with the mean CIMT, while only age (P = .02, r = 0.473) and serum creatinine levels (P = .02, r = -0.493) were significantly associated with the maximum CIMT. A positive nonsignificant correlation was observed between the mean and maximum CIMT values (P = .08, R2 linear = 0.214). CONCLUSIONS: These findings suggest that in dialysis patients, effects of cardiovascular risk factors on the mean and maximum CIMT might be different. Further studies are recommended to evaluate the prediction impact of each risk factor in end-stage renal disease patients compared with otherwise healthy individuals.

Association of sterile pyuria and coronary artery aneurysm in Kawasaki syndrome.

Kawasaki disease (KD) is an inflammatory multiorgan disease of unknown etiology. The most dramatic organ involved is the heart. There were a few studies about cardiac involvement and sterile pyuria. This study guides to determine if sterile pyuria is associated with coronary artery aneurysm (CAA) in KD patients and to consider it as a predicting factor for coronary artery involvement. Forty seven patients with KD were studied by echocardiography in admission and one month later. Urine analysis, complete blood count, erythrocyte sedimentation rate and C-reactive protein were measured in admission. Data were analyzed using SPSS-14 software. Patients' age was ranged from 13 month to 7 years old (mean age of 3.43 ± 1.54 years). Thirty patients (63.8%) were male and 17 patients (36.1%) were female. Cardiac involvement was detected in 32 patients (68%) using echocardiography, of which CAA was reported in 8 cases (17%). Six of CAA (75%) were in association with sterile pyuria, although it was statistically insignificant (P>0.05). Although the majority of patients with CAA had sterile pyuria, this association is not statistically significant, thus it couldn't be considered as a predicting factor for CAA.