The prognostic value of malnutrition in elderly patients with non-ST-elevated myocardial infarction (NSTEMI) is not fully understood. Nutritional characteristics were evaluated by novel Controlling Nutritional status (CONUT), the prognostic nutritional index (PNI) and the geriatric nutritional risk index (GNRI) scores. The impact of these scores on major outcomes in 253 NSTEMI patients over 60 years and older were assessed. Compared to those with good nutritional status; malnourished patients had more major adverse cardiac and cerebrovascular events (MACCEs) at 1-year follow up. Multivariable cox regression analysis revealed that CONUT (hazard ratio = 1.372; p < 0.01) was independent predictor of MACCEs, whereas PNI (p = 0.44) and GNRI (p = 0.52) were not. The discriminating power of the CONUT (AUC: 0.79) was adequate and significantly superior to both the PNI (AUC: 0.68) and the GNRI (AUC: 0.60), with a p-value for both < 0.01. Patients with elevated CONUT exhibited the highest event rate for all-cause mortality and MACCEs in survival analysis (p < 0.01). We conclude that malnutrition is strongly associated with adverse outcomes in older patients with NSTEMI. In fact, the CONUT score adequately predicts one-year MACCEs among elderly NSTEMI patients who achieve complete revascularization after coronary intervention.

Introduction. Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum free thyroxine. There is growing evidence that SCH is associated with increased cardiovascular risk. We tried to investigate prevalence of SCH in acute myocardial infarction patients. Methods and Results. We evaluate free T3, free T4, and TSH levels of 604 patients (age 58.4) retrospectively, who have been admitted to the coronary intensive care unit between years 2004–2009 with the diagnosis of ST elevation (STEMI) or non-ST elevation acute myocardial infarction (NSTEMI). Mild subclinical hypothyroidism (TSH 4.5 to 9.9 mU/l) was present in 54 (8.94%) participants and severe subclinical hypothyroidism (TSH 10.0 to 19.9 mU/l) in 11 (1.82%). So 65 patients (10.76%) had TSH levels between 4.5 and 20. Conclusions. In conclusion, 65 patients (10.76%) had TSH levels between 4.5 and 20 in our study, and it is a considerable amount. Large-scale studies are needed to clarify the effects of SCH on myocardial infarction both on etiologic and prognostic grounds.

Background: The goal of this study was to examine if the uric acid/albumin ratio (UAR) could predict major adverse cardiac and cerebral events (MACCEs) such as stroke, readmission, and short-term all-cause death in aortic stenosis (AS) patients, after transcatheter aortic valve implantation (TAVI). Material and Methods: A total of 150 patients who had TAVI for AS between 2013 and 2022 were included in our study, retrospectively. Before the TAVI, each patient’s baseline uric acid/albumin was determined. The study’s major endpoint was MACCEs, which included stroke, re-hospitalization, and 12-month all-cause death. Results: The UAR was found to be higher in TAVI patients who developed MACCEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the UAR (HR: 95% CI; 2.478 (1.779–3.453) p < 0.01), was an independent predictor of MACCEs in AS patients after TAVI. The optimal value of the UAR for MACCEs in AS patients following TAVI was >1.68 with 88% sensitivity and 66% specificity (AUC (the area under the curve): 0.899, p < 0.01). We noted that the AUC of UAR in predicting MACCEs was significantly higher than the AUC of albumin (AUC: 0.823) and uric acid (AUC: 0.805, respectively). Conclusion: MACCEs in AS patients who received TAVI may be predicted by high pre-procedural uric acid/albumin levels. The uric acid/albumin ratio (UAR) can be used to determine MACCEs in such patients following TAVI because it is inexpensive and straightforward to calculate inflammatory parameters.

Background: Optimal glycemic control is necessary to prevent cardiovascular events in patients with type 2 diabetes. The positive impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiovascular events and mortality in these patients has been demonstrated by previous studies although the mechanism is unclear. Aims: We aimed to compare the influence of SGLT2i on left ventricular remodeling and strain in diabetic patients with coronary artery disease (CAD) and without CAD during 6-month follow-up. Methods: Between October 2021 and June 2022, 100 diabetic patients with preserved ejection fraction (HbA1c levels 6.5-10%) were started on SGLT2i (empagliflozin or dapagliflozin) and were prospectively followed up. Conventional and speckle-tracking echocardiography was performed by blinded sonographers, at baseline and then at 1 month and 6 months of treatment. After 6 months, the initial and biochemical blood tests were administered, and N-terminal pro-B-type natriuretic peptide levels of the patients were measured. Results: Patients with CAD were older (P = 0.008), more frequently hypertensive (P = 0.035), and had dyslipidemia (P = 0.021). N-terminal pro-B-type natriuretic peptide levels did not change significantly after treatment in both groups. Left ventricular ejection fraction, global, 2-chamber, and 3-chamber strain values were improved significantly following SGLTi administration for the overall patient cohort, regardless of CAD status (P <0.05 for all groups). Conclusions: Treatment with SGLT2i resulted in improvement in left ventricular strain parameters, which indicates that they might have a positive impact on outcomes for diabetic patients with preserved EF.

OBJECTIVE: The purpose of this study was to explore the efficacy of the triglyceride glucose (TyG) index on in-hospital mortality in nondiabetic coronavirus disease 2019 (COVID-19) patients with myocardial injury.METHODS: This was a retrospective study, which included 218 nondiabetic COVID-19 patients who had myocardial injury. The TyG index was derived using the following equation: log [serum triglycerides (mg/dL) xfasting blood glucose (mg/dL)/2].RESULTS: Overall, 49 (22.4%) patients died during hospitalization. Patients who did not survive had a higher TyG index than survivors. In multivariate Cox regression analysis, it was found that the TyG index was independently associated with in-hospital death. A TyG index cutoff value greater than 4.97 was predicted in-hospital death in nondiabetic COVID-19 patients with myocardial damage, with 82% sensitivity and 66% specificity. A pairwise evaluation of receiver operating characteristic (ROC) curves demonstrated that the TyG index (AUC: 0.786) had higher discriminatory performance than both triglyceride (AUC: 0.738) and fasting blood glucose (AUC: 0.660) in predicting in-hospital mortality among these patients. CONCLUSIONS: The TyG index might be used to identify high-risk nondiabetic COVID-19 patients with myocardial damage.

Ticagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (≥1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.