Clopidogrel versus ticagrelor in chronic kidney disease patients presenting with acute coronary syndrome: A retrospective evaluation

Aim: To compare the efficacy and bleeding risk of clopidogrel versus ticagrelor in patients presenting with the acute coronary syndrome (ACS). Method: This was a single-center retrospective comparison of in-hospital and 1-year major advance cardiovascular events (MACE) in patients with ACS and reduced estimated glomerular filtration rate (eGFR <60 mL/min) who were treated with clopidogrel or ticagrelor in addition to aspirin. Clinicodemographic features, medication use, and laboratory values were recorded. eGFR was calculated by means of the modification of diet in renal disease (MDRD) equation. The Killip classification was used to quantify the severity of heart failure. The primary outcome measures were in-hospital and 1-year MACEs and major and minor bleeding. MACE definition included recurrent myocardial infarction, stroke, and cardiovascular death. Results: In total, 235 patients (40.9% female, mean age 67.8 ± 12.4 years) were included. Of all patients, 56% presented with ST-elevation myocardial infarction (STEMI), whereas 44% had a non-ST-elevation myocardial infarction. Sixty-eight patients were treated with ticagrelor, while 167 patients were administered clopidogrel. The groups were comparable in terms of in-hospital mortality, cerebrovascular accident (CVA), and re-infarction rates. There was no statistical difference between the mortality, CVA and re-infarction rates between the groups at 12-month. In-hospital minor bleedings were more common among ticagrelor users. In-hospital major bleeding frequencies were similar in both groups. There was no statistical difference in terms of major or minor bleeding rates at 12 months. Conclusion: The findings of the present study showed comparable efficacy and bleeding risk in ACS patients who were treated clopidogrel or ticagrelor

Association Between Atherogenic Index of Plasma and Atherogenic Coefficient and in-Stent Restenosis After Drug-eluting Stent Implantation for Stable Coronary Artery Disease

Introduction:Despite improvements in stent science, in-stent restenosis (ISR) remains a major problem. This study was designed to evaluate the atherogenic index of plasma (AIP) and atherogenic coefficient (AC) levels and their predictive values in patients who developed ISR after drug-eluting stent implantation for stable coronary artery disease.Methods:One hundred ninety-nine patients with ISR and 377 without ISR were included in the study. The biochemical and hematological parameters of the patients were measured. The AIP and AC values were calculated.Results:Patients with ISR had significantly longer stent length, lower stent diameter, lower ejection fraction, and higher SYNTAX score. They also had significantly higher levels of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol, AIP, and AC compared to that of patients who did not develop ISR. AIP had a sensitivity of 61.3% and specificity of 72.1% for predicting ISR a cut-off value of 0.58. AC had sensitivity and specificity of 69.8% and 58.8%, respectively, for the presence of ISR a cut-off value of 3.44. LDL-C level of 111.5 mg/dL had sensitivity and specificity of 65.3% and 54% for developing ISR, respectively. Paired comparisons of area difference under the receiver operating characteristic curve showed that AIP and AC had significantly greater area compared with that of LDL-C. Stent diameter, stent length, SYNTAX score, ejection fraction, AIP, and AC were the predictors of ISR.Conclusion:AIP and AC had higher specificities compared with that of LDL-C in predicting ISR. The calculation of AIP and AC is simple and could be used easily in clinical practice

Predicting One-Year Deaths and Major Adverse Vascular Events with the Controlling Nutritional Status Score in Elderly Patients with Non–ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

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 < 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 < 0.01. Patients with elevated CONUT exhibited the highest event rate for all-cause mortality and MACCEs in survival analysis (p < 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

The Relationship between Grade of Ischemia, Success of Reperfusion, and Type of Thrombolytic Regimen

Background: This study was aimed to determine whether the grade of ischemia can predict the success of reperfusion in patients treated with thrombolytic therapy (TT) for ST elevation myocardial infarction (STEMI)

Serum Presepsin Levels in Patients with Decompensated Heart Failure.

13th International Congress of Update in Cardiology and Cardiovascular Surgery (UCCVS) -- MAR 23-26, 2017 -- Cesme, TURKEYWOS: 00040730920008

Long-Term Clinical Consequences of Patients Hospitalized for COVID-19 Infection

Background: Coronavirus disease 2019, putatively caused by infection with severe acute respiratory coronavirus 2, often involves injury to multiple organs and there are limited data regarding the mid- to long-term consequences of coronavirus disease 2019 after discharge from the hospital. The study aimed to describe the mid- to long-term consequences of coronavirus disease 2019 in hospitalized patients after discharge. Methods: This single-center, prospective study enrolled coronavirus disease 2019 patients who were discharged uneventfully from our center. All participants underwent face-to-face interviews by trained physicians and were asked to complete a series of questionnaires on third and sixth months' follow-up visits. Results: A total of 406 consecutive discharged coronavirus disease 2019 patients were enrolled in this study. Patients were divided into 3 groups according to World Health Organization classification as follows: World Health Organization-3 (n=83); World Health Organization-4 (n=291); and World Health Organization-5,6 (n =32). Length of hospital stay was highly, significantly increased in the higher World Health Organization groups (World Health Organization-3 vs. World Health Organization-4, P < .0001; World Health Organization-3 vs. World Health Organization-5,6, P < .0001; World Health Organization-4 vs. World Health Organization-5,6, P < .0001), whereas the length of intensive care unit stay was highly, significantly increased only in World Health Organization-5,6 group compared to other groups (World Health Organization-3 vs. World Health Organization-5,6, P < .0001; World Health Organization-4 vs. World Health Organization-5,6, P < .0001). The most frequent complaints were chest pain (39%), and the frequency of complaints decreased during the 3-6 months follow-up period. Multiple logistic regression analysis indicated that age, coronary artery disease, fibrinogen, C-reactive protein, troponin I, D-dimer, use of steroid and/or low molecular weight heparin, and World Health Organization class were found to be independent predictors of ongoing cardiovascular symptoms. Conclusions: The current data demonstrated that persistent symptoms were common after coronavirus disease 2019 among hospitalized patients. This should raise awareness among healthcare professionals regarding coronavirus disease 2019 aftercare

Is there any association between rs1303 (Pi*M3) variant of alpha-1 antitrypsin gene and atrial septal aneurysm development?

Aim Atrial septal aneurysm (ASA) is one of the congenital heart defects. The underlying pathophysiology of ASA has not been fully understood yet. Alpha-1 antitrypsin (A1AT) is a serine protease inhibitor glycoprotein, which is held responsible from tissue wall proteolysis if it is deficient in the body. The aim of this study was to investigate A1AT serum levels and the rs1303 (Pi*M3) variant in A1AT gene in patients with ASA. Material and Methods Thirty patients (7 male and 23 female) with isolated ASA and 33 patients (11 male and 22 female) with normal atrial septum on echocardiography were included in this study. A1AT serum levels of study patients were measured quantitatively by the enzyme-linked immune sorbent assay (ELISA) method. The A1AT gene mutation rs1303 was analyzed by genotyping, which is performed on genomic DNA extracted from circulating mononuclear blood cells. Single-nucleotide polymorphism was evaluated on polymerase chain reaction using commercial kits. Results A1AT serum levels were not statistically different among patients with and without ASA (9.52 +/- 4.33 mu g/mL vs 9.83 +/- 5.27 mu g/mL, respectively, P = .80). A1AT homozygote mutation (PiM3M3) was significantly higher in the ASA group than the control group (21 vs 11, OR (95% CI): 6.68 [2.09-21.40], P = .001). A1AT serum levels were similar among patients with normal A1AT allele (PiMM), homozygote variant (PiM3M3), and heterozygote variant (PiMM3) (P = .79). Conclusion This preliminary study revealed that homozygote A1AT rs1303 (PiM3M3) variant is significantly higher in patients with isolated ASA and may be associated with ASA development. Large scale comprehensive studies are needed to validate these results

Addition of the duration of ST segment depression to Duke treadmill score for diagnostic accuracy of exercise electrocardiography to predict obstructive coronary artery disease

Introduction Exercise electrocardiography (EET) is a safe and cost-effective method to predict the presence, prognosis, and severity of coronary artery disease (CAD). Various score models have been developed to increase predictive power of EET. In this study, we aimed to evaluate whether adding ST depression duration could have an effect on increasing the value of Duke treadmill score (DTS) in predicting obstructive CAD. Methods In this single centred, cross-sectional study, we evaluated a total of 258 patients who presented with a complaint of chest pain and undergone coronary angiogram in result of a positive EET. DTS was calculated for all the patients. The new score-revised DTS- was calculated by adding total ST depression time to classical DS parameters. We compared area under the curve (AUC) of DTS and revised DTS by Delongi method. Results Mean age of the group was 58.43 +/- 9.37, and 37.2% (n = 96) were female. Mean total ST-depression duration was 171.72 +/- 91.43 msec in normal artery group,241.54 +/- 118.11 msec in non-obstructive CAD group, and 281.26 +/- 113.64 in obstructive CAD group.ST-depression duration in both exercise and recovery, and total ST depression duration were significantly higher in obstructive CAD group than non-obstructive and normal artery groups (p = 0.024, p = 0.01, p < 0.01, and p < 0.01, respectively). Revised DTS had significantly higher predictive value of obstructive CAD compared to classical DS (AUC (95%CI): 0.744 vs. 0.626, p < 0.001). The AUC of DS was significantly lower than the new score (z-score:3.274, p = 0.011). Conclusion In conclusion, adding ST depression duration to DTS calculation is increasing the discriminative value of DTS to predict obstructive CAD. Benefits of EET within the context of the management of CAD is well-known, hence, it is clear that physicians may use revised DTS

Czy skala SYNTAX umożliwia prognozowanie powikłań wewnątrzszpitalnych u chorych z zawałem serca z uniesieniem odcinka ST poddanych pierwotnej przezskórnej interwencji wieńcowej?

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 (&lt; 22) and high SxS (&gt; 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 &lt; 0.001, respectively), lower ejection fraction (38.2 ± 7.5% and 44.6 ± 8.8%, p &lt; 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.Wstęp: Wykazano, że punktacja w skali SYNTAX (SxS) jest czynnikiem predykcyjnym odległych powikłań u pacjentów ze stabilną chorobą wieńcową. Jednak jej wartość prognostyczna u chorych z ostrym zespołem wieńcowym nadal nie jest znana.Cel: Niniejsze badanie przeprowadzono, aby ustalić, czy punktacja SxS umożliwia prognozowanie powikłań wewnątrzszpitalnych u pacjentów hospitalizowanych z powodu zawału serca z uniesieniem odcinka ST (STEMI) poddanych pierwotnej przezskórnej angioplastyce wieńcowej (pPCI).Metody: Do badania włączono 538 chorych z STEMI, u których wykonano pPCI w okresie od stycznia 2010 do grudnia 2012 r. Pacjentów podzielono na dwie grupy: z niską punktacją SxS (&lt; 22) i z wysoką punktacją SxS (&gt; 22). Punktację SxS dla wszystkich badanych obliczono na podstawie wykonanych początkowo angiogramów, a po przeprowadzeniu pPCI określono stopień przepływu w skali TIMI w tętnicy odpowiedzialnej za zawał. Czynność skurczową lewej komory oceniano w badaniu echokardiograficznym w następnym tygodniu. Odsetek pacjentów, u których nastąpił dorzut zawału lub zgon w trakcie hospitalizacji, uzyskano z dokumentacji medycznej szpitala.Wyniki: W grupie z wysoką punktacją SxS stwierdzono częstsze występowanie zjawiska no-reflow (odpowiednio 41% i 25,1%;p &lt; 0,001), mniejszą wartość frakcji wyrzutowej (odpowiednio 38,2 ± 7,5% i 44,6 ± 8,8%; p &lt; 0,001) oraz większy odsetek dorzutów zawału (odpowiednio 9,5% i 7,3%; p = 0,037) i zgonów (odpowiednio 0,9% i 0,2%; p = 0,021) w trakcie hospitalizacji w porównaniu z grupą charakteryzującą się niską punktacją SxS. W wieloczynnikowej analizie regresji logistycznej uwzględniającej zmienne kliniczne punktacja SxS była niezależnym czynnikiem predykcyjnym zjawiska no-reflow (OR 1,081; 95% CI 1,032–1,133; p = 0,001).Wnioski: Skala SYNTAX jest przydatnym narzędziem umożliwiającym prognozowanie powikłań wewnątrzszpitalnych u chorych z STEMI poddanych pPCI