Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Increased neutrophil-to-lymphocyte ratio predicts persistent coronary no-flow after wire insertion in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVES: Acute ST-segment elevation myocardial infarction patients presenting persistent no-flow after wire insertion have a lower survival rate despite successful mechanical intervention. The neutrophil-to-lymphocyte ratio has been associated with increased mortality and worse clinical outcomes in ST-segment elevation myocardial infarction. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would also be associated with a persistent Thrombolysis In Myocardial Infarction flow grade of 0 after wire insertion in patients undergoing primary percutaneous coronary intervention. METHODS: A total of 644 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention within 12 hours of symptom onset were included in our study. Blood samples were drawn immediately upon hospital admission. The patients were divided into 3 groups according to their Thrombolysis In Myocardial Infarction flow grade: Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion, Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. RESULTS: The neutrophil-to-lymphocyte ratio was significantly higher in the group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion compared with the group with Thrombolysis In Myocardial Infarction flow grade 1-3 after wire insertion and the group with Thrombolysis In Myocardial Infarction flow grade 1-3 at baseline. The group with Thrombolysis In Myocardial Infarction flow grade 0 after wire insertion also had a significantly higher in-hospital mortality rate. Persistent coronary no-flow after wire insertion was independently associated with the neutrophil-to-lymphocyte ratio. CONCLUSIONS: An increased neutrophil-to-lymphocyte ratio on admission is significantly associated with persistent coronary no-flow after wire insertion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Mitral annular calcification and its severity predict high risk for cardio-embolic stroke in elderly patients with first diagnosed atrial fibrillation

Background: Atrial fibrillation (AF) is the most common arrhythmia worldwide and a large proportion of patients with AF are older than 75 years of age. Mitral annular calcification (MAC), which is usually observed in advanced age, is associated with increased risk of AF and cardio-embolic stroke in the general population. Objectives: This study was performed to assess whether presence of MAC and its severity predict cardio-embolic stroke in elderly patients with first diagnosed AF. Methods: In this cross-sectional study, 72 elderly patients suffering from acute cardio-embolic stroke with first diagnosed AF and 79 elderly control group patients with first diagnosed AF and without stroke were investigated. A parasternal short-axis view at the level of the mitral annulus was used for MAC measurements. The severity of MAC was measured from the anterior to posterior edge at its greatest width. Results: MAC thicknesses were significantly higher in the stroke group. ROC curve analysis showed that a cut point of 2.5 mm for the value of MAC thickness exhibited 68.1% sensitivity and 77.2% specificity for detecting cardio-embolic stroke in elderly patients with AF. In multivariate logistic regression analysis, MAC thickness (OR = 1.173, 95% CI 1.083-1.270; p < 0.001) was found to be independent predictor of cardio-embolic stroke in elderly patients with AF. Conclusion: MAC thickness may provide useful information for the relevant risk evaluation of elderly patients with AF. Pre-stroke MAC presence and its severity appear to have better clinical value for predicting cardio-embolic stroke in elderly patients with AF, independent from traditional risk factors for stroke

Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction

BackgroundRecently, it has been shown that the lymphocyte-to-monocyte ratio (LMR) is a novel inflammatory marker. A decreased LMR is associated significantly with a high risk for vascular endpoints in patients with peripheral arterial disease. We aimed to investigate whether LMR on admission is associated with no-reflow after a primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).Patients and methodsA total of 857 patients (mean age 58.913.1 years, 75.6% men), who were admitted to our hospital for STEMI and undergoing primary PCI within 12h of onset of symptoms, were recruited. LMR was calculated by dividing the lymphocyte count by the monocyte count. The patients were divided into two groups according to the postprocedural thrombolysis in myocardial infarction (TIMI) flows: no-reflow and normal-reflow. No-reflow was defined as a final TIMI flow of 2 or less or final TIMI flow of 3 with a myocardial blush grade of less than 2.ResultsAdmission LMR levels were significantly lower in patients with no-reflow than in patients with normal-reflow (1.85 +/- 1.01 vs. 3.64 +/- 1.74, P<0.001). A receiver-operating characteristic analysis indicated that an LMR value of less than 2.292 and had a 76.3% sensitivity and a 72.5% specificity in predicting no-reflow. Multivariate analysis showed that LMR less than 2.292 [odds ratio (OR) 2.657, P=0.030], Killip class at least 2 at admission (OR 3.442, P=0.039), baseline infarct artery patency (OR 0.260, P=0.004), neutrophil count (OR 1.213, P=0.002), and total stent length (OR 1.059, P=0.001) were independent factors for predicting no-reflow.ConclusionOur results suggested that LMR could be a simple and useful marker to predict high risk of patients for no-reflow in patients with STEMI who underwent primary PCI. (C) 2015 Wolters Kluwer Health, Inc. All rights reserved

The relationship between lymphocyte-to-monocyte ratio and saphenous vein graft patency in patients with coronary artery bypass graft

Aim: A lower lymphocyte count and a high monocyte count give important clues about the prognosis of various cardiovascular diseases. We hypothesized that lymphocyte-to-monocyte ratio (LMR) was associated with the saphenous vein graft disease (SVGD) in patients with coronary artery bypass graft (CABG). Patients & methods: A total of 218 patients with previous history of CABG surgery, who underwent coronary angiography due to stable angina symptoms, were investigated, retrospectively. Results: LMR levels were significantly lower in the SVGD group. Multiple logistic regression analyses showed that LMR levels were independent predictors of SVGD (OR: 0.648; 95% CI: 0.469-0.894; p = 0.008). Conclusion: Our results suggested that LMR levels may provide useful information for the relevant risk evaluation of SVGD in CABG patients

Zależność między stężeniem fibrynogenu w osoczu a zaawansowaniem i rozległością zmian w naczyniach wieńcowych u pacjentów z ostrym zespołem wieńcowym

Background: High Syntax score (SXscore) is associated with more serious disease and worse prognosis in patients with acute coronary syndrome (ACS). Plasma fibrinogen levels are associated with poor cardiovascular outcomes. Aim: To investigate the relation of admission fibrinogen levels with intermediate-high SXscore in patients with ACS. Methods: A total of 752 patients (61.6 ± 12.8 years, 67.3% men) with ACS, who underwent urgent coronary angiography (CAG) were enrolled. Laboratory data including fibrinogen and high sensitivity C-reactive protein were obtained before CAG. Syntax scores of all patients were calculated from baseline CAG. The patients were divided into two groups: low SXscore (≤ 22) and intermediate-high SXscore (≥ 23). Results: Admission fibrinogen levels were significantly higher in the SXscore ≥ 23 group when compared with the SXscore ≤ 22 group (median 492 mg/dL, interquartile range 428–581 mg/dL vs. median 370 mg/dL, interquartile range 309–428 mg/dL, respectively; p &lt; 0.001). In multivariate analysis, the independent predictors of intermediate-high SXscore were fibrinogen (OR 1.008, 95% CI 1.005–1.010, p &lt; 0.001), left ventricular ejection fraction (OR 0.935, p &lt; 0.001), and age (OR 1.029, p = 0.041). A level of fibrinogen &gt; 417 mg/dL had an 80.0% sensitivity and 71.3% specificity in predicting intermediate-high SXscore. Conclusions: Increased fibrinogen levels are independently associated with intermediate-high SXscore in patients with ACS.Wstęp: Wysoka punktacja w skali Syntax (SXscore) wiąże się z bardziej zaawansowaną chorobą i gorszym rokowaniem u pa­cjentów z ostrym zespołem wieńcowym (ACS). Większe stężenie fibrynogenu koreluje ze zwiększonym ryzykiem zdarzeń sercowo-naczyniowych. Cel: Celem pracy było zbadanie zależności między stężeniem fibrynogenu przy przyjęciu do szpitala a pośrednimi i wysokimi wartościami SXscore u pacjentów z ACS. Metody: Do badania włączono ogółem 752 chorych (61,6 ± 12,8 roku; 67,3% mężczyzn) z ACS, u których wykonano w trybie pilnym koronarografię (CAG). Przed CAG przeprowadzono badania laboratoryjne, w tym zmierzono stężenia fibry­nogenu i białka C-reaktywnego oznaczonego metodą wysokoczułą. U wszystkich chorych obliczono SXscore na podstawie wyjściowej CAG. Chorych podzielono na dwie grupy: osoby z niską punktacją SXscore (≤ 22) i osoby z pośrednią/wysoką punktacją SXscore (≥ 23). Wyniki: Stężenie fibrynogenu przy przyjęciu do szpitala było istotnie wyższe w grupie z punktacją SXscore ≥ 23 niż w grupie, w której punktacja SXscore wynosiła ≤ 22 (odpowiednio: mediana 492 mg/dl, zakres międzykwartylowy 428–581 mg/dl vs. me­diana 370 mg/dl, zakres międzykwartylowy 309–428 mg/dl; p &lt; 0,001). W analizie wieloczynnikowej niezależnymi czynnikami predykcyjnymi pośredniej/wysokiej punktacji SXscore były: stężenie fibrynogenu (OR 1,008; 95% CI 1,005–1,010; p &lt; 0,001), frakcja wyrzutowa lewej komory (OR 0,935; p &lt; 0,001) i wiek (OR 1,029; p = 0,041). Stężenie fibrynogenu &gt; 417 mg/dl pozwalało prognozować pośrednią/wysoką punktację SXscore z czułością wynoszącą 80,0% i swoistością równą 71,3%. Wnioski: Zwiększone stężenia fibrynogenu są niezależnie związane z pośrednimi/wysokimi wartościami SXscore u pacjentów z ACS

Glomerular Filtration Rate is Associated With Burden of Coronary Atherosclerosis in Patients With Acute Coronary Syndrome

We aimed to elucidate the relationship between mild to moderate renal impairements and burden of atherosclerosis in patients with acute coronary syndrome (ACS). A total of 380 patients with ACS were included in the study. Gensini and SYNTAX scores were also calculated. Kidney function was classified based on estimated glomerular filtration rate (eGFR) into stage 1: eGFR > 90, stage 2: 60 to 89, and stage 3: 30 to 60 mL/min per 1.73 m(2). Gensini and SYNTAX scores were higher in stages 2 and 3 than in stage 1. Also, the number of diseased vessels, number of critical lesions (> 50 and 70%), left main disease, and number of total occlusion vessels were higher in stages 2 and 3 than in stage 1. Multivariate linear regression analysis demonstrated that a decreased eGFR was an independent risk factor for SYNTAX and Gensini scores together with age and male gender

Relation Between Mean Platelet Volume and Severity of Atherosclerosis in Patients With Acute Coronary Syndromes

Platelets play a central role in the pathophysiology of coronary artery disease (CAD). Increased mean platelet volume (MPV) is an indicator of platelet function and associated with poor clinical outcome in patients with acute coronary syndrome (ACS). We evaluated the relationship between MPV and severity of CAD in patients with ACS. A total of 395 patients with ACS were included. Severity of CAD was assessed with the Gensini and Syntax scores. High levels of MPV were associated with the Gensini and Syntax scores, number of diseased vessels (> 50%), number of critical lesions (> 50% and > 70%), and noncritical lesions. After multivariate analysis, high levels of MPV were independent predictors of multivessel CAD together with age. In patients with ACS, high MPV levels were associated with severity of CAD. It is possible that MPV can be a helpful marker in patients with CAD for the severity of coronary atherosclerosis