Bahri AKDENİZ, Sema GÜNERİ, Özgür ASLAN, Özer BADAK, Murat ÖZDAMAR, Batuhan TAMCI, Özhan GÖLDELİ

Anstabil angina pektoriste uzun dönem mortalite ve morbiditeye etki eden faktörler

Amaç: Kararsız angına pektoriste çeşitli faktörler prognoza etki etmektedir. Bu faktörlerin kardiak mortalite ve morbiditeye olan etkilerinin araştırılması amaçlanmıştır. Gereç ve yöntem: Ocak 1995-şubat 1999 tarihleri arasında kararsız angina pektoris tanısıyla koroner yoğun bakım ünitesinde yatan ve koroner anjiografisi yapılmış olan 240 hastanın uzun dönem prognozları incelendi. Hastalar; hasta özellikleri, koroner risk faktörleri, kroner anjiografide tutulan damar sayısı ve yatışında tercih edilen tedavi yöntemi (PTCA, Koroner Bypass, tıbbi tedavi) bakımından incelendiler. Bu faktörlerin uzun dönemde majör kardiyak olaylar (MKO; hastane dışı ölüm, miyokard infarktüsü, yeniden PTCA gereksinimi, koroner by-pass gereksinimi) ve kardiyak mortaliteye etkileri incelendi. Bulgular: Toplam 240 hasta (176'sı erkek, ortalama yaş: 60,3±9,9) ortalama 29,6$pm$14,3 ay süre ile (5-54 ay) izlendi. Taburcu olmadan yapılan koroner anjiografilerinde hastaların %26,2'sinde tek damar, %30,5'de iki damar, %22,5'de üç damar, %6,2'de ciddi ana koroner lezyonu, %20,7'sinde ise ciddi olmayan dadılar veya normal koroner arter morfolojisi saptandı. Toplam 15 hasta (%5.8) öldü. Uzun dönem rakipte 27 olguda (%11,2) MKO gelişti. Üç damar hastalığı olanlarda MKO (%21,3) olmayan hastalara göre (%8,6) anlamlı olarak daha sık bulundu. Tek değişkenli analizlerde kardiyak risk faktörleri ile majör kardiyak olay (MKO) arasında herhangi bir ilişki bulunmazken; yaş, sol ventrikül sistolik disfoııksiyonu, 3 damar hastalığı ve geçirilmiş miyokard infarktüsü ile kardiyak mortalite arasında ilişki saptandı. Logistik regresyon modelinde ise 3 damar hastalığı hem MKO hem de mortalite ile ilişkili bulundu. Sonuç: Kararsız angina pektoris ile koroner yoğun bakım ünitesine başvuran hastalarda üç damar hastalığı olmasının hem majör kardiyak olay, hem de kardiyak mortalite açısından önem taşıdığı düşünülmüştür.

Anahtar Kelimeler:

Anjina pektoris, Anjina, kararsız, Hastalık oranı, Ölüm oranı, Koroner anjiyografi

Factors that influence long term cardiac mortality and morbidity in unstable angina pectoris

Objective: Several factors may affect prognosis in unstable angina pectoris. We aimed to investigate these factors which affects cardiac mortality and morbidity. Material and method: Its investigated to long term prognosis in 240 patients that were admitted to the coronary care unit with unstable angina pectoris and that were performed coronary angiography between January 1995- February 1999. We obtained information about patient's final condition regarding to phone diem or search to hospital records. These patients were investigated with age, gender, coronary risk factors, number of involved vessels in coronary angiography, previous Myocardial infarction and preferred treatment modality (medical therapy, PTCA,CABG) in admission. These factors were evaluted to effect on long term outcomes of major adverse cardiac events (MACE; death, nonfatal MI, necessity to re-PTCA and CABG arid cardiac mortality). Results: We folowed up 240 patients (176 men, mean age:60,3±9,9) with mean •. 29,6$pm$14,3 months (5-54 months). We determined one, two, three vessel arid left main involvement in coronary angiography which performed inhopistal in 26,3%, 30,5% 22,5% and 6,2% patients subsequently and 50 patients (20,7%) had normal - coronary arteries or nonsignificant lesions. Fifteen patients (5,8%) have died. In long term follow up period, MACE developed in 27 patients (11.2%). Cardiac mortality and in hospital mortality were estimated in 5,4% and 3,3% respectively. There was no correlation between MACE and each coronary risk factors in univariate analysis. In multivariate logistic regression analysis, only three vessel disease were predictors of MACE and death. Age, left ventricular systolic dysfunction, history of previous myocardial infarction were significantly correlated with cardiac mortality in univariate analysis but this correlation was not seen in multivariate analysis. Conclusion: Its thought that the presence of three vessel disease in patients who admitted to the coronary care unit with unstable angina pectoris have carrying importance about major cardiac events and cardiac mortality.

Keywords:

Angina Pectoris, Angina, Unstable, Morbidity, Mortality, Coronary Angiography,

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