Objective: The coronavirus disease 2019 (COVID-19) pandemic caused by the emergence of severe acute respiratory syndrome coronavirus 2 has resulted in a health crisis and a significant number of deaths worldwide. The full effect on access to medical care and the treatment for patients with chronic diseases and acute conditions is still unknown. This is an investigation of access to primary percutaneous coronary intervention (PPCI) for patients diagnosed with ST-segment myocardial infarction (STEMI) during the pandemic.
Methods: Consecutive patients who were diagnosed with STEMI and underwent PPCI during the ongoing COVID-19 pandemic were included in the study. Clinical and angiographic characteristics of the patients were assessed. A control group of patients diagnosed with STEMI and who underwent PPCI during the same time interval a year prior to the outbreak of the disease was analyzed retrospectively for comparison.
Results: There was a significant reduction in the number of STEMI cases during the COVID-19 crisis period. Furthermore, these patients had a prolonged ischemic time; they were more likely to have a longer pain-to-balloon (Odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.1–10.2) and door-to-balloon time (OR: 5.4, 95% CI: 3.1–22.8).
Conclusion: Patients diagnosed with STEMI during the pandemic experienced a significant delay between the onset of symptoms and PPCI.

Objective: Moderate and severe carotid artery stenosis in the internal carotid artery causes 10% to 15% of all strokes. The aim of this study was to evaluate the safety and short-term efficacy of carotid artery stenting (CAS) performed at a tertiary referral center.
Methods: The records of patients who underwent CAS between January 2017 and May 2018 at a tertiary care center were analyzed retrospectively and a total of 145 patients were included in the study.
Results: The mean age of the patients was 70.1±8.6 years, 75.2% of the study group was male, and 37.9% had hypertension. Of the patients evaluated, 81 (55.9%) were classified as symptomatic and 64 (44.1%) were classified as asymptomatic. A percutaneous coronary intervention was performed after CAS more often in symptomatic patients (38.9%), while it was observed at the same rate both before (25.9%) and after (25.9%) CAS in the asymptomatic group, but the difference between the groups was not statistically significant. A distal embolic protection device (EPD) was used in symptomatic patients (59.2%) and in the asymptomatic group (78.7%); however, a proximal EPD was used significantly more often in symptomatic patients (45.6%) compared with asymptomatic patients. No patient death was recorded while in hospital, and stroke/transient ischemic attack (TIA) development was observed in 5 (3.4%) patients. Stroke was seen in 2 patients (2.4%) and TIA in 3 patients (3.7%) in the symptomatic group; TIA or stroke was not seen in the asymptomatic group.
Conclusion: The results of this study revealed that CAS was a safe and practical procedure with an acceptable complication rate. In the appropriate patients, experienced interventionists can achieve good results when aggressive risk modification is applied and an EPD and optimal medical therapy are used.

Objective: Coronavirus disease 2019 (COVID-19) is an infectious disease that was first reported in December 2019 in Wuhan, China, and has since spread rapidly around the world, resulting in the ongoing COVID-19 pandemic. The CHA2DS2-VASc score is a well‐validated risk stratification tool for predicting stroke in atrial fibrillation (AFib), as well as morbidity and mortality in several entities. The aim of this study was to evaluate the relationship between the CHA2DS2-VASc score and in-hospital mortality in patients with COVID-19, regardless of AFib.
Methods: This multicenter, retrospective study included a total of 349 patients with COVID-19 who were hospitalized between March 15 and April 15, 2020. The CHA2DS2-VASc score of each patient was calculated. Mortality outcomes were followed up until April 25, 2020.
Results: The CHA2DS2-VASc score was significantly higher in non-survivor COVID-19 patients than in survivor COVID-19 patients (p<0.001). Forward stepwise logistic regression analysis demonstrated that a CHA2DS2-VASc score of ≥3 (odds ratio [OR]: 12.613, 95% confidence interval [CI]: 3.092–51.451; p<0.001), and the leukocyte count (OR: 1.327, 95% CI: 1.145-1.538; p<0.001), C-reactive protein level (OR: 1.010, 95% CI: 1.002–1.018; p=0.012), and ferritin level (OR: 1.005, 95% CI: 1.003–1.007; p<0.001) on admission were independent predictors of in-hospital mortality of COVID-19 patients.
Conclusion: The CHA2DS2-VASc score predicted in-hospital mortality in patients with COVID-19, regardless of AFib.

Objective: No-reflow is a phenomenon that can arise due to factors such as distal embolization, microvascular occlusion, or prolonged myocardial ischemia and damage. It occurs in about 5% to 10% of patients after primary percutaneous coronary intervention. The CHA2DS2-VASc score can be easily calculated in daily practice and the components of this score are similar to common risk factors for no-reflow. Chronic renal disease generates a hypercoagulable state, which is associated with increased risk of no-reflow in cases of ST-segment elevation myocardial infarction (STEMI). A modified CHA2DS2-VASc score has been developed to include patients with renal dysfunction. The aim of this study was to investigate the prognostic significance of this scoring system, the RCHA2DS2-VASc score, in patients with no-reflow.
Methods: A total of 75 patients with no-reflow and 1138 patients without no-reflow after STEMI were retrospectively enrolled in this study. The CHA2DS2-VASc and RCHA2DS2-VASc scores of the two groups were compared.
Results: The median CHA2DS2-VASc score and the median RCHA2DS2-VASc score were significantly higher in the no-reflow group (p<.001, for both). There was a statistically significant difference between the groups in all of the components of the CHA2DS2-VASc score. An RCHA2DS2-VASc score of ≥2 was a predictor of no-reflow with a sensitivity of 83% and specificity of 62%.
Conclusion: The RCHA2DS2-VASc score is a simple, inexpensive, and easily accessible score to predict no-reflow.

Objective: The aim of this study was to investigate the effects of the CETP gene rs289714 polymorphism on the serum lipid profile and other metabolic parameters in Turkish patients with coronary artery disease (CAD).
Methods: The CETP rs289714 variant was examined in 104 patients with CAD and 77 controls using the polymerase chain reaction-restriction fragment length polymorphism method.
Results: The CETP rs289714 genotype and allele distribution was not statistically different between the groups (p>0.05). The body mass index (BMI) values in men with CAD were higher in patients with the G allele compared with those carrying the AA genotype (p=0.05). Logistic regression analysis showed that the G allele in male CAD patients was a risk factor for a BMI of 27 kg/m2 (odds ratio: 0.269, 95% confidence interval: 0.075–0.966; p=0.044). The G allele in female patients was associated with lower HDL-C levels than the AA genotype (p=0.049).
Conclusion: The results suggest that the CETP rs289714 polymorphism may cause risk for the development of CAD due to its effects on high-density lipoprotein cholesterol values in male patients and BMI in female patients.

Objective: Acute decompensated heart failure (ADHF) is a life-threatening medical condition and more than 30% of patients hospitalized for ADHF develop acute kidney injury (AKI), which increases the rate of both mortality and morbidity. Previous research has indicated that several biomar-
kers may help to predict the development of AKI. The aim of this study was to investigate the relationship between lactate level at the time of admission and AKI in ADHF patients.
Methods: A total of 154 consecutive ADHF patients were prospectively enrolled from June 2018 to December 2018, and after applying the exclusion criteria, a total of 91 patients were included in the study. The patients were divided into 2 groups: those with and without AKI.
Results: There were 63 patients in the group without AKI and 28 patients in the group with AKI. The AKI group had a higher percentage of a history of chronic kidney disease (CKD), a higher creatinine level, lower glomerular filtration rate level, lower bicarbonate level, higher lactate level, and a lower left ventricular ejection fraction compared with the non-AKI group (p<0.05 for all parameters). Multiple logistic regression analysis determined that CKD history (odds ratio [OR]: 4.003, 95% confidence interval [CI]: 1.295–12.371; p=0.016) and lactate level (OR: 1.545, 95% CI: 1.222–1.954; p<0.001) were independent predictive parameters for developing AKI.
Conclusion: An elevated lactate level may help to make an early diagnosis of AKI, an important concern in ADHF.

Objective: The precise pathophysiology of slow coronary flow (SCF) has not yet been clarified; however, many studies have shown that significant fructose consumption is associated with oxidative stress and inflammation, which may play a role in the pathophysiology of SCF. The aim of this study was to investigate the association between fructose consumption and isolated SCF.

Methods: Patients with stable angina pectoris who underwent coronary angiography between December 2018 and April 2019 were evaluated for this study. In all, 45 patients with isolated SCF were selected as the patient group (SCF group) and 50 patients with a normal coronary flow pattern were enrolled as a control group. Participants used a dietary record to provide details of nutrient consumption and all of the data from the 2 groups were compared.

Results: The high-sensitivity C-reactive protein (Hs-CRP) level (p=0.024), white blood cell count (p=0.038), and smoking rate (p=0.012) were higher in the SCF group. Total energy (p=0.029), carbohydrate (p=0.047), and fructose consumption (p<0.001) were also higher in the SCF group. Multivariable logistic regression analysis demonstrated that a higher level of Hs-CRP, fructose consumption, and smoking were independently associated with SCF.

Conclusion: The SCF group demonstrated a higher level of fructose consumption. Excessive fructose consumption may play a role in SCF pathophysiology

Acute heart failure (HF) is one of the most common cardiac emergencies. Pulmonary edema caused by HF may mimic an exudative disease on chest computed tomography scans. Coronavirus disease 2019 (COVID-19) emerged in China in December 2019 and quickly spread around the world. During this pandemic period, the need to exclude the possibility of COVID-19 pneumonia in patients with acute dyspnea may cause a delay in the diagnosis and treatment of patients with acutely decompensated HF who have similar symptoms. This case report describes a diabetic patient admitted with dyspnea one week after she suffered an acute myocardial infarction. The objective of this report is to draw attention to the differential diagnosis of HF and COVID-19 pneumonia.

The clinical presentation of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2, can range from only mild, flu-like symptoms to severe progressive pneumonia. Cardiac involvement may be observed during the course of the infection and may include myocarditis, acute myocardial infarction, heart failure, and cardiac rhythm disturbances, but cases describing cardiac tamponade in patients previously diagnosed with COVID-19 are very rare. A 58-year-old female had been hospitalized in another hospital 2 weeks prior to the currently described presentation due to atypical pneumonia. A nasopharyngeal swab specimen was positive for COVID-19. The hospitalization was uncomplicated and she was discharged after a week. She presented at our emergency department with symptoms of shortness of breath and swelling in both legs. A bedside transthoracic echocardiography showed globally depressed left ventricular contraction with an ejection fraction of 30% and there was significant pericardial effusion, which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit with the diagnosis of pericardial tamponade. Bedside pericardiocentesis was performed and serohemorrhagic fluid was drained. Pericardial effusion and pericardial tamponade should be considered in the differential diagnosis of patients with COVID-19 exhibiting dyspnea or worsening of dyspnea. A 58-year-old female has been hospitalized in another hospital two weeks ago due to atypical pneumonia. Her nasopharyngeal swab specimen was positive for COVID-19. She had an uncomplicated course during the hospitalization and was discharged a week ago. She presented to our emergency department (ED) with symptoms of shortness of breath and swelling in both legs. We performed bedside transthoracic echocardiography (TTE) which showed globally depressed left ventricular contraction with ejection fraction (EF) of 30% and there was significant pericardial effusion which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit (CICU) with the diagnosis of pericardial tamponade. Bedside pericardiosentesis was performed and serohemorrhagic fluid was drained.
Patients with COVID-19 infection who develops or have worsening dyspnea, pericardial effusion and pericardial tamponade should be considered in differential diagnosis.

Premature ventricular complexes (PVCs) are one of the most common arrhythmias seen in daily practice. Although PVCs are generally considered benign, they can lead to the development of cardiomyopathy and, rarely, can be associated with sudden cardiac death. Recently, the American College of Cardiology Electrophysiology Council published a state-of-the-art review on PVCs to provide diagnostic and therapeutic considerations for clinical practice. Presented are some important points about the diagnosis, approach, and treatment of PVCs.