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    Reasonability of urine toxicology screening for methamphetamine and cocaine in young acute myocardial infarction
    (2020) Örnek, Ender; Kurtul, Alparslan; Gök, Murat
    Aim: Prior cocaine and methamphetamine use influence treatment strategies in subjects with acute myocardialinfarction. Often patients may not self-report illicit drug use on admission but urine analysis may reveal etiology. Thisstudy aimed to investigate if routine screening of cocaine and methamphetamine use by urine analysis is reasonablein young myocardial infarction.Material and Methods: This study enrolled 50 consecutive young patients (?50 years old) with acute myocardialinfarction. Mean age was 41.3±7.8 (21-50) and 80% of patients were male. Patients were queried about the use of any illicitdrug use on admission. Urine samples for cocaine and methamphetamine analysis were done using immunuassay testswithin the first day of admission. Cocaine use was considered as positive if the level of benzoylecgonine was above 300ng/mL. Methamphetamine use was considered as positive if the level was above 1000 ng/mL. All the patients underwentcoronary angiography and percutaneous coronary revascularization if they had significant coronary artery stenosis.Results: ST elevated acute myocardial infarction was diagnosed in 38 patients (76%) and non-ST elevated acute myocardialinfarction was diagnosed in 12 patients (24%). No patient self-reported cocaine or methamphetamine use. Urine analysesfor cocaine were negative in all 50 patients. In urine analyses methamphetamine were found to be positive in 5 patients(10%). Classical risk factors for atherosclerosis were similar between the groups.Conclusion: As we found 10% incidence of methamphetamine use, it may be reasonable to screen methamphetamineuse but not cocaine use by urine analysis in younger myocardial infarction patients.
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    The relationship between serum vitamin d and bare-metal in-stent restenosis in patients with stable coronary artery disease
    (2020) Kurtul, Alparslan; Gök, Murat; Örnek, Ender
    Aim: It has been shown that low levels of vitamin D are associated with increased cardiovascular risk factors and adverse events. The relationship between serum vitamin D level and bare-metal stent in-stent restenosis was investigated in our study. Material and Methods: A total of 181 patients with stable coronary artery disease and previously implanted (>3 months) bare-metal stent were included in the study. Two groups were formed according to angiographic results as Group 1 (?50% in-stent stenosis) and Group 2 (<50% in-stent stenosis). Serum vitamin D measurements were performed by reverse-phase HPLC. Results: The mean serum vitamin D levels were found to be significantly lower in Group 1 compared to Group 2 (17.7 ± 5.3 ng/ml and 20.9 ± 6.7 ng/ml, p<0.01, respectively) and length of stent was longer in Group 1 compared to Group 2 (18.7 ± 5.3 mm and 17.1 ± 11.2 mm, p<0.01, respectively). In multivariate logistic regression analysis, only low level of serum vitamin D and stent length were independent risk factors for bare-metal in-stent stenosis. Conclusion: Low level of vitamin D might be related to fibrosis and inflammation resulting in in-stent stenosis. Further studies are warranted to determine whether vitamin D supplementation could prevent progression of stent re-stenosis.