White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction

Background: Increased white blood cell (WBC) count is associated with increased mortality in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate predictive value of admission WBC to mean platelet volume (MPV) ratio (WMR) on prognosis in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. Methods: A total of 2,603 consecutive patients with STEMI who underwent pPCI were recruited for the study. Follow-up data were obtained from digital records, patient files or by telephone interview with patients, family members, or primary care physicians. Results: WMR has the highest area under receiver operating characteristic (ROC) curve and pairwise comparisons of the ROC curves revealed that WMR has the higher discriminative ability for long-term mortality than WBC, MPV, red blood cell distribution with (RDW), WBC-MPV combination, and platelet to lymphocyte ratio and neutrophil to lymphocyte ratio (PLR-NLR) combination in patients undergoing pPCI for STEMI (a WMR value of 1,653.47 was also found as threshold value for mortality with 75.4% sensitivity and 87.3% specificity by ROC curve analysis). Conclusions: Higher WMR value on admission was associated with worse outcomes in patients with STEMI and independently better predicted the long-term mortality than other complete blood count components, such as MPV, RDW, PLR-NLR and WBC-MPV combinations

Unfavorable social determinants of health and risk of mortality in adults with diabetes: findings from the National Health Interview Survey

Introduction Understanding the role of social determinants of health as predictors of mortality in adults with diabetes may help improve health outcomes in this high-risk population. Using population-based, nationally representative data, this study investigated the cumulative effect of unfavorable social determinants on all-cause mortality in adults with diabetes. Research design and methods We used data from the 2013–2018 National Health Interview Survey, linked to the National Death Index through 2019, for mortality ascertainment. A total of 47 individual social determinants of health were used to categorize participants in quartiles denoting increasing levels of social disadvantage. Poisson regression was used to report age-adjusted mortality rates across increasing social burden. Multivariable Cox proportional hazards models were used to assess the association between cumulative social disadvantage and all-cause mortality in adults with diabetes, adjusting for traditional risk factors. Results The final sample comprised 182 445 adults, of whom 20 079 had diabetes. In the diabetes population, mortality rate increased from 1052.7 per 100 000 person-years in the first quartile (Q1) to 2073.1 in the fourth quartile (Q4). In multivariable models, individuals in Q4 experienced up to twofold higher mortality risk relative to those in Q1. This effect was observed similarly across gender and racial/ethnic subgroups, although with a relatively stronger association for non-Hispanic white participants compared with non-Hispanic black and Hispanic subpopulations. Conclusions Cumulative social disadvantage in individuals with diabetes is associated with over twofold higher risk of mortality, independent of established risk factors. Our findings call for action to screen for unfavorable social determinants and design novel interventions to mitigate the risk of mortality in this high-risk population

Treatment of Iatrogenic Aortocoronary Arteriovenous Fistula with Coronary Covered Stent

An 83-year-old man, who underwent coronary artery bypass operation of left internal mammary artery (LIMA) to left anterior descending (LAD) artery, with sequential saphenous vein to the first and second obtuse marginal (OM) branches of circumflex artery 5 years ago and coronary artery stent implantation to right coronary artery 2 months ago, was admitted to the hospital with syncope and chest pain. Aortosaphenous graft selective angiography revealed that first sequential side to side ligation was inadvertently anastomosed to left posterolateral coronary vein with resultant flow into the coronary sinus and distal end to side sequential anastomosis to OM 2 coronary artery which was filling very weakly. In order to close this iatrogenic coronary arteriovenous fistula and to supply saphenous vein flow to OM artery, we decided to implant a graft covered stent into the saphenous vein at the same session

Związek stężenia serglicyny z izolowanym tętniakowatym poszerzeniem tętnic wieńcowych

Background: Serglycin plays an important role in the inflammatory status, but the relationship between coronary artery ectasia (CAE) and serglycin is still unknown. Aim: In this study, we aimed to investigate the association of serglycin level with isolated CAE. Methods: Fifty-two patients with isolated CAE and 35 individuals with normal coronary angiography were included into the study. The Markis classification and number of ectatic coronary arteries were recorded. Plasma serglycin levels were measured. Results: Multivariate logistic regression analysis revealed that serglycin and high-sensitivity C-reactive protein were indepen­dently associated with the presence of CAE. In receiver operating characteristics curve analysis the cut of serglycin level for the prediction of isolated CAE was 13.5, with a sensitivity of 88.5% and a specificity of 84.8%. However, there was no association between serglycin levels and Markis classification. Conclusions: Serglycin levels are significantly and independently higher in patients with CAE.Wstęp: Wiadomo, że serglicyna odgrywa istotną rolę w stanie zapalnym, lecz zależności między tętniakowatym poszerzeniem tętnic wieńcowych (CAE) a serglicyną nadal nie są znane. Cel: Celem badania była analiza związku między stężeniem serglicyny a izolowanym CAE. Metody: Do badania włączono 52 chorych z izolowanym CAE i 35 osób z prawidłowym obrazem tętnic wieńcowych w ko­ronarografii. Określono klasyfikację tętniaków wg Markisa oraz liczbę poszerzonych tętnic wieńcowych. Oznaczono stężenie serglicyny. Wyniki: W analizie regresji logistycznej wykazano, że stężenia serglicyny i białka C-reaktywnego były niezależnie związane z obecnością CAE. W analizie krzywych ROC punkt odcięcia dla prognozowania izolowanego CAE wynosił 13,5, a czułość i swoistość metody — odpowiednio 88,5% i 84,8%. Nie stwierdzono jednak żadnych zależności między stężeniem serglicyny a klasyfikacją wg Markisa. Wnioski: Stężenie serglicyny jest istotnie wyższe u osób z CAE i stanowi niezależny czynnik predykcyjny tego zaburzenia

Zależność między stężeniem albuminy modyfikowanej niedokrwieniem a dobrze rozwiniętym krążeniem obocznym

Background: It is important to determine the grade of the coronary collateral circulation (CCC) in patients with stable coronary artery disease. Aim: In this study, we aimed to investigate the relationship between the ischaemia-modified albumin (IMA) level and good CCC. Methods: A total of 95 patients with coronary angiography and at least one epicardial coronary artery obstruction were included in the study. The Rentrop classification was used with CCC grading, where 0 and 1 were defined as poor collateral, and 2 and 3 were defined as good collateral. The IMA level of the patients was measured using an enzyme-linked immunosorbent assay (ELISA). The receiver–operating characteristic curve was used to show the sensitivity and specificity of IMA levels and the optimal cut-off value for predicting good CCC. Results: The multiple logistic regression analysis revealed that the IMA level in the good CCC group was higher (p &lt; 0.045). Conversely, the high-sensitivity C-reactive protein level was lower in the good CCC group (p &lt; 0.023). We found an IMA cut-off value (4.7 ng/mL) that indicated good CCC level, and this shows good CCC with 70.2% sensitivity and 60.3% specificity. Conclusions: The IMA level could serve as a simple and useful predictor of well-developed CCC.Wstęp: U chorych ze stabilną chorobą wieńcową (CAD) istotne jest ustalenie stopnia rozwoju wieńcowego krążenia obocznego (CCC). Cel: Badanie przeprowadzono w celu oceny zależności między stężeniem albuminy modyfikowanej niedokrwieniem (IMA) a dobrze rozwiniętym CCC. Metody: Do badania włączono 95 chorych z dostępnym wynikiem koronarografii, u których stwierdzono co najmniej jedno zwężenie nasierdziowej tętnicy wieńcowej. Do określenia stopnia CCC używano klasyfikacji Rentropa, w której oceny 0 i 1 oznaczały słabe krążenie oboczne, natomiast 2 i 3 — dobre krążenie oboczne. Stężenie IMA mierzono za pomocą metody immunoenzymatycznej (ELISA). Wyznaczono krzywe ROC w celu określenia czułości i swoistości oznaczania stężeń IMA oraz optymalnej wartości granicznej pozwalającej na predykcję dobrze rozwiniętego CCC. Wyniki: W analizie wielokrotnej regresji logistycznej wykazano, że stężenie IMA było wyższe w grupie z dobrym CCC (p < 0,045). Z kolei stężenie białka C-reaktywnego oznaczane metodą wysokoczułą było niższe u osób z dobrym CCC (p < 0,023). Autorzy określili wartość graniczną stężenia IMA (4,7 ng/ml), która wskazywała na obecność dobrze rozwiniętego CCC z czułością wynoszącą 70,2% i swoistością równą 60,3%. Wnioski: Stężenie IMA może służyć jako łatwy w zastosowaniu i użyteczny predyktor dobrze rozwiniętego CCC

A Practical Method for No-Reflow Treatment

No-reflow is an undesirable result of percutaneous coronary interventions. Vasoactive drug administration at the distal part of the coronary artery is suggested as a therapeutic option for no-reflow treatment. Here, we represent two cases of successful no-reflow management with previously used monorail balloon at the same procedure as a hand-made distal infusion catheter