Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction.

BACKGROUND: The coronary slow flow/no-reflow phenomenon (CSF/NRP) is a common complication of emergency percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI). Its long-term prognostic value, however, remains unclear. This study investigated the long-term outcome and prognostic value of CSF/NRP after emergency PCI for STEMI. METHODS: This retrospective, multicenter registry-based cohort study was conducted in STEMI patients who underwent emergency PCI between 2015 and 2016. Incidence of in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), and all-cause mortality during long-term follow-up were compared between CSF/NRP patients and the normal flow group. Cox proportional-hazards regression model was performed to identify the predictive impact of CSF/NRP in short- and long-term outcomes. RESULTS: A total of 649 STEMI patients were included in the study, of whom 193 (29.7%) developed CSF/NRP following emergency PCI. The CSF/NRP group had a higher incidence of in-hospital mortality than the non-CSF/NRP group (8.2 vs. 4.3%, P  = 0.04). All-cause mortality incidence was also higher in the CSF/NRP group during 5-year follow-up (22.2 vs. 16.2%, P  = 0.04). The Cox proportional hazards model adjusting for demographic and clinical variables identified the NRP as an independent predictor of 5-year cardiac mortality [hazard ratio: 1.89; 95% confidence interval (CI): 1.07-3.31; P  = 0.02]. In a landmark analysis, no difference was seen in overall mortality among the two study groups between 1 month and 5-year follow-up (hazard ratio: 1.33; 95% CI: 0.80-2.21, P -value: 0.23). Kaplan-Meier analysis showed lower 3-year cumulative MACCE-free survival in the CSF/NRP group compared with the normal flow group ( P  = 0.02). CONCLUSION: CSF/NRP in STEMI patients is associated with a worse short- and long-term prognosis. These results, however, are mostly related to the acute phase, and CSF/NRP had limited influence on clinical outcomes in early survivors of STEMI.

Outpatient Cardiovascular Rehabilitation Registry in Iran: The First Rehabilitation Registry Experience at EMR.

INTRODUCTION: The collected information includes demographic profile, medical history, physical examination, patient risk factors, anthropometric evaluation, medications, echocardiographic results, and exercise testing of all patients who participated in the outpatient cardiac rehabilitation program in Cardiac Rehabilitation Department since 1996 until now. Each patient was assigned an electronic code by which the patient's information could be identified. Subsequently, standard questionnaires were used, such as International physical activity questionnaire (IPAQ) to assess physical activity, MAC NEW to assess the quality of life, Spielberg to measure anxiety, Beck to assess depression, and nutritional questionnaires. RESULTS: The findings were recorded, and the data were analyzed by the web and SPSS software. For all patients, the forms were filled based on a number of variables including backgrounds, registration components, type of referral, diagnosis of underlying heart disease, methods of data collection and entry, details of the educational program, return to work, psychiatric condition, drug regimen, clinical condition, echocardiography findings, functional capacity and exercise test response, smoking status, nutritional habits, and finally their 5-year follow-up for events and re-hospitalization. CONCLUSION: It is necessary for the authors to establish a cardiac rehabilitation registration that can properly display care quality indicators and collect and report standard data from different nations to improve the quality of cardiac rehabilitation services and identify weaknesses.

The Effects of Comprehensive Home-Based Cardiac Rehabilitation versus Usual Care in Patients with Ischemic Heart Disease in Iran: Study Protocol for a Multicenter Randomized Controlled Trial.

Background: Cardiovascular diseases are the leading causes of mortality all around the world. Patients with Ischemic heart disease (IHD) are at an increased risk of ischemic events; therefore, secondary prevention measures should continue for these patients. Although Cardiac rehabilitation (CR) is one of the secondary prevention measures for IHD patients which has favorable clinical outcomes, only 50% of patients are referred and among them, a small percentage attends CR. Therefore, other strategies should be considered, one of which is home-based cardiac rehabilitation. Methods: A multicenter, parallel-group randomized controlled trial has been conducting in three hospitals in Isfahan and patients have been assigned into a 1:1 ratio for the evaluation of the effectiveness of home-based cardiac rehabilitation versus usual care. Psycho-educational consultation based on the Health Action Process Approach including heart-healthy diet, stress management, lifestyle changes, smoking cessation, and physical activity has been performed. Primary outcomes, including the quality of life, psychological and smoking status, body mass index, blood pressure, blood cholesterol level, and physical activity level have been measured at 6 months after the randomization and intervention. One year after the intervention, primary and secondary outcomes, including cardiovascular events, the frequency of hospital admissions, and the death rates due to cardiovascular reasons will be assessed. Conclusion: HBCR program can increase patient accessibility to CR services its implantation can be reduce burden IHD.

Predictors of Mortality for Patients with ST-Elevation Myocardial Infraction after 2-Year Follow-Up: A ST-Elevation Myocardial Infarction Cohort in Isfahan Study.

Background: Mortality of ST-elevation myocardial infarction (STEMI) patients is increasing in world. This study defines predictors of mortality in patients who have STEMI. Materials and Methods: This study was a part of the ST-elevated myocardial infarction cohort study in Isfahan conducted on 876 acute myocardial infarction (MI) followed for 2 years that 781 patient entered. The effect of predictors of mortality includes demographic, physiological, and clinical characterizes compared in two groups alive and died patients. MACE was defined as nonfatal MI, nonfatal stroke, and atherosclerosis cardiovascular disease-related death was recorded. Univariate and multiple logistic regression analyses were performed. All analyses performed using SPSS 20.0. P < 0.05 considered statistically significant. Results: A total 781 patients, 117 (13%) that 72 (8.5%) was in-hospital died. The mean (standard deviation) age of the patients was 60.92 (12.77) years and 705 (81.3%) patients were males. Significant factors that affected mortality on analysis of demographic and physiological parameters were age (P < 0.001), sex (P = 0.004), transfusion (P = 0.010), STEMI type (P < 0.001), number epicardial territories >50% (P = 0.001), ventilation options (P < 0.001), smoker (P = 0.003), and diabetes (P = 0.026). Significant clinical factors affected mortality were ejection fraction (EF) (P < 0.001), creatinine (P < 0.001), hemoglobin (P < 0.001), low-density lipoprotein-cholesterol (LDL-C) (P = 0.019), and systolic blood pressure (P < 0.001). Multiple logistics regression model definition significant predictors for mortality were age (P < 0.001), heart rate (HR) (P = 0.007), EF (0.039), LDL-C (P = 0.002), and preangia (P = 0.022). Conclusion: The set of factors can increase or decrease mortality in these patients. Significant predictors of mortality STEMI patients by 2-year follow up were age, HR, EF, LDL-C, and preangia. It seems that more articles need to be done in different parts of Iran to confirm the results.

The effect of home-based cardiac rehabilitation on depression score in patients with ischemic heart disease: A longitudinal clinical trial study.

BACKGROUND: Depression is common in patients with cardiovascular disease (CVD). Home-based cardiac rehabilitation (HBCR) is a program that alleviates depression. This study aimed to determine and compare HBCR programs and usual care (UC) effects on depression control in patients with ischemic heart disease (IHD). METHODS: This clinical trial study was performed on 259 patients with IHD that were randomly allocated to the HBCR and UC groups for stress management. Data were collected using the "Beck Depression Inventory" (BDI) at baseline and 6 and 12 months. Generalized estimating equation (GEE) models were applied to examine the associations between times of the groups and changes in outcomes over the study times. Data analysis was done in SPSS software at the significance level of 0.05. RESULTS: A total of 247 participants with a mean age of 55.22 ± 7.40 years participated in this study, and 209 (84.6%) of the study participants were men. Among patients, 128 patients in the UC program and 119 patients in the HBCR program attended at least one of the pre-determined visits (months 6 and 12). The patterns of change of the depression parameter were similar through the course of the study between the two groups (P = 0.04). In the HBCR group, the depression reduced continuously from baseline to 6 months, baseline to 12 months, and 6 to 12 months (P < 0.05). In the UC group, depression was significantly reduced from baseline to 6 months and from baseline to 12 months. CONCLUSION: HBCR was effective in continuous reducing of depression scores in long-term follow-up of patients with IHD. These findings suggest that HBCR can alleviate depression in patients who do not participate in hospital-based cardiac rehabilitation (CR).

Serum interleukin-18 and extent of coronary artery disease in unstable angina.

BACKGROUND: Interleukin-18 (IL-18) is an inflammatory marker with challenging role in atherosclerosis. The present study was carried out aiming to evaluate the association between IL-18 serum level and extent and severity of atherosclerosis among young patients with unstable angina (UA) who underwent coronary angiography. METHODS: This cross sectional study was performed from July to October 2015 in Chamran heart center, Isfahan, Iran. 180 patients with UA in the age range of below 50 years entered the study. All demographic, past history, physical examination, electrocardiogram (EKG or ECG), and transthoracic echocardiogram (TTE) data were collected. Serum level of IL-18 was measured using enzyme-linked immunosorbent assay (ELISA) method. A coronary angiography was performed on all patients to evaluate the presence and the incidence rate of coronary artery disease (CAD). RESULTS: Mean age of the patients was 46.0 ± 4.6 years [47.4 ± 4.3 and 45.9 ± 4.9 among patients with CAD and normal coronary, respectively (P = 0.040)]. Rate of severe CAD was greater among men compared to women with values 67.8% and 51.8%, respectively (P = 0.032). The median [interquartile range (IQR)] value of serum IL-18 among patients with CAD [192.86 (128.03,325.75)] was higher than normal coronary subjects [172.81 (139.77,243.21)], however it was not significant (198.4 ± 93.5, P = 0.287). A significant difference between serum IL-18 level and number of stenosis vessels was detected only among women (P = 0.032). CONCLUSION: Serum IL-18 level can predict the number of coronary arteries with significant stenosis among women with unstable angina.

Cardiovascular disease events and its predictors in women: Isfahan Cohort Study (ICS).

Introduction: As a lack of validated data about cardiovascular (CV) events and its risk factors (RFs) in women of Eastern Mediterranean region, we aimed to evaluate common predictors of CV events among Iranian women. Methods: Isfahan cohort study (ICS) is a prospective cohort that followed 6323 residents (51.3% women, aged 35-75 years) from three counties and their rural districts in central Iran. Common cardiovascular disease (CVD) RFs namely hypertension (HTN), diabetes mellitus, dyslipidemia, abdominal obesity, smoking, low apolipoproteins A ( apo-A) and high apolipoprotein B (apo-B) were evaluated. End points (CV events) were defined as fatal and nonfatal myocardial infarction, sudden cardiac death (SCD), unstable angina and stroke. Results: After 9 years of follow-up, 265 CV events were detected. The mean age of women with CV event was 57.6±10.9; about 8 years older than those without event. All CV RFs were significantly more prevalent in women with CV event except for low HDL cholesterol, overweight and low apo-A. HTN, diabetes, high triglyceride (TG), high LDL-C and obesity were significantly associated with CV events after adjustment for age, smoking and menopausal status (hazard ratios [95% CI]: 2.56 [1.93, 3.95], 2.43 [1.76, 3.35], 2.02 [1.49, 2.74], 1.59 [1.20, 2.11] and 1.49 [1.16-1.92], respectively), while low HDL cholesterol and abdominal obesity were not predictors for CV events (hazard ratios [95% CI]: 1.26 [0.96, 1.65], 1.71 [0.99, 2.96], respectively). Conclusion: In ICS, HTN, diabetes mellitus and high triglyceride are strong predictors for CV events in Iranian women. As almost all strong risk markers of CVD events are preventable, health policy makers have to give urgent consideration to make preventive public health strategies.

Women health heart project: Methodology and effect of interventional strategies on low education participants.

BACKGROUND: Cardiovascular diseases (CVD) are the most common cause of mortality and morbidity in women. Intervention programs aimed at improving the lifestyle can reduce the incidence of these diseases and their factors. The purpose of this study was to evaluate the difference of the interventions impact on CVD risk factors and the women's physical and biochemical indicators based on education levels. MATERIALS AND METHODS: As part of Isfahan Healthy Heart Program after identifying the status of women over the age of 18 and over five years, a large educational or environmental intervention was performed in different methodologies and in order to improve the lifestyle. Some organizations such as health care centers and the Literacy Campaign Organization have cooperated for low educated women. Demographic data and risk factors such as obesity, hypertension, diabetes and serum lipids were investigated and compared during the first and last phase. Data were entered in SPSS-15 software and were analyzed by using T-test in two independent samples, Chi-square test and Fisher exact test. RESULTS: Findings of this study showed that performing the five years interventions could reduce physical and biochemical indexes such as nutrition, lipid profile, waist circumference and waist-to-hip ratio in both groups (P < 0.005). In the pre-intervention phase, 6391 subjects and after the intervention 4786 women participated. After Interventions, women with higher educational levels were showed significant decrease in Body Mass Index (BMI) (P = 0.01) and dyslipidemia (P = 0.02). CONCLUSION: The present study showed that the community-based interventions even in low-literate women could cause effective changes on improving lifestyle and CVD risk factors. Due to the greater impact of interventions in literate women, effective interventions should be considered in the society to decrease the prevalence of Non-Communicable Diseases (NCDs).

The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study.

BACKGROUND: The current study aims to determine the relation between ankle-brachial index (ABI) and angiographic findings and major cardiovascular risk factors in patients with suspected coronary artery diseases (CAD) in Isfahan. METHODS: In this cross-sectional descriptive-analytic research, patients with suspected CAD were studied. Characteristics of studied subjects including demographics, familial history, past medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension, hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured in all studied patients. ABI≤0.9 (ABI(+)) was considered as peripheral vessel disease and ABI>0.9 (ABI(-)) was considered as normal. Then, all studied patients underwent coronary artery angiography. The results of the questionnaire and angiographic findings were compared in ABI(+) and ABI(-) groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank correlation coefficient, and discriminant analysis. RESULTS: In this study, 125 patients were investigated. ABI≤0.9 was seen in 25 patients (20%). The prevalence of ABI(+) among men and women was 25.9% and 7.5%, respectively (P=0.01). The prevalence of atherosclerotic risk factors was significantly higher in ABI(+) patients than in ABI(-) ones (P<0.05). ABI(+) patients had more significant stenosis than ABI(-) ones. The mean of occlusion was significantly higher in ABI(+) patients with left main artery (LMA), right coronary artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex artery (LCX) involvements (P<0.05). CONCLUSION: The findings of this research indicated that ABI could be a useful method in assessing both the atherosclerotic risk factors and the degree of coronary involvements in suspected patients. However, in order to make more accurate decisions for using this method in diagnosing and preventing CAD, we should plan further studies in large sample sizes of general population.