Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy.

INTRODUCTION: In patients who have undergone interventional cardiac procedures, the risk of bleeding is higher than in patients who received conservative treatment due to multiple medications and comorbidities. AIM: This study aimed to evaluate the usefulness of the age, creatinine and ejection fraction (ACEF) score for predicting bleeding events and to compare short- and long-term clinical outcomes according to the ACEF score in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with bail-out tirofiban therapy (BOTT). MATERIAL AND METHODS: A total of 2,543 patients were included and divided into three groups according to the following ACEF score tertiles: T1 (ACEFlow ≤ 1.033), T2 (1.033 < ACEFmid ≤ 1.371), and T3 (ACEFhigh > 1.371). The main outcomes measured were the incidence rates of relevant bleeding events and mortality within 30 days and 3 years after the procedure. RESULTS: A total of 73 (2.9%) patients had Bleeding Academic Research Consortium bleeding events of grades 3, 4 or 5 and 104 (4%) patients died in a 30-day period. The ACEF score was effective at predicting 30-day bleeding (area under the receiver operating characteristic curve (AUC): 0.658, 95% confidence interval (CI): 0.579-0.737; p < 0.001), 30-day mortality (AUC = 0.701, 95% CI: 0.649-0.753; p < 0.001) and 3-year mortality (AUC = 0.778, 95% CI: 0.748-0.807; p < 0.001) events. Considering the ACEF score tertiles, T3 patients presented greater 30-day bleeding (1.6%, 2.8% and 4.1%; odds ratio (OR) = 2.56, 95% CI: 1.37-4.80), 30-day mortality (1.7%, 3.5% and 7.1%; OR = 4.53, 95% CI: 2.51-8.18) and 3-year mortality (6.4%, 11% and 19.8%; hazard ratio = 3.56, 95% CI: 2.58-4.91) risks. CONCLUSIONS: The ACEF score is a user-friendly tool with excellent predictive value for bleeding events and mortality in patients undergoing pPCI with BOTT.

Mean platelet volume/platelet count ratio as a predictor of stent thrombosis in patients with ST-segment-elevation myocardial infarction.

BACKGROUND: Despite the important role of some haematological parameters in tendency to thrombosis is known, their relationship with long-term stent thrombosis (ST) remains unclear. AIMS: This study aimed to investigate the association between the mean platelet volume (MPV) to platelet count (PC) ratio and long-term ST and mortality in patients with ST-segment-elevation myocardial infarction (STEMI) treated successfully by primary percutaneous coronary intervention (pPCI). METHODS: In a retrospective cohort study, according to their baseline MPV/PC ratios, 3667 consecutive STEMI patients undergoing pPCI were divided into three groups: tertile 1 (T1) (n = 1222, 0.357 ≥ MPV/PC ≥ 0.043), tertile 2 (T2) (n = 1222, 0.033 < MPV/PC < 0.043) and tertile 3 (T3) (n = 1223, 0.009 ≤ MPV/PC ≤ 0.032). Patients were followed up with for 5 years, focusing on ST and all-cause mortality outcomes. RESULTS: Patients with T1 displayed a greater 5-year ST rate, including a 2.76-fold greater (95% confidence interval 1.68-10.33) rate than that of patients with T3, who had the lowest rates and were used as the reference group. Meanwhile, the 5-year mortality rate was similarly higher among patients with T1 by 1.72 times (95% confidence interval 1.33-2.22) relative to that among patients with T3. These significant relationships persisted even after adjustment for all confounders. CONCLUSION: We found that higher MPV/PC ratios were associated with long-term ST and mortality. The MPV/PC ratio may constitute both a rapid and an easily obtainable parameter for identifying reliably high-risk patients who have undergone pPCI.

Value of the neutrophil-to-lymphocyte ratio in predicting left ventricular recovery in patients with peripartum cardiomyopathy.

OBJECTIVE: The aim of this study was to assess the value of the neutrophil-to-lymphocyte ratio (NLR) in predicting left ventricular (LV) recovery in patients with peripartum cardiomyopathy (PPCM). METHODS: Patients with PPCM (n = 40), who were admitted to our tertiary reference hospital between 2007 and 2015 were retrospectively analyzed. All patients were followed-up for at least 12 months after the diagnosis. All patients had standard echocardiographic examination at baseline and the last follow-up visit. Recovery of LV function was defined as the presence of LV ejection fraction (EF) >45%. Data on blood parameters were also collected at baseline. Univariate and multivariate analysis were used to assess the significant predictive variables for persistent LV systolic dysfunction. RESULTS: Of the patients 21 (52.5%) did not recover LV function at the last follow-up visit (nonrecovery group), while 19 of the patients (47.5%) exhibited LV recovery (recovery group). The LV EF and fractional shortening (FS) were significantly lower in the nonrecovery group. The baseline LV end-diastolic diameter, LV end-systolic diameter (LVESD) and systolic pulmonary arterial pressure were significantly increased in the nonrecovery group. The NLR, C­reactive protein and troponin levels were significantly higher in the nonrecovery group. In multivariate logistic regression analysis only NLR and LVESD were identified as independent predictors of persistent LV systolic dysfunction in patients with PPCM (p = 0.020 and p = 0.009 respectively). CONCLUSION: Elevated NLR and increased LVESD were independent prognostic factors in predicting persistent LV dysfunction in patients with PPCM. The NLR might assist in identifying high risk patients with PPCM.

The accuracy of combined use of troponin and red cell distribution width in predicting mortality of patients with acute pulmonary embolism.

BACKGROUND: Cardiac troponins and red cell distribution width (RDW) are associated with increased mortality in acute pulmonary embolism (PE). In this study, we aimed to investigate the accuracy of the combined use of troponin and RDW in predicting short-term mortality in acute PE patients. METHODS: The data of 201 patients with the diagnosis of acute PE were retrospectively analyzed. We obtained troponin-RDW scores (TR scores) using a combination of troponin and RDW values, and then evaluated this score's accuracy in predicting mortality in patients with acute PE. RESULTS: The mean participant age was 68 ± 16 years, and 52 % of patients were female. Fifteen (7.4 %) patients died during the first month. Patients classified as high-risk according to TR scores were older (72 ± 15 vs. 66 ± 15 years, p = 0.005), and they had higher heart rates (101 ± 20 vs. 90 ± 15 beat/min, p < 0.001) and respiratory rates (23 ± 4 vs. 21 ± 3 breath/min, p = 0.001). In multivariate analysis, TR (odds ratio [OR] 4.93, 95 % confidence interval [CI] 1.13-21.38, p = 0.033) and simplified pulmonary embolism severity index (sPESI) scores (OR 3.78, 95 % CI 1.71-8.37, p = 0.002) were independent predictors of 30-day mortality. For 30-day mortality, the TR score had a slightly lower sensitivity (87 % vs. 93 %), but a higher specificity (69 % vs. 52 %) compared to the sPESI score. CONCLUSION: The TR score is easy to calculate, and it may be used to predict early mortality in patients with acute PE.

Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed with contrast CT.

OBJECTIVE: Limited data exist on the incidence of contrast induced nephropathy (CIN) and its impact on in-hospital prognosis of patients diagnosed with acute pulmonary embolism (APE) using contrast computerized tomography pulmonary angiography (CTPA). In this study, we examined the frequency of nephropathy after CTPA in APE patients and its link to in-hospital adverse outcomes. METHODS: This was a retrospective study of 189 patients (mean age 67+16years, 48% male) with APE who underwent CTPA. CIN was defined as a≥0.5mg/dl and/or ≥25% increase in serum creatinine levels >48hours after CTPA. Patients were divided into two groups according to the presence or absence of CIN to compare clinical characteristics, risk factors, and in-hospital adverse events. RESULTS: Twenty-four (13%) of the patients were diagnosed with CIN. Patients with CIN were older (73±17 vs. 67±15years, P=.01) and had higher rates of heart failure (17% vs. 6%, P=.04). Preexisting renal dysfunction and advanced age were found to be independent predictors of CIN (OR: 4.2, 95% CI: 1.5-11.9, P=.006; OR: 3.2, 95% CI: 1.1-9.8, P=.03 respectively). The in-hospital adverse event rate was significantly higher in patients with CIN (16.7% vs. 2.4%, P=.001). A multivariate analysis revealed CIN as an independent predictor of in-hospital adverse event rate (OR: 6.1, 95%CI: 1.2-29.3, P=.02). CONCLUSION: CIN is associated with a higher in-hospital adverse event rate in APE patients diagnosed using CTPA. This is first large study to focus specifically on CIN in patients diagnosed with APE using CTPA.

Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease.

BACKGROUND: The prognostic value of baseline SYNTAX (SS) and clinical SYNTAX (cSS) scores has been shown in different populations with coronary artery disease. However, their prognostic value has not been compared in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. METHODS: Patients who had undergone a primary percutaneous coronary intervention (PCI) for STEMI and had at least one critical lesion other than the culprit artery were recruited retrospectively. SS and cSS were calculated from medical records and angiograms and were compared in coronary artery by-pass grafting (CABG) and PCI groups. Long-term major adverse cardiac events (MACE) were defined as mortality, reinfarction, and target vessel revascularization. RESULTS: A total of 460 patients (214 in the CABG group and 246 in the PCI group) were analyzed. The baseline SS and the cSS were significantly higher in the CABG group compared with the PCI group (30.1±6.7 vs. 22.5±5.6; P<0.01 and 41.4±21.2 vs. 27.2±15.9; P<0.01, respectively). During a follow-up period of 32±8 months, 15 patients from the CABG group and 12 patients from the PCI group died (P=0.33), but the rate of MACE was higher in the PCI group (31 vs. 20%, P<0.01). Receiver operating curve analysis and univariate Cox regression analysis indicated that SS and cSS have prognostic value in the CABG group, but not in the PCI group. In the CABG group, SS and cSS showed significant discriminative power for long-term mortality (for SS>33 sensitivity 73.3%, specificity 71.4% and for cSS>38.4 sensitivity 93.3%, specificity 58.3%) and for MACE (for SS>34.5 sensitivity 50%, specificity 81.4% and for cSS>43.5 sensitivity 66.7%, specificity 73.8%). CONCLUSION: SS and cSS scores have prognostic value in STEMI patients with multivessel disease treated with CABG surgery. cSS may be superior to SS for prediction of long-term adverse events in CABG patients.