Association of monocyte-to-high density lipoprotein ratio with arterial stiffness in patients with diabetes.

BACKGROUND: Previous studies proposed that chronic inflammation in diabetes has a role in abnormal collagen production and elastin degradation, which promotes arterial stiffness. Monocyte-to-High Density Lipoprotein cholesterol ratio (MHR) is a simple measurement associated with inflammation and oxidative stress. However, little is known about the relationship of MHR with arterial stiffness. This study aimed to determine the association of MHR with arterial stiffness in patients with diabetes. METHODS: A total of 81 patients with type 2 diabetes mellitus were enrolled in a cross-sectional study. Arterial stiffness factor in this study was Cardio Ankle Vascular Index (CAVI). We analyzed complete blood count and lipid profile in all participants, then performed statistical analysis to determine the relationship between MHR and CAVI. Receiver operating characteristic (ROC) analysis was used to estimate the cut-off values of MHR to predict CAVI ≥ 9. RESULTS: Median of MHR in this study was 11.91 with the mean of CAVI was 8.13 ± 0.93. Spearman correlation analysis revealed a significant positive correlation between MHR and CAVI (ρ = 0.239, p = 0.031). Multivariate analysis showed the independent association of MHR to arterial stiffness (ß = 0.361, 95% CI 0.023-0.093) and to CAVI ≥ 9 (OR 1.181, 95% CI 1.047-1.332). The cut-off values of MHR for predicting CAVI ≥ 9 were identified as ≥ 13 (OR 3.289, 95% CI 1.036-10.441). CONCLUSION: MHR is associated with CAVI in patients with diabetes, irrespective of various potential confounders.

Left Circumflexus Coronary Artery Total Occlusion with Clinical Presentation as NSTEMI and Acute Pulmonary Oedema.

Current guidelines for the management of patients with acute coronary syndromes (ACSs) focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI) or non-ST-elevation acute myocardial infarction (NSTEMI)/unstable angina (UA). Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the 'sine qua non' for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx) occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession.

In-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI.

AIM: to compare the in-hospital major cardiovascular events between thrombolysis therapy and primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute myocardial infarction (STEMI. METHODS: the study design is retrospective cohort. Medical record of patients with STEMI onset<12 hour receiving thrombolysis treatment or primary PCI in Dr. Sardjito Hospital Yogyakarta between January 2008 and March 2010 are evaluated. The primary outcome is major cardiovascular events which comprise cardiovascular death, reinfarction and stroke during hospitalisation. The secondary outcomes are post infarction angina pectoris, heart failure, cardiogenic shock and bleeding. RESULTS: among 78 patients with thrombolysis and 53 patients with primary PCI, in-hospital major cardiovascular events do not differ significantly (10.3% versus 9.4%; RR 1.09, 95%CI 0.33-3.55; p=0.87). Post infarction angina pectoris is 7% versus 3.8% (RR 2.51, 95%CI 0.50-12.60; p=0.24). The incidence of heart failure is significantly higher in thrombolysis (17.9% versus 5.7%; RR 3.64, 95%CI 0.99-13.38; p=0.04), primary PCI reduces 68.1% relative risk to develop acute heart failure in STEMI. The incidence of cardiogenic shock is not different. Major and minor bleeding do not differ significantly either. CONCLUSION: the in-hospital major cardiovascular events between STEMI receiving thrombolysis therapy and primary PCI is not significantly different. Heart failure is significantly higher in thrombolysis therapy and the primary PCI reduces the risk.

Rotational Atherectomy in Sub-Acute Anterior STEMI with Cardiogenic Shock.

Rotational atherectomy (RA) is a proven technique to modify a heavily calcified coronary lesion if balloon angioplasty failed. RA is frequently avoided in ST-elevation myocardial infarction (STEMI) as it may increase the risk of slow or no-reflow. It is also considered to be relatively contraindicated in lesions with a visible thrombus, by its manufacturer. Regardless, RA may be a life-saving procedure in cases where no other percutaneous coronary intervention (PCI) technique is available to modify the lesion adequately. This case reports successful use of RA to facilitate dilation and stent delivery of a previously non-dilatable lesion in a patient with sub-acute anterior STEMI complicated by cardiogenic shock.

Comparison between radial versus femoral percutaneous coronary intervention access in Indonesian hospitals, 2017-2018: A prospective observational study of a national registry.

BACKGROUND: Coronary heart disease is a leading cause of death in Indonesia and percutaneous coronary intervention (PCI) is a routinely performed procedure. The aim of this study is to provide real-world insight on the demographics of coronary artery disease and comparison between radial compared to femoral PCI in Indonesia, which performed radial access whenever possible. METHODS: This is a prospective cohort study involving 5420 patients with coronary artery disease who underwent PCI at 9 participating centers in the period of January 2017-December 2018. RESULTS: Radial access rate was performed in 4038 (74.5%) patients. Patients receiving femoral access has a higher rate of comorbidities and complex lesions compared to radial access. The incidence of in-hospital mortality, cardiogenic shock, major arrhythmia, and tamponade were higher in femoral group. The incidence of in-hospital mortality was 114 (2.1%). New-onset angina (OR 3.412), chronic renal failure (OR 3.47), RBBB (OR 4.26), LBBB (OR 6.26), left main stenosis PCI (OR 3.58), cardiogenic shock (OR 4.9), and arrhythmia (OR 15.59) were found to be independent predictors of in-hospital mortality. Radial access did not independently affect in-hospital mortality. In propensity-matched cohort, radial access was not associated with lower in-hospital mortality in both bivariable and multivariable model. However, radial access was associated with reduced in-hospital mortality in STEMI subgroup (OR 0.31). CONCLUSION: Higher rate of adverse events was noted on the femoral access group. However, it might stem from the fact that patients with more comorbidities and complex lesions are more likely to be assigned to femoral access-group. Neither radial or femoral access is superior in terms of in-hospital mortality upon propensity-score matching/multivariable analysis.

A Simplified Risk Scoring System to Predict Mortality in Cardiovascular Intensive Care Unit.

BACKGROUND: Cardiovascular intensive care unit (CICU) is an area with high mortality rates globally. The prediction of inpatients mortality risk at CICU needs a simplified scoring systems. Hence, this study aims to analyze the predictors for in-hospital mortality of patients whom hospitalized at CICU of Sardjito General Hospital Yogyakarta and to create a mortality risk score based on the results of this analysis. METHODS: Data were obtained from SCIENCE (Sardjito Cardiovascular Intensive Care) registry. Outcomes of 595 consecutive patients (mean age 59.92 ± 13.0 years) from January to November 2017 were recorded retrospectively. Demography, risk factor, comorbidities, laboratory result and other examinations were analyzed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause. RESULTS: A total of 595 subjects were included in this research; death was found in 55 patients (9.2%). Multiple logistic regression analysis showed some variables that became independent predictor of mortality, i.e. age ≥ 60 years, pneumonia, the use of ventilator machine, and increased of serum glutamate-pyruvate transaminase level, an increased of creatinine level and an ejection fraction < 40%. Receiver operating characteristic (ROC) curve analysis showed a cut-off model scoring system with score 3 to 9 predicting mortality compared to score 0 - 2. This model yielded sensitivity of 80% and specificity 74%. While the probability scoring system (score 0 to 9) showed that the higher the score, the higher the mortality probability (e.g. the mortality of patient with score 2 is 5.27%; while the mortality of patient with score 8 is 87.5%). CONCLUSIONS: Scoring system derived from this study can be used to predict the in-hospital mortality of patients whom hospitalized in our CICU and show a favorable sensitivity and specificity result.

Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young Male Presenting with Positive Ischemic Response on Treadmill Test.

Anomalous origination of coronary artery from the opposite sinus (ACAOS) is a rare coronary artery anomaly. Right ACAOS with interarterial course is a type of ACAOS, which conveys a high risk for myocardial ischemia or sudden death. We reported a case of right ACAOS with interarterial course in otherwise healthy young male. He was asymptomatic, until an obligatory medical check-up with treadmill test showed a sign of positive ischemic response. Further work-up revealed that he had right ACAOS with interarterial course. Watchful observation was applied to him, while strenuous physical activity and competitive sport were absolutely prohibited.