Objective: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocar... more Objective: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. Methods: A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. Results: The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality. Conclusion: In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.
Her geçen gün insan ömrünün uzaması ile birlikte kronik hastalıkların da görülme sıklığı artmakta... more Her geçen gün insan ömrünün uzaması ile birlikte kronik hastalıkların da görülme sıklığı artmaktadır. Bunlardan biri de paroksismal atriyum fibrilasyonu'dur (PAF). Ne var ki PAF tedavisinde etkin bir yöntem henüz belirlenmiş olmayıp, sık uygulanan tedavilerin başında pulmoner ven izolasyonu gelmektedir, ancak bu yönteme rağmen alternatif tedavi yaklaşımlarına ihtiyaç duyulmaktadır. Dolayısıyla bradikardiye sekonder PAF hastalarına DDDR (dual-chamber, rate-modulated pacing) "pacemaker" implantasyonu yaparak PAF atak sıklığını değerlendirmek istedik. Hastalar ve Yöntem: Bu amaçla son bir yıl içerisinde en az iki kez PAF atağı olan toplam 54 akut AF'lı hasta çalışmaya dahil edildi. Tüm hastaların ritimleri sinüs ritmine çevrildikten sonra 48 saat içerisinde hastalara ritim holteri takıldı. Ortalama kalp hızları <60/dakika olanlara DDDR "pacemaker " implantasyonu yapılarak AF supresyon modu açık bırakıldı. Üç, altı, dokuz ve 12. aylarda hastaların birçok parametreleri değerlendirildi. Bulgular: Hastaların yaş ortalaması 60±15,5 yıl idi. Ortalama sol atriyum çapı 42,4±6,3 mm olarak ölçüldü. Koroner arter hastalığı veya mitral kapak hastalığı bulunanlarda bulunmayanlara oranla PAF'a girme oranı anlamlı oranda daha yüksek bulundu. (sırasıyla %41,7'ye %28,57 ve %44,4'e %28,9), (p<0,01). Tüm veriler incelendiğinde sırası ile üç, altı, dokuz ve 12. aylarda hastaların %88,9, %79,6, %77,8 ve 68,5'inin hiçbir şekilde AF'a girmediği tespit edildi. Sonuç: Yaptığımız çalışmanın neticesinde, bir yıl içerisinde en az iki kez PAF atağı öyküsü olan hastalara takılan DDDR "pacemaker" ile hastaların %68,5'nin hiçbir şekilde AF atağına girmediği gösterilmiştir. Anahtar Kelimeler: Bradikardi; paroksismal atriyum fibrilasyonu; pacemaker Introduction: The incidence of chronic diseases increases along with the extension of the life of humans day by day. One of them is a paroxysmal atrial fibrillation (PAF). However, there has been no accurate treatment method for PAF yet and the most commonly applied method is radiofrequency isolation of pulmonary veins. But still alternative treatment approaches are needed. For this reason we implanted dual-chamber, rate-modulated pacing (DDDR) pacemaker in patients with PAF secondary to bradycardia and evaluated the frequency of PAF attacks. Patients and Methods: For this reason 54 patients with acute AF who had at least two PAF attacks within the last year were enrolled our study. After converting the cardiac rhythms of the patients to sinus rhythm, rhythm holter device was connected to the patients within first 48 hours. Patients with average heart rate <60/min were treated with DDDR pacemaker implantation and AF suppression mode was activated in all patients. Various parameters of patients were evaluated at 3 rd , 6 th , 9 th and 12 th months. Results: The mean age of patients were 60±15.5 years. Mean left atrium diameter was measured as 42.4±6.3 mm. The rate of PAF was significantly higher in patients with coronary artery disease or mitral valve disease as compared to those without these diseases (41.7% vs 28.57% and 44.4% vs 28.9%, respectively), (p<0.01). Regarding the data obtained at 3 rd , 6 th , 9 th and 12 th months, AF was not detected in 88.9%, 79.6%, 77%, and 68.5% of the patients, respectively. Conclusion: Result of our study showed that in 68.5% of the patients who have a history of at least two PAF attacks within the last year and in whom DDDR pacemaker was implanted AF attack was not observed.
Günlük klinik uygulamada kronik obstrüktif akciğer hastalığının şiddetinin değerlendirilmesinde e... more Günlük klinik uygulamada kronik obstrüktif akciğer hastalığının şiddetinin değerlendirilmesinde elektrokardiyografinin rolü Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) kronik morbidite ve mortalitenin dördüncü önde gelen nedenidir. Bronşiyal obstrüksiyon ve artmış pulmoner vasküler direnç sağ atriyal fonksiyonları bozmaktadır. Bu çalışmada, KOAH hastalarında bronşiyal obstrüksiyonun p dalga aksı üzerine olan etkisini ve KOAH şiddetini değerlendirmede elektrokardiyografi (EKG)'nin yararlılığını araştırmayı amaçladık.
Journal of Interventional Cardiac Electrophysiology, 2008
In this case report, we present a patient with intermittent isorhythmic atrioventricular dissocia... more In this case report, we present a patient with intermittent isorhythmic atrioventricular dissociation mimicking two different electrocardiographic entities: ventricular preexcitation pattern and recurrent acute inferior myocardial infarction.
The Ravitch operation is frequently performed to correct pectus excavatum with few and minor comp... more The Ravitch operation is frequently performed to correct pectus excavatum with few and minor complications. We present a case of pulmonary embolism with pulmonary endarterectomy in a patient undergoing Ravitch repair for pectus excavatum 2 years ago.
We evaluated the relationship between admission blood glucose levels and estimated coronary flow ... more We evaluated the relationship between admission blood glucose levels and estimated coronary flow by the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The TFC of 121 consecutive patients with STEMI were evaluated after pPCI. Patients with admission glucose levels >198 mg/dL (11 mmol/L) were defined as hyperglycemic. Hyperglycemia was observed in 36 (29.8%) patients. The TFC was significantly higher in patients with hyperglycemia (70.75 [10-96] vs 56.87 [8-100], P = .04). No-reflow frequency was higher in the hyperglycemia group (44.4% vs 23.5%, P = .02). In multivariate linear regression analysis admission glucose was an independent predictor of high TFC ( B = 0.21, P = .02). Our findings suggest that admission blood glucose is a predictor of TFC which reflects coronary blood flow.
Objective: The relationship between oxidative stress and acute myocardial infarction has been sho... more Objective: The relationship between oxidative stress and acute myocardial infarction has been shown in studies. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) reflect the oxidative balance. The risk factors, clinical features, and prognosis of acute myocardial infarction (AMI) in young patients differ from older counterparts. This study aims to determine the oxidative stress in the young acute AMI patients and its' correlation with cardiac markers within 48 hours by the quantitative measurement of TAS, TOS, and OSI. Material and Method: In this prospective, controlled study, we included 50 patients who were 45 years old or younger and diagnosed with AMI, as well as 20 healthy individuals as the control group. TOS and TAS were measured from venous blood samples via the spectrophotometric method. The oxidative stress index was obtained from these parameters. Results: Forty-five of totally 50 patients were male, and the mean age was (36...
This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atr... more This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score (RS), which determines the predisposition to thromboembolic and hemorrhagic events in atrial fibrillation, as a predictor of prognosis in patients having acute myocardial infarction (AMI), and to compare the predictive ability of ATRIA RS with GRACE RS. We analyzed 1627 patients having AMI who underwent coronary angiography and/or percutaneous coronary intervention (PCI) between January 2011 and February 2015. The primary endpoints included all-cause mortality, non-fatal MI, and cerebrovascular events during follow-up. Multivariate Cox regression analysis showed that the ATRIA RS>3 was an independent predictor of major adverse cardiac events in patients with AMI [hazard ratio, 2.00, 95% confidence interval, 1.54 to 2.60, p<0,001]. The area under the curve (AUC) for ATRIA RS and GRACE RS was 0.66 and 0.67 (p<0.001, and p<0.001), respectively...
Introduction: Restenosis is a gradual re-narrowing of the stented segment that occurs mostly betw... more Introduction: Restenosis is a gradual re-narrowing of the stented segment that occurs mostly between 3 to 12 months after stent placement. It can usually be managed by repeat percutaneous revascularization. We report here a very late stent restenosis of Cx artery treated succesfully by using drug coated balloon catheters. Case report: 57 year old male patient was presented with exertional chest pain for 6 months. In 2001, BMS was placed to obtus marginal branch of Cx artery because of ACS. Treadmill exercise test was performed and the test result was interpreted as positive. The patient’s coronary angiography was revealed OM stent restenosis (90% narrowing of the vessel) (Figure 1). Restenosis was treated by using drug coated balloon catheters. At six month follow up outpatient visit patient was completely asymptomatic under medical treatment. Discussion: In early phase of PCI, BMS was used commonly in clinical practice. Although BMS restenosis is more frequent then DES, very late r...
We present a case report of a 55-year-old male who underwent coronary angiography secondary to NS... more We present a case report of a 55-year-old male who underwent coronary angiography secondary to NSTMI. Diagnostic catheterization revealed subtotal oclusion of OM stent and total oclusion of RCA from proximal segment. While engaging RCA a rarely described descending septal artery (Bonapace’s branch) originating from a separate ostium in the right aortic sinus was shown. This artery was supplying interventricular septum and giving collaterals to the RCA. Although postmortem studies report more frequently, our case is the third described case in vivo.
We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-ind... more We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-induced nephropathy (CIN) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). A total of 488 patients with NSTE-ACS who underwent urgent coronary angiography were enrolled. Levels of PLR and creatinine were measured before angiography and at 72 hours after angiography. Patients were divided into 2 groups, namely, the CIN group, 80 patients (16.3%; age 65.3 ± 12.5years; 66.7% men) and the non-CIN group, 408 patients (83.7%; age 61.2 ± 12.3 years; 72.5% men). Patients in the CIN group had significantly higher PLR than those in the non-CIN group (152.9 ± 99.6 vs 120.4 ± 66.1, P < .001). In logistic regression analysis, PLR (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.001-1.007, P = .02), diabetes mellitus (OR 1.75, 95% CI 1.02-2.98, P = .03), and ST-segment depression on admission electrocardiogram (OR 1.68, 95% CI 1.00-2.81, P = .04) were independent pre...
Although statins have been shown to prevent contrast-induced acute kidney injury in patients with... more Although statins have been shown to prevent contrast-induced acute kidney injury in patients with acute coronary syndromes, the benefit of statins is not known for patients at high risk for nephropathy who undergo elective coronary angiography. Two hundred twenty consecutive statin-naive patients with chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m 2) who underwent elective coronary or peripheral angiography were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/ day; n [ 110) or no statin treatment (control group, n [ 110). Contrast-induced acute kidney injury was defined by an absolute increase in serum creatinine of ‡0.5 mg/dl or a relative increase of ‡25% measured 48 or 72 hours after the procedure. Contrast-induced acute kidney injury occurred in 15 patients (7.2%), 9 (8.5%) in the control group and 6 (5.8%) in the rosuvastatin group (p [ 0.44). The incidences of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) were similar between the two groups at follow-up. In conclusion, rosuvastatin did not reduce the risk for contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients who underwent coronary and peripheral vascular angiography.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014
We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on... more We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on the pathogenesis of atrial fibrillation (AF) developing after coronary artery bypass graft (CABG) surgery. In our prospective, single-center study, 118 patients who underwent elective isolated on-pump CABG surgery were included. Patients were divided into two groups according to the development of postoperative atrial fibrillation (POAF) as Group 1: Patients who developed POAF, and Group 2: Patients who remained in sinus rhythm. In addition to preoperative demographic, laboratory, echocardiographic, intraoperative, and postoperative clinical characteristics, levels of plasma total oxidative status (TOS) after placement and removal of aortic cross clamp (ACC) were compared between the two groups. Predictors of POAF were also investigated by multivariate logistic regression analysis. A comparison of preoperative demographic, laboratory, echocardiographic, and postoperative clinical charac...
Hyperglycemia on admission is associated with increased mortality rates in patients with ST-eleva... more Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT. This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution ≥50 %. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2 %) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p = 0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p = 0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p = 0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction. In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis.
Bicuspid aortic valve and the aorta Valve anatomy, aortic diameters at different levels, and pres... more Bicuspid aortic valve and the aorta Valve anatomy, aortic diameters at different levels, and presence and degree of valve dysfunction were analysed. Results: Of the 401 FDR recruited: 113 (28.1%) refused the study and 288 (71.9%) underwent screening (mean age: 36.1±19 years; 66.7% males). Twentyone aortic valve abnormalities were encountered: 20 BAV and 1 quadricuspid valve, distributed in 17 of the 90 families, yielding a BAV family prevalence of 18.8% (Table). BAV phenotype was not consistent among probands and positive FDR in 6 of the affected families (35.3%). The prevalence of BAV among the FDR screened was 7.3%, higher than that reported in the general population (0.5-1.0%). The number of FDR required to screen for identifying a new BAV case is 14, in contrast to 100 in the general population. Conclusions: The prevalence of BAV is higher in FDR of BAV patients than in the general population. Discordance between BAV phenotypes within the same family is not rare. Echocardiographic screening of FDR is a useful approach for identifying asymptomatic cases, and should therefore be offered to all FDR of BAV individuals.
Objective: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocar... more Objective: The incidence of atrial fibrillation (AF) in patients with ST segment elevation myocardial infarction (STEMI) varies between 7% and 21%, and most of these studies were in the thrombolytic era. However, the frequency of new-onset AF during the primary percutaneous coronary intervention (PCI) period is still unclear. We aimed to investigate the frequency of new-onset AF and its effects on long-term clinical events in patients undergoing primary PCI. Methods: A total of 1,603 patients who were diagnosed with STEMI and underwent primary PCI were included in the study. All the patients were monitored for at least 48 hours after the procedure. The primary endpoint of the study was defined as new-onset AF during hospitalization. Results: The median follow-up period of our study was 44 months. New-onset AF developed in 85 (6.1%) patients. CHADs-VASc > 2, KILLIP > 2, and left atrial diameter were found to be independent predictors for the development of new-onset AF. In the AF (+) group, the all-cause and in-hospital mortality rates were found to be significantly higher. New-onset AF development in patients with STEMI was detected as an independent predictor of in-hospital mortality. Conclusion: In the era of primary percutaneous transluminal coronary angioplasty, new-onset AF rates were found to be lower than the literature data. In addition, new-onset AF was found to be a predictor of in-hospital mortality, and deaths occurred mostly in the early period. Therefore, close follow-up of these patients in the early period and re-evaluation in terms of AF burden when the patient becomes stable are important.
Her geçen gün insan ömrünün uzaması ile birlikte kronik hastalıkların da görülme sıklığı artmakta... more Her geçen gün insan ömrünün uzaması ile birlikte kronik hastalıkların da görülme sıklığı artmaktadır. Bunlardan biri de paroksismal atriyum fibrilasyonu'dur (PAF). Ne var ki PAF tedavisinde etkin bir yöntem henüz belirlenmiş olmayıp, sık uygulanan tedavilerin başında pulmoner ven izolasyonu gelmektedir, ancak bu yönteme rağmen alternatif tedavi yaklaşımlarına ihtiyaç duyulmaktadır. Dolayısıyla bradikardiye sekonder PAF hastalarına DDDR (dual-chamber, rate-modulated pacing) "pacemaker" implantasyonu yaparak PAF atak sıklığını değerlendirmek istedik. Hastalar ve Yöntem: Bu amaçla son bir yıl içerisinde en az iki kez PAF atağı olan toplam 54 akut AF'lı hasta çalışmaya dahil edildi. Tüm hastaların ritimleri sinüs ritmine çevrildikten sonra 48 saat içerisinde hastalara ritim holteri takıldı. Ortalama kalp hızları <60/dakika olanlara DDDR "pacemaker " implantasyonu yapılarak AF supresyon modu açık bırakıldı. Üç, altı, dokuz ve 12. aylarda hastaların birçok parametreleri değerlendirildi. Bulgular: Hastaların yaş ortalaması 60±15,5 yıl idi. Ortalama sol atriyum çapı 42,4±6,3 mm olarak ölçüldü. Koroner arter hastalığı veya mitral kapak hastalığı bulunanlarda bulunmayanlara oranla PAF'a girme oranı anlamlı oranda daha yüksek bulundu. (sırasıyla %41,7'ye %28,57 ve %44,4'e %28,9), (p<0,01). Tüm veriler incelendiğinde sırası ile üç, altı, dokuz ve 12. aylarda hastaların %88,9, %79,6, %77,8 ve 68,5'inin hiçbir şekilde AF'a girmediği tespit edildi. Sonuç: Yaptığımız çalışmanın neticesinde, bir yıl içerisinde en az iki kez PAF atağı öyküsü olan hastalara takılan DDDR "pacemaker" ile hastaların %68,5'nin hiçbir şekilde AF atağına girmediği gösterilmiştir. Anahtar Kelimeler: Bradikardi; paroksismal atriyum fibrilasyonu; pacemaker Introduction: The incidence of chronic diseases increases along with the extension of the life of humans day by day. One of them is a paroxysmal atrial fibrillation (PAF). However, there has been no accurate treatment method for PAF yet and the most commonly applied method is radiofrequency isolation of pulmonary veins. But still alternative treatment approaches are needed. For this reason we implanted dual-chamber, rate-modulated pacing (DDDR) pacemaker in patients with PAF secondary to bradycardia and evaluated the frequency of PAF attacks. Patients and Methods: For this reason 54 patients with acute AF who had at least two PAF attacks within the last year were enrolled our study. After converting the cardiac rhythms of the patients to sinus rhythm, rhythm holter device was connected to the patients within first 48 hours. Patients with average heart rate <60/min were treated with DDDR pacemaker implantation and AF suppression mode was activated in all patients. Various parameters of patients were evaluated at 3 rd , 6 th , 9 th and 12 th months. Results: The mean age of patients were 60±15.5 years. Mean left atrium diameter was measured as 42.4±6.3 mm. The rate of PAF was significantly higher in patients with coronary artery disease or mitral valve disease as compared to those without these diseases (41.7% vs 28.57% and 44.4% vs 28.9%, respectively), (p<0.01). Regarding the data obtained at 3 rd , 6 th , 9 th and 12 th months, AF was not detected in 88.9%, 79.6%, 77%, and 68.5% of the patients, respectively. Conclusion: Result of our study showed that in 68.5% of the patients who have a history of at least two PAF attacks within the last year and in whom DDDR pacemaker was implanted AF attack was not observed.
Günlük klinik uygulamada kronik obstrüktif akciğer hastalığının şiddetinin değerlendirilmesinde e... more Günlük klinik uygulamada kronik obstrüktif akciğer hastalığının şiddetinin değerlendirilmesinde elektrokardiyografinin rolü Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) kronik morbidite ve mortalitenin dördüncü önde gelen nedenidir. Bronşiyal obstrüksiyon ve artmış pulmoner vasküler direnç sağ atriyal fonksiyonları bozmaktadır. Bu çalışmada, KOAH hastalarında bronşiyal obstrüksiyonun p dalga aksı üzerine olan etkisini ve KOAH şiddetini değerlendirmede elektrokardiyografi (EKG)'nin yararlılığını araştırmayı amaçladık.
Journal of Interventional Cardiac Electrophysiology, 2008
In this case report, we present a patient with intermittent isorhythmic atrioventricular dissocia... more In this case report, we present a patient with intermittent isorhythmic atrioventricular dissociation mimicking two different electrocardiographic entities: ventricular preexcitation pattern and recurrent acute inferior myocardial infarction.
The Ravitch operation is frequently performed to correct pectus excavatum with few and minor comp... more The Ravitch operation is frequently performed to correct pectus excavatum with few and minor complications. We present a case of pulmonary embolism with pulmonary endarterectomy in a patient undergoing Ravitch repair for pectus excavatum 2 years ago.
We evaluated the relationship between admission blood glucose levels and estimated coronary flow ... more We evaluated the relationship between admission blood glucose levels and estimated coronary flow by the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The TFC of 121 consecutive patients with STEMI were evaluated after pPCI. Patients with admission glucose levels >198 mg/dL (11 mmol/L) were defined as hyperglycemic. Hyperglycemia was observed in 36 (29.8%) patients. The TFC was significantly higher in patients with hyperglycemia (70.75 [10-96] vs 56.87 [8-100], P = .04). No-reflow frequency was higher in the hyperglycemia group (44.4% vs 23.5%, P = .02). In multivariate linear regression analysis admission glucose was an independent predictor of high TFC ( B = 0.21, P = .02). Our findings suggest that admission blood glucose is a predictor of TFC which reflects coronary blood flow.
Objective: The relationship between oxidative stress and acute myocardial infarction has been sho... more Objective: The relationship between oxidative stress and acute myocardial infarction has been shown in studies. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) reflect the oxidative balance. The risk factors, clinical features, and prognosis of acute myocardial infarction (AMI) in young patients differ from older counterparts. This study aims to determine the oxidative stress in the young acute AMI patients and its' correlation with cardiac markers within 48 hours by the quantitative measurement of TAS, TOS, and OSI. Material and Method: In this prospective, controlled study, we included 50 patients who were 45 years old or younger and diagnosed with AMI, as well as 20 healthy individuals as the control group. TOS and TAS were measured from venous blood samples via the spectrophotometric method. The oxidative stress index was obtained from these parameters. Results: Forty-five of totally 50 patients were male, and the mean age was (36...
This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atr... more This study is designed to evaluate the recently developed AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) risk score (RS), which determines the predisposition to thromboembolic and hemorrhagic events in atrial fibrillation, as a predictor of prognosis in patients having acute myocardial infarction (AMI), and to compare the predictive ability of ATRIA RS with GRACE RS. We analyzed 1627 patients having AMI who underwent coronary angiography and/or percutaneous coronary intervention (PCI) between January 2011 and February 2015. The primary endpoints included all-cause mortality, non-fatal MI, and cerebrovascular events during follow-up. Multivariate Cox regression analysis showed that the ATRIA RS>3 was an independent predictor of major adverse cardiac events in patients with AMI [hazard ratio, 2.00, 95% confidence interval, 1.54 to 2.60, p<0,001]. The area under the curve (AUC) for ATRIA RS and GRACE RS was 0.66 and 0.67 (p<0.001, and p<0.001), respectively...
Introduction: Restenosis is a gradual re-narrowing of the stented segment that occurs mostly betw... more Introduction: Restenosis is a gradual re-narrowing of the stented segment that occurs mostly between 3 to 12 months after stent placement. It can usually be managed by repeat percutaneous revascularization. We report here a very late stent restenosis of Cx artery treated succesfully by using drug coated balloon catheters. Case report: 57 year old male patient was presented with exertional chest pain for 6 months. In 2001, BMS was placed to obtus marginal branch of Cx artery because of ACS. Treadmill exercise test was performed and the test result was interpreted as positive. The patient’s coronary angiography was revealed OM stent restenosis (90% narrowing of the vessel) (Figure 1). Restenosis was treated by using drug coated balloon catheters. At six month follow up outpatient visit patient was completely asymptomatic under medical treatment. Discussion: In early phase of PCI, BMS was used commonly in clinical practice. Although BMS restenosis is more frequent then DES, very late r...
We present a case report of a 55-year-old male who underwent coronary angiography secondary to NS... more We present a case report of a 55-year-old male who underwent coronary angiography secondary to NSTMI. Diagnostic catheterization revealed subtotal oclusion of OM stent and total oclusion of RCA from proximal segment. While engaging RCA a rarely described descending septal artery (Bonapace’s branch) originating from a separate ostium in the right aortic sinus was shown. This artery was supplying interventricular septum and giving collaterals to the RCA. Although postmortem studies report more frequently, our case is the third described case in vivo.
We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-ind... more We assessed the relation between platelet-to-lymphocyte ratio (PLR) on admission and contrast-induced nephropathy (CIN) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). A total of 488 patients with NSTE-ACS who underwent urgent coronary angiography were enrolled. Levels of PLR and creatinine were measured before angiography and at 72 hours after angiography. Patients were divided into 2 groups, namely, the CIN group, 80 patients (16.3%; age 65.3 ± 12.5years; 66.7% men) and the non-CIN group, 408 patients (83.7%; age 61.2 ± 12.3 years; 72.5% men). Patients in the CIN group had significantly higher PLR than those in the non-CIN group (152.9 ± 99.6 vs 120.4 ± 66.1, P < .001). In logistic regression analysis, PLR (odds ratio [OR] 1.004, 95% confidence interval [CI] 1.001-1.007, P = .02), diabetes mellitus (OR 1.75, 95% CI 1.02-2.98, P = .03), and ST-segment depression on admission electrocardiogram (OR 1.68, 95% CI 1.00-2.81, P = .04) were independent pre...
Although statins have been shown to prevent contrast-induced acute kidney injury in patients with... more Although statins have been shown to prevent contrast-induced acute kidney injury in patients with acute coronary syndromes, the benefit of statins is not known for patients at high risk for nephropathy who undergo elective coronary angiography. Two hundred twenty consecutive statin-naive patients with chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m 2) who underwent elective coronary or peripheral angiography were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/ day; n [ 110) or no statin treatment (control group, n [ 110). Contrast-induced acute kidney injury was defined by an absolute increase in serum creatinine of ‡0.5 mg/dl or a relative increase of ‡25% measured 48 or 72 hours after the procedure. Contrast-induced acute kidney injury occurred in 15 patients (7.2%), 9 (8.5%) in the control group and 6 (5.8%) in the rosuvastatin group (p [ 0.44). The incidences of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) were similar between the two groups at follow-up. In conclusion, rosuvastatin did not reduce the risk for contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients who underwent coronary and peripheral vascular angiography.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014
We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on... more We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on the pathogenesis of atrial fibrillation (AF) developing after coronary artery bypass graft (CABG) surgery. In our prospective, single-center study, 118 patients who underwent elective isolated on-pump CABG surgery were included. Patients were divided into two groups according to the development of postoperative atrial fibrillation (POAF) as Group 1: Patients who developed POAF, and Group 2: Patients who remained in sinus rhythm. In addition to preoperative demographic, laboratory, echocardiographic, intraoperative, and postoperative clinical characteristics, levels of plasma total oxidative status (TOS) after placement and removal of aortic cross clamp (ACC) were compared between the two groups. Predictors of POAF were also investigated by multivariate logistic regression analysis. A comparison of preoperative demographic, laboratory, echocardiographic, and postoperative clinical charac...
Hyperglycemia on admission is associated with increased mortality rates in patients with ST-eleva... more Hyperglycemia on admission is associated with increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) who are treated with either fibrinolytic therapy (FT) or primary percutaneous coronary intervention (PCI). However, data regarding the relationship between hyperglycemia and the success of FT are lacking. The aim of this study was to investigate the value of admission blood glucose for the prediction of failed reperfusion following FT. This is a retrospective study of 304 STEMI patients who received FT and whose admission glucose levels were recorded. The main outcome measure was ST segment resolution ≥50 %. The median (interquartile range [IQR]) blood glucose level in the entire study group was 112 (95-153). In 92 (30.2 %) patients, FT was unsuccessful and rescue PCI was performed. Admission glucose (126 [99-192] vs. 110 [94-144] mg/dL, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), time from symptom onset to FT (180 [120-270] vs. 150 [120-180] min, p = 0.009), and maximum ST elevation amplitude (3 [2-7] vs. 3 [2-6] mm, p = 0.05) were higher in the failed reperfusion group than in the reperfusion group. Admission hyperglycemia was an independent predictive factor for failed reperfusion (hazard ratio 4.79 [1.80-12.76], p = 0.002), along with time from symptom onset to fibrinolysis and anterior wall myocardial infarction. In patients with STEMI who undergo FT, admission hyperglycemia is an independent predictor of the failure of fibrinolysis.
Bicuspid aortic valve and the aorta Valve anatomy, aortic diameters at different levels, and pres... more Bicuspid aortic valve and the aorta Valve anatomy, aortic diameters at different levels, and presence and degree of valve dysfunction were analysed. Results: Of the 401 FDR recruited: 113 (28.1%) refused the study and 288 (71.9%) underwent screening (mean age: 36.1±19 years; 66.7% males). Twentyone aortic valve abnormalities were encountered: 20 BAV and 1 quadricuspid valve, distributed in 17 of the 90 families, yielding a BAV family prevalence of 18.8% (Table). BAV phenotype was not consistent among probands and positive FDR in 6 of the affected families (35.3%). The prevalence of BAV among the FDR screened was 7.3%, higher than that reported in the general population (0.5-1.0%). The number of FDR required to screen for identifying a new BAV case is 14, in contrast to 100 in the general population. Conclusions: The prevalence of BAV is higher in FDR of BAV patients than in the general population. Discordance between BAV phenotypes within the same family is not rare. Echocardiographic screening of FDR is a useful approach for identifying asymptomatic cases, and should therefore be offered to all FDR of BAV individuals.
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