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    Impact of insulin resistance on contrast induced nephropathy in patients undergoing percutaneous coronary intervention
    (Springer India, 2014) Elbey, Mehmet Ali; Evliyaoglu, Osman; Simsek, Ziya; Oylumlu, Mustafa; Akil, Mehmet Ata; Aydin, Mesut; Bilik, Zihni
    Contrast-induced nephropathy (CIN) is a common complication following percutaneous coronary intervention (PCI). Contrast-induced nephropathy after emergency PCI in subjects with insulin resistance (IR) has not been studied before. In this prospective study we determined the relation between IR on CIN, among those undergoing PCI due to acute coronary syndrome. One hundred twenty four consecutive acute coronary syndrome patients with diabetes (N = 44), insulin resistance (N = 38) and normal glycemic metabolism (N = 42) were included in the study. They were all treated with PCI. Pre- and post procedural creatinines were measured and independent predictors of CIN were analyzed. IR was defined as a HOMA level (HOMA-IR = Serum Glucose (mg/dL) X Plasma Insulin (micro unit/mL) / 405 > 2.5. Patients with IR or diabetes had significantly higher levels of creatinine after procedure, serum cholesterol, glucose, contrast volume, hospital stay and HOMA. Female gender, frequency of CIN and multivessel disease were also higher in these patients. On the other hand they had significantly lower ejection fraction. Logistic regression analysis showed that HOMA was the single independent risk factor for CIN in patients with acute coronary syndrome treated with PCI. Insulin resistance is an independent risk factor for CIN in patients with acute coronary syndrome treated with PCI. It carries a similar risk with diabetes and proper prophylaxis should be performed.
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    PROGNOSTIC FACTORS AND IN-HOSPITAL OUTCOME OF NATIVE VALVE ENDOCARDITIS IN TURKEY. A MULTICENTER STUDY
    (Carbone Editore, 2014) Akil, Mehmet Ata; Acet, Halit; Elbey, Mehmet Ali; Aydin, Mesut; Bilik, Zihni; Yildiz, Abdulkadir; Yuksel, Murat
    Aim: To investigate the predisposing factors, demographic and clinical characteristics, echocardiographic and prognostic features, and Outcomes of patients with native valve infective endocarditis (IE) in Turkey in a multicenter based study. Materials and methods: The study population consisted Of 15,8 consecutive patients with native valve IE (NVE). Data on demographics, medical history, medications, clinical procedures, predisposing factors, clinical examination, microbiology, antibiotic therapy, echocardiography, surgery, complications, and outcome were collected and compared. Results: The mean age of the patients was 47 19 (range 13-87). Seventy seven patients (49%) Were female. Of the 158. NVE patients, 49 died during hospitalization. Mortality rate was 31%. Twenty eight patients experienced a stroke. The patients who died during hospitalization were significantly older than the survivors and had higher mean heart rate, white blood cell, C reactive protein, creatinine, poor NYHA functional etas's, multiple vegetations and large vegetations. Culture negative endocarditis was seen in 54 eases (34%). Staphylococci were the most common causative organisms (28%). Eighty patients had undergone surgical treatment (51%). Hemoglobin, presence of multiple vegetation, vegetation size. (>10 mm), septic shock and poor NYHA Class on admission were independent risks for in hospital mortality and stroke Beside these variables C. reactive Protein was also an independent risk for in hospital mortality Conclusion: Native valve IE in Turkey was associated with high in hospital mortality. Rheumatic heart disease continues to be the most common underlying heart condition and echocardiographie findings on admission were the most important independent predictors of mortality or stroke.