Comparative Analysis of Angiographic Parameters and Percutaneous Coronary Intervention Outcomes in Diverse Populations in Türkiye.

OBJECTIVE: Due to the conflict in Syria since 2011, more than 3.5 million Syrian citizens reside in Türkiye. Because Syrian patients were underrepresented in previous studies on percutaneous coronary intervention (PCI) outcomes, we aimed to analyze the severity of coronary artery disease and in-hospital outcomes of PCI in this population. METHODS: We retrospectively analyzed 142 Syrian patients who underwent PCI at our center between June 2020 and October 2022 and compared the data with that of age- and sex-matched Turkish patients (n = 271) who also underwent PCI. We assessed comorbidities, coronary anatomy features, procedural complications, and in-hospital cardiovascular outcomes (Major Adverse Cardiac and Cerebrovascular Events, MACCE). RESULTS: The mean age of the study population was 57 ± 12 years, with 15% being female. Clinical indication and coronary anatomy features did not differ between the groups. However, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was higher in Syrian patients compared to Turkish patients (16 [11-22] vs. 12 [8-20]; P < 0.001). Complex PCI rates, in-hospital bleeding and contrast nephropathy were similar in both groups. MACCE was comparable between Syrian and Turkish patients (13 [4.8%] vs. 13 [9.2%], P = 0.083). CONCLUSION: Comparable MACCE rates were observed in both ethnic groups undergoing PCI, despite a higher SYNTAX score in Syrian patients. Future research should investigate whether similar in-hospital MACCE rates are observed in other regions of Türkiye and whether long-term cardiovascular outcomes differ between Turkish and Syrian patients.

Thromboembolic risk scores in patients with non-obstructive coronary architecture with and without coronary slow flow: A case-control study.

AIM: Coronary slow flow phenomenon (CSFP) detected on coronary angiography (CA) has been related to poor prognosis. We sought to examine the relationship between thromboembolic risk scores, routinely used in cardiology practice, and CSFP. METHODS: This single-center, retrospective, case-control study comprised 505 individuals suffering from angina and had verified ischemia between January 2021 and January 2022. Demographic and laboratory parameters were obtained from the hospital database. The following risk scores were calculated; CHA2DS2-VASc, M-CHA2DS2-VASc, CHA2DS2-VASc-HS, R2-CHA2DS2-VASc, M-R2-CHA2DS2-VASc, ATRIA, M-ATRIA, M-ATRIA-HSV. The overall population was divided into two groups; coronary slow flow and coronary normal flow. Multivariable logistic regression was performed to compare risk scores between patients with and without CSFP. Pairwise comparisons were then undertaken to test performance in determining CSFP. RESULTS: The mean age was 51.7 ± 10.7 years, of whom 63.2% were male. CSFP was detected in 222 patients. Those with CSFP had higher rates of male gender, diabetes, smoking, hyperlipidemia, and vascular disease. All scores were higher in CSFP patients. Multivariable logistic regression analysis found that CHA2DS2-VASc-HS score was the most powerful determinant of CSFP among all risk schemes (for each one-point increase in score OR = 1.90, p < 0.001; for score of 2-3 OR = 5.20, p < 0.001; for score of >4 OR = 13.89, p < 0.001). Also, the CHA2DS2-VASc-HS score provided the best discriminative performance, with a cut-off value of ≥2 in identifying CSFP (AUC = 0.759, p < 0.001). CONCLUSION: We showed that thromboembolic risk scores may be associated with CSFP in patients with non-obstructive coronary architecture who underwent CA. The CHA2DS2-VASc-HS score had the best discriminative ability.

Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study.

Mitral valve aneurysms (MVAs) are rarely encountered in echocardiography laboratories. Although they are commonly associated with endocarditis of the aortic valve, various mechanisms have been suggested for the etiopathogenesis of MVAs associated with non-infectious conditions. 5,887 patients who underwent transesophageal echocardiography (TEE) between 2007 and 2012 were evaluated retrospectively for MVA. Mitral valve aneurysm is defined as a localized saccular bulging of the mitral leaflet towards the left atrium with systolic expansion and diastolic collapse. The color flow Doppler image of a perforation was described as a high-velocity turbulent jet traversing a valve leaflet in systole. We found that 12 of 5,887 patients (0.204 %) had MVA in TEE examinations. The mean age of patients with MVA was 53 years (range 21-80 years), including four females and eight males. Nine patients presented with symptoms of endocarditis. On TEE, aneurysms were located in the anterior mitral leaflet in 11 patients, and in the posterior mitral leaflet in one patient. Eight patients had severe, three had moderate, and one had trace mitral regurgitation. Of the nine patients with perforated leaflets, eight patients had severe and one patient had moderate mitral regurgitation. Aortic regurgitation was present in nine patients, being severe in three, moderate in two, mild in two, and trace in two patients. Two patients without severe mitral regurgitation were followed-up conservatively, while nine patients underwent surgery. Two patients died from septic shock, one in the postoperative period and the other one prior to surgery. Although MVAs occur during the course of aortic valve endocarditis and, in particular, due to aortic regurgitation jet, it should be borne in mind that they may develop as an isolated valvular pathology and may be misdiagnosed as chordal rupture, other cardiac masses, or vegetation. Thus, MVAs may not be so infrequent as they are thought; they may justify to be considered in the differential diagnosis of masses seen on the mitral valve on echocardiographic examination.