Retrospectively, compared percutaneous coronary intervention and surgical revascularization for the treatment of multivessel coronary artery disease according to syntax scores groups

Giriş ve Amaç: Koroner arter hastalığının (KAH) ciddiyetini belirlemede, angiografik olarak lezyon sayısı, lezyonun yeri ve fonksiyonel önemi gibi özellikleri göz önünde bulundurarak hazırlanan Syntax skorlama sistemi önemli ve objektif veriler sunmaktadır. Bu çalışmanın amacı, perkütan koroner girişim (PKG) ya da koroner arter baypas greftleme (KABG) gibi revaskülarizasyon yöntemlerinin ilk defa uygulandığı çok damar koroner arter hastaları ya da sol ana koroner arter (LMCA) hastalarının syntax skoruna göre sınıflandırılması ve her iki revaskülarizasyon yönteminin sonuçlarının karşılaştırılmasıdır. Yöntem: 1 Ocak 2009 ile 31 Aralık 2010 tarihleri arasında Dokuz Eylül Tıp Fakültesi Hastanesi Kardiyoloji Anabilim Dalında koroner angiografi uygulanıp çok damar KAH ya da LMCA hastalığı tespit edilmiş ve daha sonra Kardiyoloji ? Kalp Damar Cerrahisi ortak konseyinde ilk defa revaskülarizasyon kararı (PKG ya da KABG) verilen toplam 391 hasta (PKG:171 hasta vs KABG:220 hasta) çalışmaya dahil edilmiştir. Hem PKG hem de KABG yapılan hastalar syntax skoruna göre düşük (<23), orta (23-32) ve yüksek (>32) olmak üzere üç gruba ayrıldı. Ayrıca KABG uygulanan hastaların EuroSCORE II ve lojistik EuroSCORE değerleri hesaplandı. Her iki revaskülarizasyon yönteminin hastane içi ve taburculuk sonrası ilk bir yıllık mortalite oranları değerlendirildi. Bulgular: PKG yapılan hastaların ortalama yaşı 61.21±10.93, %71,3?ü erkek iken KABG yapılan hastaların ortalama yaşı 63.08±9.43, %80,0?i erkek idi (yaş, p=0,013; cinsiyet, p=0,046). PKG yapılan hastaların ortalama syntax skoru 19.72 ±5.85, KABG yapılan hastaların ise ortalama syntax skoru 28.23±7.11 olarak saptandı (p=0,008). KABG yapılan hastaların ortalama EuroSCORE II değeri 1,43, ortalama lojistik EuroSCORE değeri 7,20 olarak tespit edildi. Hastane içi mortalite PKG uygulanan hastalarda %1,2 (2 hasta), KABG uygulanan hastalarda %9,5 (21 hasta) oranında gerçekleşti (p<0,001). Taburculuk sonrası ilk bir yıllık mortalite ise PKG yapılan hastalarda %2,3 (4 hasta), KABG yapılan hastalarda %3,2 (7 hasta) olarak saptandı (p=0,762). PKG uygulanan grupta hastane içi mortalitenin izlendiği iki hastada yüksek syntax skoruna sahip idi. KABG uygulanan hastalarda syntax skoruna göre gruplandırılması sonucunda hastane içi mortalitede yüksek syntax skoruna sahip hastalarda istatistiksel anlamlılık oluşmadı (p=0,18). Hastane içi mortalitenin gerçekleştiği ve gerçekleşmediği KABG grubundaki hastalarda EuroSCORE II ortalamaları arasındaki farkın istatistiksel olarak en anlamlı parametre olduğu (p<0,001), daha sonra ise yaş ve sol ventrikül ejeksiyon fraksiyonu ortalamalarının istatistiksel anlamlılık oluşturduğu tespit edildi (sırasıyla X p=0,003 ve p=0,021). Bu grupta syntax skor ortalamalarına göre istatistiksel anlamlılık tespit edilmedi (p=0,121). Tartışma: Çalışmamızda retrospektif olarak PKG ve KABG uygulanan çok damar koroner arter hastaları ve LMCA hastalarının syntax skoruna göre hastane içi ve ilk 1 yıldaki mortalite sonuçları incelenmiştir. KABG uygulanan hastalarda hastane içi mortalite PKG uygulanan hastalara göre daha fazla tespit edilmiştir. Ancak PKG uygulanan hastalar daha düşük syntax skoruna ve çok daha az LMCA hastalığına sahipti. KABG uygulanan hastalarda hastane içi ve ilk bir yılda mortaliteyi ön görmede syntax skor risk belirleme modelinin başarılı olmadığı saptanmıştır. Introduction and Objective: Syntax scoring system was established by lesion number, place and functional importance in angiography which projects objective and essential data for severity of coronary artery disease (CAD). Our aim in this study is to classify and compare the results of revascularization methods in multiple vessel CAD or left main coronary artery disease (LMCA) patients in their first intervention as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) due to syntax scoring system. Method: We included totally 391 patients which were diagnosed previously as multiple vessel CAD or LMCA disease after coronary angiography in Cardiology Department in Dokuz Eylul Faculty of Medicine Hospital between 01/01/2009 and 12/31/2010. 171 of 391 patients was initially revascularized by PCI, CABG was performed in 220 of 391 patients. Both PCI and CABG groups were divided into three subgroups as syntax scoring system as low (<23), intermediate (23-32) and high (>32) . Also, EuroSCORE II and logistic EuroSCORE values were calculated in CABG group. Mortality rates in hospital stay and during first year were evaluated in both revascularization method. Results: The mean age in PCI group was 61.21±10.93 and 71,3% was male on the other hand in CABG group the mean age was 63.08±9.43 and 80,0 % was male (age, p=0,013; sex, p=0,046). Mean syntax score was detected as 19.72 ±5.85 in PCI group and 28.23±7.11 in CABG group (p=0,008). The mean EuroSCORE II value was 1,43 and mean logistic EuroSCORE value was 7,20 in CABG group. Mortality rate during hospital stay was detected as 1,2 % (2 patients) in PCI group, 9,5 % (21 patients) in CABG group (p<0,001). First year mortality in PCI group was 2,3 % (4 patients), 3,2% (7 patients) in CABG group (p=0,762). High syntax score was calculated in two mortal patients during hospital stay in PCI group. İn CABG group, there was no statistically significant difference in hospital mortality occured in patient with a high score of syntax (p=0,18). The most significant parameter in mortality during hospital stay was detected as EuroSCORE II average values (p<0,001) followed by age and left ventriculus ejection fraction average values (respectively p=0,003 and p=0,021) in CABG group. In this group there were no significant difference due to syntax scoring averages (p=0,121). XII Discussion: In our study we investigated retrospectively the mortality rates during hospital stay and first year in PCI or CABG which performed in multiple vessel CAD and LMCA disease patients. The mortality rates during hospital stay was significantly higher in CABG group in comparison to PCI group. However PCI group had lower syntax score average and less LMCA disease patients. Syntax scoring system is not successful in prediction of mortality during hospital stay and first year in CABG group

Does prolonged QTc predict pulmonary involvement in COVID-19 patients?

Objectives: Coronavirus disease (COVID-19) is a disease with high mortality due to acute respiratory distress syndrome (ARDS) secondary to viral pneumonia. In addition to its effects on the respiratory system, coronavirus is known to have serious systemic effects on the cardiovascular system. In this study, we aimed to investigate the association between prolonged QTc duration and COVID-19 specific pulmonary involvement Methods: Between December 2020 and February 2021, 112 patients who were diagnosed with COVID-19 in our COVID-19 outpatient clinic and met the inclusion criteria were evaluated for the association between cardiac variables (heart rate, PR width, QRS width, fQRS, and QTc interval), other patient characteristics and lung involvement. Results: A significant difference was found between the QTc intervals of COVID-19 patients with and without lung involvement (p < 0.026). In the ROC analysis for the QTc interval, which was found to be significant in the multivariate regression analysis, the cut-off value of 419.5 ms had a sensitivity of 72% and a specificity of 51.6% in predicting pulmonary involvement. Conclusions: Prolonged QTc duration may be useful in predicting COVID-19 pulmonary involvement in patients admitted to the emergency department

Diagnostic accuracy of mean platelet volume in prediction of clopidogrel resistance in patients with acute coronary syndrome

Objective: Clopidogrel therapy is the standard of care in patients with acute coronary syndrome (ACS) and stent implantation. However, concern arises because 25% of subjects are nonresponders to clopidogrel. As this nonresponsiveness is associated with increased adverse outcome, detection of these subjects in daily practice is important in order to withhold a more aggressive therapy and closer follow up. In this study we aimed to evaluate the relation between mean platelet volume (MPV) which is an indicator of platelet activation and clopidogrel nonresponsiveness

Diagnostic accuracy of mean platelet volume in prediction of clopidogrel resistance in patients with acute coronary syndrome

Objective: Clopidogrel therapy is the standard of care in patients with acute coronary syndrome (ACS) and stent implantation. However, concern arises because 25% of subjects are nonresponders to clopidogrel. As this nonresponsiveness is associated with increased adverse outcome, detection of these subjects in daily practice is important in order to withhold a more aggressive therapy and closer follow up. In this study we aimed to evaluate the relation between mean platelet volume (MPV) which is an indicator of platelet activation and clopidogrel nonresponsiveness

Purpura fulminans as the presenting manifestation in a patient with juvenile SLE

We present a 12-year-old girl with systemic lupus erythematosus and associated antiphospholipid syndrome who developed an unusual manifestation of purpura fulminans in an accelerated fashion. The patient improved after prompt treatment with anticoagulants, aggressive immunosuppressive drugs and plasmapheresis. This is the first pediatric case of purpura fulminans due to secondary antiphospholipid syndrome of systemic lupus erythematosus. We suggest that SLE patients with lupus anticoagulant should be followed closely for similar complications

The role of tricuspite annular plane systolic excursion as a marker of hypovolemia in healthy blood donor volunteers

Aim: The aim of this study is to compare the diameter of the inferior vena cava with tricuspid annular plane systolic excursion (TAPSE) measurement in order to determine the volume loss before and after blood donation in healthy volunteers. Methods: This Institutional Review Board-approved single center, prospective, cross-sectional study included 60 healthy blood donors donating in a tertiary care hospital's blood bank. After obtaining written consent, systolic, diastolic, and mean arterial blood pressures along with pulse rate of the donors were measured in sitting and supine positions by the attending physician, then, inferior vena cava (IVC) and TAPSE measurements were made before and after blood donation. Results: Statistically significant differences was found between standing systolic blood pressure and pulse rate, lying systolic blood pressure and pulse rate, IVC and TAPSE values before and after blood donation (p 0.05). There was no difference between the other variables before and after blood donation. Conclusion: Our study revealed that, low IVC and TAPSE values correlated in determining blood loss after blood donation. TAPSE may be useful to predict blood loss in early stages of hypovolemic shock. (c) 2021 Published by Elsevier Inc