Acute serious thrombocytopenia associated with intracoronary tirofiban use for primary angioplasty

Tirofiban, a specific glycoprotein IIb/IIIa inhibitor, may cause extensive thrombocytopenia with an incidence of 0.2% to 0.5%. We report the case of a 50-year-old man who developed thrombocytopenia after tirofiban use (both intracoronary and peripheral) over hours and the successful management of this complication after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. © 2014 Mustafa Yurtdaş et al

Determining the most proper number of cluster in fuzzy clustering by using artificial neural networks

In a clustering problem, it would be better to use fuzzy clustering if there was an uncertainty in determining clusters or memberships of some units. Determining the number of cluster has an important role on obtaining sensible and sound results in clustering analysis. In many clustering algorithm, it is firstly need to know number of cluster. However, there is no pre-information about the number of cluster in general. The process of determining the most proper number of cluster is called as cluster validation. In the available fuzzy clustering literature, the most proper number of cluster is determined by utilizing cluster validation indices. When the data contain complexity are being analyzed, cluster validation indices can produce conflictive results. Also, there is no criterion point out the best index. In this study, artificial neural networks are employed to determine the number of cluster. The data is taken as input so the output is membership degree. The proposed method is applied some data and obtained results are compared to those obtained from validation indices like PC, XB, and CE. It is shown that the proposed method produce accurate results

The relationship of the degree of coronary stenosis and percutaneous coronary revascularization with heart rate recovery index

OBJECTIVES: Heart rate recovery (HRR) is influenced by autonomic function. We aimed to investigate the effect of percutaneous coronary intervention (PCI) on HRR with respect to the degree of coronary stenosis (DCS) in severe coronary artery disease (CAD). METHODS: The treatment group (TG) consisted of 70 severe stable CAD patients treated with PCI and the control group (CG), 62 non-critical CAD patients, who were not treated with PCI. All participants underwent exercise test both at baseline and 3 months after coronary angiography (CAG)/PCI. HRR was defined as a change in heart rate from peak exercise to 1 minute after exercise. HRR index was described as the percentage change in HRR from 3 months after CAG/PCI to baseline. RESULTS: The TG had lower HRR than the CG (p<0.001). In the TG, HRR was inversely correlated with the number of diseased vessels at baseline (r=-0.418, p<0.001). HRR index was higher in TG than CG (p<0.001). No associations were found between HRR (p=0.136), HRR index (p=0.703) and the DCS. Patients who had multiple vessels treated, had the highest HRR index. CONCLUSION: HRR is not associated with the DCS of 70% to 99%, and PCI improves HRR in proportion to the number of coronary vessels treated in severe stable CAD

Heart rate recovery after exercise and its relation with neutrophil-to-lymphocyte ratio in patients with cardiac syndrome X

OBJECTIVES: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are measures of systemic inflammation. Heart rate recovery (HRR) after exercise is influenced by autonomic function. The aim of this study was to ascertain whether HRR and the Duke Treadmill Score (DTS) values are related to NLR and PLR in patients with cardiac syndrome X (CSX). METHODS: A total of 350 participants were enrolled in the study. Complete blood counts and high-sensitivity C-reactive protein (hsCRP) were obtained. All participants underwent an exercise test. HRR and DTS were calculated after exercise. Abnormal HRR was defined as 12 beats/min or less. RESULTS: CSX and coronary artery disease (CAD) groups had higher NLR, PLR, and hsCRP, and lower HRR and DTS values than the control group (for all, P<0.05). In both CSX and CAD groups, HRR was positively correlated with DTS (r=0.468, P<0.001 and r=0.491, P<0.001, respectively) and negatively correlated with NLR (r=-0.519, P<0.001 and r=-0.612, P<0.001, respectively), PLR (r=-0.422, P<0.001 and r=-0.438, P<0.001, respectively), and hsCRP (r=-0.553, P<0.001 and r=-0.521, P<0.001, respectively). NLR and hsCRP were important two predictors of the presence of lower HRR in both CSX [NLR: odds ratio (OR), 0.395; 95% confidence interval (CI), 0.168-0.925; P=0.032 and hsCRP: OR, 0.748; 95% CI, 0.591-0.945; P=0.015], and CAD groups (NLR: OR, 0.115; 95% CI, 0.026-0.501; P=0.004 and hsCRP: OR, 0.637; 95% CI, 0.455-0.892; P=0.009). CONCLUSION: CSX patients have higher NLR and PLR and slower HRR and lower DTS, similar to CAD patients, suggesting that CSX patients may be at a higher risk for developing cardiovascular events in the future. NLR may predict autonomic imbalance assessed by HRR in CSX