La paradoja del tabaco en el síndrome coronario agudo sin elevación del ST

Preinterventional pan-immune-inflammation value as a tool to predict postcontrast acute kidney injury among acute coronary syndrome patients implanted drug-eluting stents: a retrospective observational study

We evaluated the value of pan-immune-inflammation value (PIV) in predicting the risk for postcontrast acute kidney injury (PCAKI), an important complication following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients. Medical records of 839 ACS patients underwent PCI between June 2019 and December 2022 were retrospectively analyzed. Patients were divided into two groups: PCAKI (-) and PCAKI (+). PCAKI was defined as a ≥ 0.5 mg/dL and/or a ≥ 25% increase in serum creatinine within 72 h after PCI. The PIV was computed as [neutrophils × platelets × monocytes]÷lymphocytes. The mean age was 60.7 ± 12.9 years. PCAKI was detected in 105 (12.51%) patients. PIV was higher in the PCAKI (+) group compared to PCAKI (-) group (median 1150, interquartile range [IQR] 663-2021 vs median 366, IQR 238-527, p < 0.001). Receiver operating characteristic curve analysis showed that the best cutoff of PIV for predicting PCAKI was 576 with 81% sensitivity and 80% specificity. PIV was superior to neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for the prediction of PCAKI (area under curve:0.894, 0.849 and 0.817, respectively, p < 0.001 for all). A high PIV was independently correlated with PCAKI (≤576 vs. >576, odds ratio [OR] 12.484, 95%confidence interval [CI] 4.853-32.118, p < 0.001) together with older age (OR 1.058, p = 0.009), female gender (OR 4.374, p = 0.005), active smoking (OR 0.193, p = 0.012), left ventricular ejection fraction (OR 0.954, p = 0.021), creatinine (OR 10.120, p < 0.001), hemoglobin (OR 0.759, p = 0.019) and c-reactive protein (OR 1.121, p = 0.002). In conclusion, a high PIV seems to be an easily assessable tool that can be used in clinical practice for predicting the risk of PCAKI in ACS patients implanted drug-eluting stents.

Correlation Between Smoking Paradox and Heart Rhythm Outcomes in Patients With Coronary Artery Disease Receiving Percutaneous Coronary Intervention

BACKGROUND

The effect of smoking on short-term outcomes among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is controversial. However, little is known about the impact of smoking on long-term outcomes in patients with stable coronary artery disease (CAD) who receive PCI.

METHODS

A total of 2,044 patients with stable CAD undergoing PCI were evaluated. They were divided into two groups according to smoking status (current smokers vs. non-smokers). Baseline characteristics, exposed risk factors, angiographic findings, and interventional strategies were assessed to compare the long-term clinical outcomes between groups. Predictors for myocardial infarction (MI), all-cause death, cardiovascular (CV) death, and repeated PCI procedures were also analyzed.

RESULTS

Compared with non-smokers, current smokers were younger and mostly male (both P < 0.01). They also had a lower prevalence of chronic kidney disease (CKD) and diabetes (both P < 0.01). Drugs including a P2Y12 receptor inhibitor of platelets (P2Y12 inhibitor), beta-blockers (BB), and statins were used more frequently in current smokers (P < 0.01, P < 0.01, P = 0.04, respectively). Freedom from all-cause death and CV death was lower in the non-smoker group (P < 0.001, P = 0.003, respectively). After adjustment, logistic regression revealed smoking was a major predictor for all-cause death and repeated PCI procedure [hazard ratio(HR): 1.71 and 1.46, respectively].

CONCLUSIONS

Smoker's paradox extends to long-term outcome in patients with stable CAD undergoing PCI, which is partially explained by differences in baseline characteristics. However, smoking strongly predicted all-cause mortality and repeated PCI procedures in patients with stable CAD undergoing PCI.