Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

We assessed the relationship between the severity of coronary artery disease assessed by SYNTAX score (SS) and neutrophil to lymphocyte ratio (N:L ratio) in patients with ST elevation myocardial infarction (STEMI). In total, 840 patients with STEMI in whom primary percutaneous coronary intervention was performed were prospectively included (622 male, 218 female; mean age 58.6 ± 12.4 years). Total and differential leukocyte counts and other biochemical markers were measured at admission. Patients were categorized into tertiles on the basis of SS. The N:L ratio of SShigh group was higher compared with SSlow and SSmid groups (P < .001 for all). Multivariate regression analysis showed that N:L ratio (β = .277, P < .001), ejection fraction (β = -.086, P = .012), age (β = .104, P = .004), and diabetes (β = .152, P < .001) were the independent predictors for SS in patients with STEMI.

We assessed the relationship between contrast-induced nephropathy (CIN) and SYNTAX score (SS) and serum uric acid (SUA) levels in patients with ST elevation myocardial infarction (STEMI). A total of 835 STEMI patients in whom primary percutaneous coronary intervention was performed in our cardiology clinic were included in this study (615 male, 220 female; mean age 58.1 ± 12.2 years). The patients were divided into 2 groups (CIN and non-CIN). Contrast-induced nephropathy was observed in 9.6% (80) of patients; SS (13.9 ± 6.2/22.1 ± 5.8) and SUA (5.1 ± 0.9/6.2 ± 0.9) values in the CIN group were higher compared with the non-CIN group (P < .001, for all). All SS (95% confidence interval [CI] = 1.136-1.250, P = .001), SUA (95% CI = 1.877-3.236, P = .002), and diabetes (95% CI = 0.998-1.039, P = .026) were independent predictors of CIN in logistic regression analysis. Procedures that can prevent CIN may be beneficial in patients at high risk as identified by the SS and SUA levels.

Reactive oxygen species have been implicated in the pathogenesis of contrast-induced nephropathy (CIN). We investigated the relationship between CIN with paraoxonase 1 (PON-1) activity and oxidative stress markers (total antioxidant status [TAS], total oxidant status [TOS], and oxidative stress index [OSI]) in patients with anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention; 289 consecutive patients with STEMI were prospectively included. The patients were divided into 2 groups: CIN (n = 69) and non-CIN (n = 220). Activity of PON-1 and TAS levels were significantly lower and OSI and TOS levels were significantly higher in patients with CIN compared to the non-CIN group (P < .05, for all). On multivariate logistic regression analysis, PON-1 activity and OSI as well as the amount of contrast medium and diabetes were independent predictors for CIN in patients with anterior STEMI. Activity of PON-1 and oxidative stress may play a role in the pathogenesis of CIN.

Increased mean platelet volume (MPV) is associated with poor clinical outcome in patients with acute coronary syndrome. We evaluated the predictive role of MPV in young patients with acute myocardial infarction (AMI). This study includes 373 patients who presented to our hospital with AMI (group 1: 134 young patients, males aged <45 years and females aged <55 years; group 2: 239 older patients) and 141 adults with normal coronary angiography as a control group (group 3). In group 1, the levels of MPV and hemoglobin were higher than that in groups 2 and 3. In group 1, blood urea nitrogen levels were lower than that in groups 2 and 3 and creatinine levels were lower than that in group 2. After multivariate analysis, MPV and age were independent predictors of AMI in young patients.

Serum uric acid (SUA) levels have been proposed as a biomarker of coronary artery disease (CAD) and coronary collateral circulation (CCC). We investigated the association between SUA levels and development of CCC in patients with stable CAD. Consecutive patients (n = 480) with stable CAD who underwent coronary angiography and documented total occlusion in 1 of the major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell (WBC), creatinine, platelet count, and SUA were significantly higher in patients with poor CCC than in those with good CCC. After multivariate analysis, high levels of SUA were an independent predictor of CCC together with levels of fasting blood glucose and WBC. The receiver-operating characteristic analysis provided a cutoff value of 5.65 mg/dL for SUA to predict poor CCC with 60% sensitivity and 66% specificity. High levels of SUA may be associated with poor CCC in patients with stable CAD.

SUMMARYSeveral studies claim that prothrombin 20210GA and factor V Leiden mutations are related to arterial thrombosis. We investigated the frequencies of these mutations and their significance in the development of early atherosclerosis in acute myocardial infarction (AMI) patients younger than 55 years of age. We investigated 96 patients with AMI and 77 control subjects. The diagnosis of AMI was established by typical chest pain and ST elevations on the presentation electrocardiogram and characteristic cardiac enzyme elevations. None of the control subjects had evidence of cardiovascular disease. DNA samples were isolated from all subjects and prothrombin 20210GA and factor V Leiden mutations were determined by the RealTime PCR technique with the aid of a Light Cycler device. The prevalence of factor V Leiden mutation was 6.3% and 5.2% in the patient and control groups, respectively (OR 0.6 [95% CI 0.1-3.9], P = 0.6), whereas the prevalence of prothrombin G20210A mutation was 4.2% and 2.6% in the patient and control groups, respectively (OR 2.8 [95% CI 0.2 -32.2], P = 0.4). None of the patients had both mutations. Prothrombin 20210GA and factor V Leiden mutations are not significant risk factors for the development of myocardial infarction in patients less than 55 years old in Southern Turkey. (Jpn Heart J 2004; 45: 505-512)

Background and ObjectivesWe have intended to investigate the influence of the timing of invasive procedures on all-cause mortality, recurrent myocardial infarction (MI), re-hospitalization due to cardiac causes and left ventricular function over a 3-month period among patients with Non-ST-elevation myocardial infarction (NSTEMI).Subjects and MethodsA total of 131 NSTEMI patients with moderate-high Thrombolysis in Myocardial Infarction risk scores, who had been admitted to our department between July 2011-December 2011 were included in our study. They had been randomized into 2 groups according to the timing of the percutaneous coronary intervention (PCI). Patient undergoing PCI in the first 24 hours of hospitalization were named the "Early Invasive Group" and those undergoing PCI between 24-72 hours of hospitalization were named the "Delayed Invasive Group". All patients were followed up for 3 months.ResultsThird month left ventricular ejection fraction (LVEF) values were higher in the early invasive group (59.9±6.0% vs. 54.1±8.7%; p<0.001). Recurrent MI rates were lower in the early invasive group (2.9% vs. 14.5%; p=0.016). Similarly, hospitalization rates due to cardiac events were lower in the early invasive group (8.7% vs. 30.6%; p=0.001). All cause mortality appeared to be lower in the early invasive group, although not to a statistically significant degree (0% vs. 4.8%; p=0.065).ConclusionThe early invasive strategy appears to be more effective for the reduction of recurrent MI, re-hospitalization due to cardiac events, and the preservation of 3rd month LVEF in patients with moderate-high risk NSTEMI when compared to a delayed invasive strategy.