Introduction: Coronary artery disease (CAD) is one of the most common causes of morbidity and mortality in developed countries. SYNTAX (SX) score is a useful index that scores lesion severity during coronary angiography (CA) and can predict the patient’s outcome. Recent studies have associated a number of serum parameters with SX score, including platelet volume, and platelet-to-lymphocyte ratio (PLR). Objectives: We aimed to study the SX score in association with various serum parameters to find a valuable parameter for prediction of CAD severity. Patients and Methods: This study consisted of 363 patients referred to Heshmat hospital (Rasht) from March 2016 to October 2016 with acute coronary syndrome (ACS). Serum laboratory parameters were measured after 12 hours of fasting. Severity of CAD was evaluated during CA by SX score. The associations were analyzed using multinomial logistic regression model. Results: The mean age of patients was 63.68±11.03 years; since 26.2% of cases had severe, 43% had moderate, and 30.8% had mild CAD. Comparing to mild CAD, the multivariate adjusted model showed higher significant odds of severe CAD for one elevation of platelets (odds ratio [OR] =2.18 (95% CI: 1.35-3.50), white blood cells (WBCs) (OR=1.66, 95% CI: 1.17-2.35) RDW (red cell distribution width), (OR=1.59, 95% CI: 1.08-2.35) and serum creatinine (OR=1.75, 95% CI: 1.16-2.63). Conclusion: Plasma platelets, WBC and RDW and also serum creatinine were all independently correlated with severity of CAD.

Background Studies have shown that the primary causes of death in patients with acute coronary syndrome are arrhythmias and heart failure. The aim of this study is to evaluate the short-term prognosis of fragmented QRS (f-QRS) in patients with acute myocardial infarction (MI). Methods This study was a prospective and longitudinal analytic study performed on all patients with acute MI admitted to Rasht Heshmat Hospital Emergency during 2018–2019. Serial Electrocardiography (ECG) was performed in the emergency room after patient admission and was repeated 24 h after percutaneous coronary intervention and fibrinolytic therapy, as well as at the time of patient discharge. Short-term prognosis of f-QRS in patients was evaluated by a cardiologist within admission, 40 days after hospitalization and three months later again. Results In this study, 453 patients with MI were evaluated in two treatment methods of fibrinolytic and invasive with and without f-QRS. Based on the data of this study, the four study groups had no statistically significant difference in arrhythmia ( p = 0.196). In addition, the effect of study groups on left ventricular ejection fraction index was not statistically significant ( p = 0.597). The probability of adverse outcomes occurrence was not statistically significant among the four groups ( p = 0.07). Conclusion The final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.

Introduction: In patients with coronary chronic total occlusion (CTO), adequate coronary collateral circulation (CCC) supports myocardial tissue versus ischemia. Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome and ischemic heart disease. Objectives: In this study, we evaluated whether coronary CTO is associated with serum levels of vitamin D and CCC. Patients and Methods: Around 216 patients with coronary CTO at coronary angiography were incorporated in this investigation. Serum 25(OH)D level and low-density lipoprotein (LDL-C), triglyceride (TG), total cholesterol, fasting blood sugar (FBS), serum creatinine, high-density lipoprotein (HDL-C), were assessed before angiography. Patients were divided into a poor coronary collateral circulation group (Rentrop grades 0-1) or good coronary collateral circulation group (Rentrop grades 2-3). Results: A total of 216 patients (mean age 61.48±9.5 years) were included in this study. Regression analysis results displayed that serum 25(OH)D level had a significant correlation with CCC according to Rentrop scoring system (P<0.0001). We also found that variables such as gender (P=0.05), HDL-C (P=0.01) and serum creatinine (P=0.05) were a predictor for CCC. This model described 33% of the CCC’s variance in the study patients. Besides, in the analysis of clinical levels of vitamin D, it can be stated that the probability of having a high degree of Rentrop criterion in the patients with adequate level of vitamin D is 24.5 times higher than the patients with vitamin D deficiency (P<0.001). Conclusion: The results of this study emphasize the importance of informing patients with CTO commonly associated with serum vitamin D level.

Background: Despite significant improvements in diagnosis and treatment, non-ST-Elevation Myocardial Infarction (NSTEMI) is still one of the health problems in developed and developing countries. Objectives: The present study was performed to assess the electrocardiographic changes and coronary findings in patients with NSTEMI. Methods: The study enrolled 158 patients with NSTEMI diagnosis at the discharge time. Demographic characteristics and electrocardiographic changes were collected using a checklist from the medical records of the patients. The angiography data were used to calculate a syntax score for each patient. Finally, patients were divided into three groups based on this score: high risk >32, intermediate risk 22-32, and low risk < 22. Involved vessels, including the left anterior descending artery, Right Coronary Artery (RCA), Left Circumflex Artery (LCX), and the left main stem, were also determined. Results: The mean age of the patients was 60.68 ± 12.15 years. The LAD, LCX, and RCA were the most common involved vessels, in sequence. About 27.73, 67.15, and 5.12% of the patients were assigned to low, moderate, and high-risk groups, respectively. Statistically significant differences were observed in the frequencies of ECG changes (P = 0.003) and types of involved vessels (P < 0.001) between low, moderate, and high-risk patients. In addition, there were statistically significant differences in the mean syntax scores between different types of involved vessels (P < 0.001). Conclusions: The findings of the present study showed a significant relationship between the types of vessel involvement and syntax score. Also, there was a high prevalence of ST changes in precordial leads that may improve the sensitivity of diagnosis. We did not find any significant relationship between the frequencies of ECG changes based on the types of involved vessels.

Objective: To evaluate the relationship between platelet count after primary percutaneous coronary intervention (p-PCI) and left ventricular aneurysm (LVA) in patients with acute anterior ST-elevation myocardial infarction(STEMI). Methodology: This descriptive study was performed on a population of patients with acute anterior STEMI, who had undergone p-PCI. Sampling was carried out by a consecutive survey of patients, who were admitted to the Medical Center in summer and fall of 2018. Blood samples were collected intravenously from all the patients at admission to the emergency department before and after p-PCI. Echocardiographic examinations were routinely performed by a specialist assistant as the co-author 8 to 12 hours after p-PCI and at follow-up (10 to 14 months after acute MI). The TIMI flow was observed immediately after p-PCI. In all the patients undergoing p-PCI, the location of left anterior descending (LAD) artery involvement during coronary arteries angiography was divided into three sections based on LAD artery length. Results: The mean WBC and PMN before p-PCI were statistically higher in the group of patients with LVA compared to individuals without LVA (p<0.001). Based on multivariate analysis platelet count (OR=0.999, age (OR=1.07), PMN before P-PCI (OR=1.001) had a significant additive effect on the probability of LVA formation. Conclusion: Platelet count can be used for prediction of the risk of future LVA formation in acute STEMI patients. Key words: ST-segment elevation myocardial infarction; platelet count; mortality; percutaneous coronary intervention; left ventricular aneurysm

Introduction: Statins are beneficial treatments for patients with cardiovascular disease; however the relation between dose and clinical outcomes has not been evaluated. Objectives: We compared the effects of high versus low-dose of rosuvastatin on postoperative outcomes in patients undergoing coronary artery bypass graft (CABG). Patients and Methods: In this randomized clinical trial study, patients undergoing open heart surgery were randomly divided into two groups of 76 (received 5 mg dose) and 84 (received 20 mg dose) in Heshmat hospital, in Rasht. The study was started during the hospitalization period and after discharge until one month. Data were obtained by demographic questionnaire, clinical and changes in laboratory tests based on pre- and post-surgery. To analyze the variables, paired sample t test was applied. P value ≤0.05 was taken as significant. Results: The ages of the participants were 58.36±7 and 59.5±9 years for the treatment with high and low dosages of rosuvastatin (20 mg and 5 mg) respectively (P = 0.28). AKI (acute kidney injury) as a primary outcome was not significantly different between the two groups (P>0.05). Secondary outcomes (changes in lipid profiles, new atrial fibrillation (AF), postoperative infection) were not significantly different between the two groups (P>0.05). However, the increased values of CK-MB were significantly more in high-dose rosuvastatin than in low-dose rosuvastatin treated group (P<0.05). Conclusion: In this study, we compared the effects of high versus low doses of rosuvastatin on postoperative outcomes such as AKI, new AF, infection and myocardial infarction (MI) in CABG surgery. We found rosuvastatin can associate with decreased occurrence of postoperative outcomes of CABG in which no significant differences between high versus low dose of this drug. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT20180113038329N1; https://irct.ir/trial/29938; ethical code# IR.GUMS.REC.1396.368).

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