Onur Kadir Uysal

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.

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.

Mean platelet volume and extent and complexity of coronary artery disease in diabetic and nondiabetic patients with ST elevation myocardial infarction.

We investigated whether the mean platelet volume (MPV) is associated with the extent and complexity of coronary artery disease in patients with ST elevation myocardial infarction (STEMI). We prospectively included 912 STEMI patients (663 male and 249 female; mean age 58.7 ± 12.4 years) who underwent primary percutaneous coronary intervention. The patients were divided into 3 groups according to MPV tertiles. Highest SYNTAX score (SS) was observed in MPVhigh group compared with MPVmid and MPVlow groups (P < .001 for all). The SS of MPVmid group was higher than MPVlow group (P = .036). The MPV in diabetic STEMI patients was higher than in nondiabetic STEMI patients (P < .001). Multivariate linear regression analysis showed that the MPV was associated with diabetes (β = .115, P = .001), troponin level (β = .131, P = .001), platelet count (β = −.241, P < .001), and SS (β = .216, P < .001). The relation between MPV and SS in diabetic STEMI patients was stronger than for nondiabetic STEMI patients (r = .473, P < .001 vs r = .129, P = .001).

Relationship between mean platelet volume and atherosclerosis in young patients with ST elevation myocardial infarction.

Increased mean platelet volume (MPV) is associated with poor clinical outcome in patients with acute coronary syndrome. We evaluated the predictive role of MPV in young patients with acute myocardial infarction (AMI). This study includes 373 patients who presented to our hospital with AMI (group 1: 134 young patients, males aged <45 years and females aged <55 years; group 2: 239 older patients) and 141 adults with normal coronary angiography as a control group (group 3). In group 1, the levels of MPV and hemoglobin were higher than that in groups 2 and 3. In group 1, blood urea nitrogen levels were lower than that in groups 2 and 3 and creatinine levels were lower than that in group 2. After multivariate analysis, MPV and age were independent predictors of AMI in young patients.

Relation between serum total bilirubin levels and severity of coronary artery disease in patients with non-ST-segment elevation myocardial infarction.

We studied 403 consecutive patients with non-ST-segment elevation myocardial infarction (NSTEMI). This population was divided into tertiles according to the SYNTAX score (SXscore). The high SXscore group was defined as an SXscore ≥13, and the low SXscore group as an SXscore <13. The total bilirubin (sTB) and direct bilirubin levels of patients were significantly higher in the high SXscore group (P = .001 and P = .007, respectively). There was a correlation between sTB and SXscore (r = .495; P = .005). On multivariate linear regression analyses, age (β = .100; P = .041), sTB levels (β = .171; P = .005), low-density lipoprotein cholesterol (β = .121; P = .014), and troponin-I (β = .124; P = .011) remained independent correlates of high SXscore. The mean follow-up period was 18.2 months. All-cause mortality rate was higher in the high SXscore group but did not reach significance (P = .058). In conclusion, high sTB level is independently associated with severity of coronary artery disease in patients with NSTEMI. However, no association was found with long-term mortality.

Association Between Uric Acid and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease

Serum uric acid (SUA) levels have been proposed as a biomarker of coronary artery disease (CAD) and coronary collateral circulation (CCC). We investigated the association between SUA levels and development of CCC in patients with stable CAD. Consecutive patients (n = 480) with stable CAD who underwent coronary angiography and documented total occlusion in 1 of the major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell (WBC), creatinine, platelet count, and SUA were significantly higher in patients with poor CCC than in those with good CCC. After multivariate analysis, high levels of SUA were an independent predictor of CCC together with levels of fasting blood glucose and WBC. The receiver–operating characteristic analysis provided a cutoff value of 5.65 mg/dL for SUA to predict poor CCC with 60% sensitivity and 66% specificity. High levels of SUA may be associated with poor CCC in patients with stable CAD.

Red cell distribution width is associated with acute myocardial infarction in young patients

BACKGROUND There are few studies about predictors of ST elevation myocardial infarction (STEMI) in young patients. High red cell distribution width (RDW) levels were associated with adverse outcomes in patients with STEMI. We aimed to investigate the relationship between RDW and STEMI in young patients. METHODS This study included 370 patients who presented to our hospital with acute myocardial infarction (Group 1: 198 young patients, 〈 45 ages for male, 〈 55 ages for female, Group 2: 172 elderly patients) and 156 adults with normal coronary angiography as a control group (Group 3: 91 young patients, 〈 45 ages for male, 〈 55 ages for female, Group 4: 65 elderly patients). RESULTS Compared with Group 3, Group 1 had a significantly higher value of RDW (Group 1 RDW 14.1 ± 1.1%, Group 3 RDW 13.4 ± 0.9, p1 〈 0.01). Value of RDW was similar both of Group 2 and 4 (Group 2 RDW 13.7 ± 1.2, Group 4 RDW 13.5 ± 0.9, p2 = 0.1). After multivariate analysis, high levels of RDW were independent predictors of STEMI in young patients (OR: 0.337, p 〈 0.01) together with gender (OR: 3.725, p 〈 0.01), history of hyperlipidemia (OR: 25.172, p 〈 0.01) and high density lipoprotein cholesterol (OR: 1.088, p 〈 0.01). CONCLUSIONS High levels of RDW were associated with STEMI in young patients. We think that RDW is a widely available marker with no additional costs, in contrast to other novel markers of cardiovascular risk.

The relationship between neutrophil-to-lymphocyte ratio and coronary collateral circulation.

Neutrophil/lymphocyte ratio (NLR) has been proposed as a prognostic marker to determine systemic inflammatory response and atherosclerosis. Our aim was to determine the relationship between NLR and development of coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). A total of 521 consecutive patients with stable CAD who underwent coronary angiography and documented total occlusion in one of those major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell, and NLR were significantly higher in patients with poor collateral than in those with good collateral. After multivariate analysis, high level of NLR was an independent predictor of CCC together with levels of fasting blood glucose. The receiver–operating characteristic analysis provided a cutoff value of 2.75 for NLR to predict poor CCC with 65% sensitivity and 68% specificity. We demonstrated an independent association between levels of NLR and development of CCC in patients with stable CAD.

Association of mean platelet volume and pre- and postinterventional flow with infarct-related artery in ST-segment elevation myocardial infarction.

Platelets play a role in the pathogenesis of ST-segment elevation myocardial infarction (STEMI). We assessed the relationship between mean platelet volume (MPV) on admission and pre- and postinterventional flow with the infarct-related artery (IRA) in patients with STEMI. We prospectively included 840 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). The patients were divided into 3 groups according to MPV tertiles. Pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow grade was determined. Initial TIMI flow grade 3 was accepted as patent IRA. After the primary PCI, normal flow was defined as post-PCI TIMI flow 3. When the MPV was increased, the incidence of pre-PCI patent IRA (P = .004) and post-PCI normal TIMI flow (P < .001) was significantly decreased. Multivariate analysis showed that MPV was independently associated with post-PCI TIMI flow grade.