OBJECTIVE:Accurate estimation of left ventricular ejection fraction (LVEF) after ST-segment elevation myocardial infarction (STEMI) is essential for optimizing long-term management and cardiovascular risk stratification. This study aimed to identify predictors of LVEF at six months after STEMI and to develop a clinically applicable nomogram for individualized prognostic assessment. METHOD:This prospective, single-center cohort study included consecutive patients admitted with STEMI between July 2018 and October 2018. Baseline clinical, laboratory, and angiographic variables were collected. LVEF was assessed by transthoracic echocardiography during the index hospitalization and at six-month follow-up. Patients were categorized into four groups according to follow-up LVEF. Predictors of six-month LVEF were identified using proportional odds logistic regression, and a nomogram was constructed based on the final multivariable model. RESULTS:A total of 231 patients were analyzed (median age: 57 years; 83% male). At baseline, 119 patients (51%) had an LVEF < 50%, whereas at six months 115 patients (49%) had an LVEF < 50%. Multivariable analysis identified baseline LVEF, peak creatine kinase-myocardial band (CKMB) level, age, hypertension, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade as independent predictors of follow-up LVEF (all P < 0.05). CONCLUSION:Baseline LVEF and peak CK-MB level were the strongest independent predictors of six-month LVEF following STEMI. Age, hypertension, and final TIMI flow grade were identified as additional predictors. The proposed nomogram provides a practical tool for individualized follow-up planning and risk assessment in STEMI survivors.

AIMS:Fragmented QRS (fQRS) is an electrocardiographic marker of myocardial injury associated with adverse outcomes in acute coronary syndromes. This study aimed to examine its prognostic value within the acute coronary occlusion myocardial infarction (ACOMI) classification framework. METHODS:We retrospectively analyzed 996 patients with Type 1a or Type 1b ACOMI-compatible ECGs. The primary endpoint was all-cause mortality. A prespecified multivariable Cox regression model with 10 covariates was used. Model discrimination was assessed using the area under the ROC curve (AUC). RESULTS:fQRS was present in 237 patients (23.7%). During a median follow-up of 618 days (IQR: 398-725 days), 127 deaths occurred (12.6%). Kaplan-Meier analysis showed significantly lower survival in fQRS-positive patients (79.3% vs. 89.7%; P < 0.001). On multivariable Cox regression, fQRS was an independent predictor of mortality [hazard ratio (HR): 1.702; 95% confidence interval (CI) 1.050-2.760; P = 0.032], alongside the GRACE risk score (HR: 1.021; P < 0.001) and left ventricular ejection fraction (HR: 0.955; P < 0.001). fQRS improved model discrimination (AUC: 0.784-0.800; ΔAUC = +0.016). In the Type 1a subgroup, a signal toward increased fQRS-associated mortality was observed (HR: 1.662; P = 0.056), though this did not reach statistical significance. The fQRS × ECG type interaction was nonsignificant (P-interaction = 0.733); subgroup findings should be regarded as hypothesis-generating. CONCLUSION:fQRS on admission ECG is independently associated with all-cause mortality in ACOMI patients and may serve as a simple adjunctive marker for risk stratification, though prospective validation is needed.

BACKGROUND:Extrinsic left main coronary artery (LMCA) stenosis is a rare but potentially life-threatening complication that may occur after modified Bentall surgery because of BioGlue use. CASE SUMMARY:We present a case of LMCA stenosis thought to be secondary to BioGlue application after modified Bentall surgery, diagnosed through multimodal imaging and successfully treated with intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). DISCUSSION:In conjunction with a review of the existing literature, this case adds to the limited number of reports on the diagnosis and management of BioGlue-related LMCA stenosis. It emphasizes the feasibility of multimodality imaging and IVUS-guided PCI, and outlines factors to consider in stent selection for this context. TAKE-HOME MESSAGE:IVUS-guided PCI may be an important therapeutic option in patients with a recent history of cardiac surgery.

The present study retrospectively assessed clinical outcomes of proximal optimization technique (POT)-kissing-POT (PKP) and POT-side-POT (PSP) in ST-segment elevation myocardial infarction (STEMI) patients with culprit coronary bifurcation lesion (CBL) following a provisional stenting (PS). This large-scale multicenter (n = 10) study included STEMI patients with culprit CBLs who underwent PKP or PSP following PS. The primary endpoint was defined as the major adverse cardiac events (MACE; cardiac death, target vessel myocardial infarction [TVMI], or clinically driven target lesion revascularization [TLR]). Consecutive patients (n = 596; male: 491 [82.3%], mean age: 58.1 ± 11.7 years) were included. The study cohort was divided into 2 groups: PKP (n = 386) and PSP (n = 210). In the overall population, mid-term MACE (hazard ratio [HR]: 0.921, P = .461) did not differ in individuals with CBL-related STEMI treated with either PKP or PSP. The frequency of main vessel-TLR (0% vs 30%, P = .001) and main vessel-TVMI (0% vs 20%, P = .014) were significantly lower in the PKP group in the left main bifurcation localization. Diabetes mellitus (HR: 2.628, P < .001), high SYNTAX score (HR: 1.081, P < .001), and bifurcation localization (HR: 2.109, P = .014) were found to be independent predictors of MACE. In the overall population, risk-adjusted MACE rates for culprit CBLs were comparable between both techniques.

BACKGROUND:Atrial fibrillation (AF) is a major public health issue associated with thromboembolism and mortality. Real-world data from Türkiye are limited despite expanding use of non-vitamin K antagonist oral anticoagulants (NOACs). The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study aimed to characterize the demographic features, risk profiles, treatment patterns, and 2-year clinical outcomes of patients with non-valvular AF (NVAF) in Türkiye. METHODS:TRAFFIC was a national, prospective, multicenter, observational registry enrolling 1659 NVAF patients from 36 centers with 6-monthly follow-up for 24 months. Baseline data included demographics, comorbidities, CHA₂DS₂-VASc, HAS-BLED, AF subtype, European Heart Rhythm Association (EHRA) score, and antithrombotic therapy. Outcomes were ischemic stroke/systemic embolism (SE), major bleeding, and all-cause mortality. Predictors of mortality were evaluated using adjusted Cox regression, and associations of risk scores were explored using univariate Cox models with restricted cubic splines. RESULTS:Median age was 70 years, 48% female, with intermediate CHA₂DS₂-VASc (most 2-5) and low-to-intermediate HAS-BLED scores (most 0-2). Permanent AF was the most common subtype (48%). Antithrombotic therapy largely reflected risk profiles, with NOACs being the dominant treatment (65%). Over 2 years, all-cause mortality was 8.9%, ischemic stroke/SE 2.4%, and major bleeding 1.3%. In adjusted analysis, age, congestive heart failure, and diabetes mellitus were independent predictors of mortality. Both CHA₂DS₂-VASc and HAS-BLED scores showed threshold effects for mortality and thromboembolic risk but not for bleeding. CONCLUSION:TRAFFIC provides contemporary Turkish NVAF data, showing lower event rates than historical cohorts. Outcomes are comparable with international registries; persistent mortality burden highlights the need for AF care beyond anticoagulation.

Background and Objectives: In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods: In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results: The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6–20.4) vs. 0.6 (IQR = 0.1–2.6), p < 0.001]. In addition, patients in the T3 tertile (patients with the highest CAR) had a higher rate of all-cause mortality [n = 90 cases (66.2%), p < 0.001]. Multivariate Cox regression analysis revealed that CAR was an independent predictor of mortality in patients with HFrEF (hazard ratio: 1.852, 95% confidence interval: 1.124–2.581, p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions: The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker.

OBJECTIVE:This study aims to evaluate the role of elevated lipoprotein (a) [Lp(a)] levels as a potential contributor to residual risk in individuals with atherosclerotic cardiovascular disease (ASCVD). Considering that approximately 90% of Lp(a) levels are genetically determined and can vary regionally, we assessed Lp(a) levels in a cohort of ASCVD patients from the Turkish population, where data is currently limited. METHODS:We conducted a retrospective analysis of data and Lp(a) measurements collected from individuals diagnosed with ASCVD at a single center. RESULTS:The analysis included Lp(a) levels of 1193 consecutive individuals. The mean Lp(a) level was 28.2 mg/dL, with a median of 16 mg/dL and an interquartile range (IQR) from the 25th to the 75th percentile, 7 mg/dL to 39 mg/dL. The highest recorded Lp(a) level was 326 mg/dL. Among the cases, 18.7% exhibited Lp(a) levels ≥ 50 mg/dL, 10.8% had levels ≥ 70 mg/dL, and 5.8% had levels ≥ 90 mg/dL. The mean levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were 132 ± 47 mg/dL and 212 ± 54 mg/dL, respectively. Lp(a) levels were significantly higher in females compared to males. Furthermore, the proportion of females with Lp(a) levels ≥ 90 mg/dL was higher than in males (11.4% vs. 1.4%; P < 0.01). Additionally, a modest but significant correlation was observed between Lp(a) levels and TC (r = 0.075, P = 0.01) as well as LDL-C (r = 0.106, P < 0.01). CONCLUSION:This study revealed that Lp(a) concentrations were higher in women and statin users among ASCVD patients and identified a weak but significant correlation between Lp(a) levels and both TC and LDL-C.

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality.The latest research that shows the prevalence and incidence of AF patients in Türkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. Methods:The TRAFFIC study is a national, prospective, multicenter, observational registry.The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Türkiye.The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2-VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients.For patients who use warfarin, international normalized ratio levels will be monitored.Follow-up data will be collected at 6, 12, 18, and 24 months.Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis).The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. Results:The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. Conclusion:The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Türkiye.Additionally, it will provide insights into how current treatments are reflected in this population.Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

The CHA₂DS₂-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA₂DS₂-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA₂DS₂-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA₂DS₂-VASc score without dichotomization was the main difference of this study from others.

Stent under-expansion is a predictor of restenosis and stent thrombosis. It remains uncertain whether enhanced stent imaging (ESI) (CLEARstent) guidance can improve stent under-expansion. Our aim was to assess the effect of using ESI on stent under-expansion, after percutaneous coronary intervention (PCI) in a single center, cross-sectional observational study. Participants attending our cardiology clinic with stable angina or acute coronary syndrome, from March to September 2020 were recruited. A total of 164 patients who underwent post-PCI ESI (CLEARstent) were compared with 77 age- and sex-matched control patients. Post-procedural minimal lumen diameter (MLD) was calculated. The patients in the ESI-guided PCI group, had a median age of 61 (54–69 IQR 25-75) years and 76.8% (n = 126) were males. The patients in ESI-guided PCI group had a greater minimal lumen diameter compared with the X-ray guided PCI group (βeta coefficient:2.88 (95% CI:2.58–2.99) vs βeta coefficient 2.55 (95% CI 2.34–2.63), P < .001). Our finding supports the use of the ESI system to optimize stent placement as expressed by the MLD.

OBJECTIVE:Different results have been obtained in studies on the effect of anesthesia type applied during transcatheter aortic valve implantation on in-hospital outcomes. In this study, we aimed to investigate the association of the type of anesthesia with the lenght of stay in the intensive care unit and the need for inotropes in patients undergoing transcatheter aortic valve implantation.METHODS:A total of 140 patients who underwent transcatheter aortic valve implantation between January 2016 and January 2022 were retrospectively analyzed. The patients were divided into 2 groups as deep sedation and general anesthesia according to the type of anesthesia.RESULTS:The mean age of all patients was 78.5 ± 8.6 years, and 69 of the patients (49.3%) were female. Length of stay in intensive care unit, midazolam dosage, use of inotropic agents, and procedural hypotension were significantly lower in the deep sedation group than in the general anesthesia group [(1[1-2] vs. 1[1-2.5] days, P = 0.03), (2.1 ± 0.4 mg/kg vs. 2.3 ± 05, P = 0.02), (39 (37.9%) vs. 22 (59.5%), P = 0.02), (41 (39.8%) vs. 25 (67.6%), P = 0.004)]. General anesthesia was associated with increased use of inotropic agents during transcatheter aortic valve implantation compared to deep sedation (odds ratio = 2.93 95% CI = 1.18-7.30, P = 0.02).CONCLUSION:The use of inotropes is less in transcatheter aortic valve implantation procedures performed under deep sedation and length of stay in intensive care unit is shorter.

Background and Aims: Hypertriglyceridemia (HTG) is accepted as a cause of residual cardiovascular risk. We investigated the frequency of HTG in secondary prevention patients. Methods: In-hospital and 1-year follow-up data of patients hospitalized with diagnosis of acute coronary syndrome were collected. Discharge and 1-year follow-up lipid lowering therapies, achieved lowest LDL-c and TG levels were analyzed. HTG was defined as fasting triglyceride level ≥150 mg/dL. Statin adherence was defined as ≥ 9 statin refills/year. Results: Median TG level during hospitalization was 153[109-220] and 31% of the cases had TG ≥200 mg/dL and 51% of the cases had TG ≥150 mg/dL (Table 1). Eighty-eight percent of the cases were discharged with statin therapy, but only 48% were found to be statin adherent during follow-up. In total, fibrate therapy was used in 182 cases (6%). LDL-C < 70 mg/dL and LDL-C decrease ≥ 50% from baseline targets could not be achieved in 67% and 61% of the cases. In 788 cases (28%), TG levels were found ≥ 150 mg/dL during follow-up. In these patients, 431 (54%) were statin nonadherent, 590 (75%) had LDL-C ≥ 70 mg/dL and 579 (73%) did not achieve LDL-C decrease ≥ 50% from baseline. Only in 164 (21%) cases, both LDL-C targets were achieved in whom TG lowering medications were indicated according to guidelines. This corresponds to 5.9% of the study population. Conclusions: Even though, hypertriglyceridemia is common during hospitalization and follow-up of patients with ACS, it is mostly associated with inadequate use of LDL-C lowering therapies and low LDL-C target attainment rates.

Background and Aims: Guidelines recommend calculation of risk scores such as SCORE, SCORE2 and pooled ASCVD risk scores. We aimed to compare performance of different scores in patient with myocardial infarction (MI). Methods: SCORE, SCORE2 and pooled ASCVD risk scores were calculated in a cohort of 1258 patients younger than 65 years old and hospitalized for first diagnosis of MI. SCORE and SCORE2 were calculated using published charts for Turkiye. SCORE risk score was stratified as low to moderate (<4%), high (4-9%) and very high (≥10%) risk categories. SCORE2 risk scores were stratified as low to moderate, high and very high according to age groups. The pooled ASCVD risk scores were calculated from http://www.cvriskcalculator.com/. For comparison purpose, ASCVD risk score was stratified into low to moderate risk (<7.5%), high risk (7.5-20 %) and very high risk (≥20%) groups. Results: SCORE 2 stratified most of the patients in very high risk and high risk groups (44% and 43 %), whereas ASCVD stratified only 7% of the patients in the high risk and 56% of the patients in the moderate risk score groups. Only 10% of the study population was stratified as very high risk using SCORE. The proportion of patients stratified as very high risk was significantly higher in SCORE2 compared to SCORE and ASCVD risk (44% vs. 10% vs. 7%, p< 0.01). Conclusions: In this retrospective study, SCORE2 stratified a high proportion of MI patients in the very-high and high risk groups. This finding may imply that SCORE2 risk stratification is concordant to real-life findings.

OBJECTIVE:Obesity is a global health problem that increases the risk of coronary artery disease (CAD). However in studies, it has been observed that when the disease develops, obese patients have a more favorable prognosis than leaner patients. This is called the "obesity paradox." This study aims to evaluate the effect of obesity assessed with body fat percentage (BFP) and relative fat mass (RFM) besides body mass index (BMI) on infarct size (IS) estimated from peak creatine kinase-MB (CK-MB) levels in patients with non-ST-segment elevation myocardial infarction (NSTEMI).METHODS:Patients with a diagnosis of NSTEMI who underwent coronary angiography between January 2017 and January 2022 were retrospectively evaluated. Patients without available anthropometric data to calculate BMI, BFP, and RFM and serial CK-MB measurements were excluded from the study. BMI was calculated using weight(kg)/(height[m])2 formula. Patients were dichotomized as obese (BMI≥30 kg/m2) and non-obese (BMI<30 kg/m2) to compare baseline characteristics. BFP and RFM were calculated from anthropometric data. Linear regression analysis was performed to define predictors of IS.RESULTS:Final study population consisted of 748 NSTEMI patients (mean age was 59.3±11.2 years, 76.3% were men, 36.1% of the patients were obese). Obese patients were more likely to be female, hypertensive, and diabetic. Smoking was less frequently observed in obese patients. Peak CK-MB levels were similar among groups. Obese patients had higher in-hospital left ventricular ejection fraction, and less severe CAD was observed in coronary angiographies of these patients. Multivariable regression analysis identified diabetes mellitus, systolic blood pressure, white blood cell count, hemoglobin, and BFP (β=-4.8, 95% CI=-8.7; -0.3, p=0.03) as independent predictors of IS.CONCLUSION:Higher BFP is associated with smaller IS in NSTEMI patients. These findings support the obesity paradox in this patient group, but further, randomized controlled studies are required.

In this study, we aimed to evaluate the predictive value of admission C-reactive protein/albumin ratio (CAR) for acute kidney injury (AKI) in cases with moderate to severe chronic kidney disease (CKD) not on dialysis who presented with non-ST-segment elevation myocardial infarction (NSTEMI) and underwent coronary angiography (CAG). This cross-sectional and observational study included 420 NSTEMI patients. The study population was categorized based on the CAR tertiles as groups T1, T2, and T3. The primary outcome of the study was AKI development; 92 (21.9%) cases developed AKI. The frequency of AKI was significantly higher in the T3 group compared with the T2 and T1 groups (34% vs 17% vs 14%, P < .001). Age, estimated glomerular filtration rate, contrast media volume, and CAR (odds ratio: 1.36; 95% CI: 1.17-1.57; P < .01) were significant predictors of AKI. In a receiver operating characteristic curve analysis, CAR levels >0.20 predicted AKI development with a sensitivity of 74% and a specificity of 45%. We observed that the CAR may be a promising inflammatory parameter for AKI in NSTEMI patients with moderate to severe CKD after CAG.

We assessed the ability of predicting mortality and total in-hospital bleeding and adverse outcomes by the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). A total of 1441 STEMI patients were recruited: HBR group 354 (25%) patients and non-HBR group of 1087 (75%) patients. A total of 131 patients (9%) had a bleeding complication during hospitalization. The bleeding complications were also categorized according to other conventional bleeding scores. According to these conventional scores, all bleeding categories were associated with HBR. In univariate logistic regression analysis, female gender, diabetes mellitus, hypertension (HT) and HBR were associated with in-hospital bleeding. However, in multivariable analysis only HT (Odds Ratio [OR] 1.528, 95% CI 1.020-2.290; P = .040) and HBR (OR 1.612, 95% CI 1.075-2.428; P = .022) independently predicted total in-hospital bleeding complications. Hospital duration was longer and mortality rate was significantly higher in patients with HBR (OR 8.755, 95% CI 5.864-13.074; P < .01). The ARC-HBR criteria may predict in-hospital bleeding events and adverse outcomes in STEMI patients undergoing pPCI.

Studies reported conflicting results on the effect of renin-angiotensin-aldosterone system (RAAS) blocker use on acute kidney injury (AKI) in patients undergoing elective coronary angiography but association in elderly patients with ST-elevation myocardial infarction (STEMI) is not known. Also, there are limited data on the effect of inflammatory markers on AKI. We aimed to investigate the effects of RAAS blocker pretreatment and inflammatory markers on AKI in this population. A total of 471 patients were compared according to presence of RAAS blocker pretreatment at admission. Conventional and inverse probability weighed conditional logistic regression were used to determine independent predictors of AKI. Mean age of the study group was 75.4 +/- 7.1 years and 29.1% of the patients were female. AKI was observed in 17.2% of the study population. Weighted conditional multivariable logistic regression analysis revealed that AKI was associated with baseline creatinine levels and C-reactive protein/albumin ratio (CAR) (OR 2.08, 95% CI = 1.13-3.82, p = .02 and OR 1.19, 95% CI = 1.01-1.41, p = .04, respectively). No significant association was found between RAAS blocker pretreatment and AKI. CAR and elevated baseline creatinine levels were independent predictors of AKI in this patient group.