In-hospital and six-month outcomes of elderly patients undergoing primary percutaneous coronary intervention for acute st-elevation myocardial infarction

BACKGROUND: Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in- hospital and 6-month outcomes of primary PCI in elderly patients (� 75 years) with STEMI. METHODS: A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital and 6-month outcomes of patients were recorded and analyzed. RESULTS: The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0 were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged � 75 years, hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION: Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability. © 2016, Isfahan University of Medical Sciences(IUMS). All rights reserved

Impella 2.5 in a patient with left main coronary artery occlusion

Short-term assist devices have been indicated in many clinical settings mostly as a bridge to the next step. In this article, we report a case of cardiogenic shock due to acute occlusion of left main coronary artery who was scheduled to be transferred from Iran to Germany for the next treatment (permanent assist device implantation). Impella 2.5 (Abiomed Inc., Danvers, MA, USA), a short-term assist device, made the long distance journey possible.. © 2013

Carbapenem resistance in gram-negative bacilli isolates in an iranian 1000-bed tertiary hospital

Objective: Carbapenems are beta-lactamase antibiotics, presently considered as most potent agents for treatment of infections caused by Gram-negative bacilli. The aim of this study was to determine resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumonniae as prevalent nosocomial agents to commonly used antibiotics including carbapenems such as imipenem and meropenem. Methodology: A total of 202 gram-negative bacilli including K.pneumoniae, P aeruginosa and A.baumannii isolated from hospitalized patients in Milad hospital of Tehran were subject for susceptibility testing. Susceptibility testing was performed by disk diffusion and MIC methods as recommended by Clinical Laboratory Standards Institute (CLSI) Results: All isolates of K. pneumonia were susceptible to imipenem and meropenem. Resistance in non-fermenting gram-negative bacilli (NFGB) was prevalent. P.aeruginosa isolates exhibited 7.5 and 40.2 resistance to imipenem and meropenem respectively. The majority isolates of Acinetobacter baumannii were multi-drug resistant and resistance of this organism to imipenem and meropenem was 27.7 and 38.5 respectively. Conclusions: Our study revealed that in spite of resistance of K.pneumoniae to commonly used antibiotics, all isolates were susceptible to imipenem and meropeem. More than 80 isolates of A .bammanni were resistant to commonly used antibiotics. About 40.2 isolates of P.aeruginosa and (38.5) isolates of A.baumannii were resistant to meropenem respectively

The predictors of no-reflow phenomenon after primary angioplasty for acute myocardial infarction

Background: No-reflow phenomenon is a serious complication of primary Percutaneous Coronary Intervention (PCI), which may increase the risk of progressive myocardial damage, profound left ventricular dysfunction, and death. Objectives: This study aimed to investigate the incidence of no-reflow phenomenon and its clinical, para-clinical, and angiographic determinants in patients who underwent primary PCI for ST Elevation Myocardial Infarction (STEMI). Patients and Methods: This non-randomized prospective cohort study was conducted on 397 patients in a cardiovascular tertiary care center in Tehran, Iran from April 2012 to April 2014. The inclusion criteria of the study were presenting with acute STEMI of � 12 h duration or having admitted between 12 and 24 hours after onset with symptoms and signs of ongoing ischemia. The participants underwent standard coronary angiography. No-reflow phenomenon was defined as a Thrombolysis In Myocardial Infarction (TIMI) flow � 2 and no presence of spasm, distal embolization, or dissection after completion of the procedure. The association between no-reflow and its determinants was assessed by chi-square, student�s t-test, or Mann�Whitney U test. Logistic regression models were also used for multivariate analysis. P values < 0.05 were considered to be statistically significant. Results: The participants� mean (SD) age was of 59 (12.2) years and female/male ratio was 83/314. The incidence of no-reflow phenomenon was 63 (15.9). Besides, the results of multivariate analysis showed that only thrombus burden, lesion length, time to reperfusion, and type of occlusion had an adjusted association with this phenomenon. Conclusions: The study results suggested that no-reflow phenomenon after primary PCI would be predictable. Thus, preventive measures, such as using distal protective devices or administration of platelet glycoprotein IIb/IIIa antagonists, are advised to be used in high-risk patients. © 2016, Iranian Cardiovascular Research Journal. All rights reserved

Comparison of prevalence of metabolic syndrome between idiopathic and secondary deep vein thrombosis

Background- The association of the metabolic syndrome with idiopathic or secondary deep vein thrombosis (DVT) remains uncertain. In addition, the relevance of the different features of the metabolic syndrome as an independent or pivotal risk factor for DVT is controversial. We aimed to evaluate the prevalence of the metabolic syndrome in patients with idiopathic or secondary DVT and also compare the prevalence of the different components of this syndrome in the two clinical etiological conditions of DVT. Methods- In a cross-sectional study, 115 consecutive patients with a recent objective diagnosis of DVT (idiopathic in 87 patients and secondary to a known risk factor in 28 patients) who were referred to Rajaei Heart Center between April 2009 and January 2010 were enrolled in the study. In all the patients, DVT was diagnosed by means of compression Doppler ultrasonography. The metabolic syndrome was defined according to the ATP III recommendations. Results- Overall prevalence of the metabolic syndrome in the study participants was 9.6, and the prevalence of the metabolic syndrome in patients with idiopathic or secondary DVT was 9.2 and 10.7, respectively, which was not different between them. Relative to the presence of the different numbers of the metabolic syndrome features, no difference was found between the groups with idiopathic or secondary DVT. The presence of no feature was found in 6.9 and 7.1, the presence of one feature was seen in 51.7 and 42.9, and the presence of two features was found in 32.2 and 39.3, respectively. Conclusion- Regardless of the etiology of DVT, the overall prevalence of the metabolic syndrome in our DVT subjects ranged from 9.2 to 10.7, and this prevalence was independent of the etiology (idiopathic or secondary) of DVT

Percutaneous device closure for secundum-type atrial septal defect: Short and intermediate-term results

BACKGROUND: Device closure of an isolated secundum type atrial septal defect (ASD) has been used as an alternative method for open surgical closure with comparable success and lower morbidity. In this study we evaluated the procedural success and mid-term follow-up results of percutaneous closure of secundum ASD with an Amplatzer�Septal Occluder(ASO) device or a Figula ASD occluder device. METHODS: From June 2001 to January 2009, 74 consecutive patients were scheduled for percutaneous device closure in two centers in Tehran, Iran. All patients had a stretched defect diameter of 30mm or less. After using a sizing balloon to measure the stop-flow diameter, device implantation was performed under the guidance of a trans-esophageal echocardiography (TEE).The size was generally 1 - 2 mm larger than the stretched diameter. Patients were followed for an average of 11 ±4 months. RESULTS: The median stretched diameter of the defect was 20.7±4.8 mm (range: 8 - 30 mm).A total of 73 devices were used in this study. Device closure was successful in 72 (97.2) out of 74 patients. Repositioning of the device was required in one patient. Major complications(including significant residual shunt and device embolization) occurred in 3 (4) patients.There was no procedure-related mortality in our patients. Mild-to-moderate residual shunt was detectable in 10 (13.7) patients immediately following the procedure and in 5 (6.7) patients 24 hours after the procedure. None had residual flow across the device at the end of the follow-up period. CONCLUSION: Device closure of ASD has a safety profile comparable to open surgical repair and can effectively close the defect with excellent procedural and mid-term results

Path analysis of the relationship between optimism, humor, affectivity, and marital satisfaction among infertile couples

Marital satisfaction is an important factor for establishing a family relationship, feeling satisfied, and living happily together. The aim of the present study was to investigate the relationship between optimism, humor, positive and negative affect, and marital satisfaction among infertile couples. The sample comprised 80 infertile Iranian couples (n = 160) who visited infertility clinics. Participants completed a series of Persian versions of psychometric scales related to optimism (Attributional Style Questionnaire), humor (Humor Styles Questionnaire), marital satisfaction (Enrich Marital Satisfaction Questionnaire), positive affect (PA) and negative affect (NA) (Positive and Negative Affect Schedule). The obtained result of Smart PLS statistical analysis confirmed the significant positive correlation between optimism and humor with marital satisfaction and high PA and low NA. Moreover, the findings also provided an adequate fit of the model. The findings demonstrated that infertile couples high in optimism and humor have higher levels of marital satisfaction and high PA and low PA. Based on the study’s findings, interventions for facilitating optimism and humor among infertile couples are discussed

Outcomes of chronic total occlusion percutaneous coronary intervention from the RAIAN (RAjaie - Iran) registry

Objective: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. Methods: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n&nbsp;=&nbsp;555, 70.3&nbsp;%) and unsuccessful (n&nbsp;=&nbsp;235, 29.7&nbsp;%) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. Results: A global success rate of 70&nbsp;% for antegrade and 80&nbsp;% for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5&nbsp;% in successful and 10.6&nbsp;% in unsuccessful group, p&nbsp;=&nbsp;0.173). One year patients' health status improved significantly only in successful group. Conclusions: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success

Primary immunodeficiency disorders in Iran: Update and new insights from the third report of the national registry

Background: Primary immunodeficiency disorders (PID) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections and increased susceptibility to malignancies, lymphoproliferative and autoimmune conditions. National registries of PID disorders provide epidemiological data and increase the awareness of medical personnel as well as health care providers. Methods: This study presents the demographic data and clinical manifestations of Iranian PID patients who were diagnosed from March 2006 till the March of 2013 and were registered in Iranian PID Registry (IPIDR) after its second report of 2006. Results: A total number of 731 new PID patients (455 male and 276 female) from 14 medical centers were enrolled in the current study. Predominantly antibody deficiencies were the most common subcategory of PID (32.3 %) and were followed by combined immunodeficiencies (22.3 %), congenital defects of phagocyte number, function, or both (17.4 %), well-defined syndromes with immunodeficiency (17.2 %), autoinflammatory disorders (5.2 %), diseases of immune dysregulation (2.6 %), defects in innate immunity (1.6 %), and complement deficiencies (1.4 %). Severe combined immunodeficiency was the most common disorder (21.1 %). Other prevalent disorders were common variable immunodeficiency (14.9 %), hyper IgE syndrome (7.7 %), and selective IgA deficiency (7.5 %). Conclusions: Registration of Iranian PID patients increased the awareness of medical community of Iran and developed diagnostic and therapeutic techniques across more parts of the country. Further efforts must be taken by increasing the coverage of IPIDR via electronically registration and gradual referral system in order to provide better estimation of PID in Iran and reduce the number of undiagnosed cases. © 2014 Springer Science+Business Media