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Öğe Antithrombotic Therapy and Outcomes of Patients With New-Onset Transient Atrial Fibrillation After ST-Segment Elevation Myocardial Infarction(Lippincott Williams & Wilkins, 2021) Kayapinar, Osman; Kaya, Adnan; Keskin, Muhammed; Tatlisu, Mustafa AdemBackground: Atrial fibrillation (AF) is a common complication of ST-segment elevation myocardial infarction (STEMI), and AF might require anticoagulant treatment in some conditions. Study Question: There are no clear recommendations about vitamin K antagonist (VKA) use in patients with STEMI who complicated with new-onset transient AF. In this study, we examined the association of concomitant use of VKA and dual antiplatelet therapy (DAPT) with clinical outcomes of this patient population. Study Design: A total of 4086 patients with STEMI who underwent primary percutaneous coronary intervention retrospectively investigated. Among these patients, a total of 286 patients who developed new-onset transient AF during hospitalization were enrolled. VKA group consisted of 116 patients treated with warfarin, aspirin, and clopidogrel, and DAPT group consisted of 170 patients treated with aspirin and clopidogrel. Measures and Outcomes: One-year mortality, ischemic stroke, major, and minor bleeding were determined as clinical outcomes. Results: Although VKA group had proportionally lower mortality (17.2% vs. 20.0%) and ischemic stroke (7.8% vs. 11.8%) compared with DAPT group, the differences did not reach to statistical significance, whereas the 1-year major bleeding had higher rates at VKA group and that had 3.5-times higher major bleeding than DAPT group. This relationship was persisted after multivariable analysis (hazard ratio = 3.37, 95% CI, 1.76-10.04, P = 0.012). Conclusions: There is not a widely accepted treatment algorithm in patients with STEMI who complicated with new-onset AF in clinical guidelines. The current study indicated that transient form of new-onset AF might not require long-term VKA. Besides, addition of VKA to DAPT therapy may increase the rates of major and minor bleeding.Öğe The association between admission blood urea nitrogen levels with in-hospital and long-term mortality in ST-segment elevation myocardial infarction(2018) Tatlısu, Mustafa Adem; Kaya, Adnan; Keskin, Muhammed; Kozan, ÖmerObjective: The aim of this study was to investigate the association of blood urine nitrogen (BUN) levels with all-causemortality in ST-segment elevation myocardial infarction (STEMI).Method: This study included 3778 patients with STEMI treated with primary percutaneous coronary intervention. Anadmission BUN of 17.5 mg/dL was identified through a ROC analysis as an optimal cutoff value to predict the inhospitalmortality with 68% sensitivity and 66% specificity (AUC: 0.75; 95% CI:0.72-0.88; p 0.001).Results: The patients were followed up for a mean period of 330.14 months. Patients with higher BUN levels had 5.3-times higher in-hospital (OR: 6.0, 95% CI: 4.4-8.3) and 5-times higher long-term (HR: 5.3, 95% CI: 4.2-6.8) mortalityrates than patients with lower BUN levels.Conclusions: This study demonstrated that elevated BUN level was independently associated with increased in-hospitaland long-term mortality. BUN test is a simple, inexpensive, and easily bedside applicable method. Hence, it can be usedto detect high-risk patients in the setting of STEMI.Keywords: Blood urine nitrogen; ST-segment elevation myocardial infarction; primary percutaneous coronaryintervention; mortalityÖğe The association of blood urea nitrogen levels with mortality in acute pulmonary embolism(Oxford Univ Press, 2017) Tatlısu, Mustafa Adem; Kaya, Adnan; Keskin, Muhammed; Avşar, Şahin; Öz, A.…Öğe The association of right ventricular dysfunction with in-hospital and 1-year outcomes in anterior myocardial infarction(Springer, 2019) Keskin, Muhammed; Uzun, Ahmet Okan; Hayıroğlu, Mert İlker; Kaya, Adnan; Çınar, Tufan; Kozan, ÖmerIn anterior ST-segment elevation myocardial infarction (STEMI), attention paid mainly to the left ventricle. The predictive significance of right ventricular (RV) dysfunction in patients with anterior STEMI has been frequently neglected. In this study, we evaluated the prognostic effect of RV dysfunction on in-hospital and long-term outcomes in patients with first anterior STEMI. A total of 350 patients without known coronary artery disease with first anterior STEMI and treated with primary percutaneous coronary intervention were prospectively enrolled in this study. In-hospital and long-term outcomes were compared between two groups of with or without RV dysfunction. In-hospital mortality was significantly higher in the RV dysfunction group (26.7% vs. 1.6%, P<0.001). The RV dysfunction group also had a higher incidence of cardiogenic shock, recurrent myocardial infarction, target lesion revascularization and stent thrombosis. The 1-year overall survival in patients with and without RV dysfunction was 62.2% and 95.0% respectively. After multivariable analysis, RV dysfunction remained as an independent predictor for in-hospital and long-term mortality. RV dysfunction is an independent predictor of cardiogenic shock, recurrent myocardial infarction, and, in-hospital and long-term mortality in anterior STEMI. Therefore, attention should be paid to the function of right ventricle as in the left ventricle after anterior STEMI.Öğe Association of SYNTAX Score With Abdominal Aortic Intima-Media Thickness in Non-ST Elevation Myocardial Infarction(Sage Publications Inc, 2019) Kaya, Adnan; Keskin, Muhammed; Tatlısu, Mustafa Adem; Çınar, Tufan…Öğe 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(Karger, 2019) Tanık, Veysel Ozan; Aruğaslan, Emre; Çınar, Tufan; Keskin, Muhammed; Kaya, Adnan; Tekkeşin, Ahmet İlkerObjective: 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 < 0.001). In multivariable logistic regression analysis, CHA(2)DS(2)VASc scores >= 4 were independently associated with acute stent thrombosis (OR = 1.64; 95% CI 1.54-1.71, p < 0.001). In a receiver operating characteristic curve analysis, the best cut-off value for the CHA(2)DS(2)VASc score was >= 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, BaselÖğe Atrial Fibrillation: A New Risk Factor for Contrast-Induced Nephropathy(Sage Publications Inc, 2019) Çınar, Tufan; Keskin, Muhammed; Kaya, Adnan…Öğe Atrial Fibrillation: A Novel Risk Factor for No-Reflow Following Primary Percutaneous Coronary Intervention(Sage Publications Inc, 2020) Kaya, Adnan; Keskin, Muhammed; Tatlisu, Mustafa Adem; Uzman, Osman; Borklu, Edibe; Cinier, Goksel; Kayapinar, OsmanThere is a lack of evidence regarding the association of atrial fibrillation (AF) and no-reflow (NR) phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). A total of 2452 patients with STEMI who underwent pPCI were retrospectively investigated. After exclusions, 370 (14.6%) patients were in the AF group and 2095 (85.4%) were in the No-AF group. Patients with a thrombolysis in myocardial infarction flow rate <3 were defined as having NR. Patients in the AF group were older and had higher 3-vessel disease rates (24.1% vs 18.9%; P = .021) and lower left ventricular ejection fraction (45.4 [11.7] vs 48.7 [10.5%]; P < .001). No-reflow rates were higher in the AF group than in the No-AF group (29.1% vs 11.8%; P < .001). According to multivariable analysis, AF (odds ratio: 1.81, 95% confidence interval: 1.63-2.04, P < .001), age, Killip class, anterior myocardial infarction, diabetes mellitus, chronic kidney disease, stent length, and smoking were independent predictors of NR following pPCI. Atrial fibrillation is a quite common arrhythmia in patients with STEMI. Atrial fibrillation was found to be an independent predictor of NR in the current study. This effect of AF on coronary flow rate might be considered as an important risk factor in STEMI.Öğe Clinical outcomes of extended endovascular recanalization of 16 consecutive Buerger's disease patients(Sage Publications Ltd, 2019) Kaçmaz, Fehmi; Kaya, Adnan; Keskin, Muhammed; Keçeoğlu, Serdar; Algın, İbrahim Halil; Yılmazkaya, Bayram; İlkay, ErdoğanObjective Buerger's disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger's disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions. Methods A total of 16 consecutive patients with confirmed diagnosis of Buerger's disease that percutaneously treated in our center between February 2014 and March 2018 were included in the study. The mean age of the patients was 44.25 +/- 4.28 ranging from 36 to 50 years. After physical examination and complementary diagnostic tests, performance of extended angioplasty for occluded arteries was intended to restore direct blood flow to at least one of the blow-the-knee arteries. Results A successful extended endovascular treatment was performed in 20 of 22 limbs, achieving a technical success of 91%. All patients were successfully discharged without any complication. Mean follow-up duration was 21.43 +/- 7.08 months. Reintervention was performed in one patient and minor amputation was needed in one of the failed limbs. Limb salvage rate was 100%. A significant difference was observed based on Rutherford classification, ankle brachial index, direct blood flow to foot, presence of ulcer and rest pain when compared before and after the intervention. Conclusion We showed successful extended endovascular recanalization of Buerger's disease patients with a high technical success rate and sustained clinical improvement. Extended endovascular recanalization could be a therapeutic option in Buerger's disease patients, since they are not good candidates for surgery.Öğe Effect of Adjunctive Thrombus Aspiration on In-Hospital and 3-Year Outcomes in Patients With ST-Segment Elevation Myocardial Infarction and Large Native Coronary Artery Thrombus Burden(Excerpta Medica Inc-Elsevier Science Inc, 2017) Keskin, Muhammed; Kaya, Adnan; Tatlısu, Mustafa Adem; Uzman, Osman; Börklü, Edibe Betül; Çinier, Göksel; Kozan, ÖmerAlthough the long-term clinical benefit of adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) remains controversial, the impact of TA in patients with large thrombus has not been evaluated. The aim of the present study was to investigate the effect of adjunctive TA during PPCI on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and a large thrombus. We assessed the effect of adjunctive TA on in-hospital and 3-year clinical outcomes in 627 patients with STEMI and a large thrombus in the native coronary artery. The cumulative 3-year incidence of all-cause death was not significantly different between the 2 groups (91.5% vs 89.0%, log-rank test p = 0.347). After adjusting for confounders, the risk of all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio 1.11, 95% confidence interval 0.60 to 3.54, p = 0.674). The adjusted risks of target lesion revascularization, nonfatal acute myocardial infarction, and stent thrombosis were also not significantly different between the 2 groups. In conclusion, adjunctive TA during PPCI was not associated with better in-hospital and 3-year all-cause deaths in patients with STEMI and a large coronary artery thrombus. (C) 2017 Elsevier Inc. All rights reserved.Öğe Effect of Dynamic Potassium Change on In-Hospital Mortality, Ventricular Arrhythmias, and Long-Term Mortality in STEMI(Sage Publications Inc, 2019) Kaya, Adnan; Keskin, Muhammed; Tatlısu, Mustafa Adem; Kayapınar, OsmanWe evaluated the effect of serum potassium (K) deviation on in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were normokalemic at admission. A total of 2773 patients with an admission serum K level of 3.5 to 4.5 mEq/L were retrospectively analyzed. The patients were categorized into 3 groups according to their K deviation: normokalemia-to-hypokalemia, normokalemia-to-normokalemia, and normokalemia-to-hyperkalemia. In-hospital mortality, long-term mortality, and ventricular arrhythmias rates were compared among the groups. In a hierarchical multivariable regression analysis, the in-hospital mortality risk was higher in normokalemia-to-hypokalemia (odds ratio [OR] 3.03; 95% confidence interval [CI], 1.72-6.82) and normokalemia-to-hyperkalemia groups (OR 2.81; 95% CI, 1.93-4.48) compared with the normokalemia-to-normokalemia group. In a Cox regression analysis, long-term mortality risk was also higher in normokalemia-to-hypokalemia (hazard ratio [HR] 3.78; 95% CI, 2.07-7.17) and normokalemia-to-hyperkalemia groups (HR, 2.97; 95% CI, 2.10-4.19) compared with the normokalemia-to-normokalemia group. Ventricular arrhythmia risk was also higher in normokalemia-to-hypokalemia group (OR 2.98; 95% CI, 1.41-5.75) compared with normokalemia-to-normokalemia group. The current study showed an increased in-hospital ventricular arrhythmia and mortality and long-term mortality rates with the deviation of serum K levels from normal ranges.Öğe Evaluation of the Early Effects of Childhood Asthma and Its Treatment on Cardiac Function as Revealed by Two-Dimensional Speckle-Tracking Echocardiography(Springer, 2022) Özde, Şükriye; Kayapınar, Osman; Doğru, Mahmut; Aktüre, Gülşah; Kaya, Adnan; Coşkun, Gökhan; Keskin, MuhammedThere is minimal information available regarding the early effects of bronchial asthma (BA) and its treatment on cardiac function in children. We used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate cardiac function before and after the treatment of childhood BA. We enrolled 44 children with moderate and severe BA who had not been treated over the preceding 3 months or who were newly diagnosed. All children received the same treatment (that recommended by the Global Initiative for Asthma [GINA] in 2017). All children also underwent transthoracic 2D-STE before treatment and 6 months later. Clinical data were compared before and after treatment. After treatment, significant increases were evident in right ventricular (RV) systolic and diastolic strain, as well as the systolic strain rate. Before and after treatment, the RV global longitudinal systolic strains were - 22.8 +/- 3.6 and - 25.1 +/- 4.5, respectively (p = 0.036); the RV global longitudinal diastolic strains were - 18.5 +/- 6.0 and - 21.5 +/- 5.2, respectively (p = 0.038); and the RV systolic strain rates were - 1.26 +/- 0.4 and - 1.12 +/- 0.3, respectively (p = 0.025). After treatment, significant increases were observed in the right atrial (RA) peak longitudinal strain and strain rate. Before and after treatment, the RA peak atrial longitudinal strains were 32.5 +/- 10.8 and 44.7 +/- 11.2, respectively (p = 0.042) and the RA longitudinal strain rates were - 1.6 +/- 0.3 and - 2.0 +/- 0.5, respectively (p = 0.041). RV and RA subclinical dysfunction may develop in children with early-stage BA. However, asthma treatment appears to improve such dysfunction. In children with BA, clinical and subclinical changes in cardiac functions can be easily detected via 2D-STE.Öğe Female and urban participants demonstrate an adverse trend in overall mortality in Turkey - and a report on the TARF survey 2016(Turkish Soc Cardiology, 2017) Onat, Altan; Özbek, Mehmet; Karakoyun, Süleyman; Uzun, Okan; Keskin, Muhammed; Karadeniz, Yusuf; Can, GünayObjective: This study is an examination of 1) overall mortality trend in the Turkish Adult Risk Factor (TARF) study stratified by sex and place of residence, and 2) brief report on main aspects of the 2016 survey. Methods: The period of last 18 years was divided into 2 for trend analysis of data. Required information on deaths was obtained. Baseline age >= 40 years at the beginning of each period was the inclusion criterion. Cox regression analyses were performed. Results: Among over 2500 participants in each, deaths were recorded in 281 and 334 individuals in Periods 1 and 2, respectively, and baseline mean age was 54.6 years and 56.4 years, respectively, in each period. Age-adjusted hazard ratio for mortality in Period 2 remained virtually the same for rural males, rose to borderline significance for urban males and rural females (p=0.06, p=0.09), and increased 1.72-fold for urban females (p=0.006), as compared to Period 1. Whereas males gained an average of 3.8 years of survival in the later period compared with the earlier period, females gained only 1.8 years. This narrowed the difference in mean age at death in favor of women from 2.5 years to 0.5 year. Of 1144 participants to be surveyed in the TARF 2016, 48 were lost to follow-up, 695 were examined, and 39 participants were ascertained to be deceased. In 362 cases, verbal information was obtained regarding health status. Conclusion: Gain in survival in Turkish women has distinctly stagnated compared with men, and hazard of death has risen significantly for women and urban residents in the past decade, suggesting interaction between female sex and urban residence. Both phenomena require recognition and adoption of appropriate measures.Öğe Fonksiyonel triküspit stenozuna sekonder bulantı ile başvuran rüptüre olmamış non-koroner sinüs Valsalva anevrizması(2017) Hayıroğlu, Mert İlker; Keskin, Muhammed; Balcı, Ahmet Yavuz; Altay, Servet; Güvenç, Tolga Sinan…Öğe Hiatal hernia presenting like a large left atrial mass(Turkish Soc Cardiology, 2017) Keskin, Muhammed; Hayıroğlu, Mert İlker; Keskin, Taha; Kaya, Adnan; Kozan, Ömer…Öğe The Impact of Plasma Glucose Levels on In-Hospital and Long-Term Mortality in Non-Diabetic Patients with ST-Segment Elevation Myocardial Infarction Patients(Duzce Univ, 2020) Tatlisu, Mustafa Adem; Kaya, Adnan; Keskin, Muhammed; Baycan, Omer Faruk; Kayapinar, Osman; Caliskan, MustafaObjective: Increased admission plasma glucose can be seen in the acute phase of acute coronary syndromes (ACS). Hence, we performed a retrospective study to evaluate the admission plasma glucose concentration in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and who had no previous diagnosis of Diabetes Mellitus (DM). Methods: This retrospective study included 2504 consecutive confirmed STEMI patients treated with pPCI. The patients were divided into quantiles according to the admission glucose levels. Quantile I: 94 +/- 7 mg/dL (n = 626), quantile II: 112 +/- 5 mg/dL (n = 626), quantile III: 131 +/- 6 mg/dL (n = 626), quantile IV: 184 +/- 46 mg/dL (n = 626). Results: Patients with higher plasma glucose (Q4) had 6.6 times higher in-hospital all-cause mortality rates (95% CI: 3.95-9.30) and 3.12 times higher (95% CI: 2.2-4.4) long-term all-cause mortality rates than patients with lower plasma glucose (Q1-Q3), who had lower rates and were used as the reference. This significant relationship remained even after adjustment for all confounders. Conclusions: Even though glucose-lowering therapy is recommended in ACS patients with glucose levels >180 mg/dL, our results showed that high plasma glucose, even lower than 180 mg/dL, could predict in-hospital and long-term mortality.Öğe The Impact of Plasma Glucose Levels on In-Hospital and Long-Term Mortality in Non-Diabetic Patients with ST-Segment Elevation Myocardial Infarction Patients(Duzce Univ, 2020) Tatlısu, Mustafa Adem; Kaya, Adnan; Keskin, Muhammed; Baycan, Ömer Faruk; Kayapınar, Osman; Çalışkan, MustafaObjective: Increased admission plasma glucose can be seen in the acute phase of acute coronary syndromes (ACS). Hence, we performed a retrospective study to evaluate the admission plasma glucose concentration in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) and who had no previous diagnosis of Diabetes Mellitus (DM). Methods: This retrospective study included 2504 consecutive confirmed STEMI patients treated with pPCI. The patients were divided into quantiles according to the admission glucose levels. Quantile I: 94 +/- 7 mg/dL (n = 626), quantile II: 112 +/- 5 mg/dL (n = 626), quantile III: 131 +/- 6 mg/dL (n = 626), quantile IV: 184 +/- 46 mg/dL (n = 626). Results: Patients with higher plasma glucose (Q4) had 6.6 times higher in-hospital all-cause mortality rates (95% CI: 3.95-9.30) and 3.12 times higher (95% CI: 2.2-4.4) long-term all-cause mortality rates than patients with lower plasma glucose (Q1-Q3), who had lower rates and were used as the reference. This significant relationship remained even after adjustment for all confounders. Conclusions: Even though glucose-lowering therapy is recommended in ACS patients with glucose levels >180 mg/dL, our results showed that high plasma glucose, even lower than 180 mg/dL, could predict in-hospital and long-term mortality.Öğe The Impact of Plasma Glucose Levels on In-Hospital and Long-Term Mortality in Non-Diabetic Patients with STSegment Elevation Myocardial Infarction Patients(2020) Tatlısu, Mustafa Adem; Kaya, Adnan; Keskin, Muhammed; Baycan, Ömer Faruk; Kayapınar, Osman; Çalışkan, MustafaObjective: Increased admission plasma glucose can be seen in the acute phase ofacute coronary syndromes (ACS). Hence, we performed a retrospective study toevaluate the admission plasma glucose concentration in patients with ST-segmentelevation myocardial infarction (STEMI) undergoing primary percutaneous coronaryintervention (pPCI) and who had no previous diagnosis of Diabetes Mellitus (DM).Methods: This retrospective study included 2504 consecutive confirmed STEMIpatients treated with pPCI. The patients were divided into quantiles according to theadmission glucose levels. Quantile I: 94 ± 7 mg/dL (n= 626), quantile II: 112 ± 5mg/dL (n = 626), quantile III: 131 ± 6 mg/dL (n= 626), quantile IV: 184 ± 46 mg/dL(n= 626).Results: Patients with higher plasma glucose (Q4) had 6.6 times higher in-hospitalall-cause mortality rates (95% CI: 3.95–9.30) and 3.12 times higher (95% CI: 2.2–4.4)long-term all-cause mortality rates than patients with lower plasma glucose (Q1–Q3),who had lower rates and were used as the reference. This significant relationshipremained even after adjustment for all confounders.Conclusions: Even though glucose-lowering therapy is recommended in ACS patientswith glucose levels >180 mg/dL, our results showed that high plasma glucose, evenlower than 180 mg/dL, could predict in-hospital and long-term mortality.Öğe More About the Effect of Dynamic Potassium Change in STEMI(Sage Publications Inc, 2019) Kaya, Adnan; Keskin, Muhammed; Tatlısu, Mustafa Adem; Kayapınar, Osman…Öğe A novel and useful predictive indicator of prognosis in ST segment elevation myocardial infarction; prognostic nutritional index(Oxford Univ Press, 2017) Keskin, Muhammed; Hayıroğlu, Mert İlker; Keskin, Taha; Kaya, Adnan; Tatlısu, Mustafa Adem; Altay, Servet; Kozan, Ömer…
