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Background: Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30- day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran. Methods: In this registry-based cohort study (2016–2019), we investigated reperfusion therapies – primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone – used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. Results: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36–2.97), referral from non-PPCI-capable hospitals (1.73, 1.22–2.46), age (1.03, 1.01–1.04), glomerular filtration rate (0.97, 0.96–0.97), heart rate>100 bpm (1.94, 1.22–3.08), and systolic blood pressure

Introduction: This study was conducted to investigate prevalence and predictors of slow coronary flow phenomenon (SCF) phenomenon. Methods: This cross-sectional study was performed at Imam Ali Cardiovascular Hospital affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah province, Iran. From March 2017 to March 2019, all the patients who underwent coronary angiography were enrolled in this study. Data were obtained using a checklist developed based on the study’s aims. Independent samples t tests and chi- square test (or Fisher exact test) were used to assess the differences between subgroups. Multiple logistic regression model was applied to evaluate independent predictors of SCF phenomenon. Results: In this study, 172 (1.43%) patients with SCF phenomenon were identified. Patients with SCF were more likely to be obese (27.58±3.28 vs. 24.12±3.26, P

Objective: breast arterial calcification (BAC) is one of the most prevalent mammographic findings and has been debated as a marker of cardiovascular disease (CVDs). The present study aimed to assess the findings of stress echo in women with BAC. Materials and methods: This cross-sectional study was conducted on women who undergo mammography for routine breast cancer screening at Imam Reza hospital, western Iran from March 2018 to July 2018. The patients underwent stress echocardiography to evaluate the probability of myocardial ischemia (MI). Chi-square and independent t-tests were used to assess the differences between subgroups. Results: BAC was present in 61 (15.2%) women. The mean age of the patients with BAC was significantly higher than the patients without BAC (58.59± 7.82 vs. 55.32±6.57, p =0.003). Prevalence rates of the menopause (88.5% vs. 71.1%, p=0.009), hypertension (29.5% vs. 17.7%, p=0.032), and hypercholesterolemia (24.6% vs. 13.0, p=0.018) were significantly higher in the patients with BAC compared to the patients without BAC. The prevalence rate of MI symptoms in the patients with BAC was equal to 24.6%. Significantly, more women with BAC were positive for myocardial ischemia compared to the women without BAC (24.6% vs. 8.5%, p

Objective Smoking is a risk factor for coronary artery disease (CAD) and a known factor influencing the severity and pattern of CAD. We summarized evidence regarding the effect of smoking on the number of occluded coronary arteries and the severity and pattern of CAD. Methods We extracted data from observational studies reporting the pattern and severity of CAD in smokers. The quality of studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and results are reported in the Garrard table. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results We screened 11 studies including 6037 samples. Six studies reported no relationship between smoking and the number of damaged arteries. One study reported that smoking was related to occlusion in the left anterior descending artery, but there was no relationship between smoking and the location of occlusion in the arteries. Smoking was related to CAD severity in five studies. Conclusions Smoking was found to be related to CAD severity and location of the damaged artery in the heart. However, there was no significant association of smoking with the number of damaged arteries and location of arterial occlusion.

The serum levels and activity of matrix metalloproteinases (MMPs) are associated with the risk of coronary artery calcification (CAC). We sought to investigate the association between MMP-2 -1575GA (rs243866) and MMP-9 -1562 CT (rs3918242) SNPs with MMP-2 and MMP-9 serum levels and activity in individuals with CAC. One hundred and fifty-five cases with CAC and 155 healthy individuals as control group from West of Iran were included and frequency of genotypes and alleles of rs243866 and rs3918242 in MMP-2 and MMP-9 genes were determined using PCR-RFLP. We also investigated the serum levels of MMP-2 and MMP-9 and their activity using ELISA and gelatin zymography, respectively. Additionally, serum biochemical parameters including FBS (fasting blood sugar), urea, creatinine, cholesterol, triglyceride, HDL (high-density lipoprotein), LDL (low-density lipoprotein), calcium, and phosphorus as well as blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were measured. Our results showed that both serum levels of MMP-2 and MMP-9 (P 0.001) and their activity (P 0.001) were higher in individuals with CAC when compared to the control group. Carrying A and T alleles in MMP-2 -1575GA (rs243866) and MMP-9 -1562 CT (rs3918242) SNPs, respectively, may predispose the individuals to CAC by acting as the risk factors. Serum levels and activity of MMP-2 and MMP-9 were found to be higher in CAC cases when compared to the healthy controls. Carriers of A allele in rs243866 SNP and T allele in rs3918242 SNP were shown to have higher MMP-2 and MMP-9 serum levels and activity that may result in increased ECM degradation and support the initiation and development of calcification.

Introduction: This study aimed to evaluate the in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI), according to gender and other likely risk factors. Methods: This study reports on data relating to 1,484 consecutive patients with STEMI registered from June 2016 to May 2018 in the Western Iran STEMI Registry. Data were collected using a standardized case report developed by the European Observational Registry Program (EORP). The relationship between in-hospital mortality and potential predicting variables was assessed multivariable logistic regression. Differences between groups in mortality rates were compared using chi-square tests and independent t-tests. Results: Out of the 1484 patients, 311(21%) were female. Women were different from men in terms of age (65.8 vs. 59), prevalence of hypertension (HTN) (63.7% vs. 35.4%), diabetes mellitus (DM) (37.7% vs. 16.2%), hypercholesterolemia (36.7% vs. 18.5%) and the history of previous congestive heart failure (CHF) (6.6% vs. 3.0%). Smoking was more prevalent among men (55.9% vs. 13.2%). Although the in-hospital mortality rate was higher in women (11.6% vs. 5.5%), after adjusting for other risk factors, female sex was not an independent predictor for in-hospital mortality. Multivariable analysis identified that age and higher Killip class (≥II) were significantly associated with in-hospital mortality rate. Conclusion: In-hospital mortality after STEMI in women was higher than men. However, the role of sex as an independent predictor of mortality disappeared in regression analysis. The gender based difference in in-hospital mortality after STEMI may be related to the poorer cardiovascular disease (CVD) risk factor profile of the women.

Fetuin-A (AHSG) is a multifunctional secretory protein and acts as an ectopic valve and artery calcification inhibitor. We assessed the correlation between serum levels of Fetuin-A and both exon 6 (248 C/T) and exon 7 (256 C/G) mutations in patients with coronary artery calcification (CAC), mitral annular calcification (MAC), and aortic valve calcification (AVC). 184 patients and 184 healthy individuals as control group were included. The genetic variants of rs4917 and rs4918 for the AHSG gene were determined by PCR-RFLP and T-ARMS PCR techniques. Fetuin-A levels, fasting blood sugar (FBS), urea, creatinine, calcium phosphorus, and lipid profile were measured. Fetuin-A levels were remarkedly lower in individuals with AVC, MAC, and CAC comparing to the control group (p

Background: Despite the health benefits of smoking cessation on patients with cardiovascular diseases (CVDs), some resume smoking even after their discharge from hospital with acute coronary syndrome (ACS). Objectives: This study aimed to determine the predictors of smoking resumption after ACS in western Iran. Patients and Methods: This prospective cohort study was performed on 175 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of ACS from January 2018 to December 2018. Data were collected by a trained interviewer using a checklist developed based on the study objectives. Differences between groups were evaluated by independent t-test, chi-square, and Fisher’s exact tests. The relationship between smoking resumption and predicting variables was assessed using univariate and multivariate logistic regression models (Forward LR). Results: All participants were male with a mean age of 56.30 ± 8.91 (mean ± SD) years. Three months post-discharge, 137 (78.3%) patients quit smoking, and 38 (21.7%) patients resumed it. The patients who resumed smoking were more likely to be divorced (20.6% vs. 0.7%), unemployed or retired (73.7% vs. 63.5%), have smokers in household (86.8% vs. 50.4%), and have history of depression (52.7% vs. 20.4%) (P-values < 0.05). The independent predictors of smoking resumption were divorce (OR 4.2, 95% CI: 1.31 - 19.01), having smokers in household (OR 12.08, 95% CI: 3.45 - 40.81), and history of depression (OR 12.16, 95% CI: 3.68 - 39.04). Conclusions: Divorce, having smokers in household, and history of depression were identified as the independent predictors of smoking resumption in ACS patients. Those who have these characteristics should be viewed as having a high risk of smoking relapse and be provided with more support to quit smoking.

Introduction: Acute myocardial infarction (AMI) is a leading cause of death and disability worldwide. Determining seasonal pattern of AMI may contribute to disease prevention and better treatment. Objective: The present study was conducted to investigate daily, monthly, and seasonal pattern for symptoms҆ onset in the patients with ST-segment elevation myocardial infarction (STEMI), and also other possible associated factors. Methods: This cross-sectional study was conducted on 777 patients diagnosed with STEMI admitted at the Imam Ali Cardiovascular Hospital affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah province, Iran from March 2018 to February 2019. Data were collected using a checklist developed based on the study's objectives. Differences between subgroups were assessed using one-way analysis of variance (ANOVA) followed by Tukeys҆ post‐hoc test and Chi-Square test (or Fishers҆ exact test). Results: Out of 777 patients, 616 (79.3%) of them were male. Mean age of the patients was (mean±SD) equal to 60.93±12.86 years old. Occurrence of STEMI was most common in winter (38.4%), followed by autumn (27.8%), spring (22.9%), and summer (10.9%), respectively. Monthly occurrence of AMI was at the highest level in January (10.8%) and December (9.9%), and it was at the lowest level in July (4.9 %). Most patients were admitted on Fridays (15.8%) and Wednesdays (15.6%). Hypercholesterolemia, prior congestive heart failure (CHF), prior MI, prior stroke, prior atrial fibrillation (AF), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, creatine phosphokinase (CPK), and creatine kinase myocardial band (CK-MB) were significantly associated with seasonal pattern of STEMI (p-value

Background: Doing percutaneous coronary intervention (PCI) in the first hours of myocardial infraction (MI) is effective in re-establishment of blood flow. Anticoagulation treatment should be prescribed in patients undergoing PCI to decrease the side effects of ischemia. The aim of this study is to determine the effect of heparin prescription after PCI on short-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Materials: This randomized clinical trial study was conducted at Imam Ali cardiovascular center at Kermanshah university of medical science (KUMS), Iran. Between April 2019 to October 2019, 400 patients with STEMI which candidate to PCI were enrolled. Patients randomly divided in two groups: intervention group (received 5,000 units of heparin after PCI until first 24 hours, every 6 hours) and control group (did not receive heparin). Data were collected using a checklist developed based on the study's aims. Differences between groups were assessed using independent t-tests and chi-square (or Fisher exact tests).Result: Observed that, mean prothrombin time (PT) (13.30±1.60 vs. 12.21±1.15, p

BACKGROUND: There is considerable disagreement over the effects of percutaneous coronary intervention (PCI) on left ventricular diastolic function that has necessitated the investigation of diastolic indices. The present study was conducted to evaluate left ventricular diastolic function and its indices, three months after performing the PCI procedure in patients with coronary artery disease (CAD). METHODS: In a quasi-experimental clinical trial study (before and after), 51 patients with CAD scheduled for elective PCI were investigated provided that their Ejection Fraction (EF) was > 30%. Before and three months after PCI, echocardiography was carried out to evaluate left ventricular diastolic indices including the E/Ea as the most important criteria for diagnosis of diastolic heart failure (DHF). RESULTS: Based on the E/Ea indices and after PCI, the number of patients with DHF decreased significantly: 40 patients (78.4%) before PCI versus 28 patients (54.9%) after PCI (p CONCLUSION: The E/Ea ratio as an important criterion for diagnosis of DHF was improved after PCI. Improvement of several other diastolic indices was observed after the PCI procedure. It can be concluded that PCI can be an effective treatment modality in patients with left ventricular diastolic indices.

Introduction: Atrial septal defect (ASD) is a common congenital heart disease and causes left-to-right shunting and significant right ventricular (RV) volume overload. The goal of this study was to evaluate the influence of these hemodynamic changes on pulmonary venous flow pattern in young adults.Methods: Complete echocardiographic examination was performed in a group of 40 young adults (aged < 40 years) who had secundum type ASD and was compared to 40 age-matched individuals in control group who had no cardiac abnormality. Systolic and diastolic flow velocities in pulmonary veins (PV), superior vena cava (SVC), inferior vena cava (IVC) and RV functional parameters were recorded and evaluated.Results: As opposed to healthy young individuals who showed distinct S and D waves with diastolic predominance in pulmonary vein Doppler, in patients with ASD a continuous flow with increased systolic peak that began in systole and continued to the late diastole was observed. The RV systolic function increased compared to the control group.Conclusions: In patients with ASD, the pattern of pulmonary veins flow transforms into a single continuous antegrade wave with systolic dominance due to persistent shunting of left atrial blood in to right heart chambers as well as increased RV pump function on pulmonary vein (by means of ASD), SVC and IVC, and could be used as a screening method for the presence of secundum type ASDs in young adults.

This study has been conducted to compare one-year survival rate of patients who underwent coronary artery bypass sur- gery (CABG) vs. percutaneous coronary intervention (PCI) in general as well as considering the number of diseased coro- nary vessels. In this retrospective study, we reviewed the medical records of patients who underwent CABG (484 cases) or PCI (292 cases) at out university heart center from 2009 to 2012. The mortality and survival was compared between the two studied groups based on left ventricular function and number of diseased coronary vessels. Twenty-seven patients (5.57%) died in CABG group which was significantly higher than in PCI group (8 cases, 2.73%); P= 0.04. However, no significant dif- ference was observed regarding mortality between CABG and PCI groups in one- diseased vessel (5.15% vs. 2.22%, P= 0.28), two- diseased vessel (6.12% vs. 3.57%, P= 0.41), and three-vessel disease (5.41% vs.0, P= 0.4). Although PCI was associated with a better one-year survival rate compared to CABG, but number of the diseased coronary vessels did not af- fect survival rate significantly.

To determine short-term (in-hospital) outcome and complications of surgical and interventional procedures performed for patients with coarctation of the aorta (CoA) in the age range of 5 to 25 year. Medical records of 64 patients (48 males and 16 females) with CoA who underwent surgical treatment March 2002 to March 2012 were reviewed. Surgical operation was done for 26 patients and interventional procedures were done for 18 cases. The data gathered included type of CoA, anatomic type, hospitalization duration, and complications occurred during hospitalization such as hypertension, persistent CoA, surgical wound infection, and death. Both surgery and interven- tional procedures restored pre-operative hypertension significantly. The safest method regarding in-hospital complications was balloon angioplasty (1 patient had systemic hypertension after the procedure, 25%) followed by Dacron patch (3 cases had hypertension and one patient had persistent coarctation). However, no significant difference was observed between different surgical and interventional procedures. Pre-operative systolic blood pressure, age group, peak systolic gradient, simple or complex CoA, discrete or segmental CoA had no significant relationship with in-hospital complications/outcome. In conclusion, we suggest considering all aspects of patients with CoA to choose the best surgical treatment. Based on our experience balloon angioplasty and Dacron patch were the safest method with acceptable rate of restoration in blood pressure during in-hospital follow-up period.

Considering the importance of cardiovascular disease and the role that platelets have in thrombosis formation in the coronary arteries, this study was done in order to assess platelet-related indices in patients who suffered acute myocardial infarction (MI) and compare them with those who had normal coronary angiography results.In this descriptive-analytical study, 200 patients who were admitted to our university hospital due to chest pain were included. The patients were divided into five groups including ST-segment elevation MI (STEMI), non-STEMI, unstable angina (UA), stable angina (SA), and healthy subjects (as control group). Platelet-related indices including platelet count as well asmean platelet volume (MPV) was determined. For this purpose, blood samples were taken from the patients upon admission and platelet count and volume were measured within three hours of admission.There was no statistically significant difference regarding MPV between the study groups (P> 0.05).MPV did not have any role in diagnosing various types of coronary artery disease (CAD).