Browsing by Author "Orhan, Ahmet Lutfullah"

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The Association Between Whole Blood Viscosity and High Thrombus Burden in Patients With Non-St Elevation Myocardial Infarction
(Polish Cardiac Soc, 2022) Cinar, Tufan; Saylik, Faysal; Akbulut, Tayyar; Asal, Suha; Selcuk, Murat; Cicek, Vedat; Orhan, Ahmet Lutfullah
Background: Prior studies showed that patients with elevated whole blood viscosity (WBV) had a higher risk of arterial thrombosis, acute stent thrombosis, and left ventricular apical thrombus presence after acute coronary syndrome. This investigation aimed to determine the association between WBV and high thrombus burden (HTB) in non-ST elevation myocardial infarction (NSTEMI) patients treated with percutaneous coronary intervention (PCI). Methods: This retrospective cohort investigation included data from consecutive 290 NSTEMI patients who received PCI at a tertiary institution. Patients with grade 1-3 thrombus burden were categorized as having low thrombus burden (LTB) (n = 178), whereas those with grade 4-5 thrombus burden were classified as having HTB (n = 112). WBV at high shear rate (HSR) and low shear rate (LSR) were estimated using hematocrit (HTC) and total protein levels. Results: Patients with HTB had higher WBV at both LSR and HSR. In HTB patients, the frequency of infarct-related artery (IRA) reference vessel diameter, distal embolization, and no-reflow was also higher. Multivariable logistic regression models indicated that WBV at LSR (odds ratio [OR], 1.028; 95% confidence interval [CI], 1.014-1.043; P < 0.001) and HSR (OR, 1.606; 95% CI, 1.334-1.953; P < 0.001) were independent predictors of HTB in NSTEMI patients. Notably, the area under the curve value of WBV at both shear rates was greater than that of its components, including total protein and HTC. Conclusion: This is the first study showing that WBV at both shear rates is a significant predictor of HTB in NSTEMI patients.
Comparison of Outcomes Between Single Long Stent and Overlapping Stents: a Meta-Analysis of the Literature
(Urban & Vogel, 2023) Saylik, Faysal; Cinar, Tufan; Selcuk, Murat; Cicek, Vedat; Hayiroglu, Mert Ilker; Orhan, Ahmet Lutfullah
ObjectivesThere is no consensus on whether to treat diffuse coronary artery lesions with a single long stent (SLS) or by overlapping two or more stents (OLS). The goal of this review was to compare the outcomes of these two approaches through a meta-analysis of the literature.MethodsWe searched for relevant studies in MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library. Our meta-analysis included 12 studies (n = 6414) that reported outcomes during the follow-up period.ResultsIndividuals who received OLS had a greater risk of cardiac mortality and target lesion revascularization (TLR) than those who received SLS (RR: 1.51, CI: 1.03-2.21, p = 0.03, I-2 = 0% and RR: 1.64, CI: 1.02-2.65, p = 0.04, I-2 = 38%, respectively). The fluoroscopy period in the OLS group was longer than in the SLS group (SMD: 0.35, CI: 0.25-0.46, p < 0.01, I-2 = 0%). more contrast volume was sued for the OLS group; however, there was substantial variability in the pooled analysis (I-2 = 95%). In terms of all outcomes, there were no differences between stent generation types.ConclusionIn the first meta-analysis of mainly observational data comparing OLS vs. SLS for long coronary lesions, OLS had higher rates of cardiac mortality and TLR as well as longer fluoroscopy times compared to SLS.
Evaluating the Systemic Immune-Inflammation Index for In-Hospital and Long-Term Mortality in Elderly Non-St Myocardial Infarction Patients
(Springer, 2022) Orhan, Ahmet Lutfullah; Saylik, Faysal; Cicek, Vedat; Akbulut, Tayyar; Selcuk, Murat; Cinar, Tufan
Introduction This investigation aimed to evaluate the predictive value of the systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Methods This retrospective investigation included 314 consecutive elderly NSTEMI patients in a tertiary center. SII is computed as (neutrophils x platelets)/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes. Results Patients in the T3 group had lower chances of survival in the in-hospital and long-term periods compared with those in the T2 and T1 groups. According to the multivariable Cox regression models, SII independently related with in-hospital (hazard ratio (HR): 1.001, 95% CI: 1.000-1.1003, p = 0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002-1.006, p < 0.001). To predict long-term mortality, the optimal SII value was > 2174 with 80% sensitivity and 85.4% specificity. SII had a slightly lower but statistically non-inferior discriminative ability for long-term mortality compared with the Charlson comorbidity index (CCI) in the receiver operating characteristic curve comparison (AUC: 86.2 vs. AUC: 890, p > 0.05). Additionally, combining SII with traditional risk factors and the CCI revealed a significant improvement in C-statistics. Conclusion This investigation may be the first to demonstrate that SII is independently linked with in-hospital and long-term mortality in elderly NSTEMI patients.
One-Year Outcomes of Invasively Managed Acute Coronary Syndrome Patients With Covid-19
(Mosby-elsevier, 2022) Cinar, Tufan; Saylik, Faysal; Akbulut, Tayyar; Asal, Suha; Selcuk, Murat; Cicek, Vedat; Orhan, Ahmet Lutfullah
Background: There is a limited data about the one-year outcomes of patients diagnosed with acute coronary syndrome (ACS) and coronavirus disease 2019 (COVID-19). Objectives: To assess one-year mortality of invasively managed patients with ACS and COVID-19 compared to ACS patients without COVID-19. Methods: In our investigation, we defined the study time period as April 30 through September 1, 2020. The control groups consisted of ACS patients without COVID-19 at the same time period and ACS patients prior to the pandemic, within the same months as those of the study. COVID-19 infection was confirmed in all participants utilizing real-time polymerase chain reaction testing. Results: This investigation examined 721 ACS participants in total. Among the participants, 119 patients were diagnosed with ACS and COVID-19, while 149 were diagnosed with ACS and without COVID-19. The other 453 ACS participants were diagnosed before the outbreak of the pandemic, within the same months as those of the study. One-year mortality rates were higher in the ACS participants with COVID-19 than in the ACS participants without COVID-19 and the pre-COVID-19 ACS participants (21.3% vs. 6.5% vs. 6.9%, respectively). An ACS along with COVID-19 was the only independent predictor of one-year mortality (HR=2.902, 95%Cl=1 .211-6.824, P = 0.018). According to the Kaplan-Meier survival curves, patients with ACS and COVID-19 had a lower chance of survival in the short-term and one-year periods. Conclusion: This is believed to be the first study to report that ACS patients with COVID-19 had higher one-year risk of mortality compared to ACS patients without COVID-19. (C) 2022 Elsevier Inc. All rights reserved.
Predicting Short-Term Mortality in Patients With Acute Pulmonary Embolism With Deep Learning
(Japanese Circulation Soc, 2025) Cicek, Vedat; Orhan, Ahmet Lutfullah; Saylik, Faysal; Sharma, Vanshali; Tur, Yalcin; Erdem, Almina; Bagci, Ulas
Background: Accurate prediction of short-term mortality in patients with acute pulmonary embolism (PE) is critical for optimizing treatment strategies and improving patient outcomes. The Pulmonary Embolism Severity Index (PESI) is the current reference score used for this purpose, but it has limitations regarding predictive accuracy. Our aim was to develop a new short-term mortality prediction model for PE patients based on deep learning (DL) with multimodal data, including imaging and clinical/demographic data. Methods and Results: We developed a novel multimodal deep learning (mmDL) model using contrast-enhanced multidetector computed tomography scans combined with clinical and demographic data to predict short-term mortality in patients with acute PE. We benchmarked various machine learning architectures, including XGBoost, convolutional neural networks (CNNs), and Transformers. Our cohort included 207 acute PE patients, of whom 53 died during their hospital stay. The mmDL model achieved an area under the receiver operating characteristic curve (AUC) of 0.98 (P<0.001), significantly outperforming the PESI score, which had an AUC of 0.86 (P<0.001). Statistical analysis confirmed that the mmDL model was superior to PESI in predicting short-term mortality (P<0.001). Conclusions: Our proposed mmDL model predicts short-term mortality in patients with acute PE with high accuracy and significantly outperforms the current standard PESI score.
The Predictive Value of the Meld-Xi Score for Short- and Long-Term Mortality in Elderly Patients With Non-St Elevation Myocardial Infarction
(Springer, 2022) Cinar, Tufan; Saylik, Faysal; Selcuk, Murat; Akbulut, Tayyar; Orhan, Ahmet Lutfullah
Background In this study, we investigated the utility of the Model for End-stage Liver Disease excluding INR (MELD-XI) score in predicting short- and long-term mortality in elderly patients with non-ST elevation myocardial infarction (NSTEMI) who underwent coronary angiography (CAG). Methods In total, we analyzed 228 elderly NSTEMI patients above the age of 75. We used the modified 5-item frailty index and the Charlson Comorbidity Index (CCI) to assess the comorbidities. The MELD-XI score was calculated using the logarithmic relationship between the serum creatinine and total bilirubin. Results The median long-term follow-up was 530 [interquartile range (IQR) = 303-817] days and the short- and long-term mortality rates were 11.8% (n = 27) and 16.4% (n = 33), respectively. Patients who did not survive had a substantially higher MELD-XI score than those who did [10.1 (IQR = 7.8-15.1) vs. 4.5 (IQR = 1.9-6.9), p < 0.001, respectively]. Multivariable Cox regression analyses indicated that the MELD-XI score predicted both short- and long-term mortality independently. When the MELD-XI score, serum creatinine, and total bilirubin area under the curve (AUC) values were compared to predict long-term mortality, the MELD-XI score had the highest value (AUC: 0.833), followed by the serum creatinine (AUC: 0.741), and the total bilirubin (AUC: 0.723). The accuracy of the MELD-XI score was further tested with the GRACE risk score, which demonstrated noninferiority. Conclusion This was the first investigation which indicated that elderly NSTEMI patients with a high MELD-XI score had poor prognosis in the short- and long-term period.