We aimed to examine in-hospital and long-term outcomes of red blood cell (RBC) transfusions in patients undergoing a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).Overall, 2537 consecutive STEMI patients (mean age 56.2 ± 11.7 years, 2111 men, 426 women) undergoing primary angioplasty were enrolled retrospectively into the present study. Patients were categorized according to whether they received RBC transfusions during hospitalization. Clinical characteristics, and in-hospital and long-term outcomes of the primary PCI were analyzed.Of the consecutive 2537 patients, 88 (3.4%) received RBC transfusions during the index hospitalization. The transfused patients were older than nontransfused patients (mean age 63.6 ± 12.1 vs. 56.2 ± 11.8, P<0.001). Compared with nontransfused patients, female sex and hypertension were more prevalent in transfused patients (45.4 vs. 15.8%, P<0.001; 52.3 vs. 40.7%, P=0.04, respectively). Baseline values of hematocrit and hemoglobin were lower in patients receiving transfusion (33 ± 6.2 vs. 40.2 ± 4.7%, P<0.001; 11.1 ± 2.3 vs. 13.7 ± 1.6 mg/dl, P<0.001, respectively). The transfused patients had significantly higher in-hospital and long-term mortality (for in-hospital mortality: 10.2 vs. 2.7%, P<0.001; for long-term mortality: 14.1 vs. 5.1%, P=0.001). By multivariate Cox regression analysis, in all 2537 patients, RBC transfusion was found to be a powerful independent predictor of in-hospital cardiovascular mortality (odds ratio 8.31, P<0.001).These results show that RBC transfusion is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing a primary PCI.
Hypertension is a known risk factor for coronary artery disease. However, the number of studies focusing on the events following ST elevation myocardial infarction (STEMI) in patients with an antecedent hypertension is limited. Our aim is to evaluate the clinical outcomes of primary angioplasty in STEMI patients with antecedent hypertension during hospital stay and follow-up. A total of 373 patients (177 of whom had antecedent hypertension) who were treated by primary angioplasty because of STEMI were included in this study. All parameters were compared between the groups with and without hypertension. Hypertensive patients who received primary angioplasty were older (59.9 ± 12.6 vs. 52 ± 12.3, P < .001) and had higher rates of in-hospital mortality and major adverse cardiac events than patients without hypertension. Among STEMI patients, only history of hypertension for more than 10 years was a predictor of in-hospital mortality (odds ratio: 4.374, 95% CI 1.017–18.822, P = .04). Patients with an antecedent hypertension have higher initial risk profiles and show more negative outcomes during a 6-month follow-up period.
The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI).A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (>6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles (≤6.97).High NLR group had higher incidence of inhospital and long-term cardiovascular mortality (5% vs 1.4%, P < .001; 7% vs 4.8%, P = .02, respectively). High NLR (>6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005).High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.
Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices.In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF.Among the 147 patients (mean age 52.7 ± 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 ± 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15-10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99-12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43-8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22-2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43-4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05-4.33, p = 0.03) was identified as an independent correlate of extent of SCF.Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF.
We evaluated in-hospital and long-term clinical results of female patients following primary angioplasty for ST-elevation myocardial infarction (STEMI), in comparison with male patients.We reviewed 2,644 patients (2,188 males, 456 females) who underwent primary angioplasty for STEMI between October 2003 and March 2008. Data on female patients concerning demographic and clinical characteristics, primary angioplasty results, in-hospital and 25-month follow-up results were compared with those of male patients.Hypertension, diabetes mellitus, anemia, shock, and renal failure were more common in female patients, while smoking was more frequent in males (p<0.05). The mean age was higher in female patients (63.9±11.7 vs. 55.2±11.3 years, p<0.001). Females also presented with higher values of glucose, mean platelet volume, and platelet count, and lower hemoglobin and hematocrit values (p<0.05). The frequencies of multivessel disease and procedure failure were significantly higher, and pain-to-balloon time was significantly longer in females (p<0.05). Mortality associated with cardiovascular causes occurred in 148 patients (5.6%), being significantly higher in females (9.4% vs. 4.8%, p<0.001). In-hospital mortality, major cardiac events, stroke, cardiogenic shock, and major bleeding were more frequent in women (p<0.05). Long-term mortality rate was also significantly higher in females (10% vs. 4.5%, p<0.001). Multivariate analysis showed female gender as one of the independent predictors of mortality (odds ratio=1.75, 95% CI 1.02-2.99; p<0.04).Female patients with STEMI undergoing primary angioplasty have a higher risk profile and poorer in-hospital and follow-up clinical results. Therefore, female patients should be treated more aggressively.
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