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Background: Several randomized controlled trials have demonstrated the safety and efficacy of drug eluting stents (DES) in selected groups of patients with less complicated diabetes. We conducted this study to determine how an unselected group of diabetic patients in Iran fare following DES implantation. Methods: Data were collected on 147 consecutive diabetic patients who underwent percutaneous coronary intervention (PCI) with the implantation of at least one DES at the Tehran Heart Center from June 2003 to September 2005. Clinical follow-up was performed by timely scheduled visits at one, four and nine months following DES implantation. Nine months of follow-up was completed for 94.5% of the patients. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which include cardiac death, myocardial infarction and target vessel revascularization (TVR). In-hospital complications were the secondary endpoint.Results: A total of 158 coronary artery lesions were treated with DES in 147 diabetic patients (mean age = 56.4±8.92 years, 57.1% were men). During the nine-month follow-up, MACE occurred in 3.4% of patients, with a myocardial infarction rate of 1.4% and TVR rate of 1.4%. Considering one patient who underwent TVR due to acute stent thrombosis following angioplasty (during hospitalization) the total number of TVR reached 3 (2%). Only one patient (0.7%) died of cardiac death, which occurred after the procedure and before discharge. In-hospital complications occurred in six patients (4.1%); five patients suffered from myocardial infarction. Conclusions: PCI with DES seems to be safe and effective in diabetic patients. However, more studies with larger study populations and longer follow-up are required to confirm this issue.

Background: Transcatheter closure of atrial septal defect secundum (ASD-II) has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE) method for measuring atrial septal defect with balloon occlusive diameter (BOD) in transcatheter ASD-II closure.Methods: A total of 39 patients (71.1% female, mean age: 35.31 +/- 15.37 years) who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE) and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1-2 mm larger than the BOD of the defect.Results: The mean defect size obtained by TEE and BOD was 18.50 +/- 5.08 mm and 22.86 +/- 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 +/- 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r[2] = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013).Conclusion: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure. [ABSTRACT FROM AUTHOR]

An isatin-Schiff base ligand (ISS) bearing a pyridine-2-carboxamidine moiety was synthesized through a facile and convenient method for the highly selective colorimetric detection of Hg +2 and F - ions. The sensing ability of the synthesized ISS sensor toward Hg +2 and F - was established using colorimetric and UV-visible techniques. The developed sensor showed excellent selectivity in the presence of other competing ions for Hg +2 and F - , with a color change from yellow to red. The limits of the detection for sensing Hg +2 and F - were calculated to be 2.9 ×10 - M and 1.4 ×10 6 M, respectively. Job's plot based on spectroscopic data revealed a 1:1 binding stoichiometry between ISS and Hg - 5 M, respectively. Job's plot based on spectroscopic data revealed a 1:1 binding stoichiometry between ISS and Hg +2 or F - ion. Furthermore, the binding mechanism, optimized structures and electronic properties of ISS, ISS-F - adduct and ISS-Hg +2 complex were investigated using density functional theory (DFT) calculations. DFT results indicated a decrease of the HOMO-LUMO energy gap for ISS upon interaction with the F - and Hg +2 species which were in good agreement with the experimental outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Acute ST-elevation myocardial infarction (STEMI) is a leading cause of mortality and morbidity worldwide, and primary percutaneous coronary intervention (PCI) is the preferred treatment option., Hypothesis: Machine learning (ML) models have the potential to predict adverse clinical outcomes in STEMI patients treated with primary PCI. However, the comparative performance of different ML models for this purpose is unclear., Methods: This study used a retrospective registry-based design to recruit consecutive hospitalized patients diagnosed with acute STEMI and treated with primary PCI from 2011 to 2019, at Tehran Heart Center, Tehran, Iran. Four ML models, namely Gradient Boosting Machine (GBM), Distributed Random Forest (DRF), Logistic Regression (LR), and Deep Learning (DL), were used to predict major adverse cardiovascular events (MACE) during 1-year follow-up., Results: A total of 4514 patients (3498 men and 1016 women) were enrolled, with MACE occurring in 610 (13.5%) subjects during follow-up. The mean age of the population was 62.1 years, and the MACE group was significantly older than the non-MACE group (66.2 vs. 61.5 years, p < .001). The learning process utilized 70% (n = 3160) of the total population, and the remaining 30% (n = 1354) served as the testing data set. DRF and GBM models demonstrated the best performance in predicting MACE, with an area under the curve of 0.92 and 0.91, respectively., Conclusion: ML-based models, such as DRF and GBM, can effectively identify high-risk STEMI patients for adverse events during follow-up. These models can be useful for personalized treatment strategies, ultimately improving clinical outcomes and reducing the burden of disease., (© 2023 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Aim: A considerable proportion of patients admitted with acute coronary syndrome (ACS) have no standard modifiable cardiovascular risk factors (SMuRFs: hypertension, diabetes mellitus, dyslipidemia, and cigarette smoking). The outcomes of this population following percutaneous coronary intervention (PCI) are debated. Further, sex differences within this population have yet to be established., Methods: This retrospective cohort study included 7,847 patients with ACS who underwent PCI. The study outcomes were in-hospital mortality, all-cause mortality, and major adverse cardio-cerebrovascular events (MACCE). The association between the absence of SMuRFs (SMuRF-less status) and outcomes among all the patients and each sex was assessed using logistic and Cox proportional hazard regressions., Results: Approximately 11% of the study population had none of the SMuRFs. During 12.13 [11.99-12.36] months of follow-up, in-hospital mortality (adjusted-odds ratio (OR):1.51, 95%confidence interval (CI): 0.91-2.65, P :0.108), all-cause mortality [adjusted-hazard ratio (HR): 1.01, 95%CI: 0.88-1.46, P : 0.731], and MACCE (adjusted-HR: 0.93, 95%CI:0.81-1.12, P : 0.412) did not differ between patients with and without SMuRFs. Sex-stratified analyses recapitulated similar outcomes between SMuRF+ and SMuRF-less men. In contrast, SMuRF-less women had significantly higher in-hospital (adjusted-OR: 3.28, 95%CI: 1.92-6.21, P  < 0.001) and all-cause mortality (adjusted-HR:1.41, 95%CI: 1.02-3.21, P : 0.008) than SMuRF+ women., Conclusions: Almost one in 10 patients with ACS who underwent PCI had no SMuRFs. The absence of SMuRFs did not confer any benefit in terms of in-hospital mortality, one-year mortality, and MACCE. Even worse, SMuRF-less women paradoxically had an excessive risk of in-hospital and one-year mortality., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Sheikhy, Fallahzadeh, Jameie, Aein, Masoudkabir, Maghsoudi, Tajdini, Salarifar, Jenab, Pourhosseini, Mehrani, Alidoosti, Vasheghani-Farahani and Hosseini.)

In this study, the carrier mobility of monolayer Ti 2 CO 2 was evaluated by employing the Boltzmann transport equation and superconducting transition temperature ( T c ) of Ti 2 CO 2 was determined by utilizing the Migdal and Eliashberg formalism in the first-principles framework. In contrast to previous studies, the results reveal that optical phonons in monolayer Ti 2 CO 2 have dominant roles in scattering processes, which significantly reduce the mobility of carriers. Alongside the rigid band model, the jellium model is implemented to investigate the screening effects on electron-phonon interactions. Based on the jellium model and full-band electron-phonon calculations, the predicted maximum electron mobility at room temperature is 38 cm 2 V -1 in which 80% of the total scattering rate originates from the intra-valley transitions within the M-valleys, indicating the crucial role of the long wavelength phonon wavevectors in scattering processes. On the other hand, for the p-type material, a maximum room temperature mobility of about 285 cm -1 in which 80% of the total scattering rate originates from the intra-valley transitions within the M-valleys, indicating the crucial role of the long wavelength phonon wavevectors in scattering processes. On the other hand, for the p-type material, a maximum room temperature mobility of about 285 cm 2 V -1 s -1 is calculated, which can be explained by a relatively small effective mass and tiny scattering phase space. Moreover, a maximum T c of 39 (10) K is obtained for the n-type monolayer Ti 2 CO 2 based on the rigid (jellium) model. Outcomes indicate that the important peaks of α 2 F ( ω ) are mainly caused by the optical phonons. The remarkable couplings between the electron states and phonons are related to the non-zero slope of (near the Brillouin zone center) the longitudinal optical branch denoted by E u caused by the displacements of oxygen and carbon atoms at intermediate and high energy ranges of phonon dispersion, respectively.

Background and Aims: Neuregulin 4 (NRG4) and irisin are adipokines that have been suggested to be associated with cardiometabolic risk factors and coronary artery disease (CAD), but the data are inconclusive. This study aimed to investigate the relationship between circulating NRG4 and irisin and cardiometabolic risk factors with CAD risk and severity., Methods and Results: In this cross-sectional study, the presence of CAD and the severity of stenosis (gensini score) were documented based on coronary angiography in 166 adults. Circulating NRG4 and irisin, glucose homeostasis markers, hs-CRP, lipid profiles, blood pressure, and anthropometric measurements were assessed as well. Age (p = 0.005), sex (p = 0.008), SBP (p = 0.033), DBP (p = 0.04), MAP (p = 0.018), FBG (p = 0.012), insulin (p = 0.039) and HOMA-IR (p = 0.01) were significantly associated with odds of having CAD. The final logistic regression model showed that age, sex, HOMA-IR, and MAP were the most important determinants of having CAD. There were no significant associations between circulating irisin and NRG4 with odds of having CAD. The final general linear model showed that being men (β = 17.303, 95% CI: 7.086-27.52, P = 0.001), age (Aβ = 0.712, 95% CI: 0.21-1.214, P = 0.006), HOMA-IR (Aβ = 2.168, 95% CI: 0.256 to 4.079, P = 0.027), and NRG4 level (β = 1.836, 95% CI: 0.119-3.553, P = 0.036) were directly associated with higher gensini score. Participants with the three-vessel disease had a mean increase of about 5 units in circulating irisin compared to those with no clinical CAD (β = 5.221, 95% CI: 0.454-9.987, p = 0.032)., Conclusions: This study showed that the adipokines NRG4 and Irisin might be associated with the severity of coronary stenosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Percutaneous transvenous mitral commissurotomy (PTMC) is one of the non-surgical methods for patients with significant mitral stenosis. It is less invasive, less complicating with better outcomes compared to surgery. The Wilkins score ≤8 is used to select patients for PTMC, but the results of several studies suggest that PTMC can also be successful in a higher Wilkins score. The aim of this study is to compare the outcomes of PTMC between two groups., Methods: In this retrospective study, patients who underwent PTMC between April 2011 and December 2019 were included. Patients were divided into two groups based on Wilkins score: 196 patients (57.64%) with a Wilkins score ≤8 (group I) and 134 patients (39.4%) with a Wilkins score >8 (group II)., Results: There was no difference in demographic characteristics between two groups except for age ( p  = 0.04). Pre and post-interventional echocardiographic and catheterization measurements including left atrial pressure, pulmonary artery pressure, mitral valve area, mitral valve mean, and peak gradient were measured, and there was no difference between the two groups ( p  > 0.05). The most common complication was mitral regurgitation (MR). Serious complications such as stroke and arrhythmias were rare in both groups (<1%). There was no difference between MR, ASD (atrial septal defect) and serious complications between the two groups., Conclusion: This study shows that the Wilkins score with a cutoff value of 8 is not suitable for patient selection and novel criteria including both mitral valve features and other variables affecting the PTMC outcomes is needed.

Background: Insulin resistance (IR), even in its subclinical state, is a significant risk factor for the onset and progression of coronary artery disease (CAD). IR is a multifactorial condition, and dietary composition is a factor associated with its development. Elevated advanced glycation end products (AGEs) in the body, secondary to highly processed food consumption, can impair glucose metabolism. The present study investigated whether a restricted AGE diet could affect insulin sensitivity and anthropometric indices reflecting visceral adipose tissue in nondiabetic CAD patients., Methods: This trial randomly allocated 42 angioplasty-treated patients to follow either low-AGE or control diets based on the AHA/NCEP guidelines for 12 weeks. Serum levels of total AGEs, insulin, HbA1c, and fasting blood sugar, as well as anthropometric measurements, were evaluated before and after the intervention. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and anthropometric indices were calculated according to the proposed formula. The patients' health status was assessed using the Seattle Angina Questionnaire (SAQ) at baseline and after the intervention., Results: Our study showed a significant reduction in anthropometric indices in the low-AGE group after 12 weeks. Insulin levels and IR decreased during the low-AGE diet. No significant changes were observed in the other serum biochemical markers. All SAQ domains significantly decreased in both groups, except for Treatment Satisfaction., Conclusion: A low-AGE diet for 12 weeks had beneficial effects on HOMA-IR and insulin levels in patients with CAD. Regarding the fundamental role of AGE in IR development and body fat distribution, AGE restriction may positively affect these patients., (Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Abstract: Primary percutaneous coronary intervention (PPCI) is the gold standard of treatment in patients with acute ST-elevation myocardial infarction (STEMI). The no-reflow phenomenon (NRP) is a detrimental consequence of STEMI. Colchicine is an anti-inflammatory drug that may help prevent the NRP and improve patient outcomes. In a randomized, double-blind, placebo-controlled clinical trial, 451 patients with acute STEMI who were candidates for PPCI and eligible for enrollment were randomized into the colchicine group (n = 229) and the control group (n = 222). About 321 patients were eligible to participate; 161 patients were assigned to the colchicine group, whereas 160 patients were assigned to the control group. Colchicine was administered 1 mg before PCI and 0.5 mg daily after the procedure until discharge. NRP, measured by angiographic findings including the thrombolysis in myocardial infarction flow grade and the thrombolysis in myocardial infarction myocardial perfusion grade, was reported as the primary outcome. Secondary end points included ST resolution 90 minutes after the procedure, P-selectin, high-sensitivity C-reactive protein, and troponin levels postprocedurally, predischarge ejection fraction, and major adverse cardiac events (MACE) at 1 month and 1 year after PPCI. NRP rates did not show a significant difference between the 2 groups ( P = 0.98). Moreover, the levels of P-selectin, high-sensitivity C-reactive protein, and troponin were not significantly different. MACE and predischarge ejection fraction were also not significantly different between the groups. In patients with STEMI treated by PPCI, colchicine administered before PPCI was not associated with a significant reduction in the NRP and MACE prevention (trial registration: IRCT20120111008698N23)., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: COVID-19 infection can involve the cardiovascular system and worsen the prognosis of the patients. This study aimed to investigate the adverse effects of COVID-19 on angiographic and clinical outcomes of primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation MI and compare results with those patients without COVID-19 disease., Methods: The study was a retrospective observational cohort, in which patients presented with ST-elevation MI from February 2020 to April 2021, treated with primary PCI were divided into 2 groups based on the COVID-19 infection. Then, the procedural and angiographic indices and also clinical outcomes were compared between the 2 groups., Results: A total of 1150 patients were enrolled in the study. Those with established COVID-19 infection had worse baseline thrombolysis in myocardial infarction flow grade and also were at higher risk for worse procedural outcomes such as lower thrombolysis in myocardial infarction frame count, myocardial blush grade, and slow-flow coronary disease, after the primary PCI. Additionally, the presence of COVID-19 at the time of primary PCI was related to a significantly higher duration of hospitalization and in-hospital mortality. Given the potential impact of other factors on outcomes, analysis for all of the primary endpoints was done again after adjustment of these factors and the results were the same as before, suggesting the independent effect of COVID-19 infection., Conclusions: The concomitant COVID-19 infection in the patients undergoing primary PCI is associated with significantly worse angiographic, procedural and clinical outcomes. Surprisingly, this finding is regardless of patients' baseline risk factors and demographical characteristics., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Baseline biomarkers including glomerular filtration rate (GFR) guide the management of patients with ST-segment elevation myocardial infarction (STEMI). GFR is a tool for prediction of adverse outcomes in these patients., Objectives: We aimed to determine the prognostic utility of estimated GFR using Chronic Kidney Disease Epidemiology Collaboration in a cohort of STEMI patients., Methods: A retrospective cohort was designed among 5953 patients with STEMI. Primary endpoint of the study was major adverse cardiovascular events. GFR was classified into 3 categories delineated as C1 (<60 mL/min), C2 (60-90), and C3 (≥ 90)., Results: Mean age of the patients was 60.38 ± 5.54 years and men constituted 78.8% of the study participants. After a median of 22 months, Multivariate Cox-regression demonstrated that hazards of major averse cardiovascular event, all-cause mortality, cardiovascular mortality, and nonfatal myocardial infarction were significantly lower for subjects in C3 as compared with those in C1. Corresponding hazard ratios (HRs) for mentioned outcomes regarding C3 versus C1 were (95% confidence interval) were (HR = 0.852 [0.656-0.975]; P = 0.035), (HR = 0.425 [0.250-0.725]; P = 0.002), (HR = 0.425 [0.242-0.749]; P = 0.003), and (0.885 [0.742-0.949]; P = 0.003), respectively. Normal GFR was also associated with declined in-hospital mortality with HR of C3 versus C1: 0.299 (0.178-0.504; P < 0.0001)., Conclusions: Baseline GFR via Chronic Kidney Disease Epidemiology Collaboration is associated with long-term cardiovascular outcomes following STEMI., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Octogenarians (age≥80 years) with coronary artery disease constitute a high-risk group and the elderly undergoing percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared to young patients. In this study, we aimed to describe the outcomes of the elderly with acute coronary syndrome (ACS) who underwent PCI and also to identify the predictors of short-term major adverse cerebrocardiovascular events (MACCE) in octogenarians., Methods: In this registry-based cohort study, we reviewed the data of patients (aged≥65 years) who underwent PCI. Univariate Cox-regression model was used to assess the univariate effects of covariates on mortality and MACCE and multivariate Cox-regression analysis were used to discover MACCE predictors., Results: We reviewed the data of 3332 patients (2722 elderly [65 to 79 years], and 610 octogenarians [≥80 years]). The cumulative hazard of MACCE was significantly higher in the octogenarian group compared with the younger group ( P <0.001). MACCE in octogenarians presenting with ST-elevation myocardial infarction (STEMI) was significantly higher than those with non-ST-elevation myocardial infarction/Unstable angina (NSTEMI/UA) ( P <0.001); however, the cumulative hazard of mortality was not significantly different between the two groups ( P =0.270). Successful PCI, left main stenosis and estimated glomerular filtration rate (eGFR) were independent predictors of MACCE in octogenarians with ACS., Conclusion: Octogenarians undergoing PCI had a higher rate of MACCE and mortality compared with a younger population. In octogenarians, MACCE in those with STEMI was significantly higher than those with NSTEMI/UA and the mortality trend was similar; however, the 1-year trend was in favor of the STEMI subgroup., (© 2022 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Debates still surround using lipoproteins including Apo-B in risk assessment, management, and prognosis of patients with coronary artery disease. During an acute ST-segment elevation myocardial infarction, Apo-B might help to achieve incremental prognostic information., Objective: We sought to determine the potential prognostic utility of calculated Apo-B in a cohort of patients with STEMI undergoing primary PCI., Methods: A retrospective cohort study was conducted enrolling 2,259 patients with a diagnosis of acute STEMI who underwent primary PCI. Apo-B was obtained using a valid equation based on initial lipid measurements. High Apo-B was defined as a level of 65 or higher. Primary endpoint of the study was major adverse cardiovascular events (MACE)., Results: Mean age of the participants was 59.54 years and 77.9% of them were male. After a Median follow up of 15 (6.2) months, high Apo-B was associated with MACE and the OR (95% CI) was 3.02 (1.07-8.47), p = .036. Odds ratios for prediction of MACE pertaining to LVEF, and smoking were 0.97 (p = .044), and 1.07 (p = .033), respectively. However, High Apo-B was not able to predict suboptimal TIMI flow. Accordingly, the Odds ratio was 0.56 (0.17-1.87), p = 0.349. The power of High LDL-C and Non-HDLC for prediction of MACE were assessed in distinct models. Attained odds ratios were [2.40 (0.90-6.36), p = .077] and [1.80 (0.75-4.35), p = 0.191], respectively., Conclusion: Calculated Apo-B appears to be a simple tool applicable for prediction of cardiovascular events in patients with STEMI superior to both Non-HDLC and LDL-C., (© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.)

Background: Primary percutaneous coronary intervention (PPCI) as the treatment of choice for ST‑segment elevation myocardial infarction (STEMI) should be rapidly performed. It is necessary to use preventive strategies during the coronavirus disease 2019 (COVID‑19) outbreak, which is an ongoing global concern. However, critical times in STEMI management may be influenced by the implementation of infection control protocols., Aims: We aimed to investigate the impact of our dedicated COVID‑19 PPCI protocol on time components related to STEMI care and catheterization laboratory personnel safety. A subendpoint analysis to compare patient outcomes at a median time of 70 days during the pandemic with those of patients treated in the preceding year was another objective of our study., Methods: Patients with STEMI who underwent PPCI were included in this study. Chest computed tomography (CT) and real‑time reverse transcriptase-polymerase chain reaction (rRT‑PCR) tests were performed in patients suspected of having COVID‑19. A total of 178 patients admitted between February 29 and April 30, 2020 were compared with 146 patients admitted between March 1 and April 30, 2019., Results: Severe acute respiratory syndrome coronavirus 2 infection was confirmed by rRT‑PCR in 7 cases. In 6 out of 7 patients, CT was indicative of COVID‑19. There were no differences between the study groups regarding critical time intervals for reperfusion in STEMI. The 70‑day mortality rate before and during the pandemic was 2.73% and 4.49%, respectively (P = 0.4)., Conclusions: The implementation of the dedicated COVID‑19 PPCI protocol in patients with STEMI allowed us to achieve similar target times for reperfusion, short‑term clinical outcomes, and staff safety as in the prepandemic era.

Background: Performing primary percutaneous coronary intervention (PCI) as a preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardiocerebrovascular events (MACCEs). Thus, timely primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce the door-to-balloon time to <90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment, such as the symptom-to-balloon time, as an indicator of the total ischemic time, which includes the symptom-to-door time and door-to-balloon time, in terms of clinical outcomes of patients with STEMI undergoing primary PCI., Objective: We aimed to determine the association between each component of time to treatment (ie, symptom-to-door time, door-to-balloon time, and symptom-to-balloon time) and in-hospital MACCEs among patients with STEMI who underwent primary PCI., Methods: In this observational study, according to a prospective primary PCI 24/7 service registry, adult patients with STEMI who underwent primary PCI in one of six catheterization laboratories of Tehran Heart Center from November 2015 to August 2019, were studied. The primary outcome was in-hospital MACCEs, which was a composite index consisting of cardiac death, revascularization (ie, target vessel revascularization/target lesion revascularization), myocardial infarction, and stroke. It was compared at different levels of time to treatment (ie, symptom-to-door and door-to-balloon time <90 and ≥90 minutes, and symptom-to-balloon time <180 and ≥180 minutes). Data were analyzed using SPSS software version 24 (IBM Corp), with descriptive statistics, such as frequency, percentage, mean, and standard deviation, and statistical tests, such as chi-square test, t test, and univariate and multivariate logistic regression analyses, and with a significance level of <.05 and 95% CIs for odds ratios (ORs)., Results: Data from 2823 out of 3204 patients were analyzed (mean age of 59.6 years, SD 11.6 years; 79.5% male [n=2243]; completion rate: 88.1%). Low proportions of symptom-to-door time ≤90 minutes and symptom-to-balloon time ≤180 minutes were observed among the study patients (579/2823, 20.5% and 691/2823, 24.5%, respectively). Overall, 2.4% (69/2823) of the patients experienced in-hospital MACCEs, and cardiac death (45/2823, 1.6%) was the most common cardiac outcome. In the univariate analysis, the symptom-to-balloon time predicted in-hospital MACCEs (OR 2.2, 95% CI 1.1-4.4; P=.03), while the symptom-to-door time (OR 1.4, 95% CI 0.7-2.6; P=.34) and door-to-balloon time (OR 1.1, 95% CI 0.6-1.8, P=.77) were not associated with in-hospital MACCEs. In the multivariate analysis, only symptom-to-balloon time ≥180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR 2.3, 95% CI 1.1-5.2; P=.04)., Conclusions: A longer symptom-to-balloon time was the only component associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten the symptom-to-balloon time in order to improve in-hospital MACCEs., International Registered Report Identifier (irrid): RR2-10.2196/13161., (©Younes Nozari, Babak Geraiely, Kian Alipasandi, Seyedeh Hamideh Mortazavi, Negar Omidi, Hassan Aghajani, Alireza Amirzadegan, Hamidreza Pourhoseini, Mojtaba Salarifar, Mohammad Alidoosti, Ali-Mohammad Haji-Zeinali, Ebrahim Nematipour, Mahin Nomali. Originally published in the Interactive Journal of Medical Research (http://www.i-jmr.org/), 16.12.2020.)

Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS., Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score., Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25-88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus., Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS., (Copyright © 2020 Tehran University of Medical Sciences.)

Background: Coronary artery ectasia (CAE) is a rare condition with unclear pathophysiology, optimal treatment, and prognosis. We aimed to determine the prognostic implications of CAE following coronary angioplasty. Methods: We conducted a retrospective cohort study on 385 patients, including 87 subjects with CAE, who underwent percutaneous coronary intervention (PCI). Major adverse cardiovascular events (MACE) were considered to consist of mortality, nonfatal myocardial infarction (MI), repeated revascularization, and stroke. Results: The mean age of the participants was 57.31±6.70 years. Multivariate regression analysis revealed that patients with diabetes, ST-segment-elevation MI at presentation, and high thrombus grades were more likely to have suboptimal post-PCI thrombolysis in myocardial infarction (TIMI) flow. However, CAE was not a predictor of a decreased TIMI flow (OR: 1.46, 95% CI: 0.78-8.32; P=0.391). The Cox-regression model showed that CAE, the body mass index, and a family history of MI were risk factors for MACE, while short lesion lengths (<20 vs >20 mm) had an inverse relationship. The adjusted hazard ratio (HR) for the prediction of MACE in the presence of CAE was 1.65 (95% CI: 1.08-4.78; P=0.391). All-cause mortality (HR: 1.69, 95% CI: 0.12-3.81; P=0.830) and nonfatal MI (HR: 1.03, 95% CI: 0.72-4.21; P=0.341) occurred similarly in the CAE and non-CAE groups. Conversely, CAE increased urgent repeat revascularization (HR: 2.40; 95% CI: 1.13-5.86; P=0.013). Conclusion: Although CAE had no substantial short-term prognostic effects on post-PCI TIMI flow, considerable concerns regarding adverse outcomes emerged during our extended follow-up. Stringent follow-ups of these patients should be underscored due to the high likelihood of urgent revascularization., (Copyright © 2020 Tehran University of Medical Sciences.)