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Background: There are very few scientific data about the effectiveness of primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) due to stent thrombosis (ST). The purpose of the present study is to investigate the efficacy and outcome of primary PCI for STEMI due to ST in the largest consecutive patient population with ST reported to date. Methods: A total of 2,644 consecutive STEMI patients undergoing primary PCI were retrospectively enrolled into the present study. The primary end point of this study was successful angiographic reperfusion defined as postprocedural Thrombolysis In Myocardial Infarction grade III flow. The secondary end points were cardiovascular death and reinfarction. Results: Stent thrombosis was the cause of STEMI in 118 patients (4.4%). In patients with ST, angiographic success (postprocedural Thrombolysis In Myocardial Infarction grade III flow) was worse than in patients with de novo STEMI (76.3% vs 84.8%, P = .01). Patients with ST had significantly higher incidence of in-hospital cardiovascular mortality than patients with de novo STEMI (10.2% vs 5.3%, P = .02). In-hospital reinfarction rate was similar in both groups. In addition, long-term (mean 22 months) cardiovascular mortality and reinfarction rates were significantly higher in patients with ST compared with those without (17.4% vs 10.5%, P = .02 and 15.6% vs 9.5%, P = .03, respectively). Conclusions: Primary PCI for treatment of ST is less effective, and these patients are at increased risk for in-hospital and long-term mortality compared with patients undergoing primary PCI due to de novo STEMI. [Copyright &y& Elsevier]

Abstract: The issue of whether or not incident type 2 diabetes mellitus and coronary heart disease (CHD) can be predicted by high-density lipoprotein (HDL) cholesterol in both sexes needs investigation. A representative sample of 3035 middle-aged Turkish adults free of CHD at baseline was studied with this purpose prospectively over a mean of 7.8 years. High-density lipoprotein cholesterol levels were found to be correlated in women positively with plasma fibrinogen and weakly with waist girth and C-reactive protein, and to be not correlated with fasting insulin. High-density lipoprotein cholesterol protected men against future CHD risk (for a 12-mg/dL increment: relative risk = 0.80 [95% confidence interval, 0.69-0.95]) after multivariable adjustment in logistic regression analyses for age, smoking status, physical activity grade, hypertension, abdominal obesity, diabetes, and lipid-lowering drugs. However, men were not protected against risk of diabetes. In women, HDL cholesterol was not associated with risk for CHD, whereas intermediate (40-60 mg/dL) compared with lower HDL cholesterol levels proved protective against risk of diabetes (relative risk = 0.57 [95% confidence interval, 0.36-0.90]) after adjustments that included apolipoprotein A-I tertiles. Yet higher serum concentrations failed to yield protection against diabetes. It was concluded that HDL particles confer partially lacking protection against cardiometabolic risk among Turks, and this impairment is modulated by sex. This highly important observation may result from a setting of prevailing chronic subclinical inflammation. [Copyright &y& Elsevier]

Abstract: We investigated among sexes the associations of visceral adipose tissue area (VAT) and body fat mass with smoking status, atherogenic dyslipidemia, inflammatory markers, insulin resistance, and blood pressure (BP). A random sample of the Turkish adult population consisting of 157 middle-aged men and women was evaluated cross-sectionally and partly prospectively. Although men were not influenced significantly, smoking vs never-smoking women had 4 years later a lower VAT (by 31 cm2, P = .005). Fat mass was significantly correlated with homeostasis model, C-reactive protein, and BP in both sexes, although not with atherogenic dyslipidemia as was VAT. Compared with men, women had lower VAT (P < .01) and, because of interaction of sex and smoking (P = .06), tended to be less susceptible to accumulation of VAT per kilogram body fat mass. In linear regression models comprising 7 variables, VAT was associated in men with systolic BP, apolipoprotein B, and C-reactive protein (each P = .04) and was associated in women with age, smoking status, and high-density lipoprotein cholesterol (each P ≤ .01). Significant positive correlations of VAT were obtained with future systolic BP in either sex (P < .03). Body fat mass and visceral fat accumulation are inhibited by cigarette smoking in women. Markers of insulin resistance and inflammation are independently associated with visceral fat marginally in women but significantly in men. Visceral fat is better associated than fat mass with atherogenic dyslipidemia and, in men, with apolipoprotein B. Thus, sex interacts with the dynamics of cardiometabolic risk. [Copyright &y& Elsevier]

Summary: Background & aims: To investigate the relationship of neck circumference (NC) to metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS) and whether it adds information to that provided by waist circumference. Methods: Cross-sectional analysis of a population sample of 1912 men and women, aged 55.1 ±12 years, representative of Turkish adults. MetS was identified based on modified criteria of the ATP-III, OSAS when habitual snoring and episodes of apnea were combined with another relevant symptom. Results: NC measured 36.7 (±3.5) cm in the total sample. It was significantly correlated with numerous risk factors, above all body mass index and waist girth (r ≥0.6), homeostatic model-assessed insulin resistance, blood pressure and, inversely, with smoking status and sex hormone-binding globulin. Sex- and age-adjusted NC was associated significantly with MetS, at a 2–3-fold increased likelihood for 1 standard deviation (SD) increment. After further adjustment for waist circumference and smoking status, a significant residual odds ratio (OR, 1.13 [95% CI 1.08; 1.19]) persisted, corresponding to ORs of 1.53 and 1.27 in males and females, respectively, for 1 SD increment. Even when adjusted for all MetS components, a residual OR (1.08 [95% CI 1.000; 1.17]) remained. Sex- and age-adjusted NC was associated significantly also with OSAS in genders combined, independent of waist girth, yielding an added OR of 1.3 for 1 SD increment. Conclusions: NC contributes to MetS likelihood beyond waist circumference and the MetS components. Regarding association with OSAS, NC is of greater value than WC among Turkish men, not women. [Copyright &y& Elsevier]

Summary: Background & aims: Whether serum homocysteine levels are associated with coronary heart disease (CHD) and the metabolic syndrome (MS) needs investigation in different ethnic groups. These associations and the influence of serum folate and vitamin B12 thereupon were addressed separately in genders. Methods: A random sample of Turkish adults was studied cross-sectionally. Results: Median age of 338 men and 342 women was 55 years. Geometric mean serum homocysteine concentrations were 12.7±1.5μmol/l in men and 9.6±1.4μmol/l in women (p <0.001). Linear regression analysis among 11 variables revealed male sex, reduced estimated glomerular filtration rate (eGFR) and vitamin B12, (in men) reduced folate as significant independent covariates of higher homocysteine levels. Logistic regression analysis disclosed that (sex-specific) top versus bottom homocysteine tertile was borderline significantly and independently associated with CHD in men and both genders combined, after adjustment for gender, age, smoking status, systolic blood pressure, eGFR, folate and vit B12. Folate revealed significant inverse association with CHD likelihood in men and combined genders (OR 0.73 for doubling [95%CI 0.56; 0.94]), independently of homocysteine levels and even of presence of type-2 diabetes. Serum vit B12 concentrations were significantly associated with MS likelihood in women alone after adjustment for sex, age, smoking status, folate and antidiabetic medication. Conclusion: High serum homocysteine and low folate levels are associated in Turkish men independently with CHD, which needs confirmation in a larger sample. In women, vitamin B12 concentrations are significantly associated with MS likelihood. [Copyright &y& Elsevier]