Factors affecting in-hospital mortality of acute myocardial infarction

Acute myocardia infarction [AMI] is one of the most common causes of morbidity and mortality. Considering immense socioeconomic damages of growing AMI in developing countries we estimated prognostic value of major risk factors of AMI to predict probable In- hospital AMI mortality. In a cohort survey from June 2004 to March 2006, 1798 patients hospitalized with proven AMI entered into two groups: Survived [patients discharged alive] and Expired [patients expired during hospitalization due to AMI]. We evaluated relationship of 17 risk factors including age, sex, smoking, opium usage, hypertension, diabetes mellitus [DM], dyslipidemia, Killip class, existence of Q wave, St segment elevation, bundle branch blocks [BBB], involved surface of heart, mean left ventricular ejection fraction [LVEF], mitral valve regurgitation [MR], and serum level of Troponin I and CKMB, with patients' survival and expiry by using chi square test, T test and multivariate logistic regression analysis. P value II [P<0.001], hypertension [P=0.036], DM [P<0.001], bundle branch block [P<0.001], Moderate to severe mitral regurgitation [P<0.001], lower Mean LVEF [P<0.001], and lower mean serum concentration of CKMB and Troponin I [P<0.001]. Mortality was significantly higher in anterolateral infarction. Mean age>69.01 yr, femaleness, Killip class III and V, hypertension, DM, moderate to severe MR, anterolateral AMI, bundle branch block and higher serum concentration of CKMB and Troponin I are associated with higher In-hospital post-AMI mortality

[Predictors of 30-day incidence of coronary artery disease in patients with chest pain]

The previous investigations show that cardiovascular diseases, which are spreading all over our country, account for most health and social problems. The objective of this study was to determine the relation between demographic factors, medical history as well as para clinical factors and Coronary Artery Disease [CAD] within a period of 30 days for patients with chest pain. This was a prospective cohort study. Patients referred to the emergency department of Tehran heart centre with a chief complaint of chest pain without ST - segment elevation were followed for 30 days. The outcome variable was coronary artery disease. The Poisson Regression Model was applied in order to identify significant predictors of outcome. Applying this model, we could calculate Adjusted Risk Ratio and 95% confidence interval. The data were analyzed by standard statistical tests using SAS and Stata software. 609 eligible patients were enrolled. Of these 51% were male and 49% female. Based on the final model of Poisson Regression, variables like sex, blood pressure history, heart disease history, changes in electrocardiogram, WBC and CRP had meaningful relationship with CAD. We concluded that prognosis in patients with chest pain needed considering clinical factors [acquired through interview], electrocardiogram and lab findings. Also we were conducted not to rely on traditional risk factors such as history of diabetes, hypercholesterolemia, smoking and family history of heart disease for prediction of the disease

Routine use of cerebral protection [filter wire] during carotid artery stenting: results of a single center registry of 37 patients

To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. In our center, 36 successful carotid stenting procedures [of 38 at tempted] were performed in 37 patients [23 men; aged 66 +/- 7 years]. Cerebral protection involved distal filter devices [n = 36] of which 12 were Accunet and 24 were EZ filter wires. The protection devices were positioned successfully in 36 of the 38 attempted vessels. The 30-day incidence of stroke and neurological death was three. Neurological complications included one major stroke, and one minor stroke. There was also one [sudden cardiac death on the first day]. The proportion of stroke or death was two for symptomatic lesions and one for asymptomatic lesions, and two in patients aged < 80 years and one in those aged >/= 80 years. Protection device-related vascular complications included mild spasm, which occurred after three procedures [8%], none of which led to neurological symptoms. There were another four cardiogenic deaths in 30-day follow-up. In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurological complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection