Predictive Value of the Naples Prognostic Score on Long-Term Outcomes in Patients with Peripheral Artery Disease Revascularized via Percutaneous Intervention.

BACKGROUND: Lower extremity peripheral artery disease (PAD) is the third most common clinical manifestation of atherosclerosis after coronary artery disease and stroke. Despite successful endovascular treatment (EVT), mortality and morbidity rates still remain higher in patients with PAD. Naples prognostic score (NPS) is a novel scoring system, reflects the patient's nutritional and immunological statuses as well as systemic inflammatory responses. In this study, we aimed to investigate the relationship between NPS and long-term outcomes in patients with PAD. METHODS: The population of this retrospective study consisted of 629 PAD patients who underwent EVT at Kafkas University Hospital between 2020 and 2023. For each patient, the NPS was calculated and then patients were divided into 3 groups based on their NPS. The primary end point of the study was the rate of major adverse cardiovascular (MACEs) and limb events (MALEs), that is, all-cause death or development of critical limb ischemia with consequent amputation. RESULTS: Of a total of 629 patients, 62 were classified into group 0 (NPS 0), 315 into group 1 (NPS 1 or 2), and 252 into group 2 (NPS 3 or 4). The distribution of patients' baseline characteristics, angiographic features and MACEs and MALEs according to the NPS groups was analyzed. Significant adverse outcomes differences were observed among the 3 groups (P < 0.001). Multivariate logistic regression analysis revealed that age, diabetes mellitus, chronic kidney disease, lowest preprocedure ankle-brachial index, left ventricular ejection fraction and NPS (hazard ratio 1.916, 95% confidence interval [CI] 1.530-2.398, P < 0.001) were independent predictors of MACE whereas diabetes mellitus, presence of previous PAD, hemoglobin level, in-hospital acute thrombotic occlusion and NPS (odds ratio 1.963, 95% CI 1.489-2.588, P < 0.001) were independent predictors of MALE. CONCLUSIONS: The inflammatory and nutritional state reflected by NPS levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, NPS was found to be an independent predictor of these clinical outcomes.

Evaluation of Symptomatic and Asymptomatic Outpatients in the Post-COVID-19 Period With Electrocardiographic Ventricular Depolarization and Repolarization Parameters

Abstract Background A recently identified viral illness called coronavirus disease 2019 (COVID-19) is spreading quickly. Numerous cardiovascular issues such as arrhythmias and electrocardiogram (ECG) alterations have been linked to COVID-19. Objective In this investigation, we compared ECG indicators of depolarization and repolarization heterogeneity between symptomatic individuals who complained of palpitations and chest discomfort following COVID-19 and those who did not. Methods In this prospective case-control study, 56 post-COVID-19 patients who did not have any symptoms of chest discomfort or palpitations were included in the control group and compared with a study group comprising 73 post-COVID-19 patients who presented at the outpatient clinic with complaints of chest pain and palpitation. Electrocardiographic (ECG) measures were used to assess depolarization and repolarization of the ventricles. These measures included the Tpeak-Tend (Tp-e) interval, QT dispersion (QTd), Tp-e/QT ratio, Tp-e/QTc ratio, frontal QRS-T (fQRS-T) angle, and fragmented QRS (FQRS). Two cardiologists recorded the patients' ECG data. A statistically significant result was defined as a p value less than 0.05. Results The results of multivariate analysis including FQRS, Tp-e interval, Tp-e/QT, and Tp-e/cQT showed that presence of FQRS (OR: 6.707, 95% CI: 1.733-25.952; p = 0.006) was an independent predictor of symptomatic post-COVID -19 patients. Conclusion In our study, FQRS was found to be significantly higher in symptomatic post-COVID-19 patients than in non-symptomatic post-COVID-19 patients, while Tp-e interval was found to be lower.

Predictors of left ventricular ejection function decline in young patients with ST-segment elevation myocardial infarction

SUMMARY OBJECTIVE: A decrease in the left ventricular ejection fraction (≤40%) in the setting of ST-segment elevation myocardial infarction is a significant predictor of mortality in the young ST-segment elevation myocardial infarction population. In this study, we aimed to investigate the predictors of left ventricular ejection fraction reduction and evaluate the long-term mortality rates in young ST-segment elevation myocardial infarction patients with or without decreased left ventricular ejection fraction. METHODS: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial infarction patients aged 45 years or below who underwent primary percutaneous coronary intervention. Young ST-segment elevation myocardial infarction patients were divided into two groups according to their left ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were compared with each other. RESULTS: Statin use, white blood cell count, C-reactive protein, peak creatine kinase-MB, prolonged ischemia time, left anterior descending artery-related infarction, proximally/ostial located lesion, and no-reflow were independently associated with low left ventricular ejection fraction. Additionally, long-term mortality was considerably higher in the left ventricular ejection fraction ≤40% group than those in the left ventricular ejection fraction>40% group (18.1% versus 2.4%; p<0.001). CONCLUSIONS: In young ST-segment elevation myocardial infarction patients, lesion properties (left anterior descending lesion, proximally located lesion), no-reflow, and prolonged ischemia time appeared to be important determinants for the left ventricular ejection fraction decline, rather than coronary disease severity or demographic and hematological parameters. Statin use may be preventive in the development of left ventricular ejection fraction decline in young ST-segment elevation myocardial infarction patients.

Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome.

The association of coronary artery disease (CAD) severity with increased C-reactive protein (CRP) and decreased albumin levels has been reported. However, to our knowledge, no study has investigated the usefulness of the CRP to albumin ratio (CAR) in predicting intermediate-high SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and high SS II. Consecutive patients (n = 344) treated with percutaneous coronary intervention comprised the study population. The study population was divided into 2 groups according to SS >22 and mean SS II values, respectively. Patients with intermediate-high SS and high SS II had higher CAR than patients with low SS and SS II. History of diabetes mellitus, decreased albumin, lower left ventricular ejection fraction, and elevated CAR (odds ratio [OR]: 1.020; 95% confidence interval [CI], 1.009-1.031; P < .001) were independent predictors of high SS. The presence of hypertension, decreased hemoglobin and albumin levels, and increased CAR (OR: 1.014; 95% CI, 1.004-1.023; P < .001) were independent predictors of SS II. In receiver operating characteristic curve comparison, CAR was superior to CRP and albumin in prediction of intermediate-high SS, but only CRP in prediction of high SS II. The CAR calculated from the admission blood samples could be a useful parameter for predicting CAD severity using SS and SS II.

Usefulness of The C-Reactive Protein/Albumin Ratio for Predicting No-Reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: The ratio of serum C-reactive protein (CRP) to albumin has been proven to be a more accurate indicator than albumin and CRP levels alone in determining the prognosis of patients with cancer and critical illness. The aim of this study was to determine whether the CRP/albumin ratio (CAR) can be linked to imperfect reperfusion that can worsen the prognosis of ST-elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention (pPCI). MATERIALS AND METHODS: A total of 1217 consecutive STEMI patients who achieved epicardial vessel patency with pPCI were recruited to this study. RESULTS: The study population was divided into 2 groups: reflow (n = 874) and no-reflow (NR) (n = 343) groups. The white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR) and CAR (0.03 [0.01-0.04] vs 0.06 [0.03-0.12] (P < .001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. The best cut-off value of CAR predicting NR was 0.59 with a sensitivity of 54.7% and specificity of 86.7. The predictive power of CAR surpassed that of CRP, albumin, WBC count and NLR in the receiver operator curve (ROC) curve comparison. CONCLUSION: No-reflow can be predicted by systemic inflammation markers including WBC count, NLR and CAR measured from the blood sample obtained on admission. CAR has a higher clinical value than CRP, albumin level, WBC count and NLR in NR prediction.

Assessment of the relationship between reperfusion success and T-peak to T-end interval in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention.

OBJECTIVE: T-peak-T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI. METHODS: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population. RESULTS: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR. CONCLUSION: To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.

Association of Syntax Score II with Contrast-induced Nephropathy and Hemodialysis Requirement in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI. METHODS: A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN. RESULTS: In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012-1.051; p<0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046-1.078; p<0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p<0.001) and an integrated discrimination improvement of 9.1% (p<0.001). CONCLUSIONS: The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS.

Association of the SYNTAX Score II with cardiac rupture in patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention.

BACKGROUND: Despite advances in reperfusion strategies, medical therapy, and emergent surgery, cardiac rupture (CR) is still a major lethal complication. Numerous parameters have been found to be associated with CR development after a primary percutaneous coronary intervention (pPCI). SYNTAX Score (SS) and SYNTAX Score II (SSII) have been studied in ST-segment elevation myocardial infarction (STEMI) patients, and higher scores have been associated with higher mortality. However, the relationship between CR and SSII is unclear. This study investigates the possible relationship between CR and SS, SSII in STEMI patients treated with pPCI. PATIENTS AND METHODS: We enrolled 1663 consecutive STEMI patients treated with pPCI, who were divided into two groups according to CR development and compared with each other. Patients were further stratified into the three groups according to their SSII values. RESULTS: In this study, 33 (1.98%) patients developed CR. Both SS and SSII of those with CR were significantly higher than those without (19.27±4.0 vs. 16.40±4.55; P<0.001 and 49.40±16.54 vs. 30.92±11.80; P<0.001, respectively). It was also observed that CR increased gradually according to increasing SSII tertiles. SSII was found to be an independent predictor for CR (odds ratio=1.043, 95% confidence interval: 1.012-1.074; P=0.006). In the long-term follow-up, all-cause mortality was significantly higher in patients with CR than those without (60.6 vs. 8.8%; P<0.001). CONCLUSION: This study shows that SSII is an independent predictor for CR. Furthermore, patients with CR were associated with a poor prognosis. Closer follow-up of patients with high SSII may be useful in the early detection and treatment of this fatal complication.