Gokhan Cetinkal

Impact of Rosuvastatin on Contrast-Induced Acute Kidney Injury in Patients at High Risk for Nephropathy Undergoing Elective Angiography

Although statins have been shown to prevent contrast-induced acute kidney injury in patients with acute coronary syndromes, the benefit of statins is not known for patients at high risk for nephropathy who undergo elective coronary angiography. Two hundred twenty consecutive statin-naive patients with chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) who underwent elective coronary or peripheral angiography were randomly assigned to receive rosuvastatin (40 mg on admission, followed by 20 mg/day; n = 110) or no statin treatment (control group, n = 110). Contrast-induced acute kidney injury was defined by an absolute increase in serum creatinine of ≥0.5 mg/dl or a relative increase of ≥25% measured 48 or 72 hours after the procedure. Contrast-induced acute kidney injury occurred in 15 patients (7.2%), 9 (8.5%) in the control group and 6 (5.8%) in the rosuvastatin group (p = 0.44). The incidences of adverse cardiovascular and renal events (death, dialysis, myocardial infarction, stroke, or persistent renal damage) were similar between the two groups at follow-up. In conclusion, rosuvastatin did not reduce the risk for contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients who underwent coronary and peripheral vascular angiography.

Contrast-Induced Acute Kidney Injury Is Associated With Long-Term Adverse Events in Patients With Acute Coronary syndrome

Contrast-induced acute kidney injury (CI-AKI) is associated with increased mortality, morbidity, and prolonged hospitalization. Patients with acute coronary syndrome (ACS) have a 3-fold higher risk of developing CI-AKI. The aim of our study was to evaluate the predictors of CI-AKI and long-term prognosis in patients with ACS who developed CI-AKI (1083 patients were enrolled). Contrast-induced acute kidney injury was defined as an increase of ≥0.5 mg/dL and/or an increase of ≥25% of pre-percutaneous coronary intervention (PCI) to post-PCI serum creatinine levels within 48 to 72 hours after the procedure. Primary end point was defined as all-cause mortality, myocardial infarction, and cerebrovascular event at long-term follow-up (36 ± 12 months). Contrast-induced acute kidney injury occurred in 178 (16.4%) of the 1083 patients. The primary end points were significantly high in patients with ACS who developed CI-AKI (P < .001). The occurrence of CI-AKI was identified as an independent predictor of primary end point. Risk of CI-AKI development was more frequently seen in patients with ACS. Also, patients who developed CI-AKI have worse prognosis at long-term follow-up. Additional preventive treatment strategies need to be developed in this group of patients.

The role of media on statin adherence

Fig. 1. Percentage of days covered by statin from 2011 to 2013. Statins have been reported to reduce the incidence of cardiovascular events after coronary stenting and current guidelines recommend the routine use of statins in this population. But, about half of patients discontinue statin therapy within the first year, and adherence decreases during follow-up period [1,2]. Medication adherence is a complex problem that is affected by many factors, including perceptions and understanding of the disease burden. Specific factors identified include low socioeconomic status, high medication costs, lack of transportation and poor understanding of medication instructions [3]. In addition, media coverage of health facts may also have an impact on beliefs, and behaviors related to health. Niederdeppe et al. [4] reported that exposure to statin advertisements increased the diagnosis of hypercholesterolemia and use of statins. However in recent years, statins were frequently criticized in Turkish media and most of them were also presented in a negative fashion in globalmedia. Our goalwas to analyze the effects of media on statin adherence. We retrospectively analyzed the statin adherence of 908 percutaneous coronary intervention patients whom were prescribed a statin before 2011 at our institute and had continuous insurance coverage to determine statin adherence. We used the pharmacy-based proportion of days covered (PDC)method to quantify statin adherence. To quantify the effects of media, we made a search on Google. We searched the word “cholesterol drugs” on Turkish pages from “news” section for 2011 to 2014 individually.

Usefulness of Serum Omentin-1 Levels for the Predictions of Adverse Cardiac Events in Patients with Hypertrophic Cardiomyopathy

Objective: To investigate the association between serum omentin-1 levels and adverse cardiac events in patients with hypertrophic cardiomyopathy (HCM). Subjects and Methods: This prospective, observational study included 87 patients with HCM and 50 age- and sex-matched control subjects. Serum omentin-1 and brain natriuretic peptide (BNP) levels were measured in all subjects, using enzyme-linked immunosorbent assay and electrochemiluminescence, respectively. Patients with HCM were divided into 2 groups according to their omentin levels, i.e., low: ≤291 ng/mL (n = 48) and high: > 291 ng/mL (n = 39). Cardiac mortality, hospitalization due to heart failure, and implantable cardioverter-defibrillator (ICD) implantation were considered adverse cardiac events. Statistical analysis included uni- and multivariant logistic regression, receiver-operating characteristic (ROC) analysis, and the Kaplan-Meier method. Results: Serum omentin-1 levels were significantly lower in the obstructive (253.9 ± 41.3 ng/mL) and nonobstructive (301.9 ± 39.8 ng/mL) HCM groups than in the control group (767.1 ± 56.4 ng/mL), p < 0.001, respectively. The BNP levels were higher in the obstructive and nonobstructive HCM groups than in the control group (269.5 ± 220, 241.0 ± 227, and 24.0 ± 18.9 pg/mL, respectively, p < 0.001). The Kaplan-Meier analysis indicated that patients with low omentin-1 levels showed a significantly higher (48.2%) 2-year cumulative incidence of overall adverse cardiac events than those with high omentin-1 levels (16.2%) (log-rank test, p  =  0.001). In the multivariate logistic regression analysis, omentin-1, interventricular septum (IVS) thickness, and male gender were independent predictors of adverse cardiac events in the follow-up. Conclusion: Omentin-1 levels were lower in patients with HCM than in the control group, and this was associated with worse cardiac outcomes.

Contrast-induced acute kidney injury in patients with non-ST-segment elevation myocardial infarction undergoing early versus delayed invasive strategy

at high risk NSTEMI (requiring urgent coronary angiography within 2 h); advanced left ventricular dysfunction; acute renal failure or endstage renal failure requiring dialysis; contrast agent allergy; contrast agent exposure within the previous 2 weeks; and advanced comorbidities; pregnant patients; and those who refused follow-up were excluded from the study. Thus, 624 patients with NSTEMI were included. Following the exclusion of 15 patients who did not undergo coronary angiography and 9 patients with no information regarding serial measurements of serum creatinine because of discharge on the next day, 600 patients with NSTEMI were analyzed. Informed consent forms were signed by all patients, and the study protocol was approved by the local ethical committee. Before coronary angiography, eGFR of the patients was calculated with the Levey-modified Modification of Diet in Renal Disease formula: (186.3× serum creatinine[mg/dL] −1.154 )× (age [years] −0.203 )× (0.742 if female). According to the guideline recommendations, i.v. isotonic saline (1 mL/kg/h, 0.9% sodium chloride) was administered to patients who were at high risk of developing CI-AKI before and 12–24 h after the procedure [4]. Infusion rate was reduced to 0.5 mL/kg/h in patients with left ventricular ejection fraction (LVEF) b40%. Invasive treatments were performedbyexperiencedinterventionalcardiologistsviafemoral or radial artery puncture. Non-ionic contrast agent with low-osmolar osmolality (Iohexol, Omnipaque, GE Healthcare, France) was used in all patients. Serum creatinine, blood urea nitrogen, sodium and potassium levels were measured before and 48–72 h after the procedure. In patients who had developed CI-AKI, measurements were repeated on the 5th and 10th days after the procedure. Patients were divided into 3 groups according to the timing of angiography: ≤24, 25–72, and N72 h. While the primary endpoint was defined as CI-AKI (≥0.5 mg/dL or ≥25% increase in creatinine level between 48 and 72 h after contrast agentexposure),secondary endpoints were definedasall-causemortality, and occurrence of myocardial infarction (MI) or cerebrovascular event (CVE) in the 12-month follow-up period. There was no significant difference between the groups in the incidence of CI-AKI (15.4%, 14%, 19.5% p: 0.29, respectively). The composite endpoint of all-cause mortality, MI and CVE was significantly higher in the delayed angiography group (N72 h), compared with the 2 earlier angiography groups. Patients who developed CI-AKI showed significantly higher rates of 1-year mortality, nonfatal MI or CVE than patients withoutCI-AKI.All-causemortalitywasapproximately4timeshigherin

Effect of chronic toluene exposure on heart rhythm parameters

Toluene is used extensively in various industrial processes, and an increasing number of workers are getting exposed to its vapor. Cardiac abnormalities that have been reported in association with toluene exposure (in toxic doses) are atrioventricular conduction abnormalities, sinus bradycardia, ventricular tachycardia, recurrent myocardial infarction, dilated cardiomyopathy, and coronary vasospasm.

The impact of infection on mortality in octogenarians who were admitted due to acute coronary syndrome

BACKGROUND The prevalence of coronary artery disease is on the rise as the life expectancy of the population increases. However, treatment of acute coronary syndrome in the elderly patients has its own problems that have not been thoroughly addressed in the clinical trials. Since these patients are generally fragile and have multiple co-morbidities, the course of acute coronary syndrome can frequently be complicated. Infection, which co-exists either at the initial presentation or is acquired during the hospital stay, is a condition about which there is little published data. Therefore, in our study, we wanted to assess the impact of infection on mortality in octogenarians who have acute coronary syndrome METHODS: We retrospectively analyzed the data of 174 octogenarians who had been admitted to the coronary care unit with acute coronary syndrome. All-cause mortality was defined as the primary endpoint of the study. RESULTS Overall 53 octogenarian patients (30.5%) had an infection along with acute coronary syndrome. The mean duration of follow-up was 10 months (1-25 months). Both in-hospital and long-term mortality were higher in these patients (18.9% vs 6.6%, p = 0.01; 52.8% vs 27.5%, p < 0.01; respectively). Kaplan-Meier analysis also showed lower cumulative survival. (p [log-rank] = 0.002). In multivariate Cox regression analysis; undergoing coronary angiography, infection (HR 1.96, 95% CI 1.15-3.34, p = 0.01), left ventricular ejection fraction and maximum C reactive protein levels were found as independent predictors of long-term survival. CONCLUSION Infection in octogenarians who were admitted due to acute coronary syndrome was frequent and increased their mortality substantially.

Persistent smoking rate after coronary revascularization and factors related to smoking cessation in Turkey

Background Although smoking is an established risk factor for coronary artery disease, smoking cessation efforts, as part of a lifestyle change, have been disappointing so far. Therefore, assessing current smoking trends and identifying patients who are at risk of smoking continuation is of paramount importance. In this study, our aim was to assess current smoking rates after coronary revascularization as of 2017, and to define factors that potentially affect smoking cessation. Methods Overall, 350 patients who had undergone coronary revascularization, either by percutaneous coronary intervention or bypass surgery were included in this cross-sectional, observational study. Patients were queried for various sociodemographic characteristics and smoking habits. Disease related data were obtained from the hospital archives. Results The overall smoking rate was 57% after coronary revascularization. Age, bypass surgery and the occurrence of in-hospital adverse events were found to be independent predictors of smoking cessation in multivariate analysis. Conclusions Despite efforts, smoking rates after coronary intervention remain substantially high. Therefore, a multidisciplinary approach to smoking cessation that incorporates cardiac rehabilitation programs and medications should be implemented in clinical practice.

Right ventricular outflow tract tachycardia after an initial dose of amantadine.

Amantadine hydrochloride is an antiviral agent that is also effective in the treatment of Parkinsons disease. In the literature, cardiac arrhythmia is reported in toxic doses of amantadine, but in this paper we report a patient with right ventricular outflow tract (RVOT) tachycardia after an initial dose of amantadine. A 47-year-old female patient was admitted to the emergency department with the complaint of palpitation and dizziness after taking 200 mg amantadine. A 12-lead standard ECG showed wide QRS complex tachycardia with a heart rate of 167/min. The wide QRS complex tachycardia had an inferior axis and left bundle branch block morphology, compatible with RVOT ventricular tachycardia (RVOT-VT). Tachycardia terminated spontaneously and sinus ECG was completely normal. No arrhythmia was inducible at the electrophysiological study. To the best of our knowledge, this is the first case in the literature to describe RVOT-VT after amantadine intake. Amantadine may cause RVOT-VT as well as other cardiac arrhythmias.

Pulmonary embolism: a late complication of pectus excavatum repair.

The Ravitch operation is frequently performed to correct pectus excavatum with few and minor complications. We present a case of pulmonary embolism with pulmonary endarterectomy in a patient undergoing Ravitch repair for pectus excavatum 2 years ago.