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Öğe Effect of Serum Gamma-Glutamyl Transferase Levels on Myocardial Perfusion and Long-Term Prognosis After Primary Angioplasty in Patients With Acute ST-Elevation Myocardial Infarction(Bmj Publishing Group, 2012) Ozcan, Firat; Karakas, Mehmet Fatih; Ozlu, Mehmet Fatih; Akcay, Adnan Burak; Buyukkaya, Eyup; Kurt, Mustafa; Erden, GonulBackground: Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population. Methods and Results: One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow <= 2 or TIMI flow 3 with final myocardial bush grade <= 2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P<0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events. Conclusions: In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.Öğe Erythrocyte sedimentation rate in acute myocardial infarction as a predictor of poor prognosis and impaired reperfusion(Medical Assoc Zenicadoboj Canton, 2012) Ozlu, Mehmet Fatih; Sen, Nihat; Karakas, Mehmet Fatih; Turak, Osman; Ozcan, Firat; Kanat, Selcuk; Aras, DursunAim To investigate whether the elevated erythrocyte sedimentation rate (ESR) is associated with an adverse prognosis in the patients with ST-segment elevation myocardial infarction (STEM I) undergoing primary percutaneous coronary intervention (PCI). Methods It included 140 consecutive patients undergoing primary PCI for acute STEM!, <12 hours after symptom beginning and 50 healthy age and sex matched control subjects. All patients were categorized into two groups defined by the median ESR level on admission. These two groups were compared in terms of myocardial perfusion, and one year outcomes. Results Levels of ESR were higher ill patients with STEM! than in the healthy group. Patients in the elevated ESR group had a higher incidence of impaired angiographic reperfusion compared to patients in the lower ESR group (Mean TIMI frame count; 25.5 +/- 6.5 versus 20.4 +/- 5.2, p<0.01, TMPG 0-2; 55 % versus 29%, p<0.01). In-hospital and one-year mortality rates were significantly higher in patients with higher ESR. In-hospital and one-year MACE rates were significantly greater in elevated ESR group (14%-26), compared to the lower ESR group (4%-13%). Increased ESR levels on admission emerged as independent predictors of long term prognosis. The ROC analysis revealed an optimal cut-point of >= 33 mm/h, detected I year mortality with a negative predictive value of 96%. Conclusion The high admission ESR levels are found to be related with impaired coronary flow in patients undergoing primary PC-I that possibly contribute to poor short- and long-term prognosis. Therefore, admission ESR evaluation may be helpful in identifying patients with a poor prognosis.Öğe The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention(Elsevier Ireland Ltd, 2013) Sen, Nihat; Afsar, Baris; Ozcan, Firat; Buyukkaya, Eyup; Isleyen, Ahmet; Akcay, Adnan Burak; Yuzgecer, HuseyinObjectives: In the present study we aimed to reveal any probable correlation between neutrophil-to-lymphocyte ratio (N/L ratio) and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with ST-segment elevation myocardial infarction (STEMI). Background: The N/L ratio stands practically for the balance between neutrophil and lymphocyte counts in the body, which can also be utilized as an index for systemic inflammatory status. Methods: In our study, we included 204 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (PCI). Patients with STEMI were assigned into distinct tertiles based on their N/L ratios on admission. No-reflow encountered following PCI was evaluated through both angiography [Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade (MBG)] and electrocardiography (as ST-segment resolution). Results: Patients featured with no ST-resolution were documented to have displayed significantly higher N/L ratio on admission compared to those with intermediate or complete ST-segment resolution. The number of the patients characterized with no-reflow, evident both angiographically (TIMI flow <= 2 or TIMI flow 3 with final myocardial bush grade <= 2 after PCI) and electrocardiographically (ST-resolution <30%), was encountered to depict increments throughout successive N/L ratio tertiles. Moreover, the same also held true for three-year mortality rates across the tertile groups (9% vs. 15% vs. 35%, p < 0.01). Multivariable logistic regression analysis disclosed that N/L ratio on admission stood for a significant indicator for long-term mortality in patients with no-reflow phenomenon detected with MBG. Elevated N/L ratio on admission was also found to be a significant indicator for three-year mortality and major adverse cardiac events. Conclusions: In patients with STEMI who underwent primary PCI, elevated N/L ratios on admission were revealed to be correlated with both no-reflow phenomenon and long-term prognosis. (C) 2013 Elsevier Ireland Ltd. All rights reserved.Öğe Serum Uric Acid, Inflammation, and Nondipping Circadian Pattern in Essential Hypertension(Wiley, 2013) Turak, Osman; Ozcan, Firat; Tok, Derya; Isleyen, Ahmet; Sokmen, Erdogan; Tasoglu, Irfan; Aydogdu, SinanUric acid (UA) is independently associated with the emergence of hypertension. Nocturnal nondipping pattern of hypertension is associated with a greater risk of cardiovascular, renal, and cerebrovascular complications than dippers. The aim of the present study was to evaluate the relationship between the circadian blood pressure rhythm and UA level in patients with newly diagnosed essential hypertension. The study included 112 essential hypertensive patients and 50 healthy controls. The hypertensive patients were divided into two groups according to the results of 24-hour ambulatory blood pressure monitoring, including 60 dippers (35 men, 25 women; mean age, 52.6 +/- 15.8 years) and 52 nondippers (29 men, 23 women; mean age, 55.9 +/- 13.2 years). Nondippers had significantly higher serum UA levels than the dippers and controls (5.8 +/- 0.8, 5.1 +/- 0.9 and 4.2 +/- 0.9 mg/dL, respectively; P<.001). Serum high-sensitivity C-reactive protein levels were also significantly higher in the nondipper group than the other groups (P<.001) and significantly correlated with serum UA (r=0.358, P<.001). Multivariate logistic regression analysis revealed an independent positive association between serum UA levels and nondipper pattern (odds ratio, 2.28; 95% confidence interval, 1.333.94; P=.003). Serum UA is strongly and independently associated with the nondipper circadian pattern in essential hypertension.Öğe Usefulness of the Neutrophil-to-Lymphocyte Ratio to Predict Bare-Metal Stent Restenosis(Excerpta Medica Inc-Elsevier Science Inc, 2012) Turak, Osman; Ozcan, Firat; Isleyen, Ahmet; Tok, Derya; Sokmen, Erdogan; Buyukkaya, Eyup; Aydogdu, SinanInflammation plays a crucial role in the pathogenesis of in-stent restenosis (ISR). Neutrophil-to-lymphocyte ratio (NLR) provides a simple method for assessment of inflammatory status and prognosis in patients with coronary artery disease. The aim of the present study was to investigate the predictive value of preprocedural NLR on development of ISR in patients undergoing coronary stent implantation. We retrospectively analyzed clinical, hematologic, and angiographic data of 624 patients (mean age 60.5 +/- 10.2 years, 71.8% men) who had undergone coronary stent implantation and a further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural NLR. Restenosis occurred in 21 patients (10.1%) in the lowest tertile, in 62 (29.8%) in the middle tertile, and in 107 (51.4%) in the highest NLR tertile (p <0.001). Serum C-reactive protein levels were also significantly higher in patients in tertile 3 than in those in tertiles 1 and 2 (p <0.001). Using multiple logistic regression analysis, smoking, diabetes mellitus, stent length, preprocedural NLR, and C-reactive protein levels emerged as independent predictors of ISR. In receiver operating characteristics curve analysis, NLR >2.73 had 80% sensitivity and 75% specificity in predicting ISR. In conclusion, high preprocedural NLR is a powerful and independent predictor of bare-metal stent restenosis in patients with stable and unstable angina pectoris. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1405-1410)
