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    Association Between N-Terminal Pro-Brain Natriuretic Peptide Levels and Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome
    (Wiley, 2014) Kurtul, Alparslan; Duran, Mustafa; Yarlioglues, Mikail; Murat, Sani Namik; Demircelik, Muhammed Bora; Ergun, Gokhan; Acikgoz, Sadik Kadri
    Background: Contrast-induced nephropathy (CIN) is associated with significantly increased morbidity and mortality after percutaneous coronary intervention (PCI). Patients with acute coronary syndrome (ACS) are at higher risk for CIN. N-terminal pro-brain natriuretic peptide (NT-proBNP) is closely linked to the prognosis as a strong predictor of both short-and long-term mortality in patients with ACS. Hypothesis: We hypothesized that NT-proBNP levels on admission can predict the development of CIN after PCI for ACS. Methods: A total of 436 patients (age 62.27 +/- 13.01 years; 64.2% male) with ACS undergoing PCI enrolled in this study. Admission NT-proBNP levels were measured before PCI. Serum creatinine values were measured before and within 72 hours after the administration of contrast agents. Patients were divided into 2 groups: CIN group and no-CIN group. CIN was defined as an increase in serum creatinine level of >= 0.5 mg/dL or >= 25% above baseline within 72 hours after contrast administration. Results: CIN developed in 63 patients (14.4%). Baseline NT-proBNP levels were significantly higher in patients who developed CIN compared to those who did not develop CIN (median 774 pg/mL, interquartile range 177.4-2184 vs median 5159 pg/mL, interquartile range 2282-9677, respectively; P < 0.001). Multivariate analysis found that NT-proBNP (odds ratio [OR]: 3.448, 95% confidence interval [CI]: 1.394-8.474, P = 0.007) and baseline creatinine (OR: 6.052, 95% CI: 1.860-19.686, P = 0.003) were independent predictors of CIN. Conclusions: Admission NT-proBNP level is an independent predictor of the development of CIN after PCI in ACS.
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    Association of Platelet-to-Lymphocyte Ratio With Severity and Complexity of Coronary Artery Disease in Patients With Acute Coronary Syndromes
    (Excerpta Medica Inc-Elsevier Science Inc, 2014) Kurtul, Alparslan; Murat, Sani Namik; Yarlioglues, Mikail; Duran, Mustafa; Ergun, Gokhan; Acikgoz, Sadik Kadri; Demircelik, Muhammed Bora
    The SYNTAX score (SXscore) is an anatomic scoring system based on coronary angiography (CA) that not only quantifies lesion severity and complexity but also predicts poor cardiovascular outcomes, including mortality, in patients with acute coronary syndromes (ACS). Recent studies have shown that platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in many cardiovascular diseases. The aim of this study was to investigate the association of PLR with the severity and complexity of coronary atherosclerosis as assessed by the SXscore in patients with ACS who underwent urgent CA. A total of 1,016 patients with ACS who underwent urgent CA were included in the study from August 2012 to March 2014. Admission PLR values were calculated before CA was performed. The SXscore was determined from baseline CA. The patients were divided into 2 groups, those with low SXscores (<= 22) and those with intermediate to high SXscores (>= 23). PLRs were significantly higher in patients with intermediate to high SXscores compared with those with low SXscores (p <0.001). In-hospital mortality was significantly higher in the groups with high PLR and intermediate to high SXscores. In multivariate analysis, the independent predictors of intermediate to high SXscore were PLR (odds ratio 1.018, 95% confidence interval 1.013 to 1.023, p <0.001) together with the left ventricular ejection fraction (odds ratio 0.935, 95% confidence interval 0.910 to 0.960, p <0.001), and age (odds ratio 1.029, 95% confidence interval 1.029 to 1.054, p = 0.02). A PLR >= 116 had 71% sensitivity and 66% specificity in predicting intermediate to high SXscore. In conclusion, the PLR at admission is significantly associated with the severity and complexity of coronary atherosclerosis in patients with ACS. Increased PLR is an independent predictor of higher SXscore in patients with ACS who undergo urgent CA. (C) 2014 Elsevier Inc. All rights reserved.
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    Predictors of Chronic Total Occlusion in Nonculprit Artery in Patients With Acute Coronary Syndrome: Mean Platelet Volume and Uric Acid
    (Sage Publications Inc, 2015) Kurtul, Alparslan; Yarlioglues, Mikail; Murat, Sani Namik; Celik, Ibrahim Etem; Demircelik, Muhammed Bora; Ocek, Adil Hakan; Duran, Mustafa
    Chronic total occlusion (CTO) in a noninfarct-related artery (non-IRA) is an independent predictor of mortality in acute coronary syndrome (ACS). Mean platelet volume (MPV) and serum uric acid (SUA) are associated with cardiovascular events in ACS. We investigated the relationship between the presence of non-IRA-CTO with MPV and SUA levels in patients with ACS. Patients (n = 1024) who underwent urgent coronary angiography for ACS were included in this study. Blood samples were drawn on admission. Patients were categorized into 2 groups: non-IRA-CTO (-) and non-IRA-CTO (+). The MPV and SUA levels on admission were significantly higher in the non-IRA-CTO (+) group than in the non-IRA-CTO (-) group (P < .001). At multivariate analysis, MPV (odds ratio [OR]: 4.705, P < .001) and SUA (OR: 2.535, P < .001) were independent predictors of non-IRA-CTO together with age, hemoglobin, ejection fraction, and non-ST-segment elevation ACS. The MPV and SUA levels were significant and independent predictors for the presence of non-IRA-CTO in patients with ACS.
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    Red Cell Distribution Width Predicts Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome
    (Sage Publications Inc, 2015) Kurtul, Alparslan; Yarlioglues, Mikail; Murat, Sani Namik; Demircelik, Muhammed Bora; Acikgoz, Sadik Kadri; Ergun, Gokhan; Duran, Mustafa
    We investigated the relationship between red cell distribution width (RDW) and contrast-induced nephropathy (CIN) in patients (aged 61 +/- 12, 69% men) with acute coronary syndrome (ACS). Consecutive patients diagnosed with ACS (n = 662) who underwent percutaneous coronary intervention (PCI) were included in the study. Patients were divided into 2 groups: CIN and no CIN. Contrast-induced nephropathy was defined as an increase in serum creatinine level of 0.5 mg/dL or 25% above baseline within 72 hours after PCI. Contrast-induced nephropathy occurred in 81 (12.2%) patients. Red cell distribution width, creatinine, and high-sensitivity C-reactive protein levels were significantly higher in the CIN group than in the no-CIN group. Multivariate regression analysis revealed that baseline RDW level (odds ratio 1.379, 95% confidence interval 1.084-1.753, P = .009), age (P = .025), creatinine (P = .004), and left ventricular ejection fraction (P = .011) were independent risk factors for the development of CIN. In conclusion, increased RDW levels are independently associated with a greater risk of CIN in patients undergoing PCI for ACS.
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    Serum Albumin Levels on Admission Are Associated With Angiographic No-Reflow After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction
    (Sage Publications Inc, 2015) Kurtul, Alparslan; Ocek, Adil Hakan; Murat, Sani Namik; Yarlioglues, Mikail; Demircelik, Muhammed Bora; Duran, Mustafa; Ergun, Gokhan
    Low serum albumin (SA) levels are associated with increased cardiovascular mortality. We investigated whether baseline SA levels are associated with no-reflow following primary percutaneous coronary intervention (pPCI). A total of 536 patients (aged 60 +/- 13 years; 74% men) who underwent pPCI were enrolled. The patients were divided into 2 groups: no-reflow and normal-reflow. No-reflow was defined as thrombolysis in myocardial infarction 2 flow. Admission SA levels were significantly lower in the no-reflow group than in the normal-reflow group (3.55 +/- 0.44 vs 4.01 +/- 0.32 mg/dL, P < .001). Also, high-sensitivity C-reactive protein (hsCRP), creatinine, creatine kinase myocardial band isoenzyme, and troponin T were significantly higher while hemoglobin and left ventricular ejection fraction (LVEF) were significantly lower in the no-reflow group. In multivariate analysis, SA level remained an independent predictor of angiographic no-reflow (odds ratio 0.114, 95% confidence interval 0.032-0.405, P = .001) together with LVEF, hsCRP, and baseline culprit artery patency. Admission SA level was an independent predictor of no-reflow after pPCI.
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    Usefulness of the Platelet-to-Lymphocyte Ratio in Predicting Angiographic Reflow After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction
    (Excerpta Medica Inc-Elsevier Science Inc, 2014) Kurtul, Alparslan; Yarlioglues, Mikail; Murat, Sani Namik; Ergun, Gokhan; Duran, Mustafa; Kasapkara, Haci Ahmet; Demircelik, Muhammed Bora
    Impaired coronary flow after primary percutaneous coronary intervention (PPCI) is associated with short- and long-term morbidity and mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Recent studies have demonstrated that platelet-to-lymphocyte ratio (PLR) is associated with adverse cardiovascular outcomes. The aim of this study was to assess the relation between admission PLR and angiographic reflow after PPCI. A total of 520 patients with acute STEMI (age 60 +/- 13 years; 74% men) occurring within 12 hours of the onset of symptoms who underwent PPCI were enrolled. The PLR and other laboratory parameters were measured before PPCI. The patients were divided into 2 groups based on the postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: normal-reflow group (defined as postintervention TIMI grade 3 flow) and none-reflow group (consisted of both patients with angiographic no-reflow defined as postintervention TIMI grades 0 to 1 flow and slow flow defined as postintervention TIMI grade 2 flow). There were 117 patients (22.5%) in the none-reflow group (age 68 +/- 13 years and 77% men) and 403 patients in the normal-reflow group (age 58 +/- 12 years and 63% men). The none-reflow group had significantly higher PLR compared with the normal-reflow group (219 79 vs 115 +/- 59, p <0.001). In logistic regression analysis, PLR (odds ratio 1.818, 95% confidence interval 1.713 to 1.980, p <0.001) and total stent length (OR 1.052, confidence interval 1.019 to 1.086, p = 0.002) were independent predictors of none-reflow after PPCI. In conclusion, preintervention PLR is a strong and independent predictor of slow flow/no-reflow after PPCI in patients with acute STEMI. (C) 2014 Elsevier Inc. All rights reserved.