We investigated whether the lymphocyte-to-monocyte ratio (LMR) 48 hours after admission is related to 30-day and long-term mortality in patients with ST-elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PCI). We evaluated 318 consecutive patients with STEMI who were undergoing primary PCI. The relationship between the LMR and all-cause mortality (30-day and long-term) was analyzed by categorizing the patients into tertiles (T) according to LMR-T1 (>2.46), T2 (1.67-2.46), and T3 (<1.67). The T3 group exhibited the highest risk of 30-day all-cause mortality (hazard ratio [HR]: 8.093 [1.006-65.074]; P = .049). For long-term mortality, a significantly higher mortality risk was observed in both T2 (HR: 2.005 [1.021-3.939]; P = .043) and T3 groups (HR: 2.374 [1.160-4.857]; P < .001) compared to the T1 group (reference group). In multivariate analysis, these associations remained unaltered even after adjusting for confounders. A low LMR at 48 hours after admission may be independently associated with both 30-day and long-term mortality in patients with STEMI who were treated with primary PCI. This marker may be used for identifying patients with STEMI at high risk.

BackgroundThe prognostic significance of changes in mean platelet volume (MPV) during hospitalization in ST segment elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (pPCI) has not been previously evaluated. The aim of this study was to determine the association of in-hospital changes in MPV and mortality in these patients.MethodsFour hundred eighty consecutive STEMI patients were enrolled in this retrospective study. The patients were grouped as survivors (n = 370) or non-survivors (n = 110). MPV at admission, and at 48–72 h was evaluated. Change in MPV (MPV at 48–72 h minus MPV on admission) was defined as ΔMPV.ResultsAt follow-up, long-term mortality was 23%. The non-survivors had a high ΔMPV than survivors (0.37 (− 0.1–0.89) vs 0.79 (0.30–1.40) fL, p <  0.001). A high ΔMPV was an independent predictor of all cause mortality ((HR: 1.301 [1.070–1.582], p = 0.008). Morever, for long-term mortality, the AUC of a multivariable model that included age, LVEF, Killip class, and history of stroke/TIA was 0.781 (95% CI:0.731–0.832, p <  0.001). When ΔMPV was added to a multivariable model, the AUC was 0.800 (95% CI: 0.750–0.848, z = 2.256, difference p = 0.0241, Fig. 1). Also, the addition of ΔMPV to a multivariable model was associated with a significant net reclassification improvement estimated at 24.5% (p = 0.027) and an integrated discrimination improvement of 0.014 (p = 0.0198).ConclusionsRising MPV during hospitalization in STEMI patients treated with pPCI was associated with long-term mortality.

Introduction: There are some studies regarding the prognostic value of coagulation abnormalities both in heart failure and acute pulmonary embolism patients. However, it is unclear whether prothrombin time (PT) at presentation will be associated with long-term mortality in acute coronary syndrome (ACS) patients not on anticoagulant therapy. Thus, we investigated the prognostic role of initial PT in such patients. Patients and Methods: A total of 1100 consecutive patients with ACS undergoing percutaneous coronary intervention (PCI) who were not receiving anticoagulant therapy were included in the study, retrospectively. PT was measured on admission in these patients before anticoagulation therapy. The study population was divided into three groups based on the PT values: A high-PT group (PT ≥ 14 sec, n= 50), intermediate-PT group (12.5 < PT < 14 sec, n= 169), and low-PT group (PT ≤ 12.5 sec, n= 881). The primary end point was all-cause death during the median follow-up of 30.5 months. Results: The rate of the primary end point was 15% in the low-PT group, 27% in the intermediate-PT group, and 52% in the high-PT group (p< 0.001). For long-term mortality, a significantly higher mortality risk was observed in high-PT group (HR: 2.648, 95% CI: 1.590-4.410, p< 0.001) compared with the others group in multivariate analysis. The addition of PT to a multivariable model that included the left ventricular ejection fraction, histories of diabetes mellitus and stroke, age, hemoglobin, creatinine, white blood cell count, total bilirubin levels and Killip class led to a significant net reclassification improvement (NRI) of 26.7% (p< 0.001) and an integrated discrimination improvement of 0.022 (p= 0.001). Conclusion: Our findings suggest that prolonged initial PT in the absence of anticoagulant therapy can be associated with all-cause mortality in ACS patients who were undergoing PCI. In addition, PT may be used to identify the high-risk patients with ACS.

Background Although cardiac implantable electronic device ( CIED ) implantation is considered to be minor surgery, almost 60% of the patients suffer from shoulder‐related problems a short time after the procedure. The purpose of this study was to determine the possible effects of the preference of the dominant side for CIED implantation on the ipsilateral superior extremity functions. Methods The study included a total of 107 patients who had been living with a CIED for >6 months. Patients were separated into two groups according to the dominant hand and side of the CIED . The ipsilateral dominant‐hand group comprised those with a CIED on the same side as the dominant hand and the contralateral dominant‐hand group included patients with the CIED placed on the contralateral side to the dominant hand. Visual analogue scale ( VAS ) pain score, quick disability of the arm shoulder and hand questionnaire (Quick DASH ) and maximum isometric grip strength tests were used to evaluate the upper extremity disabilities. Results No significant difference was determined between the groups in respect of VAS pain scores ( P = 0.10), Quick DASH scores ( P = 0.21), and limitations of the shoulder joint range of motion ( P = 0.192). The maximum isometric grip strength was significantly different in the right hands between two groups (34 [16‐95]‐40 [24‐85]) ( P = 0.02). Conclusion The present study shows that the joint range of motion limitation, pain, and disability of the upper extremity were no different in the affected arm compared to the healthy contralateral side with respect to the placement of the CIED on the dominant or non‐dominant side.

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