Mustafa ÇELİK, Recep KARATAŞ, Ahmet YILMAZ, Fikret KELEŞ, Nazif AYGÜL, Hüsamettin VATANSEV, Erdoğan SÖKMEN, Ahmet ERSEÇGİN

Akut ST elevasyonlu miyokard infaktüsünde ısı şok proteini 60’ın hastane içi ve kısa dönem prognostik değeri

Amaç: HSP60'ın daha önce konjestif kalp yetmezliği için bağımsız bir risk faktörü olduğu gösterilmiştir. Son zamanlarda artan HSP60 değerinin mortalite ile ilişkili olduğu gösterilmiştir. Çalışmanın amacı HSP 60'ın akut ST segment yükselmeli miyokard enfarktüslü (STEMI) hastalarda bağımsız bir hastane içi veya kısa süreli mortalite belirleyicisi olup olmadığını belirlemek ve aynı popülasyonda kardiyojenik şok gelişimi ve hastanede kalp yetmezliğinin erken bir belirleyicisi olarak kullanılıp kullanılmayacağını değerlendirmektir.Yöntemler: Çalışmamıza 2011-2013 yılları arasında STEMI semptomlarının başlamasından sonraki 12 saat içinde başvuran 18 yaş üstü 221 hasta alındı. Çalışmamız prospektif kohort olarak dizayn edildi. Klinik kalp yetmezliği, kardiyojenik şok gelişimi ve hastanede yatış sırasındaki ölüm gibi çeşitli klinik durumlar, hastanede kalış süresi, MI lokalizasyonu, revaskülarizasyon stratejisi ve koroner kalp hastalığı ile ilişkili risk faktörleri ile ilgili verilerle birlikte kaydedildi. Hastaların taburcu olduktan 1 ay sonra mortalite açısından telefonla aranarak bilgi alındı.Bulgular: Hastanede yatış sırasında ölen hastalarda (P=0,004) veya taburcu olduktan sonraki 1 ay içinde HSP 60 değerleri anlamlı olarak daha yüksekti (P=0,020). Bu sonuçlar STEMI sonrası mortalite ile ilişkili diğer faktörlerden bağımsızdı. HSP 60 değeri ile hastanede kardiyojenik şok (P=0,03) veya kalp yetmezliği (P=0,03) arasında anlamlı bir ilişki izlendi.Sonuç: HSP60'ın STEMI ile başvuran hastalarda artmış mortalite ile bağımsız olarak ilişkili olduğu ve bu nedenle umut verici bir mortalite belirleyicisi olarak kullanılabileceği düşünülebilir.

Anahtar Kelimeler:

Miyokard enfarktüsü, HSP60, Prognoz, İnflamasyon, Ateroskleroz

The value of heat shock protein (HSP) 60 on in-hospital and short-term prognosis in patients with acute ST segment elevation myocardial infarction

Aim: HSP60 has previously been shown to be an independent risk factor for congestive heart failure. Recently, increased HSP60 values have been shown to be associated with increased mortality in patients hospitalized with acute heart failure. The purpose of our study was to determine whether HSP 60 is an independent predictor of in-hospital or short-term mortality in patients with acute ST segment elevation myocardial infarction (STEMI) and to assess whether it may be used as an early predictor of in-hospital heart failure or cardiogenic shock development in the same population.Methods: A total of 221 patients over 18 years of age presenting within 12 hours after the onset of symptoms with STEMI between 2011 and 2013 were enrolled to our study. Our study was designed as a prospective cohort. Several clinical conditions, such as clinical heart failure, development of cardiogenic shock and death during hospitalization were recorded together with the data pertaining to the length of hospital stay, MI localization, revascularization strategy and risk factors associated with coronary heart disease. Patients were called 1 month after discharge to find out if anyone had died. Results: HSP 60 values were significantly higher in patients who died during hospitalization (P=0.004) or within 1 month after discharge (P=0.020). These results were independent from other factors associated with mortality following STEMI. Significant association was found between HSP60 value and in-hospital development of cardiogenic shock (P=0.03) or heart failure (P=0.03).Conclusion: HSP60 was found to be independently associated with increased mortality in patients admitted for STEMI and therefore may be used as a promising predictor of mortality.

Keywords:

Myocardial infarction, HSP60, Prognosis, Inflammation, Atherosclerosis,

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