Experience from a regional percutaneous coronary intervention center: Aiming to assess and improve quality of care.

INTRODUCTION AND OBJECTIVES: Ischemic heart disease is the single most common cause of death in Europe. Mortality in patients presenting with ST-elevation myocardial infarction (STEMI) is associated with many factors, one of which is the time delay to treatment. The purpose of this work is to analyze the coronary pathway in our region in terms of timing, taking into consideration the place of first medical contact (FMC). METHODS: Consecutive patients admitted to our center with STEMI to undergo percutaneous coronary intervention (PCI) between 2013 and 2022 were analyzed. Age, gender, and time delays were collected. Analysis was performed with IBM SPSS version 28 for a significance level of 0.05. RESULTS: We found that non-PCI centers had a significantly greater FMC to diagnosis delay and diagnosis to wire delay compared to other places of origin. Only 2.2% of patients met the 10-min FMC to diagnosis target; 44.8% met the target of 90 min from diagnosis to wire in transferred patients, while 40.6% met the 60-min target for patients admitted to a PCI center. Median patient, electrocardiogram (ECG) and logistic delays are 92.0±146.0 min, 19.0±146.0 min and 15.5±46.3 min, respectively. CONCLUSION: A significant difference between state-of-the-art targets and reality was found, depending on the place of FMC, with the worst delays in non-PCI centers. Patient delay, ECG delay, FMC to diagnosis and logistic delay are identified as key areas in which to intervene.

Effect of CASC15 on apoptosis and oxidative stress of cardiomyocytes after hypoxia/reperfusion injury.

INTRODUCTION AND OBJECTIVES: The increasing incidence of ischemic heart disease is a serious threat to human health. Increased CASC15, a long non-coding RNA, has been shown to adversely affect cardiac muscle. The objective of this paper was to explore the effect of CASC15 on a cell model of myocardial infarction and its possible mechanism. METHODS: H9c2 cells were selected to establish the myocardial infarction model through hypoxia/reoxygenation (H/R) treatment. The expression of CASC15 was attenuated by cell transfection in vitro. The level of CASC15 was detected by RT-qPCR. Cell viability was detected by CCK-8 assay, and cell apoptosis was assessed by flow cytometry. The content of MDA and the activity of SOD and GSH-Px were measured by ELISA. Luciferase reporter gene assay was used to determine the relationship between CASC15 and miRNA. RESULTS: CASC15 expression was increased in H/R-treated H9c2 cells. Overexpression of CASC15 adversely affected cell viability and promoted H/R-induced oxidative stress. Inhibition of CASC15 promoted cell viability and suppressed cell apoptosis and oxidative stress damage. Additionally, luciferase reporter gene assay confirmed the targeting relationship between CASC15 and miR-542-3p, and attenuating CASC15 expression enhanced the level of miR-542-3p. Reduction of miR-542-3p weakened the viability of the H/R cell model, increased apoptosis, and enhanced oxidative stress damage. CONCLUSION: This study suggests that overexpression of CASC15 may inhibit the viability of H9c2 cells, promote apoptosis and induce oxidative stress through targeted regulation of miR-542-3p expression.

Spontaneous coronary artery dissection: Ten years' experience of a tertiary center.

INTRODUCTION: Spontaneous coronary artery dissection (SCAD) represents 1-4% of all acute coronary syndromes (ACS), and is a particularly important cause among young women and individuals with few cardiovascular risk factors. OBJECTIVES: To characterize clinical background, therapeutic management and clinical outcomes in a SCAD population. METHODS: We retrospectively analyzed all consecutive patients diagnosed with SCAD at a tertiary center between August 2009 and May 2020, with a median follow-up of 40 months (IQR 14-95 months). SCAD was classified according to the Saw angiographic SCAD classification. RESULTS: A total of 36 patients were included, 94% female, mean age 51 years (±11 years). A trigger was only detected in 8% and associated conditions in 31% of patients, mainly inflammatory or autoimmune systemic diseases and migraine. Most patients had non-ST-elevation ACS and 33% presented with ST-elevation ACS. The most frequent culprit lesion was the left anterior descending (LAD) artery (67%); mid to distal segments were the most affected (94%) and type 2 dissection the most prevalent (60%). Almost all patients were successfully medically managed, with only four undergoing percutaneous intervention. During follow-up, ischemic events recurred in 15% of patients and no patient died. Patients with type 2 dissection exhibited lower risk of recurrence compared to type 1 (p=0.049, OR=0.13). CONCLUSION: SCAD patients were mainly young or middle-aged women; the LAD artery was the most affected vessel and type 2 dissection the most prevalent. This report showed for the first time a correlation between type 2 SCAD and lower risk of recurrence.

Iron metabolism and cardiovascular disease: Basic to translational purviews and therapeutical approach.

Iron interactions with the cardiovascular system were proposed about half a century ago, yet a clear-cut understanding of this micronutrient and its intricacies with acute and chronic events is still lacking. In chronic heart failure, patients with decreased iron stores appear to benefit from intravenous administration of metallic formulations, whereas acute diseases (e.g., myocardial infarction, stroke) are barely studied in randomized controlled trials in humans. However, proof-of-concept studies have indicated that the dual redox characteristics of iron could be involved in atherosclerosis, necrosis, and ferroptosis. To this end, we sought to review the currently available body of literature pertaining to these temporal profiles of heart diseases, as well as the pathophysiologic mechanism by which iron enacts, underlining key points related to treatment options.

Ventricular arrhythmias are associated with increased QT interval and QRS dispersion in patients with ST-elevation myocardial infarction.

INTRODUCTION AND OBJECTIVES: The electrocardiogram continues to be essential in the diagnosis of acute myocardial infarction, and a useful tool in arrhythmic risk stratification. We aimed to determine which electrocardiographic variables can successfully predict the occurrence of ventricular arrhythmias (VA) in patients following ST-segment elevation myocardial infarction (STEMI). METHODS: We performed an observational study including 667 patients with STEMI admitted to the University Hospital in Sancti Spíritus, Cuba. Demographic variables, cardiovascular risk factors, and clinical variables were recorded. Electrocardiographic variables included QT interval duration (measured and corrected) and QT dispersion, QRS duration and dispersion, JT interval duration and ST-segment elevation magnitude. We also determined left ventricular ejection fraction and glomerular filtration rate. A binary statistical regression model and a regression tree were used to determine the variables that successfully predicted VA. RESULTS: VA occurred in 92 (13.8%) patients, within the first 48 hours in 68 (73.9%) and after this period in 24 (26.1%) patients. The variables associated with VA were QT interval duration >529 ms and QT dispersion >66 ms, QRS dispersion >50 ms, and the presence of ST-segment elevation in six or more leads. CONCLUSIONS: The main predictor of VA occurring during the initial 48 hours was QT interval duration, while, after this period, it was QRS dispersion.

Prognostic value of brain natriuretic peptide in ST-elevation myocardial infarction patients: A Portuguese registry.

INTRODUCTION: Brain natriuretic peptide (BNP) is a highly sensitive and specific biomarker for the extent of myocardial infarction that is strongly related to short- and long-term prognosis in patients with acute coronary syndromes. OBJECTIVE: To assess the prognostic value of BNP levels in a Portuguese cohort of ST-elevation myocardial infarction (STEMI) patients. METHODS: We performed a retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 2019. Patients were divided into three groups according to BNP level (<100 pg/ml, 100-399 pg/ml and ≥400 pg/ml) and compared. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. For sample homogenization, propensity score matching and pairwise matching with a tolerance level of 0.005 were performed. RESULTS: A total of 1650 patients were included, of whom 21.5% presented high BNP levels (≥400 pg/ml). These were older and had more comorbidities, lower admission systolic blood pressure and hemoglobin, higher heart rate, Killip class and creatinine, worse left ventricular systolic function and severe coronary anatomy. Higher BNP was associated with more in-hospital complications, in-hospital mortality and adverse outcomes at one year. CONCLUSION: BNP levels during the index hospitalization were a powerful prognostic biomarker for all-cause mortality and major adverse cardiac events in patients admitted with STEMI to Portuguese hospitals.

High expression of SGK1 in thrombosis of acute ST-segment elevation myocardial infarction: Based on proteomics analysis of intracoronary thrombosis.

INTRODUCTION AND OBJECTIVES: Thrombosis is involved in the onset and progression of ST-segment elevation myocardial infarction (STEMI). The aim of this study was to explore the expression level of serum- and glucocorticoid-inducible kinase 1 (SGK1) in intracoronary thrombus and the relationship between them. METHODS: We identified 30 patients who received treatment in the Affiliated Hospital of Hangzhou Normal University between May 2018 to May 2020 and who underwent thrombus aspiration and percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Additionally, we selected 30 patients with normal coronary angiography for the control group. We analyzed thrombus protein expression profiling by combining tandem mass tag labeling, high-performance liquid chromatography fractionation and mass spectrometry quantification approach. RESULTS: The differentially regulated protein profiles revealed the alteration of serine-threonine/tyrosine-protein kinase, which was upregulated significantly in the experimental group. We selected SGK1 downstream factor for validation and found that the expression of SGK1 in the thrombus of STEMI was significantly increased. Immunohistochemistry (IHC) showed significantly increased expression of SGK1 in the thrombus of STEMI patients compared with the control group (17.21±2.36 vs. 4.14±1.17%, p<0.05). Similar findings were observed in the Western blot analysis (p<0.05). IHC showed that SGK1 expressed in a region similar to that of the platelets. CONCLUSION: This is the first quantitative proteomics study to assess thrombus in patients with STEMI. The expression of SGK1 in thrombus was significantly higher in patients with acute STEMI than in the control group. SGK1 might be involved in the platelet physiological process.

Inflammation and ischemic heart disease: The next therapeutic target?

Inflammation plays an important role in several stages of the cardiovascular continuum. In recent decades a plethora of studies have provided new data highlighting the role of inflammation in atherogenesis and atherothrombosis in two-way interactions with various cardiovascular risk factors and further influencing these dynamic processes. The concept of targeting residual inflammatory risk among individuals with ischemic heart disease (IHD) is therefore gaining increasing attention. Recently, several landmark randomized controlled trials have assessed different pharmacological approaches that may mitigate this residual risk. The results of some of these studies, such as CANTOS with canakinumab and COLCOT and LoDoCo2 with colchicine, are promising and have provided data to support this concept. Moreover, though several aspects remain to be clarified, these trials have shown the potential of modulating inflammation as a new target to reduce the risk of cardiovascular events in secondary prevention patients. In the present review, we aim to present a pragmatic overview of the complex interplay between inflammation and IHD, and to critically appraise the current evidence on this issue while presenting future perspectives on this topic of pivotal contemporary interest.

Peripheral neutrophils and naive CD4 T cells predict the development of heart failure following acute myocardial infarction: A bioinformatic study.

INTRODUCTION: Heart failure (HF) secondary to acute myocardial infarction (AMI) is still a worldwide problem with a high mortality rate. The current study aimed to explore early and reliable predictive biomarkers of HF following AMI. METHODS: The gene expression profile GSE59867 was downloaded from GEO. Array data from peripheral blood mononuclear cells (PBMCs) was used from 46 control patients and 111 patients with AMI at four time points: (i) first day of AMI; (ii) 4-6 days after AMI; (iii) one month after AMI; and (iv) six months after AMI. Among the 111 AMI patients, nine with HF and eight without HF were studied. CIBERSORT was used to analyze the relative proportions of immune cells in PBMCs. The proportions of immune cells in different groups were compared. Differentially expressed genes (DEGs) were analyzed with R language packages. RESULTS: The percentages of monocytes and neutrophils increased significantly on the first day of AMI, and then decreased gradually. The percentage of regulatory T cells increased significantly 4-6 days after AMI, while the percentage of resting memory CD4 cells, CD8 T cells, and resting natural killer cells decreased significantly on the first day of AMI, and then increased gradually. Patients who developed HF had a significantly higher proportion of neutrophils in PBMCs on the first day of AMI, but had a significantly lower proportion of naive CD4 T cells. Two shared genes, interleukin-1 receptor 2 (IL1R2) and leucine-rich repeat neuronal protein 3 (LRRN3), were found to have potentially important roles in predicting the development of HF following AMI. CONCLUSION: A higher proportion of neutrophils and a lower proportion of naive CD4 T cells in PBMCs on the first day of AMI may be correlated with the development of HF following AMI. IL1R2 and LRRN3 may exert functions in the development of HF following AMI.

Inflammation and ischemic heart disease: The next therapeutic target?

Inflammation plays an important role in several stages of the cardiovascular continuum. In recent decades a plethora of studies have provided new data highlighting the role of inflammation in atherogenesis and atherothrombosis in two-way interactions with various cardiovascular risk factors and further influencing these dynamic processes. The concept of targeting residual inflammatory risk among individuals with ischemic heart disease (IHD) is therefore gaining increasing attention. Recently, several landmark randomized controlled trials have assessed different pharmacological approaches that may mitigate this residual risk. The results of some of these studies, such as CANTOS with canakinumab and COLCOT and LoDoCo2 with colchicine, are promising and have provided data to support this concept. Moreover, though several aspects remain to be clarified, these trials have shown the potential of modulating inflammation as a new target to reduce the risk of cardiovascular events in secondary prevention patients. In the present review, we aim to present a pragmatic overview of the complex interplay between inflammation and IHD, and to critically appraise the current evidence on this issue while presenting future perspectives on this topic of pivotal contemporary interest.

Acute myocardial infarction in a child with nephrotic syndrome.

Myocardial infarction is very rare in children. It can have different etiologies such as thromboembolism caused by nephrotic syndrome (NS). We report the case of a 15 year old boy with NS, diagnosed at the age of 7 year, admitted for prolonged chest pain. The final diagnosis was ST-elevation myocardial infarction with thromboembolism in the left anterior descending artery due to hypercoagulability of NS. This association is very uncommon and the management of both conditions presents a challenge.

Predictive value of oxidant and antioxidant status for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction.

BACKGROUND: Contrast-induced nephropathy (CIN) is a life-threatening complication after primary percutaneous coronary intervention (p-PCI). Oxidative stress and inflammation may play an important role in the development of CIN. OBJECTIVE: We aimed to assess the relationship between total oxidant status, total antioxidant capacity, high-sensitivity C-reactive protein (hs-CRP), gamma-glutamyltransferase and uric acid (UA) in the development of CIN in patients presenting with ST-elevation myocardial infarction (STEMI). METHODS: This prospective cohort study consisted of 341 patients with STEMI. Patients were divided into two groups: those with and those without CIN. Predictors of CIN were determined by multivariate regression analyses. RESULTS: Multivariate regression analysis showed that initial glucose level, contrast media volume/glomerular filtration ratio (eGFR) ratio, hs-CRP, UA and oxidative status index were associated with the development of CIN in patients with STEMI. CONCLUSION: The main finding of this study is that increased oxidative stress and inflammation parameters were associated with the development of CIN in patients with STEMI. Other independent predictors of CIN were contrast media volume/eGFR ratio, initial glucose level, UA and hs-CRP.

Influence of left ventricular systolic function on the long-term benefit of beta-blockers after ST-segment elevation myocardial infarction.

INTRODUCTION: Beta-blockers are recommended after ST-elevation myocardial infarction (STEMI), but their benefit in patients with preserved left ventricular ejection fraction (LVEF) is unclear. METHODS: Consecutive patients discharged in sinus rhythm after STEMI between January 2010 and April 2015 were followed until December 2017. Percutaneous coronary intervention (PCI) was performed in 969 (99.7%, including 112 with rescue PCI) and three (0.3%) received only thrombolytic therapy without rescue PCI. RESULTS: Of these 972 patients, mean age 62.6±13.5 years, 212 (21.8%) were women and 835 (85.9%) were prescribed beta-blockers at discharge. Patients who did not receive beta-blockers had more comorbidities than those who did, including chronic obstructive pulmonary disease (14.6% vs. 4.2%), anemia (8.0% vs. 3.7%), and cancer (7.3% vs. 2.8%), and more frequently had inferior STEMI (75.9% vs. 56.0%) and high-grade atrioventricular block (13.1% vs. 5.3%) (all p<0.01). After a mean follow-up of 49.6±24.9 months, beta-blocker treatment at discharge was independently associated with lower mortality (HR 0.61, 95% confidence interval [CI] 0.38-0.96, p=0.03). This effect was present in 192 patients with LVEF ≤40% (HR 0.57, 95% 95% CI 0.34-0.97, p=0.04) but was not clear in 643 patients with LVEF >40% (HR 0.67, 95% 95% CI 0.25-1.76, p=0.42). CONCLUSION: In the LVEF >40% group, the results raise reasonable doubts about the real benefit of systematic use of beta-blockers as treatment for these patients. These findings reinforce the need for large randomized clinical trials within this group of patients.

D-dimers are associated with coronary artery disease severity assessed using Syntax and Syntax II scores in patients with ST elevation myocardial infarction.

INTRODUCTION AND OBJECTIVES: D-dimers are a determinant of hypercoagulable state and have been found to be related to acute coronary syndromes. We aimed to establish the association between increased D-dimer levels and coronary artery disease (CAD) severity using SYNTAX Score (SS) II in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: This retrospective study included 300 consecutive patients (81.7% males, mean age 55±12 years) with STEMI who underwent a primary PCI. Patients were divided into two groups according to their median SSII [SSII<25 as a low group (n=151) and SSII≥25 as a high group (n=149)]. Blood samples for D-dimers and the other biochemical parameters were obtained from each patient at admission. RESULTS: When compared with the low SSII group, frequency of female gender, no-reflow phenomenon, D-dimer levels, thrombus score, creatine kinase MB and troponin were significantly higher, whereas left ventricular ejection fraction (LVEF) and glomerular filtration rate (GFR) were lower in the high SSII group (p<0.05, for all). D-dimer levels, thrombus score, LVEF, GFR and no-reflow phenomenon were independent predictors of CAD severity (p<0.05, for all). Receiver operating characteristic curve analysis showed that the D-dimer cut-off value for predicting the severity of CAD was 0.26 µg/ml (69.8% sensitivity and 65.6% specificity, p<0.001). CONCLUSION: Increased D-dimer levels are associated with the severity of CAD based on Syntax Score II, in patients with STEMI who successfully underwent revascularization with a primary PCI.

Quality of life in adults living in the community with previous self-reported myocardial infarction.

AIM: Quality of life (QoL) is one of the most important patient-reported outcomes in chronic diseases. Using a population-based cohort, our objective was to assess health-related QoL in individuals with a previous myocardial infarction (MI). METHODS: This study was conducted on a large database representative of the adult Portuguese population aged 18 years or over, living in the community. Participants were assessed through telephone interview. A standardized questionnaire was applied to every individual about self-reported chronic diseases, including previous MI. QoL was assessed with the EQ-5D-3L version of EuroQol. The prevalence of previous MI was calculated and linear regression analysis was performed. RESULTS: The estimated prevalence of previous MI in the adult Portuguese population was 1.1%. These patients were older and more often male, had lower income and lower education levels, and were more often from urban areas. Respondents with self-reported MI assigned a lower self-perception to their health status in all domains, particularly in mobility and anxiety/depression. The mean EQ-5D-3L score in patients with MI was 0.73±0.34, significantly lower than in patients without MI (0.78±0.29). Also, the number of chronic diseases was significantly higher in patients with MI (5.0±2.2 vs. 1.7±1.8). Previous MI was not independently associated with QoL, which was related to age, gender and number of comorbidities. CONCLUSIONS: Adults with previous MI have a worse self-perceived health status and QoL. Previous MI was not an independent predictor of health-related QoL after controlling for age, gender and associated chronic diseases.

Indirect costs of myocardial infarction in Portugal.

INTRODUCTION: Cardiovascular disease, and particularly myocardial infarction (MI), carries a significant economic burden, through productivity losses (indirect costs) associated with temporary absence from work, that has not yet been adequately studied in Portugal. Our objective was to quantify the indirect costs of MI in the first year after admission. METHODS: Consecutive patients admitted to a single center aged <66 years who survived to discharge during a one-year period were included. Employment status on admission was assessed and for every employed patient, their monthly wage was estimated from market wage rates taken from the Ministry of Labor database according to gender and age. The duration of temporary absence from work was assessed in follow-up contacts for up to one year. Indirect costs were calculated in this sample and the results were applied to the number of MIs in Portugal during 2016 and separately to ST-elevation MI (STEMI) and non-ST-elevation acute coronary syndrome. RESULTS: A total of 219 patients were included, of whom 66.2% were working. The mean monthly labor cost was 1802 euros. A total cost of 760 521.55 euros was obtained. At national level there were 4133 patients aged <66 years admitted with acute MI who survived to discharge. Costs were higher in STEMI patients and the total indirect cost was estimated at 10.12 million euros. CONCLUSIONS: In Portugal, the costs to society of disability-generated productivity losses exceed ten million euros in the first year after MI. Strategies to promote an earlier return to work are needed to lower these costs.

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain.

OBJECTIVE: To assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI). METHODS: An observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per 100000 population for AMI (ICD-9-CM code 410) for men and women were calculated. RESULTS: Adjusted hospital admission rates per 100000 population for AMI decreased markedly from 141.1 in 2005 to 119.2 in 2007, with a further reduction to 102.9 in 2013. Reductions in hospital admission were recorded in both men and women, but the downward trends were stronger in women. CONCLUSION: The Spanish comprehensive smoking ban was associated with a marked reduction in the adjusted rate of hospital admissions due to AMI in the Autonomous Community of Valencia. This decrease in the number of persons requiring in-patient care due to AMI is important from both a health care and a societal perspective.

Effects of exercise training and stem cell therapy on the left ventricle of infarcted rats.

INTRODUCTION AND OBJECTIVES: Stem cell therapy and aerobic exercise are non-pharmacological therapies following myocardial infarction. The aim of this study was to test whether aerobic exercise training enhances the benefits of mesenchymal stem cell (MSC) therapy on remodeling of the extracellular matrix and fetal gene expression in the left ventricle of infarcted rats. METHODS: Myocardial infarction was surgically induced in six-week old male Wistar rats. Animals were divided into four groups: sedentary control (SC) and sedentary and stem cell treated (SCMSC); exercised (EX) and exercised and stem cell treated (EXMSC). Bone marrow-derived MSCs were immediately transplanted via the tail vein (concentration: 1×106 cells). Exercise training (five days/week, 60 min/day; 60% of maximal running speed) started 24 hours after myocardial infarction and lasted for 12 weeks. RESULTS: Exercise capacity was higher in exercised than in sedentary groups. Animals in the SCMSC, EX and EXMSC groups exhibited better cardiac function than those in SC. Collagen content was lower in the SCMSC, EX and EXMSC groups than in SC and skeletal α-actin expression was lower in EX and EXMSC than in SC. The α/ß-MHC ratio was higher in EX and EXMSC than in SC. The combination of therapies further reduced collagen content in the remote region of the infarct (∼24%) and skeletal α-actin expression (∼30%). CONCLUSION: Aerobic exercise training appears to enhance the beneficial effects of stem cell therapy on remodeling of the extracellular matrix and fetal gene expression in the left ventricle of rats with moderate infarction.

Adjuvant antithrombotic therapy in ST-elevation myocardial infarction: A narrative review.

This article reviews the major pharmacologic features of, and clinical evidence on, adjuvant medical therapy in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. These drugs include oral antiplatelets (aspirin and P2Y12 inhibitors such as clopidogrel, prasugrel and ticagrelor), intravenous antiplatelet agents (the P2Y12 inhibitor cangrelor, GP IIb/IIIa inhibitors such as abciximab, eptifibatide and tirofiban), and intravenous anticoagulant agents (unfractionated heparin, low molecular weight heparin and bivalirudin).

Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction.

INTRODUCTION: Stent restenosis remains a clinical challenge for patients with ischemic heart disease, since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs. Inflammation plays a significant role. Although an association between stent restenosis, increased C-reactive protein (CRP) and decreased albumin levels has been previously reported, no studies have investigated the ability of the CRP/albumin ratio to predict stent restenosis. METHODS: This retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms. The study population was divided into two groups based on whether the patient had developed stent restenosis. They were then stratified into three groups according to their CRP/albumin ratio. RESULTS: Out of 448 patients, stent restenosis was observed in 24.5% (n=110), as determined by coronary angiography. Patients with stent restenosis had a higher CRP/albumin ratio, greater platelet distribution width (PDW), higher CRP levels, and lower levels of both high-density lipoprotein (HDL) cholesterol and serum albumin. The CRP/albumin ratio (OR: 2.289, 95% CI: 1.056-4.959; p=0.036), stent diameter, PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis. A ROC curve comparison demonstrated that the CRP/albumin ratio was a better predictor of restenosis than either albumin and CRP individually, but it was not better than PDW and HDL cholesterol. CONCLUSION: As a novel inflammation-based risk score, the CRP/albumin ratio may be an easily accessible marker for assessment of stent restenosis risk.