Association between Systolic Pulmonary Artery Pressure and Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction.

Introduction: The objective of this study was to examine whether there is an elevated risk of developing contrast induced nephropathy (CIN) in patients with high systolic pulmonary artery pressure (SPAP) in ST-segment elevation myocardial infarction (STEMI). Methods: A total of 213 patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention were enrolled in the study. The patients were stratified into two groups based on the presence of CIN. Comparisons between these groups included an assessment of demographic characteristics, laboratory findings, and risk factors. SPAP was calculated for each patient upon admission through echocardiography, and subsequent comparisons were performed between the groups. Results: The distribution of the study population was as follows: 33 (15.5%) were CIN(+) and 180 (84.5%) were CIN(-). SPAP [odds ratio (OR) = 1.295, 95% confidence interval (CI): 1.157-1.451, p < 0.001], and diabetes (OR = 1.241, 95% CI: 1.194-1.287, p = 0.013) were identified as independent factors associated with CIN development. In receiver operating characteristic curve analysis, SPAP above a cut-off level of 31.5 mmHg could determine the presence of CIN with a sensitivity of 91.0% and specificity of 90.0% (p < 0.001). Conclusions: SPAP on echocardiography is an independent predictor of the development of CIN in patients with STEMI. Its ease of calculation renders it a valuable tool for predicting CIN among STEMI patients.

Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome.

BACKGROUND: Early diagnosis of non-ST elevation acute coronary syndrome (NSTE-ACS) and prediction of the severity of current coronary artery disease (CAD) play a major role in patient prognosis. Electrocardiography has a unique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between P wave peak time (PWPT) and the severity of CAD in patients with NSTE-ACS. METHODS: A total of 132 consecutive patients (female: 35.6%; mean age: 60.1 ± 11.6 years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the P wave, and R wave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the R wave. RESULTS: There were 59 (44.6%) patients in the high-GS group (GS ≥25 ) and 73 (55.3%) patients in the low-GS group (GS <25 ). Presence of diabetes mellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of a high GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p = 0.573). CONCLUSION: The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.

Is the use of ACE inb/ARBs associated with higher in-hospital mortality in Covid-19 pneumonia patients?

INTRODUCTION: The present research aimed to determine the relation between the use of angiotensin-converting enzyme inhibitors (ACE inh) and angiotensinogen receptor blockers (ARBs) and in-hospital mortality of hypertensive patients diagnosed with Covid-19 pneumonia. MATERIAL AND METHOD: In this retrospective study, we included 113 consecutive hypertensive patients admitted due to Covid-19 infection. In all patients, Covid-19 infection was confirmed with using reverse-transcription polymerase chain reaction. All patients were on ACE inh/ARBs or other antihypertensive therapy unless no contraindication was present. The primary outcome of the study was the in-hospital all-cause mortality. RESULTS: In total, 113 hypertensive Covid-19 patients were included, of them 74 patients were using ACE inh/ARBs. During in-hospital follow up, 30.9% [n = 35 patients] of patients died. The frequency of admission to the ICU and endotracheal intubation were significantly higher in patients using ACE inh/ARBs. In a multivariable analysis, the use of ACE inh/ARBs was an independent predictor of in-hospital mortality (OR: 3.66; 95%CI: 1.11-18.18; p= .032). Kaplan-Meir curve analysis displayed that patients on ACE inh/ARBs therapy had higher incidence of in-hospital death than those who were not. CONCLUSION: The present study has found that the use of ACE inh/ARBs therapy might be associated with an increased in-hospital mortality in patients who were diagnosed with Covid-19 pneumonia. It is likely that ACE inh/ARBs therapy might not be beneficial in the subgroup of hypertensive Covid-19 patients despite the fact that there might be the possibility of some unmeasured residual confounders to affect the results of the study.

Relationship between paroxysmal atrial fibrillation and a novel electrocardiographic parameter P wave peak time.

OBJECTIVE: The aim of this study was to compare the relationship between a novel electrocardiographic (ECG) parameter P wave peak time (PWPT) and classic P wave parameters with atrial fibrillation (AF). METHODS: A total of 140 individuals, including 70 patients with AF history and 70 healthy individuals without AF as the control group were included in the study. These groups were compared in terms of demographic characteristics, laboratory findings and ECG parameters. P wave parameters including; PR interval, P wave dispersion(PWDIS), P wave max duration(PWD) abnormal P wave axis, P-wave terminal force in lead V1 and a novel parameter PWPT were calculated from a 12-lead surface ECG recorded in all patients during sinus rhythm. RESULTS: PR duration, PWDIS, PWD and PWPT in lead V1 and D2 were found to be longer in AF group compared to the control group. The presence of a P-terminal force in lead 1(V1TF) > 0.04 mm/s and abnormal P wave axis were shown to be significantly more frequent in the AF group. Univariate and multivariate regression analyses revealed independent relationship between the PWPT in lead V1 and AF(OR: 1.09, CI:1.01-1.17, p:0.024). In ROC curve analysis PWPTV1 above a cut-off level of 49.5msc predicted AF with a sensitivity of 79.4% and a specificity of 56.3% (Area Under Curve(AUC): 0.737, p < 0.001). CONCLUSION: In this study, we observed that PWPTV1 is longer in patients with paroxysmal AF than in controls.

Is Fasting for Ramadan Safe in Patients with Mechanical Cardiac Valves?

BACKGROUND AND AIM OF THE STUDY: The study aim was to investigate the safety and effects of fasting during Ramadan on the International Normalized Ratio (INR) in patients with mechanical cardiac valves. METHODS: A total of 105 patients admitted to the authors' hospital between June and October 2015, who had history of prosthetic valve replacement, was investigated. The patients were allocated to two groups: those fasting during Ramadan (n = 42) and those not fasting (n = 63). All patients were examined by a cardiologist, and the clinical findings and complaints for the past three months were evaluated. The INR, complete blood count (CBC) and a basic biochemical panel were monitored for all patients. RESULTS: The mean corpuscular volume (MCV) of the fasting group was significantly higher than that of the non- fasting group (87.59 ± 6.39 (µm3) versus 84.28 ± 6.387 (µm3); p = 0.011). Other CBC parameters and basic biochemical values did not differ significantly different between groups. Neither were significant differences noted in INR values during Ramadan (fasting group 2.87 ± 0.97; non-fasting group 2.73 ± 0.78; p = 0.50) and at routine control one month later (fasting group 3.07 ± 1.55; non-fasting group 2.94 ± 1.03; p = 0.601). No significant differences related to increased rates of hospitalization, valvular dysfunction on echocardiography, thrombus, embolism, bleeding and clinical complaints were identified between the groups. CONCLUSIONS: Fasting during Ramadan had no adverse effects on the INR of patients, and appears to be safe for patients with mechanical prosthetic cardiac valves.

The relationship between fragmentation on electrocardiography and in-hospital prognosis of patients with acute myocardial infarction.

BACKGROUND: In patients with acute ST elevation myocardial infarction (STEMI), QRS fragmentation was determined as one of the indicators of mortality and morbidity. The development of fragmented QRS (fQRS) is related to defects in the ventricular conduction system and is linked to myocardial scar and fibrosis. MATERIAL AND METHODS: We prospectively enrolled 355 consecutive patients hospitalized in the coronary intensive care unit of our hospital with STEMI between the years 2010 and 2012 and their electrocardiographic features and the frequency of in-hospital cardiac events were evaluated. RESULTS: There were 217 cases in the fQRS group and 118 cases in the control group. QRS fragmentation was found to be a predictor for major cardiac events. In the fragmented QRS group, the frequency of in-hospital major cardiac events (MACE) and death were higher (MACE p<0.001; death p<0.003). In the fragmented QRS group, the cardiac enzymes (Troponin-I, CK-MB) were significantly higher than in the control group (p<0.001). In subgroup analyses, apart from the presence of fragmentation, the presence of more than 1 type of fragmentation and the number of fragmented deviations were also found to be related with MACE. A significant negative correlation was observed with the ejection fraction and, in particular, the number of fragmented deviations. CONCLUSIONS: Fragmented QRS has emerged as a practical and easily identifiable diagnostic tool for predicting in-hospital cardiac events in acute coronary syndromes. Patients who present with a fragmented QRS demonstrate increased rates of major cardiac events, death risk, and low ejection fraction. In patients with STEMI, the presence of fQRS on the ECG and number of fQRS derivations are a significant predictor of in-hospital major cardiac events.

Relationship between adiponectin and copeptin levels with long-term cardiovascular mortality in ST-segment elevation myocardial infarction after percutaneous coronary intervention.

OBJECTIVE: The aim of this study was to determine adiponectin and copeptin levels that might be prognostic for cardiovascular mortality (CvsM) in ST-segment elevation myocardial infarction (STEMI) patients who had percutaneous coronary intervention (PCI). METHODS: Patients who underwent PCI between November 2010 and April 2011 were enrolled and followed for more than eight years. The baseline, demographic and angiographic findings, in-hospital follow up, laboratory results including adiponectin and copeptin levels, and echocardiographic data of the patients were evaluated. RESULTS: There were 78 males and 20 females. The CvsM rate was 26.66% at 112 months of follow up. Some factors were significantly related to CvsM and adiponectin level was an independent predictor of mortality. A cut-off value of ≥ 8 950 ng/ml for adiponectin and ≥ 7.41 ng/ml for copeptin was related to a 3.01- and 2.83-times higher CvsM risk, respectively. CONCLUSION: Adiponectin level was a predictor for CvsM. Higher levels of adiponectin and copeptin could predict a higher risk of CvsM in STEMI patients.

The relationship between CHA2DS2VASc score and left ventricular apical thrombus formation in patients with acute anterior ST segment elevation myocardial infarction.

BACKGROUND: Left ventricular apical thrombus (LVAT) formation is a well-known complication of acute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has been used to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation. This score has also been used for other clinical conditions. The aim of this study was to investigate the relationship between CHA2DS2VASc score and development of LVAT in patients with AMI. METHOD: The study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography. RESULTS: The incidence of the LVAT was 8.5% (n = 32) during a mean follow-up time of 233.1 ± 66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT compared to patients in the control group (3.1 ± 1.9 vs. 1.9 ± 1.2, p < 0.001). In Cox regression analysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence of LV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of these parameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p < 0.001 for all). CONCLUSION: High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

Management of patients with drug-induced atrioventricular block.

OBJECTIVE: To identify the frequency of atrioventricular (AV) conduction improvement after discontinuation of the culprit drug in patients with AV block. BACKGROUND: AV blockers are considered as reversible causes of AV block that do not require pacemaker (PM) implantation. However, controversial reports declared that a major part of these drug-induced AV blocks are persistent or recurrent. METHODS: Of 668 consecutive patients with symptomatic type II second- or third-degree AV block, 2:1 AV block, atrial fibrillation, and bradyarrhythmia, 108 patients (62 patients enrolled prospectively) using AV blockers without myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope were enrolled into the present study. The level of AV block (AV-nodal or infranodal) was defined according to electrocardiographic characteristics. RESULTS: The most frequent culprit medications were ß-blockers followed by digoxin. Drug discontinuation was followed by resolution of AV block in 72% of cases, whereas spontaneous resolution of AV block occurred in only 6.6% of patients who had AV block in the absence of medications. However, 27% of patients with improved AV conduction experienced a recurrence of AV block despite discontinuation of the culprit drug. Twenty-one of 24 carvedilol-induced AV blocks resolved after discontinuation of the drug and never recurred, whereas 24 of 36 metoprolol-induced AV blocks persisted or recurred. A digoxin-induced AV block usually improved (28 of 39) after withdrawal of the drug. Roughly half of the patients with drug-induced AV block underwent permanent PM implantation. CONCLUSION: Drug-induced AV block is a serious disease that requires a permanent PM for almost half of the patients.

Orthognathic surgery of a patient with oligodontia: alternative technique for intermaxillary fixation.

Oligodontia may cause various problems during orthognathic surgery because it may be difficult to fix the surgical guide splints. The aim of this clinical report was to present an alternative technique for intermaxillary fixation of a patient with oligodontia and facial deformity. A 20-year-old male patient, whose 8 maxillary and 11 mandibular teeth were congenitally missing, was treated using bimaxillary orthognathic surgery. Before the surgical approach, fixed mandibular prosthesis containing pins on the vestibule sides of the crowns was constructed to provide anchorage for intermaxillary splint and to achieve occlusal stability and vertical dimension during the surgery. This prosthesis was also used to hang intraoral elastics during the postoperative orthodontic treatment. At the end of treatment, these pins were cut, composite restoration material was applied to camouflage the places of the pins, and the patient continued to use this prosthesis. The patient gained an appropriate facial aesthetics and oral function using multidisciplinary approach.

The relationship between H2FPEF score and contrast induced nephropathy in patients with ST elevation myocardial infarction.

Introduction: In the present study, we aimed to investigate the relationship between H2FPEF score and Contrast Induced Nephropathy (CIN) in patients with myocardial infarction with ST segment elevation (STEMI). Methods: A total of 355 patients who had been diagnosed with ST elevation-myocardial infarction and undergone primary coronary angioplasty were retrospectively included in the study. The patients were divided into two groups according to the presence of CIN and these groups were compared in terms of baseline characteristics and laboratory findings. The H2FPEF score was calculated for each patient on admission and later compared between the groups. Results: The distribution of the study population was as following: 63 (17.7%) CIN (+) and 292 (82.2%) CIN (-). In CIN (+) group, the mean H2FPEF Score (2.00±1.60 vs 1.25±1.26, P<0.001) was significantly higher than the CIN (-) group. H2FPEF Score (OR: 1.25, 95%CI: 1.01-1.55), and mean age (OR: 1.03, 95%CI: 1.00-1.06) were found to be independently associated with CIN development. Conclusion: H2FPEF score is an independent predictor of CIN development in patients with acute STEMI. It is easily calculated and and may be used to estimate the CIN in STEMI patients.

The Association of a PRECISE-DAPT Score With No-Reflow in Patients With ST-Segment Elevation Myocardial Infarction.

This study aimed to evaluate the association of admission PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score with the development of no-reflow (NR) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). In this observational, retrospective study, 335 consecutive STEMI patients who were treated with primary PCI were included. We classified the study population into 2 groups: patients with a PRECISE-DAPT score <25 and those with a PRECISE-DAPT score ≥25. Overall, 30 (8.9%) patients developed NR. The mean PRECISE-DAPT score (20.03 ± 15.32 vs 11.33 ± 12.18; P = .005) was significantly higher in cases who developed NR. Moreover, arrhythmic complications, in-hospital shock, and in-hospital mortality rates were significantly higher in patients with a PRECISE-DAPT score ≥25 compared to those with a PRECISE-DAPT score <25. According to a multivariable analysis, the PRECISE-DAPT score was found to be independently linked with NR (odds ratio: 2.87, with P = .015). To our knowledge, these data are the first in major medical science databases to determine the relationship between the PRECISE-DAPT score and the NR phenomenon in patients with STEMI undergoing primary PCI.

Volumetric Evaluation of Pharyngeal Airway after Functional Therapy.

The aim of this study was to evaluate three-dimensional (3D) effects of Twin-block functional appliance (TB) on the pharyngeal airway by using cone beam computed tomography (CBCT). A total of 30 patients (14 females, 16 males; mean age 12.50 ± 1.23 and 12.83 ± 1.17 years, respectively) with skeletal Class II malocclusion were included in this study and were treated with TB. On the pretreatment (T1) and posttreatment (T2) CBCT scans, volumetric changes in the pharyngeal airway; SNA, SNB, and ANB angles; and bilateral effective mandibular (Co-Gn) and midfacial length (Co-A) were also evaluated. The statistical differences were accessed by Wilcoxon signed-rank tests, and Mann-Whitney U tests were used to analyze the scores of male and female subjects. In this study, an increase was observed in SNB and Co-Gn (p < 0.01) while a decrease in ANB and SNA (p < 0.01 and p < 0.05, respectively) was found. However, increase in midfacial length was not statistically significant (p > 0.05). In the evaluation of volumetric pharyngeal airway changes, statistically significant increases (p < 0.01) in the upper and lower division and total airway volume were determined. Gender differences were insignificant for all measurements (p > 0.05). Volumetric changes in the pharyngeal airway after functional therapy can be successfully evaluated by CBCT images. The anterior repositioning of the mandible by TB increases the mandibular length and pharyngeal airway volume in patients with retrognathic mandible.

Three-Dimensional Evaluation of Soft Tissue Changes after Functional Therapy.

This study was aimed at proposing a three-dimensional (3D) evaluation method for the soft tissue effects of Twin Block (TB) functional appliance therapy by using cone beam computed tomography (CBCT) images. In this retrospective study, a total of 60 pre- and posttreatment (T0 and T1) CBCT images of Class II patients with mandibular retrognathia treated with a TB appliance were used. Volumetric and linear soft tissue changes were evaluated quantitatively with 3D measurements and qualitatively with color mapping visual. Linear (NV-A and NV-Pog) and angular (SNA, SNB, and ANB) skeletal changes were also measured on 3D images. The Wilcoxon signed-rank test was used to compare statistical differences, and the scores of male and female participant differences were observed with the Mann-Whitney U test. In this study, a decrease was observed in SNA (p < 0.05), ANB (p < 0.01), and NV-Pog (p < 0.05) while an increase in SNB (p < 0.01) was found. However, decrease in NV-A distance was not statistically significant (p > 0.05). As a result of the evaluation of soft tissue changes, while the anterior reposition of the lower lip, soft tissue pogonion, and soft tissue gnathion was found to be significant (p < 0.01, p < 0.01, and p < 0.05, respectively), the upper lip and subnasale repositions were not statistically significant (p > 0.05). 3D soft tissue changes after TB therapy can be evaluated quantitatively and qualitatively by using CBCT images. Anterior repositioning of the mandible with functional therapy also provides improvement in soft tissue profile, especially in the lower facial region.

The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction.

BACKGROUND: The Synergy between Percutaneous Coronary Intervention (SYNTAX) score, has been used to estimate the extent and complexity of coronary artery disease (CAD). The H2FPEF score enables robust discrimination of heart failure with preserved ejection fraction (HFpEF) from non-cardiac aetiologies of dyspnea. In the present study, we aimed to investigate the relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). METHOD: Two hundred eighty two consecutive patients with NSTEMI who underwent coronary angiographic examination were enrolled in this study. The H2FPEF score was calculated for each patient on admission. All patients underwent coronary angiography within 2 days following their admission. The SYNTAX scoring system was used to evaluate the severity and extent of CAD. RESULTS: The mean H2FPEF Score [3(2-4) vs 1(0.5-1.5), p < .001] and the frequencies of diabetes mellitus, hypertension and, atrial fibrillation were significantly higher and LVEF was significantly lower in patients with high SYNTAX score. High H2FPEF Score (OR: 3.61, 95%CI: 2.64-4.93; p = .001) and low left ventricular ejection fraction (OR: 0.94, 95%CI: 0.89-0.98; p = .013) were found to be independent associates for high SYNTAX score. H2FPEF Score above a cut-off level of 2.5 predicted high SYNTAX score with a sensitivity of 80% and a specificity of 82.5% (AUC: 0.890; 95%CI: 0.848-0.931; p < .001). There was a significant and moderate positive correlation between H2FPEF and SYNTAX Scores (r = 0.694, p < .001). CONCLUSION: High H2FPEF score may be associated with high SYNTAX score and may be used to estimate the extent and complexity of CAD in NSTEMI patients.

Performance of neutrophil to lymphocyte ratio for the prediction of long-term morbidity and mortality in coronary slow flow phenomenon patients presented with non-ST segment elevation acute coronary syndrome.

Introduction: In this study, we aimed to determine if neutrophil to lymphocyte ratio could predict long term morbidity and mortality in patients who hospitalized for non-ST segment elevation acute coronary syndrome (NSTE-ACS) and had coronary slow flow on coronary angiography. Methods: In this observational study, 111 patients who presented with NSTE-ACS and diagnosed with coronary slow flow phenomenon on angiographic examination were included. Neutrophil to lymphocyte ratio (NLR) calculated as the ratio of the number of neutrophils to the number of lymphocytes. Patients classified into three groups according to NLR values. The term coronary slow flow phenomenon was depicted by calculating Thrombolysis in Myocardial Infarction frame count.Patients were followed up and the occurrence of recurrent angina, recurrent myocardial infarction, and long-term mortality was determined using medical records, phone calls, or face-to-face interviews. P values <0.05 considered to indicate statistical significance. Results: Recurrent angina and myocardial infarction occurred more frequently in the highest NLR tertile compared with middle and lowest NLR tertiles. High NLR group (NLR≥ 3.88 n=38) was significantly associated with younger age and smoking status. WBC, troponin I and CRP levels increased as the NLR tertile increased. Recurrent myocardial infarction and angina showed strong relationship with increasing NLR values. In multivariate regression analyses smoking and high NLR levels were independent predictors of recurrent myocardial infarction (HR:4.64 95%CI 0.95-22.52 P=0.04, HR: 1.48 95%CI 1.16-1.90 P<0.01 respectively) in the long term follow up. Conclusion: Our study demonstrated that high NLR values can be a valuable prognostic tool in the long term follow up of patients who presented with NSTE-ACS and diagnosed with slow flow phenomenon on coronary angiography.

The relationship between dual antiplatelet treatment (DAPT) score and saphenous venous grafts patency after coronary artery bypass grafting surgery.

BACKGROUND: Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. METHOD: This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 ± 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. RESULTS: Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823-0.924; p < 0.001). CONCLUSION: The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency.

[Primary percutaneous coronary intervention in patients admitted with cardiogenic shock and ST-elevation myocardial infarction: prognosis and predictors of in-hospital mortality]. / Kardiyojenik sokla basvuran ST yükselmeli miyokart enfarktüslü hastalarda primer perkütan koroner girisim: Prognoz ve hastane içi mortalitenin belirleyicileri.

OBJECTIVES: We investigated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients admitted with cardiogenic shock and ST-elevation myocardial infarction (STEMI). STUDY DESIGN: We reviewed 91 consecutive patients (66 males, 25 females; mean age 61 ± 11 years) treated with primary PCI for cardiogenic shock due to STEMI. All clinical, angiographic data, and in-hospital and long-term outcomes were collected. The patients were classified into two groups depending on the presence (n = 59, 64.8%) or absence (n= 32, 35.2%) of in-hospital mortality. RESULTS: Hospital nonsurvivors were older (mean age 62.7 ± 11.1 vs. 57.7 ± 11.4 years; p = 0.04) and exhibited higher frequencies of diabetes mellitus (DM), renal failure, and history of myocardial infarction. Multi-vessel disease (p = 0.004) and circumflex artery involvement (p = 0.03) were more frequent and the rates of tirofiban administration (p = 0.02) and stenting (p = 0.007) were lower in nonsurvivors. Procedural success rate was substantially lower in nonsurvivors (39% vs. 84.4%; p < 0.001). Of 32 survivors, cardiovascular mortality occurred in only three patients (9.4%) during a median follow-up of 26 months. In multivariate regression analysis, unsuccessful procedure (OR 7.2, 95% CI 1.77-29.27; p = 0.006) and DM (OR 3.92, 95% CI 1.13-13.62; p = 0.03) were the independent predictors of in-hospital mortality. CONCLUSION: Mortality rate is considerably higher and successful procedure yields a two-fold decrease in in-hospital mortality in patients with cardiogenic shock complicated by STEMI. Unsuccessful procedure and DM represent as two independent predictors of in-hospital mortality.

[Efficacy and outcome of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction due to saphenous vein graft occlusion]. / Safen ven greft tikanikligi nedeniyle ST yükselmeli miyokart enfarktüsü gelisen hastalarda primer perkütan koroner girisimin etkinligi ve sonuçlari

OBJECTIVES: We evaluated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) due to saphenous vein graft (SVG) occlusion. STUDY DESIGN: We reviewed 2,646 consecutive patients (mean age 56.6±11.8 years) who underwent primary PCI for STEMI between 2003 and 2009. All clinical and angiographic data and in-hospital and long-term (median 22 months) outcomes were retrospectively collected. The patients were classified into two groups based on the lesions treated with primary PCI, i.e., native vessels (n=2,625) and SVG (n=21). RESULTS: Compared to patients with occluded native vessels, patients with SVG occlusion had significantly higher rates of coronary bypass operation (100% vs. 2.3%, p<0.001), previous myocardial infarction (52.4% vs. 10.8%, p<0.001), and diabetes mellitus (52.4% vs. 25.1%, p=0.002), but lower frequency of anterior myocardial infarction (9.5% vs. 49.3%, p<0.001). Tirofiban use (71.4% vs. 48.2%, p=0.01) and three-vessel disease (81% vs. 25.6%, p<0.001) were significantly more common in the SVG group. The rate of successful primary PCI was lower in SVG occlusions compared to native vessels (61.9% vs. 84.7%, p=0.01). The two groups did not differ significantly with respect to in-hospital and long-term cardiovascular events and mortality (p>0.05). In multivariate logistic regression analysis, application of PCI to SVG was found to be an independent predictor for unsuccessful procedure (OR 6.76, 95% CI 2.05-22.21; p=0.002). CONCLUSION: Although the success rate of primary PCI in SVG lesions was lower compared to native vessels, this did not have an adverse effect on postprocedural cardiovascular events and mortality in patients presenting with STEMI.

Effect of heroin on right ventricular cardiac performance.

OBJECTIVE: The aim of this study was to investigate the effects of heroin addiction, which is an important social and health problem, on right cardiac function. METHODS: A total of 85 individuals were included in the study. The study group comprised 45 patients smoking heroin and the control group was 40 healthy individuals with no drug addiction. Patients injecting heroin were excluded. Echocardiographic evaluation of patients using heroin was performed and compared with those in the control group. RESULTS: The right ventricle and pulmonary artery diameters in the heroin group were found to be higher compared to the control group. The myocardial performance index (MPI) was higher and more abnormal in the heroin group (0.48 ± 0.22 vs 0.39 ± 0.11, p < 0.05) whereas isovolumic acceleration (IVA) of the right ventricle was significantly lower in the heroin group (2.92 ± 0.69 vs 3.4 ± 0.68 m/s2, p < 0.01). No significant difference was observed between the groups with regard to the right ventricular ejection fraction (RVEF) (59.6 ± 2.5 vs 60.6 ± 2.3%, p = 0.08), tricuspid annular plain systolic excursion (TAPSE) (24.1 ± 4.2 vs 24.5 ± 2.4 mm, p = 0.7), tissue Doppler imaging S wave (TDI-S) (13.7 ± 2.1 vs 13.8 ± 2.1 cm/s, p = 0.86) and right ventricular fractional area change (RVFAC) (42.7 ± 8.3 vs 43.9 ± 3.5%, p = 0.4). Multivariate and univariate regression analyses revealed independent correlation between the pulmonary artery diameter and RVIVA, and heroin addiction. CONCLUSIONS: Heroin addiction negatively affected right ventricular function and more attention should be paid to the cardiac function of these patients.