Does Invasive Treatment Increase the Long-Term Survival of ST-Elevation Myocardial Infarction Patients with a History of Coronary Artery Bypass Graft Surgery?

Background: Although invasive treatments such as primary percutaneous coronary intervention (PPCI) are the treatment of choice in ST-elevation myocardial infarction (STEMI) patients, the survival benefit of this treatment in patients with a history of coronary artery bypass graft (CABG) has yet to be fully evaluated. Methods: In this historical cohort study, 251 STEMI patients with a history of CABG between 2007 and 2017 were stratified into 3 groups of no reperfusion, thrombolytic, and PPCI based on their treatment strategy. Baseline clinical characteristics, details of the STEMI event, and the course of hospitalization were evaluated for all patients and they were followed up until May 2018 to assess all-cause mortality. Results: The mean age of the study population was 64.019.45 years, and 81.7% of them were male. The median follow-up time was 1304 (IQR25%-75%: 571-2269) days, the short-term (1 month) mortality rate was 5.97%, and the long-term mortality rate was 15.1%. There was no significant difference between the 3 different strategies in terms of survival. In the fully adjusted multivariate analysis, cardiopulmonary resuscitation (HR: 15.06, 95% CI: 2.25-101.14, P=0.005) was significantly associated with short-term mortality, while diabetes (HR: 5.95, 95% CI: 2.03-17.44, P=0.001), opium abuse (HR: 4.85, 95% CI: 1.45-16.23, P=0.010), and cardiopulmonary resuscitation (HR: 11.73, 95% CI: 3.44-40.28, P=0.001) were significantly associated with long-term mortality. Conclusion: Our results failed to show the superiority of invasive treatment in terms of survival. Further studies regarding the advantages and disadvantages of invasive treatment in post-CABG patients are required.

Evaluation of subclinical left ventricular dysfunction in diabetic patients: longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study.

BACKGROUND: We evaluated left ventricular (LV) subclinical systolic dysfunction in diabetes mellitus patients using two-dimensional speckle tracking echocardiography (STE) for early detection of changes in LV longitudinal strain (ST) or synchronized contraction. METHODS: To determine ST and LV dyssynchrony, 37 normal coronary and normotensive diabetes mellitus patients with LV ejection fraction >50% were enrolled and compared to 39 nondiabetic normal coronary and LV function subjects. The cases underwent standard conventional transthoracic echocardiography and tissue Doppler imaging (TDI) and STE. End-systolic ST and time-to-peak systolic strain (Ts) were measured in 18 LV segments. RESULTS: Conventional parameters were similar between diabetic and nondiabetic subjects. In diabetic patients, significant reduction in global and segmental ST adjusted for age and body mass index, independently correlated with early diastolic velocity at the septal mitral valve annulus by TDI (P = 0.001), ratio of transmitral early and late diastolic velocities (P < 0.001), relative wall thickness (P = 0.014), glycosylated hemoglobin (P < 0.001), and fasting blood sugar (P < 0.001). These correlations were not found in the nondiabetic patients. After adjustment, presence of diabetes mellitus remained an independent correlate of reduced LV global longitudinal ST (R = 0.688, P = 0.003). Delay of Ts between the anteroseptal and posterior walls and all the LV segments was markedly higher in the diabetic group regardless of diastolic dysfunction. CONCLUSION: In diabetic patients with normal coronary and ejection fraction, segmental and global end-systolic longitudinal ST decreased and differences between Ts among LV segments increased irrespective of diastolic dysfunction at early stage. These results suggest that there might be early detectable changes in systolic function in the natural course of diabetes mellitus by STE study.

Factors associated with adoption acceptance rate from the view point of infertile couples.

BACKGROUND: Nowadays artificially assisted reproductive techniques are used to cure infertility. These methods are highly expensive, time-consuming and have low success rates which are usually around 20-40%. One of the best alternate methods for infertility treatment that can be considered is adoption that often decreases the treatment costs and the psychological impact within an infertile couple. OBJECTIVE: This study has been done with the aim of determining adoption acceptance rates and the effective factors of adoption in infertile couples. MATERIALS AND METHODS: A cross-sectional study was performed between October 2009-2010 on 200 infertile couples who had been referred to Infertility Center of Shahid Sadoughi University of Medical Sciences. Information gathered through face-to-face interview and questionnaires. The data analyzed through a SPSS software program using ANOVA test. RESULTS: There was a significant statistical relationship between adoption acceptance value scores and marriage duration of a couple (p=0.002 in men, p=0.004 in women) and presence of adoption backgrounds in male relatives (p=0.004). There was no statistically significant relationship between age, gender, education level, and onus of infertility, the number of previous referrals for an infertility solution and presence of adoption backgrounds in female relatives. CONCLUSION: Adoption as an alternative option to infertility treatment need to be more considered as a medical, social and cultural issue.