Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome

Objective:

Platelets and inflammatory cells are vital elements of acute coronary syndromes (ACS). Recent studies have shown that the plateletto-lymphocyte ratio (PLR) is associated with several malignancies; however, there are not enough data in cardiovascular diseases. Therefore, the aim of this study was to explore the association between PLR and in-hospital mortality in patients with ACS.

Methods:

We retrospectively collected patients with ACS undergoing coronary angiography. Total and differential leukocyte counts were measured by an automated hematology analyzer.

Results:

This study is single-centered and observational. In total, 587 patients with a mean age of 61.8±13.1 years (68.4% male) were enrolled in the study. Patients were divided into 3 tertiles based on PLR levels. In-hospital mortality was significantly higher among patients in the upper PLR tertile when compared with the middle and lower PLR tertile groups [29 (14.8%) vs. 17 (8.7%) and 2 (1.0%); p<0.001]. In the multiple logistic regression analysis, a high level of PLR was an independent predictor of in-hospital mortality, together with age, total leukocyte count, and creatinine. Using a cutoff point of 142, the PLR predicted in-hospital mortality with a sensitivity of 69% and specificity of 63%.

Conclusion:

Different from other inflammatory markers and assays, PLR is an inexpensive and readily available biomarker that may be useful for cardiac risk stratification in patients with ACS.

Midterm Results of Off-Pump Coronary Artery Bypass Surgery in 136 Patients: An Angiographic Control Study

BACKGROUND

Off-pump coronary artery bypass surgery may provide an alternative form of surgical revascularization by avoiding the complications of cardiopulmonary bypass (CPB). This study summarizes the midterm results of 136 off-pump bypass surgery patients.

METHODS

Between January 2000 and March 2002, out of 178 surgical myocardial revascularizations, 136 (76.4%) were off-pump bypass surgery. Complete revascularization was done and especially arterial grafts were used. All patients were followed clinically and with treadmill test for 2 years. Average control angiography was performed at the end of 2-year follow-up.

RESULTS

Of all the patients, 56.7% were male and the mean age of the patients was 63.6 +/- 7.4 years. A total of 481 anastomoses were performed-136 (28.27%) to the left anterior descending artery (LAD), 135 (28.07%) to the circumflex coronary artery (Cx) branches, 102 (21.20%) to the right coronary artery (RCA), 108 (22.46%) to the Di. The mean graft number was 3.46. We used 96.6% of patients' left internal mammarian artery (LITA), 29.2% radial artery (RA), 4.4% right internal thoracic artery (RITA), and 100% saphenous vein. There were ischemic changes within 12 patients. All ischemic changes came back to normal within 4 and 18 hours, postoperatively. Mean extubation time was 5.36 +/- 2.23 hours, mean stay in intensive care unit was 17.53 +/- 3.15 hours, mean hospital stay was 5.03 +/- 1.29 days. The LITA patency was 99.25%, RA patency was 97.84%, RITA patency was 100%, and saphenous vein patency was 91.79% with control angiography.

CONCLUSION

Off-pump coronary artery bypass graft (CABG) is efficient procedure with lower index of mortality, morbidity, ICU stay, hospital stay, good wound healing, early socialization, and results in lower costs.

Large Ascending Aortic Aneurysm and Severe Aortic Regurgitation in a 7-year-Old Child with Marfan Syndrome and a Review of the Literature: Marfan Syndrome in Childhood

A 7-year-old girl was admitted because of dyspnea on exertion and palpitations. Her symptoms had gradually worsened for the last 6 months. She had physical features of the Marfan syndrome. Transthoracic echocardiography showed an ascending aortic aneurysm, severe aortic regurgitation, and mildly dilated left ventricle. Because of marked aortic aneurysm and severe aortic regurgitation, the patient was treated with a beta-blocker and an angiotensin converting enzyme inhibitor. Surgery was refused by her parents. We describe here a child with Marfan syndrome in whom significant dilatation of the ascending aorta and severe aortic regurgitation is encountered and major cardiovascular complications of Marfan syndrome were reviewed.

Association between angiotensin converting enzyme gene polymorphism and coronary artery disease in individuals of the South-Eastern Anatolian population

OBJECTIVE

The deletion (D) allele of the angiotensin-converting enzyme (ACE) gene has been proposed as a genetic marker of the risk of coronary artery disease (CAD). In this study we aimed to determine the relevance of ACE gene polymorphism for coronary artery disease in the South-Eastern Anatolian population.

METHODS

Angiotensin converting enzyme genotypes were determined in 133 CAD patients who underwent coronary angiography. Severity of CAD was subgrouped according to the number of stenotic vessels on coronary angiography. The control group was selected from 154 healthy volunteers. Angiotensin converting enzyme genotypes were determined by agarose gel sizing after polymerase chain reaction (PCR) amplification.

RESULTS

Frequency of ACE DD genotype did not differ between patients with CAD and control subjects. However the ACE II genotype in CAD group was significantly less frequent than in control group (p=0.02). The relative risks were 0.9 (95% CI=0.56-1.43) for the DD genotypes, and 2.2 (95% CI=1.09 - 4.11) for the II genotype. In the 2-vessel CAD subgroups, the II genotypes were significantly different from control group.

CONCLUSION

Our study did not confirm the possibility that the ACE DD genotypes may be associated with predisposition to CAD in this certain population but there is a relationship between the least frequencies of the II genotype and CAD. The II genotype seems to be an independent protective factor for CAD in the South-Eastern Anatolian population.