Browsing by Author "Güzel, Tuncay"

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Citation - WoS: 3
Citation - Scopus: 3
Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
(Springer, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed
Background: In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥ 75 years) than in younger (< 75 years) patients. Methods: This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically significant hematoma (CSH), pericardial effusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. Results: The overall sample included 1923 patients (1419 < 75 years and 504 aged ≥ 75 years). There was no difference between the groups in terms of cumulative events defined as primary outcome (3.5% vs. 4.4%, p = 0.393). Infection related to device system was significantly higher in the ≥ 75 age group (1.8% vs. 3.4%, p = 0.034). There was no significant difference between the groups in terms of clinically significant hematoma and pneumothorax (0.7% vs. 0.4%, p = 0.451, 1.4% vs. 1.0%, p = 0.477, respectively). In multivariate model analysis, no association was found between age ≥ 75 years and infection related to the device system. Conclusion: Infection rates were relatively higher in the patient group aged ≥ 75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.
Citation - WoS: 3
Aging and cardiac implantable electronic device complications: is the procedure safe in older patients?
(ELSEVIER, 2023) Güzel, Tuncay; Aktan, Adem; Kılıç, Raif; Günlü, Serhat; Arslan, Bayram; Arpa, Abdulkadir; Güzel, Hamdullah; Tatlı, İsmail; Aydın, Saadet; Suzan, Veysel; Demir, Muhammed
Background In this study, we investigated whether there is a higher incidence of cardiac implantable electronic devices (CIED) procedures related complications in older (≥75 years) than in younger (<75 years) patients. Methods This retrospective cohort study enrolled patients who had undergone CIED procedures (de novo implantation, system upgrade, generator substitution, pocket revision or lead replacement) at two heart centers in Turkey between January 2011 and May 2023. The primary composite endpoint included clinically signifcant hematoma (CSH), pericardial efusion or tamponade, pneumothorax, and infection related to the device system. Secondary outcomes included each component of the composite end point. Results The overall sample included 1923 patients (1419<75 years and 504 aged≥75 years). There was no diference between the groups in terms of cumulative events defned as primary outcome (3.5% vs. 4.4%, p=0.393). Infection related to device system was signifcantly higher in the≥75 age group (1.8% vs. 3.4%, p=0.034). There was no signifcant diference between the groups in terms of clinically signifcant hematoma and pneumothorax (0.7% vs. 0.4%, p=0.451, 1.4% vs. 1.0%, p=0.477, respectively). In multivariate model analysis, no association was found between age≥75 years and infection related to the device system. Conclusion Infection rates were relatively higher in the patient group aged≥75 years. This patient group should be evaluated more carefully in terms of infection development before and after the procedure.
Citation - WoS: 1
Citation - Scopus: 1
Comparison of Evolut-R 34 mm Valve and Smaller Evolut-R Valves in Patients Undergoing Transcatheter Aortic Valve Implantation and Determination of Mild Paravalvular Leak Predictors
(Kare Publ, 2024) Demir, Muhammed; Aktan, Adem; Güzel, Tuncay; Kılıç, Raif; Arslan, Bayram; Ertas, Faruk; Günlü, Serhat
Objective: The main purpose of this study was to evaluate and compare the in-hospital, 1-month and 1-year post-procedure outcomes of patients treated with Evolut-R 34 mm and Evolut-R 23/26/29 mm devices. Additionally, the study aimed to identify factors that could predict the occurrence of ≥ mild paravalvular leaks (PVL). Methods: Between April 2015 and May 2022, 269 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with Evolut-R 34 mm (n = 66, 24.5%) and Evolut-R 23/26/29 mm (n = 203, 75.5%) devices in a single center were retrospectively analyzed. Results: Patients in the Evolut-R 34 mm group had a lower female sex ratio (16.7% vs. 66.5%, P < .001, respectively), ejection fraction (50.7 ± 10.1% vs. 54.5 ± 9.3%, P = .016, respectively), and mean aortic gradient (7.4 ± 3.3 vs. 9.2 ± 5.0, P = .026, respectively) compared to the Evolut-R 23/26/29 mm group. The groups did not exhibit any statistically significant dis- tinctions with regard to technical success, the need for a permanent pacemaker, occur- rences of stroke, major vascular complications, PVL, major adverse cardiovascular and cerebrovascular events, or mortality. Peak velocity was confirmed as a significant pre- dictor of ≥mild PVL in both patient groups in the receiver operating characteristic curve analysis. In logistic regression analysis; In patients with Evolut-R 34 mm valve, pre-TAVI aortic valve peak velocity (odds ratio (OR) = 23.202; P = .019) and calcium volume 800 Hounsfield Units (mm3) (OR = 1.017; P < .001) were independent predictors of ≥mild PVL. Conclusion: The Evolut-R 34 mm valve has shown comparable in-hospital results with smaller valve sizes. Pre-TAVI aortic valve peak velocity and calcium volume predicted ≥ mild PVL in Evolut-R 34 mm patients.
Dekompanse Kalp Yetmezliği Hastalarında Başvuru Serum Kreatinin/albümin Oranı ve 1 Yıllık Mortalite ile İlişkisi
(2024) Karahan, Mehmet Zülküf; Özbek, Mehmet; Arpa, Abdulkadir; Polat, Nihat; Yüksel, Murat; Işık, Mehmet Ali; Kayan, Fethullah; Aktan, Adem; Demir, Muhammed; Güzel, Tuncay
Amaç: Tıbbi gelişmelere rağmen kalp yetmezliği (KY) yüksek mortalite oranlarını korumaktadır. Araştırmamız, dekompensesistolik KY hastalarında serum kreatinin/albumin oranı ile bir yıllık mortalite arasındaki ilişkiyi incelemeye odaklanmaktadır. Yöntemler: Ekim 2014 ile Ekim 2015 tarihleri arasında akut sistolikdekompanse KY tanısı konmuş ve sol ventrikülejeksiyon fraksiyonu (LVEF) ≤ 40% olan 80 hasta (37 kadın) çalışmamıza dahil edildi. Hastalar, bir yıl içinde tüm nedenlere bağlı mortalite olup olmadığına göre iki gruba ayrıldı. Bulgular: 80 katılımcının 31'i (%39), birinci yıl içinde ölümle sonuçlandı. Ölen grubun ortalama yaşı 69±14 yıl olup, bunların %38,7'si (n=12) kadındı. Buna karşılık, hayatta kalan grupta ortalama yaş 66±12 yıl olup, bunların %51'i (n=25) kadındı. Mortalite yaşanan KY grubu, serum kreatinin-albümin oranı, üre ve kreatinin değerlerinde anlamlı düzeyde daha yüksek seviyeleri sergiledi ve pretibial ödem prevalansı daha yüksekti (p<0.01). Ayrıca, ölen KY grubu, LVEF, albumin seviyeleri, lenfosit sayısı, sistolik ve diyastolik kan basıncı değerlerini anlamlı derecede düşük gösterdi. İstatistiksel analiz, ölen grup (0.68±0.27) ile sağ kalan grup (0.38±0.18) arasında serum kreatinin/albumin oranı açısından anlamlı bir farklılık olduğunu gösterdi, p<0.01 idi. Serum kreatinin/albumin oranı için 0.45 kesme değeri kullanarak, KY hastalarındaki bir yıl içindeki mortaliteyi tahmin etmek için duyarlılık ve özgüllük sırasıyla %81 ve %78 idi. Sonuç: Yüksek kreatinin seviyeleri, azalmış albumin seviyeleri ve artmış kreatinin/albumin oranının birleşimi, sistolikdekompenseKY'li hastalarda bir yıllık tüm nedenlere bağlı mortaliteyi öngörmede basit, ekonomik prognostik göstergeler olarak işlev görebilir.
Citation - WoS: 2
Citation - Scopus: 3
The effect of body mass index on complications in cardiac implantable electronic device surgery
(WILEY, 2023) Güzel, Tuncay; Demir, Muhammed; Aktan, Adem; Kılıç, Raif; Arslan, Bayram; Günlü, Serhat; Altıntaş, Bernas; Karahan, Mehmet Zülkif; Özbek, Mehmet; Aslan, Burhan; Arpa, Abdulkadir; Coşkun, Mehmet Sait; Altunbaş, Mahsum; Tüzün, Rohat; Akgümüş, Alkame; Karadeniz, Muhammed; Aydın, Saadet; Güzel, Hamdullah; Aslan, Selen Filiz; Söner, Serdar; Taş, Ahmet; Ertaş, Faruk
Background: Cardiac implantable electronic device (CIED) procedures are prone to complications. In our study, we investigated the effect of body mass index (BMI) on CIED-related complications. Methods: 1676 patients who had undergone CIED surgery (de novo implantation, system upgrade, generator change, pocket revision or lead replacement) at two heart centers in Turkey and met the study criteria were included in our study. For analysis of primary and secondary endpoints, patients were classified as non-obese (BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). The primary endpoint was accepted as cumulative events, including the composite ofclinically significant hematoma (CSH), pericardial effusion or tamponade, pneumoth- orax, and infection related to the device system. Secondary outcomes included each component of cumulative events. Results: The rate of cumulative events, defined as primary outcome, was higher in the obese patient group, and we found a significant difference between the groups (3.0%, 4.3%, 8.9%, p = .001). CSH and pneumothorax rates were significantly higher in the obese patient group (0.3%, 0.9%, 1.9%, p = .04; 1.0%, 1.4%, 3.3%, p = .04, respectively). According to our multivariate model analysis; gender (OR:1.882, 95%CI:1.156–3.064, p = .01), hypertension (OR:4.768, 95%CI:2.470–9.204, p < .001), BMI (OR:1.069, 95%CI:1.012–1.129, p = .01) were independent predictors of cumulative events rates. Conclusions: Periprocedural complications associated with CIED (especially hematoma and pneumothorax) are more common in the group with high BMI.
Citation - Scopus: 7
The effect of coronary slow flow on ventricular repolarization parameters
(ScienceDirect, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Günlü, Serhat; Kılıç, Raif
Introduction: Ischemia due to microvascular dysfunction may be responsible for the heterogeneity of ventricular repolarization in coronary slow flow. To our knowledge, there is no study in which QT interval, Tp-Te interval, index of cardiac-electrophysiological balance (iCEB), and frontal QRS-T angle were evaluated together in patients with CSF. In this study, we examined for the first time the relationship between all these myocardial repolarization parameters and CSF. Materials and methods: The study group included 178 patients (99 female, mean age: 50.6 ± 8.6 years) with isolated CSF without stenotic lesions and with angiographically proven normal coronary arteries. The control group included 120 patients (71 female, mean age: 49.3 ± 9.4 years) with normal coronary angiography. QRS duration, QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp- Te/QTc, iCEB score, and frontal QRS-T angle were calculated from 12‑lead ECGs. Results: There was no significant difference in demographic parameters between the two groups. Compared with the control group, patients with CSF had significantly longer QTmax duration, QT dispersion, Tp-Te interval, and higher iCEB score, wider frontal QRS-T angle. Conclusion: In our study, we found that many of the ventricular repolarization parameters were adversely affected in patients with CSF. Impaired parameters may be associated with the risk of malignant ventricular arrhythmias.
The effect of coronary slow flow on ventricular repolarization parameters
(ELSEVIER, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Günlü, Serhat; Kılıç, Raif
Introduction: Ischemia due to microvascular dysfunction may be responsible for the heterogeneity of ventricular repolarization in coronary slow flow. To our knowledge, there is no study in which QT interval, Tp-Te interval, index of cardiac-electrophysiological balance (iCEB), and frontal QRS-T angle were evaluated together in patients with CSF. In this study, we examined for the first time the relationship between all these myocardial repolarization parameters and CSF. Materials and methods: The study group included 178 patients (99 female, mean age: 50.6 ± 8.6 years) with isolated CSF without stenotic lesions and with angiographically proven normal coronary arteries. The control group included 120 patients (71 female, mean age: 49.3 ± 9.4 years) with normal coronary angiography. QRS duration, QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp- Te/QTc, iCEB score, and frontal QRS-T angle were calculated from 12‑lead ECGs. Results: There was no significant difference in demographic parameters between the two groups. Compared with the control group, patients with CSF had significantly longer QTmax duration, QT dispersion, Tp-Te interval, and higher iCEB score, wider frontal QRS-T angle. Conclusion: In our study, we found that many of the ventricular repolarization parameters were adversely affected in patients with CSF. Impaired parameters may be associated with the risk of malignant ventricular arrhythmias.
Citation - Scopus: 3
Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
(Sociedade Brasileira de Cardiologia, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kayan, Fethullah; Günlü, Serhat
Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student’s t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE
Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia
(Sociedade Brasileira de Cardiologia – SBC, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kayan, Fethullah; Günlü, Serhat
Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student’s t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.
Citation - WoS: 2
Evaluation of Hematological Parameters After Transcatheter Aortic Valve Replacement
(SAGE, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kılıç, Raif; Günlü, Serhat; Demir, Muhammed; Ertaş, Faruk
Although transcatheter aortic valve replacement (TAVR) is safe and effective, mortality and bleeding events post procedure are important. The present study investigated the changes in hematologic parameters to evaluate whether they predict mortality or major bleeding. We enrolled 248 consecutive patients (44.8% male; mean age 79.0 ± 6.4 years) undergoing TAVR. In addition to demographic and clinical examination, blood parameters were recorded before TAVR, at discharge, 1 month and 1 year. Hemoglobin levels before TAVR 12.1 ± 1.8 g/dL, 10.8 ± 1.7 g/dL at discharge, 11.7 ± 1.7 g/dL at first month, 11.8 ± 1.4 g/dL at first year (Hemoglobin values compared with pre-TAVR, P < .001, P = .019, P = .047, respectively). Mean platelet volume (MPV) before TAVR 8.72 ± 1.71 fL, 8.16 ± 1.46 fL at discharge, 8.09 ± 1.44 fL at first month, 7.94 ± 1.18 fL at first year (MPV values compared with pre-TAVR, P < .001, P < .001, P < .001, respectively). Other hematologic parameters were also evaluated. Hemoglobin, platelet count, MPV, and red cell distribution width before the procedure, at discharge, and at the first year did not predict mortality and major bleeding in receiver operating characteristic analysis. After multivariate Cox regression analysis, hematologic parameters were not independent predictors of in-hospital mortality, major bleeding, and death at 1 year after TAVR.
Citation - WoS: 2
Citation - Scopus: 2
Evaluation of Hematological Parameters After Transcatheter Aortic Valve Replacement
(Sage Journals, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Kılıç, Raif; Günlü, Serhat; Demir, Muhammed; Ertaş, Faruk
Although transcatheter aortic valve replacement (TAVR) is safe and effective, mortality and bleeding events post procedure are important. The present study investigated the changes in hematologic parameters to evaluate whether they predict mortality or major bleeding. We enrolled 248 consecutive patients (44.8% male; mean age 79.0 ± 6.4 years) undergoing TAVR. In addition to demographic and clinical examination, blood parameters were recorded before TAVR, at discharge, 1 month and 1 year. Hemoglobin levels before TAVR 12.1 ± 1.8 g/dL, 10.8 ± 1.7 g/dL at discharge, 11.7 ± 1.7 g/dL at first month, 11.8 ± 1.4 g/dL at first year (Hemoglobin values compared with pre-TAVR, P < .001, P = .019, P = .047, respectively). Mean platelet volume (MPV) before TAVR 8.72 ± 1.71 fL, 8.16 ± 1.46 fL at discharge, 8.09 ± 1.44 fL at first month, 7.94 ± 1.18 fL at first year (MPV values compared with pre-TAVR, P < .001, P < .001, P < .001, respectively). Other hematologic parameters were also evaluated. Hemoglobin, platelet count, MPV, and red cell distribution width before the procedure, at discharge, and at the first year did not predict mortality and major bleeding in receiver operating characteristic analysis. After multivariate Cox regression analysis, hematologic parameters were not independent predictors of in-hospital mortality, major bleeding, and death at 1 year after TAVR.
How Optimal Is the Treatment for Heart Failure Patients with Low Ejection Fraction?
(2025) Özbek, Mehmet; Aktan, Adem; Coşkun, Mehmet Sait; Senoz, Oktay; Kılıç, Raif; Oktay, Mesut; Güzel, Tuncay
Objectives: The aim of our study was to investigate the medical treatment and doses used in patients with a diagnosis of heart failure (HF) and whether these vital drugs were used by cardiologists at the required doses in patients with indications. Patients and methods: This single-center, prospective study included a total of 419 chronic HF (CHF) patients (275 males, 144 females; mean age: 65.2±13.8 years; range, 22 to 94 years) between April 1st, 2020 and November 15th, 2020. Patients and their relatives were interviewed and sociodemographic data of the patients were recorded. Routine hematological and biochemical parameters, electrocardiographic findings, electrocardiographic and echocardiographic findings, and systolic and diastolic pressure data were recorded during follow-up. The New York Heart Association (NYHA) functional classes were also determined. Results: The causes of CHF were as follows: 55.6% ischemic heart disease, 33.9% dilated cardiomyopathy (CMP), 3.8% valvular, 1.9% peripartum CMP, 1.9% post-chemotherapy (CT), 1% non-compaction CMP, and 1.9% other causes. The most common reason for not receiving medical treatment at the maximal doses recommended by the guidelines was "not recommended by the physician" (beta-blockers 49.6%, n=208, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers [ACEI/ARBs] 44.6%, n=187, mineralocorticoid receptor antagonists [MRAs] 38.7%, n=162). The second most common reason was the lack of desired follow-ups due to socioeconomic reasons. Conclusion: The most common reason why HF patients do not receive optimal treatment, including beta-blocker, ACEI/ARB, and MRA groups is that clinicians do not recommend it. This study may be a reference to the fact that clinicians' maximal sensitivity in treatment optimization in fragile patient groups, such as HF, would significantly change patient outcomes.
Local Against General Anesthesia For Transcatheter Aortic Valve Replacement
(Bandırma Onyedi Eylül Üniversitesi Tıp Fakültesi, 2023) Günlü, Serhat; Kayan, Fethullah; Güzel, Tuncay; Aktan, Adem; Tanırcan, Muhammed Raşid; Karahan, Mehmet Zülkif
Background/Aims: Transcatheter aortic valve replacement (TAVR) poses significant challenges concerning anesthesia management. There is no consensus on the type of safer anesthesia for TAVR procedures. We aimed to evaluate the effectiveness and safety of TAVR performed with trans-femoral approach under local anesthesia with sedation (LAS) against general anesthesia (GA). Methods: This observational and retrospective analysis included individuals who were admitted on a planned basis from 2016 to 2022 and underwent Transfemoral TAVR. Effectiveness and safety outcomes were evaluated at 30 days. İndividuals were separated into two groups: GA and LAS. Demographic characteristics and procedural data were recorded during hospitalization. Results: 115 patients were included, of whom 62 (53.9%) received LAS and 53 received GA (46.1%). 59 female (48.8%) patients with a mean age of 83.2±5.7 participated in the study. Successful TAVR procedure was performed in 100 (86.9%) of 115 patients with the transfemoral approach. The mean procedure time was 136.7±46.7 minutes, and the procedure time was shorter in patients who underwent LAS against GA (p=0.001). There were no differences among the groups including fluoroscopy time, contrast, and radiation dose (p>0.05). In 2 patients (3.2%), significant vascular complications necessitated immediate surgical intervention, necessitating a change in the anesthesia technique. Overall 30-day mortality was 5.2%, with no significant differences among the groups (GA 7.5% vs. LAS 3.2%, p =0.28). GA had substantially longer ICU and total hospitalization stays than LAS (p=0.009 and p =0.004, respectively). Conclusions: In our study, TAVR via the transfemoral route using LAS was an alternative for GA.
Citation - WoS: 3
The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome
(ELSEVIER, 2023) Günlü, Serhat; Arpa, Abdulkadir; Kayan, Fethullah; Güzel, Tuncay; Kılıç, Raif; Aktan, Adem; Bernas, Altıntaş; Karahan, Mehmet Zülkif
Background: The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. Objective: This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. Methods: This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02–5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45–0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01–1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61–3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69–5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). Conclusion: In ACS patients, the ORBIT score independently predicted major bleeding.
Citation - WoS: 3
Citation - Scopus: 3
The prognostic value of ORBIT risk score in predicting major bleeding in patients with acute coronary syndrome
(ScienceDirect, 2023) Günlü, Serhat; Arpa, Abdulkadir; Kayan, Fethullah; Güzel, Tuncay; Kılıç, Raif; Aktan, Adem; Altintaş, Bernas; Karahan, Mehmet Zülkif
Background: The most significant adverse effect of antithrombotic medication in acute coronary syndrome (ACS) is major bleeding, which is related to increased mortality. Studies on ORBIT risk score in predicting major bleeding in ACS patients are limited. Objective: This research aimed to examine whether the ORBIT score calculated at the bedside can identify major bleeding risk in patients with ACS. Methods: This research was retrospective, observational, and conducted at a single center. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value of CRUSADE and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. Discrimination and reclassification performances were evaluated by the integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: The study included 771 patients with ACS. The mean age was 68.7 ± 8.6 years, with 35.3 % females. 31 patients had major bleeding. Twenty-three of these patients were BARC 3 A, five were BARC 3 B, and three were BARC 3 C. Bleeding history [OR (95 % CI), 2.46 (1.02-5.94), p = 0.021], hemoglobin levels [OR (95 % CI), 0.54 (0.45-0.63), p < 0.001], and age > 74 years [OR (95 % CI), 1.03 (1.01-1.06), p = 0.039] were independent predictors of major bleeding. The ORBIT score was an independent predictor of major bleeding in the multivariate analysis: continuous variables [OR (95 % CI), 2.53 (2.61-3.95), p < 0.001] and risk categories [OR (95 % CI), 3.06 (1.69-5.52), p < 0.001]. Comparison of c-indexes for major bleeding events revealed a non-significant difference for the discriminative ability of the two tested scores (p = 0.07) with a continuous NRI of 6.6 % (p = 0.026) and an IDI of 4.2 % (p < 0.001). Conclusion: In ACS patients, the ORBIT score independently predicted major bleeding.
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.