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The article illustrates the complete occlusion of all supra-aortic branches due to Takayasu arteritis, as evidenced by invasive coronary angiography and computed tomography (CT) angiography. Topics include the findings from catheter angiography revealing the occluded branches of the aortic arch, the sagittal CT angiography highlighting calcification in the occluded branches, and the observation of a thickened aortic wall.

Objective: The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and uric acid (UA) are inflammatory markers in cardiovascular disease. However, there are not enough data on infarct-related artery (IRA) patency in ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association of NLR, PLR, and UA with IRA patency before percutaneous coronary intervention (PCI) in STEMI. Methods: The study was designed as a retrospective study. Three hundred and twenty-four consecutive patients with STEMI were divided into two groups according to pre-PCI Thrombolysis in Myocardial Infarction flow grade (TIMI). Patients with a TIMI flow grade of into the spontaneous reperfusion (SR) group, while patients with TIMI flow grade of 0, 1 and 2 were placed into the non-SR group. The χ² and independentsamples t-test, Mann-Whitney U test, multivariate logistic regression analysis, and receiver-operator characteristic (ROC) curve analysis were used for the statistical analysis. Results: PLR, NLR, and UA values in the SR group were lower than in the non-SR group (p<0.004, p<0.001, p<0.001, respectively). In the multivariate analysis, serum UA level and PLR were found to be independent predictors of pre-PCI IRA patency. In the ROC curve analysis, PLR >190, UA>5.75 mg/dL, and NLR>4.2 predicted non-SR. The sensitivity and specificity of the association between low IRA TIMI flow grade and PLR were 88% and 84%, 72% and 66% for UA, and 74% and 44% for NLR, respectively. Conclusion: We determined that PLR and UA are novel predictors of IRA patency before PCI. We suggest that PLR and UA may be used in riskstratifying STEMI. [ABSTRACT FROM AUTHOR]

Introduction: The thrombolysis in myocardial infarction (TIMI) risk score is calculated as the sum of independent predictors of mortality and ischemic events in ST elevation acute myocardial infarction (STEMI). Several studies show that the neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory marker. In preliminary studies, platelet to lymphocyte ratio (PLR) has been proposed as a pro-thrombotic marker. The relationship between NLR, PLR and TIMI risk score for STEMI has never been studied. Aim: To evaluate the association between TIMI-STEMI risk score and NLR, PLR and other biochemical indices in STEMI. Material and methods: In this retrospective study, we evaluated 390 patients who presented with STEMI within 12 h of symptom onset. Patients were grouped according to low and high TIMI risk scores. Results: We enrolled 390 patients (mean age 61.9 ±13.6 years; 73% were men). The NLR, platelet distribution width (PDW) and uric acid level (UA) were significantly associated with a high TIMI-STEMI risk score (p = 0.016, p = 0.008, p = 0.030, respectively), but PLR was not associated with a high TIMI-STEMI risk score. Left ventricular ejection fraction was an independent predictor of TIMI-STEMI risk score. A cut-off point of TIMI-STEMI score of > 4 predicted in-hospital mortality (sensitivity 75%, specificity 70%, p < 0.001). We found that NLR, PDW, and UA level were associated with TIMI-STEMI risk score. Conclusions: Neutrophil to lymphocyte ratio, PDW and UA level are convenient, inexpensive and reproducible biomarkers for STEMI prognosis before primary angioplasty when these indicators are combined with the TIMI-STEMI risk score. We believe that these significant findings can guide further clinical practice. [ABSTRACT FROM AUTHOR]

ST elevation myocardial infarction is a clinic situation usually presents with total occlusion in the coronary artery. The electrocardiography (ECG) at the presentation helps us to diagnose, to guess the occluded coronary artery and to assess the treatment. However, sometimes the ECG could not be enough to guess the occluded coronary artery. Left anterior descending (LAD) coronary artery occlusion resulting in inferior ST-segment elevation without anterior ST-segment elevation is an extremely rare finding. In this study, we presented a case who admitted to the emergency department with a typically chest pain and inferior ST-segment elevation without anterior ST-segment elevation ECG pattern but a total occlusion in LAD in the coronary angiography. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the relationship between serum thyroid hormone levels that are within the normal range and the presence and severity of coronary artery disease (CAD) in patients referred for coronary angiography. Methods: In this observational study, we enrolled 119 consecutive patients (77 men, mean age 60.7±13.8 years) who underwent coronary angiography. Blood samples were tested for thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) concentrations. Additionally, risk factors, clinical characteristics and angiographic results were obtained. The patients were separated into two groups according to the Gensini score as those with mild or severe atherosclerosis. Statistical analysis was performed using the Chi-square, Mann-Whitney U, correlation and logistic regression tests, and ROC analysis. Results: FT3 levels were significantly lower in subjects with CAD (4.0±0.7 vs. 4.6±0.6 pmol/L; p<0.001). Moreover, lower FT3 levels were found in patients with severe atherosclerosis (3.9±0.7 vs. 4.5±0.6 pmol/L; p<0.001). Logistic regression analysis demonstrated that the lower FT3 levels were associated with the presence (OR =0.266, 95% CI: 0.097-0.731, p=0.01) and severity (OR=0.238, 95% CI:0.083-0.685, p=0.008) of CAD. In the ROC analysis, a level of FT3 ≤4.2 pmol/L was found to predict the presence of CAD with 69% sensitivity and 71% specificity (AUC:0.744, 95% CI:0.653-0.834, p<0.001); and the severity of CAD with 75% sensitivity and 67% specificity (AUC:0.733, 95% CI:0.642-0.824, p<0.001). Conclusions: FT3 levels within the normal range were inversely correlated with the presence and severity of CAD. Moreover, lower FT3 concentrations were correlated with the Gensini score and independently predicted the presence and severity of CAD. Thus, the FT3 levels may be used as the indicator of increased risk for CAD. (Anadolu Kardiyol Derg 2012; 12: 591-6) Amaç: Çalişmamizin amaci, koroner anjiyografi için kaynak gösterilen hastalarda normal sinirlardaki tiroid hormon düzeylerinin koroner arter hastaliğinin (KAH) varliği ve şiddeti ile ilişkisini araştirmaktir. Yöntem: Bu gözlemsel çalişmaya koroner anjiyografi yapilan ardişik 119 hasta (77 erkek, ortalama yaş 60.7±13.8 yil) alindi. Serum serbest triiyodotironin (FT3), serbest tiroksin (FT4) ve tiroid uyarici hormon (TSH) düzeyleri alinan kan örneklerinde test edildi. Hastalarin konvansiyonel risk faktörleri, klinik karakteristikleri ve anjiyografi sonuçlari değerlendirildi. Hastalar Gensini skoruna göre hafif ve şiddetli ateroskleroz olarak iki ayri gruba ayrildi. İstatistiksel analiz olarak Ki-kare, Mann-Whitney U testleri ve korelasyon, lojistik regresyon ve ROC analizleri kullanildi. Bulgular: Serum FT3 düzeyleri KAH'i olan kişilerde olmayanlara oranla önemli ölçüde düşük bulundu (4.0±0.7 karşi 4.6±0.6 pmol/L; p<0.001). Ayrica, şiddetli aterosklerozu olan hastalarda FT3 düzeyleri önemli ölçüde düşüktü (3.9±0.7 karşi 4.5±0.6 pmol/L; p<0.001). Lojistik regresyon analizinde düşük FT3 düzeylerinin KAH'in varliği (OR:0.266, 95% GA:0.097-0.731, p=0.01) ve şiddeti (OR:0.238, 95% GA:0.083-0.685, p=0.008) ile ilişkili olduğu gösterildi. ROC analizinde FT3 seviyesinin ≤4.2 pmol/L olmasi KAH varliğini %69 duyarlilik ve %71 özgüllük ile (EAA:0.744, 95% GA:0.653-0.834, p<0.001), KAH şiddetini ise %75 duyarlilik ve %71 özgüllük ile (EAA:0.744, 95% GA:0.653-0.834, p<0.001) tespit edebiliyordu. Sonuç: Normal sinirlardaki FT3 düzeyleri koroner anjiyografi için kaynak gösterilen hastalarda KAH'in varliği ve şiddeti ile ters ilişkilidir. Ayrica düşük FT3 düzeyleri Gensini skoru ile korelasyon gösterip KAH'in varliği ve şiddetinin bağimsiz bir prediktörüdür. Düşük FT3 düzeyleri KAH riskini belirlemekte kullanilabilir. (Anadolu Kardiyol Derg 2012; 12: 591-6) [ABSTRACT FROM AUTHOR]