Veysel Oktay

Relationship Between Increased Serum Resistin Level and Severity of Coronary Artery Disease

Resistin, which is derived from the gene of RSTN, belongs to a family of cysteine-rich secretory proteins called resistin-like molecules (RELMs). Increased serum resistin levels are associated with coronary artery disease (CAD) and the risk of cardiovascular death. Patients (n = 214) with an initial diagnosis of stable angina pectoris, unstable angina pectoris, and myocardial infarction without ST-segment elevation and referred to catheter laboratory for coronary angiography were enrolled in the study. We aimed to investigate the relationship between increased serum resistin level and CAD. The severity of CAD was calculated by the Gensini scoring system. In conclusion, we established a significant correlation between serum resistin levels and CAD (P = .010). Also, serum resistin levels correlated with the Gensini score that represents the severity of CAD angiographically (P = .010).

Percutaneous coronary intervention vs. optimal medical therapy – the other side of the coin: medication adherence

Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence‐based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone.

Impact of continuation of metformin prior to elective coronary angiography on acute contrast nephropathy in patients with normal or mildly impaired renal functions

Objective: Discontinuation of metformin treatment in patients scheduled for elective coronary angiography (CAG) is controversial because of post-procedural risks including acute contrast-induced nephropathy (CIN) and lactic acidosis (LA). This study aims to discuss the safety of continuing metformin treatment in patients undergoing elective CAG with normal or mildly impaired renal functions. Methods: Our study was designed as a single-centered, randomized, and observational study including 268 patients undergoing elective CAG with an estimated glomerular filtration rate of >60 mL/min/1.73 m2. Of these patients, 134 continued metformin treatment during angiography, whereas 134 discontinued it 24 h before the procedure. CIN was defined as either a 25% relative increase in serum creatinine levels from the baseline or a 0.5 mg/dL increase in the absolute value that measured 48 h after CAG. Logistic regression analysis was performed to identify independent predictors of CIN and LA after CAG. Results: Both groups were comparable in terms of demographics and laboratory values. CIN at 48 h was 8% (11/134) in the metformin continued group and 6% (8/134) in the metformin discontinued group (p=0.265). Patients in neither of the groups developed metformin-induced LA. Based on multiple regression analysis, the ejection fraction [p=0.029, OR: 0.760; 95% CI (0.590–0.970)] and contrast volume [p=0.016, OR: 0.022 95% CI (0.010–0.490)] were independent predictors of CIN. Conclusion: Patients scheduled for elective CAG with normal or mildly impaired renal functions and preserved left ventricular ejection fraction (>40%) may safely continue metformin treatment.

Isolated Right Ventricular Infarction Mimicking Anterior ST-Segment Elevation

Acute coronary syndromes in patients with presence of ST-segment elevation in the anterior precordial leads indicates left anterior descending coronary artery occlusion. However, anterior ST-segment elevation has also been described in right ventricular myocardial infarction and is thought to be due to right coronary artery (RCA) occlusion. We present a rare case of isolated RVMI presenting with anterior ST-segment elevation due to proximal occlusion of a right coronary artery that was treated by primary coronary angioplasty. Primary coronary angioplasty and stenting of this artery was performed resulting in resolution of the chest pain and ST- segment elevation.

GRACE score also predicts anatomic complexity of coronary artery disease patients presenting with non-STEMI

Acute Coronary Syndromes (ACS) represent the most common cause of death in the western world. We retrospectively screened data of non-STEMI patients admitted to the coronary care unit of a tertiary center between March 2015 and March 2016. GRACE score was calculated and patients were classified into low (1 to 108), intermediate (109 to 140) and high risk (>40) groups according to GRACE categories. SYNTAX scores were also calculated. 201 patients (mean age: 63 ± 12 years, 53.7% female) were admitted with a diagnosis of non-STEMI. The mean GRACE score and SYNTAX score of study population were 105 ± 34.1 and 16.9 ± 12. Based on the GRACE score for in-hospital deaths, the SYNTAX score was 14.2 ± 10.1 in the low-risk group, 16.0 ± 13.4 in the intermediators group, and 24 ± 12.2 in high-risk group (ANOVA p<0.0001). Post-hoc Tukey analysis showed that the high-risk group had a significantly higher SYNTAX score than the low-risk and intermediate risk groups (p<0.0001 vs p=0.003 respectively). There were significant positive correlations between the SYNTAX score and GRACE scores of the study population calculated at admission for in-hospital deaths (r=0.363, p<0.0001). GRACE score can predict complexity of CAD (high risk coronary anatomy). As we can decide to perform early invasive strategy according to GRACE score, we may consider detecting high risk complex coronary anatomy during coronary angiography. So, we may be ready to discuss with heart team about treatment strategy (ad hoc-PCI, multi-vessel PCI or CABG) in patients with high GRACE score. Before giving ADP receptor antagonist, we may consider CABG requirement in these patient population.

Relationship between myocardial performance index and severity of coronary artery disease in patients with non-ST -segment elevation acute coronary syndrome : Cardiovascular topics

Summary Objectives We aimed to investigate the relationship between myocardial performance index (MPI) and severity of coronary artery disease, as assessed by the Gensini score (GS), in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods Ninety patients with an initial diagnosis of NSTEMI were enrolled in our study. They were divided into tertiles according to the GS: low GS <19; mid GS > 19 and ≤ 96; and high GS > 96. Results The low-, mid- and high-GS groups included 24, 38 and 28 patients, respectively. Clinical features such as gender distribution; body mass index (BMI); prevalence of diabetes mellitus, hypertension and hyperlipidaemia; and smoking status were similar in the three groups. MPI and isovolumic relaxation time were significantly higher in the high-GS group than in the low- and mid-GS groups (p < 0.001 and p = 0.005, respectively). Furthermore, the high-GS group had a significantly lower ejection fraction and ejection time (p = 0.01 and p < 0.001, respectively). MPI was positively correlated with the GS (r = 0.47, p < 0.001), and multivariate regression analysis showed that MPI was an independent predictor of the GS (β = 0.358, p < 0.001). Conclusions Patients with NSTEMI who fall within the high-risk group may be identified by means of a simple MPI measurement.

A Rare Case of Type IV Dual Left Anterior Descending Coronary Artery

Coronary artery anomalies are usually asymptomatic and associated with other cardiac malformations. Dual left anterior descending coronary artery (LAD) is an uncommon congenital anomaly with four subtypes. This anomaly has been described in the angiographic literature and dual LAD types depending on the origin of major septal and diagonal branches and course within the anterior interventricular sulcus. Type IV expresses the anomaly of a rudimentary LAD artery ending in the mid-portion of the anterior interventricular sulcus, and the presence of other LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus. We report the rare case of a patient with the type IV dual left anterior descending coronary artery.

Mobitz Type 2 AV Block Dissolved With Contrast Injection.

There are many cases in the literature concerning the occurence of atrioventricular block in acute myocardial infarction. The prevelance and management of AV block in the setting of chronic myocardial ischemia remains unclear. Our case presented with stable angina pectoris. Treadmill test revealed Mobitz Type 2 AV block which disappeared with contrast injection and re-occured after injection during PCI.

Heart rate turbulence in patients with stable coronary artery disease and its relationship with the severity of the disease.

OBJECTIVE Heart rate turbulence (HRT) indicates the impairment of cardiac autonomic function. With the literature containing insufficient information on HRT in stable coronary artery disease (CAD), this study aimed to investigate the role of HRT in patients with stable CAD. METHODS The study included 58 patients (mean age: 58.9 ± 10.0 years; 25 male) with documented CAD and demonstrating ventricular premature complexes on Holter monitoring, and a control group of 52 patients (mean age: 55.9 ± 9.3 years; 36 male) with no history of CAD and demonstrating ventricular premature complexes. HRT parameters such as turbulence onset (TO) and slope (TS) were analyzed. Angiographic Gensini score were used to evaluate CAD severity. RESULTS There was a significant difference in HRT parameters between the 2 groups. TO: 0.47 ± 1.52% vs. -1.61 ± 2.0% (p=0.001) and TS: 4.7 ± 3.0 vs. 6.4 ± 3.7 ms/RR (p=0.009) in patients with CAD and control group respectively. Given also that TO ≥ 0% and TS ≤ 2.5 ms/ RR values are considered abnormal, there was significant difference between the two groups; TO abnormal: 27 patients (46.6%) vs. 7 patients (13.5%), p=0.001, and TS abnormal: 15 patients (25.9%) vs. 4 patients (7.7%), (p=0.004) in CAD patients and control group respectively. A positive correlation was detected between TO and Gensini score (r=0.282, p=0.001) and a negative correlation detected between TS and Gensini score (r=-0.287, p=0.001). CONCLUSION The study demonstrated that HRT variables are impaired in patients with stable CAD when compared to those in the control group, and that these variables also correlate with severity of CAD.

Akut Koroner Sendrom ve Akut Pankreatit Birlikteliği

Acute pancreatitis is an inflammatory syndrome with unpredictable progression to systemic inflammation and multi-organ dysfunction. As in our case rarely, acute pancreatitis can be presented with the coexistance of acute coronary syndrome. To prevent a misdiagnosis of acute situation presented with chest or abdominal pain, physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations.