Contrast-induced nephropathy (CIN) remains a frequent and clinically relevant complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study evaluated the predictive performance of inflammation-based indices for CIN development, with a focus on the inflammatory prognostic index (IPI). STEMI patients (n = 563) were retrospectively analyzed. CIN developed in 85 patients (15.1%). Admission IPI values were significantly higher in patients who developed CIN compared with those without CIN (10.9 [7.6-16.2] vs 4.8 [3.1-7.9], P < .001). In multivariate logistic regression analysis, IPI remained independently associated with CIN (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.61, P = .013), together with advanced age, higher blood urea nitrogen levels, reduced left ventricular ejection fraction, history of stroke, and the occurrence of no-reflow. Receiver operating characteristic analysis demonstrated superior discriminative performance for IPI (area under the curve [AUC] 0.826, 95% CI 0.783-0.869) compared with neutrophil-to-lymphocyte ratio (NLR; AUC 0.691), C-reactive protein-to-albumin ratio (CAR; AUC 0.712), and systemic immune inflammation index (SII; AUC 0.704). An admission IPI cutoff value of 8.35 predicted CIN with 82.4% sensitivity and 65.9% specificity. IPI demonstrates superior discriminative performance compared with CAR, NLR, and SII for predicting CIN in STEMI patients undergoing pPCI.

Objectives: Cardiac syndrome Y (CSY) phenomenon is characterized by the gradual opacification of the coronary vasculature at the distal level. The leuko-glycemic index (LGI) is a blood glucose and white blood cell count index. This study investigates the relationship between CSY and the leuko-glycemic index. Methods: A case-control, retrospective study was conducted. Consecutively selected individuals with complaints of angina were included in the study. Subjects with normal coronary flow ( n = 132) and coronary slow flow ( n = 136) were classified, after confirmation of coronary angiography results. Results: The age ranges were recorded as 57 (48–64) for the NCF group vs. 52 (46–58) for the CSY group, P = .010. The mean hematocrit (Hct), Hemoglobin (Hg), White blood cells (WBC), and LGI were significantly higher in the CSY group than in the normal coronary flow group ( P < .001). Accordingly, CSY was positively correlated with Hct, Hg, and WBC ( P < .001). ROC curve analysis indicated that a cut-off value of ≥9.28 for the LGI predicted CSF with a sensitivity of 78% and a specificity of 78.1% [Area under the curve (AUC): 0.626 and 95% CI: 0.559–0.693]. Conclusions: In this study, we show for the first time that elevated LGI levels can independently predict CSF formation in the subclinical process.

Background: Transulnar access has emerged as a feasible alternative to transradial access for coronary angiography. However, the electrophysiological effects of proximal and distal transulnar approaches on ulnar nerve function remain insufficiently characterized. This study aimed to compare electrophysiological changes following proximal and distal transulnar coronary angiography and to evaluate their association with ulnar nerve involvement. Methods: This single-center retrospective observational study included 97 patients who underwent proximal (n = 56) or distal (n = 41) transulnar coronary angiography and developed post-procedural pain and/or paresthesia. Electroneuromyography and nerve conduction studies were performed before the procedure and at the fourth post-procedural week. Sensory and motor amplitudes, conduction velocities, and delta (Δ) changes were compared between groups. Generalized estimating equation analysis was additionally performed to evaluate longitudinal electrophysiological changes after adjustment for demographic and procedural variables. Results: No significant between-group differences were observed in pre- or post-procedural electrophysiological parameters. Although significant reductions in right ulnar sensory amplitude were observed over time, only 4 patients (4.1%) demonstrated post-procedural ulnar sensory amplitudes below the laboratory reference range, and no patient developed clinically significant ulnar neuropathy. Comparison of electrophysiological changes (Δ values) revealed no significant differences between proximal and distal transulnar access techniques. Generalized estimating equation analysis, adjusted for age and procedural characteristics, confirmed that the magnitude of electrophysiological changes over time was comparable between the two groups. Conclusions: Both proximal and distal transulnar access may be associated with mild, predominantly sensory, subclinical ulnar nerve involvement. However, distal transulnar access did not result in greater electrophysiological deterioration or additional neurological risk compared with proximal access.

Background and objectives: Paroxysmal atrial fibrillation (PAF) is a common arrhythmia associated with adverse cardiovascular outcomes. Inflammation and nutritional imbalance contribute to arrhythmogenesis. The Naples Prognostic Score (NPS), derived from inflammatory and nutritional laboratory markers, has shown prognostic value in cardiovascular disease, but its association with PAF in outpatients has not been evaluated. This study assessed whether NPS is independently associated with the presence of PAF in a cardiology outpatient population. Methods: This retrospective case–control study included 429 patients evaluated between January 2023 and January 2025. Among them, 155 had documented PAF and 274 patients in sinus rhythm served as controls. Demographic, laboratory, and echocardiographic data were collected. NPS was calculated using serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Multivariable logistic regression identified variables independently associated with PAF. Results: Among patients with calculable NPS (n = 386), NPS was higher in the PAF group (1.92 ± 0.98 vs. 0.96 ± 0.93; p < 0.001), and high NPS was more frequent (26.0% vs. 7.8%; p < 0.001). In multivariable analysis, NPS remained independently associated with documented prevalent PAF (OR 2.46; 95% CI 1.79–3.36; p < 0.001). Conclusions: NPS was independently associated with documented prevalent PAF in this outpatient cohort. These findings do not establish diagnostic or predictive utility, and prospective longitudinal studies are required to determine whether NPS is associated with incident PAF.

INTRODUCTION AND AIM: In this study, we aimed to investigate the effects of P2Y12 inhibitors administered at the time of admission to the emergency department in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention on the thrombus score in the culprit lesion. MATERIALS AND METHODS: This retrospective study planned to compare the pre-procedural thrombus scores of 225 patients who presented with STEMI underwent primary percutaneous coronary intervention, and received different P2Y12 inhibitors within 2 hours after the onset of chest pain. RESULTS: A total of 225 patients were included in our study. Among them, 72 patients received clopidogrel, 85 received ticagrelor, and 68 received prasugrel as the P2Y12 inhibitor. The pre-procedural Grade 5 thrombus was significantly lower in the ticagrelor group compared to the other groups (Clopidogrel 77.78%, Ticagrelor 61.18%, Prasugrel 77.94%; p=0.017). CONCLUSIONS: In our study, ticagrelor among the pre-procedurally loaded P2Y12 inhibitors was found to be superior in terms of early thrombus intensity, and these results are thought to be associated with the early onset antiplatelet effect of ticagrelor. Keywords: ST segment elevation myocardial infarction, clopidogrel, prasugrel, ticagrelor, thrombus score

Background: Metabolic dysregulation substantially contributes to adverse outcomes in acute myocardial infarction (AMI). While the triglyceride–glucose (TyG) index reflects chronic insulin resistance, the stress hyperglycemia ratio (SHR) represents acute stress-related glycemic perturbation. Methods: In this retrospective cohort study, 494 patients with STEMI who underwent primary PCI were included. SHR was calculated using admission blood glucose, whereas the TyG index was calculated using glucose and triglyceride levels obtained from routine morning blood samples, generally collected between 04:00 and 06:00 a.m. The primary outcomes were in-hospital mortality and congestive heart failure (CHF). Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate independent associations and discriminative performance. Results: Patients who developed CHF or in-hospital mortality exhibited significantly higher SHR and TyG index levels compared with those without adverse outcomes (all p < 0.05). SHR demonstrated a moderate positive correlation with TyG index (r = 0.441, p < 0.001), supporting the interplay between chronic insulin resistance and acute metabolic stress during AMI. For in-hospital mortality, SHR had a numerically higher area under the ROC curve [AUC: 0.823 (95% CI: 0.727–0.920)] than TyG [AUC: 0.714 (95% CI: 0.605–0.824)]; a formal comparison of the AUCs was not performed. At a cut-off value of 1.45, SHR demonstrated 76.5% sensitivity and 80.0% specificity for in-hospital mortality. In the original multivariable model, the SHR group was associated with in-hospital mortality (OR: 9.61, 95% CI: 2.599–35.578; p = 0.001), although the small number of deaths and incomplete adjustment for established clinical prognostic factors limit interpretation. Conclusions: Among patients with STEMI, both chronic insulin resistance and acute stress-related hyperglycemia were associated with adverse in-hospital outcomes. However, SHR demonstrated superior discriminative capacity and independently predicted mortality, highlighting the dominant prognostic impact of acute metabolic stress during AMI. Integrated assessment of chronic and acute metabolic dysfunction may improve early risk stratification in high-risk myocardial infarction patients.