Baseline coronary artery stenosis severity is an independent predictor of subsequent poor sleep quality in patients with acute coronary syndrome.

AIM: To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI). METHODS: This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity. RESULTS: A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37 ±â€…12.23 years, 59.69 ±â€…11.85 years in the SYNTAX ≤22 groups and 61.90 ±â€…12.98 years in the SYNTAX >22 group (P = 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (P = 0.383). According to the univariate logistic regression analysis, age (P = 0.014), diabetes (P = 0.027), left ventricular ejection fraction (P = 0.001), estimated glomerular filtration rate (P = 0.039), creatine kinase MB (P = 0.040) and SYNTAX scores (P < 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); P < 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (P < 0.001 for all). CONCLUSION: Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.

Association of CHA2DS2-VASc score with thrombus burden in patients with acute myocardial infarction undergoing SVG-PCI.

BACKGROUND: The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA2DS2-VASc score is used to predict the risk of thromboembolic events in patients with nonvalvular atrial fibrillation. We aimed to evaluate the predictive role of the CHA2DS2-VASc score in the estimation of intracoronary thrombus burden in patients with acute myocardial infarction (AMI) who underwent SVG-PCI. METHODS: We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0-3) and high thrombus burden (HTB; TIMI 4 and 5). RESULTS: The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA2DS2-VASc scores (p < 0.001) compared with LTB patients. Univariate and multivariate regression analysis demonstrated that both CHA2DS2-VASc score (OR: 1.573, 95% CI: 1.153-2.147, p = 0.004) as a continuous variable and a binary cut-off level of the CHA2DS2-VASc score > 3 (OR: 3.876, 95% CI: 1.705-8.808, p = 0.001) were significantly associated with HTB. The ability of the CHA2DS2-VASc score to predict HTB burden was evaluated by receiver-operating characteristics analysis curve analysis. The optimum cut-off value of the CHA2DS2-VASc score for predicting HTB was 3 (with a sensitivity of 67.9% and a specificity of 69.3%) according to the Youden index. CONCLUSION: The CHA2DS2-VASc score can be used as an easy practical tool to predict HTB in AMI patients undergoing SVG-PCI.

Coronary Sinus Diameter to Inferior Vena Cava Diameter Ratio in the Diagnosis of Cardiac Tamponade: A Novel Approach.

BACKGROUND: In cardiac tamponade, coronary sinus (CS) as an intrapericardial structure can be easily compressed, whereas inferior vena cava (IVC) dilates. This inverse relationship may augment their roles in the evaluation of tamponade imaging. AIM: We assessed the usefulness of computerized tomographic measures of CS diameter and also CS/IVC ratio to predict tamponade in clinically stable patients with large pericardial effusion. METHODS: Sixty-six clinically stable patients who had large pericardial effusions were included. Coronary sinus diameter was measured from the point at 1 cm proximal to the CS ostium. Inferior vena cava diameter was measured from the segment between its right atrial orifice and hepatic vein. RESULTS: Patients with tamponade had smaller CS diameter and CS/IVC ratio. After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade, respectively. (Nagelkerke r value for CS was 53.7% and 72.1% for CS/IVC ratio). In Receiver Operating Characteristic Curve analysis, a cutoff value of 6.85 mm for CS diameter had 82.6% sensitivity and 83.7% specificity and a cutoff value of 27% for CS/IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade. CONCLUSIONS: The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade.

A new risk model for the evaluation of the thromboembolic milieu in patients with atrial fibrillation: the PALSE score.

BACKGROUND: The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu. AIMS: We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu. METHODS: We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation. RESULTS: In patients with the thromboembolic milieu, total protein and C­reactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast. CONCLUSIONS: The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.