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OBJECTIVE: In this study, we aimed to determine whether admission hemoglobin versus post-percutaneous coronary intervention (PCI) hemoglobin level at 24 hours is a predictor of in-hospital mortality for patients with ST elevation myocardial infarction (STEMI) without evidence of clinical hemorrhage who underwent primary PCI. METHODS: In this study, we included 1,444 consecutive patients with STEMI who underwent primary PCI at a tertiary heart hospital. The primary outcome of the study was the in-hospital all-cause mortality. We used the penalized maximum likelihood estimation (PMLE) logistic regression method to examine the relationship between primary outcome and candidate predictors. RESULTS: In total, 172 (11.9%) patients died during the in-hospital course. According to a PMLE logistic regression analysis, age, KILLIP class ≥2, pre-PCI thrombolysis in myocardial infarction (TIMI) flow

Funding Acknowledgements Type of funding sources: None. Inotroduction . CHA₂DS₂-VASc scoring system, which includes traditional risk factors of coronary artery disease, is actually created to determine the risk of thromboembolism in patients with atrial fibrillation. In this study; the value of CHA₂DS₂-VASc score, which can be calculated easily on admission, was evaluated for predicting in-hospital adverse outcomes in ST elevation miyocardial infarction (STEMI) patients without atrial fibrillation. Method This was a single center cross-sectional study. 1933 STEMI patients enrolled to the study. Primary end points include in-hospital death, cardiopulmonary arrest and cerebrovascular accident and were identified as MACE Results MACE rate was 10% (193 patients), in-hospital mortality rate was 9% (169 patients).In proportional logistic regression analysis, CHA₂DS₂-VASc score was an independent predictor for MACE (OR and CI 95%, 2.31[1.37-3.90]; p value:0.0016). In the regression analysis, the CHA₂DS₂-VASc score was taken as an uncatagorized continuous variable, and the relationship between the CHA₂DS₂-VASc score and MACE was observed to be linear. Additionally heart rate (OR and 95% CI, 1.56 [0.97- 2.50]; p value: 0.0242), killip class on admission (OR and 95% CI, 24.19[10.74-54.46]; p value Conclusion CHA₂DS₂-VASc score was observed as an indepented predictor for MACE in STEMI patients. To evaluate the relationship between CHA₂DS₂-VASc score and outcomes, the linear analysis of the CHA₂DS₂-VASc score without categorization in prediction model is used and this is the main difference of our study from others. Table-1 Variables Odss Ratio (OR) and 95% CI p value CHA₂DS₂-VASc ( 0 to 3) 2.31 (1.37-3.90) p = 0,0016 Heart Rate (Beats per minute) ( 68 to 94) 1.56 (0.97-2.50) p =0.0242 Systolic Blood Pressure (mmHg) ( 115 to 156) 0.83 (0.51-1.34) p = 0.3523 Killip Class ( I to IV) 24.19 (10.74-54.46) p Abstract Figure. Partial impact plots of predictors

Background In-stent restenosis (ISR) remains a potential problem and raises concerns about the long-term safety and efficacy of carotid artery stenting (CAS). As inflammation has a pivotal role in the pathogenesis of ISR, a novel and more sensitive inflammatory marker, CRP/albumin ratio (CAR) may be used to predict ISR in patients undergoing CAS. Purpose The present study aimed to assess the predictive value of preprocedural C-reactive protein/albumin ratio (CAR) for ISR after CAS. Method In this retrospective study, 206 patients who underwent successful CAS procedure in a tertiary heart centre were included. For each patient, both C-reactive protein (CRP) and serum albumin were determined before the index procedure. The CAR was calculated by dividing serum CRP by serum albumin level. The main end-point of the study was ISR during long-term follow-up. Results ISR developed in 34 (16.5%) out of 206 patients after a mean follow-up of 24.2±1.5 months. The CAR was significantly elevated in patients with ISR compared to those who were not (0.99 [1.3] vs. 0.15 [0.2], p0.53 with a sensitivity of 100% and a specificity of 97.1% [area under curve (AUC) 0.98, p Conclusion The present study demonstrated that CAR, a new inflammatory-based index, is a strong independent predictor of ISR after CAS. As a simple and easily accessible parameter, this index may be used for the assessment of ISR in patients who are treated with CAS. Funding Acknowledgement Type of funding source: None

Introduction: In-stent restenosis (ISR) still constitutes a major problem after percutaneous vascular interventions and the inflammation has a pivotal role in the pathogenesis of such event. The C-reactive protein/albumin ratio (CAR) is a newly identified inflammatory biomarker, and it may be used as an indicator to predict ISR in subjects with coronary artery stenting. In light of these data, our main objective was to investigate the relationship between the preprocedural CAR and ISR in patients undergoing successful iliac artery stent implantation. Methods: In total, 138 consecutive patients who had successful iliac artery stent implantation in a tertiary heart center between 2015 and 2018 were enrolled in the study. The study population was categorized into two groups; patients with ISR and those without ISR during follow-up. The CAR was determined by dividing CRP by serum albumin. Results: In the multivariable regression analysis; the CAR (HR: 2.66, 95% CI: 1.66-4.25, P < 0.01), stent length (HR: 1.01, 95% CI: 0.99-1.02, P = 0.04), and HbA1c levels (HR: 1.22, 95% CI: 0.99-1.51, P = 0.04) were independently related with ISR. A receiver operating curve analysis displayed that the CAR value of >0.29 predicted ISR with sensitivity of 97.5% and specificity of 88.8% (AUC 0.94, P < 0.01). Conclusion: Our findings provide evidence that the CAR may be an applicable inflammatory biomarker in predicting ISR in subjects undergoing iliac artery stenting for the treatment of peripheral artery disease (PAD). Also, the stent length and poor glycemic control were found to be associated with ISR.

Objective: The present study aimed to assess the predictive value of preprocedural C-reactive protein/albumin ratio (CAR) for in-stent restenosis (ISR) after carotid artery stenting (CAS).Materials and Method: In this retrospective study, 206 patients who underwent successful CAS procedure in a tertiary heart centre were included. For each patient, both C-reactive protein (CRP) and serum albumin were determined before the index procedure. The CAR was calculated by dividing serum CRP by serum albumin level. The main end-point of the study was ISR during long-term follow-up.Results: ISR developed in 34 (16.5%) out of 206 patients after a mean follow-up of 24.2 ± 1.5 months. The CAR was significantly elevated in patients with ISR compared to those who were not (0.99 [1.3] vs. 0.15 [0.2], p < 0.01, respectively). In a multivariate Cox regression analysis, the CAR was an independent predictor of ISR (HR: 1.85, %95 CI: 1.29 – 2.64, p < 0.01). A ROC curve analysis revealed that the optimal value of CAR in predicting ISR was > 0.53 with a sensitivity of 100 % and a specificity of 97.1 % [area under curve (AUC) 0.98, p < 0.001].Conclusion: The present study demonstrated that CAR, a new inflammatory-based index, is a strong independent predictor of ISR after CAS. As a simple and easily accessible parameter, this index may be used for the assessment of ISR in patients who are treated with CAS.Keywords: CAR, in-stent restenosis, carotid artery stenting, inflammation ÖZETAmaç: Çalışmamızda, karotid arter stentleme (KAS) işlemi öncesi bakılan C-reaktif protein/albumin oranının (CAO) stent içi restenozu (SİR) öngördürme potansiyelini araştırmayı amaçladık. Gereç ve Yöntem: Retrospektif olarak dizayn edilen bu çalışmaya tersiyer merkezimizde başarılı bir şekilde karotid arter stentleme yapılan toplam 206 hasta alındı. İşlem öncesi her hastanın C-reaktif protein (CRP) ve serum albumin değerleri çalışıldı. CAO değeri, CRP değeri serum albumin değerine bölünerek hesaplandı. Çalışmanın primer sonlamın noktası takip sırasında gelişen SİR olarak belirlendi. Bulgular: 206 hastanın ortalama 24.2 ± 1.5 ay takibi sonunda SİR toplam 34 (%16.5) hastada izlendi. SİR gelişmeyen hastalarla karşılaştırıldığında, CAO, SİR gelişen hastalarda anlamlı olarak daha yüksek saptandı (0.15 [0.2] vs. 0.99 [1.3], p < 0.01, sırasıyla). Çok değişkenli COX analizinde, CAO, SİR ‘un bağımsız öngördürücüsü olarak saptandı (HR: 1.85, %95 CI: 1.29 – 2.64, p < 0.01). ROC eğrisi analizinde CAO değerinin > 0.53 olması, SİR ‘u %100 duyarlılık ve %97.1 özgüllük ile öngördürmekteydi (AUC) 0.98, p < 0.01).Sonuç: Çalışmamızın sonuçları göstermiştir ki, inflamatuar bazlı yeni bir belirteç olan CAO KAS işlemi yapılan hastaların takiplerinde gelişen SİR ‘un güçlü ve bağımsız bir öngördürücüsüdür. Hızlı ve kolayca bakılabilen bu parametre, KAS işlemi yapılan hastalarda SİR gelişimini değerlendirmek için kullanılabilir. Anahtar kelimeler: CAO, stent içi restenoz, karotis arter stentleme, inflamasyon

Electrocardiographic (ECG) abnormalities are often indicative of acute coronary artery occlusion. Early detection of these abnormalities is important for the identification of patients who may be candidates for emergent percutaneous coronary revascularization (PCR). In most cases, ST-segment elevation is the key factor in selecting patients for PCR. However, some cases with acute coronary artery occlusion do not have ST-segment elevation, resulting in delays in coronary reperfusion treatment. A 37-year-old male presented to the emergency department with typical chest pain. The patient indicated that he was a heavy marijuana user. Even though his admission ECG did not reveal ST-segment elevation, he was hemodynamically stable, and he did not develop life-threatening arrhythmias, he was immediately taken to the catheterization laboratory for urgent angiography with the diagnosis of acute myocardial infarction. The occluded left anterior descending artery seen in angiography was successfully revascularized with percutaneous coronary intervention. Herein, we present a case of a patient who was admitted to the emergency department with chest pain and ECG demonstrating the de Winter pattern. Based on this case, we present a detailed evaluation regarding the de Winter ECG pattern, which is equivalent to ST-segment elevation.

Introduction Interatrial block (IAB) is strongly associated with recurrence of atrial fibrillation (AF) in different clinical scenarios. Atrial fibrosis is considered the responsible mechanism underlying the pathogenesis of IAB. The aim of this study was to investigate whether IAB predicted AF at 12 months follow-up in a population of patients with ST segment elevation myocardial infarction (STEMI). Hypothesis We aimed to investigate whether IAB predicted AF at 12 months follow up in a population of patients with STEMI. Methods Prospective, single center, observational study of patients presenting with ST-segment elevation myocardial infarction (STEMI) and referred to primary percutaneous coronary intervention (P-PCI). Surface electrocardiograms (ECG) were recorded on admission and at 6th hour post P-PCI. Patients were screened for the occurrence of AF at a 12-months visit. Results A total of 198 patients were included between September 2015 and September 2016. IAB (partial and advanced) was detected in 102 (51.5%) patients on admission. Remodeling of the P-wave and subsequent normalization reduced the prevalence of IAB to 47 (23.7%) patients at 6th hour. AF was detected in 17.7% of study patients at 12 months. Partial IAB (p-IAB) on admission (OR 5.10; 95% CI, 1.46-17.8; P = 0.011) and on 6th hour (OR 4.15; 95% CI, 1.29-13.4; P = 0.017), presence of a lesion in more than one coronary artery (OR 3.29; 95% CI, 1.32-8.16; P = 0.010) found to be independent predictors of AF at 12 months. Conclusion IAB is common in patients with STEMI and along with the presence of diffuse coronary artery disease is associated with new onset of AF.