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Background and Objectives : In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods : In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results : The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6-20.4) vs. 0.6 (IQR = 0.1-2.6), p < 0.001]. In addition, patients in the T3 tertile (patients with the highest CAR) had a higher rate of all-cause mortality [n = 90 cases (66.2%), p < 0.001]. Multivariate Cox regression analysis revealed that CAR was an independent predictor of mortality in patients with HFrEF (hazard ratio: 1.852, 95% confidence interval: 1.124-2.581, p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions : The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker.

Objective: Atrial High Rate Episodes (AHRE) are subclinical atrial tachyarrhythmias detectable by cardiac implantable electronic devices (CIEDs). AHREs have been associated with an increased risk of developing atrial fibrillation (AF), thromboembolism, cardiovascular and cerebrovascular events, and mortality. Although recent studies have assessed the value of oxidative stress markers in patients with AF, the relationships between AHRE and oxidative stress markers, including nitric oxide, has not yet been elucidated. This study aims to investigate the relationship between these markers and AHRE., Method: This prospective, cross-sectional study comprised 180 patients with CIEDs. The study population was divided into two groups based on the presence (n = 78) and absense (n = 102) of AHRE to analyze its association with biomarkers., Results: The AHRE (+) group was significantly older, had a higher prevalence of hypertension, higher NT-proBNP (508.8 ± 249 pg/mL vs. 415.3 ± 292.1; P = 0.037), MDA levels (20.9 ± 4.1 μmol/L vs. 19.1 ± 3.1 μmol/L; P = 0.006), and iNOS activity (1,935.9 ± 326.1 pg/mL vs. 1,677.4 ± 363.2 pg/mL; P < 0.001). Logistic regression analysis identified age, hypertension, MDA (odds ratio [OR]: 1.131, 95%CI: 1.009 - 1.268, P = 0.035), inducible nitric oxide synthase (iNOS) activity (OR = 1.002, 95% CI = 1.001 - 1.003, P < 0.001), and endothelial nitric oxide synthase (eNOS) activity (OR = 0.990, 95% CI = 0.986 - 0.984, P < 0.001) as independent predictors of AHRE., Conclusion: The study findings indicated that plasma levels of NT-proBNP, MDA, nitric oxide, and the expression of iNOS and eNOS were significantly associated with AHRE. Moreover, elevated plasma MDA concentrations, increased iNOS activity, and decreased eNOS activity were identified as independent predictors of AHRE.

Objectives: This study aimed to investigate the relationship between subclinical left ventricular (LV) systolic dysfunction and ECG parameters in newly diagnosed hypertension patients., Methods: In this cross-sectional study, adults diagnosed with hypertension based on 24-h ambulatory blood pressure monitor recordings were included. The patients were classified into two groups based on the presence of subclinical LV systolic dysfunction according to LV global longitudinal strain (LVGLS). Findings were compared between the two groups., Results: A total of 244 patients (female, 55.7%) were included. Based on LVGLS, 82 (33.6%) patients had subclinical LV systolic dysfunction. The proportion of early repolarization pattern (ERP) on ECG was significantly higher in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [24 (28.6%) vs. 8 (5%), P < 0.001]. PR and corrected QT intervals were also significantly longer in patients with subclinical LV systolic dysfunction than in patients with normal LV systolic function [median (interquartile range), 148 (132-158) vs. 141 (127-152), P = 0.036 and 443 (427-459) vs. 431 (411-455), P = 0.007, respectively]. According to multivariate regression analysis ERP, early (E) wave velocity/late (A) wave velocity (E/A), and LV mass index were independently associated with subclinical LV systolic dysfunction., Conclusion: In newly diagnosed hypertension patients, the ERP on admission ECG could be a sign of subclinical systolic dysfunction., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: A decrease in the left ventricular ejection fraction (≤40%) in the setting of ST-segment elevation myocardial infarction is a significant predictor of mortality in the young ST-segment elevation myocardial infarction population. In this study, we aimed to investigate the predictors of left ventricular ejection fraction reduction and evaluate the long-term mortality rates in young ST-segment elevation myocardial infarction patients with or without decreased left ventricular ejection fraction., Methods: We enrolled retrospectively 411 consecutive ST-segment elevation myocardial infarction patients aged 45 years or below who underwent primary percutaneous coronary intervention. Young ST-segment elevation myocardial infarction patients were divided into two groups according to their left ventricular ejection fraction (≤40%, n=72 and >40%, n=339), which were compared with each other., Results: Statin use, white blood cell count, C-reactive protein, peak creatine kinase-MB, prolonged ischemia time, left anterior descending artery-related infarction, proximally/ostial located lesion, and no-reflow were independently associated with low left ventricular ejection fraction. Additionally, long-term mortality was considerably higher in the left ventricular ejection fraction ≤40% group than those in the left ventricular ejection fraction>40% group (18.1% versus 2.4%; p<0.001)., Conclusions: In young ST-segment elevation myocardial infarction patients, lesion properties (left anterior descending lesion, proximally located lesion), no-reflow, and prolonged ischemia time appeared to be important determinants for the left ventricular ejection fraction decline, rather than coronary disease severity or demographic and hematological parameters. Statin use may be preventive in the development of left ventricular ejection fraction decline in young ST-segment elevation myocardial infarction patients.

Background: Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT., Method: Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution's medical records., Results: The mean follow-up period was 22 months (14-40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan-Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%., Conclusion: The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.

Aim: Monocyte to high-density lipoprotein cholesterol ratio (MHR) has recently emerged as a predictor of cardio-cerebrovascular diseases. Since around one-fifth of strokes are linked to atherosclerosis carotid artery, we aimed to present the relationship between carotid artery disease (CAD) and MHR value in acute ischemic stroke (AIS). Materials & methods: A total of 209 adult AIS patients analyzed. Patients divided into two groups in respect to the existence of CAD. MHR was compared between the two groups. Results: MHR with a cut off of 17.23 predicted the presence of disease in the carotid artery, with a sensitivity of 91.9% and specificity of 66.7. MHR was the independent predictor for the presence of disease in the carotid artery. Conclusion: MHR was found to be an independent predictor for the CAD in AIS. Therefore, in AIS patients with high MHR value, CAD should be examined more carefully.

Objectives: To investigate the effects of low-flow anesthesia on hemodynamic parameters and recovery from anesthesia in obese individuals undergoing laparoscopic surgery., Methods: This randomized-controlled and prospective study included 44 obese patients who underwent laparoscopic sleeve gastrectomy operation. The patients were randomly allocated into 2 groups as low-flow and high-flow anesthesia. Further, the groups compared in terms of hemodynamic parameters, anesthesia recovery times, operation times, and arterial blood gas parameters., Results: The groups were similar with respect to demographic data. Heart rate, peripheral oxygen saturation, arterial blood pressure measurements, end-tidal, and CO 2 , lactate levels measurements were similar in both groups during the entire procedure. There was also no statistically significant difference in terms of arterial blood gas parameters or anesthesia recovery periods., Conclusion: Low-flow anesthesia in laparoscopic obesity surgery seems to be safer compared to high-flow anesthesia in terms of the adequacy of tissue perfusion, depth of anesthesia, and postoperative recovery., (Copyright: © Saudi Medical Journal.)

Background: This investigation aims to evaluate the effect of a mobile application and smart devices on frequency and time domains of heart rate variability (HRV) in diabetic patients in 1-year follow-up., Methods: This is post-hoc analysis of a diabetic subgroup of "Lifestyle Intervention usinG mobile technology in patients with high cardiovascular risk: a pragmatic randomized clinical Trial" (LIGHT). One hundred and nine and 118 patients were enrolled in two arms: the intervention plus usual care and the usual care arm. The study outcome was the 1-year HRV parameters adjusted to the baseline HRV parameters. HRV measures were recorded for every patient at the randomization and final visits with 24-hour Holter monitoring., Results: There was an improvement in the standard deviation of normal to normal (SDNN) R-R intervals 24-hour by 4.8 (adjusted treatment effect 4.8, 95% confidence interval [CI], 0.1-9.5; P = 0.044) in the intervention-plus-usual-care arm compared to usual care after a 1-year follow-up. The improvement was also experienced in other HRV time domains including standard deviation of the mean R-R intervals calculated over a 5-minute period, SDNN, square root of the mean squared difference of successive R-R intervals, and the percentage of the differences between adjacent normal R-R intervals exceeding 50 milliseconds. A significant enhancement was also detected in HRV frequency domains of total power low frequency and high frequency in the intervention plus usual care compared to usual care after a 1-year follow-up., Conclusions: The mobile application and smart device technology compared to usual care alone improved HRV parameters in diabetic patients at 1-year follow-up.

Background: Peripheral arterial disease is associated with increased cardiovascular mortality and morbidity. C-reactive protein and albumin are biomarkers of inflammation and malnutrition that play key roles in the pathophysiological pathways involved in the progression of atherosclerosis and peripheral arterial disease. In this study, we aimed to assess the relationship between C-reactive protein to albumin ratio and the suprapopliteal peripheral arterial disease severity and complexity as assessed by TransAtlantic Inter-Society Consensus-II (TASC-II) classification., Method: Our study enrolled 224 consecutive patients referred for peripheral angiography with the clinical features of possible peripheral arterial disease at a tertiary care center between January 2016 and September 2019. Level of disease and lesion characteristics were defined with reference to angiographic findings according to the TASC-II classification., Results: C-reactive protein/albumin ratio levels were significantly higher in TASC-II class C and D than in TASC-II class B patients with a median level of 1.8 to 2.1 vs 1.4, respectively ( p  = 0.018). In multivariate regression analysis, C-reactive protein to albumin ratio remained an independent predictor of severe peripheral arterial disease. The predictive performance of C-reactive protein to albumin ratio, C-reactive protein, and albumin were compared by Receiver Operating Characteristic curve analysis. C-reactive protein to albumin ratio surpassed C-reactive protein and albumin in predicting peripheral arterial disease severity and complexity. A level of C-reactive protein to albumin ratio  > 0.14 predicted a higher grade of suprapopliteal TASC-II class with sensitivity and specificity of 68.2% and 56.0%, respectively., Conclusion: C-reactive protein to albumin ratio was strongly associated with peripheral arterial disease severity and complexity, as assessed by TASC-II classification. Also, C-reactive protein to albumin ratio was found to be a more accurate marker than C-reactive protein and albumin alone in predicting more severe and complex lesions in patients with peripheral arterial disease.

Coronary artery fistulas (CAFs) are described as abnormal communications between a coronary artery and cardiac chambers, or other vascular structures. The two types of CAFs are defined as type I (singular fistula) and type II (microfistulas). Even though various electrocardiographic changes have been previously described in CAF patients, coronary-artery microfistulas causing ST-segment elevation in diverse locations have not been reported. We describe a case report of an adult patient who presented with acute inferior myocardial infarction due to coronary-artery microfistulas. During the hospital stay, the patient re-experienced chest pain, and control electrocardiography revealed ST-segment elevation in the I and AVL leads along with reciprocal ST-segment depression in the inferior precordial leads. Although CAFs are clinically rare, they can have important clinical consequences. Microfistulas should be kept in mind as a cause of ST elevation myocardial infarction in some patients., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objective: Many studies have examined the capability of electrocardiography (ECG) changes to predict the severity and prognosis of patients with acute pulmonary embolism (APE). RS time in ECG is potentially valuable in evaluating the prognosis of APE. In our study, we aimed to assess the predictive value of RS time, which is a novel electrocardiographic parameter of one-month mortality of APE., Methods: This retrospective study included 216 patients who were diagnosed with APE by pulmonary computed tomography angiography. RS time was measured from the ECG (inferolateral leads) at the time of hospital admission using a computer program (imagej.nih.gov/ij/). The patients were divided into two groups according to the median values of RS time: the group with RS time ≤ 60 msec (n:108) and the group with RS time > 60 msec (n:108). The groups were compared in terms of mortality., Results: In our study, the one-month mortality was 15.3% (33) in the patients hospitalized with APE. In the multivariate analysis, RS time prolongation (HR: 1.037; 95%CI: 1.005-1.065; p = .02) was independently correlated with mortality. The ROC curve analysis revealed that RS time > 64.8 msec predicted the one-month mortality in APE with a sensitivity of 68.6% and a specificity of 73.9% (AUC: 0.708; 95% CI: 0.643-0.768; p < .001)., Conclusion: As a novel ECG parameter, RS time could be measured for each patient with APE. Prolongation of RS time could be a useful index for predicting the one-month mortality of patients diagnosed with APE., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction and Objectives: The aim of this study was to investigate the association of serum albumin (SA) level with long-term prognosis in patients with acute pulmonary embolism (PE)., Materials and Methods: We retrospectively enrolled 269 patients with acute PE. The SA level was obtained within 12-24 hours following admission. The primary endpoints were the incidence of short- and long-term mortality in acute PE patients. The mean duration of the study follow-up was 21 ± 19 months., Results: During the follow-up period, short- and long-term mortality rates were higher in patients who had low SA level compared to those who did not have. In multivariate Cox regression analysis, the SA level was found to be independently associated with long-term mortality (HR: 0.47, 95%CI: 0.28-0.78, P = 0.004). In receiver operating characteristics analysis, the SA level of ≤3.17 predicted long-term mortality with a sensitivity of 77.5% and a specificity of 79.5% (area under the curve 0.82, 95%CI: 0.76-0.87, P < 0.001). In addition, when the SA plus simplified pulmonary embolism severity index (sPESI) risk score compared to the sPESI risk score alone, it produced a net reclassification improvement of 0.22 with P < 0.001, that is a 22% improved classification., Conclusion: To the best of our knowledge, this is the first study to demonstrate that the low SA level is a strong and independent predictor for long-term mortality in patients with acute PE., (© 2020 John Wiley & Sons Ltd.)

Because the phenomenon of no reflow has a poor prognosis in ST-segment elevation myocardial infarction (STEMI) patients and the atherogenic index of plasma (AIP) has been shown to be a strong predictor of coronary heart disease, we aimed to investigate the relationship between AIP and no-reflow in patients with acute STEMI who underwent primary percutaneous coronary intervention (PCI). A total of 763 consecutive STEMI patients (648 men; mean age 58 ± 12 years) who underwent primary PCI were recruited for this study. The patients were classified into a reflow group (n = 537) and a no-reflow group (n = 226) according to the postprocedural angiographic features of thrombolysis in the myocardial infarction flow of the infarct-related artery. The AIP value was significantly higher in the no-reflow group than in the reflow group [0.50 (0.38-0.65) vs. 0.39 (0.25-0.49) p < .001], and AIP was found to be an independent predictor of no-reflow development. The best cut-off value of AIP for predicting no-reflow was 0.54, with sensitivity of 46.02 and specificity of 84,73. In addition, the predictive power of AIP was greater than that of triglycerides and high-density lipoprotein cholesterol based on a receiver operator curve comparison. The AIP was independently associated with no-reflow in patients with STEMI after primary PCI. This might be a superior indicator compared to traditional lipid profiles.

Aim: Current literature lacks a definitive threshold of idiopathic premature ventricular complex (PVC) burden for predicting cardiomyopathy (CMP). The main objective of the present study was to evaluate relationship between the PVC burden and left ventricular ejection fraction (LVEF)., Method: This multicenter, cross-sectional study included 341 consecutive patients with more than 1,000 idiopathic PVC in 24 hr of Holter monitoring admitted to the cardiology clinics between January 2019 and May 2019 in the nineteen different centers. The primary outcome was the LVEF measured during the echocardiographic examination., Result: Overall, the median age was 50 (38-60) and 139 (49.4%) were female. Percentage of median PVC burden was 9% (IQR: 4%-17.4%). Median LVEF was found 60% (55-65). We used proportional odds logistic regression method to examine the relationship between continuous LVEF and candidate predictors. Increase in PVC burden (%) (regression coefficient (RE) -0.644 and 95% CI -1.063, -0.225, p < .001), PVC QRS duration (RE-0.191 and 95% CI -0.529, 0.148, p = .049), and age (RE-0.249 and 95% CI -0.442, -0.056, p = .018) were associated with decrease in LVEF. This inverse relationship between the PVC burden and LVEF become more prominent when PVC burden was above 5%. A nomogram developed to estimate the individual risk for decrease in LVEF., Conclusion: Our study showed that increase in PVC burden %, age, and PVC QRS duration were independently associated with decrease in LVEF in patients with idiopathic PVC. Also, inverse relationship between PVC burden and LVEF was observed in lower PVC burden than previously known., (© 2019 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals, Inc.)

Objective: Contrast-induced acute kidney injury (CI-AKI) is a well-known and life-threating complication in patients with ST-elevation myocardial infraction (STEMI) after primary percutaneous coronary intervention (PCI). Several studies demonstrated that the Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a useful risk model in predicting early mortality in patients with acute coronary syndrome. The objective of the present study is to evaluate the predictive value of admission TRI for the occurrence of CI-AKI in patients with STEMI treated with primary PCI. Methods: This retrospective study was consisted of a total of 660 consecutive STEMI patients who had undergone primary PCI from December 2015 to March 2017.The primary end-point was CI-AKI incidence after primary PCI during the in-hospital course. Results: The TRI of CI-AKI group was higher than the non-CI-AKI group (24.2 (19.3-32.2) vs. 17.5 (12.9-24.3), p  < .001, respectively). In multivariable logistic regression analysis, TRI was found to be an independent predictors of CI-AKI (OR: 1.055, 95% CI: 1.027-1.083, p  < .001). The discriminative power of TRI with regards to occurrence of CI-AKI was superior compared to its components. Conclusion: This study is the first to demonstrate that TRI can be used to predict the development of CI-AKI in patients with STEMI who undergo primary PCI. Health professionals might be able to use the TRI risk score to predict CI-AKI due to the simplicity and accessibility of this risk index.

Objective: An increased left atrial volume index (LAVI) is related to increased mortality in hemodialysis patients. In the present study, we evaluated the association between the LAVI and the P wave peak time (PWPT), a newly introduced electrocardiographic parameter, in hemodialysis patients., Methods: The study population was made up of 79 hemodialysis patients with a mean age of 53 ± 18 years (55.7% were males). These patients were divided into a normal LAVI (≤28 mL/m2) group (n = 45) and an increased LAVI (>28 mL/m2) group (n = 34). The demographic, clinical, laboratory, echocardiographic, and electrocardiographic variables of the groups were compared., Results: The P wave terminal force from lead V1, P wave dispersion and PWPTs obtained from leads V1 and D2 (PWPTD2) were significantly higher in the patients with increased LAVIs. In multivariable analysis, only the PWPTD2was an independent predictor of an increased LAVI (odds ratio = 1.117, 95% CI = 1.052-1.185, p < 0.001). The receiver-operating characteristic curve analysis showed that the best PWPTD2 cutoff value for predicting an increased LAVI was 60 ms, with a sensitivity of 76.5% and a specificity of 66.7% (area under the curve = 0.736, 95% CI = 0.625-0.829, p < 0.001)., Conclusion: This study showed that a prolonged PWPTD2 was independently associated with an increased LAVI in hemodialysis patients. Therefore, measuring the PWPTD2 duration on an electrocardiogram may help define high-risk hemodialysis patients with increased LAVIs., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Objective: Acute kidney injury (AKI), which is prevalent in ST-segment elevated myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. As high pulse pressure (PP) is associated with adverse cardiovascular events, the present study's aim was to evaluate the relationship between fractional PP (PPf) and AKI in patients with STEMI who underwent primary PCI., Subjects and Methods: All laboratory findings as well as echocardiographic and angiographic data of 1,170 consecutive STEMI patients were retrospectively screened. PPf was calculated from the pressures invasively measured after sheath insertion and before performing coronary angiography., Results: From 1,170 eligible STEMI patients (mean age 56 years, 18.2% female), AKI developed in 143 (12.2%) patients. The PPf and pulsatility index were significantly higher in patients with AKI than those without (0.53 ± 0.10 vs. 0.61 ± 0.10, p < 0.001, and 0.80 ± 0.03 vs. 0.82 ± 0.03, p < 0.001, respectively). PPf was also found to be associated with AKI in univariable (OR 2.183, 95% CI 1.823-2.614, p< 0.001) and multivariable (OR 1.874, 95% CI 1.513-2.322, p < 0.001) analysis. In-hospital mortality was higher in patients with AKI than those without., Conclusion: Invasively measured PPf, which can be easily measured and has no additional cost in STEMI patients undergoing coronary intervention, is an independent predictor of AKI. In addition, PPf is superior to other blood pressure values and derivatives in AKI prediction., (© 2020 The Author(s) Published by S. Karger AG, Basel.)

Background: The relationship between severity of coronary artery disease and inflammatory parameters has been previously demonstrated. However, there is a lack of data regarding the role of C-reactive protein-to-albumin ratio (CAR) in slow coronary flow (SCF) in patients with stable angina pectoris (SAP). In this study, we aimed to investigate the relationship between CAR and presence of SCF in patients with SAP., Patients and Methods: This study enrolled 217 patients undergoing coronary angiography for SAP. SCF was detected in 81 (37.3%) patients, and the control group included 136 patients. All clinical, demographical, and laboratory parameters were entered into a dataset and compared between SCF group and the controls., Results: The mean age of the patients was 66.1 ± 12.1 years (male: 57.1%). C-reactive protein and CAR were significantly higher in patients with SCF compared with controls (P = 0.004 and < 0.001, respectively). Logistic regression analysis demonstrated that high CAR level was an independent determinant of SCF (odds ratio: 1.023; 95% confidence interval: 1.013-1.034; P < 0.001)., Conclusion: Higher CAR level may be a valuable predictor of SCF in patients with SAP who undergo coronary angiography. Inflammation may play an important role in the pathogenesis of SCF.

Background: The relationship between acute kidney injury (AKI) and C-reactive protein (CRP) and albumin has been previously demonstrated in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). However, to our knowledge, CRP to albumin ratio (CAR), a newly introduced inflammation-based risk score, has not yet been studied. In this study, we aimed to investigate the possible relationship between the CAR and AKI., Method: A total of 815 consecutive STEMI patients treated with pPCI were reviewed., Results: One hundred ten 110 (13.5%) patients developed AKI in the study population. The subjects were divided into two groups according to AKI development. The in-hospital mortality rate was higher in patients with AKI than those without AKI (15.5% vs. 1.3%; p<0.001). The patients with AKI had significantly higher mean value of CRP and CAR (0.29 [0.16-0.50] vs. 0.55 [0.37-1.05]; p<0.001) and lower mean levels of albumin than those without AKI. Age, diabetes mellitus, haematocrit, left ventricular ejection fraction, hypotension, and CAR (Odds ratio [OR]2.307, 95% confidence interval [CI] 1.397-3.809, p=0.001) were independent predictors of AKI., Conclusion: The CAR may be a useful inflammation-based risk score to predict AKI development in STEMI patients treated with pPCI., (Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: The recent reclassification of heart failure (HF) patients in the 2016 European Society of Cardiology HF guidelines according to the left ventricular ejection fraction (LVEF) has created a 'grey area' consisting of midrange ejection fraction (mrEF) HF patients with LVEFs of 40-49%. Additionally, there is limited data regarding the in-hospital and long-term prognoses of patients with an mrEF after an ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the baseline characteristics, in-hospital and long-term mortalities, clinical events in mrEF, preserved ejection fraction (pEF), and reduced ejection fraction (rEF) patients during their hospital stays in a cohort of consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI). Methods: One thousand two hundred sixty patients were enrolled in the study. The incidences of all the clinical events were recorded during the hospital stays and the mean follow-up duration was 34.4 ± 15.4 months. Results : The incidence of HF signs and symptoms was statistically significant in the mrEF patients when compared to the pEF patients during their hospital stays (3vs. 0.8%, p = 0.05). The overall survival rate in the mrEF patients was between those of the rEF and pEF patients. However, the rate of rehospitalisation due to HF was significantly higher in the mrEF patients when compared to the pEF patients [ p (log-rank) < 0.001]. Conclusion: Although the mrEF patients with primary PCI-treated STEMIs exhibited similar baseline clinical characteristics, their in-hospital, long term mortality rates and rate of rehospitalisation due to HF were different from those of the rEF and mrEF patients.

Background: Multi-vessel coronary artery disease (CAD) is associated with worse outcome in non-ST segment elevation myocardial infarction (NSTEMI) patients. Depending on the severity of CAD, there may be prolongation of atrial depolarization time as a result of left ventricular dysfunction and atrial ischemia. Therefore, we aimed to study whether the severity of CAD can be predicted with the P wave peak time (PWPT) in the electrocardiography (ECG) obtained during the diagnosis in NSTEMI patients., Method: A total of 162 patients were included. The coronary angiography records of all patients were analyzed and SYNTAX scores were calculated. Patients were divided into two groups, according to CAD severity. In addition to well-known P wave parameters, PWPT, defined as the time from the beginning of the P wave to its peak, was measured in the leads D II and V 1 ., Results: The PWPTs in the leads D II and V 1 were significantly longer in the group with severe CAD (71 ± 13 vs. 61 ± 12, p < 0.001, 63 ± 24 vs. 53 ± 18, p = 0.024, respectively). PWPT was found to be an independent predictor of severe CAD and the best cut-off value of PWPT in the lead D II was 69.6 ms with sensitivity of 58.3% and specificity of 78.9%., Conclusion: Our findings show that prolonged PWPT, which is a parameter easily obtainable from the ECG, is associated with severe CAD. Recognition of NSTEMI patients with severe CAD at the time of diagnosis before performing coronary angiography may be important for the planning of treatment., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to evaluate the usefulness of the Syntax Score II (SSII) in predicting in-hospital and long-term mortality in octogenarians who presented with ST-segment elevation myocardial infarction (STEMI) and were treated with primary percutaneous coronary intervention (pPCI) in addition to compare SS II with other risk-scoring systems., Methods: We retrospectively enrolled 312 consecutive STEMI patients in the eighth decade of life or older who underwent pPCI. The octogenarians were divided into two groups according to their median SSII (low SSII ≤ 43.6 and high SSII > 43.6), and these groups were compared in terms of mortality. The performance of the SSII in predicting patients' outcomes was further compared with that of other well-known risk-scoring systems., Results: In the study, the SSII was an independent predictor of long-term mortality (OR: 1.036 95% CI: 1.005-1.068; p = 0.024). Both in-hospital (20.8% vs. 1.2%; p < 0.001) and long-term mortality (45.0% vs. 11%; p < 0.001) were higher among the patients with a high SSII compared to those with a low SSII. An ROC curve comparison showed that SSII was a better predictor (AUC: 0.807; 95% CI: 0.750-0.863) of long-term mortality than SS, PAMI, TIMI, and GRACE risk scores but not CADILLAC., Conclusions: Based on the study findings, octogenarians with a high SSII had worse in-hospital and long-term survival. The SSII, which includes several clinical and anatomical parameters, may be a better predictor of mortality than other risk-scoring systems in octogenarians., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Given that parameters used in the calculation of the PRECISE-DAPT risk score are important contributors to contrast-induced nephropathy (CIN) development, we hypothesized that the PRECISE-DAPT risk score would show good accuracy for predicting CIN in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Therefore, in this study, we aimed to determine the predictive value of the admission PRECISE-DAPT score for the occurrence of CIN in patients with STEMI treated with primary PCI. After evaluation regarding with exclusion criteria, 1280 patients were, respectively, enrolled in the study. The primary end-point was the incidence of CIN. The PRECISE-DAPT score of CIN group was higher than the non-CIN group [31 (24-41) vs. 14 (9-23), p < 0.001, respectively]. In multivariate logistic regression analysis, PRECISE-DAPT score was independently associated with the development of CIN [odds ratio (OR) 1.090, 95% confidence interval (CI) 1.066-1.114, p < 0.001]. A receiver-operating characteristic (ROC) analysis was drawn to show the best cut-off value of the PRECISE-DAPT score to predict CIN was ≥ 21 with 81.3% sensitivity and 72.7% specificity [area under curve (AUC): 0.834; 95% CI 0.812-0.854; p = 0.017]. The PRECISE-DAPT score may be a significant independent predictor of CIN in patients with STEMI treated with primary PCI. Therefore, follow-up of patients with higher PRECISE-DAPT score should be performed more cautiously, and it should be noted that the development of CIN risk of these patients group is high.

Objectives: Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute PE., Methods: We retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated., Results: Sixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS time was an independent predictor of PE (OR: 1.397, 95% CI: 1.171-1.667; p < 0.001). The ROC curve analyses revealed that the cut-off value of RS time for predicting acute PE was 64.20 ms with a sensitivity of 85.3% and a specificity of 79.4% (AUC: 0.846, 95%CI: 0.749-0.944; p < 0.001). In the correlation analyses; the RS time was correlated with RV end-diastolic diameter (r = 0.422; p < 0.001), RV/left ventricle (LV) ratio (r = 0.622; p < 0.001), and systolic pulmonary artery pressure (SPAP) (r = 0.508; p < 0.001)., Conclusion: As a novel ECG parameter, RS time could be measured for each patient. A longer RS time can be a very useful index for diagnosing acute PE as well as for estimating the RV end-diastolic diameter and SPAP., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Left ventricular diastolic dysfunction (LVDD) is commonly seen in hypertensive patients, and it is associated with increased morbidity and mortality. Hence, the detection of LVDD with a simple, inexpensive, and easy-to-obtain method can contribute to improving patient prognosis. Therefore, we aimed to evaluate whether there was any association between the electrocardiographic P wave peak time (PWPT) and invasively measured left ventricular end-diastolic pressure (LVEDP) in hypertensive patients who had undergone coronary angiography following preliminary diagnosis of coronary artery disease. A total of 78 patients were included in this cross-sectional study. The PWPT was defined as the time from the beginning of the P wave to its peak, and it was calculated from the leads D II and V I . In all patients, LVEDP was measured in steady state. The PWPT in lead D II was significantly longer in patients with high LVEDP; however, there was no significant difference between groups in terms of PWPT in the lead V I . In multivariable analysis, PWPT in lead D II was found to be independent predictor of increased LVEDP (OR: 1.257, 95% CI: 1.094-1.445; P = 0.001). In receiver operating characteristic curve analysis, the optimal cut-off value of PWPT in the lead D II for prediction of elevated LVEDP was 64.8 ms, with a sensitivity of 68.7% and a specificity of 91.3% (area under curve: 0.882, 95% CI: 0.789-0.944, P < 0.001). In conclusion, this study result suggested that prolonged PWPT in the lead D II may be an independent predictor of increased LVEDP among hypertensive patients., (©2019 Wiley Periodicals, Inc.)

The association of coronary artery disease (CAD) severity with increased C-reactive protein (CRP) and decreased albumin levels has been reported. However, to our knowledge, no study has investigated the usefulness of the CRP to albumin ratio (CAR) in predicting intermediate-high SYNergy between Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score (SS) and high SS II. Consecutive patients (n = 344) treated with percutaneous coronary intervention comprised the study population. The study population was divided into 2 groups according to SS >22 and mean SS II values, respectively. Patients with intermediate-high SS and high SS II had higher CAR than patients with low SS and SS II. History of diabetes mellitus, decreased albumin, lower left ventricular ejection fraction, and elevated CAR (odds ratio [OR]: 1.020; 95% confidence interval [CI], 1.009-1.031; P < .001) were independent predictors of high SS. The presence of hypertension, decreased hemoglobin and albumin levels, and increased CAR (OR: 1.014; 95% CI, 1.004-1.023; P < .001) were independent predictors of SS II. In receiver operating characteristic curve comparison, CAR was superior to CRP and albumin in prediction of intermediate-high SS, but only CRP in prediction of high SS II. The CAR calculated from the admission blood samples could be a useful parameter for predicting CAD severity using SS and SS II.

Objective: Although the prognostic efficacy of C-reactive protein (mg/L) and albumin levels (g/L) has been previously associated with poor prognosis in ST elevation myocardial infarction (STEMI), to the best of our knowledge, the prognostic efficacy of C-reactive protein/Albumin ratio (CAR) (mg/g) has not been investigated yet. Thus, this study aimed to investigate the potential efficacy of the CAR in predicting prognosis in STEMI patients., Method: We conducted a detailed investigation of 2437 patients with first STEMI treated with a primary percutaneous coronary intervention. After evaluation regarding to exclusion criteria, 2243 patients were found to be eligible for analysis. The mean follow-up of the study was 34 ± 15 months., Results: The median CAR value of the study population was 2.70 (range: 1.44-4.76), and the patients were divided into three tertiles according to their CAR values. Kaplan-Meier survival analysis showed significantly lower in-hospital and long-term survival rates for the patients in a high CAR tertile. In addition, the CAR was found to be an independent predictor of all-cause mortality (Hazards ratio: 1.033, 95% Confidence Interval: 1.007-1.061, p = .033), and the prognostic performance of the CAR was superior to that of C-reactive protein, albumin, and neutrophil to lymphocyte ratio in the receiver operating characteristic curve comparison., Conclusion: The CAR, a newly introduced inflammation-based risk index, was found to be a potentially useful prognostic tool for predicting a poor prognosis in STEMI patients. However, this finding needs to be validated in the future prospective studies.

Objective: To evaluate left atrial (LA) deformation parameters strain (S)/strain rate (SR) and time to peak S/SR obtained by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension for three LA mechanical phases and to compare them with the same indices in the control subjects., Methods: Fifty-five patients with hypertension (HT) and 29 healthy controls were included in the study. All patients had normal LA poster-anterior diameter, LA and left ventricular ejection fractions (LVEF >50%) in two-dimensional echocardiography (2-DE). The peak S/SR values (PS/PSR), the time to peak S/SR (TPS/TPSR) were measured using the 12-segment model for the left atrium during contractile (CP) reservoir (RP) and conduit period (COP) of the LA cycle., Results: For two periods (RP and COP), all of the PS and PSR values were significantly lower in hypertensive patients with preserved LAEF and LVEF compared to those in the controls, except for the CP. Similarly, hypertensive patients had significantly higher TPS and TPSR than those in the controls for the RP and COP in the LA wall, except for the CP., Conclusion: LA mechanical function was impaired in hypertensive patients with preserved LA and LV ejection fraction compared to the controls. Although the PS and PSR were decreased for the RP and COP of LA mechanical phases, the TPS/TPSR were prolonged in the HT patients compared to the controls. This might be additional diagnosis criteria to detect the LA myocardial dysfunction and might be a predisposing factor for atrial arrhythmia formation in the hypertensive patients.

Introduction: Stent restenosis remains a clinical challenge for patients with ischemic heart disease, since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs. Inflammation plays a significant role. Although an association between stent restenosis, increased C-reactive protein (CRP) and decreased albumin levels has been previously reported, no studies have investigated the ability of the CRP/albumin ratio to predict stent restenosis., Methods: This retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms. The study population was divided into two groups based on whether the patient had developed stent restenosis. They were then stratified into three groups according to their CRP/albumin ratio., Results: Out of 448 patients, stent restenosis was observed in 24.5% (n=110), as determined by coronary angiography. Patients with stent restenosis had a higher CRP/albumin ratio, greater platelet distribution width (PDW), higher CRP levels, and lower levels of both high-density lipoprotein (HDL) cholesterol and serum albumin. The CRP/albumin ratio (OR: 2.289, 95% CI: 1.056-4.959; p=0.036), stent diameter, PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis. A ROC curve comparison demonstrated that the CRP/albumin ratio was a better predictor of restenosis than either albumin and CRP individually, but it was not better than PDW and HDL cholesterol., Conclusion: As a novel inflammation-based risk score, the CRP/albumin ratio may be an easily accessible marker for assessment of stent restenosis risk., (Copyright © 2019 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Serum uric acid (SUA) level was shown in various studies to be related to the presence of coronary artery disease and subsequent cardiovascular events. The aim of the present study was to evaluate the association of SUA with SYNTAX score II (SSII) and the long-term prognosis of patients with stable angina pectoris who underwent percutaneous revascularization due to multivessel disease (MVD) and/or unprotected left main disease (UPLMD). Two-hundred and ninety patients with MVD and/or UPLMD who were treated consecutively with percutaneous coronary intervention (PCI) were included in the present study. The study population was divided into high SSII (n: 145; SSII > 32.9) and low SSII (n: 145; SSII ≤ 32.9) according to the median SSII value. The SUA value was significantly higher in the high SSII group than in the low SSII group (5.53 ± 1.95 vs. 6.07 ± 1.88; p = 0.001) and was found to be an independent predictor of high SSII (OR 1.306; 95% CI 1.119-1.525; p = 0,001). Twenty-eight patients (9.7%) died during the long-term follow-up, and SUA and SSII were additionally found to be independent predictors of long-term mortality (HR 1.245, 95% CI 1.046-1.482, p = 0.014; HR 1.042, 95% CI 1.007-1.079, p = 0.018, respectively). In the present study, SUA level was demonstrated to be associated with high SSII and long-term mortality in patients with MVD and/or UPLMD who were treated with PCI.

Background: Renal artery stenosis (RAS) is a leading cause of hypertension, renal failure, pulmonary edema, and loss of renal mass. Atherothrombotic renal disease is a well-described entity, known primarily for its high mortality rate., Case: Here, we present a case of acute unrecognized atherothrombosis of RAS due to catheter-induced dissection in a patient with a limited functioning renal artery and solitary kidney. A fifty-two-year-old patient recently diagnosed with hypertension was admitted to our cardiology clinic showing symptoms of uncontrolled hypertension. A renal angiography revealed 90% stenosis in the proximal segment of the right renal artery and totally occluded left renal artery. We decided to perform a percutaneous revascularization. However, the patient did not accept it. During follow-up, the patient's clinical condition deteriorated abruptly due to acute iatrogenic atherothrombosis. A percutaneous transluminal angioplasty was performed, and the patency of the renal artery was secured., Conclusion: Renal angiography may cause acute iatrogenic atherothrombosis due to catheter-induced dissection in patients with solitary functioning kidneys. Percutaneous transluminal angioplasty may secure the patency of the renal artery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: The present study aimed to evaluate the potential utility of thrombosis in myocardial infarction (TIMI) risk index (TRI) for the prediction of stent thrombosis (ST) in ST elevation myocardial infarction (STEMI) patients who were treated with primary percutaneous coronary intervention ( pPCI ). Methods: This retrospective study was related to the clinical data of 1275 consecutive STEMI patients who underwent pPCI from January 2013 to January 2018. The TRI was calculated for each patient, and the following equation was used; TRI = heart rate x [age/10]2/systolic blood pressure. For the definition of ST, the criteria as proposed by the Academic Research Consortium were applied. Results: The incidence of ST was 3.2% (n=42 patients) in the study. The median value of the TRI was significantly elevated in patients with ST compared to those without ST (22 [17-32] vs. 16 [11-21], P <0.001, respectively). In a multivariate logistic regression analysis, the TRI was an independent predictor of ST (odds ratio [OR]: 1.061; 95% CI: 1.038-1.085; P <0.001). In a receiver operating characteristic curve analysis, the optimal value of the TRI for the prediction of ST was 25.8 with a sensitivity of 45.2% and a specificity of 86.4%. Conclusion: The present study finding has demonstrated that the TRI may be an independent predictor of ST in STEMI patients who were treated with pPCI . To the best of our knowledge, this is the first study in the literature in which the TRI and its relationship with ST was evaluated in STEMI patients treated with pPCI ., (© 2019 The Author(s).)

Background: This study aimed to investigate the diagnostic value of QRS and S wave variation in patients admitted to the emergency department with suspicion of acute pulmonary embolism (APE)., Method: Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive patients to evaluate patients with suspected APE, and 106 subjects with appropriate electrocardiogram and CT images constituted the study population., Results: Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison of patients with APE and those without APE revealed that increased heart rate, right axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8-19,0] vs 3,8[2,7-71]; p<0,001), S wave variation (22,3[9,6-31,9] vs 4,8 [2-8]; p<0,001) and ΔS wave amplitude (1.1[0.5-1.5] vs 0.2[0.1-0.5]; p<0.001) were significantly associated with APE, but no relationship was detected with respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3 patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011-1137) was found to be an independent predictor of APE. ΔS wave amplitude>0.5mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805, 95% CI: 0.717-0.876; p<0.001)., Conclusion: The present study demonstrated that QRS and S wave variation could be useful electrocardiographic signs for the diagnosis of APE., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Even though the relationship between syntax score (SS) and fragmented QRS (fQRS) has been studied, the relation between syntax score II (SS II) and fQRS in patients with ST elevation myocardial infarction (STEMI) is undefined. We aimed to define the relationship between fQRS and SS II for the evaluation of extension and complexity of coronary artery disease., Material and Methods: This study enrolled 167 patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. The standard 12-lead electrocardiograms (ECGs) were obtained from all patients before and after PCI. SS and SS II were calculated in all patients. Transthoracic echocardiography was performed to all patients., Results: Thirty-nine patients (23.4%) had fQRS on their ECGs. The median SS II was 27 (22.9-33.9). SS II values in the fQRS(+) group were statistically significantly higher than that of the fQRS(-) group (35.2 (26.4-47.2) vs. 25.7 (22.1-30.7), p < 0.001). Also, in patients with higher SS II, there was significantly higher number of ECG derivations with fQRS., Conclusions: The presence of fQRS and high number of derivations with fQRS on ECG may be associated with high SS II in patients undergoing pPCI for STEMI., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Venous thrombosis is recognized as one of the most important complications of nephrotic syndrome (NS). In patients with NS, venous thrombosis may develop in the renal veins, the deep veins of the lower limb, and the inferior vena cava. Here, we describe a case report of an NS patient with multiple venous thrombosis in the right renal vein, the left iliac vein, the vena cava inferior, the right atrium, and the pulmonary arteries. Moreover, we describe the successful treatment of multiple venous thrombosis with prolonged thrombolytic treatment in spite of an increased risk of bleeding due to renal biopsy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. C-reactive protein (CRP) and albumin are indicators of inflammation, and high levels of them are associated with high SS. We aimed to investigate whether baseline CRP to albumin ratio C-Reactive Protein/Albumin Ratio (CAR), an easily available and novel inflammatory marker, is associated with SS., Method: A total 403 consecutive patients with stabile angina pectoris, who underwent coronary angiography for suspected CAD from January 2015 to June 2016, were classified into two groups, low SS (≤22) and intermediate-high SS (>22)., Results: C-Reactive Protein/Albumin Ratio was significantly higher in patients with intermediate-high SS group (P < .001). In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with hypertension and LDL. The predictive performance of CAR, CRP, and albumin was compared by ROC curve analysis. CAR surpassed CRP and albumin in predicting intermediate-high SS group. CAR >6.3 predicted an intermediate-high SS with sensitivity and specificity of 86.8% and 43.4%, respectively., Conclusion: C-Reactive Protein/Albumin Ratio was more tightly associated with the complexity and severity of CAD than CRP and albumin alone and was found to be an independent predictor for intermediate-high SS group., (© 2018 Wiley Periodicals, Inc.)

SYNTAX score II (SS-II) has a powerful prognostic accuracy in patients with stable complex coronary artery disease who have undergone revascularization; however, there is limited data regarding the prognosis of patients with ST segment elevation myocardial infarction (STEMI). The aim of this study is to examine both the predictive performance of SS-II in determining in-hospital and long term mortality of STEMI patients and to compare SYNTAX score (SS) and TIMI risk score (TRS). Consecutive 1912 STEMI patients treated with primary percutaneous coronary intervention (p-PCI) retrospectively reviewed, and the remaining 1708 patients constituted the study population after exclusion. The patients were divided into three groups according to increased SS-II value: low (n:562; SS-II ≤ 24.6); intermediate (n:563; 24.6 < SS-II < 34.4); and high tertile (n:583; SS-II ≥ 34.4). In-hospital and long term mortality rate from all causes (0 vs. 0.5 vs. 10.6% and 1.8 vs. 3.2 vs. 18.1% respectively, p ≤ 0.001) were significantly increased with SS-II tertiles and SS-II was found to be independent predictor of in-hospital and long term mortality (HR: 1.076 95% CI 1.060-1.092, p < 0.001) and (HR: 1.070 95% CI 1.050-1.090, p < 0.0001). The predictive power of SS-II, SS, and TRS were compared by ROC curve and decision curve analysis. SS-II surpassed SS and TRS in long-term and in-hospital mortality prediction. SS-II is a powerful tool to predict in-hospital and long-term mortality from all causes in STEMI patients treated with p-PCI.

Background: The ratio of serum C-reactive protein (CRP) to albumin has been proven to be a more accurate indicator than albumin and CRP levels alone in determining the prognosis of patients with cancer and critical illness. The aim of this study was to determine whether the CRP/albumin ratio (CAR) can be linked to imperfect reperfusion that can worsen the prognosis of ST-elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention (pPCI)., Materials and Methods: A total of 1217 consecutive STEMI patients who achieved epicardial vessel patency with pPCI were recruited to this study., Results: The study population was divided into 2 groups: reflow (n = 874) and no-reflow (NR) (n = 343) groups. The white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR) and CAR (0.03 [0.01-0.04] vs 0.06 [0.03-0.12] (P < .001) were significantly higher in the NR group than in the reflow group, and these factors were found to be independent predictors of NR development. The best cut-off value of CAR predicting NR was 0.59 with a sensitivity of 54.7% and specificity of 86.7. The predictive power of CAR surpassed that of CRP, albumin, WBC count and NLR in the receiver operator curve (ROC) curve comparison., Conclusion: No-reflow can be predicted by systemic inflammation markers including WBC count, NLR and CAR measured from the blood sample obtained on admission. CAR has a higher clinical value than CRP, albumin level, WBC count and NLR in NR prediction., (© 2018 Stichting European Society for Clinical Investigation Journal Foundation.)

Background: We aimed to evaluate possible association between QRS duration (QRSD), R wave peak time (RWPT), and coronary artery disease severity identified using the SYNTAX score (SS) in patients with unstable angina pectoris (USAP) or non-ST segment elevation myocardial infarction (NSTEMI)., Method: A total of 176 USAP/NSTEMI patients were enrolled in the study., Results: The high SS group (>22, n:45) patients had a higher prevalence of diabetes mellitus (DM); presence of ST segment depression ≥0.5 mm and 1 mm; ST segment elevation in the AVR lead (AVRSTE); longer QRSD and RWPT; and lower left ventricular ejection fraction (LVEF) than the low SS group (≤22, n: 131). The LVEF, AVRSTE, and RWPT (OR: 1.035, 95% CI: 1.003-1.067; p = 0.030) were independent predictors of high SS., Conclusion: The present study demonstrated that RWPT and AVRSTE could be used as predictors of high SS., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Despite advances in reperfusion strategies, medical therapy, and emergent surgery, cardiac rupture (CR) is still a major lethal complication. Numerous parameters have been found to be associated with CR development after a primary percutaneous coronary intervention (pPCI). SYNTAX Score (SS) and SYNTAX Score II (SSII) have been studied in ST-segment elevation myocardial infarction (STEMI) patients, and higher scores have been associated with higher mortality. However, the relationship between CR and SSII is unclear. This study investigates the possible relationship between CR and SS, SSII in STEMI patients treated with pPCI., Patients and Methods: We enrolled 1663 consecutive STEMI patients treated with pPCI, who were divided into two groups according to CR development and compared with each other. Patients were further stratified into the three groups according to their SSII values., Results: In this study, 33 (1.98%) patients developed CR. Both SS and SSII of those with CR were significantly higher than those without (19.27±4.0 vs. 16.40±4.55; P<0.001 and 49.40±16.54 vs. 30.92±11.80; P<0.001, respectively). It was also observed that CR increased gradually according to increasing SSII tertiles. SSII was found to be an independent predictor for CR (odds ratio=1.043, 95% confidence interval: 1.012-1.074; P=0.006). In the long-term follow-up, all-cause mortality was significantly higher in patients with CR than those without (60.6 vs. 8.8%; P<0.001)., Conclusion: This study shows that SSII is an independent predictor for CR. Furthermore, patients with CR were associated with a poor prognosis. Closer follow-up of patients with high SSII may be useful in the early detection and treatment of this fatal complication.

Background and Objectives: Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI., Methods: A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN., Results: In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012-1.051; p<0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046-1.078; p<0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p<0.001) and an integrated discrimination improvement of 9.1% (p<0.001)., Conclusions: The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2018. The Korean Society of Cardiology)

Objective: T-peak-T-end (TPE) interval, which represents the dispersion of repolarization, is defined as the interval between the peak and end of the T-wave, and is associated with increased malignant ventricular arrhythmia and sudden cardiac death (SCD) in patients with ST elevation myocardial infarction (STEMI). Although prolonged TPE interval is associated with poor short- and long-term outcomes, even in patients with STEMI treated with successful primary percutaneous coronary intervention (pPCI), clinical, angiographic, and laboratory parameters that affect TPE remain to be elucidated. The aim of our study was to evaluate the potential relationship between prolonged TPE interval and reperfusion success using ST segment resolution (STR) in patients with STEMI undergoing pPCI., Methods: In the current study, 218 consecutive patients with STEMI who underwent pPCI were enrolled; after exclusion, 164 patients were included in the study population., Results: Patients were divided into two groups according to the presence of complete (STR%≥70) or incomplete (STR%<70) STR. Preprocedural corrected TPE (cTPEPRE;116±21 ms vs. 108±21 ms; p=0.027), postprocedural TPE (TPEPOST; 107±16 ms vs. 92±21 ms; p<0.001), and postprocedural cTPE (cTPEPOST; 119±19 ms vs. 102±17 ms; p<0.001) intervals were significantly longer in patients with incomplete STR than in patients with complete STR, whereas there was no statistically significant difference between the two groups in terms of pre- and postprocedural and corrected QT intervals. cTPEPRE and cTPEPOST were found to be independent predictors for incomplete STR., Conclusion: To our knowledge, this is the first study that evaluated the relationship between TPE interval and no-reflow defined by STR in patients with STEMI who were treated with pPCI.

Background: Monocyte to high-density-lipoprotein cholesterol ratio (MHR) simply reflects proatherogenic and antiatherogenic balance and high level of this ratio is associated with severity of coronary atherosclerosis and cardiac events. We investigated the association between MHR and coronary artery disease severity using SYNTAX score and SYNTAX score II (SSII) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI)., Methods: A total of 315 consecutive patients with STEMI who underwent pPCI from January 2014 to January 2016 were enrolled. After exclusion 264 patients remained in the study population. Patients were divided into 2 groups according to median SSII [SSII ≤ 34.2 as low group (n = 132) and > 34.2 as high group (n = 132)]., Results: Median value of MHR was 10.5 in SSII low group and 16.1 in SSII high group (p < 0.001). There was a strong correlation between MHR and SSII (r = 0.580, p < 0.001). Diabetes mellitus [odds ratio (OR): 8.604; 95% confidence interval (CI): 2.469-29.978], glomerular filtration rate (OR: 0.961; 95% CI: 0.939-0.983), infarct related artery of left anterior descending (LAD) (OR: 7.325; 95% CI: 2.262-23.723), SYNTAX score (OR: 1.422; 95% CI: 1.275-1.585), neutrophil to lymphocyte ratio (NLR) (OR: 1.156; 95% CI: 1.058-1.264) and MHR (OR: 1.027; 95% CI: 1.013-1.041) were independent predictors of SSII > 34.2 in multivariate analysis., Conclusions: MHR could be a better parameter than NLR and C-reactive protein at predicting severity of coronary artery disease in STEMI patients treated with pPCI.

Background: Fragmented QRS (fQRS) has been shown to be a marker of local myocardial conduction abnormalities, cardiac fibrosis in previous studies. It was also reported to be a predictor of sudden cardiac death and increased morbidity and mortality in selected populations. However, there is no study investigating the role of fQRS in the development of atrial fibrillation in patients with ST segment elevation myocardial infarction (STEMI). In this study we aimed to investigate the relationship between the presence of fQRS after primary percutaneous coronary intervention (pPCI) and in-hospital development of new-onset atrial fibrilation (AF) in patients with STEMI., Material and Methods: This study enrolled 171 patients undergoing pPCI for STEMI. Among these patients 24 patients developed AF and the remaining 147 patients were designated as the controls. All clinical, demographical and laboratory parameters were entered into a dataset and compared between AF group and the controls., Results: The presence of fQRS was higher in the AF group than in the controls (P=0.001). Diabetes mellitus and fQRS was significantly more common in the AF group (P=0.003 and P=0.001 respectively) Logistic regression analysis demonstrated that the presence of fQRS was the independent determinant of AF (OR: 3.243, 95% CI 1.016-10.251, P=0.042)., Conclusions: Increased atrial fibrillation was observed more frequently in STEMI patients with fQRS than in patients without fQRS. fQRS is an important determinant of AF in STEMI after pPCI., (Copyright © 2017 Elsevier Inc. All rights reserved.)