12071

Akut Koroner Sendromlu Hastalarda Plazma von Willebrand Faktör Düzeyi ile Koroner Arter Hastalığı Ciddiyeti Arasındaki İlişkisi

Amaç: Koroner arter hastalığının yaygınlığını ve ciddiyetini değerlendirmek için anjiyografik bir skorlama sistemi olan Gensini skoru kullanılmaktadır. Yüksek Gensini skoru ve vonWillebrand faktör düzeyi akut koroner sendromlu hastalarda kötü kardiyak olaylar ile ilişkilidir. Bu çalışmada akut koroner sendromlu hastalarda Gensini skoru ile vonWillebrand faktör düzeyi arasındaki ilişkiyi araştırmayı planladık.Materyal ve Metot: Çalışmaya akut koroner sendrom tanısıyla koroner anjiyografi yapılan 141 hasta dahil edildi. Gensini skoru <32 olan hastalar grup 1, gensini skoru ≥ 32 olan hastalar ise grup 2 olarak tanımlandı. Her iki grup, anjiyografik özellikler ve plazma vonWillebrand faktör düzeyleri açısından karşılaştırıldıBulgular: Grup 1 hastalar ile karşılaştırıldıklarında, grup 2 hastalarda vonWillebrand faktör düzeyi anlamlı olarak daha yüksek idi (140 IU [101-149]’e karşın 120 IU [100-134], P=0.010). Korelasyon analizinde gensini skoru ile vWF arasında pozitif bir korelasyon mevcuttu (r = 0.228, p = 0.007). Çok değişkenli lojistik regresyon analizinde, vWF yüksek Gensini skorunun bağımsız bir öngördürücüsü olarak tespit edildi (odds oranı, 1.013; % 95 güven aralığı, 1.002 - 1.026, P <0.027). vonWillebrand faktör sınır değerinin ≥ 128 IU alınması, % 59 duyarlılık ve % 63 özgüllük ile yüksek gensini skorunu öngördü. Sonuç: Akut koroner sendromlu hastalarda yüksek von Willebrand faktör seviyesi bağımsız olarak yüksek gensini skoru ile ilişkilidir.

Anahtar Kelimeler:

Akut koroner sendrom, Gensin skoru, von Willebrand faktör

The Relationship between Plasma von Willebrand Factor Level and Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Background: Gensini score, an angiographic scoring system, is used to evaluate the extent and severity of coronary artery disease. High Gensini score and von Willebrand factor level are associated with poor cardiac events in patients with acute coronary syndrome. In this study, we aimed to investigate the relationship between Gensini score and von Willebrand factor level in patients with acute coronary syndromeMaterials and Methods: The study included 141 patients with acute coronary syndrome who underwent coronary angiography. Patients with gensini score <32 were defined as group 1, while patients with gensini score ≥32 were defined as group 2. Angiographic characteristics and plasma von Willebrand factor level were compared between two groups.Results: When compared to group 1 patients, group 2 patients had significantly higher levels of von Willebrand factor (140 IU [101-149] vs. 120 IU [100-134], P = 0.010). In correlation analysis, Gensini score and von Willebrand factor level was positively correlated (r = 0.228, p = 0.007). Multivariate logistic regression analysis demonstrated that Willebrand factor was an independent predictor of high gensini score (odds ratio, 1.013; 95% confidence interval, 1.002 - 1.026, P <0.027]. von Willebrand factor level ≥ 128 IU predicted high gensini score with a sensitivity of 59% and specificity of 63%. Conclusion: High von Willebrand factor level is independently associated with high gensini score in patients with acute coronary syndrome.

PDF

___

Kaynaklar1. David E. Gutstein, Valentin Fuster. Pathophysiology and clinical significance of atherosclerotic plaque rupture Cardiovascular Research, 1999:(41)323–333
2. Kolansky, D.M. Acute coronary syndromes: Morbidity, mortality, and pharmacoeconomic burden. Am. J. Manag. Care 2009;15: 36–41.
3. Whincup PH, et all. von Willebrand factor and coronary heart disease: prospective study and meta-analysis. Eur Heart J. 2002;23(22):1764-70.
4. B. E. Pottinger, R. C. Read, E. M. Paleolog, P. G. Higgins, J. D. Pearson, “von Willebrand factor is an acute phase reactant in man,” Thrombosis Research.1989;53 (4) :387–94
5. Folsom AR, Wu K, Rosamond WD, Sharret AR, Chambless LE. Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 1997; 96: 1102–8.
6. Smith FB, Lee AJ, Fowkes FGR, Rumley A, Lowe GDO. Hemostatic factors as predictors of ischemic heart disease and stroke in the Edinburgh Artery Study. Arterioscler Thromb Vasc Biol 1997; 17: 3321–5.
7. Rumley A, Lowe GDO, Sweetnam PM, Yarnell JWG, Ford RP. Factor VIII, von Willebrand factor and the risk of majör ischaemic heart disease in the Caerphilly Heart Study. Br J Haematol 1999; 105: 110–16.8. Thogersen AM, et al. High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first acute myocardial infarction in both men and women: evidence for the fibrinolytic system as an independent primary risk factor. Circulation 1998; 98: 2241–7.
9. Meade TW, Cooper JA, Stirling Y, Howarth DJ, Ruddock V, Miller GJ. Factor VIII, ABO blood group and the incidence of ischaemic heart disease. Br J Haematol 1994; 88: 601–7.
10. Tascanov MB, et all. Association between the No-Reflow Phenomenon and Soluble CD40 Ligand Level in Patients with Acute ST-Segment Elevation Myocardial Infarction. Medicina (Kaunas). 2019; 7:55
11. Gensini, G.G. A more meaningful scoring system for determining the severity of coronary heart disease. Am. J. Cardiol. 1983; 51: 606.
12. Zhou BY, et all. Free triiodothyronine in relation to coronary severity at different ages: Gensini score assessment in 4206 euthyroid patients. J Geriatr Cardiol. 2016;13: 978-83.
13. Zencirci AE, et all. The relationship between Gensini score and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Kardiol Pol. 2014;72(6):494-503
14. Danesh J, Lewington S. Plasma homocysteine and coronary heart disease: systematic review of published epidemiological studies. J Cardiovasc Risk 1998; 5: 229–32.
15. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999; 340: 115–20
16. Dursun, İ. Taşcanov MB. Akut ST Elevasyonlu Miyokard Enfarktüslü Hastalarda Aritmiler. Cukurova Med J 2019;44: 416-24
17. Sazonova, et all. New markers of atherosclerosis: A threshold level of heteroplasmy in mtdna mutations. Vessel Plus 2017; 1: 182–91