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BACKGROUND: No-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment-elevation myocardial infarction (STEMI) is relatively common and has therapeutic and prognostic implications. Cigarette smoking is known as deleterious in patients with coronary artery disease (CAD), but the effect of smoking on no-reflow phenomenon is less investigated. The aim of this study was to compare no-reflow phenomenon after percutneous coronary intervention for acute myocardial infarction, between smokers and non smokers. MATERIALS AND METHODS: A total of 141 patients who were admitted to Chamran Hospital (Isfahan, Iran) between March and September, 2012 with a diagnosis of STEMI, enrolled into our Cohort study. Patients were divided into current smoker and nonsmoker groups (based on patient's information). All patients underwent primary PCI or rescue PCI within the first 12-h of chest pain. No-reflow phenomenon, thrombolysis in myocardial infarction (MI) flow, and 24-h complications were assessed in both groups. RESULTS: A total of 47 current smoker cases (32.9%) and 94 (65.7%) nonsmoker cases were evaluated. Smokers in comparison to nonsmokers were younger (53.47 ± 10.59 vs. 61.46 ± 10.55, P < 0.001) and they were less likely to be hypertensive (15.2% vs. 44.7%, P < 0.001), diabetic (17% vs. 36.2%, P < 0.05), and female gender (4.3% vs. 25.5%, P < 0.01). Angiographic and procedural characteristics of both groups were similar. 9 patients died during the first 24-h after PCI (4.3% of smokers and 6.4% of nonsmokers, P: 0.72). No-reflow phenomenon was observed in 29.8% of current smokers and 31.5% of nonsmokers (P = 0.77). CONCLUSION: No-reflow phenomenon or short-term complications were not significantly different between current smokers and non smokers.
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BACKGROUND: The relation between left anterior descending artery (LAD) anatomy and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. The aim of this study was to determine the frequency and severity of short-term cardiovascular outcomes in patients with Anterior ST-Segment Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous intervention (PCI), based on wraparound and non-wraparound left anterior descending artery (LAD). METHODS: In a cross-sectional study, 126 patients with anterior STEMI who were admitted to Shahid Chamran Hospital in Isfahan during 2020 were studied. Patients were evaluated for anatomical features of LAD coronary artery and clinical outcomes determined and compared based on wraparound LAD and non-wraparound LAD during hospitalization and up to one month after PCI. RESULTS: The prevalence of wraparound LAD in the studied patients was 73% and left ventricular systolic dysfunction in admission was greater and more severe in patients with wraparound LADs compared with those with non-wraparound. Severe LV systolic dysfunction in the wraparound and non-wraparound groups was 39.6% and 8.8%, respectively (P < 0.001). Also, the frequency of arrhythmias in the wraparound group (21.7%) was higher than the non-wraparound group (5.9%) (P = 0.037). CONCLUSION: The patients with anterior STEMI and wraparound LAD have a worse clinical outcome and more severe left ventricular systolic dysfunction. Therefore, it seems that the study of the anatomical condition of the LAD artery at the time of angiography is of great importance in the way of observation and care, and treatment of patients.
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BACKGROUND: Recently, the relationship between increased level of inflammatory mediators and occurrence of left ventricular failure in patients with kidney disease has been suggested. The present study attempted to assess relationship between inflammatory mediators and occurrence of left ventricular failure in patients with chronic kidney disease. MATERIALS AND METHODS: This cross-sectional study was performed at Noor and Hazrat Aliasghar hospital in Isfahan between September 2012 to September 2013 on patients aged >19 years that referred for following their chronic kidney disease. Serum level of inflammatory parameters including C-reactive protein (CRP) and Interleukin-6 (IL-6) was measured using spectrophotometer. All patients were also assessed using M-mode echocardiography to determine left ventricular ejection fraction (LVEF). RESULTS: The group with significant reduced LVEF showed lower GFR when compared to the normal LVEF group (40.73 ± 20.61% versus 44.43 ± 17.98%, P = 0.032). Comparing GFR across the three groups with normal LVEF (>55%), with mild LV dysfunction (LVEF: 45 - 55) those with significant LV dysfunction (LVEF < 45%) showed significantly lower GFR level in latter group compared with normal LVEF and mild LV dysfunction group (P = 0.026). Although the level of serum CRP was significantly higher in patients with significant left ventricular failure than other groups (P = 0.018). CONCLUSION: Inflammatory processes can potentially affect left ventricular function in patients with chronic kidney disease. In this regard, increased level of CRP may be a main factor for predicting severity of left ventricular failure in these patients.
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BACKGROUND: Methadone is a synthetic opioid, which has been successfully used in treating heroin addiction and chronic pain syndrome in palliative care for more than 30 years. This drug is a potent blocker of the delayed rectifier potassium ion channel, which may result in corrected QT (QTc) interval prolongation and increased risk of torsades de pointes (TdP) in susceptible individuals. CASE REPORT: We describe here a case of methadone-induced TdP that deteriorated into ventricular fibrillation, which was resolved after treatment with IV magnesium, potassium, and Lidocaine. Our purpose in this case review was to highlight the risk of cardiac arrhythmias, in particular QTc interval prolongation leading to TdP in a heroin-dependent patient receiving methadone substitution therapy, and then to present a perspective on treatment and prevention strategies of methadone induced prolonged QTc. CONCLUSION: Methadone-induced TdP is a potentially fatal complication of methadone therapy. As the popularity of methadone use grows, clinicians will encounter more cases of methadone induced TdP, especially in our region, Iran. Hence, a thorough patient history and electrocardiogram monitoring are essential for patients treated with this agent, and alterations in treatment options may be necessary.
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BACKGROUND: Percutaneous nephrolithotomy is the treatment of choice in large and staghorn renal stones, and myocardial infarction is one the possible complications during and after the surgery. We investigated if renal and skeletal muscle injury, caused by percutaneous nephrolithotomy, can cause elevation in cardiac troponins (cTn). METHODS: This study was conducted on otherwise healthy patients with renal stone undergoing percutaneous nephrolithotomy. A baseline 12-lead electrocardiogram, echocardiography, and cTn assessment confirmed no cardiac pathology in any patients. Cardiac troponins T (cTnT) and I (cTnI), and also creatine kinase (CK) were assessed before and after surgery. RESULTS: A total of 55 patients (69.1% males, mean age: 40.5 ± 13.8 year) were included. Serum creatinine level ranged from 0.7 to 1.3 mg/dl (mean = 1.03 ± 0.17). The level of CK was significantly increased by 469.5 ± 201.4 U/l (P < 0.001), and no positive cTnT or cTnI was observed after surgery. CONCLUSION: The results of the present study showed that renal cell injury, caused by percutaneous nephrolithotomy, is not associated with elevated cardiac troponins. These findings show that increasing troponins in patients undergoing percutaneous nephrolithotomy indicate a cardiovascular pathology.
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BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST elevation myocardial infarction (STEMI). However, the required equipments are not available in all hospitals. Thus, due to shortage of time, some patients receive thrombolysis therapy first. Patients with chest pain and/or persistent ST segment elevation will then undergo rescue percutaneous coronary intervention (PCI). The present study evaluated and compared the frequency of no-reflow phenomenon and 24-hour complications after PCI among patients who underwent PPCI or rescue PCI. METHODS: This cross-sectional study assessed no-reflow phenomenon, 24-hour complications, and thrombolysis in myocardial infarction (TIMI) flow in patients admitted to Chamran Hospital (Isfahan, Iran) with a diagnosis of STEMI during March-September, 2011. Subjects underwent PPCI if they had received eptifibatide. Rescue PCI was performed if patients had chest pain and/or persistent ST segment elevation despite receiving streptokinase (SK). Demographic characteristics, history of diseases, medicine, angiography findings, PCI type, and complications during the first 24 hours following PCI were collected. Data was then analyzed by Student's t-test, chi-square test, and logistic regression analysis. RESULTS: A total number of 143 individuals, including 67 PPCI cases (46.9%) and 76 cases of rescue PCI (53.1%), were evaluated. The mean age of the participants was 58.92 ± 11.16 years old. Females constituted 18.2% (n = 26) of the whole population. No-reflow phenomenon was observed in 51 subjects (37.1%). Although 9 patients (6.3%) died during the first 24 hours after PCI, neither the crude nor the model adjusted for age and gender revealed significant relations between rescue PCI and death or no-reflow phenomenon. Rescue PCI and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, hyperlipidemia, coronary artery disease, smoking, platelets number, myocardial infarction level, the extent of stenosis, and the involved artery. CONCLUSION: According to the present study, although SK is more effective than eptifibatide in resolution of thrombosis and clots, rescue PCI did not differ from PPCI in terms of the incidence of no-reflow phenomenon or short-term complications.
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Contrast-induced nephropathy (CIN) is characterized by acute deterioration of renal function that occurs after parenteral administration of contrast media in the absence of other causes. Although no definite proof has been obtained yet, the risk of diuretics or angiotensin-converting enzyme inhibitors (ACEI) to exacerbate CIN has been reported because of their effects on renal perfusion. This study was conducted to assess the protective effect of hydration alone in the prevention of CIN after percutaneous coronary intervention (PCI) in patients on diuretics or ACEI. This randomized clinical trial was conducted at the Chamran Hospital, Isfahan University of Medical Sciences, Iran, during the years 2006-2007. The study patients were divided into four groups, each group containing 60 patients. Patients in groups A and B were on regular treatment with ACEI (captopril) and patients in groups C and D were on regular diuretic (furosemide) therapy. About 36 h before PCI, captopril in group A and furosemide in group C were discontinued. The serum creatinine (Cr) levels were measured at the time of performing PCI and 24 h and 48 h after PCI in all patients. All patients received 1 mL/kg/h normal saline (0.9%) 12 h before and 24 h after PCI. The occurrence of CIN after PCI was diagnosed based on the following formula: Cr level after PCI - Cr level before PCI. If this value was greater than 0.5 mg/dL, it was coded as one and if the value was less than 0.5 mg/dL, it was coded as zero. The mean difference was analyzed and compared among the four groups by the ANOVA test. Three patients (5%) in group A, two patients (3.3%) in group B, two patients (3.3%) in group C and one patient (1.6%) in group D had a >0.5 mg/dL difference in serum Cr. The difference seen between these groups was not statistically significant (P > 0.05). This study shows that although furosemide and captopril can exacerbate CIN by impairment of renal perfusion, this can be prevented by hydration and discontinuation of furosemide and captopril may not be required.