Zeki Yüksel Günaydın

Neutrophil-to-Lymphocyte Ratio Predicts Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention

We investigated the relationship between baseline neutrophil-to-lymphocyte ratio (NLR) and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI). Consecutive patients diagnosed with STEMI (n = 691) who underwent primary percutaneous coronary intervention (p-PCI) were included in the study. The CIN was defined as an increase in serum creatinine concentration ≥25% over baseline at 48 hours. Both NLR and C-reactive protein levels were significantly higher in the CIN group. There was a stronger correlation in patients with a known history of chronic kidney disease and in patients with a history of diabetes mellitus (DM). Advanced age, DM, low baseline glomerular filtration rate, reduced postprocedural ST resolution, high amount of contrast media, high NLR, and low left ventricular ejection fraction were independent predictors of CIN. The NLR may be used as a simple and reliable indicator of CIN in patients with STEMI who underwent p-PCI.

Relation of Neutrophil to Lymphocyte Ratio With the Presence and Severity of Stable Coronary Artery Disease

Objectives: We examined the association between neutrophil to lymphocyte ratio (NLR) and the complexity of coronary artery disease assessed by SYNTAX score (SS). Methods: The study population included patients with chest pain who had undergone coronary angiography for stable angina pectoris. Patients were classified depending on whether the SS was 0 or SS > 0. Results: Left ventricular ejection fraction, estimated glomerular filtration rate, and NLR were found to be the independent predictors of high SS in multivariate analysis. The area under the receiver–operating curve of NLR was 0.72 (0.65-0.80, P < .001) for predicting high SS. The optimal cutoff value of NLR to predict high SS was 2.7 (sensitivity of 72% and a specificity of 61%). There was a significant correlation between NLR ratio and continuous SS (r = .552, P < .001). Conclusion: The NLR is a readily measurable systemic inflammatory marker and is associated with both the presence and the complexity of coronary artery disease.

The outcome of primary percutaneous coronary intervention for stent thrombosis causing ST-elevation myocardial infarction.

BACKGROUND There are very few scientific data about the effectiveness of primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) due to stent thrombosis (ST). The purpose of the present study is to investigate the efficacy and outcome of primary PCI for STEMI due to ST in the largest consecutive patient population with ST reported to date. METHODS A total of 2,644 consecutive STEMI patients undergoing primary PCI were retrospectively enrolled into the present study. The primary end point of this study was successful angiographic reperfusion defined as postprocedural Thrombolysis In Myocardial Infarction grade III flow. The secondary end points were cardiovascular death and reinfarction. RESULTS Stent thrombosis was the cause of STEMI in 118 patients (4.4%). In patients with ST, angiographic success (postprocedural Thrombolysis In Myocardial Infarction grade III flow) was worse than in patients with de novo STEMI (76.3% vs 84.8%, P = .01). Patients with ST had significantly higher incidence of in-hospital cardiovascular mortality than patients with de novo STEMI (10.2% vs 5.3%, P = .02). In-hospital reinfarction rate was similar in both groups. In addition, long-term (mean 22 months) cardiovascular mortality and reinfarction rates were significantly higher in patients with ST compared with those without (17.4% vs 10.5%, P = .02 and 15.6% vs 9.5%, P = .03, respectively). CONCLUSIONS Primary PCI for treatment of ST is less effective, and these patients are at increased risk for in-hospital and long-term mortality compared with patients undergoing primary PCI due to de novo STEMI.

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.

Which is worst in patients undergoing primary angioplasty for acute myocardial infarction? Hyperglycaemia? Diabetes mellitus? Or both?

Objective— The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).Methods— 2482 consecutive patients with STEMI (mean age 56.5 ± 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > 200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n = 1806) patients; diabetic/non-hyperglycaemic (DNH, n = 271) patients; non-diabetic/hyperglycaemic (NDH, n = 64); and diabetic/hyperglycaemic (DH, n = 341).Results— In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac eve...

Comparison of outcomes in young versus nonyoung patients with ST elevation myocardial infarction treated by primary angioplasty.

ObjectivesWe sought to determine in-hospital and intermediate-term outcomes of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) in young adults. MethodsWe reviewed 2424 consecutive patients treated with primary angioplasty for acute MI; 465 were aged 45 or less (young group) and 1959 were 46–74 years of age (nonyoung group). Clinical characteristics, in-hospital and intermediate-term outcomes of primary PCI were analyzed. ResultsCompared with nonyoung patients, the young patients had significantly lower in-hospital and intermediate-term mortality (for in-hospital mortaliy: 5.4 vs. 1.2%, P<0.001; for intermediate-term mortality: 5 vs. 1.3%, P<0.001). By multivariate Cox regression analysis in all 2424 patients; cardiogenic shock, diabetes mellitus, anterior MI and unsuccessful procedure were independent predictors of both in-hospital and intermediate-term mortality whereas age [odds ratio (OR): 1.07, P<0.001], female sex (OR: 1.88, P = 0.04), MI history (OR: 3.05, P = 0.001) and multivessel disease (OR: 2.15, P = 0.01) were independent predictors of only intermediate-term mortality. The young group had lower unsuccessful procedure rates of primary PCI for STEMI (4.9 vs. 10.1%, P = 0.001). ConclusionThese results suggest that young adults who underwent primary PCI have favorable in-hospital and intermediate-term outcomes. Moreover, primary PCI for young adults with STEMI is safer, more feasible and effective than for a relatively older population.

Acute inferior myocardial infarction in a patient with severe haemophilia A disease

Dear Editor, A 60-year-old male haemophiliac since 6 months old was referred to our department for suspected acute myocardial infarction. He had experienced recurrent intramuscular haemorrhagic problems on both upper and lower extremities with flexion contractures, but received factor VIII concentrates only two times because of social problems. He had reports of factor VIII level <1% in the blood. There was no history of hypertension, diabetes mellitus and ischaemic heart disease. Patient was nonsmoker. Physical examination on admission revealed haematoma on left arm and left leg calf with flexion contractures. Pulse was regular and heart rate was 70 bpm. Blood pressure was 120/80 mmHg. An electrocardiogram revealed acute inferior and right ventricular myocardial infarction (Fig. 1a, b) without clinical right ventricular dysfunction, also confirmed with elevated cardiac markers such as troponin I and creatin kinase MB. Chest and lung examination was normal. Emergency coronary angiograms taken without delay showed diffuse coronary artery disease, and proximal part of right coronary artery was 100% obstructed. Coronary vessels were appropriate for surgical revascularisation. We did not perform primary percutaneous intervention to right coronary artery because pain was relieved without any intervention during cathetherisation. Patient transferred to coronary care unit without any complication. Clopidogrel treatment was not prescribed. The level of activated partial thromboplastin time (PTT) on admission was 69.5 s without any medication, so we did not administer heparin. Lipid profile was within normal ranges. B-blocker, ACE inhibitor and statin therapy were administered. Patient was haemodynamically stable and no mechanical complication observed in hospital. He was discharged in good clinical situation without any complaints of chest pain, breathlessness and bleeding on fifth day of hospitalisation. The patient was offered to admit to vascular surgeon in centre with hematology specialist and blood bank. Haemophilia is a bleeding disorder of varying severity which is due to a deficiency in specific clotting factors. It is an X-linked recessive disorder in which one of the proteins needed to form blood clots is missing or reduced. Haemophilia exclusively occurs in males. In this case, the patient was male and he was diagnosed when he was 6 months old. There are three main clinical status, mild, moderate and severe, in which the levels of factor VIII or IX in the blood are 5–30%, 1–5% and <1%, respectively. This patient had reports of factor VIII levels indicating severe disease. The most common type is haemophilia A, as in this case. The main treatment is to inject the missing clotting factor into the bloodstream. The patient in this case was treated intravenously with factor VIII concentrates only two times in his lifetime. Myocardial infarction and other arterial occlusions are considered to be rare in haemophilia A. There are few case reports of acute myocardial infarction in patients with haemophilia in the literature [1], and in most case reports which were gathered and evaluated by Girolami et al. [1], in 22 of 36 patients, the myocardial infarction occurred during or briefly after infusion of factor VIII or IX concentrates. In our case, the patient received this therapy 5 years ago and it seems that myocardial infarction was not related to the treatment complication, which makes the case Ann Hematol (2009) 88:711–712 DOI 10.1007/s00277-008-0663-9

Relationship Between Red Cell Distribution Width and Stroke in Patients With Stable Chronic Heart Failure: A Propensity Score Matching Analysis

Aim: We aimed to investigate the association between baseline red cell distribution width (RDW) level and the risk of stroke in patients with heart failure (HF). Methods: A total of 153 consecutive patients with HF (New York Heart Association [NYHA] I-III and left ventricular ejection fraction of <40%) were included in this prospective study. All the patients were followed up for 1 year, and during this period the cerebrovascular disease was questioned. Results: In matched population, using propensity score matching comparing patients with HF having stroke with patients without stroke, we found significantly increased basal RDW and serum uric acid. The receiver-operating characteristic curves of RDW for predicting stroke are performed. An RDW ≥15.2% measured on admission had 87% sensitivity and 74% specificity in predicting stroke in patients with HF (area under the curve: 0.923, 95% confidence interval: 0.852-0.994, P < .001). Conclusion: In conclusion, this study demonstrated that RDW may be important hematological indices for stroke in patients with HF using propensity score analysis.

Evaluation of cardiovascular risk in patients with Parkinson disease under levodopa treatment

Background Levodopa is the indispensable choice of medial therapy in patients with Parkinson disease (PD). Since L-dopa treatment was shown to increase serum homocysteine levels, a well-known risk factor for cardiovascular disorders, the patients with PD under L-dopa treatment will be at increased risk for future cardiovascular events. The objective of this study is to evaluate cardiovascular risk in patients with PD under levodopa treatment. Methods The study population consisted of 65 patients with idiopathic PD under L-dopa treatment. The control group included 32 age and gender matched individuals who had no cognitive decline. Echocardiographic measurements, serum homocysteine levels and elastic parameters of the aorta were compared between the patients with PD and controls. Results As an expected feature of L-dopa therapy, the Parkinson group had significantly higher homocystein levels (15.1 ± 3.9 µmol/L vs. 11.5 ± 3.2 µmol/L, P = 0.02). Aortic distensibility was significantly lower in the patients with PD when compared to controls (4.8 ± 1.5 dyn/cm2 vs. 6.2 ± 1.9 dyn/cm2, P = 0.016). Additionally, the patients with PD had higher aortic strain and aortic stiffness index (13.4% ± 6.4% vs. 7.4% ± 3.6%, P < 0.001 and 7.3 ± 1.5 vs. 4.9 ± 1.9, P < 0.001 respectively). Furthermore, serum homocysteine levels were found to be positively correlated with aortic stiffness index and there was a negative correlation between aortic distensibility and levels of serum homocysteine (r = 0.674, P < 0.001; r = −0.602, P < 0.001, respectively). Conclusions The patients with PD under L-dopa treatment have increased aortic stiffness and impaired diastolic function compared to healthy individuals. Elevated serum homocysteine levels may be a possible pathophysiological mechanism.

Relationship between Serum Gamma-glutamyl Transferase Levels with Ascending Aortic Dilatation

OBJECTIVE Increased serum gamma-glutamyl transferase levels (GGT) have been shown to directly promote oxidative stress. Previous studies have shown the relationship between the dilatation of the ascending aorta and oxidative stress. This study was designed to examine the relationship between serum GGT concentrations with dilatation of the ascending aorta. MATERIALS AND METHODS Ninety patients with ascending aortic dilatation and 90 age-sex-matched patients without aortic dilatation were included in the study. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions, where a diameter of 3.7 cm and above was accepted as ascending aortic dilatation. Serum GGT concentration was measured in all patients. RESULTS In the group with aortic dilatation, HT frequency, serum uric acid, hs-CRP and GGT levels, the LV mass index, and the left atrial volume index were found to be higher than the control group. The logistic regression analysis showed that only HT frequency (OR:1.23, 95% CI 1.11-1.35, p value: 0.02), the LA volume index (OR: 1.34, 95% CI 1.21±1.4, p:0.005) and serum GGT levels (OR: 1.12, 95% CI 1.01±1.20, p:0.03) were found to be independent predictors. There was a significant correlation between serum GGT levels and ascending aortic diameter (r: 0.268, p<0.001). In the ROC curve analysis, AUC was 0.659 (0.580±0.738) for a 23.5 serum GGT cut-off value (64% sensitivity and 53% specificity). CONCLUSION We found that serum GGT concentration was significantly associated with ascending aortic dilatation. Large epidemiological studies are required to correlate the findings from this study with clinical outcome.