Can Syntax Score predict angiographically visible distal embolization during primary percutaneous coronary intervention?

BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the most effective and validated treatment strategy of ST segment elevation myocardial infarction (STEMI). Nevertheless, normal myocardial perfusion cannot always be achieved at the end of the procedure in a significant number of patients with STEMI. The aim of this study was to investigate angiographic and procedural predictors of angiographically visible distal embolization (AVDE) during PPCI and the assessment of mid and long term mortality. METHODS: Four hundred and sixty five consecutive patients undergoing PPCI for acute STEMI and matching eligibility criteria of the study between January 2010 and December 2011 were enrolled in the study. Patients were divided into two groups; 61 (13.1%) with AVDE and 404 patients without AVDE based on angiograms performed during PPCI. RESULTS: Longer stent length, higher balloon diameter, low Syntax score (SxS), low LVEF, high neutrophil/lymphocyte ratio and chronic renal failure were seemed to be associated with AVDE in univariate analysis and these variables were entered into multivariate analysis. In multivariate analyzes, stent length, LVEF and low SxS were found to be associated with AVDE (OR: 1,11, 95 % CI: 1,06-1,16, p< 0,001; OR: 0,80, 95%CI: 0.80-0.91, p< 0,001; OR: 0,85, 95%CI: 0,79-0,91, P< 0,001, respectively). CONCLUSIONS: This study concluded that low SxS, longer stent length, low LVEF were predicting risk factors associated with the development of AVDE in patients undergoing PPCI. Low SxS associated with AVDE may be linked to the strong relation between AVDE and high thrombus burden and composition of atherosclerotic plaque rather than complex coronary lesions.

Serum copeptin levels in predicting nondippers in newly diagnosed hypertension.

OBJECTIVES: The nondipper pattern in hypertension is associated with worse cardiovascular outcomes. In this study, we hypothesized that high copeptin levels could predict nondippers among hypertensive patients and investigated the associations between copeptin levels and nondipper pattern in newly diagnosed hypertensive patients. METHODS: Ambulatory blood pressure measurements were obtained and the patients were divided into two groups according to ambulatory blood pressure measurement as nondippers and dippers. Serum copeptin levels were measured in addition to routine laboratory investigations. A total of 76 patients were included in the study. RESULTS: The clinical and laboratory characteristics of the two groups were similar. The mean copeptin values were found to be significantly higher in the nondipper hypertensive group [1.66 (1.19-4.01) and 1.35 (1.12-2.09) IU/ml, respectively, P=0.026]. In the correlation analysis, no correlation was found between copeptin levels and daytime diastolic blood pressure, but there were weak positive correlations with daytime systolic, 24 h systolic, and diastolic blood pressure values (r=0.335, P=0.034, r=0.350, P=0.027, r=0.372, P=0.018, respectively). However, there were significant positive correlations between serum copeptin levels and nocturnal systolic and diastolic blood pressure values (r=0.593, P<0.001, r=0.523, P=0.001, respectively). CONCLUSION: This study showed that high serum copeptin levels could predict the nondipper pattern in newly diagnosed hypertension.

Does intravenous or oral high-dose N-acetylcysteine in addition to saline prevent contrast-induced nephropathy assessed by cystatin C?

AIMS: The objective of this study is to determine the effect of intravenous (i.v.) or oral N-acetylcysteine (NAC) in preventing contrast-induced nephropathy (CIN) in patients with moderate-to-severe renal insufficiency undergoing intra-arterial interventions. MATERIALS AND METHODS: We studied 307 patients with estimated glomerular filtration rate of less than 60 ml/min/1.73 m undergoing an elective intra-arterial procedure. Patients were assigned randomly to three groups according to the prophylactic regimen used. In group 1, patients were administered an i.v. infusion of 0.9% saline (n=103); in group 2, patients were administered oral NAC in addition to an i.v. saline infusion (n=102); and in group 3, patients were administered i.v. NAC in addition to an i.v. saline infusion (n=102). Serum creatinine (SCr) and cystatin C levels were measured at baseline and 4, 24, and 48 h after the application of contrast media. The primary endpoint was defined as an increase in the SCr or cystatin C concentration of at least 0.5 mg/dl and/or of at least 25% from the baseline value at 48 h after administration of the contrast dye. RESULTS: The overall incidence of SCr-based CIN was 11.1%: 6.8% in the saline group, 13.7% in the oral NAC group, and 12.7% in the i.v. NAC group (P=0.231). That of cystatin C-based CIN was 8.1%: 6.8% in the saline group, 6.9% in the oral NAC group, and 10.8% in the i.v. NAC group (P=0.491). CONCLUSION: In this study, there was no detectable benefit of either high-dose oral or i.v. NAC over an aggressive hydration protocol in patients with moderate-to-severe renal insufficiency.