Background: The CHADS2 and CHA2DS2VASc and scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation (AF). All the components of CHA2DS2VASc are important risk and prognostic factors for cardiovascular disease. This study evaluates the effectiveness and accuracy of CHA2DS2VASc score as a risk-stratification tool for in hospital and short-term clinical outcome in ST-elevation myocardial infarction (STEMI) patients. Materials and methods: Our study involved 171 patients admitted with STEMI regardless of presence or absence of AF.GRACE, TIMI and CHA2DS2VASc scores were calculated to all patients at hospital admission. Patients were divided into three groups (score0-2, 3-4 and ≥5) according to CHA2DS2VASc RS .The primary end point was major adverse cardiovascular events (MACE) including cardiovascular death, non- fatal myocardial infarction (MI), and stroke during hospital admission at 3 months and 6 months. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. Results: Our six months follow up was completed in all patients. Cumulative incidence of MACE was 29 cases. In chi-square analysis, incidence of MACE was significantly higher in patients with CHA2DS2VASc score ≥5compared to3–4and 0–2 (38.89% vs19.57% vs12.15%, P = 0.01).Death is the most significant complication (p0.001). Both TIMI score and GRACE RS didn't demonstrate better discrimination than CHA2DS2VASc risk score in predicting in-hospital, 3-month and 6-month MACE. Conclusion: Our study demonstrates that CHA2DS2VASc score is an independent predictor for short-term prognosis in STEMI patients and can be used as a risk-stratification system in STEMI patients irrespective of method of treatment.

Background: The CHADS2 and CHA2DS2VASc and scoring systems were designed to stratify thromboembolic risk in patients with atrial fibrillation (AF). All the components of CHA2DS2VASc are important risk and prognostic factors for cardiovascular disease. This study evaluates the effectiveness and accuracy of CHA2DS2VASc score as a risk-stratification tool for in hospital and short-term clinical outcome in ST-elevation myocardial infarction (STEMI) patients. Materials and methods: Our study involved 171 patients admitted with STEMI regardless of presence or absence of AF.GRACE, TIMI and CHA2DS2VASc scores were calculated to all patients at hospital admission. Patients were divided into three groups (score0-2, 3-4 and ≥5) according to CHA2DS2VASc RS .The primary end point was major adverse cardiovascular events (MACE) including cardiovascular death, non- fatal myocardial infarction (MI), and stroke during hospital admission at 3 months and 6 months. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. Results: Our six months follow up was completed in all patients. Cumulative incidence of MACE was 29 cases. In chi-square analysis, incidence of MACE was significantly higher in patients with CHA2DS2VASc score ≥5compared to3–4and 0–2 (38.89% vs19.57% vs12.15%, P = 0.01).Death is the most significant complication (p0.001). Both TIMI score and GRACE RS didn't demonstrate better discrimination than CHA2DS2VASc risk score in predicting in-hospital, 3-month and 6-month MACE. Conclusion: Our study demonstrates that CHA2DS2VASc score is an independent predictor for short-term prognosis in STEMI patients and can be used as a risk-stratification system in STEMI patients irrespective of method of treatment.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Introduction: Acute heart failure (AHF) complicates acute Myocardial infarction (AMI) as a result of complex interaction of structural, hemodynamic, neurohormonal, and genetic maladaptations. This study aims to analyse the role of left atrial volume index (LAVI) compared to other conventional parameters of systolic and diastolic left ventricular function in patients with first time STEMI, in predicting in-hospital heart failure, in-hospital mortality and development of heart failure and mortality over a follow up period of 6 months. Material and Methods: The present study is a prospective observational study conducted in the cardiology department of Assiut University Hospitals (AUH) on 70 STEMI patients admitted to coronary care unit (CCU). LVEF, LV wall dimensions, left atrial volume index, diastolic and systolic parameters were measured within 24 hours after admission and then 6 months later. These variables were correlated with development of heart failure according to Killip classification on admission and 6 months later by NYHA classification. Results: There was a statistically significant difference regarding development of in-hospital heart failure (Killip classification > II) with the following variables LAV, LAVI, LVESD, FS, EF, and the diastolic parameters used to evaluate diastolic function whereas in-hospital mortality was related significantly to the same variables except LAVI, E/A ratio and EF by univariate analysis. Six months later, follow up of our patients revealed a statistically significant relation between mortality development and the following variables; LAVI, EF, E/A ratio, DT, IVRT, TDI Septal e` and E/e` by univariate analysis. A statistically significant relation between development of heart failure symptoms according to NYHA classification and subsequent admission was observed with the previously mentioned variables except DT and IVRT by univariate analysis. Regarding LAVI, EF, E/A ratio, TDI septal é and E/é ratio as predictors of both in-hospital heart failure and mortality, all five variables had a statistically significant relation with development of in-hospital heart failure, but only TDI septal é and E/é ratio were significantly related to in-hospital mortality. All the previously mentioned five variables were related also to development of mortality or symptoms of heart failure and readmission over six months follow up. Using multiple regression analysis, LAVI ml/m2, E/e` ratio, EF were the most significant predictors of in-hospital heart failure with E/e` ratio being the most powerful predictor. Conclusions: LAVI and other determinants of systolic and diastolic functions of the heart played an important role in prediction of heart failure and mortality both in the in-hospital setting and after a follow up period of 6 months. LAVI, E/e` ratio and EF are the most significant predictors of in hospital heart failure with E/e` ratio being the most powerful predictor. LAVI and EF were the most powerful predictors of mortality and heart failure during a follow up period of 6 months respectively.

Abstract: Objectives: The purpose of the study is to evaluate whether NLR adds additional information about presence and severity of coronary artery disease in patients referred for coronary angiography for various reasons.Background: White blood cell count is known to be an independent predictor of cardiovascular events and all-cause mortality [ ].The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic marker and seemed to be related to a pro-inflammatory state imposing worse clinical outcomes in patients with cardiovascular disease [ ].Patients and methods: This prospective cohort study included 101 patients who were referred to Assiut University Hospital for coronary angiography for various reasons including chronic stable angina, unstable angina, and myocardial infarction. NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count. Coronary artery disease (CAD) severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression.Results: Our patients divided into 3 groups according to the value of NLR (2, 2-3, and >3). NLR was independently associated with CAD severity and contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 3.56, CI 95% 1.76-3.42, p = 0.001). They were further divided according to the severity of coronary artery stenosis into three categories, i.e. 0-30%, 30-70% and more than 70% (groups 1-3). NLR increase as the severity of coronary artery stenosis increases, the mean NLR was 2.37+1.27 (p=0.007) and in patients who had severe lesions the mean neutrophil count was 2.55+0.98 (p=0.008).Conclusion: NLR is a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Abstract: Objectives: The purpose of the study is to evaluate whether NLR adds additional information about presence and severity of coronary artery disease in patients referred for coronary angiography for various reasons.Background: White blood cell count is known to be an independent predictor of cardiovascular events and all-cause mortality [ ].The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic marker and seemed to be related to a pro-inflammatory state imposing worse clinical outcomes in patients with cardiovascular disease [ ].Patients and methods: This prospective cohort study included 101 patients who were referred to Assiut University Hospital for coronary angiography for various reasons including chronic stable angina, unstable angina, and myocardial infarction. NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count. Coronary artery disease (CAD) severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression.Results: Our patients divided into 3 groups according to the value of NLR (2, 2-3, and >3). NLR was independently associated with CAD severity and contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 3.56, CI 95% 1.76-3.42, p = 0.001). They were further divided according to the severity of coronary artery stenosis into three categories, i.e. 0-30%, 30-70% and more than 70% (groups 1-3). NLR increase as the severity of coronary artery stenosis increases, the mean NLR was 2.37+1.27 (p=0.007) and in patients who had severe lesions the mean neutrophil count was 2.55+0.98 (p=0.008).Conclusion: NLR is a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Abstract: Objectives: The purpose of the study is to evaluate whether NLR adds additional information about presence and severity of coronary artery disease in patients referred for coronary angiography for various reasons.Background: White blood cell count is known to be an independent predictor of cardiovascular events and all-cause mortality [ ].The neutrophil-to-lymphocyte ratio (NLR) has been proposed as a prognostic marker and seemed to be related to a pro-inflammatory state imposing worse clinical outcomes in patients with cardiovascular disease [ ].Patients and methods: This prospective cohort study included 101 patients who were referred to Assiut University Hospital for coronary angiography for various reasons including chronic stable angina, unstable angina, and myocardial infarction. NLR is calculated by taking the absolute neutrophil count and dividing it by the absolute lymphocyte count. Coronary artery disease (CAD) severity was determined by an interventional cardiologist unaware of the study aims. The association between NLR and CAD severity was assessed by logistic regression.Results: Our patients divided into 3 groups according to the value of NLR (2, 2-3, and >3). NLR was independently associated with CAD severity and contributed significantly to the regression models. Patients with NLR >3 had more advanced obstructive CAD (OR = 3.56, CI 95% 1.76-3.42, p = 0.001). They were further divided according to the severity of coronary artery stenosis into three categories, i.e. 0-30%, 30-70% and more than 70% (groups 1-3). NLR increase as the severity of coronary artery stenosis increases, the mean NLR was 2.37+1.27 (p=0.007) and in patients who had severe lesions the mean neutrophil count was 2.55+0.98 (p=0.008).Conclusion: NLR is a simple marker which can be derived from a routine complete blood count test was significantly and independently related to presence and severity of coronary atherosclerosis.

Background: Primary PCI (PPCI) with noreflow (NR) has been previously associated with worse outcomes. Objectives: We aimed to identify the prevalence of NR in patients with ST elevation myocardial infarction (STEMI) undergoing PPCI in the current era and its predictors with short term outcome. Methods: This prospective study enrolled 310 consecutive STEMI patients underwent PPCI. Patients were divided into 2 groups: patients with normal flow and others with NR whose (final TIMI flow 3 in the absence of coronary dissection or spasm) compared for demographic, procedural characteristics, ST resolution and short term outcomes. Results: 293 patients were finally included. NR was observed in 91 (31.06%) patients. The occurrence of NR was associated with higher mortality (25.3% vs. 3%, P=0.003) compared to patients with normal flow. Multivariate logistic regression analysis showed that high thrombus burden (thrombus grade ≥4), reference luminal diameter ≥3 mm, symptoms to first medical contact time ≥4h, anterior infarctions and syntax score ≥19 were independent predictors of NR. Using thrombus aspiration was found to be protective against NR only in patients with high thrombus burden which was associated with mortality reduction. Conclusion: In the contemporary era of PPCI, NR is more likely to occur in patients with high thrombus burden presenting late and is still associated with marked increases in adverse outcomes. Thrombus aspiration can prevent NR in patients with high thrombus burden.