Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction

Background

Inflammatory markers are significantly associated with cardiovascular disease and many markers have been used as predictor in patients with STEMI. This study examines the predictive value of the novel systemic immune-inflammation index (SII) in patients with ST-segment elevation myocardial infarction (STEMI).

Method

A total of 1660 patients with STEMI who underwent primary percutaneous coronary intervention in a tertiary heart center were enrolled in the study. SII was calculated using the following formula: Platelet × Neutrophil/Lymphocyte ratio. The patients were stratified into four quartiles (Q) according to admission SII level. In-hospital and 3-year outcomes were compared between the four groups (Q1–4)

Results

In-hospital cardiogenic shock, acute respiratory failure, acute kidney injury, ventricular arrhythmia, stent thrombosis, recurrent myocardial infarction, major adverse cardiac events, and mortality were significantly higher in the high SII groups (Q3 and Q4). Logistic regression models demonstrated that Q3 and Q4 had independent risk of mortality and Q4 had an independent risk of cardiogenic shock compared to Q1. ROC analysis showed that the best cut-off value of the Systemic Immune-Inflammatory Index to predict the in-hospital mortality was 1781 with 66% sensitivity and 74% specificity (AUC: 0.75; 95% CI: 0.69–0.81; p<0.001). Kaplan Meier overall survivals for Q1, Q2, Q3 and Q4 were 97.6%, 96.9%, 91.6% and 81.0% respectively. Cox proportional analysis for 3-year mortality demonstrated that Q3 and Q4 had independent risk of death compared to Q1.

Conclusion

SII, a novel inflammatory index, had a better prediction of in-hospital and long-term outcomes than traditional risk factors in patients with STEMI.

Funding Acknowledgement

Type of funding sources: None.

Mass-Difference Measurements on Heavy Nuclides with an eV/c^{2} Accuracy in the PENTATRAP Spectrometer

First ever measurements of the ratios of free cyclotron frequencies of heavy, highly charged ions with Z>50 with relative uncertainties close to 10^{-11} are presented. Such accurate measurements have become realistic due to the construction of the novel cryogenic multi-Penning-trap mass spectrometer PENTATRAP. Based on the measured frequency ratios, the mass differences of five pairs of stable xenon isotopes, ranging from ^{126}Xe to ^{134}Xe, have been determined. Moreover, the first direct measurement of an electron binding energy in a heavy highly charged ion, namely of the 37th atomic electron in xenon, with an uncertainty of a few eV is demonstrated. The obtained value agrees with the calculated one using two independent, different implementations of the multiconfiguration Dirac-Hartree-Fock method. PENTATRAP opens the door to future measurements of electron binding energies in highly charged heavy ions for more stringent tests of bound-state quantum electrodynamics in strong electromagnetic fields and for an investigation of the manifestation of light dark matter in isotopic chains of certain chemical elements.

g Factor of Boronlike Argon ^{40}Ar^{13+}

We have measured the ground-state g factor of boronlike argon ^{40}Ar^{13+} with a fractional uncertainty of 1.4×10^{-9} with a single ion in the newly developed Alphatrap double Penning-trap setup. The value of g=0.663 648 455 32(93) obtained here is in agreement with our theoretical prediction of 0.663 648 12(58). The latter is obtained accounting for quantum electrodynamics, electron correlation, and nuclear effects within the state-of-the-art theoretical methods. Our experimental result distinguishes between existing predictions that are in disagreement, and lays the foundations for an independent determination of the fine-structure constant.

The low levels of bone morphogenic protein-4 and its antagonist noggin in type 2 diabetes

OBJECTIVE

Bone morphogenic protein-4 (BMP-4) is a proinflammatory cytokine which is controlled by BMP-4 antagonists. Our aim was to investigate the levels of BMP-4 and its antagonists, noggin and matrix Gla protein (MGP), in prediabetes and diabetes.

DESIGN

One hundred and forty-two type 2 diabetic, 32 prediabetic, and 58 control subjects participated in this cross-sectional study. BMP-4, noggin, and MGP were measured with the ELISA method.

RESULTS

There was a significant difference between the three groups in relation to sex, hypertension, fasting plasma glucose, HbA1c, lipid profiles, and diastolic blood pressure (p < 0.05). BMP-4 levels were significantly lower in the diabetic group compared to the control group (108.5 and 127.5 ng/mL, respectively, p < 0.001 diabetes vs. control). Noggin levels were significantly lower in the diabetic group compared to the prediabetic and control groups (10.5, 11.5, and 12.0 ng/mL, as median, respectively, p < 0.001; diabetes vs. control, p = 0.002; diabetes vs. prediabetes). BMP-4 was associated significantly with noggin in the entire study population (ß coefficient = 0.796, p < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.708 (95% CI 0.551-0.864, p = 0.011) for BMP-4 levels. The optimal cutoff value of BMP-4 for detecting albuminuria was 118.5 ng/mL for which sensitivity was 71.4% and specificity was 66.4%.

CONCLUSIONS

BMP-4 and noggin levels were lower in the diabetic group. High BMP-4 levels were significantly associated with albuminuria. Further studies are warranted to determine the role of BMP-4 in the pathogenic processes underlying albuminuria and hyperglycemia in patients with type 2 diabetes.

Inflammation, Atrial Fibrillation and Cardiac Surgery: Current Medical and Invasive Approaches for the Treatment of Atrial Fibrillation

Atrial fibrillation (AF) is a cardiac dysrhythmia commonly seen in clinical practice especially after cardiac surgery. It is associated with increased morbidity and mortality for the patients. The pathogenesis of AF is not exactly understood yet, but there is growing data about the relationship between AF and inflammation. Cardiac surgery itself is a big source for inflammation. It causes major surgical trauma, ischemia/reperfusion injury, hypothermia, low arterial pressure, and the equipment of cardiopulmonary bypass makes a large foreign surface thus it activates inflammatory response. There is a large number of data about the treatment options of AF and there are also strategies, which are related to reduction of inflammatory activation during cardiopulmonary bypass. In order to review the relationship between cardiac surgery, inflammation, AF and treatment strategies in patients with AF, we conducted a search through Pubmed for articles in English using the keywords: "atrial fibrillation, cardiac surgery, inflammation, medical therapy, surgical therapy, ablation therapy" from January 2012 to present. We also searched separately for each alternative treatment modality on Pubmed. To identify further articles, we also looked into related citations in review articles and commentaries. We searched thoroughly the guidelines published by the European Society of Cardiology (2016), and the American Heart Association/ American College of Cardiology/ Heart Rhythm Surgery (2014). Many studies concluded that inflammation contributes in the occurrence of AF. Inflammatory markers, such as CRP, interleukins and complements have high sensitivity and specificity for prediction of AF whether the patient having cardiac surgery or not. Betablockers, diltiazem and amiodarone are the most commonly used drugs for rate control in AF following surgery. Although there are some new therapeutic approaches to reduce postoperative inflammatory activation, such as the use of vitamins, fatty acids, statins, or technical improvements to cardiopulmonary bypass unit like miniaturized bypass circuits, heparin coating of the circuits, leukocyte filters, or various surgical approaches like off-pump coronary bypass surgery, we still need more effective strategies to reduce both postoperative inflammation and postoperative AF risk after cardiac surgery. Today we use more advanced invasive and surgical treatment strategies for AF although we need far more advanced technics to reduce perioperative inflammatory activation, which actually causes AF.

Dynamic alterations in cerebral, celiac and renal flows resulting from ascending aorta, subclavian artery and femoral artery cannulations of extracorporeal devices

INTRODUCTION

The aim of this study was to assess the relationships among cardiac output, extracorporeal blood flow, cannulation site, right (RCa) and left carotid (LCa), celiac (Ca) and renal artery (Ra) flows during extracorporeal circulation.

METHODS

A mock circulatory circuit was assembled, based on a compliant anatomical aortic model. The ascending aorta, right subclavian and femoral artery cannulations were created and flow was provided by a centrifugal pump (Cp); cardiac output was provided by a roller pump (Rp). Five volume flow rates were tested. The Rp was set at 4 L/min with no Cp flow (R⁴-C⁰) and the basic volume flow rates of the vessels were measured. The flow of the Cp was increased while the Rp flow was decreased for other measurements; R³-C¹, R²-C², R¹-C³ and R⁰-C⁴. Measurements were repeated for all cannulation sites.

RESULTS

The RCa flow rate at R⁴-C⁰ was higher compared to the R³-C¹, R²-C², R¹-C³ and R⁰-C⁴ RCa flows with subclavian cannulation. The RCa flow decreased as the Cp flow increased (p<0.05). The RCa flow with ascending aortic and femoral cannulation was higher compared to subclavian cannulation. Higher flows were obtained with subclavian cannulation in the LCa compared to the others (p<0.05). R⁴-C⁰ Ca and Ra flows were higher compared to other Ca and Ra flows with femoral cannulation. Ca and Ra flows decreased as Cp flow increased. Flows of the Ca and Ra with ascending and subclavian cannulations were not lower compared to the R⁴-C⁰ flow (p<0.05).

CONCLUSION

This study shows that prolonged extracorporeal circulation may develop flow decrease and ischemia in cerebral and abdominal organs with both subclavian and femoral cannulations.

Should we change the cannulation site for right subclavian artery cannulation? An experimental study with a newly designed cannula

BACKGROUND:

In this experimental study, we primarily aimed to show the hemodynamic effects and superiority of this newly designed cannula for perfusion compared to standard subclavian cannulation. The new cannula (Figure 1) allows bidirectional axial flow and it directly fits in the brachiocephalic trunk (innominate artery).

METHODS:

We used a cardiopulmonary bypass roller pump, reservoir, 3/8- 1/2- 1/4-inch Y-connectors and tubing set. Lines were set as seen in Figures 2, 3, 4 and 5. The anatomy of the aorta (ascending, arch, branches, descending) was mimicked, using tubing sets with different sizes and the connectors yielding similar angles and configurations. In this experimental vascular system, systemic vascular resistance was created with partial clamping of the common tubing set. The cannulation sites were created in the subclavian artery and the innominate artery. Perfusion was established with the same pump rate and the same occlusion pressures (systemic vascular resistance). The pressure readings were obtained in the right carotid artery, the left carotid artery and the left subclavian artery.

RESULTS:

These experimental models of vasculature allowed us to measure pressures in the carotid system for different cannulation set-ups, using both our newly designed double-outflow cannula, which was introduced via the innominate artery, and the standard arterial cannula, which was introduced via the subclavian artery. Higher pressure recordings were obtained in the carotid system with the new cannula introduced through innominate artery.

CONCLUSION:

Higher cerebral perfusion readings were obtained with our newly designed bidirectional cannula introduced via the innominate artery compared to standard cannulation through the right subclavian artery.

Risk factors for intraaortic balloon pump use in coronary artery bypass surgery

OBJECTIVES

The study was aimed at investigating the risk factors of using an intraaortic balloon pump (IABP) in coronary artery bypass surgery and presenting the authors' clinical experience of IABP use.

MATERIAL AND METHODS

The study included 1094 patients who underwent coronary artery bypass surgery at the authors' clinic between January 2009 and December 2011. A comparison was made between 17 patients in whom an IABP was used and 1077 patients in whom it was not used.

RESULTS

An intraaortic balloon pump was used in 17 patients (1.55%) out of 1094 patients who underwent isolated coronary artery bypass surgery. The ratio of patients who had had preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50% and emergency surgery in Group 1 were higher than in Group 2 (p < 0.05). The total cardiopulmonary bypass time of Group 1 was found to be longer than that of Group 2 (p < 0.05). The demand for inotropics after weaning from cardiopulmonary bypass was greater in Group 1 than in Group 2 (p < 0.05). The need for reoperation (because of bleeding) was higher in Group 1 than in Group 2 (p < 0.05). The patients' stay on the intensive care unit was longer in Group 1 than in Group 2 (p < 0.05). Mortality rates were 29.4% in Group 1 and 1.2% in Group 2 (p < 0.05).

CONCLUSIONS

Preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50%, emergency surgery and long cardiopulmonary bypass time are important risk factors for IABP use in coronary artery bypass surgery.

Coronary artery bypass surgery: beating heart or cardiopulmonary bypass?

In this study, we examined the early results for patients who underwent beating heart coronary bypass surgery and compared these results with those of conventional coronary bypass surgery.A total of 1094 patients who underwent isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic were included in this study. Seventy-three patients in whom cardiopulmonary bypass was not used (group 1) were compared to 1021 patients in whom cardiopulmonary bypass was used (group 2).The mean age was 60.7 ± 9.3 in group 1 and 58.9 ± 9.7 in group 2 (P > 0.05). There was no significant difference between the two groups in terms of gender, or the coexistence of diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and hypertension (P > 0.05). There was no significant difference between group 1 and group 2 in terms of development of postoperative atrial fibrillation (AF), use of an intra-aortic balloon pump, need for re-operation for bleeding, or duration of hospital stay and intensive care unit stay (P > 0.05). The need for inotropic support and the amount of mediastinal drainage were less in group 1 than in group 2 (P = 0.002, P < 0.001). The incidences of postoperative cerebrovascular accident, development of chronic renal failure, and sternal wound infection did not significantly differ between the groups (P > 0.05). There was no mortality in group 1, whereas it was calculated as 1.8% in group 2 (P = 0.63).Beating heart coronary artery bypass surgery decreases the need for inotropic support and transfusion.