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Objective: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial., Methods: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded., Results: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]., Conclusion: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions.

Objective: The time in therapeutic range (TTR) of international normalized ratio (INR) is essential for the safety and efficacy of warfarin treatment. In this study, we aimed to determine TTR and the factors that affect TTR in patients using warfarin., Methods: Patients taking warfarin for valvular and nonvalvular atrial fibrillation (AF) or prosthetic heart valves who were admitted to our cardiology outpatient clinic were enrolled. TTR was calculated using the linear interpolation method. The patients were analyzed according to warfarin indications and TTR efficiency (TTR ≥60%). Weekly warfarin dose, the duration of warfarin use, the frequency of INR visits per year, and the awareness of patients regarding target INR were noted., Results: The TTR of 248 patients (aged 57.21±12.45 years, 33.1% male) was 55.92±27.84%, and 48.0% patients exhibited efficient TTR. Clinical and demographic characteristics (age, sex, socioeconomic status, and comorbidities) exerted no effect on TTR and TTR efficiency. The frequency of INR visits per year was 10.02±3.80. TTR was related to the frequency of annual INR visits (r=0.131, p=0.039). Only one-third (30.2%) of patients were aware of their target INR. The literacy of the patients and duration of warfarin use exerted a positive effect on awareness (p=0.011 and p=0.024, respectively)., Conclusion: The findings of our study demonstrated that TTR and TTR efficiency were low and not associated with the characteristics of patients or indications. Unfortunately, in patients with valvular AF and prosthetic valves, warfarin is the sole drug that can be used. Thus, awareness and knowledge regarding target INR are essential to overcome poor anticoagulation monitoring with frequent INR visits.

Objective: Acute pulmonary embolism (APE) is a serious clinical situation and atrial fibrillation (AF) is the most common arrhytmia in clinical practice. The Pulmonary Embolism Severity Index (PESI) is an accepted risk stratification tool used to predict short term mortality in APE. The aim of this study was to evaluate the relationship between the PESI score and new-onset AF in patients with APE., Methods: The records of 869 APE patients admitted between May 2012 and December 2015 were evaluated retrospectively. The PESI score was calculated for every patient. Clinical variables associated with new-onset AF in APE were assessed after the exclusion of patients with hypertension, coronary or hemodynamically significant valvular heart disease, hepatic or renal dysfunction, chronic obstructive pulmonary disease, thyroid dysfunction, diabetes mellitus, sleep apnea, any history of inflammatory or infectious disease, or recent trauma. New-onset AF was detected in 42 (4.8%) patients., Results: Age, gender, systolic and diastolic blood pressure, heart rate, fasting glucose level, serum creatinine, left ventricle ejection fraction, tricuspid annular plane systolic excursion value, and pulmonary artery systolic pressure measures were not significantly different between patients with and without AF. New-AF patients demonstrated larger LVEDD and LAD dimensions (p <0.001 for both). The PESI score was higher in the new-onset AF group (93+-23 vs.75+-17; p <0.001). LVEDD, LAD, levels of uric acid, bilirubin, albumin, and troponin, and PESI score were univariate predictors of new-onset AF., Conclusion: In patients with APE, the PESI score was positively correlated with new-onset AF. A PESI score greater than 82.50 may be useful to predict new-onset AF in these patients.

Objective: The aim of this study was to determine the relationship between serum uric acid (UA) level and the predicted risk score for sudden cardiac death in 5 years (the HCM Risk-SCD), galectin-3 level, and positive fragmented QRS (fQRS) on electrocardiography (ECG) in patients with hypertrophic cardiomyopathy (HCM)., Methods: This was a prospective, observational study. In all, 115 consecutive patients (age >17 years) with HCM and 80 healthy participants were included in the study. The HCM Risk-SCD score (%), galectin-3 level, and fQRS on ECG were evaluated in all patients., Results: The serum UA, galectin-3 level, UA/Creatinine ratio, incidence of ventricular tachycardia (VT) and syncope, and some echocardiographic parameters were significantly higher in the patient group than in the control group (all p<0.05). The UA value was significantly higher in patients with a high score on the HCM Risk-SCD, a positive fQRS, a high galectin-3 level, VT incidence, and need for implantable cardioverter defibrillator (ICD) implantation or cardiopulmonary resuscitation (CPR) than in those without (HCM Risk-SCD >6%. Namely, HCM Risk-SCD >6%, UA: 6.71±1.29 mg/dL, HCM Risk-SCD ≤5.9%, UA: 5.84±1.39 mg/dL, p=0.001; fQRS(+), UA: 6.56±1.20 mg/dL, fQRS(-), UA: 5.63±1.49 mg/dL, p<0.001; galectin-3 >6.320 pg/mL, UA: 6.56±1.27 mg/dL, galectin-3 ≤6.310 pg/mL, p=0.016; left atrium anterior-posterior dimension (LAAPD) >36 mm, UA: 6.31±1.33 mg/dL, LAAPD <36 mm, UA: 5.20±1.60 mg/dL, p=0.005; VT(+), UA: 6.83±1.19 mg/dL, VT(-), UA: 5.97±1.42 mg/dL, p=0.008; ICD(+), UA: 7.08±0.88 mg/dL, ICD(-), UA: 6.06±1.42 mg/dL, p=0.022; CPR(+), UA: 7.03±0.96 mg/dL, CPR(-), UA: 6.04±1.42 mg/dL, p=0.018. A statistically significant correlation was observed between UA and HCM Risk-SCD, galectin-3 level, LAAPD, and left ventricular (LV) mass (LVM) (r and p values, respectively: 0.355, <0.001; 0.297, 0.002; 0.309, 0.001; 0.276, 0.003., Conclusion: The serum UA level was significantly higher in patients with HCM compared with the control group. A high UA level was associated with a higher HCM Risk-SCD score, positive fQRS, higher galectin-3 level, greater LAAPD, VT incidence, and the need for ICD implantation and CPR in patients with HCM.

Objective: Right ventricular (RV) functions are clinically important in acute pulmonary embolism (APE). Measurement of systolic function of the right ventricular outflow tract (RVOT) with echocardiography is a simple method to evaluate RV function. The aim of this study was to determine the relationship between RVOT systolic function and the Pulmonary Embolism Severity Index (PESI)., Methods: A total of 151 patients diagnosed with APE by pulmonary computed tomography angiography or ventilation/perfusion scintigraphy were included. Patients were assigned to 2 groups based on the simplified PESI (sPESI): sPESI <1 (n=85) and sPESI ≥1 (n=66). RV conventional parameters, RVOT dimensions, and fractional shortening (RVOT-FS) were also measured., Results: Mean age was similar between sPESI <1 and >1 patients (58.7±12.9 years vs. 61.1±12.7 years, respectively). Frequency of male gender was significantly higher in PESI <1 group (61.2% vs. 40.2%, p=0.013). No significant differences were found between the groups in fasting glucose, serum creatinine, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, troponin, and D-dimer levels, and left ventricular ejection fraction. RVOT-FS was higher in patients with sPESI <1 than in patients with sPESI ≥1 (34.41±3.56 vs. 22.98±4.22), and this difference was significant (p<0.001). Tricuspid annular plane systolic excursion values were lower and pulmonary artery systolic pressure values were higher in the sPESI ≥1 group, which was also statistically significant (p<0.05). Mortality occurred in 7 patients with sPESI <1 and in 16 patients with sPESI ≥1. The mortality rate was higher in patients with lower RVOT-FS, and a RVOT-FS <0.22 predicted mortality with a sensitivity of 54.5% (AUC: 0.674, 95% CI 0.552-0.796; p=0.009)., Conclusion: The RVOT-FS is a noninvasive measurement of RV systolic function, is well-correlated with the sPESI score, and associated with mortality in patients with APE. This easily applied measurement may be used to predict short-term mortality in patients with APE.

Cardiac mass can be described as an abnormal structure within or directly contiguous to the heart. Tumors and thrombi are the most common types of cardiac masses. Intracardiac thrombi have been encountered in various clinical settings and can result in severe morbidity and mortality due to embolic events. Cardiac neoplasms are extremely rare, and are usually metastatic tumors. The major primary malignancies associated with cardiac metastases include cancers of the lung, breast, stomach, and liver, and lymphoma, leukemia, and melanoma. Osteosarcoma (OS) is the most common type of bone malignancy, and is almost always highly malignant. A previous study demonstrated that OS very rarely metastasizes to the heart. Presently reported is an unusual case of OS with intracaval, right atrial, and right ventricular extension that was misdiagnosed as venous thrombus.

Objectives: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients., Study Design: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization)., Results: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016., Conclusion: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

Objectives: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study., Study Design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed., Results: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect., Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

Objectives: The iso-osmolar contrast agent iodixanol may be associated with fewer contrast-induced acute kidney injuries when compared with low-osmolar contrast agents. The aim of this study is to compare iodixanol and iopamidol in patients with acute coronary syndrome (ACS) who are currently undergoing coronary angiography., Study Design: Two hundred and seventy five consecutive patients who presented to a tertiary cardiovascular center with acute non-ST elevation myocardial infarction and underwent coronary angiography as a part of an early invasive strategy were included in the study (mean age 58±11 years, 79% male). Study participants were administered either iodixanol (n=45) or iopamidol (n=230) and the groups were compared for the highest creatinine levels, the absolute and percent change in creatinine levels, and for the development of contrast induced nephropathy within 72 hours of the procedure., Results: Baseline demographic and clinical characteristics of the patients were similar between the two groups. There were no differences in the preprocedural serum creatinine (iopamidol 1.10±0.54 mg/dl, iodixanol 1.09±0.24 mg/dl, p=0.680), glomerular filtration rate (iopamidol 89±35 ml/dk/1.73 m(2), iodixanol 89±26 ml/dk/1.73 m(2), p=0.934), or contrast volume used during the procedure (iopamidol 180±80 ml vs. iodixanol 166±73 ml, p=0.226) between the groups. The absolute change in serum creatinine after the procedure (iopamidol 0.136±0.346 mg/dl, iodixanol 0.072±0.070 mg/dl, p=0.118) and the percent change in serum creatinine after the procedure (iopamidol 12.1±29.6%, iodixanol 6.8±6.9%, p=0.075) were not statistically significant between the two groups. Contrast induced nephropathy developed 10% (95% confidence interval [CI] 6-14%) in iopamidol group whereas it was 2.2% (95% CI -2-7%) in iodixanol group (p=0.144)., Conclusion: Iodixanol was not superior to iopamidol regarding contrast induced acute kidney injury after coronary angiography in an unselected general patient population with ACS.

Objectives: We investigated the effect of chronic kidney disease (CKD) on in-hospital results in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction (STEMI)., Study Design: The study included 2,486 patients (2,070 men, 416 women) who were treated with primary angioplasty for STEMI. Of these, 273 patients (11%) were found to have CKD (glomerular filtration rate <60 ml/min/1.73 m2) before the procedure. Patients with and without CKD were evaluated with respect to demographic and clinical features, primary angioplasty findings, and in-hospital clinical results., Results: Patients with CKD exhibited a higher mean age, Killip class, and higher frequencies of female gender, diabetes, hypertension, anemia, and previous myocardial infarction (p<0.05). Angioplasty showed higher rates of right coronary artery lesion, multivessel disease, contrast nephropathy, unsuccessful procedure, and increased stenosis rate and stent length in CKD patients (p<0.05). Cardiovascular mortality occurred in 11.7% and 1.4% of patients with and without CKD, respectively (p<0.001). Patients with CKD had significantly higher incidences of target vessel revascularization, major cardiac events, stroke, cardiopulmonary resuscitation, hemodialysis, ventricular tachycardia/fibrillation, severe heart failure, cardiogenic shock, and significant hemorrhage (p<0.05). Multivariate analysis showed that CKD was an independent predictor of mortality (OR=4.1, 95% CI 1.83-9.17; p=0.001)., Conclusion: Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality.

Objectives: We evaluated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) due to saphenous vein graft (SVG) occlusion., Study Design: We reviewed 2,646 consecutive patients (mean age 56.6±11.8 years) who underwent primary PCI for STEMI between 2003 and 2009. All clinical and angiographic data and in-hospital and long-term (median 22 months) outcomes were retrospectively collected. The patients were classified into two groups based on the lesions treated with primary PCI, i.e., native vessels (n=2,625) and SVG (n=21)., Results: Compared to patients with occluded native vessels, patients with SVG occlusion had significantly higher rates of coronary bypass operation (100% vs. 2.3%, p<0.001), previous myocardial infarction (52.4% vs. 10.8%, p<0.001), and diabetes mellitus (52.4% vs. 25.1%, p=0.002), but lower frequency of anterior myocardial infarction (9.5% vs. 49.3%, p<0.001). Tirofiban use (71.4% vs. 48.2%, p=0.01) and three-vessel disease (81% vs. 25.6%, p<0.001) were significantly more common in the SVG group. The rate of successful primary PCI was lower in SVG occlusions compared to native vessels (61.9% vs. 84.7%, p=0.01). The two groups did not differ significantly with respect to in-hospital and long-term cardiovascular events and mortality (p>0.05). In multivariate logistic regression analysis, application of PCI to SVG was found to be an independent predictor for unsuccessful procedure (OR 6.76, 95% CI 2.05-22.21; p=0.002)., Conclusion: Although the success rate of primary PCI in SVG lesions was lower compared to native vessels, this did not have an adverse effect on postprocedural cardiovascular events and mortality in patients presenting with STEMI.

Objectives: We investigated the prevalence, distribution, risk factors, and prognosis of coronary artery ectasia (CAE) in patients undergoing coronary angiography for suspected coronary artery disease (CAD)., Study Design: Of 4,119 patients undergoing elective coronary angiography between 2003 and 2005, 173 patients (139 males, 34 females; mean age 61+/-11 years) had CAE, with a prevalence of 4.2%. Distribution of CAE was made according to the classification of Markis et al. The results were compared with those of 145 control patients (115 males, 30 males; mean age 61+/-10 years) who had CAD but not CAE. Following coronary angiography, treatment was designed as aortocoronary bypass (n=3), percutaneous coronary intervention (n=36), and medical therapy (n=98). The mean follow-up was 34.2+/-2.5 months., Results: Among CAE patients, there was a marked male preponderance with 80.3%. Coronary ectasia was isolated in 46 patients (26.6%) and was associated with significant coronary artery stenoses in 127 patients (73.4%). The only significant difference with the control group with respect to baseline features was the higher frequency of hypertension in the CAE group (p=0.002). Coronary ectasia involved a single vessel in 67.1%, two vessels in 24.9%, and three vessels in 8.1%, with the right coronary artery being the most common localization (50.9%). The diameters of ectatic coronary arteries ranged from 3.2 mm to 9.7 mm (mean 5.6 mm). According to the classification of Markis et al., the majority of patients (64.2%) had type IV ectasia. In multiple regression analysis, hypertension was independently associated with CAE (OR: 0.378; 95% CI: 0.211-0.678; p=0.001). Mortality occurred in nine patients (5.2%). The annual mortality rates were 1.5%, 2.1%, and 2.9% with medical therapy, percutaneous coronary intervention, and aortocoronary bypass, respectively., Conclusion: Our findings suggest that further prospective studies focus on the dependent relationship between hypertension and CAE, and on marked coexistence of CAD and CAE.