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Aim: To investigate the relationship of various hematological and biochemical parameters besides the cardiac enzymes with 30-day outcomes in patients with successfully restored coronary TIMI-3 flow by primary percutaneous coronary intervention (p-PCI). Materials and methods: Two hundred patients with ST elevation myocardial infarction (STEMI), with no history of prior myocardial infarction (MI), who underwent p-PCI and had TIMI-3 flow, were enrolled, consecutively. The primary endpoint of the study was defined as the composite of death, fatal and non-fatal MI, target vessel revascularization and cerebrovascular event. Results: Only ALT concentration (OR: 1.010, 95% CI: 1.003-1.018, P = 0.008), monocyte count (OR: 1.002, 95% CI: 1.001 - 1.004, P = 0.005), hypertension (OR: 3.010, 95% CI: 1.081 - 8.384, p = 0.035) and lower LVEF (OR: 0.926, 95% CI: 0.875 - 0.981, P = 0.008) were independent predictors of primary endpoint in multivariate logistic regression analysis. Conclusion: We found that elevated liver enzymes as determined by serum Alanine aminotransferase levels and monocyte count as well as hypertension and lower LVEF independently predicted 30-day outcomes in patients with successfully restored coronary flow by p-PCI. These parameters may provide new aspects, to identify the pathophysiology and prognosis of acute vascular events, which in turn may facilitate discovery of new treatment modalities. © 2012 Düzce Medical Journal. Source


Ugur M.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Ayhan E.,Balikesir University | Bozbay M.,Marmara University | Cicek G.,Ankara Numune Resaerch and Training Hospital | And 10 more authors.
Journal of Critical Care | Year: 2014

Purpose: Platelets play a key role in the genesis of thrombosis. Plateletcrit (PCT) provides complete information on total platelet mass. The relationship between PCT values and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary angioplasty is not known. We sought to determine the effect of PCT values on the outcomes of primary angioplasty for STEMI. Methods: Overall, 2572 consecutive STEMI patients (mean age, 56.6 ± 11.8 years) undergoing primary percutaneous coronary intervention were enrolled retrospectively into the present study. Plateletcrit at admission was measured as part of the automated complete blood count. Patients were classified into 2 groups: high PCT (> 0.237, n = 852) and nonhigh PCT (<. 0.237, n = 1720). Clinical characteristics and in-hospital and long-term (median, 21 months) outcomes of primary angioplasty were analyzed. Results: A higher in-hospital shock rate was observed among patients with high PCT values compared with those with nonhigh PCT values (6.5 vs 3.8%, respectively; P = .003). The long-term cardiovascular prognosis was worse for patients with high PCT values (Kaplan-Meier, log-rank test; P = .007). We used Cox proportional hazard models to examine the association between PCT and adverse clinical outcomes. High PCT values were also an independent predictor of cardiovascular mortality (hazard ratio, 1.85; 95% confidence interval, 1.061-3.22; P = .03). Conclusion: High PCT values on admission are independently associated with long-term adverse outcomes in patients with STEMI who undergo primary angioplasty. © 2014 Elsevier Inc. Source


Kaya A.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Tatlisu M.A.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Kaplan Kaya T.,Yeditepe University | Yildirimturk O.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | And 6 more authors.
Journal of Emergency Medicine | Year: 2016

Background There are confusing data in literature regarding oral and sublingual captopril effects over blood pressure (BP) decrease. Objectives In our study we compared oral and sublingual captopril effectiveness over BP decrease in patients admitted to our Emergency Department with hypertensive urgency. Methods Our study was conducted from January 2012 to January 2013 in patients with hypertensive urgency. In this cross-sectional study after two initial BP measurements, patients were identified as eligible for the study. An initial electrocardiogram was obtained and blood samples were drawn. A total of 212 patients were accepted as eligible for the study, and 25 mg of captopril was randomly given orally or sublingually; BP was measured at 10, 30, and 60 min. We selected the patients to the groups consecutively. A 25% reduction of initial BP 1 h after initiation of the treatment was accepted as an accomplishment. A second 25 mg of captopril was given if the target of 25% reduction of BP was not reached after the first tablet. Intravenous drugs were administered to the patients resistant to the captopril and these patients were excluded from the study. Results The 10-min systolic BP (SBP), diastolic BP, and mean BP (MBP) decrease was more prominent in the sublingual captopril group (p < 0.001). This decrease was statistically significant in the SBP and MBP at 30 min (p < 0.001), and no statistical difference was recorded at 60 min (p > 0.05). Conclusions In our study, sublingual captopril was found to decrease BP more efficiently in the first 30 min, but this difference equalized at 60 min. Copyright © 2016 Elsevier Inc. Source


Kaya A.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Sungur A.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Tekkesin A.I.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Turkkan C.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center | Alper A.T.,Dr Siyami Ersek Cardiovascular and Thoracic Surgery Center
Journal of Arrhythmia | Year: 2015

Abstract Cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) is the preferred treatment for patients with severe heart failure, dyssynchrony, and an increased risk of sudden cardiac death or for primary ventricular arrhythmia survivors. Rarely, left ventricular epicardial pacing can induce ventricular tachyarrhythmia rather than a beneficial effect. We describe an ischemic cardiomyopathy patient who underwent CRT-D therapy and developed sustained torsades de pointes (TdP) immediately after switching to biventricular pacing (BVP) mode. Here, TdP possibly developed owing to the change in the dispersion of repolarization of the left ventricle myocardium. The diagnosis and management of BVP-induced ventricular arrhythmia is discussed. © 2014 Japanese Heart Rhythm Society. Source

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