Mustafa Duran

Prognostic value of neutrophil/lymphocyte ratio in patients with ST-elevated myocardial infarction undergoing primary coronary intervention: A prospective, multicenter study

OBJECTIVE The pre-procedural neutrophil to lymphocyte ratio (N/L) is associated with adverse outcomes among patients with coronary artery disease but its prognostic value in ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. This study evaluated the relations between pre-procedural N/L ratio and the in-hospital and long-term outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI). METHODS A total of 682 STEMI patients presented within the first 6h of symptom onset were enrolled and stratified according to tertiles of N/L ratio based on the blood samples obtained in the emergency room upon admission. RESULTS The mean follow-up period was 43.3 months (1-131 months). In-hospital in-stent thrombosis, non-fatal myocardial infarction, and cardiovascular mortality increased as the N/L tertile ratio increased (p<0.001, p<0.001, p=0.003, respectively). Long-term in-stent thrombosis, non-fatal myocardial infarction and cardiovascular mortality also increased as the N/L ratio increased (p<0.001, p<0.001, p=0.002, respectively). On multivariate analysis, N/L ratio remained an independent predictor for both in-hospital (OR 1.189, 95% CI 1.000-1.339; p<0.001) and long-term major (OR 1.228, 95% CI 1.136-1.328; p<0.001) adverse cardiac events. CONCLUSION The N/L ratio was an independent predictor of both in-hospital and long-term adverse outcomes among STEMI patients undergoing primary PCI. Our findings suggest that this inexpensive, universally available hematological marker may be incorporated into the current established risk assessment model for STEMI.

Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes.

The SYNTAX score (SXscore) is an anatomic scoring system based on coronary angiography (CA) that not only quantifies lesion severity and complexity but also predicts poor cardiovascular outcomes, including mortality, in patients with acute coronary syndromes (ACS). Recent studies have shown that platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in many cardiovascular diseases. The aim of this study was to investigate the association of PLR with the severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with ACS who underwent urgent CA. A total of 1,016 patients with ACS who underwent urgent CA were included in the study from August 2012 to March 2014. Admission PLR values were calculated before CA was performed. The SXscore was determined from baseline CA. The patients were divided into 2 groups, those with low SXscores (≤22) and those with intermediate to high SXscores (≥23). PLRs were significantly higher in patients with intermediate to high SXscores compared with those with low SXscores (p<0.001). In-hospital mortality was significantly higher in the groups with high PLR and intermediate to high SXscores. In multivariate analysis, the independent predictors of intermediate to high SXscore were PLR (odds ratio 1.018, 95% confidence interval 1.013 to 1.023, p<0.001) together with the left ventricular ejection fraction (odds ratio 0.935, 95% confidence interval 0.910 to 0.960, p<0.001), and age (odds ratio 1.029, 95% confidence interval 1.029 to 1.054, p=0.02). A PLR≥116 had 71% sensitivity and 66% specificity in predicting intermediate to high SXscore. In conclusion, the PLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Increased PLR is an independent predictor of higher SXscore in patients with ACS who undergo urgent CA.

Relation Between Red Cell Distribution Width and Severity of Coronary Artery Disease in Patients With Acute Myocardial Infarction

Increased red blood cell distribution width (RDW) has been associated with adverse outcomes in acute myocardial infarction (AMI). We evaluated the relationship between RDW and severity of coronary artery disease (CAD) in patients with AMI. We analyzed the relation between RDW and angiographic severity of CAD. Patients (n = 580) with elevated Syntax scores (SSs >32) had higher RDW values (15.1% ± 1.7% vs 14.1 ± 1.7%, P < .001). The SS was positively correlated with RDW level (r = .252, P < .001) and neutrophil/lymphocyte (N/L) ratio (r = .178, P < .001). There was a mild significant association between RDW level and N/L ratio (r = .106, P = .033). In the multiple logistic regression analysis, RDW (odds ratio = 1.165, 95% confidence interval 1.02-1.32, P = .021) remained a significant predictor for the severity of CAD. Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is independently associated with the severity of CAD in patients with AMI.

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.

Predictive Value of Admission Platelet Volume Indices for In-hospital Major Adverse Cardiovascular Events in Acute ST-Segment Elevation Myocardial Infarction

Although mean platelet volume (MPV) is an independent correlate of impaired angiographic reperfusion and 6-month mortality in ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), there is less data regarding the association between platelet distribution width (PDW) and in-hospital major adverse cardiovascular events (MACEs). A total of 306 patients with STEMI pPCI were evaluated. No reflow was defined as a post-PCI thrombolysis in myocardial infarction (TIMI) flow grade of 0, 1, or 2 (group 1). Angiographic success was defined as TIMI flow grade 3 (group 2). The values of MPV and PDW were higher among patients with no reflow. In-stent thrombosis, nonfatal myocardial infarction, in-hospital mortality, and MACEs were significantly more frequent among patients with no reflow. In multivariate analysis, PDW, MPV, high-sensitivity C-reactive protein, and glucose on admission were independent correlates of in-hospital MACEs. Admission PDW and MPV are independent correlates of no reflow and in-hospital MACEs among patients with STEMI undergoing pPCI.

Serum vitamin D levels are independently associated with severity of coronary artery disease.

Background and Objectives Low-serum vitamin D levels have been associated with increased cardiovascular risk in the general population. We hypothesized that serum vitamin D levels would be inversely associated with inflammation and with severity of coronary atherosclerosis. We therefore investigated the link between serum vitamin D levels and (1) the extent of coronary artery disease (CAD) assessed by the Gensini score and (2) inflammatory parameters, including C-reactive protein and fibrinogen. Materials and Methods We measured 25-hydroxyvitamin D (25[OH]D) and inflammatory markers in 239 patients who underwent coronary angiography. We analyzed the relation between serum levels of 25(OH)D and inflammatory markers and angiographic severity of CAD. The Gensini lesion severity score was used for assessing the severity of coronary atherosclerosis. Results Vitamin D insufficiency was very common among our study population: 83% of the study population had levels less than 30 ng/mL. The Gensini score was negatively associated with serum vitamin D levels (r = −0.416, P < 0.001), and positively correlated with age (r = 0.209, P = 0.001), blood pressure (r = 0.379, P < 0.001), diabetes (r = 0.335, P < 0.001), hyperlipidemia (r = 0.150, P = 0,021), and C-reactive protein levels (r = 0.214, P = 0,001). After adjustments for traditional and nontraditional cardiovascular risk factors, vitamin D (B = −0,345, P < 0,001) remained a significant predictor for the severity of CAD. Conclusions Low-serum 25(OH)D levels are associated with the severity of coronary artery stenosis. Further studies are warranted to determine whether vitamin D supplementation could prevent progression of CAD.

The long‐term effects of arteriovenous fistula creation on the development of pulmonary hypertension in hemodialysis patients

The aim of this prospective study was to evaluate long‐term effects of arteriovenous fistula (AVF) on the development of pulmonary arterial hypertension (PAH) and the relationship between blood flow rate of AVF and pulmonary artery pressure (PAP) in the patients with end‐stage renal disease (ESRD). This prospective study was performed in 20 patients with ESRD. Before an AVF was surgically created for hemodialysis, the patients were evaluated by echocardiography. Then, an AVF was surgically created in all patients. After mean 23.50 ± 2.25 months, the second evaluation was performed by echocardiography. Also, the blood flow rate of AVF was measured at the second echocardiographic evaluation. Pulmonary arterial hypertension was defined as a systolic PAP above 35 mmHg at rest. Mean age of 20 patients with ESRD was 55.05 ± 13.64 years; 11 of 20 patients were males. Pulmonary arterial hypertension was detected in 6 (30%) patients before AVF creation and in 4 (20%) patients after AVF creation. Systolic PAP value was meaningfully lower after AVF creation than before AVF creation (29.95 ± 10.26 mmHg vs. 35.35 ± 7.86 mmHg, respectively, P: 0.047). However, there was no significant difference between 2 time periods in terms of presence of PAH (P>0.05). Pulmonary artery pressure did not correlate with blood flow rate of AVF and duration after AVF creation (P>0.05). In hemodialysis patients, a surgically created AVF has no significant effect on the development of PAH within a long‐term period. Similarly, blood flow rate of AVF also did not affect remarkably systolic PAP within the long‐term period.

High levels of serum uric acid predict severity of coronary artery disease in patients with acute coronary syndrome.

We aimed to elucidate the relation between serum uric acid (SUA) level and severity of coronary artery disease (CAD) in nondiabetic, nonhypertensive patients (n = 246) with acute coronary syndrome (ACS). Severity of CAD was assessed by the Gensini score. One, 2, and 3 or more diseased vessels were identified in 87 (35.4%), 55 (22.4%), and 104 (42.2%) patients, respectively. Patients with hyperuricemia had higher Gensini score, high number of diseased vessels, critical lesions, and total occlusion. Serum uric acid level was significantly associated with number of diseased vessels. Serum uric acid was an independent risk factor for multivessel disease by univariate analysis. High levels of SUA associated with the severity of CAD in nondiabetic, nonhypertensive patients with ACS.

High Levels of Serum Uric Acid Impair Development of Coronary Collaterals in Patients With Acute Coronary Syndrome

We evaluated the association of serum uric acid (SUA) level and development of coronary collateral vessels (CCVs) in patients with acute coronary syndrome (ACS). Patients (n = 224) with ACS were included in the study. Coronary collateral vessels were graded according to the Rentrop scoring system. Rentrop grade 0 was accepted as absence of CCV (group 1; n = 117) and Rentrop grade ≥1 was accepted as presence of CCV (group 2; n = 107). Rentrop 0-1 (poor CCV) were determined in 167 patients and Rentrop 2-3 (good CCV) were determined in 57 patients. Both presence of CCV (P < .001) and development of good CCV (P = .003) were significantly associated with low levels of SUA. We suggest that high levels of SUA affect the CCV development negatively in nondiabetic and nonhypertensive patients with ACS.

Effects of Atorvastatin and Lisinopril on Endothelial Dysfunction in Patients with Behçet's Disease

Objective: Behçets disease is a chronic inflammatory vasculitis. Vascular involvement is one of the major complications of Behçets disease, during the course of the disease. Previous studies showed that ACE inhibitors and statins may improve endothelial functions in endothelial dysfunction. The aim of our study is to compare the effects of atorvastatin and lisinopril to placebo on endothelial dysfunction in patients with Behçets disease. Patients and methods: We prospectively studied 92 (48 female) Behçets patients who were diagnosed according to the International Study Group criteria. Endothelial dysfunction was evaluated by brachial artery flow‐mediated dilatation (FMD) method using high‐resolution vascular ultrasound device at baseline and after for 3‐month therapy. Patients were consecutively randomized into three groups as (atorvastatin (n = 31), lisinopril (n = 31), and placebo groups (n = 30). Patients in atorvastatin group received 20 mg atorvastatin, lisinopril group received 10 mg lisinopril per day, and placebo group received placebo per day for 3 months. Results: The baseline characteristics of patients were similar among three groups; however, high‐sensitive C‐reactive protein (hs‐CRP) levels were lower in atorvastatin group than placebo group. A significant improvement in FMD was observed in both atorvastatin (5.0 ± 1.4 vs. 12.8 ± 3.6%, P < 0.001) and lisinopril groups (5.0 ± 1.2 vs. 11.4 ± 5.0%, P < 0.001). Partial significant enhancement was observed in placebo group (4.9 ± 1.1% vs. 5.7 ± 1.0, P = 0.002). However, it was lower than the cutoff value for endothelial dysfunction. Conclusion: These findings suggest that atorvastatin and lisinopril improve endothelial functions in Behçets disease patients. However, large studies are needed to determine the long‐term effects of atorvastatin and lisinopril therapy. (Echocardiography 2010;27:997‐1003)