Comparative Analysis of Neutr ophil -to-l ympho cyte Ratio, Systemic Immune-Inflammation Index, and Prognostic Nutritional Index in Acute Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention.

OBJECTIVE: Acute myocardial infarction constitutes one of the leading reasons for cardiac mortality. Therefore, early identification of high-risk patients provides better prognostic accuracy. This study aimed to investigate the prognostic significance of novel inflammatory biomarkers such as neutr ophil -to-l ympho cyte ratio, systemic immune-inflammation index, and prognostic nutritional index in acute myocardial infarction patients treated with percutaneous coronary intervention and to compare their predictive abilities with each other. METHODS: A total of 828 acute myocardial infarction patients treated with percutaneous coronary intervention were retrospectively analyzed. The inflammatory indices, such as neutr ophil-to-l ympho cyte ratio, systemic immune-inflammation index, and prognostic nutritional index, were calculated by admission blood tests. The study population was divided into 2 groups according to the occurrence of major adverse cardiac events, which were defined as all-cause mortality, non-fatal myocardial infarction, and cerebrovascular events. RESULTS: Multivariate Cox regression analysis determined prognostic nutritional index as an independent predictor of major adverse cardiac event and all-cause mortality (hazard ratio: 1.05, 95% CI: 1.02-1.07, P < .001 for major adverse cardiac event and hazard ratio: 1.05, 95% CI: 1.02-1.09, P = .002 for all-cause mortality). Receiver operating characteristic curves revealed that the predictive value of prognostic nutritional index with both regard to major adverse cardiac event and all-cause mortality was better than the systemic immune-inflammation index and neutr ophil -to-l ympho cyte ratio (by DeLong method, area under curvePNI vs. area under curveSII z test = 2.66, P = .008; area under curvePNI vs. area under curveNLR z test = 2.8, P = .006; area under curvePNI vs. area under curveSII z test = 2.58, P = .009; area under curvePNI vs. area under curveNLR z test = 3.28, P = .001; respectively). CONCLUSIONS: Prognostic nutritional index was demonstrated as an independent predictor of major adverse cardiac events and all-cause mortality and a more powerful prognostic index than other novel inflammatory biomarkers in acute myocardial infarction patients treated with percutaneous coronary intervention.

Comparison of Sequential POT-Side-POT and Kissing Balloon Techniquesin Patientswith Coronary Bifurcation Lesions Treatedwith Single-Stent Strategy; Which One is Simple and Safe? Propensity Score Analysis.

BACKGROUND: It is unknown whether the novel POT-side-POT technique is more useful than the commonly preferred kissing balloon inflation in patients with non-complex coro- nary bifurcation lesions treated with a single-stent strategy. The aim of this study was to compare the efficacy of POT-side-POT and kissing balloon inflation techniques in one- stent strategy for non-complex coronary bifurcation lesions. METHODS: In this study, 283 patients were retrospectively analyzed (POT-side-POT group, n = 149; KBI group, n = 134). Primary endpoints of the study were defined as follows: in- hospital and 30-day mortality, contrast-induced acute kidney injury, stent thrombosis, side branch dissection, and need for side-branch stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting. RESULTS: Procedure time (minute, 30.6 ± 8.5 vs. 34.3 ± 11.6; P = .003) and contrast volume (milliliter, 153.7 ± 42.4 vs. 171.1 ± 58.2; P = .004) were significantly lower in POT-side-POT group. Besides, side branch residual stenosis and number of patients with >50% side branch residual stenosis remained significantly higher in POT-side-POT group both in general and true bifurcation subgroup analysis (20.3 ± 19.8% vs. 16.5 ± 16.4%, P=.022; 11.9% vs. 5.7%, P = .013 and 24.1 ± 23.2% vs. 18.8 ± 18.7%, P = .033; 17.6% vs. 6.6%, P = .005; respectively). Combined clinical adverse outcomes were similar between groups. Side branch dissection (10.2% vs. 20.1%, P = .001) and need for side branch stenting (12.6% vs. 19%, P=.040) reached statistically significance in kissing balloon inflation group after adjustment. CONCLUSION: POT-side-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse clinical events in non-complex coronary bifurcationlesions treated with single-stent strategy.

The relation between left ventricular global longitudinal strain and troponin levels in patients hospitalized with COVID-19 pneumonia.

Left ventricular global longitudinal strain (LVGLS) from two-dimensional speckle-tracking echocardiography (2D-STE) provides a more accurate estimation of subclinical myocardial dysfunction. In patients with COVID-19, elevated high sensitive troponin (hs-TnI) levels are frequent independent from the underlying cardiovascular disease. However, the relationship between high troponin levels and LVGLS in such patients remains unknown. We aimed to investigate the relation between troponin levels and LVGLS values in patients with COVID-19. A total of thirty-eight patients diagnosed with COVID-19 pneumonia who underwent echocardiography examination within the first week of hospital admission were enrolled in our study. Patients were divided into two groups according to their hs-TnI levels. Conventional left venticular (LV) function parameters, including ejection fraction, LV diastolic and systolic volumes were obtained and LVGLS was determined using 2D-STE. Frequency of hypertension, diabetes mellitus and current smoking were similar among groups. Compared with the patients in the negative troponin group, those in the positive troponin group were more likely to have a higher age; higher levels of D-dimer, C-reactive protein and ferritin; higher need for high-flow oxygen, invasive mechanical ventilation therapy or both; and a higher number of intensive care unit admissions. There was no statistically significant difference in LVGLS and ejection fraction values between the two groups.(- 18.5 ± 2.9, - 19.8 ± 2.8, p = 0.19; 55.2 ± 9.9, 59.5 ± 5.9, p = 0.11 respectively). Despite troponin increase is highly related to in-hospital adverse events; no relevance was found between troponin increase and LVGLS values of COVID-19 patients.

Assessment of electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in the octogenarian population.

BACKGROUND: Although there are several electrocardiographic (ECG) diagnostic criteria for identifying left ventricular hypertrophy (LVH), the sensitivity of these criteria remains low. Recently, the Peguero-Lo Presti criterion provides a higher sensitivity than the current criteria. We aimed to test this ECG criterion prospectively, in the octogenarian population. METHODS: We prospectively enrolled outpatients over 80 years of age who were referred to our echocardiography laboratory. The Peguero-Lo Presti criterion was assessed along with other established ECG criteria. Left ventricular mass was calculated by echocardiography. Performance of ECG indices in diagnosing LVH were evaluated. RESULTS: Overall, 119 patients were included in the study. The sensitivity and specificity of the Peguero-Lo Presti criterion were 62.5% and 87.3%, respectively. In addition, the highest sensitivity belonged to the Peguero-Lo Presti criterion, and the highest AUC value was also seen in this criterion (AUC: 0.787, 95% CI, 0.698-0.876, P < .001). CONCLUSION: The Peguero-Lo Presti criteria showed the highest sensitivity for LVH detection, and it outperformed the other validated criteria in this octogenarian population. The Peguero-Lo Presti criteria seemed to be more effective for diagnosing LVH in this setting.

Comparative performance of AnTicoagulation and Risk factors In Atrial fibrillation and Global Registry of Acute Coronary Events risk scores in predicting long-term adverse events in patients with acute myocardial infarction.

OBJECTIVE: This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score (RS), which determines the predisposition to thromboembolic and hemorrhagic events in atrial fibrillation, as a predictor of prognosis in patients having acute myocardial infarction (AMI), and to compare the predictive ability of ATRIA RS with GRACE RS. METHODS: We analyzed 1627 patients having AMI who underwent coronary angiography and/or percutaneous coronary intervention (PCI) between January 2011 and February 2015. The primary endpoints included all-cause mortality, non-fatal MI, and cerebrovascular events during follow-up. RESULTS: Multivariate Cox regression analysis showed that the ATRIA RS>3 was an independent predictor of major adverse cardiac events in patients with AMI [hazard ratio, 2.00, 95% confidence interval, 1.54 to 2.60, p<0,001]. The area under the curve (AUC) for ATRIA RS and GRACE RS was 0.66 and 0.67 (p<0.001, and p<0.001), respectively. We performed a pair-wise comparison of receiver operating characteristic curves,and noted the predictive value of ATRIA RS with regard to primary endpoints was similar to that of GRACE RS (By DeLong method, AUCATRIA vs. AUCGRACE z test=0.64, p=0.52). CONCLUSION: ATRIA RS may be useful in predicting prognosis in patients having AMI during long-term follow-up.

Persistent smoking rate after coronary revascularization and factors related to smoking cessation in Turkey.

Background: Although smoking is an established risk factor for coronary artery disease, smoking cessation efforts, as part of a lifestyle change, have been disappointing so far. Therefore, assessing current smoking trends and identifying patients who are at risk of smoking continuation is of paramount importance. In this study, our aim was to assess current smoking rates after coronary revascularization as of 2017, and to define factors that potentially affect smoking cessation. Methods: Overall, 350 patients who had undergone coronary revascularization, either by percutaneous coronary intervention or bypass surgery were included in this cross-sectional, observational study. Patients were queried for various sociodemographic characteristics and smoking habits. Disease related data were obtained from the hospital archives. Results: The overall smoking rate was 57% after coronary revascularization. Age, bypass surgery and the occurrence of in-hospital adverse events were found to be independent predictors of smoking cessation in multivariate analysis. Conclusions: Despite efforts, smoking rates after coronary intervention remain substantially high. Therefore, a multidisciplinary approach to smoking cessation that incorporates cardiac rehabilitation programs and medications should be implemented in clinical practice.

The value of the Clinical SYNTAX Score in predicting long-term prognosis in patients with ST-segment elevation myocardial infarction who have undergone primary percutaneous coronary intervention.

BACKGROUND: The Clinical SYNTAX Score (CSS) combines anatomical and clinical risk assessment. OBJECTIVES: This study was designed to evaluate CSS as a predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (p-PCI). METHODS: We evaluated 433 patients who were diagnosed with STEMI and underwent p-PCI. CSS was calculated by multiplying the anatomically derived SYNTAX score (Sx) by the modified age, creatinine, and ejection fraction score. Patients were divided into tertiles according to the CSS: CSS(Low)≤14 (n=141), 1426 (n=148). The primary endpoints were defined as all-cause mortality, myocardial infarction, and cerebrovascular events over 15 months' follow-up. RESULTS: Primary endpoints were achieved in 9.2% of patients with CSS≤14, 12.5% of those with 1426 (P<0.001). Kaplan-Meier analysis showed that the CSS>26 group had a significantly higher incidence of primary endpoints [P (log-rank)<0.001]. CSS>26 was identified as an independent predictor for all-cause mortality, myocardial infarction, and cerebrovascular events (hazard ratio 3.58, 95% confidence interval 1.68-7.60, P=0.001). Receiver operating characteristic analysis found areas under the curve of 0.66, 0.59, and 0.64 for CSS, Sx score, and age, creatinine, and ejection fraction score (P<0.001, P=0.01, P<0.001, respectively). CONCLUSION: CSS may be better than the Sx score for predicting long-term prognosis in patients with STEMI undergoing p-PCI.