Increased serum IL-6 is predictive of long-term cardiovascular events in high-risk patients submitted to coronary angiography: an observational study.

BACKGROUND: Interleukin-6 (IL-6) is an inflammation-related cytokine associated with an elevated risk of cardiovascular events. In a previous study, we demonstrated that increased IL-6 was predictive of sub-clinical atherosclerotic coronary disease in intermediate-risk patients undergoing coronary angiography. In the present study, we investigated whether increased serum IL-6 is predictive of cardiovascular events in high-risk patients. METHODS: In this observational study, consecutive patients referred for elective coronary angiography due to stable chest pain/myocardial ischemia had IL-6 measured immediately before the procedure. Long-term follow-up was performed by phone call or e-mail, and their clinical registries were revised. The primary outcome was a composite of new myocardial infarction, new ischemic stroke, hospitalization due to heart failure, new coronary revascularization, cardiovascular death, and death due to all causes. RESULTS: From 141 patients submitted to coronary angiography and IL-6 analysis, 100 had complete follow-up data for a mean of 5.7 years. The median age was 61.1 years, 44% were men, and 61% had type-2 diabetes. The median overall time-to-event for the primary outcome was 297 weeks (95% confidence interval [CI] 266.95-327.16). A receiver operator characteristic curve defined the best cut-off value of baseline serum IL-6 (0.44 pg/mL) with sensitivity (84.37%) and specificity (38.24%) to define two groups. High (> 0.44 pg/mL) IL-6 levels were predictive of cardiovascular events. (p for interaction = 0.015) (hazard ratio = 2.81; 95% CI 1.38-5.72, p = 0.01). Subgroup analysis did not find interactions between patients with or without diabetes, obesity, or hypertension. CONCLUSION: In conclusion, an interleukin-6 level higher than 0.44 pg/mL, obtained just before elective coronary angiography, was associated with a poorer prognosis after a mean of 5,7-year. A pre-procedure IL-6 below 0.44 pg/mL, on the other hand, has a very good negative predictive value, suggesting a good prognosis, and may be useful to better indicate coronary angiography in high-risk patients. .

Diagnostic Accuracy of Perfusional Computed Tomography in Moderate Coronary Stenosis: Comparison With Fractional Flow Reserve.

Coronary computed tomography with myocardial perfusion imaging (CCTA-MPI) provides data on coronary anatomy and perfusion and may be useful in the assessment of ischemic coronary artery disease (CAD). Management of angiographically intermediate coronary lesions is challenging, and coronary fractional flow reserve (FFR) evaluation is recommended to assess whether these lesions are functionally significant. Our aim was to evaluate the diagnostic accuracy of CCTA-MPI in patients with stable CAD and at least 1 angiographically intermediate coronary lesion submitted to FFR. In this single-center prospective study, patients with stable CAD and at least 1 moderate coronary stenosis (50%-70% by visual estimation) were referred for CCTA-MPI (64-row multidetector) assessment before coronary FFR evaluation. Patients with severe coronary obstructions (≥70%) were excluded. The significance level adopted for all tests was 5%. Twenty-eight patients (mean age 60 ± SD years, 54% women) with 33 intermediate coronary obstructions were enrolled. Ten patients (30%) had functionally significant coronary obstructions characterized by FFR ≤0.8. The sensitivity, specificity, and accuracy of CCTA-MPI for the detection of functionally significant coronary obstructions were 30%, 100%, and 78.8%, respectively. CCTA-MPI positive predictive value was 100%, whereas negative predictive value was 76.7%. Correlation coefficient between tests was 0.48 (P = 0.005). On a novel approach to evaluate intermediate coronary lesions, accuracy of CCTA-MPI was 78.8%. The positive predictive value of an abnormal CCTA-MPI on this population was 100%, suggesting that CCTA-MPI may have a role in the assessment of patients with anatomically identified intermediate coronary lesions.

Elevated neutrophil-to-lymphocyte ratio can predict procedural adverse events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: Elevated neutrophil-to-lymphocyte ratio (NLR) is an indirect marker of inflammation, and is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the usefulness of NLR to predict procedural adverse events is patients who underwent primary percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Consecutive patients with STEMI who underwent primary PCI were divided into low and high NLR, whereas high was defined as an NLR value above 75° percentile (≥9.45). The occurrence of procedural complications, in-hospital, and 30-day major adverse cardiovascular events and 1-year all-cause mortality were evaluated. RESULTS: We included 664 patients with a mean age of 60.5 (±12.1) years and 66.3% were male. In multivariate analysis, NLR remained an independent predictor of in-hospital death [relative risk (RR)=1.03; 95% confidence interval (CI)=1.00-1.08; P=0.04], contrast-induced nephropathy (RR=2.35; 95% CI=1.11-4.71; P=0.02), distal embolization (RR=2.72; 95% CI=1.55-4.75; P<0.001), and no-reflow (RR=2.31; 95% CI=2.31-4.68; P=0.01). The area under the curve for distal embolization was 0.67, 0.64 for no-reflow and 0.62 for procedural complications. A low value of NLR had an excellent negative predictive value of 97.8, 96.9, and 92.1 for distal embolization, no-reflow, and procedural complications, respectively. CONCLUSION: High NLR is an independent predictor of distal embolization, no-reflow, and procedural complications in patients with STEMI who underwent primary PCI. A low NLR value has an excellent negative predictive value for these procedural outcomes. NLR may be a useful and inexpensive tool that may be used at bedside.

Comparison of neutrophil-to-lymphocyte ratio and mean platelet volume in the prediction of adverse events after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

BACKGROUND AND AIMS: Elevated neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are indirect inflammatory markers. There is some evidence that both are associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The aim of the present study was to compare the capacity of NLR and MPV to predict adverse events after primary PCI. METHODS: In a prospective cohort study, 625 consecutive patients with STEMI, who underwent primary PCI, were followed. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) for the occurrence of procedural complications, mortality and major adverse cardiovascular events (MACE). RESULTS: Mean age was 60.7 (±12.1) years, 67.5% were male. The median of NLR was 6.17 (3.8-9.4) and MPV was 10.7 (10.0-11.3). In multivariate analysis, both NLR and MPV remained independent predictors of no-reflow (relative risk [RR] = 2.26; 95%confidence interval [95%CI] = 1.16-4.32; p = 0.01 and RR = 2.68; 95%CI = 1.40-5.10; p < 0.01, respectively), but only NLR remained an independent predictor of in-hospital MACE (RR = 1.01; 95%CI = 1.00-1.06; p = 0.02). The AUC for in-hospital MACE was 0.57 for NLR (95%CI = 0.53-0.60; p = 0.03) and 0.56 for MPV (95%CI = 0.52-0.60; p = 0.07). However, when AUC were compared with DeLong test, there was no statistically significant difference for these outcomes (p > 0.05). NLR had an excellent negative predictive value (NPV) of 96.7 for no-reflow and 89.0 for in-hospital MACE. CONCLUSIONS: Despite no difference in the ROC curve comparison with MPV, only NLR remained an independent predictor for in-hospital MACE. A low NLR has an excellent NPV for no-reflow and in-hospital MACE, and this could be of clinical relevance in the management of low-risk patients.

On- vs. off-hours admission of patients with ST-elevation acute myocardial infarction undergoing percutaneous coronary interventions: data from a tertiary university Brazilian hospital

Introduction: Early reperfusion therapy is crucial in patients with ST-elevation myocardial infarction (STEMI). Off-hours hospital presentation may increase the time from pain to coronary reperfusion, and it may be responsible for increased cardiovascular outcomes. The aim of this study was to compare the effect of different times of presentation (on- and off-hours) on early mortality and major cardiovascular outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Methods: We have included consecutive patients with STEMI who underwent primary PCI between April 2011 and November 2016 in a tertiary university hospital in southern Brazil. Patients were divided into on- and off-hours admission. In-hospital and 30-day outcomes were evaluated. Results: A total of 301 patients (57.4%) were admitted during off-hours, and 223 (42.5%) during on-hours. Baseline characteristics were well balanced between the two groups. Median door-to-balloon time was higher in the off-hours group than in the on-hours group: 75 min (IQR 60-95) vs. 60 min (IQR 50-73.7) respectively (p < 0.001). In-hospital mortality was similar between groups (odds ratio [OR] = 0.56; 95% confidence interval [95%CI] 0.31-1.03; p = 0.06) and at 30-day follow-up (OR = 0.2; 95%CI 0.02-1.72 p = 0.14). In the matched cohort, no difference was found in the rates of in-hospital mortality (OR = 2.0; 95%CI 0.75-5.32; p = 0.16) and 30-day MACE (OR= 0.9; 95%CI 0.49-1.66; p = 0.75). Conclusions: In our center with PCI available 24/7 - without in-house staff - we did not observe any difference in patient characteristics, management, and outcomes, although a significant longer door-to-balloon time was found in patients treated during night shifts. Our results are consistent with those of other trials.

Giant thrombus entrapped by a patent foramen ovale in a patient with polycystic kidney disease

Polycystic kidney disease (PKD) is the most common genetic cause of chronic kidney disease (CKD). The most common cause of death in patients with this condition is cardiovascular disease, mainly due to hypertension and its consequences. We report a case of a 42-year-old male patient with polycystic kidney disease who developed a giant thrombus entrapped by a patent foramen ovale after an acute myocardial infarction (AU)

Desfechos cardiovasculares em pacientes tratados com intervenção percutânea coronária primária em hospital geral terciário / Cardiovascular outcomes in patients treated with primary percutaneous coronary intervention in a general tertiary hospital

Introdução: Existem poucos dados nacionais a respeito dos resultados da intervenção coronária percutânea (ICP) primária, e os registros são uma ótima ferramenta para a avaliação do perfil dos pacientes e dos desfechos pós-procedimento. O objetivo deste estudo foi descrever o perfil dos pacientes com ICP primária em um hospital geral terciário, bem como avaliar os desfechos cardiovasculares hospitalares e em 30 dias. Métodos: Foram incluídos todos os pacientes submetidos à ICP primária entre 2012 a 2015. Trata-se de um registro prospectivo, no qual os desfechos clínicos analisados foram a ocorrência de morte, infarto ou acidente vascular cerebral, e eventos cardiovasculares e cerebrovasculares maiores (ECCAM). Resultados: Foram incluídos 323 pacientes, com idade 60 ± 12 anos, sendo 66,7% do sexo masculino, 28,5% diabéticos. Na admissão, 13,5% dos pacientes apresentavam-se em Killip III/IV. O tempo dor-porta foi de 4,4 ± 2,5 horas e o tempo porta-balão foi 68,0 ± 34,0 minutos. A mortalidade hospitalar foi de 9,9%, e 18,3% dos pacientes apresentaram ECCAM em 30 dias. Conclusões: Os pacientes submetidos à ICP primária apresentaram taxas elevadas de ECCAM, que podem ser atribuídas à apresentação clínica mais grave e a um longo tempo de isquemia. Um atendimento mais rápido destes pacientes, variável modificável, demanda uma atenção imediata do sistema de saúde

Background: There are few national data on the results of primary percutaneous coronary intervention (PCI), and registries are a great tool for assessing patient profiles and post-procedure outcomes. The aim of this study was to describe the profile of patients with primary PCI in a general tertiary hospital, as well as to evaluate in-hospital and 30-day cardiovascular outcomes. Methods: The study included all patients submitted to primary PCI between 2012 and 2015. This was a prospective registry, in which the analyzed clinical outcomes were the occurrence of death, infarction, or stroke, and major cardiovascular and cerebrovascular events (MACCE). Results: The study included 323 patients, aged 60 ± 12 years, of whom 66.7% were males, 28.5% diabetics. At admission, 13.5% of the patients were classified as Killip class III/IV. The pain-to-door time was 4.4 ± 2.5 hours and the door-to-balloon time was 68.0 ± 34.0 minutes. Hospital mortality was 9.9%, and 18.3% of the patients presented MACCE in 30 days. Conclusions: Patients submitted to primary PCI had high rates of MACCE, which can be attributed to the more severe clinical presentation and to a long time of ischemia. The faster treatment of these patients, a modifiable variable, demands immediate attention from the health system