Is atrial fibrillation a risk factor for contrast-induced nephropathy in patients with ST-elevation myocardial infarction?

PubMedID: 26589269Background: Contrast-induced nephropathy (CIN) is an iatrogenic problem in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Atrial fibrillation (AF) may also contribute to impaired kidney function. Several factors may contribute to the development of CIN. In patients with STEMI, concomitant AF is associated with higher in-hospital/follow-up mortality and morbidity. Therefore, we aimed to investigate the relationship between AF and CIN developments. Methods: In this study, 650 consecutive STEMI patients treated with PPCI were enrolled. Patients with AF at admission who did not achieve a sinus rhythm during 48 h after hospitalization were defined as AF patients. CIN was defined by an increase in serum creatinine by >25% or 0.5 mg/dL within 72 h following contrast media exposure. Results: Our patients were divided into two groups based on whether they had AF, and although warfarin usage was different, the other parameters were similar between the groups. When our patients were grouped according to CIN development [group 1: CIN (+), group 2: CIN (-)], creatinine levels prior to PPCI (p = 0.020), estimated glomerular filtration rate (eGFR) prior to PPCI (p < 0.001), left ventricular ejection fraction (LVEF) (p = 0.011), AF (p < 0.001), and warfarin usage (p = 0.016) were different between the two groups. We also performed multivariate logistic regression analyses and found that AF [odds ratio (OR), 6.945; 95% confidence interval (CI), 2.789-17.293; p < 0.001], eGFR (OR, 0.973; 95% CI, 0.957-0.989; p = 0.001), and LVEF (OR, 0.963; 95% CI, 0.935-0.991; p = 0.010) independently predicted CIN development in patients with STEMI. Conclusions: The risk factors for CIN are multifactorial and identifying high-risk patients is the most important step for prevention. In addition to traditional risk factors, AF can contribute to CIN development in patients with STEMI. © 2015 Japanese College of Cardiology

Use of the neutrophil to lymphocyte ratio for prediction of in-stent restenosis in bifurcation lesions

PubMedID: 26044233OBJECTIVE: Percutaneous coronary interventions (PCI) are the preferred treatment for coronary artery disease, even though the development of in-stent restenosis (ISR) continues to be an important complication. Neutrophil to lymphocyte ratio (NLR) is indicative of the inflammatory process and can predict the short- and long-term prognosis of cardiovascular diseases. We investigated the relationship between ISR development and neutrophil-lymphocyte ratio (NLR) in bifurcation lesions in stable coronary artery disease (CAD) patients. PATIENTS AND METHODS: We analyzed the clinical and angiographic data of 181 consecutive stable CAD patients who had undergone successful PCI to the true bifurcation lesion from January 2010-December 2012. Patients were divided into two groups based on the development of ISR (group 1, ISR-; group 2, ISR +). RESULTS: NLRafter(p &lt; 0.001) and NLRNLR?(p &lt; 0.001) were significantly higher in group 2. NLRNLR?was found to be significant independent predictor of ISR in the multivariate logistic regression analysis. A NLRNLR?level &gt; 0.58 mg/dL had 81.8% sensitivity and 93.5% specificity for the prediction of ISR, as identified by the ROC curve. A NLRafter level &gt; 3.43 predicted ISR with 45.5% sensitivity and 95.8% specificity. The comparison of ROC curve analysis demonstrated that NLRNLR?was the strongest independent predictor of ISR (p = 0.001). CONCLUSIONS: As a result, although drug eluting stent implantation is known to be recommended in the bifurcation lesion PCI in worldwide, we want to emphasize the usage of the NLR values in the prediction of ISR. So, we think that NLRNLR?levels may be a useful marker for the prediction of ISR in patients who undergo bifurcation PCI

Relationship of platelet indices with acute stent thrombosis in patients with acute coronary syndrome

Introduction: Despite major advances in stent technology and antithrombotic therapy, the development of stent thrombosis continues to be a major problem in patients who have undergone percutaneous coronary intervention (PCI). Although a few studies have investigated the relationship between early stent thrombosis and platelet activity, the relationship between acute stent thrombosis (AST) (within the first 24 h) and platelet indices is unclear. Aim: We investigated the relationship between AST development and platelet indices in acute coronary syndrome patients. Material and methods: In our case-control study, 33 patients who underwent PCI with subsequent AST development and 59 patients without AST were selected by propensity analysis. We compared the clinical, angiographic, and laboratory data between the AST and control groups. Results: Mean platelet volume (MPV) (p = 0.002) and platelet distribution width (p = 0.014) were significantly higher and platelet count (p = 0.017) was significantly lower in the AST group. Logistic regression analyses showed that MPV was a significant independent predictor of AST (OR = 1.67; 95% CI: 1.11-2.51; p = 0.013). In the ROC analyses, the cut-off value of MPV to detect AST was > 9.1 fl with a sensitivity of 90.9%, a specificity of 42.4%, a positive predictive value of 46.9% and a negative predictive value of 89.3% (AUC: 0.687, 95% CI: 0.582-0.780, p = 0.001). Conclusions: Our study shows that baseline MPV predicts the development of AST in patients with ACS. Mean platelet volume therefore might be an easily accessible marker in the identification of patients at high risk for the development of AST

Increased ventricular pacing threshold levels in patients with high serum uric acid levels

PubMedID: 24560275Background: Permanent cardiac pacemakers (PCM) are accepted as the most effective treatment for symptomatic bradyarrhythmias. Serum uric acid (UA) levels are associated with various inflammatory markers, oxidative stress, and endothelial dysfunction. This study aimed to investigate the association between serum UA and ventricular pacing threshold (VPT) levels in patients who underwent permanent pacemaker implantation. Materials and methods: We retrospectively analyzed a total of 198 patients who underwent PCM implantation for indications such as symptomatic bradycardia without a reversible etiology and high-degree and complete atrioventricular block. Results: VPT values were found to correlate with serum UA levels ( r= 0.591, p < 0.001), high sensitivity C-reactive protein (hs-CRP) levels (r= 0.505, p< 0.001), and ventricular impedance (r= 0.220, p= 0.016). The serum UA levels and hs-CRP levels were also correlated (r= 0.691, p < 0.001). To identify independent risk factors for VPT values, a multivariate linear regression model was conducted, and serum UA levels (ß= 0.361, p= 0.001), hs-CRP levels (ß= 0.277, p= 0.012), and impedance values (ß= 0.207, p= 0.011) were found to be independent risk factors for VPT. Conclusion: In the present study, VPT values at the time of implantation and at the 30th day were increased in patients with high serum UA levels. To further extend the life of pacemakers, as well as other factors that affect threshold values, serum UA levels should be noted. © 2014 Japanese College of Cardiology