Endocarditis-TR: Diagnosis, treatment, and prognosis of the infective endocarditis patients admitting tertiary centres of Turkey.

BACKGROUND: Infective endocarditis (IE) is still a significant cause of morbidity and mortality among cardiovascular diseases. ENDOCARDITIS-TR study aims to evaluate the compliance of the diagnostic and therapeutic methods being used in Turkey with current guidelines. METHODS: The ENDOCARDITIS-TR trial is a multicentre, prospective, observational study consisting of patients admitted to tertiary centres with a definite diagnose of IE. In addition to the demographic, clinical, microbiological, and echocardiographic findings of the patients, adverse events, indications for surgery, and in-hospital mortality were recorded during a 2-year time interval. RESULTS: A total of 208 IE patients from 7 tertiary centres in Turkey were enrolled in the study. The study population included 125 (60.1%) native valve IE (NVE), 65 (31.3%) prosthetic IE (PVIE), and 18 (8.7%) intracardiac device-related IE (CDRIE). One hundred thirty-five patients (64.9%) were culture positive, and the most frequent pathogenic agent was methicillin-susceptible Staphylococcus aureus (MSSA) (18.3%). Among 155 (74.5%) patients with an indication for surgery, only 87 (56.1%) patients underwent surgery. The all-cause mortality rate was 29.3% in-hospital follow-up. Multivariable Cox regression analysis revealed that absence of surgery when indicated (HR: 3.29 95% CI: 0.93-11.64 p = 0.05), albumin level at admission (HR: 0.46 95% CI: 0.29-0.73 P < 0.01), abscess formation (HR: 2.11 95% CI: 1.01-4.38 p = 0.04) and systemic embolism (HR: 1.78 95% CI: 1.05-3.02 p = 0.03) were ascertained independent predictors of in-hospital all-cause mortality. DISCUSSION: The short-term results of the ENDOCARDITIS-TR trial showed the high frequency of staphylococcal IE, relatively high in-hospital mortality rates, shortage of surgical treatment despite guideline-based surgical indications and low usage of novel imaging techniques. The results of this study will provide a better insight to physicians in respect to their adherence to clinical practice guidelines.

The established electrocardiographic classification of anterior wall myocardial infarction misguides clinicians in terms of infarct location, extent and prognosis.

BACKGROUND: The currently used scheme for the classification of infarct location and extent in anterior myocardial infarction (MI) is intuitive rather than being evidence-based, and recent evidence suggests that it may be misleading both in anatomic and prognostic sense. MATERIAL AND METHODS: Consecutive patients with the diagnosis of anterior MI were enrolled. All electrocardiograms (ECG) were first classified according to established scheme and then reassessed using newer criteria for angiographic site of occlusion. The site of left anterior descending (LAD) occlusion was determined using multiple angiographic views. Clinic, echocardiographic and angiographic outcomes were compared. RESULTS: A total of 379 anterior MI cases were enrolled, final study population consisted of 267 patients. The established scheme did not predict infarct size or adverse outcomes. Location of the myocardium subtended by the occluded coronary network did not match with the anatomic location as ECG classification implies. Many high-risk patients with proximal LAD were classified as "anteroseptal", whereas the majority of the patients labeled as "extensive anterior MI" had in fact distal occlusions. On the other hand, expert interpretation was fairly accurate in predicting adverse outcomes and the site of angiographic involvement. CONCLUSION: Classifying patients according to the established scheme neither gives prognostic information nor accurately localizes infarction. It should be regarded as obsolete and its use should be abandoned. Instead, the extent of infarction can be inferred from newer criteria provided by the angiographic correlation studies.

Predictors of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) remains as an unresolved condition causing high morbidity and mortality despite advances in medical treatment and coronary intervention procedures. In the current study, we evaluated the predictors of in-hospital mortality of STEMI complicated with CS. METHODS: In this retrospective study, we evaluated the predictive value of baseline characteristics, angiographic, echocardiographic and laboratory parameters on in-hospital mortality of 319 patients with STEMI complicated with CS who were treated with primary percutaneous coronary intervention. Patients were divided into two groups consisting of survivors and non-survivors during their index hospitalisation period. RESULTS: The mortality rate was found to be 61.3% in the study population. At multivariate analysis after adjustment for the parameters detected in univariate analysis, chronic renal failure, Thrombolysis In Myocardial Infarction (TIMI) post percutaneous coronary intervention (PCI) ≤2, plasma glucose and lactate level, blood urea nitrogen level, Tricuspid Annular Plane Systolic Excursion (TAPSE) and ejection fraction were independent predictors of in-hospital mortality. CONCLUSIONS: Apart from haemodynamic deterioration, angiographic, echocardiographic and laboratory parameters have an impact on in-hospital mortality in patients with STEMI complicated with CS.

ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

OBJECTIVE: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). METHODS: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). RESULTS: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). CONCLUSION: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

The prognostic significance of early and late right precordial lead (V4 R) ST-segment elevation in patients with acute anterior myocardial infarction.

BACKGROUND: The predictive significance of ST-segment elevation (STE) in lead V4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V4 R in patients with anterior STEMI. METHODS: A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V4 R STE (Group 1), early but not late V4 R STE (Group 2) and late V4 R STE (Group 3). RESULTS: In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < .001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p < .001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). CONCLUSION: Late V4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V4 R in patients with anterior STEMI has an important prognostic value.

A tale of two formulas: Differentiation of subtle anterior MI from benign ST segment elevation.

BACKGROUND: It may sometimes be difficult to differentiate subtle ST-segment elevation (STE) due to anterior myocardial infarction (MI) from benign variant (BV) STE. Recently, two related formulas were proposed for this purpose. However, they have never been tested in an external population. MATERIALS AND METHODS: Consecutive patients from May 2017 to January 2018, who were admitted with the diagnosis of acute anterior STEMI, were enrolled. Electrocardiograms were systematically reviewed and only subtle ones were included. First 200 consecutive patients with noncardiac chest pain were also enrolled as a control group. Relevant electrocardiographic parameters were measured. RESULTS: A total of 379 anterior MI and 200 BV-STE cases were enrolled during study period. A total of 241 patients in STEMI group were excluded for not matching subtleness criteria, four patients in control group were also excluded because of prior left-anterior descending artery intervention. The three-variable formula, with recommended cut-point of 23.5, had a sensitivity, specificity, and diagnostic accuracy of 73.9%, 86.7%, and 81.4%, respectively. The four-variable formula, with the published cut-point of 18.2, had a sensitivity, specificity, and diagnostic accuracy of 83.3%, 87.7%, and 85.9%, respectively. CONCLUSION: Three- and four-variable formulas with recommended cutoffs have a reasonable sensitivity, specificity, and diagnostic accuracy in differentiating subtle STEMI with BV-STE. Although both perform well, the four-variable formula has a higher sensitivity, specificity, and diagnostic accuracy and should be preferred.

An algorithm for the differentiation of the infarct territory in difficult to discern electrocardiograms.

BACKGROUND: In a minority of the patients presenting with ST-segment elevation (STE) myocardial infarction (MI), electrocardiogram (ECG) may show a balanced STE in both anterior and inferior lead groups and may cause diagnostic confusion about involved myocardial territory. In this study, we sought ECG clues which may facilitate discriminating (1) MI location and then (2) culprit artery in patients with difficult-to-discern ECGs. MATERIAL AND METHODS: Consecutive patients with the diagnosis of STEMI were scanned and patients with ECGs displaying both anterior and inferior STE were enrolled. ECGs with obvious ST elevation in either lead group and reciprocal ST-segment depression were excluded. Predictive power of several ECG variables has been analyzed and an algorithm has been constructed. RESULTS: A total of 959 STEMI cases were scanned, the final study population was consisted of 114 patients. Our algorithm for locating MI territory had a sensitivity, specificity, positive and negative predictive value of 72.1%, 92.5%, 91.7% and 74.2% for inferior versus anterior location, respectively (P < 0.001, φ = 0.652). As anterior MI was strictly reserved for left anterior descending (LAD) artery occlusion, these diagnostic values were also valid for discriminating circumflex artery [Cx]/right coronary artery [RCA] versus LAD as the culprit artery. In patients classified as having inferior MI, an STE in lead III greater than STE in lead II favored RCA over Cx as the culprit artery with a sensitivity, specificity, positive and negative predictive value of 97%, 46.6%, 80% and 87.5%, respectively (P < 0.001; φ = 0.544). CONCLUSION: Our algorithm can be used in difficult-to-discern ECGs for defining involved myocardial territory and culprit artery.

What is the predictive value of ST segment depression in inferior leads in first acute anterior myocardial infarction?

BACKGROUND: Electrical phenomenon and remote myocardial ischemia are the main factors of ST segment depression in inferior leads in acute anterior myocardial infarction (AAMI). We investigated the prognostic value of the sum of ST segment depression amplitudes in inferior leads in patients with first AAMI treated with primary percutaneous coronary intervention. (PPCI). METHODS: In this prospective analysis, we evaluated the in-hospital prognostic impact of the sum of ST segment depression in inferior leads on 206 patients with first AAMI. Patients were stratified by tertiles of the sum of admission ST segment depression in inferior leads. Clinical outcomes were compared between those tertiles. RESULTS: Univariate analysis revealed higher rate of in-hospital death for patients with ST segment depression in inferior leads in tertile 3, as compared to patients in tertile 1 (OR 9.8, 95% CI 1.5-78.2, p<0.001). After adjustment for baseline variables, ST segment depression in inferior leads in tertile 3 was associated with 5.7-fold hazard of in-hospital death (OR: 5.7, 95% CI 1.2-35.1, p<0.001). Spearman rank correlation test revealed correlation between the sum of ST segment depression amplitude in inferior leads and the sum of ST segment elevation amplitude in V1-6, L1 and aVL. Multivessel disease and additional RCA stenosis were also detected more often in tertile 3. CONCLUSION: The sum of ST segment depression amplitude in inferior leads of admission ECG in patients with first AAMI treated with PPCI provide an independent prognostic marker of in-hospital outcomes. Our data suggest the sum of ST segment depression amplitude to be a simple, feasible and clinically applicable tool for rapid risk stratification in patients with first AAMI.

Which admission electrocardiographic parameter is more powerful predictor of no-reflow in patients with acute anterior myocardial infarction who underwent primary percutaneous intervention?

BACKGROUND: Acute transmural ischemia due to left anterior descending artery (LAD) occlusion changes precordial R and Q wave durations owing to depressed intramyocardial activation. We investigated the prognostic value of sum of precordial Q wave duration/sum of precordial R wave duration ratio (Q/R) in patients with first acute anterior myocardial infarction (AAMI) treated with primary percutaneous coronary intervention (PPCI). METHODS: In this prospective analysis, we evaluated the no-reflow predictive value of Q/R on 403 patients with first AAMI. Patients were divided into two as no-reflow group (n=32) and control (n=371) group according to post-PPCI flow status. RESULTS: The patients in the no-reflow group had significantly higher Q/R on admission electrocardiography (ECG) compared to patients in the control group (p<0.001). When admission ECG parameters were compared according to no-reflow prediction, Q/R was stronger than other well-accepted parameters. The best cut-off value of the Q/R to predict no-reflow was 1.08 with 76% sensitivity and 73% specificity (AUC: 0.78; 95% CI: 0.72-0.83; p<0.001). CONCLUSION: In patients with first AAMI treated with PPCI, Q/R in admission ECG may have a role as an independent predictive marker of no-reflow.

A simple independent prognostic electrocardiography parameter in first acute anterior myocardial infarction; Precordial total Q wave/precordial total R wave.

BACKGROUND: We investigated the prognostic value of precordial total Q wave amplitude/precordial total R wave amplitude ratio (Q/R) in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PPCI). METHODS: We evaluated the in-hospital prognostic impact of Q/R on 354 patients with first acute anterior MI. Patients were stratified by tertiles of admission Q/R, clinical outcomes were compared between those groups. RESULTS: In-hospital univariate analysis revealed notably higher rates of in-hospital death for patients in tertile 3, as compared to patients in tertile 1 (OR 9.7, 95% CI 2.8-33.5, p. CONCLUSION: Q/R in admission ECG in patients with first acute anterior MI provide an independent prognostic marker of in-hospital outcomes.

An unexpected complication of acute pancreatitis: Intra-cardiac thrombus.

Left atrial thrombus after acute pancreatitis (AP) is a rare clinical statement. Because of induction of systemic prothrombotic process by AP; some patients with underlying risk factors may develop an intra-cardiac thrombus. We present a 53years-old-woman with moderate mitral stenosis and atrial fibrillation. However the patient was under warfarin treatment, she developed a big left atrial big thrombus which was originated from left atrial appendage after she was suffered from AP.

Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure.

BACKGROUND: Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. METHODS AND RESULTS: We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensin-converting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-B-type natriuretic peptide and troponin) versus enalapril. CONCLUSIONS: Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255.

The Predictive Value of Fragmented QRS and QRS Distortion for High-Risk Patients with STEMI and for the Reperfusion Success.

BACKGROUND: QRS fragmentation (fQRS) and QRS distortion were separately shown to be related to increased cardiovascular mortality and morbidity. To our knowledge, no study so far evaluated both parameters together in ST segment elevation myocardial infarction (STEMI). The main goal of our study is to find out if fQRS and QRS distortion can help us to determine high-risk STEMI patients, and the success of reperfusion. METHODS: Two hundred forty-eight eligible patients with acute STEMI that underwent coronary angiography consecutively between January 1, 2009, and July 1, 2011, were enrolled in this study. Twelve-lead electrocardiography (ECG) of the patients taken in the first 48 hours were analyzed. Patients with fQRS formed group 1, without fQRS formed group 2; with QRS distortion formed group 3, and without QRS distortion formed group 4. RESULTS: Group 1 have lower left ventricular ejection fraction (LVEF; P < 0.001), higher maximum troponin levels (P < 0.001), lower ST segment resolution (P < 0.001), more frequent proximal lesions (P < 0.001) when compared to group 2. Similar findings were observed in group 3 in comparison to group 4. Group 1 had also more frequent three vessels disease (P < 0.001), and higher rates of failed thrombolysis (P < 0.001). In-hospital mortality was found to be higher in group 1 and group 3. CONCLUSION: fQRS and QRS distortion may be useful for identifying patients at higher cardiac risk. fQRS can foresee thrombolytic therapy failure and three vessels disease whereas QRS distortion does not possess such quality. These findings may guide the physician deciding initial treatment modality in STEMI.

Diagnostic value of combining heart rate recovery and P-wave changes with exercise-induced changes in the ST segments for prediction of myocardial ischaemia.

BACKGROUND: In patients admitted to outpatient clinics with chest pain, changes in the ST-segments of electrocardiogram (ECG) readings are the most widely used criteria during treadmill ECG tests to determine myocardial ischaemia, despite its poor accuracy. In this study, we evaluated the benefit of combining elongation of P-wave duration (Pdur) and abnormal heart rate recovery (HRR) parameters in addition to changes in the ST-segments for the detection of myocardial ischaemia with treadmill ECG testing. METHODS: Patients (n = 369) with chest pain who underwent both a treadmill ECG test and myocardial perfusion scintigraphy (MPS) were enrolled. P-wave duration was measured at rest and at the end of the first minute of the recovery phase and elongation of the P-wave was calculated. Abnormal HRR was defined as the failure of a decreasing HR at the end of the first minute of the recovery phase >10% of the maximum HR reached during treadmill ECG testing. The sensitivity, specificity, positive and negative predictive values, diagnostic accuracy values, and likelihood ratios (LRs) of changes in the ST-segments, P-wave elongation, abnormal HRR, and the combination of these three variables for predicting myocardial ischaemia detected by MPS, were calculated separately-in patients without previous coronary artery disease (CAD) and in those with CAD. RESULTS: Elongation of Pdur by 20 ms or longer and abnormal HRR during treadmill ECG test were more common in patients with reversible perfusion defects in MPS than in those without perfusion defects (both P < 0.001). When patients were divided into two groups according to the presence or absence of a history of CAD, the addition of elongation of Pdur 20 ms and abnormal HRR to the development of significant changes in the ST-segments detected myocardial ischaemia with 46.7% sensitivity, 97.8% specificity, 67.2% negative predictive value, 88.9% positive predictive value, and 70% diagnostic accuracy in 77 patients with previous CAD. The LR+ of the combination of the three variables was 12.27. The addition of elongation of Pdur 20 ms and abnormal HRR to the development of significant changes in the ST-segments detected myocardial ischaemia with 52.7% sensitivity, 98.7% specificity, 89.9% negative predictive value, 90.6% positive predictive value, and 90% diagnostic accuracy in 292 patients without previous CAD. The LR+ of the combination of the three variables to detect myocardial ischaemia was calculated to be 41.48 in patients without a history of CAD. CONCLUSIONS: The addition of elongation of Pdur and abnormal HRR to the conventionally used criterion of changes in the ST-segments in patients with suspected myocardial ischaemia increased the specificity and positive and negative predictive values of treadmill ECG testing for detecting myocardial ischaemia, which might reduce the need for other expensive noninvasive techniques. The diagnostic utility of adding these two parameters was more obvious in patients with no history of CAD.

Rapid retraction of a post-infarction intramyocardial dissecting hematoma.

A 60-year-old male with a recent anterior myocardial infarction (MI) was referred to our hospital for implantable cardioverter defibrillator (ICD) implantation. He was on the 42nd day of MI and clinically stable on admission. Electrocardiography showed right bundle branch block with QS pattern on anterior leads. Transthoracic echocardiographic examination revealed an ejection fraction of 25% with akinesis of the apex and mid-apical segments of anterior and septal walls. In the apical-septal region, a pulsatile cavity with systolic expansion surrounded by a thin endomyocardial border was visualized. Color-Doppler interrogation did not demonstrate any flow within that structure. These findings suggested an intramyocardial dissecting hemorrhage formed after MI. Cardiac magnetic resonance imaging also confirmed an intramyocardial hematoma in the mid-apical anteroseptal region. A conservative approach was assumed as the patient was hemodynamically stable. The planned ICD implantation was postponed due to the high risk of perforation. Subsequently, oral anticoagulant therapy with warfarin was initiated against risk of intracardiac thrombus formation. The existing dual antiplatelet therapy was also continued. One week after hospital discharge, he was rehospitalized due to a very high INR of 6.3. The repeated transthoracic echocardiography revealed an almost complete resolution of the intramyocardial dissecting hematoma and adhesion of the surrounding myocardial layers. Oral anticoagulant therapy was discontinued. Echocardiographic examinations showed no change compared to the last examination during hospitalization. This case illustrates a conservatively managed intramyocardial dissecting hematoma case, in which anticoagulant and antiaggregant therapy yielded a rapid retraction without any complication.

Oral amiodarone and propranolol in maintenance therapy of postimplantation tachycardia: An observational study.

Left ventricular assist devices (LVADs) are widely used as end-stage therapy in patients with advanced heart failure, whereas implantation increases the risks of development of sustained ventricular tachycardia at the later postimplantation stage. Therefore, this study aimed to evaluate the clinical efficacy of orally administered amiodarone and propranolol in 3 patients with ventricular tachycardia (VT) after LVAD implantation who were resistant to initial anti-antiarrhythmic drugs. This retrospective cohort study consisted of the initial evaluation of the clinical data of 14 adult patients who underwent implantation of LVAD between January 2019 and March 2021. A total of 3 patients with resistant VT were finally included. In all cases, the patients were initially administered amiodarone in the different doses intravenously to stabilize the critical condition, whereas its oral form along with that of propranolol was used as maintenance therapy in the first 2 cases. In the third case, amiodarone was withdrawn because of the risk of development of hyperthyroidism, while oral propranolol was used in the treatment. The assessment in the 16-month follow-up period after discharge did not show presence of non-sustained and sustained VT in all 3 cases. In the ventricular arrhythmia-free group, the total mortality rate within the follow-up period was 11.1 ±â€…7.78 months in the 3 patients. We suggest that maintenance oral therapy of propranolol and amiodarone can significantly decrease the risks of complications in patients with VT after implantation of ventricular assist device in the long term.

[The role of angiotensin-receptor blockers in cardiovascular processes]. / Anjiyotensin reseptör blokerlerinin kardiyovasküler süreçteki yerleri.

Angiotensin-receptor blockers (ARBs) are frequently used in cardiology practice. Thanks to their potent antihypertensive effects, and lower side effect profiles, these drugs are well tolerated, and used for various indications in the field of cardiovascular medicine. This article summarizes clinical fields, and large-scale clinical studies where efficacy of ARBs has been demonstrated.

[The final situation in the Turkey "Stent for Life" project]. / Türkiye "Stent for Life" projesinde son durum.

OBJECTIVES: The Stent for Life (SFL) project's main mission is to increase the use of primary percutaneous coronary intervention (PCI) in more than 70% of all acute ST segment elevation myocardial infarction (STEMI) patients. Previous to the SFL project, thrombolysis was the dominant reperfusion strategy since a low percentage of acute STEMI patients had access to primary PCI in our country. In this study, we present the main barriers of access to primary PCI in the centers that were involved with the SFL project. STUDY DESIGN: Patients with acute STEMI admitted to the centers that were involved in the SFL project between 2009 and 2011 were included in the analysis. RESULTS: Since the inception of the SFL project, the primary PCI rate has reached over 90% in SFL pilot cities. In the last 5 years, the number of ambulances and emergency stations has increased. Since the collaboration with 112 Emergency Service, a great majority of cases were reached via the emergency medical system. The mean door-to-balloon time for the pilot cities was 54.72±43.66 minutes. CONCLUSION: After three years of the SFL project, primary PCI has emerged as the preferred reperfusion strategy for patients with STEMI in pilot cities.

[The evaluation of hypertensive patients who are supposedly under control according to office blood pressure measurements with ambulatuar blood pressure monitoring: an observational prospective study in three big cities (AKB3IL study)]. / Ofis ölçümleri ile kan basincinin kontrol altinda oldugu düsünülen hipertansiyonlu hastalarin ambulatuvar kan basinci monitörizasyonu ile degerlendirilmesi: Üç büyük ilde ileriye dönük gözlem çalismasi (AKB3IL çalismasi).

OBJECTIVES: The aim of the study is to evaluate hypertensive patients who are supposedly under control according to office blood pressure measurements with 24 hour ambulatuar blood pressure monitoring for determining their actual controlled hypertension rate. In addition, we investigate the adherence ratio of blood pressure measurements to current guidelines. STUDY DESIGN: Nine hundred-forty hypertensive patients supposedly under control according to office blood pressure measurements were enrolled in the study. Twenty-four hour ambulatuar blood pressure monitoring was performed on all of them. RESULTS: Actual controlled hypertension was determined in 617 (65.6%) patients whereas 323 (34.4%) patients had uncontrolled hypertension. The blood pressure measurements that were over threshold values were seen mostly at night and in the early morning during ambulatuar blood pressure monitoring. Nocturnal and early morning hypertension was determined in most of the patients who were supposedly under control according to office blood pressure measurements. This was especially true in patients with high cardiovascular risk such as diabetes mellitus, chronic kidney failure, and metabolic syndrome. CONCLUSION: Efficacy of antihypertensive therapy during 24 hour and the early morning period is essential for optimal risk modification.

[Heart failure prevalence and predictors in Turkey: HAPPY study]. / Türkiye'deki kalp yetersizligi prevalansi ve öngördürücüleri: HAPPY çalismasi

OBJECTIVES: The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor. STUDY DESIGN: 4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHA