Ahmet Can Çakmak

Background: Metabolic dysregulation substantially contributes to adverse outcomes in acute myocardial infarction (AMI). While the triglyceride–glucose (TyG) index reflects chronic insulin resistance, the stress hyperglycemia ratio (SHR) represents acute stress-related glycemic perturbation. Methods: In this retrospective cohort study, 494 patients with STEMI who underwent primary PCI were included. SHR was calculated using admission blood glucose, whereas the TyG index was calculated using glucose and triglyceride levels obtained from routine morning blood samples, generally collected between 04:00 and 06:00 a.m. The primary outcomes were in-hospital mortality and congestive heart failure (CHF). Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate independent associations and discriminative performance. Results: Patients who developed CHF or in-hospital mortality exhibited significantly higher SHR and TyG index levels compared with those without adverse outcomes (all p < 0.05). SHR demonstrated a moderate positive correlation with TyG index (r = 0.441, p < 0.001), supporting the interplay between chronic insulin resistance and acute metabolic stress during AMI. For in-hospital mortality, SHR had a numerically higher area under the ROC curve [AUC: 0.823 (95% CI: 0.727–0.920)] than TyG [AUC: 0.714 (95% CI: 0.605–0.824)]; a formal comparison of the AUCs was not performed. At a cut-off value of 1.45, SHR demonstrated 76.5% sensitivity and 80.0% specificity for in-hospital mortality. In the original multivariable model, the SHR group was associated with in-hospital mortality (OR: 9.61, 95% CI: 2.599–35.578; p = 0.001), although the small number of deaths and incomplete adjustment for established clinical prognostic factors limit interpretation. Conclusions: Among patients with STEMI, both chronic insulin resistance and acute stress-related hyperglycemia were associated with adverse in-hospital outcomes. However, SHR demonstrated superior discriminative capacity and independently predicted mortality, highlighting the dominant prognostic impact of acute metabolic stress during AMI. Integrated assessment of chronic and acute metabolic dysfunction may improve early risk stratification in high-risk myocardial infarction patients.

Aim: This study aimed to evaluate five-year clinical outcomes and investigate baseline factors associated with major adverse cardiovascular events (MACE) in patients presenting with transient ST-segment elevation myocardial infarction (STEMI).Material and Methods: This retrospective, single-center, observational study included 52 patients who presented between January 2019 and December 2020 with ST-segment elevation on the initial electrocardiogram followed by complete resolution before coronary angiography. The primary outcome was five-year MACE, defined as a composite of cardiovascular death, acute coronary syndrome, revascularization, and ischemic cerebrovascular events. Follow-up data were obtained from hospital records and the national electronic health record system. Patients with and without MACE were compared, and associated factors were examined using univariable logistic regression.Results: The median age was 54.5 years, and 80.8% of patients were male. During five-year follow-up, MACE occurred in 11 patients (21.2%). All-cause mortality was 7.7%, cardiovascular mortality was 1.9%, and acute coronary syndrome and revascularization each occurred in 15.4%. Patients with MACE were older (63.0 vs. 51.0 years; p=0.003) and more frequently had hypertension (72.7% vs. 29.3%; p=0.014) and hyperlipidemia (45.5% vs. 12.2%; p=0.025). In univariable analysis, age (OR: 1.09; 95% CI: 1.02-1.17; p=0.016), hypertension (OR: 6.44; 95% CI: 1.46-28.53; p=0.014), and hyperlipidemia (OR: 6.00; 95% CI: 1.32-27.19; p=0.020) were significantly associated with five-year MACE.Conclusion: Long-term cardiovascular risk was not negligible after transient STEMI despite resolution of ST-segment elevation. Age, hypertension, and hyperlipidemia were associated with five-year MACE in univariable analyses and may help identify patients at higher long-term cardiovascular risk.

Kronik mezenterik iskemi, mezenterik arterlerde gelişen aterosklerotik darlık veya oklüzyon sonucu intestinal dolaşımın metabolik gereksinimleri karşılayamaması ile ortaya çıkan, tanısı sıklıkla geciken ancak tedavi edilmediğinde ciddi morbidite ve mortaliteye neden olabilen önemli bir vasküler hastalıktır. Günümüzde endovasküler revaskülarizasyon, daha düşük periprosedürel komplikasyon oranları nedeniyle birçok merkezde öncelikli tedavi seçeneği haline gelmiştir. Bu bölümde, postprandiyal karın ağrısı ve belirgin kilo kaybı yakınmaları ile başvuran 73 yaşındaki kadın hastada izole superior mezenterik arter kronik total oklüzyonuna yönelik başarılı perkütan endovasküler tedavi sunulmaktadır. Sağ brakiyal arter yaklaşımı ile gerçekleştirilen işlemde, farklı kılavuz tel stratejileri sonrasında lezyon başarıyla geçilmiş, predilatasyon sonrası stent implantasyonu uygulanarak tam revaskülarizasyon sağlanmıştır. İşlem sırasında komplikasyon gelişmemiş, takipte hastanın abdominal semptomlarında belirgin düzelme ve kilo alımı gözlenmiştir. Bu olgu, uygun hasta seçimi ve dikkatli teknik planlama ile kompleks superior mezenterik arter kronik total oklüzyonlarında endovasküler tedavinin güvenli ve etkili bir seçenek olduğunu göstermektedir. Chronic mesenteric ischemia is an important vascular disease characterized by the inability of the intestinal circulation to meet metabolic demands due to atherosclerotic stenosis or occlusion of the mesenteric arteries. Although the diagnosis is frequently delayed, if left untreated, it may lead to serious morbidity and mortality. Nowadays, endovascular revascularization has become the preferred treatment option in many centers because of its lower periprocedural complication rates. In this chapter, we present a successful percutaneous endovascular treatment of isolated chronic total occlusion of the superior mesenteric artery in a 73-year-old female patient who presented with postprandial abdominal pain and significant weight loss. During the procedure, which was performed via a right brachial artery approach, the lesion was successfully crossed after the use of different guidewire strategies, followed by predilatation and stent implantation, resulting in complete revascularization. No procedural complications occurred, and follow-up revealed significant improvement in the patient’s abdominal symptoms along with weight gain. This case demonstrates that endovascular treatment is a safe and effective option in complex chronic total occlusions of the superior mesenteric artery when appropriate patient selection and careful technical planning are applied.

Peripartum cardiomyopathy (PPCM) is a life-threatening form of heart failure characterized by substantial heterogeneity in left ventricular recovery. Ident

Background: Transulnar access has emerged as a feasible alternative to transradial access for coronary angiography. However, the electrophysiological effects of proximal and distal transulnar approaches on ulnar nerve function remain insufficiently characterized. This study aimed to compare electrophysiological changes following proximal and distal transulnar coronary angiography and to evaluate their association with ulnar nerve involvement. Methods: This single-center retrospective observational study included 97 patients who underwent proximal (n = 56) or distal (n = 41) transulnar coronary angiography and developed post-procedural pain and/or paresthesia. Electroneuromyography and nerve conduction studies were performed before the procedure and at the fourth post-procedural week. Sensory and motor amplitudes, conduction velocities, and delta (Δ) changes were compared between groups. Generalized estimating equation analysis was additionally performed to evaluate longitudinal electrophysiological changes after adjustment for demographic and procedural variables. Results: No significant between-group differences were observed in pre- or post-procedural electrophysiological parameters. Although significant reductions in right ulnar sensory amplitude were observed over time, only 4 patients (4.1%) demonstrated post-procedural ulnar sensory amplitudes below the laboratory reference range, and no patient developed clinically significant ulnar neuropathy. Comparison of electrophysiological changes (Δ values) revealed no significant differences between proximal and distal transulnar access techniques. Generalized estimating equation analysis, adjusted for age and procedural characteristics, confirmed that the magnitude of electrophysiological changes over time was comparable between the two groups. Conclusions: Both proximal and distal transulnar access may be associated with mild, predominantly sensory, subclinical ulnar nerve involvement. However, distal transulnar access did not result in greater electrophysiological deterioration or additional neurological risk compared with proximal access.

Background/Objectives: Transradial access (TRA) is a standard approach in the management of ST-segment elevation myocardial infarction (STEMI); however, evidence on using a single catheter for both diagnostic angiography and percutaneous coronary intervention (PCI) is limited. This study evaluates the feasibility and clinical outcomes of using a single Judkins Left (JL) 3.5 guiding catheter via TRA in STEMI patients. Methods: A total of 1139 patients undergoing radial access PCI with a single JL 3.5 catheter were included. Procedural success was defined as completing both diagnostic coronary angiography and PCI without catheter exchange. Procedural characteristics and access-site complications were evaluated. Results: The success rate of completing diagnostic angiography and PCI using a single JL 3.5 guiding catheter without catheter exchange was 91.1%. Compared to procedures requiring multiple catheters, the single-catheter group had significantly lower total contrast volume (200 vs. 250 mL), procedure time (20 vs. 30 min), fluoroscopy time (10.3 vs. 17.6 min), radiation dose (358 vs. 545 mGy), and needle-to-balloon time (6 vs. 9 min), all with p < 0.001. Access-site complications were also lower (8.2% vs. 15.8%; p = 0.010), primarily due to reduced radial artery spasm (4.0% vs. 12.9%; p = 0.001). Conclusions: A single JL 3.5 catheter strategy via transradial access is a safe, efficient, and effective method for STEMI intervention, offering significant procedural and clinical advantages.

Aim: To investigate the impact of direct and indirect revascularization, based on the angiosome concept, on major amputation, minor amputation, and wound healing outcomes after endovascular intervention in patients with critical limb ischemia.Material and Methods: A total of 121 patients with critical limb ischemia and foot ulcer (Rutherford stage 5–6) were evaluated. During follow-up, 3 patients died, and successful revascularization could not be achieved in 29 patients. The remaining 89 patients were classified according to successful restoration of blood flow to the affected angiosome as direct revascularization (DR, n=59) or indirect revascularization (IR, n=30). Patients were followed for three months for major amputation, minor amputation, and wound healing outcomes.Results: Among 89 successfully revascularized patients (mean age 63.9 ± 10.2 years, 81.6% male), direct angiosome-targeted flow was achieved in 59 patients (66.3%). During follow-up, the DR group had a significantly lower major amputation rate compared to the IR group (10.2% vs 30%, p=0.018). Minor amputation rates were similar between groups (23.7% vs 23.3%, p=0.967), while wound healing was significantly better in the DR group (61% vs 36.7%, p=0.030).Conclusion: Angiosome-guided direct revascularization may reduce major amputation risk and improve wound healing in isolated below-knee lesions. Whenever feasible, direct revascularization should be considered the preferred treatment strategy.