Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye.

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

Door to Balloon Time of Non-ST Elevation Myocardial Infarction May be Reconsidered According to Systemic Immune-Inflammation Index.

Aim    Early diagnosis and treatment is very important in acute coronary syndromes (ACS). Previous studies showed that not all non-ST elevation myocardial infarction (NSTEMI) patients should be considered and treated in the same way. The systemic immune-inflammation index (SII), which is an easily accessible, rapidly computed, and cost-effective parameter, was evaluated in this study to determine the optimal intervention time for NSTEMI.Material and methods    469 patients diagnosed with ACS were included to the study. STEMI and NSTEMI patients were compared according to their SII. Univariate and binary logistic regression analysis were performed to determine which parameters have a significant effect on the discrimination of types of myocardial infarction.Results    The mean age of the patients was 61.43±11.52 yrs, and 348 (74.2 %) were male. NSTEMI patients with an SII value higher than 768×109 / l may be assumed to be STEMI (p<0.001). Univariate analysis and binary logistic regression showed that only SII and hypertension had statistically impact on differentiation of STEMI and NSTEMI. In addition, SII value of 1105×109 / l was the cut-off point for discrimination of cardiovascular survival (p<0.001, AUC =0.741). This study was performed to find out which NSTEMI patients should be treated percutaneously immediately after first medical contact according to SII. It was found that, SII value of higher than 768×109 / l is related with STEMI.Conclusion    In conclusion, NSTEMI patients with a SII value higher than 768×109 / l may be considered as STEMI and treated with in 120 min after first contact. In addition, SII was found to be a cardiovascular mortality predictor after myocardial infarction, and this may be used for identifying high-risk patients after percutaneous coronary intervention.

[Evaluation of the operator learning curve for radiofrequency ablation for atrioventricular nodal reentrant tachycardia].

Aim    The aim of this study was to determine the average minimum number of slow pathway ablation procedures required to reach a steady success rate among inexperienced operators.Material and Methods    We analyzed the consecutive AVNRT ablation procedures of three inexperienced operators for the rate of operational success and complications.Results    Operators performed a total of 156 AVNRT ablation procedures. There was no statistical significance between the three operators regarding the rate of success (p=0.69) and complications. There were significant differences between the operators in terms of procedure time, fluoroscopy time, and cumulative air kerma. The variability of procedure time and cumulative air kerma, both among three operators and within each operator, decreased significantly after the 25th case. Each operator was analyzed individually for the probability of success as related to the cumulative number of ablations. All trainee operators reached a success rate of 90 % at the 27th procedure.Conclusion    An average of 27 slow pathway ablation procedures should be performed by a beginner operator to achieve proficiency.

Real-World Evaluation of Anticoagulant Treatment Patterns in Patients with Atrial Fibrillation: Data from Multicenter ROTA Study.

OBJECTIVE: Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation. METHODS: The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021. RESULTS: The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2-VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants. CONCLUSIONS: The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.time in therapeutic range with <70%.

Comparison of pan-immune-inflammation value with other inflammation markers of long-term survival after ST-segment elevation myocardial infarction.

BACKGROUND: Atherosclerosis is a process that causes coronary artery disease and is associated with the inflammatory response. In this study, we aimed to evaluate the association of Pan-Immune-Inflammation Value (PIV) with in-hospital and long-term mortality in STEMI patients. METHODS: A total of 658 patients who were admitted to the emergency department of two tertiary centers with the diagnosis of STEMI and underwent percutaneous coronary intervention (PCI) between 2018 and 2022 were retrospectively enrolled. PIV and other inflammation parameters were compared for the study population. The primary outcome was one-year all-cause of mortality. RESULTS: The mean age was 58.7 ± 17.1 years and 507 (76.9%) were male. The mean duration of the follow-up was 18.8 ± 8.5 months (median 18.9 months). PIV was superior to the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammation index for the prediction of primary and secondary outcomes in STEMI. CONCLUSION: Our study reveals that PIV is a better predictor of mortality in STEMI patients. Prospective studies are needed to validate this biomarker.

PrevAleNce and Associated factors of inappropriaTe dosing of direct Oral anticoaguLants In pAtients with Atrial Fibrillation: the ANATOLIA-AF Study.

PURPOSE: Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings. METHODS: This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association. RESULTS: The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants. CONCLUSION: The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.

Clinical usability of morning surge blood pressure for predicting future hypertension in a young population.

Objective    Early diagnosis of hypertension (HT) is a critical issue for physicians. This study was conducted to determine if morning surge blood pressure (MSBP) could be used to predict future HT. The study also examined which demographic data in a regression model might help to detect future HT without any invasive procedure.Material and methods    A young population between 18 and 40 yrs of age was included in the study. MSBP and demographic data were used to determine an optimal model for predicting future HT by using Bayesian information criteria and binary logistic regression.Results    1321 patients with 24 hr ambulatory blood pressure monitoring were included in this study. The odds ratio of 10 units of increase in diastolic MSBP was 1.173511 in the model, which indicates that a 10 mmHg increase in diastolic MSBP increases the odds of future HT in the patient by 17.4 %. The odds ratio of age was 1.096365, meaning that at each age above 18 yrs, the patients' odds of future HT rise by 9.6 %. The odds ratios for gender (male) and previous HT were 1.656986 and 3.336759, respectively. The odds of future HT in males were 65 % higher than for females, and a history of HT implies that the odds of future HT were higher by 230 %.Conclusion    Diastolic MSBP can be used to predict HT in young individuals. In addition, age, male gender, and previous HT add more predictive power to diastolic MSBP. This statistically significant, predictive model could be useful in lessening or preventing future HT.

Prolongation of QTc interval due to increased parity and great grand multiparity.

Women are more prone to cardiac arrhythmias. Increased exposure to sex hormones may alter the ventricular repolarisation of the heart as the parity number increases. In this study, we aim to investigate the effect of parity number to electrocardiographic parameters. A total of 205 adult women were included for the study. Nulliparous (NP), primiparous (PP), multiparous (MP), grand multiparous (GMP) and great grand multiparous (GGMP) women constituted the study population. Increased parity has positive correlation with QTc interval (p=.000, r = 0.303). GGMP has significantly higher QTc compared to NP, PP, MP and GMP (p=.001, p=.000, p=.004 and p=.007, respectively). GGMP and parity have explanatory power on QTc (p=.019 and p=.020, respectively). Parity and GGMP affect cardiac repolarisation and prolong the QTc interval most probably due to repeated exposure to sex hormones. This study showed that GGMP and parity are independent risk factors for QTc interval prolongation.Impact StatementWhat is already known on this subject? Increased exposure to sex hormones may alter the ventricular repolarisation of the heart as the parity number increases. Previous studies showed that increased parity (up to 7) deteriorates ventricular diastolic functions, prolongs QTc interval and these conditions cause cardiovascular diseases.What do the results of this study add? In this study, we added great grand multiparity (10 or more parity) (GGMP) group that have never been studied before. We found that GGMP has much more impact on QTc prolongation than fewer parity groups and this result shows us that GGMP deteriorates ventricular functions more.What are the implications of these findings for clinical practice and/or further research? These results show us that women should be discouraged from having more delivery. Also, women with a pregnancy history of five and more (grand multiparity) should be evaluated with an electrocardiography and a cardiology consultation should be performed before re-conception. In the future, larger prospective studies are needed on this subject. In addition, other electrocardiographic parameters (QRS-T angle and Tpe/QTc in electrocardiography, etc.) that related with diastolic functions should be evaluated for comparison of GGMP and non-GGMP populations in future studies.

Long-term Prognosis after Treatment of Total Occluded Coronary Artery is well Predicted by Neutrophil to High-Density Lipoprotein Ratio: a Comparison Study.

Aim    Mortality prediction is very important for more effective treatment of patients with acute coronary syndrome. Hematological and lipid parameters have been used for this purpose, as this approach is non-invasive and cost effective. In this study, our aim was to evaluate which parameter predicts mortality most accurately.Material and Methods    Data of 554 patients with at least one total coronary artery occlusion were collected retrospectively. Receiver operating characteristic curves were used to determine the optimal cut-off points of Neu / HDL, Neu / Lym, Mono / HDL, Trig / HDL, HDL / LDL, Plt / Lym and Lym / HDL according to long-term cardiovascular survival. Median follow-up time was 520 days, and 30 patients died.Results    The mean age was 60.96±0.50 yrs. The area under the curve (AUC) for Neu / HDL was 0.830 (p<0.001, 95 % confidence interval [CI]: 0.753 to 0.908). The cut-off point was 0.269, with a sensitivity of 74.2 % and a specificity of 74.2 %. The AUC for Neu / Lym was 0.688 (p<0.001, 95 % CI: 0.586 to 0.790). The cut-off point was 5.322, with a sensitivity of 67.7 % and a specificity of 67.1 %. The Neu / HDL (hazard ratio, HR [confidence interval, CI]: 0.202 [0.075-0.545], p=0.002) and Neu / Lym (0.306 [0.120-0.777], p=0.013) were associated with increased risk of death according to multivariate Cox regression analysis.Conclusions    Neu / HDL offers a better long-term mortality prediction than Neu / Lym, Mono / HDL, Trig / HDL, HDL / LDL, Plt / Lym, or Lym / HDL after treatment of total coronary artery occlusion.

The effect of heart rate and pulse pressure on mean arterial pressure: the combined formula for calculation of mean arterial pressure.

BACKGROUND: We demonstrate a new formula to predict mean arterial pressure (MAP) using corrections of the key factors associated with the inaccuracy of the standard formula: heart rate (HR) and pulse pressure (PP). METHODS: A total of 99 patients (50 men, 49 women; mean age 52.5 ± 10.3 years), who underwent elective coronary angiography, were enrolled in our study. The arterial pressure was measured in the aortic root. MAP was measured digitally by the area-under-the-pressure-time curve method. We evaluated the accuracy of four different formulas: the standard formula, the formula of Razminia et al., the formula of Meaney et al. and the combined formula. RESULTS: PP coefficient deviation of the standard formula was negatively correlated with PP (R = -0,561, P < 0.001), and positively correlated with HR (R = 0,298, P = 0.003). Both R and R2 values of the combined formula were higher than previous formulas. Accuracy parameters of the combined formula [root mean square error (RMSE): 1.801 mmHg, mean square residuals (MSR): 3.244 mmHg2, Akaike information criterion (AIC): 401.4] were superior to the standard formula (RMSE: 1.902 mmHg, MSR: 3.620 mmHg2, AIC: 412.3), the formula of Razminia et al. (RMSE: 2.022 mmHg, MSR: 4.089 mmHg2, AIC: 424.3) and the formula of Meaney et al. (RMSE: 2.137 mmHg, MSR: 4.568 mmHg2, AIC: 435.3). In the multivariate linear regression analysis, the combined formula was the only method that independently predicts the measured MAP (beta = 0,990, P < 0.001). CONCLUSION: The combined formula is superior to previous formulas for accurately predicting MAP.

The usefulness of plateletcrit to predict cardiac syndrome X in patients with normal coronary angiogram.

INTRODUCTION: Cardiac syndrome X (CSX) is a clinical entity defined as the triad of typical angina pectoris on exercise, electrocardiographic or metabolic findings of ischemia and normal epicardial coronary arteries. Platelets, whose amount in the blood is indicated with plateletcrit (PCT), play an important role in inflammatory and thrombotic processes and the physiopathology of cardiovascular events. AIM: To investigate the association between cardiac syndrome X and PCT and platelet count. MATERIAL AND METHODS: A total of 113 patients with normal coronary angiogram were included in the study. Fifty patients with typical chest pain and evidence of myocardial ischemia in non-invasive tests formed the CSX patient group. The control group consisted of 63 age- and gender-matched patients with normal coronary arteries but without angina. RESULTS: The mean PCT value of the CSX group was significantly higher than that of the control group (0.22 ±0.06 vs. 0.19 ±0.04; respectively, p=0.03). Higher PCT was found to be associated with the presence of CSX in patients with normal coronary arteries by multivariate logistic regression analysis. CONCLUSIONS: We suggest that high PCT may predict the presence of cardiac syndrome X in patients with normal coronary arteries. The value of PCT appears additive to conventional expensive methods commonly used in CSX prediction.