Contrast-induced nephropathy (CIN) remains a frequent and clinically relevant complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study evaluated the predictive performance of inflammation-based indices for CIN development, with a focus on the inflammatory prognostic index (IPI). STEMI patients (n = 563) were retrospectively analyzed. CIN developed in 85 patients (15.1%). Admission IPI values were significantly higher in patients who developed CIN compared with those without CIN (10.9 [7.6-16.2] vs 4.8 [3.1-7.9], P < .001). In multivariate logistic regression analysis, IPI remained independently associated with CIN (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.61, P = .013), together with advanced age, higher blood urea nitrogen levels, reduced left ventricular ejection fraction, history of stroke, and the occurrence of no-reflow. Receiver operating characteristic analysis demonstrated superior discriminative performance for IPI (area under the curve [AUC] 0.826, 95% CI 0.783-0.869) compared with neutrophil-to-lymphocyte ratio (NLR; AUC 0.691), C-reactive protein-to-albumin ratio (CAR; AUC 0.712), and systemic immune inflammation index (SII; AUC 0.704). An admission IPI cutoff value of 8.35 predicted CIN with 82.4% sensitivity and 65.9% specificity. IPI demonstrates superior discriminative performance compared with CAR, NLR, and SII for predicting CIN in STEMI patients undergoing pPCI.

Background:To compare the procedural success, complication rates, and clinical outcomes of transradial and transulnar arterial interventions in patients undergoing primary percutaneous coronary interventions (PCIs) due to acute ST elevation myocardial infarction (STEMI). The effectiveness of access routes was evaluated in procedures performed using a single catheter. Materials and Methods:A total of 258 patients diagnosed with STEMI and who underwent primary PCI were included in the study. Eighteen patients were excluded for not meeting the study criteria, and the remaining 240 patients were randomized 1:1 into radial and ulnar groups. After excluding cross-overs, the remaining 231 patients underwent the procedure, including 113 via the radial route (Group R) and 118 via the ulnar route (Group U), and their data were analyzed. Procedural success, the number of arterial punctures, procedure duration, complication rates and clinical outcomes were prospectively compared. Results:No significant difference in procedural success was observed between the two groups. However, the number of arterial punctures was higher in the transulnar group (≥ 2 punctures: Group R: 24 [21.2%], Group U: 48 [40.7%]; p = 0.001), and the puncture duration was longer (Group R: 15 sec [10-20], Group U: 15 sec [10-30], p = 0.001). There were no significant differences in post-procedural hematoma formation or arterial occlusion rates between the two groups. Conclusions:Our results demonstrated that single-catheter transulnar access offers a similar procedural success rate and safety profile to transradial access. However, transulnar access was associated with a longer puncture duration and increased puncture attempts. Transulnar access may be considered a reliable alternative when transradial access is not feasible.

ObjectivesCardiac syndrome Y (CSY) phenomenon is characterized by the gradual opacification of the coronary vasculature at the distal level. The leuko-glycemic index (LGI) is a blood glucose and white blood cell count index. This study investigates the relationship between CSY and the leuko-glycemic index.MethodsA case-control, retrospective study was conducted. Consecutively selected individuals with complaints of angina were included in the study. Subjects with normal coronary flow (n = 132) and coronary slow flow (n = 136) were classified, after confirmation of coronary angiography results.ResultsThe age ranges were recorded as 57 (48-64) for the NCF group vs. 52 (46-58) for the CSY group, P = .010. The mean hematocrit (Hct), Hemoglobin (Hg), White blood cells (WBC), and LGI were significantly higher in the CSY group than in the normal coronary flow group (P < .001). Accordingly, CSY was positively correlated with Hct, Hg, and WBC (P < .001). ROC curve analysis indicated that a cut-off value of ≥9.28 for the LGI predicted CSF with a sensitivity of 78% and a specificity of 78.1% [Area under the curve (AUC): 0.626 and 95% CI: 0.559-0.693].ConclusionsIn this study, we show for the first time that elevated LGI levels can independently predict CSF formation in the subclinical process.

ABSTRACT: INTRODUCTION AND AIM: In this study, we aimed to investigate the effects of P2Y12 inhibitors administered at the time of admission to the emergency department in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention on the thrombus score in the culprit lesion. MATERIALS AND METHODS: This retrospective study planned to compare the pre-procedural thrombus scores of 225 patients who presented with STEMI underwent primary percutaneous coronary intervention, and received different P2Y12 inhibitors within 2 hours after the onset of chest pain. RESULTS: A total of 225 patients were included in our study. Among them, 72 patients received clopidogrel, 85 received ticagrelor, and 68 received prasugrel as the P2Y12 inhibitor. The pre-procedural Grade 5 thrombus was significantly lower in the ticagrelor group compared to the other groups (Clopidogrel 77.78%, Ticagrelor 61.18%, Prasugrel 77.94%; p=0.017). CONCLUSIONS: In our study, ticagrelor among the pre-procedurally loaded P2Y12 inhibitors was found to be superior in terms of early thrombus intensity, and these results are thought to be associated with the early onset antiplatelet effect of ticagrelor. Keywords: ST segment elevation myocardial infarction, clopidogrel, prasugrel, ticagrelor, thrombus score

In this study, we aimed to evaluate the utility of the immune-inflammation index (SII) in estimating the no-reflow phenomenon and short-term cardiovascular prognosis in patients with ST-segment elevation myocardial infarction (STEMI). 723 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled in our study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. The multivariate regression analysis analyzed the correlation between no-reflow and SII. The median value of SII was significantly higher in patients with no-reflow in comparison with normal reperfusion [1466 (939-2409) vs 905 (566-1379), p < .001]. The optimal threshold for SII in predicting the no-reflow phenomenon was 1036, with sensitivity and specificity of 70% and 59%, respectively. The area under the ROC curve (AUC) was 0.71 (95% CI, 0.66-0.75, p < .001). In multivariate analysis, SII ≥ 1036 value showed an independent predictive value for the no-reflow (OR = 0.51, 95% CI: 0.29-0.92, p = .02) and the 30-day cardiovascular mortality (OR = 2.37, 95% CI: 1.34-4.19, p = .003). Our results suggest that higher SII levels are independently associated with the no-reflow phenomenon and 30-day mortality in STEMI patients undergoing primary PCI.

OBJECTIVE:To investigate the relationship between cardio-ankle vascular index (CAVI), which is a marker of arteriosclerosis and the development of contrast-induced nephropathy (CIN).STUDY DESIGN:Descriptive study.PLACE AND DURATION OF STUDY:Department of Cardiology, Sakarya University Medical Faculty, from May to December 2019.METHODOLOGY:Between May and December 2019, demographic characteristics, CAVI measurements, and in-hospital clinical outcomes were compared among 66 patients, who developed CIN after coronary angiography (CAG) and an acute coronary syndrome (ACS) diagnosis, and 60 ACS patients without CIN.RESULTS:The frequency of CIN development in the study was 5.5%. In the CIN group, EF was lower (44.5 ± 10.6% vs. 49.3 ± 9.8%, p = 0.011) and GFR (mL/min/1.73 m2) at admission, was lower (60.3 ± 23.3 vs. 87.0 ± 21.5, p <0.001) than in the non-CIN group. CAVI values indicative of arterial stiffness (AS) were significantly higher in the CIN group. Mortality was not significantly higher in the CIN group (p = 0.099).CONCLUSION:AS is more common in ACS patients, who developed CIN after CAG. Older patients with low EF and low GFR, in whom AS is more common, should be intravenously hydrated and more closely monitored to prevent CIN development. Key Words: Contrast-induced nephropathy, Acute coronary syndrome, Cardio-ankle vascular index, Arterial stiffness.

Amaç: Primer perkutan koroner girişim (pPKG), ST elevasyonlu miyokard infarktüsünde (STEMI) ölüm başta olmak üzere klinik sonuçları fibrinolitik tedaviye kıyasla daha iyi olması üzerine, önerilen ve gittikçe daha yaygın kullanılan tedavi yöntemidir. Amacımız hastanemizde bir yıl içinde yapmış olduğumuz pPKG işlemlerinin ve hastane içi klinik sonuçlarının istatistiksel analizini yapmaktır. Gereç ve yöntem: Ocak 2018 ile Aralık 2018 arasında pPKG ile tedavi edilmiş STEMI hastaları retrospektif olarak hastane kayıtlarından belirlendi, anjiyografi görüntüleri izlendi, hastane içi mortalite ve iskemik-kanama-prosedürel komplikasyon oranları analiz edildi. Bulgular: Acil pPKG tedavisi amacıyla kateter laboratuvarına alınmış olan 982 hasta belirlendi. İşlem başarısı oranı %96.9 idi. Ortalama (Ort.) yaş kadın hastalarda (69±11) erkeklere (59±12) göre daha fazlaydı. Ortalama kapı-balon zamanı (KBZ) 60.0±18 dk. olup, hastaların %94.5’inde lt;90dk. KBZ hedefine ulaşıldı. Ponksiyon yeri ile ilişkili komplikasyon oranına bakıldığında radyal ponksiyon femoral ponksiyona göre daha güvenli bulundu (%1.4 v.s. % 3.5, p=0.037). Kardiyojenik şokta olan hastaların mortalite oranı %76.0’dı. STEMI hastane içi mortalite oranı %8.6 saptandı. Mortal seyreden grupta yaş ort.’sı daha yüksekti (69±14 v.s. 60±12, p lt;0.001) ve kadın cinsiyette ölüm oranı (%15.0 v.s. % 6.8, p lt;0.001) erkeklerdeki ölüm oranına göre anlamlı olarak daha fazla saptandı. Sonuç: Verilerimiz neticesinde, STEMI hastalarında mortalite özellikle kardiyojenik şok tablosundaki hastalar ile, ileri yaş ve kadınlarda daha yüksek saptanmıştır. STEMI hastalarında pPKG kliniğimizde yüksek başarı oranı ile uygulanmaktadır.