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    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 Adem
    Background: 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.
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    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, Osman
    There 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.
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    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, Mustafa
    Objective: 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.