Arafat YILDIRIM, Özge ÖZCAN ABACIOĞLU, Nermin YILDIZ KOYUNSEVER

The relationship between microvascular angina and De Ritis ratio in normal coronary artery patients with recurrent chest pain / De Ritis ratio and microvascular angina

Objective: De Ritis ratio (AST/ALT) is a strong predictor of outcomes in both heart failure and acute coronary syndromes. The usability of this parameter in patients with normal coronary arteries who had repeated application to health institutions due to chest pain has not been evaluated before. In this paper we aimed to investigate if De Ritis ratio may be used as a guiding in this group of patients.Methods: This retrospective study included 545 patients with normal coronary arteries according to the coronary angiographies performed in our clinic between January 2018 and June 2019. They were grouped into two according to hospital admittance with chest pain after angiography; group 1: no application, group 2: repeated application. At least 8 hours of fasting venous samples were collected for routine laboratory tests.Results: 545 patients with a mean age of 52.3 ± 11.2 (41.1%male) were included in the study. 16.5% of them had repeated applications with chest pain. Mean De Ritis ratio and CRP levels were different between the groups (p=0.028 and 0.045, respectively). In multivariate logistic regression analysis, De Ritis ratio was the only parameter that predicted repeated application with an Odds ratio (OR) = 3.062 ,95% CI= 1.267- 7.400 and p=0.013).Conclusion: Elevated De Ritis ratio and CRP conclude us that there may be microvascular coronary disease in this group of patients. The repeated application with chest pain, although normal coronary artery was obtained, should be taken into consideration and it should be kept in mind that additional tests may be required to rule out microvascular coronary disease.

Tekrarlayan göğüs ağrısı olan normal koroner arter hastalarında mikrovasküler anjina ve De Ritis oranı arasındaki ilişki

Giriş: De Ritis oranının (AST / ALT) hem kalp yetmezliği hem de akut koroner sendromlarda sonlanımları öngördürücü rolü olduğu bilinmektedir. Normal koroner arter saptanan hastalardan anjiyografi sonrası göğüs ağrısı ile sağlık kurumlarına tekrarlayan başvurusu olanlarda bu parametrenin kullanılabilirliği daha önce değerlendirilmemiştir. Bu yazıda De Ritis oranının bu grup hastalarda yol gösterici olarak kullanılıp kullanılamayacağını araştırmayı amaçladık. Yöntemler: Bu retrospektif çalışmaya Ocak 2018 - Haziran 2019 tarihleri arasında kliniğimizde yapılan anjiyografilerde normal koroner arter saptanan 545 hasta dahil edildi. Anjiyografi sonrası göğüs ağrısı ile başvuru olup olmamasına göre iki gruba ayrıldı; grup 1: başvuru yok, grup 2: tekrarlayan başvuru. Rutin laboratuvar testleri için en az 8 saatlik açlık venöz kan örnekleri toplandı. Bulgular: Yaş ortalaması 52.3 ± 11.2 olan 545 hasta (% 41.1 erkek) çalışmaya dahil edildi. %16.5’i (90 hasta) göğüs ağrısı ile tekrar başvurmuştu. Ortalama De Ritis oranı ve CRP düzeyleri gruplar arasında farklıydı (sırasıyla p = 0.028 ve 0.045). Çok değişkenli lojistik regresyon analizinde, (OR) = 3.062,% 95 CI = 1.267- 7.400 ve p = 0.013 ile tekrarlanan başvuruyu öngören tek parametre De Ritis oranı idi. Sonuç: Artmış De Ritis oranı ve CRP, bu hasta grubunda mikrovasküler koroner hastalık olabileceği sonucuna vardırmıştır. Normal koroner arter saptansa bile, göğüs ağrısı ile tekrarlayan başvurusu olanlar dikkate alınmalı ve mikrovasküler koroner hastalığı ekarte etmek için ek testlerin gerekli olabileceği akılda tutulmalıdır.

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