Background and Objectives: This study aimed to investigate whether neutrophil percentage-to-albumin ratio (NPAR) levels on admission have prognostic significance regarding one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST-elevation myocardial infarction (NSTEMI) patients. Materials and Methods: A total of 464 patients aged 59.2 ± 11.6 years constituted the cohort of this retrospectively designed study. Considering a 1-year follow-up period, the patients were divided into two groups: those with MACCEs and those without. The complete blood count, serum C-reactive protein and serum albumin levels were measured at admission. The NPAR, C-reactive protein/albumin ratio (CAR) and systemic immune-inflammation (SII) index were calculated for all patients, and the associations of these inflammatory-based biomarkers with 1-year MACCEs were evaluated. Results: During the 12-month follow-up period, MACCEs were observed in 75 (16.2%) patients, of which 35 (7.5%) patients died. The patients with MACCEs had higher CRP (p < 0.001), a higher percentage of neutrophils (p < 0.001), lower albumin levels (p < 0.001), a higher CAR (p < 0.001), a higher SII index (p = 0.008) and a higher NPAR (p < 0.001). A high anatomical SxSI score, a high low-density lipoprotein cholesterol level, hypoalbuminemia, high neutrophil counts, a high NPAR level and a high CAR level were independent predictors for one-year MACCEs (all p < 0.05). The NPAR (area under the curve [AUC] = 0.775, p < 0.001) and albumin level (AUC = 0.708, p < 0.001) had better and sufficient discriminatory power and predictive accuracy in determining one-year MACCEs, when compared to the neutrophil (AUC = 0.693, p < 0.001), CAR (AUC = 0.639, p < 0.001) and SII index (AUC = 0.660, p < 0.001), in terms of the receiver operating characteristic curve. The DeLong test revealed that the predictive performance of the NPAR was superior to that of the other inflammatory parameters. In particular, individuals with an NPAR value greater than 17.6 were at greater risk of developing MACCEs (p < 0.001). Conclusions: The NPAR can be used as a newly identified promising inflammatory biomarker to predict one-year MACCEs in NSTEMI patients undergoing revascularization therapy.

Objectives: Our aim was to investigate whether admission advanced lung cancer inflammation index (ALI) values have a prognostic role on one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). Methods: Our study consisted of 1173 consecutive patients aged 61.9 ± 12.5 years. The study population was divided into two groups according to the occurrence of MACCEs. BMI (body mass index), serum albumin levels and NLR (neutrophil to lymphocyte ratio) of patients were collected from hospital records, and ALI was calculated based on the following formula: BMI × serum albumin/NLR. We also calculated neutrophil to lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and uric acid to albumin ratio (UAR) and investigated the association of these inflammation-based biomarkers with one-year MACCEs. Results: During the 12-month follow-up period, 158 (13.5%) patients had MACCEs, 55 (4.7%) of whom had all-cause mortality, 96 (8.2%) had nonfatal MI and 7 (0.6%) had nonfatal stroke. Patients with MACCEs had significantly lower ALI (p < 0.001), and also ALI (area under the curve [AUC] = 0.658, p < 0.001) had better discriminatory power and predictive accuracy in determining one-year MACCEs compared to albumin (AUC = 0.594, p < 0.001), NLR (AUC = 0.631, p < 0.001), CAR (AUC = 0.595, p < 0.001) and UAR (AUC = 0.577, p = 0.001) in the ROC analysis. Individuals with an ALI value lower than 43.9 were at greater risk of developing MACCEs (p < 0.001) due to the Delong test. Conclusions: Determining the level of ALI may have the potential to improve risk prognostication in NSTEMI patients undergoing revascularization therapy.

Background: Preventive measures for radial artery complications in distal transradial approach are not fully studied. Our aim was to investigate the role of nitroglycerine injection in patients undergoing coronary angiography via distal transradial access. Methods: In this study, 168 patients who underwent angiographic procedures performed via distal transradial route with or without nitroglycerine injection were evaluated. Demographic, angiographic, and laboratory characteristics were recorded. Radial artery outcomes, including radial artery spasm, radial artery occlusion, and hematoma were compared between these groups and P values < .05 indicated significant differences. Results: Radial artery outcome occurred in 22% of the study population (n = 37), with radial artery spasm being the most encountered complication (n = 28, 16.7%). The groups were not different in terms of radial artery complications. Procedural features were also comparable except for the total contrast volume used. Conclusion: Coronary angiographic procedures could be performed safely using distal transradial access without nitroglycerine injection.

Background and Objectives: and Objectives: Admission hyperglycemia (AH) is common in acute ST-elevation myocardial infarction (STEMI) and linked to poor prognosis. The stress hyperglycemia ratio (SHR) reflects relative hyperglycemia and may more accurately predict outcomes. This study examined AH, SHR, and in-hospital stent thrombosis (ST) in STEMI patients undergoing primary percutaneous coronary intervention (p-PCI). Material and Methods: Retrospective analysis included 1034 patients. AH was defined as glucose ≥ 11.1 mmol/L at admission. SHR was calculated as admission glucose divided by estimated average glucose derived from hemoglobin A1c (HbA1c). The primary outcome was in-hospital stent thrombosis. Patients were grouped by the occurrence of in-hospital ST. Univariable, multivariable, and LASSO (Least Absolute Shrinkage and Selection Operator) logistic regression identified predictors of ST. Results: In-hospital ST occurred in 1.5% of patients. ST patients had higher Killip class, heart rate, white blood cell, platelet counts, creatinine, AH, and SHR. SHR was an independent predictor of ST (OR 3.15, 95% CI 1.88–5.27, p < 0.001), whereas AH was not (p = 0.182). Neutrophil count, correlated with WBC, was also a significant risk factor. ROC analysis showed SHR ≥ 1.26 as an optimal cutoff predicting ST. Conclusions: SHR is a strong independent predictor of in-hospital ST after STEMI, superior to AH. Monitoring and managing stress-induced hyperglycemia play a crucial role in the setting of STEMI. Further studies are needed.

Belirli aralıklarla güncellenen, ayrıntılı ve iyi tanımlanmış kapak hastalıkları kılavuzlarına rağmen, kalp kapak hastalıklarının teşhisi, takip stratejileri ve doğru zamanda uygun tedavi yöntemlerinin multidisipliner kalp takımları tarafından yönetilmemesi yanlış tanılara, kapak hastalığının cerrahi veya perkütan girişim ile tedavisinde gecikmelere sebebiyet vermektedir. Bu tür istenmeyen sonuçları en aza indirmek için, özel olarak yapılandırılmış tüm tanı, takip ve tedavi süreçlerinde belirlenmiş standartları olan; kapak hastalıkları alanında uzmanlaşmış farklı disiplinlerden birçok klinisyenin görev aldığı, ayaktan hasta takibi ile birlikte yatan hasta tedavi süreçlerini de yöneten; bununla birlikte eğitim ve öğretim faaliyetlerinide sürdüren “Kalp Kapak Klinikleri” bulunmaktadır. Uluslararası kalp kapak hastalıkları tedavi kılavuzları, bu uzman kalp kapak kliniği konseptini, “Kalp Kapak Mükemmelliyet Merkezi” veya “Kalp Kapak Merkezi” olarak tanımlamaktadır. Dr.Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi de ülkemizde bu tanımlamalara uyan az sayıdaki merkezlerden en köklü ve büyük olanlarındandır.

To the Editor, We would like to thank the authors 1 for their interest in our study. We agree that using sedative agents might mask the effect of nitroglycerine and make the interpretation of the results difficult. However, our main aim in using sedative agents was to decrease the pain while inserting the sheath rather than preventing radial artery spasm. Secondly, the percentage of sedative medication usage between the groups was similar as presented in Table 2 (41.5% vs. 46.5%, P = .510). 2 On the other hand, there are well-documented risk factors for radial artery complications. However, in our study, we did not analyze all the predictors of radial artery complications. Thus, we did not need to perform a logistic regression analysis. We also totally agree that well-designed, large-scale, prospective, randomized studies are needed to delineate this issue.