A Novel Score for an Old Enemy: Atherogenic Plasma Index Predicts In-Stent Restenosis among Stable Angina Pectoris Patients.

Objectives: Although the association of Atherogenic index of plasma (AIP) with coronary artery disease (CAD) and atherosclerosis is known, the relationship between AIP and in-stent restenosis (ISR) remains unclear. We aimed to investigate the relationship between AIP and ISR in patients with stable angina pectoris (SAP) treated with drug-eluting stent (DES). Methods: Patients with a history of DES implantation following stable angina were evaluated between January 2015 and November 2019 in this observational and retrospective study. 608 eligible patients were dichotomized into ISR+ (n=241) and ISR- (n=367). ISR was defined as the presence of 50% or greater stenosis. AIP was defined as log [TG/HDL-C]. Results: AIP levels were significantly higher in patients who developed ISR compared with those who did not (0.33 [0.15-0.52] vs 0.06 [-0.08-0.21] respectively, p<0.001). The AUC value of AIP levels for predicting ISR was 0.746 (p<0.001). Multivariate logistic regression analysis revealed that AIP, diabetes mellitus, higher LDL-C levels and lower LVEF values were independently associated with ISR. Conclusion: Multivariate analysis revealed that AIP was strongly independently associated with ISR. Using this novel inexpensive and easily calculable index may provide early recognition of ISR in patients with SAP who were treated with DES.

Effects of Atrioventricular Blocks in Acute Coronary Syndrome: Long-Term Follow-Up.

Objectives: Arrhythmias are the common, potentially lethal, and treatable complication of acute coronary syndrome (ACS). Arrhythmic findings of ischemic cardiac events are well-known, but long-term results have not been scrutinized. In the study, we aimed to analyze the long-term findings of the atrioventricular block (AVB) in ACS patients. Methods: This is a single-center and retrospective study of patients admitted with ACS and AVB. The primary endpoint has combined the outcome of major adverse cardiovascular events and mortality. Results: Seventy-six (89.4%) patients had 3rd-degree AVB. Fifty (58.8%) patients are needed for temporary ventricular pacing and 4 (4.7%) for a permanent pacemaker. Although no cardiac death occurred during the 5-year follow-up period, the in-hospital mortality ratio was 30.6%. Patients with older age and lower systolic blood pressure (SBP) levels had higher mortality rates (respectively, odds ratio [OR] 1.088, [p=0.003], OR 0.912, [p<0.001]). Even in ST-segment elevation myocardial infarction and complete AVB subgroup analyses, mortality rates were associated with SBP and age (respectively, OR: 0.917, [p<0.001], OR: 1.107 [p=0.002]), (respectively, OR: 0.917 [p<0.001], OR: 1.087 [p=0.004]). Conclusion: The study results are associated with a better long-term overall prognosis in patients with ACS with AVB, but lower SBP and older in-hospital follow-up are associated with poor prognosis.

Association Between Serum Irisin Levels and ST-Segment Elevation Myocardial Infarction.

Background: An acute ST-elevation myocardial infarction (STEMI) is a serious cardiovascular condition with a high risk of morbidity and mortality. Irisin is adipomyokine that is associated with various health conditions. In post-STEMI, elevated serum irisin levels are associated with more adverse cardiovascular events. Objective: The purpose of this study was to investigate associations between the serum irisin levels and acute MI (AMI) and whether irisin may be a useful biomarker for severity of AMI in patients with STEMI. Possible correlations between serum irisin and cardiac troponin-I (cTi) levels were investigated. Methods: A total of 90 subjects (46 control subjects and 44 STEMI patients) were included in the study. Besides demographic data, presence of diabetes mellitus and hypertension, electrocardiography (ECG) findings, blood biochemistry, cardiac biomarkers (cTi) and serum irisin levels were examined. Results: Significantly lower heart rate (HR) and significantly higher ST-elevation and QTc interval were detected in ECG recordings in STEMI patients (p < 0.05). Serum irisin levels were significantly lower in STEMI patients compared to the control subjects (p < 0.001). The decrease in the serum irisin levels was significantly correlated with the increase in cTi levels, as well as increased QTc (p < 0.05). The sensitivity and specificity of irisin were found to be 93% and 78%, respectively. Conclusion: Decreased irisin levels were found to be highly predictive in STEMI. In patients with STEMI, the serum irisin levels were associated with cTi levels and QTc, suggesting that irisin is a promising biomarker for AMI cases.

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.

In-Hospital Bleeding in Elderly Patients With Acute Coronary Syndrome: Are Potent Antiplatelet Agents Safe?

Despite implementation of new interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome (ACS) continue to be susceptible to in-hospital bleeding compared with younger ones. Thus, we investigated the incidence of in-hospital bleeding events and associated risk factors in elderly (≥ 75°years) ACS patients. We also wanted to define the bleeding sites, characteristics, and associated mortality. Bleeding Academic Research Consortium (BARC) classification type 2, 3, or 5 was used to define bleeding events. Overall, 539 patients were included in the study (mean age: 82.5 ± 4.8°years; 282 (52.3%) females). Of these patients, 69 (12.8%) developed in-hospital bleeding. Factors that were independently related with in-hospital bleeding were age (odds ratio (OR): 1.08; 95% confidence interval (CI): 1.011.14, P = .01), acute kidney injury (OR: 3.66; 95% CI: 2.016.69; P < .01), tirofiban (OR: 4.43; 95% CI: 1.7810.99; P < .01), and ticagrelor (OR: 1.93; 95% CI: 1.013.73; P = .04) administration. The urinary tract was the most frequent bleeding site, followed by femoral arteries. In conclusion, ticagrelor and tirofiban should be used with caution in elderly ACS patients.

Relation of a novel fibrosis marker and post-myocardial infarction left ventricular ejection fraction in revascularized patients.

Aim: To investigate the relationship between post-myocardial infarction (MI) left ventricular ejection fraction (LVEF) and fibrosis marker HE-4 in primarily revascularized patients with ST-segment elevation MI (STEMI). Patients & methods: In 94 consecutive STEMI patients (median age 57 [IQR: 50-69] years; 77.7% male), HE-4 values were measured at hospital admission and 4 days after STEMI. Transthoracic echocardiography was performed 4 days after STEMI (median 5 days [interquartile range: 4-6]). Results: HE-4 levels 4 days after STEMI were significantly higher in the low ejection fraction group (30.1 [26.0-46.5] pmol/l vs 48.5 [32.5-85.9] pmol/l, p = 0.004). In the multivariable analysis, HE-4 values (odds ratio: 1.029, 95% CI: 1.012-1.046, p = 0.001), troponin I levels, anterior MI and diabetes mellitus were independent predictors of low LVEF after STEMI. A negative correlation existed between ΔHE-4 levels and LVEF (r: -0.337, p = 0.001). Receiver operating characteristic analysis indicated 34.01 pmol/l HE-4 at 4 days after STEMI identified patients with low LVEF (AUC = 0.707; 95% CI: 0.601-0.813; p = 0.001). Conclusion: In revascularized STEMI patients, high HE-4 levels are associated with decreased LVEF. HE-4 may represent a diagnostic marker and treatment target for patients with heart failure or left ventricular systolic dysfunction after STEMI.

Interarm blood pressure differences and 2-year mortality in acute coronary syndrome patients.

BACKGROUND AND AIMS: Interarm blood pressure difference (IABPD) was associated with increased cardiovascular and all-cause mortality in various cohorts previously. In this study, we planned to explore the association between the IABPD obtained with simultaneous measurements in both arms and the risk of mortality over a 2-year follow-up of patients with acute coronary syndrome (ACS). METHODS: Simultaneous blood pressure (BP) measurements were performed during initial admission in patients with ACS. Systolic ≥10 mmHg and diastolic ≥5 mmHg absolute IABPD was defined as cutoff values in this study. The relationship of IABPD and all-cause mortality was assessed using Kaplan-Meier curves and Cox analysis. RESULTS: A total of 532 patients with ACS were included in the study. Mean age of the study participants was 60.1 ± 12.6. Patients included in the study were followed for 23.2 ± 7.2 months (median 25.3, min: 0, max: 28.7 months). Survival was assessed using Kaplan-Meier curves. Patients with systolic IABPD ≥ 10 mmHg and systolic IABPD < 10 mmHg had an average survival time of 25.94 ± 0.84 and 25.92 ± 0.38 months (P = 0.925), respectively. Survival times of diastolic IABPD ≥5 mmHg and diastolic IABPD <5 mmHg were 26.44 ± 0.62 and 25.71 ± 0.41 (P = 0.251) months, respectively. CONCLUSIONS: In the current study, we did not find a significant association between IABPD and all-cause mortality in patients with ACS in 2-years follow-up. Future studies may be required for further evaluation of the prognostic importance of IABPD in patients with ACS.

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.

The Association between Chronic Use of Renin-Angiotensin-Aldosterone System Blockers and in-Hospital Adverse Events among COVID-19 Patients with Hypertension.

OBJECTIVES: The effects of chronic renin-angiotensin-aldosterone system (RAAS) blockers usage on adverse outcomes and disease severity remain uncertain in COVID-19 patients with hypertension. In this study, we aimed to determine the relationship between chronic use of RAAS inhibitors and in-hospital adverse events among hypertensive patients hospitalized with COVID-19. METHODS: In this retrospective single-center study, we enrolled 349 consecutive hypertensive patients diagnosed with COVID-19 infection. All patients were chronically on angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) or other antihypertensive therapies before hospital admission. Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and intubation. RESULTS: Patients were categorized into two groups according to the type of antihypertensive therapy. (ACEI/ARBs users, N=201; ACEI/ARB nonusers, N=148) There was no statistically significant difference between ACEI/ARBs users and ACEI/ARBs nonusers concerning adverse clinical events, such as in-hospital mortality (29 (14.4%) vs. 20 (13.5%), p=0.81), ICU admission (45(22.4%) vs. 27 (18.2%), p=0.34), need for high-flow oxygen (97 (48.3%) vs. 68 (45.9%), p=0.67) and need for intubation (32(15.9%) vs. 23(15.5%), p=0.92), respectively. Also, the severity of infection did not differ among groups. The logistic regression multivariate analysis showed that age, neutrophil-lymphocyte ratio, procalcitonin and ferritin levels were independent predictors of in-hospital mortality. CONCLUSION: Our results suggest that chronic use of ACEI/ARBs did not increase in-hospital adverse outcomes of hypertensive patients hospitalized with COVID-19. Although the recent data are contradictory, chronic ACEI/ARB therapy is not recommended to be discontinued in hypertensive patients during their hospitalization for COVID-19.

Assessment of the Modified CHA2DS2VASc Risk Score in Predicting Mortality in Patients Hospitalized With COVID-19.

Since the modified CHA2DS2VASC (M-CHA2DS2VASc) risk score includes the prognostic risk factors for COVID-19; we assumed that it might predict in-hospital mortality and identify high-risk patients at an earlier stage compared with troponin increase and neutrophil-lymphocyte ratio (NLR). We aimed to investigate whether M-CHA2DS2VASC RS is an independent predictor of mortality in patients hospitalized with COVID-19 and to compare its discriminative ability with troponin increase and NLR in terms of predicting mortality. A total of 694 patients were retrospectively analyzed and divided into 3 groups according to M-CHA2DS2VASC RS which was simply created by changing gender criteria of the CHA2DS2VASC RS from female to male (Group 1, score 0-1 (n = 289); group 2, score 2-3 (n = 231) and group 3, score ≥4 (n = 174)). Adverse clinical events were defined as in-hospital mortality, admission to intensive care unit, need for high-flow oxygen and/or intubation. As the M-CHA2DS2VASC RS increased, adverse clinical outcomes were also significantly increased (Group 1, 3.8%; group 2, 12.6%; group 3, 20.8%; p <0.001 for in-hospital mortality). The multivariate logistic regression analysis showed that M-CHA2DS2VASC RS, troponin increase and neutrophil-lymphocyte ratio were independent predictors of in-hospital mortality (p = 0.005, odds ratio 1.29 per scale for M-CHA2DS2VASC RS). In receiver operating characteristic analysis, comparative discriminative ability of M-CHA2DS2VASC RS was superior to CHA2DS2VASC RS score. Area under the curve (AUC) values for in-hospital mortality was 0.70 and 0.64, respectively. (AUCM-CHA2DS2-VASc vs. AUCCHA2DS2-VASc z test = 3.56, p 0.0004) In conclusion, admission M-CHA2DS2VASc RS may be a useful tool to predict in-hospital mortality in patients with COVID-19.

Prognostic impact of infection in octogenarians with ST-segment elevation myocardial infarction.

PURPOSE: Contemporary studies assessing outcomes in octogenarian patients presenting with ST-segment elevation myocardial infarction (STEMI) and infection are scarce. This study investigated the impact and prognostic value of infection on long-term mortality in octogenarian patients with STEMI. METHODS: A total of 1564 patients admitted with STEMI between May 2015 and September 2019 were retrospectively analyzed, and 110 octogenarians were identified and included. Predictors of mortality were determined by multivariate Cox regression analysis. Survival curves were generated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 85 ± 4 years, and 58 (52%) were male. Median follow-up was 41 months. Patients with infection had higher rates of in-hospital (16.4% vs. 8.2%, p = 0.001) and long-term (33.6% vs. 20%, p = 0.001) mortality. Multivariate Cox regression analysis revealed that infection (HR 3.16; 95% CI 1.52-6.59; p = 0.002) and C-reactive protein levels (HR 0.99; 95% CI 0.98-1.00; p = 0.042) were independent predictors of mortality in patients with infection. Kaplan-Meier analysis also showed that patients with infection had a significantly higher mortality rate (p < 0.001). CONCLUSION: Infection is an independent predictor of long-term mortality in octogenarian patients with STEMI.

The predictive value of stress hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction.

: It is established that hyperglycemia directly effects the platelet functions and fibrin structure. In this study, we aimed to investigate the predictive value of hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction (STEMI) who underwent to primer percutaneous coronary intervention (PPCI). We enrolled 619 nondiabetic patients with STEMI who received PPCI. Patients were divided two groups according to thrombus burden. Stress hyperglycemia was determined as blood glucose concentration more than 180 mg/dl and angiographic coronary thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades. Patients with thrombus grades 4 were defined as large thrombus burden (LTB), patients with thrombus burden less than thrombus grades 4 were defined as small thrombus burden. A total of 68 (11.0%) STEMI patients had stress hyperglycemia, while 223 (36.0%) patients had LTB. Sex, the prevalence of hypertension, smoking, and dyslipidemia were not different between the thrombus burden groups (P > 0.05 for all parameters). Compared with the patients with small thrombus burden, the patients with LTB were had significantly higher admission blood glucose concentrations (135 ±â€Š39.1 mg/dl vs. 145.9 ±â€Š43.1, P = 0.002, respectively). The multivariate logistic regression analysis demonstrated that stress hyperglycemia is an independent predictor of LTB (odds ratio: 3.025, confidence interval 1.200-7.622, P = 0.019). Admission hyperglycemia is associated with the LTB which cause adverse cardiac outcomes. Hyperglycemia may play a role on thrombus development.

Presence of fragmented QRS may be associated with complex ventricular arrhythmias in patients with essential hypertension.

BACKGROUND: Ventricular arrhythmias (VAs) are frequent in hypertensive patients. Myocardial fibrosis is one of the components of left ventricular hypertrophy secondary to hypertension. Fragmented QRS (fQRS) on electrocardiography (ECG) has been shown to be a marker of myocardial fibrosis. In this study, we aimed to investigate the association between fQRS and complex VAs in patients with essential hypertension. METHODS: Two hundreds consecutive patients who were diagnosed with hypertension were included in the study. The control group consisted of 153 age and sex matched healthy individuals. ECG and transthoracic echocardiography were performed to all patients. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. All patients underwent 24-hour Holter monitoring and VAs were classified using Lown's scoring system. Lown class ≥3 VAs were considered as complex VAs. RESULTS: There was no significant difference with respect to age (52 ±â€¯8 vs 52 ±â€¯6 years, p = 0.836) and gender distribution (female: 64% vs 63%, p = 0.907) between the groups. As compared to the healthy individuals, prevalence of fQRS (67% vs 9.2%, p < 0.001) and complex VAs (19% vs 0%, p < 0.001) were significantly higher in patients with hypertension. Furthermore, complex VAs (25.4% vs 6.1%, p = 0.001) were significantly higher in hypertensive patients with fQRS. In multiple logistic regression analysis, left ventricular ejection fraction (OR: 1.11, 95%CI: 1.025 to 1.183; p = 0.006), left ventricular mass index (OR: 1.04, 95%CI: 1.021 to 1.107; p = 0.001) and presence of fQRS (OR: 5.605, 95%CI: 1.427 to 22.019; p = 0.014) were independent predictors for complex VAs. CONCLUSION: The presence of fQRS may be associated with complex VAs in patients with essential hypertension. Therefore, fQRS may be used in risk stratification of complex VAs and sudden cardiac death especially in hypertensive patients with left ventricular hypertrophy.

Can Thrombus Burden Predict Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction?

The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden

In-hospital Outcomes of Patients with ST-segment Elevation Myocardial Infarction who were Intubated before Primary Percutaneous Intervention: Experience of a tertiary center.

OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) complicated by respiratory failure is associated with a greater number of in-hospital and out-of-hospital adverse cardiovascular events (CVEs). The aim of this study was to analyze in-hospital outcomes and the factors affecting the outcomes of intubated patients diagnosed with STEMI who underwent primary percutaneous coronary intervention (pPCI) at a single tertiary care center. METHODS: The data of 592 patients diagnosed with acute STEMI who were admitted to the emergency department between May 2017 and January 2019 and subsequently underwent pPCI were retrospectively reviewed. Cardiovascular risk factors as well as biochemical and angiographic characteristics of patients who were intubated in the emergency room or ambulance due to cardiac arrest and those who were not intubated were compared. Adverse CVEs were defined as in-hospital death, cerebrovascular stroke, and acute stent thrombosis. RESULTS: A total of 60 patients (70% male; mean age: 63.6±14.0 years) who were intubated and 532 non-intubated patients (81% male; mean age: 60.2±12.1 years) were included in the study. The angiographic features of the 2 groups were similar. An adverse CVE was experienced by 43.3% of the intubated patients and 3.6% of the non-intubated patients. Multivariate analysis indicated that age (odds ratio [OR]: 1.065; p<0.001), serum lactate level (OR: 1.308; p<0.001), and left ventricle ejection fraction (OR: 0.946; p<0.001) were independent predictors of in-hospital adverse CVE in the intubated patient group. CONCLUSION: The results of this single-center study showed that 1 in 10 patients hospitalized with STEMI were intubated, and approximately 4 in 10 intubated STEMI patients had an in-hospital CVE.

The Association of Plasma Apelin Levels with Plaque Vulnerability.

OBJECTIVES: Apelin is a recently discovered peptide that is expressed in many tissues particularly in the cardiovascular system and exerts several actions, most of which are vasodilatory and positive inotropic effects. Based on this, an apelin deficiency is believed to play a significant role in the development of hypertension and heart failure. However, the association of apelin with the pathogenesis of atherosclerosis and especially plaque vulnerability remains unestablished. Thus, to contribute to the literature, in this study, we sought to determine the association of apelin concerning plaque vulnerability in the setting of the acute coronary syndrome. METHODS: In this study, we prospectively enrolled a total of 80 patients; 40 with acute coronary syndrome and 40 patients with stable chronic ischemic heart disease. Plasma apelin levels were measured in all patients along with other routine biochemical parameters, and all patients underwent a transthoracic echocardiographic examination. RESULTS: Plasma apelin levels were significantly lower in patients with the acute coronary syndrome (221.2±66.7 vs 254.3±77.9 p=0.04). However, there was no correlation between plasma apelin levels and serum inflammatory markers or coronary artery disease severity. CONCLUSION: Low plasma apelin levels may create a tendency towards vulnerable plaque and acute coronary syndrome.

Usefulness of Serum Omentin-1 Levels for the Prediction of Adverse Cardiac Events in Patients with Hypertrophic Cardiomyopathy.

OBJECTIVE: To investigate the association between serum omentin-1 levels and adverse cardiac events in patients with hypertrophic cardiomyopathy (HCM). SUBJECTS AND METHODS: This prospective, observational study included 87 patients with HCM and 50 age- and sex-matched control subjects. Serum omentin-1 and brain natriuretic peptide (BNP) levels were measured in all subjects, using enzyme-linked immunosorbent assay and electrochemiluminescence, respectively. Patients with HCM were divided into 2 groups according to their omentin levels, i.e., low: ≤291 ng/mL (n = 48) and high: > 291 ng/mL (n = 39). Cardiac mortality, hospitalization due to heart failure, and implantable cardioverter-defibrillator (ICD) implantation were considered adverse cardiac events. Statistical analysis included uni- and multivariant logistic regression, receiver-operating characteristic (ROC) analysis, and the Kaplan-Meier method. RESULTS: Serum omentin-1 levels were significantly lower in the obstructive (253.9 ± 41.3 ng/mL) and nonobstructive (301.9 ± 39.8 ng/mL) HCM groups than in the control group (767.1 ± 56.4 ng/mL), p < 0.001, respectively. The BNP levels were higher in the obstructive and nonobstructive HCM groups than in the control group (269.5 ± 220, 241.0 ± 227, and 24.0 ± 18.9 pg/mL, respectively, p < 0.001). The Kaplan-Meier analysis indicated that patients with low omentin-1 levels showed a significantly higher (48.2%) 2-year cumulative incidence of overall adverse cardiac events than those with high omentin-1 levels (16.2%) (log-rank test, p = 0.001). In the multivariate logistic regression analysis, omentin-1, interventricular septum (IVS) thickness, and male gender were independent predictors of adverse cardiac events in the follow-up. CONCLUSION: Omentin-1 levels were lower in patients with HCM than in the control group, and this was associated with worse cardiac outcomes.

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.