Comparison of ticagrelor and clopidogrel in anemic patients with acute coronary syndrome: efficacy and safety outcomes over one year.

OBJECTIVE: This retrospective study aimed to investigate the potential impact of ticagrelor and clopidogrel treatment on cardiovascular outcomes in patients with anemia and acute coronary syndrome (ACS) and to provide insights into the optimal therapeutic approach for this vulnerable patient population. METHODS: A retrospective research design was employed, involving patients diagnosed with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) between 2014 and 2021. Inclusion criteria required a hemoglobin level below 12 mg/dL and a minimum 12-month P2Y12 inhibitor treatment. Comprehensive clinical, biochemical, and echocardiographic data were collected from the hospital's electronic repository. The primary efficacy endpoint was major adverse cardiovascular events (MACE), encompassing total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke. Major hemorrhage was the primary safety endpoint. Secondary outcomes included total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke, individually. RESULTS: Patients treated with ticagrelor (n = 118) and clopidogrel (n = 538) were compared. No significant difference was observed in major adverse cardiovascular events (MACE) and major bleeding between ticagrelor and clopidogrel treatment groups (MACE: clopidogrel 10.0% vs. ticagrelor 11.0%, p = 0.75; major bleeding: clopidogrel 2.8%, ticagrelor 2.5%, p = 0.88). Patients with hemoglobin levels ≤ 8 mg/dL demonstrated significantly higher MACE and major bleeding rates in the ticagrelor group (p = 0.008 and p = 0.002, respectively). Among patients aged ≥ 75 years, ticagrelor treatment was associated with a higher risk of major bleeding (p = 0.04). CONCLUSIONS: Ticagrelor and clopidogrel exhibited comparable efficacy and safety outcomes in anemic ACS patients over a one-year period. Although ticagrelor demonstrated superiority in reducing ischemic events, it is crucial to recognize the limitations of retrospective studies in informing clinical practice. This study offers valuable insights into tailoring antiplatelet therapy for anemic ACS patients and provides guidance for personalized treatment strategies, acknowledging the hypothesis-generating nature of retrospective analyses.

The predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock.

BACKGROUND: Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS. METHODS: The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno's C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R2] and likelihood ratio χ2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death. RESULTS: All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59-3.68], R2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased. CONCLUSION: The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.

Comparison of Ticagrelor and Clopidogrel in Patients With Acute Coronary Syndrome at High Bleeding or Ischemic Risk.

Current guidelines recommend individualizing the choice and duration of P2Y12 inhibitor therapy based on the trade-off between bleeding and ischemic risk. However, whether a potent P2Y12 inhibitor (ticagrelor) or a less potent one (clopidogrel) is more appropriate in patients with acute coronary syndrome (ACS) in the setting of high bleeding or ischemic risk is not clear. The study aimed to compare the clinical outcomes of clopidogrel and ticagrelor in patients with ACS at high bleeding or ischemic risk. A total of 5,713 patients with ACS were included in this retrospective study. The Cox proportional hazard regression model was adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The primary clinical outcome was all-cause death. Secondary outcomes included in-hospital death, ACS, target vessel revascularization, stent thrombosis, stroke, or clinically significant or major bleeding. The median follow-up duration was 53.6 months. After multivariable Cox model using an inverse probability weighted approach, all-cause death in the overall population and subgroups of patients at high bleeding risk, and/or at high ischemic risk were not significantly different between clopidogrel and ticagrelor. Rates for secondary outcomes were also similar between the groups. In conclusion, ticagrelor and clopidogrel are associated with comparable clinical outcomes in patients with ACS irrespective of bleeding and ischemic risk.

Predictive value of PRECISE-DAPT score for long-term all-cause mortality in atrial fibrillation patients with non-ST-elevation myocardial infarction.

Introduction: Atrial fibrillation (AF) may co-exist in patients with non-ST-elevation myocardial infarction (NSTEMI). In patients with NSTEMI, AF should therefore be regarded as an important risk factor irrespective of its presentation. To predict outcomes in AF patients presenting with NSTEMI, early risk stratification can help to identify the patients with a possible poor long-term prognosis. The development of the PRECISE-DAPT score aimed to predict the risk of bleeding in patients who underwent stent implantation and received dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), providing a valuable tool for assessing bleeding risk in this specific patient population. Aim: To assess the performance of the PRECISE-DAPT score in predicting long-term prognosis in AF patients with NSTEMI. Material and methods: Five hundred and twenty-six consecutive AF patients presenting with NSTEMI were included in the present study. The PRECISE-DAPT score was calculated in each case and evaluated for the association of increased mortality in the study population, who survived in-hospital but died in the long term. Results: All-cause mortality deaths occurred in 278 (52.6%) patients. Higher PRECISE-DAPT score, shorter duration of P2Y12 inhibitor therapy, decreased left ventricular ejection fraction (LVEF), and a history of diabetes mellitus (DM) were all associated with an increased risk of all-cause mortality in the multivariable logistic regression model. Conclusions: High PRECISE-DAPT score was associated with higher long-term all-cause mortality in AF patients presenting with NSTEMI.

The relation of polymer structure of stent used in patients with acute coronary syndrome revascularized by stent implantation with long-term cardiovascular events.

INTRODUCTION: Drug-eluting stents (DES) have revolutionized percutaneous coronary intervention (PCI) by improving event-free survival compared to older stent designs. However, early-generation DES with polymer matrixes have raised concerns regarding late stent thrombosis due to delayed vascular healing. To address these issues, biologically bioabsorbable polymer drug-eluting stents (BP-DES) and polymer-free drug-eluting stents (PF-DES) have been developed. AIM: The aim of the present study is to evaluate and compare the long-term effects of different stent platforms in patients with acute coronary syndrome (ACS) undergoing PCI. MATERIAL AND METHODS: We conducted a retrospective, observational study involving 1192 ACS patients who underwent urgent PCI. Patients were treated with thin- strut DP-DES, ultra-thin strut BP-DES, or thin-strut PF-DES. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (CITLR) at 12 months and 4 years. RESULTS: The baseline demographics and clinical characteristics of patients in the three stent subgroups were similar. No significant differences were observed in target lesion failure (TLF), cardiac mortality, TVMI, and stent thrombosis (ST) rates among the three subgroups at both 12 months and 4 years. However, beyond the first year, the rate of CITLR was significantly lower in the ultra-thin strut BP-DES subgroup compared to thin-strut DP-DES, suggesting potential long-term advantages of ultra-thin strut BP-DES. Additionally, both ultra-thin strut BP-DES and thin-strut PF-DES demonstrated lower ST rates after the first year compared to thin-strut DP-DES. CONCLUSION: Our study highlights the potential advantages of ultra-thin strut BP-DES in reducing CITLR rates in the long term, and both ultra-thin strut BP-DES and thin-strut PF-DES demonstrate lower rates of ST beyond the first year compared to thin-strut DP-DES. However, no significant differences were observed in overall TLF, cardiac mortality and TVMI rates among the three stent subgroups at both 12 months and 4 years.

Endocarditis-TR: Diagnosis, treatment, and prognosis of the infective endocarditis patients admitting tertiary centres of Turkey.

BACKGROUND: Infective endocarditis (IE) is still a significant cause of morbidity and mortality among cardiovascular diseases. ENDOCARDITIS-TR study aims to evaluate the compliance of the diagnostic and therapeutic methods being used in Turkey with current guidelines. METHODS: The ENDOCARDITIS-TR trial is a multicentre, prospective, observational study consisting of patients admitted to tertiary centres with a definite diagnose of IE. In addition to the demographic, clinical, microbiological, and echocardiographic findings of the patients, adverse events, indications for surgery, and in-hospital mortality were recorded during a 2-year time interval. RESULTS: A total of 208 IE patients from 7 tertiary centres in Turkey were enrolled in the study. The study population included 125 (60.1%) native valve IE (NVE), 65 (31.3%) prosthetic IE (PVIE), and 18 (8.7%) intracardiac device-related IE (CDRIE). One hundred thirty-five patients (64.9%) were culture positive, and the most frequent pathogenic agent was methicillin-susceptible Staphylococcus aureus (MSSA) (18.3%). Among 155 (74.5%) patients with an indication for surgery, only 87 (56.1%) patients underwent surgery. The all-cause mortality rate was 29.3% in-hospital follow-up. Multivariable Cox regression analysis revealed that absence of surgery when indicated (HR: 3.29 95% CI: 0.93-11.64 p = 0.05), albumin level at admission (HR: 0.46 95% CI: 0.29-0.73 P < 0.01), abscess formation (HR: 2.11 95% CI: 1.01-4.38 p = 0.04) and systemic embolism (HR: 1.78 95% CI: 1.05-3.02 p = 0.03) were ascertained independent predictors of in-hospital all-cause mortality. DISCUSSION: The short-term results of the ENDOCARDITIS-TR trial showed the high frequency of staphylococcal IE, relatively high in-hospital mortality rates, shortage of surgical treatment despite guideline-based surgical indications and low usage of novel imaging techniques. The results of this study will provide a better insight to physicians in respect to their adherence to clinical practice guidelines.

Successful treatment of patent ductus arteriosus accompanying right-sided aortic arch and aberrant left subclavian artery: a case report.

Background: The coexistence of a right-sided aortic arch (RAA), an aberrant left subclavian artery (ALSA), and a patent ductus arteriosus (PDA) is a rarely seen vascular ring anomaly. There is currently no general guideline consensus on the management and follow-up of this congenital defect, posing a challenge to the clinicians. At this point, the heart team plays a critical role in the management of the disease. Case summary: In the present case, a 25-year-old male patient was presented to the outpatient clinic with dyspnoea and fatigue. A transthoracic echocardiography revealed PDA with a left-to-right shunt. To evaluate the anatomy thoroughly, a thoracic computed tomographic angiography was performed and showed PDA accompanying ALSA and RAA. The patient was evaluated by the Heart Team, and a percutaneous closure of PDA was recommended due to signs of left ventricular volume overload. The closure was successfully performed with Amplatzer vascular plug II. At follow-up, the patient was free of symptoms. Discussion: Clinicians should be aware of the potential concomitant lesions during the diagnostic work-up. In selected patients, percutaneous closure of PDA may be the first-line therapy in experienced centres.

Prognostic Significance of Controlling Nutritional Status Score (CONUT) in Patients Undergoing Pericardiocentesis.

BACKGROUND: Malnutrition is associated with a poor prognosis in cardiovascular diseases, however the prognostic impact of the Controlling Nutritional Status (CONUT) score in patients with pericardial effusion (PE) is not known. METHODS: This was a retrospective study conducted among 301 consecutive patients with PE who underwent pericardiocentesis. CONUT score was calculated from serum albumin level, total cholesterol level and lymphocyte count. The prognostic role of admission CONUT score on long-term mortality was evaluated. RESULTS: The patients were divided into two groups according to long-term mortality. A total of 131 patients died during follow-up. In multivariable regression analysis, chronic heart failure [hazard ratio (HR): 3.21, 95% confidence interval (CI): 1.18-8.70, p < 0.01], malignancy (HR: 5.67, 95% CI: 3.34-9.63, p < 0.01) and CONUT score (HR: 1.21, 95% CI: 1.10-1.33, p < 0.01) were found to be independent predictors of long-term mortality. CONUT score was significantly higher in the patients who died (5.8 ± 2.4 vs. 3.6 ± 2.2, p < 0.01). In receiver operating characteristics analysis, a CONUT score ≥ 4.5 predicted long-term mortality with 66% sensitivity and 69% specificity (area under curve: 0.73, 95% CI: 0.67-0.79, p < 0.01). CONCLUSIONS: In patients with PE, CONUT score is an independent prognostic factor for mortality.

Percutaneous closure of a complex fistula that originates from all coronary arteries and drains to the pulmonary artery.

A coronary-to-pulmonary-artery fistula (CPAF) is defined as a connection between the coronary arteries and the pulmonary arteries (PAs). Invasive treatment options for CPAFs include surgical ligation and transcatheter coil or plug embolization. A 60-year-old female patient was referred to our hospital with symptoms of exercise-induced angina (Canadian Cardiovascular Society Class III [CCS-3]). Her relevant history included elective stenting of the left anterior descending (LAD) artery in 2013 and surgery for an LAD to PA fistula in 2015. Upon recurrence of the same fistula in 2017, she underwent a failed antegrade (from LAD to PA) attempt for percutaneous closure of the fistula. A retrograde approach was decided because of the extensive tortuosity of the fistula's proximal part that led to the previous failed attempt and the likelihood of ceasing whole blood flow at the fistula's distal neck. Through right femoral venous access, we advanced a 5 Fr. 45 cm TorqVue low-profile delivery system (St. Jude Medical, Little Canada, MN, USA) over a J-tip 0.035-inch guidewire to the PA. The antegrade imaging guidance enabled us to advance the guidewire to the distal neck of the fistula retrogradely. As the distal part of the fistula was similar to a tunnel-shaped patent ductus arteriosus (PDA) and was measured 4 mm at the narrowest diameter, we opted for an Amplatzer duct occluder II 6 × 6 (Abbott Vascular, Chicago, IL, USA) to close it.

Higher CHA2DS2-VASc Score Is Associated With Increased Mortality in Acute Pulmonary Embolism.

BACKGROUND: CHA2DS2-VASc score has been validated in risk prediction for stroke and thromboembolism in patients with atrial fibrillation (AF). Association of CHA2DS2-VASc score with higher risk of venous thromboembolism and pulmonary embolism (PE) has also been shown. In this study, we investigated the long-term prognostic value of CHA2DS2-VASc score in patients with acute pulmonary embolism (APE). METHODS: Consecutive patients with APE presenting to our emergency department were retrospectively recruited. Patients with AF and who died secondary to causes other than PE were excluded from the study. The CHA2DS2-VASc score and pulmonary embolism severity index (PESI) were calculated. RESULTS: Two hundred seventy seven participants were included in the study. The mortality rate was 18.7%. Twenty-two cases died within 30 days, and 30 cases died during the follow-up period (median: 13 months). The mean CHA2DS2-VASc score was significantly higher in dead patients compared to survivors (3.61 ± 1.35 vs 1.95 ± 1.52, P < .01). In multivariate regression analysis, systolic pulmonary artery pressure (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.01-1.06, P = .02), PESI score (HR: 1.010, 95% CI: 1.004-1.017, P < .01), and CHA2DS2-VASc score (HR: 1.67, 95% CI: 1.19-2.16, P < .01) were found to be independently correlated with mortality. The patients whose CHA2DS2-VASc score was between 1 and 3 had 5.67 times and patients whose CHA2DS2-VASc score was ≥4 had 16.8 times higher risk of mortality compared to patients with CHA2DS2-VASc score = 0. CONCLUSION: Patients with higher CHA2DS2-VASc scores had higher rates of mortality after APE.

The accuracy of combined use of troponin and red cell distribution width in predicting mortality of patients with acute pulmonary embolism.

BACKGROUND: Cardiac troponins and red cell distribution width (RDW) are associated with increased mortality in acute pulmonary embolism (PE). In this study, we aimed to investigate the accuracy of the combined use of troponin and RDW in predicting short-term mortality in acute PE patients. METHODS: The data of 201 patients with the diagnosis of acute PE were retrospectively analyzed. We obtained troponin-RDW scores (TR scores) using a combination of troponin and RDW values, and then evaluated this score's accuracy in predicting mortality in patients with acute PE. RESULTS: The mean participant age was 68 ± 16 years, and 52 % of patients were female. Fifteen (7.4 %) patients died during the first month. Patients classified as high-risk according to TR scores were older (72 ± 15 vs. 66 ± 15 years, p = 0.005), and they had higher heart rates (101 ± 20 vs. 90 ± 15 beat/min, p < 0.001) and respiratory rates (23 ± 4 vs. 21 ± 3 breath/min, p = 0.001). In multivariate analysis, TR (odds ratio [OR] 4.93, 95 % confidence interval [CI] 1.13-21.38, p = 0.033) and simplified pulmonary embolism severity index (sPESI) scores (OR 3.78, 95 % CI 1.71-8.37, p = 0.002) were independent predictors of 30-day mortality. For 30-day mortality, the TR score had a slightly lower sensitivity (87 % vs. 93 %), but a higher specificity (69 % vs. 52 %) compared to the sPESI score. CONCLUSION: The TR score is easy to calculate, and it may be used to predict early mortality in patients with acute PE.

Incremental value of live/real time three-dimensional transesophageal echocardiography over the two-dimensional technique in the assessment of a tuberculoma involving the left atrium and appendage.

Intracardiac tuberculomas are extremely rare, and cardiac involvement in tuberculosis accounts for only 0.5% of extrapulmonary tuberculosis. We report for the first time incremental value of live/real time three-dimensional transesophageal echocardiography over two-dimensional transesophageal echocardiography in the assessment of a tuberculoma involving the left atrium and left atrial appendage.

Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed with contrast CT.

OBJECTIVE: Limited data exist on the incidence of contrast induced nephropathy (CIN) and its impact on in-hospital prognosis of patients diagnosed with acute pulmonary embolism (APE) using contrast computerized tomography pulmonary angiography (CTPA). In this study, we examined the frequency of nephropathy after CTPA in APE patients and its link to in-hospital adverse outcomes. METHODS: This was a retrospective study of 189 patients (mean age 67+16years, 48% male) with APE who underwent CTPA. CIN was defined as a≥0.5mg/dl and/or ≥25% increase in serum creatinine levels >48hours after CTPA. Patients were divided into two groups according to the presence or absence of CIN to compare clinical characteristics, risk factors, and in-hospital adverse events. RESULTS: Twenty-four (13%) of the patients were diagnosed with CIN. Patients with CIN were older (73±17 vs. 67±15years, P=.01) and had higher rates of heart failure (17% vs. 6%, P=.04). Preexisting renal dysfunction and advanced age were found to be independent predictors of CIN (OR: 4.2, 95% CI: 1.5-11.9, P=.006; OR: 3.2, 95% CI: 1.1-9.8, P=.03 respectively). The in-hospital adverse event rate was significantly higher in patients with CIN (16.7% vs. 2.4%, P=.001). A multivariate analysis revealed CIN as an independent predictor of in-hospital adverse event rate (OR: 6.1, 95%CI: 1.2-29.3, P=.02). CONCLUSION: CIN is associated with a higher in-hospital adverse event rate in APE patients diagnosed using CTPA. This is first large study to focus specifically on CIN in patients diagnosed with APE using CTPA.

Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease.

BACKGROUND: The prognostic value of baseline SYNTAX (SS) and clinical SYNTAX (cSS) scores has been shown in different populations with coronary artery disease. However, their prognostic value has not been compared in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. METHODS: Patients who had undergone a primary percutaneous coronary intervention (PCI) for STEMI and had at least one critical lesion other than the culprit artery were recruited retrospectively. SS and cSS were calculated from medical records and angiograms and were compared in coronary artery by-pass grafting (CABG) and PCI groups. Long-term major adverse cardiac events (MACE) were defined as mortality, reinfarction, and target vessel revascularization. RESULTS: A total of 460 patients (214 in the CABG group and 246 in the PCI group) were analyzed. The baseline SS and the cSS were significantly higher in the CABG group compared with the PCI group (30.1±6.7 vs. 22.5±5.6; P<0.01 and 41.4±21.2 vs. 27.2±15.9; P<0.01, respectively). During a follow-up period of 32±8 months, 15 patients from the CABG group and 12 patients from the PCI group died (P=0.33), but the rate of MACE was higher in the PCI group (31 vs. 20%, P<0.01). Receiver operating curve analysis and univariate Cox regression analysis indicated that SS and cSS have prognostic value in the CABG group, but not in the PCI group. In the CABG group, SS and cSS showed significant discriminative power for long-term mortality (for SS>33 sensitivity 73.3%, specificity 71.4% and for cSS>38.4 sensitivity 93.3%, specificity 58.3%) and for MACE (for SS>34.5 sensitivity 50%, specificity 81.4% and for cSS>43.5 sensitivity 66.7%, specificity 73.8%). CONCLUSION: SS and cSS scores have prognostic value in STEMI patients with multivessel disease treated with CABG surgery. cSS may be superior to SS for prediction of long-term adverse events in CABG patients.

Validity of the updated GRACE risk predictor (version 2.0) in patients with non-ST-elevation acute coronary syndrome.

OBJECTIVES: A new version of the Global Registry of Acute Coronary Events (GRACE) risk score (version 2.0) has been released recently. The purpose of the present study was to assess the validity of GRACE 2.0 for in-hospital and 1-year mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. METHODS: The prospective cohort comprised 396 consecutive NSTE-ACS patients admitted to a tertiary hospital between May 2012 and January 2013. The main outcome measure was the discrimination and calibration performance of GRACE 2.0, which were evaluated with the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS: In-hospital and 1-year mortality were 2% (8/396) and 12.4% (48/388), respectively. The discrimination performance was inadequate (AUC=0.62) for predicting in-hospital mortality for the overall cohort. Also, the calibration performance for in-hospital mortality could not be evaluated due to the low number of patients who died. At one year, the Hosmer-Lemeshow p-values for all subgroups were >0.05, suggesting a good model fit, and the discrimination performance was good (AUC=0.77) for the overall cohort, driven mainly by better accuracy for low-risk patients. CONCLUSIONS: In a contemporary cohort of NSTE-ACS patients, GRACE 2.0 was valid for 1-year mortality assessment. Its value for in-hospital mortality requires validation in a larger cohort.

The Prognostic Impact of In-Hospital Change in Mean Platelet Volume in Patients With Non-ST-Segment Elevation Myocardial Infarction.

It is unclear whether changes in mean platelet volume (MPV) are associated with total mortality in acute coronary syndromes. We investigated whether the change in MPV predicts total mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We retrospectively analyzed 419 consecutive patients (19 patients were excluded). The remaining patients were categorized as survivors (n = 351) or nonsurvivors (n = 49). Measurements of MPV were performed at admission and after 24 hours. The difference between the 2 measurements was considered as the MPV change (ΔMPV). The end point of the study was total mortality at 1-year follow-up. During the follow-up, there were 49 deaths (12.2%). Admission MPV was comparable in the 2 groups. However, both MPV (9.6 ± 1.4 fL vs 9.2 ± 1.0 fL, P = .044) and ΔMPV (0.40 [0.10-0.70] fL vs 0.70 [0.40-1.20] fL, P < .001) at the first 24 hours were higher in nonsurvivors than survivors. In multivariate analysis, ΔMPV was an independent predictor of total mortality (odds ratio: 1.84, 95% confidence interval: 1.28-2.65, P = .001). An early increase in MPV after admission was independently associated with total mortality in patients with NSTEMI. Such patients may need more effective antiplatelet therapy.

Fragmented QRS on Admission Electrocardiography Predicts Long-Term Mortality in Patients with Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Early diagnosis and identification of high-risk non-ST elevation myocardial infarction (NSTEMI) is an important issue. Fragmented QRS (fQRS) complexes are defined as various RSR' patterns on 12-lead resting electrocardiography (ECG). Previous studies revealed that fQRS is related with increased ventricular arrhythmias and cardiovascular mortality. The relation between fQRS and mortality in acute coronary syndromes, mitral valve disease severity and structural heart disease has been shown in different studies. The aim of this study was to investigate relation between fQRS and long-term cardiovascular mortality in NSTEMI patients. METHODS: Patients who admitted to our emergency unit and diagnosed NSTEMI between 2012 and 2013, 433 patients were included prospectively. fQRS complexes determined in 85 patients. Patients were divided into two groups according to fQRS existence. All patients evaluated for their clinical, laboratory, electrocardiographic, and echocardiographic characteristics. Angiographic features of 315 patients who underwent coronary angiography was also recorded. In-hospital, 30-day and 12-month mortality was compared between these groups. RESULTS: Demographic characteristics and cardiovascular risk factors were similar in both groups except hyperlipidemia. GRACE risk score was higher in patients with fQRS and positively correlated with existence of fQRS. In hospital and 30-days mortality were similar but late mortality was higher in fQRS group. Predictors of late mortality were found to be age, heart rate, male sex in addition to fQRS. CONCLUSION: We found a relation between fQRS and late mortality. Fragmented QRS may be seen as a cautionary signal for extensive myocardial damage and thereby increased long-term mortality for patients with NSTEMI.