Coronary care units are sophisticated clinics established to reduce deaths due to acute cardiovascular events. Current data on coronary care unit mortality rates and predictors of mortality in Turkey ...are very limited. The MORtality predictors in CORonary care units in TURKey (MORCOR-TURK) trial was designed to provide information on the mortality rates and predictors in patients followed in coronary care units in Turkey.
The MORCOR-TURK trial will be a national, observational, multicenter, and noninterventional study conducted in Turkey. The study population will include coronary care unit patients from 50 centers selected from all regions in Turkey. All consecutive patients admitted to coronary care units with cardiovascular diagnoses between 1 and 30 September 2022 will be prospectively enrolled. All data will be collected at one point in time, and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT05296694). In the first step of the study, admission diagnoses, demographic characteristics, basic clinical and laboratory data, and in-hospital management will be assessed. At the end of the first step, the predictors and rates of in-hospital mortality will be documented. The second step will be in cohort design, and discharged patients will be followed up till 1 year. Predictors of short- and long-term mortality will be assessed. Moreover, a new coronary care unit mortality score will be generated with data acquired from this cohort.
The short-term outcomes of the study are planned to be shared by early 2023.
The MORCOR-TURK trial will be the largest and most comprehensive study in Turkey evaluating the rates and predictors of in-hospital mortality of patients admitted to coronary care units.
Amiloidoz; organ ve yumuşak dokuların hücre dışı boşluğunda amiloid fibril birikiminin neden olduğu bir hastalıktır. Öncü proteinin tipine göre amiloidoz sınıflandırması yapılır. Kalp, böbrek, ...karaciğer, gastrointestinal sistem ve/veya otonom sinir sistemi gibi çeşitli organlarda amiloid birikimi izlenebilmekle birlikte, prognozu en kötü olan organ tutulumu türü kardiyak amiloidozdur. Birçok amiloidoz türleri arasında hemen hemen tüm klinik kardiyak amiloidoz vakalarına, transtiretin amiloidoz (ATTR) veya hafif zincir amiloidoz (AL veya primer sistemik) neden olur. Kardiyak ATTR; kalıtsal (ATTRm) veya doğal tip (ATTRwt) olabilir. Kardiyak tutulum sıklığı ve kardiyomiyopatinin prognozu amiloidoz tipleri arasında değişkenlik gösterir ve klinik belirtiler, organ tutulum paternine bağlı olarak değişir. Değişken klinik fenotip ve genellikle özgül olmayan klinik özellikler, bu hastalıkta tanıda gecikmelere neden olabilir ve tanıda multidisipliner (hematoloji, patoloji, radyoloji, nükleer tıp, nöroloji, nefroloji, kardiyoloji, romatoloji, gastroenteroloji) yaklaşım gerekir. Gelişen tanı yöntemleri klinisyene kardiyak amiloidozda erken tanı olanağını vermektedir. Kardiyak amiloidozdan şüphelenilen hastalarda; görüntüleme yöntemleri ve gerekirse doku biyopsisi ile amiloid birikimi gösterilmelidir. Amiloidoza sebep olan öncü protein saptandıktan sonra, altta yatan hastalığın tedavisi ve semptomatik hastalarda kalp yetmezliğine yönelik tedavi uygulanmaktadır. Erken tanı ve tedavi yaklaşımları ile prognozun düzeltilebildiği gösterilmiştir. Bu derlemede, kardiyak amiloidoz hastalığı hakkında farkındalığın artırılması amaçlanmış olup, günlük pratiğimizde kullanabileceğimiz güncel tanı yöntemleri ve tedavi yaklaşımları ele alınacaktır.
Amyloidosis is a disease caused by the accumulation of amyloid fibril in the extracellular space of organs and soft tissues. Amyloidosis classification is made according to the type of precursor protein. Although amyloid accumulation can be observed in various organs such as heart, kidney, liver, gastrointestinal and/or autonomic nervous system; the worst prognosis type of organ involvement is cardiac amyloidosis. Among many types of amyloidosis, almost all clinical cases of cardiac amyloidosis are caused by transtiretin amyloidosis (ATTR) or light chain amyloidosis (AL or primary systemic). Cardiac ATTR can be hereditary (ATTRm) or wild type (ATTRwt). The frequency of cardiac involvement and prognosis of cardiomyopathy varies between the types of amyloidosis and clinical symptoms vary depending on the organ involvement pattern. Variable clinical phenotype and often non-specific clinical features can cause delays in diagnosis and a multidisciplinary (hematology, pathology, radiology, nuclear medicine, neurology, nephrology, cardiology, rheumatology, gastroenterology) approach is required in diagnosis. The developing diagnostic methods give the clinician early diagnosis of cardiac amyloidosis. Amyloid accumulation should be demonstrated by imaging methods and tissue biopsy is necessary in patients with suspected cardiac amyloidosis. Once the precursor protein that causes amyloidosis has been identified, treatment of the underlying disease and heart failure is performed in symptomatic patients. It has been shown that prognosis can be corrected with early diagnosis and treatment approaches. In this review, it is aimed to raise awareness about cardiac amyloidosis disease, current diagnostic methods and treatment approaches that we can use in our daily practice will be discussed.
Purpose: Arrhythmias and conduction disturbances are common during acute myocardial infarction (AMI) and a major cause of death in the pre-hospital phase. The aim of this study was to investigate ...common predictors for all arrhythmias in patients with ST elevation AMI (STEMI) during in-hospital phase. Materials and Methods: Ninety patients (74 male, 55 ±11 years) with acute STEMI were included. Clinical charesteristics were recorded and laboratory parameters including serum C- reactive protein (CRP), creatinine kinase MB (CKMB) and potassium levels were measured. The patients were divided into two groups according to development of arrhythmias.Results: Group 1 (n=42) patients had new onset arrhythmias and Group 2 (n=48) patients had without arrhythmias. Median baseline CRP levels were significantly higher in group 1 (36.6 (21.8-77) mg/dl vs. 21.8 (24.2-30.7) mg/dl), especially in patients with atrial fibrillation and ventricular arrhythmias. Logistic regression analysis showed that baseline higher CRP level, peak CKMB level and inferior localization of AMI were significantly associated with the development of arrhythmia following AMI. Conclusion: Levels of CRP and CKMB and inferior infarct localization have predictive values for all the arrhythmic events during AMI. CRP levels were found to be associated with both atrial and ventricular arrhythmias. The assessment of CRP levels can be used to detect patients at high risk for arrhythmic events after STEMI.
This study aimed to assess the safety and tolerability of nebivolol in hypertensive patients with coronary artery disease and left ventricular ejection fraction ≥ 40% in a Turkish cohort.
A total of ...1015 hypertensive patients and coronary artery disease with left ventricular ejection fraction ≥ 40% were analyzed from 29 different centers in Turkey. Primary outcomes were the mean change in blood pressure and heart rate. Secondary outcomes were to assess the rate of reaching targeted blood pressure (<130/80 mmHg) and heart rate (<60 bpm) and the changes in the clinical symptoms (angina and dyspnea). Adverse clinical events and clinical outcomes including cardiovascular mortality, cardiovascular hospital admissions, or acute cardiac event were recorded.
The mean age of the study population was 60.3 ± 11.5 years (male: 54.2%). During a mean follow-up of 6 months, the mean change in blood pressure was -11.2 ± 23.5/-5.1 ± 13.5 mmHg, and the resting heart rate was -12.1 ± 3.5 bpm. Target blood pressure and heart rate were achieved in 76.5% and 37.7% of patients. Angina and functional classifications were improved by at least 1 or more categories in 31% and 23.2% of patients. No serious adverse events related to nebivolol were reported. The most common cardiovascular side effect was symptomatic hypotension (4.2%). The discontinuation rate was 1.7%. Cardiovascular hospital admission rate was 5% and hospitalization due to heart failure was 1.9% during 6 months' follow-up. Cardiovascular mortality rate was 0.1%.
Nebivolol was well tolerated and safe for achieving blood pressure and heart rate control in hypertensive patients with coronary artery disease and heart failure with preserved or mildly reduced ejection fraction.
OBJECTIVEAcute coronary syndrome (ACS) is a leading cause of death worldwide. There is great interest in defining the risk factors and underlying mechanisms of ACS among young people. The microbiota ...and its metabolites have recently become a popular research topic, yet there is still no study that investigated microbiota-generated metabolites as a possible risk factor in young patients with ACS. In this study, we aimed to investigate the relationship between microbiota-generated metabolites and ACS in young people. METHODSThis study included 44 young patients with ACS (<50 years of age), 39 elderly patients with ACS, and 44 patients with normal coronary arteries. Inflammatory parameters and serum trimethylamine N-oxide (TMAO) and choline levels were measured in all patients. RESULTSYoung patients with ACS had significantly higher levels of TMAO and choline compared to the control and elderly ACS groups. Also, elderly patients with ACS had a significantly higher level of TMAO than the control group. Linear regression analysis was performed to determine the independent predictors of TMAO. Two regression models were involved. The first model included young ACS and control groups, while the second model included young and elderly ACS groups. In the first model, we found that young ACS (ß=0.399, p=0.004) and smoking ACS (ß=0.211, p=0.046) were significantly associated with TMAO level. In the second model, young ACS was significantly associated with TMAO level (ß=0.230, p=0.035). CONCLUSIONIn this study, we have shown that young ACS was significantly associated with increased TMAO level.
Amaç: Akut koroner sendrom (AKS), küresel ölümlerin birincil nedenidir. Genç nüfus arasında AKS'nin risk faktörlerini ve altta yatan nedenlerini belirleme konusunda özel bir endişe vardır. Genetik ...faktörler, günümüzde hastalık önleme ve erken teşhis açısından popüler bir çalışma konusu haline gelmiştir. Bu çalışmada genç akut koroner sendromlu (GACS) hastalarda Monosit Kemoatraktan Protein-1(MCP-1) (A-2518G) ve C-C kemokin reseptör tip 2 (CCR2) (G190A) gen polimorfizmleri arasındaki klinik önemi araştırmayı amaçladık.
Materyal ve metod: GACS'li (<40 yaş) 63 ve koroner arterleri normal olan 103 hasta bu çalışmaya dahil edildi. Tüm hastalarda MCP-1(A-2518G) ve CCR2(G190A) gen polimorfizmleri ölçüldü.
Bulgular: MCP 1 gen polimorfizmi iki grupla karşılaştırıldığında önemli ölçüde farklıydı. GACS grupta MCP-1 (A-2518G) geni GG (sırasıyla %12,7 ’e karşı %3,7), AG (sırasıyla %33,3’e karşı %50,5), AA (sırasıyla %54’e karşı %45,8), (p: 0.021) genotipleri arasındaki ilişkinin önemli ölçüde yüksek olduğu gösterilmiştir.
Sonuç: Bu çalışmada GACS'li hasta grubunda MCP-1 (A-2518G) GG genotipinin yüksek olduğu ve hastalık riskini 2 kat arttırdığı gösterildi.
Objective: Code blue is an organization established to provide basic and advanced life support as soon as possible, effectively and accurately in patients who develop in-hospital cardiac arrest. The ...aim of this study is to investigate the effectiveness and results of code blue calls (CBCs) in our hospital, to make a comparison between pre-pandemic and post-pandemic periods, and to contribute to the literature and clinical practice.
Material and Methods: This study was carried out by retrospectively examining the code blue notification forms between 01.01.2019 and 20.05.2021 in the code blue system, which is actively applied in the 350-bed Samsun Gazi State Hospital.
Results: 370 code blue calls were included in this retrospective study. 54.1% of the cases were male and the mean age was 63.6 ± 1.1. 55.7% of the calls were made during working hours. The calls were mostly made from polyclinics with 28.6%. This was followed by the Covid-19 service with 25.7% and the palliative care service with 15.9%. 60% of the calls were made in the pre-pandemic period. CPR was performed in 48.6% of the cases. 30.3% of the cases resulted in exitus. In terms of CBC causes, code blue call was made due to cardiopulmonary arrest in 48.6%, syncope in 16.8%, and hypotensive attack in 13% of the cases. Code Blue team reached the calls in an average of 2.63±0.1 minutes.
Compared to the CBCs during the pandemic period with the pre-pandemic period; Age, male gender ratio, transfer rate to the ICU, team response time and prolenged call rates were found to be higher during the pandemic period ( respectively p= 0.017, p=0.03, p=0.001, p=0.001, p=0.006) . The defibrillation rate and the rate of transfer to the ED were found to be lower during the pandemic period (respectively p=.0.02, p=0.001).
Conclusion: When the pandemic period and the pre-pandemic period were compared in the CBCs in our hospital; Parameters such as defibrillation application, outcome, team arrival time and prolonged call rates were negatively affected. CBC and its results can be improved with continuous and effective training.
Amaç: Mavi Kod Hastane içi kardiyak arrest gelişen hastalarda temel ve ileri yaşam desteğini en kısa sürede, etkin ve doğru bir şekilde yapmak için oluşturulmuş organizasyondur. Bu çalışmada amacımız hastanemizdeki mavi kod çağrılarının (MKÇ) etkinliği ve sonuçlarını araştırmak ve pandemi öncesi-pandemi sonrası karşılaştırılmasını yapmak, literatüre ve uygulamaya katkı sağlamaktır.
Materyal ve Metod: Bu çalışma 350 yataklı Samsun Gazi Devlet Hastanesi’nde aktif olarak uygulanmakta olan mavi kod sisteminde 01.01.2019-20.05.2021 tarihleri arasındaki mavi kod bildirim formlarının retrospektif olarak incelenmesi ile yapılmıştır.
Bulgular: Bu retrospektif çalışmaya 370 mavi kod çağrısı dahil edilmiştir. Vakaların % 54.1’i erkek olup ortalama yaş 63.6 ± 1.1. Çağrıların %55.7’si mesai içinde verilmiştir. Çağrılar en sık %28.6 ile polikliniklerden verilmiştir. Bunu %25.7 ile pandemi servisi ve %15.9 palyatif bakım servisi izlemektedir. Çağrıların%60’ı pandemi öncesi dönemde verilmiştir. Vakaların %48.6’sına CPR yapılmıştır. Vakaların %30.3’ü exitus ile sonuçlanmıştır. MKÇ’nin verilme sebeplerine baktığımızda; %48.6 hastaya kardiyopulmoner arrest, %16.8 hastaya senkop, %13 hastaya ise hipotansif atak nedeniyle mavi kod çağrısı verilmiştir. Mavi kod ekibi çağrılara ortalama 2.63 ± 0.1 dakikada ulaşmıştır.
Pandemi dönemi ile pandemi öncesi dönemdeki MKÇ’ler karşılaştırıldığında; pandemi döneminde yaş, erkek cinsiyet oranı, YB’a transfer oranı, ekip yanıt süresi ve uzayan çağrı oranları daha yüksek bulundu (sırasıyla p= 0.017;p=0.03; p=0.001; p=0.001;p= 0.006) . Pandemi döneminde defibrilasyon hızı ve AS’e transfer hızı daha düşük bulundu (sırasıyla p=0.02; p=0.001).
Sonuç: Hastanemizdeki MKÇ’lerde Pandemi dönemi ile pandemi öncesi dönem karşılaştırıldığında; defibrilasyon uygulama, sonuç, ekip geliş süresi ve uzamış çağrı oranları gibi parametrelerde negatif yönde etkilenim olmuştur. MKÇ sonuçları sürekli ve etkili eğitimlerle daha iyi seviyelere çıkarılabilir.
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