To document the association between serum transaminases and in-hospital mortality in pulmonary embolism (PE) patients. Analytical study. Patients treated with acute PE in hospital between January 2011 and December 2019 from Sakarya University Medical School Research and Teaching Hospital, Sakarya, Turkey. Patients with PE were included. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value for AST/ALT ratio to predict in-hospital death. Simplified pulmonary embolism severity index (sPESI) scores were calculated and the AST/ALT ratio were entered into binary logistic regression analysis with components of sPESI score to document the prognostic significance of as an independent predictor of in-hospital mortality. 164 acute PE patients were included; of those, 33 (20%) died in hospital. Deceased patients had higher AST/ALT ratio (median, 1.4; 25th-75th percentile, 1.1-1.8) comparing to patients with discharged home (median, 1.1; 25th-75th percentile, 0.84-1.4) (p=0.006). ROC analysis showed that AST/ALT ratio was an indicator of in-hospital mortality, and the calculated area under the curve was 0.655 (95% CI, 0.547-0.764). The cut-off value of 1.3 was associated with a prognostic sensitivity of 61% and specificity of 65%. Binary logistic regression analysis failed to show AST/ALT ratio as an independent predictor of in-hospital mortality. AST/ALT ratio predicts in-hospital mortality with acceptable sensitivity and specificity in patients with acute PE and might be used as a biomarker for risk stratification. Key Words: Pulmonary embolism, In-hospital mortality, Transaminases.

Contrast-induced nephropathy (CIN) remains a frequent and clinically relevant complication in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This study evaluated the predictive performance of inflammation-based indices for CIN development, with a focus on the inflammatory prognostic index (IPI). STEMI patients (n = 563) were retrospectively analyzed. CIN developed in 85 patients (15.1%). Admission IPI values were significantly higher in patients who developed CIN compared with those without CIN (10.9 [7.6-16.2] vs 4.8 [3.1-7.9], P < .001). In multivariate logistic regression analysis, IPI remained independently associated with CIN (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06-1.61, P = .013), together with advanced age, higher blood urea nitrogen levels, reduced left ventricular ejection fraction, history of stroke, and the occurrence of no-reflow. Receiver operating characteristic analysis demonstrated superior discriminative performance for IPI (area under the curve [AUC] 0.826, 95% CI 0.783-0.869) compared with neutrophil-to-lymphocyte ratio (NLR; AUC 0.691), C-reactive protein-to-albumin ratio (CAR; AUC 0.712), and systemic immune inflammation index (SII; AUC 0.704). An admission IPI cutoff value of 8.35 predicted CIN with 82.4% sensitivity and 65.9% specificity. IPI demonstrates superior discriminative performance compared with CAR, NLR, and SII for predicting CIN in STEMI patients undergoing pPCI.

Long-term Outcomes According to Final Single-stent or Two-stent Treatment for Culprit Medina 1.1.1 Bifurcation Lesions in ST-elevation Myocardial Infarction - The Medical Bulletin of Haseki

Amaç: Üst ekstremite arterlerinden perkütan girişimler sonrası psödoanevrizma nadiren görülür. Bu çalışmada üst ekstremitede iatrojenik psödoanevrizması olan hastaların demografik özelliklerini ve psödoanevrizma tedavi yöntemlerini değerlendirmeyi amaçladık. Yöntem ve Gereçler: 2012-2022 yılları arasında kliniğimizde psödoanevrizma nedeniyle takip edilen 17 hasta retrospektif olarak incelendi. Son nokta sinir hasarı, kompartman sendromu, tromboembolik olay, fistül ve cerrahi ihtiyacı olarak belirlendi. Sinir hasarı, elektromiyografi ve semptomlarla görüldüğü gibi aksonal dejenerasyon olarak belirlendi. Bulgular: Çalışmaya alınan 17 hastanın 8'inde radial arter psödoanevrizması, 5'inde ulnar arter psödoanevrizması ve 4'ünde brakiyal arter psödoanevrizması gelişti. 15'i konservatif yöntemlerle tedavi edilirken, 2'si cerrahi olarak tedavi edildi. İkisinden biri geç dönemde teşhis edilen 9X9 mm çapındaki psödoanevrizma nedeniyle, diğeri ise ağrı ve 36x26 mm çapındaki psödoanevrizma nedeniyle ameliyat edildi. Bir hastada ulnar sinir hasarı tespit edildi. Bir hastaya fistül teşhisi konuldu. Ulnar sinir yaralanması ve brakial arterovenöz fistül konservatif yöntemlerle ameliyatsız tedavi edildi. Sonuç: Üst ekstremite arterlerinde perkütan girişim sonrası gelişen psödoanevrizmaların çoğu konservatif yöntemler ile tedavi edilebilmektedir. Girişimsel kardiyologlar psödoanevrizmalar için farklı tedavi yöntemlerinin olduğunu bilmeli ve güncel veriler ışığında başarılı bir şekilde tedavi edebilmelidir. Erken tanı ve tedavi, geç tanı daha kötü komplikasyonlara ve cerrahi müdahale gereksinimine yol açtığı için hayati önem taşımaktadır.

Background: Transulnar access has emerged as a feasible alternative to transradial access for coronary angiography. However, the electrophysiological effects of proximal and distal transulnar approaches on ulnar nerve function remain insufficiently characterized. This study aimed to compare electrophysiological changes following proximal and distal transulnar coronary angiography and to evaluate their association with ulnar nerve involvement. Methods: This single-center retrospective observational study included 97 patients who underwent proximal (n = 56) or distal (n = 41) transulnar coronary angiography and developed post-procedural pain and/or paresthesia. Electroneuromyography and nerve conduction studies were performed before the procedure and at the fourth post-procedural week. Sensory and motor amplitudes, conduction velocities, and delta (Δ) changes were compared between groups. Generalized estimating equation analysis was additionally performed to evaluate longitudinal electrophysiological changes after adjustment for demographic and procedural variables. Results: No significant between-group differences were observed in pre- or post-procedural electrophysiological parameters. Although significant reductions in right ulnar sensory amplitude were observed over time, only 4 patients (4.1%) demonstrated post-procedural ulnar sensory amplitudes below the laboratory reference range, and no patient developed clinically significant ulnar neuropathy. Comparison of electrophysiological changes (Δ values) revealed no significant differences between proximal and distal transulnar access techniques. Generalized estimating equation analysis, adjusted for age and procedural characteristics, confirmed that the magnitude of electrophysiological changes over time was comparable between the two groups. Conclusions: Both proximal and distal transulnar access may be associated with mild, predominantly sensory, subclinical ulnar nerve involvement. However, distal transulnar access did not result in greater electrophysiological deterioration or additional neurological risk compared with proximal access.