Thrombotic coronary artery occlusions usually manifest as acute coronary syndrome with cardiogenic shock, acute pulmonary edema, cardiac arrest, fatal arrhythmias, or sudden cardiac death. Although it usually occurs based on atherosclerosis, it can also occur without atherosclerosis. There is no predictor of coronary artery thrombosis clinically and no consensus regarding the optimal treatment. In the current literature, treatment options include emergency coronary artery bypass grafting, entrapment of thrombus in vessel wall with stent implantation, intracoronary thrombolysis, glycoprotein IIb/IIIa inhibitors, anticoagulation with heparin, and thrombus aspiration as reperfusion strategies. Here, we reviewed a new treatment strategy based on the literature, and a case series with successful results in hemodynamically stable patients with low-dose slow infusion tissue plasminogen activator (tPA) for thrombotic coronary artery occlusions that allow coronary flow was reported. Prospective randomized studies and common consensus are needed on low-dose, slow-infusion tissue plasminogen activator treatment regimen and optimal treatment management for thrombotic coronary artery occlusions.

Background: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial has been the largest study ever conducted among patients in Turkey regarding aspirin treatment. In the subgroup analysis of the hypertensive group of the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial, we aimed to evaluate the physicians’ adherence to current guidelines regarding their aspirin treatment preferences.

Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial is a cross-sectional and multicenter study conducted among 5007 consecutive patients aged ≥18 years. The study population consisted of outpatients on aspirin treatment (80-300 mg). The patient data were obtained from 30 different cardiology clinics of 14 cities from all over Turkey. In this subgroup analysis, patients were divided into 2 groups: the hypertensive group (n=3467, 69.3%) and the group without hypertension (n=1540, 30.7%) according to the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the Management of Arterial Hypertension.

Results: Aspirin use for primary prevention was higher in patients with hypertension compared to patients without hypertension [328 (21.3%); 1046 (30.2%); P <.001]. Treatment with a dose of 150 mg aspirin (n=172, 5%) was mostly preferred by internists for hypertensive patients (n =226, 6.5%); however, a daily dose of 80-100 mg aspirin therapy (n=1457, 94.6%) was mostly prescribed by cardiologists (n=1347, 87.5%) for patients without hypertension.

Conclusion: Aspirin was found to be used commonly among patients with hypertension for primary prevention despite the current European Society of Cardiology Arterial Hypertension Guideline not recommending aspirin for primary prevention in patients with hypertension.

Background: The present study aimed to assess and compare regional strain of the right and left sides of interventricular septum in healthy subjects using velocity vector imaging analysis due to the importance of interventricular septum and limited basic information about the exact function of the interventricular septum.

Methods: The present study was conducted on 40 healthy subjects. Echocardiography was performed in the apical 4-chamber view in the left lateral decubitus position. Image analysis was done offline with velocity vector imaging; the longitudinal strain and strain rate were calculated during 3 cardiac cycles. Strain-time and strain rate-time curves in basal, middle, and apical segments of the left and right sides of interventricular septum were recorded; peak values and time to peak strain were determined.

Results: There was no significant difference between the longitudinal strain in the right and left basal (−17.7 ± 5.10% vs. −18.2 ± 5.14%, P=.550), middle (−17.1 ± 4.53% vs. −17.9 ± 4.29%, P =.197) segments, strain rate of basal (−1.1 ± 0.36 1/s vs. −1.0 ± 0.36 1/s, P =.350), and middle (−1.0 ± 0.30 1/s vs. −1.1 ± 0.32 1/s, P =0.551) segments. However, there was a significant difference between the longitudinal strain (−22.2 ± 5.55% vs. −16.6 ± 4.45%, P <.001) and strain rate (−1.5 ± 0.46 1/s vs. −1.1 ± 0.33 1/s, P <.001) of the apical segment. Time to peak strain was significantly different only in the middle segment of interventricular septum (right side: 351.0 ±11.5 ms vs.left side: 344.4 ± 13.1 ms, P =.004).

Conclusions: The findings of this study suggest that the right and left function of the septum was comparable in the basal and middle segments of healthy subjects; this function was significantly different in the apical segments.

Background: Transcatheter closure of perimembraneous ventricular septal defect still poses a challenge due to the adjacent structures of the tricuspid and aortic valves and the risk of atrioventricular block. We report our experience at 2 centers using the KONAR-MF (multifunctional occluder) ventricular septal defect device, which gained its CE mark in May 2018.

Methods: A retrospective study was carried out on all patients who underwent transcatheter ventricular septal defect closure with the KONAR-MF (multifunctional occluder) ventricular septal defect device at 2 centers.

Results: A total of 47 patients were identified. The median age and weight of the patients were 25.8 months and 11 kg. The ventricular septal defects that were closed in 5 cases were post-operative hemodynamically significant residual ventricular septal defects. Forty-eight devices were used in the 47 cases. As for the location of the ventricular septal defect, 40/48 (83.33%) ventricular septal defects were perimembranous and 8/48 (16.66%) were muscular. The percutaneous device closure was successful in 46 procedures (95.8%). Device embolization was observed in 2 patients, and a significant residual shunt was observed in 2 cases. In the follow-up, there was no enhancement in the residual shunt in the remaining cases. Temporary atrioventricular block occurred in 2 cases during the procedure and improved after long sheath withdrawal.

Conclusion: Soft, flexible, and low-profile KONAR-MF (multifunctional occluder) occluders ensure easy and safe implantation, and small sheath sizes allow for their use in small infants. Although near and mid-term follow-ups did not indicate any permanent atrioventricular block, a larger sample of patients and a longer follow-up period is necessary to understand long-term outcomes.

Background: The aim of this study was to provide insight into the real-life clinical presentation and outcomes of the elderly presenting with acute myocardial infarction from the Turkish Myocardial Infarction registry database.

Methods: TURKMI was a nationwide, multicenter, observational, 15-day snapshot registry conducted to address the management of acute myocardial infarction patients admitted to percutaneous intervention-capable hospitals. The present analysis included the comparison of consecutively enrolled acute myocardial infarction patients aged ≥75 and <75 years.

Results: Of the overall 1930 patients, 362 patients were aged ≥75 years. Elderly patients were more likely to have hypertension and renal failure and less likely to have hypercholesterolemia. Elderly patients were admitted to hospitals almost 1 hour later mainly due to a late call to emergency medical service. At discharge, medical therapies were significantly less prescribed to the elderly. The proportion of patients undergoing coronary angiography was significantly lower in elderly (81.8% vs. 96.4%, P <.001). Both in-hospital and 1-year mortality were significantly higher in elderly patients (9.1% vs. 2.7% and 22.7% vs. 5.8%, P <.001 respectively). The adjusted risk of 1-year mortality was 4-fold in elderly (hazard ratio and 95% CI 4.0 [2.9-5.6], P <.001). In multivariate analysis, every 5-beat/min increase in heart rate increased mortality by 7%. Higher heart rate and use of antiplatelet agents on admission were predictors of mortality in elderly.

Conclusion: In real-life settings, elderly patients presenting with acute myocardial infarction are prone to prolonged total ischemic time and are subjected to less-intensive medical treatment and interventional approaches. Besides age, the increased heart rate could be the major determinant of mortality.

Background: Silent cranial embolism due to carotid artery stenting has been demonstrated to cause dementia, cognitive decline, and even ischemic stroke. The purpose of this study was to compare the periprocedural asymptomatic cranial embolism rates of different stent designs used for extracranial carotid stenosis with diffusion-weighted magnetic resonance imaging.

Methods: A total of 507 consecutive patients who underwent carotid artery stenting at our center from December 2010 to June 2020 (mean age, 66.4 ± 9.5) were analyzed retrospectively. The patients were divided into 3 groups as open-cell stent (334 patients), closed-cell stent (102 patients), and hybrid-cell stent (71 patients) groups. Diffusionweighted magnetic resonance imaging was performed for the patients before and after carotid artery stenting and compared. The diffusion limitations of 3 stent groups on cranial diffusion-weighted magnetic resonance imaging were compared with one another.

Results: Periprocedural asymptomatic same-side microembolism, which was the primary endpoint of our study, was detected in 58 (17.4%) patients in the open-cell stent group, 6 (5.9%) patients in the closed-cell group, and 8 (11.3%) patients in the hybrid cell group, and overall in 72 (14.2%) patients. On diffusion-weighted magnetic resonance imaging, periprocedural asymptomatic same-side cranial embolism was found to be statistically significantly higher in the open-cell group compared to the other two groups (P=.011).

Conclusions: The result of this study showed us that the rate of same-side cranial embolism detected on cranial diffusion-weighted magnetic resonance imaging after carotid artery stenting performed with open-cell stent was higher than those of the carotid artery stenting procedure performed with closed-cell and hybrid-cell stents.

Background: Coronavirus disease 2019, putatively caused by infection with severe acute respiratory coronavirus 2, often involves injury to multiple organs and there are limited data regarding the mid- to long-term consequences of coronavirus disease 2019 after discharge from the hospital. The study aimed to describe the mid- to long-term consequences of coronavirus disease 2019 in hospitalized patients after discharge.

Methods: This single-center, prospective study enrolled coronavirus disease 2019 patients who were discharged uneventfully from our center. All participants underwent face-toface interviews by trained physicians and were asked to complete a series of questionnaires on third and sixth months’ follow-up visits.

Results: A total of 406 consecutive discharged coronavirus disease 2019 patients were enrolled in this study. Patients were divided into 3 groups according to World Health Organization classification as follows: World Health Organization-3 (n=83); World Health Organization-4 (n=291); and World Health Organization-5,6 (n=32). Length of hospital stay was highly, significantly increased in the higher World Health Organization groups (World Health Organization-3 vs. World Health Organization-4, P <.0001; World Health Organization-3 vs. World Health Organization-5,6, P <.0001; World Health Organization-4 vs. World Health Organization-5,6, P <.0001), whereas the length of intensive care unit stay was highly, significantly increased only in World Health Organization-5,6 group compared to other groups (World Health Organization-3 vs. World Health Organization-5,6, P <.0001; World Health Organization-4 vs. World Health Organization-5,6, P <.0001). The most frequent complaints were chest pain (39%), and the frequency of complaints decreased during the 3-6 months follow-up period. Multiple logistic regression analysis indicated that age, coronary artery disease, fibrinogen, C-reactive protein, troponin I, D-dimer, use of steroid and/or low molecular weight heparin, and World Health Organization class were found to be independent predictors of ongoing cardiovascular symptoms.

Conclusions: The current data demonstrated that persistent symptoms were common after coronavirus disease 2019 among hospitalized patients. This should raise awareness among healthcare professionals regarding coronavirus disease 2019 aftercare.

Background: Alcohol septal ablation is recommended for hypertrophic obstructive cardiomyopathy patients who had refractory symptoms despite optimal medical treatment. We compared the periprocedural, short-, and long-term clinical outcomes and mortality predictors in hypertrophic obstructive cardiomyopathy patients who underwent alcohol septal ablation.

Methods: Hypertrophic obstructive cardiomyopathy patients aged ≥18 years (63 females and 71 males) who underwent alcohol septal ablation were included. The primary endpoint was all-cause mortality.

Results: The mean patient age was 60.0 (standard deviation 13.7) years. The median follow-up time was 13 (7.6-18.5) years. During the procedure, 9, 2, and 1 patients developed ventricular fibrillation, remote site myocardial infarction, and pericardial tamponade, respectively, but none died. One patient died during hospitalization. During the long-term follow-up, 17, 5, 20, and 8 patients developed heart failure, myocardial infarction, chronic atrial fibrillation, and non-fatal stroke, respectively, and 24 died. There was no significant difference between the sexes (all P >.05). Age (hazard ratio=0.69, 95% CI=0.61‒0.78, P <.001), body mass index (hazard ratio=1.20, 95% CI=1.04-1.40, P=.01), age at diagnosis (hazard ratio=1.57, 95% CI=1.34-1.78, P <.001), and time from diagnosis to ablation (hazard ratio=1.57, 95% CI=1.35-1.84, P<.001) predicted all-cause mortality. In Kaplan‒Meier curves, long-term all-cause mortality was similar in men and women (P[log-rank]=.43).

Conclusion: Alcohol septal ablation has similar short- and long-term outcomes for both sexes in hypertrophic obstructive cardiomyopathy patients. Risk factors for longterm mortality were age, body mass index, diagnosis age, and time delay to operation. Therefore, alcohol septal ablation timing is essential for better clinical outcomes. Our findings may contribute to the increased performance of alcohol septal ablation in hypertrophic obstructive cardiomyopathy patients in our country.