Akut ST elevasyonlu miyokard enfarktüslü hastalarda aritmiler

Amaç: Aritmiler ve iletim bozuklukları akut miyokard enfarktüsünde (AMİ) yaygındır ve hastane öncesi dönemde önemli bir ölüm nedenidirler. Bu çalışmanın amacı, hastane içi dönemde ST yükselmeli AMI (STEMI) hastalarında tüm aritmiler için ortak öngördürücüleri araştırmaktı.

Arrhythmias in patients with acute ST elevation myocardial infarction

Purpose: Arrhythmias and conduction disturbances are common during acute myocardial infarction (AMI) and a major cause of death in the pre-hospital phase. The aim of this study was to investigate common predictors for all arrhythmias in patients with ST elevation AMI (STEMI) during in-hospital phase. Materials and Methods: Ninety patients (74 male, 55 ±11 years) with acute STEMI were included. Clinical charesteristics were recorded and laboratory parameters including serum C- reactive protein (CRP), creatinine kinase MB (CKMB) and potassium levels were measured. The patients were divided into two groups according to development of arrhythmias.Results: Group 1 (n=42) patients had new onset arrhythmias and Group 2 (n=48) patients had without arrhythmias. Median baseline CRP levels were significantly higher in group 1 (36.6 (21.8-77) mg/dl vs. 21.8 (24.2-30.7) mg/dl), especially in patients with atrial fibrillation and ventricular arrhythmias. Logistic regression analysis showed that baseline higher CRP level, peak CKMB level and inferior localization of AMI were significantly associated with the development of arrhythmia following AMI. Conclusion: Levels of CRP and CKMB and inferior infarct localization have predictive values for all the arrhythmic events during AMI. CRP levels were found to be associated with both atrial and ventricular arrhythmias. The assessment of CRP levels can be used to detect patients at high risk for arrhythmic events after STEMI.

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  • 1. Pedersen OD, Bagger H, Kober L, Torp – Pedersen C. The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE study group. TRAndolapril Cardiac Evalution. Eur Heart J. 1999;20:748-54.
  • 2. Boateng S, Sanborn T. Acute myocardial infarction. Dis Mon. 2013;59:83-96.
  • 3. Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Staszewsky L et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation.1993;87:312-22.
  • 4. Escosteguy CC, Carvalho Mde A, Medronho Rde A, Abreu LM, Monteiro Filho MY. Bundle branch and atrioventricular block as complications of acute myocardial infarction in the thrombolytic era. Arq Bras Cardiol. 2001;76:291-96.
  • 5. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al. American College of Cardiology; American Heart Association; Canadian Cardiovascular Society. ACC/AHA guidelines for the management of patients with STelevation myocardial infarction executive summary. A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Am Coll Cardiol. 2004;44:671-719.
  • 6. Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm AJ et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA,ACCA,and EAPCI task force. Europace. 2014;16:1655-73.
  • 7. Pietilä KO, Harmoinen AP, Jokiniitty J, Pasternack AI. Serum C-reactive protein concentration in acute myocardial infarction and its relation to mortality during 4 months of follow-up in patients under thrombolytic treatment. Eur Heart J. 1996;17:1345- 49.
  • 8. Anzai T, Yoshikawa T, Shiraki H, Asakura Y, Akaishi M, Mitamura H et al. C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation.1997;96:778-84.
  • 9. Anzai T, Yoshikawa T, Kaneko H, Maekawa Y, Iwanaga S, Asakura Y et al. Association between serum c-reactive protein elevation and left ventricular thrombus formation after first anterior myocardial infarction. Chest. 2004;125;384- 89.
  • 10. Gedikli O, Orem C, Baykan M, Karahan C, Kucukosmanoglu M, Sahin S et al. Association between serum C-reactive protein elevation and atrial fibrillation after first anterior myocardial infarction.Clin Cardiol. 2008;31:482-7.
  • 11. Aronson D, Boulos M, Suleiman A, Bidoosi S, Agmon Y, Kapeliovich M et al. Relation of C-reactive protein and new-onset atrial fibrillation in patients with acute myocardial infarction. Am J Cardiol. 2007;100:753-7.
  • 12. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108:3006-10.
  • 13. Boss CJ, Lip GYH. The role of inflammation in atrial fibrillation. Int J Clin Pract. 2005;59:870-72.
  • 14. Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA et al. C-Reactive protein elevation in patients with atrial arrhythmias. Inflammatory mechanisms and persistence of atrial fibrillation. Circulation. 2001;104:2886- 91.
  • 15. Watanabe T, Takeishi Y, Hirono O, Itoh M, Matsui M, Nakamura K et al. C-Reactive protein elevation predicts the occurrence of atrial structural remodeling in patients with paroxysmal atrial fibrillation. Heart Vessels. 2005;20:45–9.
  • 16. Beck OA, Hochrein H: Initial serum potassium level in relation to cardiac arrhythmias in acute myocardial infarction (author’s transl). Z Kardiol. 1977;66:187- 90.
  • 17. Gettes LS. Electrolyte abnormalities underlying lethal and ventricular arrhythmias. Circulation. 1992;85:170- 6.
  • 18. Gang UJ, Hvelplund A, Pedersen S, Iversen A, Jøns C, Abildstrøm SZ et al. High-degree atrioventricular block complicating ST-segment elevation myocardial infarctionin the era of primary percutaneous coronary intervention. Europace. 2012;14:1639-45.
  • 19. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H et al. Recommendations for quantification of the left ventricle by two - dimensional echocardiography. J Am Soc Echo.1989;2:358-67.
  • 20. Lehto M, Snapinn S, Dickstein K, Swedberg K, Nieminen MS; OPTIMAAL investigators. Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience. Eur Heart J. 2005;26:350- 56.
  • 21. Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ et al. Acute myocardial infaction complicated by atrial fibrillation in the elderly. Circulation. 2000;101:969-74.
  • 22. Parashar S, Kella D, Reid KJ, Spertus JA, Tang F, Langberg J et al. New-onset atrial fibrillation after acute myocardial infarction and its relation to admission biomarkers (from the TRIUMPH registry). Am J Cardiol. 2013;112:1390-5.
  • 23. Henkel DM, Witt BJ, Gersh BJ, Jacobsen SJ, Weston SA, Meverden RA et al. Ventricular arrhythmias after acute myocardial infarction: a 20 - year community study. Am Heart J. 2006;151:806-12.
  • 24. Gettes LS. Electrolyte abnormalities underlying lethal and ventricular arrhythmias. Circulation.1992;85:170- 76.
  • 25. Juul-Moller S, Lilja B, Johansson BW. Ventricular arrhythmias and left ventricular function: one-year follow-up after myocardial infarction. Eur Heart J. 1988;9:1181- 7.
  • 26. Heidbuchel H, Tack J, Vanneste L, Ballet A, Ector H, Van de Werf F. Significance of arrhythmias during the first 24 hours of acute myocardial infarction treated with alteplase and effect of early administration of a beta- blocker or a bradycardiac agent on their incidence. Circulation. 1994;89:1051-59.
  • 27. Grande P, Pedersen A. Myocardial infarct size: correlation with cardiac arrhythmias and sudden death. Eur Heart J. 1984;5:622-27.
  • 28. Khairy P, Thibault B, Talajic M, Dubuc M, Roy D, Guerra PG et al. Prognostic significance of ventricular arrhythmias post - myocardial infarction. Can J Cardiol. 2003;19:1393-1404.
  • 29. Marín F, Pascual DA, Roldán V, Arribas JM, Ahumada M, Tornel PL et al. Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting. Am J Cardiol. 2006;97:55- 60.
  • 30. Amar D, Zhang H, Heerdt PM, Park B, Fleisher M, Thaler HT. Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein. Chest. 2005;128:3421-27.
  • 31. Vyas AK, Guo H, Moss AJ, Olshansky B, McNitt SA, Hall WJ et al. Reduction in ventricular tachyarrhythmias with statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)- II. J Am Coll Cardiol. 2006;47:769-73.
  • 32. Chiu JH, Abdelhadi RH, Chung MK, Gurm HS, Marrouche NF, Saliba WI et al. Effect of statin therapy on risk of ventricular arrhythmia among patients with coronary artery disease and an implantable cardioverter-defibrillator. Am J Cardiol. 2005;95:490-91.
  • 33. Nordrehaug JE, Johannessen KA, von der Lippe LG. Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction. Circulation. 1985;71:645-49.
  • 34. Solomon RJ, Cole AG. Importance of potassium in patients with acute myocardial infarction. Acta Med Scand Suppl. 1981;647:87–93.
  • 35. Jurkovicova O, Cagan S. Supraventricular arrhythmias and disorders of atrioventricular and intraventricular conduction in patients with acute myocardial infarct. Bratisl Lek Listy. 1998;99:172 -80.
  • 36. Ledwidge M, Gallagher J, Conlon C, Tallon E, O'Connell E, Dawkins I et al. Natriuretic peptidebased screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA. 2013;310:66-74.
  • 37. Huelsmann M, Neuhold S, Resl M, Strunk G, Brath H, Francesconi C et al. PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. J.Am. Coll. Cardiol. 2013;62:1365-72.
  • 38. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-140.
Cukurova Medical Journal-Cover
  • ISSN: 2602-3032
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1976
  • Yayıncı: Çukurova Üniversitesi Tıp Fakültesi
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