CHA2DS2-VASc score predicts contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction, who have undergone primary percutaneous coronary intervention.

BACKGROUND AND AIM: We aimed to investigate the predictive value of the CHA2DS2-VASc score in the development of contrast-induced nephropathy (CIN). METHODS: A total of 2972 patients who had been diagnosed with ST elevation myocardial infarction (STEMI) and who had undergone primary coronary angioplasty were included in the study. The patients were divided into three groups according to the CHA2DS2-VASc score, i.e.: low risk (1 point), intermediate risk (2 points), and high risk (≥ 3 points). The groups were followed with regard to CIN development. RESULTS: The median CHA2DS2-VASc score was significantly higher in the CIN(+) group compared to the CIN(-) group (3 vs. 2, p < 0.001). The rate of CIN was 3.32-fold higher (OR 3.32, 95% CI 1.98-5.55, p < 0.001) in the high-risk group (CHA2DS2-VASc ≥ 3) compared to the low-risk group (CHA2DS2-VASc = 1). Age (OR 1.25, 95% CI 1.14-1.36, p < 0.001), female gender (OR 1.52, 95% CI 1.23-1.89, p < 0.001), hypertension (OR 1.50, 95% CI 1.265-1.78, p < 0.001), peak creatinine kinase-MB (OR 1.15, 95% CI 1.10-1.21, p < 0.001), and the Killip score > 1 (OR 4.25, 95% CI 3.10-5.82, p < 0.001) were found to be independent predictors for CIN development. CONCLUSIONS: The CHA2DS2-VASc score is an independent and strong predictor of CIN development in patients with acute STEMI.

A Novel Risk Scoring System to Predict Cardiovascular Death in Patients With Acute Myocardial Infarction: CHA2DS2-VASc-CF Score.

The present study aimed to determine the long-term prognostic validity of the CHA2DS2-VASc score in patients with acute myocardial infarction (AMI). In addition, we formulated a novel scoring system, the CHA2DS2-VASc-CF (which includes cigarette smoking and a family history of coronary artery disease as risk factors). This study included 4373 consecutive patients with AMI who presented to the emergency department of our hospital and underwent cardiac catheterization procedures between December 2009 and September 2016. Among these patients, 1427 were diagnosed with ST elevation myocardial infarction (STEMI) and 2946 were diagnosed with non-STEMI. The study included 4373 patients. The study population was divided into 2 groups according to the occurrence of cardiovascular death during the follow-up period. Multivariate logistic regression analysis showed that the CHA2DS2-VASc-CF score, CHA2DS2-VASc score, major adverse cardiac events, current cigarette smoking, older age, hypertension, and family history of coronary artery disease were significantly higher, and that the left ventricular ejection fraction and glomerular filtration rate were significantly lower in the cardiovascular death (+) group. Using a cutoff score of >3 for the CHA2DS2-VASc-CF score, long-term cardiovascular death was predicted with a sensitivity of 78.4% and specificity of 76.4%. The CHA2DS2-VASc-CF score is suitable for use in all patients with AMI, regardless of the type of treatment, presence of atrial fibrillation, and type of AMI. This risk score, which is easy to calculate, provides important prognostic data. In the future, we think that interventional cardiologists will be able to use this novel scoring system to identify patients with a high risk of long-term cardiovascular death.

The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

BACKGROUND: The aim of this study is to determine the impact of ratio of contrast volume to glomerular filtration rate (V/GFR) on development of contrast-induced nephropathy (CIN) and long-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: A total of 645 patients with STEMI undergoing primary PCI was prospectively enrolled. CIN was defined as an absolute increase in serum creatinine > 0.5 mg/dL or a relative increase > 25% within 48 h after PCI. The study population was divided into tertiles based on V/GFR. A high V/GFR was defined as a value in the third tertile (> 3.7). RESULTS: Patients in tertile 3 were older, had higher rate of smoking, diabetes mellitus and CIN, lower left ventricular ejection fraction, hemoglobin, and systolic and diastolic blood pressure compared to tertiles 1 and 2 (p < 0.05). V/GFR was found an independent predictor of in-hospital and 6-month mortality. We found 2 separate values of V/GFR for 2 different end points. While the ratio of 3.6 predicted in-hospital mortality with 78% sensitivity and 82% specificity, the ratio of 3.3 predicted 6-month mortality with 71% sensitivity and 76% specificity. Survival rate decreases as V/GFR increases both for in-hospital and during 6-month follow-up. Diabetes mellitus and multivessel disease were other predictors of in-hospital mortality. CONCLUSIONS: High V/GFR level is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing primary PCI.

The reliability of computed tomography-derived SYNTAX score measurement.

The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) was developed for evaluation of coronary artery disease complexity. We aimed to compare the SS calculated by conventional coronary angiography (CAG) and computed tomography angiography (CTA). Retrospectively, 107 patients were recruited (mean age 55.9 ± 12.4 years). The SS measured by conventional CAG was divided into 3 groups (group 1 SS ≤ 22, group 2 SS > 22 to <32, and group 3 SS ≥ 32). The SS calculated by both methods has a high correlation (r = .972 and P < .001). The κ analysis showed a substantial agreement between both imaging modalities. Computed tomography angiography highly predicted conventional CAG lesions (area under curve 0.96, 95% confidence interval 0.92-0.99, and P < .001). The SS measured by CTA is highly correlated with conventional CAG. Therefore, we propose that prior to coronary revascularization, CTA-derived SS could be used for risk stratification.

Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction.

BACKGROUND: Hemoglobin concentration (Hb) and left ventricular ejection fraction (EF) are known predictors of contrast induced nephropathy (CIN). We hypothesized that combination of Hb concentration and left ventricular EF is superior to either variable alone in predicting contrast induced nephropathy in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS: Consecutive patients with ACS were prospectively enrolled. Patients considered for invasive strategy were included. Baseline creatinine levels were detected on admission and 24, 48 and 72 hours after coronary intervention. 25% or 0,5 umol/L increase in creatinine level was considered as CIN. RESULTS: 268 patients with ACS (mean age 58±11 years, 77% male) were enrolled. Contrast induced nephropathy was observed in 26 (9.7%) of patients. Baseline creatinine concentration, left ventricular EF, and Hemoglobin was significantly different between two groups. Contrast volume to estimated glomerular filtration rate ratio (OR: 1.310, 95% CI: 1.077-1.593, p=0.007) and the combination of Hb and left ventricular EF (OR: 0.996, 95% CI: 0.994-0.998, p=0.001) were found to be independent predictors for CIN. Hb × LVEF ≤690 had 85% sensitivity and 57% specificity to predict CIN (area under curve: 0.724, 95% CI: 0.625-0.824, p<0.001). In addition, Hb × LVEF ≤690 had a negative predictive value of 97% in our analysis CONCLUSIONS: The combination of Hb and left ventricular EF is better than either variable alone at predicting CIN in patients with ACS that undergone percutaneous coronary intervention. The prediction was independent of baseline renal function and volume of contrast agent.

Is there a relationship between severity of coronary artery disease and severity of erectile dysfunction?

INTRODUCTION: The correlation between erectile dysfunction (ED) and coronary artery disease has been emphasized and ED has been recognized as a potential independent risk factor and/or predictor of coronary artery disease (CAD). We evaluated the association between the number of occluded coronary arteries in myocardial infarction (MI) patients with the severity of ED, and investigated the influence of related risk factors in our study group. MATERIALS AND METHODS: 183 male patients who underwent coronary angiography because of acute MI from November 2009 to May 2011 were included. Following the stabilization of patients after the treatment, each patient was evaluated for erectile functionality. Risk factors such as age, diabetes, smoking, waist circumference, hypertension, and hematologic parameters were recorded. RESULTS: Among 183 patients with a mean age of 55.2 years who underwent coronary angiography due to acute MI, 100 (54.64 %) had ED, while the ED rate was 45.36 % (44/97) in cases of single-vessel disease, 64.5 % (31/48) in cases of two-vessel disease, and 65.7 % (25/38) in cases of three-vessel disease. The mean IIEF score was 24.2 ± 4.3, 20.4 ± 4.9 and 20.5 ± 4.2 for single or two or three-vessel disease, respectively. The presence of hypertension aggravated ED only in patients with three-vessel disease and increased total and LDL cholesterol levels in patients with single-vessel or two-vessel disease were accompanied by significantly decreasing IIEF scores. CONCLUSION: The severity of ED correlated with the number of occluded vessels documented by coronary angiography, in male patients with acute myocardial infarction. In addition, the presence of hypertension had a significant influence over erectile function only in patients with three-vessel occlusion.

Is there a relationship between severity of coronary artery disease and severity of erectile dysfunction?

Introduction The correlation between erectile dysfunction (ED) and coronary artery disease has been emphasized and ED has been recognized as a potential independent risk factor and/or predictor of coronary artery disease (CAD). We evaluated the association between the number of occluded coronary arteries in myocardial infarction (MI) patients with the severity of ED, and investigated the influence of related risk factors in our study group. Materials and Methods 183 male patients who underwent coronary angiography because of acute MI from November 2009 to May 2011 were included. Following the stabilization of patients after the treatment, each patient was evaluated for erectile functionality. Risk factors such as age, diabetes, smoking, waist circumference, hypertension, and hematologic parameters were recorded. Results Among 183 patients with a mean age of 55.2 years who underwent coronary angiography due to acute MI, 100 (54.64%) had ED, while the ED rate was 45.36% (44/97) in cases of single-vessel disease, 64.5% (31/48) in cases of two-vessel disease, and 65.7% (25/38) in cases of three-vessel disease. The mean IIEF score was 24.2 ± 4.3, 20.4 ± 4.9 and 20.5 ± 4.2 for single or two or three-vessel disease, respectively. The presence of hypertension aggravated ED only in patients with three-vessel disease and increased total and LDL cholesterol levels in patients with single-vessel or two-vessel disease were accompanied by significantly decreasing IIEF scores. Conclusion The severity of ED correlated with the number of occluded vessels documented by coronary angiography, in male patients with acute myocardial infarction. In addition, the presence of hypertension had a significant influence over erectile function only in patients with three-vessel occlusion. .

Fasting, non-fasting glucose and HDL dysfunction in risk of pre-diabetes, diabetes, and coronary disease in non-diabetic adults.

We determined in non-diabetic persons the risk of fasting and non-fasting glucose levels for pre-diabetes, diabetes, and coronary heart disease (CHD), including the roles of serum C-reactive protein (CRP) and HDL cholesterol, and delineated risk profiles of the pre-diabetic states. Over 7» years, 2,619 middle-aged Turkish adults free of diabetes and CHD were studied prospectively. Using different serum glucose categories including impaired fasting glucose (IFG, 6.1-6.97 mmol/L) and impaired glucose tolerance (IGT), outcomes were analyzed by Cox regression. IFG was identified at baseline in 112 and IGT in 33 participants. Metabolic syndrome components distinguished individuals with IFG from those with normoglycemia. Participants with IGT tended to differ from adults in normal postprandial glucose categories in regard to high levels of triglycerides, apoA-I, and CRP. Diabetes risk, adjusted for sex, age, waist circumference, CRP, and HDL cholesterol, commenced at a fasting 5.6-6.1 mmol/L threshold, was fourfold at levels 6.1-6.97 mmol/L. Optimal glucose values regarding CHD risk were 5.0-6.1 mmol/L. Fasting and postprandial glucose values were not related to CHD risk in men; IGT alone predicted risk in women (HR 3.74 [1.16;12.0]), independent of age, systolic blood pressure, non-HDL cholesterol, waist circumference, smoking status, and CRP. HDL cholesterol was unrelated to the development of IFG, IGT, and diabetes, while CRP elevation independently predicted the development of diabetes. IGT independently predicts CHD risk, especially in women. HDL dysfunction associated with low-grade inflammation is a co-determinant of pre-diabetic states and their progression to diabetes.

Short stature is an independent risk marker for mortality and incident coronary heart disease only in women: a structural relationship?

OBJECTIVE: We evaluated the associations of short stature with coronary heart disease (CHD) risk or overall mortality, which vary with sex and ethnicity/race. METHODS: Such associations were studied prospectively at a mean 13.5-years' follow-up in a population-based sample of 3394 Turkish adults (mean age 44±11 years) using Cox proportional hazards models. Covariates of height were sought in sex-specific tertiles. RESULTS: Height averaged 162.7±6.5 cm. Age-adjusted estimated marginal means for serum triglycerides, C-reactive protein and complement C3 in women (but not men) were significantly higher with decreasing height tertiles. In sex- and age-adjusted models, height was associated in men with neither incident CHD, nor death. In women, 1-SD increment (6.5 cm) in height only tended to marginal inverse association with CHD, but predicted significantly all-cause death (HR 0.83, 95% CI 0.59-0.98); HR attenuated only marginally after further adjustment for family income bracket, smoking status, alcohol usage, systolic blood pressure, serum high-density lipoprotein (HDL)- and non HDL-cholesterol. A threshold below 160 cm of female height doubled the adjusted risk of death compared to taller women. CONCLUSION: In contrast to men, short stature in Turkish women tends to be an independent risk marker for CHD, and height below 160 cm is a strong marker of death. Gender-specific early-life influences enhancing pro-inflammatory state may affect death and future CHD.

Serum γ-glutamyltransferase: independent predictor of risk of diabetes, hypertension, metabolic syndrome, and coronary disease.

Serum γ-glutamyltransferase (GGT) is associated with oxidative stress and hepatic steatosis. The extent to which its value in determining incident cardiometabolic risk (coronary heart disease (CHD), metabolic syndrome (MetS), hypertension and type 2 diabetes) is independent of obesity needs to be further explored in ethnicities. After appropriate exclusions, a cohort of 1,667 adults of a general population (age 52 ±11 years) was evaluated prospectively at 4 year's follow-up using partly Cox proportional hazard regressions. GGT activity was measured kinetically, and values were log-transformed for analyses. MetS was identified by Adult Treatment Panel-III criteria modified for male abdominal obesity. Median (interquartile range) GGT activity was 24.9 (17.0; 35.05) U/l in men, 17.0 (12.3; 24.0) U/l in women. In linear regression analysis, while smoking status was not associated, (male) sex, sex-dependent age, alcohol usage, BMI, fasting triglycerides and C-reactive protein (CRP) were significant independent determinants of circulating GGT. Each 1-s.d. increment in (= 0.53 ln GGT) GGT activity significantly predicted in each sex incident hypertension (hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10; 1.31)), and similarly MetS, after adjustment for age, alcohol usage, smoking status, BMI and menopause. Strongest independent association existed with diabetes (HR 1.3 (95% CI 1.1; 1.5)) whereas GGT activity tended to marginally predict CHD independent of total bilirubin but not of BMI. Higher serum total bilirubin levels were protective against CHD risk in women. We conclude that elevated serum GGT confers, additively to BMI, risk of hypertension, MetS, and type 2 diabetes but only mediates adiposity against CHD risk.

Diverging sex-specific long-term effects of cigarette smoking on fasting insulin and glucose levels in non-diabetic people.

OBJECTIVES: We determined in non-diabetic persons the associations of current smoking with future glucose and insulin concentrations. DESIGN AND METHODS: Middle-aged non-diabetic adults (n=1071) were studied in whom these values were measured at baseline and 5.2-years later. RESULTS: Age-adjusted fasting insulin concentrations in 137 smoking men remained lower than never smokers at both surveys. While age-adjusted fasting glucose values in male never smokers declined at follow-up (p=0.037), they rose in male smokers. In 94 female smokers, age-adjusted fasting insulin values marginally declined, and fasting glucose was reduced (by 0.09 mmol/L, p=0.055) during follow-up. In contrast in never-smoking women, insulin and glucose concentrations rose (p<0.001 in both). Age-adjusted insulin levels in former smokers exhibited similar trends as never smokers. Trends were essentially unchanged when adjustment included body mass index. Current male smokers demonstrated evidence of reduced insulin sensitivity, female smokers of improved one, as assessed by QUICKI. CONCLUSION: Smoking among Turks induces at long-term lower fasting insulin levels which represent improved insulin sensitivity in women, yet a reduced one in men.

[Primary angioplasty in women with ST-elevation myocardial infarction: in-hospital and long-term clinical results]. / ST yükselmeli miyokart enfarktüslü kadinlarda primer anjiyoplasti: Hastaneiçi ve uzun dönem klinik sonuçlar.

OBJECTIVES: We evaluated in-hospital and long-term clinical results of female patients following primary angioplasty for ST-elevation myocardial infarction (STEMI), in comparison with male patients. STUDY DESIGN: We reviewed 2,644 patients (2,188 males, 456 females) who underwent primary angioplasty for STEMI between October 2003 and March 2008. Data on female patients concerning demographic and clinical characteristics, primary angioplasty results, in-hospital and 25-month follow-up results were compared with those of male patients. RESULTS: Hypertension, diabetes mellitus, anemia, shock, and renal failure were more common in female patients, while smoking was more frequent in males (p<0.05). The mean age was higher in female patients (63.9±11.7 vs. 55.2±11.3 years, p<0.001). Females also presented with higher values of glucose, mean platelet volume, and platelet count, and lower hemoglobin and hematocrit values (p<0.05). The frequencies of multivessel disease and procedure failure were significantly higher, and pain-to-balloon time was significantly longer in females (p<0.05). Mortality associated with cardiovascular causes occurred in 148 patients (5.6%), being significantly higher in females (9.4% vs. 4.8%, p<0.001). In-hospital mortality, major cardiac events, stroke, cardiogenic shock, and major bleeding were more frequent in women (p<0.05). Long-term mortality rate was also significantly higher in females (10% vs. 4.5%, p<0.001). Multivariate analysis showed female gender as one of the independent predictors of mortality (odds ratio=1.75, 95% CI 1.02-2.99; p<0.04). CONCLUSION: Female patients with STEMI undergoing primary angioplasty have a higher risk profile and poorer in-hospital and follow-up clinical results. Therefore, female patients should be treated more aggressively.

Coronary disease risk and fasting glucose levels in a non-diabetic population.

We addressed whether or not the risk of coronary heart disease (CHD) in non-diabetic persons is linear at the lower end of fasting glucose levels. Middle-aged Turkish adults (n=2893) free from diabetes and CHD at baseline were studied prospectively over a 7.6-year follow-up. Participants with fasting glucose measurements were analyzed in 3 groups separated by 90 mg/dl and 110 mg/dl limits. Outcomes were analyzed by Cox regression. Cox regression for CHD incidence (n=374) showed an increased age-adjusted risk in the <90 mg/dl fasting glucose group (n=788) [HR 1.32 (1.03; 1.68)], compared with the 90-110 mg/dl group after adjustment for sex, age and the glucose groups. Further adjustment for waist circumference, C-reactive protein and conventional risk factors attenuated the HR to 1.27 (p=0.077). The risk profile in the low-glucose group could not be accounted for by age, smoking status, systolic blood pressure or fasting insulin levels but tended to show higher levels of circulating C-reactive protein. The increased CHD risk observed in individuals with lower compared with higher normal glucose concentrations is likely to be related to an associated pro-inflammatory state.

APOC3 -482C>T polymorphism, circulating apolipoprotein C-III and smoking: interrelation and roles in predicting type-2 diabetes and coronary disease.

OBJECTIVES: We determined the relationship of smoking status on APOC3 -482C>T polymorphism and apolipoprotein C-III (apoC-III) concentrations and the latter two parameters' influence on risk of diabetes and coronary heart disease (CHD). DESIGN AND METHODS: Prediction of incident cases was assessed at 5.5years' follow-up in unselected 519 individuals of a general population genotyped for -482C>T polymorphism. RESULTS: Female sex and current smoking were significantly associated with low circulating apoC-III in subjects without (p≤0.033) than with abdominal obesity (p=0.053) or than insulin resistant -482TT homozygotes (p=0.034) who had 20-30% higher serum apoC-III. Multi-adjusted serum apoC-III was log-linearly associated with fasting triglycerides. ApoC-III levels determined the development of diabetes [RR 1.56 (95%CI 1.21; 2.01)] and CHD [RR 1.38 (1.10; 1.72) for an increment of 14%], after adjustment for confounders. CONCLUSION: APOC3 -482TT genotype is associated with high apoC-III concentrations only in the presence of abdominal obesity or insulin resistance, but not in current smokers who remain lean or insulin-sensitive. Rather than APOC3 -482C>T polymorphism, circulating apoC-III determines cardiometabolic risk.