Audit and quality assessment of national persian registry of cardiovascular disease(N-PROVE) in terms of comorbidities, angiography, and angioplasty characteristics in Iran.

BACKGROUND: The National Persian Registry of Cardiovascular Disease (N-PROVE) has been established to provide a comprehensive database of cardiovascular diseases in the Iranian community for further investigations and to develop national guidelines for the diagnosis, treatment, and prevention of cardiovascular disease (CVD). As with most clinical registries, a quality control audit is necessary to ensure a comprehensive and accurate registry; the current study aims to assess the validity and quality of the N-PROVE/Angiography/Percutaneous Coronary Intervention (PCI) registry. METHODS: The current cross-sectional quality assessment study serves as an example of data quality assessment in N-PROVE on a sample of patients registered in the N-PROVE/Angiography/PCI registry since 2020. Accordingly, data of 194 patients, including comorbidities, angiography, and angioplasty characteristics, were collected from the N-PROVE/Angiography/PCI registry as the main database and reevaluated by a panel consisting of a cardiologist and two coronary intervention fellowships as a test database. RESULTS: The quality control of the population-based healthcare database, the N-PROVE/PCI, revealed that the average error rate in terms of comorbidities, angiography characteristics, angioplasty characteristics, and in total were 3.8%, 2.3%, 3%, and 3.03%, respectively. CONCLUSION: According to the findings of this study, the N-PROVE/PCI registry had an average error of less than 4% in the assessed dimensions, including comorbidities, angiography, and angioplasty characteristics. Therefore, this registry appears valid and may be used for contemporary epidemiological studies.

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.

Ultra-processed food consumption and cardiovascular events rate: An analysis from Isfahan Cohort Study (ICS).

BACKGROUND AND AIMS: The contribution of ultra-processed foods (UPFs) to daily energy intake and, therefore, their health effects may vary between countries. We aimed to investigate the association between UPFs and the incidence risk of cardiovascular events (CVEs) and cardiovascular mortality in the Isfahan cohort study. METHODS AND RESULTS: In 2001, 6504 participants aged ≥35 years were enrolled and followed until 2017. Dietary intake was assessed using a validated food frequency questionnaire, and the NOVA system was applied for UPF classification. Any new case of CVE, including fatal and non-fatal myocardial infarction (MI) or stroke, unstable angina (UA), and CVD death, was recorded. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through Cox proportional hazards regression models. A total number of 819 CVE, 164 MI, 348 UA, 172 strokes, and 181 cardiovascular deaths were recorded during 61352.5 person-years of follow-up. The median (IQR) of UPF consumption was 2.47 (1.00-5.23) times/week. In the fully adjusted model, individuals in the fourth quartile of UPFs had no higher risk for incident MI and UA (HR = 1.12, 95% CI: 0.87, 1.46; P for trend = 0.364), stroke (HR = 0.93, 95% CI: 0.58, 1.46; P for trend = 0.601), cardiovascular mortality (HR = 0.95, 95% CI: 0.61, 1.47; P for trend = 0.596), and CVE (HR = 1.08, 95% CI: 0.88,1.34; P for trend = 0.515) in comparison with those in the first quartile. CONCLUSION: This mid-term prospective cohort study provides no evidence for a significant association between UPF and CVE risk. Longer studies are required to confirm this association.

Body weight changes and diabetes mellitus incident: A cohort study from the Middle East.

Objective: Obesity is a known risk factor for diabetes, but the effect of weight changes on the incidence of diabetes is not yet determined. This study aims to evaluate the long-term effects of weight change [based on body mass index (BMI)] on the incidence of diabetes mellitus (DM) in a middle eastern population. Method: In the Isfahan Cohort Study (ICS) 6504 adults equal or greater than 35 years of age were recruited at 2001 and were followed until 2013. Absolute BMI changes (ΔBMI) were calculated by subtracting the baseline BMI from the BMI measured at follow-ups. To compare participants with different baseline BMI easier, relative changes in BMI were quantified as the percentage of changes from baseline. DM was assessed based on standard definitions. Multivariable Cox regression was used to determine the association between ΔBMI and the incidence of diabetes. Results: During follow-ups, 261 new cases of diabetes were recorded, with an IR of 3401.29 per 100,000 P-Y. The highest number of new cases of type 2 DM belongs to participants with overweight and obesity who had minimal BMI changes (less than 5% of their baseline BMI limits; 42 and 38 new cases, respectively). Participants who were obese at baseline and had lost more than 10% or gained 5-10% of baseline BMI were in the groups with the highest IR [360.05-95% CI (239.3-541.8) and 322.39-95% CI (178.5-582.1) respectively]. There was no significant association between BMI changes and the incidence of DM in the participants with normal BMI, overweight, and obesity at baseline in cure and adjusted models. Conclusions: This study showed there was no significant association between diabetes mellitus incidence and BMI changes.

Cardiovascular and Bleeding Events of Ticagrelor Monotherapy after Short-term Dual Antiplatelet Therapy (DAPT) in Diabetics and Non-Diabetics Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

INTRODUCTION: Ticagrelor monotherapy after short-term (1-3 months) dual antiplatelet therapy (DAPT) with aspirin and ticagrelor can reduce bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). However, its effect in diabetic and non-diabetic individuals has not been evaluated as a meta-analysis so far. METHOD: This systematic review and meta-analysis were conducted covering PubMed, ISI Web of Science, and Scopus without date restrictions for English published clinical trials. The authors searched the mentioned databases, wherein the screening led to 151 studies, of which 40 were assessed for eligibility, and finally, three studies were included. These trials compared ticagrelor monotherapy after a short duration of aspirin plus ticagrelor with conventional 12 months DAPT. RESULTS: The results showed that the risk of major bleeding (based on Bleeding Academic Research Consortium (BARC) type 3 or 5) for ticagrelor monotherapy subjects was lower in both diabetics and non-diabetics. It was especially significant in non-diabetic patients (HR 95%CI: 0.79(0.64, 0.98); p=0.029). In cardiovascular events assessment, the pooled estimate on cardiac deaths was significantly lower in diabetic subjects treated by ticagrelor monotherapy (HR 95%CI: 0.71(0.51, 1); p=0.05), while this reduction was not significant for non-diabetics (p=0.843) in comparison to patients treated by 12 months DAPT. However, there was no significant decrease or rise in myocardial infarction (MI) and ischemic stroke in patients treated by short-term DAPT strategy. CONCLUSION: In conclusion, discontinuing aspirin after short-duration DAPT could minimize the incidence of cardiac death and BARC type 3 or 5 bleeding in diabetic and non-diabetic patients who underwent PCI, with no increase in MI and ischemic stroke.

The Effect of High-dose Allopurinol Pretreatment on Inflammatory Biomarkers and Post-revascularization Coronary Blood Flow in Non-STEMI Patients: A Randomized Double Blind Clinical Trial.

INTRODUCTION: The use of allopurinol has shown promising outcomes in reducing oxidative processes responsible for atherogenic-related cardiovascular events. The current study aims to assess the effects of high-dose allopurinol on the post-revascularization coronary blood flow and inflammatory biomarkers in patients with non-ST segment elevated myocardial infarction (NSTEMI). METHOD: Eighty NSTEMI patients were randomly divided into two groups: the intervention group (n=40), medicated with a high loading dose of 600 mg allopurinol before the coronary angiography, and the control group (n=40), treated with a placebo. The highly sensitive C-reactive protein (hs-CRP) was measured at baseline and within 24 hours after the cardiac interventions and compared between the case and control groups. Post percutaneous coronary intervention (PCI) Thrombolysis in Myocardial Infarction (TIMI) flow grading was also evaluated as a revascularization endpoint. RESULTS: The two groups of the study were similar in terms of demographic, clinical, laboratory, and angiographic characteristics (P-value>0.050). The assessed TIMI flow was similar between the cases and the controls both prior to (P-value=0.141) and after (P-value=0.395) the coronary angioplasty. The hs-CRP (P-value=0.016) was significantly higher in the control group. Post-angiographic assessment of hs-CRP revealed an insignificant difference between the groups (P-value=0.104). CONCLUSION: In conclusion, premedication with a high dose of allopurinol in NSTEMI patients did not affect the inflammatory biomarker or the revascularization endpoint.

Apixaban, a Novel Oral Anticoagulant, Use to Resolute Arterial Patency in Radial Artery Occlusion Due to Cardiac Catheterization; A Pilot Randomized Clinical Trial.

INTRODUCTION: In recent years, transradial cardiac catheterization has become the preferred method. However, it can result in a significant complication known as radial artery occlusion (RAO). The medical management of RAO remains controversial, especially with the emergence of novel oral anticoagulants. Nevertheless, there is limited data on the use of these agents for treating RAO, which is the focus of this study using apixaban. METHOD: This pilot double-blinded randomized clinical trial involved 30 patients who developed RAO following transradial coronary angiography. The patients were randomly assigned to receive either apixaban (2.5 mg twice daily) or a conservative approach for 30 days. Doppler ultrasonography was performed at baseline and at the end of the intervention to assess radial artery diameter and the resolution of arterial patency. Demographic, medical, medication, and clinical characteristics were collected. RESULTS: The mean age of the studied population was 59.43±12.14 years, and the majority were males (60%). Radial artery resolution was observed in 21 (70%) patients, independent of medication use. There was no significant association between resolution and age (P-value=0.62), gender (P-value=0.74), body mass index (P-value=0.23), smoking (P-value=0.64), diabetes (P-value=0.999), hypertension (P-value=0.74), statins (P-value=0.999), antiplatelet therapy (P-value=0.999), length of angiography (P-value=0.216), or follow-up arterial diameter (P-value=0.304). Recanalization occurred in 13 (86.7%) cases in the apixaban treatment group, compared to 8 (53.3%) individuals in the control group, indicating a significant difference (P-value=0.046). CONCLUSION: The study findings suggest no demographic, medical, medication, or clinical factors were associated with arterial recanalization. However, a one-month treatment with apixaban at a dose of 2.5 mg twice daily appeared to be effective.

Impact of Allopurinol Pretreatment on Coronary Blood Flow and Revascularization Outcomes after Percutaneous Coronary Intervention in Acute STEMI Patients: A Randomized Double Blind Clinical Trial.

INTRODUCTION: The generation of reactive oxygen species, which is induced by the activation of the xanthine oxidase (XO) enzymatic system, is one of the primary causes of ischemia-reperfusion injury for an ischemic heart. Allopurinol, as an XO inhibitor, plays an inhibitory role in free radical production in ST-elevation myocardial infarction (STEMI) patients. The aim of this study is to evaluate the impact of allopurinol pre-treatment on post-revascularization outcomes in patients admitted with STEMI. METHOD: Ninety patients with acute STEMI were enrolled in this randomized double-blind clinical trial and divided into two equal groups. The allopurinol group received a 600 mg allopurinol loading dose before the emergency PCI, and the control group received a placebo medication of the same shape. Thrombolysis in Myocardial Infarction (TIMI) flow, ECG changes, troponin level, and the occurrence of major cardiac events (MACE) during a 1-month follow-up were assessed. RESULTS: In the end, 81 patients were analyzed. The mean age of the patients was 59.52(11.31) and 61.3(9.25) in the allopurinol and control groups, respectively (p = 0.49). The troponin level 48 hours after the PCI and ST-elevation regression showed no significant difference between the groups [(p = 0.25) and (p = 0.21), respectively]. TIMI flow had improved in the allopurinol group compared to the placebo (p = 0.02). The PCI success rate was 78.6% and 61.5% in the case and control groups, respectively (p = 0.09). MACE and other clinical outcomes were similar between the groups (p > 0.05). CONCLUSION: This study revealed that allopurinol pre-treatment could improve TIMI flow in patients undergoing primary or rescue PCI in an acute STEMI setting.