p Factor V Leiden but not the factor II 20210G>A mutation is a risk factor for premature coronary artery disease: a case-control study in Iran

Background: Factor V Leiden (FVL) and factor II c.*97G>A (rs1799963) are genetic risk factors for venous thromboembolism. Their contribution to coronary artery disease (CAD) is less clear. Objectives: This study aimed to investigate the association between FVL, rs1799963, and premature CAD in Iranians.Methods: We performed a genetic case-control study of 944 cases and 1081 controls from the premature CAD Milano-Iran study, including patients aged 18-55 (female) and 18-45 years (male) who underwent coronary angiography at the Tehran Heart Centre (Iran) in 2004-2011. Cases had luminal stenosis & GE;50% in at least 1 main coronary ar-tery or branch. Controls were age-and sex-matched with no CAD history. FVL and rs1799963 were genotyped using TaqMan SNP genotyping assays. Association was tested by logistic regression adjusted for matching factors and ethnicity. Effect modi-fication by sex and cardiovascular risk factors (metabolic [obesity, hypertension, hyperlipidemia, and diabetes], and smoking) was assessed.Results: The risk of premature CAD was increased by 50% in FVL carriers (adjusted odds ratio [adjOR] 1.54 [95% CI, 0.95-2.48]) and slightly reduced in rs1799963 carriers (adjOR 0.71 [95% CI, 0.40-1.27]). These effects were more pronounced in women than men (FVL, adjOR 1.66 vs 1.25; rs1799963, adjOR 0.60 vs 1.07). The risk of premature CAD was substantially increased in carriers of FVL with at least 1 metabolic risk factor compared with noncarriers without metabolic risk factors (adjOR 25.14 [95% CI, 12.51-50.52]).Conclusion: FVL but not FII rs1799963 was associated with an increased risk of CAD in young Iranians. This risk increased considerably when combined with metabolic car-diovascular risk factors.Clinical epidemiolog

The impact of a dedicated coronavirus disease 2019 primary angioplasty protocol on time components related to ST-segment elevation myocardial infarction management in a 24/7 primary percutaneous coronary intervention�capable hospital

Background Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST-segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID-19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols. aims We aimed to investigate the impact of our dedicated COVID-19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study. methods Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real-time reverse transcriptase�polymerase chain reaction (rRT-PCR) tests were performed in patients suspected of having COVID-19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019. results Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT-PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID-19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70-day mortality rate before and during the pandemic was 2.73 and 4.49, respectively (P = 0.4). conclusions The implementation of the dedicated COVID-19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short-term clinical outcomes, and staff safety as in the prepandemic era. Copyright by the Author(s), 2020

Factors Associated with Anxiety in Premature Coronary Artery Disease Patients : THC-PAC Study

Anxiety may negatively affect the course of coronary artery disease (CAD). The aim of this study was to assess which factors are associated with anxiety in young adults with CAD. A cohort of individuals with premature coronary artery disease was formed between 2004-2011, as the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Patients (men 6445-year-old, and women 6455-year-old) were visited between March 2013 and February 2014. All participants were examined, and their demographic, clinical, and laboratory data were collected. Then, all participants filled in the Beck Anxiety Inventory. Logistic regression models were used to identifying factors related to anxiety in both sexes. During the study, 708 patients (mean [SD] age: 45.3 [5.8] y, men:48.2%) were visited. Anxiety was present in 53.0% of participants (66.0% of women and 39.0% of men). The logistic regressions model showed that the associated factors for anxiety in men were opium usage (OR=1.89, 95% CI: 1.09-3.27), positive family history (OR=1.49, 95% CI:0.94-2.35), and creatinine serum level (OR=1.17, 95% CI:1.05-1.303); and in women were major adverse cardiac events (MACE) during follow-up (OR=2.30, 95% CI:1.25-4.23), hypertension (OR=1.71, 95% CI:1.07-2.73) and the duration of CAD (OR=0.99, 95% CI:0.98-1.00). In premature CAD patients, the determinants of anxiety seem to be different in each sex. Opium usage, positive family history of CAD, and creatinine serum levels in men, and MACE, hypertension, and duration of CAD in women appear the relevant factors in this regard