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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 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)
