İnvaziv Tedavi Uygulanmış Akut Koroner Sendromlu Hastalarda Prognostik Belirteçler

Amaç: Akut Koroner Sendrom (AKS) invaziv tedavi ihtiyacý olan ölüm riski yüksek hastalar yanýnda uygun tedavi rejimlerine yanýt veren iyi prognozlu heterojen bir hasta grubunu temsil etmesi nedeniyle risk sýnýflamasý bu hastalarýn tedavisinde önemli rol oynar. Sadece invaziv tedavi alan AKS hastalarýna yönelik bir risk skorlamasý mevcut deðildir. Bu çalýºmada invaziv tedavi uygulanmýº AKS hasta grubu özelinde klasik risk skorlama sistemlerine alternatif, klinik uygulamada kullanýlabilir bir risk skorlama sistemi geliºtirilmesi hedeflenmiºtir. Yöntem: Bu retrospektif çalýºmaya invaziv tedavi uygulanmýº 192 USAP/NSTEMI hastasý (131 erkek, 61 bayan) dahil edilmiºtir. Hastalarýn 37±21 aylýk takibinde ölen hastalarýn deðerleriyle hayatta kalan hastalarýn deðiºkenleri kýyaslanmýºtýr. Bulgular: Ölen hastalarýn baºvuru sýrasýndaki yaºý, Killip skoru, kardiyak enzim deðerleri ölenlerden anlamlý olarak daha yüksek iken ejeksiyon fraksiyonu anlamlý olarak daha düºüktü. Ayrýca ölen hastalarda DM ve KKY, hastane yatýºý öncesi aspirin kullanýmý, atrial fibrilasyon, ST ve T dalgasý hareketlenme sýklýðý anlamlý olarak daha fazlaydý. HDL ve AF lojistik regresyon analizinde anlamlý mortalire belirteci olarak saptandý. TIMI puanýna AF için 2 ve HDL si düºük(
Anahtar Kelimeler:

AKS, Risk Skorlamasý, AF, HDL

___

  • Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36: 959-969.
  • Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation 1995; 92: 657-671.
  • Bassand JP, Hamm CW, Ardissino D et al. The Task Force for the Diagnosis and Treatment of non-ST- segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. European Heart Journal 2007; 28: 1598-1660.
  • Boersma E, Pieper KS, Steyerberg EW et al. Predictors of outcome in patients with acute coronary syndromes without persistent STsegment elevation. Results from an international trial of 9461 patients. The PURSUIT Investigators. Circulation 2000; 101: 2557-2567.
  • Granger CB, Goldberg RJ, Dabbous O et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003; 163: 2345-2353.
  • Fox KAA, Dabbous OH, Goldberg RJ et al for the GRACE Investigators Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006; 333: 1091-1094.
  • Antman EM, Cohen M, Bernink PJLM et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000; 284: 835-842.
  • Hoekstra J, Cohen M. Management of patients with unstable angina⁄non-ST-elevation myocardial infarction: a critical review of the 2007 ACC ⁄AHA guidelines Int J Clin Pract 2009; 63: 642-655.
  • Khalill R, Han L, Jing C, Quan H. The use of risk scores for stratification of non-ST elevation acute coronary syndrome patients. Exp Clin Cardiol. 2009; 14: 25-30.
  • Haklin A, Singh M, Nikolsky E et al. Prediction of Mortality After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction. J Am Coll Cardiol 2005; 45: 1397-1405.
  • Addala S, Grines CL, Dixon SR et al. Predicting Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Am J Cardiol 2004; 93: 629-632.
  • Devlin G, Gore JM, Elliott J et al. Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST elevation acute coronary syndromes: The Global Registry of Acute Coronary Events for the GRACE Investigators European Heart Journal 2008; 29: 1275-1282.
  • Gonc¸alves PA, Ferreira J, Aguiar C, Gomes RS. TIMI, PURSUIT, and GRACE risk scores: sustained prognostic value and interaction with revascularization in NSTE-ACS European Heart Journal 2005; 26: 865-872.
  • Emmanouil S, Brilakis R, Wright S et al. Association of the PURSUIT risk score with predischarge ejection fraction, angiographic severity of coronary artery disease, and mortality in a nonselected, community-based population with non-ST-elevation acute myocardial infarction. Am Heart J 2003; 146: 811-818.
  • Gibson M, Dumaine RL, Gelfand EV et al. Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13.307 patients in five TIMI trial C. European Heart Journal 2004;25: 1998-2005.
  • Correia LC. HDL-cholesterol level provides additional prognosis in acute coronary syndromes. Int J Cardiol 2009; 136: 307-314.