Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Real-World Data on the Incidence of Stroke, Myocardial Infarction, and Mortality Among Nonvalvular Atrial Fibrillation Patients in Türkiye: New Oral Anticoagulants-TURKey Study(2023) Unlu, Serkan; Altay, Servet; Gedikli, Omer; Ozden, Ozge; Canpolat, Ugur; Askin, Lutfu; Yayla, Cagri; Yanik, Ahmet; Cakmak, Huseyin Altug; Sinan, Umit Yasar; Besli, Feyzullah; Sahin, Mahmut; Pehlivanoglu, Seckin; 0000-0002-4837-7099; 37888785; A-7003-2017Background: Atrial fibrillation (AF) is strongly associated with an increased risk of isch- emic events. Anticoagulation focuses on reducing the risk of embolism. Guideline recom- mended CHA2DS2-VASc scoring system is most widely used; however, different scoring systems do exist. Thus, we sought to assess the impact of anticoagulant treatment and different scoring systems on the development of stroke, myocardial infarction, and allcause mortality in patients with nonvalvular AF. Methods: The present study was designed as a prospective cohort study. The enrollment of the patients was conducted between August 1, 2015, and January 1, 2016. The followup period was defined as the time from enrollment to the end of April 1, 2017, which also provided at least 12 months of prospective follow-up for each patient. Results: A total of 1807 patients with AF were enrolled. During the follow-up, 2.7% (48) of patients had stroke, 0.8% (14) had myocardial infarction, and 7.5% (136) died. The antico- agulation and risk factors in AF (ATRIA) score had a better accuracy for the prediction of stroke compared to other scoring systems (0.729, 95% CI, 0.708-0.750, P < .05). Patients under low -dose rivaroxaban treatment had significantly worse survival (logrankP < .001). Age, CHA2DS2-VASc score, R2CHADS2 score, ATRIA score, chronic heart failure, prior stroke, and being under low -dose rivaroxaban treatment were independent predictors of clinical endpoint (P < .001). Conclusion: Low -dose rivaroxaban treatment was independently and strongly associated with the combined clinical endpoint. Furthermore, the ATRIA score proved to be a stronger predictor of stroke in the Turkish population.Item Successful Thrombolysis of A Subacute Prosthetic Valve Thrombosis With Modified Ultra-Slow Thrombolytic Therapy(2018) Altay, Hakan; Kocabas, Umut; Yildirimturk, Ozlem; Ozkalayci, Flora; Saritas, Bulent; Pehlivanoglu, Seckin; https://orcid.org/0000-0001-6424-9399; 29943853; AAE-1392-2021; AAG-5856-2020; ABC-9264-2021Prosthetic valve thrombosis is a serious complication of heart valve surgery. According to the recent studies, thrombolytic therapy is an important alternative therapy to the open heart surgery with successful outcomes. We present a case of a prosthetic mitral valve thrombosis who was successfully treated with modified ultra-slow thrombolytic therapy.Item Reply to The Letter to The Editor: Successful Thrombolysis of A Subacute Prosthetic Valve Thrombosis with Modified Ultra-Slow Thrombolytic Therapy(2018) Altay, Hakan; Kocabas, Umut; Yildirimturk, Ozlem; Ozkalayci, Flora; Saritas, Bulent; Pehlivanoglu, Seckin; 30079510Item Real-Life Data of Major and Minor Bleeding Events with Direct Oral Anticoagulants in the One-Year Follow-Up Period: The NOAC-TURK Study(2021) Gedikli, Omer; Altay, Servet; Unlu, Serkan; Cakmak, Huseyin Altug; Askin, Lutfu; Yanik, Ahmet; Besli, Feyzullah; Sinan, Umit Yasar; Canpolat, Ugur; Sahin, Mahmut; Pehlivanoglu, Seckin; 33690135; ABC-9264-2021Objective: This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice. Methods: This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged >= 18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC. Results: A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6 +/- 10.2 years, CHA2DS2-VASc score was 3.6 +/- 1.4, and HAS-BLED score was 2 +/- 1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p<0.001). Patients on rivaroxaban 15 mg od also had a higher prevalence of chronic renal failure, 46 (16.7%) patients. A total of 205 (11.4%) bleeding events were observed; among these, 34 (1.9%) patients had major bleeding and 171 (9.4%) patients had minor bleeding. The major and minor bleeding events were 2/273 (0.7%) and 30/273 (10.9%) in patients receiving dabigatran 150 mg bid, 13/409 (3%) and 44/409 (10.7%) in patients receiving dabigatran 110 mg bid, 4/385 (1%) and 42/385 (10.9%) in patients receiving rivaroxaban 20 mg od, 8/276 (2.9%) and 27/276 (9.7%) in patients receiving rivaroxaban 15 mg od, 3/308 (0.9%) and 14/308 (4.5%) in patients receiving apixaban 5 mg bid, 4/156 (2.5%) and 14/156 (9%) in patients receiving apixaban 2.5 mg bid, respectively. The total bleeding events were 17 (5.6%) in patients receiving apixaban 5 mg, less than those receiving other DOACs. On multivariate analyses, rivaroxaban 20 mg od (p=0.002), ATRIA and HAS-BLED scores, and peripheral artery disease were independent indicators of bleeding. The most frequent location of major bleeding was the gastrointestinal system (GIS) [17 (0.9%) patients], and the most frequent location of minor bleeding was the gingiva [45 (2.5%) patients]. Conclusion: This study showed that similar results as the previous real-life study; however, we had some different results, such as the GIS tract bleeding was more frequent in patients receiving dabigatran 110 mg bid. The major and intracranial bleeding events were similar for different DOACs; and among DOACs, only rivaroxaban 20 mg od was associated with a high risk of bleeding.Item Effect of acute kidney injury on long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention in a high-volume tertiary center(2020) Hayiroglu, Mert Ilker; Bozbeyoglu, Emrah; Yildirimturk, Ozlem; Tekkesin, Ahmet Ilker; Pehlivanoglu, Seckin; 31974325Objective: Acute kidney injury (AKI) is a reflection of both renal and cardiac reserve in patients with ST-segment elevation myocardial infarction (STEMI), but there is a lack of evidence related to the effect of AKI on long-term mortality in patients with STEMI. This study was an investigation of the prognostic value of AKI for long-term mortality in patients with STEMI complicated by cardiogenic shock (CS) and primary percutaneous coronary intervention (PPCI). Methods: This retrospective analysis evaluated the long-term prognostic impact of AKI on 492 patients with STEMI complicated by CS who were treated with PPCI. AKI was defined as >= 0.3mg/dL increase in serum creatinine within 48 hours or a >= 50% increase in serum creatinine in 7 days, or a reduction in urine output (documented oliguria of less than 0.5mL/kg per hour >6 hours. Patients were grouped according to the incidence of AKI and long-term mortality was compared. Cox regression analysis was used to determine independent prognostic factors of long-term mortality. Results: In Cox regression analysis, the age- and sex- adjusted hazard ratios (HRs) were higher for all-cause mortality in patients with AKI. [HR: 4.556; 95% confidence interval: (CI) 2.370-8.759]. After adjustment for confounding variables, the relative risk was greater for patients with AKI in comparison with patients without AKI (HR: 2.207; 95% CI: 1.150-4.739). Age (HR: 1.060, 95% CI: 1.027-1.094; p<0.001), left ventricular ejection fraction (HR: 0.952, 95% CI: 0.916-0.989; p=0.012), blood urea nitrogen level (HR: 1.019, 95% CI: 1.005-1.034; p=0.010), and AKI (HR: 2.244, 95% CI: 1.077-4.676; p=0.031) were found to be independent factors to determine long-term mortality. Conclusion: The results of this study demonstrated that AKI was an independent prognostic factor for long-term mortality among patients with STEMI complicated by CS and treated with PPCI.Item ADHERENCE TO GUIDELINE-DIRECTED MEDICAL AND DEVICE THERAPY IN HEART FAILURE WITH REDUCED EJECTION FRACTION(2020) Kocabas, Umut; Kivrak, Tarik; Oztekin, Gulsum Meral Yilmaz; Tanik, Veysel Ozan; Ozdemir, Ibrahim; Kaya, Ersin; Yuce, Elif Ilkay; Demir, Fulya Avci; Dogdus, Mustafa; Pehlivanoglu, Seckin; ABA-3670-2020Item Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study(2020) Kocabas, Umut; Sariturk, Cagla; Altay, Hakan; Pehlivanoglu, Seckin; 32628147; AAE-1392-2021Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction <= 40%). Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019. Results: The study included 1462 outpatients (male: 70.1%, mean age: 67 +/- 11 years, mean LVEF: 30%+/- 6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279). Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.Item Acute Coronary Syndrome Associated with Carfilzomib Treatment(2020) Kocabas, Umut; Atalay, Figen; Altay, Hakan; Altun, Armagan; Pehlivanoglu, Seckin; 0000-0003-4384-2913; 0000-0002-8506-7583; 0000-0002-3233-8263; 32647445; AAE-1392-2021; B-5507-2014; ABB-5844-2020Item Predictors of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock(2019) Hayiroglu, Mert Ilker; Keskin, Muhammed; Uzun, Ahmet Ozkan; Yildirim, Duygu Ilke; Kaya, Adnan; Cinier, Goksel; Bozbeyoglu, Emrah; Yildirimturk, Ozlem; Kozan, Omer; Pehlivanoglu, Seckin; 29191504Background ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) remains as an unresolved condition causing high morbidity and mortality despite advances in medical treatment and coronary intervention procedures. In the current study, we evaluated the predictors of in-hospital mortality of STEMI complicated with CS. Methods In this retrospective study, we evaluated the predictive value of baseline characteristics, angiographic, echocardiographic and laboratory parameters on in-hospital mortality of 319 patients with STEMI complicated with CS who were treated with primary percutaneous coronary intervention. Patients were divided into two groups consisting of survivors and non-survivors during their index hospitalisation period. Results The mortality rate was found to be 61.3% in the study population. At multivariate analysis after adjustment for the parameters detected in univariate analysis, chronic renal failure, Thrombolysis In Myocardial Infarction (TIMI) post percutaneous coronary intervention (PCI) <= 2, plasma glucose and lactate level, blood urea nitrogen level, Tricuspid Annular Plane Systolic Excursion (TAPSE) and ejection fraction were independent predictors of in-hospital mortality. Conclusions Apart from haemodynamic deterioration, angiographic, echocardiographic and laboratory parameters have an impact on in-hospital mortality in patients with STEMI complicated with CS.Item Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction(2020) Kocabas, Umut; Kivrak, Tarik; Yilmaz Oztekin, Gulsum Meral; Tanik, Veysel O.; Ozdemir, Ibrahim; Kaya, Ersin; Yuce, Elif Ilkay; Avci Demir, Fulya; Dogdus, Mustafa; Altinsoy, Meltem; Ustundag, Songul; Ozyurtlu, Ferhat; Karagoz, Ugur; Karakus, Alper; Urgun, Orsan Deniz; Sinan, Umit Yasar; Mutlu, Inan; Sen, Taner; Astarcioglu, Mehmet Ali; Kinik, Mustafa; Ozden Tok, Ozge; Uygur, Begum; Yeni, Mehtap; Alan, Bahadir; Dalgic, Onur; Altay, Hakan; Pehlivanoglu, Seckin; 33063424; AAE-1392-2021Aim Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard. Methods We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019. Results Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 +/- 11 years vs 69 +/- 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy. Conclusion In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.