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BACKGROUND: In patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied. METHODS: We conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation. RESULTS: In all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI - 1.3%-1.6%, P < .0001; non-inferiority margin 5%). CONCLUSION: A strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings. (CTRI/2018/08/015384).
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Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Angioplastia , Infarto del Miocardio con Elevación del ST/terapia , Tomografía Computarizada de Emisión de Fotón Único , Resultado del TratamientoRESUMEN
Coronary artery ectasia (CAE) is associated with increased risk of mortality, equivalent to that of patients with obstructive coronary artery disease (CAD). Considering the role of inflammation in the pathogenesis of CAE, we aimed to investigate whether there is an association between systemic immune-inflammation index (SII) and isolated CAE. The study population included 510 patients of which 170 patients with isolated CAE, 170 patients with obstructive CAD and 170 patients with normal coronary angiograms (NCA). The severity of CAE was determined according to the Markis classification. Patients with isolated CAE had significantly higher SII values compared to those with obstructive CAD and NCA [median 550 IQR (404-821), median 526 IQR (383-661), and median 433 IQR (330-555), respectively, p < .001]. In multivariate analysis, SII (OR 1.032, 95% CI 1.020-1.044, p = .003), male gender (OR 2.083, p = .008), eGFR (OR 0.979, p = .016), and CRP (OR 1.105, p = .005) were independent factors of isolated CAE. Moreover, in the Spearman correlation analysis, there was a moderate but significant positive correlation between SII and CRP (r = 0.379, p < .001). In conclusion, higher SII levels were independently associated with the presence of isolated CAE. This result suggests that a more severe inflammatory process may play a role in the development of this variant of CAD.
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Enfermedad de la Arteria Coronaria , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/patología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Dilatación Patológica/diagnóstico por imagen , Dilatación Patológica/patología , Humanos , Inflamación/patología , MasculinoRESUMEN
PURPOSE: An elevated left ventricular (LV) filling pressure is the main finding in heart failure patients with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines. In this study, we sought to determine the efficacy of the LV global longitudinal strain (GLS) in predicting an elevated LV filling pressure. METHODS AND RESULTS: A total of 73 prospectively selected patients undergoing LV catheterization (mean age 63.19 ± 9.64, 69% male) participated in this study. Using the algorithm, the LV filling pressure was estimated using the echocardiographic parameters obtained within 24 hours before catheterization. The LV GLS was measured using an automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and a LAP of >12 mm Hg was defined as elevated. Invasive LV filling pressure was elevated in 43 patients (59%) and normal in 30 patients (41%). Nine of 73 (12%) patients were defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS determined the elevated LAP (AUC =0.79; specificity, 73%; sensitivity, 84%) with better sensitivity compared to that by the algorithm (AUC =0.76; specificity, 77%; sensitivity, 72%). CONCLUSIONS: We demonstrated that LV GLS was an independent predictor of elevated LAP as the E/e' ratio and TR jet velocity and may be used as a major criterion for the diagnosis of HFpEF.
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Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Anciano , Presión Atrial , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico por imagen , Función Ventricular Izquierda , Presión VentricularRESUMEN
BACKGROUND: Acute Stanford type A aortic dissection (ATAAD) is a life-threatening medical emergency. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a novel inflammatory marker for ATAAD patients undergoing surgical repair. METHODS: We retrospectively examined the medical records of 151 ATAAD patients who treated surgically. Patients were divided into two groups (survival and death) and these groups were compared with respect to clinical and laboratory parameters. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Logistic regression analyses were performed to identify the risk factors of in-hospital mortality. RESULTS: The mean age of the study cohort was 61 ± 12 years, 99 (65.6%) were males, and 35 (23.2%) patients died during the hospital stay. The PNI levels were significantly lower in death group compared with survival group (32.80 ± 4.90 vs. 37.94 ± 5.42, p < 0.001). Multivariate analysis showed that the PNI (OR: 0.795, p = 0.005), age (odds ratio [OR]: 1.085, p = 0.034), operating time (OR: 1.660, p = 0.042), and D-dimer (OR: 1.002, p = 0.001) independently predicted in-hospital mortality. The calculated cutoff value of the PNI was 33.01. CONCLUSION: Lower PNI values are independently associated with in-hospital mortality in ATAAD. The PNI may be a useful tool for predicting the early mortality of ATAAD patients after surgical repair.
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Disección Aórtica , Evaluación Nutricional , Anciano , Disección Aórtica/cirugía , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) previously known as contrast-induced nephropathy is associated with a worse prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a simple index comprised of serum albumin level and lymphocyte count which reflects the immunonutritional-inflammatory status. Recently, clinical studies have shown associations between the PNI and clinical outcomes in several cardiovascular diseases. The aim of the study was to assess the possible utilization of the PNI to predict the development of CA-AKI after primary PCI. METHODS: We retrospectively included 836 patients (mean age 58 ± 12 years, 76% men) with STEMI treated with primary PCI. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The patients were divided into two groups according to whether or not CA-AKI developed. RESULTS: The overall incidence of CA-AKI was 9.4%. Compared to the patients without CA-AKI, those with CA-AKI had a significantly lower PNI value (40.7 ± 3.7 vs. 35.2 ± 4.9; p < 0.001). In receiver operating characteristic curve analysis, the optimal cutoff value of the PNI to predict CA-AKI was 38, with 82% sensitivity and 70% specificity (area under the curve 0.836, p < 0.001). In multivariate logistic regression analysis, PNI < 38, body mass index and creatinine were independently associated with CA-AKI (odds ratio 11.275, 95% confidence interval 3.596-35.351; p < 0.001). CONCLUSIONS: The PNI was inversely and significantly associated with the development of CA-AKI in acute STEMI. Assessing PNI at admission may be useful for early risk stratification of STEMI patients.
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PURPOSE OF REVIEW: Herein, we provide a review of the recent literature on the epidemiological and pathophysiological relationship between hypertension (HTN) and diabetes mellitus, along with prognostic implications and current treatment concepts. RECENT FINDINGS: Diabetes mellitus affects â¼10% of US adults. The prevalence of HTN in adults with diabetes mellitus was 76.3% or 66.0% based on the definitions used by guidelines. There exist differences among major society guidelines regarding the definition of HTN and target blood pressure (BP) levels. Recent basic and clinical research studies have shed light on pathophysiologic and genetic links between HTN and diabetes mellitus. Randomized controlled trials over the past 5 years have confirmed the favorable BP and cardiovascular risk reduction by antidiabetic agents. SUMMARY: HTN and diabetes mellitus are 'silent killers' with rising global prevalence. The development of HTN and diabetes mellitus tracks each other over time. The coexistence of both clinical entities synergistically contributes to micro- and macro-vasculopathy along with cardiovascular and all-cause mortality. Various shared mechanisms underlie the pathophysiological relationship between HTN and diabetes mellitus. Moreover, BP reduction with lifestyle interventions and antihypertensive agents is a primary target for reducing cardiovascular risk among patients with HTN and diabetes mellitus.
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Diabetes Mellitus/epidemiología , Hipertensión/tratamiento farmacológico , Adulto , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Determinación de la Presión Sanguínea , HumanosRESUMEN
BACKGROUND: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. OBJECTIVE: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. METHODS: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. RESULTS: The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. CONCLUSION: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.
FUNDAMENTO: A circulação colateral coronária (CCC) pode efetivamente melhorar o suprimento sanguíneo miocárdico para a área de OCT (oclusão coronariana total crônica) e pode, assim, melhorar o prognóstico de pacientes com síndrome coronariana estável (SCE). O grau de inflamação e alguns marcadores de inflamação foram associados ao desenvolvimento de colaterais. OBJETIVO: Investigar se o índice nutricional prognóstico (INP) tem associação com o desenvolvimento de CCC em pacientes com SCE. MÉTODOS: Um total de 400 pacientes com SCE com presença de OTC em pelo menos uma importante artéria coronária epicárdica foi incluído neste estudo. Os pacientes foram divididos em dois grupos de acordo com o escore Rentrop. Escores de 0 a 1 foram considerados CCC pouco desenvolvidas e escores de 2 a 3 foram aceitos como CCC bem desenvolvidas. A significância estatística foi definida como um valor p < 0,05 para todas as análises. RESULTADOS: A média de idade da coorte do estudo foi de 63±10 anos; 273 (68,3%) eram do sexo masculino. O grupo CCC pouco desenvolvido apresentou um nível de INP significativamente mais baixo em comparação com o grupo CCC bem desenvolvido (38,29±5,58 vs 41,23±3,85, p<0,001). Na análise multivariada, o INP (odds ratio 0,870; intervalo de confiança de 95% 0,822-0,922; p<0,001) foi um preditor independente de CCC pouco desenvolvida. CONCLUSÃO: O INP pode ser utilizado como um dos preditores independentes da formação do CCC. Foi positivamente associado ao desenvolvimento de colaterais coronárias em pacientes com SCE com OTC.
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Angina Estable , Oclusión Coronaria , Masculino , Humanos , Persona de Mediana Edad , Anciano , Femenino , Evaluación Nutricional , Pronóstico , Circulación Colateral , Circulación Coronaria , Inflamación , Angiografía CoronariaRESUMEN
Systemic immune-inflammation index (SII), which is a good predictive marker for coronary artery disease, can be calculated by using platelet, neutrophil, and lymphocyte counts. The no-reflow occurrence can also be predicted using the SII. The aim of this study is to reveal the uncertainty of SII for diagnosing ST-elevation myocardial infarction (STEMI) patients who were admitted for primary percutaneous coronary intervention (PCI) for the no-reflow phenomenon. A total of 510 consecutive acute (STEMI) patients with primary PCI were reviewed and included retrospectively. For diagnostic tests which are not a gold standard, there is always an overlap between the results of patients with and without a certain disease. In the literature, for quantitative diagnostic tests where the diagnosis is not certain, two approaches have been proposed, named "grey zone" and "uncertain interval". The uncertain area of the SII, which is given the general term "gray zone" in this article, was constructed and its results were compared with the "grey zone" and "uncertain interval" approaches. The lower and upper limits of the gray zone were found to be 611.504-1790.827 and 1186.576-1565.088 for the grey zone and uncertain interval approaches, respectively. A higher number of patients inside the gray zone and higher performance outside the gray zone were found for the grey zone approach. One should be aware of the differences between the two approaches when making a decision. The patients who were in this gray zone should be observed carefully for detection of the no-reflow phenomenon.
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Background: Atrial fibrillation (AF) remains the most common arrhythmia following mitral valve surgery. Although numerous clinical and laboratory indicators and possible mechanisms of postoperative AF (PoAF) have been described, the role of microvascular dysfunction in pathogenesis has not been assessed. We aimed to evaluate the association between microvascular dysfunction and PoAF in patients undergoing isolated mitral valve replacement. Methods: 188 patients undergoing mitral valve replacement were included in this retrospective study. Demographic characteristics of the patients were recorded. Angiographic assessment of microvascular perfusion was performed using the myocardial blush grading technique for each patient. Univariate and multivariate logistic regression analyses were utilized to determine predictors of PoAF. Results: Of 188 patients (56.69 ± 8.9 years, 39.4% male) who underwent mitral valve replacement, 64 (34%) patients developed PoAF. In the PoAF group, a lower basal hemoglobin level (12.64 ± 0.89 vs. 14.46 ± 0.91 g/dL; p < 0.001), a higher left atrial diameter [5.9 (5.2-6.47) vs. 4.9 (4.5-5.8) cm; p < 0.001], and a lower total blush score (TBS) (8.33 ± 0.84 vs. 8.9 ± 0.31; p < 0.001) were detected. Multivariate logistic regression analysis revealed that preoperative LA diameter (OR:2.057; 95% CI: 1.166-3.63; p = 0.013), preoperative hemoglobin (OR:0.12; 95% CI: 0.058-0.245; p < 0.001), and abnormal TBS (OR:15.1; 95% CI: 1.602-142.339; p = 0.018) were independent predictors of PoAF. Conclusions: Our findings demonstrated that TBS at the preoperative period was an independent predictor of PoAF in patients undergoing isolated mitral valve replacement.
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AIMS: Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of cardioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF. METHODS AND RESULTS: Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulse-wave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The >10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk >10%, and the ≤10% group (100 patients; 68%) was defined as having a predicted risk <10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score (r = -0.74, p < 0.0001). CONCLUSIONS: LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.
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Fibrilación Atrial , Humanos , Masculino , Persona de Mediana Edad , Anciano , Fibrilación Atrial/complicaciones , Atrios Cardíacos/diagnóstico por imagen , Factores de Riesgo , Ecocardiografía/métodos , Frecuencia CardíacaRESUMEN
We herein describe a challenging acute anterior ST-elevation myocardial infarction (STEMI) case. The patient was hemodynamically unstable during the procedure and the extremely angulated culprit vessel hindered our repeated attempts of wiring. Procedural complexity and risks were increased not only due to angulation but also the bifurcational nature of the culprit lesion. We report an innovative solution that enabled the successful revascularisation of such a complex situation, after the failure of multiple attempts of conventional methods for wiring. We also briefly review the literature about recommended methods for such severely angulated vessels. Key Words: Angulation, infarction, Vessel, Angiography.
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Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Angiografía Coronaria , Intervención Coronaria Percutánea/métodos , Infarto del Miocardio con Elevación del ST/cirugía , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugíaRESUMEN
BACKGROUND: Lower extremity arterial disease is usually a widespread vessel disease of atherosclerotic origin with a predisposition for certain anatomical sites. This study aimed to evaluate the relationship between lower extremity arterial disease anatomic and clinical features and various sitting patterns. METHODS: Patients who underwent invasive peripheral angiography and who were diagnosed with lower extremity arterial disease in a single tertiary center were included in the study. Six sitting positions were defined. Sitting patterns and other clinical data were collected using a standardized questionnaire. RESULTS: In this study, 150 patients diagnosed with lower extremity arterial disease who underwent invasive peripheral angiography were enrolled. The mean age of the study population was 66.2 ± 9.5 years, and an overwhelming majority of the participants were men (91.3% vs. 8.7%). A significant relationship was found between sitting positions #1-5 and right-sided lesions, as well as sitting positions #1-4 and left-sided lesions (sitting position #5 and right-sided lesions P=.039, all others P <.001). Longer and more frequent sitting conditions were found to be associated with lesions in the proximal arteries (common iliac artery and external iliac artery) but not in the more distal artery (superficial femoral artery, popliteal artery, anterior tibial artery, and posterior tibial artery) lesions. CONCLUSIONS: A clear relationship between sitting positions and lower extremity arterial disease sites was demonstrated. This data indicate that sitting patterns should be evaluated in every lower extremity arterial disease patient.
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Extremidad Inferior , Sedestación , Anciano , Angiografía , Femenino , Arteria Femoral , Humanos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Arteria PoplíteaRESUMEN
Cardiac resynchronization therapy is a treatment modality developed in the early 2000s that targets the mechanical and electrical dyssynchrony in heart failure with reduced ejection fraction patients. Appropriate patient selection conditions specified in the guidelines include measurement of left ventricular systolic dysfunction, QRS width, and assessment of functional classification. Despite consistent and increasing evidence sup-porting the use of cardiac resynchronization therapy in eligible patients, proportion of patients with the device is still not at the desired level. In addition, studies conducted in recent years have shown that the cardiac resynchronization therapy response of patients is quite heterogeneous and in echocardiographic follow-up, it was observed that reverse remodeling was not at the supposed level in approximately one-third of the patients. In order to change this result, which is due to many reasons, solutions such as using assistive imaging methods, providing optimal patient selection, trying different pacing techniques and post-procedural programming strategies (AV-delay and VV-delay optimization) have been the subject of debate. In this article, we aim to review the mechanisms that have been revealed regarding the differences in cardiac resynchronization therapy response and new pacing techniques-especially conduction system pacing-that may be preferred to resolve poor cardiac resynchronization therapy response.
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Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Ecocardiografía , Sistema de Conducción Cardíaco , Insuficiencia Cardíaca/terapia , Humanos , Resultado del TratamientoRESUMEN
Coronary artery anomalies (CAA) are frequently asymptomatic clinical entities, associated with variable prognosis. Single coronary artery anomaly is a rare type of coronary anatomy anomaly with little data in the literature. Although prognostic data are not clear, it is thought that the course of anomalous artery is the most important determinant. Percutaneous revascularisation of concomitant atherosclerotic disease in anomalous coronary arteries may be technically challenging. In this report, we present a case of a single coronary artery undergoing percutaneous revascularisation with an alternative technique of advancing a guidewire into the anomalous left main coronary artery and then crossing the culprit lesion in the left anterior descending artery. This report highlights the importance of catheter stabilisation during percutaneous revascularisation with a simple yet very practical solution. Key Words: Coronary angiography, Coronary vessel anomalies, Myocardial infarction, Percutaneous coronary intervention.
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Enfermedad de la Arteria Coronaria , Anomalías de los Vasos Coronarios , Intervención Coronaria Percutánea , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , HumanosRESUMEN
Intervention of aorto-ostial stent restenosis is challenging due to coronary anatomical variations, possible non-selective ostial engagements, and difficulties crossing the central lumen. Aorto-ostial stent restenosis is intervened through the central lumen or protruding side struts using various techniques. These techniques are often difficult and complex such as double wire technique, balloon-assisted technique, snare technique, side-strut sequential ballooning technique, and guideline-facilitated side strut stenting technique. In this case report, we presented an intervention for right coronary artery (RCA) ostial stent restenosis using a combination of balloon-assisted double wire technique and side-strut stenting technique in an acute coronary syndrome patient.
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BACKGROUND: Left atrial scar is an important entity in the atrial fibrillation substrate. P wave dispersion (PWD) is an indicator of slow and inhomogeneous conduction in the atria. In this study, we aim to investigate the relation between PWD and left atrial scars identified by electroanatomical mapping. METHODS: Patients who had an electroanatomical map obtained during sinus rhythm as well as at least one electrocardiogram in sinus rhythm prior to the procedure were included in the study. Left atrial scar (defined as <0.5 mV) area was calculated on the electroanatomical map. Maximum and minimum P wave duration and PWD were compared between patients with and without left atrial scar. RESULTS: A total of 224 patients were enrolled in the study. Of them, 47.9% of the patients were female. On the electroanatomical map, left atrial scar was identified in 103 patients, and no scar was present in 121 patients. PWD was significantly increased in patients with left atrial scar when compared to the no-scar group (46 ms ± 20 vs. 38 ms ± 15, respectively, p < 0.001). Similarly, PWD was significantly increased in patients with moderate-to-severe scar, when compared to patients with mild scar (50 ms ± 19 vs. 41 ms ± 19, respectively, p = 0.026). PWD was found not to be a good predictor of left atrial scar with an AUC of 0.625 for scar vs. no scar. CONCLUSION: PWD is significantly increased in patients with left atrial scar identified by electroanatomical mapping, however, the receiver operating characteristic analysis showed that PWD is not a good predictor of presence of left atrial scar.
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Fibrilación Atrial , Ablación por Catéter , Humanos , Femenino , Masculino , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Cicatriz/diagnóstico , Cicatriz/etiología , Recurrencia , Atrios Cardíacos , Electrocardiografía/métodosRESUMEN
OBJECTIVE: Systemic immune-inflammation index (SII), on the basis of lymphocyte, neutrophil and platelet counts had been published to be a good prognostic factor in coronary artery disease. Nevertheless, the prognostic value of Systemic immune-inflammation index (SII) in a condition of no-reflow phenomenon (NRP) remains inconsistent, we evaluated the SII as a simple calculated tool for predicting the NRP among patients with STEMI who underwent primary percutaneus coronary intervention (PCI). METHOD: 510 consecutive acute STEMI patients who underwent primary PCI within 12 h from symptom onset from October 2015 to January 2020 were enrolled in our study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. Multivariate stepwise logistic regression, including covariates found to have a significant association with NRP in univariate analysis, was used to identify independent predictors of no-reflow. RESULTS: A ROC curve analysis showed that the best cut-off value of SII for predicting no-reflow was 1028, with sensitivity and specificity of 79% and 70, respectively (AUC, 0.839; 95% CI 0.797-0.881). An ROC curve comparison analysis was performed to compare the SII with NLR and PLR. Multivariate analysis revealed that SII ≥1028 value (OR = 6.622, 95% confidence interval (CI): 3.802-11.627, p < .001), not using aspirin prior to admission (OR = 0.431, 95%CI: 0.236-0.786, p = .006), and CRP (OR = 1.004, 95%CI: 1.001-1.008, p = .041) were independent predictors related to occurrence of NRP after primary PCI in patients with acute STEMI. CONCLUSION: SII levels are independently associated with the NRP in patients undergoing primary PCI for acute STEMI. High SII may be a promising indicator for the prediction of NRP in these patients.
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Fenómeno de no Reflujo , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Inflamación , Neutrófilos , Fenómeno de no Reflujo/diagnóstico , Fenómeno de no Reflujo/etiología , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/cirugíaRESUMEN
A 63-year-old man with active COVID-19 infection and a history of coronary artery bypass grafting presented with acute thrombotic occlusion of saphenous venous graft which was anastomosed to the left anterior descending artery. Initial antegrade approach, complicated by a small leakage in the distal left anterior descending artery, was later converted to a retrograde approach via occluded saphenous vein graft. After successful stenting, TIMI 3 flow was achieved.
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COVID-19 , Trombosis , COVID-19/complicaciones , Angiografía Coronaria/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Vasos Coronarios/cirugía , Humanos , Masculino , Persona de Mediana Edad , Vena Safena , Trombosis/diagnóstico por imagen , Trombosis/etiologíaRESUMEN
Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology in the developed world. Nonalcoholic fatty liver disease is associated with a higher risk of cardiovascular disease. We investigated the impact of ranolazine on liver tests in patients with NAFLD and coronary artery disease (CAD). Patients who had established CAD and NAFLD (as assessed by raised serum transaminase activity, sonographic criteria, and the absence of any other obvious liver disease) were allocated to "on ranolazine" (n = 40) or "not on ranolazine" (n = 35) groups. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured in all patients at baseline and at the end of the study. After 6 months of ranolazine treatment, both ALT and AST activities were significantly lower in patients in the "on ranolazine" group compared with "not on ranolazine" patients (change from baseline: ALT, -11.0 ± 1.7 IU/L, P < .001; AST, -5.2 ± 1.9 IU/L, P =.009). In conclusion, the present study showed that treatment with ranolazine for 6 months led to a significant reduction in the activities of both serum aminotransferases in patients with stable CAD and NAFLD.
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Enfermedad de la Arteria Coronaria , Enfermedad del Hígado Graso no Alcohólico , Aspartato Aminotransferasas , Humanos , Pruebas de Función Hepática , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Ranolazina/uso terapéuticoRESUMEN
BACKGROUND: Cardioneuroablation is one of the emerging therapies in vasovagal syncope. In this study, we present a simple method of cardioneuroablation performed via a rightsided approach, targeting anterior-right and right-inferior ganglionated plexi, along with procedural and follow-up data. METHODS: Patients who had underwent cardioneuroablation between March 2018 and September 2019 with vasovagal syncope in 2 clinics were enrolled in the study. All patients underwent radio-anatomically guided radiofrequency ablation targeting anterior-right ganglionated plexi and right-inferior ganglionated plexi. Syncope and symptom burden, 24-hour ambulatory electrocardiogram data at presentation, and at follow-up were assessed along with procedural data. RESULTS: A total of 23 patients underwent modified right-sided cardioneuroablation. Mean basal cycle length decreased significantly from 862.3 ± 174.5 ms at the beginning of the procedure 695.8 ± 152.1 ms following the final radiofrequency ablation (P < .001). Mean 24-hour ambulatory heart rate increased significantly from 66.4 ± 10.7 bpm at baseline to 80 ± 7.6 bpm at follow-up (P < .001). Only 1 patient had 1 episode of syncope following the procedure at the mean follow-up period of 10 ± 2.9 months. The same patient had recurrent presyncope. CONCLUSION: The right-sided cardioneuroablation approach was found to be an effective treatment for vasovagal syncope and may be regarded as a default initial cardioneuroablation technique.