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    Impact of chronic total occlusion in a non-infarct-related coronary artery on contrast-associated nephropathy in acute ST-elevation myocardial infarction
    (Taylor & Francis Ltd, 2023) Gok, Murat; Kurtul, Alparslan; Taylan, Gokay; Ozturk, Cihan; Cakir, Burcu; Yilmaz, Efe; Altay, Servet
    Objectives Co-existing chronic total occlusion (CTO) in a non-infarct-related artery (IRA) might serve as an important trigger of adverse outcomes in ST-segment elevation myocardial infarction (STEMI). Therefore, we planned to analyse the potential impact of non-IRA CTO on the evolution of contrast-associated nephropathy (CAN) in STEMI patients managed with primary percutaneous coronary intervention (P-PCI). Methods A total of 537 subjects with STEMI undergoing P-PCI during the first 12 h after the onset of their symptoms were enrolled in this retrospective study. The subjects were categorised based on the angiographic presence of non-IRA CTO. Moreover, the subjects were also divided into 2 groups based on their CAN status following P-PCI (CAN (+) and CAN (-)). Results Co-existing non-IRA CTO was demonstrated in 86 subjects (16%). During the hospitalisation period, we identified 81 (15.1%) subjects with CAN. Subjects with non-IRA CTO had a significantly higher incidence of CAN compared with those without (56 [12.4%] vs 25 [29.1%], respectively, p < 0.001). In a logistic regression analysis, an existing non-IRA CTO (odds ratio: 2.840, 95%CI: 1.451-5.558, p = 0.002), as well as age, haemoglobin, diabetes mellitus, creatinine, and white blood cell count, were independent of predictors of CAN. Conclusion In STEMI patients managed with P-PCI, a co-existing non-IRA CTO had an independent association with the evolution of CAN.
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    Integrating the Left Atrium Diameter to Improve the Predictive Ability of the Age, Creatinine, and Ejection Fraction Score for Atrial Fibrillation Recurrence After Cryoballoon Ablation
    (Kare Publ, 2023) Taylan, Gokay; Gok, Murat; Kurtul, Alparslan; Uslu, Abdulkadir; Kup, Ayhan; Demir, Serdar; Gulsen, Kamil
    Background: Several clinical trials have assessed predictors for atrial fibrillation recur rence following cryoballoon catheter ablation. With these predictors, a practical and new scoring system can be developed to evaluate atrial fibrillation recurrence. The present study aimed to analyze the predictive value of the age, creatinine, and ejection fraction -left atrium score for potential recurrence of atrial fibrillation following cryoballoon cath- eter ablation in patients with symptomatic paroxysmal or persistent atrial fibrillation. Methods: We retrospectively analyzed records of patients undergoing cryoballoon cath- eter ablation. atrial fibrillation recurrence was defined as an emerging atrial fibrillation episode around 12-month follow-up (with the exclusion of a 3-month blanking period). Univariate and multivariate analyses were performed to assess predictors of atrial fibrilation recurrence. In addition, receiver operating characteristic analysis was harnessed to evaluate the performance of the age, creatinine, and ejection fraction, left atrium score in determining the risk of atrial fibrillation recurrence. Results: The study population comprised 106 subjects (age 52 +/- 13 years, 63.2% women) with paroxysmal (84.9%, n = 90) or persistent (15.1%, n = 16) atrial fibrillation. age, cre- atinine, and ejection fraction, left atrium score was significantly higher in subjects with atrial fibrillation recurrence in comparison to those with the maintenance of sinus rhythm. However, on multivariate logistic regression analysis, only the age, creatinine, and ejection fraction, left atrium score (OR = 12.93, 95% CI: 2.22-75.21, P = .004) served as an independent predictor of atrial fibrillation recurrence following cryoballoon catheter ablation. Conclusion: Age, creatinine, and ejection fraction, left atrium score had an independent association with the risk of atrial fibrillation recurrence in subjects with atrial fibrillation undergoing cryoballoon catheter ablation. Therefore, this score might potentially serve as a useful tool for risk stratification of patients with atrial fibrillation.
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    A novel marker for predicting severity of acute pulmonary embolism: systemic immune-inflammation index
    (Taylor & Francis Ltd, 2021) Gok, Murat; Kurtul, Alparslan
    Background Systemic pro-coagulatory and pro-inflammatory factors are critical factors in acute pulmonary embolism (APE). Recently the systemic immune-inflammation index (SII) has emerged as a new inflammatory and prognostic marker. We aimed to determine whether there is a relationship between SII and the severity of the APE. Methods. A total of 442 patients with APE, 202 women (45.7%) with an average age of 64 +/- 16, were included in this retrospective observational study. APE severity was classified as massive (high risk), submassive (intermediate risk), and nonmassive (low risk). On admission, blood samples were collected for SII and other laboratory measurements. The SII was defined as platelet x neutrophil/lymphocyte counts. Results. SII levels were higher in patients with massive APE and gradually increased from nonmassive to massive APE (p < .001). SII was also significantly higher in patients with in-hospital death. Multivariable analysis showed that SII was an independent predictor for massive APE (Odds ratio 1.005 (95% CI 1.002-1.007), p < .001), together with C-reactive protein and cardiac troponin. In the receiver operating characteristic curve, the optimal cutoff value of SII to predict a massive APE was 1161, with 91% sensitivity and 90% specificity (area under the curve: 0.957). Conclusion. Our findings support an association between a higher SII level and a massive APE. As a simple biomarker, SII is an independent predictor of more severe disease in patients with APE. SII is a more powerful tool than traditional inflammatory markers for predicting the severity of disease in these patients
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    Preinterventional pan-immune-inflammation value as a tool to predict postcontrast acute kidney injury among acute coronary syndrome patients implanted drug-eluting stents: a retrospective observational study
    (Taylor & Francis Ltd, 2024) Kurtul, Alparslan; Gok, Murat
    We evaluated the value of pan-immune-inflammation value (PIV) in predicting the risk for postcontrast acute kidney injury (PCAKI), an important complication following percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients. Medical records of 839 ACS patients underwent PCI between June 2019 and December 2022 were retrospectively analyzed. Patients were divided into two groups: PCAKI (-) and PCAKI (+). PCAKI was defined as a >= 0.5 mg/dL and/or a >= 25% increase in serum creatinine within 72 h after PCI. The PIV was computed as [neutrophils x platelets x monocytes]divided by lymphocytes. The mean age was 60.7 +/- 12.9 years. PCAKI was detected in 105 (12.51%) patients. PIV was higher in the PCAKI (+) group compared to PCAKI (-) group (median 1150, interquartile range [IQR] 663-2021 vs median 366, IQR 238-527, p < 0.001). Receiver operating characteristic curve analysis showed that the best cutoff of PIV for predicting PCAKI was 576 with 81% sensitivity and 80% specificity. PIV was superior to neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for the prediction of PCAKI (area under curve:0.894, 0.849 and 0.817, respectively, p < 0.001 for all). A high PIV was independently correlated with PCAKI (<= 576 vs. >576, odds ratio [OR] 12.484, 95%confidence interval [CI] 4.853-32.118, p < 0.001) together with older age (OR 1.058, p = 0.009), female gender (OR 4.374, p = 0.005), active smoking (OR 0.193, p = 0.012), left ventricular ejection fraction (OR 0.954, p = 0.021), creatinine (OR 10.120, p < 0.001), hemoglobin (OR 0.759, p = 0.019) and c-reactive protein (OR 1.121, p = 0.002). In conclusion, a high PIV seems to be an easily assessable tool that can be used in clinical practice for predicting the risk of PCAKI in ACS patients implanted drug-eluting stents.
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    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, Kerim
    Background: 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.
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    Serum Prealbumin: a potential predictor of Right Ventricular Dysfunction in patients receiving programmed hemodialysis
    (Assoc Medica Brasileira, 2022) Gok, Murat; Kurtul, Alparslan; Taylan, Gokay; Sayilar, Emel Isiktas; Yalta, Kenan
    OBJECTIVE: Prealbumin has been a reliable marker to predict protein energy malnutrition and hypercatabolic state. In this analysis, we particularly aimed to investigate the potential association between serum prealbumin levels and right ventricular dysfunction in patients receiving programmed hemodialysis. METHODS: A total of 57 subjects were included in the analysis. The subjects were then categorized into two groups: right ventricular dysfunction (n=18) and non-right ventricular dysfunction (n=39) groups. In all patients, detailed transthoracic echocardiography (following hemodialysis) were performed along with the evaluation of complete blood count, routine biochemistry parameters, and, in particular, serum prealbumin levels. RESULTS: Mortality rate at 3 years was found to be significantly higher in the right ventricular dysfunction group (p=0.042). Serum prealbumin levels were also significantly lower in the right ventricular dysfunction group compared with the non-right ventricular dysfunction group (23.83??8.50 mg/dL versus 31.38??6.81 mg/dL, p=0.001). In the receiver operating characteristics curve analysis, a prealbumin cutoff value of <28.5 mg/dL was found to predict right ventricular dysfunction, with a sensitivity of 67% and a specificity of 62% (area under the curve: 0.744). In the correlation analysis, a moderate yet significant positive correlation was demonstrated between serum prealbumin and tricuspid annular plane systolic excursion (r=0.365, p=0.005). CONCLUSION: This study suggests that low serum prealbumin might serve as a potential predictor of right ventricular dysfunction (and its clinical consequences) in patients receiving programmed hemodialysis.