The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction

Background: The aim of this study is to determine the impact of ratio of contrast volume to glomerular filtration rate (V/GFR) on development of contrast-induced nephropathy (CIN) and long-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 645 patients with STEMI undergoing primary PCI was prospectively enrolled. CIN was defined as an absolute increase in serum creatinine > 0.5 mg/dL or a relative increase > 25% within 48 h after PCI. The study population was divided into tertiles based on V/GFR. A high V/GFR was defined as a value in the third tertile (> 3.7). Results: Patients in tertile 3 were older, had higher rate of smoking, diabetes mellitus and CIN, lower left ventricular ejection fraction, hemoglobin, and systolic and diastolic blood pressure compared to tertiles 1 and 2 (p < 0.05). V/GFR was found an independent predictor of in-hospital and 6-month mortality. We found 2 separate values of V/GFR for 2 different end points. While the ratio of 3.6 predicted in-hospital mortality with 78% sensitivity and 82% specificity, the ratio of 3.3 predicted 6-month mortality with 71% sensitivity and 76% specificity. Survival rate decreases as V/GFR increases both for in-hospital and during 6-month follow-up. Diabetes mellitus and multivessel disease were other predictors of in-hospital mortality. Conclusions: High V/GFR level is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing primary PCI.

The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: A four-year prospective study

Background: Red cell distribution width (RDW) is an indicator of erythrocyte in different size, and its prognostic value has been demonstrated in numerous cardiac and non-cardiac diseases. The purpose of this study was to evaluate the predictive value of RDW on the long- -term cardiovascular events in patients undergoing primary percutaneous coronary intervention (PCI). Methods: Ninety-six consecutive patients (mean age 60.6 ± 12.5 years, 77.1% male) with ST-segment elevation myocardial infarction (STEMI), who were treated with primary PCI, were analyzed prospectively. Baseline RDW and high sensitive C-reactive protein (hs-CRP) were measured. The patients were followed up for major adverse cardiac events (MACE) for up to 48 months after discharge. Results: There were 30 patients with long-term MACE (Group 1) and 66 patients without long-term MACE (Group 2). Age, admission RDW, hs-CRP and creatine kinase-MB levels, heart rate after PCI, previously used angiotensin converting enzyme inhibitor, left anterior descending artery lesion, and electrocardiographic no-reflow were higher in Group 1. Admission hemoglobin levels were lower in Group 1. An RDW level ≥ 13.85% measured on admission had 80% sensitivity and 64% specificity in predicting long-term MACE on receiver-operating characteristic curve analysis. In multivariate analyses, only admission RDW (HR 5.26, < 95% CI 1.71–16.10; p = 0.004) was an independent predictor of long-term MACE. Conclusions: A high baseline RDW value in patients with STEMI undergoing primary PCI is independently associated with increased risk for long term MACE

Increased mean platelet volume associated with extent of slow coronary flow

Background: Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices. Methods: In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF. Results: Among the 147 patients (mean age 52.7 ± 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 ± 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15–10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99–12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43–8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22–2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43–4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05–4.33, p = 0.03) was identified as an independent correlate of extent of SCF. Conclusions: Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF

Acute alcohol intake and QT dispersion in healthy subjects.

Objective: QT dispersion (QTd) is the maximal interlead difference in the QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in patients with various cardiac diseases and reflects cardiac autonomic imbalance. Variability of QT duration among the 12 surface ECG leads expresses electrical instability and greater susceptibility to malignant ventricular arrhythmias. Electrophysiological studies have shown that heavy episodic drinking facilitates the induction of ventricular tachyarrhythmias in some heavy drinkers. However, the association between QTd and acute alcohol intake has not been studied previously in healthy subjects. Method: In a randomized crossover study, 10 healthy male volunteers (average [SD] age 30 [2.1] years, range: 25-33) received either alcohol (six 12-oz cans of beer) or placebo (juice). The alcohol group consumed 0.97 [0.12] g/kg body weight ethanol, and the placebo group consumed the same amount of juice in a 1-hour period. After a 48-hour washout period, the alcohol group drank juice, and the juice group drank alcohol. QTd and corrected QTd (cQTd) were measured in a baseline ECG after the alcohol period (AP) and after the juice period (JP). Results: In comparison with baseline ECG (31.7 [9.4] ms), QTd values after AP (42.1 [10.8] ms) were significantly prolonged (p = .027), but this was not so after JP (33.8 [7.1] ms; p = NS). Also in comparison with baseline ECG (35.7 [11.1] ms), cQTd values after the AP (49.8 [12.7] ms) were significantly prolonged (p = .005), but again, this was not so after the JP (36.8 [7.3] ms; p = NS). Conclusions: Heavy episodic drinking is associated with an increase in QTd and cQTd

Acute alcohol intake and QT dispersion in healthy subjects

Objective: QT dispersion (QTd) is the maximal interlead difference in the QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in patients with various cardiac diseases and reflects cardiac autonomic imbalance. Variability of QT duration among the 12 surface ECG leads expresses electrical instability and greater susceptibility to malignant ventricular arrhythmias. Electrophysiological studies have shown that heavy episodic drinking facilitates the induction of ventricular tachyarrhythmias in some heavy drinkers. However, the association between QTd and acute alcohol intake has not been studied previously in healthy subjects. Method: In a randomized crossover study, 10 healthy male volunteers (average [SD] age 30 [2.1] years, range: 25-33) received either alcohol (six 12-oz cans of beer) or placebo (juice). The alcohol group consumed 0.97 [0.12] g/kg body weight ethanol, and the placebo group consumed the same amount of juice in a 1-hour period. After a 48-hour washout period, the alcohol group drank juice, and the juice group drank alcohol. QTd and corrected QTd (cQTd) were measured in a baseline ECG after the alcohol period (AP) and after the juice period (JP). Results: In comparison with baseline ECG (31.7 [9.4] ms), QTd values after AP (42.1 [10.8] ms) were significantly prolonged (p = .027), but this was not so after JP (33.8 [7.1] ms; p = NS). Also in comparison with baseline ECG (35.7 [11.1] ms), cQTd values after the AP (49.8 [12.7] ms) were significantly prolonged (p = .005), but again, this was not so after the JP (36.8 [7.3] ms; p = NS). Conclusions: Heavy episodic drinking is associated with an increase in QTd and cQTd