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Introduction Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. Aim To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. Material and methods We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 ±12.1 years). Results The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. Conclusions Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization.

The prognostic importance of high-sensitivity cardiac troponin T (hs-cTnT) has recently been reported in patients with heart failure. The myocardial performance index (MPI), which combines parameters of both systolic and diastolic ventricular function, provides a better marker of left ventricular dysfunction in hypertensive patients with preserved left ventricular ejection fraction (LVEF). We aimed to investigate the relationship between hs-cTnT and tissue Doppler-derived MPI in newly diagnosed hypertensive patients with preserved LVEF. We studied 306 patients with newly diagnosed hypertension. The patients were divided into two groups according to their median MPI values: MPIlo and MPIhigh groups. The MPI was calculated from the pulsed-wave Doppler recordings. Left ventricular mass index (LVMI) was determined according to the Devereux formula. hs-cTnT, uric acid, and high-sensitivity C-reactive protein (hs-CRP) levels were measured in all patients. Hs-cTnT, hs-CRP, and uric acid levels were higher in the MPIhigh group compared with the MPIlow group (p

OBJECTIVE Morning blood pressure surge (MBPS) is an independent predictor of atherothrombotic cardiovascular events in hypertensive patients. There is evidence from studies supporting the validity of mean platelet volume (MPV) as a marker of vascular risk and predictor of thrombotic complications. The aim of this study is to investigate the relationship between MPV and MBPS in hypertensive patients. METHODS Measurements were obtained from 298 patients with newly diagnosed essential hypertension (Mean age: 51.9 ± 11.7 years). The patients were divided into two groups (MPV(low) group

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age = 51.7 ± 5.8 years) and 44 healthy control subjects (mean age; 51.3 ± 4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p0.05). NT-proBNP levels of all geometric patterns were higher than the control group (p0.05, for all). NT-proBNP levels were similar between CR and NG groups (p0.05). NT-proBNP was independently associated with LV geometry (β = 0.304, p = 0.003) and LVMI (β = 0.266, p = 0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.

Objectives This study sought to propose a new technique for the treatment of Medina type 1.1.1 bifurcation lesions. Background Although there are many different 2-stent techniques, the optimal strategy for patients with Medina type 1.1.1 bifurcation lesions has not yet been determined. Methods The authors selected 30 patients who had Medina type 1.1.1 coronary bifurcation lesions. The most important characteristics of this new technique are complete coverage of the side branch (SB) ostium by stent struts and lower metallic burden at carina region. All procedures were performed using drug-eluting stents. All patients were followed up to 9 months after the intervention. Quantitative coronary angiography (QCA) analyses were performed for both the main and the side branches at baseline, after stent implantation, and at 9-month follow-up. Results Procedural success rate was 100%. Final kissing balloon inflation could be performed in all patients. There was no major adverse cardiac events during hospital stay. Clinical and angiographic QCA follow-up was available in 28 patients (93.4%). There was no death, myocardial infarction, or stent thrombosis at 9 months follow-up. In-stent restenosis requiring reintervention was noted at the SB ostium in only 1 patient. Conclusions This new “modified flower petal” technique has several advantages for stent implantation of Medina type 1.1.1 bifurcation lesions over the available techniques: complete coverage of the SB ostium, lower metallic burden at the carina, and excellent immediate and midterm clinical outcomes.

Objective: To assess the relationship between aortic distensibility (AD) and the extent and complexity of atherosclerotic lesions assessed with SYNTAX score (SS) in patients with stable coronary artery disease. Subjects and Methods: Three hundred and seventy-six consecutive patients (230 males and 146 females; mean age: 61.6 ± 9.9 years) with angiographically proven coronary artery disease were included in the study. The SS was calculated using the SS algorithm on the baseline diagnostic angiogram in the 376 patients. AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. Frequencies of risk factors, biochemical and hematological data were recorded. The patients were divided into two groups according to the median AD value as ADlow and ADhigh groups. Results: The SS was higher in the ADlow group compared with the ADhigh group (18.5 ± 10.2 vs. 8.3 ± 5.9, p < 0.001). The AD was independently related to age (β = -0.104, p = 0.019), hypertension (β = -0.202, p < 0.001) and SS (β = -0.457, p < 0.001) and was more strongly associated with SS in hypertensive patients compared to nonhypertensive patients (r = -0.524 vs. r = -0.414, p < 0.001 for all). Conclusion: The findings showed that impaired AD might be an independent predictor for the severity of coronary atherosclerosis, particularly in patients with hypertension.

We aimed to assess the effective factors on high mean platelet volume (MPV) in patients with stable coronary artery disease (CAD). A total of 411 patients (247 males and 164 females; mean age: 61.7 ± 9.9 years) with angiographically proven CAD were included. The patients were divided into 2 groups according to the median MPV value (MPVlow group high group ≥9.5 fL). The SYNTAX score, high sensitive C-reactive protein (hsCRP) levels, and frequencies of diabetes and hypertension were higher in MPVhigh group compared to MPVlow group. Aortic distensibility (AD) and platelet count of patients in MPVhigh group were lower than patients in MPVlow group ( P < .05, for all). Multivariate linear regression analysis showed that MPV was independently related with diabetes (β = 0.135, P = .007), hsCRP (β = 0.259, P < .001), platelet count (β = −0.144, P < .001), and AD (β = −0.425, P < .001). High MPV value is independently related to AD, as well as diabetes, hsCRP, and platelet count in patients with stable CAD.

Background The aim of the study was to investigate the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX score (SS) and myocardial performance index (MPI) in stable CAD. Methods The study participants consisted of 106 consecutive patients (mean age: 57.6 ± 9.5 years) with angiographically proven obstructive stable CAD and 30 patients with nonobstructive CAD (control group) (mean age: 58.0 ± 7.6 years). The MPI was calculated by using pulsed-wave Doppler before coronary angiography. Coronary angiography was performed in all patients. The SS was prospectively calculated in 106 obstructive CAD patients. Patients were partitioned into 3 groups based on SS. Frequencies of risk factors, biochemical and hematological data were recorded in all patients. Results The SS tertiles were defined as SSlow ≤ 8 (n = 35), SSmid ≤ 17 (n = 36), and SShigh > 17 (n = 35). The patients with SShigh group (mean MPI; 0,48 ± 0.06) based on SS had significantly higher MPI values compared with the SSmid (mean MPI; 0,44 ± 0.05), SSlow (mean MPI; 0.43 ± 0.06), and control (mean MPI; 0.41 ± 0.05) groups (P

We assessed the relationship between contrast-induced nephropathy (CIN) and SYNTAX score (SS) and serum uric acid (SUA) levels in patients with ST elevation myocardial infarction (STEMI). A total of 835 STEMI patients in whom primary percutaneous coronary intervention was performed in our cardiology clinic were included in this study (615 male, 220 female; mean age 58.1 ± 12.2 years). The patients were divided into 2 groups (CIN and non-CIN). Contrast-induced nephropathy was observed in 9.6% (80) of patients; SS (13.9 ± 6.2/22.1 ± 5.8) and SUA (5.1 ± 0.9/6.2 ± 0.9) values in the CIN group were higher compared with the non-CIN group ( P < .001, for all). All SS (95% confidence interval [CI] = 1.136-1.250, P = .001), SUA (95% CI = 1.877-3.236, P = .002), and diabetes (95% CI = 0.998-1.039, P = .026) were independent predictors of CIN in logistic regression analysis. Procedures that can prevent CIN may be beneficial in patients at high risk as identified by the SS and SUA levels.

OP-049 The no-reflow phenomenon has a negative prognostic value in patients with acute ST elevation myocardial infarction (STEMI). SYNTAX score (SS) quantifies extent and complexity of angiographic disease and predict long-term mortality and morbidity in STEMI. We aimed to assess the no-reflow and

Background: There is growing evidence that aortic distensibility (AD) is a subclinical marker of early atherosclerosis. Aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atherosclerosis. In this study, we aimed to assess the relationship between thoracic aortic IMT and AD. Methods: We studied 192 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Four different grades were determined according to IMT of thoracic aorta (Grade 1

The high-sensitivity cardiac troponin T (hs-cTnT) assay provides important prognostic information on cardiovascular diseases. Although hs-cTnT is associated with left ventricle (LV) hypertrophy (LVH), it has not been investigated in different LV geometric patterns incorporating normal LV structure and concentric remodeling in addition to LVH.We aimed to investigate the possible association between hs-cTnT and LV geometric patterns in newly diagnosed hypertensive patients.We studied 306 patients with newly diagnosed hypertension (HT; mean age 51.7 ± 5.6 years) and 44 healthy control subjects (mean age 51.3 ± 4.7 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWth). hs-cTnT and other biochemical markers were measured in all participants.The highest hs-cTnT values were observed in the concentric hypertrophy group compared with the control, normal geometry, concentric remodeling and eccentric hypertrophy groups (p0.05, for all). Also, hs-cTnT values of the eccentric hypertrophy group were higher than the control, normal geometry and concentric remodeling groups (p0.05, for all). Multivariate regression analysis showed that hs-cTnT was independently associated with LV geometry (β = 0.326, p = 0.001) as well as LVMI (β = 0.228, p = 0.010) and creatinine level β = 0.132, p = 0.012).hs-cTnT level is related not only to LVH but also to LV geometry in hypertensive patients. hs-cTnT levels may mediate poorer LV geometric patterns in hypertensive patients.

Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.

The increased prognostic accuracy of the high-sensitivity cardiac troponin T (hs-cTnT) assay vs the conventional cTnT assay has recently been reported in hypertensive patients. The authors aimed to investigate the significance of serum hs-cTnT marker for prediction of nondipper hypertension (HTN) in hypertensive patients. A total of 317 patients with newly diagnosed HTN were studied. The patients were divided into two groups: 198 dipper hypertensive patients (mean age, 51.7 ± 5.1 years) and 119 nondipper hypertensive patients (mean age, 53.4 ± 7.6 years). Hs-cTnT and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in all patients. hs-cTnT and NT-proBNP were independent predictors for nondipper HTN (P

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9 ± 5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group114 pg/ml and NT-proBNPhigh group ≥114 pg/ml). Patients with NT-proBNPhigh were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNPlow. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.

Background Patients with diabetes mellitus (DM) are at high risk of left ventricular (LV) dysfunction. A reduction of coronary flow reserve (CFR) has been demonstrated in diabetic patients without coronary artery stenosis. In this study, we investigated the association between LV myocardial diastolic and systolic functions and the CFR in newly diagnosed diabetic patients in the absence of coronary artery disease. Method We studied 88 patients (mean age 49 ± 10 years) with newly diagnosed DM and 40 healthy control subjects (mean age 50 ± 9 years). All subjects underwent transthoracic echocardiography. The myocardial performance index (MPI) was determined by using pulsed-wave Doppler. The CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. Results Patients with diabetes had significantly longer mitral E-wave deceleration time and higher MPI value than control group (P = 0.023 and P

Abnormal left ventricular (LV) geometric patterns, particularly concentric LV hypertrophy, are associated with a greater risk of hypertensive complications. The aim of this study was to investigate the association between LV myocardial performance index (LVMPI) and aortic distensibility (AD) with different LV geometric patterns in patients with newly diagnosed hypertension (HT).We studied 181 patients with newly diagnosed HT (mean age 51.7 ± 5.4 years) and 39 healthy control subjects (mean age 51.2 ± 5.1 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWT). AD was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. LVMPI was calculated from the tissue Doppler-derived ejection time, isovolumic contraction and relaxation times.The highest LVMPI and the lowest AD values were observed in concentric hypertrophy group compared with control, normal geometry, concentric remodelling and eccentric hypertrophy groups (p0.05, for all). LVMPI was associated with LVMI (r = 0.497, p0.001), RWT (r = 0.270, p0.001), AD (r = -0.316, p0.001) and E deceleration time (r = 0.171, p = 0.02) in bivariate analysis. In multiple linear regression analysis, LVMPI was independently related to LVMI (β = 0.381, p0.001) and AD (β = -0.263, p = 0.001).The LVMPI was highest and AD was lowest in patients with concentric hypertrophy. The LVMPI was independently associated with LVMI and AD in hypertensive patients.

The no-reflow phenomenon has a negative prognostic value in patients with acute ST-elevation myocardial infarction (STEMI). The SYNTAX score (SS) quantifies the extent and complexity of angiographic disease and predicts long-term mortality and morbidity in STEMI. We aimed to assess the no-reflow and its possible relationships with SS and clinical characteristics in patients with STEMI treated with a primary percutaneous coronary intervention (PPCI).In this study, 880 patients with STEMI treated with PPCI were included prospectively (646 men and 234 women, mean age 58.5±12.4 years). The SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score were determined in all patients. No-reflow was defined as TIMI grade 0, 1 and 2 flows or TIMI grade 3 with myocardial blush grade 0 and 1. The patients were divided into two groups: a normal flow group and a no-reflow group.No-reflow was observed in 32.8% of patients. The mean SS of the no-reflow group was higher than that of the normal flow group (19.2±6.8/12.9±6.1, P0.001). On multivariate logistic regression analysis, SS [β=0.872, 95% confidence interval (CI)=0.845-0.899, P0.001], diabetes (β=0.767, 95% CI=0.128-4.597, P=0.004), anterior myocardial infarction (β=5.421, 95% CI=1.369-21.469, P=0.025), and thrombus grade after wiring (β=2.537, 95% CI=1.506-4.273, P0.001) were found to be independent predictors of no-reflow. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 19.75 for the prediction of no-reflow (sensitivity: 70.6%, specificity: 69.4%).The SS is a predictor of no-reflow in patients with STEMI treated with PPCI.

We investigated whether the mean platelet volume (MPV) is associated with the extent and complexity of coronary artery disease in patients with ST elevation myocardial infarction (STEMI). We prospectively included 912 STEMI patients (663 male and 249 female; mean age 58.7 ± 12.4 years) who underwent primary percutaneous coronary intervention. The patients were divided into 3 groups according to MPV tertiles. Highest SYNTAX score (SS) was observed in MPVhigh group compared with MPVmid and MPVlow groups ( P < .001 for all). The SS of MPVmid group was higher than MPVlow group ( P = .036). The MPV in diabetic STEMI patients was higher than in nondiabetic STEMI patients ( P < .001). Multivariate linear regression analysis showed that the MPV was associated with diabetes (β = .115, P = .001), troponin level (β = .131, P = .001), platelet count (β = −.241, P < .001), and SS (β = .216, P < .001). The relation between MPV and SS in diabetic STEMI patients was stronger than for nondiabetic STEMI patients ( r = .473, P < .001 vs r = .129, P = .001).

This study sought to propose a new technique for the treatment of Medina type 1.1.1 bifurcation lesions.Although there are many different 2-stent techniques, the optimal strategy for patients with Medina type 1.1.1 bifurcation lesions has not yet been determined.The authors selected 30 patients who had Medina type 1.1.1 coronary bifurcation lesions. The most important characteristics of this new technique are complete coverage of the side branch (SB) ostium by stent struts and lower metallic burden at carina region. All procedures were performed using drug-eluting stents. All patients were followed up to 9 months after the intervention. Quantitative coronary angiography (QCA) analyses were performed for both the main and the side branches at baseline, after stent implantation, and at 9-month follow-up.Procedural success rate was 100%. Final kissing balloon inflation could be performed in all patients. There was no major adverse cardiac events during hospital stay. Clinical and angiographic QCA follow-up was available in 28 patients (93.4%). There was no death, myocardial infarction, or stent thrombosis at 9 months follow-up. In-stent restenosis requiring reintervention was noted at the SB ostium in only 1 patient.This new "modified flower petal" technique has several advantages for stent implantation of Medina type 1.1.1 bifurcation lesions over the available techniques: complete coverage of the SB ostium, lower metallic burden at the carina, and excellent immediate and midterm clinical outcomes.

Even a slight decrease in the glomerular filtration rate (GFR) is an independent risk factor for cardiovascular disease. Arterial stiffness, left ventricular hypertrophy and N-terminal pro-brain natriuretic peptide (NT-proBNP) are independent risk factors for cardiovascular disease, which are particularly common in end-stage renal disease. We aimed to evaluate the association between GFR with arterial stiffness, left ventricle mass (LVM) and NT-proBNP in hypertensive subjects with normal to mildly impaired renal function. The study population consisted of 285 newly diagnosed hypertensive patients (mean age; 49.9 ± 11.8 years). GFR was estimated (eGFR) by the Modification of Diet in Renal Disease formula. Pulse wave velocity (PWV) and augmentation index (AIx), which reflects arterial stiffness, were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. LVM was obtained by echocardiography. Plasma NT-proBNP was measured by electrochemiluminescence. The patients were divided into two groups according to the median eGFR value (eGFRlow group 101 ml/min/1.73 m(2) and eGFRhigh group ≥ 101 ml/min/1.73 m(2)). LVM and NT-proBNP values were higher in eGFRlow group compared with eGFRhigh group (p0.05). Pulse wave velocity and augmentation index values were higher in eGFRlow group compared with eGFRhigh group (p0.05, for all). Multiple linear regression analysis showed that eGFR was independently associated with PWV (β=-0.422, p0.001) and NT-proBNP (β=-0.404, p0.001). Present study showed that eGFR was independently associated with PWV and NT-proBNP values. Importantly, these findings may explain, in part, the increase in cardiovascular risk in with slightly impaired renal function.