Prognostic factors of the patients admitted to the hospital at the subacut period of STEMI

YÖK Tez No: 272444Amaç: Akut miyokard infarktüsü (AMİ), ciddi morbidite ve mortalite ile seyreden yaygın bir hastalıktır. Hastaların başvuru anındaki risk derecelendirilmesinin yapılması, uygulanacak medikal ve girişimsel tedavinin belirlenmesi açısından önemlidir. ST elevasyonlu miyokard infarktüsü (STEMI) tedavisinin en önemli aşaması hızlı damar reperfüzyonudur ve pek çok çalışmada reperfüzyon ne kadar erken sağlanırsa o kadar çok canlı miyokard dokusunun kurtarıldığı gösterilmiştir. Ancak subakut dönemde başvuran hastalarla ilgili halen süren iskemiye işaret eden klinik ve/veya elektrokardiyografik kanıt bulunmaması durumunda, perkutan koroner girişimin (PKG) semptomların başlamasının üzerinden 12 saatten daha uzun bir süre geçmiş hastalarda da yararlı olup olmadığı konusunda görüş birliği bulunmamaktadır. Bu çalışmada STEMI ile uyumlu semptomların başlamasından sonra subakut dönemde hastaneye başvuran hastalarda morbidite ve mortalite üzerine etkili olabilecek faktörlerin, girişimsel ve medikal tedavi seçenekleri ile ilgili önerilerin belirlenmesi hedeflenmiştir.Yöntem: Bu retrospektif çalışmaya subakut dönemde hastaneye başvurmuş 94 STEMI hastası (62 erkek, 32 bayan) dahil edilmiştir. Hastalar 29±27 ay süresince takip edilmiştir. Hastane içi dönemde ve takip süresince ölüm görülen ve hayatta kalan, takip döneminde major istenmeyen kardiyovasküler olay yaşayan ve yaşamayan hastaların klinik özellikleri ve laboratuvar değerleri birbirleri ile karşılaştırılmıştır.Bulgular: Ölen hastaların başvuru sırasındaki yaşı, Killip skoru, başvuru anında EKG'de ST elevasyon miktarı, kreatinin ve MPV değerleri yaşayanlardan anlamlı olarak daha yüksek iken ejeksiyon fraksiyonu ve hematokrit değerleri anlamlı olarak daha düşüktü. Ayrıca ölen hastalarda KKY öyküsü, hastane yatışında EKG'de atrial fibrilasyon ve geniş QRS varlığı anlamlı olarak daha fazlaydı. Hastane içi dönemde ölüm görülen hasta grubunda yaş, Killip skoru ve kreatinin değeri lojistik regresyon analizinde anlamlı mortalite belirteci olarak saptandı. Takip süresince PKG uygulanmış hasta grubunda ölüm ve major istenmeyen kardiyovasküler olay geçirme oranları daha düşük olarak tespit edildi.Sonuç: STEMI ile uyumlu semptomların başlamasından sonra subakut dönemde hastaneye başvuran hastalarda, başvuru anında morbidite ve mortalite üzerine etkili faktörlerin belirlenmesi, gerek hastane içi gerekse uzun dönem takip sonuçları ile ilgili öngörüde bulunmamıza ve hastalar için en uygun tedavi protokolünü belirlememize olanak sağlayabilir. Halen süren iskemiye işaret eden klinik ve/veya elektrokardiyografik kanıt bulunmayan hasta grubunda geç dönemde PKG uygulanması major kardiyovasküler istenmeyen olay yaşama ve ölüm görülme oranlarında azalma sağlayabilir.Background: Acute myokardial infarction (AMI) is a common disease that causes severe morbidity and mortality. Assesment of risk stratification at admission is important for deciding whether medical or interventional therapy is better. The most important step of the STEMI treatment is rapid reperfusion of arteries and it is shown in many studies that, sooner you get reperfusion more you get alive myocardial tissue. But it?s not clear whether percutaneus coronary intervention (PCI) is better for the patients who applied to hospital at subacute period and not have any clinic and/or electrocardiographic evidence for continued ischemia when more than 12 hours passed from onset of the symptoms. We aimed to determine the factors that may be responsible for morbidity and mortality at the time of admission and also interventional or medical treatment options in the patients who applied to hospital at subacute period after beginning of the STEMI concordant symptoms.Methods: 94 patients with subacute STEMI were included in this study. (62 male, 32 female) Their follow-up time is 29±27 months. The patients?, who died or lived and who had or not have major adverse cardiovascular events during in-hospital and out hospital follow up time, clinic and biochemical values were compared to each other.Results: Age, Killip score, ST elevation amount on admission ECG, creatinin and MPV values of the patients who died, were significantly higher than the patients who lived and their ejection fraction, hematocrit values were significantly lower. Also history of congestive cardiac failure, atrial fibrillation on ECG at admission and large QRS existance were significantly much more than the patients who survive. Killip score, age and creatinin were determined by logistics regression analysis to be significant mortality marker in the patients who died during in hospital follow up time. Major adverse cardiovascular events and death rate were found lower in the patients who underwent PCI during follow up time.Conclusions: Determination of the factors that may be responsible for morbidity and mortality at the time of admission in the patients who admitted to hospital at subacute period after beginning of the STEMI concordant symptoms, can help us to predict patients? in hospital and life time prognosis and to decide the most suitable therapy for the patients. Late percutaneus coronary intervention (PCI) may reduce major adverse cardiovascular events and death rate in the patients who not have any clinic and/or electrocardiographic evidence for continued ischemia

Spontaneous occlusion of the left anterior descending artery immediately following coronary angiography

Kandis, Hayati/0000-0001-9151-6050WOS: 000310402100036During coronary angiography of the patients with acute coronary syndrome, exposure of highly thrombogenic subendothelial collagen and local thrombin generation may rarely counteract with the contrast media used resulting promotion of platelet recruitment and degranulation. Final state may result in potentially fatal complications, such as abrupt occlusion of the coronary artery. In this article, a 60-year-old male case with unstable angina who had developed spontaneous occlusion of the left anterior descending artery immediately following coronary angiography

Left main coronary artery occlusion during elective coronary angiography: Case report [Elektif koroner anjiyografi esnasinda sol ana koroner arter tikanmasi]

Acute left main coronary artery thrombosis is a rare but potentially lethal complication of coronary angiography. Pulmonary edema, resistent ventricular arrhytmias, cardiogenic shock, and sudden death are seen in most of the patients who develop clinically acute left coronary artery occlusion. It can be seen during percutaneoous interventions or after spontaneous plaque rupture. Occurrence of complications during cardiac catheterization and coronary angiography is rare. However, complications may be fatal if they occur. Acute left main coronary artery occlusion is one of the complications that may develop during diagnostic coronary angiography. This complication is severely life-threatening. Recognition of the lesion and urgent interventional therapy can be life saver. Herein, we report a case of left main coronary artery occlusion during elective coronary angiography which was treated urgently with direct stenting, and discuss the treatment modalities in the light of literature. Copyright © 2012 by Türkiye Klinikleri

Primary angioplasty in very old patients with acute myocardial infarction: Report of two cases and review of the literature

There is limited data regarding treatment of acute myocardial infarction in very old patients. The very elderly population has complex co-morbidities, worse left ventricular function, poor functional status, increased risk, and reduced benefit from treatment. Contraindications to lytic therapy are common in the elderly, and the incidence of hemorrhagic stroke after thrombolytic therapy is strictly associated with age. Primary percutaneous coronary angioplasty results were also limited in octogenerians and nonagenarians. We report here two patients in 89 and 93 years who were admitted to the cardiology department with the diagnosis of acute myocardial infarction and subsequently treated with percutaneous intervention. The results of primary coronary angioplasty in old patients were also discussed in light of the literature. Copyright © 2012 by Türkiye Klinikleri

The impact of metabolic syndrome on carotid intima media thickness

WOS: 000325204600005PubMed: 24065221OBJECTIVES: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness (CIMT) is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study. METHODS: The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1 subjects with a body mass index (BMI) = 30 kg/m(2) and 39.9 kg/m(2) [n = 822 (MetS-= 375, MetS+ = 477)], and Group 4 BMI >= 40 kg/m(2) [n = 88 (MetS-= 27, MetS+ = 61)]. RESULTS: Carotid intima media thickness was higher in the individuals with MetS compared to their normal counterparts. Furthermore, the sub-group analysis showed that CIMT values in Group 1 (0.55 +/- 0.18 vs 0.82 +/- 0.70; p < 0.001), Group 2 (0.59 +/- 0.20 vs 0.68 +/- 0.18; p < 0.001) and Group 3 (0.61 +/- 0.15 vs 0.65 +/- 0.18; p < 0.001) were significantly higher in subjects with MetS compared to their normal counterparts, whereas the values were similar in Group 4 (0.62 +/- 0.13 vs 0.65 +/- 0.17; p = 0.363). CONCLUSIONS: Carotid intima media thickness of overweight, obese and normal weight individuals without MetS were lower than their counterparts with MetS. MetS had no impact on CIMT in morbid obese individuals possibly due to established insulin resistance earlier than MetS

Pioglitazone improves ventricular diastolic function in patients with diabetes mellitus: A tissue Doppler study

WOS: 000281697100004PubMed: 20821932Objective - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients. Methods and results - Forty-nine diabetic patients were included in the study. The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbAIc and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolunnetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased. Conclusion - Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function

THE PROGNOSTIC IMPORTANCE OF CYSTATIN C IN SEVERE SYSTOLIC DYSFUNCTIONWITHOUT CHRONIC KIDNEY DISEASE

WOS: 000209824900115

Mean platelet volume in patients with dipper and non-dipper hypertension

WOS: 000276866600006PubMed: 19929284Patients with non-dipper hypertension are known to carry a high risk of cardiovascular complications. In this study, we hypothesized that non-dippers may be associated with platelet dysfunction and it can be determined by mean platelet volume (MPV). A total of 216 outpatients treated with antihypertensive drugs for at least 6 months were enrolled. Dipper and non-dipper patterns were detected and clinical, laboratory and ambulatory blood pressure recording data were matched between non-dipping and dipping groups. MPV was significantly higher in patients in non-dipping than dipping groups (p < 0.001). In correlation analyses, MPV was negatively correlated with the rate of systolic and diastolic fall at night (p < 0.001, r=-0.46) and (p < 0.001, r=-0.43), respectively. Also MPV was correlated with nocturnal pulse pressure (p=0.001, r=0.22). Other variables were similar between non-dipping and dipping groups. The present study showed that MPV is higher in non-dipping than dipping hypertensive patients. Platelet activation or dysfunction probably is an alternative mechanism for increasing cardiovascular events in non-dippers