Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during prim... more Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking. Aim: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI. Material and methods: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death. Results: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group (p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups (p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group. Conclusions: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time.
Is trans-radial approach related to an increased risk of radiation exposure in patients who under... more Is trans-radial approach related to an increased risk of radiation exposure in patients who underwent diagnostic coronary angiography or percutaneous coronary intervention? (The SAKARYA study) Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were overrepresented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.
Introduction: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk pa... more Introduction: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate. Aim: To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices. Material and methods: All CAS procedures with both closed-and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA) vasospasm rates were compared between the closed-cell and hybrid-cell stent groups. Results: The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular) (mean age: 68.5 ±8.6; 67.1% male) and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic) (mean age: 67.2 ±12.8; 68.2% male). There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23%) compared with the hybrid-cell stent group (10 patients, 11%) (p = 0.017). Conclusions: The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closedcell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.
Purpose: The purpose of this study was to investigate the relationship between the Duke Treadmil ... more Purpose: The purpose of this study was to investigate the relationship between the Duke Treadmil Score (DTS) and coronary artery disease (CAD) complexity in patients with suspected coronary artery disease (CAD). Methods: Sixty five patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed and Syntax score (SxScore), a marker of CAD complexity, was determined. The relationship between DTC and SxScore then evaluated. Results: There was a strong negative correlation between DTS and SxScore (r= - 0.91, p < 0.001). In addition, patients with higher and intermediate risk as evaluated by DTS had increased SxScore compare to those that were low risk (23 ± 6, 6 ± 5 and 0 ± 0 respectively). Conclusions: A strong negative correlation was seen between DTS and coronary lesion complexity. By assessing DTS important information about coronary artery lesion complexity can be obtained before invasive coronary angiography.
Objective: The aim of the present study was to investigate the association between nitrate-induce... more Objective: The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). Subjects and Methods: Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. Results: The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis,...
A 23-year-old man presented with dyspnoea and a blood pressure of 180/120 mmHg in both arms. Femo... more A 23-year-old man presented with dyspnoea and a blood pressure of 180/120 mmHg in both arms. Femoral and popliteal pulses were absent and there was a systolic ejection murmur along the left intercostal area.The chest X-ray showed rib notching and a normal cardiac silhouette.Transthoracic echocardiography showed a bicuspid aortic valve with a mild degree of left ventricular dysfunction and an interruption of the aorta 3 cm distally of the left subclavian artery. A 64-slice CT angiography confirmed an interruption with extensive collateral circulation. Angioplasty and implantation of a covered stent were successful. Six months after the procedure, the patient is asymptomatic and without any complication.
Blood-filled cysts of heart valves are rare in adults. These cysts are diverticuli lined by endot... more Blood-filled cysts of heart valves are rare in adults. These cysts are diverticuli lined by endothelium and filled with blood. They appear to be benign lesions and should be removed if they cause problems. We present the case of a mobile tricuspid valve blood cyst that was incidentally found in a patient evaluated for systolic heart murmur. Systolic murmur was found to originate from a muscular-type ventricular septal defect of no haemodynamic significance. The lack of echocardiographic evidence of tricuspid valvular dysfunction and indication for repair of co-existent ventricular septal defect suggested a benign course and, therefore, we monitored the patient safely by echocardiography.
Purpose: Gender differences in outcome of patients presenting with acute STelevation myocardial i... more Purpose: Gender differences in outcome of patients presenting with acute STelevation myocardial infarction (STEMI) are known. There is some uncertainty whether this is only attributable to different baseline characteristics or additional factors. Therefore we compared indicators of guideline adherent therapy in a large cohort of consecutive STEMI patients according to gender. Methods: We combined the databases of two German myocardial infarction network registries with a total of n = 1104 consecutive patients admitted for primary percutaneous coronary intervention (PCI). Databases contain information on baseline characteristics, time delays to reperfusion, reperfusion therapy, secondary prophylaxis and long term outcome. Both networks aim at reperfusion therapy with primary PCI for all regional STEMI patients. Network A (n = 603 patients) is located in the Northeast and network B (n = 501 patients) in the Southwest of Germany. Patients were included from 2001-2003 (network A) and 2005-2007 (network B). Results: Approximately 25% of patients were female. Their mean age at presentation was eight years older than in male patients (69 vs 61 years) and they had significantly more often diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%). Presence of cardiogenic shock was comparable (10% vs 9%) in both genders. Mean prehospital delay was insignificantly longer in female patients (229 vs 210 min) as was the in hospital delay until start of catherization (35 vs 31 min). Emergency medical services (EMS) escorted transfer with announcement to the interventional facility was comparable in both genders (60% vs 59%). Procedural success (95% vs 97%) and mean number of stents (1.41 vs. 1.45) was also comparable. Use of GP 2b 3a blockers, however, was less frequent in females (75% vs 89%). At discharge prescription of anticoagulants was numerically higher in females (12% vs 10%) with lesser use of antiplatelets, whereas prescription of beta blockers and lipid lowering drugs was significantly lower in females (84% vs 90% and 71% vs 84%). These differences were more pronounced in network A. Differences in secondary prophylaxis persisted at 12 month (data only available for network B). Hospital mortality was significantly higher in females (10% vs 4%) as was 6 month mortality (14% vs 7%). Conclusions: Higher mortality in females after primary PCI in an unselected STEMI population was accompanied by significant differences in baseline characteristics and secondary prophylaxis whereas time delays before reperfusion and reperfusion success were comparable.
Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker ... more Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels.Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were ) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure.Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in pa...
Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (AC... more Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software.
Journal of the American College of Cardiology, 2013
Background: Cheloid is an excessive fibrous growth as a result of abnormal wound healing in respo... more Background: Cheloid is an excessive fibrous growth as a result of abnormal wound healing in response to skin injury. As postulated in "response to injury hypothesis", atherosclerosis could also be an abnormal wound healing response to an endothelial injury. It is well known that endothelial dysfunction is an early finding of atherosclerosis. As a result, it could be hypothesized that endothelial dysfunction would be more prominent in patients having cheloid. The aim of this study was to assess the relationship between flow mediated diatation and cheloid formation. Method: Consecutive patients, who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grefting operation were evaluated. After application of exclusion criteria 69 patients enrolled into the study. 33 patients having cheloid formed cheloid group and 36 patients not having cheloid formed normal group. Endothelial function was measured with the help of flow mediated vasodilatation (FMD) of the brachial artery. Results: There is no signicant difference according to the demographical data, biochemical parameters, clinical parameters and number of grefts between cheloid and normal groups. Only fasting blood glucose was significantly higher in normal group (p¼0.02) (Table 1). In cheloid group nomber of revascularization was s higher than normal group (p¼0.025). Mean baseline brachial artery diameter was significantly lower in normal group than cheloid group (35.0AE4.59, 37.7AE4.03 respectively; p¼0.012). No significant difference was found in mean hyperemia diameter of brachial artery between cheloid and normal groups. FMD was lower in cheloid group than normal group. (9.30AE3.5, 18.68AE8.2 respectively p¼0.001) (Table 2). Conclusıon: This study showed that; endothalial function is significantly worsened in patients having cheloid after coronary artery bypass grefting operation than patients who did not. If we assume that endothelial function is an early finding of atherosclerosis we might say that atherosclerotic process would grow more agressive in patients havig cheloid than who do not. Hence, patients having cheloid might need more redo coronary artery bypass grefting or percutaneous coronary interventions.
BMI body mass index, LDL low density cholesterol, HDL high density cholesterol, SxScore SYNTAX sc... more BMI body mass index, LDL low density cholesterol, HDL high density cholesterol, SxScore SYNTAX score, LM-CA left main coronary artery, LAD left anterior descending, LCX left circumflex artery, RCA right coronary artery.
The main purpose of this study was to investigate the relation between carotid intima–media thick... more The main purpose of this study was to investigate the relation between carotid intima–media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT ( r = .42, P < .001), age ( r = .23, P < .001), hypertension ( r = .27, P = 0.001), diabetes ( r = 0.11, P = 0.02), smoking ( r = .24, P = .01), dyslipidemia ( r = .2, P = 0.03), and β-blocker use ( r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect c...
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary synd... more Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS ( r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.
Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during prim... more Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking. Aim: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI. Material and methods: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death. Results: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group (p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups (p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group. Conclusions: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time.
Is trans-radial approach related to an increased risk of radiation exposure in patients who under... more Is trans-radial approach related to an increased risk of radiation exposure in patients who underwent diagnostic coronary angiography or percutaneous coronary intervention? (The SAKARYA study) Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were overrepresented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.
Introduction: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk pa... more Introduction: Carotid artery stenting (CAS) is a promising alternative to surgery in high-risk patients. However, the impact of stent cell design on outcomes in CAS is a matter of continued debate. Aim: To compare the periprocedural and clinical outcomes of different stent designs for CAS with distal protection devices. Material and methods: All CAS procedures with both closed-and hybrid-cell stents performed at our institution between February 2010 and December 2015 were analyzed retrospectively. Adverse events were defined as death, major stroke, minor stroke, transient ischemic attack and myocardial infarction. Periprocedural and 30-day adverse events and internal carotid artery (ICA) vasospasm rates were compared between the closed-cell and hybrid-cell stent groups. Results: The study included 234 patients comprising 146 patients with a closed-cell stent (Xact stent, Abbott Vascular) (mean age: 68.5 ±8.6; 67.1% male) and 88 patients with a hybrid-cell stent (Cristallo Ideale, Medtronic) (mean age: 67.2 ±12.8; 68.2% male). There was no significant difference between the groups with respect to periprocedural or 30-day adverse event rates. While there was no difference in terms of tortuosity index between the groups, there was a higher procedural ICA vasospasm rate in the closed-cell stent group (35 patients, 23%) compared with the hybrid-cell stent group (10 patients, 11%) (p = 0.017). Conclusions: The results of this study showed no significant difference in the clinical adverse event rates after CAS between the closedcell stent group and the hybrid-cell stent group. However, procedural ICA vasospasm was more common in the closed-cell stent group.
Purpose: The purpose of this study was to investigate the relationship between the Duke Treadmil ... more Purpose: The purpose of this study was to investigate the relationship between the Duke Treadmil Score (DTS) and coronary artery disease (CAD) complexity in patients with suspected coronary artery disease (CAD). Methods: Sixty five patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed and Syntax score (SxScore), a marker of CAD complexity, was determined. The relationship between DTC and SxScore then evaluated. Results: There was a strong negative correlation between DTS and SxScore (r= - 0.91, p < 0.001). In addition, patients with higher and intermediate risk as evaluated by DTS had increased SxScore compare to those that were low risk (23 ± 6, 6 ± 5 and 0 ± 0 respectively). Conclusions: A strong negative correlation was seen between DTS and coronary lesion complexity. By assessing DTS important information about coronary artery lesion complexity can be obtained before invasive coronary angiography.
Objective: The aim of the present study was to investigate the association between nitrate-induce... more Objective: The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). Subjects and Methods: Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. Results: The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis,...
A 23-year-old man presented with dyspnoea and a blood pressure of 180/120 mmHg in both arms. Femo... more A 23-year-old man presented with dyspnoea and a blood pressure of 180/120 mmHg in both arms. Femoral and popliteal pulses were absent and there was a systolic ejection murmur along the left intercostal area.The chest X-ray showed rib notching and a normal cardiac silhouette.Transthoracic echocardiography showed a bicuspid aortic valve with a mild degree of left ventricular dysfunction and an interruption of the aorta 3 cm distally of the left subclavian artery. A 64-slice CT angiography confirmed an interruption with extensive collateral circulation. Angioplasty and implantation of a covered stent were successful. Six months after the procedure, the patient is asymptomatic and without any complication.
Blood-filled cysts of heart valves are rare in adults. These cysts are diverticuli lined by endot... more Blood-filled cysts of heart valves are rare in adults. These cysts are diverticuli lined by endothelium and filled with blood. They appear to be benign lesions and should be removed if they cause problems. We present the case of a mobile tricuspid valve blood cyst that was incidentally found in a patient evaluated for systolic heart murmur. Systolic murmur was found to originate from a muscular-type ventricular septal defect of no haemodynamic significance. The lack of echocardiographic evidence of tricuspid valvular dysfunction and indication for repair of co-existent ventricular septal defect suggested a benign course and, therefore, we monitored the patient safely by echocardiography.
Purpose: Gender differences in outcome of patients presenting with acute STelevation myocardial i... more Purpose: Gender differences in outcome of patients presenting with acute STelevation myocardial infarction (STEMI) are known. There is some uncertainty whether this is only attributable to different baseline characteristics or additional factors. Therefore we compared indicators of guideline adherent therapy in a large cohort of consecutive STEMI patients according to gender. Methods: We combined the databases of two German myocardial infarction network registries with a total of n = 1104 consecutive patients admitted for primary percutaneous coronary intervention (PCI). Databases contain information on baseline characteristics, time delays to reperfusion, reperfusion therapy, secondary prophylaxis and long term outcome. Both networks aim at reperfusion therapy with primary PCI for all regional STEMI patients. Network A (n = 603 patients) is located in the Northeast and network B (n = 501 patients) in the Southwest of Germany. Patients were included from 2001-2003 (network A) and 2005-2007 (network B). Results: Approximately 25% of patients were female. Their mean age at presentation was eight years older than in male patients (69 vs 61 years) and they had significantly more often diabetes (28% vs 20%), hypertension (68 vs 58%) and renal insufficiency (26% vs 19%). Presence of cardiogenic shock was comparable (10% vs 9%) in both genders. Mean prehospital delay was insignificantly longer in female patients (229 vs 210 min) as was the in hospital delay until start of catherization (35 vs 31 min). Emergency medical services (EMS) escorted transfer with announcement to the interventional facility was comparable in both genders (60% vs 59%). Procedural success (95% vs 97%) and mean number of stents (1.41 vs. 1.45) was also comparable. Use of GP 2b 3a blockers, however, was less frequent in females (75% vs 89%). At discharge prescription of anticoagulants was numerically higher in females (12% vs 10%) with lesser use of antiplatelets, whereas prescription of beta blockers and lipid lowering drugs was significantly lower in females (84% vs 90% and 71% vs 84%). These differences were more pronounced in network A. Differences in secondary prophylaxis persisted at 12 month (data only available for network B). Hospital mortality was significantly higher in females (10% vs 4%) as was 6 month mortality (14% vs 7%). Conclusions: Higher mortality in females after primary PCI in an unselected STEMI population was accompanied by significant differences in baseline characteristics and secondary prophylaxis whereas time delays before reperfusion and reperfusion success were comparable.
Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker ... more Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels.Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were ) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure.Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in pa...
Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (AC... more Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software.
Journal of the American College of Cardiology, 2013
Background: Cheloid is an excessive fibrous growth as a result of abnormal wound healing in respo... more Background: Cheloid is an excessive fibrous growth as a result of abnormal wound healing in response to skin injury. As postulated in "response to injury hypothesis", atherosclerosis could also be an abnormal wound healing response to an endothelial injury. It is well known that endothelial dysfunction is an early finding of atherosclerosis. As a result, it could be hypothesized that endothelial dysfunction would be more prominent in patients having cheloid. The aim of this study was to assess the relationship between flow mediated diatation and cheloid formation. Method: Consecutive patients, who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grefting operation were evaluated. After application of exclusion criteria 69 patients enrolled into the study. 33 patients having cheloid formed cheloid group and 36 patients not having cheloid formed normal group. Endothelial function was measured with the help of flow mediated vasodilatation (FMD) of the brachial artery. Results: There is no signicant difference according to the demographical data, biochemical parameters, clinical parameters and number of grefts between cheloid and normal groups. Only fasting blood glucose was significantly higher in normal group (p¼0.02) (Table 1). In cheloid group nomber of revascularization was s higher than normal group (p¼0.025). Mean baseline brachial artery diameter was significantly lower in normal group than cheloid group (35.0AE4.59, 37.7AE4.03 respectively; p¼0.012). No significant difference was found in mean hyperemia diameter of brachial artery between cheloid and normal groups. FMD was lower in cheloid group than normal group. (9.30AE3.5, 18.68AE8.2 respectively p¼0.001) (Table 2). Conclusıon: This study showed that; endothalial function is significantly worsened in patients having cheloid after coronary artery bypass grefting operation than patients who did not. If we assume that endothelial function is an early finding of atherosclerosis we might say that atherosclerotic process would grow more agressive in patients havig cheloid than who do not. Hence, patients having cheloid might need more redo coronary artery bypass grefting or percutaneous coronary interventions.
BMI body mass index, LDL low density cholesterol, HDL high density cholesterol, SxScore SYNTAX sc... more BMI body mass index, LDL low density cholesterol, HDL high density cholesterol, SxScore SYNTAX score, LM-CA left main coronary artery, LAD left anterior descending, LCX left circumflex artery, RCA right coronary artery.
The main purpose of this study was to investigate the relation between carotid intima–media thick... more The main purpose of this study was to investigate the relation between carotid intima–media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT ( r = .42, P < .001), age ( r = .23, P < .001), hypertension ( r = .27, P = 0.001), diabetes ( r = 0.11, P = 0.02), smoking ( r = .24, P = .01), dyslipidemia ( r = .2, P = 0.03), and β-blocker use ( r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect c...
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary synd... more Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS ( r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.
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