Incidence of coronary bifurcation lesion as a culprit lesion in patients with acute myocardial infarction: impact of treatment strategy on short- and long-term outcomes

Background: Although, there are several studies comparing single and two-stent techniques in patients with bifurcation lesions, evidence in patients presenting with myocardial infarction (MI) is still insufficient.1-3 We aimed to assess the short- and long-term outcomes of provisional and two-stent techniques of bifurcation lesions in patients with acute coronary syndromes (ACS). Patients and Methods: 2992 patients with MI who underwent percutaneous coronary intervention (PCI) were enrolled in the present study. Of 2992 patients, 385 patients with MI had bifurcation lesions. The Synergy between PCI with TAXUS™ and Cardiac Surgery (SYNTAX) score, pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow, post-PCI TIMI flow, duration of procedure, angiographic features, post-PCI side branch loss, 1- and 12-month mortality rates were noted. Results: 169 (43.9%) patients had ST-segment elevation MI, whereas 216 (56.1%) patients had non-STsegment elevation MI. 355 (92.2%) patients underwent provisional stenting and 30 (7.8%) patients underwent two-stent technique. Side branch loss was observed in 40 patients (11.2%) in the provisional group and 1 patient (3.3%) in the two-stent group (p=0.2). Compared to provisional group, durations of angiography and revascularization in two-stent group were significantly longer (p<0.001 and p<0.001). Both 1-month and 12-month mortality rates were similar in provisional and two-stent groups (4.2% vs. 3.3%, p=0.8 and 11.5% and 13.3%, p=0.7; respectively). Conclusion: In patients presenting with ACS and bifurcation lesions, procedural success, side branch loss, as well as short- and long-term mortality were similar in both provisional and two-stent techniques

Association Between Morning Surge in Systolic Blood Pressure and SYNTAX Score I in Patients With Stable Coronary Artery Disease

A high morning surge in systolic blood pressure poses a risk in people who have cardiovascular disease. We investigated the relationship between this phenomenon and the SYNTAX score I in patients who had stable coronary artery disease. Our single-center study included 125 consecutive patients (109 men and 16 women; mean age, 54.3 ± 9 yr) in whom coronary angiography revealed stable coronary artery disease. We calculated each patient\u27s sleep-trough morning surge in systolic blood pressure, then calculated the SYNTAX score I. The morning surge was significantly higher in patients whose score was \u3e22 (mean, 22.7 ± 13.2) than in those whose score was ≤22 (mean, 12.4 ± 7.5) (P \u3c0.001). Forward stepwise logistic regression analysis revealed that morning surge in systolic blood pressure was the only independent predictor of an intermediate-to-high score (odds ratio=1.183; 95% CI, 1.025–1.364; P=0.021). To our knowledge, this is the first study to show an association between morning surge in systolic blood pressure and the SYNTAX score I in patients who have stable coronary artery disease

Clinical features and major bleeding predictors for 161 fatal cases of COVID-19: A retrospective observational study

The aim of this study was to investigate the patient characteristics and laboratory parameters for COVID-19 non-survivors as well as to find risk factors for major bleeding complications. For this retrospective study, the data of patients who died with COVID-19 in our intensive care unit were collected in the period of March 20 - April 30, 2020. D-dimer, platelet count, C-reactive protein (CRP), troponin, and international normalized ratio (INR) levels were recorded on the 1st, 5th, and 10th days of hospitalization in order to investigate the possible correlation of laboratory parameter changes with in-hospital events. A total of 161 non-survivors patients with COVID-19 were included in the study.  The median age was 69.8±10.9 years, and 95 (59%) of the population were male. Lung-related complications were the most common in-hospital complications. Patients with COVID-19 had in-hospital complications such as major bleeding (39%), hemoptysis (14%), disseminated intravascular coagulation (13%), liver failure (21%), ARDS (85%), acute kidney injury (40%), and myocardial injury (70%). A multiple logistics regression analysis determined that age, hypertension, diabetes mellitus, use of acetylsalicylic acid (ASA) or low molecular weight heparin (LMWH), hemoglobin, D-dimer, INR, and acute kidney injury were independent predictors of major bleeding. Our results showed that a high proportion of COVID-19 non-survivors suffered from major bleeding complications

Effect of Seven Different Modalities of Antihypertensive Therapy on Pulse Pressure in Patients with Newly Diagnosed Stage I Hypertension

In this study, we investigated the effect of different antihypertensive agents on pulse pressure (PP). The study was designed in a prospective manner and patients were sequentially allocated to one of the seven different therapy groups, according to the order of enrollment (every first patient to group I, every second patient to group II, and etc). Patients in group I received 10 mg of lisinopril, in group II 10/6.25 mg of lisinopril/hydrochlorothiazide, in group III 80 mg of valsartan, in group IV 80/6.25 mg of valsartan/hydrochlorothiazide, in group V 5 mg of amlodipine, in group VI 1.25 mg of indapamide, and finally those in group VII received 50 mg of atenolol. The reduction in PP was more significant in patients receiving lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide, when compared with patients receiving indapamide, atenolol, and amlodipine (P < 0.05 for each group). Factors such as age, gender, and body mass index were not found to significantly influence the effectiveness of antihypertensive agents on PP. The reduction in PP was more apparent with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide in diabetic patients, when compared with those without diabetes (P < 0.001, P < 0.05). And also patients on therapy with 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors had a greater reduction in PP with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide (P < 0.001, P < 0.05)

<p>The Impact of Lesion Complexity and the CHA(2)DS(2)-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction</p>

Background. In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). Objective. The present study aimed to determine the impact of lesion complexity and the CHA(2)DS(2)-VASc score on SR in patients with STEMI. Methods. A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(-) (n = 1402), according to their initial angiography and SR status. CHA(2)DS(2)-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. Results. The CHA(2)DS(2)-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(-) (mean CHA(2)DS(2)-VASc, 1.36 +/- 0.64 vs. 2.01 +/- 0.80, p < 0.001; mean SYNTAX score, 15.51 +/-& nbsp;5.94 vs. 17.08 +/-& nbsp;8.29, p < 0.001). After the multivariate regression analysis, a lower CHA(2)DS(2)-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(-) (0% vs. 6.7%, p < 0.001). Conclusion. Our study demonstrated that lesion complexity and the CHA(2)DS(2)-VASc score are independently associated with spontaneous reperfusion

The Relationship Between Contrast Associated Nephropathy and Coronary Collateral Circulation in very Old Patients

Background: The aim of this study was to investigate whether there is a relationship between coronary collateral circulation (CCC) and contrast associated nephropathy (CAN) in very elderly patients. Methods: Patients aged 90 years or older with at least one major occlusion of the coronary artery proximal or mid-section were included in the study. CCC was graded according to the Rentrop classification. CAN was defined as an increase in blood creatinine value of 25% or more on the second day after coronary angiography. Results: Thirty-six patients who met the study criteria were included in the study. In the study group, CAN developed in 12 patients (CAN (+) group), 24 patients did not develop CAN (CAN (&minus;) group). The creatinine levels before coronary angiography were 1.05 &plusmn; 0.12 in the CAN (&minus;) group and 1.22 &plusmn; 0.14 in the CAN (+) group. Baseline creatinine values were significantly higher in the CAN (+) group (p = 0.001). The contrast agent used in the CAN (+) group was significantly higher (p = 0.001). In the CAN (+) group, nine patients (43%) had poor collateral circulation, whereas only three patients (20%) had well-developed collateral circulation. In a logistic regression analysis, the collateral class was not a risk factor for CAN, whereas contrast agent volume and basal creatinine were independent predictors of CAN. Conclusion: We found that CCC grade was not associated with the development of CAN in very old patients, but the amount of contrast agent and pre-procedure creatinine values were independent variables in the development of CAN

The Prevalence of Low T3 With Arrhythmia and Heart Failure in Patients With Acute Coronary Syndrome

Aims: To investigate the prevalence of low T3 in patients with acute coronary syndrome (ACS)