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

Impact of using surgical face masks on exercise test parameters in professional athletes

Background: The use of face masks is common worldwide due to the COVID-19 pandemic. However, the debate on the advantages and disadvantages of face masks continues. While face masks have been recommended to protect from COVID-19, their potential risks on cardiorespiratory systems in various populations are being investigated. This study aims to examine the impact of face masks on exercise test parameters in professional athletes. Materials and Methods: 25 professional athletes (mean age: 19.6±2.4 years; F/M: 11/14; BMI: 20.2±1.6 kg/m2) were included in the study. They performed an exercise test two times, with and without face masks, 48 hours apart. A comparison of exercise test parameters with and without face masks was made to determine cardiorespiratoryresponses in professional athletes. Results: The participants with and without face masks were statistically similar for the test parameters, excluding final oxygen saturation, test duration (min), and peak heart rate. The participants with face masks had significantly lower scores of final oxygen saturation (p<0.001), test duration (p<0.001), and peak heart rate (p=0.004) compared with the participants without face masks. Conclusion: Our results revealed that the use of face masks during the exercise test is associated with lower scores of oxygen saturation, test duration, and peak heart rate

Wpływ terapii nebiwololem na zmniejszenie ryzyka komorowych zaburzeń rytmu u chorych ze zwolnionym przepływem wieńcowym

Background: Coronary slow-flow (CSF) is an angiographic phenomenon characterised by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. QT interval dispersion (QTD) reflects regional variations in ventricular repolarisation and cardiac electrical instability and has been reported to be longer in patients with CSF. Aim: To examine QT duration and dispersion in patients with CSF and the effects of nebivolol on these parameters. Methods: The study population included 67 patients with angiographically proven normal coronary arteries and CSF, and 38 patients with angiographically proven normal coronary arteries without associated CSF. The patients were evaluated with 12-lead electrocardiography, and echocardiography before and three months after treatment with nebivolol. Results: Compared to the control group QTcmax and QTcD were significantly longer in patients with CSF (p = 0.036, p = 0.019, respectively). QTcD significantly correlated with the presence of CSF (r = 0.496, p &lt; 0.001). QTcmax (p = 0.027), QTcD (p = 0.002), blood pressure (p = 0.001), and heart rate (p &lt; 0.001) values significantly decreased after treatment with nebivolol. Conclusions: Coronary slow flow is associated with increased QTD. Nebivolol reduced increased QTD in patients with CSF after three months.  Wstęp: Zwolniony przepływ wieńcowy (CSF) jest zjawiskiem angiograficzne cechującym się opóźnieniem opacyfikacji tętnic wieńcowych przy braku jakichkolwiek cech choroby wieńcowej w obrazie tętnic nasierdziowych. Dyspersja odstępu QT (QTD) odzwierciedla regionalne zróżnicowanie w zakresie repolaryzacji komór i elektryczną niestabilność miokardium. Doniesienia wskazują, że QTD przybiera większe wartości u chorych z CSF. Cel: Celem niniejszej pracy była ocena czasu trwania i dyspersji odstępu QT u chorych z CSF oraz wpływu nebiwololu na te parametry. Metody: Do analizy włączono 67 chorych, u których w badaniu angiograficznym potwierdzono prawidłową budowę tętnic wieńcowych i wykazano CSF, oraz 38 pacjentów, u których zarówno budowa tętnic wieńcowych, jak i przepływ wieńcowy zostały ocenione w angiografii jako prawidłowe. U wszystkich chorych przed rozpoczęciem leczenia nebiwololem i po 3 miesiącach stosowania leku wykonano 12-odprowadzeniowe badanie elektrokardiograficzne i badanie echokardiograficzne. Wyniki: U chorych z CSF czas trwania odstępów QTcmax i QTcD był istotnie dłuższy niż u osób z grupy kontrolnej (odpowiednio p = 0,036 i p = 0,019). Długość odstępu QTcD istotnie korelowała z obecnością CSF (r = 0,496; p &lt; 0,001). Po leczeniu nebiwololem stwierdzono znamienne skrócenie odstępów QTcmax (p = 0,027) i QTcD (p = 0,002) oraz zmniejszenie ciśnienia tętniczego (p = 0,001) i częstości rytmu serca (p &lt; 0,001). Wnioski: Zwolniony przepływ wieńcowy wiąże się ze zwiększoną QTD. Stosowanie nebiwololu spowodowało redukcję zwiększonej QTD u chorych z CSF po 3 miesiącach.

Profile of patients with acute myocardial infarction in Turkey: Results from TURK MI registry

Background and Aim:&nbsp;There is no up-to-date study representing Turkish population that gives information about patient profile, treatment choice and prognosis in patients with acute myocardial infarction (AMI). In this study, we present characteristics of AMI patients from a recently conducted TURKMI registry&nbsp;Methods:&nbsp;TURKMI registry included consecutive patients with acute coronary syndromes who were hos- pitalized between 1-15 November 2018 in 50 hospitals representing the country’s population based on 12 Euronuts regions. Demographic characteristics, risk factors, history of cardiovascular diseases and comor- bidities were recorded in each patients.Results:&nbsp;TURKMI Registry included 1930 patients [504 female (26.1%), 1426 male (73.9%), median (IQR) age 62 (53-71)]. Of those, 1191 (61.7%) had NSTEMI, and 739 (38.3%) had STEMI. NSTEMI patients were older (median age 63 (54-72) vs. 60 (51-69); p&lt;0.001). Most of the patients were male (71.3% for NSTEMI and 78.1% for STEMI). Diabetes, hypertension and hyperlipidemia were higher in NSTEMI patients; however, smoking was higher in STEMI patients (Table 1). History of MI, coronary bypass, percutaneous coronary intervention, and heart fail- ure were significantly higher in NSTEMI patients (Table 2). Among the associated disease, chronic obstructive pulmonary disease and chronic kidney disease were significantly higher in NSTEMI patients (Table 3).&nbsp;Conclusions:&nbsp;Most common risk factors in AMI were hypertension and smoking, each of them were avail- able nearly half of the patients. The third and fourth most common risk factor was diabetes and hyperlip- idemia, respectively. Distribution of risk factors differ in STEMI and NSTEMI patients. History of MI and coronary interventions were more common in NSTEMI patients.</div

Demographic, Clinical, and Angiographic Characteristics of Atrial Fibrillation Patients Suffering From de novo Acute Myocardial Infarction: A Subgroup Analysis of the MINOCA-TR Study Population.

BACKGROUND: Atrial fibrillation (AF) prevalence in patients with acute myocardial infarction (MI) ranges from 3% to 25%. However demographic, clinical, and angiographic characteristics of AF patients who admitted with de novo MI are unclear. The aim of this study was to investigate the prevalence of patients presenting with de novo MI with AF. METHODS: The study was performed as a sub-study of the MINOCA-TR (Myocardial Infarction with Non-obstructive Coronary Arteries in Turkish Population) Registry, a multicenter, cross-sectional, observational, all-comer registry. MI patients without a known history of stable coronary artery disease and/or prior coronary revascularization were enrolled in the study. Patients were divided into AF and Non-AF groups according to presenting cardiac rhythm. RESULTS: A total of 1793 patients were screened and 1626 were included in the study. The mean age was 61.5 (12.5) years. 70.7% of patients were men. The prevalence of AF was 3.1% (51 patients). AF patients were older [73.4 (9.4) vs. 61.0 (12.4) years, p<0.001] than non-AF patients. The proportion of women to men in the AF group was also higher than in the non-AF group (43.1% vs. 28.7%, p=0.027). Only 1 out of every 5 AF patients (10 patients, 19.6%) was using oral anticoagulants (OAC). CONCLUSIONS: AF prevalence in patients presenting with de novo MI was lower than previous studies that issued on AF prevalence in MI cohorts. The majority of AF patients did not have any knowledge of their arrhythmia and were not undergoing OAC therapy at admission, emphasizing the vital role of successful diagnostic strategies, patient education, and implementations for guideline adaptation

Awareness and Knowledge of Pneumococcal Vaccination in Cardiology Outpatient Clinics and the Impact of Physicians' Recommendations on Vaccination Rates

Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians' recommendations on vaccination rates. Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 +/- 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians' recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25-1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15-1.92), p = 0.002] patients' knowledge [OR = 1.93 (95% CI = 1.56-2.40), p < 0.001], and their physician's recommendation [OR = 5.12 (95% CI = 1.92-13.68), p = 0.001]. Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates

Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study

© 2020 by Turkish Society of Cardiology.Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recent pre-pandemic registry (TURKMI-1). Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic