Bendopnea Predicts High SYNTAX Score in Patients With Coronary Artery Disease: A Bayesian Approach.

Coronary artery disease (CAD) is one of the major health problems worldwide. CAD severity, as calculated by SYNTAX score (SS), is associated with higher morbidity and mortality. A new symptom of shortness of breath within 30 s while bending forward is described as bendopnea and is related to elevated cardiac filling pressure. It is also known that a high SS is associated with left ventricular (LV) dysfunction which leads to higher LV filling pressure. We aimed to investigate whether there was an association between bendopnea and high SS in CAD patients. A high SS was defined ≥22. Of 374 stable angina pectoris patients, 238 (64%) patients had bendopnea and 136 (36%) patients had no bendopnea in this study. The bendopnea (+) group had higher SS and Gensini scores than the bendopnea (-) group (posterior probabilities >0.999 and 0.995, respectively). The presence of bendopnea was independently associated with a higher SS (odds ratio [OR] = 3.82, 95% credible intervals [CrI] = 1.93-8.17). When different priors were used in the context of meta-analysis, there was only 18% heterogeneity among the results, indicating that the results of our study were robust. This is the first study to report that bendopnea was independently associated with CAD severity.

Association of Coronary Artery Severity and Late In-Stent Restenosis: An Angiographic Imaging Study.

Coronary in-stent restenosis (ISR) remains a challenge in interventional cardiology. We investigated the relationship between angiographic pre-interventional grade of lesion stenosis (LS) and the prognosis of late ISR. After exclusions, 110 patients with ISR and 109 patients without ISR were compared. In the ISR group, the grade of LS was greater (P < .001) and the length of the critical segment (LCS) was longer (P < .001). Stent length was longer in the ISR group (P = .008). Compared with the LCS, the grade of LS above 87.5% is 6.9 times more predictive of ISR than the LCS >10.5 mm. Kaplan-Meier curve analysis showed that the grade of initial LS >87.5% had a higher ISR rate than the grade of LS <87.5% (log-rank test P < .001) and critical lesion length over 10.5 mm had a higher ISR rate than critical lesion length under 10.5 mm (log-rank test P < .001). The present study found that the angiographic pre-interventional grades of LS and LCS were important predictors of ISR. Pre-interventional angiographic stenosis >87.5% was significantly predictive of late ISR.

Comparison of Long-Term Outcomes Between Intravascular Ultrasound-, Optical Coherence Tomography- and Angiography-Guided Stent Implantation: A Meta-Analysis.

Intravascular ultrasonography (IVUS) and optical coherence tomography (OCT) guided percutaneous coronary interventions (PCI) are alternative techniques to angiography-guided (ANG-g) PCI in patients with coronary artery disease (CAD), especially for optimal stent deployment in coronary arteries. We conducted a network meta-analysis including studies comparing those three techniques. We searched databases for studies that compared IVUS, OCT, and ANG-g PCI in patients with CAD. Overall, 52 studies with 231,137 patients were included in this meta-analysis. ANG-g PCI had higher major adverse cardiovascular events (MACEs), all-cause death, cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) than IVUS-guided PCI. Of note, both OCT-guided and IVUS-guided PCI had similar outcomes. The frequency of MACEs, cardiac death, and MI were higher in ANG-g PCI than in OCT-guided PCI. The highest benefit was established with OCT for MACEs (P-score=.973), MI (P-score=.823), and cardiac death (P-score=.921) and with IVUS for all-cause death (P-score=.792), TLR (P -score=.865), and ST (P-score=.930). This network meta-analysis indicated that using OCT or IVUS for optimal stent implantation provides better outcomes in comparison with ANG-g in patients with CAD undergoing PCI.

The association of serum uric acid/albumin ratio with the development of coronary collateral circulation in patients with chronic total occluded coronary arteries.

Introduction: Coronary collateral circulation (CCC) develops in chronic total occluded (CTO) vessels and protects the myocardium against ischemia in addition to the improvement of cardiac functions. Poor CCC is related to adverse cardiac events as well as poor prognosis. Serum uric acid/albumin ratio (UAR) has emerged as a novel marker associated with poor cardiovascular outcomes. We aimed to investigate whether there was an association between UAR and poor CCC in CTO patients. Methods: This study was comprised of 212 patients with CTO (92 with poor CCC and 120 with good CCC). All patients were graded based on Rentrop scores to poor CCC (Rentrop scores 0 and 1) and good CCC (Rentrop scores 2 and 3). Results: Poor CCC patients had higher frequencies of diabetes mellitus, triglyceride levels, Syntax and Gensini scores, uric acid, and UAR and lower lymphocyte, high-density lipoprotein cholesterol, and ejection fraction when compared to good CCC patients. UAR was an independent predictor of poor CCC in CTO patients. Furthermore, UAR had a better discriminative ability for patients with poor CCC from good CCC compared to serum uric acid and albumin. Conclusion: Based on the results of the study, the UAR could be used to detect poor CCC in CTO patients.

Evaluation of Naples Score for Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

The Naples score (NS), which is a composite of cardiovascular adverse event predictors including neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, albumin, and total cholesterol, has emerged as a prognostic risk score in cancer patients. We aimed to investigate the predictive value of NS for long-term mortality in ST-segment elevation myocardial infarction patients (STEMI). A total of 1889 STEMI patients were enrolled in this study. The median duration of the study was 43 months (IQR: 32-78). Patients were divided into 2 groups according to NS as group 1 and group 2. We created 3 models as a baseline model, model 1 (baseline + NS in continuous), and model 2 (baseline + NS as categorical). Group 2 patients had higher long-term mortality rates than group 1 patients. The NS was independently associated with long-term mortality and adding NS to a baseline model improved the model performance for prediction and discrimination of long-term mortality. Decision curve analysis demonstrated that model 1 had a better net benefit probability for detecting mortality compared with the baseline model. NS had the highest contributive significant effect in the prediction model. An easily accessible and calculable NS might be used for risk stratification of long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention.

Serum Uric Acid to Albumin Ratio Can Predict Contrast-Induced Nephropathy in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is one of the common complication of ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI). Serum uric acid to albumin ratio (UAR) is a novel marker, which is associated with acute kidney injury in intensive care unit patients. We investigated the predictive value of UAR for the development of CIN in STEMI patients (n = 1379) after pPCI. The diagnosis of CIN was made based on an increase of basal creatinine levels >.5 mg/dL or 25% within 72 h after pPCI; 128 patients were in the CIN (+) group and 1251 patients were in the CIN (-) group. CIN (+) patients had higher serum uric acid (SUA), UAR, and lower albumin levels than CIN (-) patients. Age, diabetes, hypertension, hemoglobin, glucose at admission, basal creatinine, peak troponin I, total bilirubin, contrast volume/glomerular filtration rate, and UAR were independent predictors of CIN. A cutoff value of 1.62 for UAR detected CIN development with a sensitivity of 54% and specificity of 87.4%, and the discrimination ability of UAR was better than that of SUA or albumin. In conclusion, UAR was an independent predictor of the development of CIN.

Evaluation of Intermountain Risk Score for Short- and Long-Term Mortality in ST Elevation Myocardial Infarction Patients.

The aim of this study was to examine the Intermountain Risk Score (IMRS) for short- and long-term mortality in ST elevation myocardial infarction (STEMI) patients and compare it with the well-known risk scores, such as the Thrombolysis in Myocardial Infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE). In this retrospective and cross-sectional study, 1057 consecutive patients with STEMI were evaluated. The end-points of the study were short- and long-term mortality. The overall mortality rate was 16% (n = 170 patients). The IMRS was significantly higher in STEMI patients who did not survive compared with those who survived. According to multivariable COX proportional regression analysis, the IMRS was independently related to both short- (HR: 1.482, 95% CI: 1.325-1.675, p < .001) and long-term mortality (HR: 1.915, 95% CI: 1.711-2.180, p < .001). The comparison of receiver operating characteristic curves revealed that the IMRS had non-inferior predictive capability for short- and long-term mortality than the TIMI and GRACE risk scores. To the best of our knowledge, this is the first study to show that the IMRS can predict short- and long-term prognosis of patients with STEMI. Further, the IMRS' predictive value for overall mortality was non-inferior compared with TIMI and GRACE scores.

Comparison of catheter ablation and medical therapy for atrial fibrillation in heart failure patients: A meta-analysis of randomized controlled trials.

BACKGROUND: The results of studies comparing the outcomes of catheter ablation (CA) to those of medical therapy (MT) for atrial fibrillation (AF) in heart failure (HF) patients are contradictory. OBJECTIVES: Our objective was to conduct a meta-analysis that included randomized controlled trials (RCTs) that compared these two therapy options for AF in HF patients. METHODS: We searched PubMed, Google Scholar, and the Cochrane Library for eligible studies. After reviewing all potential studies, we conducted this meta-analysis with the remaining 10 RCTs. We used a modified Jadad scale to assess the publications' quality, and we used the Risk of Bias 2 tool to assess the RCTs' bias risk. RESULTS: The meta-analysis comprised 2,187 patients. Patients treated with CA had a lower risk of all-cause mortality than patients treated with MT (RR=0.64 [0.5, 0.82]; p < 0.01). The CA group had greater improvement in left ventricular ejection fraction (LVEF) than the MT group (mean difference [MD]=5.38 [1.80, 8.97]; p < 0.01). Patients in the CA group had longer 6-min walking distances than patients in the MT group (MD=20.3 [-4.37, 44.9], p < 0.01). Compared to the MT group, the CAD group demonstrated a greater reduction in scores on the Minnesota Living with Heart Failure Questionnaire (MD= -9.59 [-16.72, -2.45], p < 0.01). CONCLUSION: This meta-analysis highlights the importance of CA in terms of all-cause mortality and includes the highest number of patients of any study on this topic. Moreover, compared to MT, CA therapy is associated with greater improvements in LVEF and quality of life.

Temporal relationship between serum calcium and triglyceride-glucose index and its impact on the incident of the acute coronary syndrome: a cross-lagged panel study.

BACKGROUND: Serum calcium (Ca) and insulin resistance (IR) can have impact on each other and both are associated with the acute coronary syndrome (ACS). The triglyceride-glucose (TyG) index is a surrogate marker of IR that can be easily calculated from fasting glucose and fasting triglyceride. AIM: We aimed to investigate the temporal relationship between serum Ca and the TyG index and its impact on ACS development. METHODS: We retrospectively collected 2856 eligible patients in this longitudinal observational study. Patients' basal characteristics and laboratory values, including serum Ca and TyG index, were noted at baseline and after a median 4-year (3-6 years) follow-up period at two different times. Cross-lagged panel analysis was performed to demonstrate the temporal relationship between serum Ca and the TyG index. The incidence of ACS was noted, and mediation analysis was used to detect the mediation effect of variables on the ACS. RESULTS: Baseline serum Ca and TyG index were associated with follow-up serum Ca and TyG index. The path coefficient from baseline serum Ca to the follow-up TyG index was significantly different from the baseline TyG index to the follow-up serum Ca, which indicated a reciprocal temporal relationship. The TyG index had a mediation effect of 23.5% on the serum Ca-ACS association in the total population. CONCLUSION: There was a reciprocal temporal relationship between serum Ca and the TyG index, and both were associated with the risk of incident ACS. The TyG index mediation effect on the association of serum Ca with ACS was 23.5%.

The Clinical Outcomes of COVID-19 in Patients on Warfarin: A Propensity Score Matching Study.

BACKGROUND: COVID-19 is associated with vascular thrombosis in critical patients. However, warfarin has not been adequately studied in patients with COVID-19. This study aimed to evaluate whether the use of warfarin, a potent oral anticoagulant, was of clinical benefit in patients with COVID-19. METHODS: This was a retrospective cohort study of COVID-19 patients diagnosed at 3 different centers in Turkey between April 2020 and April 2021. Patients were grouped by whether they were taking warfarin or not. Propensity score matching analysis was used to compare the dif ferences between the groups in mortality, hospitalization, and admission to the intensive care unit. RESULTS: A propensity score analysis was performed on 128 patients in the warfarin group and 372 patients in the control group. After matching, 84 pairs of patients were compared. The patients in the control group were more likely to be admitted to the intensive care unit (33.3% vs. 14.3%, respectively; P=.007) and had longer hospital stays than the warfarin group (7.1 vs. 14.1 days; P=.005). The warfarin group had a lower death rate compared to the control group (7.1% vs. 27.4%, respectively; P=.001), and surviving patients were sig nificantly more likely to be in the warfarin group than the control group (56.1% vs. 20.7%, respectively; P=.001). In patients on warfarin, there was a lower incidence of in-hospital death (log-rank test P=.005). CONCLUSIONS: Warfarin therapy could provide clinical benefits in patients with COVID-19. The current data highlight the importance of potent anticoagulation in the treatment of COVID-19.

The Association between Vitamin D Levels and Thrombus Burden in Patients with ST-Elevation Myocardial Infarction.

Background: In current practice, establishing the potential predictors of high thrombus burden (HTB) before primary percutaneous coronary intervention (PCI) is crucial for its management. In this research, we aimed to investigate the association between vitamin D levels and HTB in patients with ST-elevation myocardial infarction (STEMI). Methods: This prospective, observational study was conducted on 257 STEMI patients undergoing primary PCI in Van Education and Research Hospital between March 2020 and March 2021. The thrombus burden grade was determined for each subject. The study population was divided into 2 groups: patients with HTB and those with low thrombus burden (LTB) based on the thrombus burden grade. Demographic, laboratory, and angiographic features were compared between the groups. Results: In total, 154 patients (mean age±SD=63.42±11.53 y, 65.6% male) had HTB and 103 patients had LTB (mean age±SD=61.50±10.23 y, 70.9% male). The patients stratified into the HTB group had lower vitamin D levels than those in the LTB group (8.0 ng/mL vs 17.9 ng/mL, respectively; P<0.001). The patients with HTB and low vitamin D levels had lower post-PCI thrombolysis in myocardial infarction (TIMI) flow, TIMI myocardial perfusion grade, and post-PCI ST resolution. In a multivariable analysis, vitamin D was an independent predictor of HTB among the STEMI patients (OR: 0.76, 95%CI: 0.70-0.82; P<0.001). The ideal value of vitamin D to predict HTB was >17.6 ng/mL with a sensitivity of 81.8% and a specificity of 90.3%. Conclusion: The study results showed that vitamin D levels were an independent predictor of HTB in STEMI patients treated by primary PCI.

Triglyceride-to-glucose index to detect a non-dipping circadian pattern in newly diagnosed hypertensive patients.

Introduction: In this investigation, we aimed to explore the relationship between the triglyceride-glucose (TyG) index and the non-dipping blood pressure (BP) pattern in newly diagnosed hypertensive patients. Methods: In this retrospective study, 216 consecutive newly diagnosed hypertensive patients who had undergone 24-hour ambulatory blood pressure (ABPM) monitoring and had not received anti-hypertensive drugs were included. Non-dipping status was evaluated by a 24-h ABPM monitoring in all patients. We categorized the patients into two groups as; dippers (n=104 cases) and non-dippers (n=112 cases). The TyG index was derived from the fasting triglyceride and fasting glucose levels using the formula; ln[fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Results: Non-dipper group had a higher TyG index than the dipper group. The TyG was an independent predictor of non-dipping BP in hypertensive individuals, according to multivariable analysis. The TyG index was negatively associated with a decrease in both systolic and diastolic BP during the nighttime. The ideal cutoff value of the TyG index in detecting non-dipping status was≥9.01 with 74.1% sensitivity and 71.2% specificity. A ROC comparison indicated that the area under the curve value of TyG index was superior to fasting triglyceride, fasting glucose, and homeostasis model assessment of IR (HOMA-IR) in detecting non-dipping BP. Conclusion: The TyG index was an independent predictor of non-dipping status in newly diagnosed hypertensive patients who had undergone 24-hour ABPM monitoring and had not received anti-hypertensive drugs. As a simple and easily obtained parameter, the TyG index can be used to detect such pattern among these patients.

Association of Tp-e/QT ratio with SYNTAX score II in patients with coronary artery disease.

Background. The SYNTAX score II (SS) is an angiographic tool, which grades the complexity of coronary artery lesions and predicts short- and long-term events. Tp-e/QT ratio is a novel electrocardiographic marker for the risk of ventricular arrhythmias. We aimed to investigate whether there was a correlation between SS and Tp-e/QT ratio.Methods. A total of 227 consecutive patients who underwent elective coronary angiography were enrolled in this study. Patients who had a lumen diameter >1.5 mm and at least % 50 diameter stenosis on coronary angiogram were determined as coronary artery disease (CAD) group, and others were identified as a control group. The SS was calculated for the CAD group, and SS ≥23 was defined as a high SS group, and SS < 23 was identified as a low SS group. Electrocardiographic indices, such as Tp-e and Tp-e/QT, were measured for all patients. A multivariable logistic regression analysis was performed with variables age, interventricular septum thickness (IVS), hypertension, and Tp-e/QT. Results. Tp-e interval and Tp-e/QT ratio were higher in the CAD group compared with the control group. Tp-e, corrected Tp-e (cTP-e) and Tp-e/QT were higher in the high SS group than in the low SS group. The cTp-e and Tp-e/QT were correlated with SS score. Age, IVS and Tp-e/QT ratio were independent predictors of high SS in the logistic regression analysis. Conclusions. Tp-e/QT ratio was an independent predictor of high SS and might be used for risk stratification in CAD patients.

Systemic Immune-Inflammation Index Predicts Major Cardiovascular Adverse Events in Patients with ST-Segment Elevated Myocardial Infarction. / Índice de Inflamação Imune Sistêmica é Preditor de Eventos Cardiovasculares Adversos Maiores em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST.

BACKGROUND: The systemic immune-inflammation index (SII) has been reported as a new prognostic marker in tumors and cardiovascular diseases. OBJECTIVE: To investigate the association of SII with adverse cardiovascular events in patients with ST-segment elevated myocardial infarction (STEMI). METHODS: A retrospective observational study was conducted on 843 patients with STEMI. Patients were divided into two groups based on the median value of SII. Major adverse cardiovascular events were compared between SII groups. Cox regression analysis was used for detecting independent predictors of cardiovascular adverse events. The improvement of discrimination ability by adding SII to the traditional risk factors such as age, hypertension, diabetes mellitus, and male gender for major adverse events was calculated by c-statistics, integrated discrimination improvement, and net reclassification improvement. A two-sided p-value <0.05 was considered significant. RESULTS: High SII group was older than the low SII group (61.2±11.2, 59.2±7.9, respectively, p=0.002). The high SII group had higher rates of cardiac death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, revascularization, and composite major adverse cardiovascular events than the low SII group. SII was an independent predictor of all events mentioned above. Adding SII to traditional risk factors improved their discrimination ability for cardiovascular events. SII was superior to the neutrophil-to-lymphocyte and platelet-to- lymphocyte ratios for predicting cardiovascular adverse events. CONCLUSION: SII was an independent predictor of major adverse events in patients with STEMI and may be used to improve the prediction of adverse events, especially when combined with traditional risk factors.

FUNDAMENTO: O índice de inflamação imune sistêmica (SII, systemic immune-inflammation index) tem sido descrito como um novo marcador prognóstico em tumores e doenças cardiovasculares. OBJETIVOS: Investigar a associação entre eventos cardiovasculares adversos em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). MÉTODOS: Foi realizado um estudo observacional retrospectivo em 843 pacientes com IAMCSST. Os pacientes foram divididos em dois grupos segundo valores medianos de SII. A análise de regressão de Cox foi usada para detectar preditores independentes de eventos adversos cardiovasculares. A melhora na capacidade discriminatória pela adição do SII aos fatores de risco tradicionais ­ idade, hipertensão, diabetes mellitus, e sexo masculino para eventos adversos maiores foi calculada por estatística c, melhora da discriminação integrada (IDI), e melhora na reclassificação. Um valor de p bilateral <0,05 foi considerado estatisticamente significativo. RESULTADOS: O grupo com SII elevado apresentou idade mais avançada que o grupo com SII baixo (61,2±11,2 e 59,2±7,9, respectivamente, p=0,002). O grupo com SII elevado apresentou taxas mais altas de morte cardiovascular, infarto do miocárdio não fatal, acidente vascular cerebral não fatal, hospitalização por insuficiência cardíaca, revascularização, e eventos cardiovasculares adversos maiores que no grupo com SII baixo. O SII foi um preditor independente de todos os eventos mencionados. A adição do SII aos fatores de risco tradicionais melhorou sua capacidade discriminatória para eventos cardiovasculares. O SII foi superior à razão neutrófilo-linfócito e à razão plaqueta-linfócito para predizer eventos adversos cardiovasculares. CONCLUSÃO: O SII foi um preditor independente de eventos adversos maiores em pacientes com IAMCSST e pode ser usado para melhorar a predição de eventos adversos risco, especialmente se combinado com fatores de risco tradicionais.

Predictive value of uric acid/albumin ratio for the prediction of new-onset atrial fibrillation in patients with ST-Elevation myocardial infarction.

Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

Predictive Value of Uric Acid/Albumin Ratio for the Prediction of New-Onset Atrial Fibrillation in Patients with ST-Elevation Myocardial Infarction

ABSTRACT Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

Índice de Inflamação Imune Sistêmica é Preditor de Eventos Cardiovasculares Adversos Maiores em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST / Systemic Immune-Inflammation Index Predicts Major Cardiovascular Adverse Events in Patients with ST-Segment Elevated Myocardial Infarction

Resumo Fundamento O índice de inflamação imune sistêmica (SII, systemic immune-inflammation index) tem sido descrito como um novo marcador prognóstico em tumores e doenças cardiovasculares. Objetivos Investigar a associação entre eventos cardiovasculares adversos em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Métodos Foi realizado um estudo observacional retrospectivo em 843 pacientes com IAMCSST. Os pacientes foram divididos em dois grupos segundo valores medianos de SII. A análise de regressão de Cox foi usada para detectar preditores independentes de eventos adversos cardiovasculares. A melhora na capacidade discriminatória pela adição do SII aos fatores de risco tradicionais - idade, hipertensão, diabetes mellitus, e sexo masculino para eventos adversos maiores foi calculada por estatística c, melhora da discriminação integrada (IDI), e melhora na reclassificação. Um valor de p bilateral <0,05 foi considerado estatisticamente significativo. Resultados O grupo com SII elevado apresentou idade mais avançada que o grupo com SII baixo (61,2±11,2 e 59,2±7,9, respectivamente, p=0,002). O grupo com SII elevado apresentou taxas mais altas de morte cardiovascular, infarto do miocárdio não fatal, acidente vascular cerebral não fatal, hospitalização por insuficiência cardíaca, revascularização, e eventos cardiovasculares adversos maiores que no grupo com SII baixo. O SII foi um preditor independente de todos os eventos mencionados. A adição do SII aos fatores de risco tradicionais melhorou sua capacidade discriminatória para eventos cardiovasculares. O SII foi superior à razão neutrófilo-linfócito e à razão plaqueta-linfócito para predizer eventos adversos cardiovasculares. Conclusão O SII foi um preditor independente de eventos adversos maiores em pacientes com IAMCSST e pode ser usado para melhorar a predição de eventos adversos risco, especialmente se combinado com fatores de risco tradicionais.

Abstract Background The systemic immune-inflammation index (SII) has been reported as a new prognostic marker in tumors and cardiovascular diseases Objective To investigate the association of SII with adverse cardiovascular events in patients with ST-segment elevated myocardial infarction (STEMI). Methods A retrospective observational study was conducted on 843 patients with STEMI. Patients were divided into two groups based on the median value of SII. Major adverse cardiovascular events were compared between SII groups. Cox regression analysis was used for detecting independent predictors of cardiovascular adverse events. The improvement of discrimination ability by adding SII to the traditional risk factors such as age, hypertension, diabetes mellitus, and male gender for major adverse events was calculated by c-statistics, integrated discrimination improvement, and net reclassification improvement. A two-sided p-value <0.05 was considered significant. Results High SII group was older than the low SII group (61.2±11.2, 59.2±7.9, respectively, p=0.002). The high SII group had higher rates of cardiac death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, revascularization, and composite major adverse cardiovascular events than the low SII group. SII was an independent predictor of all events mentioned above. Adding SII to traditional risk factors improved their discrimination ability for cardiovascular events. SII was superior to the neutrophil-to-lymphocyte and platelet-to- lymphocyte ratios for predicting cardiovascular adverse events. Conclusion SII was an independent predictor of major adverse events in patients with STEMI and may be used to improve the prediction of adverse events, especially when combined with traditional risk factors.

The Effect of Chronic Inhouse Biomass Fuel Smoke Exposure on Coronary Slow Flow Phenomenon in Women Living in the Eastern Region of Turkey.

Objective: Biomass fuel (BMF) is still widely used in rural areas for cooking and heating worldwide. BMF smoke inhalation is a prominent cause of respiratory and cardiovascular disease. The slow coronary flow (SCF) phenomenon is known as the delayed opacification of distal coronary arteries on a coronary angiogram. SCF is known to be related to cardiovascular morbidity and mortality. Thus, we aimed to investigate the relationship between exposure to BMF and SCF in women in this study. Methods: A total of 457 consecutive women who underwent coronary angiography were retrospectively enrolled in this study. Patients were divided into two groups according to the use of BMF during their lives, from birth to older ages, as biomass exposure group (BEG) and non-exposure group. The presence of SCF was calculated based on thrombolysis in myocardial infarction frame count. Results: Two hundred fifty nine patients were in the BEG, whereas 198 patients were in the non-exposure group. The prevalence of SCF was higher in the BEG compared to the non-exposure group (47.9% vs. 13.1%, respectively, p<0.001). The presence of biomass exposure, body mass index, white blood cell count, low-density lipoprotein cholesterol, C-reactive protein, serum creatinine, and hypertension were independent predictors of SCF. The optimal cutoff point of biomass exposure time in years to detect the presence of SCF was 30 years (Area under the curve: 0.71, sensitivity: 0.65, specifity: 0.71). Conclusions: Exposure to indoor BMF was associated with a SCF phenomenon in women.