Mykola KOPYTSYA, Yaroslava HİLOVA, Yuliia RODİONOVA, Igor POLİVENOK, Borys SHELEST

ST-Yükselmeli Miyokard Enfarktüslü Hastalarda Perkütan Koroner Girişim ile Revaskülarizasyon Sonrası Advers Sonucu Öngörmede Çözünür ST2

Amaç: Bu çalışmanın amacı, ST-segment yükselmesi (STEMI) olan miyokard enfarktüslü hastalarda perkütan koroner girişim sonrası tümörijenisitenin çözünür baskılanması 2 (soluble suppression of tumorigenicity 2, sST2) seviyesi ile epikardiyal kan akımının düzelme derecesi arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntemler: Çalışmaya ortalama yaşı 59.85±10.01 yıl olan 61 hasta (%83,6 erkek) dahil edildi. sST2 seviyesi enzim immunoassay ile ölçüldü. Hastalar iki gruba ayrıldı. Birinci grup (n=12) miyokard enfarktüsünde tromboliz (thrombolysis in myocardial infarction, TIMI) ≤II akım dereceli hastaları, ikinci grup (n=49) ise TIMI III akım dereceli hastaları içeriyordu. Bulgular: Epikardiyal kan akımı azalmış (TIMI≤II) olan grupta perkütan koroner girişim sonrası hastalığın ilk saatlerinde sST2 düzeyi anlamlı olarak daha yüksekti (p=0.003). Alıcı işlem karakteristiği eğrisi analizi, başvuru sırasında saptanan 34,2 ng/ml'nin üzerindeki sST2 düzeylerinin, STEMI hastalarında %92,3 duyarlılık ve %62,5 özgüllük ile advers revaskülarizasyonun (TIMI ≤II) bağımsız bir ön gördürücüsü olduğunu göstermiştir; eğri altında kalan alan 0,811 (%95 GA: 0,651 - 0,873; p=0,001) idi. Hem tek değişkenli (OR: 1,020; %95 GA: 1,001-1,041; p=0.028) ve hem de çok değişkenli (OR: 1,030; %95 GA: 1,002-1,057; p=0.033) analizler sST2'nin epikardiyal vasküler revaskülarizasyonun olumsuz sonucunun (TIMI≤ІІ) anlamlı bir ön gördürücüsü olduğunu gösterdi. Sonuç: sST2, STEMI olan hastalarda perkütan koroner girişim sonrası kan akımındaki iyileşme derecesi ile yüksek oranda ilişkilidir ve prognostik bir belirteç olarak büyük klinik öneme sahiptir.

Anahtar Kelimeler:

akut miyokard infarktüsü, sST2, “no-reflow” fenomeni, perkütan koroner girişim

Soluble ST2 in Predicting Adverse Outcome after Revascularization with Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction

Aim: The aim of the study was to investigate the relationship between the soluble suppression of tumorigenicity 2 (sST2) level and the degree of epicardial blood flow recovery in patients with myocardial infarction with ST-segment elevation (STEMI) after percutaneous coronary intervention. Material and Methods: The study involved 61 patients (83.6% males), with a mean age of 59.85±10.01 years. sST2 level was measured by enzyme immunoassay. Patients were divided into two groups. The first group (n=12) included patients with thrombolysis in myocardial infarction (TIMI) ≤II flow grade, the second group (n=49) with TIMI III flow grade. Results: The sST2 level was significantly higher in the first hours of the disease in the group with decreased epicardial blood flow (TIMI ≤II) after percutaneous coronary intervention (p=0.003). Receiver operating characteristics curve analysis showed that sST2 levels over 34.2 ng/ml, detected on admission, was an independent predictor of adverse revascularization (TIMI ≤II) in patients with STEMI with a sensitivity of 92.3% and a specificity of 62.5%; the area under curve was 0.811 (95% CI: 0.651 - 0.873; p=0.001). Both the univariate (OR: 1.020, 95% CI: 1.001-1.041, p=0.028) and multivariate (OR: 1.030; 95% CI: 1.002-1.057; p=0.033) analyzes showed that sST2 was a significant predictor of the unfavorable outcome of epicardial vascular revascularization (TIMI ≤ІІ). Conclusion: sST2 is highly associated with the degree of blood flow recovery after percutaneous coronary intervention in patients with STEMI and is of great clinical importance as a prognostic marker.

Keywords:

acute myocardial infarction, sST2, no-reflow phenomenon, Percutaneous Coronary Intervention,

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