Ali DENİZ, Onur KAYPAKLI, Yahya Kemal İÇEN, Rabia Eker AKILLI, Mustafa DEMİRTAŞ, Halil AKTAŞ, Çağlar Emre ÇAĞLAYAN, Durmuş Yıldıray ŞAHİN

Çoklu Damar Hastalığı Olan Baypas Cerrahisi ve Perkütan Koroner Girişim Yapılan Hastalarda Modifiye Global Risk Skorunun Prognoz Üzerindeki Etkisi

Amaç: Bu çalışmanın amacı, “Modifiye Global Risk Sınıflaması” kullanarak çok damar hastalığı olan hastalarda mortalite ve miyokard enfarktüsünü karşılaştırmaktır. Yöntemler: EuroSCORE ve SYNTAX Skoru değerleri göz önüne alınarak 579 hasta; düşük, yüksek EuroSCORE’lu orta, yüksek SYNTAX Skorlu orta ve yüksek modifiye Global Risk gruplarına ayrıldı. Hastalar ölüm, miyokard enfarktüsü, serebrovasküler olay gelişimi, tekrar girişim ihtiyacı ve bu dördünden herhangi birinin gelişmesi anlamına gelen bileşke sonlanım noktası açısından taburculuk öncesi, 1. ay, 6. ay ve 12. ayda değerlendirildi. Bulgular: Modifiye Global Risk skorlamasına göre bypass cerrahisi ve perkutan koroner girişim yapılan hasta grupları karşılaştırıldığında yüksek SYNTAX skorlu orta risk grubunda miyokard enfarktüsü gelişimi oranında (p=0,047) bypass cerrahisi yapılan hastalarda daha iyi prognostik sonuçlar elde edildi. Logistik regresyon analizinde bileşke sonlanım noktasına ulaşma için EuroSCORE, SYNTAX Skoru ve Global Risk Skoru bağımsız risk faktörü olarak saptanmıştır. mGRC’nin 1 yıllık mortalite için diskriminasyon yeteneğinin EuroSCORE ve SYNTAX skorundan daha iyi olduğu bulunmuştur. Sonuç: Çoklu damar hastalığına sahip hastalarda EuroSCORE ve SYNTAX skorunun beraber değerlendirilmesiyle oluşturulan, anatomik ve klinik risk faktörlerine birleştiren bir risk skorlaması olan modifiye Global Risk Skoru prognozun öngörülmesinde ve tedavi seçiminde ek fayda sağlamaktadır.

Effect of Modified Global Risk Classification on Prognosis at Patients Undergoing Bypass Surgery and Percutaneous Coronary Intervention with Multi-vessel Disease

Objective: The aim of this study was to compare mortality and myocardial infarction in patients with multi-vessel disease using“Modified Global Risk Classification” (mGRC).Methods: We divided 579 patients into low, intermediate risk with a high EuroSCORE (IE), intermediate risk with a high SYNTAXscore (IS), and high Modified Global Risk groups. Patients were evaluated for death, myocardial infarction, cerebrovascular events,need for re intervention, and a primary endpoint, which denotes the occurrence of any one of the four events.Results: Comparing the bypass surgery and percutaneous coronary intervention groups using mGRC showed significantly better prognostic results in the bypass surgery patients for the rate of the occurrence of the myocardial infarction for the IS group(p=0.047). In terms of the primary endpoint, the EuroSCORE, SYNTAX score, and Global Risk Classification (GRC) were found to beindependent risk factors in logistic regression analysis. The ability of GRC to discriminate for the 1-year mortality was found to bebetter than that of the EuroSCORE and SYNTAX score.Conclusion: With the evaluation of the EuroSCORE and SYNTAX score together, the modified GRC, which includes both anatomicaland clinical risk factors, provides an additional benefit for predicting the prognosis and decision of treatment in patients withmulti-vessel disease.

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