Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001). On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179)Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome

Association of neutrophil/lymphocyte ratio with plaque morphology in patients with asymptomatic intermediate carotid artery stenosis

WOS: 000384706100016PubMed ID: 27721862Background and Objectives: Non-calcified carotid plaques are more unstable than calcified plaques; and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke. The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis with respect to neutrophil/lymphocyte ratio (NLR). Subjects and Methods: A total number of 139 asymptomatic patients with 50-70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n=73)and non-calcified (n=66) plaque groups were compared with respect to total neutrophil count, lymphocyte count and NLR. Results: Total lymphocyte count was statistically significantly lower in the non-calcified plaque group compared to the calcified plaque group (total lymphocyte count in non-calcified/calcified plaque groups [10(3)/mm(3)]: 2.1/2.3, respectively) (p=0.002). NLR was statistically significantly higher in the non-calcified plaque group compared to the calcified plaque group (NLR in non-calcified/calcified plaque groups: 2.6/2.1, respectively) (p2.54. Multivariate regression analysis showed that NLR was independently associated with non-calcified carotid artery plaques (odds ratio 5.686, 95% CI 2.498-12.944, p<0.001). Conclusions: NLR is increased in the presence of non-calcified carotid artery plaques that cause asymptomatic intermediate stenosis. Increased NLR can be used as a marker to assess the risk of rupture of non-calcified carotid artery plaques

ST segment yükselmeli hastalarda trombolitik tedavi sonrası infark genişliği ve QRS aks değişikliği arasındaki ilişki

Amaç: Elektrokardiyografi (EKG) ST yükselmeli akut miyokard infarktüsü (STYAMİ) ile gelen hastalarda prognostik infarkt genişliğini belirlemede pratik ve yönlendirici bir araç olabilir. Bu çalışma ile infarkt genişliği ile trombolitik tedavi sonrası QRS aks değişim miktarı arasında bir ilişki olup olmadığını bulmaya çalıştık. Gereç ve Yöntem: Bu çalışmada trombolitik tedavi alan STYAMİ hastaları retrospektif olarak seçildi. İki EKG’de (trombolitik tedavi öncesindeki ve tedavi sonrası 90. dakikadaki) ortalama QRS aksı bir formül yardımıyla hesaplandı. İnfarkt genişliğini belirlemede belirteç olarak kreatinin kinaz MB (CKMB) kullanıldı. Bulgular: Tüm Mİ altgrupları gözönüne alındığında infarkt genişliği ile QRS aksı değişimi arasında korelasyon saptamadık (p=0.80). Sadece izole inferior Mİ grubunda CKMB ile QRS aksı değişimi arasında iyi derece korelasyon saptadık (r=-0.52 p=0.049). Sonuç: QRS aksı değişimi, trombolitik tedavinin etkinliğinin değerlendirilmesinde ve prognostik infarkt genişliğinin belirlenmesinde çok vurgulanmamış, pratik ve gelecek vadeden bir araç gibi gözükmektedir.Objective: Electrocardiography (ECG) may be a practical guiding tool for prognostic infarct sizing in ST elevation acute myocardial infarction (STEAMI). In this study, we sought to find a relation between the infarct size and the change in the QRS axis after thrombolytic therapy. Materials and Methods: Patients with STEAMI who received thrombolytic therapy were selected retrospectively. The mean QRS axes of two ECGs (before and 90 minutes after thrombolytic therapy) were calculated. Creatinine kinase MB (CKMB) was used as the marker of infarct size. Results: We did not detect any correlation between infarct size and change in the QRS axis with respect to any myocardial infarction MI localizations (p=0.80). However, in the isolated inferior MI group, there was a good correlation between CKMB and change in the QRS axis (r=-0.52 p=0.049). Conclusion: The change in the QRS axis is rarely emphasized, providing a practical and promising tool for evaluating both the efficiency of the thrombolytic therapy and prognostic infarct sizing

Effect of left bundle branch block on TIMI frame count

Aim: Left bundle branch block is an independent risk factorfor cardiac mortality. In this study we aimed to evaluatecoronary blood flow with TIMI frame count in patients with left bundle branch block and angiographically proven normal coronary arteries.Materials and methods: We retrospectively studied 17 patients with left bundle branch block and as a control group 16 patients without left bundle branch block. All patientshad angiographically proven normal coronary arteries.Left bundle branch block was determined according to standart electrocardiographic criteria. The TIMI frame count was measured for each major coronary artery in each patient.Results: TIMI frame count for left anterior descending coronary artery was found to be significantly higher in patientswith left bundle branch block compared with patients without left bundle branch block (35.4±16.7 ve 23.8±4.5, p=0.012). TIMI frame counts for circumflex and right coronaryarteries were similar in patients with and without left bundle branch block (TIMI frame count for circumflex artery:32.4±15.4 ve 27.7±7.6, p=0.275; TIMI frame count for right coronary artery: 31.9±9.6 ve 27.0±8.6, p=0.141).Conclusion: We have found that TIMI frame count for left anterior descending coronary artery was higher in patients with left bundle branch block compared with patients without left bundle branch block whereas there were no difference for TIMI frame counts for circumflex and right coronary arteries. Impaired coronary blood flow in left anterior descending artery may help to explain the sintigraphic perfusion defects in septum of patients with left bundle branch block

Predictors of symptom development in intermediate carotid artery stenosis: Mean platelet volume and platelet distribution width

Platelets play an important role in the pathogenesis of atherothrombosis. Platelet activation is associated with increased mean platelet volume (MPV) and platelet distribution width (PDW). In this study, we investigated the relation of MPV and PDW with the risk of stroke in patients with intermediate (50%-70%) carotid artery stenosis. A total of 254 patients (115 symptomatic and 139 asymptomatic) with intermediate carotid artery stenosis were enrolled in this study. Symptomatic and asymptomatic patients were compared in regard to MPV and PDW. Mean platelet volume was significantly greater in the symptomatic group compared with the asymptomatic group (11.1 and 9.4 fL, respectively; P < .001). Platelet distribution width was significantly greater in the symptomatic group compared with the asymptomatic group (15.0% and 11.9%, respectively; P < .001). Multivariate regression analysis showed that an MPV 10.2 fL and a PDW 14.3% were independent predictors of developing symptomatic carotid artery stenosis. Mean platelet volume and PDW are increased in the presence of symptomatic intermediate carotid artery stenosis. Increased MPV and PDW may be independent predictors of developing symptomatic carotid artery plaque