Baseline Characteristics of a Patient Cohort and Predictors of In-hospital MORtality in CORonary Care Units (MORCOR-TURK) Trial in Türkiye

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.

Neutrophil Gelatinase-Associated Lipocalin Level Can Predict Early Organ Damage in Primary Hypertensive Patients: A Pilot Study

BACKGROUND

Early detection and treatment of complicated arterial hypertension will prevent its effect on the target organs. In line with this purpose, we aimed to reveal the prediction capability of neutrophil gelatinase-associated lipocalin to complicated hypertension.

METHODS

In total, 46 patients with hypertension and 21 healthy volunteers were included in the study. Left ventricle morphology and geometry, as systolic and diastolic functions, were analyzed. Global longitudinal strain was measured from recorded apical 3-chamber views. An ophthalmic examination was performed to investigate the presence of retinopathy in individuals with hypertension. In addition, plasma neutrophil gelatinase-associated lipocalin values were evaluated via the method of the enzyme-linked immunosorbent assay.

RESULTS

Both neutrophil gelatinase-associated lipocalin levels and global longitudinal strain percentages were statistically significant between the groups with diastolic dysfunction and the groups without diastolic dysfunction. Complicated hypertension was detected in 42 patients. Here, it was found that the neutrophil gelatinase-associated lipocalin level of 144.3 ng/mL predicted complicated hypertension with 0.872 sensitivity and 0.65 specificity values.

CONCLUSION

Analyzing neutrophil gelatinase-associated lipocalin levels in patients with hypertension in routine practice can easily and practically detect complicated hypertension patients earlier.

Systemic immune-inflammation index (SII) may be an effective indicator in predicting the left ventricular hypertrophy for patients diagnosed with hypertension

The development of left ventricular hypertrophy (LVH) induced by hypertension is considered a poor prognosis for patients. Similarly, high values of the systemic immune-inflammation index (SII) are correlated with high mortality and morbidity in cardiovascular events. Within this context, our study aimed to detect the association of SII with LVH caused by hypertension. The study included 150 patients diagnosed with hypertension in total and evaluated them as two separate groups with regard to left ventricular mass index (LVMI), including 56 patients (37.3%) with LVH and 94 patients (62.6%) with non-LVH. SII was calculated as platelet × neutrophil/lymphocyte counts. The SII values regarding the group with LVH were detected remarkably higher than those of the non-LVH group (p < 0.001). Additionally, the SII levels of patients with eccentric and concentric hypertrophy were detected higher than those of the normal ventricular geometry and concentric remodeling groups. About curve analysis of the receiver-operating characteristic (ROC), SII values above 869.5 predicted LVH with a sensitivity of 82.1% and specificity of 86.2% (AUC: 0.861; 95% CI: 0.792-0.930; p < 0.001). LVH can be predicted independently through the use of SII in patients diagnosed with hypertension, which may be a simple and easily calculable marker for judging LVH. Moreover, SII can serve as an accurate determinant for the prediction of LVH, in comparison to NLR and PLR.

The Role of Serum Resolvin D1 Levels in Determining the Presence and Prognosis of ST-Segment Elevation Myocardial Infarction

BACKGROUND

Resolvin D1 (RvD1) can play a determining role in inflammatory cell migration and reduce the expression of inflammatory cytokines to enhance cardioprotection. The aim of this study was to compare serum RvD1 levels in patients with ST-segment elevation myocardial infarction (STEMI) and individuals with normal coronary arteries (NCAs) and to evaluate the association between serum RvD1 levels and prognostic markers of STEMI.

METHODS

140 subjects (88 patients diagnosed with the indication of STEMI and 52 healthy individuals with NCA) were studied.

RESULTS

Regression analysis revealed that RvD1 levels were independently associated with STEMI. While RvD1 levels were negatively correlated with high-sensitivity C-reactive protein, pro-brain natriuretic peptide, peak troponin, and Thrombolysis in Myocardial Infarction thrombus grade, they were positively correlated with left ventricular ejection fraction. An RvD1 cut-off value of 5.07 (ng/mL) was effective in predicting STEMI with a sensitivity of 79.5% and specificity of 96.2%.

CONCLUSION

Serum RvD1 levels were found to be lower in the group with STEMI compared to the control group. Levels of RvD1 at admission were associated with poor prognostic markers of STEMI.

Impact of statin use on high sensitive troponin T levels with moderate exercise

Background: High-sensitive cardiac troponin (hsTn) levels can be elevated due to non-pathological events such as strenuous exercise. However, the effect of statins on circulating hsTnT levels with moderate exercise is uncertain. Therefore, we evaluated the impact of statins on hsTnT level with moderate exercise. Methods: We enrolled a total of 56 patients: 26 statin users and 30 non-users. All patients were shown to have no coronary artery disease before participating in the study. Participants performed a fixed-protocol moderate level exercise. HsTnT levels were measured before and 4 h after the exercise. Participants were also grouped based on their hsTnT levels, as proposed in the recent European Society of Cardiology guideline (0-1 hour algorithm) for acute coronary syndromes without persistent ST-segment elevation. Results: Statin users showed a significant increase in serum hsTnT levels with moderate exercise (p = .004), whereas the control group showed a modest increase without statistical significance (p = .664). The percentage of patients whose hsTnT levels exceeded the rule-out limits for non-ST-segment myocardial infarction diagnosis (according to the 0-1 algorithm) after moderate exercise varied significantly between groups (p = .024). Conclusions: Statin therapy can cause a significant increase in hsTnT levels after moderate exercise. This increase can jeopardise the accuracy of clinical diagnoses based on the newly implemented algorithms. The awareness of these adverse effects of statins, mainly used by patients with high risk of coronary events, can prevent misdiagnosis or unnecessary hospitalisations.