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Coronary artery perforation is a serious and potentially life-threatening complication of percutaneous coronary intervention. Although there are a few treatment options available, such as coil or fat tissue embolization and stent-graft implantation, the closed-loop balloon-stent technique can be especially effective for thin vessel ruptures. In this case report, we demonstrate the successful application of the closed-loop balloon-stent embolization for a perforation of the distal left anterior descending artery, a procedure which, to our knowledge, has not been previously documented in the literature.

Objective: This study aimed to describe the effects of new academic criteria established in 2016 on the abstracts of the National Congress of the Turkish Society of Cardiology., Methods: The abstracts presented at 13 consecutive annual congresses were obtained. A literature search was conducted with PubMed, Google Scholar, and Web of Science databases to analyze whether the abstract was published in a scientific journal. The study was divided into 2 time groups according to the new academic criteria published in 2016. Group 1 included 4828 abstracts accepted at National Congress of the Turkish Society of Cardiology between 2009 and 2016, while Group 2 included 2284 abstracts accepted at National Congress of the Turkish Society of Cardiology between 2017 and 2021., Results: A total of 7112 abstracts were accepted for the 2009-2021 National Congress of the Turkish Society of Cardiology meetings scientific program. The publication rate (43.2% vs. 23.9%, P < 0.001), number of authors [7(5-9) vs. 4(3-6), P < 0.001], and rate of original investigation (72.3 vs. 56.5%, P < 0.001) were significantly lower in group 2 than in group 1. Among the quality parameters of the journals in which the abstracts were published, the impact factor (0.59 ± 1.71 vs. 0.26 ± 1.09, P < 0.001), the rate of journals in science citation index or science citation index-expanded indexes (70.4 vs. 57.9%, P < 0.001), and the rate of the second or third-quartile class (24.2 vs. 16.1%, P < 0.001) were significantly lower in group 2 as compared to group 1. Being in group 1 oral presentation, original investigation, and cardiac imaging were identified as independent predictors for publication in scientific journals., Conclusion: This study showed that the 2016 new academic criteria negatively affected the publication processes of accepted abstracts in National Congress of the Turkish Society of Cardiology.

Coronary bifurcation lesions account for 15%-20% of all percutaneous coronary interven tions and are associated with greater procedural complexity and consequently at higher risk for cardiac adverse events. Early clinical trials in the interventional approach to bifurcation lesions supported provisional stenting. However, the most recent randomized studies have indicated potentially superior results using a double-kissing crush technique, particularly for unprotected distal left main bifurcation lesions. Moreover, many operators recently favor double-kissing mini-culotte, nanocrush, and double-kissing nanocrush stenting techniques for bifurcation lesions. In this review, we describe the traditional and novel bifurcation stenting techniques and the current evidence for each and review general principles for bifurcation percutaneous coronary intervention.

Objective: Infective endocarditis (IE)-related ST elevation myocardial infarction (STEMI) is extremely rare. A clear clinical consensus is lacking regarding the management of this emergency. In this study, we aimed to describe the clinical outcomes of treatment strategies in this patient population., Methods: The study population comprised 19 retrospectively evaluated patients (nine women; mean age 52±11.8 years) with a diagnosis of IE-related STEMI. Transesophageal echocardiography detected vegetation in all the patients. The study population was divided into two groups on the basis of in-hospital mortality., Results: Major clinical manifestations included dyspnea (89.5%), fever (78.9%), and chest pain (63.2%). Catheter-based coronary angiography was performed in all the patients. The causative agent was isolated in all the cases, and Staphylococcus aureus was identified in seven (36.8%). The most common infarction was in the left anterior descending artery (n=12 [63.2%]). The treatment strategy consisted of mechanical thrombectomy (n=1), valve replacement following stent implantation (n=5), direct balloon angioplasty (n=4), valve replacement along with coronary artery bypass grafting (CABG; n=6), and medical follow-up (n=3). Moreover, thrombolysis in myocardial infarction III flow was significantly higher in the survival group (100% vs. 0%, p<0.001). All these patients preferred CABG or stent implantation for revascularization., Conclusion: The current data suggest that a revascularization strategy with stent implantation or revascularization with CABG has a lower mortality rate in patients with IE-related STEMI.

Objective: The optimal treatment modality for left main coronary artery (LMCA) disease is still controversial. The aim of this study was to investigate long-term prognostic determinants of percutaneous coronary intervention (PCI) for LMCA disease and the role of coronary artery disease (CAD) severity in this population., Methods: A total of 60 consecutive patients who underwent LMCA PCI were enrolled in this study. Baseline demographic and clinical variables were recorded, as well as the SYNTAX score (SS), SS II, and residual SS (rSS). The primary endpoints of the study were all-cause death, non procedural myocardial infarction (MI), and stroke. The patients were then divided into 2 groups: patients without a composite endpoint (Group 1) and those with a composite endpoint (Group 2)., Results: Of the 60 patients, 15 (25%) were female and the mean age was 59.8±14.7 years. The median follow-up time was 25 months (range: 12-33 months). A primary composite endpoint was observed in 16 patients (26.7%): mortality occurred in 10 patients (16.7%), 4 (6.6%) experienced MI, and stroke was seen in 2 patients (3.3%). Target vessel revascularization was performed in 3 patients (5%). The mean SYNTAX score (Group 1: 19.9±9.8; Group 2: 26.8±12.2; p=0.029), SS II PCI (Group 1: 27.7 [range: 17.7-36.8]; Group 2: 34.2 [range: 27.9-55.2]; p=0.030) and rSS (Group 1: 0 [range: 0-5]; Group 2: 12.5 [range: 3.5-22.5]; p=0.001) were higher in patients with a composite endpoint. Additionally, creatinine (odds ratio [OR]: 13.098; 95% confidence interval [CI]: 1.471-116.620; p=0.021), non-postdilatation (OR: 8.340; 95% CI: 1.230-56.570; p=0.030), and rSS (OR: 1.157; 95% CI: 1.024-1.307; p=0.019) were independent predictors of a primary composite endpoint., Conclusion: CAD severity has prognostic value for mortality, MI, and stroke in patients who undergo unprotected LMCA PCI. An increased initial SS and post-procedural rSS were related to adverse cardiovascular outcomes. The rSS was also an independent predictor of major adverse cardiac and cerebrovascular events and mortality.

Objective: Stress is known to be a significant risk factor for coronary atherosclerosis and adverse cardiovascular events; however, the stress-related coronary atherosclerotic burden has not yet been investigated. The aim of this study was to investigate the relationship between the Perceived Stress Scale (PSS) and the SYNTAX scores in patients with ST-segment elevation myocardial infarction (STEMI)., Methods: A total of 440 patients with STEMI were prospectively enrolled and divided into 2 groups according to the PSS score with a ROC curve analysis cut-off value of 17.5. In all, 361 patients with a low PSS score were categorized as Group 1 and 79 patients with a high PSS score were categorized as Group 2., Results: The SYNTAX score [Group 1, 16.0 (10.0-22.5); Group 2, 22.5 (15.0-25.5); p<0.001] and the SYNTAX score II were significantly higher in Group 2 [Group 1, 24.8 (19.0-32.6); Group 2, 30.9 (22.3-38.9); p<0.001]. Spearman analysis demonstrated that the PSS score was associated with the SYNTAX score (r=0.153; p=0.001) and the SYNTAX score II (r=0.216; p<0.001). Additionally, the PSS (odds ratio: 2.434, confidence interval: 1.446-4.096; p=0.001) was determined to be an independent predictor of a moderate-to-high SYNTAX score. The PSS score of patients with in-hospital mortality was also higher than those who survived [15 (10-20); 9 (4-16), respectively; p=0.007]., Conclusion: Stress appears to accelerate the coronary atherosclerotic process and the associated burden. An increased stress level was found to be an independent predictor of a high SYNTAX score.

Objective: The prognostic nutritional index (PNI), based on serum albumin and lymphocyte concentration, is an inflammation-based nutritional score that has been shown to be a prognostic determinant in several populations. The aim of this study was to investigate the impact of PNI on mortality in patients with infective endocarditis (IE)., Methods: A total of 131 patients with IE were enrolled in this retrospective study. The patients were divided into 2 groups based on in-hospital mortality. The PNI value of the patients was evaluated, as well as baseline clinical and demographical variables., Results: Among the study group, 29 patients died in-hospital during the median follow-up of 37 days. The PNI was found to be lower in cases of mortality (35.90±6.96; 31.09±5.88; p=0.001). ROC curve analysis also demonstrated that the PNI had a good predictive value for in-hospital mortality with a cut-off value of 35.6 (Area under the curve: 0.691; 95% confidence interval [CI]: 0.589-0.794; p=0.002). In multivariate logistic regression analysis, advanced age (Odds ratio [OR]: 1.078; 95% CI: 1.017-1.143; p=0.012), PNI (OR: 0.911; 95% CI: 0.835-0.993; p=0.034), and leaflet perforation (OR: 5.557; 95% CI: 1.357-22.765; p=0.017) were found to be independent predictors of mortality. Kaplan-Meier survival analysis revealed that long-term survival was found to be significantly decreased in patients with a lower PNI (Log rank: p=0.008)., Conclusion: The PNI result was associated with an increased in-hospital mortality rate in patients with IE. The PNI value, advanced age, and cardiac valve perforation as a complication of IE were found to be independent predictors of mortality.

Objective: The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF., Methods: This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared., Results: In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III-IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group., Conclusion: The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.

Objective: In patients with aortic stenosis (AS), the left ventricular (LV) geometry changes due to the increased LV afterload. However, subclinical myocardial dysfunction can develop despite a normal LV ejection fraction (EF). This study was an investigation of subclinical LV systolic dysfunction in patients with severe AS with a normal LV EF using a strain imaging method, speckle-tracking echocardiography (STE), and an evaluation of its correlation with novel indices to assess the severity of AS., Methods: A total of 45 asymptomatic patients with severe AS and 25 age- and sex-matched controls without any cardiac disease and with preserved LV EF (EF ≥60%) were studied. In addition to performing conventional echocardiography and STE-based strain imaging, novel indices (energy loss index [ELI], valvulo-arterial impedance, systemic arterial compliance) were also measured., Results: The LV EF, and the LV end-diastolic and end-systolic diameters were similar in the 2 groups. The LV longitudinal peak systolic strain (10.66±1.15% to 19.66±2.62%; p=0.0001) and strain rate (0.32±0.07 s-1 to 1.85±0.32 s-1; p=0.0001) were significantly impaired in the study patients compared to the controls, demonstrating subclinical ventricular systolic dysfunction. A significant positive correlation was observed between the ELI and the LV strain/strain rate (r=0.45, p=0.002; r=0.55, p=0.0001, respectively)., Conclusion: Patients with severe AS develop subclinical LV systolic dysfunction, despite a preserved EF. Novel strain imaging-based echocardiographic techniques may provide additional data that can detect early myocardial systolic deterioration in these patients.

Objective: Clopidogrel inhibits platelet aggregation by blockade of platelet adenosine diphosphate (ADP) P2Y12 receptor. Leptin is the obesity gene product, and its serum level increases with obesity. Platelets have leptin receptors on their surfaces. Hyperleptinemia may induce ADP-mediated platelet aggregation. It has been proposed that clopidogrel effect could be diminished with high serum leptin levels. The aim of the present trial was to further investigate the relationship between serum leptin level and clopidogrel resistance., Methods: A total of 100 subjects who underwent percutaneous coronary intervention were enrolled. Two groups were organized according to presence of clopidogrel resistance, and serum leptin levels were compared. Threshold for clopidogrel resistance and hyperleptinemia were accepted as ≥P2Y12 reaction unit (PRU) 240 and ≥15 ng/mL leptin, respectively. Body mass index (BMI) of 30 kg/m2 or greater was considered obese., Results: A total of 37% of patients were considered clopidogrel-resistant. Comparison of groups revealed significantly higher clopidogrel resistance (p=0.017) and PRU levels (p=0.001) in hyperleptinemic patients. No significant difference in serum leptin levels (p=0.116) was found. Increased clopidogrel resistance was observed in patients with BMI >30 kg/m2 (p=0.015)., Conclusion: Clopidogrel resistance is more common in obese and hyperleptinemic patients. Dosage should be individualized in these populations.

Objective: Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation between EAT, CIMT, and DELC had yet to be studied. The present objective was to analyze this association., Methods: Subjects were apparently healthy individuals referred to the cardiology outpatient clinic. A total of 65 subjects with DELC and 65 age- and sex-matched controls without DELC were enrolled. EAT thickness and CIMT were measured and analyzed., Results: Epicardial adipose tissue thickness was significantly higher in the DELC group (0.57±0.12 vs. 0.35±0.05; p<0.0001). CIMT was also significantly higher in DELC group (0.85±0.16 vs. 0.60±0.15; p<0.0001). Correlation analysis showed that CIMT was significantly correlated with EAT thickness (r: 0.594; p<0.0001). Linear regression analysis showed that presence of DELC was independently associated with CIMT and EAT thickness., Conclusion: A significant and independent association between the presence of DELC and increased CIMT and EAT thickness was presently determined, for the first time, in subjects free of clinical cardiovascular disease.