Angiographic Indexes Research Articles

Functional assessment of coronary stenosis: alternative hyperemic, nonhyperemic, and angiographic indexes

Functional assessment of coronary stenosis: alternative hyperemic, nonhyperemic, and angiographic indexes

Prognostic Value of Coronary Microvascular Dysfunction Assessed by Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction.

CaIMR is proposed as a novel angiographic index designed to assess microcirculation without the need for pressure wires or hyperemic agents. We aimed to investigate the impact of caIMR on predicting clinical outcomes in STEMI patients. One hundred and forty patients with STEMI who received PCI in Putuo Hospital of Shanghai from October 2021 to September 2022 were categorized into CMD and non-CMD groups according to the caIMR value. The baseline information, patient-related examinations, and the occurrence of MACE at the 12-month follow-up were collected to investigate risk factors in patients with STEMI. We divided 140 patients with STEMI enrolled into two groups according to caIMR results, including 61 patients diagnosed with CMD and 79 patients diagnosed with non-CMD. A total of 21 MACE occurred during the 1 year of follow-up. Compared with non-CMD group, patients with CMD showed a significantly higher risk of MACE. A multivariate Cox regression model was conducted for the patients, and it was found thatcaIMR was a significant predictor of prognosis in STEMI patients (HR: 8.921). Patients with CMD were divided into culprit vascular CMD and non-culprit vascular CMD, and the result found that culprit vascular CMD was associated with the incidence of MACE (OR: 4.75) and heart failure (OR: 7.50). CaIMR is a strong predictor of clinical outcomes and can provide an objective risk stratification for patients with STEMI. There is a strong correlation among leukocyte index, the use of furosemide, Killips classification, and clinical outcomes.

Ultrasound-Facilitated, Catheter-Directed Thrombolysis for Acute Pulmonary Embolism.

Acute pulmonary embolism (APE) poses a significant risk to patient health, with treatment options varying in efficacy and safety. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has emerged as a potential alternative to conventional catheter-directed thrombolysis (CDT) for patients with intermediate to high-risk APE. This study aimed to compare the efficacy and safety of USCDT versus conventional CDT in patients with intermediate to high-risk APE. This observational retrospective study was conducted at the Armed Forces Hospital, Al-Hada, Taif, the Kingdom of Saudi Arabia (KSA), on 135 patients diagnosed with APE and treated with either USCDT or CDT (58 underwent CDT, while 77 underwent USCDT). The primary efficacy outcome was the change in the right ventricle to the left ventricle (RV/LV) diameter ratio.Secondary outcomes included changes in pulmonary artery systolic pressure and the Miller angiographic obstruction index score. Safety outcomes focused on major bleeding events. Both USCDT and CDT significantly reduced RV/LV diameter ratio (from 1.35 ± 0.14 to 1.05 ± 0.17, P < 0.001) and systolic pulmonary artery pressure (SPAP) (from 55 ± 7 mmHg to 38 ± 7 mmHg, P < 0.001) at 48- and 12-hours post-procedure, respectively, with no significant differences between treatments. However, USCDT was associated with a significantly lower rate of major bleeding events compared to CDT (0% vs. 3.4%, P = 0.008). Multivariate logistic regression analysis revealed that USCDT was associated with a 71.9% risk reduction of bleeding (OR = 0.281, 95% CI = 0.126 - 0.627, P = 0.002). USCDT is a safe and effective alternative to CDT for the treatment of intermediate to high-risk APE, as it significantly reduces the risk of major bleeding.

The correlation between the CT angiographic pulmonary artery obstructive index and clinical data in patients with acute pulmonary thromboembolism.

The potentially fatal consequences of pulmonary embolism emphasize the need for more effective diagnostic methods. The Qanadli obstruction index has been described as a convenient tool for risk stratification to determine and quantify the degree of obstruction. This study aimed to assess the correlations between the Qanadli index with clinical and paraclinical findings (D-dimer, troponin, and echocardiographic findings) in patients with pulmonary embolism. A total of 102 patients with pulmonary embolism underwent echocardiography and CT pulmonary angiography at a single tertiary referral center between 2019 and 2020. The clinical and paraclinical findings, pulmonary arterial obstruction index, atrial measurements, right and left ventricle size and function, tricuspid annular plane systolic excursion, pulmonary artery pressure, and pulmonary hypertension (PH) were analyzed. Vital signs were recorded and assessed. The Qanadli index score was measured, and graded risk stratification was measured based on the quantified index score. The total mean Qanadli index was 28.75 ± 23.75, and there was no significant relationship between the Qanadli index and gender. Patients' most common clinical findings were exertional dyspnea (84.3%; n = 86) and chest pain (71.7%; n = 73). There were significant correlations between the Qanadli index and pulse rate (PR), troponin, D-dimer levels, and PH. Four patients died during the study, including one from a cardiac condition and three with non-cardiac conditions. It is possible to determine the severity, prognosis, and appropriate treatment by the Qanadli index based on strong correlations with PR, troponin, D-dimer levels, and PH.

A novel coronary angiographic index for predicting correlation between fractional flow reserve and resting full-cycle ratio.

The discordant results between fractional flow reserve (FFR) and resting full-cycle ratio (RFR) and the influence of angiographic characteristics on their correlation have not been sufficiently investigated. We aimed to identify angiographic characteristics that can predict FFR and RFR correlations using a novel angiographic scoring system. This retrospective analysis included 220 patients with 252 intermediate coronary lesions assessed using FFR and RFR. Each branch distal to the target lesion was scored based on the vessel diameter (0 points: < 1.5 mm, 1 point: 1.5-2.0 mm, and 2 points: > 2.0 mm) measured using quantitative coronary angiography. The angiographic score was calculated by adding these scores. In a propensity score-matched cohort including 84 lesions (42 lesions in each low-and high-angiographic score group), the correlation between FFR and RFR in the high-angiographic score group (>4) was weaker than that in the low-score group (≤4) (Spearman's correlation: r = 0.44 vs. r = 0.80, P < 0.01). Considering a threshold of functional myocardial ischemia as FFR ≤ 0.80 and RFR ≤ 0.89, the low-angiographic score group showed a significantly lower discordance rate of abnormal FFR/normal RFR than the high-angiographic score group (7.1% vs. 23.8%, P = 0.03), whereas the discordance rates of normal FFR/abnormal RFR were similar in both groups (7.1% vs. 9.5%, P = 0.69). This retrospective analysis highlights the influence of angiographic characteristics on the correlation between FFR and RFR. Our simple angiographic assessment method may be useful for interpreting physiological evaluations in daily clinical practice.

Development of an Angiography Guide Indicator for Stereotactic Radiosurgery for High Precision

Stereotactic radiosurgery (SRS) is effectively used for treating various cerebrovascular diseases, including arteriovenous malformations. As image-based surgery is the gold standard technique in SRS, the quality of stereotactic angiography images greatly influences the surgical approach for cerebrovascular diseases. Despite several studies in the relevant literature, research on auxiliary devices, including angiography indicators used for cerebrovascular disease surgeries, is limited. Thus, the development of angiographic indicators may provide meaningful data for stereotactic surgery. This study aimed to develop a stereotactic radiographic angiography guide indicator and evaluate its accuracy and precision. A centerline was drawn, and a guideline was attached such that the "+" and "X" centers of the existing angiography guide indicator intersect. Further, a guideline wire connecting "+" and "X" was fixed using a tape. Based on the presence or absence of the guide indicator, angiography anterior-posterior (AP) and lateral (LAT) images were taken 10 times each, and statistical analysis was performed. The average and standard deviation of the conventional AP and LAT indicators were 10.22 ± 0.53 and 9.02 ± 0.33 mm, and those of the developed AP and LAT indicators were 10.3 ± 0.57 and 8.92 ± 0.23 mm, respectively. The results confirmed that the use of the lead indicator developed in this study provides higher accuracy and precision compared to that of the use of the conventional indicator. Furthermore, the developed guide indicator may provide meaningful information during SRS.

Prepercutaneous coronary intervention Zalunfiban dose-response relationship to target vessel blood flow at initial angiogram in st-elevation myocardial infarction – A post hoc analysis of the cel-02 phase IIa study

Zalunfiban (RUC-4) is a novel, subcutaneously administered glycoprotein IIb/IIIa inhibitor (GPI) designed for prehospital treatment to initiate reperfusion in the infarct-related artery (IRA) before primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI). Since GPIs have been reported to rapidly reperfuse IRAs, we assessed whether there was a dose-dependent relationship between zalunfiban treatment and angiographic reperfusion indices and thrombus grade of the IRA at initial angiogram in patients with STEMI. This was a post hoc analysis from the open-label Phase IIa study that investigated the pharmacodynamics, pharmacokinetics, and tolerability of three doses of zalunfiban - 0.075, 0.090 and 0.110 mg/kg - in STEMI patients. This analysis explored dose-dependent associations between zalunfiban and three angiographic indices of the IRA, namely coronary and myocardial blood flow and thrombus burden. Zalunfiban was administered in the cardiac catheterization laboratory prior to vascular access, ∼10 to 15 minutes before the initial angiogram. All angiographic data were analyzed by a blinded, independent, core laboratory. Twentyfour out of 27 STEMI patients were evaluable for angiographic analysis (0.075 mg/kg [n=7], 0.090 mg/kg [n=9], and 0.110 mg/kg [n=8]). TIMI flow grade 2 or 3 was seen in 1/7 patients receiving zalunfiban at 0.075 mg/kg, in 6/9 patients receiving 0.090 mg/kg, and in 7/8 patients receiving 0.110 mg/kg (ptrend=0.004). A similar trend was observed based on TIMI flow grade 3. Myocardial perfusion was also related to zalunfiban dose (ptrend=0.005) as reflected by more frequent TIMI myocardial perfusion grade 3. Consistent with the dose-dependent trends in greater coronary and myocardial perfusion, TIMI thrombus ≥4 grade was inversely related to zalunfiban dose (ptrend=0.02). This post hoc analysis found that higher doses of zalunfiban administered in the cardiac catheterization lab prior to vascular access were associated with greater coronary and myocardial perfusion, and lower thrombus burden at initial angiogram in patients with STEMI undergoing primary percutaneous coronary intervention.

Angiographic Index for the Treatment Efficacy and Functional Outcomes of Spinal Cord Arteriovenous Shunts: the Vertebral Blush Sign.

The functional outcomes in spinal cord arteriovenous shunts (SCAVSs) are usually unpredictable from current assessments of treatment results. We aimed to investigate and propose anew index marker, the vertebral blush (VB) sign, for assessing the treatment efficacy of SCAVSs. This retrospective cohort study enrolled patients diagnosed with SCAVSs between June 2012 and May 2021. The VB sign was defined as the angiographic finding of reappearance or enhanced contrast staining of the vertebral bodies fed by shunt-related arteries observed after shunt occlusion. The primary outcome was the improvement in motor/sensory disturbances or sphincter impairments within 1 year after treatment. The secondary outcome was shunt recanalization. VB sign characteristics and associations with outcomes were analyzed. Of 65patients with SCAVSs, 57were eligible for VB sign assessment; among these, there were 26with the VB sign and 31without the VB sign. Among vascular shunts perimedullary arteriovenous fistula showed the greatest difference in prevalence rate between those with and without the VB sign (33.3%, n = 9/27 versus 10.0%, n = 3/30; P = 0.031). On multivariable logistic regression analysis, SCAVSs with the VB sign had significantly more favorable outcomes than those without the VB sign (adjusted odds ratio, 5.61; 95% confidence interval, 1.48-21.23; P = 0.01). There was no relationship between the VB sign and secondary outcomes (P = 0.35). The VB sign is independently associated with functional recovery after shunt occlusion and could be an assessment tool for the treatment efficacy of SCAVSs.

Pre-stenting residual thrombotic volume assessed by dual quantitative coronary angiography predicts microvascular obstruction in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Microvascular obstruction (MVO) is a frequent occurrence after primary percutaneous coronary intervention (pPCI), and is associated with adverse left ventricular remodeling and worse clinical outcome. Distal embolization of thrombotic material is one of the most important underlying mechanisms. The aim of this study was to investigate the relation between the thrombotic volume evaluated by dual quantitative coronary angiography (QCA) prior to stenting and the occurrence of MVO as assessed by cardiac magnetic resonance (CMR). Forty-eight patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI and receiving CMR within 7 days from admission were included. Pre-stenting residual thrombus volume at the site of the culprit lesion was measured by applying automated edge detection and video-assisted densitometry techniques (i.e., dual-QCA), and patients were categorized into tertiles of thrombus volume. The presence of delayed-enhancement MVO, as well as its extent (MVO mass), were assessed by CMR. Pre-stenting dual-QCA thrombus volume was significantly greater in patients with MVO than in those without (5.85 mm3 [2.05-16.71] vs. 1.88 mm3 [1.03-6.92], P=0.009). Patients in the highest tertile showed greater MVO mass compared to those in the mid and lowest tertiles (113.3 gr [0.0-203.8] vs. 58.5 g [0.00-144.4] vs. 0.0 g [0.0-60.225], respectively; P=0.031). The best cut-off value of dual-QCA thrombus volume for prediction of MVO was 2.07 mm3 (AUC: 0.720). The addition of dual-QCA thrombus volume to the traditional angiographic indices of no-reflow enhanced the prediction of MVO by CMR (R=0.752). Pre-stenting dual-QCA thrombus volume is associated with the presence and extent of MVO detected by CMR in patients with STEMI. This methodology may aid the identification of patients at higher risk of MVO and guide adoption of preventive strategies.

Radial artery – perspective or fallacy?

Highlights. Radial artery is the second after internal thoracic artery by frequency of use among all of autogenous arterial conduits. Some modern studies indicate the superiority of this conduit to autogenous venous conduits; however, it remains an ongoing discussion.The article presence an analytical review regarding the use of the radial artery as one of conduits during coronary artery bypass grafting. Historical and contemporary perspectives of its use are given, examples of large-scale studies and results are provided, including the “graft-artery junction” concept.Abstract. Radial artery (RA) is the second after internal thoracic artery (ITA) by frequency of use among all of autogenous arterial conduits in coronary artery bypass grafting (CABG), however it is used in less than 13% of cases. The story of RA as a conduit starts in the 1970s, when the famous French surgeon, founder of modern mitral valve repair Alain Frédéric Carpentier proposed to use it. During the development of cardiovascular surgery, RA was actively introduced as a conduit for CABG, and nowadays there are both supporters and opponents of its application. On the one hand, long-term results of CABG with RA are superior to CABG with autogenous venous conduits, whereas the patency of RA is comparable with ITA. On the other hand, RA demonstrates worse angiographic indicators, which could be explained by a diffuse narrowing resulting in complete occlusion; such phenomenon is entitled “string-sign”. Moreover, as in case with other conduits, the site of proximal anastomosis, and harvesting method (open or endoscopic) play an important role in the long-term RA functioning and its resistance to atherosclerosis in grafted coronary arteries, thus making RA a good target for studing and predetermining new perspectives of its use.

The association of new atherosclerosis markers with coronary collaterals in chronic total occlusion patients

Objectives: In the present study, we investigated the relationship between mentioned markers and chronic total occlusion collateral development. Patients and methods: A total of 243 patients (210 males, 33 females; mean age: 63.3±11.5; range, 51 to 76 years) who underwent coronary angiography due to typical chest pain or myocardial ischemia detected in noninvasive stress tests and diagnosed with ≥1 major coronary artery occlusion between January and September 2020 were included in the cross-sectional observational study. The angiographic collateral index was determined according to the Cohen-Rentrop classification. The patients were divided into two groups according to the sufficiency of collateral development: the well-developed collaterals group (n=155) and the poor-developed collaterals group (n=88). Results: Statistically significant parameters in univariate logistic regression analysis were evaluated with multivariate (stepwise) logistic regression analysis; as a result, presence of chronic total occlusion in left anterior descending artery (odds ratio [OR]=2.447; 95% confidence interval [CI], 1.160-5.162; p=0.019), total number of occlusions (OR=3.503; 95% CI, 1.445-8.494; p=0.006), left ventricular ejection fraction (OR=1.056; 95% CI, 1.022-1.091; p=0.001), and the atherogenic index of plasma (OR=0.017; 95% CI, 1.022-1.091; p&lt;0.001) were independently associated with well-developed collaterals. Although the triglyceride-glucose index had statistical significance in the univariate analysis, it was not detected as an independent variable in the multivariate analysis. The monocyte-lymphocyte ratio was not significant in the univariate analysis. Conclusion: Of the new atherosclerosis markers, only the atherogenic index of plasma had an independent association with poor collateral development.

Нospital outcomes of coronary artery bypass grafting in patients with coronary heart disease with previous percutaneous coronary intervention

Evaluation of the frequency hospital cardiovascular events in groups of patients with stable angina who underwent percutaneous coronary interventions (PCI) with stenting of the arteries before coronary bypass surgery, or who did not have previous myocardial revascularization. The 120 patients with stable angina who underwent routine coronary artery bypass grafting were examined. Group composition: Men 80.8%, age 587.6, duration of coronary heart disease 65.7 years, history of myocardial infarction (MI) 77.5%. Arterial hypertension was present in 92.5%, diabetes mellitus in 12.5% of patients. Multivessel coronary artery disease in 72.5% of patients. 28 (23.4%) patients had previously undergone PCI with stenting of the coronary arteries. The period from PCI to coronary bypass surgery was 2032.6 months. Coronary bypass surgery on-pump was performed in 88.3%, coronary bypass surgery on off-pump in 11.7%. The number of distal anastomoses ranged from 1 to 4. There were no differences in clinical and angiographic indicators, pharmacotherapy, and operation characteristics between the groups of patients who were subjected to or did not have PCI before coronary bypass surgery. There were no differences between the analyzed groups of patients in the frequency of cardiac death (0 and 1.1%, p=0.58), non-fatal MI (3.6% and 9.8%, p=0.29), stroke (0 and 1.1%, p=0.58), acute heart failure (11.7% and 34.8%, p=0.06), the number of patients with paroxysms of atrial fibrillation (28.6% and 17.4%, p=0.94), the proportion of patients with resternotomies (3.6% and 3.3%, p=0.94) and gastrointestinal bleeding (3.6% and 4.3%, p=0.86). PCI with coronary artery stenting, prior to coronary bypass surgery, does not affect the frequency of post-operative hospital cardiovascular and hemorrhagic complications.

Comparison of Angiographic and Clinical Outcomes After Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction Between Patients With and Without Concomitant COVID-19 Infection.

COVID-19 infection can involve the cardiovascular system and worsen the prognosis of the patients. This study aimed to investigate the adverse effects of COVID-19 on angiographic and clinical outcomes of primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation MI and compare results with those patients without COVID-19 disease. The study was a retrospective observational cohort, in which patients presented with ST-elevation MI from February 2020 to April 2021, treated with primary PCI were divided into 2 groups based on the COVID-19 infection. Then, the procedural and angiographic indices and also clinical outcomes were compared between the 2 groups. A total of 1150 patients were enrolled in the study. Those with established COVID-19 infection had worse baseline thrombolysis in myocardial infarction flow grade and also were at higher risk for worse procedural outcomes such as lower thrombolysis in myocardial infarction frame count, myocardial blush grade, and slow-flow coronary disease, after the primary PCI. Additionally, the presence of COVID-19 at the time of primary PCI was related to a significantly higher duration of hospitalization and in-hospital mortality. Given the potential impact of other factors on outcomes, analysis for all of the primary endpoints was done again after adjustment of these factors and the results were the same as before, suggesting the independent effect of COVID-19 infection. The concomitant COVID-19 infection in the patients undergoing primary PCI is associated with significantly worse angiographic, procedural and clinical outcomes. Surprisingly, this finding is regardless of patients' baseline risk factors and demographical characteristics.

Neuropeptide-Y Levels in ST-Segment-Elevation Myocardial Infarction: Relationship With Coronary Microvascular Function, Heart Failure, and Mortality.

BackgroundThe sympathetic cotransmitter, neuropeptide Y (NPY), is released into the coronary sinus during ST‐segment–elevation myocardial infarction and can constrict the coronary microvasculature. We sought to establish whether peripheral venous (PV) NPY levels, which are easy to obtain and measure, are associated with microvascular obstruction, myocardial recovery, and prognosis.Methods and ResultsNPY levels were measured immediately after primary percutaneous coronary intervention and compared with angiographic and cardiovascular magnetic resonance indexes of microvascular function. Patients were prospectively followed up for 6.4 (interquartile range, 4.1–8.0) years. PV (n=163) and coronary sinus (n=68) NPY levels were significantly correlated (r=0.92; P<0.001) and associated with multiple coronary and imaging parameters of microvascular function and infarct size (such as coronary flow reserve, acute myocardial edema, left ventricular ejection fraction, and late gadolinium enhancement 6 months later). We therefore assessed the prognostic value of PV NPY during follow‐up, where 34 patients (20.7%) developed heart failure or died. Kaplan‐Meier survival analysis demonstrated that high PV NPY levels (>21.4 pg/mL by binary recursive partitioning) were associated with increased incidence of heart failure and mortality (hazard ratio, 3.49 [95% CI, 1.65–7.4]; P<0.001). This relationship was maintained after adjustment for age, cardiovascular risk factors, and previous myocardial infarction.ConclusionsBoth PV and coronary sinus NPY levels correlate with microvascular function and infarct size after ST‐segment–elevation myocardial infarction. PV NPY levels are associated with the subsequent development of heart failure or mortality and may therefore be a useful prognostic marker. Further research is required to validate these findings.

Angiographic index of myocardial viability in patients with different duration of occlusive coronary lesion

INTRODUCTION. Evaluation of myocardial viability in chronic coronary occlusion determines the feasibility of revascularization of this zone.The OBJECTIVE was to evaluate the significance of the angiographic index in determining the viability of the myocardium at various times after occlusion of the coronary artery.METHODS AND MATERIALS. 156 patients with coronary artery disease (CAD) with chronic coronary occlusion according to coronary angiography (CG) were examined and treated during the period from 2012 to 2021. All patients underwent endovascular recanalization of chronic coronary occlusion. All patients were divided into 4 groups depending on the time of coronary occlusion (up to 3 months, 3-6 months, 6-9 months, more than 9 months) The results of recanalization were compared to the preoperative evaluation of myocardial viability based on the volume of collateral blood flow (Renrop score).RESULTS. The angiographic index of non-viable myocardium was highly specific from the first months in all observation groups (77, 94, 97, 97.5 %), however, its sensitivity had diagnostic value only in patients with occlusion duration of more than 6 months (80 % or more).CONCLUSION. The diagnostic value (sensitivity and specificity) of detecting non-viable myocardium based on retrograde collateral blood flow is significant for occlusion duration of more than 6 months. Refusal of revascularization based on the absence of retrograde blood flow during the first 6 months after coronary occlusion is not correct.

Diagnostic agreement of quantitative flow ratio with fractional flow reserve in a Latin-American population.

Quantitative flow ratio (QFR) is a recently proposed angiographic index that allows to assess the pressure loss in coronary arteries in a similar fashion as the fractional flow reserve (FFR). The purpose of this study was to evaluate the diagnostic performance of QFR as compared to FFR, in a Latin-American population of patients with suspected ischaemic heart disease. QFR was retrospectively derived from coronary angiograms. The association, diagnostic performance, and continuous agreement of fixed-flow QFR (fQFR) and contrast-flow QFR (cQFR) with FFR was assessed by continuous and dichotomous methods. 90 vessels form 66 patients were finally included. The study comprised coronary stenoses of intermediate severity, both angiographically (diameter stenosis: 46.6 ± 12.8%) and physiologically [median FFR = 0.83 (quartile 1-3, 0.76-0.89)]. The correlation of FFR with both fQFR [ρ = 0.841, (95% CI 0.767 to 0.893), p < 0.001] and cQFR [ρ = 0.833, (95% CI 0.755 to 0.887), p < 0.001] was strong. The diagnostic performance of cQFR was good [area under the ROC curve of 0.92 (95% CI 0.86 to 0.97, p < 0.001)], with 0.80 as the optimal cQFR cut-off against FFR ≤ 0.80. This 0.80 cQFR cut-off classified correctly 83.3% of total stenoses, with a sensitivity of 85.2% and specificity of 80.6%. QFR was strongly associated with FFR and exhibited a high diagnostic performance in this Latin-American population.

GRACE, SYNTAX I and SYNTAX II scores as predictors of one-year MACE outcome in patients with myocardial infarction treated with percutaneous coronary intervention

Background/Aim. The fundamental objective of primary percutaneous coronary intervention (PCI) in myocardial infarction is to provide early, complete, and sustained flow in the occluded artery that has led to myocardial ischemia or necrosis. The aim of this study was to determine the predictive power of a combination of GRACE, SYNTAX I, and SYNTAX II scores in predicting major adverse cardiovascular events (MACE) and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after primary PCI. Methods. The study included 400 patients who had their first acute myocardial infarction and underwent PCI. The patients were treated and followed for one year at the Clinical Hospital Center Zvezdara at the Department of Interventional Cardiology. By monitoring the defined clinical parameters, a comparative analysis of risk scores GRACE, SYNTAX I, and SYNTAX II was performed. Their sensitivity, specificity as well as predictive possibilities in predicting adverse outcomes were determined. Results. The incidence of MACE in our sample was 12.8%. Patients with STEMI entity had significantly higher values of GRACE, SYNTAX I, and SYNTAX II scores. The highest value for predicting the occurrence of MACE was shown by the SYNTAX II score (score value 29.3), with a sensitivity of 88.2% and a specificity of 76.8%. The GRACE score was a significant predictor of SYNTAX I and SYNTAX II scores. A two-way correlation was observed between the high score values of all three scores. Conclusion. The presented scores for the assessment of clinical and angiographic indicators showed good predictive power in assessing the outcome of adverse cardiovascular events in both clinical entities of acute myocardial infarction during one-year follow-up. By using the proposed scores to assess MACE, we can single out high-risk patients in order to prevent adverse events and reduce mortality. This suggests its suitability for clinical use in this patient population.

Elevated uric acid is related to the no-/slow-reflow phenomenon in STEMI undergoing primary PCI.

No-/slow-reflow phenomenon (NRP) is a severe complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study aimed to explore the relationship between elevated serum uric acid (SUA) and NRP in patients with STEMI undergoing pPCI, focusing on inflammation and angiographic findings. A total of 610 patients who received pPCI for STEMI were retrospectively enrolled. Patients were divided into a hyperuricaemia group and a non-hyperuricaemia group according to SUA levels. Clinical information and angiographic indicators were compared between the two groups. Thrombolysis in myocardial infarction (TIMI) flow and TIMI myocardial perfusion grade (TMPG) <3 after stent implantation were defined as TIMI-NRP and TMPG-NRP, respectively. A logistic model was used to analyse the relationship between hyperuricaemia and NRP. The hyperuricaemia group had a higher incidence of TIMI-NRP (24.9% vs 14.0%, p<.001) and TMPG-NRP (33.0% vs 24.9%, p=.03), higher levels of C-reactive protein (7.2 vs 4.1mg/L, p<.001) and worse left ventricular ejection fraction (51.5% vs 54.0%, p=.002) than the non-hyperuricaemia group. As for angiographic findings, there was no significant difference between the two groups in terms of lesion characteristics measured by quantitative coronary angiography. After multivariable adjustment, elevated SUA was significantly associated with TIMI-NRP (odds ratio: 1.94, 95% confidence interval: 1.24-3.01, p=.003). Subgroup analysis showed that the effect of hyperuricaemia in TIMI-NRP was more pronounced in patients with delayed perfusion as well as in patients with diabetes mellitus. Elevated SUA is associated with severe inflammation and has higher incidence of TIMI-NRP in patients with STEMI undergoing pPCI, especially in those with delayed perfusion or diabetes mellitus.

Performance Evaluation of Multiple Ultrasonographical Methods for the Detection of Primary Sjögren's Syndrome.

Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.

Uncontrolled diabetes predicts anxiety and depression in CAD patients

Abstract Background and aim Coronary artery disease (CAD) is a major public health problem worldwide because of high incidence of comorbidity and mortality. Diabetes mellitus (DM) is associated with clustered risk factor for CAD. The aim of this study was to assess the impact of diabetes in CAD and its relationship with depression. Methods The study included 77 patients (mean age 64±11 years, 63% female) with CAD. Based on comorbidity patients were classified into CAD with DM (n=49) and CAD without DM (n=28). In this prospective study demographic, clinic, echocardiographic and angiographic indices were collected as well as scale of anxiety and depression. Results Patients with CAD and DM were older (p=0.001), had reduced left ventricular ejection fraction-EF (p=0.02), more obese (p=0.03), had higher NYHA class (p=0.04), more prevalent arterial hypertension (p=0.04), and higher anxiety and/or depression scales (p&amp;lt;0.001) compared with patients without DM. Whereas gender was not significantly difference (p=0.11). Diabetes most closely correlated with the scale of depression (r=0.61, p&amp;lt;0. 001). In multivariate analysis, only diabetes OR=1.099 (95% CI 1.028 to 1.231, p&amp;lt;0.001), predicted depression in patients with CAD. Glycemic &amp;gt;8.9 mmol/L, predicted the scale of depression in patients with CAD (sensitivity 75%, specificity 70%, AUC=0.72, p&amp;lt;0.001). Conclusions Diabetes is the most important risk factor for CAD and the uncontrolled levels are related to patient's disturbed mental health. These results constitute important knowledge for nurses serving CAD patients. Funding Acknowledgement Type of funding sources: None.