Suleyman Sezai Yildiz

Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors Used Concomitantly with Cangrelor in Patients Undergoing Percutaneous Coronary Intervention - Interventional Cardiology Perspectives

Background: Non-dipping blood pressure pattern, characterized by a blunted nocturnal decline in blood pressure, is associated with increased cardiovascular morbidity and mortality. Restless legs syndrome (RLS) has been linked to sympathetic hyperactivity and altered circadian regulation, potentially contributing to abnormal blood pressure patterns. This study aimed to evaluate the relationship between RLS and non-dipping pattern in patients undergoing ambulatory blood pressure monitoring. Methods: In this prospective observational study, 501 eligible participants were included after excluding those with obstructive sleep apnea syndrome, type 1 diabetes, or morbid obesity. RLS was diagnosed according to National Institutes of Health consensus criteria using clinical assessment, the International RLS Study Group scale, and the Berlin Questionnaire. A non-dipping pattern was defined as <10% nocturnal reduction in mean systolic or diastolic blood pressure. Results: RLS was diagnosed in 158 patients (31.5%). Compared with controls, RLS patients were more often female and had higher rates of diabetes and hyperlipidemia. Non-dipping was significantly more prevalent in the RLS group (69.0% vs 48.7%, P < .001), accompanied by lower systolic and diastolic blood pressure variability (both P < .001). In multivariable logistic regression, independent predictors of RLS included female sex (β = 0.701, P = .049), hyperlipidemia (β = 0.850, P = .031), and non-dipping status (β = 1.057, P < .001). Receiver operating characteristic analysis demonstrated modest predictive ability (area under the curve = 0.601; 95% confidence interval 0.557–0.645). Conclusions: RLS is independently associated with a non-dipping blood pressure pattern, even after excluding major confounders. These findings suggest a shared autonomic mechanism linking RLS with impaired nocturnal blood pressure regulation and heightened cardiovascular risk.

Background/Objectives: The only intravenous P2Y12 inhibitor used in the management of acute and chronic coronary syndromes is cangrelor. Previous studies have demonstrated the efficacy of cangrelor. However, limited real-world data are available for cangrelor usage. This study aimed to investigate the use of cangrelor in large-volume percutaneous coronary intervention (PCI) centers in Türkiye, and examine the indications, patient characteristics, bleeding, and ischemic events. The efficacy and safety of cangrelor in this high-risk group were evaluated. Methods: This study was conducted retrospectively in 14 high-volume centers in Türkiye with extensive cangrelor experience. Cangrelor indications, patient clinical characteristics, periprocedural and postprocedural treatments, in-hospital and follow-up bleeding, ischemic events, and mortality were analyzed. Results: This study recruited 411 patients (mean age: 63.8 ± 12.7 years; 76% male). The most common conditions in which cangrelor is used in Türkiye are cardiogenic shock, intubation and nausea/vomiting, where P2Y12 cannot be used adequately due to impaired oral intake. The incidence rate of any bleeding within 48 h was 6.4% (n = 26), with major bleeding accounting for 1.7% of all cases (n = 7). The bleeding rates were similar between patients aged p = 0.326), as well as between patients with chronic kidney disease (CKD) and those without CKD (6.3% vs. 7.9%, p = 0.600). Conclusions: This is the first multicenter, large-cohort study to examine cangrelor use in Türkiye, providing real-world evidence for the efficacy and safety in high-risk patients with complex clinical features and lesion characteristics.

Background: The inflammatory response is critically important in ST-segment elevation myocardial infarction (STEMI). The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), novel inflammatory biomarkers, have been linked to the determination of outcomes in various diseases. The aim of the current study was to examine the relation of the SII and SIRI with contrast-induced acute kidney injury (CI-AKI) in elderly subjects with STEMI undergoing primary percutaneous coronary intervention (pPCI). Methods: All patients diagnosed with STEMI between November 2020 and September 2024 were screened, and patients aged over 70 were retrospectively analyzed in the present study. The patients were divided into two groups according to CI-AKI development. The SII and SIRI were calculated based on the peripheral blood counts. A receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of the SII and SIRI in predicting CI-AKI. Additionally, multivariable logistic regression models were employed to investigate the associations between inflammatory indices and the incidence of CI-AKI in elderly patients with STEMI. Results: A total of 263 participants were included (mean age 77.67 ± 6.20, 56% women). Both the SII and SIRI were higher in the CI-AKI group than in the non-CI-AKI group (3252 ± 2257, 1097 ± 991 p < 0.001 for SII; 12.1 ± 4.54, 4.86 ± 2.42 p < 0.006 for SIRI). In the receiver operating characteristic analysis, the SII and SIRI showed the highest area under curve (AUC) compared with other inflammatory parameters. The AUC of the SII and SIRI were 0.903 and 0.867 (p < 0.001). In multivariate logistic regression analysis, the SII and SIRI were found as independent predictors of CI-AKI. Conclusions: The SII and SIRI were found to be important markers for predicting post-procedural CI-AKI in elderly patients with STEMI.

Background: The inflammatory response is critically important in ST-segment elevation myocardial infarction (STEMI). Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), which are novel inflammatory biomarkers, have been linked to determining outcomes in various diseases. The aim of the current study was to examine the relation of the SII index and SIRI with contrast-induced acute kidney injury (CI-AKI) in elderly subjects with (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods: All patients diagnosed with STEMI between November 2020 and September 2024 were screened, and patients aged over 70 were retrospectively analyzed in the present study. The patients were divided into 2 groups according to CI-AKI development. SII and SIRI were calculated based on peripheral blood counts. A receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity and specificity of SII and SIRI in predicting CI-AKI. Additionally, multivariable logistic regression models were employed to investigate the associations between inflammatory indices and the incidence of CI-AKI in elderly patients with STEMI. Results: A total of 263 participants were included (mean age 77,67±6,20, 56% women). Both SII and SIRI were higher in the CI-AKI group than in the non-CI-AKI group (3252±2257, 1097±991 p< .001 for SII; 12,1±4,54, 4,86±2,42 p< .006 for SIRI). In the receiver operating characteristic analysis, SII and SIRI showed the highest area under curve (AUC) compared with other inflammatory parameters. The AUC of SII and SIRI were 0.903 and 0.867, the sensitivity and specificity were 80.1% and 84.4%, 77.5% and 81.0% respectively (p< .001, p< .001). In multivariate logistic regression analysis, SII (odds ratio (OR): OR: 1.114, 95% CI: 1.050–1.183, p = .001), and SIRI (OR: 1.23, 95% CI: 1.057–1.433, p = .008) were associated with CI-AKI. Conclusions: SII and SIRI were found to be important markers for predicting post-procedural CI-AKI in elderly patients with STEMI.

Purpose: It is not clear whether cognitive functions are impaired in young patients with acute coronary syndrome (ACS). This study aims to detect whether or not there is cognitive impairment and cerebral changes in young patients with ACS undergoing percutaneous coronary intervention (PCI). Patients and Methods: All 50 patients with ACS who were treated with primary PCI were eligible for this prospective study. All participants had normal cognitive function before ACS. Brain magnetic resonance imaging (MRI) was performed to quantify changes in brain white and gray matter. Cognitive functions (CFs) were evaluated by seven cognitive tests. Patients were categorized by MRI findings and test scores were compared from the first day to after the first month. Results: We determined 25 patients with impaired CFs on the first day. After the first month, we identified 18 patients with transient impaired CFs. No structural difference was observed between impaired CF and normal CF. While 25 patients had a score of 1 according to Fazekas, 10 patients had a score of 1 according to MTLA. While the mean Stroop test completion time and Stroop test error rate scores were significantly higher on the first day than after the first month in the Fazekas+ group (p = 0.003, p < 0.001, respectively), other cognitive test scores—except clock drawing test, digital span forwards, and backwards—were significantly lower on the first day compared to after the first month in the Fazekas+ group (p < 0.05). Conclusions: Patients with ACS have transient impairment in cognitive functions. Acute coronary syndrome is not associated with structural changes in the brain.

Aim: To investigate the relationship between post-myocardial infarction (MI) left ventricular ejection fraction (LVEF) and fibrosis marker HE-4 in primarily revascularized patients with ST-segment ...

Although there are reviews and meta-analyses focusing on hematological indices for risk prediction of mortality in patients with ST segment elevation myocardial infarction (STEMI), there are not enough data with respect to direct to head-to-head comparison of their predictive values. We aimed to investigate which hematological indices have the most discriminatory capability for prediction of in-hospital and long-term mortality in a large STEMI cohort. We analyzed the data of 1186 patients with STEMI. In-hospital and long-term all-cause mortality was defined as the primary end point of the study. In-hospital mortality rate was 8.6% and long-term mortality rate 9.0%. Although the neutrophil to lymphocyte ratio (NLR) and age were found to be independent predictors of in-hospital mortality in the multivariate regression analyses; Cox regression analysis revealed that age, ejection fraction, red cell distribution width (RDW), and monocyte to high-density lipoprotein ratio (MHDLr) were independently associated with long-term mortality. Neutrophil to lymphocyte ratio had the highest area under curve value in the receiver operating characteristic curve analyses for prediction of in-hospital mortality. In conclusion, while NLR may be used for prediction of in-hospital mortality, RDW and MHDLr ratio are better hematological indices for long-term mortality prediction after STEMI than other most common indices.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with an inflammatory etiopathogenesis. This study investigated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients with MINOCA. Coronary angiographies performed between June 2015 and August 2018 were analyzed retrospectively and included 72 patients with MINOCA and 248 controls with normal coronary angiograms. The predictors of mortality were determined by univariate Cox regression analysis. The mean age of the subjects was 46 ± 9 years, and 176 (55%) were female. Median follow-up was 21 (max: 42) months. Neutrophil-to-lymphocyte ratio was significantly higher in the MINOCA group than in the controls (P < .01). During long-term follow-up, the number of deaths was 6 in the MINOCA group and none in the control patients (P < .01). Univariate Cox regression analysis revealed that the NLR (hazard ratio: 1.24, 95% confidence interval: 1.09-1.41, P = .001) was a predictor of mortality in patients with MINOCA. Kaplan–Meier analysis also showed that patients with MINOCA had relatively higher mortality rate (long-rank test; P < .01). In conclusion, the NLR is significantly higher in patients with MINOCA compared with controls, and it is a predictor of long-term mortality.