Objectives Platelets play an important role in the pathogenesis of atherosclerosis and the physiopathology of cardiovascular events. Plateletcrit provides complete information on total platelet mass. The relationship between plateletcrit values and long-term outcomes in patients with carotid stenosis is not known. The purpose of the present study is to evaluate the reliability of plateletcrit for predicting major adverse cardiac and cerebrovascular events (MACCE) in patients with carotid stenosis. Methods A total of 230 patients with more than 50% stenosis of the carotid artery were retrospectively included in this study. All cases were divided into two groups according to the calculated threshold value of plateletcrit with receiver operating characteristics curve and baseline parameters and clinical outcomes were compared. Univariate and multivariate analyses were used to evaluate the association between the plateletcrit and MACCE. Results The cut-off value for plateletcrit was found to be 0.233 for predicting MACCE, with 56.2% sensitivity and 68.0% specificity. High plateletcrit levels were demonstrated to be statistically higher in patients with MACCE (0.247 in the MACCE (+) group vs. 0.213 in the MACCE (–) group, p < 0.001). In the Kaplan–Meier survival analysis, the long-term mortality rate was higher in the high plateletcrit group ( p = 0.006). Multivariate regression analysis showed that plateletcrit was independently associated with MACCE (OR: 2.196, CI: 1.200–4.018; p = 0.011). Conclusions Our data suggest that plateletcrit has an independently predictive value for long-term mortality and MACCE, and it can be used as a marker to predict the long-term adverse outcomes in patients with carotid stenosis.
Background Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures. Methods We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients. Results Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023–1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003). Conclusions The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis.
Background : In patients with essential hypertension, fragmented QRS has been associated with many remodeling components that might lead to adverse cardiovascular effects. This study aimed to evaluate the relationship between fragmented QRS and adverse events and its potential long-term prognostic value. Methods: The patients with essential hypertension were divided into two groups according to the presence of fragmented QRS: fragmented QRS (+) and fragmented QRS (−). During long-term follow-up, the relationship of fragmented QRS to coronary artery disease, congestive heart failure, stroke, cardiovascular death, all-cause death, and major adverse cardiovascular and cerebrovascular events was evaluated. Results: The study group included 542 patients with essential hypertension. Fragmented QRS on ECG was observed in 224 (41.3%) patients. Considering the incidence rates at the end of 5.6 ± 1.3 years’ follow-up, the total incidence rate of major adverse cardiovascular and cerebrovascular events ( P < .001), coronary artery disease ( P < .001), and congestive heart failure ( P < .001) were higher in patients with fragmented QRS. No significant difference was observed between the two groups in terms of stroke ( P = .734), cardiovascular death ( P = 1), and all-cause death ( P = .574). As a result of multiple cox regression analysis, fragmented QRS ( P = .005) was identified as an independent predictor for major adverse cardiovascular and cerebrovascular events development. Conclusion: In patients with hypertension, the presence of fragmented QRS was found as an independent predictor for major adverse cardiovascular and cerebrovascular events development.
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