Can Yucel Karabay

A 66-year-old woman with severe symptomatic aortic stenosis (STS-PROM 5.15%; EuroSCORE II 3.66%), right carotid occlusion, 50% left carotid stenosis, and a preference for TAVI underwent multidisciplinary assessment. Computed tomography demonstrated a 6 mm left main coronary artery (LMCA) ostial height, hypoplastic right coronary artery, 31 mm left coronary sinus, and no bulky calcification facing the LMCA. Following Heart Team assessment of obstruction risk and the potential complications of prophylactic stenting, transfemoral TAVI was performed without coronary protection using a 29 mm recapturable self-expanding valve, with emergency revascularization, hemodynamic support, and surgical backup available. Preserved left coronary perfusion after 18 mm balloon predilatation provided reassurance but could not exclude obstruction during valve deployment. Recovery was uneventful, with no reported adverse cardiovascular events during approximately 18 months of follow-up. Favorable sinus anatomy may inform procedural planning but cannot independently establish protection against coronary obstruction. This single case illustrates individualized anatomical assessment and Heart Team decision-making, not the general safety of omitting coronary protection in similarly high-risk patients.

Background/Objectives: In patients with non-ST-segment elevation myocardial infarction (NSTEMI), contrast-associated acute kidney injury (CA-AKI) is a clinically important complication of coronary angiography. Whether the Fibrosis-4 (FIB-4) index and aspartate aminotransferase-to-platelet ratio index (APRI) relate to CA-AKI in this setting is unclear. We compared the associations of both indices with CA-AKI. Methods: We retrospectively analyzed 771 patients with NSTEMI who underwent coronary angiography from May 2020 to May 2025. CA-AKI was identified from changes in serum creatinine 48–72 h after contrast administration. Both indices were derived from admission laboratory values. Associations were evaluated using separate multivariable logistic regression models. Discrimination was compared using the paired DeLong test, and the incremental performance of FIB-4 beyond the Mehran score was explored. Results: Overall, 97 patients (12.6%) developed CA-AKI. In the primary adjusted model, FIB-4 was associated with CA-AKI (odds ratio 1.19, 95% confidence interval 1.04–1.36; p = 0.013), but APRI was not. FIB-4 showed modest discrimination but a significantly higher area under the receiver operating characteristic curve (AUC) than APRI (0.614 versus 0.535; DeLong p < 0.001). Adding FIB-4 to the Mehran score improved model fit (likelihood-ratio p = 0.009), but the increase in AUC from 0.646 to 0.666 was not statistically significant (DeLong p = 0.100). Sensitivity analyses showed that the association varied with covariate adjustment. Conclusions: FIB-4 was associated with CA-AKI in the primary adjusted model and showed higher discrimination than APRI. These findings support further investigation of FIB-4 as a potential adjunct to renal risk assessment, although its modest discrimination and uncertain incremental clinical value require independent validation.

Background and Objectives: Composite indices from routine inflammatory, haematological and nutritional measurements are widely reported as prognostic markers after acute coronary syndromes, but whether they add information beyond their components is uncertain. Materials and Methods: In 30-day survivors of non-ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary angiography at a single centre, thirteen composite indices and six prespecified components were evaluated for five-year all-cause mortality using ROC analysis, Cox regression and the change in Harrell’s C-index (ΔC) over a study clinical model. Each index was also compared with a freely weighted model of its own constituents and with a reference model adding CRP and albumin. Results: Among 561 patients (median follow-up 5.48 years), 94 died, 86 within five years. Composite-index AUCs ranged from 0.616 to 0.689; none exceeded CRP alone after multiplicity correction. Eight indices were nominally associated with mortality after adjustment (hazard ratios 1.26–1.38 per 1 SD), but every bootstrap confidence interval for ΔC over the clinical model included zero. Fixed indices and freely weighted constituents performed similarly (cross-validated ΔC −0.0089 to +0.0053), with one small exploratory difference favouring the fixed MLR ratio. Adding CRP and albumin raised the C-index from 0.7720 to 0.7826; over this reference, no estimable composite showed evidence of association (all p ≥ 0.19). Conclusions: In 30-day survivors of NSTEMI, composite indices showed no evidence of improved long-term mortality discrimination over a study-specific clinical model and contained no information beyond their measured constituents. Their independent associations may largely reflect information already present in the components. Small gains cannot be excluded; the findings do not establish equivalence.

Objective: With the growing number of individuals over the age of 90 (nonagenarians), understanding the risk factors and clinical outcomes associated with acute coronary syndrome (ACS) in this population has become increasingly important. This study aims to compare demographic, biochemical, and clinical parameters between nonagenarian ACS patients and a control group of healthy individuals within the same age bracket, as well as to analyze differences within the ACS group according to myocardial infarction type and evaluate the impact of percutaneous coronary intervention (PCI) on in-hospital mortality. Methods: 104 patients aged 90–100 years diagnosed with ACS for the first time between January 2022 and January 2024 were included in this retrospectively designed case-control study. The patients were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups based on their electrocardiographic findings. The control group included 113 healthy individuals within the same age range with no prior history of coronary artery disease. Data on traditional risk factors, including lipid profiles and family history, were analyzed using logistic regression models. Additionally, differences in clinical outcomes, including the length of hospital stay and mortality rates, were evaluated based on the application of PCI. Results: The ACS group exhibited significantly higher glucose, white blood cell count, and total cholesterol levels, along with lower hemoglobin and mean corpuscular volume, compared to the control group (p < 0.05). While no significant difference was found in low-density lipoprotein (LDL) levels, high-density lipoprotein (HDL) levels were significantly lower in ACS patients (p < 0.001). Family history played a more substantial role in the STEMI group compared to the NSTEMI group (p = 0.049). Additionally, STEMI patients were more likely to undergo invasive procedures, which were associated with reduced in-hospital mortality (p = 0.042). In contrast, no significant difference in mortality was observed in the NSTEMI group based on PCI status. Conclusions: This study highlights the distinct risk profiles of elderly ACS patients, emphasizing the critical role of low HDL levels and family history, particularly in STEMI cases. Furthermore, PCI was shown to reduce in-hospital mortality rates in STEMI patients, suggesting that invasive treatment approaches may be beneficial even in this vulnerable population. Personalized and multidisciplinary management strategies are essential for this vulnerable population. Further prospective research is needed to validate these findings and guide clinical decision-making for nonagenarians.

Objective: With the growing number of individuals over the age of 90 (nonagenarians), understanding the risk factors and clinical outcomes associated with acute coronary syndrome (ACS) in this population has become increasingly important. This study aims to compare demographic, biochemical, and clinical parameters between nonagenarian ACS patients and a control group of healthy individuals within the same age bracket as well as to analyze differences within the ACS group according to myocardial infarction type and evaluate the impact of percutaneous coronary intervention (PCI) on in-hospital mortality. Methods: This retrospective case-control study included 104 patients aged 90-100 years diagnosed with ACS for the first time between January 2022 and January 2024. The patients were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups based on their electrocardiographic findings. The control group consisted of 113 healthy individuals in the same age range who had no history of coronary artery disease. Data on traditional risk factors, including lipid profiles and family history, were analyzed using logistic regression models. Additionally, differences in clinical outcomes, including length of hospital stay and mortality rates, were evaluated based on the application of PCI. Results: The ACS group exhibited significantly higher glucose, white blood cell count, and total cholesterol levels, along with lower hemoglobin and mean corpuscular volume, compared to the control group (p<0.05). While no significant difference was found in low-density lipoprotein (LDL) levels, high-density lipoprotein (HDL) levels were significantly lower in ACS patients (p<0.001). Family history played a more substantial role in the STEMI group compared to the NSTEMI group (p=0.049). Additionally, STEMI patients were more likely to undergo invasive procedures, which were associated with reduced in-hospital mortality (p=0.042). In contrast, no significant difference in mortality was observed in the NSTEMI group based on PCI status. Conclusion: This study highlights the distinct risk profiles of elderly ACS patients, emphasizing the critical role of low HDL levels and family history, particularly in STEMI cases. Furthermore, PCI was shown to reduce in-hospital mortality rates in STEMI patients, suggesting that invasive treatment approaches may be beneficial even in this vulnerable population. Personalized and multidisciplinary management strategies are essential for this vulnerable population. Further prospective research is needed to validate these findings and guide clinical decision-making for nonagenarians.

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

Background and Objectives: In this study, we aimed to investigate the prognostic value of the C-reactive protein to albumin ratio (CAR) for all-cause mortality in patients with chronic heart failure with reduced ejection fraction (HFrEF). Materials and Methods: In total, 404 chronic HFrEF patients were included in this observational and retrospective study. The CAR value of each patient included in this analysis was calculated. We stratified the study population into tertiles (T1, T2, and T3) according to CAR values. The primary outcome of the analysis was to determine all-cause mortality. Results: The median follow-up period in our study was 30 months. In the follow-up, 162 (40%) patients died. The median value of CAR was higher in patients who did not survive during the follow-up [6.7 (IQR = 1.6–20.4) vs. 0.6 (IQR = 0.1–2.6), p < 0.001]. In addition, patients in the T3 tertile (patients with the highest CAR) had a higher rate of all-cause mortality [n = 90 cases (66.2%), p < 0.001]. Multivariate Cox regression analysis revealed that CAR was an independent predictor of mortality in patients with HFrEF (hazard ratio: 1.852, 95% confidence interval: 1.124–2.581, p = 0.005). In a receiver operating characteristic curve analysis, the optimal cut-off value of CAR was >2.78, with a sensitivity of 66.7% and specificity of 76%. Furthermore, older age, elevated N-terminal pro-brain natriuretic peptide levels, and absence of a cardiac device were also independently associated with all-cause death in HFrEF patients after 2.5 years of follow-up. Conclusions: The present study revealed that CAR independently predicts long-term mortality in chronic HFrEF patients. CAR may be used to predict mortality among these patients as a simple and easily obtainable inflammatory marker.

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide and is associated with an increased risk of thromboembolism, ischemic stroke, impaired quality of life, and mortality. The latest research that shows the prevalence and incidence of AF patients in Turkiye was the Turkish Adults' Heart Disease and Risk Factors study, which included 3,450 patients and collected data until 2006/07.The Turkish Real Life Atrial Fibrillation in Clinical Practice (TRAFFIC) study is planned to present current prevalence data, reveal the reflection of new treatment and risk approaches in our country, and develop new prediction models in terms of outcomes. Methods: The TRAFFIC study is a national, prospective, multicenter, observational registry. The study aims to collect data from at least 1900 patients diagnosed with atrial fibrillation, with the participation of 40 centers from Turkiye. The following data will be collected from patients: baseline demographic characteristics, medical history, vital signs, symptoms of AF, ECG and echocardiographic findings, CHADS2VASC2 and HAS-BLED (1-year risk of major bleeding) risk scores, interventional treatments, antithrombotic and antiarrhythmic medications, or other medications used by the patients. For patients who use warfarin, international normalized ratio levels will be monitored. Follow-up data will be collected at 6, 12, 18, and 24 months. Primary endpoints are defined as systemic embolism or major safety endpoints (major bleeding, clinically relevant nonmajor bleeding, and minor bleeding as defined by the International Society on Thrombosis and Hemostasis). The main secondary endpoints include major adverse cardiovascular events (systemic embolism, myocardial infarction, and cardiovascular death), all-cause mortality, and hospitalizations due to all causes or specific reasons. Results: The results of the 12-month follow-up of the study are planned to be shared by the end of 2023. Conclusion: The TRAFFIC study will reveal the prevalence and incidence, demographic characteristics, and risk profiles of AF patients in Turkiye. Additionally, it will provide insights into how current treatments are reflected in this population. Furthermore, risk prediction modeling and risk scoring can be conducted for patients with AF.

Introduction: Percutaneous left atrial appendage closure (LAAC) is considered in patients with non-valvular atrial fibrillation (AF) who cannot receive long-term anticoagulant therapy or who experience thromboembolism despite anticoagulant therapy. The structural feature of the left atrial appendage (LAA) and high variability of the clinical features of the patients endorse the difficulty of the procedure. In this study, it was aimed to present our single-center LAAC experience and in-hospital follow-up results of the patients. Patients and Methods: Patients who had undergone LAAC in our cardiology clinic between 2017 and 2022 were included in the study retrospectively. All clinical, laboratory and imaging characteristics of the patients and in-hospital follow-up results were evaluated. Results: Median age of 29 patients included in the study was 78 years (65-82, IQR= 25-75) and 17 were males (58.6%). Median score of CHA₂ DS₂ -VASc was 4 (4-6, IQR= 25-75). In addition, median value of the HASBLED score was 3 (3-4, IQR= 25-75). The rate of complete closure, minor bleeding during the procedure, and pericardial tamponade were 27 (93.1%), 1 (3.4%), and 1 (3.4%) respectively, and the device was dislocated immediately after the procedure in one patient (3.4%). The most common type of LAA appendix was chicken wings 15 (51.7%). Conclusion: Success rate of the LAAC procedure was high in this single-center study conducted in our country with a relatively high number of patients.

Purpose: Numerous cardiovascular disorders have been related to mitral annular calcification (MAC). This study looked at the effects of mitral annular calcification on one-month mortality in ST-segment elevation myocardial infarction (STE-MI) patients. Methods: This single-center, retrospective observational study was carried out between 2017 and 2021. The study included 1541 patients who presented to the Dr. Siyami Ersek Hospital emergency department with a diagnosis of STE-MI and underwent primary percutaneous intervention. The patients' clinical and demographic characteristics were investigated. Images taken during percutaneous intervention using angiography were used to assess the presence of MAC in patients. According to death, the patients were split into two groups, and a statistical analysis was done. Results: The median age of 1541 STE-MI patients included in the study was 59 years (51, 68) and 78% were male. While MAC was present in 134 patients (8.7%) in the whole group, the frequency of MAC was significantly higher in the deceased compared to the survivors (19% vs. 7.8%, p