Bayram Köroğlu

The relationship between platelet to lymphocyte ratio and the clinical outcomes in ST elevation myocardial infarction underwent primary coronary intervention.

The platelet to lymphocyte ratio (PLR) has been investigated as a new predictor for cardiovascular risk. The aim of the present study was to investigate the prognostic role admission PLRat admission in predicting in-hospital and early mortality in patients presenting with ST segment elevation myocardial infarction (STEMI). A total of 639 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were included. The study population was divided into tertiles on the basis of PLR values at the admission. A high PLR (N = 213) was defined as a value in the upper third tertile (PLR >174.9) and a low PLR (N = 426) was defined as any value in the lower two tertiles (PLR ⩽174.9). The patients were followed for clinical outcomes for up to 6 months after discharge. In Kaplan–Meier survival analysis, the rate of 6-month all-cause deaths was 7% in the high PLR group versus 3% in the low PLR group (P = 0.03). In multivariate analyses, a significant association was noted between high PLR levels and the adjusted risk of 6-month all-cause deaths (odds ratio = 2.51, 95% confidence interval = 1.058–5.95; P = 0.03). PLR is a readily available clinical laboratory value associated with 6-month all-cause death in patients with STEMI who undergo primary PCI.

Predictors of anticoagulant treatment in patients with nonvalvular atrial fibrillation: results from atrial fibrillation in Turkey: epidemiologic registry.

The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

Serum creatinine is associated with coronary disease risk even in the absence of metabolic disorders.

Abstract Background. In view of recent evidence that serum creatinine and dysfunctional apolipoprotein (apo)A-I may serve as inflammation mediators in people with enhanced inflammation, we studied whether or not these molecules were interrelated and associated with coronary heart disease (CHD) likelihood even in subjects without metabolic syndrome (MetS) or type-2 diabetes. Methods. Among unselected middle-aged Turkish adults with available serum apo A-I, lipoprotein(a) and creatinine measurements, 697 participants (designated as ‘healthy’) were enrolled, after exclusion of the stated metabolic disorders. CHD was identified in 87 subjects, roughly half during 3.1 years’ follow-up. Results. ‘Healthy’ individuals were overweight and had partly impaired fasting glucose but otherwise normal serum creatinine and other biochemical measurements. Being consistent with lacking anti-inflammatory activity, apoA-I was linearly and positively associated with apoB, in women further with creatinine. Logistic regression analyses showed that, beyond age, not non-HDL-cholesterol, systolic blood pressure and smoking status, but serum creatinine in each sex (OR in men 1.63 [95% CI 1.14; 2.31]) and CRP in women were significantly associated with CHD likelihood. The combined highest and lowest creatinine quartiles in women displayed an OR 2.14 (1.02; 4.51) compared with the intermediate quartiles, after similar adjustments. Conclusion. Elevated creatinine levels within normal range, linked to apoA-I dysfunctionality, are independently associated with CHD likelihood even in non-diabetic subjects without MetS. In such women the lowest creatinine quartile is also linked to CHD risk.

The reliability of computed tomography-derived SYNTAX score measurement.

The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) was developed for evaluation of coronary artery disease complexity. We aimed to compare the SS calculated by conventional coronary angiography (CAG) and computed tomography angiography (CTA). Retrospectively, 107 patients were recruited (mean age 55.9 ± 12.4 years). The SS measured by conventional CAG was divided into 3 groups (group 1 SS ≤ 22, group 2 SS > 22 to <32, and group 3 SS ≥ 32). The SS calculated by both methods has a high correlation (r = .972 and P < .001). The κ analysis showed a substantial agreement between both imaging modalities. Computed tomography angiography highly predicted conventional CAG lesions (area under curve 0.96, 95% confidence interval 0.92-0.99, and P < .001). The SS measured by CTA is highly correlated with conventional CAG. Therefore, we propose that prior to coronary revascularization, CTA-derived SS could be used for risk stratification.

Serum total and high-density lipoprotein phospholipids: independent predictive value for cardiometabolic risk.

OBJECTIVE Given that serum phospholipids (PL) may serve as inflammation mediators, we studied whether they predicted metabolic syndrome (MetS), type-2 diabetes or coronary heart disease (CHD) risk in people prone to enhanced low-grade inflammation. METHODS We analyzed unselected middle-aged Turkish adults with available serum total (n = 852) and HDL-PL (n = 428) measurements and follow-up (mean 6.6 years) by Cox or logistic regression, after exclusion of prevalent cases of outcome disorder. The enzymatic method used measured total content of phosphatidylcholine, sphingomyelin and lyso-phosphatidylcholine. RESULTS Most lipid and non-lipid variables were significantly different in the upper two compared with the lowest total PL tertile, whereby apolipoprotein (apo)A-I and HDL-cholesterol were higher (not lower). ApoA-I, HDL-cholesterol and uric acid were uniformly positive independent linear covariates of total and HDL PL, apoA-I even in participants without MetS. After adjustment for sex, age, waist circumference, HDL-cholesterol and systolic blood pressure, logistic regression for incident MetS disclosed a 3-fold risk (RR [95% CI 1.28; 6.81]) in the upper HDL-pl tertile. In Cox regression models, while the combined two higher HDL-pl tertiles significantly protected against CHD risk in males (HR 0.29 [95% CI 0.10; 0.89]), they weakly tended to impart risk in females: upper two total PL tertiles tended to increased risk of diabetes and CHD. CONCLUSION Excess total PL may mediate inflammatory properties to apoA-I, HDL and uric acid. Excess HDL-pl independently predict risk for MetS in each gender, but are protective against CHD risk in men, possibly because oxidized PL content mediated by total PL is sex-dependent, as reviewed elsewhere.

The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction

BACKGROUND The aim of this study is to determine the impact of ratio of contrast volume to glomerular filtration rate (V/GFR) on development of contrast-induced nephropathy (CIN) and long-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS A total of 645 patients with STEMI undergoing primary PCI was prospectively enrolled. CIN was defined as an absolute increase in serum creatinine > 0.5 mg/dL or a relative increase > 25% within 48 h after PCI. The study population was divided into tertiles based on V/GFR. A high V/GFR was defined as a value in the third tertile (> 3.7). RESULTS Patients in tertile 3 were older, had higher rate of smoking, diabetes mellitus and CIN, lower left ventricular ejection fraction, hemoglobin, and systolic and diastolic blood pressure compared to tertiles 1 and 2 (p < 0.05). V/GFR was found an independent predictor of in-hospital and 6-month mortality. We found 2 separate values of V/GFR for 2 different end points. While the ratio of 3.6 predicted in-hospital mortality with 78% sensitivity and 82% specificity, the ratio of 3.3 predicted 6-month mortality with 71% sensitivity and 76% specificity. Survival rate decreases as V/GFR increases both for in-hospital and during 6-month follow-up. Diabetes mellitus and multivessel disease were other predictors of in-hospital mortality. CONCLUSIONS High V/GFR level is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing primary PCI.

Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction

Background Hemoglobin concentration (Hb) and left ventricular ejection fraction (EF) are known predictors of contrast induced nephropathy (CIN). We hypothesized that combination of Hb concentration and left ventricular EF is superior to either variable alone in predicting contrast induced nephropathy in patients with acute coronary syndrome (ACS). Material/Methods Consecutive patients with ACS were prospectively enrolled. Patients considered for invasive strategy were included. Baseline creatinine levels were detected on admission and 24, 48 and 72 hours after coronary intervention. 25% or 0,5 umol/L increase in creatinine level was considered as CIN. Results 268 patients with ACS (mean age 58±11 years, 77% male) were enrolled. Contrast induced nephropathy was observed in 26 (9.7%) of patients. Baseline creatinine concentration, left ventricular EF, and Hemoglobin was significantly different between two groups. Contrast volume to estimated glomerular filtration rate ratio (OR: 1.310, 95% CI: 1.077–1.593, p=0.007) and the combination of Hb and left ventricular EF (OR: 0.996, 95% CI: 0.994–0.998, p=0.001) were found to be independent predictors for CIN. Hb × LVEF £690 had 85% sensitivity and 57% specificity to predict CIN (area under curve: 0.724, 95% CI: 0.625–0.824, p<0.001). In addition, Hb × LVEF £690 had a negative predictive value of 97% in our analysis. Conclusions The combination of Hb and left ventricular EF is better than either variable alone at predicting CIN in patients with ACS that undergone percutaneous coronary intervention. The prediction was independent of baseline renal function and volume of contrast agent.

Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

BACKGROUND The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. METHODS Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. RESULTS The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. CONCLUSIONS Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.

The serious adjustment bias and competing outcomes in hypertriglyceridemic waist phenotype

The newly published article by Hadaeghs group [1] points to paradoxical aspects regarding the pathogenesis of cardiovascular disease (CVD), yet without optimal evaluation and interpretation. Utilizing a large sample of the Tehran Lipid and Glucose study cohort, authors investigated the predictive value of hypertriglyceridemic waist (HtgW) for CVD and mortality. Authors concluded that, after adjustment for potential confounders, though inwomen incident CVD risk was significantly increased all-cause mortality was inversely associated with HtgW in each gender and CVD mortality in men. HtgW is a crucially important distinct phenotype leading to excess cardiometabolic risk. It is a state of enhanced subclinical inflammation and autoimmune activation in either gender [2]. Sexand age-adjusted differences of this phenotype in the Turkish Adult Risk Factor study participants bystratifying into the categories of “healthy”, onlyabdominal obesity, hypertriglyceridemia (N1.7 mmol/L) aloneandHtgWemergedas follows. Compared with the “healthy” category, HtgW had significantly higher bloodpressure (BP), total, low-density lipoprotein andnon-highdensity lipoprotein(HDL)-cholesterol, apolipoprotein B, glucose, Creactive protein and complement C3 (a marker of autoimmunity) concentrations, and lowerHDL-cholesterol levels andprevalence ineach sex of current smoking. Individuals with HtgW further displayed lower circulating Lp(a), adiponectin, and sex hormone-binding globulin (SHBG). Collectively, these aspects strongly support the notion that HtgW phenotype is driven by oxidized phospholipids, particularly concentrated on Lp(a) particles which also become gradually oxidized, resulting in damaged epitopes that render themnot being captured fully by the immunoassay. The consequence is on one hand an “apparently” low Lp(a) level, on the other higher apoB-containing lipoproteins, because apoB itself, not damaged in the pro-inflammatory milieu, is assayed adequately. Protective plasma proteins such as apoA-I, HDL, adiponectin and SHBG combat the slow process of subclinical inflammation and autoimmune activation but, eventually, may each be converted pro-inflammatory during the stage of HtgW (as yet unpublished findings). In people with this phenotype, adjusting for total and HDLcholesterol, BP, and CRP has inherent bias [3] because HtgW represents enhanced pro-inflammatory state with elevated apoB, and resultant elevated BP. As regards adjusting for smoking status, this is a fallacy by causal relationship, because non-smoking in many ethnicities contributes to drive pro-inflammatory state, and current smoking induces avoidance of abdominal obesity [4,5] and may inhibit the autoimmune process [2,6]. A second important factor that deforms the paradoxical assessment is that HtgW phenotype leads not only to cardiovascular disease and death from it but also to other diseases, such as chronic kidney disease [7], diabetes mellitus [8] and presumably also to certain types of cancer, so that overall mortality is influenced by competing causes. Adjustment for conventional cardiovascular risk factors reduces the attributable part for cardiovascular mortality without substantially modifying mortality due to other causes. Inappropriate evaluation of the huge clinical significance of HtgW maymislead to imperfect guidelines anderraticmedical practice.Hence, the clinical significance of HtgWshouldbeput into proper context in the future by further related research across various ethnicities and appropriate assessment.

ST-Segment Elevation of Right Precordial Lead (V4R) Is Associated with Multivessel Disease and Increased In-Hospital Mortality in Acute Anterior Myocardial Infarction Patients

ST segment elevation of chest lead V4R is associated with worse prognosis in acute inferior ST‐elevation myocardial infarction (STEMI). This study tried to determine the relationship between ST elevation in the right precordial lead V4R and acute anterior STEMI.