Zależność między punktacją w skali Gensiniego a rezolucją uniesienia odcinka ST u chorych z ostrym zawałem serca z uniesieniem odcinka ST poddanych pierwotnej przezskórnej interwencji wieńcowej

Background: Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis.Aim: To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI).Methods: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplastyand 60 min after pPCI. ΣSTR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(–), and those with STR(+). Patients were also analysed according to the infarct-related artery.Results: GS-pPCI was significantly higher in patients with STR(–) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = –0.287, p = 0.002). In subgroup analysis, patients in the STR(–) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(–) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03–1.12, p = 0.001 and OR 3.28, 95% CI1.11–9.72, p = 0.03, respectively).Conclusions: GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI. Wstęp: Stan kliniczny chorych, którzy przebyli zawał serca, zależy głównie od skutecznego przywrócenia perfuzji mięśnia sercowego i nasilenia zmian miażdżycowych w naczyniach wieńcowych.Cel: Celem pracy była ocena wartości predykcyjnej punktacji w skali Gensiniego w odniesieniu do rezolucji uniesienia odcinka ST (STR) u osób poddanych pierwotnej przezskórnej interwencji wieńcowej (pPCI) z powodu ostrego zawału serca z uniesieniem odcinka ST (STEMI).Metody: Do badania włączono 114 kolejnych pacjentów (średnia wieku 54 ± 10 lat, 15 kobiet) ze STEMI, u których wykonano — zakończony powodzeniem — zabieg pPCI. Obliczono łączne uniesienie odcinka ST w milimetrach przed angioplastyką i 60 min po pPCI. ΣSTR < 50% uznano za elektrokardiograficzny wskaźnik zjawiska no-reflow. Stopień obciążenia skrzeplinami określono na podstawie koronarografii, a punktację w skali Gensiniego (GS-pPCI) obliczono po przeprowadzeniu pPCI, nie uwzględniając zmiany odpowiedzialnej za powstanie zawału. Pacjentów podzielono na dwie grupy w zależności od STR:STR(–) i STR(+). Chorych analizowano również w zależności od tętnicy odpowiedzialnej za zawał.Wyniki: U pacjentów z STR(–) wartość GS-pPCI była istotnie wyższa (10,1 ± 11,8 vs. 22 ± 18,6; p = 0,005). Stwierdzo noujemną korelację między GS-pPCI i STR (r = –0,287; p = 0,002). W analizie podgrup wykazano ponadto, że u chorych z grupy STR(–), u których zmiana będąca przyczyną zawału (culprit lesion) znajdowała się w gałęzi międzykomorowej przedniej lub gałęzi okalającej, wartości GS-pPCI były wyższe (odpowiednio 10,9 ± 13,5 vs. 23,5 ± 21,3; p = 0,03 i 9,6 ± 8,7 vs. 24,1 ± 21; p = 0,04). U pacjentów z STR(–) częściej stwierdzano również duże obciążenie skrzeplinami (68% vs. 43%, p = 0,03). W wieloczynnikowej analizie regresji logistycznej wykazano, że GS-pPCI i duże obciążenie skrzeplinami były niezależnymi czynnikami predykcyjnymi niedostatecznej STR (odpowiednio, OR 1,07; 95% CI 1,03–1,12; p = 0,001 i OR 3,28; 95% CI 1,11–9,72; p = 0,03).Wnioski: Wartość GS-pPCI i duże obciążenie skrzeplinami są ważnymi czynnikami predykcyjnymi niedostatecznej STR u chorych ze STEMI poddanych pPCI.

The relationship between epicardial adipose tissue and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 +/- A 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (Delta STR) < 70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 +/- A 1.7 vs. 5.4 +/- A 2, p = 0.001). EAT thickness was also found to be inversely correlated with Delta STR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI

Picturing asthma in Turkey: results from the Turkish adult asthma registry

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery

Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

ObjectiveThe older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey.MethodsThe data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire.ResultsOf the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma.ConclusionsHerein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors