Comparing TIMI, HEART, and GRACE Risk Scores to Predict Angiographic Severity of Coronary Artery Disease and 30-Day Major Adverse Cardiac Events in Emergency Department Patients with NSTEACS

By

Ocak, NY (Ocak, Necmiye Yalcin) ; Yesilaras, M (Yesilaras, Murat) ; Kilicaslan, B (Kilicaslan, Baris) ; Eyler, Y (Eyler, Yesim) ; Mutlu, I (Mutlu, Inan) ; Kutlu, M (Kutlu, Murat)

 (provided by Clarivate) 

Source

PREHOSPITAL AND DISASTER MEDICINE

DOI

10.1017/S1049023X23006490

Early Access

OCT 2023

Indexed

2023-11-01

Document Type

Article; Early Access

Abstract

Background:Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined.Methods:This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients' demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score.Results:The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant.Conclusion:The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.

Keywords

Author Keywords

Gensini GRACE HEART MACE NSTEACS TIMI

EVALUATION OF DIABETES AND SMOKING AS PREDICTORS OF SEVERE CORONARY ARTERY DISEASE BASED ON GENDER INEQUALITY

By

Durmaz, S (Durmaz, Seyfi) ; Mutlu, I (Mutlu, Inan) ; Kursun, M (Kursun, Mustafa)

 (provided by Clarivate) 

Source

ACTA MEDICA MEDITERRANEA

Volume

38

Issue

5

Page

3489-3494

DOI

10.19193/0393-6384_2022_5_515

Published

2022

Indexed

2023-01-27

Document Type

Article

Abstract

Aim: This research aims to assess the severity of coronary artery disease in patients admitted with chest pain to the emergency department and focus on how risk factors vary with gender.

Methods: This is a cross-sectional study of 247 patients with a pre-diagnosis of acute coronary syndrome between August 2020 and February 2021. The severity of coronary artery disease in all patients was evaluated with the Gensini score. Independent risk factors that were found to be related to severe coronary artery patients were analyzed by logistic regression.

Results: The risk of severe coronary artery disease of the 247 individuals included in the study was increased by 5% (p <0.005) with each year of rising age, the presence of diabetes was increased by 2.51 (95% Cl 1.38-5.57) fold, and the presence of cigarette consumption increased by 2.79 (95% Cl 1.51-5.13) fold. In comparison, each year of age rise in women increased the risk of severe coronary artery disease by 6% (p <0.005), the presence of diabetes was prominently (5.32-fold; 95% Cl 2.10-13.47) as a risk factor. In men, the prominent risk factor was cigarette consumption (4.51-fold; 95% Cl 2.03-10.02).

Conclusion: Studies that attach importance to the necessity of questioning the risks in serious coronary artery diseases based on gender and accepting the possibility that these risks may turn into reverse inequalities in countries with different development levels will shed light on clinical practices and preventive medicine.

Keywords

Author Keywords

Gensini coronary artery disease cardiac prevention gender reverses inequalities

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study

By

Kocabas, U (Kocabas, Umut) ; Kivrak, T (Kivrak, Tarik) ; Öztekin, GMY (Oztekin, Gulsum Meral Yilmaz) ; Tanik, VO (Tanik, Veysel Ozan) ; Özdemir, IH (Ozdemir, Ibrahim Halil) ; Kaya, E (Kaya, Ersin) ; Yüce, EI (Yuce, Elif Ilkay) ; Demir, FA (Demir, Fulya Avci) ; Dogdus, M (Dogdus, Mustafa) ; Altinsoy, M (Altinsoy, Meltem) ; 

 (provided by Clarivate) 

Source

ANATOLIAN JOURNAL OF CARDIOLOGY

Volume

24

Issue

1

Page

32-40

DOI

10.14744/AnatolJCardiol.2020.91771

Published

JUL 2020

Indexed

2020-07-20

Document Type

Article

Abstract

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction <= 40%).

Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.

Results: The study included 1462 outpatients (male: 70.1%, mean age: 67 +/- 11 years, mean LVEF: 30%+/- 6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).

Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.

Keywords

Author Keywords

Adherence chronic heart failure device therapy guidelines pharmacological treatment outpatients

Transient Contrast Neurotoxicity After Percutaneous Coronary Intervention Mimicking Subarachnoid Hemorrhage in a Patient With Chronic Kidney Disease

By

Simsek, EÇ (Simsek, Ersin Cagri) ; Ertürk, E (Erturk, Elif) ; Uçar, R (Ucar, Roza) ; Yilmaz, AO (Yilmaz, Artun Onat) ; Ekmekçi, C (Ekmekci, Cenk) ; Mutlu, I (Mutlu, Inan) ; Sari, C (Sari, Cenk)

 (provided by Clarivate) 

Source

CLINICAL MEDICINE INSIGHTS-CASE REPORTS

Volume

12

DOI

10.1177/1179547619867671

Article Number

1179547619867671

Published

AUG 1 2019

Indexed

2019-08-13

Document Type

Article

Abstract

Transient contrast neurotoxicity is a rare but well-recognized complication of angiography that is due to neurotoxicity of the contrast agent. Patients with renal dysfunction may be inclined to develop contrast medium neurotoxicity due to delayed elimination of the contrast medium in renal metabolism. In this report, we present an unusual case of transient neurotoxicity in a patient with severe chronic kidney disease following percutaneous coronary intervention mimicking clinically and radiologically subarachnoid hemorrhage. The patient's clinical symptoms improved rapidly and fully recovered after hemodialysis and conservative treatment. We believe that performing early hemodialysis is an effective treatment to improve symptoms in end-stage renal disease patients with contrast-induced encephalopathy.

Keywords

Author Keywords

Contrast neurotoxicity coronary angioplasty

Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction

By

Kocabas, U (Kocabas, Umut) ; Kivrak, T (Kivrak, Tarik) ; Öztekin, GMY (Yilmaz Oztekin, Gulsum Meral) ; Tanik, VO (Tanik, Veysel O.) ; Özdemir, I (Ozdemir, Ibrahim) ; Kaya, E (Kaya, Ersin) ; Yüce, EI (Yuce, Elif Ilkay) ; Demir, FA (Avci Demir, Fulya) ; Dogdus, M (Dogdus, Mustafa) ; Altinsoy, M (Altinsoy, Meltem) ; 

 (provided by Clarivate) 

Source

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE

Volume

75

Issue

3

DOI

10.1111/ijcp.13765

Article Number

e13765

Published

MAR 2021

Early Access

NOV 2020

Indexed

2020-11-25

Document Type

Article

Abstract

Aim Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard.

Methods We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019.

Results Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 +/- 11 years vs 69 +/- 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy.

Conclusion In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.

Keywords

Keywords Plus

SEX-DIFFERENCES MORTALITY GUIDELINE ANEMIA AGE PREVALENCE PHYSICIANS PROGNOSIS SURVIVAL OUTCOMES

Prevalence of inappropriate sinus tachycardia and the comparison of the heart rate variability characteristics with propensity score-matched controls

By

Simsek, E (Simsek, Evrim) ; Özbay, B (Ozbay, Benay) ; Mutlu, I (Mutlu, Inan) ; Gürses, E (Gurses, Ecem) ; Kemal, HS (Kemal, Hatice S.) ; Yagmur, B (Yagmur, Burcu) ; Can, LH (Can, Levent Hurkan)

 (provided by Clarivate) 

Source

TURK KARDIYOLOJI DERNEGI ARSIVI-ARCHIVES OF THE TURKISH SOCIETY OF CARDIOLOGY

Volume

48

Issue

2

Page

96-102

DOI

10.5543/tkda.2019.92735

Article Number

PMID 32147657

Published

MAR 2020

Indexed

2020-03-26

Document Type

Article

Abstract

Objective: Inappropriate sinus tachycardia (IST) is a syndrome characterized by an elevated resting heart rate with distressing symptoms and no secondary cause of sinus tachycardia. This study was conducted to evaluate both the prevalence of IST among symptomatic patients and heart rate variability (HRV) characteristics.

Methods: The records of all consecutive symptomatic patients who had undergone 24-hour Holter monitoring between September 2015 and November 2016 at a single center were retrospectively evaluated. IST was defined as a 24-hour mean heart rate (HR) of >= 90 beats/minute and a resting HR of >= 100 beats/minute in the absence of any secondary cause of sinus tachycardia. All of the study data related to clinical characteristics, symptoms, concomitant diseases, and Holter electrocardiogram parameters were obtained from the electronic hospital records. A propensity age- and sex-matched control group was selected from a non-IST patient cohort.

Results: A total of 1865 consecutive patients were evaluated and 32% were excluded due to an inadequate Holter recording period or insufficient quality, atrial fibrillation episodes, atrioventricular block, or >1% atrial or ventricular extrasystoles. Among 1265 patients with sinus rhythm, 4.98% (n=63) had IST The IST patients were younger (39.6 +/- 17.4 vs. 50.2 +/- 17.2 years; p<0.001), and female gender was more prominent (60.3% vs. 43.8%; p=0.009). All of the time and frequency domain parameters of HRV except the low frequency/high frequency ratio were significantly reduced in the IST group compared with the propensity-matched controls.

Conclusion: The IST prevalence among symptomatic patients in sinus rhythm was 4.98%. IST was primarily seen in younger women, and they had diminished time and frequency domain HRV parameters.

Keywords

Author Keywords

Epidemiology heart rate variability Holter electrocardiogram inappropriate sinus tachycardia

Survival Benefit of Implantable-Cardioverter Defibrillator Therapy in Ambulatory Patients With Left Ventricular Assist Device

By

Simsek, E (Simsek, Evrim) ; Nalbantgil, S (Nalbantgil, Sanem) ; Demir, E (Demir, Emre) ; Kemal, HS (Kemal, Hatice Soner) ; Mutlu, I (Mutlu, Inan) ; Ozturk, P (Ozturk, Pelin) ; Engin, C (Engin, Cagatay) ; Yagdi, T (Yagdi, Tahir) ; Ozbaran, M (Ozbaran, Mustafa)

 (provided by Clarivate) 

Source

TRANSPLANTATION PROCEEDINGS

Volume

51

Issue

10

Page

3403-3408

DOI

10.1016/j.transproceed.2019.06.010

Published

DEC 2019

Indexed

2020-01-14

Document Type

Article

Abstract

Background. Analysis of the prognostic effect of concomitant use of left ventricular assist devices (LVADs) and implantable -cardioverter defibrillators (ICDs) is lacking. The aim of this study is to define the survival effects of ICD therapy in ambulatory patients with LVAD.

Methods and results. Patients with continuous-flow (cf) LVAD in a single tertiary center from December 2010 to May 2016 were retrospectively analyzed. Over a 6-year period, 257 patients had cf-LVAD implantation, 227 of them survived to discharge after the first month of LVAD implantation and were included in the study. The median follow-up time was 14 months, and 104 (45.8%) patients had 'CD. One hundred and thirty-two (58.1%) patients were still under LVAD support at the end of the study period. Forty (17.6%) patients had heart transplantation, and 55 (24.2%) died. There was no significant difference between groups with ICD and without ICD for baseline characteristics except for higher pulmonary pressures and amiodarone use in the ICD group. Survival analysis showed significant survival benefit of ICD therapy (P =.02). After multivariate analyses including age, sex, left ventricular ejection fraction, and P-blocker usage, the benefit of ICD continued (hazard ratio: 0.54; 95% confidence interval, 0.303-0.975; P =.041).

Conclusions. Ventricular arrhythmias (VAs) do not cause acute hemodynamic deterioration in patients with LVAD. However, VAs might be associated with poor prognosis. The present study showed that ICD therapy may improve survival among ambulatory patients with cf-LVAD supported heart failure.