Can AKTAŞ, Gökçe AKGÜL KARADANA, Elif DEĞİRMENCİ, Yoldaş DEMİRTAŞ, Şevki Hakan EREN

Perkutanöz Girişim Yapılan STEMI hastalarındaki Kardiyak Biyomarkerların Erken Prognostik Önemi

Amaç: ST segment elevasyonlu miyokard infarktüsü olanhastalarda başvuru anındaki kardiyak biyomarkerların(CKMB, hs-Troponin T, BNP) prospektif olarak mortalite,Gensini skoru ve LAD lezyonun varlığını belirleyerek erkenprognostik önemini değerlendirmektir.Materyal ve Metod: Bu çalışma altı aylık bir periyotta acilservise ilk kez göğüs ağrısı ile başvurup perkutan koronergirişim (PCI) yapılan 70 hastada yapılmıştır. Başvuru anındailk kardiyak biyomarkerlar ölçülmleri, hastaların demografik veklinik özellikleri ve PCI sonuçlarına göre Gensini skorlarıhesaplanarak kaydedilmiştir. Her bir kardiyak biyomarker ileilişkili mortalite varlığı ve LAD tutulumu hesplanmıştır.Biyomarker düzeyleri ile Gensini skoru arasındaki korelasyonSpearman korelasyon analizi ile test edilmiştir.Bulgular: BNP (p=0.005) ve hs-Troponin T (p=0.002) artmışmortalite ile ilşkliydi. Gensini skoru ile mortalite ve ilk başvuruanındaki kardiyak biyomarkerlar arsında herhangi bir ilişkitespit edilmemiştir (p>0.05). Yüksek BNP düzeylerindeyüksek oranda LAD tutulumu tespit edilmiştir (p<0.05) ancakdiğer biyomarkerlar (CKMB, hs-Troponin T) ile LAD lezyonuvarlığı arasında bir ilişki tespit edilmemiştir (p>0.05).Sonuç: Akut ST segment elevasyonu MI ile başvuranhastalarda yüksek BNP ve hs-Troponin düzeyleri artmışmortalitenin bir göstergesi olabilir bu nedenle daha ciddi biryaklaşım ve takibe gereksinim vardır. Buna ilaveten yüksekBNP düzeyleri potansiyel olarak LAD tutulumunugösterebilmekte olup bu da mortalite ile sıkı bir ilişkiiçerisindedir. Başvuru anındaki BNP ve hs-Troponin Tdeğerleri ST segmen elevasyonu olan MI’ lü hastalarda erkenprognostic sonuçları gösterebilmektedir ancak lezyonunciddiyeti hakkında bir fikir vermemektedir.

Anahtar Kelimeler:

Miyokard İnfarktüsü, Biyomarker, Perkutan koroner girişim, Mortalite

Early Prognostic Values of Cardiac Biomarkers in STEMI patients that underwent Percutaneous Coronary Intervention

Aim: To assess the early prognostic values of admission cardiac biomarkers (CKMB, hs-Troponin T, BNP) in patients with STEMI by determining the association of these markers with mortality, Gensini scores and LAD involvement prospectively.Materials and Method: The current study was performed through the six-month period on 70 STEMI patients admitted to ED who had chest pain for the first time in their lives and underwent to percutaneous coronary intervention (PCI). Admission first cardiac biomarker values measured within 6 hours, patient demographics and clinical characteristics (age, gender, PCI results, LAD involvement) and Gensini scores calculated in regards to PCI results were recorded. Association of each cardiac biomarker (CKMB, hs-Troponin T, BNP) with the presence of mortality and LAD involvement was calculated. Correlation between biomarker levels and gensini scores were sought with Spearman correlation coefficients test.Results: BNP (p=0.005) and hs-Troponin T (p=0.002) were associated with increased mortality. There was no association between mortality and the first admission value of cardiac biomarkers (BNP, CK-MB, hs-troponin T) with Gensini score (p>0.05). Higher BNP values indicated higher LAD (+) lesion probability (p<0.05) while no association between LAD(+) lesion and the other biomarkers (CKMB, hs- Troponin T) (p>0.05).Conclusions: Acute STEMI with high BNP and hs-Troponin T levels predict increased mortality and needs more serious treatment and close follow-up. Additionally, higher BNP levels suggest a potential LAD (+) lesion which is closely related with mortality. Admission BNP and hs-Troponin T values indicate early prognostic outcome in STEMI patients, however they don’t point out the severity of the lesions.

Keywords:

Myocardial infarction, Biomarkers, Percutaneous Coronary Intervention, Mortality,

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