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    Comparison of traditional risk factors, angiographic findings, and in-hospital mortality between smoking and nonsmoking turkish men and women with acute myocardial infarction
    (2010) Aygül, Nazif; Özdemir, Kurtuluş; Abacı, Adnan; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Yazıcı, Hüseyin Uğur; Özdoğru, İbrahim; Karakaya, Ekrem
    Background: The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. Hypothesis: The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. Methods: This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. Results: The proportion ofmale smokers was significantly higher than that ofwomen (68%vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had lessmultivessel disease andless comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. Conclusions: Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI betweenmen and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking. © 2010 Wiley Periodicals, Inc.
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    Emergency revascularization procedures in patients with acute ST-elevation myocardial infarction due to acute total occlusion of unprotected left main coronary artery: A report of five cases
    (Turkish Anaesthesiology and Intensive Care Society, 2010) Aygül, Nazif; Aygül, Meryem Ülkü; Özdemir, Kurtuluş; Altunkeser, Bülent Behlül
    Several studies have compared the efficacy of elective coronary artery stenting and coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery (ULMCA) disease. However, a definite reperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI) due to acute total occlusion of ULMCA, which has catastrophic clinical results. We presented five patients (3 males, 2 females; mean age 59 years; range 53 to 67 years) with acute anterior STEMI and angiographically documented acute total occlusion of ULMCA. On presentation, all the patients had chest pain and four patients were in cardiogenic shock. All the patients were taken to the catheterization room with minimum delay. Intra-aortic balloon counterpulsation was used during coronary angiography in all the patients. Three patients underwent PCI and, after balloon predilatation, bare-metal stents were implanted and TIMI III flow was achieved. One patient who had atrial fibrillation on admission died on the 14th day of hospitalization after PCI due to pump failure. After diagnostic coronary angiography, two patients were submitted to surgery for emergency CABG. They both died, one within two hours of admission during preparation of the surgical team, and the other on the third postoperative day. Both were in cardiogenic shock on admission.
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    Intravenous N-acetylcysteine Plus High-dose Hydration Versus High-dose Hydration and Standard Hydration for the Prevention of Contrast-induced Nephropathy: CASİS-A Multicenter Prospective Controlled Trial
    (Elsevier Ireland Ltd, 2012) Koç, Fatih; Özdemir, Kurtuluş; Kaya, Mehmet Güngör; Doğdu, Orhan; Vatankulu, Mehmet Akif; Ayhan, Selim; Erkorkmaz, Ünal; Sönmez, Osman; Aygül, Meryem Ülkü; Kalay, Nihat; Kayrak, Mehmet; Karabağ, Turgut; Alihanoğlu, Yusuf İzzettin; Günebakmaz, Özgür
    Background: Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. We investigated the efficacy of prophylactic intravenous (IV) N-acetylcysteine (NAC) and hydration for the prevention of CIN in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods: A total of 220 patients who had mild to moderate renal dysfunction with serum creatinine (SCr) >= 1.1 mg/dL or creatinine clearance <= 60 mL/min were randomized in 3 groups: 80 patients were assigned to IV NAC plus high-dose hydration with normal saline, 80 patients to only high-dose hydration with normal saline and 60 patients to standard hydration with normal saline (control group). The primary end point was the alteration of SCr level. The secondary end point was the development of CIN after the procedure. Results: SCr levels changed the least in the NAC plus high-hydration group (P=0.004). The rate of the CIN in the NAC plus high-dose hydration group was also lower than the high-dose hydration group (P=0.006). No significant differences in the primary and secondary end points were found between high-dose hydration and control group. Conclusion: The results of this study suggest that NAC plus high-dose hydration was superior to high-dose hydration alone as well as standard hydration for the protection of renal functions in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or PCI. High-dose hydration without NAC was not better than standard hydration alone.
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    Percutaneous Coronary Intervention of a Single Coronary Artery Originating From Right Sinüs of Valsalva in a Patient With Inferior Myocardial Infarction
    (2010) Aygül, Nazif; Aygül, Meryem Ülkü; Altunkeser, Bülent Behlül
    Sol ana koroner arterin tek koroner arter olarak sağ Valsalva sinüsünden çıkması oldukça nadir görülen bir koroner arter çıkış anomalisidir. Literatürde insidansı genel popülasyonda %0.017, koroner arter anomalileri içerisinde ise %1.3 olarak bildirilmektedir. Bu anomali sıklıkla çocukluk veya genç erişkinlik döneminde miyokardiyal iskemi veya ani ölümle karakterizedir. Biz bu yazıda, sağ Valsalva sinüsünden çıkan tek koroner artere sahip, inferiyor duvar miyokard infarktüsü ile kliniğe başvuran 75 yaşında bir olguyu takdim etmeyi amaçladık.
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    Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia
    (TURKISH SOC CARDIOLOGY, 2009) Aygül, Nazif; Özdemir, Kurtuluş; Abacı, Adnan; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Vatankulu, Mehmet Akif; Yazıcı, Hüseyin Uğur
    Objective: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). Methods: This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A - age <= 44 years; Group B - age 45-64 years; and Group C - age >= 65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated. Results: The mean age was 58+/-11 years (range 24-96 years). Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DIM (p<0.001). Prevalence of smoking was the highest in young patients and males (p<0.001). Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001). Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average. Conclusions: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors. (Anadolu Kardiyol Derg 2009; 9: 3-8)
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    Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and in-hospital outcome in ST-elevation myocardial infarction: an electrocardiographic predictor of poor prognosis
    (CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS, 2008) Aygül, Nazif; Özdemir, Kurtuluş; Tokaç, Mehmet; Aygül, Meryem Ülkü; Düzenli, Mehmet Akif; Abacı, Adnan; Bacaksız, Ahmet; Yazıcı, Hüseyin
    Background: We aimed to investigate the value of ST elevation in lead aVR (ST up arrow aVR) in predicting the left anterior descending coronary artery (LAD) occlusion site proximal to first septal perforator (SI) and its effect on in-hospital outcome in ST-elevation myocardial infarction (STEMI). Methods: The study included 950 patients with STEMI. Patients were divided into 2 groups as aVR (+) and aVR(-)according to the presence of an ST up arrow aVR of 0.5 mm or greater. Results: ST elevation in lead aVR was seen in 155 (16%) patients, and LAD occlusion proximal to S, was detected in 52% of patients in the aVR(+) group and in 9% of patients in the aVR(-) group. aVR positivity was associated with higher heart rate, lower systolic blood pressure and ejection fraction, and worse Killip class at the hospital admission. In-hospital mortality was 19% in the aVR(+) group and 5% in the aVR(-) group. aVR positivity was an independent predictor of in-hospital death. Conclusion: This study revealed that ST up arrow aVR was not only a good indicator of LAD occlusion proximal to S, but also a source of valuable information about in-hospital outcome in patients with STEMI. (C) 2008 Elsevier Inc. All rights reserved.