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Sheikhy A, Fallahzadeh A, Jameie M, Aein A, Masoudkabir F, Maghsoudi M, Tajdini M, Salarifar M, Jenab Y, Pourhosseini H, Mehrani M, Alidoosti M, Vasheghani-Farahani A, Hosseini K. In-hospital and 1-year outcomes of patients without modifiable risk factors presenting with acute coronary syndrome undergoing PCI: a Sex-stratified analysis. Front Cardiovasc Med 2023; 10:1235667. [PMID: 38173819 PMCID: PMC10761535 DOI: 10.3389/fcvm.2023.1235667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Aim A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established. Methods This retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions. Results Approximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99-12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91-2.65, P:0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P: 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P: 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92-6.21, P < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P: 0.008) than SMuRF+ women. Conclusions Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality.
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Affiliation(s)
- Ali Sheikhy
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Fallahzadeh
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Aein
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Maghsoudi
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Naderian M, Khederlou H, Hosseinsabet A, Salarifar M. Extensive cardiovascular involvement in a young boy with Gaucher's disease: a case report. Eur Heart J Case Rep 2023; 7:ytad456. [PMID: 37767233 PMCID: PMC10519875 DOI: 10.1093/ehjcr/ytad456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Background Lysosomal storage diseases (LSDs) are rare, progressive, multi-organ disorders caused by inherited enzyme deficiencies. Gaucher's disease (GD) is the most prevalent form of LSDs. Case summary A 19-year-old Caucasian male presented with exertional dyspnoea. Physical examination revealed a Grade III/VI systolic diamond murmur at the heart base and a Grade IV/VI systolic murmur at the apex. Electrocardiogram showed signs of left ventricular hypertrophy (LVH). Trans-thoracic echocardiography (TTE) and trans-oesophageal echocardiography (TEE) demonstrated moderate LVH, severe aortic valve stenosis, severe supra-valvular aortic stenosis, and moderate mitral stenosis with severe degenerative mitral valve regurgitation. Bone marrow biopsy and aspiration confirmed the presence of characteristic Gaucher's cells. The patient underwent the Bentall procedure and mitral valve replacement and was discharged in good condition. Discussion Gaucher's disease exhibits three clinical phenotypes, and cardiovascular involvement is commonly seen in GD Type III. Valvular calcification and ascending aorta involvement are frequent cardiovascular manifestations. Although severe valvular heart involvement is rare in GD, cardiac valve surgery has shown favourable outcomes in previous studies and our case.
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Affiliation(s)
- Mohammadreza Naderian
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Hamid Khederlou
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Ali Hosseinsabet
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
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Alidoosti M, Sattartabar B, Pourhoseini H, Salarifar M, Nematipour E, Hajizeinali A, Aghajani H, Amirzadegan A, Baharvand F. Comparative outcomes of percutaneous transvenous mitral commissurotomy between low and high Wilkins score. Asian Cardiovasc Thorac Ann 2023:2184923231187052. [PMID: 37424238 DOI: 10.1177/02184923231187052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Percutaneous transvenous mitral commissurotomy (PTMC) is one of the non-surgical methods for patients with significant mitral stenosis. It is less invasive, less complicating with better outcomes compared to surgery. The Wilkins score ≤8 is used to select patients for PTMC, but the results of several studies suggest that PTMC can also be successful in a higher Wilkins score. The aim of this study is to compare the outcomes of PTMC between two groups. METHODS In this retrospective study, patients who underwent PTMC between April 2011 and December 2019 were included. Patients were divided into two groups based on Wilkins score: 196 patients (57.64%) with a Wilkins score ≤8 (group I) and 134 patients (39.4%) with a Wilkins score >8 (group II). RESULTS There was no difference in demographic characteristics between two groups except for age (p = 0.04). Pre and post-interventional echocardiographic and catheterization measurements including left atrial pressure, pulmonary artery pressure, mitral valve area, mitral valve mean, and peak gradient were measured, and there was no difference between the two groups (p > 0.05). The most common complication was mitral regurgitation (MR). Serious complications such as stroke and arrhythmias were rare in both groups (<1%). There was no difference between MR, ASD (atrial septal defect) and serious complications between the two groups. CONCLUSION This study shows that the Wilkins score with a cutoff value of 8 is not suitable for patient selection and novel criteria including both mitral valve features and other variables affecting the PTMC outcomes is needed.
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Affiliation(s)
- Mohammad Alidoosti
- Tehran Heart Center, Interventional Cardiology Departement, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Sattartabar
- Tehran Heart Center, Interventional Cardiology Departement, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhoseini
- Tehran Heart Center, Interventional Cardiology Departement, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Interventional Cardiology Departement, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Interventional Cardiology Departement, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohammad Hajizeinali
- Tehran Heart Center, Interventional Cardiology Departement, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Fateme Baharvand
- Department of cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Sahebjam M, Zoroufian A, Hajizeinali A, Salarifar M, Jalali A, Ayati A, Farmanesh M. Comparison of 1-year Follow-up Echocardiographic Outcomes of Sapien 3 Versus Evolut R Bioprosthetic Transcatheter Aortic Valves: A Single-center Retrospective Iranian Cohort Study. Crit Pathw Cardiol 2023; 22:54-59. [PMID: 37053035 DOI: 10.1097/hpc.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE The current study aimed to compare 1-year echocardiographic outcomes of the new generations of self-expanding (Evolut R) versus balloon-expandable (Sapien 3) bioprosthetic transcatheter aortic valves. METHODS In this study, gradients and flow velocities obtained from transthoracic Doppler-echocardiography were retrospectively collected from patients who underwent 2 new generations of transcatheter aortic valve implantation interventions with Sapien 3 and Evolut R valves. Patients underwent echocardiography before the procedure and at discharge, 6 months, and 1-year follow-up. RESULTS Of the 66 patients, 28 received Sapien 3 and 38 received Evolut R valves. Evolut R valve presented a lower mean gradient at all follow-up time points compared with Sapien 3 valves (14.4 mm Hg, 14.9 mm Hg, 15.5 mm Hg compared with 10.1 mm Hg, 11.6 mm Hg, 11.8 mm Hg, respectively; all P -values <0.001). Small valve sizes of Evolut R, including 23 and 26, had higher echocardiographic mean gradient or peak gradient at the time of discharge compared with larger valves, including sizes 29 and 34 (11.1 mm Hg and 11.2 mm Hg vs. 10.2 mm Hg, 9.1 mm Hg) and 1-year follow-up (11.0 mm Hg, 11.0 mm Hg vs. 9.9 mm Hg, 8.4 mm Hg; all P -values = 0.001). Although Sapien 3 valves demonstrated a higher peak gradient in smaller sizes at discharge (18.44 mm Hg in size 23 vs. 17.9 mm Hg, 16.5 mm Hg in size 26 and 29, respectively; P = 0.001), the peak gradients did not show a statistically significant difference in the 1-year follow-up. CONCLUSIONS The current study detected significantly lower mean and peak gradients in Evolut R compared with Sapien 3 at all follow-up time points. Furthermore, smaller valve sizes were associated with significantly higher gradients at all follow-ups, regardless of the valve type.
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Affiliation(s)
- Mohammad Sahebjam
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alimohammad Hajizeinali
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahkameh Farmanesh
- From the Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Kakavand H, Saadatagah S, Naderian M, Aghakouchakzadeh M, Jalali A, Sadri F, Amoli AI, Hosseini SH, Jenab Y, Pourhosseini H, Salarifar M, Talasaz AH. Evaluating the role of intravenous pentoxifylline administration on primary percutaneous coronary intervention success rate in patients with ST-elevation myocardial infarction (PENTOS-PCI). Naunyn Schmiedebergs Arch Pharmacol 2023; 396:557-565. [PMID: 36856810 PMCID: PMC9975441 DOI: 10.1007/s00210-022-02368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 03/02/2023]
Abstract
Ischemia reperfusion injury can lead to further myocardiocyte damage in patients with ST-elevation myocardial infarction (STEMI). Pentoxifylline is a methylxanthine derivative with known anti-inflammatory, antioxidant, vasodilator, and rheological properties which can be a promising agent in preventing reperfusion injury. PENTOS-PCI is a single-center, randomized, double-blind, placebo-controlled trial which evaluated the efficacy and safety of preprocedural administration of intravenous pentoxifylline in patients undergoing primary percutaneous coronary intervention (PCI). Patients with acute STEMI who were eligible for PCI were randomized to receive either 100-mg intravenous infusion of pentoxifylline or placebo, prior to transferring to catheterization laboratory. Overall, 161 patients were included in our study of whom 80 patients were assigned to pentoxifylline and 81 to the control groups. Per-protocol analysis of primary endpoint indexing PCI's success rate as measured by thrombolysis in myocardial infarction (TIMI) flow grade 3 was not significantly different between pentoxifylline and placebo (71.3% and 66.3% respectively, P = 0.40). In addition, pentoxifylline could not improve secondary angiographic endpoints including myocardial blush grade 3 (87.5% and 85.2%, P = 0.79) and corrected TIMI frame count (22.8 [± 9.0] and 24.0 [± 5.1], P = 0.33) in the intervention and placebo groups respectively. The rates of major adverse cardiac and treatment emergent adverse effects were not significantly different between the two groups. Administration of intravenous pentoxifylline before primary PCI did not improve the success rate of the procedure in patients with STEMI. Intravenous administration of pentoxifylline was well tolerated, and there were no significant differences regarding adverse drug reactions in the two groups. Panel A, background: pentoxifylline is a methylxanthine derivative with known anti-inflammatory, antioxidant, vasodilator, and rheological properties which can be a promising agent in preventing reperfusion injury. Panel B: study design and main results of the PENTOS-PCI trial. cTFC corrected TIMI frame count, ED emergency department, IRI ischemia reperfusion injury, MBG myocardial blush grade, PCI percutaneous coronary intervention, PPCI primary PCI, PTX pentoxifylline, ROS reactive oxygen species, SD standard deviation, STEMI ST-elevation myocardial infarction, TIMI thrombolysis in myocardial infarction.
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Affiliation(s)
- Hessam Kakavand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedmohammad Saadatagah
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Translational Research On Inflammatory Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Mohammadreza Naderian
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Maryam Aghakouchakzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Farshad Sadri
- Department of Cardiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Izadi Amoli
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | | | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Hamidreza Pourhosseini
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Azita H Talasaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
- Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran.
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Emami M, Mirzamohamadi S, Heidari A, Aein A, Salarifar M, Nematipour E. Evaluation of the Causes of Door-to-Balloon Time Delays in Patients with ST-Elevation Myocardial Infarction at Tehran Heart Center. J Tehran Heart Cent 2023; 18:68-71. [PMID: 37252220 PMCID: PMC10225033 DOI: 10.18502/jthc.v18i1.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/17/2022] [Indexed: 05/31/2023] Open
Abstract
Background Coronary artery disease (CAD) is the leading cause of cardiovascular death globally, and the most severe form of CAD, ST-elevation myocardial infarction (STEMI), needs immediate treatment. This study aimed to report patient characteristics and the causes of door-to-balloon time (D2BT) delays in STEMI patients admitted to Tehran Heart Center with a D2BT exceeding 90 minutes. Methods This cross-sectional study was conducted at Tehran Heart Center, Iran, from March 20th, 2020, through March 20th, 2022. Variables consisted of age, sex, diabetes mellitus, hypertension, dyslipidemia, smoking, opium, family history of CAD, in-hospital mortality, primary percutaneous coronary intervention results, culprit vessels, causes of delays, the ejection fraction, triglycerides, and low and high-density lipoprotein levels. Results The study population was composed of 363 patients (272 males [74.9]) at a mean (SD) age of 60±11.47 years. The leading causes of D2BT delays were the catheterization lab used in 95 patients (26.2) and misdiagnosis in 90 (24.8). Other causes were ST-elevation less than 2 mm in electrocardiograms in 50 patients (13.8) and referral from other hospitals in 40 (11.0). Conclusion The catheterization lab in use and misdiagnosis were the leading causes of D2BT delays. We recommend that high-volume centers allocate an additional catheterization lab with an on-call cardiologist. Improved resident training and supervision in hospitals with many residents are also necessary.
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Affiliation(s)
- Mohammadamin Emami
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Mirzamohamadi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Heidari
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Aein
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, 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Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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8
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Masoudkabir F, Yavari N, Jameie M, Pashang M, Sadeghian S, Salarifar M, Jalali A, Ahmadi Tafti SH, Abbasi K, Salehi Omran A, Momtahen S, Mansourian S, Shirzad M, Bagheri J, Barkhordari K, Karimi A. The association between different body mass index levels and midterm surgical revascularization outcomes. PLoS One 2022; 17:e0274129. [PMID: 36174074 PMCID: PMC9522296 DOI: 10.1371/journal.pone.0274129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background There are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed “the obesity paradox”. This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG. Methods This historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m2): 18.5≤BMI<25, 25≤BMI<30, 30≤BMI<35, 35≤BMI<40, and BMI≥40. Patients with BMIs below 18.5 kg/m2 were excluded. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. For the assessment of the linearity of the relationship between continuous BMI and the outcomes, plots for time varying hazard ratio of BMI with outcomes were provided. Results Of 17 751 patients (BMI = 27.30 ±4.17 kg/m2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m2 kg/m2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints. Conclusions Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.
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Affiliation(s)
- Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Yavari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mana Jameie
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Ahmadi Tafti
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiomars Abbasi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Salehi Omran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Momtahen
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mansourian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Shirzad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Khosro Barkhordari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Karimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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9
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Sadre-Bafghi SA, Mohebi M, Hadi F, Parsaiyan H, Memarjafari M, Tayeb R, Ghodsi S, Sheikh-Sharbafan R, Poorhosseini H, Salarifar M, Alidoosti M, Haji-Zeinali AM, Amirzadegan A, Aghajani H, Jenab Y, Hosseini Z. Impact of Baseline Estimated Glomerular Filtration Rate Using CKD-EPI Equation on Long-term Prognosis of STEMI Patients: A Matter of Small Increments! Crit Pathw Cardiol 2022; 21:153-159. [PMID: 35994724 DOI: 10.1097/hpc.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients. OBJECTIVES We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients. METHODS A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60-90), and C3 (≥ 90). RESULTS Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656-0.975]; P = 0.035), (HR = 0.425 [0.250-0.725]; P = 0.002), (HR = 0.425 [0.242-0.749]; P = 0.003), and (0.885 [0.742-0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178-0.504; P < 0.0001). CONCLUSIONS Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI.
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Affiliation(s)
- Seyed-Ali Sadre-Bafghi
- From the Afshar Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehrnaz Mohebi
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- Department of Obstetrics and Gynecology, Imam Hossein Medical Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Parsaiyan
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Memarjafari
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Tayeb
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Ghodsi
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Sheikh-Sharbafan
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Haji-Zeinali
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirzadegan
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Department of Cardiology, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Research Department, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Fazlzadeh M, Hassanvand MS, Nabizadeh R, Shamsipour M, Salarifar M, Naddafi K. Effect of portable air purifier on indoor air quality: reduced exposure to particulate matter and health risk assessment. Environ Monit Assess 2022; 194:638. [PMID: 35925421 DOI: 10.1007/s10661-022-10255-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
We sought to investigate the impact of air purifiers in the removal of particular matter (PM)10, PM2.5, PM1, and particle number concentration (PNC) in the indoor air of dormitories located at Iran's largest medical university, Tehran University of Medical Sciences. Twelve rooms were selected and randomly assigned to two rooms: sham air purifier system deployed room (SR) and true air purifier system deployed room (TR). All study samples were drawn simultaneously from assigned rooms using portable GRIMM dust monitors for 24 h. The PM monitors of air were positioned in the middle of each room next to the air purifier at the height of the breathing zone (1.5 m in height). The mean PM10, PM2.5, PM1, and PNC removal efficiency in rooms with and without a smoker were measured to be 40.7 vs 83.8%, 31.2 vs 78.4%, 29.9 vs 72.3%, and 44.3 vs 75.6%, respectively. The results showed that smoking is an important influencing factor on the indoor air quality; smoking lowered the removal efficiency of PM10, PM2.5, PM1, and PNC by 43%, 47%, 43%, and 31%, respectively. An air purifier could decline the PM10 and PM2.5 even lower than the WHO 24-h guideline level in non-smoker rooms. This study revealed that using household air purifiers in rooms with smokers and non-smokers significantly reduces the non-carcinogenic risks of exposure to PM10 and PM2.5.
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Affiliation(s)
- Mehdi Fazlzadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
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11
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Fallahzadeh A, Sheikhy A, Aein A, Salarifar M, Pourhosseini H, Aghajani H, Alidoosti M, Sadeghian S, Hosseini K. Outcome of Percutaneous Coronary Intervention in Old Patients Presenting with Acute Coronary Syndrome. Arch Iran Med 2022; 25:523-532. [PMID: 37543874 DOI: 10.34172/aim.2022.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/11/2022] [Indexed: 08/07/2023]
Abstract
BACKGROUND Octogenarians (age≥80 years) with coronary artery disease constitute a high-risk group and the elderly undergoing percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared to young patients. In this study, we aimed to describe the outcomes of the elderly with acute coronary syndrome (ACS) who underwent PCI and also to identify the predictors of short-term major adverse cerebrocardiovascular events (MACCE) in octogenarians. METHODS In this registry-based cohort study, we reviewed the data of patients (aged≥65 years) who underwent PCI. Univariate Cox-regression model was used to assess the univariate effects of covariates on mortality and MACCE and multivariate Cox-regression analysis were used to discover MACCE predictors. RESULTS We reviewed the data of 3332 patients (2722 elderly [65 to 79 years], and 610 octogenarians [≥80 years]). The cumulative hazard of MACCE was significantly higher in the octogenarian group compared with the younger group (P<0.001). MACCE in octogenarians presenting with ST-elevation myocardial infarction (STEMI) was significantly higher than those with non-ST-elevation myocardial infarction/Unstable angina (NSTEMI/UA) (P<0.001); however, the cumulative hazard of mortality was not significantly different between the two groups (P=0.270). Successful PCI, left main stenosis and estimated glomerular filtration rate (eGFR) were independent predictors of MACCE in octogenarians with ACS. CONCLUSION Octogenarians undergoing PCI had a higher rate of MACCE and mortality compared with a younger population. In octogenarians, MACCE in those with STEMI was significantly higher than those with NSTEMI/UA and the mortality trend was similar; however, the 1-year trend was in favor of the STEMI subgroup.
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Affiliation(s)
- Aida Fallahzadeh
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheikhy
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Aein
- Department of Health Education and Health Promotion, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhosseini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Nozari Y, Mojtaba Ghorashi S, Alidoust M, Hamideh Mortazavi S, Jalali A, Omidi N, Fazeli A, Aghajani H, Salarifar M, Reza Amirzadegan A. In-hospital and 1-Year Outcomes of Repeated Percutaneous Coronary Intervention for In-stent Restenosis With Acute Coronary Syndrome Presentation. Crit Pathw Cardiol 2022; 21:87-92. [PMID: 35416802 DOI: 10.1097/hpc.0000000000000283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In-stent restenosis (ISR) is the Achilles' heel of percutaneous coronary intervention (PCI). There have been controversial data about outcomes of repeated PCI (redo-PCI) for ISR. This study aims to determine the predictors of major adverse cardiac events (MACE) in patients underwent redo-PCI for ISR. METHODS In this retrospective study, all patients with acute coronary syndrome who were underwent successful PCI for ISR at Tehran Herat Center (between 2004 and 2019) were eligible for inclusion. Patients with moderate to severe valvular heart disease and/or hematological disorders were excluded. Participants were divided into 2 groups based on the occurrence of the MACE [composite of cardiovascular death, myocardial infarction (MI), coronary artery bypass grafting, target vessel revascularization, and target lesion revascularization]; then, the study variables were compared between the 2 groups. Finally, the predictors of MACE were identified using Cox regression analysis. RESULTS Of 748 redo-PCI patients (mean age: 65.2 ± 10.1; 71.0% males), 631 patients had met the inclusion criteria. Fifty-four patients (9.8%) developed MACE within a 1-year follow-up period. Multivessel disease, primary PCI, Ad-hoc PCI, history of non-ST-segment elevation MI, and diabetes mellitus were independent predictors for MACE. In a subgroup analysis, 30 patients who experienced third PCI (target lesion revascularization/target vessel revascularization) were followed more as 1-year MACE. Among these patients, 14 MACEs were observed during the last follow-up (till June 2020). CONCLUSIONS Multivessel disease, primary PCI, and history of non-ST-segment elevation MI were the predictors of higher 1-year MACE, whereas Ad-hoc PCI and diabetes mellitus had a protective effect on MACE.
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Affiliation(s)
- Younes Nozari
- From the Department of Cardiovascular Disease Research, Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
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13
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Naghshtabrizi N, Alizadeh S, Naghshtabrizi B, Jalali A, Salarifar M. Relationship between Severity and Complexity of Coronary Artery Involvement and Obstructive Sleep Apnea Based on STOP-BANG Questionnaire. Int J Prev Med 2022; 13:34. [PMID: 35392318 PMCID: PMC8980830 DOI: 10.4103/ijpvm.ijpvm_443_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA), which has a known correlation with cardiovascular disease, is a possible risk factor of coronary artery disease (CAD) that is preventable. Aims: We sought to put lights on the relationship between OSA based on the STOP-BANG questionnaire (SBQ) and the severity and complexity of coronary artery involvement. Methods: This cross-sectional, single-center, retrospective study was conducted among 145 patients who underwent selective coronary angiography (SCA) between October 2018 and March 2019, admitted to the Tehran Heart Center, Tehran, Iran. OSA risk was assessed in patients based on SBQ categories. Also, the severity and complexity of coronary artery involvement calculated according to SYNTAX and Gensini scores. Analysis performed by statistical software SPSS 25. Results: Based on SBQ risk assessment categories, 22 (15.2%), 64 (44.1%), and 59 (40.7%) of the patients were low, intermediate, and high-risk for OSA, respectively. By comparing the means of coronary artery involvement, there was no significant difference in SYNTAX score 17.15 ± 13.67 (10.56–23.74) in low, 15.67 ± 9.78 (13.19–18.16) in intermediate, and 16.93 ± 9.21 (14.42–19.45) in high-risk groups; P value: 0.754, and Gensini score 66.4 ± 70.75 (35.04–97.77) in low, 66.21 ± 55.05 (52.45–79.96) in intermediate, 74.61 ± 56.33 (59.93–89.3) iin high risk groups; P value: 0.697 with groups of OSA risks. Also, after adjusting confounding factors, there was still no statistically significant difference in terms of coronary involvement scores. Conclusions: There was no statistically significant difference in SYNTAX and Gensini scores of different groups of OSA risk categories based on the SBQ. However, our results can't be extended into the connection between OSA and CAD.
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Affiliation(s)
- Nima Naghshtabrizi
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| | - Soroosh Alizadeh
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
| | | | - Arash Jalali
- Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran University of Medical Science, Tehran, Iran
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14
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Ghorashi SM, Salarifar M, Poorhosseini H, Sadeghian S, Jalali A, Aghajani H, Haji-Zeinali AM, Omidi N. Predictors of in-hospital mortality in diabetic patients with non-ST-elevation myocardial infarction. Egypt Heart J 2022; 74:20. [PMID: 35347479 PMCID: PMC8960521 DOI: 10.1186/s43044-022-00256-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background There have been little data about the additive effects of coronary risk factors on mortality in diabetic patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI). This study aimed to evaluate the predictors of mortality in diabetic patients presenting with NSTEMI. All patients admitted to Tehran Heart Center (THC) with a confirmed diagnosis of NSTEMI and a history of diabetes mellitus (DM) type 2 between September 2003 and April 2017 were included. Clinical characteristics and paraclinical data such as lipid profiles, creatinine, hemoglobin, and hemoglobin A1C (HbA1C) were evaluated in these patients to predict in-hospital mortality. The approach for model calibration was a logistic regression with the backward elimination method. Results Of a total of 9158 patients with non-ST-segment elevation myocardial infarction, 3133 had diabetes mellitus type 2 and met our criteria to enter the final analysis. In the multivariable analysis, age, chronic obstructive pulmonary disease, and a severely reduced left ventricular ejection fraction (LVEF) significantly increased the rate of in-hospital mortality, whereas mildly and moderately reduced left ventricular ejection fraction did not increase the rate of mortality. Conclusions Age, chronic obstructive pulmonary disease (COPD), and severely reduced LVEF (< 30%) independently increased in-hospital mortality in our diabetic patients with a confirmed diagnosis of NSTEMI. Severely reduced LVEF had the strongest relationship with in-hospital mortality, whereas the mean HbA1C level and the type of DM management exerted no significant effect on in-hospital mortality.
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Affiliation(s)
- Seyyed Mojtaba Ghorashi
- Department of Cardiovascular Disease Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saead Sadeghian
- Department of Cardiovascular Disease Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Cardiovascular Disease Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Haji-Zeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Omidi
- Department of Cardiovascular Disease Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Nasiri A, Shafiee A, Hosseinsabet A, Talasaz AH, Jalali A, Salarifar M. Effect of minocycline on the left ventricular function following ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Trials 2022; 23:112. [PMID: 35120566 PMCID: PMC8815113 DOI: 10.1186/s13063-021-05921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac remodeling following myocardial infarction is a pathological process. We aimed to examine the effect of early short-term minocycline on the left ventricular function following ST-elevation myocardial infarction treated by the primary percutaneous coronary intervention. METHODS In this double-blind, randomized controlled trial, data of 73 patients STEMI patients who were candidates for primary PCI were enrolled. Patients were then randomized to receive minocycline 50 mg orally, followed by 50 mg once a day for 5 days or a placebo with the same schedule. Measurement of serum matrix metalloproteinase-9 (MMP-9) and 2-dimensional speckle tracking echocardiography was performed at baseline and between 4 and 6 months after discharge. Then the demographic, clinical, echocardiographic, and angiographic data, as well as the levels of MMP-9, were compared between the study groups. RESULTS There was no statistically significant difference between the study groups regarding the baseline characteristics. Serum levels of MMP-9 did not change following the intervention within each group and were not significantly different between the groups after follow-up. In the follow-up echocardiography, we also did not observe any difference between the two groups CONCLUSION: In this study, we did not observe any effect of minocycline on cardiac remodeling based on 2-dimensional speckle tracking echocardiography and MMP-9 levels. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT201411188698N15 . Registered on 22 June 2015, prospectively.
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Affiliation(s)
- Alireza Nasiri
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Hosseinsabet
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Hajhosein Talasaz
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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16
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Mahmoudi E, Mollazadeh R, Mansouri P, Keykhaei M, Mirshafiee S, Hedayat B, Salarifar M, Yuyun MF, Yarmohammadi H. Ventricular repolarization heterogeneity in patients with COVID-19: Original data, systematic review, and meta-analysis. Clin Cardiol 2022; 45:110-118. [PMID: 35005792 PMCID: PMC8799060 DOI: 10.1002/clc.23767] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) has been associated with an increased risk of acute cardiac events. However, the effect of COVID-19 on repolarization heterogeneity is not yet established. In this study, we evaluated electrocardiogram (ECG) markers of repolarization heterogeneity in patients hospitalized with COVID-19. In addition, we performed a systematic review and meta-analysis of the published studies. METHODS QT dispersion (QTd), the interval between T wave peak to T wave end (TpTe), TpTe/QT (with and without correction), QRS width, and the index of cardio-electrophysiological balance (iCEB) were calculated in 101 hospitalized COVID-19 patients and it was compared with 101 non-COVID-19 matched controls. A systematic review was performed in four databases and meta-analysis was conducted using Stata software. RESULTS Tp-Te, TpTe/QT, QRS width, and iCEB were significantly increased in COVID-19 patients compared with controls (TpTe = 82.89 vs. 75.33 ms (ms), p-value = .005; TpTe/QT = 0.217 vs. 0.203 ms, p-value = .026). After a meta-analysis of 679 COVID-19 cases and 526 controls from 9 studies, TpTe interval, TpTe/QT, and TpTe/QTc ratios were significantly increased in COVID-19 patients. Meta-regression analysis moderated by age, gender, diabetes mellitus, hypertension, and smoking reduced the heterogeneity. QTd showed no significant correlation with COVID-19. CONCLUSION COVID-19 adversely influences the ECG markers of transmural heterogeneity of repolarization. Studies evaluating the predictive value of these ECG markers are warranted to determine their clinical utility.
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Affiliation(s)
- Elham Mahmoudi
- Gerash Amir‐al‐Momenin Medical and Educational CenterGerash University of Medical SciencesGerashIran
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Reza Mollazadeh
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Pejman Mansouri
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Mohammad Keykhaei
- Non‐Communicable Diseases Research Center (NCDRC), Endocrinology and Metabolism Research InstituteTehran University of Medical SciencesTehranIran
| | - Shayan Mirshafiee
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Behnam Hedayat
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | | | - Matthew F. Yuyun
- VA Boston Healthcare System & Harvard Medical SchoolBostonMassachusettsUSA
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17
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Hosseini K, Yavari N, Pashang M, Jalali A, Nalini M, Majdi Nassab F, Sadeghian S, Salehi Omran A, Bagheri J, Poorhosseini H, Salarifar M, Ahmadi Tafti SH, Tajdini M. Sex difference in the risk factor distributions and outcomes after coronary artery bypass graft surgery in the young population. Eur J Cardiothorac Surg 2021; 62:6423098. [PMID: 34747461 DOI: 10.1093/ejcts/ezab475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Coronary artery disease is becoming a major health concern in the young population. Male and female patients may experience different journeys after coronary artery disease events. We aimed to evaluate risk factors and compare outcomes between young male and female patients undergoing coronary artery bypass graft surgery (CABG). METHODS In this registry-based large sample size study, patients undergoing isolated CABG at a young age (premature isolated CABG) between 2007 and 2016 were included and followed up until 2020. Premature was defined as women and men younger than 55 years old. The main end points of the study were 7-year all-cause mortality and 7-year major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS Of a total of 24 428 patients who underwent CABG, 7217 patients (men-to-women ratio ≈4:1) with premature isolated CABG were included. The median follow-up duration was 78.5 months (75.2-81.6 months). The prevalence rates of diabetes mellitus, hypertension, dyslipidaemia and obesity were significantly higher in women than in men (58.3% vs 28.6%, 64.2% vs 38.5%, 69.7% vs 55.3% and 44.7 vs 23.9, respectively; all Ps < 0.05). The risk factor burden (mean of the risk factor count per year) was also higher among the female population. Diabetes mellitus was the common mortality predictor between men and women. In the subgroup analysis (interaction analysis in the adjusted model), hypertensive females had a higher rate of MACCE and a higher rate of mortality than hypertensive males; however, this difference was not significant in the non-hypertensive population. Opium addiction was a strong predictor of MACCE and all-cause mortality among men. Female patients had a higher rate of 7-year MACCE (hazard ratio, 1.33; 95% confidence interval, 1.16-1.51) and a higher rate of 7-year all-cause mortality (hazard ratio, 1.23; 95% confidence interval, 0.98-1.53). CONCLUSIONS The risk factor profile and predictors of outcomes were different between our female and male patients. Women carried a higher risk of events and mortality after CABG at a young age.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Yavari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Saeed Sadeghian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Salehi Omran
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masih Tajdini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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18
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Shafiee A, Saadat S, Shahmansouri N, Jalali A, Alaeddini F, Haddadi M, Tajdini M, Ashraf H, Omidi N, Masoudkabir F, Boroumand M, Sadeghian S, Mansournia MA, Poorhosseini H, Salarifar M, Noorbala AA, Zafarghandi M, Karimi A. Tehran cohort study (TeCS) on cardiovascular diseases, injury, and mental health: Design, methods, and recruitment data. Glob Epidemiol 2021; 3:100051. [PMID: 37635720 PMCID: PMC10446120 DOI: 10.1016/j.gloepi.2021.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/04/2021] [Accepted: 03/24/2021] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire. The mean age of the participants was 48.2 (16.41), and 46.5% were male. 64.3% of recruited individuals had no symptoms of psychiatric disorders, and 3729 (89.5%) households did not have any severe injury requiring treatment. The participants' diversity and their invaluable data will help us provide a general picture of the current prevalence and incidence of the main study objectives.
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Affiliation(s)
- Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine, CA, USA
| | - Nazila Shahmansouri
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Alaeddini
- Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Mashyaneh Haddadi
- Injury Prevention & Safety Promotion Department, Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Omidi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamamdali Boroumand
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abbasali Karimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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19
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Hosseini K, Mortazavi SH, Sadeghian S, Ayati A, Nalini M, Aminorroaya A, Tavolinejad H, Salarifar M, Pourhosseini H, Aein A, Jalali A, Bozorgi A, Mehrani M, Kamangar F. Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005-2015). BMC Cardiovasc Disord 2021; 21:477. [PMID: 34607557 PMCID: PMC8491372 DOI: 10.1186/s12872-021-02293-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a universal public health challenge, more prominently so in the low- and middle-income countries. In this study, we aimed to determine prevalence and trends of CAD risk factors in patients with documented CAD and to determine their effects on the age of CAD diagnosis. MATERIALS AND METHODS We conducted a registry-based, serial cross-sectional study using the coronary angiography data bank of the Tehran Heart Center. Adult patients who had obstructive (> 50% stenosis) CAD were included in the study. The prevalence and 11-year trends of conventional CAD risk factors were analyzed by sex and age, and their adjusted effects on the age of CAD diagnosis were calculated. RESULTS From January 2005 to December 2015, data for 90,094 patients were included in this analysis. A total of 61,684 (68.5%) were men and 28,410 (31.5%) were women. Men were younger at diagnosis than women, with a mean age of 60.1 in men and 63.2 in women (p < 0.001), and had fewer risk factors at the time of diagnosis. Mean age at diagnosis had an overall increasing trend during the study period. Increasing trend was seen in body-mass index, hypertension prevalence, diabetes mellitus. All lipid profile components (total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol) decreased over time. Of particular interest, opium consumption was associated with 2.2 year earlier age of CAD diagnosis. CONCLUSION The major results of this study (lower age of CAD diagnosis in men, lower age of diagnosis associated with most risk factors, and lower prevalence of serum lipids over time) were expected. A prominent finding of this study is confirming opium use was associated with a much younger age of CAD onset, even after adjusting for all other risk factors. In addition to recommendations for control of the traditional risk factors, spreading information about the potential adverse effect of opium use, which has only recently been associated with higher risk of CAD, may be necessary.
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Affiliation(s)
- Kaveh Hosseini
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Hamideh Mortazavi
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arya Aminorroaya
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Tavolinejad
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhosseini
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Aein
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Bozorgi
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehrani
- Tehran Heart Center Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
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20
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Omidi N, Arabloo J, Rezapour A, Alaeddini F, Bragazzi NL, Pourasghari H, Behzadifar M, Salarifar M, Khorgami M, Ghorashi SM, Azari S. Burden of Hypertensive Heart Disease in Iran during 1990-2017: Findings from the Global Burden of Disease study 2017. PLoS One 2021; 16:e0257617. [PMID: 34551003 PMCID: PMC8457465 DOI: 10.1371/journal.pone.0257617] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/06/2021] [Indexed: 01/01/2023] Open
Abstract
Background Hypertension and its consequent end-organ damage including Hypertensive Heart Disease (HHD) are a major concern that impact health, resulting into impairment and reduced quality of life (QOL). The purpose of this study was to describe the burden of HHD in Iran and comparing it with the World Bank upper middle-income countries (UMICs) in terms of disability-adjusted life years (DALY), mortality and prevalence. Methods Using data from the Global Burden of Disease study 2017, we compared the number of DALYs, deaths and prevalence trends for HHD from 1990 to 2017 in all age groups for both sex in Iran, and compared the epidemiology and trends with UMICs and globally. Results The age-standardized DALY rate for HHD increased by 51.6% for men (95% uncertainty interval [UI] 305.8 to 436.7 per 100,000) and 4.4% for women (95% UI 429.4 to 448.7 per 100,000) in Iran. The age-standardized prevalence of HHD in Iran was almost twice times higher than globally and 1.5-times more than the World Bank UMICs. The age-standardized death rate for HDD increased by 60.1% (95% UI 17.3 to 27.7% per 100,000) for men and by 21.7% (95% UI 25.85 to 31.48 per 100,000) for women from 1990 to 2017. Age-standardized death rate in Iran was 2.4 and 1.9 times higher than globally and UMICs, respectively. Conclusions The higher prevalence and death rate in Iran in comparison with UMICs and globally should encourage health care provider to perform intensive screening activities in at risk population to prevent HHD and mitigate its mortality.
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Affiliation(s)
- Negar Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Alaeddini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of mathematics and statistics, York University, Toronto, Canada
| | - Hamid Pourasghari
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - MohammdRafie Khorgami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Samad Azari
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran
- * E-mail:
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21
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Hosseinsabet A, Salarifar M. Right Atrial Appendage Thrombosis in a Patient with a History of Myocardial Infarction. J Cardiovasc Echogr 2021; 31:55-56. [PMID: 34221890 PMCID: PMC8230161 DOI: 10.4103/jcecho.jcecho_76_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/02/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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22
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Ghodsi S, Mohebi M, Sadre-Bafghi SA, Poorhosseini H, Salarifar M, Alidoosti M, Haji-Zeinali AM, Amirzadegan A, Aghajani H, Jenab Y, Hosseini Z. Prognostic implications of calculated Apo-lipoprotein B in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Outcome is tied to lower cut-points. Clin Cardiol 2021; 44:824-832. [PMID: 33942349 PMCID: PMC8207970 DOI: 10.1002/clc.23610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/24/2023] Open
Abstract
Background Debates still surround using lipoproteins including Apo‐B in risk assessment, management, and prognosis of patients with coronary artery disease. During an acute ST‐segment elevation myocardial infarction, Apo‐B might help to achieve incremental prognostic information. Objective We sought to determine the potential prognostic utility of calculated Apo‐B in a cohort of patients with STEMI undergoing primary PCI. Methods A retrospective cohort study was conducted enrolling 2,259 patients with a diagnosis of acute STEMI who underwent primary PCI. Apo‐B was obtained using a valid equation based on initial lipid measurements. High Apo‐B was defined as a level of 65 or higher. Primary endpoint of the study was major adverse cardiovascular events (MACE). Results Mean age of the participants was 59.54 years and 77.9% of them were male. After a Median follow up of 15 (6.2) months, high Apo‐B was associated with MACE and the OR (95% CI) was 3.02 (1.07–8.47), p = .036. Odds ratios for prediction of MACE pertaining to LVEF, and smoking were 0.97 (p = .044), and 1.07 (p = .033), respectively. However, High Apo‐B was not able to predict suboptimal TIMI flow. Accordingly, the Odds ratio was 0.56 (0.17–1.87), p = 0.349. The power of High LDL‐C and Non‐HDLC for prediction of MACE were assessed in distinct models. Attained odds ratios were [2.40 (0.90–6.36), p = .077] and [1.80 (0.75–4.35), p = 0.191], respectively. Conclusion Calculated Apo‐B appears to be a simple tool applicable for prediction of cardiovascular events in patients with STEMI superior to both Non‐HDLC and LDL‐C.
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Affiliation(s)
- Saeed Ghodsi
- Research department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Mohebi
- Research department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Ali Sadre-Bafghi
- Research department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Amirzadegan
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Research center at department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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23
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Omidi N, Sadeghian S, Salarifar M, Jalali A, Abbasi SH, Yavari N, Ghorashi SM, Alidoosti M, Poorhosseini H. Relationship between the Severity of Coronary Artery Disease and Cardiovascular Risk Factors in Acute Coronary Syndrome: Based on Tehran Heart Center's Data Registry. J Tehran Heart Cent 2021; 15:165-170. [PMID: 34178085 PMCID: PMC8217186 DOI: 10.18502/jthc.v15i4.5942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS. Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score. Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25–88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus. Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS.
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Affiliation(s)
- Negar Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Negin Yavari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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24
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Amirzadegan A, Sadre-Bafghi SA, Ghodsi S, Soleimani H, Mohebi M, Nematipour E, Haji-Zeinali AM, Salarifar M, Pourhosseini H, Nozari Y, Tajdini M, Aghajani H, Alidoosti M, Jenab Y, Omidi N, Jalali A, Hosseini Z. One-Year Outcome of Patients with Coronary Artery Ectasia Undergoing Percutaneous Coronary Intervention: Clinical Implications and Question Marks. J Tehran Heart Cent 2021; 15:171-177. [PMID: 34178086 PMCID: PMC8217191 DOI: 10.18502/jthc.v15i4.5943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Coronary artery ectasia (CAE) is a rare condition with unclear pathophysiology, optimal treatment, and prognosis. We aimed to determine the prognostic implications of CAE following coronary angioplasty. Methods: We conducted a retrospective cohort study on 385 patients, including 87 subjects with CAE, who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were considered to consist of mortality, nonfatal myocardial infarction (MI), repeated revascularization, and stroke. Results: The mean age of the participants was 57.31±6.70 years. Multivariate regression analysis revealed that patients with diabetes, ST-segment–elevation MI at presentation, and high thrombus grades were more likely to have suboptimal post-PCI thrombolysis in myocardial infarction (TIMI) flow. However, CAE was not a predictor of a decreased TIMI flow (OR: 1.46, 95% CI: 0.78–8.32; P=0.391). The Cox-regression model showed that CAE, the body mass index, and a family history of MI were risk factors for MACE, while short lesion lengths (<20 vs >20 mm) had an inverse relationship. The adjusted hazard ratio (HR) for the prediction of MACE in the presence of CAE was 1.65 (95% CI: 1.08–4.78; P=0.391). All-cause mortality (HR: 1.69, 95% CI: 0.12–3.81; P=0.830) and nonfatal MI (HR: 1.03, 95% CI: 0.72–4.21; P=0.341) occurred similarly in the CAE and non-CAE groups. Conversely, CAE increased urgent repeat revascularization (HR: 2.40; 95% CI: 1.13–5.86; P=0.013). Conclusion: Although CAE had no substantial short-term prognostic effects on post-PCI TIMI flow, considerable concerns regarding adverse outcomes emerged during our extended follow-up. Stringent follow-ups of these patients should be underscored due to the high likelihood of urgent revascularization.
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Affiliation(s)
| | | | - Saeed Ghodsi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehrnaz Mohebi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Yones Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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25
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Omidi N, Lotfi-Tokaldany M, Shirani S, Salarifar M, Poorhosseini H, Ghorashi SM, Aein A. Predicting the outcome in confirmed COVID-19 patients with coronary artery disease: a key role for the first chest computed tomography. Egypt Heart J 2021; 73:35. [PMID: 33788067 PMCID: PMC8011044 DOI: 10.1186/s43044-021-00148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background Serial chest computed tomography (CT) scans are used to detect coronavirus disease 2019 (COVID-19) pneumonia and monitor the disease course. This study investigates relationship between total severity score by first chest CT and the outcome of coronavirus COVID-19 patients with coronary artery disease (CAD). Results A total of 48 patients with a history of CAD (mean age=60.83±3.06 years, 75% male) with positive real-time reverse transcription-polymerase chain reaction for COVID-19 were included. Outcome was defined as acute respiratory distress syndrome or death. The unadjusted and adjusted effects of the CT score on the outcome were reported through odds ratio (OR) with 95% confidence interval (CI). Outcome occurred in 17 (35.5%) patients (8 deaths). The CT score was directly and significantly correlated with the outcome in the univariate analysis (OR 1.38, 95% CI 1.12–1.70; P=0.003) and remained significant after adjustment for diabetes, hypertension, body mass index, and serum level of highly sensitive C-reactive protein (OR 1.51, 95% CI 1.11–2.05; P=0.009). Outcome rate was 24.1% in patients with a CT score <2.5, whereas it was 8.3% in patients with a CT score>2.5. Conclusions The first chest CT score could be a robust predictor of adverse events in confirmed COVID-19 patients with coronary artery disease.
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Affiliation(s)
- Negar Omidi
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shapour Shirani
- Imaging Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Imaging Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Poorhosseini
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran, 1411713138, Iran.
| | - Seyyed Mojtaba Ghorashi
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Aein
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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26
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Jenab Y, Haji-Zeinali AM, Alemzadeh-Ansari MJ, Shirani S, Salarifar M, Alidoosti M, Vahidi H, Pourjafari M, Jalali A. Does Baseline BUN Have an Additive Effect on the Prediction of Mortality in Patients with Acute Pulmonary Embolism? J Tehran Heart Cent 2021; 15:57-63. [PMID: 33552195 PMCID: PMC7825466 DOI: 10.18502/jthc.v15i2.4184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: In patients with heart failure, elevated levels of blood urea nitrogen (BUN) is a prognostic factor. In this study, we investigated the prognostic value of elevated baseline BUN in short-term mortality among patients with acute pulmonary embolism (PE). Methods: Between 2007 and 2014, cardiac biomarkers and BUN levels were measured in patients with acute PE. The primary endpoint was 30-day mortality, evaluated based on the baseline BUN (≥14 ng/L) level in 4 groups of patients according to the European Society of Cardiology's risk stratification (low-risk, intermediate low-risk, intermediate high-risk, and high-risk). Results: Our study recruited 492 patients with a diagnosis of acute PE (mean age=60.58±16.81 y). The overall 1-month mortality rate was 6.9% (34 patients). Elevated BUN levels were reported in 316 (64.2%) patients. A high simplified pulmonary embolism severity index (sPESI) score (OR: 5.23, 95% CI: 1.43-19.11; P=0.012), thrombolytic or thrombectomy therapy (OR: 2.42, 95% CI: 1.01-5.13; P=0.021), and elevated baseline BUN levels (OR: 1.04, 95% CI: 1.01-1.03; P=0.029) were the independent predictors of 30-day mortality. According to our receiver-operating characteristics analysis for 30-day mortality, a baseline BUN level of greater than 14.8 mg/dL was considered elevated. In the intermediate-low-risk patients, mortality occurred only in those with elevated baseline BUN levels (7.2% vs. 0; P=0.008). Conclusion: An elevated baseline BUN level in our patients with PE was an independent predictor of short-term mortality, especially among those in the intermediate-risk group.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shapour Shirani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Vahidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Pourjafari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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27
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Nozari Y, Geraiely B, Alipasandi K, Mortazavi SH, Omidi N, Aghajani H, Amirzadegan A, Pourhoseini H, Salarifar M, Alidoosti M, Haji-Zeinali AM, Nematipour E, Nomali M. Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Cross-Sectional Study. Interact J Med Res 2020; 9:e20352. [PMID: 33325826 PMCID: PMC7773509 DOI: 10.2196/20352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 09/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background Performing primary percutaneous coronary intervention (PCI) as a preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardiocerebrovascular events (MACCEs). Thus, timely primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce the door-to-balloon time to <90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment, such as the symptom-to-balloon time, as an indicator of the total ischemic time, which includes the symptom-to-door time and door-to-balloon time, in terms of clinical outcomes of patients with STEMI undergoing primary PCI. Objective We aimed to determine the association between each component of time to treatment (ie, symptom-to-door time, door-to-balloon time, and symptom-to-balloon time) and in-hospital MACCEs among patients with STEMI who underwent primary PCI. Methods In this observational study, according to a prospective primary PCI 24/7 service registry, adult patients with STEMI who underwent primary PCI in one of six catheterization laboratories of Tehran Heart Center from November 2015 to August 2019, were studied. The primary outcome was in-hospital MACCEs, which was a composite index consisting of cardiac death, revascularization (ie, target vessel revascularization/target lesion revascularization), myocardial infarction, and stroke. It was compared at different levels of time to treatment (ie, symptom-to-door and door-to-balloon time <90 and ≥90 minutes, and symptom-to-balloon time <180 and ≥180 minutes). Data were analyzed using SPSS software version 24 (IBM Corp), with descriptive statistics, such as frequency, percentage, mean, and standard deviation, and statistical tests, such as chi-square test, t test, and univariate and multivariate logistic regression analyses, and with a significance level of <.05 and 95% CIs for odds ratios (ORs). Results Data from 2823 out of 3204 patients were analyzed (mean age of 59.6 years, SD 11.6 years; 79.5% male [n=2243]; completion rate: 88.1%). Low proportions of symptom-to-door time ≤90 minutes and symptom-to-balloon time ≤180 minutes were observed among the study patients (579/2823, 20.5% and 691/2823, 24.5%, respectively). Overall, 2.4% (69/2823) of the patients experienced in-hospital MACCEs, and cardiac death (45/2823, 1.6%) was the most common cardiac outcome. In the univariate analysis, the symptom-to-balloon time predicted in-hospital MACCEs (OR 2.2, 95% CI 1.1-4.4; P=.03), while the symptom-to-door time (OR 1.4, 95% CI 0.7-2.6; P=.34) and door-to-balloon time (OR 1.1, 95% CI 0.6-1.8, P=.77) were not associated with in-hospital MACCEs. In the multivariate analysis, only symptom-to-balloon time ≥180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR 2.3, 95% CI 1.1-5.2; P=.04). Conclusions A longer symptom-to-balloon time was the only component associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten the symptom-to-balloon time in order to improve in-hospital MACCEs. International Registered Report Identifier (IRRID) RR2-10.2196/13161
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Affiliation(s)
- Younes Nozari
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Geraiely
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kian Alipasandi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Hamideh Mortazavi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Omidi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirzadegan
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhoseini
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Haji-Zeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahin Nomali
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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28
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Khatami MR, Nikravan N, Salarifar M, Poorhosseini HR, Sadeghian S, Haj-Zeinali AM, Aghajani H. Comparison of Oral and Intravenous N-acetyl Cysteine in Preventing Contrast Nephropathy. Indian J Nephrol 2020; 30:403-408. [PMID: 33840960 PMCID: PMC8023025 DOI: 10.4103/ijn.ijn_260_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/08/2019] [Accepted: 01/24/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Despite high rates of morbidity and mortality in patients with contrast-induced nephropathy (CIN), there is no consensus regarding prevention of this well-known complication of contrast media use. One agent that has been widely used in this regard is N-acetyl cysteine (NAC). Nevertheless, its efficacy is still controversial. The aim of this study was to assess the efficacy of NAC, both in the oral and intravenous forms, for the prevention of CIN. Methods This study is a double-blind randomized placebo controlled clinical trial. We randomized 434 adult patients with chronic kidney disease (constant serum creatinine ≥1.5 mg/dL) who were candidates for coronary angiography/plasty. The patients were categorized into three groups. One group received 1,200 mg NAC intravenously half an hour before the procedure and oral placebo starting 3 days before angiography. The second group received oral NAC 600 mg twice daily for 3 days, starting the day before the intervention and intravenous placebo half an hour before intervention. The third group received both oral and intravenous placebo. CIN was defined as a 25% relative increase in serum creatinine from baseline value, 48 h after use of contrast medium. Results Of the 434 patients, 149 received intravenous NAC, 145 received oral NAC, and the remaining 140 received placebo. The incidence of CIN in the three groups was 6.1%, 7.6%, and 10.8%, respectively (p = 0.34). Conclusion In patients with chronic kidney disease, neither intravenous nor oral NAC is superior to placebo for preventing CIN.
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Affiliation(s)
| | - Nasrin Nikravan
- Nephrology Research Center, Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran
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29
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Farzaneh K, Mortazavi SH, Oraii A, Abbasi K, Salehi Omran A, Ahmadi Tafti SH, Bozorgi A, Kazemi Saeed A, Salarifar M, Sadeghian S. Safety of thrombolytic therapy in patients with prosthetic heart valve thrombosis who have high international normalized ratio levels. J Card Surg 2020; 35:2522-2528. [DOI: 10.1111/jocs.14777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Khadijeh Farzaneh
- Department of Cardiology, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | | | - Alireza Oraii
- Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Kyomars Abbasi
- Department of Cardiac Surgery, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Abbas Salehi Omran
- Department of Cardiac Surgery, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | | | - Ali Bozorgi
- Department of Cardiology, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Ali Kazemi Saeed
- Department of Cardiology, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Saeed Sadeghian
- Department of Cardiology, Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
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Salarifar M, Ghavami M, Poorhosseini H, Masoudkabir F, Jenab Y, Amirzadegan A, Alidoosti M, Aghajani H, Bozorgi A, Hosseini K, Lotfi-Tokaldany M, Mortazavi SH, Aein A, Ahmadian T, Sadeghian S. The impact of a dedicated coronavirus disease 2019 primary angioplasty protocol on time components related to ST‑segment elevation myocardial infarction management in a 24/7 primary percutaneous coronary intervention-capable hospital. Kardiol Pol 2020; 78:1227-1234. [PMID: 32955819 DOI: 10.33963/kp.15607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST‑segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID‑19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols. AIMS We aimed to investigate the impact of our dedicated COVID‑19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study. METHODS Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real‑time reverse transcriptase-polymerase chain reaction (rRT‑PCR) tests were performed in patients suspected of having COVID‑19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019. RESULTS Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT‑PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID‑19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70‑day mortality rate before and during the pandemic was 2.73% and 4.49%, respectively (P = 0.4). CONCLUSIONS The implementation of the dedicated COVID‑19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short‑term clinical outcomes, and staff safety as in the prepandemic era.
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Saadatagah S, Ghodsi S, Omidi N, Poorhosseini H, Salarifar M, Sadeghian S, Alidoosti M, Kassaian SE, Aghajani H, Mortazavi SH, Hosseini K, Geraiely B. Twelve-Year History of STEMI Management in Tehran Heart Center: Concomitant Reduction of In-Hospital Mortality and Hospitalization Length. Arch Iran Med 2020; 23:514-521. [PMID: 32894962 DOI: 10.34172/aim.2020.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiovascular-related death remains the major cause of mortality in Iran despite significant improvements in its care. In the present study, we report the in-hospital mortality, hospitalization length, and treatment methods for patients with ST-elevation myocardial infarction (STEMI) in Tehran Heart Center (THC). METHODS Records pertaining to patients with STEMI from March 2006 to March 2017 were extracted from the databases of THC. Besides a description of temporal trends, multivariable regression analysis was used to find factors associated with in-hospital mortality. RESULTS During the study period, 8,295 patients were admitted with STEMI with a mean age of 60.4 ± 12.5 years. Men accounted for 77.5% of the study population. Hospitalization length declined from 8.4 to 5.2 days, and in-hospital mortality was reduced from 8.0% to 3.9% (both P values < 0.001). In a multivariable model adjusted for age, sex, conventional cardiac risk factors, prior cardiac history, and indices of event severity, primary percutaneous coronary intervention (PCI) (OR: 0.280, 95% CI: 0.186 to 0.512; P<0.001), coronary artery bypass graft (CABG) surgery (OR: 0.482, 95% CI: 0.220 to 0.903; P=0.025), and rescue or facilitated PCI (OR: 0.420, 95% CI: 0.071 to 0.812; P=0.001) were all associated with reduced in-hospital mortality in comparison with medical treatment. Furthermore, primary PCI was a crucial protective factor against prolonged length of hospital stay (OR: 0.307, 95% CI: 0.266 to 0.594; P<0.001). CONCLUSION In-hospital mortality and hospitalization length were almost halved during the study period, and primary PCI has now replaced thrombolysis in the management of STEMI.
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Affiliation(s)
| | - Saeed Ghodsi
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Omidi
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mojtaba Salarifar
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | - Saead Sadeghian
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hassan Aghajani
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kaveh Hosseini
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Geraiely
- Tehran Heart Center (THC), Tehran University of Medical Sciences, Tehran, Iran
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Affiliation(s)
- Seifollah Abdi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Parham Sadeghipour
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Geraiely
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, P.O. Box: 1419733141, Tehran, Iran.
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Sadeghipour P, Talasaz AH, Eslami V, Geraiely B, Vojdanparast M, Sedaghat M, Moosavi AF, Alipour-Parsa S, Aminian B, Firouzi A, Ghaffari S, Ghasemi M, Saleh DK, Khosravi A, Kojuri J, Noohi F, Pourhosseini H, Salarifar M, Salehi MR, Sezavar H, Shabestari M, Soleimani A, Tabarsi P, Parsa AFZ, Abdi S. Management of ST-segment-elevation myocardial infarction during the coronavirus disease 2019 (COVID-19) outbreak: Iranian"247" National Committee's position paper on primary percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 97:E346-E351. [PMID: 32320138 PMCID: PMC7264551 DOI: 10.1002/ccd.28889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/17/2022]
Abstract
World Health Organization has designated coronavirus disease 2019 (COVID‐19) as a pandemic. During the past several weeks, a considerable burden has been imposed on the Iranian's healthcare system. The present document reviewed the latest evidence and expert opinion regarding the management of ST‐segment‐elevation myocardial infarction during the outbreak of COVID‐19 and outlines a practical algorithm for it.
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Affiliation(s)
- Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azita H Talasaz
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Eslami
- Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Geraiely
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vojdanparast
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences
| | | | - Saeed Alipour-Parsa
- Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Kojuri
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Feridoun Noohi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourhosseini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Reza Salehi
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sezavar
- Department of Cardiovascular Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Shabestari
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Soleimani
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Department of Infectious Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Farhang Zand Parsa
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Amirzadegan A, Hasanabadi M, Saadatagah S, Afarideh M, Omidi N, Aghajani H, Alidoosti M, Pourhosseini H, Salarifar M, Nozari Y. Single Long Stents versus Overlapping Multiple Stents in the Management of Very Long Coronary Lesions: Comparisons of Procedures and Clinical Outcomes. J Tehran Heart Cent 2019. [DOI: 10.18502/jthc.v14i3.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Different percutaneous coronary intervention (PCI) strategies, including the use of single long stents (SLSs) and overlapping multiple stents (OMSs), have been introduced to treat very long coronary lesions (VLCLs). The aim of this study was to compare procedural and long-term clinical outcomes between SLSs and OMSs in patients with VLCLs.
Methods: In this historical cohort study, 1709 patients who underwent PCI with the new generation of drug-eluting stents (length ≥38 mm) were stratified into the SLS [PROMUS /Resolute/XIENCE (PRX), (=38 mm), n=1121 (65.59%) and BioMime, (≥40 mm), n=124 (7.26%)] and OMS [(59.43±10.80 mm), n=464 (27.2%)] groups and followed up for 440.93±361.32 days. The study endpoints comprised immediate post-PCI outcomes, major adverse cardiovascular events (MACE), the patient-oriented composite endpoint (POCE), and the device-oriented composite endpoint (DOCE) at the long-term follow-up.
Results: The mean age of the patients was 59.28±10.60 years, and 69.6% of them were male. Flow grade 3 (P=0.296) and residual stenosis (P=0.533) were statistically similar between all the groups. A lower level of post-PCI troponin was observed in the BioMime group [14.52 (IQR25%-75%:10.44–22.42) ng/L; P=0.031] than in the PRX and OMS groups [18.63 (IQR25%-75%:10.51–34.02) ng/L and 18.96 (IQR25%-75%:11.17–35.34) ng/L; respectively]. Similarly, the PRX and BioMime groups received lower amounts of the contrast agent [206.29±49.15 mL and 208.06±55.23 mL; respectively] than did the OMS group [265.50±74.69 mL; P<0.001]. There were no statistically significant differences in the incidence of MACE [81 (7.2%), 7 (5.6%), and 28 (6.0%); P=0.603], the POCE [141 (12.6%), 13 (10.5%), and 54 (11.6%); P=0.731], and the DOCE [51 (4.5%), 4 (3.2%), and 21 (4.5%); P=0.791] between the PRX, BioMime, and OMS groups, respectively.
Conclusion: In the treatment of VLCLs, the SLS and OMSs appear to have similar clinical outcomes. BioMime ultra-long stents may have comparable results to PRX coronary stents.
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Saadat N, Saadatagah S, Aghajani Nargesi A, Alidoosti M, Poorhosseini H, Amirzadegan A, Lashkari R, Mortazavi SH, Jalali A, Ghodsi S, Salarifar M. Short-term safety and long-term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study. Catheter Cardiovasc Interv 2019; 95:1249-1256. [PMID: 31318488 DOI: 10.1002/ccd.28396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/25/2019] [Accepted: 07/02/2019] [Indexed: 11/07/2022]
Abstract
AIM Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long-term outcomes in patients with and without stent postdilation. METHODS A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)-comprising cardiac death, nonfatal MI, and repeat revascularization-and the device-oriented composite endpoint (DOCE)-consisting of cardiac death, target lesion revascularization, and target vessel revascularization. RESULTS The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score-matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18-0.87], p = .021). CONCLUSIONS Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI.
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Affiliation(s)
- Nasser Saadat
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arash Aghajani Nargesi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Reza Lashkari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Ghodsi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Amirzadegan A, Hasanabadi M, Saadatagah S, Afarideh M, Omidi N, Aghajani H, Alidoosti M, Pourhosseini H, Salarifar M, Nozari Y. Single Long Stents versus Overlapping Multiple Stents in the Management of Very Long Coronary Lesions: Comparisons of Procedures and Clinical Outcomes. J Tehran Heart Cent 2019; 14:94-102. [PMID: 31998385 PMCID: PMC6981347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Different percutaneous coronary intervention (PCI) strategies, including the use of single long stents (SLSs) and overlapping multiple stents (OMSs), have been introduced to treat very long coronary lesions (VLCLs). The aim of this study was to compare procedural and long-term clinical outcomes between SLSs and OMSs in patients with VLCLs. Methods: In this historical cohort study, 1709 patients who underwent PCI with the new generation of drug-eluting stents (length ≥38 mm) were stratified into the SLS [PROMUS /Resolute/XIENCE (PRX), (=38 mm), n=1121 (65.59%) and BioMime, (≥40 mm), n=124 (7.26%)] and OMS [(59.43±10.80 mm), n=464 (27.2%)] groups and followed up for 440.93±361.32 days. The study endpoints comprised immediate post-PCI outcomes, major adverse cardiovascular events (MACE), the patient-oriented composite endpoint (POCE), and the device-oriented composite endpoint (DOCE) at the long-term follow-up. Results: The mean age of the patients was 59.28±10.60 years, and 69.6% of them were male. Flow grade 3 (P=0.296) and residual stenosis (P=0.533) were statistically similar between all the groups. A lower level of post-PCI troponin was observed in the BioMime group [14.52 (IQR25%-75%:10.44-22.42) ng/L; P=0.031] than in the PRX and OMS groups [18.63 (IQR25%-75%:10.51-34.02) ng/L and 18.96 (IQR25%-75%:11.17-35.34) ng/L; respectively]. Similarly, the PRX and BioMime groups received lower amounts of the contrast agent [206.29±49.15 mL and 208.06±55.23 mL; respectively] than did the OMS group [265.50±74.69 mL; P<0.001]. There were no statistically significant differences in the incidence of MACE [81 (7.2%), 7 (5.6%), and 28 (6.0%); P=0.603], the POCE [141 (12.6%), 13 (10.5%), and 54 (11.6%); P=0.731], and the DOCE [51 (4.5%), 4 (3.2%), and 21 (4.5%); P=0.791] between the PRX, BioMime, and OMS groups, respectively. Conclusion: In the treatment of VLCLs, the SLS and OMSs appear to have similar clinical outcomes. BioMime ultra-long stents may have comparable results to PRX coronary stents.
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Affiliation(s)
| | | | - Seyedmohammad Saadatagah
- Corresponding Author: Seyedmohammad Saadatagah, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: +98 21 88029256. Fax: +98 21 88029256.E-mail: .
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Taghavi Shavazi M, Saadatagah S, Aghajani H, Poorhosseini H, Salarifar M, Amirzadegan A, Hajzeinali A, Alidoosti M, Aghajani R, Neamatipour E. Does Invasive Treatment Increase the Long-Term Survival of ST-Elevation Myocardial Infarction Patients with a History of Coronary Artery Bypass Graft Surgery? J Tehran Heart Cent 2019; 14:109-120. [PMID: 31998387 PMCID: PMC6981341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Although invasive treatments such as primary percutaneous coronary intervention (PPCI) are the treatment of choice in ST-elevation myocardial infarction (STEMI) patients, the survival benefit of this treatment in patients with a history of coronary artery bypass graft (CABG) has yet to be fully evaluated. Methods: In this historical cohort study, 251 STEMI patients with a history of CABG between 2007 and 2017 were stratified into 3 groups of no reperfusion, thrombolytic, and PPCI based on their treatment strategy. Baseline clinical characteristics, details of the STEMI event, and the course of hospitalization were evaluated for all patients and they were followed up until May 2018 to assess all-cause mortality. Results: The mean age of the study population was 64.019.45 years, and 81.7% of them were male. The median follow-up time was 1304 (IQR25%-75%: 571-2269) days, the short-term (1 month) mortality rate was 5.97%, and the long-term mortality rate was 15.1%. There was no significant difference between the 3 different strategies in terms of survival. In the fully adjusted multivariate analysis, cardiopulmonary resuscitation (HR: 15.06, 95% CI: 2.25-101.14, P=0.005) was significantly associated with short-term mortality, while diabetes (HR: 5.95, 95% CI: 2.03-17.44, P=0.001), opium abuse (HR: 4.85, 95% CI: 1.45-16.23, P=0.010), and cardiopulmonary resuscitation (HR: 11.73, 95% CI: 3.44-40.28, P=0.001) were significantly associated with long-term mortality. Conclusion: Our results failed to show the superiority of invasive treatment in terms of survival. Further studies regarding the advantages and disadvantages of invasive treatment in post-CABG patients are required.
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Affiliation(s)
| | | | - Hassan Aghajani
- Corresponding Author: Hassan Aghajani, Associate Professor of Cardiology, Interventional Cardiologist, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: +98 21 88029256. Fax: +98 21 88029256. E-mail: .
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Poorhosseini H, Saadat M, Salarifar M, Mortazavi SH, Geraiely B. Pre-Hospital Delay and Its Contributing Factors in Patients with ST-Elevation Myocardial Infarction; a Cross sectional Study. Arch Acad Emerg Med 2019; 7:e29. [PMID: 31432039 PMCID: PMC6637811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The outcome of ST-elevation myocardial infarction (STEMI) is significantly influenced by the total tissue ischemic time. In spite of efforts for reducing the in-hospital delay by full-time provision of primary percutaneous coronary intervention (P-PCI) in the 24/7 program, pre-hospital delay still persists. As a first report in Iran, we aimed to assess the duration of pre-hospital delay and its contributing factors in STEMI patients in the P-PCI era. METHODS The present cross-sectional study evaluated 2103 STEMI patients who underwent primary PCI from 2016 to 2018. Demographic, personal and socioeconomic factors, index event characteristics, past medical history, pain onset and door times of patients were recorded and independent factors of pre-hospital delay were calculated. RESULTS Median (IQR) of pain to door (P2D) time was 279 (120-630) minutes. In multivariate analysis, female gender [Beta=0.064 (95%CI: 0.003-0.125); p=0.038], being uneducated [Beta=0.213 (95%CI: 0.115-0.311); p<0.001], the onset of chest pain between 00:00 to 6:00 [Beta=0.130 (95%CI: 0.058-0.202); p<0.001] or 7:00 to 12:00 [Beta=0.119 (95%CI: 0.049-0.190); p=0.001], self-transportation [Beta=0.098 (95%CI: 0.015-0.181); p=0.020] or referral from another hospital [Beta=0.253 (95%CI: 0.117-0.389); p<0.001], atypical chest pain [Beta=0.170 (95%CI: 0.048-0.293); p=0.006], history of hypertension [Beta=0.052 (95%CI: 0.002-0.102); p=0.041], and opium abuse [Beta=0.076 (95%CI: 0.007-0.146); p=0.031] were associated with a significantly higher log(P2D), while history of CABG was associated with shorter P2D. CONCLUSION Our study showed that P2D is still very high in Iran and revealed the high-risk groups associated with longer P2D. Effective actions should be implemented to increase the public awareness about the symptoms of STEMI, and the importance of immediate appropriate help-seeking.
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Affiliation(s)
- Hamidreza Poorhosseini
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Saadat
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Babak Geraiely
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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Salarifar M, Askari J, Saadat M, Geraiely B, Omid N, Poorhosseini H, Amirzadegan A, Hajzeinali A, Alidoosti M, Aghajani H, Nozari Y, Nematipoor E. Strategies to Reduce the Door-to-Device time in ST-Elevation Myocardial Infarction Patients. J Tehran Heart Cent 2019. [DOI: 10.18502/jthc.v14i1.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Performing primary percutaneous coronary intervention (PPCI) in a timely fashion is a crucial part of the management of ST-elevation myocardial infarction (STEMI). We aimed to evaluate the contributing factors to and the etiologies of a prolonged door-to-device (D2D) time.
Methods: In 2016, the D2D time was measured in all patients who were treated with PPCI at Tehran Hear Center. The major causes of a prolonged D2D time (>90 min) were determined. The second phase was then started in 2017 by focusing on the determined causes, and direct feedback was given to anyone having contributed to the delayed D2D time. The D2D time was compared between these 2 years.
Results: The mean age of the patients was 59.54±11.82 years, and 82.2% of them were men. The median D2D time decreased from 55 minutes (IQR25-75%: 40–82) in 2016 to 46 minutes (IQR25-75%: 34–70) in 2017 (P<0.001). In the first year, 79.8% of the patients had a D2D time of below 90 minutes; the figure rose to 84.1% of the patients in the second year (P=0.017). The first cause of a prolonged D2D time was missed ST-elevation in the first electrocardiogram by physician or nurse (8.4% of the cases). Along with a declining rate of missed STE to 6.7%, the median D2D time in the missed patients also decreased from 205 minutes to 177 minutes (P=0.011). The rate of ambulance arrival increased from 10.2% to 20.7% of the cases, and the median D2D time also declined from 45 (IQR25-75%: 34–55) to 34 (IQR25-75%: 25–55) in these patients (P<0.001).
Conclusion: Even in the setting of a 24/7 on-site interventionist in the hospital, the dispatch system and prehospital electrocardiograms, along with regular assessment and feedback, may improve the D2D time.
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Nozari Y, Geraiely B, Alipasandi K, Jalali A, Omidi N, Aghajani H, Hajizeinali A, Alidoosti M, Pourhoseini H, Salarifar M, Amirzadegan A, Nematipour E, Nomali M. Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Protocol for a Cross-Sectional Study. JMIR Res Protoc 2019; 8:e13161. [PMID: 30821693 PMCID: PMC6418487 DOI: 10.2196/13161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background Patients with ST-segment elevation myocardial infarction (STEMI) experience major adverse cardiac events (MACEs) following primary percutaneous coronary intervention (PCI). Although the relationship between time to treatment (eg, door-to-balloon time, symptom onset-to-balloon time, and symptom onset-to-door time) and 1-month all-cause mortality was assessed previously, its relationship with in-hospital MACEs and the effect of some clinical characteristics on this relationship were not considered. Furthermore, previous studies that were conducted in developed countries with a different quality of care cannot be applied in Iran, as Iran is a developing country and the studies were not performed according to the 24/7 primary PCI service registry. Objective The objective of this study protocol is to determine the relationship between time to treatment and in-hospital MACEs. Methods This cross-sectional study will take place at the Tehran Heart Center (THC), which is affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. Data related to patients with STEMI, who underwent primary PCI between March 2015 and March 2019, that have been prospectively recorded in the THC’s 24/7 primary PCI service registry will be analyzed. The study outcome is the occurrence of in-hospital MACEs. Data analysis will be conducted using SPSS for Windows, version 16.0 (SPSS Inc). We will perform chi-square tests, independent-samples t tests, or the Mann-Whitney U test, as well as univariate and multivariate binary logistic regression with a significance level of less than .05 and 95% CI for odds ratios. Results From March 2015 to September 2017, 1586 patients were included in the THC service registry, consecutively. We will conduct a retrospective analysis of this registry on patient entries between March 2015 and March 2019 and data will be analyzed and published by the end of 2019. Conclusions To our knowledge, this is the first observational study based on the 24/7 primary PCI service registry in Iran. The findings of this study may reveal current problems regarding time to treatment in STEMI management in the THC. Results from this study may help determine appropriate preventive strategies that need to be applied in order to reduce time-to-treatment delays and improve patients’ outcomes following primary PCI in the setting of STEMI at the THC and similar clinical centers. International Registered Report Identifier (IRRID) DERR1-10.2196/13161
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Affiliation(s)
- Younes Nozari
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Babak Geraiely
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Kian Alipasandi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arash Jalali
- Department of Research and Biostatistics, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Negar Omidi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hassan Aghajani
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alimohammad Hajizeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hamidreza Pourhoseini
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mojtaba Salarifar
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alireza Amirzadegan
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ebrahim Nematipour
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahin Nomali
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Ashoori A, Pourhosseini H, Ghodsi S, Salarifar M, Nematipour E, Alidoosti M, Haji-Zeinali AM, Nozari Y, Amirzadegan A, Aghajani H, Jalali A, Hosseini Z, Jenab Y, Geraiely B, Omidi N. CHA2DS2-VASc Score as an Independent Predictor of Suboptimal Reperfusion and Short-Term Mortality after Primary PCI in Patients with Acute ST Segment Elevation Myocardial Infarction. ACTA ACUST UNITED AC 2019; 55:medicina55020035. [PMID: 30717292 PMCID: PMC6409514 DOI: 10.3390/medicina55020035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 01/09/2023]
Abstract
Background and objectives: We aimed to demonstrate the clinical utility of CHA2DS2-VASc score in risk assessment of patients with STEMI regarding adverse clinical outcomes particularly no-reflow phenomenon. Materials and Methods: We designed a retrospective cohort study using the data of Tehran Heart Center registry for acute coronary syndrome. The study included 1331 consecutive patients with STEMI who underwent primary angioplasty. Patients were divided into two groups according to low and high CHA2DS2-VASc score. Angiographic results of reperfusion were inspected to evaluate the association of high CHA2DS2-VASc score and the likelihood of suboptimal TIMI flow. The secondary endpoint of the study was short-term in-hospital mortality of all cause. Results: The present study confirmed that CHA2DS2-VASc model enables us to determine the risk of no-reflow and all-cause in-hospital mortality independently. Odds ratios were 1.59 (1.30–2.25) and 1.60 (1.17–2.19), respectively. Moreover, BMI, high thrombus grade, and cardiogenic shock were predictors of failed reperfusion (odds were 1.07 (1.01–1.35), 1.59 (1.28–1.76), and 8.65 (3.76–24.46), respectively). We showed that using a cut off value of ≥ two in CHA2DS2-VASc model provides a sensitivity of 69.7% and specificity of 64.4% for discrimination of increased mortality hazards. Area under the curve: 0.72 with 95% CI (0.62–0.81). Conclusions: Calculation of CHA2DS2-VASc score applied as a simple risk stratification tool before primary PCI affords great predictive power. Furthermore, incremental values are obtained by using both CHA2DS2-VASc and no-reflow regarding mortality risk assessment.
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Affiliation(s)
- Ammar Ashoori
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | | | - Saeed Ghodsi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | | | - Yones Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Alireza Amirzadegan
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Zahra Hosseini
- Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Yaser Jenab
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Babak Geraiely
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Negar Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
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Shafaei-Bajestani N, Talasaz AH, Salarifar M, Pourhosseini H, Sadri F, Jalali A. Potential Role of Vitamin C Intracoronary Administration in Preventing Cardiac Injury After Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction. J Res Pharm Pract 2019; 8:75-82. [PMID: 31367642 PMCID: PMC6636420 DOI: 10.4103/jrpp.jrpp_18_78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The aim of the present study was to determine the effects of intravenous (IV) and intracoronary administration of Vitamin C on the incidence of periprocedural myocardial injury in patients undergoing primary percutaneous coronary intervention (PCI). Methods: In this prospective, double-blind, randomized clinical trial, that was conducted in Tehran Heart Center, Iran, between October 2016 and March 2017, 252 patients undergoing primary PCI were enrolled to receive either 3 g of IV Vitamin C before PCI and 100 mg of intracoronary Vitamin C during PCI in addition to the routine treatment (n = 126) or just the routine treatment (n = 126). Cardiac biomarkers were measured before and then 6 and 12 h postprocedurally. We determined the occurrence of contrast-induced acute kidney injury (CI-AKI), according to the levels of serum creatinine, neutrophil gelatinase-associated lipocalin, and platelet activation biomarker (P-selectin) in a subset of 119 patients before and 6 h after PCI. Findings: In the patients who received Vitamin C, the serum levels of troponin T after 12 h and creatine kinase-MB after 6 h were significantly lower than those in the placebo group (P = 0.003 andP = 0.00, respectively). CI-AKI occurred in 6 (4.7%) patients in the study group and 8 (6.3%) patients in the control group; there was no significant reduction in CI-AKI in the study group. In addition, the two groups were statically similar as regards the changes in the level of P-selectin. Conclusion: In primary PCI patients, the prophylactic use of IV and intracoronary Vitamin C can confer additional clinical benefits such as cardioprotection.
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Affiliation(s)
- Negar Shafaei-Bajestani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Hajhossein Talasaz
- Department of Clinical Pharmacy, Faculty of pharmacy, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhosseini
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sadri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Alidoosti M, Lotfi R, Lotfi-Tokaldany M, Nematipour E, Salarifar M, Poorhosseini H, Jalali A. Correlates of the “No-Reflow” or “Slow-Flow” Phenomenon in Patients Undergoing Primary Percutaneous Coronary Intervention. J Tehran Heart Cent 2018. [DOI: 10.18502/jthc.v13i3.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI.
Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades: those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI.
Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784, 95% CI: 0.742–0.826; P<0.001).
Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.
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Hosseinsabet A, Faal M, Shafiee A, Aghajani H, Sotoudeh Anvari M, Jalali A, Nozari Y, Pourhosseini H, Salarifar M, Amirzadegan A, Kassaian SE, Alidoosti M, Hajizeinali A, Nematipour E. Comparing Serum Level of Vitamin D3 in Patients With Isolated Coronary Artery Ectasia and Normal Coronary Artery Individuals. Arch Iran Med 2018; 21:393-398. [PMID: 30221529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 06/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Coronary artery ectasia (CAE) is identified as dilation of one or more segments of coronary arteries that reaches 1.5 times or more, compared with near segments that are normal. Several etiologies like atherosclerosis, autoimmune diseases and congenital anomalies have been proposed for this condition. Vitamin D deficiency activates the renin-angiotensin-aldosterone system, which affects the cardiovascular system. For these reasons, we investigated the serum level of vitamin D in patients with CAE compared with individuals with normal coronary arteries. METHODS The study group included 30 patients (20 males and 10 females, mean age: 57 ± 9 years) with isolated CAE without any stenotic lesions, and the control group consisted of 60 age/gender matched subjects who had normal coronary angiograms (CAG) (40 males and 20 females, mean age: 57 ± 8 years). All participants underwent CAG at Tehran Heart Center between December 2015 and March 2016. Along with routine lab tests, vitamin D, serum albumin, calcium, phosphorus and alkaline phosphatase levels were analyzed and the unadjusted and adjusted effects of vitamin D on CAE were evaluated using logistic regression model. RESULTS The median vitamin D level of the patients with CAE was lower than that of the control group (6.5 [3.0, 18.8] ng/mL vs. 17.7 [8.9, 27.1] ng/mL; P = 0.002). The logistic regression model showed that vitamin D deficiency was a predictor for the presence of CEA (P = 0.013). After adjustment for confounding variables, this association remained significant (P = 0.025). CONCLUSION An association between CAE and vitamin D deficiency was found in our study.
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Affiliation(s)
- Ali Hosseinsabet
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Faal
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Younes Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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45
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Talasaz AH, Shafaei-Bajestani N, Salarifar M, Sadri F. P1648Potential role of vitamin C intracoronary administration in preventing cardiac injury after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A H Talasaz
- Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)
| | | | - M Salarifar
- Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)
| | - F Sadri
- Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)
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46
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Aghajani H, Nezami P, Shafiee A, Jalali A, Nezami A, Nozari Y, Pourhosseini H, Kassaian SE, Salarifar M, Hajzeinali A, Amirzadegan A, Alidoosti M, Nematipour E. Predictors of Long-term Major Adverse Cardiac Events Following Percutaneous Coronary Intervention in the Elderly. Arch Iran Med 2018; 21:344-348. [PMID: 30113855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND We aimed to recognize the predictors of long-term major adverse cardiac events (MACE) in the elderly candidates for elective percutaneous coronary intervention (PCI) at our center. METHODS In this retrospective cohort study, we reviewed the data of the elderly (age ≥65 years) candidates for elective PCI who met our study criteria, at Tehran heart center between 2004 and 2013. Demographic, anthropometric, clinical, angiographic, procedural and follow-up data of the enrolled patients were retrieved from the angiography/PCI databank of our center. The study characteristics of the patients with or without MACE were compared in a univariable Cox-regression analysis. A multivariable Cox-regression model was applied using variables selected from the univariable model to determine the predictors of MACE. RESULTS We reviewed the data of 2772 patients (mean age=70.8±4.7 years, male sex=1726 patients [62.3%]) from which 393 patients (14.4%) developed MACE. In the multivariable regression model, female sex was a protective factor for MACE (hazard ratio [HR]=0.701; P=0.001), while presence of diabetes mellitus (HR=1.333; P=0.007), family history of coronary artery disease (CAD) (HR=1.489; P=0.003) and plain balloon angioplasty (HR=1.810; P=0.010) were independent risk factors for MACE. CONCLUSION PCI is a safe and effective method of revascularization in the elderly patients, and some clinical and procedural factors can predict MACE in this group of patients.
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Affiliation(s)
- Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Paniz Nezami
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nezami
- Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Younes Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Alidoosti M, Lotfi R, Lotfi-Tokaldany M, Nematipour E, Salarifar M, Poorhosseini H, Jalali A. Correlates of the "No-Reflow" or "Slow-Flow" Phenomenon in Patients Undergoing Primary Percutaneous Coronary Intervention. J Tehran Heart Cent 2018; 13:108-114. [PMID: 30745923 PMCID: PMC6368911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Despite recent advances in interventional equipment and techniques, the angiographic no-reflow phenomenon occurs in a considerable number of patients undergoing primary percutaneous coronary intervention (PCI). We investigated the clinical, angiographic, preprocedural, and procedural characteristics associated with the no-reflow phenomenon among patients undergoing primary PCI. Methods: Between March 2008 and April 2013, 530 patients (78.5% male, mean age=58.11±12.39 y) with ST-segment-elevation myocardial-infarction who underwent primary PCI were categorized in 2 groups according to their postprocedural thrombolysis-in-myocardial infarction (TIMI) flow grades: those with a maximum score of 2 (the no-reflow or slow-flow group) and the ones with a score of 3 (the reflow group). A multivariable logistic regression model was used to find the multiple correlates of the no-reflow phenomenon after PCI. Results: There were 166 (31.3%) patients in the no-reflow group and 364 (68.7%) in the reflow group. The no-reflow patients were older and had significantly longer target lesion lengths, higher SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) scores, higher infarct-related artery SYNTAX scores, more thrombus burden, and a higher frequency of initial TIMI flow grades of 2 or lower. Our multivariable logistic regression analysis demonstrated that older age, higher numbers of Q waves, not using statin, longer target lesion lengths, higher thrombus grades, and higher infarct-related artery SYNTAX scores remained the independent correlates of increased no-reflow rates after primary PCI (area under the ROC curve=0.784, 95% CI: 0.742-0.826; P<0.001). Conclusion: Clinical, angiographic, and procedural features of patients undergoing primary PCI may be correlated with the occurrence of the no-reflow phenomenon. The thrombus grade and the infarct-related artery SYNTAX score could be among these factors.
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Affiliation(s)
- Mohammad Alidoosti
- Corresponding Author: Mohammad Alidoosti, Associate Professor in Cardiology, Tehran Heart Center, North Kargar Street, Tehran, Iran. 1411713138. Tel: + 98 21 88089256. Fax: + 98 21 88089256..
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Nozari Y, Eshraghi A, Talasaz AH, Bahremand M, Salamzadeh J, Salarifar M, Pourhosseini H, Jalali A, Mortazavi SH. Protection from Reperfusion Injury with Intracoronary N-Acetylcysteine in Patients with STEMI Undergoing Primary Percutaneous Coronary Intervention in a Cardiac Tertiary Center. Am J Cardiovasc Drugs 2018; 18:213-221. [PMID: 29322434 DOI: 10.1007/s40256-017-0258-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Evidence suggests that oxidative stress plays a principal role in myocardial damage following ischemia/reperfusion events. Recent studies have shown that the antioxidant properties of N-acetylcysteine (NAC) may have cardioprotective effects in high doses, but-to the best of our knowledge-few studies have assessed this. OBJECTIVES Our objective was to investigate the impact of high-dose NAC on ischemia/reperfusion injury. METHODS We conducted a randomized double-blind placebo-controlled trial in which 100 consecutive patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly assigned to the case group (high-dose NAC 100 mg/kg bolus followed by intracoronary NAC 480 mg during PCI then intravenous NAC 10 mg/kg for 12 h) or the control group (5% dextrose). We measured differences in peak creatine kinase-myocardial band (CK-MB) concentration, highly sensitive troponin T (hs-TnT), thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and corrected thrombolysis in myocardial infarction frame count (cTFC). RESULTS The peak CK-MB level was comparable between the two groups (P = 0.327), but patients receiving high-dose NAC demonstrated a significantly larger reduction in hs-TnT (P = 0.02). In total, 94% of the NAC group achieved TIMI flow grade 3 versus 80% of the control group (P = 0.03). No significant differences were observed between the two groups in terms of changes in the cTFC and MBG. CONCLUSIONS In this study, NAC improved myocardial reperfusion markers and coronary blood flow, as revealed by differences in peak hs-TnT and TIMI flow grade 3 levels, respectively. Further studies with large samples are warranted to elucidate the role of NAC in this population. ClinicalTrials.gov identifier: NCT01741207, and the Iranian Registry of Clinical Trials (IRCT; http://irct.ir ) registration number: IRCT201301048698N8.
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Geraiely B, Salarifar M, Alidoosti M, Mortazavi SH. Angiographic Characteristics of ST-Elevation Myocardial Infarction Patients With Infarct-related Coronary Artery Ectasia Undergoing Primary Percutaneous Coronary Intervention. Crit Pathw Cardiol 2018; 17:95-97. [PMID: 29768318 DOI: 10.1097/hpc.0000000000000143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Coronary ectasia accounts for 0.3%-4.9% of patients undergoing coronary angiography. We conducted the present study to evaluate the angiographic characteristics of ST-elevation myocardial infarction (STEMI) patients with infarct-related coronary artery ectasia (IRAE) undergoing primary percutaneous coronary intervention. We evaluated 667 STEMI patients who were divided into 2 groups of IRAE (n = 81) and non-IRAE (n = 568). Preprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural TIMI flow grade, thrombus burden grade, and TIMI frame count were then evaluated. In adjusted analysis, fewer patients with IRAE had open (TIMI flow grade II or III) infarct-related arteries before the primary percutaneous coronary intervention (7.4% vs. 27.5%; odds ratio: 4.522; 95% confidence interval, 1.924-10.628; P = 0.001). Meanwhile, postprocedural TIMI flow grade 3 was less common in these patients (49.4% vs. 68.4%; odds ratio: 2.239; 95% confidence interval, 1.392-3.599; P = 0.001). High thrombus burden was more frequent in the patients with IRAE, with an odds ratio of 1.938 in the adjusted analysis. The corrected TIMI frame count was also significantly higher in the IRAE patients than in those without. Our STEMI patients with IRAE had impaired perfusion. Moreover, this group of patients more frequently had high thrombus burden. These patients might be at increased risk of unsuccessful revascularization probably due to distal embolization and no-reflow phenomenon, which could impact their short- and long-term outcomes. Because coronary ectasia is a known risk factor for acute coronary syndrome, it is beneficial that these patients be deemed high risk and kept under close monitoring.
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Affiliation(s)
- Babak Geraiely
- From the Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Aghajani H, Alkamel A, Shafiee A, Jalali A, Nozari Y, Pourhosseini H, Kassaian SE, Salarifar M, Hajizeinali A, Amirzadegan A, Alidoosti M, Masoudkabir F, Nematipour E. Predictors of major adverse cardiac events following elective stenting of large coronary arteries. Indian Heart J 2018; 70:20-23. [PMID: 29455782 PMCID: PMC5902817 DOI: 10.1016/j.ihj.2017.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/26/2017] [Accepted: 06/18/2017] [Indexed: 11/06/2022] Open
Abstract
Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
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Affiliation(s)
- Hassan Aghajani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdolhakim Alkamel
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Younes Nozari
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mojtaba Salarifar
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Alidoosti
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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