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Objective: COVID-19 infection can involve the cardiovascular system and worsen the prognosis of the patients. This study aimed to investigate the adverse effects of COVID-19 on angiographic and clinical outcomes of primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation MI and compare results with those patients without COVID-19 disease. Methods: The study was a retrospective observational cohort, in which patients presented with ST-elevation MI from February 2020 to April 2021, treated with primary PCI were divided into 2 groups based on the COVID-19 infection. Then, the procedural and angiographic indices and also clinical outcomes were compared between the 2 groups. Results: A total of 1150 patients were enrolled in the study. Those with established COVID-19 infection had worse baseline thrombolysis in myocardial infarction flow grade and also were at higher risk for worse procedural outcomes such as lower thrombolysis in myocardial infarction frame count, myocardial blush grade, and slow-flow coronary disease, after the primary PCI. Additionally, the presence of COVID-19 at the time of primary PCI was related to a significantly higher duration of hospitalization and in-hospital mortality. Given the potential impact of other factors on outcomes, analysis for all of the primary endpoints was done again after adjustment of these factors and the results were the same as before, suggesting the independent effect of COVID-19 infection. Conclusions: The concomitant COVID-19 infection in the patients undergoing primary PCI is associated with significantly worse angiographic, procedural and clinical outcomes. Surprisingly, this finding is regardless of patients’ baseline risk factors and demographical characteristics.

BackgroundPulmonary thromboembolism (PE) is the third leading cause of cardiovascular events. The conventional modeling methods and severity risk scores lack multiple laboratories, paraclinical and imaging data. Data science and machine learning (ML) based prediction models may help better predict outcomes.Materials and methodsIn this retrospective registry-based design, all consecutive hospitalized patients diagnosed with pulmonary thromboembolism (based on pulmonary CT angiography) from 2011 to 2019 were recruited. ML based algorithms [Gradient Boosting (GB) and Deep Learning (DL)] were applied and compared with logistic regression (LR) to predict hemodynamic instability and/or all-cause mortality.ResultsA total number of 1,017 patients were finally enrolled in the study, including 465 women and 552 men. Overall incidence of study main endpoint was 9.6%, (7.2% in men and 12.4% in women; p-value = 0.05). The overall performance of the GB model is better than the other two models (AUC: 0.94 for GB vs. 0.88 and 0.90 for DL and LR models respectively). Based on GB model, lower O2 saturation and right ventricle dilation and dysfunction were among the strongest adverse event predictors.ConclusionML-based models have notable prediction ability in PE patients. These algorithms may help physicians to detect high-risk patients earlier and take appropriate preventive measures.

The present study investigates the association of cardiovascular risk factors such as metabolic syndrome (MetS), fiber-rich regimen, and Glomerular Filtration Rate (GFR) with elevated high-sensitivity C-reactive protein (hsCRP) levels. We designed a cross-sectional study based on data of the third National Survey of non-communicable diseases (SuRFNCD-2007); among 2125, Iranian adults (1168 women) aged 25-64 years. Demographic and anthropometric characteristics were collected. Biochemical assessments, were determined on venous blood samples. Quantitative highly sensitive CRP was measured via enzyme-linked immunoassay. Elevated CRP was defined as values above 3 mg/l. Metabolic syndrome was defined according to the ATP III (Adult Treatment Panel III report, 2005). GFR was calculated with the MDRD formula. Multivariable logistic regression accompanied by complex sample survey analysis, including stratified weighting, were recruited. The fiber-rich regimen was determined by the daily consumption of more than five units of vegetables or fruits. Mean age of the population was 39.4±4.5 years. Adjusted odds ratios for prediction of high CRP pertaining to High LDL, Low Physical activity, BUN, MetS ATP III, Declined GFR (per 30 units reduction), optimal Fiber intake, and Current Smoking were calculated. Corresponding values with 95 % CI were 1.36 (1.04-1.85), 1.31(1.11-4.20), 1.04(1.04-1.12), 1.47 (1.04-2.09), 1.22 (1.11-3.36), 0.84 (0.87-1.48), 1.74 (0.39-1.38), respectively. We figured out that MetS, declined GFR in early stages of CKD, and low physical activity were related to high inflammatory state, while fiber-rich regimen decreased the likelihood of high CRP in smokers.

Background Effective treatment of upper extremity deep vein thrombosis (UEDVT) is crucial to prevent further complications. Various treatments, including percutaneous mechanical thrombectomy (PMT), catheter-directed thrombolysis (CDT), decompression surgery, and venoplasty are suggested for UEDVT. However, no prospective study has yet favored any of these treatments. This study presents a review of our experience with CDT followed by balloon venoplasty in patients with acute primary UEDVT. Methods We enrolled all patients diagnosed with acute UEDVT from January 2020 to June 2021. Subjects with UEDVT due to secondary causes like malignancies, indwelling catheters, or leads were excluded. CDT was performed through brachial vein access, using a perfusion catheter, and rt-PA administration. Balloon venoplasty was performed if the treated segment had severe stenosis >50% after CDT. Patients were followed up at the vein clinic for any signs and symptoms in the upper extremity and lifestyle changes. Follow-up ultrasonography was done 12 months after discharge. Results Twelve patients with a mean age of 41.08 ± 14.0 were included in the study. The mean duration of CDT was 25.00±10.56 hours. After CDT, all patients had more than 50% stenosis, with seven having total occlusion. However, after balloon venoplasty, no patient had significant (more than 50%) stenosis. There was no serious complication after both procedures. Patients were followed up for a mean duration of twelve months after their admission, with a mean time of maintenance anticoagulation was 10.73±5.77 months. Only one patient had recurrent symptoms in his target limb, while the rest were free of symptoms in their treated extremity. No subject developed pulmonary emboli (PE) during admission or the follow-up period. There was no evidence of hospital readmission for any reason. Upper extremity color-doppler sonography of the patients at twelve months after their procedure showed normal venous flow without any significant stenosis in 8 (66.7%), and partially normal flow with patent target vein in 4 (33.3%) patients. Conclusions CDT followed by balloon venoplasty may be an effective treatment for selected patients with acute primary UEDVT, providing desirable long-term results and potentially avoiding the need for decompression surgery in the short or long term.

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The occurrence of hematuria during a right heart catheterization can be a sign of renal perforation, a rare but life-threatening complication that could be developed due to the misdirection of wire into the abdominopelvic venous plexus. We showed this complication could be managed with venoplasty of the common iliac vein.