Association of the CHA(2)DS(2)VASc Score with Acute Stent Thrombosis in Patients with an ST Elevation Myocardial Infarction Who Underwent a Primary Percutaneous Coronary Intervention

Keskin, Muhammed/0000-0002-4938-0097;WOS: 000467682900003PubMed: 30448849Objective: In this study, we aimed to determine the predictive value of the CHA(2)DS(2)VASc score for acute stent thrombosis in patients with an ST elevation myocardial infarction treated with a primary percutaneous coronary intervention (pPCI). Methods: This was a retrospective study conducted among 3,460 consecutive patients with STEMI who under-went a pPCI. The stent thrombosis was considered a definite or confirmed event in the presence of symptoms suggestive of acute coronary syndrome and angiographic confirmation of stent thrombosis based on the diagnostic guidelines of the Academic Research Consortium. The stent thrombosis was classified as acute if it developed within 24 h. Results: The mean CHA(2)DS(2)VASc score was 3.29 +/- 1.73 in the stent thrombosis group, whereas it was 2.06 +/- 1.14 in the control group (p = 4 were independently associated with acute stent thrombosis (OR = 1.64; 95% CI 1.54-1.71, p = 4, with 60% sensitivity and 73% specificity. Of note, patients with a CHA(2)DS(2)VASc score of 4 had a 4.3 times higher risk of acute stent thrombosis compared to those with a CHA(2)DS(2)VASc score of 1. Conclusions: The CHA(2)DS(2)VASc score may be a significant independent predictor of acute stent thrombosis in patients with STEMI treated with a pPCI. Therefore, the CHA(2)DS(2)VASc score may be used to assess the risk of acute stent thrombosis in patients with STEMI following a pPCI. (C) 2018 The Author(s) Published by S. Karger AG, Base

The Correlation Between Education Levels and Lifestyles of Patients Admitted Cardiology Clinics: A Subgroup Analysis of Medlife-TR Study

Objectives: The lifestyle, dietary habits, and cardiovascular (CV) risk perception of patients with CV risk factors and/or diseases in Turkish population may vary with education. We aimed to reveal the relationship between education level and lifestyles in patients who participated in the Medications and Lifestyles of Patients with Cardiovascular Risk Factors and/ or Diseases in Turkish Population (MedLife-TR) study. Materials and Methods: This study was conducted between November 2018 and March 2019 with 2793 patients. The male gender ratio was 47.91%, and the female gender ratio was 52.09%. The participants first completed a self administered questionnaire in four sections: baseline characteristics, awareness of CV risk factors and their CV risk levels ,lifestyle habits (exercise, diet, eating….) and use of drugs. This was a multicenter, national and observational study that included 27 centers in Turkey. Fisher-Freeman-Halton test was used for comparison of qualitative data. A p-value <0.05 was considered statistically significant. Results: According to the education level of patients, CV risk perception and eating habits vary as education level increases. The ratio of patients to exercise regularly was low. But as the level of education increases, the rate of regular exercise increases (p<0.001). The rate of using herbal products (p=0.086) or vitamins (p=0.384) did not change as the level of education increased. The university-level group stated that smoking was the highest risk factor for CV disease (28.33%). However, the other groups, especially the uneducated group (42.92%) think that hypertension is the most risk factor for CV diseases. The consumption of fast-food products such as hamburgers, pizza, and fries increased as the education level increased. The rate of skipping breakfast (17.69%) was higher in the university-level group than the other groups (p<0.001). Conclusion: Statistically significant differences were observed between education level and lifestyle of patients with CV risk factors and/or diseases. As the education level increases, the rate of skipping breakfast and the consumption of fast-food products increase; however, the rate of regular exercise and diet increases

The association of acute­-to­-chronic glycemic ratio with no-reflow in patients with ST­-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Background: No‑reflow (NR) is a strong and independent predictor of poor cardiovascular outcomes among patients with ST‑segment elevation myocardial infarction (STEMI). Aims: The aim of the study was to investigate the association of the acute‑to‑chronic (A/C) glycemic ratio with no‑reflow (NR) in STEMI patients following primary percutaneous coronary intervention (PCI). Methods: This retrospective study included 905 patients with STEMI. The A/C glycemic ratio was determined as admission blood glucose (ABG) divided by the estimated average glucose (eAG). We evaluated 2 primary models (full model and reduced model). The primary outcome was the presence of NR. Results: The incidence of NR was 22.7% (206 cases) in the present study. We divided the study population into 3 tertiles (T1, T2, and T3) based on the ABG/eAG ratio. There was a stepwise increase of the frequency of NR from the T1 to T3 group (36 patients [12%] vs 70 patients [23%] vs 100 patients [33%]; respectively [P &lt; 0.001, for each group comparison]). In a full model, the ABG/eAG ratio (OR, 2.274; 95% CI, 1.587–3.26; P &lt; 0.001) was associated with NR. After the performance of a step-down backward variable selection method, the thrombus grade, the ABG/eAG ratio, the infarct‑related artery diameter, and age remained in the reduced model. The ABG/eAG ratio (contributing 25.3% of the explainable outcome in the model) was one of the strong predictors of NR in the reduced model. Conclusions: To our knowledge, this might be the first study showing a significant relationship between the ABG/eAG ratios with NR in patients with STEMI after primary PCI

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: the ATA study

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess ad-herence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ?40%).Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin–angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter–defibrillator (ICD) and cardiac resynchro-nization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy. (Anatol J Cardiol 2020; 24: 32-40

Prognostic significance of medical therapy in patients with heart failure with reduced ejection fraction

Aims: The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting. Methods and results: The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20–96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ≤1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49–0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47–0.79; P < 0.001, respectively]. Conclusions: The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF

EPIC (yaşlı, ayaktan kardiyak hastalarda polifarmasi ve potansiyel ilaç-ilaç etkileşimlerinin epidemiyolojisi) çalışmasının temel, tasarım ve metodolojisi

Objective: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. Methods: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged >= 65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). Result: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1-2; moderate, those with a CCI score of 3-4; and severe, those with a CCI score of >= 5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. Conclusion: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting.Amaç: Türkiye’deki kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi prevalansını, uygunsuz ilaç kullanımını ve ilaç-ilaç etkileşimlerini (İİE) değerlendirmek. Yöntemler: EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) çalışması kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi ve İİE’nin değerlendirileceği, gerçek yaşam verilerini aktaran, çok merkezli ve gözlemsel bir çalışma olarak tasarlandı. Çalışmaya; 30 Temmuz 2018 ve 30 Temmuz 2019 tarihleri arasında farklı kardiyoloji polikliniklerine başvuran, aydınlatılmış onam formunu imzalayan, 65 yaş ve üzeri, kadın ve erkek, ardışık 5000 hastanın dahil edilmesi planlandı. Hastalarla ilgili tüm verilerin tek bir ziyarette alınması ve verilerin değerlendirilmesi planlandı (ClinicalTrials.gov numarası NCT03370523). Bulgular: Hastalara ait demografik veriler, komorbid hastalık durumları, laboratuvar test sonuçları ve ilaç bilgileri hasta beyanları ve medikal kayıtlar yoluyla toplanacaktır. Komorbid hastalıklar kaydedilecek ve komorbid hastalıkların ciddiyeti Charlson komorbidite indeksi’ne (CKİ) göre hastalar 3 gruba ayrılacaktır: CKİ skoru 1–2 olanlar hafif, CKİ skoru 3–4 olanlar orta, CKİ skoru ≥5 olanlar ciddi. Polifarmasi aynı hastanın bir kerede 5 ve üzeri ilaç kullanması olarak tanımlanacaktır. İİE Lexicomp® çevrimiçi ilaç etkileşimi tarama aracı ile kontrol edilecek, potansiyel uygunsuz ilaç kullanımı 2015 Beers kriterlerine göre tanımlanacaktır. D ve X kategorisindeki etkileşimler ciddi ilaç etkileşimi olarak sınıflandırılacaktır. Sonuç: EPIC çalışması kardiyoloji polikliniklerine başvuran yaşlı hastalarda polifarmasi, İİE ve potansiyel uygunsuz ilaç kullanımı konularında gerçek yaşam verilerini ayrıntılı olarak aktaran ilk büyük çaplı çalışma olacaktır