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    Clinical implication of totally occluded infarct-related coronary artery in non-ST-segment elevation myocardial infarction: the TOTAL-NSTEMI study
    (LIPPINCOTT WILLIAMS & WILKINS, 2023) Güner, Ahmet; Çörekçioğlu, Büşra; Uzun, Fatih; Kalçık, Macit; Ulutaş, Ahmet Emir
    BackgroundA subset ofpatients found to have total occlusion of the culprit artery (TOCA), present with non-ST-segment elevation myocardial infarction (NSTEMI) and elevated biomarkers. The aim of this study is to assess the effect of the TOCA in patients presenting with NSTEMI. MethodsThis multicenter observational study was retrospectively conducted between 2015 and 2019. Thrombolysis in myocardial infarction (TIMI) flow grades 0-1 was defined as the TOCA. The primary end point included a combination of all-cause death, myocardial infarction, target vessel revascularization, stent thrombosis, and stroke. ResultsOf 3272 patients, TIMI 0-1 flow in the culprit artery was present in 488 (14.9%) patients. TOCA was more likely to be of thrombotic origin (54.1% vs. 10.3%; P < 0.001) and visible collaterals (22.5% vs. 4.4%; P < 0.001). The rates of 30-day (14.3% vs. 7.2%; P < 0.001) and 2-year (25% vs. 19.1%; P = 0.003) primary end points were significantly higher in TOCA patients. Fatal arrhythmias were remarkably higher at 30-day (8.6% vs. 4%; P < 0.001) and 2-year (9% vs. 5.2%; P = 0.001) follow-ups. Mechanical complications were also higher in patients with TOCA at 30 days (0.8% vs. 0.2%; P = 0.013). Moreover, TOCA (OR, 1.379; P = 0.001) was one of the independent predictors of MACCE in NSTEMI patients. ConclusionThe current data suggest that patients with TOCA in the context of NSTEMI are at higher risk of MACCE, fatal arrhythmias, and mechanical complications.
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    Impaired repolarization parameters may predict fatal ventricular arrhythmias in patients with hypertrophic cardiomyopathy (from the CILICIA Registry)
    (Churchill Livingstone Inc Medical Publishers, 2020) Güner, Ahmet; Kalçık, Macit; Çelik, Mehmet; Uzun, Fatih; Çizgici, Ahmet Yaşar; Zencirkıran Ağuş, Hicaz; Kalkan, Mehmet Emin
    Background: Hypertrophic cardiomyopathy (HCM) is significantly associated with high risk of fatal ventricular arrhythmias (VAs). Increased frontal QRST angle (fQRSTa), Tpe interval, and Tp-e/QTc ratio are described as ventricular repolarization parameters which are related to arrhythmias. In this study, we aimed to investigate the predictive value of these repolarization parameters for fatal VAs in patients with HCM. Methods: A total of 127 HCM patients (mean age: 47.9 +/- 12.6 years; male:79) were enrolled in this retrospective study. All patients underwent transthoracic echocardiography. Moreover, the last electrocardiograms within 3 months prior to the fatal VA documentation were assessed. The primary outcome was the occurrence of fatal VAs including sustained ventricular tachycardia and ventricular fibrillation which were documented from implantable cardioverter defibrillator records. Results: There were documented fatal VAs in 37 (29.1%) patients during a mean follow-up time of 70.1 +/- 22.6 months. The prevalence of fatal VAs was significantly higher in patients with fQRSTa >= 140 degrees (67.4 vs. 7.4%; p < 0.001) and in patients with Tp-e/QTc ratio >= 0.19 (61.5 vs. 6.7%; p < 0.001) as compared to others. High Tp-e/QTc ratio (hazard ratio: 1.564; 95% confidence interval: 1.086-4.796; p = 0.032) and high fQRSTa (hazard ratio: 1.864; 95% confidence interval: 1.106-8.745; p = 0.002) were found to be independent predictors of fatal VAs in HCM patients. Conclusions: Wider fQRSTa, prolonged Tp-e interval, and increased Tp-e/QTc ratio may be associated with fatal VAs in HCM patients. In addition to traditional risk factors, these simple ECG parameters may provide valuable information during evaluation of sudden cardiac death risk in HCM patients. (C) 2020 Elsevier Inc. All rights reserved.
  • Küçük Resim
    Öğe
    Intravascular ultrasound is essential for left main coronary artery bifurcation stenting
    (Polish Cardiac Soc-Polskie Towarzystwo Kardiologiczne, 2021) Güner, Ahmet; Gültekin Güner, Ezgi; Kalçık, Macit; Uzun, Fatih; Ertürk, Mehmet
    To the editor We have recently read with great interest the article by Kassimis et al.1 We appreciate the authors’ management of the patient with iatrogenic left main coronary artery (LMCA) dissection and the technical success of LMCA bifurcation stenting. However, we believe that there are some major drawbacks that need to be addressed.
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    Öğe
    The effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures (from the COMPLEX-CAS Trial)
    (Sage Publications Ltd, 2021) Güner, Ahmet; Çelik, Ömer; Topel, Çağdaş; Yalçın, Ahmet Arif; Kalçık, Macit; Uzun, Fatih; Ertürk, Mehmet
    Background Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures. Methods We prospectively evaluated 122 patients (mean age: 69.5 +/- 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients. Results Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023-1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003). Conclusions The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis.