Okan Üniversitesi / Okan University

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Browsing Okan Üniversitesi / Okan University by Author "Akyuz S."

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    Comparison of Ticagrelor and Clopidogrel in Patients With Acute Coronary Syndrome at High Bleeding or Ischemic Risk
    (Excerpta Medica inc-elsevier Science inc, 2024) Akyuz, Sukru; Calik, Ali Nazmi; Yaylak, Baris; Onuk, Tolga; Eren, Semih; Kolak, Zeynep; Tanboga, Ibrahim Halil; Kardiyoloji / Cardiology; Kardiyoloji / Cardiology
    Current guidelines recommend individualizing the choice and duration of P2Y12 inhibitor therapy based on the trade-off between bleeding and ischemic risk. However, whether a potent P2Y12 inhibitor (ticagrelor) or a less potent one (clopidogrel) is more appropriate in patients with acute coronary syndrome (ACS) in the setting of high bleeding or ischemic risk is not clear. The study aimed to compare the clinical outcomes of clopidogrel and ticagrelor in patients with ACS at high bleeding or ischemic risk. A total of 5,713 patients with ACS were included in this retrospective study. The Cox proportional hazard regression model was adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The primary clinical outcome was all-cause death. Secondary outcomes included in-hospital death, ACS, target vessel revascularization, stent thrombo-sis, stroke, or clinically significant or major bleeding. The median follow-up duration was 53.6 months. After multivariable Cox model using an inverse probability weighted approach, all-cause death in the overall population and subgroups of patients at high bleeding risk, and/or at high ischemic risk were not significantly different between clopidogrel and ticagrelor. Rates for secondary outcomes were also similar between the groups. In conclusion, ticagrelor and clopidogrel are associated with comparable clinical outcomes in patients with ACS irrespective of bleeding and ischemic risk. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2024;210:241-248)
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    The predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock
    (Urban & Vogel, 2024) Akyuz, Sukru; Calik, Ali Nazmi; Onuk, Tolga; Yaylak, Baris; Kolak, Zeynep; Eren, Semih; Tanboga, Ibrahim Halil; Kardiyoloji / Cardiology; Kardiyoloji / Cardiology
    BackgroundBesides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS.MethodsThe PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno's C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R2] and likelihood ratio chi 2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death.ResultsAll-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59-3.68], R2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased.ConclusionThe PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS. HintergrundNeben seinem primaren klinischen Nutzen zur Vorhersage des Blutungsrisikos bei Patienten mit akutem Koronarsyndrom (ACS) konnte der PRECISE-DAPT-Score (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-platelet Therapy) auch zur Vorhersage der Langzeitmortalitat bei ACS-Patienten nutzlich sein, bei denen es zum kardiogenen Schock (CS) kommt, denn in verschiedenen Studien wurde uber einen Zusammenhang zwischen dem Score und bestimmten kardiovaskularen Erkrankungen oder Ereignissen berichtet. Ziel der vorliegenden Studie war es, den Nutzen des PRECISE-DAPT-Scores bei der Vorhersage der Langzeitmortalitat aus samtlichen Ursachen bei Patienten (n = 293) mit ACS und CS zu untersuchen.MethodenDazu wurde der PRECISE-DAPT-Score fur jeden Patienten bestimmt, der im Krankenhaus uberlebte, und dann der Zusammenhang mit der Langzeitmortalitat wurde untersucht. Die mittlere Nachbeobachtungsdauer betrug 2,7 Jahre. Die Leistungsfahigkeit des endgultigen Modells wurde bestimmt anhand von Messungen seiner Trennscharfe (Harrell- und Uno-C-Index sowie zeitabhangige Flache unter der Receiver-Operating-Characteristic[ROC]-Kurve, AUC) und Vorhersagegenauigkeit (Bestimmtheitsmass [R2] und Likelihood-Quotienten-chi 2). Die Hazard Ratio (HR) wurde verwendet, um die Beziehung zwischen den Variablen des Modells und der Langzeitmortalitat aus samtlichen Ursachen zu ermitteln.ErgebnisseBei 197 Patienten (67 %) kam es zum Tod aus samtlichen Ursachen. Es bestand eine positive Assoziation zwischen dem PRECISE-DAPT-Score (die anderung von 17 auf 38 ging mit einer HR von 2,42 einher [95 %-Konfidenzintervall, 95 %-KI: 1,59-3,68], R2 = 0,209, zeitabhangige AUC = 0,69) und dem Risiko fur Tod, sodass in der adjustierten uberlebenskurve das Mortalitatsrisiko mit dem Anstieg des PRECISE-DAPT-Scores zunahm.SchlussfolgerungDer PRECISE-DAPT-Score stellt moglicherweise ein einfach zu verwendendes Instrument fur die Vorhersage der Langzeitmortalitat bei Patienten mit ACS und der Komplikation eines CS dar.