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    Baseline clinical characteristics and patient profile of the TURKMI registry: Results of a nation-wide acute myocardial infarction registry in Turkey
    (Turkish Society of Cardiology, 2020) Erol, Mustafa Kemal; Kayıkçıoğlu, Meral; Kılıçkap, Mustafa; Arın, Can Baba; Kurt, İbrahim Halil; Aktaş, İbrahim; Güneş, Yılmaz; Asoğlu, Ramazan
    Objective: The TURKMI registry is designed to provide insight into the characteristics, management from symptom onset to hospital discharge, and outcome of patients with acute myocardial infarction (MI) in Turkey. We report the baseline and clinical characteristics of the TURKMI population. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of percutaneous coronary intervention selected from each EuroStat NUTS region in Turkey according to population sampling weight, prioritized by the number of hospitals in each region. All consecutive patients with acute MI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018 and November 16, 2018. Results: A total of 1930 consecutive patients (mean age, 62.0±13.2 years; 26.1% female) with a diagnosis of acute MI were prospectively enrolled. More than half of the patients were diagnosed with non-ST elevation MI (61.9%), and 38.1% were diagnosed with ST elevation MI. Coronary angiography was performed in 93.7% and, percutaneous coronary intervention was performed in 73.2% of the study population. Fibrinolytic therapy was administered to 13 patients (0.018%). Aspirin was prescribed in 99.3% of the patients, and 94% were on dual antiplatelet therapy at the time of discharge. Beta blockers were prescribed in 85.0%, anti-lipid drugs in 96.3%, angiotensin converting enzyme inhibitors in 58.4%, and angiotensin receptor blockers in 7.9%. Comparison with European countries revealed that TURKMI patients experienced MI at younger ages compared with patients in France, Switzerland, and the United Kingdom. The most prevalent risk factors in the TURKMI population were hypercholesterolemia (60.2%), hypertension (49.5%), smoking (48.8%), and diabetes (37.9%). Conclusion: The nation-wide TURKMI registry revealed that hypercholesterolemia, hypertension, and smoking were the most prevalent risk factors. TURKMI patients were younger compared with patients in European Countries. The TURKMI registry also confirmed that current treatment guidelines are largely adopted into clinical cardiology practice in Turkey in terms of antiplatelet, anti-ischemic, and anti-lipid therapy.
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    Early- And mid-term effects of percutaneous mitral balloon valvuloplasty on left atrial mechanical functions in mitral stenosis
    (Turkish Society of Cardiology, 2014) İnci, Sinan; Erol, Mustafa Kemal; Taş, Muhammed Hakan; Bakırcı, Eftal Murat; Hamur, Hikmet; Karakelleoğlu, Şule
    Objectives: The aim of the study was to evaluate left atrial (LA) mechanical functions in MS before and after percutaneous mitral balloon valvuloplasty (PMBV) and to follow it up in short- And mid-term. Study design: We carried out a prospective study of 49 patients with critical mitral stenosis (MS) who had normal sinus rhythm. LA mechanical functions were evaluated before and 24-48 h, 3 months, and 1 year after PMBV, which included LA passive emptying volume (LAPEV), LA active emptying volume (LAAEV), LA total emptying volume (LATEV), LA passive emptying fraction (LAPEF), LA active emptying fraction (LAAEF), LA total emptying fraction (LATEF), and conduit vol-ume. Results: The transthoracic echocardiography parameters of the MS patients before and 24-48 h, 3 months, and 1 year after PMBV were as follows: (a) mitral valve area 1.1 cm2 (0.9-1.6); 2.2 cm2 (1.8-2.8) (p<0.001); 2.2 cm2 (1.7-2.9) (NS); 2.1 cm2 (1.8-2.7) (p<0.001); (b) LAPEV 13 ml/m2 (9-27); 11 ml/m2 (8-19) (p<0.001); 10 ml/m2 (7-19) (p<0.001); 10 ml/m2 (6-18) (p<0.001); (c) LATEV 26 ml/m2 (19-50); 21 ml/m2 (16- 40) (p<0.001); 20 ml/m2 (15-36) (p<0.001); 19 ml/m2 (15-34) (p<0.001); (d) Conduit volume 30 ml/m2 (22-44); 33 ml/m2 (26- 46) (p<0.001); 34 ml/m2 (30-42) (p<0.001); 36 ml/m2 (31-42) (p<0.001), respectively. However, LAAEV, LAPEF, LAAEF, and LATEF were not altered after PMBV. Conclusion: The findings of this study demonstrated an improvement of LA mechanical functions, which continued to improve for 1 year, after successful treatment of MS by PMBV. © 2014 Turkish Society of Cardiology.
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    The effects of successful percutaneous mitral balloon valvuloplasty on acute and intermediate term aortic stiffness
    (Blackwell Publishing, 2015) İnci, Sinan; Nar, Gökay; Erol, Mustafa Kemal; Demirelli, Selami; Duman, Hakan; Serdar, Serkan; Erol, Fatih
    Aim The aim of this study was to evaluate the effects of percutaneous mitral balloon valvuloplasty (PMBV) on short- and intermediate-term aortic stiffness in patients with mitral stenosis. Materials and Methods This prospective study included 56 patients with critical mitral stenosis in normal sinus rhythm (68% female; mean age: 42 ± 11 years) and 37 healthy controls. Aortic stiffness was measured using transthoracic echocardiography before PMBV, and 24-48 hours and 1 year post procedure. Results Aortic strain and distensibility were significantly higher in the patients with mitral stenosis, both after PMBV and 1 year post procedure, whereas the aortic stiffness index (ASI) was significantly lower. There was also a significant decrease in mitral mean gradient (MMG) and systolic pulmonary artery pressure (sPAP) after PMBV, based on echocardiography and catheterization. Mitral valve area (MVA) significantly increased after PMBV. There was a significant correlation between change in ?MVA and ?MMG and aortic elastic properties. There was a significantly negative correlation between the ?MVA and ?? aortic stiffness (r = -0.62, P < 0.001), and a significantly positive correlation between ?MMG and ?ASI (r = 0.60, P < 0.001). Conclusion Mitral valve stenosis was associated with impaired aortic stiffness and following PMBV, aortic stiffness decreased during both the acute period and the intermediate period. © 2014, Wiley Periodicals, Inc.
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    Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry
    (NLM (Medline), 2021) Erol, Mustafa Kemal; Kayıkçıoğlu, Merve; Kılıçkap, Mustafa; Güler, Arda; Öztürk, Önder; Tuncay, Burcu; İnci, Sinan
    Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15–180) min and from EMS call to EMS arrival 15 (10–20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25–63) min, and median TIT was 195 (115– 330) min. TIT was significantly prolonged from 151 (90–285) min to 250 (165–372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.
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    Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study
    (Turkish Society of Cardiology, 2020) Erol, Mustafa Kemal; Kayıkçıoğlu, Meral; Kılıçkap, Mustafa; Güler, Arda; Yıldırım, Abdullah; Kahraman, Fatih; Can, Veysi; İnci, Sinan; Baysal, Sadettin Selçuk; Er, Okan; Zeybey, Utku; Kafkas, Çağrı
    Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recent pre-pandemic registry (TURKMI-1). Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ?18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic.