Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58 years (IQR [interquartile range]: 50–67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42 months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67 years; HR [hazard ratio]: 1.34, 95% CI 1.18–1.52) and UAR (increase 1.15–1.73; HR: 1.33, 95% CI 1.16–1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.
Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD's were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.
In addition to deaths directly caused by cardiovascular diseases (CVDs), clinical complications that may develop in the postoperative period have important effects on mortality. Contrast-induced acute kidney injury (CI-AKI) is a condition seen after cardiac or radiological evaluations using contrast agents. Up to 25% of CI-AKI is seen after diagnostic or therapeutic interventional procedures performed for cardiovascular disorders. 1,2 Information such as age, weight, diabetes mellitus (DM), hypertension, known renal insufficiency obtained from the patient before the clinical evaluation of procedure can be predictive for CI-AKI development, as well as the amount of contrast agent,
Objective: AngioJet rheolytic thrombectomy (ART) has been used as a catheter-based treatment for acute pulmonary embolism (PE). In this study, based on our 7-year experience with ART in patients with PE, we evaluated the efficacy and safety outcomes of ART. Methods: Our study is based on retrospective evaluation of 56 patients with high-and intermediate-high-risk PE, with an average age of 62 years [interquartile range (IQR) 50-73 years] who underwent ART. Results: High and intermediate-high risks were noted in 21.4% and 78.6% of the patients, respectively. The ART duration was 304 (IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio, right to left atrial diameter ratio, and pulmonary arterial pressures were improved (p<0.001 for all). During the hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. Conclusion: ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, right ventricle strain, and hemodynamics in patients with PE at high and intermediate-high risk. Aging increased the risk of post-procedural nephropathy, whereas baseline high-risk status predicted in-hospital and long-term mortality.
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