Zafer Elbasan

Neutrophil to Lymphocyte Ratio Is Associated With the Severity of Coronary Artery Disease in Patients With ST-Segment Elevation Myocardial Infarction

We assessed the relationship between the severity of coronary artery disease assessed by SYNTAX score (SS) and neutrophil to lymphocyte ratio (N:L ratio) in patients with ST elevation myocardial infarction (STEMI). In total, 840 patients with STEMI in whom primary percutaneous coronary intervention was performed were prospectively included (622 male, 218 female; mean age 58.6 ± 12.4 years). Total and differential leukocyte counts and other biochemical markers were measured at admission. Patients were categorized into tertiles on the basis of SS. The N:L ratio of SShigh group was higher compared with SSlow and SSmid groups (P < .001 for all). Multivariate regression analysis showed that N:L ratio (β = .277, P < .001), ejection fraction (β = −.086, P = .012), age (β = .104, P = .004), and diabetes (β = .152, P < .001) were the independent predictors for SS in patients with STEMI.

Uric acid and high sensitive C-reactive protein are associated with subclinical thoracic aortic atherosclerosis

BACKGROUND AND PURPOSE The detection of atherosclerotic lesions in the aorta by transesophageal echocardiography (TEE) is a marker of diffuse atherosclerotic disease. Hyperuricemia is a well-recognized risk factor for cardiovascular diseases. However, no data are available concerning the relationship between serum uric acid (UA) and subclinical thoracic aortic atherosclerosis. We aimed to investigate the association between thoracic aortic atherosclerosis and serum UA level. METHODS We studied 181 patients (mean age 46.3 ± 8 years) who underwent TEE for various indications. Four different grades were determined according to intima-media thickness (IMT) of thoracic aorta. UA and other biochemical markers were measured with an automated chemistry analyzer. RESULTS TEE evaluation characterized thoracic aortic intimal morphology as Grade 1 in 69 patients, Grade 2 in 52 patients, Grade 3 in 31 patients, and Grade 4 in 29 patients. The highest UA level was observed in patients with Grade 4 IMT when compared with Grade 1 and 2 IMT groups (p<0.001 and p=0.014, respectively). UA levels in patients with Grade 3 and Grade 2 IMT were also higher than patients with Grade 1 IMT group (p<0.001, for all). In multiple linear regression analysis, IMT was independently associated with UA level (β=0.350, p<0.001), age (β=0.219, p=0.001), total cholesterol (β=-0.212, p=0.031), low-density lipoprotein cholesterol (β=0.350, p=0.001), and high sensitivity C-reactive protein (hsCRP) levels (β=0.148, p=0.014). CONCLUSION Uric acid and hsCRP levels are independently and positively associated with subclinical thoracic atherosclerosis.

Contrast-Induced Nephropathy in Patients With ST Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

We assessed the relationship between contrast-induced nephropathy (CIN) and SYNTAX score (SS) and serum uric acid (SUA) levels in patients with ST elevation myocardial infarction (STEMI). A total of 835 STEMI patients in whom primary percutaneous coronary intervention was performed in our cardiology clinic were included in this study (615 male, 220 female; mean age 58.1 ± 12.2 years). The patients were divided into 2 groups (CIN and non-CIN). Contrast-induced nephropathy was observed in 9.6% (80) of patients; SS (13.9 ± 6.2/22.1 ± 5.8) and SUA (5.1 ± 0.9/6.2 ± 0.9) values in the CIN group were higher compared with the non-CIN group (P < .001, for all). All SS (95% confidence interval [CI] = 1.136-1.250, P = .001), SUA (95% CI = 1.877-3.236, P = .002), and diabetes (95% CI = 0.998-1.039, P = .026) were independent predictors of CIN in logistic regression analysis. Procedures that can prevent CIN may be beneficial in patients at high risk as identified by the SS and SUA levels.

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.

Mean Platelet Volume Associated With Aortic Distensibility, Chronic Inflammation, and Diabetes in Patients With Stable Coronary Artery Disease

We aimed to assess the effective factors on high mean platelet volume (MPV) in patients with stable coronary artery disease (CAD). A total of 411 patients (247 males and 164 females; mean age: 61.7 ± 9.9 years) with angiographically proven CAD were included. The patients were divided into 2 groups according to the median MPV value (MPVlow group <9.5 fL and MPVhigh group ≥9.5 fL). The SYNTAX score, high sensitive C-reactive protein (hsCRP) levels, and frequencies of diabetes and hypertension were higher in MPVhigh group compared to MPVlow group. Aortic distensibility (AD) and platelet count of patients in MPVhigh group were lower than patients in MPVlow group (P < .05, for all). Multivariate linear regression analysis showed that MPV was independently related with diabetes (β = 0.135, P = .007), hsCRP (β = 0.259, P < .001), platelet count (β = −0.144, P < .001), and AD (β = −0.425, P < .001). High MPV value is independently related to AD, as well as diabetes, hsCRP, and platelet count in patients with stable CAD.

Mean platelet volume is independently associated with renal dysfunction in stable coronary artery disease.

Abstract It has been suggested that athero-thrombotic risk progressively increases as the glomerular filtration rate (GFR) declines. Mean platelet volume (MPV) is the most commonly used measure of platelet size, and higher MPV value is independent risk factor for athero-thrombotic disease such as myocardial infarction. We aimed to evaluate the association between estimated GFR and MPV in patients with stable coronary artery disease showing normal to mildly impaired renal function. A total of 471 patients (288 males and 183 females; mean age: 62.5 + 9.5 years) with angiographically proven CAD were included. The patients were divided into two groups according to the estimated GFR value (GFRlow group: GFR <60 ml/minute per 1.73 m2 and GFRhigh group: GFR ≥ 60, ml/min per 1.73 m2). Estimated GFR was calculated according to the Cockcroft–Gault formula. MPV, high-sensitive C-reactive protein (hsCRP) and other biochemical markers were measured in all patients. Prevalent of CAD was determined by the SYNTAX score. Patients with GFRlow group were of older age, had higher incidence of female gender, current smoker, diabetes, hypertension and hyperlipidemia, lower values of total cholesterol, LDL cholesterol, hemoglobin and platelet count and higher values of BMI, SYNTAX score, hs-CRP and MPV compared with patients with GFRhigh group. Multivariate linear regression analysis showed that the MPV was independently related with diabetes (β = 0.189, p < 0.001), eGFR (β = −0.267, p < 0.001), hs-CRP level (β = 0.158, p < 0.001) and platelet count (β = −0.116, p = 0.002). In conclusion, MPV is independently associated with GFR as well as hsCRP, platelet count and diabetes. These findings may explain, in part, the increase in athero-thrombotic risk with slightly impaired renal function.

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.

SYNTAX score is a predictor of angiographic no-reflow in patients with ST-elevation myocardial infarction treated with a primary percutaneous coronary intervention.

ObjectivesThe no-reflow phenomenon has a negative prognostic value in patients with acute ST-elevation myocardial infarction (STEMI). The SYNTAX score (SS) quantifies the extent and complexity of angiographic disease and predicts long-term mortality and morbidity in STEMI. We aimed to assess the no-reflow and its possible relationships with SS and clinical characteristics in patients with STEMI treated with a primary percutaneous coronary intervention (PPCI). Materials and methodsIn this study, 880 patients with STEMI treated with PPCI were included prospectively (646 men and 234 women, mean age 58.5±12.4 years). The SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score were determined in all patients. No-reflow was defined as TIMI grade 0, 1 and 2 flows or TIMI grade 3 with myocardial blush grade 0 and 1. The patients were divided into two groups: a normal flow group and a no-reflow group. ResultsNo-reflow was observed in 32.8% of patients. The mean SS of the no-reflow group was higher than that of the normal flow group (19.2±6.8/12.9±6.1, P<0.001). On multivariate logistic regression analysis, SS [&bgr;=0.872, 95% confidence interval (CI)=0.845–0.899, P<0.001], diabetes (&bgr;=0.767, 95% CI=0.128–4.597, P=0.004), anterior myocardial infarction (&bgr;=5.421, 95% CI=1.369–21.469, P=0.025), and thrombus grade after wiring (&bgr;=2.537, 95% CI=1.506–4.273, P<0.001) were found to be independent predictors of no-reflow. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 19.75 for the prediction of no-reflow (sensitivity: 70.6%, specificity: 69.4%). ConclusionThe SS is a predictor of no-reflow in patients with STEMI treated with PPCI.

Paraoxonase-1 activity and oxidative stress in patients with anterior ST elevation myocardial infarction undergoing primary percutaneous coronary intervention with and without no-reflow.

BACKGROUND Reperfusion and ischemic injuries are pathogenetic mechanisms of no-reflow. Oxidative stress plays a critical role during ischemia as well as during the reperfusion phase following ST elevation myocardial infarction (STEMI). We sought to investigate the relationship between no-reflow with paraoxonase-1 (PON-1) activity and oxidative stress markers (total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), lipid hydro-peroxide (LOOH)) in patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS In this study, 319 consecutive anterior STEMI patients undergoing primary PCI were prospectively included (mean age 56.5 ± 12.5 years). The patients were divided into two groups as normal flow (n = 231) and no-reflow (n = 88) groups. Serum PON-1 activity was measured spectrophotometrically. TAC and TOS levels were determined by using an automated measurement method. LOOH levels were measured by ferrous oxidation with xylenol orange assay. RESULTS PON-1 activity and TAC levels were significantly lower and TOS, OSI and LOOH levels were significantly higher in patients with no-reflow compared to normal flow group (p < 0.05, for all). On multivariate logistic regression analysis, PON-1 activity (β = 0.976, 95% CI = 0.962-0.990, p = 0.001) and OSI (β = 1.094, 95% CI = 1.042-1.148, p < 0.001) as well as diabetes, infarction time, thrombus score and initial SYNTAX score were independently associated with no-reflow. CONCLUSION In patients with no-reflow compared with normal flow, oxidants are increased, while serum PON-1 activity and antioxidants are decreased. This result shows that increased oxidative stress has a role in the pathogenesis of no-reflow.