Hassan Aghajani

Background and Aims: Elevated blood glucose levels in diabetes and prediabetes contribute to vascular inflammation and may increase the risk of major adverse cardiac events (MACE). We sought to evaluate the association between different glycemic statuses and 12‐month MACE in patients undergoing elective percutaneous coronary intervention (PCI) at Tehran Heart Center. Methods: In this cohort study, patients who underwent elective PCI between 2008 and 2017 were stratified by preprocedural fasting blood glucose into normoglycemic, prediabetic, and diabetic groups. The primary endpoint was the 1‐year incidence of MACE, assessed using unadjusted and adjusted regression models. Results: The data of 10,797 patients (mean age = 64 ± 11 y; 64.6% men) were reviewed. The diabetic patients were not only older ( p < 0.001) and more frequently female ( p < 0.001) but also had higher frequencies of hypertension ( p < 0.001), using antiplatelet drugs ( p < 0.001), statin ( p < 0.001), and presence of dyslipidemia ( p < 0.001), as well as more stenotic vessels ( p = 0.007) and B2/C lesions ( p = 0.033) than the other two groups. In addition, regression model demonstrated that neither prediabetes nor diabetes was significantly associated with the risk of 12‐month MACE in both unadjusted (hazard ratio [HR]: 1.15, 95% confidence interval [95% CI]: 0.84–1.58; and HR: 1.27, 95% CI: 0.96–1.70, respectively) and adjusted models (HR: 1.19, 95% CI: 0.86–1.66; and HR: 1.11, 95% CI: 0.81–1.52, respectively). Consistently, Kaplan–Meier survival analysis revealed a gradual increase in cumulative MACE incidences across all glycemic categories over 12 months, with the highest event rate observed among diabetic patients; however, these differences were not statistically significant. Conclusion: Prediabetes and diabetes were not significant predictors of 12‐month MACE in our study population. These findings suggest that glycemic status alone may not be sufficient to stratify cardiovascular risk in patients undergoing elective PCI. Further research is warranted to validate these results and explore additional factors influencing MACE incidence in this context.

Introduction: Base excess (BE) is an indicator of non-respiratory acid-base imbalances, which can impact coronary artery disease (CAD). This study evaluated the association between the severity of CAD and peripheral blood BE. Methods: This cross-sectional study included patients aged 18 and older who were candidates for coronary angiography. Demographic and clinical data were collected from medical records. Blood gas analysis was performed on a 2-millilitre arterial blood sample taken from the access artery before contrast injection. All patients underwent coronary angiography, and the Gensini score was calculated. Results: A total of 351 patients (194 males, 55.3%) were included in the study. The study population had a mean age of 60.79±9.5 and a mean BMI of 29.4±4.85. Coronary angiography revealed normal or minimal (<50% stenosis) findings in 51.3% of cases (15.4% with normal coronary arteries and 35.9% with minimal non-obstructive lesions), single-vessel disease in 17.4%, two-vessel disease in 14.5%, and three-vessel disease in 16.8%. Median Gensini score was 13.0, with an IQR of 3.5 and 49. The findings indicated that a decrease in BE was significantly correlated with elevated Gensini scores (β: -0.04; 95% CI: -0.08 to -0.01; P=0.027). However, BE did not significantly affect the Gensini score of 0 (P=0.843). Moreover, negative values of BE were significantly and inversely associated with the Gensini score (β=-0.05; 95% CI: -0.07 to -0.02, P<0.001). Conclusion: This study revealed an association between BE and CAD, suggesting that BE tending to acidosis is potentially associated with CAD.

Background: Opium consumption has been an overlooked health issue in the Iranian population, and the prognostic role of opium consumption in patients undergoing coronary revascularization is unknown. Hypothesis: We aimed to assess the association between opium consumption and long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Methods: We screened 2203 consecutive patients who underwent elective PCI between April 2009 and April 2010 at Tehran Heart Center. Exclusion criteria were unsuccessful PCI, non-elective PCI, and missing opium use data. Opium consumption was defined as self-reported ever use of any traditional opium substances. Outcomes of interest were all-cause mortality and a composite of major adverse cardiac and cerebrovascular events (MACCE). The association between opium use and study outcomes was evaluated using the inverse probability of treatment weighting (IPTW) method. Cumulative hazard curves were demonstrated to further assess the association visually. Furthermore, the effect of opium consumption on individual components of MACCE was evaluated in a competing risk setting. Results: A total of 2025 elective PCI patients were included (age: 58.7 ± 10.67, 29.1% women), among whom 297 (14.6%) patients were opium users. After a median follow-up of 10.7 years, opium consumption was associated with a higher risk of all-cause mortality (IPTW-hazard ratio [HR] = 1.705, 95% CI: 1.125–2.585; P = 0.012) and MACCE (IPTW-HR = 1.578, 95% CI: 1.156–2.153; P = 0.004). The assessment of MACCE components suggested a non-significant borderline trend for higher non-fatal myocardial infarction (IPTW–sub-distribution HR [SHR] = 1.731, 95% CI: 0.928–3.231; P = 0.084) and mortality (IPTW-SHR = 1.441, 95% CI: 0.884–2.351; P = 0.143) among opium users. Conclusions: Opium consumption is associated with a more than 50% increase in long-term risk of mortality and MACCE in patients undergoing PCI. These findings accentuate the importance of preventive strategies to quit opium addiction in this population.

Backgrounds: Studies have shown a decline in the admission rates of various diseases during the COVID-19 pandemic. Prosthetic valve thrombosis (PVT) is a rare condition followed by surgical or transcatheter valvular interventions. Considering the lack of data on hospitalization rates due to PVT during the pandemic, this study evaluated the implications of the COVID-19 pandemic on PVT admissions and characteristics in a tertiary referral center. Methods: Data from all the consecutive patients hospitalized due to PVT between February 2020 and February 2021 (the first year of the pandemic) were collected from medical records and compared clinically with the corresponding time before the pandemic (February 2019 through February 2020). Variables of interest included the number of hospitalization, patient and valve characteristics, diagnostic and management strategies, and in-hospital events. Results: Forty patients (32.5% male, age: 54.0 [46.5-62.0 y] comprised the study population. We observed a considerable decline in hospitalization rates during the pandemic, from 31 to 9 patients. Admitted patients were 8 years younger, had a higher proportion of the New York Heart Association functional class III or IV symptoms (44.4% vs 22.6%), were more often treated with fibrinolysis (33.3% vs 22.6%) or surgical approaches (33.3% vs 22.6%), and were discharged 6 days sooner. Conclusion: We described a reduction in PVT hospitalization. Patients presented with a higher proportion of severe dyspnea and had increased treatment with fibrinolysis/surgical approaches. These observations highlight the necessity of the active surveillance of patients with prosthetic valves by caregivers for timely diagnosis and appropriate management during the pandemic.

Background: Coronary Artery Disease is one of the leading causes of death in the world. CAD usually progresses slowly during time and patients with normal or near-normal coronary arteries are also at risk of developing CAD. It is now believed that even mild atherosclerosis can increase the rate of CAD. Methods: This is a retrospective, descriptive and analytic study. We selected patients who had undergone at least two diagnostic coronary angiographies at Tehran Heart Center and had normal coronary structure or mild CAD in initial angiography. The data was obtained from the Tehran Heart Center Angiography Databank. Predicting factors in the development of CAD were determined. Results: Data on 556 patients were reviewed. The median interval between the initial and final coronary catheterization was 37.6 months. On the final evaluation, 216 patients (38.8%) found to have developed some degrees of coronary artery disease. Based on the multivariate analysis, age, hematocrit, cigarette smoking, hypertension, and initial presentation with stable and unstable angina were found to be independent predictors of progression to CAD in patients. Conclusion: In the end, 40% of patients who had normal coronary arteries or minimal CAD in the initial angiography report, developed some degrees of CAD and some clinical indices can predict the risk of CAD.

Background: ST-Elevation Myocardial Infarction (STEMI) is associated with high mortality and morbidity. In order to minimize cardiac tissue injury, primary per-cutaneous coronary intervention (PPCI) as treatment of choice should be performed as soon as possible. Coronavirus Disease 2019 (COVID-19) as an ongoing major global concern affects the other parts of health care system. Applying preventive strategies during this outbreak is necessary. However, critical times in STEMI management and outcomes may be influenced by infection control protocols implementation. The aim of this study is to investigate the differences in time intervals related to STEMI care and 15-day major adverse cardiac events (MACE) during this outbreak compared with the same period in last year and to determine whether the STEMI protocol should be changed to thrombolytic therapy during COVID-19 outbreak or not. Methods: The patients with STEMI who underwent PPCI in Tehran Heart Center were included. Chest Computed tomography (CT) imaging and real time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) were only performed for COVID-19 suspected patients. Seventy-seven patients from 29 ^th February to 29 ^th March 2020 were compared with 62 patients from 1 ^st to 30 ^th March 2019. Results: COVID-19 infection was confirmed by rRT-PCR in 5 cases. CT imaging in 4 out of 5 patients was in favor of COVID-19. The median of door-to-device time was reduced 13 minutes during this outbreak (p: 0.007). In-hospital mortality before and during outbreak was 3.22% and 5.19%, respectively (p: 0.57). Confirmed infection with COVID-19 was only reported in one of expired cases. The difference in 15-day MACE between two time periods was not statistically significant. Discussion/Conclusion: Given that 15-day outcome in acute STEMI patients is not affected by COVID-19 outbreak, we did not find it reasonable to change our protocol. However, further studies are needed to determine a standard protocol for emergency management.

Background: Anatomically myocardial bridging (MB) consists of either superficial myocardial fibers that traverse over the LAD or deep fibers that encircle the coronary artery. In this study, we present a patient with myocardial bridging, who was primarily diagnosed with coronary artery disease which did not properly respond to full-dose medical treatment ...

Background: Although invasive treatments such as primary percutaneous coronary intervention (PPCI) are the treatment of choice in ST-elevation myocardial infarction (STEMI) patients, the survival benefit of this treatment in patients with a history of coronary artery bypass graft (CABG) has yet to be fully evaluated. Methods: In this historical cohort study, 251 STEMI patients with a history of CABG between 2007 and 2017 were stratified into 3 groups of no reperfusion, thrombolytic, and PPCI based on their treatment strategy. Baseline clinical characteristics, details of the STEMI event, and the course of hospitalization were evaluated for all patients and they were followed up until May 2018 to assess all-cause mortality. Results: The mean age of the study population was 64.01±9.45 years, and 81.7% of them were male. The median follow-up time was 1304 (IQR25%-75%: 571–2269) days, the short-term (1 month) mortality rate was 5.97%, and the long-term mortality rate was 15.1%. There was no significant difference between the 3 different strategies in terms of survival. In the fully adjusted multivariate analysis, cardiopulmonary resuscitation (HR: 15.06, 95% CI: 2.25–101.14, P=0.005) was significantly associated with short-term mortality, while diabetes (HR: 5.95, 95% CI: 2.03–17.44, P=0.001), opium abuse (HR: 4.85, 95% CI: 1.45–16.23, P=0.010), and cardiopulmonary resuscitation (HR: 11.73, 95% CI: 3.44–40.28, P=0.001) were significantly associated with long-term mortality. Conclusion: Our results failed to show the superiority of invasive treatment in terms of survival. Further studies regarding the advantages and disadvantages of invasive treatment in post-CABG patients are required.

Background: Performing primary percutaneous coronary intervention (PPCI) in a timely fashion is a crucial part of the management of ST-elevation myocardial infarction (STEMI). We aimed to evaluate the contributing factors to and the etiologies of a prolonged door-to-device (D2D) time. Methods: In 2016, the D2D time was measured in all patients who were treated with PPCI at Tehran Hear Center. The major causes of a prolonged D2D time (>90 min) were determined. The second phase was then started in 2017 by focusing on the determined causes, and direct feedback was given to anyone having contributed to the delayed D2D time. The D2D time was compared between these 2 years. Results: The mean age of the patients was 59.54±11.82 years, and 82.2% of them were men. The median D2D time decreased from 55 minutes (IQR25-75%: 40–82) in 2016 to 46 minutes (IQR25-75%: 34–70) in 2017 (P<0.001). In the first year, 79.8% of the patients had a D2D time of below 90 minutes; the figure rose to 84.1% of the patients in the second year (P=0.017). The first cause of a prolonged D2D time was missed ST-elevation in the first electrocardiogram by physician or nurse (8.4% of the cases). Along with a declining rate of missed STE to 6.7%, the median D2D time in the missed patients also decreased from 205 minutes to 177 minutes (P=0.011). The rate of ambulance arrival increased from 10.2% to 20.7% of the cases, and the median D2D time also declined from 45 (IQR25-75%: 34–55) to 34 (IQR25-75%: 25–55) in these patients (P<0.001). Conclusion: Even in the setting of a 24/7 on-site interventionist in the hospital, the dispatch system and prehospital electrocardiograms, along with regular assessment and feedback, may improve the D2D time.