Klinik SYNTAX Skoru İzole Koroner Arter Bypass Cerrahisi Sonrası Serebrovasküler Olayı Öngördürmektedir

GİRİŞ ve AMAÇ: Serebrovasküler olay (SVO), koroner arterbypass cerrahisi (KABC) sonrası önemli bir mortalite vemorbidite nedenidir. İzole KABC sonrası SYNTAX skoru (SS)ile klinik SYNTAX skoru (KSS) ve SVO arasındaki korelasyonu araştıran herhangi bir veri literatürde mevcut değildir. Buçalışmanın amacı SS ve KSS ile SVO riskininöngördürücülüğünü araştırmaktır. YÖNTEM ve GEREÇLER: Hastanemizde Ekim 2011 – Aralık2013 tarihleri arasında izole KABC uygulanan 1850 hastaçalışmaya dahil edildi. Dışlama kriterlerine istinadençalışmadan çıkarılan hastalardan sonra çalışmamıza 249hasta dahil edildi. SVO, KABC sonrasında 30 gün içerisindegelişen geçici iskemik olay ve inmeleri içermekteydi ve çalışmagrubu operasyon sonrası SVO geçiren (PoSVO+) vegeçirmeyen (PoSVO-) şeklinde iki gruba ayrıldı. KSShesaplaması amacıyla her hastanın KABC öncesi sonanjiyografisi kullanılarak yapılan SS hesabına ek olarak diğerklinik parametreler (yaş, sol ventrikül ejeksiyon fraksiyonu,glomerüler filtrasyon hızı) kaydedildi. BULGULAR: Uyku ve uyanıklık periyodları incelendiğinde;TASİ grubunda bulunan hastaların, POSİ ve LAİ gruplarındakihastalara göre uyku dönemde başvuru oranlarının daha sıkolduğu tespit edildi ve bu durum istatistiksel olarak anlamlıbulundu (p=0.045). Diğer grupların arasında herhangi biristatistiksel anlamlı farklılık bulunmadı (p˃0.05). Mevsimseldeğişkenler incelendiğinde ise yine gruplar arasındaistatistiksel olarak anlamlı bir fark tespit edilmedi (p˃0.05).Ancak sonbahar ve kış döneminde yüzde olarak başvurulardabir artış olduğu saptandı. TARTIŞMA ve SONUÇ: Bu çalışma, KSS’nin KABCyapılması planlanan hastalarda operasyon sonrasındagelişebilecek SVO öngörmede yararlı ve pratik bir skorolabileceğini göstermiştir. Bu nedenle bu hastalar içinameliyat öncesi buna uygun önlemler uygulanabilir.

Clinical SYNTAX Score Predicts Cerebrovascular Event AfterIsolated Coronary Artery Bypass Surgery

INTRODUCTION: Cerebrovascular event (CVE) is majorcause of mortality and morbidity after coronary artery bypasssurgery (CABG). There is no available data in literatureinvestigating correlation between SYNTAX and clinicalSYNTAX score (CSS) and CVE after isolated CABG. The aimof the study was to investigate predicting risk of CVE withSYNTAX and CSS. METHODS: 1850 patients underwent isolated CABG betweenOctober 2011 to December 2013 were included in the study inour hospital. 249 patients included in our study aftereliminating patients having exclusion criteria. CVE includedtransient ischemic events and strokes in 30 days after CABGand two groups were determined as post-operative CVE (+)(PoCVE+) and post-operative CVE(-) (PoCVE-). SYNTAXscore and additional clinical parameters (age, left ventricularejection fraction (LVEF), glomerular filtration rate (GFR)) tocalculate CSS were recorded for patients using last coronaryangiography before isolated CABG. RESULTS: In present study, age (p=0.002), total cholesterol(p=0.048), glucose (p=0.022), uric acid (p=0.032), creatinine(p=0.022), neutrophil count (p=0.06), circumflex-saphenousgrafting (CX-SVG) (p=0.01), CSS (p=0.003) were foundstatistically higher in PoCVE(+) group. Additionally, LVEF(p=0.019) and GFR (p=0.013) were detected lower inPoCVE(+) group. logistic regression of significant parametersshowed that, average age (p=0.017), increased glucose levels(p=0.08), existence of CX-SVG (p=0.011) and CSS (p=0,026)were found contributed factors. CSS >8 predicts CVE withsensitivity of 78.6, specificity of 68.9 DISCUSSION AND CONCLUSION: This study showed CSSmight be a useful and practical score to predict CVE inpatients who planned to undergo CABG therefore precautionsmight be taken before surgery for these patients.

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