Objective: This research aimed to investigate the predictive value of the uric acid-to-serum albumin ratio (UAR) in establishing the severity and extent of coronary artery disease (CAD) with non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods: A total of 402 patients (mean age 63.5 ± 11.6 years) were included in this retrospectively designed study. We compared Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Scores (SS) between low (≤22) and intermediate-high (>22) groups. The UAR, the neutrophil-to-lymphocyte ratio (NLR), and the C-reactive protein-to-albumin ratio (CAR) were evaluated and compared. Results: SS >22 were observed in 30.8% (n = 124) of the patients, and their UAR, NLR, and CAR were significantly higher. Three separate multivariate analysis models performed as the outcome of a reliable correlation between UAR, NLR, CAR, and consequently UAR (OR = 2.08; 95% CI 1.21–3.58; p = 0.008) and CAR (OR = 3.33; 95% CI 1.85–5.9; p < 0.001) reached significance but NLR (OR = 1.26; 95% CI 0.86–1.84; p = 0.20) clinically trended significance (not statistically). Model performance comparisons demonstrated that UAR is a better predictor regarding likelihood ratios (UAR, 60.95; NLR, 57.8; and CAR, 59.0). Conclusion: As a novel inflammatory marker, UAR independently predicted better outcomes than CAR and might be used reliably in prediction of the extent of CAD in NSTEMI patients.
RVEIO index is a useful, simple, accurate, and independent predictor of severe TR that adds incrementally to traditional methods of quantifying TR severity. Accurate quantification and classification of TR severity is critical for clinical decision-making and management; therefore, the incorporation of RVEIO index into the integrative approach to grading TR severity should be considered.
Objective:The present study was designed to determine the effects of tirofiban (Tiro) infusion on angiographic measures, ST-segment resolution, and clinical outcomes in patients with STEMI undergoing PCI. Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), while the most effective timing of administration is still under investigation.Methods:A total of 1242 patients (83.0% males, mean (standard deviation; SD) age: 54.7 (10.9) years) with STEMI who underwent primary PCI were included in this retrospective non-randomized study in four groups, composed of no tirofiban infusion [Tiro (-); n=248], tirofiban infusion before PCI (pre-Tiro; n=720), tirofiban infusion during PCI (peri-Tiro; n=50), and tirofiban infusion after PCI (post-Tiro; n=224). In all Tiro (+) patients, bolus administration of Tiro (10 pg/kg) was followed by infusion (0.15 pg/kg/min) for a mean (SD) duration of 22.4±6.8 hours.Results:The pre-PCI Tiro group was associated with the highest percentage of patients with TIMI 3 flow (99.4%; p<0.001), the lowest corrected TIMI frame count [21(18-23.4); p<0.001], the highest percentage of patients with >75% ST-segment resolution (78.1%; p<0.001), and the lowest rate of in-hospital sudden cardiac death and in-hospital all-cause mortality (3.2%, p<0.05, 3.3%, p=0.01). Major bleeding was reported in 18 (1.8%) patients who received tirofiban.Conclusion:Use of standard-dose bolus tirofiban in addition to aspirin, high-dose clopidogrel, and unfractionated heparin prior to primary PCI significantly improves myocardial reperfusion, ST-segment resolution, in-hospital mortality rate, and in-hospital sudden cardiac death in patients with STEMI with no increased risk of major bleeding.
Introduction
Acute pulmonary embolism (APE) is a cardiothoracic thromboembolic emergency at risk of life‐threatening. Several risk graduation algorithms may be applied to delineate short‐term mortality in patients with APE. In this study, we aim to depict the relationship between the right ventricular early inflow‐outflow (RVEIO) index, which is a Doppler‐based parameter, and the pulmonary embolism severity index(PESI) in acute pulmonary embolism.
Methods
In the presented study, a total of 160 patients who were diagnosed with APE using pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were comprised. Patients were separated to 2 groups based on the simplified PESI (sPESI): sPESI < 1 (n = 88) and sPESI ≥ 1 (n = 72). Echocardiographic parameters, including the RVEIO index, were measured.
Results
There were no significant differences between the groups in age and gender distribution, or the presence of diabetes mellitus, hypertension, smoking, and history of coronary artery disease. There was a positive correlation with the mortality rate and RVEIO index; the mortality was higher in patients with a higher RVEIO index(<0.001). In receiver operating characteristic (ROC) curve analysis using a cutoff level of 14.39, RVEIO index predicted mortality with a sensitivity of 80.4% and specificity of 57.6%(ROC area under curve:0.694; 95%CI, 0.581‐0.814; P < .001). RVEIO index was higher in the sPESI ≥ 1(n:72) than in the patients with sPESI < 1(14.27 ± 2.13 vs 10.63 ± 2.09; P < .001). There was a positive correlation between RVEIO index and sPESI score(+0.428; P < .001).
Conclusion
As well as predicting the degree of tricuspid regurgitation (TR), the RVEIO index is well‐correlated with sPESI score and is associated with mortality in patients with APE. This easily measurable parameter may be used to predict short‐term mortality in APE patients.
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