Assessment of short-term results of thrombosuction during primary percutaneous coronary intervention in patients with acute myocardial infarction.

Aim: The study investigated the short-term outcomes of thrombosuction during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Materials & methods: The study consisted of 57 patients who underwent primary or rescue PCI. The effect of thrombosuction on thrombolysis in myocardial infarction (TIMI) flow, failure to restore blood flow in the target vessel, and occurrence of mortality were reviewed in patients. Results: Thrombosis was performed in 45.61% of patients. Thrombosuction during PCI resulted in significant incremental TIMI-flow changes in this group of patients compared with patients who did just PCI. In 86.6%, these changes were three-degree and the initial TIMI-flow has changed from 0 to 3. Conclusion: The number of patients who underwent rescue PCI was higher than the smaller number of individuals who underwent thrombosuction.

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Association between high-sensitive cardiac troponin level and coronary artery disease: A systematic review and meta-analysis.

Background and objectives: Previous studies suggest a link between high-sensitive cardiac troponin (hs-cTn) levels and coronary artery disease (CAD). However, the nature of this relationship is disputed. To address this, we conducted a study to gather and assess evidence on the association between hs-cTn and CAD prediction. Data sources: Studies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After the screening, the selected articles' quality and risk of bias assessment were evaluated. Synthesis method: Meta-analysis calculated std. mean difference on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed. Results: Twenty-two studies were included in this systematic review, with a total of 844 cases and 2101 control people. The results of the meta-analysis on nine studies showed a significant and positive association between hs-cTn levels and CAD (pooled std. mean difference = 0.44; 95% confidence interval = 0.14-0.73; p < 0.003), with no publication bias (p = 0.9170). Among subgroups, std. mean differences were notably different only when the data were stratified by region or risk of bias; however, subgroup analysis could not determine the source of heterogeneity. Conclusions: Available prospective studies indicate a strong association of hs-cTn with the risk of CAD and significant improvements in CAD prediction. Further investigations in both molecular and clinical fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of hs-cTn level in CAD patients.

Assessment of the Heart's Left and Right Ventricles (EF and TAPSE) in CABG Surgery Patients before and after Cardiac Rehabilitation.

BACKGROUND: Post-coronary artery bypass grafting (post-CABG) is a beneficial procedure for cardiac patients. However, without an appropriate cardiac rehabilitation (CR) program, patient care may be inadequate, leading to recurrent hospitalizations and heart failure. This study aims to assess the effects of a CR program on left ventricular ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE) measures in post-CABG patients at Amir-almomenin, kordkuy Hospital, Golestan, Iran. METHODS: This descriptive-analytic study included 100 patients who underwent post-CABG surgery in the second half of 2020, and whose complete information was available in their medical files. An echocardiologist assessed the LVEF and TAPSE of the patients. After one month of CR procedures, these measures were reevaluated and recorded. The CR program consisted of 5 to 10 sessions of physiotherapy per patient, with 2 or 3 sessions conducted per week. It involved a four-phase therapy that included light sports activities such as running and jogging on a treadmill at a CR clinic. Data analysis was performed using SPSS software version 18. RESULTS: The data analysis of this study suggests that implementing a CR program for post- CABG patients can have beneficial effects. CR significantly increased the patients' LVEF, but the increase in TAPSE was not statistically significant. Furthermore, both male and female patients showed improved LVEF after the CR program. There was a non-significant inverse relationship between hospitalization duration and LVEF. Statistically, older patients had a significantly longer duration of hospitalization compared to younger patients. CONCLUSION: Completion of a cardiac rehabilitation program leads to significant improvement in left ventricular function, while the improvement in right ventricular function is relatively modest. Moreover, a significant proportion of patients were able to resume their normal daily activities after completing the rehabilitation phase.

Assessing the Frequency of COVID-19 in Patients Undergoing Primary Percutaneous Coronary Intervention (PCI).

BACKGROUND: The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health crisis with significant morbidity and mortality. OBJECTIVE: The aim of this study was to investigate the incidence of COVID-19 in patients undergoing primary percutaneous coronary intervention (PCI) for myocardial infarction and identify associated demographic and clinical characteristics. METHODS: In this study, a retrospective and descriptive cross-sectional design was used to examine all patients (a total of 85) who experienced acute myocardial infarction and underwent primary percutaneous coronary intervention (PCI). The study measured various parameters, such as COVID-19 status, age, sex, ethnicity, diabetes, and hypertension. Data analysis was conducted using SPSS version 25 software. RESULTS: Out of the 85 patients who underwent primary percutaneous coronary intervention (PCI) for myocardial infarction (MI), 14 patients (16.5%) were found to have COVID-19. COVID-19 diagnosis was confirmed through RT-PCR testing for 2 patients, while the remaining 12 patients were diagnosed using lung CT scans. Among the COVID-19 patients, 21.4% (n = 3) had background diabetes, and 7.1% (n = 1) had background hypertension. MI recurrence was observed in 14.3% of COVID-19 patients (2 cases). Unfortunately, 1 COVID-19 patient, a 70- year-old Persian woman with diabetes and hypertension, passed away. No significant differences were found in terms of age, sex, ethnicity, underlying diabetes, or underlying hypertension between the COVID-19 and non-COVID-19 groups. CONCLUSION: The high occurrence of COVID-19 among myocardial infarction (MI) patients undergoing primary percutaneous coronary intervention (PCI) is worth noting. Further investigation is recommended to explore the impact of demographic and contextual factors on the severity and outcomes of primary PCI in MI patients with COVID-19, as well as the underlying mechanisms involved.

The effect of cardiac rehabilitation on left and right ventricular function in post primary PCI patients.

Objective: Acute myocardial infarction is the most severe manifestation of coronary artery disease. Cardiac rehabilitation programs following percutaneous coronary intervention (PCI) assist patients to get back to their daily routine and can improve their cardiovascular health. The aim of this study was to evaluate the effect of cardiac rehabilitation in patients after primary PCI on the left and right ventricular function. Methods: In this cross-sectional study, patient who underwent primary PCI following myocardial infarction were included. Month after the PCI procedure, 5 sessions of cardiac rehabilitation program were performed based on the patient's symptoms and according to the diagnosis by cardiologist. The duration of each rehabilitation session started from 20 min in the first session and reached 60 min in the last session. Exercises included walking on a treadmill and pedaling a stationary bike with limbs. Ventricular function was assessed after primary PCI and after the rehabilitation program. Patients were followed up by telephone after one year of the rehabilitation program. Results: 30 patients were enrolled in the study, 23 of whom were male (76.7%). Right ventricular function did not change after the cardiac rehabilitation program compared to before (p = 1.00). Left ventricular function significantly increased after rehabilitation (p = 0.003). Increased left ventricular function was significant only in males (p < 0.001). Cardiac rehabilitation program in people over 60 years did not change left ventricular function (p < 0.05). One year after the cardiac rehabilitation program, 3 patients (10%) died. Conclusion: The findings of our study showed that the implementation of an exercise-based cardiac rehabilitation program improves left ventricular function in patients with myocardial infarction after primary PCI but does not affect right ventricular function. The findings also showed that cardiac rehabilitation program may be associated with the gender and the age of the patients.

Cardiac fibrosis and curcumin: a novel perspective on this natural medicine.

BACKGROUND: According to WHO statistics, cardiovascular disease are the leading causes of death in the world. One of the main factors which is causing heart failure, systolic and diastolic dysfunction, and arrythmias is a condition named cardiac fibrosis. This condition is defined by the accumulation of fibroblast-produced ECM in myocardium layer of the heart. OBJECTIVE: Accordingly, the current review aims to depict the role of curcumin in the regulation of different signaling pathways that are involved in cardiac fibrosis. RESULTS: A great number of cellular and molecular mechanisms such as oxidative stress, inflammation, and mechanical stress are acknowledged to be involved in cardiac fibrosis. Despite the available therapeutic procedures which are designed to target these mechanisms in order to prevent cardiac fibrosis, still, effective therapeutic methods are needed. Curcumin is a natural Chinese medicine which currently has been declared to have therapeutic properties such as anti-oxidant and immunomodulatory activities. In this review, we have gathered several experimental studies in order to represent diverse impacts of this turmeric derivative on pathogenic factors of cardiac fibrosis. CONCLUSION: Curcumin might open new avenues in the field of cardiovascular treatment.

Long-term opiate use and risk of cardiovascular mortality: results from the Golestan Cohort Study.

AIMS: Tens of millions of people worldwide use opiates but little is known about their potential role in causing cardiovascular diseases. We aimed to study the association of long-term opiate use with cardiovascular mortality and whether this association is independent of the known risk factors. METHODS AND RESULTS: In the population-based Golestan Cohort Study-50 045 Iranian participants, 40-75 years, 58% women-we used Cox regression to estimate hazard ratios and 95% confidence intervals (HRs, 95% CIs) for the association of opiate use (at least once a week for a period of 6 months) with cardiovascular mortality, adjusting for potential confounders-i.e. age, sex, education, wealth, residential place, marital status, ethnicity, and tobacco and alcohol use. To show independent association, the models were further adjusted for hypertension, diabetes, waist and hip circumferences, physical activity, fruit/vegetable intake, aspirin and statin use, and history of cardiovascular diseases and cancers. In total, 8487 participants (72.2% men) were opiate users for a median (IQR) of 10 (4-20) years. During 548 940 person-years-median of 11.3 years, >99% success follow-up-3079 cardiovascular deaths occurred, with substantially higher rates in opiate users than non-users (1005 vs. 478 deaths/100 000 person-years). Opiate use was associated with increased cardiovascular mortality, with adjusted HR (95% CI) of 1.63 (1.49-1.79). Overall 10.9% of cardiovascular deaths were attributable to opiate use. The association was independent of the traditional cardiovascular risk factors. CONCLUSION: Long-term opiate use was associated with an increased cardiovascular mortality independent of the traditional risk factors. Further research, particularly on mechanisms of action, is recommended.

Joint effect of diabetes and opiate use on all-cause and cause-specific mortality: the Golestan cohort study.

BACKGROUND: Many diabetic individuals use prescription and non-prescription opioids and opiates. We aimed to investigate the joint effect of diabetes and opiate use on all-cause and cause-specific mortality. METHODS: Golestan Cohort study is a prospective population-based study in Iran. A total of 50 045 people-aged 40-75, 28 811 women, 8487 opiate users, 3548 diabetic patients-were followed during a median of 11.1 years, with over 99% success follow-up. Hazard ratio and 95% confidence intervals (HRs, 95% CIs), and preventable death attributable to each risk factor, were calculated. RESULTS: After 533 309 person-years, 7060 deaths occurred: 4178 (10.8%) of non-diabetic non-opiate users, 757 (25.3%) diabetic non-users, 1906 (24.0%) non-diabetic opiate users and 219 (39.8%) diabetic opiate users. Compared with non-diabetic non-users, HRs (95% CIs) for all-cause mortality were 2.17 (2.00-2.35) in diabetic non-opiate users, 1.63 (1.53-1.74) in non-diabetic opiate users and 2.76 (2.40-3.17) in diabetic opiate users. Among those who both had diabetes and used opiates, 63.8% (95% CI: 58.3%-68.5%) of all deaths were attributable to these risk factors, compared with 53.9% (95% CI: 50%-57.4%) in people who only had diabetes and 38.7% (95% CI: 34.6%-42.5%) in non-diabetic opiate users. Diabetes was more strongly associated with cardiovascular than cancer mortality. The risk of early mortality in known cases of diabetes did not depend on whether they started opiate use before or after their diagnosis. CONCLUSIONS: Using opiates is detrimental to the health of diabetic patients. Public awareness about the health effects of opiates, and improvement of diabetes care especially among individuals with or at risk of opiate use, are necessary.

Household Fuel Use and the Risk of Gastrointestinal Cancers: The Golestan Cohort Study.

BACKGROUND: Three billion people burn nonclean fuels for household purposes. Limited evidence suggests a link between household fuel use and gastrointestinal (GI) cancers. OBJECTIVES: We investigated the relationship between indoor burning of biomass, kerosene, and natural gas with the subsequent risk of GI cancers. METHODS: During the period 2004-2008, a total of 50,045 Iranian individuals 40-75 years of age were recruited to this prospective population-based cohort. Upon enrollment, validated data were collected on demographics, lifestyle, and exposures, including detailed data on lifetime household use of different fuels and stoves. The participants were followed through August 2018 with <1% loss. RESULTS: During the follow-up, 962 participants developed GI cancers. In comparison with using predominantly gas in the recent 20-y period, using predominantly biomass was associated with higher risks of esophageal [hazard ratio (HR): 1.89; 95% confidence interval (CI): 1.02, 3.50], and gastric HR: 1.83; 95% CI: 1.01, 3.31) cancers, whereas using predominantly kerosene was associated with higher risk of esophageal cancer (HR: 1.84; 95% CI: 1.10, 3.10). Lifetime duration of biomass burning for both cooking and house heating (exclusive biomass usage) using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.14; 95% CI: 1.07, 1.21), esophageal (10-y HR: 1.19; 95% CI: 1.08, 1.30), gastric (10-y HR: 1.11; 95% CI: 1.00, 1.23), and colon (10-y HR: 1.26; 95% CI: 1.03, 1.54) cancers. The risks of GI cancers combined, esophageal cancer, and gastric cancer were lower when biomass was burned using chimney-equipped heating-stoves (strata difference p-values=0.001, 0.003, and 0.094, respectively). Duration of exclusive kerosene burning using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.05; 95% CI: 1.00, 1.11), and esophageal cancer (10-y HR: 1.14; 95% CI: 1.04, 1.26). DISCUSSION: Household burning of biomass or kerosene, especially without a chimney, was associated with higher risk of some digestive cancers. Using chimney-equipped stoves and replacing these fuels with natural gas may be useful interventions to reduce the burden of GI cancers worldwide. https://doi.org/10.1289/EHP5907.

Opium use and subsequent incidence of cancer: results from the Golestan Cohort Study.

BACKGROUND: Evidence is emerging for a role of opiates in various cancers. In this study, we aimed to investigate the association between regular opium use and cancer incidence. METHODS: This study was done in a population-based cohort of 50 045 individuals aged 40-75 years from northeast Iran. Data on participant demographics, diet, lifestyle, opium use, and different exposures were collected upon enrolment using validated questionnaires. We used proportional hazards regression models to estimate hazard ratios (HRs) and corresponding 95% CIs for the association between opium use and different cancer types. FINDINGS: During a median 10 years of follow-up, 1833 participants were diagnosed with cancer. Use of opium was associated with an increased risk of developing all cancers combined (HR 1·40, 95% CI 1·24-1·58), gastrointestinal cancers (1·31, 1·11-1·55), and respiratory cancers (2·28, 1·58-3·30) in a dose-dependent manner (ptrend<0·001). For site-specific cancers, use of opium was associated with an increased risk of developing oesophageal (1·38, 1·06-1·80), gastric (1·36, 1·03-1·79), lung (2·21, 1·44-3·39), bladder (2·86, 1·47-5·55), and laryngeal (2·53, 1·21-5·29) cancers in a dose-dependent manner (ptrend<0·05). Only high-dose opium use was associated with pancreatic cancer (2·66, 1·23-5·74). Ingestion of opium (but not smoking opium) was associated with brain (2·15, 1·00-4·63) and liver (2·46, 1·23-4·95) cancers in a dose-dependent manner (prend<0·01). We observed consistent associations among ever and never tobacco users, men and women, and individuals with lower and higher socioeconomic status. INTERPRETATION: Opium users have a significantly higher risk of developing cancers in different organs of the respiratory, digestive, and urinary systems and the CNS. The results of this analysis show that regular use of opiates might increase the risk of a range of cancer types. FUNDING: World Cancer Research Fund International, Cancer Research UK, Tehran University of Medical Sciences, US National Cancer Institute, International Agency for Research on Cancer.

The effects of multimedia education on postoperative delirium in patients undergoing coronary artery bypass graft: A randomized clinical trial.

BACKGROUND: Patients undergoing cardiac surgeries are at high risk of developing delirium. AIMS AND OBJECTIVES: The present study aimed to determine the effects of multimedia education on postoperative delirium in patients undergoing a coronary artery bypass graft. DESIGN: This study was a randomized clinical trial. METHODS: In this study, 110 patients undergoing a coronary artery bypass graft were assigned to two groups, control and intervention. Patients in the intervention group received multimedia education, and those in the control group received routine training. The inclusion criteria were experiencing the coronary artery bypass graft for the first time and non-development of post-operative cardiogenic shock or myocardial rupture. After measuring the level of consciousness, patients were examined in terms of delirium using the confusion assessment method for the ICU scale twice a day from admission to discharge from the ICU. The data were statistically analysed using χ2 test and Fisher's exact test. RESULTS: Patients of both groups were matched in terms of demographics. The highest incidence of delirium was observed on the first day after surgery in the intervention group (14.5%) and in the morning of the second day after surgery (29.1%) in the control group. Moreover, there was a significant difference between the two groups in the incidence of delirium in the morning of the second, third, and fourth days after surgery as it was higher in the control group over these days. CONCLUSION: Considering the lower incidence of post-operative delirium in patients who experienced multimedia education rather than control group, the use of this non-pharmaceutical method is recommended to prevent delirium in such patients. RELEVANCE TO CLINICAL PRACTICE: Delirium is also an acute organic brain syndrome that often leads to complicated conditions after cardiac surgeries. Fortunately, delirium is a preventable issue. The implementation of multimedia education as a non-pharmacological approach had positive effects on patients' delirium.

Individual and Combined Effects of Environmental Risk Factors for Esophageal Cancer Based on Results From the Golestan Cohort Study.

BACKGROUND & AIMS: Northeast Iran has one of the highest reported rates of esophageal squamous cell carcinoma (ESCC) worldwide. Decades of investigations in this region have identified some local habits and environmental exposures that increase risk. We analyzed data from the Golestan Cohort Study to determine the individual and combined effects of the major environmental risk factors of ESCC. METHODS: We performed a population-based cohort of 50,045 individuals, 40 to 75 years old, from urban and rural areas across Northeast Iran. Detailed data on demographics, diet, lifestyle, socioeconomic status, temperature of drinking beverages, and different exposures were collected using validated methods, questionnaires, and physical examinations, from 2004 through 2008. Participants were followed from the date of enrollment to the date of first diagnosis of esophageal cancer, date of death from other causes, or date of last follow-up, through December 31, 2017. Proportional hazards regression models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between different exposures and ESCC. RESULTS: During an average 10 years of follow-up, 317 participants developed ESCC. Opium smoking (HR 1.85; 95% CI 1.18-2.90), drinking hot tea (≥60°C) (HR 1.60; 95% CI 1.15-2.22), low intake of fruits (HR 1.48; 95% CI 1.07-2.05) and vegetables (HR 1.62; 95% CI 1.03-2.56), excessive tooth loss (HR 1.66; 95% CI 1.04-2.64), drinking unpiped water (HR 2.04; 95% CI 1.09-3.81), and exposure to indoor air pollution (HR 1.57; 95% CI 1.08-2.29) were significantly associated with increased risk of ESCC, in a dose-dependent manner. Combined exposure to these risk factors was associated with a stepwise increase in the risk of developing ESCC, reaching a more than 7-fold increase in risk in the highest category. Approximately 75% of the ESCC cases in this region can be attributed to a combination of the identified exposures. CONCLUSIONS: Analysis of data from the Golestan Cohort Study in Iran identified multiple risk factors for ESCC in this population. Our findings support the hypothesis that the high rates of ESCC are due to a combination of factors, including thermal injury (from hot tea), exposure to polycyclic aromatic hydrocarbons (from opium and indoor air pollution), and nutrient-deficient diets. We also associated ESCC risk with exposure to unpiped water and tooth loss.

Acute effects of simvastatin to terminate fast reentrant tachycardia through increasing wavelength of atrioventricular nodal reentrant tachycardia circuit.

Simvastatin (SV) leads to reduction of ventricular rhythm during atrial fibrillation on rabbit atrioventricular (AV) nodes. The aim of our study was (i) to determine the frequency-dependent effects of SV in a functional model, and (ii) to assess the effects of SV to suppress experimental AV nodal reentrant tachycardia (AVNRT). Selective stimulation protocols were used with two different pacing protocols, His to atrial, and atrial to atrial (AA). An experimental AVNRT model with various cycle lengths was created in three groups of perfused rabbit AV nodal preparations (n = 24) including: SV 3 µm, SV 7 µm, and verapamil 0.1 µm. SV increased nodal conduction time and refractoriness by AA pacing. Different simulated models of slow/fast and fast/slow reentry were induced. SV caused inhibitory effects on the slow anterograde conduction (origin of refractoriness) more than on the fast anterograde conduction time, leading to an increase of tachycardia cycle length, tachycardia wavelength and termination of slow/fast reentrant tachyarrhythmia. Verapamil significantly suppressed the basic and frequency-dependent intrinsic nodal properties. In addition, SV decreased the incidence of gap and echo beats. The present study showed that SV in a concentration and rate-dependent manner increased the AV effective refractory period and reentrant tachycardia wavelength that lead to slowing or termination of experimental fast AVNRT. The direction-dependent inhibitory effect of SV on the anterograde and retrograde dual pathways explains its specific antireentrant actions.

The Effects of Panax Ginseng on Lipid Profile, Pro-oxidant: Antioxidant Status and High-sensitivity C Reactive Protein Levels in Hyperlipidemic Patients in Iran.

BACKGROUND: Because of the conflicting results from previous studies regarding the efficacy of ginseng on lipid profile and anti-inflammatory and anti-proliferative activities of its components, we aimed to evaluate the effects of Panax ginseng on lipid profile, pro-oxidant - anti-oxidant status and high-sensitivity C reactive protein (hs-CRP) levels. METHODS: Forty Iranian hyperlipidemic patients were randomly assigned to placebo (n = 20) or control (n = 20) groups in this double-blind randomized controlled trial. The ginseng or placebo was taken two capsules twice a day for 8 weeks. Total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), fasting blood glucose, serum creatinine and hs-CRP levels and pro-oxidant - anti-oxidant balance (PAB) were estimated before and after intervention. RESULTS: There were no significant differences between the two groups with respect to changes in serum TG, LDL-C, HDL-C, and TC/HDL-C levels. Nor were there significant differences between the two groups with respect to changes in hs-CRP level and PAB from baseline to week 8. CONCLUSIONS: Our study demonstrates that ginseng does not have significant effects on lipid profile, Hs-CRP level and PAB. Further clinical studies, with a larger sample size, more prolonged period of therapy are needed to investigate the therapeutic effects of ginseng.