Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study.

Background High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality. Objective We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran. Methods We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed. Results The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions. Conclusion Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men

Novel Scoring System for Prediction of Cardiac Syndrome X in Women with Typical Angina and a Positive Exercise Tolerance Test

A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population. Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it. The derivation dataset (809 patients) was calibrated by uing a Hosmer-Lemeshow goodness-of-fit test (8 degrees of freedom; χ2=12.9; P=0.115), and the area under the curve was 0.758. The validation dataset (167 patients) was calibrated in the same way (8 degrees of freedom; χ2=9.0; P=0.339), and the area under the curve was 0.782. Independent predictors of CSX were age \u3c55 years; negative histories of smoking, diabetes mellitus, hyperlipidemia, hypertension, or familial premature coronary artery disease; and highly positive ETTs. A total score \u3e9.5 was the optimal cutoff point for differentiating CSX from obstructive coronary artery disease. Our proposed scoring system is a simple, objective, and accurate system for distinguishing CSX from obstructive coronary artery disease in women with typical angina and positive ETTs. It may help determine which of these patients need invasive coronary angiograms or noninvasive tests like computed tomographic coronary angiography

The SYNTAX score can predict major adverse cardiac events following percutaneous coronary intervention

Objectives: The SYNTAX score is a grading system that evaluates the complexity and prognosis of patients undergoing percutaneous coronary intervention (PCI). We investigated the association between the incidence of major adverse cardiac events (MACE) following PCI and the SYNTAX score in patients with three-vessel disease. Methods: We consecutively enrolled 381 patients with three-vessel disease undergoing PCI and stenting. The SYNTAX score was divided into tertiles as low (≤16), intermediate (16-22) and high (>22). The endpoint was the incidence of MACE defined as cardiac death, in-hospital mortality, nonfatal myocardial infarction (MI), or target vessel revascularization. Then, the incidence of MACE was compared among the SYNTAX score tertile groups. Results: The median follow-up was 14 months, and the rate of MACE was 12.6%. The rates of MACE were 7.5%, 9.9%, and 21.6% in patients with low, intermediate, and high SYNTAX score tertiles, respectively. Higher SYNTAX scores significantly predicted a higher risk of MACE (hazard ratio = 2.36; P = 0.02) even after adjustment for potential confounders. The main predictors of MACE were SYNTAX score, advanced age, hyperlipidemia, presentation as recent ST-elevation MI, number of total lesions, and history of renal failure. Conclusion: The SYNTAX score could predict major cardiac outcomes following PCI in patients with three-vessel disease

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

Short-term Outcomes and Mid-term Follow-up After Coronary Angioplasty in Patients Younger Than 40 Years of Age

Background: Stenting is currently the standard of care in percutaneous coronary intervention (PCI). Whether young patients remain at increased risk after PCI in the present stent era has not been investigated widely. We evaluated angiographic characteristics and short- and mid-term outcomes in patients younger than 40 years of age who underwent PCI. Methods: From April 2003 to March 2005, prospective data were collected in 118 consecutive patients, who were less than 40 years of age and underwent PCI at our referral center. The PCI outcomes in these patients were compared to those in 354 patients, randomly selected from 2493 patients older than 40 years of age in our database. Follow-up was scheduled at 1 month, 5 months, and 9 months through clinic visits, telephone interviews, and reviewing hospital records. Results: Patients<40 years of age were more often male (91.5% vs. 71.8%, P<0.001), current smokers (33.9% vs. 15.2 %, P<0.001), and had more family history of coronary artery disease (38.1% vs. 21.8%, P<0.001) and myocardial infarction (44.1 vs. 31.1, p=0.01), while diabetes mellitus (6.8% vs. 22.1%, P<0.001), hypertension (13.6% vs. 35.3%, P<0.001), and hyperlipidemia (34.7% vs. 44.8%, P=0.055) were less common in these patients. There were no significant differences between the two groups regarding vessel involvement, reference vessel diameter, stenosis rate (before and after procedure), and lesion characteristics, with an exception that angulated lesions were more common in the patients≤ 40 years of age (P<0.05). The young patients, who underwent PCI, presented more frequently with single-vessel disease (61% vs. 46%, P=0.01).The vessel and lesion sites of PCI and clinical success rates were similar in these age groups. Usage of stent was high and similar, and drug- eluting stent use was not significantly different between the two groups. With a high procedural success (94.9% vs. 91.8%), intra-hospital and late complications were very low and similar in both groups. Conclusion: Percutaneous coronary intervention is a safe and effective procedure for young patients, and major adverse cardiac events are similar in young and older patients

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.   

Comparison of cardiovascular risk factors and biochemical profile in patients with cardiac syndrome X and obstructive coronary artery disease: A propensity score-matched study

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 BACKGROUND: This study was designed to compare the frequency of conventional cardiovascular disease risk factors and clinical biochemistry profile in patients with cardiac syndrome X (CSX) and obstructive coronary artery disease (CAD). METHODS: A cross-sectional study was conducted on patients with typical angina and positive exercise tolerance test undergoing coronary angiography in our center. 342 consecutive patients with CSX were enrolled into this study and were matched regarding age and sex with 342 patients with acute coronary syndrome (ACS) and also 342 patients with chronic stable angina (SA). Cardiovascular risk factors as well as biochemistry profile of the patients were recorded. RESULTS: Mean age of the studied patients was 53.0 years and 41.5% were male. There was no significant difference between the CSX patients and CAD patients regarding body mass index (BMI). Frequency of diabetes mellitus, hyperlipidemia, smoking, family history of premature CAD and hypertension was significantly lower in patients with CSX than ACS and SA patients. Patients with CSX had significantly higher levels of high-density lipoprotein cholesterol (HDL-cholesterol) than comparators while the levels of low-density lipoprotein cholesterol (LDL-cholesterol), total cholesterol, triglyceride and fasting blood sugar (FBS) were significantly lower in patients with CSX than CAD patients. CONCLUSION: The present study demonstrated that CSX patients had substantially lower frequency of all conventional CVD risk factors than patients with obstructive CAD. This might aid in developing novel scoring systems or appropriateness criteria for angiographic evaluation of patients with typical angina and positive exercise test in order to reduce the rate of negative results. &nbsp; Keywords: Cardiac Syndrome X, Microvascular Dysfunction, Coronary Artery Disease, Risk Factors&nbsp;&nbsp; <w:LsdException Locked="false" Priority="0" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name

Percutaneous Mitral Valve Repair with the Edge-to-Edge Technique: Case Series of First Iranian Experience

Mitral regurgitation (MR) is a common valvular lesion in the general population with considerable impact on mortality and morbidity. The MitraClip System (Abbot Laboratories, Abbot Park, IL, USA) is a novel percutaneous approach for treating MR which involves mechanical edge-to-edge coaptation of the mitral leaflets. We present our initial experience with the MitraClip System in 5 patients. In our series, the cause of MR was both degenerative and functional. Two patients received two MitraClips due to unsatisfactory results after the implantation of the first clip. Acute procedural success was seen in 4 patients. Blood transfusion was required for 2 patients. All the patients, except one, reported improvement in functional status during a 2-month follow-up period. Our initial experience with MitraClip implantation indicates that the technique seems feasible and promising with acceptable results and that it could be offered to a broader group of patients in the near future

Artykuł oryginalnyPrzebieg hospitalizacji i rokowanie po zabiegach przezskórnej interwencji wieńcowej z wszczepieniem stentów uwalniających sirolimus i paklitaksel

Background: Drug-eluting stents improved the outcome after percutaneous coronary intervention (PCI), however, there may be significant differences in their safety and efficacy. Aim: To compare the in-hospital and mid-term clinical outcomes of stenting with sirolimus-eluting stents (SES) versus paclitaxel- -eluting stents (PES) for the treatment of coronary artery lesions in our routine practice. Methods: This study was performed on 1311 consecutive patients treated exclusively either with SES or PES in our hospital between March 2003 and March 2007. Patients with acute myocardial infarction (MI) within the preceding 48 hours were excluded. The data were recorded in our computerised database, and analysed with appropriate statistical methods. Results: The frequency of angulated segments and proximal segment tortuosity was higher in the PES group (p = 0.001 and p < 0.001, respectively), while ostial and left anterior descending artery lesions were more frequently treated with SES (p < 0.001 and p = 0.022, respectively). The rate of in-hospital non-Q wave MI was higher in the SES vs. PES group (2.2 vs. 0.7%, p = 0.039). In multivariate analysis, the relationship between type of stent and in-hospital non-Q-wave MI became less significant (p = 0.083). During follow-up, 5 patients in the SES vs. 3 in the PES group died (0.7% in each group, p = 0.749). The frequency of major adverse cardiac events (MACE) and target vessel revascularisation (TVR) in the SES vs. PES group was similar (5.5 vs. 3.3%, p = 0.138, and 2.9 vs. 1.6%, p = 0.213, respectively). In multivariate analysis, reference vessel diameter was an independent predictor of both TVR (HR = 0.170, 95% CL 0.034-0.837, p = 0.029) and MACE (HR = 0.333, 95% CL 0.120-0.925, p = 0.035). Conclusion: During mid-term follow-up, sirolimus-eluting stents and paclitaxel-eluting stents demonstrate similar clinical outcomes.Wstęp: Wprowadzenie stentów powlekanych substancjami antyproliferacyjnymi zrewolucjonizowało leczenie inwazyjne choroby wieńcowej poprzez zmniejszenie częstości epizodów restenozy i potrzeby rewaskularyzacji oraz częstości występowania niekorzystnych zdarzeń sercowych (MACE). Cel: Ocena przebiegu hospitalizacji i rokowania u chorych poddanych planowanemu zabiegowi przezskórnej interwencji wieńcowej (PCI) z implantacją dwóch różnych typów stentów powlekanych: uwalniających sirolimus (SES) i paklitaksel (PES). Metody: Grupę badaną stanowiło 1311 kolejnych chorych poddanych zabiegowi PCI z implantacją SES (grupa SES) lub PES (grupa PES) w okresie od marca 2003 do marca 2007 r. Z badania wykluczono chorych z ostrym zawałem serca (MI), który wystąpił w czasie do 48 godz. od zabiegu PCI. Wyniki: Grupy SES i PES różniły się co do anatomii zmian w tętnicach wieńcowych poddanych PCI. W grupie PES częściej występowały zmiany w zagięciach tętnic i w odcinkach proksymalnych (odpowiednio 15,9 vs 7,2%, p = 0,001, oraz 46,4 vs 27,1%, p < 0,001), natomiast w grupie SES częściej występowały zmiany w ujściach tętnic i w gałęzi przedniej zstępującej lewej tętnicy wieńcowej (odpowiednio 7,2 vs 4%, p = 0,022; oraz 80,2 vs 69,1%, p < 0,001). W grupie SES w trakcie hospitalizacji częściej stwierdzano MI bez załamka Q (2,2 vs 0,7%, p = 0,039), ale związek pomiędzy typem wszczepionego stentu a wystąpieniem MI bez załamka Q w trakcie hospitalizacji, w analizie wieloczynnikowej, nie był istotny statystycznie (p = 0,083). W trakcie obserwacji odległej (średnio 16,7 &#177; 7 miesięcy) zmarło 5 chorych w grupie SES i 3 w grupie PES (p = 0,749). Częstość występowania MACE i konieczności ponownej rewaskularyzacji naczynia docelowego (TVR) była podobna w grupie SES i PES (odpowiednio 5,5 vs 3,3%, p = 0,138, oraz 2,0 vs 1,6%, p = 0,213). W analizie wieloczynnikowej średnica referencyjna naczynia była niezależnym predyktorem TVR (HR 0,170, 95% CL 0,034-0,837, p = 0,029) i wystąpienia MACE (HR 0,333, 95% CL 0,120-0,925, p = 0,035). Wnioski: W średnioterminowej obserwacji odległej skuteczność kliniczna implantacji SES i PES jest podobna

In-hospital and mid-term clinical outcomes after percutaneous coronary intervention with the use of sirolimus- or paclitaxel-eluting stents

Background: Drug-eluting stents improved the outcome after percutaneous coronary intervention (PCI), however, there may be significant differences in their safety and efficacy. Aim: To compare the in-hospital and mid-term clinical outcomes of stenting with sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) for the treatment of coronary artery lesions in our routine practice. Methods: This study was performed on 1311 consecutive patients treated exclusively either with SES or PES in our hospital between March 2003 and March 2007. Patients with acute myocardial infarction (MI) within the preceding 48 hours were excluded. The data were recorded in our computerised database, and analysed with appropriate statistical methods. Results: The frequency of angulated segments and proximal segment tortuosity was higher in the PES group (p = 0.001 and p <0.001, respectively), while ostial and left anterior descending artery lesions were more frequently treated with SES (p <0.001 and p = 0.022, respectively). The rate of in-hospital non-Q wave MI was higher in the SES vs. PES group (2.2 vs. 0.7%, p = 0.039). In multivariate analysis, the relationship between type of stent and in-hospital non Q-wave MI became less significant (p = 0.083). During follow-up, 5 patients in the SES vs. 3 in the PIES group died (0.7% in each group, p = 0.749). The frequency of major adverse cardiac events (MACE) and target vessel revascularisation (TVR) in the SES vs. PIES group was similar (5.5 vs. 3.3%, p = 0.138, and 2.9 vs. 1.6%, p = 0.213, respectively). In multivariate analysis, reference vessel diameter was an independent predictor of both TVR (HR = 0.170, 95% CL 0.034-0.837, p = 0.029) and MACE (HR = 0.333, 95% CL 0.120-0.925, p = 0.035). Conclusion: During mid-term follow-up, sirolimus-eluting stents and paclitaxel-eluting stents demonstrate similar clinical outcomes