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.

C-Reactive Protein to Albumin Ratio Predicts In-hospital Mortality in Patients with Acute Heart Failure.

OBJECTIVE: Acute heart failure remains at high risk of mortality despite recent advances in the management and treatment of heart failure. Recently, C-reactive protein to albumin ratio has been shown to predict all-cause mortality in heart failure with reduced ejection fraction. The association between C-reactive protein to albumin ratio and in-hospital mortality in patients with acute heart failure regardless of the left ventricular ejection fraction remains unknown. METHODS: In this retrospective, single-center cohort study, we included 374 hospitalized patients with acute decompensated heart failure. We calculated C-reactive protein to albumin ratio and evaluated the relationship between the values and in-hospital mortality. RESULTS: During hospitalization duration of 10 [6-17] days, need for hemodialysis/ultrafiltration, acute ischemic hepatitis, coagulopathy, ventricular tachycardia, invasive mechanical ventilation, and shock were more prevalent in the high C-reactive protein to albumin ratio (< 0.78) group compared to low C-reactive protein to albumin ratio ( ≥ 0.78) group. Mortality was higher in the high C-reactive protein to albumin ratio group in comparison to the low C-reactive protein to albumin ratio group (36.7% vs. 12%; P < 0.001). C-reactive protein to albumin ratio was independently and significantly associated with in-hospital mortality (hazard ratio = 1.69, 95% CI: 1.02-2.82; P = 0.042) by multivariate Cox proportional hazard analysis. In receiver operating characteristic analysis, C-reactive protein to albumin ratio was able to predict in-hospital mortality (area under the curve value for in-hospital mortality was 0.72; P < 0.001). CONCLUSION: Admission C-reactive protein to albumin ratio was associated with increased all-cause mortality in hospitalized patients with acute decompensated heart failure.

Gender-Dependent Comparison of Coronary Computed Tomography Angiographic Characteristics among Patients with Suspected Atherosclerosis: A Single-Center Experience.

OBJECTIVE: In this study, we aimed to examine gender-based differences in coronary artery disease (CAD) risk factors, the presence and severity of atherosclerosis, and the distribution of plaque type in patients presenting with chest pain. METHODS: A total of 1496 patients who applied to our cardiology outpatient clinic with chest pain and underwent computed coronary tomographic angiography (CTA) between August 2020 and October 2021 were included in the study. Plaque characteristics, Agatston score, and Coronary Artery Disease-Reporting and Data System (CAD-RADS) score obtained from the patients' CTAs were compared by gender. RESULTS: Of the 1496 patients evaluated, 47.9% were female. Coronary atherosclerosis was detected in 35.4% of females and 52.9% of males (P <0.001). Diabetes mellitus [155 (21.8%) vs. 123 (15.7%); P <0.001] and hypertension [271 (38.1%) vs. 249 (32%); P <0.001] rates were higher in females than in males. Plaque burden and high-risk plaque rate were found to be higher in males (P <0.001). Next, the rate of moderate-to-high coronary artery stenosis (CAD-RADS ≥3) was observed at 21.6% in men and 12.2% in women (P <0.001). Agatston score was found to be higher in males than in females for all age groups (P <0.001). The severity of CAD increased sharply with age in females (P interaction = 0.003). CONCLUSION: Although female patients demonstrated higher rates of traditional risk factors, the male gender was associated with increased coronary plaque burden, high-risk plaque, CADRADS, and Agatston scores. Therefore, patient-based approaches that consider gender-related differences could provide effective treatment and follow-up.

A combination of severe complications in a case of infective endocarditis: Dehiscence of prosthetic aortic valve, aortic dissection, pseudoaneurysm, and hematoma causing right ventricular collapse.

Prosthetic valve endocarditis with mechanical complications causing pulmonary edema is fatal, therefore it needs to be diagnosed early and should be treated surgically in emergency setting. Transesophageal echocardiogram is crucial for recognizing the mechanical complications, which can be encountered on daily practice, but the coexistence of complications occurring on different mechanism is rather uncommon. Herein, we report a 21-year-old gentleman presenting with acute heart failure, whose imaging tests showed a combination of dehiscence of mechanical aortic valve prosthesis, aortic dissection, pseudoaneurysm, and hematoma causing right ventricular collapse.