Mehmet Baran KARATAŞ, Barış GÜNGÖR, Ender Özgün ÇAKMAK, Göktürk İPEK, Tolga ONUK, İbrahim Halil ALTIPARMAK, Kazım Serhan ÖZCAN, Yiğit ÇANGA, Gündüz DURMUŞ, Osman BOLCA

Akut ST Yükselmeli Miyokart İnfarktüsü Hastalarında Magnezyum Tedavisi ve P Dalga Dispersiyonu

Amaç: Miyokard infarktüsünün (MI) akut fazında gelişen atriyal fibrilasyon (AF) hastane içi ve sonrasında uzun dönemdeki mortalitenin önemli göstergelerinden biridir. Bu çalışmanın amacı, primer perkütan koroner girişim uygulanmış akut anterior ST yükselmeli miyokard infarktüsü hastalarında MgSO4 infüzyonunun en uzun p dalga süresi( Pmax ), en kısa p dalga süresi( Pmin ) , p dalga dispersiyonu (Pdd) ve bunun AF ile ilişkisi üzerine etkisini araştırmak olarak belirlenmiştir. Metod: Çalışmaya akut anterior ST yükselmeli miyokard infarktüsü tanısıyla hastaneye yatırılan ve primer perkütan koroner girişim uygulanmış 55 hasta ( yaş ortalaması 55.1 ± 6.7 ) ile kontrol grubu olarak 47 normal birey ( yaş ortalaması 54.1 ± 7.2 ) prospektif olarak alındı. Bütün hastaların demografik ve klinik özellikleri kaydedildi. Hasta grubunda Mg tedavisi uygulanan 25 hasta ile Mg tedavisi uygulanmayan 30 hastanın, başvuru sırasında ve PKG sonrası 5.saatte elektrokardiyografileri çekilerek Pmax, Pmin ve Pdd süreleri ölçüldü. Bulgular: Akut MI hastalarında Pmax. ve Pdd, kontrol grubuna göre daha yüksek bulundu ( sırasıyla 118.7 ± 6.3 msn vs. 107.1 ± 3.4 msn, p = 0.01 ve 40.5 ± 4.8 msn vs. 30.2 ± 3.3 msn; p = 0.01). Magnezyum tedavisi alan hastaların PKG sonrası 5.saat EKG'sindeki Pmax. ve Pdd değerleri, başvuru EKG'sine göre karşılaştırıldığında anlamlı olarak daha düşük saptandı ( sırasıyla 121.4 ± 7.1 vs. 109.6 ± 4.1 msn, p= 0.01 ve 41.3 ± 4.7 vs 30.7 ± 2.9 msn, p = 0.01). Magnezyum tedavisi almayan hastaların ise PKG sonrası 5.saat EKG' sindeki sadece Pmax değeri başvuru EKG' sine göre anlamlı olarak düşük bulundu (116.6 ± 4.7 vs 114.7 ± 4.2 msn, p = 0.04). Tedavi sonrası Pdd azalışı, Mg (+) grupta Mg (-) gruba göre anlamlı olarak daha yüksek saptandı ( 10.6 ± 5.1 vs 2.1 ± 1.4 msn, p = 0.01). Sonuç: Akut anterior MI nedeniyle primer PKG uygulanan hastalarda Mg tedavisi Pdd' da belirgin azalma sağlamaktadır. Bu sonuç, özellikle AF gelişme riski yüksek olan hasta grubunda Mg tedavisinin yararlı olabileceğine işaret etmektedir.

Anahtar Kelimeler:

Akut anterior STyükselmeli miyokard infarktüsü, Magnezyum, Pdalga dispersiyonu

Magnesium Treatment and P wave Dispersion in Patients with Acute ST Elevation Myocardial Infarction

Backgrounds: Atrial fibrillation (AF) occuring in the acute phase of Myocardial Infarction (MI) is an important predictor of in- hospital and long-term mortality. The aim of this study is to investigate the effect of MgSO4 therapy on the maximum P wave duration(P max), minimum P wave duration (Pmin), P wave dispersion (PWD) and its relationship with AF in acute anterior ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary interventions (PCI). Methods: Fifty-five patients (mean age 55.1 ± 6.7) who were hospitalized with diagnosis of STEMI and 47 normal individuals (mean age 54.1 ± 7.2 years) were prospectively enrolled. Percutaneous coronary intervention was performed to all MI patients with conventional methods. All patients' demografic and clinical features were recorded. In STEMI patients group, admission and fifth-hour electrocardiographic parameters (Pmax, Pmin, PWD) were measured in patients with Mg therapy(n=25) and patients without Mg therapy(n=30). Results: Pmax and PWD values were higher in acute MI patients than the control group. (118.7 ± 6.3 msn vs. 107.1 ± 3.4 msn, 40.5 ± 4.8 msn vs. 30.2 ± 3.3 msn; p = 0.01 and p = 0.01, respectively ). In Mg(+) group, Pmax and PWD values were significantly lower on fifth-hour ECGs compared to admission ECGs( 121.4 ± 7.1 vs 109.6 ± 4.1 msn, 41.3 ± 4.7 vs 30.7 ± 2.9 msn, p = 0.01 and p = 0.01). In Mg(-) group , only Pmax values were significantly lower on fifth-hour ECGs compared to admission ECGs(116.6 ± 4.7 vs 114.7 ± 4.2 msn, p = 0.04). PWD decrease after treatment was significantly higher in Mg (+) group than Mg (-) group ( 10.6 ± 5.1 vs 2.1 ± 1.4 msn, p = 0.01). Conclusions: Mg treatment causes significant reduction in PWD values in patients with acute anterior STelevation MI after primary PCI. This result suggests that Mg treatment may be useful especially in high-risk patients in terms of developing AF.

Keywords:

Acute anterior ST-elevation myocardial infarction, Magnesium, Pwave dispersion,

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