Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction.

BACKGROUND: The coronary slow flow/no-reflow phenomenon (CSF/NRP) is a common complication of emergency percutaneous coronary intervention (PCI) for ST-elevated myocardial infarction (STEMI). Its long-term prognostic value, however, remains unclear. This study investigated the long-term outcome and prognostic value of CSF/NRP after emergency PCI for STEMI. METHODS: This retrospective, multicenter registry-based cohort study was conducted in STEMI patients who underwent emergency PCI between 2015 and 2016. Incidence of in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), and all-cause mortality during long-term follow-up were compared between CSF/NRP patients and the normal flow group. Cox proportional-hazards regression model was performed to identify the predictive impact of CSF/NRP in short- and long-term outcomes. RESULTS: A total of 649 STEMI patients were included in the study, of whom 193 (29.7%) developed CSF/NRP following emergency PCI. The CSF/NRP group had a higher incidence of in-hospital mortality than the non-CSF/NRP group (8.2 vs. 4.3%, P  = 0.04). All-cause mortality incidence was also higher in the CSF/NRP group during 5-year follow-up (22.2 vs. 16.2%, P  = 0.04). The Cox proportional hazards model adjusting for demographic and clinical variables identified the NRP as an independent predictor of 5-year cardiac mortality [hazard ratio: 1.89; 95% confidence interval (CI): 1.07-3.31; P  = 0.02]. In a landmark analysis, no difference was seen in overall mortality among the two study groups between 1 month and 5-year follow-up (hazard ratio: 1.33; 95% CI: 0.80-2.21, P -value: 0.23). Kaplan-Meier analysis showed lower 3-year cumulative MACCE-free survival in the CSF/NRP group compared with the normal flow group ( P  = 0.02). CONCLUSION: CSF/NRP in STEMI patients is associated with a worse short- and long-term prognosis. These results, however, are mostly related to the acute phase, and CSF/NRP had limited influence on clinical outcomes in early survivors of STEMI.

Predictors of Mortality for Patients with ST-Elevation Myocardial Infraction after 2-Year Follow-Up: A ST-Elevation Myocardial Infarction Cohort in Isfahan Study.

Background: Mortality of ST-elevation myocardial infarction (STEMI) patients is increasing in world. This study defines predictors of mortality in patients who have STEMI. Materials and Methods: This study was a part of the ST-elevated myocardial infarction cohort study in Isfahan conducted on 876 acute myocardial infarction (MI) followed for 2 years that 781 patient entered. The effect of predictors of mortality includes demographic, physiological, and clinical characterizes compared in two groups alive and died patients. MACE was defined as nonfatal MI, nonfatal stroke, and atherosclerosis cardiovascular disease-related death was recorded. Univariate and multiple logistic regression analyses were performed. All analyses performed using SPSS 20.0. P < 0.05 considered statistically significant. Results: A total 781 patients, 117 (13%) that 72 (8.5%) was in-hospital died. The mean (standard deviation) age of the patients was 60.92 (12.77) years and 705 (81.3%) patients were males. Significant factors that affected mortality on analysis of demographic and physiological parameters were age (P < 0.001), sex (P = 0.004), transfusion (P = 0.010), STEMI type (P < 0.001), number epicardial territories >50% (P = 0.001), ventilation options (P < 0.001), smoker (P = 0.003), and diabetes (P = 0.026). Significant clinical factors affected mortality were ejection fraction (EF) (P < 0.001), creatinine (P < 0.001), hemoglobin (P < 0.001), low-density lipoprotein-cholesterol (LDL-C) (P = 0.019), and systolic blood pressure (P < 0.001). Multiple logistics regression model definition significant predictors for mortality were age (P < 0.001), heart rate (HR) (P = 0.007), EF (0.039), LDL-C (P = 0.002), and preangia (P = 0.022). Conclusion: The set of factors can increase or decrease mortality in these patients. Significant predictors of mortality STEMI patients by 2-year follow up were age, HR, EF, LDL-C, and preangia. It seems that more articles need to be done in different parts of Iran to confirm the results.

Effects of selenium supplementation on paraoxonase-1 and myeloperoxidase activity in subjects with cardiovascular disease: the Selenegene study, a double-blind randomized controlled trial.

INTRODUCTION: We previously highlighted the potential link between supplementation with selenium, as an antioxidant trace element, and changes in the levels of paraoxonase (POX1) and myeloperoxidase (MPO), as an antioxidant enzyme, in patients with documented cardiovascular disease (CVD). The aim of this study was to determine the effects of selenium supplementation on POX1 and MPO activity in patients with cardiovascular diseases (CVDs). MATERIAL AND METHODS: A total of 160 eligible patients were enrolled in the study. After performing some laboratory tests, including the measurement of blood selenium, triglyceride, cholesterol, and low- and high-density lipoprotein levels, the patients received 200 mg tablets of either selenium yeast or placebo. The medicines were taken orally, once daily after a meal for 60 days. Four weeks after the initial visit, the patients were invited for a follow-up visit, and interviews and non-laboratory evaluations, similar to those performed at baseline, were repeated. Compliance of patients for using selenium and placebo was measured by telephone. Medication compliance rates were monitored by telephone. The final assessments were conducted eight weeks after the beginning of the study. RESULTS: There was no significant difference in cholesterol levels between intervention and control groups (p = 0.87). No significant changes in selenium levels were observed in either the selenium or the placebo group after the intervention (p = 0.44 and p = 0.48, respectively). The two groups had a significant difference in terms of POX1 level (p = 0.039). No such difference was present in the case of MPO levels. Moreover, comparison of the values before and after the intervention showed no significant differences in the mean levels of any of the measured parameters. CONCLUSIONS: According to the obtained results, the increased POX1 levels after selenium supplementation could be attributed to the positive effect of selenium on inhibiting lipid peroxidation as part of the complicated pathophysiology of CVD.