24/7 Primary Percutaneous Coronary Intervention as a National Program.

Due to the importance of early treatment in the final prognosis of ST-elevation myocardial infarction (STEMI) patients, full-time provision of revascularization services should be available 24 hours a day, 7 days a week (24/7) in conjunction with a fully-coordinated pre-hospital emergency system and equipped centers with experienced medical teams. We reviewed the 24/7 primary percutaneous coronary intervention (PCI) management registry and evaluated the quality of care and patient management as well as the temporal trend of provided health care services. In the present cross-sectional study, we retrieved the data on 11,563 STEMI patients having undergone primary PCI at the thirty-one 24/7 PCI-capable hospitals through the national 24/7 STEMI management program between September 2015 and August 2017 in Iran. The median (25th-75th) age of the patients was 59 (51-68) years. The median (25th-75th) time of door-to-device was 64 (41-100) min and 68% of patients achieved door to device time of ≤90 min. There was no significant difference in the median door-to-device time between the general and heart hospitals. This is the first Iranian National attempt to provide a uniform guideline-driven standard management in patients with STEMI undergoing primary PCI in a 24/7 program. We demonstrated an acceptable door-to-device time consistent with the recommendations of the current guidelines. We observed higher door-to-device time in older patients, female patients, and those where the culprit lesion was other than the left anterior descending coronary artery. Efforts should be made to improve door-to-device time in all patients or groups.

Long-term right ventricular changes in mustard-exposed patients: A historical cohort.

INTRODUCTION: Mustard gas (MG) is a chemical warfare agent widely used in the Iran-Iraq War. Its catastrophic effects on the lungs, eyes, and skin have been well studied. However, it also affects the cardiovascular system. We aimed to evaluate the long-term effect of MG on right ventricular (RV) function. METHODS: All patients presenting to the university clinics between May 2014 and September 2015 were consecutively evaluated to enter the study based on the inclusion criteria (documented proof of chemical injury, no past or present cardiovascular disease, not a current smoker, and no history of sleep apnea). A comparable control group of veterans without MG exposure was randomly selected. All patients underwent echocardiographic measurement of RV size and function by a blinded cardiologist. RESULTS: We included 23 patients in the MG-exposed group and 19 subjects in the control group, with a mean age of 48.6 years. Mean chemical injury severity score was 29.7% and mean time from the MG exposure was 29.2 years. The main complaint of MG-exposed patients pertained to respiratory symptoms (91%). Pulmonary artery pressure was higher (32.83 vs. 28.95 mmHg) and RV strain was lower (-17.05% vs. -20.72%) in the MG-exposed than in the control group (P < .05). CONCLUSION: Our results present baseline RV values for MG-exposed patients and show mild but significant changes after 3 decades. Further cellular and molecular studies are needed to evaluate underlying mechanisms of MG cardiotoxicity.

Extent of Coronary Stenosis and Anxiety Symptoms among Patients Undergoing Coronary Angiography.

Background: The association between coronary angiographic findings and the level of anxiety symptoms among patients who undergo coronary angiography is not known. The aim of this study was to investigate the association between the extent of coronary stenosis and anxiety symptoms in patients who undergo coronary angiography. Methods: In a cross-sectional study, 106 patients who underwent coronary angiography and had varying degrees of coronary artery disease were enrolled. Demographic characteristics (i.e., age and gender), socioeconomic status (i.e., educational attainment, income, and marital status), and traditional risk factors (i.e., hypertension, diabetes mellitus, hyperlipidemia, and smoking) were measured. The independent variable was the extent of coronary stenosis shown by coronary angiography, coded as single-vessel disease (n = 19), 2-vessel disease (n = 28), or 3-vessel disease (n = 59). The main outcome was symptoms of anxiety measured using the Hospital Anxiety Depression Scale (HADS). The Kruskal-Wallis test was used for bivariate analysis, and linear regression was applied for multivariable analysis. Results: Participants were mostly men (n = 78, 73%), at a mean age of 50.14 ± 10.60 years. We found an inverse association between the extent of coronary stenosis and anxiety symptoms in our samples. Anxiety symptoms were lowest in the patients with 3-vessel disease and highest in those with single-vessel disease. The above association remained significant in a linear regression model, controlled for the demographic, socioeconomic, and traditional risk factors. Conclusion: An inverse association may exist between the extent of coronary stenosis and the severity of anxiety symptoms in patients who undergo coronary angiography. Patients who undergo angiography and have fewer angiographic findings require screening for anxiety symptoms.

Predictive role of adiponectin and high-sensitivity C-reactive protein for prediction of cardiovascular event in an Iranian cohort Study: The Isfahan Cohort Study.

BACKGROUND: Numerous studies have been conducted on the predictive effects of high-sensitivity C-reactive protein (hs-CRP) on cardiovascular events. Few studies have been conducted to investigate the effects of adiponectin for the prediction of the incident of cardiovascular events in the Middle East area. This study compared the predictive effect of hs-CRP and adiponectin on healthy volunteers for the prediction of cerebrovascular disease (CVD). METHODS: This nested case-control in original Isfahan Cohort Study (ICS) was conducted from 2001 to 2011. Participants were selected from ICS. The case group included participants with CVD while the control group included participants without CVD. The level of hs-CRP and adiponectin was measured in the blood samples collected in the year 2007. Thereafter, the statistical analyses were performed to determine the predictive value of hs-CRP and adiponectin in CVD prediction. RESULTS: The results showed that before the elimination of diabetes effect; there was a significant difference between the two groups, in terms of the mean of adiponectin (P = 0.019) and no significant difference was observed in hs-CRP levels (P = 0.673). However, after eliminating the factor of diabetes, there was no significant difference between the case and control groups in adiponectin and hs-CRP levels (P = 0.184, P = 0.946). The results showed that the odds ratio (OR) of the adiponectin level was 0.879 [95% confidence interval (CI): 0.719-1.075, P = 0.210] while the OR of hs-CRP was 1.045 (95% CI: 0.922-1.185, P = 0.491). Furthermore, it was shown that after adjustment for age, sex, and diabetes; the OR of adiponectine was 0.875 (95% CI: 0.701-1.091, P = 0.235) and that of hs-CRP was 1.068 (95% CI: 0.935-1.219, P = 0.333). CONCLUSION: The results show that adiponectin and hs-CRP cannot be predictors for cardiovascular events in a healthy population. Risk factors such as diabetes limit the use of adiponectin as a CVD predictor.

Gender Differences in the Association between Lipid Profile and Sexual Function among Patients with Coronary Artery Disease.

BACKGROUND: Although several studies have been conducted on the association between lipid profile and sexual function among men with coronary artery disease, there is a paucity of knowledge about this association among women with coronary artery disease. OBJECTIVES: Our study aimed to evaluate the link between lipid profile and sexual function in men and women with coronary artery disease. METHODS: One hundred and twenty patients with documented coronary artery disease were consecutively sampled from an outpatient cardiovascular clinic. The patients were assessed for lipid profile and sexual relationship using the Relation and Sexuality Scale (RSS). In addition, the Hospital Anxiety and Depression Scale (HADS) was used to measure the symptoms of anxiety and depression. The characteristics of chest pain were also measured using the Rose Angina Questionnaire. The data were analyzed through linear regression analysis. RESULTS: This study was conducted on 91 males (75.8%) and 29 females (24.2%). Multivariate analysis showed that low-density lipoprotein cholesterol was correlated with sexual function (B = 0.01, P = 0.010) and total sexual relationship (B = 0.01, P = 0.050). A correlation was also observed between the level of high-density lipoprotein and sexual frequency score (B = -0.02, P = 0.040). Gender moderated these correlations. Among males, serum cholesterol (r = 0.193, P = 0.047) and low-density lipoprotein (r = 0.224, P = 0.037) were correlated to sexual function. In females, however, low-density lipoprotein was correlated to the total sexual relationship (r = 0.426, P = 0.021) and high-density lipoprotein was correlated to sexual frequency (r = -0.334, P = 0.046). CONCLUSIONS: The findings of this study showed a relationship between lipid profile and sexual relationship among both male and female patients with coronary artery disease. The link between lipid profile and sexual function of the patients with coronary artery disease is thus beyond just the effect of lipid profile on erectile dysfunction.

Association between Sexual Function and Marital Relationship in Patients with Ischemic Heart Disease.

BACKGROUND: Patients with ischemic heart disease (IHD) may report difficulties with sexual function and marital relationship. However, there is a dearth of studies focusing on the association between these aspects in IHD patients. The present study sought to assess the association between sexual function and marital relationship among IHD patients and also test the effect modification of gender, education level, and marital distress on the above association. METHODS: In this cross-sectional study, 551 patients with IHD were enrolled and their sexual function and marital relationship quality were assessed with the Relation and Sexuality Scale (RSS) and Revised Dyadic Adjustment Scale (RDAS), respectively. Association between marital relationship quality and sexual function was assessed with respect to gender, education level, and marital distress. RESULTS: Most participants (72%) were men at a mean age of 57 ± 11 (range = 36-80) years. Total sexual function was significantly correlated with total marital quality (r = -0.28), marital consensus (r = -0.17), marital coherence (r = -0.19), marital affection expression (r = -0.22), and marital satisfaction (r = -0.25). Total marital quality also showed a significant association with sexual fear (r = -0.11). These associations were moderated by gender, education level, and marital distress level. CONCLUSION: Among the IHD patients, sexual function and marital relationship quality showed a mild to moderate association. Association between sexual function and marital relationship quality, however, may depend on gender, education level, and marital distress level.

Gender modifies the effects of education and income on sleep quality of the patients with coronary artery disease.

BACKGROUND: This study aimed to investigate the interaction between gender and other socio-economic characteristics on sleep quality of the patients with Coronary Artery Disease (CAD). METHODS: This cross sectional study was conducted on 717 patients with CAD. The socio- economic status (education level, income, marital status, and place of residence) was considered as the independent variable. Besides, the study outcome was the quality of sleep which was measured using Pittsburgh Sleep Quality Index (PSQI). Gender was considered as a possible effect modifier. Two-way ANOVA was used to evaluate the interaction between gender and socio-economic factors on sleep quality. As defined by Baron and Kenny, moderator was defined as a variable that affected the direction or magnitude of the association of interest. RESULTS: Female gender, low education level, and low income were predictive of poor sleep quality. Among female (10.0 ± 4.3 vs. 7.6 ± 5.0, P < 0.05), but not male patients (6.7 ± 4.2 vs. 7.0 ± 4.2, P > 0.05), low education was associated with poor sleep quality. Also, among female (10.0 ± 4.3 vs. 5.7 ± 2.5, P < 0.05), but not male patients (7.0 ± 4.2 vs. 6.0 ± 3.8, P > 0.05), low income was predictive of poor sleep quality. Gender did not modify the effect of other socio-economic factors on sleep quality. CONCLUSIONS: Among female but not male patients with CAD, low education and income were associated with poor sleep quality. This information helps us better understand the mechanisms behind the poor sleep quality of the female patients with CAD. This is important because poor sleep is a prognostic factor among the CAD patients.

Sexual function and psychological status among males and females with ischemic heart disease.

INTRODUCTION: Patients with coronary artery disease (CAD) may also suffer from mental and sexual problems, and we should consider the mutual influence such conditions have on each other. However, the interrelation between sexual and mental problems in the context of CAD has not been fully investigated, especially when it comes to gender. AIM: Our aim was to evaluate sexuality and psychiatric symptoms among patients with CAD and the relation between them in each gender. METHODS: In this cross-sectional study, 550 (397 men and 153 women) patients with documented CAD were surveyed for anxiety and depression using the hospital anxiety and depression scale (HADS) self-administered questionnaire as well as the relation and sexuality scale (RSS). Three subscores were calculated for sexual function, frequency, and fear, with higher scores indicative of a poorer condition. MAIN OUTCOME MEASURES: The HADS and the RSS. RESULTS: Depressive symptoms and anxiety were more severe among our female subjects than they were among the male ones. In addition, the scores for sexual frequency, sexual function, and the total RSS were significantly higher in women, while men had a significantly higher score for sexual fear. The total RSS score correlated with depressive symptoms in women (r = 0.19, P = 0.03), but not in the male subjects. Considering the subscores, a higher score for sexual frequency correlated with depressive symptoms in both genders; however, being afraid of sexual relation correlated with depressive symptoms only in men with CAD and their spouses (r = 0.18, P = 0.001). CONCLUSION: We found that women with CAD have poorer sexual relation and more severe depressive symptoms than men do. Among men with CAD and their wives, fear of sexual relationship is a more serious problem. Such gender-specific characteristics and their interrelations ought to receive due consideration in the management of CAD.

Gender impact on the correlation between sexuality and marital relation quality in patients with coronary artery disease.

INTRODUCTION: Although the negative impact of coronary artery disease (CAD) on sexual and marital relation of the patients is known, data are lacking regarding possible gender difference. AIM: We designed a study on patients with CAD to investigate sexual relation and marital adjustment and their association with regard to gender differences. MAIN OUTCOME MEASURES: Questionnaires including the Dyadic Adjustment Scale for evaluating the couple's agreement on decisions and appropriate behavior, marital satisfaction, and marital cohesion, and the Relation and Sexuality Scale (RSS) for sexual function, frequency, and fear. METHODS: We surveyed 650 patients with documented CAD without any other major comorbidities. RESULTS: The patients were 464 men (73.1%) and 171 women (26.9%) with CAD. The mean age of the men and the women were 57.1 +/- 11.6 years and 56.3 +/- 9.7 years, respectively. The women had a significantly poorer dyadic adjustment and sexual relation than men, except for sexual fear, which was more prominent in men with CAD and their spouses. The sexual frequency and the total RSS scores correlated with all aspects of the patients' marital relation in both genders. However, only men suffered from a poorer dyadic satisfaction, dyadic consensus, affectional expression, and overall marital adjustment if they were more afraid of sexual relation. In women, but not men, sexual function was significantly associated with their dyadic satisfaction and their overall marital relation. CONCLUSIONS: Poorer sexual relation and marital adjustment was detected in our women with CAD. To manage all the problems of the patients that may impact their cardiac status, we should consider factors such as fear of sexual activity in men sexual dysfunction in women, and their correlation with marital adjustment.

Fear of sexual intercourse in patients with coronary artery disease: a pilot study of associated morbidity.

INTRODUCTION: Sexual fear is a known cause for avoidance of intercourse, especially in patients with chronic conditions. AIM: Given the significant impact of fear of intercourse on the quality of life, we herein report our pilot results regarding the differences in the demographic, clinical, marital, and psychological characteristics of coronary artery disease (CAD) patients with and without sexual fear. METHODS: In this cross-sectional study conducted in Baqyiatallah Hospital, Tehran, Iran, in 2006, 87 married CAD patients were assessed for the presence of sexual fear. Subjects with and without sexual fear were compared for demographic and clinical data as well as for Hospital Anxiety and Depression Scale (HADS) and Revised-Dyadic Adjustment Scale (R-DAS) scores. MAIN OUTCOME MEASURE: Demographic and clinical data, sexual fear (Relationship and Sexuality Scale), symptoms of anxiety and depression (HADS), and marital relation quality (R-DAS). RESULTS: Twenty-nine subjects were reported to have some degrees of fear of sexual intercourse and a lower frequency of sexual intercourse. Age, socioeconomic status, education level, tobacco smoking, and history of myocardial infarction were significantly different between those with and the ones without sexual fear. Body mass index, extent of coronary involvement, chronic obstructive pulmonary disease, hypertension, stroke, hyperlipidemia, history of diabetes, and the use of beta-blockers were not statistically different in the two groups. The subjects with sexual fear reported higher HADS depressive and R-DAS scores but not higher HADS anxiety scores. CONCLUSION: Among different nonmodifiable and modifiable correlates of fear of sexual intercourse in CAD patients, marital relationship and depressive symptoms should be highlighted in future interventional studies with the aim of allaying such fears.