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Introduction: Cigarette smoking is a preventable cause of cardiovascular morbidity and mortality. Despite the adverse effects of smoking, some studies have reported the term "smoker's paradox', meaning better outcomes in smokers following acute myocardial infarction., Aim: The aim of the present study was to evaluate the relationship between smoking status and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI)., Materials and Methods: This was a registry-based cohort study of STEMI patients from Imam-Ali hospital, Kermanshah, Iran. Consecutive STEMI patients (July 2016-October 2018) were stratified by smoking status and followed for one year. Cox proportional models were used to estimate crude, age-adjusted, and full-adjusted hazard ratios with 95% confidence intervals (HR, 95%CI)., Results: Of 1975 patients (mean age 60.1 years, 76.6% male) included in the study, 48.1% (n=951) were smokers (mean age 57.7 years, 94.7% male). Crude and age-adjusted HR (95% CI) for the associations of smoking and mortality were 0.67 (0.50-0.92) and 0.89 (0.65-1.22), respectively. After adjusting for age, sex, hypertension, diabetes, body-mass index, anterior wall myocardial infarction, creatine kinase-MB, glomerular filtration rate, left ventricular ejection fraction, low-density lipoprotein cholesterol, and hemoglobin, smoking was associated with increased risk of mortality: HR (95% CI: 1.56 (1.04-2.35)., Conclusions: In our study, smoking was associated with an increased risk of mortality. Although the smokers had a better outcome, this would be reversed after controlling for age and the other STEMI associated factors., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Little is known about the predictors of left ventricular ejection fraction (LVEF) -an important predictor of mortality- after primary percutaneous coronary intervention (PCI) in low- and middle-income countries., Methods: In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multi-variable logistic regression models., Results: Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35- 50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996- 0.999); door-balloon time (3 rd vs. 1 st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively)., Conclusion: Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Little is known about the predictors of left ventricular ejection fraction (LVEF) --an important predictor of mortality-- after primary percutaneous coronary intervention (PCI) in low- and middle-income countries. Methods: In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multivariable logistic regression models. Results: Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35-50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996-0.999); door-balloon time (3rd vs. 1st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively). Conclusion: Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Identifying the long-term predictors of recurrent cardiovascular events may help improve the quality of care and prevent subsequent events. We aimed to investigate the predictors of 1-year major cardiovascular events (MACE) in patients discharged after ST-elevation myocardial infarction (STEMI) in a tertiary hospital in Iran. Methods: This registry-based cohort study included consecutive STEMI patients between 2016 and 2019 in Imam-Ali Hospital, Kermanshah, Iran. All patients discharged alive from STEMI hospitalization were followed up for 1 year for MACE, consisting of all-cause mortality, nonfatal MI, and nonfatal stroke. We estimated the hazard ratio (HR) and the 95% confidence interval (95% CI) using Cox proportional-hazard models to evaluate potential predictors, including demographic characteristics, medical history, cardiovascular risk factors, laboratory tests, reperfusion therapy, and medications. Results: During 2187.2 person-years, 21 patients were lost to follow-up (success rate =99.1%). Of2274post-discharge STEMI patients (mean age =60.26 y; 21.9% female), 151 (6.6%) experienced MACE, including, all-cause mortality (n=115, 5.1%), nonfatal MI (n=20, 0.9%), and nonfatal stroke (n=16, 0.7%). Independent predictors of MACE were age (HR:1.02; 95% CI: 1.00-1.04), no education vs ≥12 years of formal schooling (HR: 2.07; 95% CI: 1.17-3.67), stroke history (HR: 2.37; 95% CI: 1.48-3.81), the glomerular filtration rate (HR: 0.98; 95% CI: 0.97-1.00), the body mass index (HR: 0.94; 95% CI:, 0.89-0.99), peak creatine kinase-MB (HR: 1.00; 95% CI: 1.00-1.002), thrombolysis vs primary percutaneous coronary intervention (HR: 1.85; 95% CI: 1.21-2.81), and left ventricular ejection fraction <35% vs ≥50% (HR: 2.82; 95% CI: 1.46-5.47). Conclusion: Age, education, stroke history, the glomerular filtration rate, the body mass index, peak creatine kinase-MB, reperfusion therapy, and left ventricular function can be independently associated with 1-year MACE. [ABSTRACT FROM AUTHOR]

BACKGROUND: Circadian variation is known as an important factor in acute myocardial infarction (AMI). Moreover, the circadian pattern may help in disease prevention and better medication prescription. Therefore, the aim of our study was to investigate the circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: This cross-sectional study was conducted on 777 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of STEMI from March 2018 to February 2019. Data were collected using a checklist developed based on the study's objectives. Differences between subgroups were assessed using one-way analysis of variance (ANOVA) with post-hoc testing and chi-square test (or Fisher's exact test). RESULTS: Out of the 777 patients, 616 (79.3%) were men. The mean and standard deviation (SD) of age of the patients was 60.93 ± 12.86 years. 380 patients (48.9%) were current smoker, 40.3% were hypertensive, 21.1% had hypercholesterolemia, 18.3% had diabetes mellitus (DM), 25.2% had history of angina, and about 15.0% had history of myocardial infarction (MI). The occurrence of STEMI was most common during hours between 06:01-12:00 (27.7%), followed by 12:01-18:00 (27.3%), 00:00-06:00 (24.3%), and 18:01-24:00 (20.7%), respectively. Gender was significantly associated with circadian pattern of STEMI. Women showed a double peak of symptom onset in 06:01-12:00 and 12:01-18:00. CONCLUSION: The present study of Iranian patients displayed circadian pattern of STEMI with 2 peaks in the morning and afternoon, and the both peaks were dominated by women. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI), according to gender and other likely risk factors. Methods: This study reports on data relating to 1,484 consecutive patients with STEMI registered from June 2016 to May 2018 in the Western Iran STEMI Registry. Data were collected using a standardized case report developed by the European Observational Registry Program (EORP). The relationship between in-hospital mortality and potential predicting variables was assessed multivariable logistic regression. Differences between groups in mortality rates were compared using chi-square tests and independent t-tests. Results: Out of the 1484 patients, 311(21%) were female. Women were different from men in terms of age (65.8 vs. 59), prevalence of hypertension (HTN) (63.7% vs. 35.4%), diabetes mellitus (DM) (37.7% vs. 16.2%), hypercholesterolemia (36.7% vs. 18.5%) and the history of previous congestive heart failure (CHF) (6.6% vs. 3.0%). Smoking was more prevalent among men (55.9% vs. 13.2%). Although the in-hospital mortality rate was higher in women (11.6% vs. 5.5%), after adjusting for other risk factors, female sex was not an independent predictor for in-hospital mortality. Multivariable analysis identified that age and higher Killip class (≥II) were significantly associated with in-hospital mortality rate. Conclusion: In-hospital mortality after STEMI in women was higher than men. However, the role of sex as an independent predictor of mortality disappeared in regression analysis. The gender based difference in in-hospital mortality after STEMI may be related to the poorer cardiovascular disease (CVD) risk factor profile of the women. [ABSTRACT FROM AUTHOR]

Background: In patients who undergoing PCI, association between right ventricular function and outcome of the procedure remained unclear. The present study aimed to determine association between echocardiography findings of systolic right ventricular function and functional status of patients following PCI. Methods: In a cross-sectional study conducted at Imam Ali hospital and heart center in Kermanshah, Iran in 2013, 40 patients with history of inferior wall myocardial infarction (Inf MI) according to previous electrocardiography (ECG) in past hospitalization for MI who were candidate for percutaneous coronary intervention (PCI) on right coronary artery (RCA) and had left ventricle ejection fraction (LVEF) less than 40% were included. The subjects underwent echocardiography on admission to assess echocardiography indices of systolic right ventricular function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TASV), Tei-index (Myocardial performance index), and RV fractional area (RVFA) change that was repeated one month later. Baseline functional status was assessed based on the New York Heart Association functional classification score (NYHA score) that divided to 4 grades. Results: NYHA score improved following PCI procedure (from 2.20±0.46 to 1.10±0.30, P<0.001). The mean score of TAPSE significantly increased from 18.68±2.12 to 20.40±2.11 (P<0.001). The mean of TASV also increased from 13.28±1.52 to 14.85±1.90 (P<0.001). Also, Tei-index was improved from 0.52±0.05 to 0.47±0.03 (P<0.001). Moreover, RVFA was significantly increased after PCI (from 35.02±2.40 to 38.25±2.57, P<0.001). There was no significant relationship between the changes in NYHA score and each of right ventricular systolic function indices. Conclusion: Although right ventricular systolic function considerably improved following PCI procedure, but the changes in this improvement is not associated with the improvement of function class after the procedure. [ABSTRACT FROM AUTHOR]