Fahri Er

This study evaluated whether model complexity adds value when differentiating myocardial infarction with non-obstructive coronary arteries (MINOCA) from coronary slow flow in a small clinical tabular dataset. The retrospective cohort included 107 coronary slow-flow and 104 MINOCA patients represented by 19 variables obtained before angiography and definitive group assignment. Penalized logistic regression was compared with kernel- and tree-based machine-learning models. Imputation, scaling, hyperparameter selection, and calibration were restricted to training folds within 5-fold nested cross-validation repeated 10 times. Discrimination, probabilistic accuracy, calibration, threshold-dependent metrics, learning curves, estimator dynamics, and paired uncertainty were evaluated. Random forest achieved the highest AUROC (0.825; 95% CI, 0.774–0.873), whereas elastic net achieved an AUROC of 0.810 (0.753–0.863). The paired random-forest minus elastic-net AUROC difference was 0.015 (−0.027 to 0.060), and the Brier-score difference was −0.0068 (−0.0291 to 0.0138); no superiority was demonstrated after Holm correction. Learning curves showed continued validation gains for the tree ensembles as training size increased, with persistent training–validation separation. Feature-group analyses indicated model-specific contributions from hemogram and lipid variables. The findings do not establish equivalence or generalizability to all small clinical datasets. They support leakage-controlled, calibration-aware, and uncertainty-aware benchmarking before any consideration of external validation or clinical use.

This study aimed to comparatively evaluate the predictive value of four albumin-based biomarker ratios — C-reactive protein-to-albumin ratio (CAR), platelet-to-albumin ratio (PAR), calcium-to-albumin ratio (CALR), and uric acid-to-albumin ratio (UAR) — for in-stent restenosis (ISR) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). A total of 608 STEMI patients who underwent primary PCI between January 2020 and January 2025 were retrospectively analyzed; the median follow-up was 59.3 months (IQR: 52.5–67.0), and ISR developed in 63 patients (10.4%). The association between the four ratios and restenosis was assessed using univariable and multivariable logistic and Cox regression analyses, receiver operating characteristic (ROC) curve analysis, and restricted cubic spline (RCS) modeling. All four biomarkers were significantly higher in the ISR (+) group and showed significant discriminative ability on ROC analysis (UAR AUC=0.741, CALR AUC=0.710, CAR AUC=0.632, PAR AUC=0.614). All four ratios were independent predictors in multivariable logistic regression; however, in multivariable Cox regression, CAR lost statistical significance (HR=1.28, p=0.071), whereas UAR (HR=2.93, p<0.001), CALR (HR=2.97, p<0.001), and PAR (HR=1.16, p=0.010) remained independent predictors. RCS analysis revealed nonlinear threshold-type relationships for CAR, CALR, and UAR, whereas PAR demonstrated a linear dose-response relationship. In conclusion, CALR and UAR emerged as strong and consistent independent predictors of ISR risk in both cross-sectional and long-term analyses, whereas the predictive value of CAR was largely confined to the cross-sectional assessment

Background: Chronic coronary syndrome (CCS) remains a major cause of morbidity and mortality worldwide, and real-world data on outpatient management are limited. Methods: In total, 697 patients with previously diagnosed CCS who visited outpatient cardiology clinics at 25 centers in Turkey between June 2023 and December 2023 were prospectively enrolled and followed up for 12 weeks. Demographic and clinical characteristics, diagnostic and therapeutic strategies, a modified questionnaire derived from the Seattle Angina Questionnaire (modified SAQ-based questionnaire), and clinical outcomes were recorded. Results: The most common diagnostic modalities were exercise stress testing (31.6%) and coronary angiography (38.2%). Medical therapy (58.5%) was preferred over interventional treatment (41.5%). Among patients who were not receiving the respective medication at baseline, beta-blockers (61.8%), statins (46.5%), and ranolazine (40.4%) were the most commonly newly initiated medications. Patients in the intervention group were younger, were more frequently current smokers, had greater nitrate use, and had lower ejection fraction than those in the medical treatment group. Patient-reported responses to the modified SAQ-based questionnaire shifted toward less functional limitation, lower angina burden, and better perceived quality of life over the 12-week follow-up. Conclusions: Medical therapy was the predominant management strategy for CCS in Turkey. The observed diagnostic and therapeutic patterns reflect real-world management of patients with established CCS, with substantial use of invasive coronary angiography and high baseline utilization of guideline-directed medical therapies.

Background: Benidipine is a long-acting calcium channel blocker used for the treatment of hypertension and chronic coronary syndrome. Although it effectively lowers blood pressure (BP), the relationship between BP reduction and improvement in angina-related health status during benidipine therapy remains uncertain. This study evaluated changes in BP and patient-reported angina-related health status in a large real-world cohort. Methods: This prospective, multicenter, observational cohort study included 1659 patients with hypertension and/or chronic coronary syndrome who underwent baseline clinical assessment before initiation of benidipine therapy and were reassessed after 3 months. Changes in systolic and diastolic BP and Seattle Angina Questionnaire-7 (SAQ-7) scores were evaluated. Multivariable linear regression analyses were performed to identify predictors of BP reduction and symptomatic improvement. A propensity score-matched analysis according to coronary artery disease (CAD) status was conducted to further explore differences in treatment response. Results: The mean age was 62.2 ± 12.2 years, and 54.0% of participants were women. Systolic BP decreased by 13.8 mmHg and diastolic BP by 6.7 mmHg (both p < 0.001). Mean SAQ-7 score increased by 8.1 points (p < 0.001), exceeding the established threshold for clinically meaningful improvement. Baseline SAQ-7 score showed the strongest association with change in SAQ-7, whereas baseline systolic BP was the strongest predictor of BP reduction. The correlation between changes in systolic BP and SAQ-7 was weak (r = 0.058, p = 0.023). In the propensity score-matched cohort (n = 732), BP reduction was similar regardless of CAD status, whereas improvement in SAQ-7 was greater in patients without obstructive CAD. Conclusions: In this multicenter real-world cohort, benidipine therapy was associated with significant BP reduction and clinically meaningful improvement in angina-related health status over 3 months. Symptomatic improvement showed only a weak association with BP reduction. These findings should be interpreted within the limitations of an observational study and warrant confirmation in controlled comparative studies.

Introduction: Early detection of muscle loss and prediction of prognosis in cancer patients are of great importance for clinical management. This study aimed to investigate the relationship between temporal muscle thickness changes over time and clinical outcomes in patients with advanced solid cancer, and to evaluate the prognostic value of temporal muscle loss rate in predicting 90-day mortality. Methods: In this retrospective observational study, patients with advanced solid cancer who had at least two cranial computed tomography scans during follow-up were included. Temporal muscle thickness was measured on both the right and left sides at two different time points, and the temporal muscle loss rate (mm/month) was calculated. Demographic data, laboratory parameters, and anthropometric measurements were obtained from patient records. Factors predicting mortality were evaluated using logistic regression analysis, and prognostic performance was assessed by receiver operating characteristic analysis. Results: A total of 57 patients were included in the study. 90-day mortality occurred in 78.9% of patients. Neutrophil levels were significantly higher in the mortality group, while albumin and magnesium levels were significantly lower. Baseline temporal muscle thickness measurements were not associated with mortality; however, right and left temporal muscle loss rate were significantly higher in the mortality group. Multivariable logistic regression analysis identified left temporal muscle loss rate and neutrophil level as independent predictors of mortality. Receiver operating characteristic curve analysis demonstrated good discriminative performance, with the left temporal muscle loss rate exhibiting superior predictive ability. Conclusion: Temporal muscle loss rate may serve as a useful dynamic biomarker for predicting short-term mortality in patients with advanced solid cancer.

Background: Achieving target low-density lipoprotein cholesterol (LDL-C) levels in patients with atherosclerotic cardiovascular disease (ASCVD) frequently requires combination lipid-lowering therapy. Single-pill combination (SPC) regimens may improve adherence compared with free-dose combinations (FDC) in real-world clinical practice. Methods: This retrospective observational study included 450 ASCVD patients with baseline LDL-C levels of 70–189 mg/dL who were followed in cardiology outpatient clinics between January 2023 and December 2024. Patients received atorvastatin–ezetimibe either as a single-pill combination (SPC, n = 392) or as a free-dose combination (FDC, n = 58). Primary endpoints were LDL-C reduction and treatment adherence (≥ 80% of prescribed doses). Secondary endpoints included LDL-C target attainment and adverse events. Non-parametric tests and chi-square/Fisher’s exact tests were used for statistical analysis. Results: At 1 month, LDL-C levels were significantly lower in the SPC group compared with the FDC group (90.6 vs. 119 mg/dL; p = 0.005), and adherence was higher (89.8% vs. 70.7%; p < 0.001). At 4 months, LDL-C levels were comparable between groups, while continuous adherence remained significantly higher in the SPC group (86% vs. 69%; p = 0.001). A higher proportion of SPC-treated patients achieved LDL-C < 100 mg/dL at 1 month (81.9% vs. 67.2%; p = 0.009). Conclusions: In this real-world ASCVD cohort, SPC therapy with atorvastatin and ezetimibe was associated with superior adherence and comparable lipid-lowering efficacy despite lower statin doses. Fixed-dose combination strategies may represent an effective approach to optimize adherence and cardiovascular risk management.

Introduction: Atypical antipsychotics are widely prescribed in child and adolescent psychiatry and are known to affect cardiac repolarization, most commonly reflected by QTc prolongation. However, QTc alone may not fully capture repolarization heterogeneity. The frontal QRS–T angle f(QRS–T) is an electrocardiographic marker reflecting ventricular depolarization–repolarization mismatch. This study aimed to evaluate and compare f(QRS–T) alongside other repolarization parameters in children and adolescents receiving atypical antipsychotics versus healthy controls. Methods: This retrospective observational study included 45 children and adolescents (6–17 years) receiving atypical antipsychotics for at least six months and 45 age‐ and sex‐matched healthy controls. Standard 12‐lead ECG recordings were obtained to measure f(QRS–T), QTc, Tp‐e interval, and Tp‐e–based ratios. Correlation analyses assessed associations between f(QRS–T), QTc, and duration of antipsychotic use. Hierarchical multiple linear regression was performed to identify independent predictors of f(QRS–T) in the patient group. Receiver operating characteristic (ROC) analysis evaluated the discriminative ability of f(QRS–T) for QTc prolongation (QTc ≥ 440 ms). Results: Children receiving atypical antipsychotics exhibited significantly higher f(QRS–T), QTc interval, Tp‐e interval, Tp‐e(c), Tp‐e(c)/QT, and iCEBc ratios compared with healthy controls ( p < 0.05). Frontal QRS–T angle was positively correlated with QTc ( r = 0.406, p < 0.001) but not with the duration of antipsychotic treatment. In hierarchical regression analysis, age, sex, QTc and duration of antipsychotic use were not independent predictors of f(QRS–T). ROC analysis demonstrated that f(QRS–T) moderately discriminated patients with QTc prolongation (AUC = 0.735); a cut‐off value of 26.5° yielded a sensitivity of 72% and a specificity of 60%. Conclusion: f(QRS–T) is significantly increased in children and adolescents receiving atypical antipsychotics and is associated with QTc prolongation, although it is not independently predicted by treatment duration or conventional QT‐based indices. These findings suggest that f(QRS–T) may serve as a complementary electrocardiographic marker of repolarization heterogeneity alongside QTc in the cardiac safety monitoring of pediatric patients treated with atypical antipsychotics.

This study aimed to determine whether cardiovascular conditions, specifically atrial fibrillation (AF) and congestive heart failure (CHF), are associated w

Aim: The relationship between inflammatory status and poor outcomes in acute coronary syndromes is a significant area of current research. This study investigates the association between in‐hospital mortality and the modified Naples prognostic score (mNPS) as well as other inflammatory biomarkers in STEMI patients.Methods: This single‐centre, cross‐sectional study included 2576 consecutive STEMI patients who underwent primary percutaneous coronary intervention between January 2022 and November 2023. Participants were randomly divided into derivation and validation cohorts in a 6:4 ratio. The following inflammatory indices were calculated: pan‐immune‐inflammation value (PIV), systemic immune‐inflammation‐index (SII), systemic inflammation‐response index (SIRI) and conventional NPS. The mNPS was derived by integrating hs‐CRP into the conventional NPS. The performance of these indices in determining in‐hospital mortality was assessed using regression, calibration, discrimination, reclassification and decision curve analyses.Results: Inflammatory biomarkers, including PIV, SII, SIRI, NPS and mNPS, were significantly higher in patients who died during in‐hospital follow‐up compared to those discharged alive in both the derivation and validation cohorts. Multivariable logistic regression analyses were performed separately for the derivation and validation cohorts. In the derivation cohort, mNPS was associated with in‐hospital mortality (aOR = 1.490, p < .001). Similarly, in the validation cohort, mNPS was associated with in‐hospital mortality (aOR = 2.023, p < .001). mNPS demonstrated better discriminative and reclassification power than other inflammatory markers (p < .05 for all). Additionally, regression models incorporating mNPS were well‐calibrated and showed net clinical benefit in both cohorts.Conclusion: mNPS may be a stronger predictor of in‐hospital mortality in STEMI patients compared to the conventional scheme and other inflammatory indices.

Background Dual antiplatelet therapy (DAPT) is the treatment of choice for patients with acute and chronic coronary syndromes as it reduces mortality and prevents recurrent thrombotic complications. The assessment of both ischaemic burden and bleeding risk is crucial in deciding which DAPT to choose and how long it should be continued. Objectives The aim of our study was to perform prospective clinical follow-up of patients receiving fixed-dose combination therapy (ASA 75 mg + clopidogrel 75 mg). Our study is a multicentric, cross-sectional, observational, cohort study. Methods A total of 1500 patients who were started on fixed-dose combination DAPT for acute or chronic coronary syndrome were included in the study. Primary endpoints were hospitalization for any reason, hospitalization for cardiovascular cause, acute myocardial infarction, stent thrombosis, target vessel revascularization and bleeding; the secondary endpoints were death for any reason or cardiovascular cause and stroke. The significance level adopted in the statistical analysis was 5%. Results Median age was 63 years; 78.5% of the patients were receiving DAPT treatment for acute coronary syndrome. The rates of hospitalization for cardiovascular reasons, acute myocardial infartion, stent thrombosis and target-vessel revascularization were 7.9%, 2.3%, 1.3% and 4.2%, respectively. While the rate of BARC type 1 bleeding was 3.3%, the rate of BARC type 5, 3, or 2 bleeding was 0.6%. The secondary endpoints which were death from any cause, cardiovascular death and stroke were 0.5%, 0.3% and 0.3%, respectively. Conclusion: Our study shows that fixed-dose combination therapy is effective and safe in appropriately selected patients with acute or chronic coronary syndromes.