Akut koroner sendromda akut stent trombozunun ve hastane içi mortalitenin yeni bir inflamasyon göstergesi: çoklu inflamasyon indeksi

Amaç: Akut koroner sendromlu (AKS) hastalarda perkütan koroner girişim (PKG) sonrası katastrofik bir komplikasyon olarak ortaya çıkan akut stent trombozu (ST) gelişiminde inflamatuar ortam tetikleyici rol oynayabilir. Bu çalışma, PKG uygulanan AKS'li hastalarda güçlü bir yeni inflamasyon belirteci olan multi-inflamatuar indeksin (MII) yüksek SYNTAX skoru, akut ST ve hastane içi mortaliteyi öngörmede prognostik rolünü araştırmayı amaçladı. Gereç ve Yöntem: Bu retrospektif çalışma, PKG uygulanan ardışık 1488 AKS hastasını içermektedir ve kesin ST, Akademik Araştırma Konsorsiyumu kriterlerine göre belirlenmiştir. İnflamasyon indeksleri şu şekilde hesaplandı: Sistemik immün inflamasyon (SII) = nötrofil × trombosit / lenfosit oranı, CAR= CRP / albümin oranı, MII-1 = trombosit × CRP / lenfosit oranı, MII-2 = nötrofil × CRP / lenfosit oranı, MII-3 = SII × CRP. Bulgular: Akut ST insidansı %3.6 idi. Tüm inflamasyon indeksleri akut ST grubunda ve SYNTAX skoru yüksek grupta daha yüksekti. Çok değişkenli regresyon analizi, MII-3'ün akut ST ve yüksek SYNTAX skorunun bağımsız belirleyicileri olduğunu gösterdi. MII-3, diğer inflamatuar indekslerden daha iyi teşhis performansı sergiledi. MII-3'ün akut ST'yi öngörme eşik değeri >9084 (EAA= 0,842, duyarlılık= %87,3, özgüllük= %77,8) olarak saptandı ve MII-3 >9084 olan hastalarda ölüm riski 3,73 kat daha fazla belirlendi. Sonuç: MII-3, PKG sonrası akut ST'nin daha güçlü bir göstergesidir ve artmış mortalite riski ile ilişkilidir. MII, prosedürden önce yüksek riskli hastaları belirlemek için önemli bir prognostik tarama aracı olabilir.

Anahtar Kelimeler:

Akut koroner sendrom, inflamasyon, stent trombozu, SYNTAX skoru

A novel inflammation indicator of acute stent thrombosis and in-hospital mortality in acute coronary syndrome: multiple inflammation index

Aim: The inflammatory milieu plays a triggering role in the development of acute stent thrombosis (ST), which occurs as a catastrophic complication following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This study aimed to investigate the prognostic role of multi-inflammatory index (MII), a powerful new marker of inflammation, in predicting of high SYNTAX score, acute ST and in-hospital mortality in patients with ACS undergoing PCI. Material and Method: This retrospective study included 1488 consecutive patients with ACS undergoing PCI, and definitive ST was determined according to Academic Research Consortium criteria. Inflammation indices were calculated as follows: Systemic immune inflammation (SII)=neutrophil×platelet/lymphocyte ratio, CAR=CRP/albumin ratio, MII-1=platelet×CRP/lymphocyte ratio, MII-2=neutrophil×CRP/lymphocyte ratio, MII-3=SII×CRP. Results: The incidence of acute ST was 3.6%. All inflammation indices was higher in the acute ST group and high SYNTAX score group. Multivariable regression analysis showed that MII-3 independent predictors of acute ST and high SYNTAX score. MII-3 exhibited better diagnostic performance than other inflammatory indices. The threshold value of MII-3 in predicting acute ST was >9084 (AUC=0.842, sensitivity=87.3%, specificity=%77.8) and patients with MII-3 >9084 had a 3.73-fold greater risk of mortality. Conclusion: MII-3 is a stronger predictor of acute ST following PCI and it is associated with an increased risk of mortality. MII may be an essential prognostic screening tool for identifying high-risk patients prior to procedure.

Keywords:

Acute coronary syndrome, inflammation, stent thrombosis, SYNTAX score,

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