ST-segment elevation of right precordial lead (V4 R) is associated with multivessel disease and increased in-hospital mortality in acute anterior myocardial infarction patients.

BACKGROUND: ST segment elevation of chest lead V4 R is associated with worse prognosis in acute inferior ST-elevation myocardial infarction (STEMI). This study tried to determine the relationship between ST elevation in the right precordial lead V4 R and acute anterior STEMI. METHODS: Prospective study of 144 consecutive anterior STEMI patients: all had 15-lead ECG recordings (12 conventional leads and V3 R-V5 R) obtained. Patients were classified into two groups on the basis of presence (Group I, 50 patients) or absence (Group II, 94 patients) of ST-segment elevation ≥0.5 mm in lead V4 R. RESULTS: Multivessel involvement was significantly higher in Group I compared with Group II (54% and 23% respectively, P < 0.001). Major adverse cardiac events and in-hospital mortality was also significantly higher for those in Group I (P < 0.02 for both). A significant correlation was found between in-hospital mortality and those in Group I (P = 0.03, OR: 6.27, CI: 1.22-32.3). There was an independent relationship between in-hospital mortality and V4 R-ST elevation (P = 0.03, OR: 11.64, CI: 1.3-27.4). CONCLUSION: ST segment elevation in chest lead V4 R is associated with multivessel disease and increased in-hospital mortality in patients with anterior STEMI that had undergone primary percutaneous coronary intervention to the left anterior descending artery.

Neutrophil-to-lymphocyte ratio as a prognostic marker in infective endocarditis: in-hospital and long-term clinical results.

BACKGROUND AND AIM OF THE STUDY: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor prognosis in different clinical conditions such as infectious and cardiovascular diseases. It was hypothesized that a patient's admission NLR would be predictive of an adverse clinical outcome in cases of infective endocarditis (IE). METHODS: A total of 171 patients with IE was enrolled retrospectively, and allocated to two tertiles based on admission NLR values. The high-NLR group (n = 76) was defined as having an NLR value in the third tertile (> 5.46), and the low-NLR group (n = 95) as having a value in the lower two tertiles (≤ 5.46). RESULTS: Patients in the high-NLR group had a significantly higher incidence of in-hospital mortality than the low-NLR group (39.4% versus 18.9%, p = 0.003). A high NLR was found to be an independent predictor of in-hospital mortality (odds ratio 2.53, 95% confidence interval 1.19-5.3; p = 0.01). The mean follow up was 25.5 months, and long-term follow up mortality was similar in both groups (12.9% versus 19.5%; p = 0.33). CONCLUSION: A high NLR at admission is associated with increased in-hospital mortality in patients with IE. During the long-term follow up, NLR showed no predictive indication of mortality.

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.

Serum creatinine is associated with coronary disease risk even in the absence of metabolic disorders.

BACKGROUND: In view of recent evidence that serum creatinine and dysfunctional apolipoprotein (apo)A-I may serve as inflammation mediators in people with enhanced inflammation, we studied whether or not these molecules were interrelated and associated with coronary heart disease (CHD) likelihood even in subjects without metabolic syndrome (MetS) or type-2 diabetes. METHODS: Among unselected middle-aged Turkish adults with available serum apo A-I, lipoprotein(a) and creatinine measurements, 697 participants (designated as 'healthy') were enrolled, after exclusion of the stated metabolic disorders. CHD was identified in 87 subjects, roughly half during 3.1 years' follow-up. RESULTS: 'Healthy' individuals were overweight and had partly impaired fasting glucose but otherwise normal serum creatinine and other biochemical measurements. Being consistent with lacking anti-inflammatory activity, apoA-I was linearly and positively associated with apoB, in women further with creatinine. Logistic regression analyses showed that, beyond age, not non-HDL-cholesterol, systolic blood pressure and smoking status, but serum creatinine in each sex (OR in men 1.63 [95% CI 1.14; 2.31]) and CRP in women were significantly associated with CHD likelihood. The combined highest and lowest creatinine quartiles in women displayed an OR 2.14 (1.02; 4.51) compared with the intermediate quartiles, after similar adjustments. CONCLUSION: Elevated creatinine levels within normal range, linked to apoA-I dysfunctionality, are independently associated with CHD likelihood even in non-diabetic subjects without MetS. In such women the lowest creatinine quartile is also linked to CHD risk.

[Turkish Adult Risk Factor Study survey 2012: overall and coronary mortality and trends in the prevalence of metabolic syndrome]. / TEKHARF 2012: Genel ve koroner mortalite ile metabolik sendrom prevalansi egilimleri.

OBJECTIVES: We aimed to analyze 1) overall and coronary mortality findings in the Turkish Adult Risk Factor (TARF) study survey 2012 and 2) the temporal trends in prevalence of metabolic syndrome (MetS) and its distribution across seven geographic regions. STUDY DESIGN: Information on the mode of death was obtained from first-degree relatives and/or health personnel of a local health office. Information collected in survivors was based on history, physical examination of the cardiovascular system and Minnesota coding of resting electrocardiograms. RESULTS: Of 1527 participants to be surveyed, 796 were examined; information was obtained on the health status in 502 subjects, and death was ascertained in 56 participants. Thirty deaths were attributed to coronary and cerebrovascular disease. Cumulative 22-year evaluation of participants in the age bracket 45-74 years revealed coronary mortality to be high, with 7.6 per 1000 person-years in men and 3.8 in women. Data used from 1754 identical subjects (median age 46 years initially), and examined in two periods 12 years apart, indicated an increase in the prevalence of MetS by 1.3% per aging of 1 year. Analysis across geographic regions showed a rise in the prevalence in the Mediterranean region, already having highest prevalence along with Southeast Anatolia, while the prevalence declined in the Marmara region and persisted to be lowest in the Aegean region. CONCLUSION: The prevalence of MetS in Turkish adults aged 40 years or over, currently standing at 53%, shows significant differences across geographic regions, being highest in the two southern regions and lowest in the Aegean region.

Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study.

OBJECTIVES: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. STUDY DESIGN: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. RESULTS: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. CONCLUSION: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

[TARF Survey 2011: mortality and performance in the long-term follow-up]. / TEKHARF 2011 taramasi: ölümler ve uzun vadeli takipte performans.

OBJECTIVES: We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants. STUDY DESIGN: A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years. RESULTS: Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas. CONCLUSION: A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.

The Impact of Admission Serum Creatinine Derived Estimated Glomerular Filtration Rate on Major Adverse Cardiac Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

BACKGROUND: The impact of Cockroft-Gault (C-G) derived estimated glomerular filtration rate (eGFR) on mortality and major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was assessed. METHODS: A total of 884 patients were classified into four categories according to admission creatine derived eGFR: < 60, 60 - < 90, 90 - < 120, and ≥ 120 mL/min/1.73 m(2). RESULTS: In-hospital and long-term MACEs were significantly higher in eGFR < 60 mL/min/1.73 m(2) subgroup (P < 0.001 and P = 0.028). Multivariate analysis demonstrated 7.78-fold (95% CI: 0.91 - 66.8) higher mortality risk in eGFR < 60 mL/min/1.73 m(2) subgroup. CONCLUSION: As an easily applicable bedside method, C-G derived eGFR could be important for prediction of in-hospital and long-term mortality and MACE in STEMI patients undergoing primary PCI.

Safety of Early Discharge After Primary Percutaneous Coronary Intervention.

In contrast to ST-elevation myocardial infarction treatment, there is no clear definition for when and which patient to discharge. Our study's main goal was to test the hypothesis that an early discharge strategy (within 48 to 56 hours) in patients with successful primary percutaneous coronary intervention (PPCI) is as safe as in patients who stay longer. The Early Discharge after Primary Percutaneous Coronary Intervention trial was designed in a prospective, randomized, multicenter fashion and registered with http://clinicaltrials.gov (NCT01860079). Of 900 patients with ST-elevation myocardial infarction, the study randomized 769 eligible patients to the early or the standard discharge group. The study's primary outcomes were all-cause mortality and readmission at 30 days. We considered assessment of functional status and health-related quality of life to be secondary outcomes. The early discharge group had significantly shorter length of hospital stay compared with the standard discharge group (45.99 ± 9.12 vs 114.87 ± 63.53 hours; p <0.0001). Neither all-cause mortality nor readmissions were different between the 2 study groups (p = 0.684 and p = 0.061, respectively). Quality-of-life measures were not statistically different between the 2 study groups. Our study reveals that discharge within 48 to 56 hours after successful PPCI is feasible, safe, and does not increase the 30-day readmission rate. Moreover, the patients perceived health status at 30 days did not differ with early discharge.

Rheumatoid factor mediates excess serum lipoprotein(a) for independent association with type 2 diabetes in men.

OBJECTIVE: The potential association of rheumatoid factor (RF) and lipoprotein (Lp)(a) levels, as well as with the likelihood of type 2 diabetes and hypertension, needs exploring. METHODS: Cross-sectional associations were sought in this unselected and population-based 1539-adult cohort (age 58.8±10.6 years). RF was assayed nephelometrically. Multiple logistic regression analyses were used for covariates of RF positivity and for the latter's association with diabetes and hypertension. RESULTS: RF-positive individuals were older, fewer current smokers, had significantly lower fasting triglycerides (by 13%), higher fibrinogen, and tended to higher sex hormone-binding globulin (SHBG) levels. Whereas, women had a similar risk profile irrespective of RF status, RF-positive men had significantly higher Lp(a). In contrast to Lp(a) being positively correlated with SHBG in RF-negative subjects (r=0.08; p=0.007), an inverse correlation existed in seropositive individuals (r=-0.32, p=0.011), suggesting the interplay of an immune complex. In regression analyses, RF positivity was associated with Lp(a) in men but not in women, [OR 1.53 (1.19; 1.96)], independent of age, SHBG, and C-reactive protein (CRP). RF positivity was further associated with diabetes [OR 1.98 (95% CI 1.11; 3.52)] in the whole sample, additively to waist circumference and CRP, major determinants of diabetes. RF-positive subjects were not significantly associated independently with hypertension. CONCLUSION: Autoimmune activation linked to Lp(a) is mediated by the autoantibody RF in contributing to the development of type 2 diabetes.

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.

Predictors of anticoagulant treatment in patients with nonvalvular atrial fibrillation: results from atrial fibrillation in Turkey: epidemiologic registry.

The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

The neutrophil-to-lymphocyte ratio is associated with bare-metal stent restenosis in STEMI patients treated with primary PCI.

BACKGROUND: The clinical importance of complete blood count (CBC) parameters such as the neutrophil-to-lymphocyte ratio (NLR) has been shown in cardiovascular diseases. Stent restenosis (SR) is a major adverse event after stent implantation. In this study, we aimed to investigate the correlation of CBC parameters with SR rates after primary percutaneous coronary intervention (PCI). METHODS: Patients who had undergone primary PCI for ST-segment elevation myocardial infarction (STEMI) and control angiography during follow-up were retrospectively recruited. Patients were categorized according to admission NLR tertiles, and clinical, hematological, and angiographic data were compared. RESULTS: A total of 404 patients (207 patients with SR and 197 patients without SR) were included in the study. Patients were categorized into three groups according to the tertiles of admission NLRs; the NLR was less than 3.38 in tertile 1 (n=134), between 3.38 and 6.26 in tertile 2 (n=135), and greater than 6.26 in tertile 3 (n=135). During a follow-up period of a median of 14 months (minimum 6 months, maximum 60 months) SR developed in 80 patients of tertile 3 (59%), 74 patients of tertile 2 (55%), and 53 patients of tertile 1 (40%), which were significantly different (P=0.01). According to multivariate Cox regression analysis, male sex, stent length (odds ratio 1.04, 95% confidence interval 1.01-1.06, P=0.01), admission NLRs (odds ratio 1.13, 95% confidence interval 1.08-1.19, P=0.01), and white blood cell and neutrophil counts remained the independent predictors of SR in the study population. Other CBC parameters and admission C-reactive protein, creatinine, and fasting glucose levels were not independently correlated with SR. On receiver operating curve analysis, admission NLRs higher than 3.84 were found to predict SR with a sensitivity of 73.4% and a specificity of 50.8% (area under the curve 0.604, P=0.01). CONCLUSION: High NLR levels, white blood cell counts, and neutrophil counts at admission are independently correlated with SR after primary PCI.

Successful primary percutaneous coronary intervention in a centenarian patient with acute myocardial infarction.

A 104-year-old male patient was admitted to the emergency department with chest pain. An electrocardiogram showed ST-segment elevation in the anterior leads. He was immediately taken to the catheterisation laboratory for emergency angiography, which showed thrombotic stenosis at the proximal portion of the left anterior descending (LAD) artery. After intervention on the LAD lesion, successful balloon angioplasty with stenting was performed. Here, we report a case of successful primary percutaneous coronary intervention (PCI) in a centenarian patient with acute myocardial infarction. There are few clinical data on centenarian patients with acute myocardial infarction undergoing primary PCI. To the best of best our knowledge, this case is the first reported in the literature where primary PCI was performed on a centenarian patient.

Apparently "low" serum asymmetric dimethylarginine is associated with fasting glucose and tends toward association with type-2 diabetes.

OBJECTIVE: We investigated the association of serum asymmetric dimethylarginine (ADMA) with metabolic syndrome (MetS), type-2 diabetes and coronary heart disease (CHD) in the general population. METHODS: Cross-sectional and, at 2000 person-years' follow-up, prospective analysis. Adults with measured serum ADMA level (n=848) were analyzed using tertiles or dichotomized values. ADMA concentrations were measured by a validated commercial ELISA kit. RESULTS: Dichotomized subjects of combined sexes with low (≤0.68 µmol/L) ADMA values had significantly higher fasting glucose, total cholesterol, apolipoprotein B and lower diastolic blood pressure. In linear regression analyses comprising age, smoking, triglyceride, HDL-cholesterol, C-reactive protein and waist circumference as well, creatinine was significantly and independently associated with ADMA, further in women glucose (inversely). In logistic regression analyses uniformly adjusted for age, smoking status and waist girth, prevalent MetS tended to positive independent association with ADMA tertiles only in men. Combined prevalent and incident diabetes weakly tended to be associated with the lowest (vs mid- and highest) ADMA tertiles in combined gender; and prevalent and incident CHD was not associated with ADMA tertiles in either sex. CONCLUSION: Apparently "low" circulating ADMA is independently associated with fasting glucose and tends to be so with type-2 diabetes. The lack of anticipated positive associations of ADMA with cardiometabolic disorders is likely due to autoimmune responses operating against serum ADMA under oxidative stress, rendering partial failure in immunoassay.

Serum total and high-density lipoprotein phospholipids: independent predictive value for cardiometabolic risk.

OBJECTIVE: Given that serum phospholipids (PL) may serve as inflammation mediators, we studied whether they predicted metabolic syndrome (MetS), type-2 diabetes or coronary heart disease (CHD) risk in people prone to enhanced low-grade inflammation. METHODS: We analyzed unselected middle-aged Turkish adults with available serum total (n = 852) and HDL-PL (n = 428) measurements and follow-up (mean 6.6 years) by Cox or logistic regression, after exclusion of prevalent cases of outcome disorder. The enzymatic method used measured total content of phosphatidylcholine, sphingomyelin and lyso-phosphatidylcholine. RESULTS: Most lipid and non-lipid variables were significantly different in the upper two compared with the lowest total PL tertile, whereby apolipoprotein (apo)A-I and HDL-cholesterol were higher (not lower). ApoA-I, HDL-cholesterol and uric acid were uniformly positive independent linear covariates of total and HDL PL, apoA-I even in participants without MetS. After adjustment for sex, age, waist circumference, HDL-cholesterol and systolic blood pressure, logistic regression for incident MetS disclosed a 3-fold risk (RR [95% CI 1.28; 6.81]) in the upper HDL-pl tertile. In Cox regression models, while the combined two higher HDL-pl tertiles significantly protected against CHD risk in males (HR 0.29 [95% CI 0.10; 0.89]), they weakly tended to impart risk in females: upper two total PL tertiles tended to increased risk of diabetes and CHD. CONCLUSION: Excess total PL may mediate inflammatory properties to apoA-I, HDL and uric acid. Excess HDL-pl independently predict risk for MetS in each gender, but are protective against CHD risk in men, possibly because oxidized PL content mediated by total PL is sex-dependent, as reviewed elsewhere.

Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER).

BACKGROUND: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. METHODS: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. RESULTS: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. CONCLUSIONS: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.

The relationship between platelet to lymphocyte ratio and the clinical outcomes in ST elevation myocardial infarction underwent primary coronary intervention.

The platelet to lymphocyte ratio (PLR) has been investigated as a new predictor for cardiovascular risk. The aim of the present study was to investigate the prognostic role admission PLRat admission in predicting in-hospital and early mortality in patients presenting with ST segment elevation myocardial infarction (STEMI). A total of 639 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were included. The study population was divided into tertiles on the basis of PLR values at the admission. A high PLR (N = 213) was defined as a value in the upper third tertile (PLR >174.9) and a low PLR (N = 426) was defined as any value in the lower two tertiles (PLR ≤ 174.9). The patients were followed for clinical outcomes for up to 6 months after discharge. In Kaplan-Meier survival analysis, the rate of 6-month all-cause deaths was 7% in the high PLR group versus 3% in the low PLR group (P = 0.03). In multivariate analyses, a significant association was noted between high PLR levels and the adjusted risk of 6-month all-cause deaths (odds ratio = 2.51, 95% confidence interval = 1.058-5.95; P = 0.03). PLR is a readily available clinical laboratory value associated with 6-month all-cause death in patients with STEMI who undergo primary PCI.

Impaired fasting glucose: Pro-diabetic, "atheroprotective" and modified by metabolic syndrome.

AIM: To investigate whether impaired fasting glucose (IFG) confers cardiovascular risk. METHODS: A non-diabetic population-based sample representative of middle-aged and elderly Turks was studied at 8.5 years' follow-up for incident diabetes and coronary heart disease (CHD). Metabolic syndrome (MetS) was defined by ATP-III criteria modified for male abdominal obesity, and IFG and type 2 diabetes were identified by criteria of the American Diabetes Association. Stratification by presence of MetS was used. Outcomes were predicted providing estimates for hazard ratio (HR) obtained by use of Cox proportional hazards regression analysis in models that controlled for potential confounders. RESULTS: In 3181 adults (aged 52 ± 11.5 years at baseline), analysis stratified by MetS, gender and IFG status distinguished normoglycemic subjects by a "hypertriglyceridemic waist" phenotype consisting of significantly higher waist circumference, fasting triglyceride and lower high-density lipoprotein-cholesterol, regardless of gender and MetS. Additionally, lipoprotein (Lp) (a) tended to be lower in (especially female) participants with MetS. Multivariable linear regression in a subset of the sample demonstrated decreased Lp (a) levels to be associated with increased fasting glucose and insulin concentrations, again particularly in women. In Cox regression analysis, compared with normoglycemia, baseline IFG adjusted for major confounders significantly predicted incident diabetes at a 3-fold HR in men and only women with MetS. Cox models for developing CHD in 339 individuals, adjusted for conventional risk factors, revealed that IFG status protected against CHD risk [HR = 0.37 (95%CI: 0.14-0.998)] in subjects free of MetS, a protection that attenuated partly in male and fully in female participants with MetS. CONCLUSION: IFG status in non-diabetic people without MetS displays reduced future CHD risk, yet is modulated by MetS, likely due to autoimmune activation linked to serum Lp (a).