Background: Percutaneous coronary intervention is now the best way of management of acute coronary syndrome (ACS). Contrast induced nephropathy is a serious complication and greatly dependent on several factors. It is still unclear whether the vascular access migrates CIN risk. Objective: To study the impact of Radial Access (RA) compared with Femoral Access (FA) on developing contrast-induced nephropathy (CIN) in patients undergoing invasive management of acute coronary syndrome (ACS). Methods: Sixty patients eligible for invasive management of ACS at cardiology department (Menoufia University hospital and National Heart Institute) were randomized into two groups. Group I: included 30 patients with femoral approach and Group II: included 30 patients with radial approach. The occurrence of CIN estimated by KDIGO definition (absolute increase in serum creatinine (SCr) by ≥0.5 mg/dl within 48 hours; or increase in SCr to ≥25% of baseline) was estimated in both groups. Results: Only 9 patients (15%) developed CIN, 5 patients (55.6%) of them underwent PCI through FA without statistically significant difference between the two approaches. Conclusion: CIN is considered a potential complication of percutaneous coronary intervention (PCI). Our study did not show the preference of using an approach over the other.
Objective: To evaluate the relation between epicardial adipose tissue (EAT) thickness and also pericoronary fat assessed by Multidetector Computed Tomography (MDCT) with both calcium score and significance of coronary artery disease. Background: Epicardial adipose tissue (the visceral fat of the heart present under the visceral layer of the pericardium) has the same origin of abdominal visceral fat, which is known to be strongly related to the development of coronary artery atherosclerosis. Multidetector CT (MDCT) provides an accurate and reproducible quantification of EAT due to its high spatial and temporal resolution. Patients and Methods: The current study included 70 patients with low-intermediate probability of coronary artery disease. All patients were subjected to 256 Multidetectors CT to assess EAT thickness, the mean thickness of the pericoronary fat surrounding the three coronary arteries and coronary calcium score. Also coronary CT angiography was done and patients were then divided into 3 groups according to significance of coronary atherosclerosis: Group 1: No atherosclerosis (20 patients), Group 2: Non obstructive atherosclerosis (luminal narrowing less than 50% in diameter) (25 patients), Group3: Obstructive atherosclerosis (luminal narrowing ≥ 50%) (25 patients). Results: The mean EAT thickness and the mean pericoronary fat thickness were significantly higher in patients with obstructive coronary artery disease (CAD) with stenosis > 50% (group 3) compared to other groups with normal coronaries or non obstructive (CAD). ROC curve was used to define the best cut off value of the thickness of both EAT and pericoronary fat in predicting the obstructive CAD group which was ≥7.2 and 12.6 mm for epicardial and pericoronary fat respectively. Also there is a How to cite this paper: Samy, N.I., Fakhry, M. and Farid, W.
surement of HbA1c were included. Increased and a higher HbA1c levels were significantly associated with a higher syntax score (p value < 0.001). After adjustment of age, gender, smoking, hypertension, dyslipidaemia and duration of diabetes, it was found that a higher HbA1c levels were able to independently predict patients with intermediate or high syntax score (≥ 18). CONCLUSION: The complexity of coronary artery lesions was significantly correlated with HbA1c among diabetic patients. A higher HbA1c value is an independent predictor of the complexity of coronary lesions.
Background: Following primary percutaneous coronary intervention (PCI), contrast-induced nephropathy (CIN) is linked to higher mortality and morbidity. The monocyte to high density lipoprotein cholesterol ratio (MHR), which has been used as a novel predictive marker in patients with cardiovascular and renal disorders, has been linked in several studies to a number of negative cardiovascular outcomes. Objective: The current study was conducted to explore correlation between monocyte to HDL ratio and CIN after primary PCI in patients presented with ST-segment Elevation Myocardial Infarction (STEMI). Patients and methods: A total of 80 patients with acute STEMI were included. Patients were differentiated into two groups according to development of contrast induced nephropathy; Group (A) Patients who developed contrast induced nephropathy, and Group (B) Patients did not develop contrast induced nephropathy. CIN was defined as either a 25% increase in serum creatinine from baseline or 0.5 mg/dL increase in absolute value, within 48-72 h of intravenous administration of contrast medium. Results: A total of 16 (20%) patients developed CIN. MHR was significantly higher in CIN positive group [mean 0.0202 (range 0.009-0.0633) 10 8 /mg] than non-CIN group [mean 0.0129 (range 0.0031-0.0307) 10 8 /mg] with P-value = 0.003. MHR was also significantly correlated with creatinine levels 48 hours after PCI (r s : 0.322, P: 0.004). ROC statistical analysis showed that MHR >0.0131 was the best cutoff values for predicting contrast induced nephropathy with sensitivity 76% and specificity 71.2%. Conclusion: Higher MHR levels may predict CIN development after primary PCI in STEMI patients.
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