Mustafa Adem TATLISU, Muhammed KESKİN, Ömer KOZAN, Adnan KAYA

ST-segment elevasyonlu miyokard infarktüsünde başvuru kan üre azotu ile hastane içi ve uzun dönem mortalite arasındaki ilişki

Amaç: Çalışmanın amacı kan üre azotu (KÜA) seviyesi ile ST-elevasyonlu miyokard infarktüsündeki (STEMİ) tüm nedenli mortalite arasındaki ilişkiyi araştırmaktı. Yöntem: Bu çalışma primer perkütan koroner girişim yapılan 3378 STEMİ hastalarını içermekteydi. Hastane içi mortalitede başvuru KÜA seviyesi eşik değeri ROC analizinde 17.5 mg/dL olarak ve sensivite %68, spesifite %66 olarak saptanmıştır (AUC: 0.75; 95% CI:0.72-0.88; p < 0.001). Bulgular: Hastalar ortalama olarak 33±0.14 ay izlenmiştir. Yüksek KÜA seviyesine sahip hastalarda düşük KÜA seviyesine sahip hastalara göre hastane içi mortalite 5.3 kat (OR: 6.0, 95% CI: 4.4-8.3), uzun dönem mortalite 5 kat (HR: 5.3, 95% CI: 4.2-6.8) yüksek olarak saptanmıştır. Sonuç: Bu çalışmada yüksek KÜA seviyesi bağımsız olarak hastane içi ve uzun dönem mortalite ile ilişkili olarak bulunmuştur. KÜA testi basit, ucuz ve kolaylıkla uygulanabilen bir yöntemdir. Bu yüzden, STEMİ geçiren yüksek riskli hastaları saptamada kullanılabilir.

The association between admission blood urea nitrogen levels with in-hospital and long-term mortality in ST-segment elevation myocardial infarction

Objective: The aim of this study was to investigate the association of blood urine nitrogen (BUN) levels with all-causemortality in ST-segment elevation myocardial infarction (STEMI).Method: This study included 3778 patients with STEMI treated with primary percutaneous coronary intervention. Anadmission BUN of 17.5 mg/dL was identified through a ROC analysis as an optimal cutoff value to predict the inhospitalmortality with 68% sensitivity and 66% specificity (AUC: 0.75; 95% CI:0.72-0.88; p < 0.001).Results: The patients were followed up for a mean period of 33±0.14 months. Patients with higher BUN levels had 5.3-times higher in-hospital (OR: 6.0, 95% CI: 4.4-8.3) and 5-times higher long-term (HR: 5.3, 95% CI: 4.2-6.8) mortalityrates than patients with lower BUN levels.Conclusions: This study demonstrated that elevated BUN level was independently associated with increased in-hospitaland long-term mortality. BUN test is a simple, inexpensive, and easily bedside applicable method. Hence, it can be usedto detect high-risk patients in the setting of STEMI.Keywords: Blood urine nitrogen; ST-segment elevation myocardial infarction; primary percutaneous coronaryintervention; mortality

PDF

___

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133:38-360.
Lee KL, Woodlief LH, Topol EJ, Weaver WD, Betriu A, Col J, Simoons M, Aylward P, Van de Werf F, Califf RM. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators. Circulation 1995;91:1659– 1968.
Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, Fischer GA, Fung AY, Thompson C, Wybenga D, Braunwald E. Cardiacspecific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996;335:1342–1349.
de Lemos JA, Morrow DA, Bentley JH, Omland T, Sabatine MS, McCabe CH, Hall C, Cannon CP, Braunwald E. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001;345:1014–1021.
Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000;355:773-778.
Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 2005;111:3078–3086.
Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, Granger CB, Ohman EM, Holmes DR Jr. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 2002;106:974–980.
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American heart association councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circulation 2003;108(17):2154-2169.
Anavekar NS, McMurray JJ, Velazquez EJ, Solomon SD, Kober L, Rouleau JL, White HD, Nordlander R, Maggioni A, Dickstein K, Zelenkofske S, Leimberger JD, Califf RM, Pfeffer MA. Relation between renal dysfunction and cardiovascular outcomes after myocardial outcomes after myocardial infarction. N Eng J Med 2004;351(13):1285-1295.
Santopinto JJ, Fox KA, Goldberg RJ, Budaj A, Piñero G, Avezum A, Gulba D, Esteban J, Gore JM, Johnson J, Gurfinkel EP; GRACE Investigators. Creatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: finding from the global registry of acute coronary events (GRACE). Heart 2003;89(9):1003-1008.
Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RG, Van de Werf F, Goodman SG, Granger CB, Steg PG, Gore JM, Budaj A, Avezum A, Flather MD, Fox KA; GRACE investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month post discharge death in an international registry. JAMA 2004;291(22):2727-2733.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. Recommendations for quantitation of the left ventricle by twodimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358-367.
Cockcroft D. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41.
Task force on the management of STsegment elevation acute myocardial infarction of European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blömstrom- Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez- Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-2619.
Ad-hoc working group of ERBP, Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, Van Biesen W. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrastinduced nephropathy. Nephrol Dial Transplant 2012;27(12):4263-4272.
Ljungman S, Laragh JH, Cody RJ. Role of the kidney in congestive heart failure relationship of cardiac index to kidney function. Drugs 1990;39 (Suppl 4):10–21.
Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, et al. Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 2008;51:1268– 1274.
Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009;53:589–596.
Lin J, Denker BM. Azotemia and urinary abnormalities. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson SL, Loscalzo J, editors. 18th Harrison’s principles of internal medicine. McGraw- Hill Education; 2012. pp.334-341.
Conte G, Dal Canton A, Terrible M, Cianciaruso B, Di Minno G, Pannain M, Russo D, Andreucci VE. Renal handling of urea in subjects with persistent azotemia and normal renal function. Kidney Int 1987;32(5):721-727.
Kingler C, Ancellin N, Barrault MB, Morel A, Buhler JM, Elalouf JM, Clauser E, Lugnier C, Corman B. Angiotensin II potentiates vasopressin-dependent cAMP accumulation in CHO transfected cells. Mechanism of cross-talk between AT1A and V2 receptors. Cell Signal 1998;10(1):65-74.
Duncan L, Heathcote J, Djurdjev O, Levin A. Screening for renal disease using serum creatinine: who are we missing? Nephrol Dial Transplant 2001;16(5):1042-1046.
Swedko PJ, Clark HD, Paramsothy K, Akbari A. Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med 2003;163(3):356-360.
Aronson D, Mittleman MA, Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med 2004;116:466-473.
Fonarow GC, Adams Jr KF, Abraham WT, Yancy CW, Boscardin WJ. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 2005;293:572-580.
Kirtane AJ, Leder DM, Waikar SS, Chertow GM, Ray KK, Pinto DS, Karmpaliotis D, Burger AJ, Murphy SA, Cannon CP, Braunwald E, Gibson CM; TIMI Study Group. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol 2005;45:1781–1786.
Saygitov RT, Glezer MG, Semakina SV. Blood urea nitrogen and creatinine levels at admission for mortality risk assessment in patients with acute coronary syndromes. Emerg Med J 2010;27(2):105- 109.
Aronson D, Hammerman H, Beyar R, Yalonetsky S, Kapeliovich M, Markiewicz W, Goldberg A. Serum blood urea nitrogen and long-term mortality in acute ST-elevation myocardial infarction. Int J Cardiol 2008;127(3):380-385.