The ratio of contrast volume to glomerular filtration rate predicts in-hospital and six-month mortality in patients undergoing primary angioplasty for ST-elevation myocardial infarction

Background: The aim of this study is to determine the impact of ratio of contrast volume to glomerular filtration rate (V/GFR) on development of contrast-induced nephropathy (CIN) and long-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 645 patients with STEMI undergoing primary PCI was prospectively enrolled. CIN was defined as an absolute increase in serum creatinine > 0.5 mg/dL or a relative increase > 25% within 48 h after PCI. The study population was divided into tertiles based on V/GFR. A high V/GFR was defined as a value in the third tertile (> 3.7). Results: Patients in tertile 3 were older, had higher rate of smoking, diabetes mellitus and CIN, lower left ventricular ejection fraction, hemoglobin, and systolic and diastolic blood pressure compared to tertiles 1 and 2 (p < 0.05). V/GFR was found an independent predictor of in-hospital and 6-month mortality. We found 2 separate values of V/GFR for 2 different end points. While the ratio of 3.6 predicted in-hospital mortality with 78% sensitivity and 82% specificity, the ratio of 3.3 predicted 6-month mortality with 71% sensitivity and 76% specificity. Survival rate decreases as V/GFR increases both for in-hospital and during 6-month follow-up. Diabetes mellitus and multivessel disease were other predictors of in-hospital mortality. Conclusions: High V/GFR level is associated with increased in-hospital and long-term mortality in patients with STEMI undergoing primary PCI.

Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

Background: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Methods: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. Results: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. Conclusions: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism

Rheumatoid factor mediates excess serum lipoprotein(a) for independent association with type 2 diabetes in men

Altay, Servet/0000-0001-7112-3970; Ademoglu, Evin/0000-0003-2933-3119;WOS: 000362968700001PubMed: 25592098Objective: The potential association of rheumatoid factor (RF) and lipoprotein (Lp)(a) levels, as well as with the likelihood of type 2 diabetes and hypertension, needs exploring. Methods: Cross-sectional associations were sought in this unselected and population-based 1539-adult cohort (age 58.8 +/- 10.6 years). RF was assayed nephelometrically. Multiple logistic regression analyses were used for covariates of RF positivity and for the latter's association with diabetes and hypertension. Results: RF-positive individuals were older, fewer current smokers, had significantly lower fasting triglycerides (by 13%), higher fibrinogen, and tended to higher sex hormone-binding globulin (SHBG) levels. Whereas, women had a similar risk profile irrespective of RF status, RF-positive men had significantly higher Lp(a). In contrast to Lp(a) being positively correlated with SHBG in RF-negative subjects (r = 0.08; p = 0.007), an inverse correlation existed in seropositive individuals (r = -0.32, p = 0.011), suggesting the interplay of an immune complex. In regression analyses, RF positivity was associated with Lp(a) in men but not in women, [OR 1.53 (1.19; 1.96)], independent of age, SHBG, and C-reactive protein (CRP). RF positivity was further associated with diabetes [OR 1.98 (95% CI 1.11; 3.52)] in the whole sample, additively to waist circumference and CRP, major determinants of diabetes. RF-positive subjects were not significantly associated independently with hypertension. Conclusion: Autoimmune activation linked to Lp(a) is mediated by the autoantibody RF in contributing to the development of type 2 diabetes

Predictors of Anticoagulant Treatment in Patients With Nonvalvular Atrial Fibrillation: Results From Atrial Fibrillation in Turkey: Epidemiologic Registry

cagliyan, caglar/0000-0002-2529-4995; Kaya, Hasan/0000-0003-3923-4026WOS: 000350492000007PubMed: 23742948The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age >= 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF

Türkiyede atriyum fibrilasyonu epidemiyolojisi; çok merkezli AFTER çalışmasının ön sonuçları

Amaç: Atriyum fibrilasyonu (AF) klinik pratiğimizde en sık rastlanan ritm bozukluğu olup ülkemizde bu konuda yapılmış çok merkezli bir epidemiyolojik çalışma bulunmamaktadır. Bu çalışmanın amacı ülkemizde ilk kez yapılmış olan çok merkezli, ileriye dönük Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) çalışmasının kayıtlarından yararlanarak AFye klinik yönden yaklaşımımızı değerlendirmektir. Çalışma planı: Ülkemizde nüfus dağılımı göz önünde bulundurularak 17 ayrı üçüncü basamak merkezden, elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2242 hasta çalışmaya alındı. Acil polikliniğine başvuran ya da yatmakta olan hastalar çalışmadan dışlandı. Hastaların epidemiyolojik verileri ve uygulanan tedaviler değerlendirildi. Bulgular: Çalışma popülasyonunu oluşturan hastaların %60ı kadındı, hastaların ortalama yaşı 66.812.3 yıl olarak saptandı. Türk nüfusunda en sık görülen AF tipi non-valvular AF (%78) olup, AFli hastaların %81i ısrarcı-kalıcı AFli idi. AFye en sık eşlik eden komorbid durum hipertansiyon (%67) olarak bulundu. Hastaların %15.3ünde inme, geçici iskemik atak ve sistemik tromboemboli hikayesi mevcut iken kanama öyküsü hastaların %11.2sinde kaydedildi. Çalışma süresinde hastaların %50si warfarin, %53ü de aspirin kullanıyordu. Oral antikoagülan ilaç kullanan hastaların %41.3ünde etkin INR düzeyi saptandı. Oral antikoagülan ilaç kullanmamanın en sık nedeni (%69) hekim ihmali olarak saptandı. Sonuç: Bu veriler klinik pratiğimizde özellikle AFli hastaların antitrombotik tedavileri konusunda daha dikkatli olunması gerektiğini göstermektedir.Objectives: Although atrial fibrillation (AF) is one of the most com- mon rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Tur- key: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency depart- ments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study popula- tion. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co- morbidity in patients with AF. While a stroke or transient ischemic at- tack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspi- rin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy