The predictive value of PRECISE-DAPT score for arrhythmic complications in patients with ST-elevation myocardial infarction Objective: To investigate the predictive value of the PRECISE-DAPT score for the development of arrhythmias in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Method: A total of 706 patients with a diagnosis of ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled to the study. The patients were divided into two groups according to the PRECISE-DAPT score (PRECISE-DAPT score ≥25 and PRECISE-DAPT score <25). The patients were compared in terms of in-hospital arrhythmia. Results: High-degree atrioventricular block (second-degree Mobitz II or third-degree atrioventricular block) (17.2% vs. 4.9%; P < 0.001), ventricular tachycardia (11.2% vs. 4.6%; P = 0.005) and atrial fibrillation (13.8% vs. 3.1%; P < 0.001) rates were statistically higher in patients with higher PRECISE-DAPT score (≥25). There was no difference between the groups in terms of ventricular fibrillation (9.5% vs. 8.3%; P = 0.678). In multivariable logistic regression analysis; PRECISE-DAPT Score was independently associated with high-degree atrioventricular block (odds ratio: 6.38, P < 0.001) and atrial fibrillation (odds ratio: 4.33, P < 0.001). Conclusion: The PRECISE-DAPT score was associated with high-degree atrioventricular block and atrial fibrillation in patients with ST-segment elevation myocardial infarction underwent percutaneous coronary intervention. Received 25 December 2018 Accepted 1 July 2019 Correspondence to Ersin Yildirim, MD, Atatürk mah, Fırat cad. 71, Ada. Gardenya 6 Sitesi. H blok, Daire 42, 34750 Ataşehir/İstanbul, Turkey, Tel: +90 5370466515; fax: +90 216 3379719; e-mail: ersinyil44@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Interaction between eNOS gene polymorphism and current smoking on susceptibility to coronary heart disease in Chinese people Objective This study aims to explore the relation between endothelial nitric oxide synthase (eNOS) single-nucleotide polymorphisms (SNPs) and the risk of coronary heart disease (CHD). Methods SNPstats (online software: http://bioinfo.iconcologia.net/SNPstats) was performed to test Hardy–Weinberg equilibrium in controls. Generalized multifactor dimensionality reduction (GMDR) was adopted to screen the preferable interaction between eNOS SNPs and smoking. Results The frequency for the rs1799983-T allele was 31.1% in CHD patients, which was significantly higher than that of 19.8% in controls (P < 0.05). The frequency for the rs891512-A allele was 28.8% in cases, which was also significantly higher than that of 20.1% in controls (P < 0.05). Logistic regression analysis showed that both rs1799983-T and rs891512-A alleles were related with increased risk of CHD, and the odds ratios (ORs) [95% confidence interval (CI)] were 1.71 (1.31–2.15) and 1.57 (1.14–2.07), respectively. High-order interactions were investigated among SNPs and environmental factors using the GMDR method. The data showed that a two-locus model (rs1799983 × smoking) had a testing accuracy of 0.60 (P = 0.001). We found that current smokers with rs1799983-GT or TT within eNOS gene have the highest CHD risk, compared to never smokers with rs1799983-GG genotype, OR (95% CI) = 2.74 (1.78–3.85), after covariates adjustment for age, gender, BMI, and alcohol drinking. Conclusion The rs1799983-T and rs891512-A alleles and interaction between rs1799983 and smoking were all risk factors of CHD. Received 14 February 2019 Accepted 20 July 2019 Correspondence to Zhongcai Fan, PhD, Department of Vasculocardiology, the Affiliated Hospital of Southwest Medical University, the Key laboratory of Medical Electrophysiology, ministry of Education, No 25 Taiping Street, Jiangyang District, Luzhou City, Sichuan Province, China, Tel/fax: +86 0830 3165311; e-mail: fanzzccai21@163.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Hyponatremia is associated with poor prognosis among patients with chest pain discharged from internal medicine wards following acute coronary syndrome-rule-out Background Hyponatremia is the most common electrolyte abnormality observed in clinical practice. Among patients with acute coronary syndrome (ACS), serum sodium levels are inversely associated with mortality risk. We assessed associations of serum sodium level with ACS and mortality in patients with chest pain. Methods This retrospective cohort study used clinical data from a large, academic hospital. All adults admitted with chest pain and without hypernatremia and discharged after ACS rule-out from January 2010 through June 2016 were included. The primary endpoint was the composite of 30-day ACS and mortality. Secondary endpoints were a hospital admission due to ACS and mortality in the first year following discharge. Results Included were 12 315 patients (mean age 58.2 ± 13 years, 60% male). Patients were classified according to the serum sodium (Na) level: hyponatremia, defined as less than 135 mEq/L (n = 289, 2.3%); 140 > Na ≥ 135 mEq/L (n = 8066, 65.5%), and 145 > Na ≥ 140 mEq/L (n = 3960, 32.2%). Patients with serum sodium more than 145 mEq/L were excluded. Among patients with hyponatremia, low-normal, and high-normal levels, rates of the composite outcome of unadjusted 30-day all-cause mortality and ACS admission were 4.5, 1.0, and 0.7%, respectively (P < 0.001). Unadjusted one-year ACS rates were 3.8, 1.5, and 1.4%, respectively (P < 0.01). Conclusion Hyponatremia is associated with higher mortality and ACS risk among patients with chest pain who were discharged from internal medicine wards following ACS-rule-out. Sodium level may be included in the risk stratification of patients with chest pain. Received 19 April 2019 Accepted 6 July 2019 Correspondence to Guy Topaz, MD, Department of Internal Medicine C, Meir Medical Center, 59 Tchernichovsky St, Kfar-Saba 44281, Israel, Tel: +972 9 7471560; fax: +972 9 7472167; e-mail: gtopazmd@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Incidence, characteristics and outcomes in very young patients with ST segment elevation myocardial infarction Objective ST-segment elevation acute myocardial infarction (STEMI) in very young adults is uncommon. Many studies have focused on the cutoff of 45–50 years old to define young patients with STEMI leaving limited data on the group of very young patients aged less than 35 years old. We investigated the incidence of STEMI in different subgroups of young patients and focused on the characteristics, possible pathogenesis and outcomes in very young patients aged less than 35 years old. Methods We retrospectively studied 792 STEMI patients aged less than 55 years who underwent successful primary PCI. We categorized patients as very young if they were or less 35 years old and as young if they were between 36 and 55 years old. Baseline characteristics, angiographic findings, as well as short- and long-term outcomes were compared between the two groups. Results There were 46 (6%) very young patients (age ≤ 35 years) and 748 (94%) young patients (36 < age ≤ 55 years). Very young patients had fewer atherosclerotic risk factors than young patients, but there was no difference in short- or long-term outcomes. Overt hypercoagulable state was evident serologically (antiphospholipid antibodies) in 2/7 (29%) of screened patients and clinically (left ventricular thrombus or acute coronary thrombosis without an atherosclerotic plaque) in 6/46 patients (13%). Conclusion Very young patients with STEMI constitute a distinct subset of young patients with fewer atherosclerotic risk factors yet comparable outcomes. More efforts should be made screening for serologic and clinical evidence of hypercoagulability in this group of patients. Received 13 June 2019 Accepted 17 June 2019 Correspondence to Shafik Khoury, MD, Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel, Tel: +972 3 6974762; fax: +972 3 6973704, e-mail: Shafik.khoury@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Association of total bilirubin with contrast-induced nephropathy in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention No abstract available

Clinical outcomes of SeQuent Please paclitaxel-coated balloons for de novo small coronary artery lesion in a Japanese multicenter post-approval registry Objective Drug-coated balloon (DCB) angioplasty has emerged as an effective management strategy worldwide. In June 2016, DCB became available for the treatment of de novo small coronary lesions in Japan; however, there has been no multicenter analysis in a post-approval real-world clinical setting to date. The aim of this study was to evaluate the efficacy of DCB for de novo small coronary lesions based on a Japanese multicenter registry. Methods and results From June 2016 to July 2017, a total of 111 lesions (102 patients) treated with DCB for de novo small coronary lesions were enrolled at six Japanese institutions. The primary endpoint was the rate of target lesion revascularization (TLR) at 12 months. Angiographic follow-up endpoints were binary restenosis and late lumen loss (LLL). Clinical follow-up data at 12 months were available for 106 lesions, excluding five lesions that required bailout stenting. The TLR rate was 5.7% (6/106 lesions). No cardiac death or target lesion thrombosis was observed. The binary restenosis rate was 14.4% and LLL was 0.0017 ± 0.37 mm. Conclusions DCB angioplasty for de novo small coronary lesions in the real-world environment in Japan is effective with acceptable 12-month outcomes. Received 28 January 2019 Accepted 20 July 2019 Correspondence to Naohiro Funayama, MD, Hokkaido Cardiovascular Hospital, west 13, south 27, chuou-ku, Sapporo, Hokkaido 0640954, Japan, Tel: +81 11 563 3911; fax +81 11 551 3109; -mail: funa_nao@hotmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The CHADS-VASc score is a predictor of no-reflow in patients with non-ST-segment elevation myocardial infarction This study was performed to evaluate the relationship between the CHA2DS2-VASc score and no-reflow (NR) phenomena in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(-) (n=307), according to their post-PCI, no-reflow status. The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(-) (3.48 ± 1.19 vs 1.81 ± 0.82, P < 0.001). After a multivariate regression analysis, a higher CHA2DS2-VASc score (OR: 6.52, 95% CI: 3.51–12.14, P < 0.001), hs-Troponin (OR: 1.077, 95% CI: 1.056–1.099, P< 0.001) and TTG (OR: 1.563, 95% CI: 1.134–2.154, P=0.006) were independent predictors of NR. CHA2DS2-VASc score is associated with higher risk of no-reflow in patients with NSTEMI undergoing PCI. Received 5 February 2019 Accepted 20 July 2019 Correspondence to Hasan Ali Barman, MD, Okmeydani Training and Research Hospital, Darulaceze street No: 25, 34384, Okmeydani, Istanbul, Turkey, Tel: +905063261925; fax: 02122217800; e-mail: drhasanali@hotmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The predictive value of age, creatinine, ejection fraction score for in-hospital mortality in patients with cardiogenic shock Introduction: The aim of the present study was to assess the predictive value of the age, creatinine, ejection fraction score for in-hospital mortality in patients with cardiogenic shock secondary to ST-elevation myocardial infarction. Material and methods: This single-center, retrospective study was based on a comprehensive analysis of the hospital records of 318 consecutive cardiogenic shock patients. The age, creatinine, ejection fraction score was calculated for each patient using the equation of age/ejection fraction +1 if creatinine level is >2 mg/dl. The study population was stratified into tertiles: T1, T2, and T3, based on the age, creatinine, ejection fraction score. The primary endpoint of the study was the incidence of in-hospital mortality. Results: The incidence of in-hospital mortality was significantly greater in patients with a high age, creatinine, ejection fraction score (T3 group) compared with the intermediate (T2 group) or the low score group (T1 group) [86.8% (n = 92 patients) vs. 57.5% (n = 61 patients) vs. 34.9% (n = 37 patients), respectively; P < 0.05 for each]. In multivariable models, after adjusting for all covariables, the risk of in-hospital mortality was 3.21 (95% confidence interval: 2.29–4.58) for patients allocated to the T3 group. The optimal cutoff for the age, creatinine, ejection fraction score for in-hospital mortality was 2.24, with a sensitivity of 74% and a specificity of 77%. Conclusion: To the best of our knowledge, this is the first study that has demonstrated a prognostic value of the age, creatinine, ejection fraction score in patients with ST-elevation myocardial infarction-related cardiogenic shock. Received 22 June 2019 Accepted 6 July 2019 Correspondence to Tufan Çınar, MD, Department of Cardiology, Sultan Abdülhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey, Tel: +90 216 542 2010; fax: +90 216 542 2020; e-mail: drtufancinar@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Comparison of drug-eluting balloon with repeat drug-eluting stent for recurrent drug-eluting stent in-stent restenosis Objective Approximately, 10–20% of patients with drug eluting stent (DES) in-stent restenosis (ISR) will develop recurrent ISR; yet, the optimal management of recurrent DES-ISR is unknown. We sought to compare the outcomes of recurrent DES-ISR treated with drug eluting balloons (DEB) to those with repeated implantation of new-generation DES. Methods A total of 172 patients with recurrent DES-ISR were enrolled and stratified into two cohorts: the repeated DES implantation (Re-DES) group and the DEB group. The primary endpoint was the 1-year incidence of major adverse cardiovascular events (MACE). Results Ninety-three patients treated with DEB and 79 patients with Re-DES implantation were analyzed. Both groups had comparable baseline characteristics. Lesser residual stenosis was achieved in the Re-DES group (11.3 ± 3.2% vs. 22.4 ± 4.3%; P = 0.00) than in the DEB group. However, the incidence of MACE and target lesion revascularization (TLR) were less in the DEB group (17.2% vs. 32.9%; P = 0.02 and 15.1% vs. 27.8%; P = 0.04, respectively). For the ≥3 metal-layered DES-ISR subgroup, DEB drastically reduced the incidences of MACE and TLR compared with Re-DES (20.0% vs. 57.9%; P = 0.02 and 16.0% vs. 47.4%; P = 0.04, respectively). Survival analysis demonstrated that MACE-free survival was significantly higher in the DEB group compared with the Re-DES group, whether the metal layers were ≥3 or 2. Multivariate analysis revealed that the risk factors of MACE were diabetes mellitus, ≥3 metal-layered DES ISR, and repeat DES deployment. Conclusions For recurrent DES-ISR, DEB may improve clinical outcomes compared with Re-DES implantation, especially for ≥3 metal-layered DES-ISR. Received 26 December 2018 Accepted 20 July 2019 Correspondence to Guozhong Wang, MD, Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, ROC, Tel: +86 10 64456747; fax: +86 10 64456313; e-mail: wgz1974@hotmail.com This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Predictive value of the combination of age, creatinine, and ejection fraction score and diabetes in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention Background: This study investigated whether the age, creatinine, and ejection fraction (ACEF) score [age (years) /ejection fraction (%) +1 (if creatinine>176μmol/L)] could predict 1-year outcomes following ST-segment elevation myocardial infarction after percutaneous coronary intervention, and whether accuracy could be improved by establishing novel ACEF-derived risk models. Methods: A total of 1146 patients were included. The study endpoint was 1-year major adverse cardio-cerebrovascular events, including all-cause death, nonfatal myocardial infarction, unplanned revascularization, and nonfatal stroke. Accuracy was defined with area under the curve by receiver-operating characteristic curve analysis. Results: The incidence of 1-year major adverse cardio-cerebrovascular event increased with the rising age, creatinine, and ejection fraction score tertiles (4.8%, 8.4%, and 15.2%, P < 0.001 for all). Higher ACEF score was significantly associated with an increased risk of the endpoint in overall (odds ratio = 3.75, 95% confidence interval, 2.44–5.77, P < 0.001) and in subgroups (all P < 0.05). The accuracy of the ACEF score was equivalent to the other complex risk scores. The combination of ACEF, and diabetes (ACEF-diabetes score) yielded a superior discriminatory ability than the original ACEF score (increase in C-statistic from 0.67 to 0.71, P = 0.048; continuous net reclassification improvement = 51.9%, 95% confidence interval, 33.4–70.5%, P < 0.001; integrated discrimination improvement = 0.020, 95% confidence interval, 0.011–0.030, P < 0.001). Conclusions: The simplified ACEF score performed well in predicting 1-year outcomes in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. The novel ACEF-diabetes score provided a better predictive value and thus may help stratify high-risk patients and potentially facilitate decision making. Received 9 June 2019 Accepted 29 July 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.coronary-artery.com. Correspondence to Hongwei Li, MD, PhD, Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing 100050, China, Tel: + 86 13801396679; e-mail: lhw19656@sina.com This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.