The relationship between hyperpolypharmacy and one-year outcomes in patients with critical limb ischemia undergoing below-knee endovascular therapy.

BACKGROUND: Critical limb ischemia (CLI) patients take too many medications because they are elderly and frail patients with multiple comorbidities. Polypharmacy is associated with frailty, although its prognostic significance in CLI patients is unknown. In this study, we aimed to determine the prevalence of hyperpolypharmacy among adults with CLI and its effect on 1-year amputation and mortality. METHODS: A total of 200 patients with CLI who underwent endovascular therapy (EVT) for below-knee (CTC) lesions were included in this study. Hyperpolypharmacy was defined as using ≥10 drugs. Patients were divided into two groups according to the presence of hyperpolypharmacy. RESULTS: We detected hyperpolypharmacy in 66 patients. The incidence of 1-year amputation [24 (36.4) versus 12 (9), p<.001] and mortality [28 (42.4) versus 12 (9), p<.001] were higher in patients with hyperpolypharmacy. Univariate and multivariate cox regression analyses were used to determine the independent predictors of amputation and mortality. In the receiver operating characteristic curve analysis, the cut-off value was defined as 10 or more drug use was able to detect the presence of 1-year mortality with 67.5% sensitivity and 79.4% specificity. The Kaplan-Meier method showed a significant difference (rank p <.001 between log groups), and hyperpolypharmacy was associated with 1-year amputation and mortality. CONCLUSION: Hyperpolypharmacy was significantly associated with 1-year mortality and major amputation in CLI patients. Hyperpolypharmacy can be a valuable aid in patient risk assessment in the CLI.

A Simple Predictor for Long-Term Mortality After Percutaneous Iliac Artery Intervention: Systemic Immune Inflammatory Index.

BACKGROUND: Peripheral arterial disease is a common disease all over the world. Medical treatment, percutaneous invasive treatment, and operation are the considerable options. Percutaneous treatment is a valid option with a higher patency rate. Systemic immune-inflammatory index (SII) is a formula which is calculated as neutrophil count to platelet count divided into lymphocyte count. This formula demonstrates the active inflammatory state. In our study, we aimed to demonstrate the relationship with SII and the mortality, major cardiovascular events, and success rates of percutaneous treatment of iliac artery disease. METHODS: A total of 600 patients underwent percutaneous intervention due to iliac artery disease were enrolled. The primary end point was mortality and the secondary end points were in-hospital thrombosis, restenosis, residual stenosis, and postintervention complications. The best cut-off value of SII to predict mortality was determined and the patients were divided into 2 groups, as those with higher SII values (1,073.782 <) and as those with lower SII values (1,073.782 >). Each group was evaluated in terms of clinical, laboratory, and technical aspects. RESULTS: After exclusion criteria were applied, 417 patients were enrolled into the study. Patients with high SII values had higher rates of in-hospital thrombosis [0 (0%); 3 (2.2%), P = 0.037] and mortality [38 (13.7%); 46 (33.1%), P < 0.001]. In multivariate logistic regression analysis, chronic kidney disease [odds ratio: 4.104, 95 0.5 confidence interval: 2.250-7.487, P < 0.001] and SII [odds ratio: 3.346, 95 0.5 confidence interval: 1.982-5.649, P < 0.001] were found to be independent risk factors for mortality. CONCLUSIONS: SII is a relatively new, simple, and effective mortality risk predictor in patients with iliac artery disease who underwent percutaneous intervention. To the best of our knowledge, our study is the first study which uses SII to predict mortality in such patient group.

The relationship between sarcopenia and one-year mortality in patients with critical limb ischemia undergoing endovascular therapy below the knee.

OBJECTIVE: Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. METHODS: A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. RESULTS: We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan-Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. CONCLUSIONS: Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

The prognostic value of C-reactive protein to albumin ratio in patients undergoing transcatheter aortic valve implantation.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery. On the other hand, allocating transcatheter therapy to the adequate candidates and identifying a reliable and validated risk stratification tool for mortality prediction is still lacking. The C-reactive (CRP) to albumin ratio (CAR) is a novel inflammation-based prognostic tool and it is strongly associated with inflammation severity and mortality. In this study, we aimed to elucidate the predictive significance of CAR for mortality in patients who underwent TAVI. METHODS: The records of 321 consecutive patients who underwent TAVI due to symptomatic aortic stenosis between 1 January 2015 and 31 December 2020 were analysed. Patients were divided into two groups based on the CAR values. For each group, all-cause, cardiovascular, and non-cardiovascular mortality occurring >72 h after the index procedure and at maximum follow-up was documented. RESULTS: The mean follow-up time was 40 (22-63) months. A total of 180 (56.1%) patients died during long-term follow-up. According to our study, median CAR values were significantly higher among patients who died during follow-ups compared to survivors [1.13 (0.69-2.21) vs 3.56 (1.53-10.00), p < 0.001]. CONCLUSION: Our data showed that CAR is an independent predictor of long-term mortality in patients undergoing TAVI due to symptomatic aortic stenosis.

Evaluation of Long-Term Outcomes of Crossover or Focal Ostial Stenting of Left Anterior Descending Artery Ostial Stenosis.

BACKGROUND: Optimal management of patients with ostial left anterior descending artery stenosis remains an unresolved issue. METHODS: Patients with ostial left anterior descending stenosis who underwent stent implantation were included in this study. Coronary records of all patients were monitored, and long-term clinical outcomes were recorded. The patients were divided into 2 groups according to the stenting method: focal left anterior descending stenting [ostial stenting group] and stenting from the left main coronary artery to the left anterior descending [crossover stenting group]. RESULTS: Of the 97 eligible consecutive patients, 56 were treated with ostial stenting and 41 with crossover stenting. At a mean follow-up of 23.6 ± 12.6 months, non-fatal myocardial infarction (3.9% vs. 12.8%, P=.118), target lesion revascularization (5.9% vs. 12.8%, P=.252), and all-cause death (2.0% vs. 7.7%, P=.191) rates were not statistically significant. However, the rate of major adverse cardiovascular events defined as a composite of non-fatal myocardial infarction, target lesion revascularization, or all-cause death was significantly higher in the crossover stenting group (8.2% vs. 28.2%, P = .013). In the multiple regression analysis, left main coronary artery diameter (odds ratio = 4.506; 95% CI: 1.225-16.582, P = .024) and application of the crossover stenting technique (odds ratio = 5.126; 95% CI: 1.325-19.833, P = .018) were found to be the most effective predictors of major adverse cardiovascular events. CONCLUSION: In our study, the ostial stenting group was associated with better clinical outcomes in the treatment of ostial left anterior descending stenosis. However, it is notappropriate to apply a single method to all patients with such lesions.

A Novel Marker Indicating Restenosis in Superficial Femoral Artery: C Reactive Protein to Albumin Ratio.

BACKGROUND: In this study, we aimed to investigate the prognostic value of C-reactive protein (CRP) to albumin ratio (CAR) for predicting restenosis in superficial femoral artery (SFA) lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention. METHODS: The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups, based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS: According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs. 10.3%, P < 0.05) and mortality (31.3% vs. 12.9%, P < 0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs. 3%, P < 0.05). With respect to Receiver operating characteristic ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% confidence interval CI: 0.611-0.706; P < 0.01). CONCLUSIONS: Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.

The CHA2DS2-VASc Score as an Early Predictor of Graft Failure After Coronary Artery Bypass Surgery.

Background and objective Graft patency is one of the major concerns after coronary artery bypass graft (CABG) surgery. The CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus (DM), stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category] score is a tool that was developed to predict the risk of thrombotic events in patients with atrial fibrillation (AF). In this study, we evaluated the use of the CHA2DS2-VASc score as a simple tool for predicting graft failure (GF) among patients who underwent CABG surgery. Methods In this retrospective case-control study, a total of 280 patients were enrolled after applying the exclusion criteria. Angiograms were analyzed by using the QCA software system (Pie Medical Imaging, Maastricht, The Netherlands) for each patient. A graft was described as failed if it had 70% or more stenosis or was completely occluded. Patients were classified into two groups: group one included patients without GF (GF-N) and group two included patients with GF (GF-Y). Thereafter, the CHA2DS2-VASc risk score was calculated for each patient. Results In our cohort, 136 patients had GF (GF-Y group) and 144 patients did not have GF (GF-N group). GF-N and GF-Y patients had their angiography performed 100.31 ± 8.04 and 103.49 ± 8.41 months after CABG, respectively. GF-Y group had a significantly higher rate of DM, hypertension, and heart failure with reduced ejection fraction (HFrEF). GF-Y group had higher CHA2DS2 (GF-N group: 1.47 ± 0.91 vs. GF-Y group: 2.57 ± 1.17, p=0.0001) and CHA2DS2-VASc score (GF-N group: 2.80 ± 1.11 vs. GF-Y group: 4.15 ± 1.25, p=0.0001). Analyses showed that only CHA2DS2-VASc was an independent predictor of GF while other parameters including DM, hypertension, HFrEF, creatinine, and CHADS2 were not found to be independent predictors of GF. A CHA2DS2-VASc score of >3 predicted GF with a sensitivity of 65.44% and a specificity of 74.31%. Conclusions The CHA2DS2-VASc score might be used as a feasible and simple method to predict the risk of GF after CABG surgery.

Role of triglyceride glucose index in long-term mortality of patients with lower extremity arterial disease.

Aim: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of long-term mortality in patients with lower extremity artery disease (LEAD) undergoing endovascular revascularization. Methods: The records of 723 patients with symptomatic LEAD undergoing endovascular revascularization between January 2016 and December 2021, with long-term follow-up until December 2021, were analyzed. Results: The rate of long-term mortality was significantly higher among patients with high TyG index than patients with low TyG index. Conclusion: The TyG index is an independent predictor of long-term mortality in patients with LEAD undergoing endovascular revascularization.

The role of three dimensional transesophageal echocardiography novel-score in the success of redo percutaneous balloon mitral valvuloplasty.

Mitral valve commissure evaluation is known to be important in the success of percutaneous balloon mitral valvuloplasty (PBMV) and Wilkins score (WS) is used in clinical practice. In our study, we aimed to determine whether WS in redo PBMV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure. Fifty patients who underwent redo PBMV were included in the study. The patients were divided into two groups according to the success of the Redo PBMV procedure which was defined as post-procedural MVA ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation after PBMV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PBMV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated. In the study group, 36 patients (72%) had successful redo PBMV procedure. WS was 8 (IQR 7-9) and novel 3D TEE score was found 4 (IQR 3-4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). Specifically, the procedural successes rate was > 90% when novel 3D TEE score was < 4. The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PBMV, especially in patients who are considered for surgery due to the high WS.

Impact of iliac arterial calcification on procedure success and long-term outcomes among patients undergoing endovascular intervention.

OBJECTIVES: Vascular calcification is a well-known phenomenon and affects coronary and carotid arteries as well as other arterial beds. Presence of arterial calcification is associated with major adverse events in patients undergoing percutaneous coronary artery or carotid artery intervention. Even though there is a clear association between worse outcome and coronary-carotid calcification, there is no research that interrogated the relationship between iliac arterial calcification and clinical outcomes because of lack of data. Therefore, in this study, we aimed to investigate the impact of iliac arterial calcification on procedure success rates and long-term outcomes among patients undergoing endovascular intervention. METHODS: The records of 453 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into two groups based on the presence or absence of heavy calcification of iliac arteries. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS: According to our study, the rate of restenosis following endovascular intervention at 6 and 12 months were similar between two groups. On the other hand, long-term restenosis was significantly higher in patients with heavy calcification of iliac arteries as compared to patients with low calcification on iliac arteries (32.2% vs. 12.8%, p < 0.05). CONCLUSIONS: Our data showed that there was a strong association between heavy calcification of iliac arteries and long-term restenosis in patients undergoing endovascular intervention.

Association Between CRP/Albumin Ratio and Long-Term Mortality in Patients With cHronIc Limb-Threatening Ischemia Undergoing EndovaScular Therapy Below The Knee: The ACHILES-BTK Registry.

BACKGROUND: Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall, and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI. METHODS: A total of 172 patients who underwent endovascular treatment (EVT) for below the knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into 2 groups according to mortality. RESULTS: A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 [1.46 - 7.86] vs. 9.75 [4.5 - 17.71], P < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis. CONCLUSIONS: CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Association between SYNTAX II Score and late saphenous vein graft failure in patients undergoing isolated coronary artery bypass graft surgery.

OBJECTIVE: Coronary artery bypass graft (CABG) surgery is a well-established treatment modality for patients with multivessel coronary artery disease (CAD). Syntax II Score has been established as novel scoring system with better prediction of postprocedural outcomes. This study aimed to investigate the prognostic value of SYNTAX II Score for predicting late saphenous vein graft (SVG) failure in patients undergoing isolated CABG. METHODS: The records of 1,875 consecutive patients who underwent isolated CABG with at least one SVG were investigated. Those who underwent coronary angiography and SVGs angiography at least 1 year after the CABG were included. Patients were divided into two groups based on the presence or absence of SVG failure. For each group, predictors of late SVG failure and subsequent clinical outcomes were analyzed. RESULTS: According to this study, the presence of hypertension, higher rates of repeat revascularization, and higher SYNTAX II Scores were found to be independent predictors of late SVG failure. In addition, the prognostic value of SYNTAX II Score was found to be significantly higher than anatomical SYNTAX Score in terms of predicting late SVG failure and major adverse cardiovascular and cerebrovascular event. CONCLUSIONS: There was a strong association between SYNTAX II Score and late SVG failure in patients undergoing isolated CABG.

Association Between Nutritional Indices and Long-Term Outcomes in Patients Undergoing Isolated Coronary Artery Bypass Grafting.

Background It is well known that approximately 20% of patients who undergo cardiac surgery experience weight loss in postoperative period. However, there is a lack of data on postoperative consequences of malnutrition. This study aimed to investigate the relationship between nutritional status and long-term outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). Material and methods A total of 586 patients who underwent isolated CABG in our center between January 2015 and March 2016 were included in this study. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of all-cause death, non-fatal myocardial infarction (MI), and stroke. Patients were divided into two groups based on their MACCE outcomes. Prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) scores were used to show the nutritional status. Results The mean follow-up time of the whole study group was 38.08 ± 13.4 months. The follow-up time was 39 ± 13 months in patients with mortality, while it was 20 ± 15 months in those without mortality. The PNI and GNRI values were lower in patients with major adverse cardiac and cerebrovascular events (MACCE) compared to patients without MACCE. The median CONUT score was higher in patients with MACCE. Conclusion Our study showed that nutritional indices including PNI, CONUT, and GNRI were associated with long-term MACCE and mortality in patients who underwent isolated CABG. The use of these scores in order to predict prognosis in patients treated with CABG seems to be an applicable method in clinical practice.

Association between SYNTAX II Score and late saphenous vein graft failure in patients undergoing isolated coronary artery bypass graft surgery

SUMMARY OBJECTIVE: Coronary artery bypass graft (CABG) surgery is a well-established treatment modality for patients with multivessel coronary artery disease (CAD). Syntax II Score has been established as novel scoring system with better prediction of postprocedural outcomes. This study aimed to investigate the prognostic value of SYNTAX II Score for predicting late saphenous vein graft (SVG) failure in patients undergoing isolated CABG. METHODS: The records of 1,875 consecutive patients who underwent isolated CABG with at least one SVG were investigated. Those who underwent coronary angiography and SVGs angiography at least 1 year after the CABG were included. Patients were divided into two groups based on the presence or absence of SVG failure. For each group, predictors of late SVG failure and subsequent clinical outcomes were analyzed. RESULTS: According to this study, the presence of hypertension, higher rates of repeat revascularization, and higher SYNTAX II Scores were found to be independent predictors of late SVG failure. In addition, the prognostic value of SYNTAX II Score was found to be significantly higher than anatomical SYNTAX Score in terms of predicting late SVG failure and major adverse cardiovascular and cerebrovascular event. CONCLUSIONS: There was a strong association between SYNTAX II Score and late SVG failure in patients undergoing isolated CABG.

Impact of cardiac rehabilitation on ventricular repolarization indices following coronary artery bypass grafting.

BACKGROUND: The aim of this study was to evaluate the effect of cardiac rehabilitation on electrocardiographic changes in patients undergoing isolated coronary artery bypass grafting. METHODS: Between January 2016 and July 2019, a total of 625 patients (485 males, 140 females; mean age: 59.6 years; range, 50.6 to 68.6 years) who underwent isolated coronary artery bypass grafting and survived were retrospectively analyzed. The patients were divided into two groups according to the participation in the cardiac rehabilitation program as follows: the Rehab(+) group (n=363) and the Rehab(-) group (n=262). Electrocardiographic parameters of both groups were compared. RESULTS: There was a significant decrease in the electrocardiographic findings of heart rate (p<0.001), QTc (p<0.001), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001) in the Rehab(+) group before and after surgery. There was a significant decrease in the Rehab(+) group, compared to the Rehab(-) group, in terms of parameters of QT interval (p=0.001), QTc (p=0.017), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001). CONCLUSION: Cardiac rehabilitation program after coronary artery bypass grafting decreases ventricular repolarization indices of electrocardiography. Based on these changes, postoperative cardiac rehabilitation program may reduce the risk of ventricular arrhythmia and sudden cardiac death during follow-up.

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions. AIMS: We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI. METHODS: A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine >2 mg/dl). RESULTS: Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20-1.58). The ACEF score was found to be an independent predictor of AKI (P <0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI. CONCLUSIONS: Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI.

Predictors of long-term mortality in acute ST-elevation myocardial infarction patients undergoing emergent coronary artery bypass graft surgery.

OBJECTIVE: Coronary artery bypass graft (CABG) surgery as a primary treatment for acute ST-elevation myocardial infarction (STEMI) is still debated. This study aimed to evaluate the predictors of long-term mortality in STEMI patients undergoing emergent CABG. To the best of our knowledge, this is the first study to evaluate the long-term mortality predictors in patients with STEMI revascularized by primary CABG. METHODS: This retrospective study included 88 consecutive patients with STEMI, who did not qualify for primary percutaneous intervention and required emergent CABG between 2010 and 2017. The study population was divided into the following 2 groups: survivors and nonsurvivors. The 2 groups were compared in terms of demographics, preoperative, intraoperative, and postoperative characteristics. RESULTS: 23 of the 88 patients, died during the median 92.8 (69.0-105.1) months of follow-up. Data were evaluated with univariate and multivariate analyses. Killip class (p<0.001) was found to be an independent predictor of long-term all-cause mortality in patients with STEMI revascularized by CABG, and mortality rates increased significantly as Killip class increased (log-rank test, p<0.001). Moreover, age (p=0.044) was found to be an independent predictor of long-term mortality. Left ventricular ejection fraction, glomerular filtration rate, glucose levels, and left anterior descending artery to the left internal mammary artery graft usage (p=0.001, p=0.009, p<0.001, and p=0.039, respectively) were significantly associated with long-term all-cause mortality for our study population. CONCLUSION: Killip class was found to be an independent predictor of long-term all-cause mortality in patients with STEMI who underwent emergent CABG. The patients' admission status may give valuable information about long-term mortality.

Malnutrition provides important long-term prognostic information in patients undergoing endovascular abdominal aortic aneurysm repair.

OBJECTIVES: Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement. METHODS: We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality. RESULTS: During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p < 0.001) and geriatric nutritional risk index (100.7 ± 10.1 vs 107.6 ± 9.2, p < 0.001) were significantly lower, controlling nutritional status score (2.0 (1.0-4.0) vs 1.0 (0.0-2.0), p < 0.001) was higher when compared to survivor group. Kaplan-Meier curves presented higher mortality incidence in malnutrition patients evaluated with objective nutritional indexes (Log-rang test, for all three indexes p < 0.001). Besides Cox-proportional hazard analysis showed all three nutritional indexes may be a predictive marker for all-cause mortality, prognostic nutritional index introduced more valuable data than other two indexes. CONCLUSIONS: Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.

The prognostic value of fQRSTa in patients with aortic stenosis undergoing surgical aortic valve replacement.

BACKGROUND: Surgical aortic valve replacement (sAVR) is the ultimate therapy for severe aortic stenosis (AS) in suitable patients. Prognostic factors of sAVR are great interest in recent studies. Frontal QRS-T angle (fQRSTa) is a novel marker of ventricular repolarization abnormalities. In this study, we aimed to investigate the prognostic value of fQRSTa in patients with severe symptomatic AS undergoing sAVR. METHODS: A total of 372 patients with severe degenerative AS who underwent successful sAVR were included in this retrospective study. Then, patients were divided into two groups: patients with narrow fQRSTa (≤90°) as group 1 and wide fQRSTa (>90°) as group 2. Perioperative and postoperative clinical evaluation and time of death were recorded from all subjects. RESULTS: The incidence of total mortality was higher in patients with wider fQRSTa (13.8% [15]; 4.9% [9], P = .013) compared to patients with narrow fQRSTa. In multivariate logistic regression analysis, advanced age (odds ratio [OR] = 1.054; 95% confidence interval [CI] = 1.004-1.106; P = .034), dyspnea (OR = 7.687; 95% CI = 2.296-25.729; P = .001), lower efection fraction (OR = 0.924; 95% CI = 0.884-0.966; P = .001), in-hospital duration (OR = 1.051; 95% CI = 1.016-1.088; P = .004) and wider fQRSTa (OR = 4.029; 95% CI = 1.383-11.740; P = .011) were found to be independent predictors of mortality. Additionally, a Kaplan-Meier survival analysis also revealed that long-term survival was found to be significantly decreased in patients with wider fQRSTa (log-rank P = .014). CONCLUSION: fQRSTa was related with poor prognosis in patients with AS undergoing sAVR. fQRSTa was also an independent predictor of mortality in this population.