Browsing by Author "Onuk, Tolga"

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    Comparison of ticagrelor and clopidogrel in anemic patients with acute coronary syndrome: efficacy and safety outcomes over one year
    (Springer Heidelberg, 2024) Akyüz, Şükrü; Polat, Fuat; Yaylak, Baris; Akyuz, Sukru; Kolak, Zeynep; Durak, Furkan; Kardiyoloji / Cardiology; Kardiyoloji / Cardiology
    ObjectiveThis retrospective study aimed to investigate the potential impact of ticagrelor and clopidogrel treatment on cardiovascular outcomes in patients with anemia and acute coronary syndrome (ACS) and to provide insights into the optimal therapeutic approach for this vulnerable patient population.MethodsA retrospective research design was employed, involving patients diagnosed with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) between 2014 and 2021. Inclusion criteria required a hemoglobin level below 12 mg/dL and a minimum 12-month P2Y12 inhibitor treatment. Comprehensive clinical, biochemical, and echocardiographic data were collected from the hospital's electronic repository. The primary efficacy endpoint was major adverse cardiovascular events (MACE), encompassing total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke. Major hemorrhage was the primary safety endpoint. Secondary outcomes included total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke, individually.ResultsPatients treated with ticagrelor (n = 118) and clopidogrel (n = 538) were compared. No significant difference was observed in major adverse cardiovascular events (MACE) and major bleeding between ticagrelor and clopidogrel treatment groups (MACE: clopidogrel 10.0% vs. ticagrelor 11.0%, p = 0.75; major bleeding: clopidogrel 2.8%, ticagrelor 2.5%, p = 0.88). Patients with hemoglobin levels <= 8 mg/dL demonstrated significantly higher MACE and major bleeding rates in the ticagrelor group (p = 0.008 and p = 0.002, respectively). Among patients aged >= 75 years, ticagrelor treatment was associated with a higher risk of major bleeding (p = 0.04).ConclusionsTicagrelor and clopidogrel exhibited comparable efficacy and safety outcomes in anemic ACS patients over a one-year period. Although ticagrelor demonstrated superiority in reducing ischemic events, it is crucial to recognize the limitations of retrospective studies in informing clinical practice. This study offers valuable insights into tailoring antiplatelet therapy for anemic ACS patients and provides guidance for personalized treatment strategies, acknowledging the hypothesis-generating nature of retrospective analyses.
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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; Akyüz, Şükrü; 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; Akyüz, Şükrü; 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.
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    Prognostic Value of PRECİSE DAPT Score on Short- and Long-Term Outcomes in MINOCA Patients with Acute Coronary Syndrome
    (Arquivos Brasileiros Cardiologia, 2024) Akyüz, Şükrü; Polat, Fuat; Yaylak, Baris; Calik, Ali Nazmi; Eren, Semih; Akyuz, Sukru; Kardiyoloji / Cardiology
    Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) constitutes a significant subset of acute myocardial infarctions (AMI) with uncertain prognostic markers. Early risk assessment is crucial to identify MINOCA patients at risk of adverse outcomes. Objectives: This study aimed to evaluate the predictive capacity of the PRECISE-DAPT score in assessing short- and long-term prognoses in MINOCA patients presenting with ST-segment elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). Methods: Among 741 MINOCA patients, the PRECISE-DAPT score was computed to analyze its association with in-hospital and follow-up major adverse cardiovascular events (MACE). Parameters showing significance in MACE (+) groups underwent statistical analysis: univariate logistic regression for in-hospital events and univariate Cox regression for follow-up events. For statistical significance, a predefined level of alpha = 0.05 was adopted. Parameters demonstrating significance proceeded to multiple logistic regression for in-hospital events and multivariate Cox regression for follow-up events. Results: In-hospital MACE occurred in 4.1% of patients, while 58% experienced follow-up MACE. Hemoglobin levels and the PRECISE-DAPT Score were identified as independent parameters for in-hospital MACE. Furthermore, ejection fraction (EF%) and the PRECISE-DAPT Score emerged as independent predictors of follow-up MACE. Conclusions: The study revealed that a higher PRECISE-DAPT score was significantly associated with increased risks of both in-hospital and long-term major adverse cardiovascular events in MINOCA patients presenting with acute coronary syndrome (ACS), underscoring the score's potential in risk stratification for this patient cohort.
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    The relation of polymer structure of stent used in patients with acute coronary syndrome revascularized by stent implantation with long-term cardiovascular events
    (Wiley, 2023) Akyüz, Şükrü; Polat, Fuat; Onuk, Tolga; Akyuz, Sukru; Calik, Ali Nazmi; Cetin, Mustafa; Dayi, Sennur Unal; Kardiyoloji / Cardiology; Kardiyoloji / Cardiology
    Introduction: Drug-eluting stents (DES) have revolutionized percutaneous coronary intervention (PCI) by improving event-free survival compared to older stent designs. However, early-generation DES with polymer matrixes have raised concerns regarding late stent thrombosis due to delayed vascular healing. To address these issues, biologically bioabsorbable polymer drug-eluting stents (BP-DES) and polymer-free drug-eluting stents (PF-DES) have been developed.Aim: The aim of the present study is to evaluate and compare the long-term effects of different stent platforms in patients with acute coronary syndrome (ACS) undergoing PCI.Material and methods: We conducted a retrospective, observational study involving 1192 ACS patients who underwent urgent PCI. Patients were treated with thin- strut DP-DES, ultra-thin strut BP-DES, or thin-strut PF-DES. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (CITLR) at 12 months and 4 years.Results: The baseline demographics and clinical characteristics of patients in the three stent subgroups were similar. No significant differences were observed in target lesion failure (TLF), cardiac mortality, TVMI, and stent thrombosis (ST) rates among the three subgroups at both 12 months and 4 years. However, beyond the first year, the rate of CITLR was significantly lower in the ultra-thin strut BP-DES subgroup compared to thin-strut DP-DES, suggesting potential long-term advantages of ultra-thin strut BP-DES. Additionally, both ultra-thin strut BP-DES and thin-strut PF-DES demonstrated lower ST rates after the first year compared to thin-strut DP-DES.Conclusion: Our study highlights the potential advantages of ultra-thin strut BP-DES in reducing CITLR rates in the long term, and both ultra-thin strut BP-DES and thin-strut PF-DES demonstrate lower rates of ST beyond the first year compared to thin-strut DP-DES. However, no significant differences were observed in overall TLF, cardiac mortality and TVMI rates among the three stent subgroups at both 12 months and 4 years.