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Abstract Background Premature coronary artery disease (PCAD) is one of the major health concerns leading to considerable death and disabilities. This study aimed to evaluate the relationship of dietary patterns with risk of PCAD. Methods Iran premature coronary diseases (IPAD) is a case-control study consists of 3159 participants. Obstructive CAD in ≥ 75% of at least one coronary artery or ≥ 50% in the left main artery based on coronary angiography in women under 70 and men under 60 years old was considered PCAD. The habitual dietary intake of participants was collected using a semi-quantitative validated food frequency questionnaire (SFFQ). Principal Component Analysis (PCA) was used to extract dietary patterns. Results Three main dietary patterns including healthy, Western and high-fat, high-sugar were identified. Patients categorized in the last tertile of the healthy dietary pattern had a decreased risk of PCAD (OR = 0.77, 95% CI: 0.64–0.93), while those in the top tertile of Western (OR = 2.38, 95 CI:1.97–2.86) and High-fat simple carbohydrate (HFSC) (OR = 3.10, 95% CI:2.57–3.75) diets had increased risk of PCAD. Conclusions A healthy dietary pattern was significantly related to a decreased risk of PCAD presence, whereas Western and HFSC diets were connected to a higher risk of PCAD.

Introduction: Few studies have investigated the characteristics of patients with ST elevation myocardial infarction (STEMI) according to age and sex in Iran. This study aims to investigate the risk factors profile, treatment, and mortality of STEMI based on age and sex. Methods: From 10th June 2016 to December 2019 a total of 2816, STEMI patients referred to the Imam Ali heart center of Kermanshah were included in the study. Profile of the risk factors, epidemiology, treatment and 30- day mortality for all cases in the age categories of 18-49, 50-64, and≥65 years were studied. Results: There were 1256 (44.6%) middle-aged STEMI patients, and 2181 (77.45%) were male. The elderly had a longer median door-to-balloon and symptom-to-balloon time and received less primary PCI. In the absence of primary PCI, the rate of 30-day mortality in women was higher than in men, and the mortality rate increased with age. The risk of death in middle-aged women was higher than that of men. Also, in the middle-aged group, after multivariable adjustment, previous bypass surgery, diabetes, and Killip class≥2 was associated with significant increase in the risk of death. Conclusion: The present study showed that young people with STEMI had a high risk of heart failure and anterior infarction compared to the older age groups. Women had more risk factors for STEMI and a higher mortality rate than men. Therefore, there is a need to educate young age groups and women to modify their lifestyles and intervene in the risk factors of heart diseases.

INTRODUCTION: Hypertension is widely known as a significant factor in the development of cardiovascular diseases. However, there is increasing interest in the potential link between low admission systolic blood pressure (SBP) and higher mortality rates. Therefore, this study aimed to investigate the relationship between admission SBP and the probability of one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI).METHOD: This study, which used data from registries, focused on patients diagnosed with STEMI between July 2018 and December 2019. The patients were divided into three groups based on their admission SBP: normal (< 112 mm Hg), elevated (112–140 mm Hg), and hypertension (≥140 mm Hg), and were followed for one year. The researchers used Cox proportional models to analyze the data, which allowed them to estimate crude and fully adjusted hazard ratios, along with their corresponding 95% confidence intervals (HR, 95% CI).RESULTS: This study, which included 1159 patients with a mean age of 60.71±12.19, 914 (78.86%) were male, and 108 (9.32%) died within one year. Among the patients, 276 had a normal admission SBP, 338 had elevated SBP, and 545 had hypertension. Those with hypertension had a higher-risk profile, including factors such as hyperlipidemia, BMI, LDL levels, anterior myocardial infarction, and a higher prevalence of females. The crude and fully adjusted hazard ratios (HR) for the relationship between elevated admission SBP and mortality were calculated as 0.36 (95% CI: 0.23-0.56) and 0.43 (95% CI: 0.23-0.81), respectively.CONCLUSION: The study's findings indicate a connection between increased admission SBP and a decreased probability of one-year mortality among patients with STEMI. Unlike the general population, where there is a direct linear correlation between SBP and the risk of future cardiovascular events, this research demonstrates an inverse relationship between SBP and one-year mortality.

Background: Obesity is strongly associated with increased cardiovascular diseases (CVD) and cardiovascular risk factors, such as diabetes mellitus, hypertension, and dyslipidemia. However, numerous studies have suggested the existence of an “obesity paradox” in which overweight and mildly obese patients often exhibit a better outcome than their leaner counterparts. Therefore, this study aimed to characterize the association between BMI and in-hospital and one-year outcomes.Methods: This hospital-based research was conducted as a part of the Kermanshah STEMI Registry. Following the application of inclusion criteria, a total of 2,397 STEMI patients were evaluated. The data were collected using a standardized case report developed by the European Observational Registry Program (EORP). Body mass index (BMI) (kg/m2) was classified into underweight (

BACKGROUND: Acute Myocardial Infarction (AMI) is the leading cause of global mortality. Moreover, Left Ventricular Ejection Fraction (LVEF) is the most important predictor of post-AMI mortality. Thus, the present study aimed to investigate the relationship between smoking cessation and LVEF following one year from the STEMI.CASE REPORT: The present study was a part of the Kermanshah STEMI Registry and included 825 smokers admitted to Imam Ali Hospital, Kermanshah, Iran, with AMI during a 2-year study period. Data collection was performed using the standardized case report form by the European Observational Registry Program (EORP). Moreover, multiple logistic regression was used to compare LVEF between the patients who had quit smoking post-AMI and those who were still smokers after one year. Also, one-to-one Propensity Score Matching (PSM) was used to reduce the assessment error and selection bias, increase the result accuracy, and minimize the effects of confounders on the LVEF-smoking relationship.Results: Following one year after AMI, 219 (26.55%) patients had quit smoking, while 606 (73.45%) still smoked. Using the PSM, a total of 168 ex-smokers were matched to 168 current smokers. Moreover, it was shown that LVEF was higher in current smokers compared to ex-smokers. However, the difference was not significant. Also, multiple logistic regression showed that the Odds Ratio (OR) of LVEF reduction was insignificantly higher in ex-smokers (OR=1.13; 95% CI: 0.98-1.29) compared to current smokers. Multivariate regression analysis found similar results even after the application of PSM (OR 1.02; 95% CI: 0.82-1.22).CONCLUSIONS: Given the low rate of smoking cessation after MI, physicians are recommended to ask about the smoking status of MI patients at each office visit or re-admission and strongly recommend quitting smoking.

ABSTRACT Introduction: This study was aimed to evaluate the sex-based differences in baseline characteristics and one-year outcomes of men and women undergoing mitral valve repair for infective endocarditis. Methods: This cross-sectional study was performed at Imam Ali Hospital affiliated with the Kermanshah University of Medical Science. From March 21, 2014, to October 21, 2021, all patients who underwent mitral valve repair for infective endocarditis were enrolled in this study. Data were obtained using a checklist developed based on the study’s objectives. Independent samples t-tests, paired samples t-tests, and chi-squared test (or Fisher’s exact test) were used to assess the differences between subgroups. Results: Of 75 patients, 26 were women (34.7%) and 49 were men (65.3%). Women were more likely to have diabetes mellitus (20.4% vs. 57.7%, P=0.0001), hypertension (49% vs. 80.8%, P=0.007), and hypercholesterolemia (55.1% vs. 80.8%, P=0.027). Conversely, men were more likely to have a history of smoking (38.8% vs. 7.7%, P=0.004). After one year, women had significantly higher mortality (0% vs. 7.7%, P=0.049), major adverse cardiac and cerebrovascular events (51.0 vs. 76.9, P=0.029), mitral valve reoperation (8.1% vs. 34.6%, P=0.003), and treatment failure (30.6% vs. 61.5%, P=0.009) rates than men. Conclusion: Mortality, major adverse cardiac and cerebrovascular events, mitral valve reoperation, and treatment failure rates were higher in women than in men. The worse outcomes in women may be explained by their more adverse clinical risk profile.

ABSTRACT Introduction: Prosthetic valve dysfunction is a potentially critical complication of heart valve replacement. An easy and quickly applicable diagnostic procedure is required for recognizing the prosthetic valve dysfunction. The purpose of this study was to prospectively define the diagnostic value of D-dimer and INR level in predicting prosthetic valve dysfunction. Methods: This cross-sectional study was performed in 70 patients suspected to have prosthetic valve dysfunction admitted to Imam Ali Hospital, affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. Cinefluoroscopy, as the gold standard diagnostic test, was used for the diagnosis of prosthetic valve dysfunction in enrolled patients. Two milliliters of blood from each patient were taken into a tube containing sodium citrate anticoagulant. To evaluate D-dimer, the cutoff value was set at 500 ng/ml. Also, to evaluate international normalized ratio (INR), the cutoff value was set at 2. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the serum markers were used to describe predictive properties. Results: Of 70 patients, 27 (38.6%) were male and 43 (61.4%) were female, and the mean age was 54.67±15.11 years (range, 18 to 80 years). Of 70 patients, 27 (38.6%) had prosthetic heart valve malfunction demonstrable by fluoroscopy, and 19 patients (27.1%) had D-dimer levels >500 ng/ml. Elevated D-dimer levels (>500 ng/ml) have been indicated to have sensitivity of 70.4%, and hence an NPV of 84.3%, specificity of 100%, PPV of 100%, NLR of 0.3, and the infinity value of PLR for predicting prosthetic valve dysfunction. There was a significant relationship between fluoroscopy and D-dimer test (P=0.001). A kappa coefficient value of 0.745 indicated a substantial agreement between D-dimer and fluoroscopy testing. Mixing test (combination of D-dimer and INR) showed to have 100% sensitivity, and hence a NPV of 69.8%, specificity of 69.8%, PPV of 51.8%, NLR of 1.41, and PLR of 1.44 for predicting prosthetic valve dysfunction. Conclusion: D-dimer with moderate sensitivity and high specificity is an ideal marker for the diagnosis of prosthetic valve dysfunction in suspected patients. Enhanced plasma D-dimer level is not by itself diagnostic of a prosthetic valve dysfunction but may alert physicians to refer the patient for more detailed examination, preferably by fluoroscopy. Mixing test with 100% sensitivity can apply as a rule-out test.

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

BACKGROUND: Circadian variation is known as an important factor in acute myocardial infarction (AMI). Moreover, the circadian pattern may help in disease prevention and better medication prescription. Therefore, the aim of our study was to investigate the circadian pattern of symptom onset in patients with ST-segment elevation myocardial infarction (STEMI).METHODS: This cross-sectional study was conducted on 777 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of STEMI 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) with post-hoc testing and chi-square test (or Fisher’s exact test).RESULTS: Out of the 777 patients, 616 (79.3%) were men. The mean and standard deviation (SD) of age of the patients was 60.93 ± 12.86 years. 380 patients (48.9%) were current smoker, 40.3% were hypertensive, 21.1% had hypercholesterolemia, 18.3% had diabetes mellitus (DM), 25.2% had history of angina, and about 15.0% had history of myocardial infarction (MI). The occurrence of STEMI was most common during hours between 06:01-12:00 (27.7%), followed by 12:01-18:00 (27.3%), 00:00-06:00 (24.3%), and 18:01-24:00 (20.7%), respectively. Gender was significantly associated with circadian pattern of STEMI. Women showed a double peak of symptom onset in 06:01-12:00 and 12:01-18:00.CONCLUSION: The present study of Iranian patients displayed circadian pattern of STEMI with 2 peaks in the morning and afternoon, and the both peaks were dominated by women.

BACKGROUND: Premature coronary artery disease (CAD) is still prevalent worldwide and may differ in various ethnicities. Due to the presence of different ethnicities in Iran, the Iran-premature coronary artery disease (I-PAD) study aimed to determine the frequency of premature CAD and related risk factors based on each ethnicity.METHODS: In this multi-center case-control study, 4000 patients with premature CAD from ten different ethnicities who lived in different cities of Iran and underwent coronary angiography were enrolled (women aged ≤ 70 and men ≤ 60 years). Patients with CAD defined as obstruction equal or above 75% in at least a single coronary artery or left main ≥ 50% were included in the case group, while patients with normal coronary arteries were included in the control group. Lifestyle behaviors, cardiometabolic risk factors, anthropometric measurements, and other variables were collected. Serum, whole blood, buffy coat, plasma, urine, stool, and saliva samples were stored.RESULTS: The number of patients enrolled until April 2020 was 2071. The mean age of patients was 53.51 ± 7.52 and 934 (45.09%) of patients were women. To date, about 39.6% of the patients were normal. Also, about 26.0% were with one-vessel disease (1VD), 15.0% with two-vessel disease (2VD), and 15.2% with three-vessel disease (3VD). More than 30000 patients' biosamples from across the country have been stored.CONCLUSION: Knowing the frequency of premature CAD according to different ethnicities with major differences in their lifestyle behaviors and risk factors can assist health decision-makers. In addition, I-PAD biosamples will be an invaluable source.

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.

Background: Identifying the long-term predictors of recurrent cardiovascular events may help improve the quality of care and prevent subsequent events. We aimed to investigate the predictors of 1-year major cardiovascular events (MACE) in patients discharged after ST-elevation myocardial infarction (STEMI) in a tertiary hospital in Iran. Methods: This registry-based cohort study included consecutive STEMI patients between 2016 and 2019 in Imam-Ali Hospital, Kermanshah, Iran. All patients discharged alive from STEMI hospitalization were followed up for 1 year for MACE, consisting of all-cause mortality, nonfatal MI, and nonfatal stroke. We estimated the hazard ratio (HR) and the 95% confidence interval (95% CI) using Cox proportional-hazard models to evaluate potential predictors, including demographic characteristics, medical history, cardiovascular risk factors, laboratory tests, reperfusion therapy, and medications. Results: During 2187.2 person-years, 21 patients were lost to follow-up (success rate =99.1%). Of 2274 post-discharge STEMI patients (mean age =60.26 y; 21.9% female), 151 (6.6%) experienced MACE, including, all-cause mortality (n=115, 5.1%), nonfatal MI (n=20, 0.9%), and nonfatal stroke (n=16, 0.7%). Independent predictors of MACE were age (HR:1.02; 95% CI: 1.00–1.04), no education vs ≥12 years of formal schooling (HR: 2.07; 95% CI: 1.17–3.67), stroke history (HR: 2.37; 95% CI: 1.48–3.81), the glomerular filtration rate (HR: 0.98; 95% CI: 0.97–1.00), the body mass index (HR: 0.94; 95% CI:, 0.89–0.99), peak creatine kinase-MB (HR: 1.00; 95% CI: 1.00–1.002), thrombolysis vs primary percutaneous coronary intervention (HR: 1.85; 95% CI: 1.21–2.81), and left ventricular ejection fraction