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Macit Kalcik,M. Ozan Gursoy,Suleyman Karakoyun,Mahmut Yesin,Mehmet Ali Astarcioglu,Mehmet Ozkan 대한심장학회 2014 Korean Circulation Journal Vol.44 No.4
An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagu-lation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient inthe present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwenta thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prostheticvalve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C andheterozygous mutations of ß-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphismsmay be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss.
Ibrahim Rencuzogullari,Metin Çağdaş,Süleyman Karakoyun,Yavuz Karabağ,Mahmut Yesin,Mustafa Ozan Gürsoy,İnanç Artaç,Doğan İliş,Süleyman Çağan Efe,Kevser Tural,Ibrahim Halil Tanboğa 대한심장학회 2018 Korean Circulation Journal Vol.48 No.1
Background and Objectives Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI. Methods A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN. Results In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012–1.051; p<0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046–1.078; p<0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p<0.001) and an integrated discrimination improvement of 9.1% (p<0.001). Conclusions The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS.