Cost-effectiveness analysis of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation: a systematic review.

To assess the cost-effectiveness of mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation and heart failure, a systematic literature search was conducted in various electronic databases to January 3, 2020. Eligibility criteria are the population (patients with mitral regurgitation (MR)), intervention (transcatheter mitral valve repair using the MitraClip), comparator (conventional medical treatment), outcomes, and designs (Model-based or trial-based full economic evaluations).The quality of included studies was assessed using the CHEERS checklist. Mortality and survival rate, quality-adjusted life year (QALY), life years gained (LYG), total cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of MitraClip System were considered as the key outcomes. Eight articles were eligible for full-text assessment. Ultimately, a total of seven studies were considered in the current systematic review. Results demonstrated that MitraClip reduces mortality rate and increases survival rate. The mortality rate at 1 year and 10 years was 16.7% versus 29.77% and 70.9% versus 98.8%, respectively. Total cost data based on 2019 USD show that the MitraClip has the highest cost in the USA ($121,390) and the lowest cost in Italy ($33,062). The results showed that in all selected countries, willingness-to-pay (WTP) thresholds are upper than the cost per QALY; also, the highest ICER for the MitraClip is in the USA ($55,600/QALY) and the lowest in Italy ($10,616/QALY). To conclude, evidence from this systematic review suggests that MitraClip Delivery System improved both life expectancy and QALY compared with medical treatment in patients at high surgical risk and it was also a cost-effective treatment option for patients with mitral regurgitation.

Higher circulating levels of ANGPTL8 are associated with body mass index, triglycerides, and endothelial dysfunction in patients with coronary artery disease.

Bac Coronary artery disease (CAD) is the leading cause of death worldwide and most commonly develops as a result of atherosclerosis. ANGPTL8 is a secreted adipokine that regulates lipid metabolism and is associated with cardiometabolic diseases, including type 2 diabetes and CAD. However, the association between circulating ANGPTL8 levels and CAD is inconsistent among studies and the mechanism by which ANGPTL8 contributes to CAD development remains poorly understood. Here we sought to evaluate the relationship between ANGPTL8 levels and endothelial dysfunction and adipose tissue inflammation in CAD patients. Concentrations of ANGPTL8, adiponectin, TNF-α, IL6, hsCRP, ICAM-1, and VCAM-1 were measured by ELISA in serum samples from 192 CAD patients diagnosed with stenosis > 50% in at least one coronary artery by angiography and 71 individuals with normal heart function. Serum ANGPTL8 levels were significantly higher in CAD patients compared to controls (83.84 ± 23.25 ng/mL vs. 50.45 ± 17.73; p < 0.001), independent of adjustment for age, sex, BMI, smoking and statin use. ANGPTL8 could also differentiate CAD patients from controls with 82.3% specificity and 81.4% sensitivity (p < 0.001). Adiponectin levels were lower in CAD patients, while ICAM-1, VCAM-1, TNF-α, IL6, and hsCRP levels were higher compared to non-CAD controls (all p < 0.001). ANGPTL8 levels were associated with BMI in controls and with BMI, TG, and ICAM-1 in CAD patients. The presence of elevated ANGPTL8 levels in CAD patients and independent association with TG and ICAM-1 suggest a possible role related to endothelial dysfunction in the pathogenesis of atherosclerosis.

CHA2DS2-VASc Score as an Independent Predictor of Suboptimal Reperfusion and Short-Term Mortality after Primary PCI in Patients with Acute ST Segment Elevation Myocardial Infarction.

We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Patients were divided into two groups according to low and high CHA2DS2-VASc score. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and the likelihood of suboptimal TIMI flow. The secondary endpoint of the study was short-term in-hospital mortality of all cause. The present study confirmed that CHA2DS2-VASc model enables us to determine the risk of no-reflow and all-cause in-hospital mortality independently. Odds ratios were 1.59 (1.30⁻2.25) and 1.60 (1.17⁻2.19), respectively. Moreover, BMI, high thrombus grade, and cardiogenic shock were predictors of failed reperfusion (odds were 1.07 (1.01⁻1.35), 1.59 (1.28⁻1.76), and 8.65 (3.76⁻24.46), respectively). We showed that using a cut off value of ≥ two in CHA2DS2-VASc model provides a sensitivity of 69.7% and specificity of 64.4% for discrimination of increased mortality hazards. Area under the curve: 0.72 with 95% CI (0.62⁻0.81). Calculation of CHA2DS2-VASc score applied as a simple risk stratification tool before primary PCI affords great predictive power. Furthermore, incremental values are obtained by using both CHA2DS2-VASc and no-reflow regarding mortality risk assessment.

Toward analyzing and synthesizing previous research in early prediction of cardiac arrest using machine learning based on a multi-layered integrative framework.

BACKGROUND: One of the significant problems in the field of healthcare is the low survival rate of people who have experienced sudden cardiac arrest. Early prediction of cardiac arrest can provide the time required for intervening and preventing its onset in order to reduce mortality. Traditional statistical methods have been used to predict cardiac arrest. They have often analyzed group-level differences using a limited number of variables. On the other hand, machine learning approach, which is part of a growing trend of predictive medical analysis, has provided personalized predictive analyses on more complex data and produced remarkable results. OBJECTIVE: This paper has two aims. First, it offers a systematic review to evaluate the capability and performance of machine learning techniques in predicting the risk of cardiac arrest. Second, it offers an integrative framework to synthesize the researches in this field. METHOD: A systematic review of cardiac arrest prediction studies was carried out through Pubmed, ScienceDirect, Google Scholar and SpringerLink databases. These studies used machine learning techniques and were conducted between the years 2000 and 2018. RESULTS: From a total of 1617 papers retrieved from the literature search, 75 studies were included in the final analysis. In order to explore how machine learning techniques were employed to predict cardiac arrest, a multi-layered framework was proposed. Each layer of the framework represents a classification of the current literature and contains taxonomies of relevant observed information. The framework integrates these classifications and illustrates the relative influence of a layer on other layers. The included papers were analyzed and synthesized through this framework. The used machine learning techniques were evaluated in terms of application and efficiency. The results illustrated the prediction capability of machine learning methods in predicting cardiac arrest. CONCLUSION: According to the results, machine learning techniques can improve the outcome of cardiac arrest prediction. However, future research should be carried out to evaluate the efficiency of rarely-used algorithms and to address the challenges of external validation, implementation and adoption of machine learning models in real clinical environments.

Long-Term Effects of Opium Consumption Following Percutaneous Coronary Intervention: A 10-year Follow-Up Study.

Background: Opium consumption has been an overlooked health issue in the Iranian population, and the prognostic role of opium consumption in patients undergoing coronary revascularization is unknown. Hypothesis: We aimed to assess the association between opium consumption and long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Methods: We screened 2203 consecutive patients who underwent elective PCI between April 2009 and April 2010 at Tehran Heart Center. Exclusion criteria were unsuccessful PCI, non-elective PCI, and missing opium use data. Opium consumption was defined as self-reported ever use of any traditional opium substances. Outcomes of interest were all-cause mortality and a composite of major adverse cardiac and cerebrovascular events (MACCE). The association between opium use and study outcomes was evaluated using the inverse probability of treatment weighting (IPTW) method. Cumulative hazard curves were demonstrated to further assess the association visually. Furthermore, the effect of opium consumption on individual components of MACCE was evaluated in a competing risk setting. Results: A total of 2025 elective PCI patients were included (age: 58.7 ± 10.67, 29.1% women), among whom 297 (14.6%) patients were opium users. After a median follow-up of 10.7 years, opium consumption was associated with a higher risk of all-cause mortality (IPTW-hazard ratio [HR] = 1.705, 95% CI: 1.125-2.585; P = 0.012) and MACCE (IPTW-HR = 1.578, 95% CI: 1.156-2.153; P = 0.004). The assessment of MACCE components suggested a non-significant borderline trend for higher non-fatal myocardial infarction (IPTW-sub-distribution HR [SHR] = 1.731, 95% CI: 0.928-3.231; P = 0.084) and mortality (IPTW-SHR = 1.441, 95% CI: 0.884-2.351; P = 0.143) among opium users. Conclusions: Opium consumption is associated with a more than 50% increase in long-term risk of mortality and MACCE in patients undergoing PCI. These findings accentuate the importance of preventive strategies to quit opium addiction in this population.

The association between metabolic syndrome and major adverse cardiac and cerebrovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Metabolic syndrome (MetS) poses an additional risk for the development of coronary artery disease and major adverse cardiac and cerebrovascular events (MACCE). In this study, we investigated the association between MetS and its components and MACCE after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The presence of MetS was calculated at baseline using the NCEP-ATP III criteria. The primary outcome was MACCE and its components were secondary outcomes. Unadjusted and adjusted Cox Regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI) of the association between MetS or its components and MACCE and its components. A total of 13,459 ACS patients who underwent PCI (MetS: 7939 and non-MetS: 5520) with a mean age of 62.7 ± 11.0 years (male: 72.5%) were included and median follow-up time was 378 days. Patients with MetS had significantly higher MACCE risk (adjusted HR [aHR] 1.22, 95% CI 1.08-1.39). The only component of MACCE that exhibited a significantly higher incidence in MetS patients was myocardial infarction (aHR 1.43, 95% CI 1.15-1.76). MetS components that were significantly associated with a higher incidence of MACCE were hypertension and impaired fasting glucose. Having three MetS components did not increase MACCE (aHR 1.12, 95% CI 0.96-1.30) while having four (aHR 1.32, 95% CI 1.13-1.55) or five (aHR 1.42, 95% CI 1.15-1.75) MetS components was associated with a higher incidence of MACCE. MetS was associated with a higher risk of MACCE in ACS patients undergoing PCI. Among MACCE components, myocardial infarction was significantly higher in patients with MetS. Impaired fasting glucose and hypertension were associated with a higher risk of MACCE. Identifying these patterns can guide clinicians in choosing appropriate preventive measures.

COVID-19's immuno-pathology and cardiovascular diseases.

The pandemic of COVID-19 in worldwide causes recent millions of morbidity and mortality in all countries and is the most important challenge in the world in recent years. Coronavirus is a single-stranded RNA virus and infection with COVID-19 leads to acute respiratory distress syndrome, lung inflammation, cytokine storm, and death. The other complications include endothelial dysfunction, activation of coagulation, thromboembolic events, and vascular disease. Cardiovascular complications such as myocardial and stroke ischemia, pulmonary thromboembolism, systemic arterial, and deep vein thrombosis were reported. In this review, we presented immuno-pathological mechanisms and the effects of COVID-19 on the cardiovascular system, heart, vessels, coagulation system, and molecular glance of immuno-inflammation to the COVID-19's pathology on the cardiovascular system.

The Impact of the COVID-19 Pandemic on Hospitalization Rates due to Prosthetic Valve Thrombosis.

Background: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic.

Comparative outcomes of percutaneous transvenous mitral commissurotomy between low and high Wilkins score.

BACKGROUND: Percutaneous transvenous mitral commissurotomy (PTMC) is one of the non-surgical methods for patients with significant mitral stenosis. It is less invasive, less complicating with better outcomes compared to surgery. The Wilkins score ≤8 is used to select patients for PTMC, but the results of several studies suggest that PTMC can also be successful in a higher Wilkins score. The aim of this study is to compare the outcomes of PTMC between two groups. METHODS: In this retrospective study, patients who underwent PTMC between April 2011 and December 2019 were included. Patients were divided into two groups based on Wilkins score: 196 patients (57.64%) with a Wilkins score ≤8 (group I) and 134 patients (39.4%) with a Wilkins score >8 (group II). RESULTS: There was no difference in demographic characteristics between two groups except for age (p = 0.04). Pre and post-interventional echocardiographic and catheterization measurements including left atrial pressure, pulmonary artery pressure, mitral valve area, mitral valve mean, and peak gradient were measured, and there was no difference between the two groups (p > 0.05). The most common complication was mitral regurgitation (MR). Serious complications such as stroke and arrhythmias were rare in both groups (<1%). There was no difference between MR, ASD (atrial septal defect) and serious complications between the two groups. CONCLUSION: This study shows that the Wilkins score with a cutoff value of 8 is not suitable for patient selection and novel criteria including both mitral valve features and other variables affecting the PTMC outcomes is needed.

IL-33/ST2 pathway as upper-hand of inflammation in allergic asthma contributes as predictive biomarker in heart failure.

Allergic asthma is an inflammatory disorder of the bronchi, and as a major health problem, more than 350 million people suffer from asthma in the world. Many cardiovascular disorders resulted in the impairment of the heart's power to pump blood that leads to the HF. More than 25 million people worldwide live with HF. Accordingly, identifying the biomarkers to predict the onset of future asthma and HF is necessary. IL-33 is an inflammatory cytokine that has the main role in pathophysiology of asthma and HF. Also, in IL-33 receptor, the ST2 is involved in cardiac fibrosis and remodelling in HF and pathogenesis of allergic asthma. Increased sST2 in allergic asthma helps to control inflammation during asthma, but increased sST2 in HF is a predictable biomarker to present risk factor of HF during the time of the patients.

Predictors and mortality of patients with delayed pulmonary embolism diagnosis: A cohort study.

Background: Some earlier studies demonstrated an increased mortality risk attributed to delayed pulmonary embolism (PE) diagnosis. Therefore, we mainly aimed to determine the predictors of diagnostic delays and the effect of delayed diagnosis on mortality. Methods: We prospectively studied 756 consecutive patients admitted with PE between March 2007 and September 2017. The delayed diagnosis was defined as (1) patient presenting > 7 days after onset of symptoms, (2) diagnosis takes > 24 hours upon arriving in the ED, or (3) undergoing coronary angiography before establishing PE diagnosis. Results: A total of 127 (16.7%) patients met the delayed group's criteria. Heart failure (OR= 2.257, 95% CI: 1.130-4.508, P= 0.021), diabetes mellitus (OR= 1.568, 95% CI: 0.996-2.469, P= 0.052), and precordial T wave inversions (OR=2.559, 95% CI: 1.649-3.970, P< 0.001) were linked to higher rates of delayed diagnosis, while hemoptysis (OR=0.254, 95% CI: 0.059-1.087, P= 0.065) and hemodynamic instability (OR= 0.434, 95% CI: 0.168-1.123, P= 0.085) negatively correlated with it. Delayed PE diagnosis did not significantly impact the overall survival during the follow-up. The unadjusted and adjusted mortality hazard ratio for delayed diagnosis were 1.198 (95% CI: 0.758- 1.894, P= 0.439) and 1.215 (95% CI: 0.762- 1.939, P=0.413), respectively. Older age, heart failure, and hemodynamic instability increased the risk of death (p<0.001). Conclusion: Hemoptysis, hemodynamic instability, diabetes mellitus, heart failure, and T wave inversions in precordial leads were the independent predictors of delayed diagnosis. Delayed PE diagnosis did not increase the patients' mortality rates.

Outcome of Percutaneous Coronary Intervention in Old Patients Presenting with Acute Coronary Syndrome.

BACKGROUND: Octogenarians (age≥80 years) with coronary artery disease constitute a high-risk group and the elderly undergoing percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared to young patients. In this study, we aimed to describe the outcomes of the elderly with acute coronary syndrome (ACS) who underwent PCI and also to identify the predictors of short-term major adverse cerebrocardiovascular events (MACCE) in octogenarians. METHODS: In this registry-based cohort study, we reviewed the data of patients (aged≥65 years) who underwent PCI. Univariate Cox-regression model was used to assess the univariate effects of covariates on mortality and MACCE and multivariate Cox-regression analysis were used to discover MACCE predictors. RESULTS: We reviewed the data of 3332 patients (2722 elderly [65 to 79 years], and 610 octogenarians [≥80 years]). The cumulative hazard of MACCE was significantly higher in the octogenarian group compared with the younger group (P<0.001). MACCE in octogenarians presenting with ST-elevation myocardial infarction (STEMI) was significantly higher than those with non-ST-elevation myocardial infarction/Unstable angina (NSTEMI/UA) (P<0.001); however, the cumulative hazard of mortality was not significantly different between the two groups (P=0.270). Successful PCI, left main stenosis and estimated glomerular filtration rate (eGFR) were independent predictors of MACCE in octogenarians with ACS. CONCLUSION: Octogenarians undergoing PCI had a higher rate of MACCE and mortality compared with a younger population. In octogenarians, MACCE in those with STEMI was significantly higher than those with NSTEMI/UA and the mortality trend was similar; however, the 1-year trend was in favor of the STEMI subgroup.

Predictors of in-hospital mortality in diabetic patients with non-ST-elevation myocardial infarction.

BACKGROUND: There have been little data about the additive effects of coronary risk factors on mortality in diabetic patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to evaluate the predictors of mortality in diabetic patients presenting with NSTEMI. All patients admitted to Tehran Heart Center (THC) with a confirmed diagnosis of NSTEMI and a history of diabetes mellitus (DM) type 2 between September 2003 and April 2017 were included. Clinical characteristics and paraclinical data such as lipid profiles, creatinine, hemoglobin, and hemoglobin A1C (HbA1C) were evaluated in these patients to predict in-hospital mortality. The approach for model calibration was a logistic regression with the backward elimination method. RESULTS: Of a total of 9158 patients with non-ST-segment elevation myocardial infarction, 3133 had diabetes mellitus type 2 and met our criteria to enter the final analysis. In the multivariable analysis, age, chronic obstructive pulmonary disease, and a severely reduced left ventricular ejection fraction (LVEF) significantly increased the rate of in-hospital mortality, whereas mildly and moderately reduced left ventricular ejection fraction did not increase the rate of mortality. CONCLUSIONS: Age, chronic obstructive pulmonary disease (COPD), and severely reduced LVEF (< 30%) independently increased in-hospital mortality in our diabetic patients with a confirmed diagnosis of NSTEMI. Severely reduced LVEF had the strongest relationship with in-hospital mortality, whereas the mean HbA1C level and the type of DM management exerted no significant effect on in-hospital mortality.

In-hospital and 1-Year Outcomes of Repeated Percutaneous Coronary Intervention for In-stent Restenosis With Acute Coronary Syndrome Presentation.

BACKGROUND: In-stent restenosis (ISR) is the Achilles' heel of percutaneous coronary intervention (PCI). There have been controversial data about outcomes of repeated PCI (redo-PCI) for ISR. This study aims to determine the predictors of major adverse cardiac events (MACE) in patients underwent redo-PCI for ISR. METHODS: In this retrospective study, all patients with acute coronary syndrome who were underwent successful PCI for ISR at Tehran Herat Center (between 2004 and 2019) were eligible for inclusion. Patients with moderate to severe valvular heart disease and/or hematological disorders were excluded. Participants were divided into 2 groups based on the occurrence of the MACE [composite of cardiovascular death, myocardial infarction (MI), coronary artery bypass grafting, target vessel revascularization, and target lesion revascularization]; then, the study variables were compared between the 2 groups. Finally, the predictors of MACE were identified using Cox regression analysis. RESULTS: Of 748 redo-PCI patients (mean age: 65.2 ± 10.1; 71.0% males), 631 patients had met the inclusion criteria. Fifty-four patients (9.8%) developed MACE within a 1-year follow-up period. Multivessel disease, primary PCI, Ad-hoc PCI, history of non-ST-segment elevation MI, and diabetes mellitus were independent predictors for MACE. In a subgroup analysis, 30 patients who experienced third PCI (target lesion revascularization/target vessel revascularization) were followed more as 1-year MACE. Among these patients, 14 MACEs were observed during the last follow-up (till June 2020). CONCLUSIONS: Multivessel disease, primary PCI, and history of non-ST-segment elevation MI were the predictors of higher 1-year MACE, whereas Ad-hoc PCI and diabetes mellitus had a protective effect on MACE.

Impact of Baseline Estimated Glomerular Filtration Rate Using CKD-EPI Equation on Long-term Prognosis of STEMI Patients: A Matter of Small Increments!

BACKGROUND: Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients. OBJECTIVES: We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients. METHODS: A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60-90), and C3 (≥ 90). RESULTS: Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656-0.975]; P = 0.035), (HR = 0.425 [0.250-0.725]; P = 0.002), (HR = 0.425 [0.242-0.749]; P = 0.003), and (0.885 [0.742-0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178-0.504; P < 0.0001). CONCLUSIONS: Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI.

A retrospective cohort of coronary artery disease development after at least two angiograms in patients with normal coronary angiograms or mild coronary artery disease.

BACKGROUND: Coronary Artery Disease is one of the leading causes of death in the world. CAD usually progresses slowly during time and patients with normal or near-normal coronary arteries are also at risk of developing CAD. It is now believed that even mild atherosclerosis can increase the rate of CAD. METHODS: This is a retrospective, descriptive and analytic study. We selected patients who had undergone at least two diagnostic coronary angiographies at Tehran Heart Center and had normal coronary structure or mild CAD in initial angiography. The data was obtained from the Tehran Heart Center Angiography Databank. Predicting factors in the development of CAD were determined. RESULTS: Data on 556 patients were reviewed. The median interval between the initial and final coronary catheterization was 37.6 months. On the final evaluation, 216 patients (38.8%) found to have developed some degrees of coronary artery disease. Based on the multivariate analysis, age, hematocrit, cigarette smoking, hypertension, and initial presentation with stable and unstable angina were found to be independent predictors of progression to CAD in patients. CONCLUSION: In the end, 40% of patients who had normal coronary arteries or minimal CAD in the initial angiography report, developed some degrees of CAD and some clinical indices can predict the risk of CAD.

Prognostic implications of calculated Apo-lipoprotein B in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcome is tied to lower cut-points.

BACKGROUND: Debates still surround using lipoproteins including Apo-B in risk assessment, management, and prognosis of patients with coronary artery disease. During an acute ST-segment elevation myocardial infarction, Apo-B might help to achieve incremental prognostic information. OBJECTIVE: We sought to determine the potential prognostic utility of calculated Apo-B in a cohort of patients with STEMI undergoing primary PCI. METHODS: A retrospective cohort study was conducted enrolling 2,259 patients with a diagnosis of acute STEMI who underwent primary PCI. Apo-B was obtained using a valid equation based on initial lipid measurements. High Apo-B was defined as a level of 65 or higher. Primary endpoint of the study was major adverse cardiovascular events (MACE). RESULTS: Mean age of the participants was 59.54 years and 77.9% of them were male. After a Median follow up of 15 (6.2) months, high Apo-B was associated with MACE and the OR (95% CI) was 3.02 (1.07-8.47), p = .036. Odds ratios for prediction of MACE pertaining to LVEF, and smoking were 0.97 (p = .044), and 1.07 (p = .033), respectively. However, High Apo-B was not able to predict suboptimal TIMI flow. Accordingly, the Odds ratio was 0.56 (0.17-1.87), p = 0.349. The power of High LDL-C and Non-HDLC for prediction of MACE were assessed in distinct models. Attained odds ratios were [2.40 (0.90-6.36), p = .077] and [1.80 (0.75-4.35), p = 0.191], respectively. CONCLUSION: Calculated Apo-B appears to be a simple tool applicable for prediction of cardiovascular events in patients with STEMI superior to both Non-HDLC and LDL-C.

Challenging case of muscle bridge; a 15-year follow-up of a patient.

BACKGROUND: Anatomically myocardial bridging (MB) consists of either superficial myocardial fibers that traverse over the LAD or deep fibers that encircle the coronary artery. In this study, we present a patient with myocardial bridging, who was primarily diagnosed with coronary artery disease which did not properly respond to full-dose medical treatment but benefited from coronary artery bypass graft (CABG). CASE PRESENTATION: In 2017, a 53-year old man was referred to Tehran Heart Center (THC) with complaint of typical chest pain (TCP). In 2003 he had TCP and underwent coronary angiogram (CAG), due to positive non-invasive tests. Muscle-bridge in LAD was diagnosed. In 2007, he was symptomatic and another CAG was done, and percutaneous coronary intervention (PCI) with stenting was performed. In 2008 he became symptomatic and his interventionist, decided to perform another CAG. At that time, he had CABG. He was asymptomatic until 2015, he referred to us with the same TCP and we decided to perform CAG for the fourth time. After two years, again another PCI was done due to in-stent restenosis. CONCLUSION: Revascularization should be considered in MB refractory to medical treatment. However, coronary perforation, in-stent restenosis and graft failure are major concerns.

One-Month Clinical Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention at a High-volume Cardiac Tertiary Center: Routine Hours Versus Off-hours.

Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI). We aimed to compare 1-month major adverse cardiac events (MACE) of patients undergoing primary PCI between 2 routine-hour and off-hour working shifts. In this cross-sectional study, 1791 STEMI patients were retrospectively evaluated who underwent primary PCI. The patients were classified into 2 groups of routine and off-hour according to the PCI start time and date [495 patients (27.7%) in routine-hour group; 1296 patients (72.3%) in off-hour group]. Cardiovascular risk factor, angiographic, procedural data, door-to-device time, and 1-month follow-up data of patients were compared between 2 groups. There was a statistical difference in door-to-device time between routine-hour and off-hour group [55 minutes (40-100 minutes) in off-hour group vs. 49 minutes (35-73 minutes) in routine-hour group; P ≤ 0.001]. However, most of the patients in both groups had door-to-device time ≤60 minutes. The frequency of 1-month MACE was 8.5% in off-hour group and 6.9% in routine-hour group (P = 0.260). After adjustment for possible confounders, the procedure result, in-hospital death, and 1-month MACE were not significantly different between both study groups. We found that STEMI patients treated with primary angioplasty during off-hour shifts had similar 1-month clinical outcomes to routine-hour shifts. Considering the high number of patients requiring primary PCI during off-hours, the importance of early revascularization in acute myocardial infarction, and the comparable clinical outcomes and procedural success, full-time provision of primary PCI services seems to be beneficial.

Serum levels of subfatin in patients with type 2 diabetes mellitus and its association with vascular adhesion molecules.

Subfatin is a newly discovered adipokine with insulin-sensitizing properties. Studies reported conflicting data with regard to the circulating levels and expression of Subfatin in the context of type 2 diabetes mellitus (T2DM) and obesity. The present study was conducted on 52 patients with T2DM, 36 prediabetes subjects, and 50 controls. The serum levels of Subfatin, adhesion molecules were measured by the ELISA technique. The serum Subfatin was lower in the T2DM and prediabetes groups. The serum levels of adhesion molecules were higher in the T2DM group. In addition, Subfatin demonstrated lower levels in obese patients with T2DM in comparison to lean T2DM patients. Furthermore, Subfatin showed a negative association with vascular adhesion molecules in prediabetes subjects and the T2DM group. A decrease in the serum Subfatin in T2DM patients and prediabetes subjects, and its association with vascular adhesion molecules suggested the possible role of Subfatin in diabetes and endothelial dysfunction.