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IntroductionThe current investigation intended to evaluate the correlation between eosinophil-to-lymphocyte ratio (ELR) and the coronary slow-flow phenomenon (CSFP) in patients undergoing elective coronary angiography.Material and methodsA case-control investigation was conducted on 200 individual CSFP patients and another 200 individuals with normal coronary arteries and who were matched for age, gender, and body mass index. ELR was computed by dividing the number of eosinophils by the number of lymphocytes. Thrombolysis in myocardial infarction frame count was used to determine the CSFP.ResultsThe ELR in the CSFP group was substantially greater than in the control group [0.38 (0.28–0.50)] and [0.22 (0.17–0.35)], p < 0.001, respectively). With the help of multivariable logistic regression analysis, ELR independently predicted the CSFP presence (odds ratio = 1.040, 95% CI: 1.026–1.053), p < 0.001). The effective cutoff point of ELR in predicting CSFP presence was > 0.29 with sensitivity of 77% and specificity of 70%. ELR had better diagnostic accuracy to predict CSFP than either lymphocyte or eosinophil count alone [AUC = 0.746 vs. AUC = 0.687 vs. AUC = 0.687, respectively].ConclusionsTo our knowledge, this was the first investigation to determine the connection between ELR and CSFP. We discovered that individuals with CSFP had higher ELR than those with normal coronary arteries in the control group.

SUMMARY OBJECTIVE: The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury. METHODS: This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) ×fasting blood glucose (mg/dL)/2]. RESULTS: Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients. CONCLUSIONS: The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.

Introduction: To investigate the predictive accuracy of the CHA2 DS2 -VASc-HSF score in predicting the one-year mortality and major adverse cardiac and cerebrovascular events (MACCEs) in patients with non-STelevation acute coronary syndrome (NSTE-ACS). Patients and Methods: In this retrospective study, the study cohort was divided in to two groups based on the median CHA2 DS2 -VASc-HSF score: low-risk group (≤ 4 points) and high-risk group (> 4 points). Results: We enrolled 394 patients with NSTE-ACS (mean age: 58.7 ± 11.8 years). The CHA2 DS2 -VASc-HSF score independently predicted the coronary artery disease (CAD) severity (p< 0.01), one-year mortality (p< 0.01), and MACCEs (p< 0.01). The Global Registry for Acute Coronary Events (GRACE) risk score (GRS 1.0) independently predicted the CAD severity (p< 0.01), whereas the revised GRACE 2.0 risk score (GRS 2.0) independently predicted the one-year mortality (p< 0.01) and MACCEs (p< 0.01). The diagnostic performance of CHA2 DS2 -VASc-HSF was similar to GRS 2.0 in predicting the one-year mortality and MACCEs [area under the curve (AUC), 0.75 and 0.69 vs. 0.78 and 0.67; p= 0.41, p= 0.38, respectively) and better than GRS 1.0 for the CAD severity (AUC, 0.85 vs. 0.79; p= 0.03). The Kaplan-Meier curves displayed significantly higher one-year mortality and MACCEs in the high-risk group (p< 0.01) compared with the low-risk group (p< 0.01). Conclusion: The predictive accuracy of CHA2 DS2 -VASc-HSF is comparable to that of GRS 2.0 in determining the long-term cardiovascular outcomes; thus, it could be considered as a predictive model for patients with NSTE-ACS., Giriş: Bu çalışmada esas olarak modifiye CHA2 DS2 -VASc-HSF skorunun ST-yükselmesiz akut koroner sendromlu (STYz-AKS) hastalarda bir yıllık mortalite ve majör advers kardiyak ve serebrovasküler olayları (MACCEs) öngörüp öngörmediğini araştırmayı amaçladık. Hastalar ve Yöntem: Hastane kayıtları kullanılarak tasarlanmış bu retrospektif çalışmada, çalışma popülasyonu ortanca CHA2 DS2 -VASc-HSF skoruna göre düşük (≤ 4 puan) ve yüksek riskli (> 4 puan) olarak iki gruba ayrılmıştır. Bulgular: Çalışmaya ortalama 58.7 ± 11.8 yaşında olan 394 STYz-AKS hastası dahil edilmiştir. CHA2 DS2 - VASc-HSF skoru, koroner arter hastalığı (KAH) yaygınlığının, bir yıllık mortalitenin ve MACCEs’in bağımsız öngördürücüsü olarak bulunmuştur (sırasıyla, p< 0.01, p< 0.01, p< 0.01). Ayrıca “The Global Registry for Acute Coronary Events (GRACE)” 1.0 risk skorunun KAH yaygınlığı için (p< 0.01), güncellenmiş GRACE 2.0 risk skorunun ise bir yıllık mortalite ve MACCEs için bağımsız öngördürücü olduğunu saptadık (sırasıyla, p< 0.01, p< 0.01). CHA2 DS2 -VASc-HSF ve GRACE 2.0 risk skorlarının bir yıllık mortalite ve MACCEs’i öngörmede tanısal performanları istatistiksel olarak birbirine benzer iken [eğri altında kalan alan (AUC)= 0.75 ve 0.69 vs. 0.78 ve 0.67; sırasıyla, p= 0.41, p= 0.38), CHA2 DS2 -VASc-HSF KAH şiddetini öngörmede GRACE 1.0 risk skorundan daha iyi performans sergiledi (AUCs= 0.85 vs. 0.79; p= 0.03). Kaplan-Meier eğrisi CHA2 DS2 -VASc-HSF skoru > 4 puan olan hastalarda düşük riskli hastalara göre bir yıllık mortalite ve MACCEs’in istatistiksel olarak anlamlı derecede daha yüksek olduğunu gösterdi (sırasıyla, p< 0.01, p< 0.01). Sonuç: CHA2 DS2 -VASc-HSF’nin uzun dönem kardiyovasküler sonuçları öngörmedeki doğruluğu GRACE 2.0 ile kıyaslanabilir düzeyde olup klinik uygulamada STYz-AKS hastaları için bir tahmin modeli olarak düşünülebilir.

Objective: Oxidative stress has been considered to be one of the main causes for the development of pulmonary hypertension (PH) via leading alteration of pulmonary vasomotor tone induced by hypoxia. The aim of this study is to determine the serum paraoxonase-1 enzyme (PON-1) activity, arylesterase activity, the antioxidant-oxidant status in patients with PH and to compare with healthy controls. Material and Methods: Thirty five healthy ındividuals (mean age 45.7±5.9 years) as a control group and thirty eight patients (mean age 46.5±12.6 years) with a diagnosis of PH wereincluded in thestudy. Serum PON-1 and arylesterase activity, the total antioxidative capacity of plasma (TAC) and total oxidantstatus (TOS) were measured by using colorimetric methods. The Oxidative Stress Index (OSI) wascalculated as TOS/ TACX100. Results: Serum PON1 activity is significantly lower in PH patients when compared with healthy controls (p=0.001). The serum arylesterase activity and TAC, TOS and OSI status were similarin bothgroups. There is inverse correlation between serum PON1 activityand NYHA functionalcapacity (r:-0.649 p=0.001). Furthermore, PON1 activity of study patients are similarin the PH subgroups. Serum activity of PON1 wasfoundto bethe only independent parameter for the presence of PH in binary logistic regression analysis (OR 0.984, 95 % CI 0.977-0.992, p=0.001). Eight patients died follow up period (27.6±14.5 months) and none of theparametersincluding PON1 were associated with mortality. Conclusion: Serum PON1 activity of PH patients is lowerthanhealthypopulation, but does not predictmortality. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.652-658

BACKGROUND This study aimed to investigate the predictive value of the newly defined C-reactive protein (CRP)-toalbumin ratio (CAR) in determining the extent and severity of coronary artery disease (CAD) in comparison with the other inflammatory markers such as neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), in patients with non-ST-elevated myocardial infarction (NSTEMI). PATIENTS AND METHODS This study is retrospectively designed and includes 205 patients with NSTEMI with a mean age of 56.6± 11.4 years. The study cohort was subdivided into two groups according to Synergy Between Percutaneous Coronary Intervention with Taxus and cardiac surgery score (SS) as low (

OBJECTIVE To investigate whether inflammation based scores including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) predict the slow flow (SF)/no-reflow (NR) phenomenon comparatively in patients with non-ST-elevated Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). METHODS Current study is retrospective designed and includes 426 NSTEMI patients (mean age of 56.8 ± 11.4 years). The patients were grouped into non slow flow/no-reflow and slow flow/no-reflow groups according to postintervention thrombolysis in myocardial infarction flow grade. RESULTS The slow flow/no-reflow group had significantly higher MHR and lower LMR values than the non slow flow/no-reflow group (P

OBJECTIVE: In this study, we aimed to investigate the prognostic accuracy of the presence of fragmented QRS (fQRS) on baseline electrocardiogram on the adverse outcome in critical patients with coronavirus disease 2019 (COVID-19) with cardiovascular disease (CVD). METHODS: The current study was retrospective designed and included 169 patients who were critically ill with COVID-19 and CVD (mean age of 62±15 years). The patients were grouped into those who died (non-survivor group) and those who survived (survivor group). RESULTS: The non-survivors were older and more often had CVD (p=0.009), hypertension (p=0.046), diabetes (p=0.048), cancer (p=0.023), and chronic renal failure (p=0.001). Although the presence of fQRS on the basal electrocardiogram was more common in patients who died, this was not statistically significant (p=0.059). Furthermore, non-survivors had more frequent the coexistence of CVD and fQRS (p=0.029). In Model 1 multivariate regression analysis, CVD alone was not a predictor of mortality (p=0.078), whereas coexistence of CVD and fQRS was found to be an independent predictor of mortality in Model 2 analysis [hazard ratio (HR): 2.243; p=0.003]. Furthermore, older age (HR: 1.022; p=0.006 and HR: 1.023; p=0.005), cancer (HR: 1.912; p=0.021 and HR: 1.858; p=0.031), high SOFA score (HR: 1.177; p=0.003 and HR: 1.215; p

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001–1.003, p &lt, 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was &gt, 1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p &lt, 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Objective: To assess the performance of the modified R2CHA2DS2-VASc score for predicting mid-to-long-term mortality (> 30 days) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: Data of 78 patients who underwent TAVR were retrospectively reviewed. R2CHA2DS2-VASc score was compared with the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II or ES II) and the transcatheter valve therapytranscatheter aortic valve replacement (TVT-TAVR) risk score. Results: The mean follow-up period was 17.4±9.9 months (maximum 37 months). Early mortality (first 30 days) was observed in 10 (12.8%) patients, whereas mid-to-long-term mortality (> 30 days) was observed in 26 (33.3%) patients. Non-survivors had higher values of R2CHA2DS2-VASc, ES II, and TAVR scores than survivors (P

Background: There is an increased risk for coronary artery disease (CAD) at modestly elevated levels of blood glucose which is still below the present threshold for type 2 diabetes mellitus (T2DM). In the present study, we aimed to define impaired glucose tolerance (IGT) and T2DM in patients with stable CAD and observe the relationship between clinical and laboratory findings. Materials and Methods: A total of 132 patients who had stable CAD and who had not been diagnosed as glucose intolerance or diabetes were enrolled. In one of the groups, there were patients with IGT or T2DM results and the other one consisted of patients with normal oral glucose tolerance test (OGTT) results. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was investigated in patients with fasting plasma glucose (FPG)

Initial presentation in almost half of the patients with chronic ischemic heart disease (IHD) is chronic stable angina. Despite recent improvements in diagnosis and treatment, IHD still appears to be the most important cause of morbidity and mortality in our country and industrialized countries. The main aim of the treatment of chronic stable angina is to increase life expectancy and to improve quality of life by reducing the frequency and severity of angina. Beta-blockers, calcium channel blockers and nitrates constitute the main stones of anti-ischemic and antianginal treatment; new antianginal agents should be considered in patients with resistant angina despite usage of traditional agents. It is essential to add lifestyle modifications to pharmacological treatment and patients should be informed firmly. Even though revascularization therapy has not been shown to be superior to the optimal medical therapy in prognosis and mortality in chronic stabil angina, it reduces angina and necessity to anti-anginal medications and improves exercise capacity and quality of life in patients who are symptomatic despite optimal medical therapy. In this review, we summarized the current approach to chronic stable angina in the light of the American College of Cardiology and European Society of Cardiology guidelines for the diagnosis and assessment of chronic stable angina.

A 52-year-old man complaining of persistent recurring chest pain at night underwent coronary angiogram at another institution. Normal coronaries were observed and he was discharged with muscle spasmolytic prescription. Since symptoms had continued, 24-hour Holter monitoring was ordered at our facility and results revealed huge ST elevation and polymorphic ventricular tachycardia. Cold pressor test performed in catheterization laboratory also resulted in ventricular tachycardia. Nifedipine was prescribed and follow-up Holter monitoring revealed no further vasospastic episodes. Utility of 24-hour Holter rhythm monitoring and cold pressor test in patients with recurrent chest pain at night is demonstrated in this report.

Totally subcutaneous intravascular portacath provide safe and reliable vascular access and is widely utilized for venous access for long-term parenteral administration of medications. Catheter fracture and/or embolization of the catheter fragment in to the heart and or pulmonary artery is a rare and potentially serious complication. When it occurs, a prompt surgical or percutaneous extraction of the embolized foreign body is necessary. We present an asymptomatic case of metastatic colon adenocarcinoma in a patient who had fragmentation of catheter from the connection of the port and migration to left pulmonary arteries. We successfully removed the 10-cm long and 6-Fr diameter fractured catheter segment from the left pulmonary artery via the right femoral vein using a snare catheter with triple loop without complication. Post-procedure course was uneventful and the nature of the vascular access made early ambulation possible. Compared to surgery, percutaneous approach is a less invasive, safe, reliable and effective technique. Therefore, we suggest that percutaneous transcatheter technique for retrieval of embolized or broken catheter fragments should be considered as the first-choice treatment.

Objective: To evaluate the prognostic value of CHA2DS2-VASc score in individuals undergoing isolated coronary artery bypass grafting (CABG) surgery. Methods: Records of consecutive 464 patients who underwent elective isolated CABG, between January 2015 and August 2017, were retrospectively reviewed. A major adverse cardiac event (MACE) was the primary outcome of this study. MACE in patients with low (L) ( 25.1 had 68.4% sensitivity and 52.7% specificity (area under the curve [AUC]: 0.653, P=0.04, 95% confidence interval [CI]: 0.607-0.696) and CHA2DS2-VASc > 2 had 52.6% sensitivity and 84.1% specificity (AUC: 0.752, P

Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.

The prognostic value of malnutrition in elderly patients with non-ST-elevated myocardial infarction (NSTEMI) is not fully understood. Nutritional characteristics were evaluated by novel Controlling Nutritional status (CONUT), the prognostic nutritional index (PNI) and the geriatric nutritional risk index (GNRI) scores. The impact of these scores on major outcomes in 253 NSTEMI patients over 60 years and older were assessed. Compared to those with good nutritional status, malnourished patients had more major adverse cardiac and cerebrovascular events (MACCEs) at 1-year follow up. Multivariable cox regression analysis revealed that CONUT (hazard ratio = 1.372, p &lt, 0.01) was independent predictor of MACCEs, whereas PNI (p = 0.44) and GNRI (p = 0.52) were not. The discriminating power of the CONUT (AUC: 0.79) was adequate and significantly superior to both the PNI (AUC: 0.68) and the GNRI (AUC: 0.60), with a p-value for both &lt, 0.01. Patients with elevated CONUT exhibited the highest event rate for all-cause mortality and MACCEs in survival analysis (p &lt, 0.01). We conclude that malnutrition is strongly associated with adverse outcomes in older patients with NSTEMI. In fact, the CONUT score adequately predicts one-year MACCEs among elderly NSTEMI patients who achieve complete revascularization after coronary intervention.

Genetic factors and hypofibrinolytic state may contribute to the likelihood of developing in myocardial infarction (MI) in young women rather than traditional risk factors. High plasminogen-activator inhibitor-1 ( PAI-1 ) level and PAI-1 gene polymorphism have been shown to be associated with thrombotic events such as myocardial infarction, deep venous thrombosis, and stroke. We determined 4G / 4G polymorphism in a 34-year-old female patient with subacute anterior myocardial infarction and coronary thrombus in left anterior descending artery on coronary angiogram.

Background and Aim. Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). Materials and Method. The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records. Results. The mean age was 61.2±18.2 years, and the percentage of female was 33.3%. The mean duration of stay was 10.3±24.4 days. Exitus ratio, partial healing, and healing were 25%, 70%, and 5%, respectively. The mean right, left, and total PMA were 8.7±3.6, 8.9±3.4, and 17.6±6.9, respectively. The left and total PMA averages of the nonoperation patients were statistically significantly lower (p=0.021 p=0.043). The mean PMA between the ex and recovered patients were statistically significantly lower (p=0.001, p=0.001, p<0.001). Dyspnoea, renal insufficiency, COPD, transfusion rate, operation rate, ventilator needy, and mean duration of hospitalization were statistically significant higher in patients with exitus. There is a significant difference in operation types, anesthesia type, and clinic rates. Conclusion. Our data suggest that sarcopenia can be used to risk stratification in ICU patients. Future studies may use this technique to individualize postoperative interventions that may reduce the risk for an adverse discharge disposition related to critical illness, such as early mobilization, optimized nutritional support, and reduction of sedation and opioid dose.

Objective: Heart failure is frequently a serious complication of acute myocardial infarction (AMI). ACE inhibitors, Angiotensin II receptor blockers, β-blockers and aldosterone receptor blockers have been shown to improve outcomes in this setting. This study aimed to determine the effect of spironolactone on the frequency of clinical heart failure, mortality, rehospitalization and left ventricular functions determined by echocardiography. Material and methods: A total of 82 patients with STEMI hospitalized within 6–12 h of debut of symptoms were included in the study. The patients were randomly assigned into spironolactone (group A) or placebo (group B) groups after informed consent had been obtained. Results: All patients were followed for 6 months. There were no statistically signifi cant differences between the two groups when demographic criteria were compared. The incidence of post-MI angina pectoris, rhythm and conduction disturbance during hospitalization was signifi cantly higher in Group B than in Group A. Although not statistically signifi cant, the incidence of clinical heart failure was slightly lower in Group A than in Group B (5% versus 11%). Left ventricular end-diastolic volumes were slightly lower in Group A than in Group B, although statistically this was not signifi cant. Conclusions: In concordance with these fi ndings, the ejection fraction was slightly higher in Group A than in Group B, although this was not statistically signifi cant (47% versus 44%). This trend continued during a 6-month follow-up after randomization. Our fi ndings suggest that early administration of aldosterone blockers provides additional benefi ts after AMI, reducing the incidence of post-MI angina pectoris and rhythm and conduction disturbances.

Background: SYNTAX score (SxS) has been demonstrated to predict long-term outcomes in stable patients with coronary artery disease. But its prognostic value for patients with acute coronary syndrome remains unknown. Aim: To evaluate whether SxS could predict in-hospital outcomes for patients admitted with ST elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (pPCI). Methods: The study included 538 patients with STEMI who underwent pPCI between January 2010 and December 2012. The patients were divided into two groups: low SxS ( 22). The SxS of all patients was calculated from aninitial angiogram and TIMI flow grade of infarct related artery was calculated after pPCI. Left ventricular systolic functions of the patients were evaluated with an echocardiogram in the following week. The rates of reinfarction and mortality during hospitalisation were obtained from the medical records of our hospital. Results: The high SxS group had more no-reflow (41% and 25.1%, p < 0.001, respectively), lower ejection fraction (38.2 ± 7.5% and 44.6 ± 8.8%, p < 0.001, respectively), and greater rates of re-infarction (9.5% and 7.3%, p = 0.037, respectively) and mortality (0.9% and 0.2%, p = 0.021, respectively) during hospitalisation compared to the low SxS group. On multivariatelogistic regression analysis including clinical variables, SxS was an independent predictor of no-reflow (OR 1.081, 95% CI 1.032–1.133, p = 0.001). Conclusions: SxS is a useful tool that can predict in-hospital outcomes of patients with STEMI undergoing pPCI.

The prevalence of patients with noncompaction is reported to be 0.014% on echocardiographic examination. The estimated incidence of dextroversion (dextrocardia with isolated reversal of the heart with normally positioned visceral organs) is 1:2,800, while the real incidence of dextroversion and left ventricular noncompaction is still not known; to our knowledge only two cases have been reported in the literature. Noncompaction can generally be diagnosed using echocardiography; however, in the case reported here cardiac magnetic resonance imaging was important for the definitive diagnosis of dextroversion and noncompaction, because no adequate echocardiographic images could be obtained.