The Role of CT Angiography of Coronaries in Early Diagnosis of Coronary Artery Plaques in Albanian People with No History of Cardiovascular Disease in Correlation with Traditional Risk Factors.

OBJECTIVE: To evaluate the role of CT angiography of coronaries (CTAC) in the diagnosis of subclinical atherosclerosis by detection of coronary artery plaques (CAP) in a group of consecutive albanian individuals with no history of coronary artery disease (CAD) or acute coronary syndrome and to investigate the relation between the prevalence of CAP, traditional risk factors and the expected 10-year risk of fatal cardiovascular event (CVE) based on our own experience. METHOD AND TECHNIQUE: This is a prospective study including 456 patients with no history of CAD who underwent CTAC in our hospital from September 2009 to March 2013. Risk estimation of fatal CVE was assessed using Systematic Coronary Risk Evaluation (SCORE) and then CT scan was performed with a 64 detector CT, including Ca Score and angiography of coronaries with iv contrast. RESULTS: From 456 patients 61.4% were low risk and 32.9% were at intermediate risk according to SCORE. The prevalence of CAP diagnosed by CTAC was calculated as 55.7 % overall. Though the presence and severity of CAP increased significantly with the increase of SCORE, it was found to be 44.1% in the low risk patients and 80% in the intermediate risk group, with a presence of 17% and 25% of stenotic plaques (>50%) respectively. Significant correlation was found between all traditional risk factors and CAP. CONCLUSION: Although a direct relation between the prevalence of CAP, risk factors and the related 10-year risk of fatal CVE was found, there was a significant prevalence of CAP in low -intermediate risk group with a considerable presence of stenotic lesions. Also 8.3% of patients with no risk factors and 18% of the patients with Ca score 0 had CAP in CT angiography, one resulting with severe stenosis. Our results suggest once more that CT angiography is a reliable, very accurate noninvasive technique for the diagnosis of early CAD, especially in the low-intermediate risk patients compared to the traditional evaluation schemes and Ca score, thus should be considered in this group as a diagnostic guide for optimal therapy planning.

The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention.

OBJECTIVES: In the present study we aimed to reveal any probable correlation between neutrophil-to-lymphocyte ratio (N/L ratio) and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: The N/L ratio stands practically for the balance between neutrophil and lymphocyte counts in the body, which can also be utilized as an index for systemic inflammatory status. METHODS: In our study, we included 204 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (PCI). Patients with STEMI were assigned into distinct tertiles based on their N/L ratios on admission. No-reflow encountered following PCI was evaluated through both angiography [Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade (MBG)] and electrocardiography (as ST-segment resolution). RESULTS: Patients featured with no ST-resolution were documented to have displayed significantly higher N/L ratio on admission compared to those with intermediate or complete ST-segment resolution. The number of the patients characterized with no-reflow, evident both angiographically (TIMI flow ≤ 2 or TIMI flow 3 with final myocardial bush grade ≤ 2 after PCI) and electrocardiographically (ST-resolution <30%), was encountered to depict increments throughout successive N/L ratio tertiles. Moreover, the same also held true for three-year mortality rates across the tertile groups (9% vs. 15% vs. 35%, p < 0.01). Multivariable logistic regression analysis disclosed that N/L ratio on admission stood for a significant indicator for long-term mortality in patients with no-reflow phenomenon detected with MBG. Elevated N/L ratio on admission was also found to be a significant indicator for three-year mortality and major adverse cardiac events. CONCLUSIONS: In patients with STEMI who underwent primary PCI, elevated N/L ratios on admission were revealed to be correlated with both no-reflow phenomenon and long-term prognosis.

Effect of serum gamma-glutamyl transferase levels on myocardial perfusion and long-term prognosis after primary angioplasty in patients with acute ST-elevation myocardial infarction.

BACKGROUND: Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population. METHODS AND RESULTS: One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ≤2 or TIMI flow 3 with final myocardial bush grade ≤2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P < 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events. CONCLUSIONS: In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.

The relationship between saphenous coronary bypass graft occlusion and serum gamma-glutamyltransferase activity.

OBJECTIVES: Serum gamma-glutamyltransferase (GGT) activity has been shown to be associated with progression of atherosclerosis. We evaluated the relationship between serum GGT levels and saphenous vein bypass graft disease at least one year after coronary artery bypass graft (CABG) surgery. STUDY DESIGN: The study included 125 consecutive patients who had undergone CABG surgery with at least one saphenous vein graft (SVG) and were referred to cardiac catheterization for stable anginal symptoms or positive stress test results at least one year after CABG surgery. Laboratory parameters including serum GGT levels were measured before angiography. Occluded grafts were defined as a luminal stenosis of ≥70% or absence of distal TIMI 3 flow. Thus, SVGs were found to be patent in 53 patients (42.4%; 40 males, 13 females; mean age 65±8 years) and occluded in 72 patients (57.6%; 62 males, 10 females; mean age 64±9 years). RESULTS: The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, family history of coronary artery disease, smoking, and alcohol consumption. The mean time from CABG to angiography was similar in patients with a patent and occluded SVG (6.8±4.3 vs. 8.1±3.7 years; p>0.05). Waist circumference was greater (p=0.02) and serum levels of total cholesterol (p=0.001), triglyceride (p=0.02), uric acid (p<0.001), hs-CRP (p<0.001), GGT (p<0.001) and fibrinogen (p<0.001) were significantly higher in patients with occluded veins. Serum GGT level was moderately but significantly correlated with waist circumference (r=0.2, p=0.04), uric acid (r=0.3, p=0.008), and hs-CRP (r=0.3, p=0.002). In logistic regression analysis, total cholesterol (OR=1.012, 95% CI 1.002-1.023, p=0.03), hs-CRP (OR=1.968, 95% CI 1.17-3.311, 0.01), uric acid (OR=1.57, 95% CI 1.1-2.208, p=0.01), and GGT (OR=1.047, 95% CI 1.002-1.1, p=0.04) were found to be significant predictors of SVG occlusion. CONCLUSION: Our results suggest that serum GGT activity is associated with higher occlusion rates of venous bypass grafts.