Rationale, design, and methodology of the MORCOR-TURK trial: predictors of in-hospital MORtality in CORonary care patients in Turkey

Background: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey. Methods: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694). In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort. Results: The short-term outcomes of the study are planned to be shared by early 2023. Conclusion: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units

Value of lead aVr in prediction of the left anterior desending coronary artery proximal lesions in ST-segment elevation myocardial infarction

Sol ön inen arter (SİA) proksimal bölgesinin akut tıkanması sonucu meydana gelen akut miyokard infarktüsü, tehdit altındaki miyokard alanının geniş olması nedeniyle yüksek mortaliteye sahiptir. SİA'nın proksimalden tıkalı olduğu erken ve noninvaziv olarak tespit edilebilirse uygulanacak daha agressif revasküiarizasyon tedavisinin getireceği fayda daha belirgin olacaktır. Biz bu çalışmada, son zamanlarda EKG'nin değerlendirilmesinde kullanımı gündeme gelen aVR derivasyonun SİA proksimal lezyonlarını tespit etmedeki değerini araştırmayı amaçladık. Materyal-metod: Çalışmaya, tipik göğüs ağrısı nedeniyle hastaneye başvuran ve elektrokardiyografide (EKG) tipik ST segment yükselmesi görülen 361 hasta (293 erkek. 68 kadın) alındı. Hastaların hepsine taburcu olmadan koroner anjiyografi (KAG) yapılarak infarktüsten sorumlu arter ve segmenti tespit edildi. Bununla birlikte, infarktüsten sorumlu arter (İSA) olup olmadığına bakmaksızın sol ana koroner arter ve eşdeğeri lezyonlar önemli damar hastalığı olarak tanımlandı. Rcperfüzyon tedavisi öncesi ST segment değişikliklerinin en belirgin olduğu EKG'ler değerlendirildi. EKG'de her bir derivasyonda ve aVR'de meydana gelen ST segment yükseklikleri ve çökmeleri kaydedildi. Hastalar aVR*de >0.5mm ST segment yüksekliği varlığına göre aVR pozitif (+) ve negatif (-) olmak üzere iki gruba ayrıldı. Bulgular: elektrokardiyografık değerlendirmede 189 hastada anteriyor Mİ. 172 hastada inferiyor Mİ örneği tespit edildi. aVR (+)'liği anteriyor Mİ'larda %20 oranında (38 hasta) görülürken, bu oran inferiyor Mİ geçirenlerde %5 (8 hasta) idi. KAG'dc 52 hastada İSA, SİA proksimal oiarak bulundu. aVR (+) grupta %54 hastada İSA bölgesi, SİA proksimaü iken aVR (-) grupta bu oran %9 idi (pO.001). Önemli damar hastalığı aVR (+) grupta %61, aVR (-) grupta ise %16 olarak tespit edildi. (p0.5mm) or negative (<0.5mm). Results: There were 189 patients with anterior MI and 172 patients with inferior MI based on ECG evaluation. Twenty percent of the patients (38 patients) with anterior MI were in the aVR positive group, whereas only 5% of the patients (8 patients) with inferior MI were in aVR positive (p<0.001). In the aVR positive group, 54% of the patients had proximal LAD as the IRA segment, whereas only 9% of the patients in the aVR (-) group had the same lesion (p<0.00i). Significant coronary lesions were found in 61% of the patients in aVR positive group, although 16% of the patients were in aVR negative group (pO.001). Also, multivessel disease was more frequent in the aVR positive group (p<0.001). The degree of ST segment amlitudu of lead aVR was correlated positively with Gensini score (r= 0.21; p=0.002). In patients with anterior MI, ST segment elevation in lead aVR was useful for predicting acute proximal LAD occlusion with 47% sensitivity, 91% specifity, 81% negative predictive value, 68% positive predictive value and 78 % diagnostic accuracy. 50Conclusion: In patients with acute anterior MI, lead aVR may be used to predict the amount of myocardium at risk and localization of proximal LAD lesion as the IRA segment. Keywords: myocardial infarction, electrocardiography, lead aVR, proximal left anterior desendiniz artery lesions

The Effect of Blood Pressure Regulation on Arterial Stiffness in Individuals with Stage I-II Hypertension

Amaç: Hipertansif hastalarda sub-klinik organ hasarı göstergelerinden biri de arteryel sertliktir. Çalışmamızda Evre I-II hipertansiflerde kan basıncı düzenlemesinin arteryel sertlik üzerine etkilerini değerlendirdik. Gereç ve Yöntem: 18-65 yaş Evre I-II hipertansif 60 (34 Evre I, 26 Evre II) hastaya tedavi öncesi ve en az bir ay sonrası olmak üzere 24 saatlik ayaktan kan basıncı izlemi yapıldı. Hastaların tedavileri, arteryel sertlik parametrelerine kör olan hastanın kendi doktorunca verildi. Kan basıncı kontrol altına alınan (Grup 1, n30) ve alınamayan (Grup 2, n30) olarak iki grup oluşturuldu. 24 saatlik holter izleminden hesaplanan aortik sertlik parametrelerinin her iki grupta tedavi öncesi ve sonrası değerleri karşılaştırıldı. Bulgular: Tedavi sonrası; grup 1 hastaların kan basınçları ve arteryel sertlik parametrelerinde [Augmentasyon basıncı (13,46, 10.75.6, p0.001), Augmentasyon indeksi (29,68,2, 26,08,0, p0.001), nabız basıncı (479, 416, p0,001), nabız dalga hızı (7.70.9, 7.10.9, p0.001)] anlamlı düşme izlendi (p0,05). Grup 2 hastaların ortalama diyastolik kan basıncı (948, 918, p0,01) ile kalp hızında (788, 748, p0,03) anlamlı düşme, Augmentasyon basıncında (12,05,1, 14,05,9, p.03) anlamlı yükselme (p0,05) izlenirken, diğer parametrelerde anlamlı değişim görülmedi. Sonuç: Evre I ve Evre II hipertansif hastalarda kan basıncı kontrolü, arteryel sertlik parametrelerinde anlamlı düzelme sağlamaktadır. Yeterli kan basıncı kontrolünün sağlanamadığı durumda ise antihipertansiflere rağmen arteryel sertlik parametreleri düzelmemektedir.Aim: One of the indicators of sub-clinical organ damage in hypertensive patients is also arterial stiffness. We evaluated the effects of blood pressure regulation on arterial stiffness in stage I-II hypertensives. Material and Method: A total of 60 patients ageing 18-65 with stage I-II hypertension (34 stage I, 26 stage II) underwent 24-hour ambulatory blood pressure monitoring before and at least one month later treatment. The treatments were performed by their physi- cians who blind to parameters of arterial stiffness. Two groups were generated including blood pressure regulated- (Group 1, n30) and non-regulated (Group 2, n30). Aortic stiffness parameters, calculated by 24-hour monitoring, before and after treatment were compared in both groups. Results: After treatment, the blood pressures and arterial stiffness parameters [Augmentation pressure (13.4±6, 10.7±5.6, p>0.001), Augmentation index (29.6±8.2, 26.0±8.0, p0.001), pulse pressure (47±9, 41±6, p>0.001), pulse wave velocity (7.7±0.9, 7.1±0.9, p>0.001)] of group 1 were significantly decreased. Whereas mean diastolic blood pressures and heart rates of group 2 were significantly decreased, augmentation pressure was significantly increased, other parameters did not change significantly. Conclusion: Blood pressure regulation resulted in statistically significant improve of arterial stiffness parameters in stage I-II hypertension. When blood pressure could be not regulated, aortic stiffness parameters wasnt improved despite using the antihypertensive drugs

Paroksismal atriyal fibrilasyonu olan hastalarda paroksismal atriyal fibrilasyonun öngörülmesinde doku Doppler görüntüleme ve zirve hızlanma süresi

Atrial fibrillation is the most common arrhythmia in the population and its prevalance increases with age; and also is the most morbid and mortal arrhythmia. Usually the beginning of the persistant atrial fibrillation is recurrent episodes of the paroxysmal atrial fibrillation (PAF). Prediction of the paroxysmal atrial fibrillation can cause prevention of this arrhythmia and thus prevention of the adverse outcomes. We aimed to investigate tissue Doppler imaging (TDI) and peak acceleration time (pkAcc) parameters that can predict the paroxysmal atrial fibrillation in this study. Material and Methods: 20-73 years old (mean 47,5) 50 individuals that are diagnosed with PAF included the patient group. 50 individuals who have the similar baseline demographic charasteristics with patient group and who have no persistant or PAF included the control group. Transthoracic echocardiogaphic (TTE) evaluation is applied all of the control and study groups. Tissue Doppler parameters and pkAcc is measured in TTE and statistical analyses is performed. Results: In TTE evaluation, left atrium ejection fraction is lower in the patient group than the study group (%50,6 vs. %59,2, p<0,001). In TDI evaluation, the average of E/E’ which was measured from the anterior, inferior, lateral and septal walls of the left ventricle; is found higher in the patient group compared to the control group (8,17 vs. 7,04; p=0,004). When two groups are compared in terms of pkAcc, it was found that patient group is higher, but this difference did not reach the statistical significance (1063 vs. 994, p=0,14). Conclusions: TDI evaluation can play an important role in prediction of paroxysmal atrial fibrillation.Atriyal fibrilasyon, popülasyonda en sık görülen aritmidir ve prevalansı yaşla artar ayrıca en sık rastlanılan morbidite ve mortalite oluşturan aritmidir. Genellikle persistan atriyal fibrilasyonun başlangıcı paroksismal atriyal fibrilasyonun (PAF) tekrarlayan bölümleridir. Paroksismal atriyal fibrilasyonun öngörülmesi, bu aritminin önlenmesine ve dolayısıyla olumsuz sonuçların önlenmesine neden olabilir. Bu çalışmada paroksismal atriyal fibrilasyonu öngörebilecek doku Doppler görüntüleme (TDI) ve pik hızlanma süresi (pkAcc) parametrelerini araştırmayı amaçladık. Gereç ve Yönetemler: 20-73 yaşları arasında (ortalama 47,5) PAF tanısı almış 50 kişi ile hasta grubu oluşturuldu.. Hasta grubu ile benzer temel demografik özelliklere sahip olan ve persistan veya PAF bulunmayan 50 kişi ile kontrol grubu oluşturuldu.Tüm kontrol ve çalışma gruplarına transtorasik ekokardiyografik (TTE) değerlendirme yapıldı. Doku Doppler parametreleri ve pkAcc TTE'de ölçüldü ve istatistiksel analizler yapıldı. Bulgular: TTE değerlendirmesinde, hasta grubunda sol atriyum ejeksiyon fraksiyonu çalışma grubundan daha düşüktü (% 50,6 vs.% 59,2, p &lt;0,001). TDI değerlendirmesinde, sol ventrikülün anterior, inferior, lateral ve septal duvarlarından ölçülen E / E 'nin ortalaması; Hasta grubunda kontrol grubuna göre daha yüksek bulundu (8,17 ve 7,04; p = 0,004). İki grup pkAcc açısından karşılaştırıldığında, hasta grubunun daha yüksek olduğu bulundu ancak bu fark istatistiksel olarak anlamlı bulunmadı (1063'e karşı 994, p = 0,14). Sonuç: TDI değerlendirmesi paroksismal atriyal fibrilasyonun öngörülmesinde önemli bir rol oynayabilir

Effects of Smoking on Very-Long Term Mortality after First ST Elevation Myocardial Infarction

Background: The smoking paradox has been a matter of debate for acute myocardial infarction patients for more than two decades. Although there is huge evidence claiming that is no real paradox, publications supporting better outcomes in post-MI smokers are still being released

Effect of overweight and obesity on the left ventricular systolic and diastolic functions in patients with acute myocardial infarction

Purpose: The purpose of this study was to evaluate whether a association exits among overweight and obesity and left ventricular systolic and diastolic functions in patients admitted with first ST-elevation myocardial infarction (STEMI). Methods: The present study was performed on 451 consecutive patients diagnosed with first STEMI (376 men, 75 women; mean age 56.1±10.8 years). The patients were classified into three groups based on their body mass index (BMI) as normal weight (BMI 30 kg/m2). Echocardiographic features were evaluated and compared among the three groups. Results: Mitral annulus E velocities were higher in obese individuals than normal weight group (p 0.05). Conclusion: These results suggest that while obesity has no adverse effect on the left ventricular systolic function, it has unfavorable consequences on the left ventricular diastolic function in the patients with first STEMI. In contrast, no unfavorable effects of overweight on the left ventricular systolic and diastolic function were detected

Mortality predictors of Staphylococcus aureus bacteremia: A prospective multicenter study

Background: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1%. Healthcare associated SAB was defined in 55.7%. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2%. Initial empirical therapy was inappropriate in 28.2%. Although overall mortality was observed in 52 (20.4%), 28-day mortality rate was 15.3%. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12h, respectively; p>0.05). High Charlson comorbidity index (CCI) score (p=0.002), MRSA (p=0.017), intensive care unit (ICU) admission (p<0.001) and prior exposure to antibiotics (p=0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p=0.023], ICU admission (HR 6.9; p=0.002), and high CCI score (HR 1.32; p=0.002) as the independent predictive factors mortality. Conclusions: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB

Rationale, Design, and Methodology of the MORCOR-TURK Trial: Predictors of In-hospital MORtality in CORonary Care Patients in Turkey

BACKGROUND: Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey. METHODS: The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694). In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort. RESULTS: The short-term outcomes of the study are planned to be shared by early 2023. CONCLUSION: The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units