Browsing by Author "Evsen, Ali"

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The Predictive Value of the Cha2ds2-Vasc Score in the Development of Contrast-Induced Nephropathy After Endovascular Intervention in Peripheral Artery Disease
(Elsevier Science inc, 2025) Evsen, Ali; Aktan, Adem; Kilic, Raif; Isik, Mehmet Ali; Yalcin, Abdulaziz; Guzel, Tuncay; Ozbek, Mehmet
Background: Contrast-induced nephropathy (CIN) is a frequent complication of endovascular interventions for peripheral artery disease (PAD). It is linked to renal dysfunction, extended hospital stays, increased cardiovascular events, and higher mortality rates. The CHA2DS2-VASc score, widely utilized for assessing cardioembolic risk and guiding anticoagulation therapy in nonvalvular atrial fibrillation, encompasses risk factors that overlap with those of CIN. This study investigates whether the CHA2DS2-VASc score can predict CIN in PAD patients undergoing endovascular interventions. Methods: The study included 754 consecutive PAD patients who underwent endovascular procedures at 2 centers. Each patient's CHA2DS2-VASc score was calculated and categorized into low (<3) and high (>= 3) groups. Patients were retrospectively monitored for CIN development and divided into CIN-positive (CIN+) and CIN-negative (CIN-) groups. Univariate and multivariate regression analyses were performed to identify independent predictors of CIN, and a significance level of P < 0.05 was used for all statistical analyses. Results: Of the 754 patients, 178 (23.6%) developed CIN, with 151 (84.8%) occurring in the high CHA2DS2-VASc score group (P < 0.001). The CHA2DS2-VASc score was significantly higher in the CIN(+) group compared to the CIN(-) group (P < 0.001). Regression analysis identified the CHA2DS2-VASc score (odds ratio [OR]: 1.574, 95% confidence interval [CI]: 1.2981.907, P < 0.001), baseline creatinine (OR: 2.296, 95% CI: 1.580-3.335, P < 0.001), and hemoglobin (OR: 0.915, 95% CI: 0.844-0.992, P < 0.001) as independent risk factors. A CHA2DS2-VASc score cutoff of 2.5 predicted CIN with 85% sensitivity and 42% specificity. Conclusion: The CHA2DS2-VASc score is an independent predictor of the development of CIN in patients with PAD undergoing endovascular intervention.
Citation - WoS: 2
Citation - Scopus: 2
Assessing the Prognostic Value of Halp Score in Peripheral Artery Disease: Correlation With Lesion Severity and Long-Term Mortality
(Sage Publications Ltd, 2025) Evsen, Ali; Aktan, Adem; Kilic, Raif; Yalcin, Abdulaziz; Ozbek, Mehmet
Introduction Peripheral artery disease (PAD) poses a growing clinical challenge due to an aging population, despite advances in treatment methods. Various scoring systems have emerged to predict high-risk patients, including the HALP (hemoglobin, albumin, lymphocyte, and platelet) score, known for predicting prognosis in cancers and stroke. This study assesses the HALP score's relation to lesion severity and long-term mortality in PAD patients. Methods We retrospectively analyzed 305 symptomatic PAD patients undergoing endovascular intervention. The following formula was used to calculate the HALP score: hemoglobin (g/L) x albumin (g/L) x lymphocyte count (/L) / platelet count (/L). Lesion severity was classified by TASC-II: TASC AB and TASC CD. Mortality data were obtained from hospital and social security records. Results The study involved 305 patients (mean age 64.4 +/- 11.8 years; 72.1% male), divided into survivors (208) and non-survivors (97). ROC analysis identified HALP score as the strongest predictor of long-term mortality (AUC: 0.736; 95% CI: 0.679-0.793; p < .001). HALP score (HR, 0.087; 95% CI, 0.025-1.300; p < .001), age (p < .001), DM (p = .007), and CRP (p = .013) independently predicted mortality. Kaplan-Meier analysis showed higher HALP scores linked to lower long-term mortality (Log-rank: 20.102, p < .001), with an average follow-up of 48 +/- 18 months. Conclusion The HALP score emerged as a robust predictor of PAD prognosis, surpassing individual components and other parameters. Lower HALP scores correlated with more severe lesions and reduced life expectancy.
Ürik Asit-Albumin Oranı ile Kontrast Kaynaklı Nefropati ve Mortalite Arasındaki İlişki: Kronik Total Oklüzyon Olgularında Bir Değerlendirme
(2025) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Özbek, Mehmet; Kılıç, Raif; Altunova, Mehmet; Evsen, Ali
Amaç: Koroner anjiyografi (CAG) uygulanan bireyler arasında, kronik koroner total oklüzyon (CTO) sık görülen bir lezyon tipini temsil etmekte olup genellikle perkütan koroner girişim (PCI) ile tedavi gerektirmektedir. PCI sonrasında, kontrast kaynaklı nefropati (CIN) sık rastlanan bir komplikasyon olup artmış morbidite ve mortaliteye katkıda bulunmaktadır. Ürik asit-albumin oranı (UAR), son dönemde olumsuz klinik sonuçlarla ilişkili yeni bir biyobelirteç olarak tanımlanmıştır. Bu çalışma, CTO hastalarında UAR’ın CIN ve uzun dönem mortalite açısından prognostik önemini belirlemeyi amaçlamıştır. Yöntemler: Bir veya daha fazla CTO lezyonu nedeniyle PCI uygulanan toplam 169 hasta retrospektif olarak değerlendirildi. Hastalar, CIN gelişimine göre iki gruba ayrıldı: CIN-pozitif (n = 27) ve CIN-negatif (n = 142). Bulgular: CIN (+) grubu, CIN (−) grupla karşılaştırıldığında anlamlı şekilde daha yüksek serum ürik asit düzeyleri, daha yüksek UAR değerleri ve artmış mortalite oranları gösterdi (tümü p < 0,001). Ayrıca, çok değişkenli regresyon analizi UAR’ı CIN için bağımsız bir prognostik gösterge olarak ortaya koydu (p = 0,012). UAR için 1,77 kesme değeri CIN’i %66,7 duyarlılık ve %62 özgüllük ile öngörürken, 1,90 kesme değeri uzun dönem mortaliteyi %64,5 duyarlılık ve %73,9 özgüllük ile tahmin etti. Kaplan–Meier sağkalım eğrilerine göre, CIN-pozitif gruptaki bireyler uzun dönem sağkalım açısından belirgin şekilde daha düşük ve tüm nedenlere bağlı ölüm sıklığı açısından daha yüksek bulundu (log-rank, p < 0,001). Sonuç: Artmış UAR, CTO hastalarında hem CIN’i hem de uzun dönem mortaliteyi bağımsız olarak öngörmüş olup, bu yüksek riskli popülasyonda prognostik önemini vurgulamaktadır.
Citation - WoS: 2
The Significance of Frontal Plane QRS-T Angle for Estimating Non-Dipper Hypertension
(Cureus, 2022) Evsen, Ali; Karahan, Mehmet Zülkif
Objective: The frontal QRS-T angle (fQRS-T) is linked to myocardial ischemia and ventricular arrhythmias. On the other hand, non-dipper hypertension is a risk factor for cardiac adverse events. The objective of this research was to determine whether the fQRS-T, a marker of ventricular heterogeneity, could be used to predict non-dipper hypertensive individuals in the lack of left ventricular hypertrophy. Methods: The observational study was carried out retrospectively. Patients diagnosed with hypertension were included in this study. Blood tests were routinely conducted for all patients. Electrocardiography (ECG) was conducted for each patient and echocardiography was performed. Blood pressure (BP) values were collected from the ambulatory Holter records. According to ambulatory Holter monitoring, the individuals were separated into two groups. The association between fQRS-T and hypertension was investigated. Results: The research involved 123 patients, with an average age of 51.85±8.22 years, comprising 76 women (61.8%) and 47 males (38.2%). According to ambulatory Holter monitoring, patients were separated into dippers (n=65) and non-dippers (n=58). There were no statistically significant in the laboratory and echocardiographic variables (p>0.05). QT dispersion (QTd) and fQRS-T were substantially greater in the non-dipper group than in the dipper group (p=0.043 and p<0.001, respectively). Independent determinants of non-dipper status were determined by univariate and multivariate logistic regression analyses. fQRS-T was found to be the only independent indicator of non-dipper status (OR: 1.03, 95%CI: 1.02-1.06, p<0.001). Conclusion: The fQRS-T may be a useful marker for estimating non-dipper hypertensive individuals in the lack of left ventricular hypertrophy.
Impact of 5-and 6-Fr Sheaths on Hemostasis Duration and Access Site Complications in Distal Transradial Approach
(Wiley, 2025) Aktan, Adem; Kilic, Raif; Guzel, Tuncay; Evsen, Ali; Acun, Baris; Tanircan, Muhammed Rasit; Karahan, Mehmet Zulkuf
Background: The distal transradial approach (dTRA) is increasingly preferred for coronary angiography (CAG) and/or per-cutaneous coronary intervention (PCI) because of its advantages in patient comfort and vascular access. However, the effect of sheath size on these outcomes remains unclear.
Aim: To compare the effects of 5-French (Fr) and 6-Fr sheaths in dTRA on vascular complications, hemostasis duration, and patient comfort.
Methods: A retrospective analysis was conducted on patients who underwent dTRA for CAG between January 2020 and October 2023. Participants were categorized into two groups based on sheath size (5- vs. 6-Fr). Data on procedural details, complications, hemostasis duration, and patient discomfort were collected.
Result: A total of 228 patients were included, with 72 in the 5-Fr group and 156 in the 6-Fr group. The study found no significant difference in vascular complications between the two groups (p = 0.18). However, hemostasis duration was significantly shorter in the 5-Fr group compared to the 6-Fr group (97.8 +/- 27.6 vs. 122.0 +/- 24.9 min; p < 0.001). Severe pain was more frequent in the 6-Fr group (p = 0.036). Regression analysis showed that severe pain, puncture time, and the use of P2Y12 receptor antagonists (P2Y12 inhibitors) were significantly associated with vascular complications (p < 0.05).
Conclusion: In our study, sheath size-specifically the comparison between 5- and 6-Fr-did not significantly affect vascular complications in the dTRA. However, using a 5-Fr sheath may reduce hemostasis time and patient discomfort compared to a 6-Fr sheath. Procedural factors such as puncture time and severe pain, as well as P2Y12 inhibitor use, should be carefully considered to minimize complications. These findings support the safe application of the dTRA with sheath size tailored to individual patient characteristics.
Citation - WoS: 1
Citation - Scopus: 1
Association Between Abo Blood Group, Peripheral Artery Disease Lesion Severity, and Coronary Artery Disease Coexistence
(Elsevier Science Inc, 2025) Evsen, Ali; Aktan, Adem; Kilic, Raif; Ozbek, Mehmet
Background: This study aims to investigate the relationship between ABO blood groups and the severity of peripheral artery disease (PAD) lesions, the coexistence of coronary artery disease (CAD) with PAD, and to identify which blood groups may be more predisposed to these conditions. Methods: This study, which has a single-center and retrospective design, includes 305 patients diagnosed with peripheral artery disease (PAD) between 2015 and 2021. The patients were selected from those with at least 50% stenosis detected by computed tomography (CT) angiography. The severity of PAD lesions was evaluated according to the TransAtlantic Inter-Society Consensus (TASC-II) classification, and the presence of CAD was determined by simultaneous conventional coronary angiography. Demographic data, comorbidities, and laboratory results were collected, and statistical analyses were performed using chi-square tests, logistic regression, and t-tests. All of these patients were divided into 2 groups based on their ABO blood types: O and non-O blood groups. Results: This study demonstrates a significant relationship between blood group classification and both the severity of PAD and the prevalence of CAD. Patients with non-O blood groups exhibited a higher likelihood of having severe PAD lesions (TASC-C and TASC-D) compared to those with O blood groups, who more frequently had milder lesions (TASC-A and TASC-B) (P < 0.001). The prevalence of CAD was also significantly higher among patients with non-O blood groups than those with the O blood group (54.4% vs. 36.4%; P = 0.003). In the logistic regression analysis, non-O blood groups, alongside age, hypertension (HT), and chronic kidney disease (CKD), emerged as independent predictors of severe PAD (P < 0.001 for non-O blood groups). Similarly, older age and non-O blood group status were identified as significant independent predictors of CAD (P = 0.004). These findings suggest that blood group classification, particularly non-O groups, may influence the severity and coexistence of PAD and CAD.
Conclusion: Our study reveals a significant association between ABO blood groups and both the severity of PAD and the association of CAD, and shows that non-O blood groups are linked to more severe forms of these conditions. These findings highlight the potential role of ABO blood groups in cardiovascular risk stratification, suggesting a need for further research to confirm these associations and understand their clinical implications.
Citation - WoS: 3
Citation - Scopus: 3
Is Plasma Atherogenic Index or Ldl/Hdl Ratio More Predictive of Peripheral Arterial Disease Complexity?
(Sage Publications Ltd, 2024) Evsen, Ali; Aktan, Adem; Altunova, Mehmet; Ozbek, Mehmet
Introduction: The most basic and well-known cause of peripheral arterial disease (PAD) is atherosclerosis. One of the main factors causing atherosclerosis is dyslipidemia. We will evaluate whether specific ratios of dyslipidemia, such as the atherogenic plasma index (AIP) and LDL/HDL ratio, which have recently been used in practice, can help us to predict the complexity of PAD in the clinic. Methods: A total of 305 patients with PAD admitted to our clinic were retrospectively included in this study. After evaluation according to angiography images using TASC-II classification, patients were divided into TASC A-B and TASC C-D. AIP was evaluated with the following formula: Log (TG/HDL). Cut-off values for AIP and LDL/HDL were determined on the ROC (receiver operating characteristic) curve. Logistic regression analysis were conducted to predict peripheral arterial disease complexity. Results: The mean ages of Group 1 (n:180, 68.3% male) and Group 2 (n:125, 77.6% male) patients were 64.10 +/- 12.39 and 64.94 +/- 11.12 years, respectively. The prevalence of diabetes mellitus (DM, p < 0.016) and coronary artery disease (CAD, p < 0.001) was higher in group 2. Group 2 had higher TG (p = 0.045), LDL-C (p = 0.004), AIP (p = 0.010), LDL/HDL (p < 0.001), and lower HDL-C (p = 0.015). In multivariate logistic regression analysis evaluating parameters in predicting PAD complexity, DM (OR: 1.66 Cl 95%: 1.01-2.73 p = 0.045), CAD (OR: 2.86 Cl 95%: 1.75-4.69 p < 0.001) and LDL/HDL (OR: 1.47 Cl 95%: 1.10-1.96 p = 0.008) were independent variables. Conclusion: In our study, we compared LDL/HDL ratio and AIP in PAD for the first time in the literature and showed that LDL/HDL ratio is a more valuable ratio and an independent predictor of PAD complexity.
The Relationship Between the CHA2DS2-VASc Score and Lesion Complexity and Long-Term Outcomes in Peripheral Arterial Disease
(Kare Publ, 2025) Evsen, Ali; Aktan, Adem; Kilic, Raif; Guzel, Tuncay; Ozbek, Mehmet
Objective: Originally designed to evaluate stroke risk in individuals with atrial fibrillation unrelated to valvular disease, the CHA(2)DS(2)-VASc score (Congestive heart failure, Hypertension, Vascular disease, Age >= 74 years, and Sex category - female) is now additionally utilized for the prognostic evaluation of cardiovascular diseases. This study aimed to evaluate the predictive role of the CHA(2)DS(2)-VASc score for lesion severity and long-term survival outcomes in individuals with peripheral artery disease (PAD). Method: This retrospective analysis included 784 patients diagnosed with PAD via computed tomography (CT) angiography, consecutively enrolled from two medical centers. The CHA(2)DS(2)VASc score was determined for all participants. Lesion severity was assessed according to the TASC II (Trans-Atlantic Inter-Society Consensus II) criteria, and patients were categorized into TASC-AB (simple) and TASC-CD (complex) lesion groups. Mortality data were obtained from hospital and social security records. Results: The study included 784 patients (average age: 61.7 +/- 9.9 years; 17.2% female). In the regression analysis performed to predict lesion severity, we found that the CHA(2)DS(2)-VASc score (P < 0.007) and left ventricular ejection fraction (P = 0.009) were independent predictors. The receiver operating characteristic (ROC) curve indicated that a CHA(2)DS(2)-VASc score threshold of 3.5 predicted long-term mortality with 70% sensitivity and 79% specificity (P < 0.001). Kaplan-Meier survival estimates indicated that patients with higher CHA(2)DS(2)-VASc scores had significantly lower survival rates over the 60-month follow-up period (P < 0.001). Conclusion: The CHA(2)DS(2)-VASc score was independently associated with both lesion severity and adverse long-term outcomes in individuals with PAD.