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Öğe Comparison of long-term outcome of patients with ST-segment elevation myocardial infarction between pre-COVID-19 and COVID-19 era(Wiley, 2022) Kiris, Tuncay; Avci, Eyup; Ekin, Tuba; Akgun, Didar Elif; Tiryaki, Mucahit; Yidirim, Arafat; Hazir, KutluhanAims: To compare major cardiovascular and cerebrovascular events (MACCE) rates between patients in the pre-COVID-19 era and COVID-19 era, and to assess the impact of the presence of COVID-19 (+) on long-term MACCE in ST-segment elevation myocardial infarction (STEMI) in Turkey. Methods: Using the TURSER study (TURKISH ST-segment elevation myocardial infarction registry) data, the current study included 1748 STEMI patients from 15 centres in Turkey. Patients were stratified into COVID-19 era (March 11st-May 15st, 2020; n = 723) or pre-COVID-19 era (March 11st-May 15st, 2019; n = 1025) cohorts. Long-term MACCE rates were compared between groups. In addition, the effect of COVID-19 positivity on long-term outcomes was evaluated. The primary outcome was the occurrence of MACCE at long-term follow-up, and the secondary outcome was hospitalization with heart failure. Results: The MACCE and hospitalization with heart failure rates between pre-COVID-19 era and COVID-19 era were 23% versus 22% (p = .841), and 12% versus 8% (p = .002), respectively. In the COVID-19 era, the rates of MACCE and hospitalization with heart failure COVID-19-positive versus COVID-19-negative patients were 40% versus 20%, (p < .001), and 43% versus 11% (p < .001), respectively. Conclusion: There was no difference between the pre-COVID-19 era and the COVID-19 era in terms of MACCE in STEMI patients in Turkey. In the COVID-19 era, STEMI patients positive for COVID-19 had a higher rate of MACCE and heart failure hospitalization at the long-term follow-up.Öğe Impact of COVID-19 outbreak on patients with ST-segment elevation myocardial infarction (STEMI) in Turkey: results from TURSER study (TURKISH St-segment elevation myocardial infarction registry)(Springer, 2021) Kiris, Tuncay; Avcı, Eyüp; Ekin, Tuba; Akgün, Didar Elif; Tiryaki, Mücahit; Yidirim, Arafat; Hazır, Kutluhan; Murat, Bektaş; Yeni, Mehtap; Altındağ, Rojhad; Gül, Sefa; Arık, Baran; Güzel, Tuncay; Murat, Selda; Öz, Ahmet; Karabacak, Mustafa; Aktaş, Zihni; Yıldırım, Tarık; Kılıçaslan, Barış; Ergene, Asim OktayObjective We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey. Methods This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st–May 15st, 2020; n=733) or pre- COVID-19 era group (March 11st–May 15st, 2019; n=1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n=65) or negative (n=668). Results There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-frst medical contact time [120 (75–240) vs. 100 (60–180) minutes, p<0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p<0.001) and cardiogenic shock (20% vs. 7%, p<0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p<0.05). Conclusions We detected signifcantly lower STEMI hospitalization rates and signifcant delay in duration of symptom onset to frst medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients.Öğe Impact of the recovery of left ventricular ejection fraction after TAVI on mortality in patients with aortic stenosis(NLM (Medline), 2021) Kılıçaslan, Barış; Ünal, Barış; Arslan, Bayram; Ekin, Tuba; Özel, Erdem; Ertaş, Faruk; Dursun, HüseyinOBJECTIVE: To assess the effects of transvalvular aortic valve implantation (TAVI) on the outcomes of the patients with symptomatic severe aortic stenosis (AS), and predict the effect of left ventricular ejection fraction (LVEF) and cardiac structural recovery on mortality after the TAVI in patients with different stage of LV function. METHODS: Out of 191 patients, 151 consecutive patients in 3 centers were evaluated for outcome analysis. Patients were classified into 3 subgroups as AS with reduced ejection fraction (ASrEF) (LVEF <40%), AS with mildly reduced EF (ASmrEF) (LVEF 40-49%) and AS with preserved EF (ASpEF) (LVEF ≥50%). RESULTS: The mean follow-up period was 19.4±12.4 (up to 54) months. All-cause mortality was not different among all 3 groups. (p=0.901). In multivariate analysis, stroke volume index (SVI) (Exp(B): 0.039, 95% confidence interval [CI]: 0.011-0.013, p<0.001), baseline blood urea nitrogen (Exp(B): 1.022, 95% CI: 1.006-1.038, p=0.006), and percent LVEF change after TAVI (d-LVEF) (Exp(B): 0.046, 95% CI: 0.004-0.610, p=0.046) were the independent predictors for mortality after TAVI. The receiver operating characteristic curve analysis showed that the cutoff value of "≤10%" for d-LVEF had sensitivity of 50%, specificity of 75%, and an area under the curve of 0.72 in predicting mortality in patients with SVI <35 mL/m2. CONCLUSION: Improvement of LVEF after TAVI, which reflected the marked LV reverse remodeling, has an impact on the prediction of the survival in patients with AS, and this is more prominent in patients with low SVI.Öğe Post transcatheter aortic valve replacement ejection fraction response is predictor of survival among patients with whole range of systolic dysfunction(Taylor & Francis Ltd, 2021) Kilicaslan, Baris; Unal, Baris; Coskun, Mehmet Sait; Zeren, Gonul; Ekin, Tuba; Ozcan, Sevgi; Erdogan, SiddikAims The objective of this study is to assess the prognostic effects of T ranscatheter aortic valve replacement (TAVR) on the patients with different degrees of left ventricular systolic (LVS) function and severe symptomatic aortic stenosis. Also examines the prognostic association of LV remodelling after TAVR. Methods and results Patients stratified into four subgroups with respect to baseline LV ejection fraction (LVEF) (LVEF > 25%, LVEF 25%-40%, LVEF 41%-49% and LVEF >= 50%). We compared the baseline characteristics and temporal changes in echocardiographic parameters of the patients after TAVR, and determined all-cause mortality (ACM) in a follow-up period of mean 20.7 +/- 15.8 months (up to 84). There were 495 patients at 8 centres. ACM was similar in all groups (28.1%, 29.5%, 22.5% and 24.1% respectively; p = .44). Immediately after TAVR, there was an improvement in LVEF (from 38.7 +/- 9.4 to 44.9% +/- 10.9%, p .001). The percent change in LVEF (pDelta-EF) immediately after TAVR was more prominent in the patients with LVEF < 25% (48.1 +/- 49.6, 21.9 +/- 29.6), (8.4% +/- 15.2%) and (2.1 +/- 7)) (p .01). Importantly, a 12% increase in absolute Delta-EF was observed in patients with LVEF< 25% with 100% sensitivity and 42.5% specificity for the prediction of ACM. Conclusion This study shows that TAVR is beneficial in the whole range of LVS function, irrespective of the baseline EF. Early recovery in LVEF after TAVR is critical for survival, however, it seems to be more eye catching in the patients with advanced heart failure with reduced EF.
