Thyroid Functions Are Associated with All-Cause Long-Term Mortality in Elderly Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

OBJECTIVE: Our aim in this study was to show the relationship between long-term all-cause mortality and thyroid functions in the elderly patient group that underwent primary percuta-neous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction. METHODS: Two-hundred seventy patients over 65 years of age who underwent primary percutaneous coronary intervention with the diagnosis of ST-segment elevation myocardial infarction were analyzed retrospectively. After applying the exclusion criteria, 198 patients were included in the study. The patients were divided into 2 groups according to their out-of-hospital mortality status. Angiographic, laboratory, echocardiographic, and electrocardiographic data were analyzed. RESULTS: The mean age of 198 patients in the study was 72.5 ± 6.6 years, and the median follow-up time was 101.7 months. Age was higher in the deceased group (70.4 ± 5.4 vs. 74.5 ± 6.9, P < 0.001). In multivariate analysis, age (odds ratio: 1.59, P = 0.003), insulin (odds ratio: 2.561, P = 0.016), angina balloon time (odds ratio: 1.134, P = 0.002), number of serious stenoses (odds ratio: 1.702, P = 0.003), creatinine (odds ratio: 3.043, P < 0.001), and fT4 (odds ratio: 2.026, P = 0.026) were determined as independent predictors of mortality. The fT4 level was correlated with the uric acid level (R: 0.182, P = 0.02) and the fT3 level was correlated with albumin (R: -0.253, P = 0.001) and creatinine (R: -0.224, P = 0.003) levels. A fT4 level cutoff value of 0.99 ng/mL had a sensitivity of 76%, a specificity of 54%, and an area under the curve of 0.675 in predicting mortality. In Kaplan-Meier analysis, fT4 elevation was strongly associated with mortality (P = 0.01). CONCLUSION: In our study, subclinical values in thyroid functions were found to be associated with increased mortality, apart from known factors in elderly patients who underwent primary PTCA with the diagnosis of ST-segment elevation myocardial infarction.

Long-Term Observational Study of the Isolated Ostial Diagonal Stenosis in Patients with Chronic Coronary Syndrome.

OBJECTIVE: Isolated ostial diagonal stenoses are very rare lesions in which percutaneous intervention could cause significant vessel compromise, and the long-term results have been reported in a few studies. This study sought the characteristics and long-term follow-up of the patients with isolated osteal diagonal stenosis regarding percutaneous coronary intervention and presence of angina. METHODS: The study was an observational retrospective study conducted between January 2014 and December 2020. A total of 9769 patients who underwent coronary angiography were analyzed, and 87 patients had isolated diagonal stenosis. The patients were evaluated according to treatment modality and angina severity in long-term pattern. RESULTS: Median follow-up time was 36 months. A total of 54 (83.1%) patients were followed up with only medical treatment, and 11 (16.9%) patients underwent revascularization in addition to medical treatment. The degree of stenosis of the diagonal artery was significantly higher in the percutaneous coronary intervention group than medical group (P = 0.002) and the patients with wider reference diameter of diagonal artery complaint of more angina (P = 0.007). Class I angina was significantly higher in percutaneous coronary intervention group than medical and the patients with no angina were significantly higher in medical group than percutaneous coronary intervention group. CONCLUSION: Percutaneous coronary intervention was mainly performed for diagonal arteries with a higher degree of stenosis; however, the patients who underwent percutaneous coronary intervention had angina more than 50% rates. Furthermore, the patients with ongoing angina had a larger diameter of the diagonal artery regardless of the type of treatment.

A successful endovascular treatment of a patient with extended-spectrum beta-lactamase positive Escherichia coli related emphysematous distal abdominal aortitis rapidly progressing to a saccular aneursym.

Infectious aortitis is a rare disease and associated with adverse clinical outcomes. A 66-year-old man was admitted to the emergency department with abdominal and lower back pain, fever, chills, and anorexia continuing for a week. A contrast-enhanced computed tomography (CT) scan of the abdomen showed multiple periaortic enlarged lymphatic nodes, mural wall thickening, and gas collections in the infrarenal aorta and proximal segment of right common iliac artery. The patient was hospitalized with the diagnosis of acute emphysematous aortitis. During hospitalization, extended-spectrum beta-lactamase-positive Escherichia coli was grown in all blood and urine cultures. Despite sensitive antibiotherapy, abdominal and back pain, inflammation biomarkers, and fever of the patient were not improved. Control CT demonstrated a newly developed mycotic aneurysm, increased intramural gas collection, and periaortic soft-tissue thickening. Urgent vascular surgery was recommended to the patient by the heart team, but the patient rejected surgery due to the high perioperative risk. Alternatively, an endovascular rifampin-impregnated stent-graft was successfully implanted and antibiotics were completed at 8 weeks. After procedure, inflammatory indicators were normalized and clinical symptoms of the patient were resolved. No microorganism grew on control blood and urine cultures. The patient was discharged with a good health. Learning objective: Aortitis should be suspected in patients who present with fever, abdominal and back pain, especially in the presence of predisposing risk factors. Infectious aortitis (IA) accounts for a small part of all aortitis cases and the most common causative microorganism is Salmonella. The mainstay treatment of IA is sensitive antibiotherapy. Surgery may be required in patients who are unresponsive to antibiotics or develop aneurysm. Alternatively, endovascular treatment can be performed in selected cases.

A Transient Inferolateral ST-Segment Elevation on the Electrocardiogram Due to an Iatrogenic Left-Sided Pneumothorax After an Urgent Tracheostomy in a Patient with Metastatic Hypopharynx Cancer.

The presence of ST-segment elevation on the electrocardiogram alerts physicians in patients with chest pain. Emergency coronary angiography is usually performed in these patients. However, there are many conditions that cause ST-segment elevation on the electrocardiogram, such as pericarditis, hyperkalemia, Brugada syndrome, hypothermia, and early repolarization. Pneumothorax is a rare complication of tracheostomy and its symptoms are sudden chest pain and dyspnea. Also, it has been known that pneumothorax may cause ST-segment changes on the electrocardiogram. We presented a transient inferolateral ST-segment elevation on the electrocardiogram due to an iatrogenic left-sided pneumothorax after an urgent tracheostomy in a patient with metastatic hypopharynx cancer and normal coronary angiogram.

The Relationship Between Coronary Anatomy and Angina Pectoris During Stent Balloon Dilatation in Patients Undergoing Percutaneous Coronary Intervention.

OBJECTIVE: Angina pectoris (AP) is defined as a clinical symptom characterized by sensations such as pressure-heaviness, burning, squeezing, or discomfort in different parts of the body, including the retrosternum, chest, jaw, neck, shoulders, and back. Limited publications exist on the impact of coronary artery disease localization on the placement, character, and severity of AP. This study aimed to investigate the relationship between the frequency of AP development due to myocardial ischemia during percutaneous coronary intervention (PCI), its character, severity, localization, and coronary anatomy. METHODS: A total of 128 patients were included in the study, with 146 lesions treated among them. RESULTS: Among patients who underwent PCI of the right coronary artery (RCA), 31.1% reported no complaints. Similar rates were observed in patients undergoing PCI of the left anterior descending (LAD) and circumflex (Cx) arteries, at 23.7% and 19.1%, respectively. Pressure-heaviness was frequently observed in PCI of the LAD and Cx arteries, while burning was the dominant symptom description in PCI of the RCA. The isolated retrosternal and left thoracic regions were the most common localizations in all main coronary arteries. Epigastric localization occurred most frequently in PCI of the RCA. In terms of the severity of angina, no significant difference was observed between the three coronary arteries. CONCLUSION: Pressure-heaviness angina was commonly observed during PCI of the LAD and Cx, while burning angina was frequent during PCI of the RCA. The severity of AP was similar across the three main coronary arteries.

The Systemic Immune-Inflammation Index May Predict the Coronary Slow Flow Better Than High-Sensitivity C-Reactive Protein in Patients Undergoing Elective Coronary Angiography.

Methods: A total of 197 patients (102 patients with CSF; 95 patients with normal coronary flow) were included in this retrospective study. Clinical and angiographic characteristics of patients were obtained from hospital records. Results: Patients with CSF had higher SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and high-sensitivity C-reactive protein (hsCRP) levels compared with the control group. Body mass index (p=0.022, OR 1.151, 95% CI 1.121-1.299), low-density lipoprotein (p=0.018, OR 1.028, 95% CI 1.005-1.052), hsCRP (p=0.044, OR 1.161, 95% CI 1.004-1.343), and SII (p < 0.001, OR 1.015, 95% CI 1.003-1.026) were independent predictors of CSF in the multivariable analysis. The optimal cutoff value of SII in predicting CSF was >877 in ROC curve analysis (p < 0.001, AUC = 0.892, 95% CI 0.848-0.936). This cutoff value of SII predicted the CSF with a sensitivity of 71.5% and specificity of 92.4%. Spearman correlation analysis showed a positive correlation between the mean TFC value and PLR, NLR, hsCRP, and SII. Conclusions: SII may be used as a better indicator for the prediction of CSF than hsCRP.

The Utility of Systemic Immune-Inflammation Index for Predicting Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

OBJECTIVE: The systemic immune-inflammation index (SII), derived from counts of neutrophils, platelets, and lymphocytes, has been developed to predict clinical outcomes in several cancers and cardiovascular diseases. The aim of this study was to evaluate the utility of SII to predict contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: A total of 632 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups based on the presence or absence of CIN. Baseline demographic, laboratory, and clinic characteristics were evaluated between the two groups. Logistic regression analysis was used to identify independent predictors of CIN. RESULTS: The receiver operating characteristic curve analysis demonstrated that the optimal cutoff value of SII for predicting CIN was 1,282 with a sensitivity of 76.1% and specificity of 86.7% (AUC: 0.834; 95% CI: 0.803-0.863; p < 0.001). Multivariate analysis performed in two models (SII; as separate continuous and categorical variables) showed age, estimated glomerular filtration rate (eGFR), diabetes, left ventricular ejection fraction (LVEF), Killip class ≥2, use of an intravenous diuretic, troponin I, and SII as independent predictors of CIN in model 1. In model 2, age, eGFR, diabetes, LVEF, Killip class ≥2, use of an intravenous diuretic, troponin I, and a value of SII >1,282 (p < 0.001, OR 6.205, 95% CI: 2.301-12.552) remained as independent predictors of CIN. CONCLUSION: SII may be a useful and reliable indicator to predict the development of CIN in patients with STEMI undergoing primary PCI than NLR and PLR.