Sefa Erdi Ömür

Aim: To evaluate the temporal stability of femoral artery access-site localization in patients undergoing repeated digital subtraction angiography (DSA) and to identify independent anatomical and procedural factors associated with instability in localization.Methods: This retrospective analytical study included 161 patients who underwent femoral artery access on multiple occasions for DSA or neurointerventional procedures between December 2020 and December 2024. Only patients who underwent repeated ipsilateral femoral access were included in the primary temporal stability analysis to avoid anatomical variation between limbs. Femoral artery puncture sites were fluoroscopically classified as being located over or outside the femoral head. Punctures outside the femoral head were further categorized as high or low punctures. Multivariable logistic regression was used to identify independent predictors of localization instability.Results: The mean age was 56.25±14.42 years, and 54.2% of patients were male. The proportion of punctures located over the femoral head decreased from 78.9% during the initial access to 71.4% during repeat access. The proportion of punctures outside the femoral head increased from 21.1% to 28.6%, although this paired within-patient difference was not statistically significant. On multivariable analysis, BMI ≥25 kg/m², high femoral bifurcation, femoral artery calcification, increased skin-to-artery depth, smaller common femoral artery diameter, and absence of ultrasound guidance were independently associated with localization instability.Conclusion: Femoral artery access-site localization may vary across repeated DSA and endovascular procedures, even when ipsilateral access is used. Patient-specific reassessment of femoral anatomy and ultrasound-guided puncture may improve the reproducibility of access-site localization and procedural safety.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity with diverse underlying mechanisms, and its diagnostic evaluation remains challenging in routine clinical practice despite advances in multimodality imaging. Systemic inflammatory indices derived from routine laboratory parameters have recently gained attention as potential markers reflecting inflammatory burden in cardiovascular diseases. This study aimed to evaluate the potential diagnostic utility of systemic inflammatory indices in patients with MINOCA and to compare these indices across patients with obstructive myocardial infarction and non-critical coronary artery disease. Methods: In this retrospective single-center observational study, a total of 2,050 consecutive patients who underwent coronary angiography between January 1, 2023, and January 1, 2024 were initially screened. After applying predefined exclusion criteria, including renal failure, pulmonary embolism, cerebrovascular events, arrhythmias, severe valvular heart disease, severe anemia, and incomplete clinical data, 496 patients were eligible for the final analysis. Patients were classified into three groups according to coronary angiographic findings and troponin levels: MINOCA (n = 67), obstructive myocardial infarction (n = 222), and non-critical coronary artery disease (n = 207). Demographic characteristics, laboratory parameters, echocardiographic findings, and systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and C-reactive protein-to-albumin ratio (CAR) were analyzed. Multivariable logistic regression analysis together with receiver operating characteristic (ROC) curve analysis was performed to determine independent predictors associated with MINOCA. Results: Patients with obstructive myocardial infarction were older and had a higher prevalence of diabetes mellitus and hypertension compared with the MINOCA and non-critical coronary artery disease groups (P < 0.001). Systemic inflammatory indices including neutrophil count, SII, NLR, PLR, MLR, C-reactive protein (CRP), and CAR were significantly higher in the obstructive myocardial infarction group, whereas intermediate levels were observed in the MINOCA group (P < 0.001). Left ventricular ejection fraction (LVEF) was significantly lower in the obstructive myocardial infarction group compared with the MINOCA and non-critical coronary artery disease groups (P < 0.001). In multivariate logistic regression analysis, LVEF was identified as an independent predictor of MINOCA when compared with obstructive myocardial infarction, whereas SII remained an independent predictor in comparisons between MINOCA and non-critical coronary artery disease groups. Receiver operating characteristic (ROC) curve analyses demonstrated that LVEF showed the highest diagnostic performance among the evaluated parameters. Conclusions: Systemic inflammatory indices differ significantly among patients with MINOCA, obstructive myocardial infarction, and non-critical coronary artery disease. Easily accessible inflammatory markers together with echocardiographic parameters such as LVEF may provide additional diagnostic value in the clinical evaluation of patients with suspected MINOCA.

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.

To the EditorWe read with great interest the study by Miró et al. which examined predictors of adverse outcomes in 2,865 patients presenting with hypertensive acute heart failure (AHF) [1]. The aut...

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.

Background: Atrial fibrillation (AF) increases ischemic stroke risk nearly fivefold. Although the CHA ₂ DS ₂ ‐VA score is widely used for risk stratification, its predictive performance is limited, particularly in intermediate‐risk patients. Left atrial (LA) enlargement, a marker of structural remodeling, may improve risk prediction. Aims: To evaluate whether adding LA diameter to CHA ₂ DS ₂ ‐VA (creating CHA ₂ DS ₂ ‐VALa) enhances ischemic stroke prediction in AF patients. We additionally derived a multivariable β‐weighted model and benchmarked its performance against CHA ₂ DS ₂ ‐VA (and the simplified +1 LA rule). Methods: This retrospective study included 1648 AF patients. LA diameter was measured by standardized echocardiography. A ROC‐derived cut‐off (> 4.7 cm) defined enlargement. Patients were followed for a mean of 4.18 ± 0.35 years. Imaging‐confirmed ischemic stroke events were identified through institutional hospital records and the electronic health registry, and were validated using hospitalization documentation, neurology consultation notes, discharge summaries, and available brain CT/MRI findings. Predictors were assessed using multivariable logistic regression, and Kaplan–Meier/log‐rank analyses compared CHA ₂ DS ₂ ‐VALa versus CHA ₂ DS ₂ ‐VA. Results: Imaging‐confirmed ischemic stroke events occurred more frequently in patients with LA > 4.7 cm (25 [3.8%] vs. 21 [2.1%], p < 0.001). Elevated CRP, NT‐proBNP, diabetes, hypertension, CAD, and heart failure were also associated with stroke. LA > 4.7 cm independently predicted events (OR 1.97, 95% CI 1.36–2.86, p < 0.001). ROC analysis showed strong discrimination for LA diameter (AUC 0.872; sensitivity 82%, specificity 85%). Kaplan–Meier analysis demonstrated superior prediction with CHA ₂ DS ₂ ‐VALa compared to CHA ₂ DS ₂ ‐VA (log‐rank p < 0.001). Conclusion: The CHA ₂ DS ₂ ‐VALa score significantly improves stroke risk stratification in AF by integrating LA diameter into conventional scoring. As echocardiographic measurement is widely available and reproducible, this modification offers a simple, pragmatic approach to refine residual stroke‐risk stratification and support closer evaluation and follow‐up in anticoagulated AF patients. Prospective validation in diverse populations is warranted.