Faruk BOYACI, Murat AKÇAY, Teyyar GÖKDENİZ

ST-segment Yükselmeli Miyokart Enfarktüsünde Kronik Total Oklüzyonu Öngörmede Nötrofil/Lenfosit ve Trombosit/Lenfosit Oranı

Amaç: Nötrofil/lenfosit oranı (NLR) ve trombosit/lenfosit oranı (PLR), yeni sistemik inflamasyon belirteçleri ve olumsuz kardiyovasküler sonuçların öngörücüleridir. Primer perkütan koroner girişim (PCI), akut ST-segment yükselmeli miyokart enfarktüsü (STYME) olan hastalarda etkili bir tedavi stratejisidir. Enfarktla ilişkili olmayan arterde kronik total okluzyon (KTO), bu hastaların %10'unda mevcuttur ve kısa ve uzun dönem morbidite ve mortalite ile ilişkilidir. Biz burada, ST segment yükselmeli miyokard enfarktüslü (STYME) hastalarda NLO ve PLR' nin eşzamanlı kronik total okluzyon (KTO) ile ilişkisini araştırmayı amaçladık. Materyal ve Metod: STYME ile başvuran ve eşzamanlı başka damarda CTO'su olan ve olmayan toplam yüz doksan hasta alındı. İnflamatuvar belirteçler ve eşzamanlı CTO arasındaki ilişki analiz edildi. Bulgular: STYME’lü hastalarda eşzamanlı KTO'su olan hastalarda, KTO'su olmayan hastalara kıyasla NLR, PLR, C-reaktif protein (CRP) ve troponin artarken, glomerüler filtrasyon hızı (eGFR), sol ventrikül ejeksiyon fraksiyonu (LVEF) azaldı. Çok değişkenli analizde NLR (p=0,002), PLR (p=0,042), CRP (p=0,002), HT (p<0,001), HL (p=0,002) ve LVEF (p=0,012) parametreleri eşzamanlı CTO için bağımsız öngörücüler olarak bulundu. ROC eğrisi analizinde eşzamanlı CTO’yu sırasıyla NLR ve PLR için (>5.6) ve (> 164) kestirim değerleri saptandı. Sonuç: Basit ve kolay hesaplanan laboratuvar parametreleri olan PLR ve NLR, STYME'lü hastalarda eşzamanlı CTO'nun öngörülmesine yardımcı olabilmektedir.

Anahtar Kelimeler:

STYME, Enfarkt dışı arter kronik total oklüzyonu, Nötrofil/lenfosit oranı (NLR), Trombosit/lenfosit oranı (PLR)

Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Predicting Chronic Total Occlusion in ST-Segment Elevation Myocardial Infarction

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are new systemic inflammation markers and predictor of adverse cardiovascular outcomes. Approximately 10% of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) have chronic total occlusion (CTO) of the non-infarct-related artery. The presence of concurrent CTO is associated with short- and long-term morbidity and mortality. Here, we aimed to investi-gate the relationship of NLR and PLO with coexistent CTO in STEMI patients.Materials and Methods: Ninety consecutive STEMI patients with concurrent CTO were included in the study group and 100 STEMI patients without CTO were included in the control group retrospectively. The relationship between inflammatory markers and concurrent CTO in STEMI was analyzed.Results: STEMI patients with concurrent CTO had increased NLR, PLR, C-reaktive protein and troponin while decreased glomerular filtration rate, left ventricular ejection fraction (LVEF) in comparison with patients without CTO. In multivariate analysis, NLR (p=0.002), PLR (p=0.042), CRP (p=0.002), hypertension (p<0.001), Hyperlipidemia (p=0.002) and LVEF (p=0.012) were found to be the independent predictors for the presence of concurrent CTO. In the ROC (Receiver Operating Characteristic) curve analysis, ≥ 5.6 and ≥ 164 cut-off values were determined for NLR and PLR in detecting concurrent CTO in STEMI.Conclusions: PLR and NLR, simple and easily calculated laboratory parameters, may permit prediction of concurrent CTO in patients with STEMI.Key Words:

Keywords:

STEMI, Non-infarct artery chronic total occlusion, Neutrophil/lymphocyte ratio (NLR), Plate-let/lymphocyte ratio (PLR),

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