Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome.

High SYNTAX score is a predictor of adverse cardiovascular events, including mortality, in acute coronary syndromes (ACSs). Decreased serum albumin (SA) concentration is associated with an increased risk of cardiovascular events. We aimed to investigate whether SA levels at admission are associated with high SYNTAX score and in-hospital mortality in patients with ACS. The study included 1303 patients with ACS who underwent coronary angiography (CA). The patients were divided into 2 groups as high SYNTAX score (≥33) and lower SYNTAX score (≤32). Baseline SA levels were significantly lower in patients with high SYNTAX score than with lower SYNTAX score (3.46 ± 0.42 mg/dL vs 3.97±0.37 mg/dL, respectively; P < .001). On multivariate logistic regression, SA (<3.65 mg/dL) was an independent predictor of high SYNTAX score (odds ratio 4.329, 95% confidence interval 2.028-8.264; P < .001) together with admission glucose, estimated glomerular filtration rate, and left ventricular ejection fraction. In Cox regression analyses, systolic blood pressure, high SYNTAX score, and SA (<3.65 mg/dL) were found as independent predictors of in-hospital all-cause mortality. In conclusion, SA concentration on admission is inversely associated with high SYNTAX score and in-hospital mortality in ACS.

High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome.

High sensitive C-reactive protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23).Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12).Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.

Procalcitonin as an Early Predictor of Contrast-Induced Acute Kidney Injury in Patients With Acute Coronary Syndromes Who Underwent Percutaneous Coronary Intervention.

Contrast-induced acute kidney injury (CI-AKI) is a major issue after percutaneous coronary intervention (PCI), especially in the setting of acute coronary syndrome (ACS). Contrast-induced acute kidney injury is associated with increased mortality and morbidity. Inflammation plays an important role in the pathophysiology of CI-AKI. Procalcitonin (PCT) is introduced as a new marker of inflammation. We sought to examine whether admission PCT levels predict the development of CI-AKI. Patients (n = 814) were divided into 2 groups, namely, CI-AKI (-) and CI-AKI (+). An increase in serum creatinine of ≥0.5 mg/dL from baseline within 48 to 72 hours of contrast exposure was defined as CI-AKI. Contrast-induced acute kidney injury occurred in 96 (11.8%) patients. The PCT levels were significantly higher in patients with CI-AKI than in those without, 0.11 (0.056-0.495) vs 0.04 (0.02-0.078) µg/L; P < .001. After multivariable analysis, PCT remained a significant independent predictor of CI-AKI (odds ratio 2.544; 95% CI [1.207-5.347]; P = .014) as well as age, women, white blood cell, hemoglobin, glomerular filtration rate, creatine kinase myocarial band, and SYNTAX score. In conclusion, serum PCT levels are independently associated with a risk of CI-AKI in patients with ACS who underwent urgent PCI.

Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment ...

Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.

Low serum albumin (SA) levels are associated with increased cardiovascular mortality. We investigated whether baseline SA levels are associated with no-reflow following primary percutaneous coronary intervention (pPCI). A total of 536 patients (aged 60 ± 13 years; 74% men) who underwent pPCI were enrolled. The patients were divided into 2 groups: no-reflow and normal-reflow. No-reflow was defined as thrombolysis in myocardial infarction ≤2 flow. Admission SA levels were significantly lower in the no-reflow group than in the normal-reflow group (3.55 ± 0.44 vs 4.01 ± 0.32 mg/dL, P < .001). Also, high-sensitivity C-reactive protein (hsCRP), creatinine, creatine kinase myocardial band isoenzyme, and troponin T were significantly higher while hemoglobin and left ventricular ejection fraction (LVEF) were significantly lower in the no-reflow group. In multivariate analysis, SA level remained an independent predictor of angiographic no-reflow (odds ratio 0.114, 95% confidence interval 0.032-0.405, P = .001) together with LVEF, hsCRP, and baseline culprit artery patency. Admission SA level was an independent predictor of no-reflow after pPCI.

Predictors of Chronic Total Occlusion in Nonculprit Artery in Patients With Acute Coronary Syndrome: Mean Platelet Volume and Uric Acid.

Chronic total occlusion (CTO) in a noninfarct-related artery (non-IRA) is an independent predictor of mortality in acute coronary syndrome (ACS). Mean platelet volume (MPV) and serum uric acid (SUA) are associated with cardiovascular events in ACS. We investigated the relationship between the presence of non-IRA-CTO with MPV and SUA levels in patients with ACS. Patients (n = 1024) who underwent urgent coronary angiography for ACS were included in this study. Blood samples were drawn on admission. Patients were categorized into 2 groups: non-IRA-CTO (-) and non-IRA-CTO (+). The MPV and SUA levels on admission were significantly higher in the non-IRA-CTO (+) group than in the non-IRA-CTO (-) group (P < .001). At multivariate analysis, MPV (odds ratio [OR]: 4.705, P < .001) and SUA (OR: 2.535, P < .001) were independent predictors of non-IRA-CTO together with age, hemoglobin, ejection fraction, and non-ST-segment elevation ACS. The MPV and SUA levels were significant and independent predictors for the presence of non-IRA-CTO in patients with ACS.

Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.

Impaired coronary flow after primary percutaneous coronary intervention (PPCI) is associated with short- and long-term morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Recent studies have demonstrated that platelet-to-lymphocyte ratio (PLR) is associated with adverse cardiovascular outcomes. The aim of this study was to assess the relation between admission PLR and angiographic reflow after PPCI. A total of 520 patients with acute STEMI (age 60 ± 13 years; 74% men) occurring within 12 hours of the onset of symptoms who underwent PPCI were enrolled. The PLR and other laboratory parameters were measured before PPCI. The patients were divided into 2 groups based on the postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: normal-reflow group (defined as postintervention TIMI grade 3 flow) and none-reflow group (consisted of both patients with angiographic no-reflow defined as postintervention TIMI grades 0 to 1 flow and slow flow defined as postintervention TIMI grade 2 flow). There were 117 patients (22.5%) in the none-reflow group (age 68 ± 13 years and 77% men) and 403 patients in the normal-reflow group (age 58 ± 12 years and 63% men). The none-reflow group had significantly higher PLR compared with the normal-reflow group (219 ± 79 vs 115 ± 59, p <0.001). In logistic regression analysis, PLR (odds ratio 1.818, 95% confidence interval 1.713 to 1.980, p <0.001) and total stent length (OR 1.052, confidence interval 1.019 to 1.086, p = 0.002) were independent predictors of none-reflow after PPCI. In conclusion, preintervention PLR is a strong and independent predictor of slow flow/no-reflow after PPCI in patients with acute STEMI.

The relationship between neutrophil/lymphocyte ratio and infarct-related artery patency before mechanical reperfusion in patients with ST-elevation myocardial infarction.

OBJECTIVES: Reduced baseline coronary flow in an infarct-related artery (IRA) before a primary percutaneous coronary intervention (PPCI) increases mortality in patients with ST-elevation myocardial infarction (STEMI). Increased neutrophil/lymphocyte (N/L) ratio has been linked to poor clinical outcomes in patients with STEMI. We investigated whether the N/L ratio, as measured at admission, was associated with IRA patency before mechanical reperfusion in patients with STEMI undergoing PPCI. PATIENTS AND METHODS: A total of 404 patients who had undergone PPCI on a single culprit artery were enrolled in this study. According to thrombolysis in myocardial infarction (TIMI) flow grade in the IRA before PPCI, the study population was divided into two groups as TIMI 0 or 1 group (occluded IRA) and TIMI 2 or 3 group (patent IRA). RESULTS: The N/L ratios were found to be significantly higher in the TIMI flow 0/1 group when compared with the TIMI flow 2/3 group (6.08±3.94 vs. 4.01±2.87, P=0.001). The absence of early IRA patency was associated with higher Syntax score, mean platelet volume, creatine kinase-myocardial band, and troponin T levels (P=0.0001, P=0.03, P<0.001, and P=0.004, respectively), and lower left ventricular ejection fraction (P=0.02). Multivariate logistic regression analysis showed that the N/L ratio and Syntax score were independent predictors of IRA patency (odds ratio: 1.89, 95% confidence interval: 1.82-1.98; odds ratio=2.80, 95% confidence interval: 1.75-3.86, respectively; P=0.001). CONCLUSION: The N/L ratio has been found to be associated independently with early IRA patency before PPCI in patients who have undergone PCI for STEMI. This simple and cheap parameter can provide useful information on the related risk evaluation in these patients.

Red blood cell distribution width in saphenous vein graft disease.

BACKGROUND: Red blood cell distribution width (RDW) is related to morbidity and mortality in a wide spectrum of conditions, including atherosclerotic processes. In the present study, we aimed to investigate the significance of RDW in saphenous vein graft disease (SVGD), in which atherosclerosis plays an important pathophysiological role. METHODS: In all, 90 patients were enrolled in the study, 58 with patent SVGs and 32 with SVGD. Stable angina and/or positive stress tests were indications for coronary angiography. RDW and other laboratory parameters were measured before coronary angiography. RESULTS: Baseline characteristics of the patient groups were similar. Although triglyceride levels of the SVGD group were higher than those of the patent SVG group, the difference did not reach statistical significance (188.9 ± 99.8 mg/dL vs 151.0 ± 75.5 mg/dL, respectively; P = 0.068). Mean time interval after bypass surgery was longer in the SVGD group compared with the patent SVG group (7.8 ± 4.5 years vs 5.6 ± 3.1 years, respectively; P = 0.008). The RDW values of patients with SVGD were higher than those of patients in the patent SVG group. In logistic regression analysis, RDW and time since bypass graft were retained as independent predictors for SVGD. CONCLUSION: In the present study, we showed for the first time that RDW, which is a simple and inexpensively measured parameter used routinely in daily clinical practice, can be used as a predictor of SVGD, together with time since bypass surgery.

Coronary stent embolization to the left ventricle and its management.

We present a rare case of coronary stent embolization to the left ventricle during percutaneous coronary intervention. Fortunately we retrieved it successfully by a snare loop catheter. The approach to stents that move to the left ventricle is not clear. We may observe them conservatively without any intervention. We may also attempt to retrieve them having accepted the risk of systemic stent embolization while trying to catch it. To decide which approach is better we need more experience. .