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Öğe Are plasma resistin and omentin levels different in patients with psoriasis with or without atherosclerosis?(Springer, 2013) Sen, Bilge Bulbul; Rifalioglu, Emine Nur; Ekiz, Ozlem; Buyukkaya, Eyup; Sen, Nihat[Abstract Not Available]Öğe Assessment of left ventricular dyssynchrony in dipper and non-dipper hypertension(Taylor & Francis Ltd, 2013) Karakas, Mehmet Fatih; Buyukkaya, Eyup; Kurt, Mustafa; Karakas, Esra; Buyukkaya, Sule; Akcay, Adnan Burak; Sen, NihatBackground. Ventricular dyssynchrony is an co-determinant of progression and exacerbation of heart failure (HF). The co-existence of ventricular dyssynchrony with hypertension (HT) and HF were shown, however there is no data regarding the effect of circadian rhythm of blood pressure (BP) on ventricular synchrony. Therefore, we aimed to study the left ventricular synchrony in dipper and non-dipper normotensive and hypertensive participants. Methods. Participants (n = 142) were categorized into four groups as Normotensive-Dipper (NT-D) (n = 40), Normotensive-Non-dipper (NT-ND) (n = 30), Hypertensive-Dipper (HT-D) (n = 38) and Hypertensive-Non-dipper (HT-ND) (n = 34). Left ventricular dyssynchrony was investigated by color-coded tissue Doppler imaging. Results. Non-dippers had higher 24-h and night-time BP both in normotensives and hypertensives. The incidence of ventricular dyssynchrony (a Ts-SD-12 > 34.4 ms) was higher in the hypertensive group (47.2% vs 24.3%, p = 0.005). The frequency of ventricular dyssynchrony was higher in the HT-ND group than the HT-D group (58.8% vs 36.8%, p = 0.05); however, the frequency of ventricular dyssynchrony was similar among the normotensives (26.7% vs 22.5%, p = 0.45). Ts-SD-12 and Ts-12 were higher in NT-ND group than the NT-D group. Conclusions. Non-dipping BP pattern was associated with impaired left ventricular contraction synchrony in both normotensive and hypertensive participants, which may be related with short-and long-term effects of HT on myocardium.Öğe Correlation of Neutrophil to Lymphocyte Ratio With the Presence and Severity of Metabolic Syndrome(Sage Publications Inc, 2014) Buyukkaya, Eyup; Karakas, Mehmet Fatih; Karakas, Esra; Akcay, Adnan Burak; Tanboga, Ibrahim Halil; Kurt, Mustafa; Sen, NihatPurpose: The aim of this study is to investigate the relationship between the criteria comprising metabolic syndrome (MS) and neutrophil-lymphocyte ratio (NLR), a simple and reliable indicator of inflammation. Method: Seventy patients with MS and 71 age- and sex-matched control participants were included. Patients were classified into 3 groups based on the number of MS criteria: group 1 (with 3 criteria), group 2 (with 4 criteria), and group 3 (with 5 criteria). The NLR was calculated from complete blood count. Results: Patients with MS had significantly higher NLR compared to the control group. Moreover, the group 3 patients had higher NLR than those in groups 2 and 1 (P = .008 and P = .078, respectively), whereas there was no difference between the patients meeting 3 and 4 MS criteria (P = .320). Besides, NLR increased as the severity of MS increased (r = .586, P < .001). The cutoff level for NLR with optimal sensitivity and specificity was calculated as 1.84. Serum glucose and high-sensitive C-reactive protein level were found to be independent predictors of an NLR value greater than 1.84. Conclusion: The present study indicated a significant correlation between the criteria of MS and inflammation on the basis of NLR. Furthermore, there an increase in NLR as the severity of MS increases.Öğe An effective and safe alternative to epicardial pacemaker placement for permanent pacemaker implantation in a patient with mechanical tricuspid valve: stimulation of the left ventricle through the coronary sinus(Turkish Soc Cardiology, 2011) Demir, Ahmet Duran; Sen, Nihat; Erbay, Ali Riza; Atak, RamazanImplantation of a transvenous endocardial pacemaker is contraindicated in patients with a mechanical tricuspid valve. An epicardial left ventricular pacemaker lead was placed by a transvenous route through the coronary sinus into the lateral cardiac vein in a 58-year-old woman with mechanical aortic, mitral, and tricuspid valves, for permanent pacing due to chronic atrial fibrillation with a slow ventricular rate accompanied by syncope. This lead was then connected to a singlechamber pacemaker. The patient had no problem in the following three months. Placement of an epicardial pacing lead through the coronary sinus provides a safe and effective pacing in patients with a mechanical tricuspid valve, thus obviating major cardiac surgery.Öğe Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion(Elsevier Ireland Ltd, 2011) Sen, Nihat; Ozlu, Mehmet Fatih; Akgul, Emin Ozgur; Kanat, Selcuk; Cayci, Tuncer; Turak, Osman; Yaman, HalilObjectives: We aimed to investigate the effects of admission asymmetric dimethylarginine (ADMA) levels on myocardial perfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Background: ADMA, an endogenous inhibitor of endothelial nitric oxide synthase, was found to be elevated in plasma of patients with cardiovascular risk factors. Methods: 168 consecutive patients undergoing primary PCI for STEMI <12 h after symptom onset and 75 healthy age and sex matched volunteer controls were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission plasma ADMA levels. Major adverse cardiac events during hospitalization or at one-year clinical follow-up were evaluated. Also angiographic impaired reperfusion was assessed by 3 different methods after PCI: angiographic thrombolysis in myocardial infarction (TIMI) flow, TIMI frame count and TIMI myocardial perfusion grade (TMPG). Results: Plasma level of l-arginine were lower in patients with STEMI than in the control group subjects, whereas plasma ADMA levels were increased in the STEMI patient group. The rate of impaired angiographic reperfusion increased across the tertile groups. Also one-year mortality rates showed a significant increase across the tertile groups (4% vs. 10% vs. 20%, p < 0.01). Using multiple Cox regression analysis, only TIMI risk score, left ventricle ejection fraction (LVEF), abnormal TMPG, and increased ADMA values on admission emerged as independent predictors of one-year mortality. The ROC analysis indicated an optimal cut-point of >= 1.37 mu mol/L, which detects one-year mortality with a negative predictive value of 96%. Conclusions: In STEMI patients undergoing primary PCI, high admission ADMA levels were found to be associated with impaired myocardial perfusion and increased one-year mortality. Therefore admission ADMA level detection may be helpful in identifying the patients at a greater risk of impaired myocardial perfusion and poor prognosis. (C) 2011 Elsevier Ireland Ltd. All rights reserved.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 Evaluation of biochemical, hematological, and thyroid function parameters in nondipper and dipper hypertensive patients(Springer Wien, 2012) Akpinar, Ibrahim; Basar, Nurcan; Sen, Nihat; Kisacik, Halil LutfuIn this study we investigated the effects of biochemical, hematologic, and thyroid function parameters on the circadian rhythm of hypertensive patients whose 24-h ambulatory blood pressure was being followed. We studied the fasting glucose, urea, creatinine, uric acid, aspartate transaminase, alanine aminotransferase, gamma-glutamyl transferase, total protein, albumin, lipid profiles, sodium, potassium, hemoglobin, white blood cell count, platelet count, mean platelet volume, thyroid stimulating hormone, free thyroid hormone values obtained simultaneously with 24-h ambulatory blood pressure results, as documented in the case records of 470 patients. Of the patients, 398 were in the nondipper hypertensive group and 72 in the dipper hypertensive group. Differences in serum biochemical, hematologic, and thyroid function parameters were compared between the groups. No statistically meaningful difference was detected between the age, gender, biochemical and hematologic parameters of the two groups. When the two were compared with respect to thyroid function tests, thyroid stimulating hormone levels in the nondipper hypertensive group were significantly higher, while free triiodothyronine and thyroxine levels were significantly lower. Thyroid function disorders are associated with hypertension. However, there are not enough data on the effects of thyroid hormones particularly on the nighttime blood pressure decrease in hypertensive patients. Although the exact mechanism between low thyroid hormone levels and nondipping hypertension development is not known, relatively low thyroid hormone levels in the nondipper group may be related to the decrease in vein wall compliance, considering the vascular effect of overt hypothyroidism.Öğe Is Arterial Stiffness a Predictor of Cardiovascular Disease in All Patients With Psoriasis?(Sage Publications Inc, 2014) Sen, Bilge Bulbul; Erayman, Ali; Sen, Nihat[Abstract Not Available]Öğe Is Increased Mean Platelet Volume an Indicator of Subclinical Atherosclerosis in Patients With Behcet Disease?(Sage Publications Inc, 2014) Erayman, Ali; Sen, Nihat[Abstract Not Available]Öğe Is there a relationship between disease duration and P-wave dispersion in patients with psoriasis?(Taylor & Francis Ltd, 2013) Sen, Bilge Bulbul; Rifaioglu, Emine Nur; Ekiz, Ozlem; Buyukkaya, Eyup; Sen, Nihat[Abstract Not Available]Öğe Is there a relationship between left atrium size and p-wave dispersion in patients with lichen planus?(Hospital Clinicas, Univ Sao Paulo, 2013) Sen, Bilge Bulbul; Rifaioglu, Emine Nur; Erayman, Ali; Sen, Nihat[Abstract Not Available]Öğe Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis(Taylor & Francis Ltd, 2014) Sen, Bilge Bulbul; Rifaioglu, Emine Nur; Ekiz, Ozlem; Inan, Mehmet Ugur; Sen, Tugba; Sen, NihatObjective: Psoriasis is a chronic systemic inflammatory disorder. The neutrophil to lymphocyte ratio (N/L ratio) has been used as a marker for systemic inflammatory status. In our study, we aimed to evaluate N/L ratio in patients with psoriasis. Methods: This cross-sectional study population consisted of 138 patients with psoriasis and 120 age-and sex-matched control subjects. Results: The patients had significantly higher neutrophil counts and lower lymphocyte counts than the controls. The N/L ratios and high sensitivity C reactive protein (hs-CRP) levels were also significantly higher in patients. The N/L ratios and hs-CRP levels were increasing with increasing in Psoriasis Area and Severity Index score. Furthermore, the N/L ratios and hs-CRP levels of patients were found to be positively correlated. Conclusions: Our data show that the N/L ratio to be a simple, inexpensive and easily assessable marker of systemic inflammation in patients with psoriasis.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 Neutrophil-Lymphocyte Ratio and C-Reactive Protein May Be Correlated in Patients With Coronary Artery Ectasia(Sage Publications Inc, 2014) Erayman, Ali; Sen, Nihat[Abstract Not Available]Öğe Partial Thrombus Resolution With Trofiban in a Pregnant Woman With Mechanical Prosthetic Mitral Valve Thrombosis(Sage Publications Inc, 2011) Akcay, Adnan Burak; Yuce, Murat; Akcay, Murat; Sen, Nihat; Soydinc, Hatice Ender; Davutoglu, VedatWe present a 15-week pregnant woman who developed mechanical mitral valve thrombosis on a fixed dose of enoxaparin therapy 60 mg twice daily. No reductions were observed in the thrombus size or mean mitral gradient on transesophageal echocardiography (TEE) with 1 week of unfractioned heparin therapy. As the thrombus on TEE imaging was hypermobile and fragile, in addition to a higher dose of enoxaparin (80 mg twice daily), trofiban infusion 0.20 mu g/kg per minute was administered for another 1 week. The thrombus on the valve was reduced in size, mobility and fragility of the thrombus diminished, and mean valve gradient decreased on TEE. As complete thrombus resolution was not observed and limitation of valve mobility continued, tissue plasminogen activator (tPA) was given to the patient. A complete thrombus resolution was observed on this therapy. The patient is presented for being the first case in literature whose valvular thrombus reduced with trofiban therapy.Öğe Plateletcrit and red cell-distribution width are independent predictors of the slow coronary flow phenomenon(Elsevier, 2014) Akpinar, Ibrahim; Sayin, Muhammet Rasit; Gursoy, Yusuf Cemil; Aktop, Ziyaeddin; Karabag, Turgut; Kucuk, Emrah; Sen, NihatBackground and purpose: Endothelial dysfunction may play a role in the pathogenesis of the slow coronary flow (SCF) phenomenon. A detailed examination of blood cellular components has not been performed for this condition. We investigated the relationship between SCF and whole blood cell counts. Method: Records of 17,315 patients who underwent coronary angiography between January 2006 and December 2012 were evaluated retrospectively. A total of 146 patients with SCF were compared with 148 patients with normal coronary arteries according to demographic data, complete blood count, and biochemical parameters. Results: The following parameters were significantly higher in SCF patients than in patients with normal coronary arteries: percentage of smokers (36.3% vs. 25%, p = 0.036), body mass index (26.69 +/- 2.84 vs. 26.07 +/- 3.15, p = 0.049), white blood cells (WBCs) (7.52 +/- 1.43 x 10(3) mm(-3) vs. 7.01 +/- 1.42 x 10(3) mm(-3), p = 0.002), red cell distribution width (RDW) (13.68 +/- 1.42% vs. 13.15 +/- 1.13%, p < 0.001), platelets (250.29 +/- 50.96 x 10(3) mm(-3) vs. 226.10 +/- 38.02 x 10(3) mm(-3), p < 0.001), plateletcrit (PCT) (0.214 +/- 0.40% vs. 0.184 +/- 0.29%, p < 0.001), mean platelet volume (8.63 +/- 1.10 fL vs. 8.22 +/- 0.83 fL, p < 0.001), platelet distribution width (PDW) (16.58 +/- 0.76% vs. 16.45 +/- 0.57%, p = 0.028), and neutrophils (4.44 +/- 1.25 x 10(3) mm(-3) vs. 4.12 +/- 1.24 x 10(3) mm(-3), p = 0.029). Positive PCT values [odds ratio (OR), 4.165; 95% confidence interval (CI), 2.493-6.959; p < 0.001) and RDW (OR, 1.304; 95% Cl, 1.034-1.645; p = 0.025) were independent predictors of SCF. Conclusion: Although within the normal range, the increased numbers of WBCs and neutrophils in patients with SCF suggest that SCF may be a subclinical inflammatory condition. Furthermore, increased RDW and PDW in SCF patients may cause microvascular blood flow resistance due to impaired cell deformability. The PCT provides reliable data regarding total platelet mass and may be a useful predictor of SCF. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Öğe PREVENTION OF PERI-PROCEDURAL MYOCARDIAL INJURY USING A SINGLE HIGH LOADING DOSE OF ROSUVASTATIN(Karger, 2010) Cay, Serkan; Cagirci, Goeksel; Sen, Nihat; Balbay, Yuecel; Durmaz, Tahir; Aydogdu, Sinan[Abstract Not Available]Öğe Prevention of Peri-procedural Myocardial Injury Using a Single High Loading Dose of Rosuvastatin(Springer, 2010) Cay, Serkan; Cagirci, Goksel; Sen, Nihat; Balbay, Yucel; Durmaz, Tahir; Aydogdu, SinanExtensively used lipid-lowering statins have also non-lipid-lowering, pleiotropic effects. Previous studies have demonstrated that a pre-procedural single dose of atorvastatin is associated with reduced peri-procedural myocardial injury. The aim of the present study was to demonstrate the effect of a single high loading dose (40 mg) of rosuvastatin on peri-procedural myocardial injury. Two hundred ninety nine statin-naive patients with stable angina and de novo lesions eligible for PCI were randomized to a rosuvastatin-treatment (n = 153) and to a no-treatment (n = 146) group. A 40 mg loading dose of rosuvastatin was administrated 24 h before the PCI. CK-MB and cTnI levels were measured before and 12 h after the procedure. Baseline characteristics were fairly similar between the two arms. The incidence of a CK-MB and cTnI elevation > 3x ULN in the rosuvastatin group was significantly lower compared to the control group (0.7% vs. 11.0%, p < 0.001 and 10.5% vs. 39.0%, p < 0.001, respectively). Similarly, the incidence of any CK-MB and cTnI elevation > ULN in the rosuvastatin group was significantly lower compared to the control group (10.5% vs. 34.2%, p < 0.001 and 20.9% vs. 61.6%, p < 0.001, respectively). In addition, CK-MB and cTnI values 12 h after the PCI were significantly lower in the rosuvastatin group compared to the control group (20.13 +/- 7.24 U/L vs. 27.02 +/- 18.64 U/L, p < 0.001 and 0.14 +/- 0.34 ng/ml vs. 0.35 +/- 0.40 ng/ml, p < 0.001, respectively). A single high loading dose of rosuvastatin reduces the incidence of peri-procedural myocardial necrosis and infarction effectively.Öğe Prognostic significance of neutrophil gelatinase-associated lipocalin in St-segment elevation myocardial infarction(BMJ Publishing Group, 2012) Akcay, Adnan Burak; Ozlu, Mehmet Fatih; Sen, Nihat; Cay, Serkan; Ozturk, Oktay Hasan; YalNcn, Fatih; Bilen, PerihanObjectives: This study investigated the prognostic value of neutrophil gelatinaseYassociated lipocalin (NGAL) in patients with ST-segment elevation myocardial infarction (STEMI). Background: Neutrophil gelatinaseYassociated lipocalin is a promising biomarker for acute kidney injury. Recently, it was concluded that NGAL may be used beyond the boundaries of renal physiopathology. It was found to be an important factor indirectly contributing to the inflammatory processes. Little is known regarding its predictive role in STEMI. Methods: One hundred six consecutive patients who underwent percutaneous coronary intervention (PCI) for STEMI and control group consisted of age- and sex-matched 60 consecutive patients with chest pain admitted to the hospital for elective PCI. According to median NGAL level, patients were classified into high- and low-NGAL groups. Results: Neutrophil gelatinaseYassociated lipocalin levels were higher in patients with STEMI compared to the elective PCI group subjects. Inhospital and 1-year mortality rates were found to be significantly greater in patients with high NGAL. In addition, inhospital and 1-year major adverse cardiovascular event rates were significantly greater in the high-NGAL group, compared to the low NGAL group. High NGAL level on admission was a significant predictor for long-term mortality and major adverse cardiovascular events. The receiver operating characteristics curve analysis further illustrated that NGAL level on admission is a strong indicator of mortality, with an area under the curve of 0.76 (95% confidence interval, 0.62-0.89). Conclusions: High NGAL levels may be associated with poor prognosis after PCI in patients with STEMI. However, further studies with larger numbers of patients and longer follow-up are required to evaluate the usefulness of plasma NGAL level for predicting prognosis of STEMI. © 2012 by The American Federation for Medical Research.Öğe Prognostic Significance of Neutrophil Gelatinase-Associated Lipocalin in ST-Segment Elevation Myocardial Infarction(Bmj Publishing Group, 2012) Akcay, Adnan Burak; Ozlu, Mehmet Fatih; Sen, Nihat; Cay, Serkan; Ozturk, Oktay Hasan; Yalicn, Fatih; Bilen, PerihanObjectives: This study investigated the prognostic value of neutrophil gelatinase-associated lipocalin (NGAL) in patients with ST-segment elevation myocardial infarction (STEMI). Background: Neutrophil gelatinase-associated lipocalin is a promising biomarker for acute kidney injury. Recently, it was concluded that NGAL may be used beyond the boundaries of renal physiopathology. It was found to be an important factor indirectly contributing to the inflammatory processes. Little is known regarding its predictive role in STEMI. Methods: One hundred six consecutive patients who underwent percutaneous coronary intervention (PCI) for STEMI and control group consisted of age- and sex-matched 60 consecutive patients with chest pain admitted to the hospital for elective PCI. According to median NGAL level, patients were classified into high-and low-NGAL groups. Results: Neutrophil gelatinase-associated lipocalin levels were higher in patients with STEMI compared to the elective PCI group subjects. Inhospital and 1-year mortality rates were found to be significantly greater in patients with high NGAL. In addition, inhospital and 1-year major adverse cardiovascular event rates were significantly greater in the high-NGAL group, compared to the low NGAL group. High NGAL level on admission was a significant predictor for long-term mortality and major adverse cardiovascular events. The receiver operating characteristics curve analysis further illustrated that NGAL level on admission is a strong indicator of mortality, with an area under the curve of 0.76 (95% confidence interval, 0.62-0.89). Conclusions: High NGAL levels may be associated with poor prognosis after PCI in patients with STEMI. However, further studies with larger numbers of patients and longer follow-up are required to evaluate the usefulness of plasma NGAL level for predicting prognosis of STEMI.
