Value of CHA2DS2-VASc Score for Prediction and Ruling Out of Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention.

Acute stent thrombosis is an important complication of stent implantation. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age between 65 and 74 years, female gender) score incorporates important cardiovascular (CV) risk factors and predicts prognosis in various CV conditions. We evaluated the value of the CHA2DS2-VASc score in predicting acute stent thrombosis (ie, thrombosis during 24 hours after stent placement) in patients undergoing primary percutaneous intervention for ST-segment elevated myocardial infarction. Patients with intraprocedural stent thrombosis and complications were excluded; 48 (2.1%) of 2732 patients had acute stent thrombosis according to our definition. Median CHA2DS2-VASc score was significantly higher in this stent thrombosis group. Cumulative acute stent thrombosis rates were 0.51% for CHA2DS2-VASc score ≤1, 1.55% for ≤2, 1.80% for ≤3, 2.00% for ≤4, 2.17% for ≤5, and 2.19% for ≤6. The CHA2DS2-VASc score (odds ratio = 1.390, 95% confidence interval = 1.118-1.728; P = .003) was an independent predictor of acute stent thrombosis. The CHA2DS2-VASc score ≤1 predicted the absence of the acute stent thrombosis with 91% specificity and 36% sensitivity. Further studies are needed to establish the value of this finding in the context of current clinical practice.

Serum magnesium concentration may predict no-reflow phenomenon in primary angioplasty for ST-elevation myocardial infarction.

No-reflow phenomenon is a serious complication of percutaneous coronary intervention. Magnesium may play a role in pathogenesis of no-reflow phenomenon since it interacts with processes like platelet inhibition and endothelial-dependent vasodilatation. Relationship of serum magnesium concentration at admission and angiographic no-reflow phenomenon in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention is investigated in the present study. A total of 2.248 consecutive patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention were analyzed. After reopening of the infarct related artery, a TIMI flow rate ≤ 2 was defined as no-reflow. No-reflow phenomenon developed in 386 (17.1 %) patients. Serum magnesium concentration was significantly lower in no-reflow group (1.87 ± 0.25 vs. 2.07 ± 0.33 mg/dL, p<0.001). ROC curve analysis showed that Mg at a cut-point of 1.92 has 71.4% sensitivity and 75.2% specificity in detecting no-reflow phenomenon. In multivariate logistic regression analysis, age, serum magnesium concentration, and stent length were found as independent predictors of no-reflow phenomenon. Serum magnesium concentration is associated with no-reflow phenomenon in ST elevation myocardial infarction patients who underwent primary PCI.

Biomarkers of nondipper hypertension in prehypertensive and hypertensive patients.

Aim: The aim of this study was to evaluate the relation of gamma glutamyl transferase (GGT), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with nondipper hypertension. Methods: This study included a total of 409 patients. Patients were grouped into hypertension, prehypertension and normotensive groups, according to their clinical blood pressure. All patients were also followed by ambulatory blood pressure. Results: Mean PLR and NLR were higher in the nondippers compared with dippers among both prehypertensive and hypertensive patients. In addition, PLR (OR: 1.011; 95% CI: 1004-1017; p = 0.001), NLR (OR: 2.296, 95% CI: 1634-3225; p < 0.001), and GGT (OR: 1.067; 95% CI: 1042-1092; p < 0.001) were found to be associated with nondipper pattern among whole study population. Conclusion: The PLR, NLR and GGT values are easily accessible and fairly useful, independently associated with nondipper hypertension for both hypertensive and prehypertensive patients.

CHA2DS2-VASc score predicts contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction, who have undergone primary percutaneous coronary intervention.

BACKGROUND AND AIM: We aimed to investigate the predictive value of the CHA2DS2-VASc score in the development of contrast-induced nephropathy (CIN). METHODS: A total of 2972 patients who had been diagnosed with ST elevation myocardial infarction (STEMI) and who had undergone primary coronary angioplasty were included in the study. The patients were divided into three groups according to the CHA2DS2-VASc score, i.e.: low risk (1 point), intermediate risk (2 points), and high risk (≥ 3 points). The groups were followed with regard to CIN development. RESULTS: The median CHA2DS2-VASc score was significantly higher in the CIN(+) group compared to the CIN(-) group (3 vs. 2, p < 0.001). The rate of CIN was 3.32-fold higher (OR 3.32, 95% CI 1.98-5.55, p < 0.001) in the high-risk group (CHA2DS2-VASc ≥ 3) compared to the low-risk group (CHA2DS2-VASc = 1). Age (OR 1.25, 95% CI 1.14-1.36, p < 0.001), female gender (OR 1.52, 95% CI 1.23-1.89, p < 0.001), hypertension (OR 1.50, 95% CI 1.265-1.78, p < 0.001), peak creatinine kinase-MB (OR 1.15, 95% CI 1.10-1.21, p < 0.001), and the Killip score > 1 (OR 4.25, 95% CI 3.10-5.82, p < 0.001) were found to be independent predictors for CIN development. CONCLUSIONS: The CHA2DS2-VASc score is an independent and strong predictor of CIN development in patients with acute STEMI.

A Novel Risk Scoring System to Predict Cardiovascular Death in Patients With Acute Myocardial Infarction: CHA2DS2-VASc-CF Score.

The present study aimed to determine the long-term prognostic validity of the CHA2DS2-VASc score in patients with acute myocardial infarction (AMI). In addition, we formulated a novel scoring system, the CHA2DS2-VASc-CF (which includes cigarette smoking and a family history of coronary artery disease as risk factors). This study included 4373 consecutive patients with AMI who presented to the emergency department of our hospital and underwent cardiac catheterization procedures between December 2009 and September 2016. Among these patients, 1427 were diagnosed with ST elevation myocardial infarction (STEMI) and 2946 were diagnosed with non-STEMI. The study included 4373 patients. The study population was divided into 2 groups according to the occurrence of cardiovascular death during the follow-up period. Multivariate logistic regression analysis showed that the CHA2DS2-VASc-CF score, CHA2DS2-VASc score, major adverse cardiac events, current cigarette smoking, older age, hypertension, and family history of coronary artery disease were significantly higher, and that the left ventricular ejection fraction and glomerular filtration rate were significantly lower in the cardiovascular death (+) group. Using a cutoff score of >3 for the CHA2DS2-VASc-CF score, long-term cardiovascular death was predicted with a sensitivity of 78.4% and specificity of 76.4%. The CHA2DS2-VASc-CF score is suitable for use in all patients with AMI, regardless of the type of treatment, presence of atrial fibrillation, and type of AMI. This risk score, which is easy to calculate, provides important prognostic data. In the future, we think that interventional cardiologists will be able to use this novel scoring system to identify patients with a high risk of long-term cardiovascular death.

A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio.

BACKGROUND: Monocyte to high density lipoprotein cholesterol ratio (MHR) is generally understood to be a candidate marker of inflammation and oxidative stress. Therefore, we aimed to assess the association between MHR and aortic elastic properties in hypertensive patients. METHODS: A total of 114 newly-diagnosed untreated patients with hypertension and 71 healthy subjects were enrolled. Aortic stiffness index, aortic strain and aortic distensibility were measured by using echocardiography. RESULTS: Patients with hypertension had a significantly higher MHR compared to the control group (p < 0.001). Also, aortic stiffness index (p < 0.001) was significantly higher and aortic distensibility (p < 0.001) was lower in the hypertensive group. There was a positive correlation of MHR with aortic stiffness index (r = 0.294, p < 0.001) and negative correlation with aortic distensibility (r = -0.281, p < 0.001). In addition, MHR and high sensitivity C-reactive protein have a positive correlation (r = 0.30, p < 0.001). Furthermore, MHR was found to be an independent predictor of aortic distensibility and aortic stiffness index. CONCLUSIONS: In patients with newly-diagnosed untreated essential hypertension, higher MHR was significantly associated with impaired aortic elastic properties.

CHA2DS2-VASc Score Predicts In-Hospital and Long-Term Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention.

CHA2DS2-VASc score includes similar risk factors for coronary artery disease. We hypothesized that admission CHA2DS2-VASc score might be predictive of adverse clinical outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing primary percutaneous coronary intervention. A total of 647 patients with STEMI enrolled in this study. The study population was divided into 2 groups according to their admission CHA2DS2-VASc score. The low group (n = 521) was defined as CHA2DS2-VASc score ≤2, and the high group (n = 126) was defined as CHA2DS2-VASc score >2. Patients in the high group had significantly higher incidence of in-hospital cardiovascular mortality (8.7% vs 1.9%; P < .001). Long-term mortality was significantly frequent in the high group (13.4% vs 3.6%, P < .001). Hypertension, admission CHA2DS2-VASc score, and Killip class >1 were independent predictors of long-term mortality. Admission CHA2DS2-VASc score >2 was identified as an effective cutoff point for long-term mortality (area under curve = 0.821; 95% confidence interval: 0.76-0.89; P < .001). CHA2DS2-VASc score is a simple, very useful, easily remembered bedside score for predicting in-hospital and long-term adverse clinical outcomes in STEMI.

Two-year prognosis of admission hemoglobin A1c following a primary percutaneous coronary intervention.

OBJECTIVE: We sought to assess the effect of hemoglobin A1c (HbA1c) on the outcomes of a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Many studies have shown the diagnostic and predictive value of HbA1c levels in patients with acute myocardial infarction. We assessed the prognostic role of HbA1c in short-term and long-term mortality in 796 consecutive patients with STEMI. METHODS AND RESULTS: A total of 796 patients with STEMI undergoing primary PCI were prospectively enrolled between December 2013 and June 2015. The patients were divided into three groups on the basis of admission HbA1c levels: group I (HbA1c≤5.6%), group II (HbA1c 5.7-6.4%), and group III (HbA1c≥6.5%). The in-hospital and 2-year cardiovascular (CV) mortality and morbidity of all three patient groups were followed up. A significant association was found between HbA1c level and 2-year primary clinical outcomes, including CV mortality, heart failure/shock, and major adverse cardiovascular event (P<0.001). CONCLUSION: HbA1c is an independent predictor of the in-hospital and long-term mortality, nonfatal reinfarction, and target vessel revascularization in STEMI patients treated with primary PCI.

White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction.

BACKGROUND: Increased white blood cell (WBC) count is associated with increased mortality in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate predictive value of admission WBC to mean platelet volume (MPV) ratio (WMR) on prognosis in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. METHODS: A total of 2,603 consecutive patients with STEMI who underwent pPCI were recruited for the study. Follow-up data were obtained from digital records, patient files or by telephone interview with patients, family members, or primary care physicians. RESULTS: WMR has the highest area under receiver operating characteristic (ROC) curve and pairwise comparisons of the ROC curves revealed that WMR has the higher discriminative ability for long-term mortality than WBC, MPV, red blood cell distribution with (RDW), WBC-MPV combination, and platelet to lymphocyte ratio and neutrophil to lymphocyte ratio (PLR-NLR) combination in patients undergoing pPCI for STEMI (a WMR value of 1,653.47 was also found as threshold value for mortality with 75.4% sensitivity and 87.3% specificity by ROC curve analysis). CONCLUSIONS: Higher WMR value on admission was associated with worse outcomes in patients with STEMI and independently better predicted the long-term mortality than other complete blood count components, such as MPV, RDW, PLR-NLR and WBC-MPV combinations.

The relationship between admission monocyte HDL-C ratio with short-term and long-term mortality among STEMI patients treated with successful primary PCI.

BACKGROUND: Monocyte to HDL-C ratio (MHR) represents a simple assessment method for inflammatory status. The aim of the present study was to investigate whether MHR may be of short-term and long-term prognostic value in ST-elevation myocardial infarction (STEMI) patients who have undergone a primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 682 consecutive STEMI patients who underwent successful primary PCI between March 2013 and September 2015 were included in this study. Patients were divided into groups according to their admission MHR values. Clinical follow-up data of participating patients were obtained through an outpatient examination 30 months after PCI. RESULTS: The study population included 172 patients with an MHR less than 1.16 (Q1), 169 patients with an MHR 1.16-1.59 (Q2), 161 patients with an MHR 1.60-2.21 (Q3), and 180 patients with an MHR greater than 2.21 (Q4). Rates of in-hospital mortality, major adverse cardiovascular events, cardiopulmonary resuscitation, dialysis, use of inotropic agents, shock, late mortality, target vessel revascularization, stroke, and reinfarct were higher in the Q4 group compared with the other MHR quartile groups. CONCLUSION: The results of this study have indicated that admission MHR is associated independently and significantly with short-term and long-term mortality in STEMI patients who undergo successful primary PCI.

Magnesium as a predictor of acute stent thrombosis in patients with ST-segment elevation myocardial infarction who underwent primary angioplasty.

BACKGROUND: Although magnesium (Mg) has been proposed as a useful biomarker for predicting atherothrombosis, the association between Mg and acute stent thrombosis (ST) after primary percutaneous coronary intervention (p-PCI) for ST-segment elevation myocardial infarction (STEMI) has not yet been defined. OBJECTIVES: We aimed to examine whether admission Mg levels predicted the development of acute ST after p-PCI in STEMI patients. METHODS AND RESULTS: A total of 2633 patients with STEMI who underwent p-PCI were retrospectively analyzed. Acute ST was defined as thrombosis that occurred in the first (0-1) days following primary coronary stenting, and patients who had undergone p-PCI were divided into two groups: ST group and no-ST group. The cut-off value for Mg obtained by the receiver-operating characteristic curve analysis was less than 1.91 mg/dl for the prediction of acute ST (area under the curve was 0.761; 95% confidence interval, 0.706-0.816; P<0.001; sensitivity, 70%; specificity, 69%). Serum Mg levels were significantly lower in the ST group compared with the no-ST group (median 1.80 mg/dl, interquartile range 1.70-2.00 mg/l vs. median 2.10 mg/dl, interquartile range 1.90-2.20 mg/dl, P<0.001). After multivariable adjustment for clinical, laboratory, and angiographic variables, Mg remained a strong independent predictor for acute ST (odds ratio 5.802, 95% confidence interval, 3.069-10.967; P<0.001). CONCLUSION: Serum Mg level is associated independently with the risk of acute ST in patients with STEMI who undergo p-PCI.

Admission serum potassium level is associated with in-hospital and long-term mortality in ST-elevation myocardial infarction.

OBJECTIVE: Current guidelines recommend a serum potassium (sK) level of 4.0-5.0 mmol/L in acute myocardial infarction patients. Recent trials have demonstrated an increased mortality rate with an sK level of>4.5 mmol/L. The aim of this study was to figure out the relation between admission sK level and in-hospital and long-term mortality and ventricular arrhythmias. METHODS: Retrospectively, 611 patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention were recruited. Admission sK levels were categorized accordingly: <3.5, 3.5-<4, 4-<4.5, 4.5-<5, and ≥5 mmol/L. RESULTS: The lowest in-hospital and long-term mortality occurred in patients with sK levels of 3.5 to <4 mmol/L. The long-term mortality risk increased for admission sK levels of >4.5 mmol/L [odds ratio (OR), 1.58; 95% confidence interval (CI) 0.42-5.9 and OR, 2.27; 95% CI 0.44-11.5 for sK levels of 4.5-<5 mmol/L and ≥5 mmol/L, respectively]. At sK levels <3 mmol/L and ≥5 mmol/L, the incidence of ventricular arrhythmias was higher (p=0.019). CONCLUSION: Admission sK level of >4.5 mmol/L was associated with increased long-term mortality in STEMI. A significant relation was found between sK level of <3 mmol/L and ≥5 mmol/L and ventricular arrhythmias.

Increased mean platelet volume in patients with infective endocarditis and embolic events.

BACKGROUND: Platelet activation appears to play an important role in thromboembolic complications of infective endocarditis (IE). Mean platelet volume (MPV) is a potentially useful marker of platelet activity and a quick and easy determinant of thrombotic risk. Hence the aim of this study was to investigate the baseline platelet volume indices (MPV and platelet distribution width [PDW]) in IE patients who developed embolic events in the follow-up period and who did not. METHODS: The study group consisted of 76 consecutive patients (female: 55, male: 21, mean age: 26 years old, ranged: 8-64 years) with definite IE according to Duke Criteria. Thirty four healthy subjects, who were age and gender adjusted, served as the control group. The mean duration of hospital stay was 44 days. RESULTS: Among the IE patients, 13 (13/76, 17.1%) had major embolic events. Significantly larger vegetations were observed in patients with embolic events as compared to non-embolic group (1.4 vs. 1.0 cm, p = 0.03). MPV at hospital admission was higher in patients who had embolic events in the follow-up period compared to both those who did not and the control subjects (10.62 ± 1.13 vs. 9.25 ± 0.97 and 8.93 ± 0.82 fL, p < 0.001, respectively). Similarly, the patients with embolic events had increased PDW compared to the non-embolic ones and the control group (16.31 ± 2.42 vs. 14.35 ± 1.97 and 14.04 ± 1.82%, p < 0.001, respectively). CONCLUSIONS: The present study demonstrated that IE patients with embolic events had increased MPV and PDW values, compared to non-embolics. Future prospective studies with standardized measurements may clarify the clinical role of platelet volume indices in thrombo-embolic complications of IE.

The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

BACKGROUND: The aim of this study is to determine the impact of ratio of contrast volume to glomerular filtration rate (V/GFR) on development of contrast-induced nephropathy (CIN) and long-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: A total of 645 patients with STEMI undergoing primary PCI was prospectively enrolled. CIN was defined as an absolute increase in serum creatinine > 0.5 mg/dL or a relative increase > 25% within 48 h after PCI. The study population was divided into tertiles based on V/GFR. A high V/GFR was defined as a value in the third tertile (> 3.7). RESULTS: Patients in tertile 3 were older, had higher rate of smoking, diabetes mellitus and CIN, lower left ventricular ejection fraction, hemoglobin, and systolic and diastolic blood pressure compared to tertiles 1 and 2 (p < 0.05). V/GFR was found an independent predictor of in-hospital and 6-month mortality. We found 2 separate values of V/GFR for 2 different end points. While the ratio of 3.6 predicted in-hospital mortality with 78% sensitivity and 82% specificity, the ratio of 3.3 predicted 6-month mortality with 71% sensitivity and 76% specificity. Survival rate decreases as V/GFR increases both for in-hospital and during 6-month follow-up. Diabetes mellitus and multivessel disease were other predictors of in-hospital mortality. CONCLUSIONS: High V/GFR level is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing primary PCI.

The reliability of computed tomography-derived SYNTAX score measurement.

The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) was developed for evaluation of coronary artery disease complexity. We aimed to compare the SS calculated by conventional coronary angiography (CAG) and computed tomography angiography (CTA). Retrospectively, 107 patients were recruited (mean age 55.9 ± 12.4 years). The SS measured by conventional CAG was divided into 3 groups (group 1 SS ≤ 22, group 2 SS > 22 to <32, and group 3 SS ≥ 32). The SS calculated by both methods has a high correlation (r = .972 and P < .001). The κ analysis showed a substantial agreement between both imaging modalities. Computed tomography angiography highly predicted conventional CAG lesions (area under curve 0.96, 95% confidence interval 0.92-0.99, and P < .001). The SS measured by CTA is highly correlated with conventional CAG. Therefore, we propose that prior to coronary revascularization, CTA-derived SS could be used for risk stratification.