Mert İlker Hayıroğlu

The effect of serum potassium level on in-hospital and long-term mortality in ST elevation myocardial infarction.

Current studies evaluating the effect of serum potassium levels on mortality in patients with ST elevation myocardial infarction (STEMI) are lacking. We analyzed retrospectively 3760 patients diagnosed with STEMI. Mean serum potassium levels were categorized accordingly: <3.0, 3.0 to <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, 5.0 to <5.5, and ≥5.5mEq/L. The lowest mortality was determined in patients with serum potassium level of 4 to <4.5mEq/L whereas mortality was higher in patients with serum potassium levels of ≥5.0 and <3.5mEq/L. In a multivariable Cox-proportional regression analysis, the mortality risk was higher for patients with serum potassium levels of ≥5mEq/L [hazard ratio (HR), 2.11; 95% confidence interval (CI) 1.23-4.74 and HR, 4.20; 95% CI 1.08-8.23, for patients with potassium levels of 5 to <5.5mEq/L and ≥5.5mEq/L, respectively]. In-hospital and long-term mortality risks were also higher for patients with serum potassium levels of ≤3.5mEq/L. Conversely, ventricular arrhythmias were higher only for patients with serum potassium level of ≤3.5mEq/L. Furthermore, a significant relationship was found between the patient with serum potassium levels of ≤3.5mEq/L and ventricular arrhythmias.

Effectiveness and safety of thrombolytic therapy in elderly patients with pulmonary embolism

Pulmonary embolism (PE) is a major cause of cardiovascular death. Thrombolytic therapy was shown to reduce mortality, especially in high risk patients. In elderly patients (>65xa0years old) with PE, thrombolytic therapy may be underused due to risk of hemorrhagic complications. In this study, we aimed to assess the effectiveness and safety of thrombolytic therapy among elderly patients with PE. 363 patients (205 subjects in study group, 158 subjects in control group) who were admitted to our hospital with PE were enrolled to the study. The patients were divided into subgroups according to their age and treatment strategy. Mortality rates and bleeding complications according to TIMI bleeding criteria in 30xa0days and 1-year were analyzed. In elderly patients, total mortality (7.8 vs. 20.1xa0%, pxa0=xa00.05) and mortality at 1-year follow-up (1.9 vs. 12.9xa0%, pxa0=xa00.03) was significantly lower in patients who received thrombolytic treatment. Difference in total bleeding (9.8 vs. 4.5xa0%, pxa0=xa00.18) and major bleeding (3.9 vs. 0.6xa0%, pxa0=xa00.10) in thrombolytic and non-thrombolytic groups was non-significant. Thrombolytic therapy is associated with lower mortality and acceptable bleeding complication rates in PE patients older than 65xa0years old.

Risk factors and outcomes in patients with ectatic infarct‐related artery who underwent primary percutaneous coronary intervention after ST elevated myocardial infarction

We aimed to assess the risk factors for coronary artery ectasia (CAE) as infarct‐related artery (IRA) and short‐term and 1 year outcomes.

The association of the coronary thrombus burden with all-cause mortality and major cardiac events in ST-segment elevation myocardial infarction patients treated with tirofiban.

BackgroundThe aim of this study was to investigate the association of the coronary thrombus burden with all-cause mortality and major adverse cardiac events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients treated with ‘in-cath lab’ (downstream) high-dose bolus tirofiban. MethodsThis study included 2452 patients with STEMI treated with a primary percutaneous coronary intervention. All glycoprotein IIb/IIIa receptor inhibitor (GPI) (tirofiban) infusions were started in the catheterization laboratory according to the coronary thrombus burden; tirofiban was not administered to patients who did not have coronary thrombus burden. All patients with small, moderate, or large thrombus burden received tirofiban therapy. The primary study endpoint was the incidence of all-cause mortality. The secondary study endpoints were major bleeding and MACE, which included all-cause death, nonfatal acute coronary syndrome, and target lesion revascularization. ResultsThe patients were followed up for a mean period of 28.3±10.4 months. The groups showed similar in-hospital and long-term event rates (MACE, major bleeding, and all-cause mortality). The 3-year Kaplan–Meier overall survivals for no thrombus, small thrombus, moderate thrombus, and large thrombus were 91.9, 92.6, 92.3, and 89.5%, respectively. ConclusionDespite the fact that the large coronary thrombus was found to be a predictor of MACE and mortality in many previous studies, we found that the large thrombus was not associated with MACE or in-hospital mortality or long-term mortality. This can be an effect of downstream GPI therapy. We suggest the use of downstream GPI therapy for STEMI patients with large coronary thrombus without an increased risk of bleeding.

Validity of the updated GRACE risk predictor (version 2.0) in patients with non-ST-elevation acute coronary syndrome

OBJECTIVESnA new version of the Global Registry of Acute Coronary Events (GRACE) risk score (version 2.0) has been released recently. The purpose of the present study was to assess the validity of GRACE 2.0 for in-hospital and 1-year mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients.nnnMETHODSnThe prospective cohort comprised 396 consecutive NSTE-ACS patients admitted to a tertiary hospital between May 2012 and January 2013. The main outcome measure was the discrimination and calibration performance of GRACE 2.0, which were evaluated with the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively.nnnRESULTSnIn-hospital and 1-year mortality were 2% (8/396) and 12.4% (48/388), respectively. The discrimination performance was inadequate (AUC=0.62) for predicting in-hospital mortality for the overall cohort. Also, the calibration performance for in-hospital mortality could not be evaluated due to the low number of patients who died. At one year, the Hosmer-Lemeshow p-values for all subgroups were >0.05, suggesting a good model fit, and the discrimination performance was good (AUC=0.77) for the overall cohort, driven mainly by better accuracy for low-risk patients.nnnCONCLUSIONSnIn a contemporary cohort of NSTE-ACS patients, GRACE 2.0 was valid for 1-year mortality assessment. Its value for in-hospital mortality requires validation in a larger cohort.

Association of contrast-induced nephropathy with bare metal stent restenosis in STEMI patients treated with primary PCI

Abstract Background: Contrast induced nephropathy (CIN) has been proven as a clinical condition related to adverse cardiovascular outcomes. However, relationship between CIN and stent restenosis (SR) remains unclear. In this study, we aimed to investigate the association of CIN with SR rates after primary percutaneous coronary intervention (PCI) and bare metal stent (BMS) implantation. Methods: A total number of 3225 patients who had undergone primary PCI for STEMI were retrospectively recruited. The medical reports of subjects were searched to find whether the patients had a control coronary angiogram (CAG) and 587 patients with control CAG were included in the study. The laboratory parameters of 587 patients were recorded and patients who developed CIN after primary PCI were defined. Contrast induced nephropathy was defined as either a 25% increase in serum creatinine from baseline or 0.5u2009mg/dL increase in absolute value, within 72u2009h of intravenous contrast administration. Results: The duration between primary PCI and control CAG was median 12 months [8–24 months]. The rate of SR was significantly higher in CIN (+) group compared to CIN (−) group (64% vs. 46%, pu2009<u20090.01). In multivariate Cox regression analysis, male gender, stent length, admission WBC levels and presence of CIN (HR 1.39, 95% CI 1.06–1.82, pu2009<u20090.01) remained as the independent predictors of SR in the study population. Conclusion: Gender, stent length, higher serum WBC levels and presence of CIN are independently correlated with SR in STEMI patients treated with BMS implantation.

Giant calcific pericardial cyst: certainly unexpected during primary percutaneous coronary intervention

Pericardial cyst is a rare congenital anomaly that is usually diagnosed during evaluation for right‐sided heart failure. We report a 50‐year‐old man with a primary diagnosis of ST‐segment elevation myocardial infarction at admission, whose emergent angiography revealed a calcific mass close to right coronary artery. Further analysis of the mass with computed tomography and three‐dimensional echocardiography revealed a giant pericardial cyst causing partial obstruction of superior vena cava. Unlike previous cases reported, the patient had no symptoms compatible with right‐sided heart failure.

Hypertensive emergency due to pheochromocytoma crisis complicated with refractory hemodynamic collapse.

Hypertensive emergency usually appears in older patients with previous recurrent episodes, and is among the most frequent admissions to emergency departments. A 29-year-old woman was referred to our clinic with the diagnosis of hypertensive emergency. The patient complained of severe headache, dyspnea, palpitation, diaphoresis, and confusion due to hypertensive encephalopathy. Her blood pressure was 250/150 mmHg on admission. At the referral hospital, the patient had undergone cranial CT because of her confused state and this excluded acute cerebral hemorrhage. Also at that hospital, thoracoabdominal CT for differential diagnosis depicted an adrenal mass with a necrotic core. After admission to our clinic, initial control of excessive blood pressure was not achieved despite high dose intravenous nitrate therapy. Thereafter intravenous esmolol treatment was initiated simultaneously with oral alpha blocker therapy in order to counterbalance the unopposed alpha adrenergic activity with beta blocker therapy. After 12 hours, sudden onset of hypotension developed and deepened despite IV saline, inotropic and vasopressor agents such as IV dopamine, noradrenaline and adrenaline. The patient died at the 24th hour due to hemodynamic collapse as a result of hyperadrenergic state due to possible pheochromocytoma crisis. This case is an exceptional example of hypertensive emergency secondary to fulminant pheochromocytoma crisis failing to respond to intensive antihypertensive treatment, and in which patient death was unavoidable due to uncontrolled excessive adrenergic activity which led to profound cardiogenic shock.