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Yayın Distribution of risk factors and prophylactic drug usage in Turkish patients with angiographically established coronary artery disease(Sage Journals, 2002) Sönmez, Kenan; Akçay, Ahmet; Akçakoyun, Mustafa; Demir, Durmuş; Elönü, Orhan Hakan; Pala, Selçuk; Ekşi Duran, Nilüfer; Gençbay, Murat; Değertekin, Muzaffer; Turan, FikretBackground: Coronary artery disease (CAD) is the leading cause of adult deaths in our country. In clinical practice, an adequate level of secondary prevention towards CAD primarily requires full recognition of the distribution of risk factors. The aim of our study was to determine the prevalence of coronary risk factors and the use of prophylactic drugs among patients who have an angiographically proven CAD in our centre, and to compare it with those of the EUROASPIRE I and II studies. Design: Cross-sectional, observational study. Methods: Our patients comprise 617 subjects (516 male, mean age 57.2 +/- 10.8 years) who underwent an angiography between January 2000 and May 2000 for the first time and in whom significant coronary lesions were detected. Age, gender, family history of premature CAD (FH), diabetes mellitus (DM), hypertension (HT), lipid profile, smoking, body mass index, waist circumference, hip circumference and physical activity data were recorded prior to angiography. The medical treatments received by these cases at discharge from hospital were investigated. Data thus obtained were compared with the results of the EUROASPIRE I and II trials, which studied the frequency of existing risk factors and prophylactic drug use among CAD patients in European countries. Results: Hyperlipidaemia, FH, DM, HT, smoking, obesity, central obesity were found in 52, 26, 20, 41, 65, 18 and 29% of patients, respectively. The use of antiplatelets, beta-blockers, ACE inhibitors, statins and calcium antagonists were 99, 86, 40, 63 and 16%, respectively. Conclusion: Upon comparison of the risk factors, prevalence of obesity and DM was found to be similar to the average of nine European countries among our subjects. Smoking was found to be considerably higher, whereas HT, hyperlipidaemia and family history of premature CAD were lower than the European average within our subjects. In our cases the frequency of prophylactic drug usage at discharge was higher than the European means.Yayın High prevalence of hypercoagulable states in patients with recurrent thrombosis of mechanical heart valves(National Library of Medicine, 1998) Gençbay, Murat; Turan, Fikret; Değertekin, Muzaffer; Ekşi Duran, Nilüfer; Mutlu, Bülent; Unalp, AycanBackground and aims of the study: Thrombosis is one of the most feared and life-threatening complications of mechanical heart valves (MHV), with an incidence of 1-3 per 100 patient-years. Hypercoagulable states are highly prevalent in the general population and can predispose MHV to thrombus formation. Thus, we conducted a study to investigate the frequency of hypercoagulable states in patients with MHV who had recurrent thrombosis at least twice after valve implantation. Methods: Fifteen patients (mean age 42 +/- 11 years; range: 18 to 55 years) with recurrent thrombosis of MHV (2.4 +/- 0.8 recurrences/patient) (group 1) and 15 matched patients (mean age 40 +/- 12 years; range: 18 to 55 years) with MHV without thrombosis (group 2) were followed up with transthoracic and transesophageal echocardiography. Patients' sera were monitored for antibodies to cardiolipin (ACLA-IgG and ACLA-IgM), phosphatidylserine (APSA), lupus-type anticoagulant (LA) and lipoprotein(a) (LP(a)). Results: Average values for group 1 versus group 2 were: ACLA-IgG (normal range < 15 GPLU/ml) 24.7 +/- 14.6 versus 6.2 +/- 2.7 (p < 0.001); ACLA-IgM (< 12.5 MPLU/ml) 7.9 +/- 5.0 versus 3.3 +/- 1.7 (u = 185; p < 0.001); APSA (< 12 RLU/ml) 4.8 +/- 5.7 and 2.9 +/- 1.2 (p = 0.56); and LP(a) (< 30 mg/dl) 36.5 +/- 26.5 and 13.4 +/- 7.1 (p < 0.001). The frequency of LA-positive cases was 4/15 in group 1 and 0/15 in group 2 (p > 0.05). The frequency of abnormally high levels of ACLA-IgG was 9/15 in group 1 and 0/15 in group 2 (p < 0.001); of ACLA-IgM, 2/15 in group 1 and 0/15 in group 2 (p > 0.05); of APSA, 1/15 in group 1 and 0/15 in group 2 (p > 0.05); and of LP(a), 5/15 in group 1 and 0/15 in group 2 (p < 0.05). At least one of the factors included in this study was abnormal in 14 of 15 (93%) patients (p < 0.0001). Conclusions: Hypercoagulable states are highly prevalent in patients with recurrent thrombosis of MHV. All patients evaluated for therapy of obstructive thrombosis of MHV should be investigated for hypercoagulable state. Moreover, in high-risk patients, surgical replacement of the MHV with a bioprosthesis should be considered.Yayın İleri mitral yetersizliğinde atriyal fibrilasyonun sıklığı ve öngördürücüleri(Türk Kardiyoloji Derneği, 2003) Ekşi Duran, Nilüfer; Duran, İbrahim; Sönmez, Kenan; Gençbay, Murat; Akçay, Ahmet; Turan, FikretÇalışmamızın amacı, ileri mitral yetersizliği (MY) bulunan hastalarda atriyal fibrilasyonun (AF) sıklığını ve AF'ye neden olan öngördürücü faktörleri tespit etmektir.Yayın İntrakoroner wiktor stent implantasyonundan sonra ilk altı ayda restenoz saptanmayan olguların geç dönem (4-5 Yıl) takip sonuçları(Türk Kardiyoloji Derneği, 2001) Sönmez, Kenan; Değertekin, Muzaffer; Gençbay, Murat; Yılmaz, Ahmet; Duran, İbrahim; Turan, FikretKoroner aterosklerotik lezyonların tedavisinde konvansiyonel perkütan transluminal koroner anjiyoplasti (PTKA)'den sonra gözlenen restenozların büyük oranda ilk altı ayda ortaya çıktığı bilinmektedir.Yayın Koroner arter hastalığı bulunan olgularda obezite derecelerinin diğer risk faktörleriyle ilişkisi(Türk Kardiyoloji Derneği, 2002) Sönmez, Kenan; Akçakoyun, Mustafa; Demir, Durmuş; Akçay, Ahmet; Pala, Selçuk; Ekşi Duran, Nilüfer; Bakal, Ruken Bengi; Gençbay, Murat; Değertekin, Muzaffer; Turan, FikretDünya Sağlık Örgütü ve uluslararası kılavuz komitelerince kabul edilmiş beden kitle indeksi (BKİ) ve bel çevresi sınırlarına göre yapılan obezite sınıflamasında, farklı obezite gruplarında yer alan koroner arter hastalığı (KAH 9 olgularında, diğer koroner risk faktörlerinin dağılımını karşılaştırmak, böylece bu sınır değerlerinin diğer koroner risk faktörlerinin dağılımını ne ölçüde belirlediğini incelemektedir.Yayın Long-term (>3 years) clinical and angiographic outcomes of coronary multilink stent implantations: a single center experience(Sage Journals, 2004) Sönmez, Kenan; Turan, Fikret; Gencebay, Murat; Değertekin, Muzaffer; Ekşi Duran, NilüferThe ACS Multilink (ML) stent is a novel second-generation stent. The largest amount of information available on the long-term outcome of coronary stenting is based on the use of Palmaz-Schatz stents. Fewer data exist on long-term follow-up results of ML coronary stents implantations. The authors present the long-term (>3 years) clinical and angiographic follow-up results of the ACS Multilink coronary stents implanted in their institution. From May 1996 to December 1997, 125 patients underwent 133 coronary ML stent implantations. Stented vessels were as follows: 49% left anterior descending artery, 31% right coronary artery, and 20% left circumflex coronary artery. Indications for stent implantations were elective in 64%, because of suboptimal result from percutaneous transluminal coronary angioplasty (PTCA) in 26%, and bailout from PTCA in 10% of patients. The mean reference diameter of stented vessels was 3.2 ±0.2 mm. The mean percentage stenosis was 80 ±11% and 3 ±5% before and after stent implantation, respectively. Long-term clinical follow-up was completed in 75% (80 men, mean age 53 ±10 years) of the patients (either by interview or phone), and angiographic follow-up (37 ±12 months) was completed in 58% of the patients. There were no baseline clinical or angiographic differences between those angiographically followed up and the remaining patients. Angiographic restenosis (>50% diameter stenosis) was detected in 22% of stents. Target lesion revascularization was 12%, nontarget lesion revascularization was 14% in angiographically followed up patients. During the follow-up period death and new myocardial infarction occurred in 12% and 6% of patients, respectively, and survival rate was 88%. This study provides long-term follow-up results of intracoronary Multilink stent implantations for native coronary artery lesions. These data show that clinical and angiographic benefits of ML stents are comparable to those of the first-generation stents, especially to the Palmaz-Schatz stents, of which results have been reported previously. A considerable rate of nontarget lesion revascularization occurs during the follow-up period.Yayın Prevalence and predictors of significant coronary artery disease in Turkish patients who undergo heart valve surgery(National Library of Medicine, 2002) Sönmez, Kenan; Gençbay, Murat; Akçay, Ahmet; Yılmaz, Ahmet; Pala, Selçuk; Onat, Özgür; Ekşi Duran, Nilüfer; Değertekin, Muzaffer; Turan, FikretBackground and aims of the study: The presence of significant atherosclerotic coronary artery disease (CAD) in patients with valvular heart disease is an important predictor of perioperative mortality. The prevalence of CAD in patients undergoing valvular heart surgery is 20-40% in industrialized countries. The study aim was to determine CAD prevalence in Turkish patients undergoing valvular heart surgery, and to identify predictors of its presence. Methods: A total of 760 patients (357 males, 403 females; mean age 54.4+/-18.1 years) who underwent coronary angiography before valvular surgery between 1995 and 2000 was enrolled retrospectively. Single- and multi-valve involvement was present in 46% and 54% of patients, respectively. Patients with ischemic mitral regurgitation were excluded from the study. Significant CAD was defined as the presence of > or =50% diameter stenosis anyone of the coronary arteries. The presence of angina pectoris, and of risk factors (e.g. hypertension, smoking, diabetes mellitus (DM), hyperlipidemia, family history of CAD) were sought in all patients. Predictors of CAD were identified by logistic regression analysis. Results: Significant CAD was present in 15.8% of patients (24% males, 9% females) (p <0.001); the highest prevalence was in those with aortic stenosis (p <0.05). CAD was not seen in young patients (aged <45 years) with none of the above-mentioned risk factors. The highest correlation between CAD and risk factors was family history of CAD, followed by DM, hyperlipidemia, hypertension and smoking, in decreasing order. Conclusion: The study results showed that CAD in patients with valvular heart disease was less prevalent in Turkey than in industrialized countries. The incidence of coronary lesions rises notably from the age of 50 years in both males and females. Coronary angiography before valvular heart surgery could be omitted in young patients (age <45 years) with none of the coronary risk factors, or without angina.Yayın Which method should be used to determine the obesity, in patients with coronary artery disease? (body mass index, waist circumference or waist-hip ratio)(National Library of Medicine, 2003) Sönmez, Kenan; Akçakoyun, Mustafa; Akçay, Ayhan; Demir, Demet; Ekşi Duran, Nilüfer; Gencebay, Murat; Değertekin, Muzaffer; Turan, FikretObjective: To determine body mass index (BMI), waist circumference and waist-hip ratio (WHR) in cases with angiographically established coronary artery disease (CAD) and to compare the obesity degrees established according to the ranges determined by the International Guidelines Committees for BMI, waist circumference and WHR. Design: Cross-sectional, observational study. Subjects: A total of 617 consecutive cases (516 males, mean age: 57.2+/-10.8 y) with CAD who underwent their first coronary angiography between January 2000 and May 2000. Measurements: Before coronary angiography, their heights, weights, waist and hip circumferences were measured. Waist circumferences, BMI and WHRs were compared both as a whole and also within stratified groups as for sexes and age groups categorized in decades above 40 y of age. Results: Overweight cases comprised approximately half of the patients in both sexes. In males, the percentages of obese cases with respect to BMIs were 15%, while males with action level 2 waist circumferences were detected to be 20%. Obese male patients whose WHRs were >or=0.95 were found to be 51%. In female cases, corresponding percentages of obesity were estimated to be 32, 72 and 86%, respectively. Conclusion: In the same patient groups, the prevalence of obesity, defined by BMI, waist circumference and WHR, could vary three-fold. Thus, some patients may not display a diagnosis of obesity. To prevent this possibility the waist circumference is an easy method, which reflects central obesity more accurately.
