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OP-200 [AJC » Preventive cardiology] A Rare Cause of Acute Coronary Syndrome: Spontaneous Coronary Artery Dissection
MARCH 23e26, 2017 sociocultural level, showed that the rates of awareness and treatment were higher and the control rates were similar compared to country data. In this study, Bayraklı district of Izmir city, which is a region that varies in terms of income level and sociocultural level, has been examined in terms of the frequency and awareness of hypertension, treatment receiving and control rates. Methods: Fieldwork was carried out by trained personnel between May 2014 and May 2016 at Bayraklı Municipality Health Center and Satellite Health Units. Hypertension was defined as systolic blood pressure (BP) 140 mmHg or diastolic BP 90 mmHg. In addition, patients who were previously diagnosed as hypertensive and have been taken antihypertensive drugs were considered hypertensive regardless of BP measurements. Awareness of hypertension was defined as a previous diagnosis of hypertension made by a health care professional. Controlled Hypertension was defined as an average systolic blood pressure <140 mmHg and a diastolic blood pressure <90 mmHg. Results: A total of 2363 individuals, 1014 men (42.9%) and 1349 women (57.1%) participated in the study. It was determined that 977 of these individuals were hypertensive (the prevalence of hypertension was 41.4%). The age, BMI and blood pressure averages of the hypertensive and normotensive subjects and their associated comorbid diseases are shown in Table 1. 696 of those who were hypertensive were aware of their high blood pressure levels (awareness rate: 71.3%). The rate of awareness of hypertension was higher in women than in men (39% versus 61%, p <0.05). 648 (66.4%) of those who were hypertensive were taking antihypertensive medication (245 in males; 37.8%, 403 in females; 62.2%). In the entire hypertensive group, the number of people with regulated blood pressure was 453 (control rate: 46.41%) (187 in males; 41.3%, 266 in females; 58.7%). Conclusion: In this study, it was determined that the frequency of _ hypertension was higher in the Bayraklı district of Izmir than in the country but lower than in the Kars¸ıyaka district. It was determined that the rates of awareness and treatment were similar to those of the Kars¸ıyaka survey but higher than the average of the country and that the
Table 1: The age, BMI and blood pressure averages of the hypertensive and normotensive subjects and their associated comorbid diseases Normotensive Hypertensive All p value (n:1386) (n: 977) population (n:2363) Mean Age SD (min-max) Body Mass Index SD Mean Systolic BP SD Mean Diastolic BP SD Smoking ratio (%) Obesity (YKI 30) (%) Diabetes Mellitus (%) Hyperlipidemia (%) History of CVD (%) History of coronary intervention or coronary- by-pass greft operation (%) History of SVD (stroke or TIA) (%) History of Renal Disease (%) Regular exercise (walking, cycling or running) (%)
42.813.1 56.811.6 48.514.3 (18-91) (18-90) (18-91) 26.64.4 29.34.8 27.74.8 116.2011.4 138.1220.0 125.2618.9 75.27.7 85.412.5 79.411.2 39.4 26.1 33.9 20.3 36.9 27.2 9.5 26.1 16.4 13.8 30.9 20.9 6.3 18.8 11.5 2.2 9.4 5.2
0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001
2.5
6.0
4.0
0.001
0.8 38.5
2.1 36.9
1.4 37.6
0.001 0.445
control rates were higher than both the Kars¸ıyaka survey and the country average (table 2). In the last 10 years, the importance given to preventive medicine has been increased day by day in the whole world as well as in our country. The transition to the family medicine system has been made it easier for people to access health services, and the awareness of the community about hypertension disease has been increased with each passing year by the joint activities of the Ministry of Health and associations operating in the field of hypertension, especially by the intensive media campaigns. The high level of awareness, treatment and control rates compared to the country average may reflect this positive momentum. However, hypertension control rates are still low and it is necessary to use all health components effectively in order to increase this rate. Keywords: Bayraklı, Hypertansiyon, Prevalence
- OP-200 [AJC » Preventive cardiology] A Rare Cause of Acute Coronary Syndrome: Spontaneous Coronary Artery Dissection. Pelin Aladag, Özcan Özeke, Serkan Çay. Department of Cardiology, Yuksek Ihtisas HeartEducation and Research Hospital, Ankara, Turkey.
Figure 1. Prevalence, awareness, treatment and control data of Patent 2, KARHIP and BAYHIP studies. BAYHIP Bayrakh Hypertension Prevelance and Awareness Study. KARHIP: Kars¸iyaka Hypertension Prevelance and Awareaess Study, PATENT 2: Prevalence, awareness, treatment and control of hypertension in Turkey 2 Trial. *Sengul S, Erdem V, Akpotat T, Denci U, Sindel S, Karatan O, et al. Controlling hypertension in Turkey: not a hopeless dream. Kidney Int Suppl 2013;3:326-31
Spontaneous coronary artery dissection is a rare causeof acute coronary syndrome, which should be considered in the differential diagnosis. A 46-year-old female admitted to the emergency room with retrosternal chest pain. Just after admissionshe developedventricular fibrillation and immediate cardiopulmonary resuscitation wasinitiated with proper defibrillation. The 12-lead ECG showed ST segment elevation in the inferior leads. Echocardiography demonstrated hypokinetic segments of the apical and lateral walls of the left ventricle with an ejection fraction of 42%. Thereafter, coronary angiography illustrated irregularly contoured 70%stenosis in the proximal portion of the circumflex coronary artery with more distally located diffuse dissection and slow flow distal to the dissection. Initially, proximal stenosis and distal dissected segments were wired and then a 3.0x15 mm drug-eluting stent to the distal part and a 3.0 x 34 mm drug-eluting stent to the proximal part were implanted. Normal blood flow with the resolution of the angina and ST segment elevations was achieved.
The American Journal of Cardiologyâ MARCH 23e26, 2017 13th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
e25
O R A L A B S T R A C T S
MARCH 23e26, 2017
O R A L
Spontaneous coronary artery dissection is a less common diagnosis of acute coronary syndrome that should be suspected in younger female patients without cardiovascular risk factors. Keywords: Giris¸imsel, PCI.
A B S T R A C T S
[range: 16.08 e 30.0 ng/mL]; vs (16.8 ng/mL [range: 25.0-10.5ng/mL] P <.001). According to the Markis classification, the extent of CAE was not correlated with Galectin -3 levels (P¼0.41). Although, the prevalence of family history of coronary artery disease (CAD), uric acid were higher among patients with CAE, In addition, concentrations of galectin-3 and uric acid were determined as independent predictors of the CAE. Conclusions: It was found that galectin-3 serum concentrations are higher in patients with CAE than that in control participants with normal coronary arteries, Further studies on larger population are needed to confirm the potential role of galectin-3 in the CAE suggesting that Galectin-3 may be involved in the pathogenesis of CAE. Keywords: Coronary Artery Ectasia (CAE), Galectin-3 (Gal-3), x
Figure. Angiographic image of the left coronary system demonstrating diffuse luminal stenosis and dissection (arrow)in the distal portion of the circumflex coronary artery.
- OP-207 [AJC » Miscellaneous] Serum Concentrations of Galectin-3 in Patients with Coronary Artery Ectasia. Gönül Açıksarı1, Turgut Uygun2, Adem Atici3, Kurtulus Aciksari4, Aybala Erek Toprak5, Imran Onur6, Yusuf Yılmaz7, Muhammed Esad Cekin1, Emre Yalçınkaya5, Mustafa Caliskan7. 1Istanbul Medeniyet University Goztepe Research & Training Hospital, Department of Cardiology, Istanbul, Turkey; 2Sanliurfa Research & Training Hospital, Department of Cardiology, Sanliurfa, Turkey; 3Mus State Hospital, Department of Cardiology, Mus, Turkey; 4Istanbul Medeniyet University, Faculty of Medicine, Department of Emergency Medicine, Istanbul, Turkey; 5Istanbul Medeniyet University Goztepe Research & Training Hospital, Department of Biochemistry, Istanbul, Turkey; 6Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey; 7Istanbul Medeniyet University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey. Objective: Galectin-3 (Gal-3) is a multifunctional matricellular protein associated with heart failure and cardiovascular events. Galectin-3 represents a valuable biomarker for both progression and destabilization of atherosclerotic lesions. An important characteristic of coronary artery ectasia (CAE) is the fact that in 85% of the cases, atherosclerotic coronary disease accompanies it. The relation between CAE and serum galectin -3 has not been studied so far. We compared A1AT serum levels in patients with and without CAE to determine the association between serum Galectin -3 levels and the extent of ectasia using the Markis score. Methods: We included 49 patients (38 males) with isolated CAE patients and 43 controls (12 males) with normal coronary arteries after coronary angiography. Serum concentrations of galectin-3 were measured on the blood samples. Results: The median Galectin-3 levels were significantly higher in patients with isolated CAE than in the control group (23.2 ng/mL
Figure 1. Graph showing log-transformed serum galectin-3 concentrations in with the CAE and the controls. Table 1 Demographic, clinical, and laboratory characteristics of the study participants. Control Group
Case Group
p
Means.d./n-% Median Means.d./n-% Median Age Gender Female Male Body mass index (BMI) (kg/m2), near (SD) Smoking, % Alcohol Hypertension, % Diabetes mellitus, % Hyperlipidemia, % Family history of CAD, % Systolic BP (mmHg) Diastolic BP (mmHg) Fasting glucose (mg/dl) Uric acid (mg/dL) Total cholesterol (m/dl) LDL-cholesterol (mg/dl), Triglycerides (mg/dl) hs-CRP (mg/L) Galectin-3 (ng/ml) t
t test /
m
57,2 8,3 24 55,8% 19 44,2% 31,9 6,2
58,0
60,6 8,2
31,3
18 36,7% 31 63,3% 29,9 5,1
12 27,9% 2 4,7% 21 48,8% 7 16,3% 19 44,2% 0 0,0%
60,0
0,057 0,067
29,7
t
x2
0,084
t
2
0,271 x 2 0,597 x 2 0,164 x 2 0,457 x 0,046 2 0,003 x
19 38,8% 1 2,0% 31 63,3% 11 22,4% 12 24,5% 9 18,4%
117,9 14,3 68,9 7,9 110,1 38,3 3,9 0,8 200,4 42,5 120,3 38,0
120,0 70,0 97,0 3,9 194,0 121,0
117,5 13,5 63,3 7,8 110,5 34,5 5,4 1,6 192,5 60,7 129,1 41,1
120,0 70,0 101,0 5,5 197,0 129,0
0,933 0,745 0,488 0,000 0,790 0,360
160,8 30,4 1,8 1,5 17,8 7,3
152,0 1,3 16,8
143,9 71,2 3,2 6,5 23,9 7,1
140,0 0,8 23,2
0,305 m 0,461 m 0,000 t
m m m m m m
2
Mann-whitney u test /x Chi-square test (Fischer-exact)
e26 The American Journal of Cardiologyâ MARCH 23e26, 2017 13th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
Table 1: The age, BMI and blood pressure averages of the hypertensive and normotensive subjects and their associated comorbid diseases Normotensive Hypertensive All p value (n:1386) (n: 977) population (n:2363) Mean Age SD (min-max) Body Mass Index SD Mean Systolic BP SD Mean Diastolic BP SD Smoking ratio (%) Obesity (YKI 30) (%) Diabetes Mellitus (%) Hyperlipidemia (%) History of CVD (%) History of coronary intervention or coronary- by-pass greft operation (%) History of SVD (stroke or TIA) (%) History of Renal Disease (%) Regular exercise (walking, cycling or running) (%)
42.813.1 56.811.6 48.514.3 (18-91) (18-90) (18-91) 26.64.4 29.34.8 27.74.8 116.2011.4 138.1220.0 125.2618.9 75.27.7 85.412.5 79.411.2 39.4 26.1 33.9 20.3 36.9 27.2 9.5 26.1 16.4 13.8 30.9 20.9 6.3 18.8 11.5 2.2 9.4 5.2
0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001
2.5
6.0
4.0
0.001
0.8 38.5
2.1 36.9
1.4 37.6
0.001 0.445
control rates were higher than both the Kars¸ıyaka survey and the country average (table 2). In the last 10 years, the importance given to preventive medicine has been increased day by day in the whole world as well as in our country. The transition to the family medicine system has been made it easier for people to access health services, and the awareness of the community about hypertension disease has been increased with each passing year by the joint activities of the Ministry of Health and associations operating in the field of hypertension, especially by the intensive media campaigns. The high level of awareness, treatment and control rates compared to the country average may reflect this positive momentum. However, hypertension control rates are still low and it is necessary to use all health components effectively in order to increase this rate. Keywords: Bayraklı, Hypertansiyon, Prevalence
- OP-200 [AJC » Preventive cardiology] A Rare Cause of Acute Coronary Syndrome: Spontaneous Coronary Artery Dissection. Pelin Aladag, Özcan Özeke, Serkan Çay. Department of Cardiology, Yuksek Ihtisas HeartEducation and Research Hospital, Ankara, Turkey.
Figure 1. Prevalence, awareness, treatment and control data of Patent 2, KARHIP and BAYHIP studies. BAYHIP Bayrakh Hypertension Prevelance and Awareness Study. KARHIP: Kars¸iyaka Hypertension Prevelance and Awareaess Study, PATENT 2: Prevalence, awareness, treatment and control of hypertension in Turkey 2 Trial. *Sengul S, Erdem V, Akpotat T, Denci U, Sindel S, Karatan O, et al. Controlling hypertension in Turkey: not a hopeless dream. Kidney Int Suppl 2013;3:326-31
Spontaneous coronary artery dissection is a rare causeof acute coronary syndrome, which should be considered in the differential diagnosis. A 46-year-old female admitted to the emergency room with retrosternal chest pain. Just after admissionshe developedventricular fibrillation and immediate cardiopulmonary resuscitation wasinitiated with proper defibrillation. The 12-lead ECG showed ST segment elevation in the inferior leads. Echocardiography demonstrated hypokinetic segments of the apical and lateral walls of the left ventricle with an ejection fraction of 42%. Thereafter, coronary angiography illustrated irregularly contoured 70%stenosis in the proximal portion of the circumflex coronary artery with more distally located diffuse dissection and slow flow distal to the dissection. Initially, proximal stenosis and distal dissected segments were wired and then a 3.0x15 mm drug-eluting stent to the distal part and a 3.0 x 34 mm drug-eluting stent to the proximal part were implanted. Normal blood flow with the resolution of the angina and ST segment elevations was achieved.
The American Journal of Cardiologyâ MARCH 23e26, 2017 13th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
e25
O R A L A B S T R A C T S
MARCH 23e26, 2017
O R A L
Spontaneous coronary artery dissection is a less common diagnosis of acute coronary syndrome that should be suspected in younger female patients without cardiovascular risk factors. Keywords: Giris¸imsel, PCI.
A B S T R A C T S
[range: 16.08 e 30.0 ng/mL]; vs (16.8 ng/mL [range: 25.0-10.5ng/mL] P <.001). According to the Markis classification, the extent of CAE was not correlated with Galectin -3 levels (P¼0.41). Although, the prevalence of family history of coronary artery disease (CAD), uric acid were higher among patients with CAE, In addition, concentrations of galectin-3 and uric acid were determined as independent predictors of the CAE. Conclusions: It was found that galectin-3 serum concentrations are higher in patients with CAE than that in control participants with normal coronary arteries, Further studies on larger population are needed to confirm the potential role of galectin-3 in the CAE suggesting that Galectin-3 may be involved in the pathogenesis of CAE. Keywords: Coronary Artery Ectasia (CAE), Galectin-3 (Gal-3), x
Figure. Angiographic image of the left coronary system demonstrating diffuse luminal stenosis and dissection (arrow)in the distal portion of the circumflex coronary artery.
- OP-207 [AJC » Miscellaneous] Serum Concentrations of Galectin-3 in Patients with Coronary Artery Ectasia. Gönül Açıksarı1, Turgut Uygun2, Adem Atici3, Kurtulus Aciksari4, Aybala Erek Toprak5, Imran Onur6, Yusuf Yılmaz7, Muhammed Esad Cekin1, Emre Yalçınkaya5, Mustafa Caliskan7. 1Istanbul Medeniyet University Goztepe Research & Training Hospital, Department of Cardiology, Istanbul, Turkey; 2Sanliurfa Research & Training Hospital, Department of Cardiology, Sanliurfa, Turkey; 3Mus State Hospital, Department of Cardiology, Mus, Turkey; 4Istanbul Medeniyet University, Faculty of Medicine, Department of Emergency Medicine, Istanbul, Turkey; 5Istanbul Medeniyet University Goztepe Research & Training Hospital, Department of Biochemistry, Istanbul, Turkey; 6Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey; 7Istanbul Medeniyet University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey. Objective: Galectin-3 (Gal-3) is a multifunctional matricellular protein associated with heart failure and cardiovascular events. Galectin-3 represents a valuable biomarker for both progression and destabilization of atherosclerotic lesions. An important characteristic of coronary artery ectasia (CAE) is the fact that in 85% of the cases, atherosclerotic coronary disease accompanies it. The relation between CAE and serum galectin -3 has not been studied so far. We compared A1AT serum levels in patients with and without CAE to determine the association between serum Galectin -3 levels and the extent of ectasia using the Markis score. Methods: We included 49 patients (38 males) with isolated CAE patients and 43 controls (12 males) with normal coronary arteries after coronary angiography. Serum concentrations of galectin-3 were measured on the blood samples. Results: The median Galectin-3 levels were significantly higher in patients with isolated CAE than in the control group (23.2 ng/mL
Figure 1. Graph showing log-transformed serum galectin-3 concentrations in with the CAE and the controls. Table 1 Demographic, clinical, and laboratory characteristics of the study participants. Control Group
Case Group
p
Means.d./n-% Median Means.d./n-% Median Age Gender Female Male Body mass index (BMI) (kg/m2), near (SD) Smoking, % Alcohol Hypertension, % Diabetes mellitus, % Hyperlipidemia, % Family history of CAD, % Systolic BP (mmHg) Diastolic BP (mmHg) Fasting glucose (mg/dl) Uric acid (mg/dL) Total cholesterol (m/dl) LDL-cholesterol (mg/dl), Triglycerides (mg/dl) hs-CRP (mg/L) Galectin-3 (ng/ml) t
t test /
m
57,2 8,3 24 55,8% 19 44,2% 31,9 6,2
58,0
60,6 8,2
31,3
18 36,7% 31 63,3% 29,9 5,1
12 27,9% 2 4,7% 21 48,8% 7 16,3% 19 44,2% 0 0,0%
60,0
0,057 0,067
29,7
t
x2
0,084
t
2
0,271 x 2 0,597 x 2 0,164 x 2 0,457 x 0,046 2 0,003 x
19 38,8% 1 2,0% 31 63,3% 11 22,4% 12 24,5% 9 18,4%
117,9 14,3 68,9 7,9 110,1 38,3 3,9 0,8 200,4 42,5 120,3 38,0
120,0 70,0 97,0 3,9 194,0 121,0
117,5 13,5 63,3 7,8 110,5 34,5 5,4 1,6 192,5 60,7 129,1 41,1
120,0 70,0 101,0 5,5 197,0 129,0
0,933 0,745 0,488 0,000 0,790 0,360
160,8 30,4 1,8 1,5 17,8 7,3
152,0 1,3 16,8
143,9 71,2 3,2 6,5 23,9 7,1
140,0 0,8 23,2
0,305 m 0,461 m 0,000 t
m m m m m m
2
Mann-whitney u test /x Chi-square test (Fischer-exact)
e26 The American Journal of Cardiologyâ MARCH 23e26, 2017 13th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral