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Ilac salinimli stentlerin (ISS) sistemik anti-inflamatuar ozelliklerinin olabilecegi ve bunun restenoz oranlarindaki dususte rol oynayabilecegi iddia edilmektedir. Bu calismanin amaci, ciplak metal stentler (CMS) ile ilac salinimli stentleri sistemik inflamasyonun iyi bir gostergesi olan C-reaktif protein (CRP) duzeyleri uzerine etkileri acisindan karsilastirmakti. Ayrica inflamasyon duzeyi ile miyonekroz ve istenmeyen kardiyak olaylar arasindaki iliskinin arastirilmasi da amaclandi.Gerec ve Yontem: Elektif koroner stent uygulanan hastalar stent tipine gore CMS (n=70) ve ISS gruplarina (n=42) ayrildi. Bazal ve islem sonrasi 24. saatteki CRP ve CKMB duzeyleri olculerek aradaki fark (?-delta) gruplar arasinda kiyaslandi. Hastalar bir yil boyunca istenmeyen kardiyak olaylar (olumcul olmayan miyokard infarktusu, olum ve hedef damar revaskularizasyonu) acisindan takip edildi.Bulgular: Hastalarin yas ortalamasi 62±11 olup %75'i erkek idi. Iki stent grubu bazal ozellikleri acisindan kiyaslandiginda diyabet, hipertansiyon ve metabolik sendromu olan hastalar CMS grubunda anlamli olarak daha fazlaydi. Her iki stent grubunda da 24. saatte anlamli duzeyde CRP artisi olmasina ragmen ?CRP duzeyi CMS grubunda 2,1 (0,5 ? 6,2) mg/L, ISS grubunda ise 2,3 (0,2 ? 5,2) mg/L olup iki grup arasinda anlamli fark saptanmadi (p=0,703). Her iki stent grubunda ?CKMB duzeyleri ve major kardiyak olay sikligi benzerdi (p=0,897 ve p=0,785). ?CRP duzeyleri ile ?CKMB arasinda her iki stent grubunda da anlamli korelasyon bulunmadi (CMS icin r= -0,090 ve p=0,459, ISS icin r=0,158 ve p= 0,318). Benzer sekilde ?CRP'nin istenmeyen kardiyak olay sikligi uzerine etkisi de anlamli degildi (CMS icin p=0,349 ve ISS icin p=0,135).Sonuc: Bulgularimiz CMS ve ISS uygulanan hastalarda islem sonrasi benzer duzeyde sistemik inflamatuar yanit olustugunu gostermektedir. Benzer sistemik inflamasyon duzeyleri altinda ISS ile saglanan restenoz oranlarindaki dususte, bu stentlerin lokal anti-inflamatuar ozellikleri rol oynuyor olabilir. Abstract It's suggested that drug eluting stents (DES) may have systemic anti-inflammatory properties and this can play a role in decreased restenosis rates. The aim of this study was to compare bare metal stents (BMS) and DES on their effects on C-reactive protein (CRP) levels, a good marker of systemic inflammation. We also aimed to investigate the relation between the inflammation levels and myonecrosis and adverse cardiac events.Materials and methods: The patients undergoing elective stent implantation were grouped according to the stent type as BMS (n=70) and DES (n=42). Basal and 24th hour postprocedural CRP and CKMB levels were measured and the difference (?- delta) was compared between the groups. The patients were followed up for adverse cardiac events (non-fatal myocardial infarction, death and target vessel revascularisation) for one year.Results: Mean age was 62±11 and 75% were males. The patients with diabetes, hypertension and metabolic syndrome were significantly higher in BMS group when the basal characteristics of the stent groups were compared. There was significant CRP rise in both groups at 24th hour, but the ?CRP level was 2,1 (0,5 ? 6,2) mg/L in BMS and 2,3 (0,2 ? 5,2) mg/L in DES group, and the difference was not statistically significant (p=0,703). ?CKMB levels and adverse cardiac event rates were similar between the two groups (p=0,897 and p=0,785). There was no correlation between ?CRP and ?CKMB levels in both groups (r= -0,090 and p=0,459 for BMS, r=0,158 and p= 0,318 for DES group). Similarly, the effect of ?CRP on the incidence of adverse cardiac events was not significant (p=0,349 for BMS group and p=0,135 for DES group).Conclusion: Our findings reveal that patients with BMS and DES implantation exhibit similar grade of systemic inflammation after the procedure. At similar levels of systemic inflammation, the local anti-inflammatory properties of DES can play a role at decreased restenosis rates.

Objectives:Cerebral infarction in patients with atrial fibrillation (AF) may vary from being clinically silent to catastrophic. Elevation of neuron-specific enolase (NSE) in the absence of any clinically apparent stroke or transient ischemic attack (TIA), so-called silent cerebral infarction (SCI), may be associated with neurologic deficits, cognitive decline and even increased mortality. We aim to evaluate the prevalence of SCI in patients with non-valvular AF who are taking oral anticoagulants.Materials and Methods:Blood samples were collected from 100 consecutive patients with non-valvular AF admitted to outpatient clinic. NSE levels of greater than 12 ng/mL was considered as SCI.Results:Patients were mainly female with a mean age of 70 years. Fourty-nine of them (49%) were taking warfarin. Mean international normalized rate level was 2.3±1.1. Fifty-one patients (51%) were on direct oral anticoagulant (DOAC) treatment [dabigatran (n=7), rivaroxaban (n=13) and apixaban (n=31)]. Mean CHA2DS2-VASc score of the study population was 3.8±1.5. Fourty-three patients (43%) were found to have NSE elevation. They were older and more likely to have history of chronic heart failure and previous stroke/TIA. Increased left atrial diameter, reduced glomeruler filtration rate, and higher CHA2DS2-VASc score were other factors associated with SCI. Patients taking DOACs and patients who were taking aspirin on top of oral anticoagulant treatment were less likely to have SCI. Multivariate analysis demonstrated higher CHA2DS2-VASc score [odds ratio (OR): 2.6; 95% confidence interval (CI): 1.3-5.1; p=0.007] and use of warfarin (OR: 3.8; 95% CI: 1.2-11.9; p=0.02) as independent predictors of SCI.Conclusion:Silent brain injury is highly prevalent among patients with non-valvular AF despite the use of oral anticoagulant therapy.