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Öğe Comparison of systemic immune-inflammation index levels in patients with isolated coronary artery ectasia versus patients with obstructive coronary artery disease and normal coronary angiogram(Taylor & Francis Ltd, 2022) Esenboga, Kerim; Kurtul, Alparslan; Yamanturk, Yakup Yunus; Akbulut, Irem Muge; Tutar, Durmus EralpCoronary artery ectasia (CAE) is associated with increased risk of mortality, equivalent to that of patients with obstructive coronary artery disease (CAD). Considering the role of inflammation in the pathogenesis of CAE, we aimed to investigate whether there is an association between systemic immune-inflammation index (SII) and isolated CAE. The study population included 510 patients of which 170 patients with isolated CAE, 170 patients with obstructive CAD and 170 patients with normal coronary angiograms (NCA). The severity of CAE was determined according to the Markis classification. Patients with isolated CAE had significantly higher SII values compared to those with obstructive CAD and NCA [median 550 IQR (404-821), median 526 IQR (383-661), and median 433 IQR (330-555), respectively, p < .001]. In multivariate analysis, SII (OR 1.032, 95% CI 1.020-1.044, p = .003), male gender (OR 2.083, p = .008), eGFR (OR 0.979, p = .016), and CRP (OR 1.105, p = .005) were independent factors of isolated CAE. Moreover, in the Spearman correlation analysis, there was a moderate but significant positive correlation between SII and CRP (r = 0.379, p < .001). In conclusion, higher SII levels were independently associated with the presence of isolated CAE. This result suggests that a more severe inflammatory process may play a role in the development of this variant of CAD.Öğe Evaluation of the Impact of Ranolazine Treatment on Liver Function Tests in Patients With Coronary Heart Disease and Nonalcoholic Fatty Liver Disease(Sage Publications Inc, 2022) Esenboga, Kerim; Kurtul, Alparslan; Nazman, Huseyin; Tekin, Cemre Gul; Ozyuncu, Nil; Tan, Turkan Seda; Tutar, EralpNonalcoholic fatty liver disease (NAFLD) is the most common liver pathology in the developed world. Nonalcoholic fatty liver disease is associated with a higher risk of cardiovascular disease. We investigated the impact of ranolazine on liver tests in patients with NAFLD and coronary artery disease (CAD). Patients who had established CAD and NAFLD (as assessed by raised serum transaminase activity, sonographic criteria, and the absence of any other obvious liver disease) were allocated to on ranolazine (n = 40) or not on ranolazine (n = 35) groups. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured in all patients at baseline and at the end of the study. After 6 months of ranolazine treatment, both ALT and AST activities were significantly lower in patients in the on ranolazine group compared with not on ranolazine patients (change from baseline: ALT, -11.0 +/- 1.7 IU/L, P < .001; AST, -5.2 +/- 1.9 IU/L, P =.009). In conclusion, the present study showed that treatment with ranolazine for 6 months led to a significant reduction in the activities of both serum aminotransferases in patients with stable CAD and NAFLD.Öğe Measurement of Uncertainty in Prediction of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention Using Systemic Immune Inflammation Index: The Gray Zone Approach(Mdpi, 2023) Ozturk, Ebru; Esenboga, Kerim; Kurtul, Alparslan; Kilickap, Mustafa; Karaagaoglu, Ergun; Karakaya, JaleSystemic immune-inflammation index (SII), which is a good predictive marker for coronary artery disease, can be calculated by using platelet, neutrophil, and lymphocyte counts. The no-reflow occurrence can also be predicted using the SII. The aim of this study is to reveal the uncertainty of SII for diagnosing ST-elevation myocardial infarction (STEMI) patients who were admitted for primary percutaneous coronary intervention (PCI) for the no-reflow phenomenon. A total of 510 consecutive acute (STEMI) patients with primary PCI were reviewed and included retrospectively. For diagnostic tests which are not a gold standard, there is always an overlap between the results of patients with and without a certain disease. In the literature, for quantitative diagnostic tests where the diagnosis is not certain, two approaches have been proposed, named grey zone and uncertain interval. The uncertain area of the SII, which is given the general term gray zone in this article, was constructed and its results were compared with the grey zone and uncertain interval approaches. The lower and upper limits of the gray zone were found to be 611.504-1790.827 and 1186.576-1565.088 for the grey zone and uncertain interval approaches, respectively. A higher number of patients inside the gray zone and higher performance outside the gray zone were found for the grey zone approach. One should be aware of the differences between the two approaches when making a decision. The patients who were in this gray zone should be observed carefully for detection of the no-reflow phenomenon.Öğe Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion(Arquivos Brasileiros Cardiologia, 2024) Esenboga, Kerim; Kurtul, Alparslan; Yamanturk, Yakup Yunus; Kozluca, Volkan; Tutar, EralpBackground: Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. Objective: To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. Methods: A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. Results: The mean age of the study cohort was 63 +/- 10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29 +/- 5.58 vs 41.23 +/- 3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. Conclusion: The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.Öğe Prognostic Nutritional Index Predicts Contrast-Associated Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction(Taiwan Soc Cardiology, 2021) Kurtul, Alparslan; Gok, Murat; Esenboga, KerimBackground: Contrast-associated acute kidney injury (CA-AKI) previously known as contrast-induced nephropathy is associated with a worse prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a simple index comprised of serum albumin level and lymphocyte count which reflects the immunonutritional-inflammatory status. Recently, clinical studies have shown associations between the PNI and clinical outcomes in several cardiovascular diseases. The aim of the study was to assess the possible utilization of the PNI to predict the development of CA-AKI after primary PCI. Method: We retrospectively included 836 patients (mean age 58 12 years, 76% men) with STEMI treated with primary PCI. The PNI was calculated as 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm(3)). The patients were divided into two groups according to whether or not CA-AKI developed. Results: The overall incidence of CA-AKI was 9.4%. Compared to the patients without CA-AKI, those with CA-AKI had a significantly lower PNI value (40.7 +/- 3.7 vs. 35.2 +/- 4.9; p < 0.001). In receiver operating characteristic curve analysis, the optimal cutoff value of the PNI to predict CA-AKI was 38, with 82% sensitivity and 70% specificity (area under the curve 0.836, p < 0.001). In multivariate logistic regression analysis, PNI < 38, body mass index and creatinine were independently associated with CA-AKI (odds ratio 11.275, 95% confidence interval 3.596-35.351; p < 0.001). Conclusions: The PNI was inversely and significantly associated with the development of CA-AKI in acute STEMI. Assessing PNI at admission may be useful for early risk stratification of STEMI patients.Öğe Prognostic nutritional index predicts in-hospital mortality in patients with acute Stanford type A aortic dissection(Sage Publications Ltd, 2021) Keskin, Hasan Attila; Kurtul, Alparslan; Esenboga, Kerim; Cicek, Mustafa Cuneyt; Katircioglu, Salih FehmiBackground: Acute Stanford type A aortic dissection (ATAAD) is a life-threatening medical emergency. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a novel inflammatory marker for ATAAD patients undergoing surgical repair. Methods: We retrospectively examined the medical records of 151 ATAAD patients who treated surgically. Patients were divided into two groups (survival and death) and these groups were compared with respect to clinical and laboratory parameters. The PNI was calculated as 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm(3)). Logistic regression analyses were performed to identify the risk factors of in-hospital mortality. Results: The mean age of the study cohort was 61 +/- 12 years, 99 (65.6%) were males, and 35 (23.2%) patients died during the hospital stay. The PNI levels were significantly lower in death group compared with survival group (32.80 +/- 4.90 vs. 37.94 +/- 5.42, p < 0.001). Multivariate analysis showed that the PNI (OR: 0.795, p = 0.005), age (odds ratio [OR]: 1.085, p = 0.034), operating time (OR: 1.660, p = 0.042), and D-dimer (OR: 1.002, p = 0.001) independently predicted in-hospital mortality. The calculated cutoff value of the PNI was 33.01. Conclusion: Lower PNI values are independently associated with in-hospital mortality in ATAAD. The PNI may be a useful tool for predicting the early mortality of ATAAD patients after surgical repair.Öğe Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary intervention(Taylor & Francis Ltd, 2022) Esenboga, Kerim; Kurtul, Alparslan; Yamanturk, Yakup Yunus; Tan, Turkan Seda; Tutar, Durmus EralpObjective Systemic immune-inflammation index (SII), on the basis of lymphocyte, neutrophil and platelet counts had been published to be a good prognostic factor in coronary artery disease. Nevertheless, the prognostic value of Systemic immune-inflammation index (SII) in a condition of no-reflow phenomenon (NRP) remains inconsistent, we evaluated the SII as a simple calculated tool for predicting the NRP among patients with STEMI who underwent primary percutaneus coronary intervention (PCI). Method 510 consecutive acute STEMI patients who underwent primary PCI within 12 h from symptom onset from October 2015 to January 2020 were enrolled in our study. The receiver-operating characteristic (ROC) curve was used to determine the cut-off value of SII to predict the no-reflow. Multivariate stepwise logistic regression, including covariates found to have a significant association with NRP in univariate analysis, was used to identify independent predictors of no-reflow. Results A ROC curve analysis showed that the best cut-off value of SII for predicting no-reflow was 1028, with sensitivity and specificity of 79% and 70, respectively (AUC, 0.839; 95% CI 0.797-0.881). An ROC curve comparison analysis was performed to compare the SII with NLR and PLR. Multivariate analysis revealed that SII >= 1028 value (OR = 6.622, 95% confidence interval (CI): 3.802-11.627, p < .001), not using aspirin prior to admission (OR = 0.431, 95%CI: 0.236-0.786, p = .006), and CRP (OR = 1.004, 95%CI: 1.001-1.008, p = .041) were independent predictors related to occurrence of NRP after primary PCI in patients with acute STEMI. Conclusion SII levels are independently associated with the NRP in patients undergoing primary PCI for acute STEMI. High SII may be a promising indicator for the prediction of NRP in these patients.
