Kılıç, Raif
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Dr. Öğr. Üyesi
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raifkilic@artuklu.edu.tr
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Department of Internal Medical Sciences / Dahili Tıp Bilimleri Bölümü
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| Journal | Count |
|---|---|
| Coronary Artery Disease | 2 |
| Dicle Tıp Dergisi | 2 |
| BMC Cardiovascular Disorders | 2 |
| Journal of Electrocardiology | 2 |
| Aging Clinical and Experimental Research | 2 |
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Now showing 1 - 10 of 23
Article Citation - WoS: 1Citation - Scopus: 2Association Between the Triglyceride-Glucose Index and Contrast-Induced Nephropathy in Chronic Total Occlusion Patients Undergoing Percutaneous Coronary Intervention(Bmc, 2025) Soner, Serdar; Aktan, Adem; Kilic, Raif; Guzel, Hamdullah; Tastan, Ercan; Oksul, Metin; Guzel, TuncayObjective The triglyceride glucose (TyG) index is a biomarker of insulin resistance and is associated with an increased risk of cardiovascular events. Contrast-induced nephropathy (CIN) is an important complication that causes poor outcomes in patients undergoing percutaneous coronary intervention (PCI). In this study, we aimed to investigate the relationship between the TyG index and CIN and mortality in patients who underwent PCI due to chronic total coronary occlusion (CTO). Methods Two hundred eighteen individuals from three separate medical centers who underwent procedural PCI between February 2010 and April 2012 and had a CTO lesion in at least one coronary artery were recruited. According to the TyG index, patients were divided into two groups. Patients with a TyG index >= 8.65 were included in Group 1, and patients with a TyG index < 8.65 were included in Group 2. Patients were followed up for 96 months. The main outcome was the development of CIN and mortality. Results The mean age of the patients (65.8 +/- 10.94 vs. 61.68 +/- 11.4, P = 0.009), diabetes mellitus (60 [44.8%] vs. 11 [13.1%], P < 0.001), and dyslipidemia rates (52 [38.8%] vs. 21 [25%], P = 0.036) were higher in group 1. In multivariable logistic regression analysis, it was seen that age (OR = 1.04, 95% CI = 1.01-1.08, P = 0.020), chronic kidney disease (OR = 2.34, 95% CI = 1.02-5.33, P = 0.044), peripheral artery disease (OR = 5.66, 95% CI = 1.24-25.91, p = 0.026), LVEF (OR = 0.95, 95% CI = 0.92-0.99, P = 0.005), LDL cholesterol levels (OR = 1.00, 95%CI = 1.00-1.02, P = 0.024) and TyG index (OR = 2.17, 95% CI = 1.21-3.89, P = 0.009) were independent predictors of the development of CIN. Conclusion Our study demonstrates a correlation between the TyG index and the prevalence of CIN in patients with CTO undergoing PCI. Adding the TyG index to the routine clinical evaluation of patients with CTO undergoing PCI may help protect patients from the development of CIN.Article 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 ZulkufBackground: 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.Article Citation - WoS: 11Citation - Scopus: 12The Effectiveness of HALP Score in Predicting Mortality in Non-ST Myocardial Infarction Patients(Lippincott Williams and Wilkins, 2025) Kiliç, R.; Guzel, T.; Aktan, A.; Güzel, H.; Kaya, A.F.; Çankaya, Y.Background: The HALP score, measured based on hemoglobin, albumin, lymphocyte, and platelet levels, is regarded as a novel scoring system that indicates the status of systemic inflammation and nutritional health. Our study aimed to evaluate the relationship between HALP score and prognosis in non-ST-elevation myocardial infarction (NSTEMI) patients. Methods Between 1 January 2020 and 1 January 2022, 568 consecutive patients diagnosed with NSTEMI from a single center were included in the study retrospectively. The patients were divided into two equal groups according to the median HALP cutoff value of 44.05. Patients were followed for at least 1 year from the date of admission. Results The average age of the patients was 62.3±10.6 years and 43.7% were female. In-hospital and 1-year mortality were found to be significantly higher in the group with low HALP scores (6.0 vs. 2.1%, P=0.019 and 22.5 vs. 9.9%, P<0.001, respectively). In receiver operating characteristic curve analysis, a cutoff level of 34.6 of the HALP score predicted 1-year mortality with 71% sensitivity and 65% specificity (area under the curve: 0.707, 95% confidence interval: 0.651-0.762, P<0.001). In Kaplan-Meier analysis, higher mortality rates were observed over time in the group with lower HALP scores (log-rank test=16.767, P<0.001). In Cox regression analysis, the HALP score was found to be an independent predictor of 1-year mortality (odds ratio: 0.969, 95% confidence interval: 0.958-0.981, P<0.001). Conclusion We found that a low HALP score could predict in-hospital and 1-year mortality in patients admitted to the hospital with a diagnosis of NSTEMI. © © 2024 Wolters Kluwer Health, Inc. All rights reserved.Article Citation - WoS: 2Citation - Scopus: 3The 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, FarukBackground: 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.Article Response to Comment Letter: The Effectiveness of HALP Score in Predicting Mortality in Non-ST Myocardial Infarction Patients(Lippincott Williams & Wilkins, 2025) Kiliç, R.; Aktan, A.; Guzel, T.Article Citation - WoS: 3Citation - Scopus: 3The 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 ZülkifBackground: 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.Article Citation - Scopus: 7The effect of coronary slow flow on ventricular repolarization parameters(ScienceDirect, 2023) Karahan, Mehmet Zülkif; Aktan, Adem; Güzel, Tuncay; Günlü, Serhat; Kılıç, RaifIntroduction: 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.Article Citation - WoS: 1Citation - Scopus: 1Comparison 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, SerhatObjective: 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.Article 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, MehmetObjective: 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.Article 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, MehmetBackground: 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.
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