Investigation of the effect of nitrification inhibition on the performance and effluent quality of aerobic sequential batch reactors.

The use of nitrification inhibition as a concentrating step for ammonium (NH4+), for the purpose of increasing the potential for simultaneous recovery of phosphate (PO43-) and NH4+ from effluent streams of an aerobic sequencing batch reactor (SBR) system, has never been investigated in the literature. Therefore, the present study aimed to determine the effect of the inhibition of nitrification on both the reactor performance and effluent quality in a laboratory scale aerobic SBR system. In order to compare the observed results, a separate reactor, where the inhibition was not applied, was operated as a control reactor (CR) under the identical operational conditions used for the inhibitory reactor (IR). Experimental results for the reactor performance showed that effluents with low total suspended solids (< 50 mg/L) and chemical oxygen demand concentrations (> 90% of removal efficiency based on the influent concentration of 500 mg/L) were achieved for both SBRs by obtaining an activated sludge with a sludge volume index < 60 mL/g after the acclimation period. In the same period, the effluent PO43-, NH4+, and nitrate (NO3-) concentrations were found to be 17.0 ± 4.0, 1.26 ± 0.84, and 21.5 ± 39 mg/L for the CR and 10.0 ± 4.4, 3.9 ± 2.4, and 9.2 ± 1.5 mg/L for the IR, respectively. During this period, 94% of the removed NH4+ (NH4+rem.) was converted to NO3- in the CR, indicating almost complete nitrification occurred in the reactor. However, only 47% of the NH4+rem. was converted to NO3- in the IR as a result of the inhibition of nitrification, meaning a partial inhibition (53%) occurred due to the inhibition treatment. These results clearly demonstrated that the inhibition of nitrification allowed the effluent NH4+ concentrations to increase by suppressing the formation of NO3- ions. Based on the results, it can be concluded that inhibition of nitrification in an aerobic SBR system creates a potential for conserving the effluent NH4+ concentration and increasing consecutive recovery of PO43- together with NH4+ from the effluent discharges.

Susceptiveness of Vitamin K epOxide Reductase Complex Subunit 1 Gene Polymorphism in Essential Hypertension.

BACKGROUND: Essential hypertension (EH) is defined as a worldwide public health problem and one of the important risk factors for development of human coronary artery disease. Increased peripheral arterial resistance is one of the distinguishing characteristics of EH. The extracellular deposition of calcium in the arterial wall is defined as vascular calcification, which results in aortic stiffness and elevation of blood pressure. Regulation of vascular calcification is physiologically limited by γ-carboxylated proteins that regulate mineralization. Any deficiencies related to mineralization influence vascular calcification. As a result of vitamin-K deficiency or any problem associated with the vitamin K epOxide reductase complex subunit 1 (VKORC1) gene, Glu cannot be transformed to Gla and calcification initiates in blood vessels, myocardium, and cardiac. OBJECTIVE: The aim of the study was to investigate the potential association of VKORC1 polymorphisms with the risk of EH. MATERIALS AND METHODS: There were 100 individuals diagnosed with EH and 100 healthy individuals involved in the study. 3673G/A (rs9923231) and 9041G/A (rs7294) polymorphisms in the VKORC1 gene were determined by the PCR-restriction fragment length polymorphism method. RESULTS: A significant difference was found between the rs7294 polymorphisms ratios of the case and control groups, but significant differences weren't found in distribution of the rs9923231 alleles. Finally it was determined that the GG genotype provides a 3.97-fold increased risk for EH compared to the AA genotype for the rs7294 polymorphism. CONCLUSIONS: Our results suggest that the VKORC1 gene rs7294 polymorphism is important for the development of EH.

Role of gender in types and frequency of coronary artery aneurysm and ectasia.

This study aimed to evaluate the role of gender in types and frequency of coronary artery aneurysm and ectasia.We assessed retrospectively the angiography records of 6100 patients. At first, we mainly reviewed angiographic movies for the presence of coronary ectasia and/or aneurysm. Consequently, based on the number of the coronary artery involvement, the coronary ectasia and aneurysm were graded as mild if 1 coronary artery was involved and severe if 2 or more coronary arteries were involved. The location of ectasia and aneurysm was analyzed with respect to their isolated or combined location on various coronary arteries. The patients included in the present study were divided into 2 groups based on their gender as male and female. Then, we evaluated the impact of gender on severity and the location of the ectasia and aneurysm.The incidence of the aneurysm and ectasia was 3.5%. Among the patients with aneurysm and ectasia, 6.9% were male and 4.5% were female. Aneurysm and ectasia were evaluated together; their frequency was significantly higher in the male than female patients (P < 0.01). However, when their incidence was evaluated separately, coronary artery ectasia was markedly greater in male patients with regard to female patients (P < 0.01). Incidence of CAE presence on the RCA was significantly greater in males than females (2.7% vs 1.9%, P < 0.05).This study showed that incidence of CAE is more common in males than females. Particularly, frequency for the involvement of CAE on RCA and concurrently on 3 vessels is greater in male patients than female patients.

Does estimated glomerular filtration rate have an effect on left ventricular function after ST-elevation myocardial infarction?

OBJECTIVES: Little is known about whether estimated glomerular filtration rates (eGFR) affect left ventricular (LV) function and gain benefit with antiremodeling treatment in patients with ST-elevation myocardial infarction (STEMI). We investigated the effect of eGFR on LV function using tissue Doppler imaging (TDI) parameters. In addition, we sought to evaluate the antiremodeling effect of standard treatment at follow-up in patients with renal insufficiency (RI) after STEMI. METHODS AND RESULTS: A retrospective analysis of 579 patients with STEMI was performed. Patients were divided into 3 groups according to eGFR (Group 1: eGFR > 90 mL/min per 1.73 m(2); Group 2: eGFR = 60-89 mL/min per 1.73 m(2); Group 3: eGFR < 60 mL/min per 1.73 m(2)). Conventional echocardiography and TDI were performed within 48-72 hours after STEMI and at 6-month follow-up. The mean left ventricular ejection fraction (LVEF) was significantly lower in Group 3 than in Group 1 (P = 0.021). The mean peak systolic velocity (Sm) was significantly lower in Group 3 than in Group 1 and Group 2 (P = 0.002 and 0.006, respectively). The estimated GFR had a linear association with Sm and LVEF (P = 0.001, r = 0.161; P = 0.005, r = 0.132, respectively). Multivariate analysis showed that an eGFR < 60 mL/min per 1.73 m(2) was an independent predictor of lower Sm and in-hospital mortality. In addition, an antiremodeling effect of standard treatment was seen in all groups at 6-month follow-up. CONCLUSIONS: Estimated glomerular filtration rate of <60 mL/min per 1.73 m(2) was associated with lower LV function after STEMI, and may gain an antiremodeling effect with standard treatment at follow-up.

Effects of metoprolol and nebivolol on exercise blood pressure in patients with mild hypertension.

OBJECTIVES: We planned to compare the impact of two beta blockers, metoprolol and nebivolol, on arterial blood pressure during exercise in patients with mild hypertension. METHODS: A total of 60 patients (13 males, 47 females; mean age: 54.3 ± 10.7 years) were enrolled in the present study. The patients were randomly selected to receive either nebivolol 5 mg/day (n = 30) or metoprolol 50 mg/day (n = 30) for 8 weeks. At the end of the 8th week, each of the patients received exercise stress test according to Bruce protocol and their blood pressures were remeasured after rest, exercise, and recovery. RESULTS: Blood pressures were determined to be similar between metoprolol and nebivolol groups during rest, exercise, and recovery periods. Metoprolol and nebivolol achieved similar reductions in blood pressures during rest and exercise. However, five patients in nebivolol group and four patients in metoprolol group developed exaggerated BP response to exercise but the difference between metoprolol and nebivolol was not meaningful (P = 0.37). CONCLUSION: The results of the present study showed that metoprolol and nebivolol established comparable effects on the control of blood pressures during exercise in the patients with mild hypertensions.

Association of fragmented QRS complex with myocardial reperfusion in acute ST-elevated myocardial infarction.

In this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12-lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12-lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non-fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = -232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = -0.370, P = 0.000; r = -0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.

Cardiovascular involvement in patients with pseudoexfoliation syndrome.

AIM: Pseudoexfoliation (PEX) syndrome, diagnosed by ocular examination, is a common disorder of the extracellular matrix. Previous studies have demonstrated accumulation of PEX material in the walls of blood vessels and myocardium. We aimed to investigate whether PEX is associated with cardiovascular involvement using carotid ultrasound measurements and myocardial tissue Doppler imaging (TDI). METHODS: Thirty-six PEX patients and 34 age-matched and sex-matched healthy controls who had no PEX material were included. Fasting blood samples were taken and the following data were obtained from all cases: myocardial TDI measurements, the mean carotid intima-media thickness (IMT), total carotid plaque area and number. RESULTS: There were no significant differences between the groups regarding clinical and biochemical data. The peak systolic TDI velocities at the septal (septal S) and lateral annuli (lateral S), and the isovolumic contraction velocity at the lateral annulus [lateral isovolumic contraction velocity (IVC)] were significantly lower in patients with PEX, than in controls (P = 0.001, <0.001 and 0.016, respectively) whereas IMT, total carotid plaque area and number were significantly higher (P = 0.002, 0.035 and 0.033, respectively). In a logistic regression analysis including age, septal S, lateral S, lateral IVC, IMT, total carotid plaque area and number, septal S, lateral S and IMT were significantly associated with PEX, (P = 0.035, 0.011 and 0.035, respectively). CONCLUSION: Peak systolic TDI velocities were significantly lower and IMT was significantly increased in patients with PEX. However, PEX was weakly associated with carotid plaque measurements.

Effect of serum gamma-glutamyl transferase levels on myocardial perfusion and long-term prognosis after primary angioplasty in patients with acute ST-elevation myocardial infarction.

BACKGROUND: Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population. METHODS AND RESULTS: One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ≤2 or TIMI flow 3 with final myocardial bush grade ≤2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P < 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events. CONCLUSIONS: In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.

[A case with tricuspid valve brucella endocarditis presenting with acute right heart failure]. / Akut sag kalp yetersizligi ile basvuran hastada triküspit kapak brusella endokarditi.

Although the presence of brucella endocarditis is encountered rarely, it is the most fetal complication of brucellosis, which is shown to affect the aortic valve primarily and the mitral valve secondarily. Involvement of the tricuspid valve is extremely rare. A 62-year-old female was admitted with complaints of fever, fatigue, difficulty in breathing, and swellings in her legs. A transthoracic echocardiogram was performed since acute right heart failure was considered due to her symptoms. The echocardiogram showed enlarged right heart chambers, serious tricuspid valve insufficiency, and a mass on the tricuspid valve compatible with a vegetation moving in and out of the right ventricle. Although no growths were observed in the blood culture, antibody titration for brucellosis was found to be 1/640 (+) in the serological examination. The patient was diagnosed with brucella endocarditis and placed on doxycycline, rifampicin, and ceftriaxone treatment for eight weeks. At the end of the eight-week treatment, the symptoms of right heart failure receded and the patient recovered from the endocarditis. Tricuspid valve brucella endocarditis should be considered in patients suffering from acute right heart failure accompanied by systemic infection findings since brucellosis is presently endemic in Turkey.

Effect of overweight and obesity on the left ventricular systolic and diastolic functions in patients with acute myocardial infarction.

PURPOSE: The purpose of this study was to evaluate whether a association exits among overweight and obesity and left ventricular systolic and diastolic functions in patients admitted with first ST-elevation myocardial infarction (STEMI). METHODS: The present study was performed on 451 consecutive patients diagnosed with first STEMI (376 men, 75 women; mean age 56.1 ± 10.8 years). The patients were classified into three groups based on their body mass index (BMI) as normal weight (BMI < 25 kg/m2), overweight (BMI: 25-29.9 kg/m2) and obese (BMI > 30 kg/m2). Echocardiographic features were evaluated and compared among the three groups. RESULTS: Mitral annulus E velocities were higher in obese individuals than normal weight group (p < 0.01). In contrast, mitral A velocities were lower (p =0.03); consequently, E\A and E'\A' ratios were lower (both p = 0.01) in the obese group with respect to normal weight group. When the correction of entire variations existing among the groups were performed using multivariate linear regressions analyses, it turned out that BMI was independently associated with E/A (ß = -0.19, p = 0.044) and with E'/A' (ß = -0.016, p = 0.021). Ejection fraction, wall motion score index and myocardial S velocities were comparable among the study groups (p > 0.05). CONCLUSION: These results suggest that while obesity has no adverse effect on the left ventricular systolic function, it has unfavorable consequences on the left ventricular diastolic function in the patients with first STEMI. In contrast, no unfavorable effects of overweight on the left ventricular systolic and diastolic function were detected.

Effectiveness of cardiac simulator on the acquirement of cardiac auscultatory skills of medical students.

BACKGROUND: Cardiac simulators have been developed as an alternative training model in order to improve the cardiac auscultation skills of medical students. The effectiveness of the cardiac simulator's use in cardiac auscultatory training is presently not yet well established. OBJECTIVES: The authors aimed to investigate whether the use of a cardiac simulator can improve the auscultation skills of medical students. MATERIAL AND METHODS: The students taking the auscultation training on the cardiac simulator were grouped as Group A and the students not taking the auscultation training on the cardiac simulator were grouped as Group B (before). The students in Group B (before) were grouped as Group B (after) after receiving the auscultation training on the cardiac simulator. The percentages of accurate diagnoses for the tested heart murmurs were compared between Group A and Group B (before), and between Group B (before) and Group B (after). RESULTS: The rate of making correct diagnoses of normal heart sounds was similar in all the groups (Group A, Group B (before), and Group B (after)). By contrast, the percentage of accurate diagnoses for the tested heart murmurs was notably improved among the students in Group A with respect to Group B (before) (p < 0.01). Similarly, the rate of correct diagnoses for the tested heart murmurs was markedly higher among the students in Group B (after) than in Group B (before) (p < 0.01). CONCLUSIONS: The use of a cardiac simulator as a training tool can improve the auscultation skills of medical students quickly and efficiently.

Relationship between mean platelet volume and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction.

PURPOSE: Mean platelet volume (MPV) is an indicator of platelet activation, which is a central process in the pathophysiology of coronary heart disease. Metabolic syndrome (MS) may lead to worsened left ventricular systolic function by causing recurrent thrombotic events and by aggravating systemic inflammation in the course of acute myocardial infarction. The present study was designed to investigate the relationship between MPV and left ventricular systolic function in patients with metabolic syndrome who had first ST-elevation myocardial infarction. METHODS: MPV was measured on admission in 33 patients who had preserved left ventricle systolic function (mean age, 56.9±10.2 years) and in 48 patients who had depressed left ventricle systolic function (mean age, 57.9±10.5 years) with metabolic syndrome and first ST elevation myocardial infarction. Depressed left ventricle systolic function was defined as ≤50% ejection fraction value. MPV levels were compared in the two groups. RESULTS: MPV was significantly higher in patients with depressed left ventricle systolic function in comparison with patients showing preserved left ventricle systolic function (p=0.02). Logistic regression analysis showed an independent relationship between MPV and deteriorated left ventricular systolic function, even after adjustment for potential confounders (1.08 (1.04-1.20), CI: 95%, p=0.02). CONCLUSIONS: Increased MPV on admission can be associated with degree of left ventricle systolic depression in patients with metabolic syndrome with first ST-elevation myocardial infarction. MPV may prove to be useful as a prognostic marker in patients with metabolic syndrome and ST elevation MI.

Gender differences in the types and frequency of coronary artery anomalies.

Coronary artery anomalies are rarely encountered in general population. Gender may play a role in the types and incidence of coronary artery anomalies, although the effect of gender is not well established. In the present study, we therefore aimed to investigate the frequency and location of various types of coronary artery anomalies and their correlation with gender. We assessed retrospectively the coronary angiography movies of 7,810 patients (2,214 females and 5,596 males), the method of which is distinct from the earlier studies with angiographic archive records. We defined and classified the coronary artery anomalies according to their origin, course (myocardial bridge), and termination (fistula). The incidence of coronary artery anomalies was 3.35% (262 of 7,810): 130 individuals with anomalous origin (1.66%), 105 individuals with myocardial bridges (1.34%), and 27 with fistulas (0.35%). The frequency of the coronary artery anomalies was significantly higher in the females than the males (p = 0.001). Of the coronary artery origin anomalies, the circumflex and the left anterior descending artery originating from separate ostia in the left aortic sinus were higher in the females compared to the males (P < 0.001). In contrast, the frequency of myocardial bridges was higher in the males (P = 0.01). No gender difference was detected in fistulas. Thus, gender affects the types of coronary artery anomalies, except for fistulas. The determination of the presence of the coronary artery anomalies during the coronary angiography is critical for the planning of the treatment and for the proper clinical follow-up of patients.

Intercoronary continuity between the right and circumflex coronary arteries causing myocardial ischemia.

Intercoronary continuity refers to a bidirectional flow in patients with normal coronary arteries. Although such connections have been proposed to have a protective role against potential obstructive coronary artery disease, their functional significance is unclear. We report on a 53-year-old woman who presented with typical chest pain. Exercise myocardial perfusion imaging revealed perfusion defects involving the basal regions of the inferior and inferoseptal walls. Coronary angiography showed an intercoronary continuity between the right coronary artery and circumflex artery. Following institution of medical therapy, the patient's complaint improved and she had no complaint during one-year follow-up. This is the first reported case in which an intercoronary continuity was associated with myocardial ischemia.

[Our initial experience with stent implantation for aortic coarctation in adults]. / Eriskinlerde aort daralmasinin stent ile tedavisine iliskin ilk deneyimlerimiz.

OBJECTIVES: We evaluated the procedural success and short-mid term results of stent implantation for aortic coarctation in adults. STUDY DESIGN: The study included 15 consecutive patients (9 women, 6 men; mean age 27±7 years; range 17 to 45 years) treated with stent implantation for aortic coarctation. Fourteen patients had native, one patient had recurrent coarctation. Nine patients received bare metal and six patients received covered Cheatham-Platinum stents. Covered stents were used in patients with accompanying patent ductus arteriosus (n=2), severe coarctation (n=3), and recurrent coarctation (n=1). Procedural success was defined as the reduction in the pressure gradient across the coarctation site to less than 20 mmHg. The mean follow-up period was 10.4±4.6 months (range 3 to 18 months). RESULTS: Stent implantation was successful in all the patients. Compared to the preprocedure figures, systolic gradient across the aortic coarctation decreased from 37.2±11.3 mmHg to 3.5±2.9 mmHg, the diameter of the coarcted aortic segment increased from 5.4±1.5 mm to 17.2±1.4 mm, and systolic blood pressure declined from 154±9.7 mmHg to 130±7.3 mmHg following stenting (for all, p<0.001). There were no procedure-related major complications. CONCLUSION: Stent implantation for aortic coarctation in adults is a safe and effective alternative to surgical correction.

The relationship between admission hemoglobin level and left ventricular systolic functions in patients with first ST-segment elevated myocardial infarction.

OBJECTIVES: The goal of this study was to evaluate the relationship between admission hemoglobin levels and left ventricular systolic functions in patients admitted with first ST-segment elevated myocardial infarction (STEMI). STUDY DESIGN: The study was conducted prospectively in three centers in 483 consecutive patients (402 men, 81 women; mean age 56.5 ± 11.2 years; range 24 to 74 years) with first STEMI. All patients were evaluated by echocardiography after a mean of 2.4 days of admission. Evaluation of left ventricular systolic functions included measurements of ejection fraction (EF), wall motion score index (WMSI), and tissue Doppler S wave velocities at four different localizations (anterior, inferior, lateral, posterior septum). Hemoglobin levels were measured within one hour of admission. Anemia was defined according to the World Health Organization criteria (hemoglobin < 13.0 g/dl in men and < 12.0 g/dl in women). Echocardiographic characteristics of the patients with and without anemia were compared. RESULTS: Anemia was detected in 67 patients (13.9%). There were no significant differences between patients with and without anemia with respect to left ventricular end-systolic and end-diastolic diameters, wall thickness, WMSI, and EF. The mean EF in the anemic group (47.5%) was lower than that of the patients without anemia (48.5%), but this difference was not significant. All Sm velocities were lower in the anemic group, but only septal mitral annular Sm velocity reached statistical significance (p = 0.048). There was no correlation between hemoglobin levels and EF (r = 0.027, p = 0.55). CONCLUSION: Our findings suggest that mild to moderate anemia has no deleterious effect on systolic function in patients with first STEMI.

Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients.

BACKGROUND: Mean platelet volume (MPV) is an indicator of platelet activation which is a central process in the pathophysiology of coronary heart disease (CHD). The aim of the study was twofold; first to determine whether MPV values is increased in patients with DM, and secondly to evaluate the relation between diabetic complications and MPV. METHODS: The study population included 258 patients divided into two groups. Group A composed of 158 type 2 diabetic patients with coexistent coronary artery disease (stenotic lesions of 50%) (78 women, 80 men; mean age 53.9_10.8; mean diabetes duration 13.1_6.0). One hundred subjects (48 women, 52 men; mean age 53.9_11) without type 2 diabetes with normal coronary angiographies were taken as the control group (group B). To evaluate the extension of CHD, Gensini scoring system was used. RESULTS: The MPV was significantly different in the patient group compared to the controls (9.79 +/- 1.5 fl vs 8.3 +/- 0.9 fl, P<0.001). The existence of CHD was associated with MPV with odds ratio (95% CI) of 2.31 (1.55-4.42, p50.001). CONCLUSION: We have found that diabetic patients with coronary heart disease have significantly higher MPV values compared to control subjects without diabetes and with angiographically normal coronary arteries.

Comparison of traditional risk factors, angiographic findings, and in-hospital mortality between smoking and nonsmoking Turkish men and women with acute myocardial infarction.

BACKGROUND: The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. HYPOTHESIS: The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. METHODS: This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. RESULTS: The proportion of male smokers was significantly higher than that of women (68% vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had less multivessel disease and less comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. CONCLUSIONS: Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI between men and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking.