Tuncay KIRIŞ, Sezgin VATANSEVER, Selçuk YAZICI, Aykan ÇELİK, Eser VARIŞ, Mustafa KARACA, Mehmet Serdar BAYATA, Cem NAZLI

Perkütan Koroner Girişim Yapılan Akut Koroner Sendromlu Hastalarda Protrombin Zamanın Prognostik Değeri

Giriş: Hem kalp yetersizliği hem de akut pulmoner embolili hastalarda koagülasyon anormalliklerinin prognostik değeri ile ilgili bazı çalışmalar vardır. Fakat, antikoagülan tedavi almayan akut koroner sendrom (AKS) hastalarında kabuldeki protrombin zaman (PZ)'ın uzun dönemde mortaliteyle ilişkili olup olmadığı belli değildir. Bu yüzden, biz bu hastalarda başlangıç PZ’nin prognostik rolünü araştırdık. Hastalar ve Yöntem: Çalışmaya retrospektif olarak perkütan koroner girişim (PKG) uygulanan AKS’li ardışık 1.100 hasta alındı. Antikoagülan tedavi başlanmadan önce hastaların PZ'si ölçüldü. Hastalar PZ’sine göre; yüksek (≥ 14 saniye, n= 50), orta (12.5 < PZ < 14 saniye, n= 169) ve düşük (≤ 12.5 saniye, n= 881) olmak üzere üç gruba ayrıldı. Primer sonlanım noktası ortalama 30.5 aylık takipte tüm nedenlere bağlı ölüm olarak belirlendi. Bulgular: Uzun dönem total mortalite oranı, düşük, orta ve yüksek PZ gruplarında sırasıyla: %15, %27 ve %52 idi (p< 0.001). Çok değişkenli analizde yüksek PZ mortalite ile ilişkili bulundu (HR: 2.648, %95 CI: 1.590-4.410, p< 0.001). Sol ventrikül ejeksiyon fraksiyonu, diyabet öyküsü, inme, yaş, hemoglobin, kreatinin, beyaz küre sayısı, total bilirubin seviyeleri ve Killip sınıfını içeren çok değişkenli bir modele PZ'nin eklenmesi %26.7’lik bir net yeniden sınıflandırma iyileşmesi (p< 0.001) ve 0.022’lik total bir ayrımcılık iyileşmesi (p= 0.001) sağladı. Sonuç: Antikoagülan tedavinin yokluğunda başlangıç PZ’nin uzaması, AKS hastalarında artmış mortaliteyle ilişkili olabilir. Ayrıca, PZ yüksek riskli AKS hastaları belirlemek için kullanılabilir.

Anahtar Kelimeler:

Protrombin zamanı, antikoagülasyon, akut koroner sendromlar, mortalite

Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Introduction: There are some studies regarding the prognostic value of coagulation abnormalities both in heart failure and acute pulmonary embolism patients. However, it is unclear whether prothrombin time (PT) at presentation will be associated with long-term mortality in acute coronary syndrome (ACS) patients not on anticoagulant therapy. Thus, we investigated the prognostic role of initial PT in such patients. Patients and Methods: A total of 1100 consecutive patients with ACS undergoing percutaneous coronary intervention (PCI) who were not receiving anticoagulant therapy were included in the study, retrospectively. PT was measured on admission in these patients before anticoagulation therapy. The study population was divided into three groups based on the PT values: A high-PT group (PT ≥ 14 sec, n= 50), intermediate-PT group (12.5 < PT < 14 sec, n= 169), and low-PT group (PT ≤ 12.5 sec, n= 881). The primary end point was all-cause death during the median follow-up of 30.5 months. Results: The rate of the primary end point was 15% in the low-PT group, 27% in the intermediate-PT group, and 52% in the high-PT group (p< 0.001). For long-term mortality, a significantly higher mortality risk was observed in high-PT group (HR: 2.648, 95% CI: 1.590-4.410, p< 0.001) compared with the others group in multivariate analysis. The addition of PT to a multivariable model that included the left ventricular ejection fraction, histories of diabetes mellitus and stroke, age, hemoglobin, creatinine, white blood cell count, total bilirubin levels and Killip class led to a significant net reclassification improvement (NRI) of 26.7% (p< 0.001) and an integrated discrimination improvement of 0.022 (p= 0.001). Conclusion: Our findings suggest that prolonged initial PT in the absence of anticoagulant therapy can be associated with all-cause mortality in ACS patients who were undergoing PCI. In addition, PT may be used to identify the high-risk patients with ACS.

Keywords:

Prothrombin time, anticoagulation, acute coronary syndromes, mortality,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi