فهرست مطالب

  • Volume:16 Issue: 3, 2020
  • تاریخ انتشار: 1399/06/24
  • تعداد عناوین: 7
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  • Atefeh Torknejad, Sima Babaei*, Mohsen Mirmohammadsadeghi Pages 105-114
    BACKGROUND

    Coronary artery bypass graft (CABG) surgery is the most effective treatment for cardiovascular disease (CVD). Adherence to treatment after CABG surgery is very important. One of the educational models used in this regard is the BASNEF (Belief, Attitudes, Subjective Norms, and Enabling Factors) model. The present study aimed to assess the effect of an educational intervention based on BASNEF model on adherence to treatment in patients after CABG surgery.

    METHODS

    The present study was a randomized clinical trial. In this study, 72 patients who had undergone CABG surgery participated in the two intervention and control groups. Patients in the intervention group took part in 4 40-minute educational sessions based on BASNEF model after discharge. The patients in both groups completed the Modanloo Adherence to Treatment Questionnaire (MATQ) and a researcher-made BASNEF model questionnaire before the intervention, after the educational intervention, and at the 3-month follow-up. Data were analyzed using independent t-test, chi-square test, Man-Whitney test, and repeated measures analysis of variance (ANOVA). Mauchly’s sphericity test was used for testing sphericity and the Greenhouse-Geisser correction was used in the case of lack of sphericity. All P-values of less than 0.05 were considered significant.

    RESULTS

    The total score of the MATQ and its subscales had significantly improved in the intervention group after the intervention compared with the control group (P < 0.050). In addition, the mean scores of the model constructs (knowledge, attitude, behavior intention, subjective norms, and enabling factors) had significantly improved after the intervention in the intervention group in comparison with the control group (P < 0.050).

    CONCLUSION

    The educational intervention based on BASNEF model improved adherence to treatment in patients after CABG surgery. Moreover, the model constructs improved in the intervention group in comparison with the control group after the intervention.

    Keywords: Treatment Adherence, Coronary Artery Bypass Graft Surgery, Educational Models
  • Fardin Mirbolouk, Arsalan Salari, Mahboobeh Gholipour, Salman Nikfarjam, RezaPourbahador, Hamideh Mohamadnia, Niloufar Akbari-Parsa* Pages 115-122
    BACKGROUND

    Decreasing the hospital length of stay (LOS) in ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) is an issue which is related to reducing hospital costs. This study was aimed to determine the average number of hospital LOS among patients with STEMI treated by PPCI and predictors of longer LOS.

    METHODS

    This cross-sectional study was performed on 561 patients with STEMI who referred to Heshmat Hospital, Rasht, north of Iran, within 2015-2018. As soon as STEMI was detected, patients were transferred to the catheterization laboratory (cath lab) in the shortest possible time and underwent PPCI. A questionnaire including characteristics of patients, procedures, and in-hospital adverse events was completed. Data were analyzed with SPSS software.

    RESULTS

    The mean age of patients was 59.36 ± 11.90 years. 74.2% (n = 416) of subjects were men and 25.8% (n = 145) were women. The hospital LOS of 3 to 6 days had the highest prevalence up to 47%. The results of the multiple logistic regression showed that risk of hospital LOS > 6 days in unsuccessful percutaneous coronary intervention (PCI) was 33.2 versus 66.8 in successful PCI (P = 0/001). Moreover, the risk of hospital LOS > 6 days in subjects who had post-procedure complication, problems at admission, and primary comorbidities was 9.13 (7.22-11.53)-fold, 4.09 (2.86-5.85)-fold, and 1.75 (1.35-2.27)-fold more than those who had not, respectively

    CONCLUSION

    By identifying controllable predictive factors associated with prolonged hospitalization after PPCI, the length of hospitalization can be decreased; also, the patient remission can be enhanced and hospital costs reduced.

    Keywords: Myocardial Infarction, Percutaneous Coronary Intervention, Length of Stay
  • Maryam Soleimani, Azam Soleimani*, Hamidreza Roohafza, Nizal Sarrafzadegan, Marzieh Taheri, Ghasem Yadegarfar, Maedeh Azarm, Neda Dorostkar, Hajar Vakili, Masoumeh Sadeghi Pages 123-129
    BACKGROUND

    There is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.

    METHODS

    In this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.

    RESULTS

    The mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.

    CONCLUSION

    If the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes.

    Keywords: ST Segment Elevation Myocardial Infarction, Percutaneous Coronary Intervention, Thrombolytic Therapy, Treatment Outcome, Reperfusion
  • Suresh V. Patted, Ashok S. Thakkar * Pages 130-135
    BACKGROUND

    Evermine 50™ (Meril Life Sciences Pvt. Ltd., India) everolimus-eluting stent system (EES) is a novel ultrathin strut (50 μm) cobalt-chromium coronary drug-eluting stent (DES) platform with biodegradable polymer coating. The Evermine 50 EES-KLES study aimed to evaluate the Evermine 50 EES in terms of 24-month clinical safety and performance in patients with coronary artery disease (CAD).

    METHODS

    This retrospective study consisted of 171 patients (258 lesions) implanted with Evermine 50 EES for managing CAD. We analyzed the major adverse cardiac events (MACE) incidence, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven target lesion revascularization (ID-TLR) at 6-, 12-, and 24-month follow-ups.

    RESULTS

    A total of 171 patients were included with a mean age of 57.85 ± 10.05 years, of which, 139 (81.29%) were men, 69 (40.35%) were hypertensive, and 70 (40.94%) were diabetic. The incidence of MACE was 1 (0.58%), 3 (1.81%), and 4 (2.42%) at 6-, 12-, and 24-month follow-ups, respectively. There were three cases (1.82%) of cardiac death and one case (0.61%) of ID-TLR up to 24 months. None of the patients was presented with definite or probable stent thrombosis (ST).

    CONCLUSION

    This study demonstrated that implantation of ultrathin strut Evermine 50 EES resulted in a low rate of incidence of MACE, indicating a favourable clinical safety and performance profile of Evermine 50 EES in patients with CAD [Clinical Trials Registry-India (CTRI) Number: CTRI/2017/09/009939)].

    Keywords: Coronary Artery Disease, Drug-Eluting Stent, Everolimus, Percutaneous CoronaryIntervention
  • Marzieh Mogharrabi, Hamid Reza Rahimi, Shima Hasanzadeh, Mostafa Dastani, Reza Kazemi-Oskuee, Saeed Akhlaghi, Mohammad Soukhtanloo* Pages 136-145
    BACKGROUND

    Coronary artery disease (CAD) is the most common type of cardiovascular disease. Increasing the expression and activity of matrix metalloproteinases (MMPs) facilitates vascular remodeling and cardiovascular complications. Curcumin (the active ingredient of turmeric) is a potent natural anti-inflammatory agent, with cardiovascular protective effects. The present study was a clinical trial for investigating the effects of curcumin on activity and gene expression of MMP-2 and MMP-9 in patients with CAD.

    METHODS

    In this study, 70 patients with CAD (with 40%-50% stenosis) were randomly divided into two groups of curcumin (80 mg nanomicelle per day) and placebo. The intervention lasted 3 months. The activity levels of MMP-2 and MMP-9 in serum samples of patients were measured using gelatin zymography assay before and after the intervention. MMP-2 and MMP9 gene expression in peripheral blood mononuclear cells (PBMCs) was also analyzed using realtime polymerase chain reaction (PCR). Statistical significance was set at P < 0.0500.

    RESULTS

    After 3 months of medication, the expression of MMP-9 produced by PBMCs significantly decreased in the curcumin group (0.811 ± 0.25) in comparison with the placebo group (2.23 ± 0.94) (P < 0.0001). Furthermore, the zymographic analysis showed that the administration of curcumin significantly inhibited the activity levels of MMP-2 (12469.7 ± 5308.64 pixels) and MMP-9 (14007.2 ± 5371.67 pixels) in comparison with that in patients receiving placebo (MMP-2: 17613.8 ± 5250.68 pixels; MMP-9: 20010.1 ± 3259.37 pixels) (P < 0.0500).

    CONCLUSION

    Our results show that curcumin can significantly reduce the expression and activity of MMP-2 and MMP-9. Because of the anti-inflammatory effects of curcumin, this compound can be considered as a new strategy for the prevention of cardiovascular events.

    Keywords: Curcumin, Matrix Metalloproteinases, Coronary Artery Disease
  • Zivar Shirinpour, Zahra Farhangiyan*, Nehzat Akiash, Homeira Rashidi Pages 146-150
    BACKGROUND

    Carney complex (CNC) is an uncommon multisystem endocrine disorder with significant variability of clinical manifestations including mucocutaneous areas (pigmented lesions, myxomas, blue nevi, etc.), endocrine tumors (adrenal, pituitary, thyroid glands, or testicles), and non-endocrine tumors [cardiac myxomas, psammomatous melanotic schwannomas (PMS), breast myxomas as well as ductal adenomas, and osteochondromyxomas]. To our knowledge, this is the second report of CNC in Iran, presenting with typical manifestations.

    Case Report

    A 29-year-old man was referred to our clinic to evaluate the likelihood of CNC because of recurrent cardiac myxomas. He sometimes suffered from self-limited episodes of non-exertional palpitation, dyspnea, weakness, and pallor. He had some features of acromegaly (such as increase in acral size and frontal bossing). The laboratory tests revealed a high insulin-like growth factor 1 (IGF1) level, with no growth hormone (GH) suppression after oral glucose tolerance test (OGTT). Pituitary magnetic resonance imaging (MRI) showed a microadenoma (5.79 × 2.80 mm) of the pituitary gland; then, he was diagnosed with CNC, having the following major criteria: recurrent cardiac myxomas, skin myxomas, and acromegaly due to GH pituitary microadenoma, as well as minor criteria: multiple cafe´-au-lait (CAL) spots, several skin tags and moles, and thyroid nodules. In this patient, laboratory tests for Cushing’s syndrome were equivocal, whereas pheochromocytoma was proven biochemically but unexpectedly pathology did not confirm it. Rather, the pathology of the right adrenocortical specimen revealed nodular hyperplasia.

    CONCLUSION

    For patients with recurrent cardiac myxoma, especially with skin myxoma, the diagnosis of CNC should be considered and the search for other associations should be done even in an asymptomatic patient.

    Keywords: Carney Complex, Acromegaly, Myxoma
  • Mohammad Rafatifard* Pages 151-152