Deniz Demirci

Impact of day versus night as intervention time on the outcomes of primary angioplasty for acute myocardial infarction

Background: Conflicting datas exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST‐segment elevation myocardial infarction (STEMI) when the intervention is performed during night hours. Methods and Results: 2,644 consecutive patients with STEMI (mean age 56.7 ± 11.9, years, 2,188 male) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into this study (single high‐volume center: >3,000 PCIs/year). Day time was defined according to intervention between 08:00 am and 06:00 pm and night as intervention time between 06:00 pm and 08:00 am. 1,141 patients (43.2%) were treated during the day and 1,503 (56.8%) at night. The baseline characteristics of both groups were similar except for more frequent hypertension (42.6 vs. 36.5%; P = 0.002), women (19.7 vs. 15.4%; P = 0.003), and old (≥75y) patients (9.6 vs. 7.4; P = 0.046) in the day time group. Compared with those treated during night time, day time patients had longer angina‐reperfusion times (mean, 205 vs. 188 minutes, P = 0.016). Door‐to‐balloon times were similar (P = 0.87), and less than 90 minutes in both groups. There were no differences concerning clinical events and PCI success between the two groups. Hospital mortality was 6.1% during the day and 5.2% during the night (OR 0.98, 95% CI 0.7–1.36; P = 0.89). The median follow‐up time was 21 months. The Kaplan‐Meier survival plot for long‐term cardiovascular death was not different for both groups (P = 0.78). In‐hospital and long‐term cardiovascular mortality was also similar in shock and nonshock subgroups. Conclusions: Primary PCI can be performed safely during the night at a high‐volume PCI center with suitable and effective organization of cardiology department and catheterisation laboratory with 24 hours per day, 7 days per week onsite staffing.

[The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction].

OBJECTIVES We investigated the effect of chronic kidney disease (CKD) on in-hospital results in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction (STEMI). STUDY DESIGN The study included 2,486 patients (2,070 men, 416 women) who were treated with primary angioplasty for STEMI. Of these, 273 patients (11%) were found to have CKD (glomerular filtration rate <60 ml/min/1.73 m2) before the procedure. Patients with and without CKD were evaluated with respect to demographic and clinical features, primary angioplasty findings, and in-hospital clinical results. RESULTS Patients with CKD exhibited a higher mean age, Killip class, and higher frequencies of female gender, diabetes, hypertension, anemia, and previous myocardial infarction (p<0.05). Angioplasty showed higher rates of right coronary artery lesion, multivessel disease, contrast nephropathy, unsuccessful procedure, and increased stenosis rate and stent length in CKD patients (p<0.05). Cardiovascular mortality occurred in 11.7% and 1.4% of patients with and without CKD, respectively (p<0.001). Patients with CKD had significantly higher incidences of target vessel revascularization, major cardiac events, stroke, cardiopulmonary resuscitation, hemodialysis, ventricular tachycardia/fibrillation, severe heart failure, cardiogenic shock, and significant hemorrhage (p<0.05). Multivariate analysis showed that CKD was an independent predictor of mortality (OR=4.1, 95% CI 1.83-9.17; p=0.001). CONCLUSION Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality.

The Effects of Blood Pressure Lowering on P-Wave Dispersion in Patients with Hypertensive Crisis in Emergency Setting

Hypertensive emergency refers to a severe hypertension (HT) that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure (BP) should be reduced immediately to prevent or minimize organ dysfunction. The present study evaluated the diagnostic value of two electrocardiographic indices in detecting patients, who are at risk for paroxysmal atrial fibrillation (PAF), in the setting hypertensive crisis. The study population consisted of 30 consecutive patients aged ≥40 years, who were admitted to the emergency room with hypertensive crisis. Electrocardiographic (ECG) recordings of the patients were performed before and after the treatment. The minimum (Pmin) and maximum (Pmax) P wave duration on ECG, and P-wave dispersion (Pd), which was defined as the difference between Pmin and Pmax, were measured. The mean Pd was 118.0 ± 32.1 and 94.0 ± 44.3 before and after the treatment, respectively. The decrease observed in the mean Pd was statistically significant (p = 0.005). The mean Pmax was 214.7 ± 37.1 before the treatment, while it was 194.0 ± 47.3 after the treatment, and the difference was significant (p = 0.021). The mean Pmin was 96.7 ± 26.3 and 100.0 ± 41.0 before and after the treatment, respectively; however, the difference was not significant (p = 0.624). Pmax and Pd display significant changes with acute treatment of HT. There is a need for larger prospective studies to clearly elucidate the diagnostic value of ECG indices, Pmax and Pd as indicators of future PAF.

Do Turkish reimbursement recommendations cover current European Lipid Guidelines? A retrospective analysis of patients presenting with first acute coronary syndrome

OBJECTIVE This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Healths Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention. METHODS A total of 582 patients with first acute coronary syndrome were included in the study. Patients with noncritical stenosis observed on coronary angiography or a history of atherosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of diabetes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016). RESULTS Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommendation included 13.3% of nondiabetic patients (p<0.05). For patients younger than 60 years of age, the SUT had more guidelines than the ESC; however, for patients aged 70 to 90, the ESC had more guidelines than the SUT. For patients over 90, the indications were the same. For patients with low-density lipoprotein-cholesterol (LDL-C) >190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDLC <160b mg/dL. CONCLUSION The scope of the SUT guidelines is generally not narrower than the ESC indications. However, the indications for patients >60 years of age and those with LDL-C >160 mg/ dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined.

PP-033 EFFICIACY AND OUTCOME OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION DUE TO SAPHENOUS VEIN GRAFT OCCLUSION

OBJECTIVES We evaluated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) due to saphenous vein graft (SVG) occlusion. STUDY DESIGN We reviewed 2,646 consecutive patients (mean age 56.6±11.8 years) who underwent primary PCI for STEMI between 2003 and 2009. All clinical and angiographic data and in-hospital and long-term (median 22 months) outcomes were retrospectively collected. The patients were classified into two groups based on the lesions treated with primary PCI, i.e., native vessels (n=2,625) and SVG (n=21). RESULTS Compared to patients with occluded native vessels, patients with SVG occlusion had significantly higher rates of coronary bypass operation (100% vs. 2.3%, p<0.001), previous myocardial infarction (52.4% vs. 10.8%, p<0.001), and diabetes mellitus (52.4% vs. 25.1%, p=0.002), but lower frequency of anterior myocardial infarction (9.5% vs. 49.3%, p<0.001). Tirofiban use (71.4% vs. 48.2%, p=0.01) and three-vessel disease (81% vs. 25.6%, p<0.001) were significantly more common in the SVG group. The rate of successful primary PCI was lower in SVG occlusions compared to native vessels (61.9% vs. 84.7%, p=0.01). The two groups did not differ significantly with respect to in-hospital and long-term cardiovascular events and mortality (p>0.05). In multivariate logistic regression analysis, application of PCI to SVG was found to be an independent predictor for unsuccessful procedure (OR 6.76, 95% CI 2.05-22.21; p=0.002). CONCLUSION Although the success rate of primary PCI in SVG lesions was lower compared to native vessels, this did not have an adverse effect on postprocedural cardiovascular events and mortality in patients presenting with STEMI.