Frequency and Predictors of Renal Artery Stenosis in Patients Undergoing Simultaneous Coronary and Renal Catheterization

Background: Atherosclerotic renal artery stenosis (ARAS) remains underdiagnosed due to its nonspecific demonstrations. We aimed to both estimate the frequency of ARAS in high-risk non-selected patients undergoing simultaneous coronary and renal catheterization and possibly identify a predictive model for ARAS using baseline clinical, laboratory, and coronary angiographic variables. Methods: The records of 866 patients aged ≥ 21 years undergoing simultaneous coronary and renal angiography were retrieved for analysis from our computerized database. The degree of ARAS was estimated visually by experienced attending interventional cardiologists. Lesions with an estimated stenosis of ≥ 50% were considered significant. Multivariable stepwise logistic regression models were used to identify the risk factors predicting the presence and extent of ARAS. Results:  Of a total of 866 consecutive patients undergoing renal angiography in conjunction with coronary angiography (mean age ± SD: 63.06 ± 10.32, ranging from 24 to 89 years), 454 (57%) were men. A total of 345 (39.8%) cases had significant ARAS, 77 (22.3%) of which were bilateral. Using significant ARAS as the dependent variable, six variables were identified as the independent predictors significantly associated with the presence of ARAS, namely age, female sex (male sex was found to be a protector), hypertension, history of renal failure, left anterior descending artery (LAD) stenosis > 50%, and left circumflex artery (LCX) stenosis > 50%. The Gensini score was not found to be a predictor of the presence of ARAS, but it was more likely associated with a trend towards a more extensive ARAS (adjusted OR = 1.00, 95% CI = 1.00-1.01; p value = 0.039). Other independent determinants of the ARAS extent were the same as the predictors of the ARAS presence. Conclusions: Although risk versus benefit was not tested in this study, it seems that clinicians could consider renal catheterization in combination with coronary angiography particularly in female patients with advanced age and with significant coronary artery stenoses in the LAD and LCX

Comparing angiography features of inferior versus anterior myocardial infarction regarding severity and extension in a cohort of Iranian patients

Background: The location of acute myocardial infarction (MI) is an important prognostic factor for risk stratification of patients with first ST-segment elevation MI (STEMI). The main goal of this study was to compare the severity and extension of coronary involvement in inferior and anterior MI. Methods: This study reviewed angiographic reports of 579 patients with a first anterior wall STEMI and 690 with a first inferior STEMI that were referred to Tehran Heart Center between March 2004 and September 2007. The number of coronary vessels involvement and the presence of left main lesion were determined based on angiography reports. The Gensini score was also calculated for each patient from the coronary arteriogram. Results: Incidence of left main lesion was similar between the two groups. Although coronary arteries involvement according to Gensini score was more severe in anterior wall MI group compared with inferior wall MI group, the number of involved coronary arteries was significantly higher in the inferior MI patients. Recommendation of coronary artery bypass grafting, percutaneous coronary intervention (PCI) or medical treatment were the same for both groups; however, patients with anterior MI were treated more with primary PCI. Conclusions: According to our angiography database, despite anterior wall MI is associated with more severity of coronary artery disease; inferior wall MI is more extent with regard to the number of involved coronary vessels. Location of MI can predict the severity and extension of infarction

Synergistic effect of hypertension with diabetes mellitus and gender on severity of coronary ‎atherosclerosis: Findings from Tehran Heart Center Registry, Iran‎

BACKGROUND: We performed this study to evaluate the possible synergism between hypertension and other conventional risk factors of coronary artery disease (CAD) on an angiographic severity of coronary atherosclerosis. METHODS: A cross-sectional study was conducted on 10502 consecutive patients who underwent coronary angiography in the cardiac catheterization laboratory of Tehran Heart Center Hospital (Tehran University of Medical Sciences, Iran), and their conventional risk factors including male gender, hypertension, diabetes mellitus, dyslipidemia, smoking, and family history of premature CAD were recorded. The severity of coronary atherosclerosis evaluated by calculation of Gensini score. Results: All aforementioned conventional risk factors of CAD were independently associated with severity of CAD. Multivariate linear regression analysis demonstrated that hypertension had synergistic effect with male gender [Excess Gensini&rsquo;s score: 5.93, 95% confidence interval (CI): 2.72-9.15, P &lt; 0.001] and also with diabetes mellitus (Excess Gensini&rsquo;s score: 3.99, 95% CI: 0.30-7.69, P = 0.034) on severity of CAD. No interaction was observed between hypertension and smoking, dyslipidemia and also with a family history of CAD. CONCLUSION: Hypertension has a synergistic effect with diabetes mellitus and male gender on the severity of CAD. These findings imply that more effective screening and treatment strategies should be considered for early diagnosis and tight control of hypertension in male and diabetic people for prevention of advanced CAD.&nbsp;</p

Anatomy of Atrioventricular Node Artery and Pattern of Dominancy in Normal Coronary Subjects: A Comparison between Individuals with and without Isolated Right Bundle Branch Block

Background: Isolated right bundle branch block (RBBB) is a common finding in the general population. The atrioventricular node (AVN) artery contributes to the blood supply of the right bundle branch. Our hypothesis was that the anatomy of the AVN artery and the pattern of dominancy differ between subjects with and without RBBB. Methods: We retrospectively studied the coronary angiography of 92 patients with RBBB and 184 age- and gender- matched controls without RBBB. All the subjects had angiographically proven normal coronary arteries. The dominant circulation and precise origin of the AVN artery were determined in each subject. Obtained data were compared between the two study groups. Results: There was no significant difference between the two groups in terms of dominancy (p value = 0.200). Origination of the AVN artery from the right circulatory system was more common in both groups, but this pattern was more prevalent in the cases than in the controls (p value = 0.021). There was a great variation of the AVN artery origin. In the total study population, the AVN artery was more commonly separated from a non crux origin than from the crux area. The prevalence of the non-crux origination of the AVN artery was significantly higher in the cases than in the controls (p value < 0.001). While the origination of the AVN artery from the right circulatory system was more common in both groups, the prevalence of the right origin of the AVN artery was significantly higher in the cases than in the controls. We observed that the AVN artery most commonly originated from the dominant artery but not necessarily from the crux. Conclusion: The anatomy of the AVN artery but not the pattern of dominancy is somewhat different in subjects with RBBBcompared with normal individuals

Using Workload to Predict Left Main Coronary Artery Stenosis in Candidates for Coronary Angiography

Background: Coronary angiography, albeit a safe procedure, may cause serious complications especially in patients with left main stenosis (LMS). This study was designed to investigate the efficacy of workload achieved by exercise tolerance test (ETT) in predicting LMS in candidates for coronary angiography. Methods: A total of 743 patients with a positive ETT who subsequently underwent cardiac catheterization were retrospectively studied. Different risk factors were compared among the patients with and without LMS. A multivariate forward stepwise logistic regression analysis was used to identify the main predictors of LMS.Results: Among our 743 patients, 72% were male and 41(5.5%) had LMS≥50%. Patients with LMS, by comparison with those without LMS, were older and were more likely to be male and had higher percentages of ejection fraction less than 35% (EF≤35%), history of myocardial infarction, and lower metabolic equivalent (METs). After adjusting for important variables, we found that EF≤35%, METs, and the male sex were significant independent predictors of LMS (P<0.0001, P=0.024, and P=0.006, respectively). When the patients were divided into two groups in terms of METs≤7 and METs>7, LMS was found in 8.3% and 3.6%, respectively (P=0.006). The risk of having LMS in the men with METs≤7 was higher than that in those with METs>7 (OR=3, P=0.003, 95% CI=1.50-6.00). Among the patients with LMS, stenosis≥70% was found in 44% in METs≤7 and 18.8% in METs>7. Conclusion: Lower METs correlated with an increased likelihood of significant LMS in the patients, especially if they were male, who had a positive exercise test and were suspected of coronary artery disease. It is, therefore, advisable that patients with METs≤7 receive due attention during coronary angiography

Association between Traditional Risk Factors and CoronaryArtery Ectasia:AStudy on 10057Angiographic Procedures among Iranian Population

Background: Whether coronary artery ectasia (CAE) is a unique clinical finding or results from other clinical entities is still unknown. We aimed to determine the CAE prevalence, investigate the relationship between CAE and patients’ demographic and clinical characteristics, and assess the prognosis at follow-up in a sample of Iranian population. Methods: Totally, 10057 patients who underwent coronary angiography were divided into three categories: normal coronary arteries without co-existing coronary artery disease; CAE without co-existing coronary artery narrowing 50% luminal narrowing (CAS). Results: The prevalence of CAE was 1.5%. Compared to the normal individuals, the CAE patients were older, were more frequently male, and had higher rates of myocardial infarction (MI). The CAE patients had a lower frequency of diabetes and MI than the CAS group. The CAE patients were largely focused between 40 to 60 years of age. The right coronary and left anterior descending arteries were the most involved arteries, and ectasia was located more frequently in the proximal part of these arteries. Patients with ectasia in the three main vessels had higher rates of MI. After a mean follow-up of 54.23 ±18.41 months, chest pain and dyspnea on exertion remained the main complaint in more than 97% of the patients, leading to hospital admission in more than 14%. Conclusion: There was no relationship between the presence of ectasia and conventional risk factors. According to our study, pure CAE may be deemed a benign feature of atherosclerosis; however, it can lead to frequent hospital admissions because of the persistence of cardiovascular symptoms

One-Year Outcome of Everolimus-Eluting Stents versus Biolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention

Background: The biolimus-eluting stent (BES), with a biodegradable polymer, has not been previously compared with the everolimus-eluting stent (EES), as a second-generation drug-eluting stent (DES).We sought to compare the 1-year outcome between the PROMUS™ stent (EES type) and the BioMatrix™ stent (BES type). Methods: From March 2008 to September 2011, all patients treated with the PROMUS™ stent or the BioMatrix™ stent for coronary artery stenosis at Tehran Heart Center were enrolled. The primary end points were 1-year adverse events, comprising death, myocardial infarction, target vessel revascularization, and target lesion revascularization.  The secondary end point was stent thrombosis. The Cox proportional hazard model was used to assess the adjusted association between the stent type and the follow-up outcome. Results: From 949 patients (66.3% male, mean age =59.48 ± 10.46 y) with 1,018 treated lesions, 591 patients (630 lesions, 65.1% male, mean age = 59.24 ± 10.23 y) received the PROMUS™ stent and 358 patients (388 lesions, 68.2% male, mean age = 59.88 ± 10.83 y) were treated with the BioMatrix™ stent. Before adjustment, the rate of the primary end points was 3.2% and 3.4% in the EES and BES, respectively (p value = 0.925, HR (EES to BES) = 1.035, 95% CI: 0.50 to 2.13). The rate of stent thrombosis was 2% and 1.7% in the EES and BES, respectively (p value = 0.698). After adjustment on confounder variables, there was no statistically significant difference in major adverse cardiac events between the PROMUS™ stent and the BioMatrix™ stent (p value = 0.598, HR (EES to BES) = 0.817, 95% CI: 0.39 to 1.73). Conclusion: At 1 year’s follow-up, the BES and EES showed similar safety and efficacy rates in the patients undergoing percutaneous coronary intervention with a relatively low rate of adverse events in the 2 groups.   

Relationship between Body Mass Index and Outcome of Elective Percutaneous Coronary Intervention

Background: Studies have shown controversial effects of obesity on major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). We sought to investigate the impact of the body mass index (BMI) on the mid-term outcome following successful PCI. Methods: Between March 2006 and August 2008, 3948 patients underwent successful elective PCI in Tehran Heart Center, Tehran, Iran, and were retrospectively included in this study. Patients who underwent PCI on the same day as the occurrence of myocardial infarction were excluded. The demographic, procedural, in-hospital, and follow-up information of these patients was extracted from the PCI Data Registry of our institution. The patients were divided into three groups:  normal weight (No. 1058, BMI < 25 kg/m2 age = 58 ± 10 years); overweight (No. 1867, 25 ≤ BMI < 30 kg/m2, age = 57 ± 10 years); and obese (No. 1023, BMI ≥ 30 kg/m2, age = 56 ± 10 years). MACE included death, myocardial infarction, target vessel revascularization, and target lesion revascularization. Results: Compared with the other patients, the obese individuals were significantly younger and more frequently female, had a higher ejection fraction, and more frequently presented with hypertension, diabetes, and hyperlipidemia. There was no association between the BMI and the angiographic and procedural findings in the univariate analysis. While no difference was found in the rate of in-hospital death between the groups, the number of the obese patients undergoing emergent cardiac surgery was marginally different in the univariate analysis (p value = 0.06). At 9 months' follow-up, MACE had occurred in 92 (2.3%) patients and cardiac mortality was 9 (0.2%). After adjustments for confounders, no significant difference was observed in terms of MACE between the BMI groups. Conclusion: The BMI had no significant effect on the rate of MACE at 9 months' follow-up in our study population. Interventionists' recommendations for patients undergoing PCI should, therefore, not be significantly influenced by the BMI status

Comparison of Short-Term Clinical Outcome of Non-ST Elevation versus ST Elevation Myocardial Infarction

Background: Studies on the prognosis of ST elevation myocardial infarction (STEMI) versus non-ST elevation myocardial infarction (non-STEMI) have shown different results. The present study was designed to compare the early outcome and left ventricular systolic function of patients with ST and non-ST elevation myocardial infarction. Methods: The patients' information was derived from 10,065 consecutive patients hospitalized in Tehran Heart Center with acute MI (2007 patients with STEMI and 8058 with non-STEMI). The baseline clinical characteristics, post-MI complications, left ventricular systolic functions, and 30-day mortality rates were compared. Results: A history of current cigarette smoking, opium addiction, and brain stroke was more frequent in the STEMI patients, whereas hyperlipidemia, hypertension, and obesity were found more in the non-STEMI group. Ejection fraction was higher in the non-STEMI patients than that in the STEMI group, and anterior wall infarction was detected more frequently in the STEMI cases. A history of coronary artery bypass grafting and also percutaneous coronary intervention was observed more in the non-STEMI group. Amongst the in-hospital complications, ventricular arrhythmias (1.4 vs. 0.5, P<0.001) and pulmonary edema (0.4 vs. 0.1, P=0.002) were more prevalent in the STEMI cases. The 30-day mortality rate in the STEMI group was higher than that in the non-STEMI group (5.5 vs. 2.4, P<0.001). Early mortality in both groups was dependant on advanced age, diabetes mellitus, post-MI bradycardia, and atrioventricular block. Also, female gender and pulmonary edema in the STEMI group and family history of MI in the non-STEMI patients could predict 30-day mortality. Conclusion: There were several differences in the baseline characteristics and early outcome between the two types of STEMI and non-STEMI. The 30-day mortality rate was higher in the STEMI group than that in the non-STEMI group