İlk Akut Önduvar ST Elevasyonlu Miyokart Enfarktüsü Geçiren Hastalarda Koroner Kollateral Dolaşım ile Hastane İçi Ölüm Arasındaki İlişki

Amaç: Çalışmada ilk akut önduvar ST Elevasyonlu Miyokart Enfarktüsü (STEMI) geçirip Primer Perkütan Koroner Girişim (p-PKG) uygulanmış hastalarda Koroner Kollateral Dolaşımın (KKD) prognostik değerinin araştırılmasını amaçlanmaktadır. Materyal ve Metot: İlk akut önduvar STEMI geçiren, ilk 6 saat içinde p-PKG uygulanan toplam 220 hasta KKD varlığı ve yokluğuna göre 2 gruba ayrıldı. Başlangıç anjiogramlarda, enfarkttan sorumlu artere doğru oluşan koroner kollateral kan akımı Rentrop kalitatif sınıflama yöntemi kullanılarak derecelendirildi. Bulgular: İlk akut önduvar STEMI geçiren p-PKG uygulanan ortalama yaşları 61,4±12,3 olan toplam 220 hasta çalışmamıza dahil edildi. Hastaların %34’ünde KKD mevcuttu. Çalışmamıza alınan hastaların 64’ü (%29) kadın 156’sı (%71) erkekler oluşturmaktaydı. Gruplar arasında demografik özellikler, sol ventrikül ejeksiyon fraksiyonu, KILLIP sınıfları, koroner arter hastalığı risk faktörleri, semptomların başlangıcından p-PCI yapılıncaya kadar geçen süre, balon-kapı süresi, periprosedürel ve postprosedürel anjiografik özellikler ile başvuru anında Kardiyojenik Şok, Hastane içi Kardiyojenik Şok, Ölümcül Ventriküler Aritmiler, Komplet AV blok, Mekanik Komplikasyonlar ve Hastane içi Ölümü içeren klinik sonlanımlar arasında istatiksel olarak anlamlı farklılık mevcut değildi. Çoklu değişkenli logistik regresyon analizinde yaş ([OR] 1,08, 95 %CI 1,07 to 1,26, p=0,03), Semptomların başlangıcından p-PKG yapılıncaya kadar geçen süre ([OR] 1,6, 95 %CI 1,06 to 2,59, p=0,04), başarısız p-PKG ([OR] 3,3, 95 %CI 1,04 to 10,9, p=0,04) hastane-içi ölüm için bağımsız tahmin ettiriciler olarak olarak bulundu. Sonuç: Çalışmada ilk akut önduvar STEMI geçiren, ilk 6 saat içinde p-PKG uygulanan hastalarda KKD ile hastane-içi ölüm arasında ilişki tespit edilememiştir.

Anahtar Kelimeler:

akut önduvar STEMI, koroner kollateral dolaşım, hastane içi ölüm

The Relationship Between Coronary Collateral Circulation and In-hospital Mortality in Patients with First Acute Anterior STEMI

Aim: The aim of the present study is to investigate the prognostic value of Coronary Collateral Circulation (CCC) in patients with the first acute anterior wall ST Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention w (p-PCI). Material and Method: A total of 220 Patients with first acute Anterior STEMI within first 6th hours undergoing p-PCI were divided into 2 groups with respect to absence of CCC and presence of CCC. Coronary collateral flow to the infarct related artery (IRA) was graded on baseline angiograms with the use of qualitative classification by Rentrop. Results: A total of 220 patients mean age was of 61.4±12.3 years with first acute Anterior STEMI undergoing p-PCI were included the study. 34% of patients had CCC. The present study consisted of 64 female (29%) and 156 male (71%) patients. There were no statistically significant differences in respect to demographic characteristics, risk factors of coronary artery disease, LVEF, KILLIP classes, time from symptomps onset to PCI, door to baloon time, preprocedural and postprocedural angiographic characteristics and clinical outcomes which included cardiogenic shock on admission, cardiogenic shock in-hospital, fatal ventricular arrhtymias, complet AV block, mechanical complications and in-hospital mortality between the groups. In a stepwise backward multivariable logistic regression model, the independent prognostic indicators for in-hospital mortality were age (odds ratio [OR] 1.08, 95% CI 1.07 to 1.26, p=0.03), Time from symptoms onset to PCI (odds ratio [OR] 1.6, 95% CI 1.06 to 2.59, p=0.04) and unsuccessful p-PCI (odds ratio [OR] 3.3, 95% CI 1.04 to 10.9, p=0.04). Conclusion: Presence of CCC was not associated with in-hospital mortality in patients presenting with first acute Anterior STEMI undergoing p-PCI within first 6th hours.

Keywords:

acute anterior STEMI, coronary collateral circulation, in-hospital mortality,

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