Ayşe Saatcı YAŞAR, Nurcan BAŞAR, Ahmet KASAPKARA, İsa Öner YĞKSEL, Göktürk İPEK, Mehmet BİLGE

Akut miyokard infarktüslü hastalarda trombolitik tedavi sonrası ST segment gerilemesi üzerine metabolik sendromun etkisi

Amaç: Akut miyokard infarktüslü hastalarda, metabolik sendromun kısa dönem sonuçları ve uzun dönem sağkalım üzerine olumsuz etkileri gösterilmiştir. Çalışmamızdaki amacımız akut miyokard infarktüsü nedeni ile trombolitik alan hastalarda metabolik sendromun ST segment gerilemesi üzerine etkisini incelemektir. Gereç ve yöntemler: Akut miyokard infarktüsü ile başvuran ve göğüs ağrısının ilk 12 saati içinde trombolitik tedavi alan 161 hasta retrospektif olarak incelendi. Metabolik sendrom tanısı Ulusal Kolesterol Eğitim Programı Üçüncü Erişkin Tedavi Paneli kılavuzuna göre konuldu. Trombolitik tedavi öncesi ve 90. dakikada çekilen elektrokardiyografiler ST segment gerilemesi açısından değerlendirildi. Komplet ST segment gerilemesi ≥%70 olarak belirlendi. Bulgular: Çalışmaya alınan 161 hastanın 91’inde (%56.5) metabolik sendrom saptandı. Trombolitik tedavi sonrası komplet ST segment gerilemesi oranı metabolik sendromlu hastalarda metabolik sendromu olmayan hastalara göre daha düşük bulundu (%32.9-% 58.6, p=0.001). Çok değişkenli analizde metabolik sendrom ST segment gerilemesini öngördüren tek bağımsız faktör olarak bulundu (p=0.01, Odds oranı=2.543, %95 CI:1.248-5.179). Sonuç: Çalışmamızda akut miyokard infarktüs ile başvuran hastalardan metabolik sendromu olanlarda trombolitik tedavi sonrası komplet ST segment gerilemesi metabolik sendromu olmayanlara göre daha düşük oranda bulundu. Bu durum bu hastalarda akut miyokard infarktüsündeki artmış morbidite ve mortaliteye katkıda bulunuyor olabilir.

Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction. Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution. Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001). On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179) Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome

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