Mean platelet volume as a predictor of one-year major adverse cardiac events following elective percutaneous coronary interventions

Mean platelet volume [MPV] correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention [PCI] has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV < 9.1 fL, MPV = 9.1 to 10 fL, and MPV > 10 fL, and they were assessed for developing major adverse cardiac events [MACE], comprising death, myocardial infarction [MI], target vessel revascularization [TVR], and target lesion revascularization [TLR] over a one-year follow-up. Of 2539 patients, major adverse cardiac events [MACE] at one year occurred in 77 [3.0%] patients, including mortality in 26 [1.0%]. The patients in the highest tertile [MPV > 10 fL] had no increased frequency of MACE compared to those in the mid [9.1 to 10 fL] and lowest [< 9.1 fL] tertiles [3.3%, 2.2%, and 3.8%, respectively; p value = 0.14]. No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE [OR = 1.10, 95%CI: 0.69-1.77; p value = 0.68], death [OR = 1.14, 95%CI: 0.51-2.54; p value = 0.74], and non-fatal MI [OR = 1.85, 95%CI: 0.73-4.67; p value = 0.19] at one year's follow-up but MPV did not remain in the model in any of the cases. In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% [4 patients] in the highest tertile, 0.8% [2 patients] in the mid tertile, and 0.5% [one patient] in the lowest tertile. There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI

Comparison of short-term clinical outcome of non-ST elevation versus ST elevation myocardial infarction

Studies on the prognosis of ST elevation myocardial infarction [STEMI] versus non-ST elevation myocardial infarction [non-STEMI] have shown different results. The present study was designed to compare the early outcome and left ventricular systolic function of patients with ST and non-ST elevation myocardial infarction. The patients' information was derived from 10,065 consecutive patients hospitalized in Tehran Heart Center with acute MI [2007 patients with STEMI and 8058 with non-STEMI]. The baseline clinical characteristics, post-MI complications, left ventricular systolic functions, and 30-day mortality rates were compared. A history of current cigarette smoking, opium addiction, and brain stroke was more frequent in the STEMI patients, whereas hyperlipidemia, hypertension, and obesity were found more in the non-STEMI group. Ejection fraction was higher in the non-STEMI patients than that in the STEMI group, and anterior wall infarction was detected more frequently in the STEMI cases. A history of coronary artery bypass grafting and also percutaneous coronary intervention was observed more in the non-STEMI group. Amongst the in-hospital complications, ventricular arrhythmias [1.4 vs. 0.5, P<0.001] and pulmonary edema [0.4 vs. 0.1, P=0.002] were more prevalent in the STEMI cases. The 30-day mortality rate in the STEMI group was higher than that in the non-STEMI group [5.5 vs. 2.4, P<0.001]. Early mortality in both groups was dependant on advanced age, diabetes mellitus, post-MI bradycardia, and atrioventricular block. Also, female gender and pulmonary edema in the STEMI group and family history of MI in the non-STEMI patients could predict 30-day mortality. There were several differences in the baseline characteristics and early outcome between the two types of STEMI and non-STEMI. The 30-day mortality rate was higher in the STEMI group than that in the non-STEMI group

Repair versus replacement for ischemic mitral regurgitation

This study was undertaken to compare the outcome in patients with moderate to severe ischemic mitral regurgitation [IMR] undergoing coronary artery bypass grafting [CABG] with either mitral valve repair or mitral valve replacement. Between March 2002 and February 2005, 49 consecutive patients [mean age: 62.84 +/- 8.42 years; mean EuroSCORE: 10.03 +/- 3.12] with coronary artery disease and moderate to severe IMR underwent CABG plus mitral valve replacement or mitral valve repair. The patients with annulus dilatation were more likely to undergo repair. The mean follow-up period was 18.89 +/- 2.1 months. 40.8% of the patients underwent CABG plus mitral valve replacement, and 59.2% had CABG concomitant with mitral valve repair. The total rate of mortality in our population was 14.9% [7 patients] including 10.3% [3 patients] early mortalities; all the deceased patients were in the repair group. Both groups had a similar EuroSCORE, but more patients in the repair group had a recent episode of unstable angina [65.5% vs. 35.0%, respectively; P=0.035] and diabetes mellitus [44.8% vs. 10.0%, respectively; P=0.009]. After the follow-up period, in the repair group, 11.5% had no features of Mitral regurgitation [MR]; while 50% had mild MR, 23.1% moderate MR, 11.5% moderately severe MR, and 3.8% severe MR. Overall, 68.9% had no or mild MR, which we defined as successful repair, and 31.1% had moderate to severe MR. Success of repair and mortality were not statistically related to preoperative ejection fraction [39.2 +/- 7.8% vs. 32.5 +/- 8.5%; P=0.057]. Early mortality was higher in the repair group than that in the replacement group, but this may have been due to the higher frequency of diabetes mellitus and unstable angina in the former group. Future studies are required to determine the benefit of repair versus replacement concomitant with CABG in IMR patients

Fractional flow reserve and appropriateness of angioplasty in moderate coronary stenosis

Percutaneous coronary angioplasty [PTCA] of a coronary stenosis without documented ischemia at noninvasive stress testing is often performed, but its benefit is unproven. Coronary pressure- derived fractional flow reserve [FFR] is an invasive index of stenosis severity defined as the ratio of maximal blood pressure in a stenotic vessel to the normal maximal pressure in the same vessel. FFR is a reliable substitute for noninvasive stress testing and values below 75% identifies stenoses with hemodynamic significance. It is a method that can provide a reliable assessment of coronary stenosis especially in those with intermediate lesions. It can highly impact on decision-making in therapeutic planning and prevent many unnecessary procedures that are routinely done in these cases. In the present study, we report the results of FFR measurements in a series of patients, and this is the first report on the FFR measurement in Iran. The FFR measurement was performed for eleven vessels with intermediate stenosis, and in seven lesions [63.6%] it led to changes in the treatment strategy. On the basis of FFR, percutaneous coronary intervention [PCI] was changed into medical follow-up in five lesions, medical follow-up changed to PCI in one lesion, and coronary artery bypass grafting [CABG] changed to medical follow-up in another

Predictors of Long-term Outcome in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a single center registry [THCR]

This study sought to access differences in long-term [9 months] outcomes between Acute Coronary Syndrome [ACS] patients who undergo early intervention compared to Percutaneous Coronary Intervention [PCI] in stable and refractory conditions. Data originated from Tehran Heart Center Registry- interventional cardiology [THCR-IC] and consisted of 1267 patients divided into two categories; 227 patients had features corresponding to acute coronary syndromes [17.9%] and 1040 patients suffered from stable angina [82.1%]. They were admitted between April 3, 2003 and April 25, 2004. The clinical success rate of PCI was higher in ACS [97% vs. 94%; P=0.037], while In-hospital complications was similar in both groups. During the follow-up period, clinical restenosis was not significantly different and the overall number of re-interventions caused by restenosis or progression was not more frequent in ACS patients. Also, 1.3% of ACS and 0.4% of SA patients died, but the difference was not statistically significant [P=0.16]. Finally, Major Adverse Cardiac Events [MACE] showed no significant difference [5.2% vs. 3.9%; P=0.42]. Multivariate analysis showed that female sex [OR=25.6; P=0.003] and previous history of PCI [OR=8.4; P=0.016] were the only strong independent risk factors for major adverse cardiac events. Analyzing ACS patient outcomes using Mantel-Hanzel analysis showed that the female sex was the only factor which strongly increased the incidence of MACE. Both ACS and SA patients who underwent coronary intervention had similar in-hospital and composite major adverse cardiac events, nevertheless female gender must be considered as an independent risk factor for major adverse cardiac events especially in patients with acute coronary syndrome who undergo PCI