Regayip ZEHİR, Ahmet İlker TEKKEŞİN, Nahide HAYKIR, Yalçın VELİBEY, Edibe Betül BÖRKLÜ, Ayça GÜMÜŞDAĞ

Primer Perkütan Koroner Girişim Uygulanan St-segment Yükselmesi Miyokart İnfarktüsü Hastalarında Kontrast Nefropatisi Gelişimi İçin Monosit/Yüksek Yoğunluklu Lipoprotein Oranının Öngörülü Değeri

Giriş: Kontrast madde nefropatisi (KMN) primer perkütan koroner girişim (p-PKG) uygulanan ST yükselmeli miyokart infarktüsü (STEMİ) hastalarda ciddi bir komplikasyondur. Monosit/yüksek dansiteli lipoprotein (HDL) oranı (MHR) son zamanlarda inflamasyon ve oksidatif stres işaretleyici tanımlamıştır. Bu çalışmanın amacı, p-PKG uygulanan hastalarda KMN riski için MHR öngörü değerini araştırmaktır. Hastalar ve Yöntem: STEMİ tanısı ile hastaneye yatırılan ve p-PKG uygulanan 2120 hasta retrospektif olarak değerlendirildi. Kontrast maruziyeti sonrası 72 saat içinde başlangıç serum kreatininde ≥ %25 göreceli artış veya ≥ 0.5 mg/dL mutlak artış olması KMN olarak tanımlandı. MHR acil servis başvurusunda hesaplandı. KMN riski ile MHR arasındaki ilişki değerlendirildi. Bulgular: KMN insidansı (n= 139) %6.6 idi. Yaş (p= 0.001), bazal kreatinin (p< 0.001), DM (p< 0.001), HT (p< 0.001), anemi (p= 0.001) KMN olan hastalarda daha yüksekti. Hastalar CIN gelişimine göre iki gruba ayrıldı. Periferik monosit sayısı, HDL ve MHR gruplar arasında farklılık yoktu. Tüm temel karıştırıcı faktörler için düzeltme yapıldıktan sonra, periferik monosit sayısı ve MHR bizim çok değişkenli lojistik regresyon analizi sonrasında KMN gelişmesinin bağımsız belirleyicileri olarak saptanmadı. Sonuç: MHR infarktüsün erken safhasında stabil hastalardan çok farklı olmadığından, p-PKG uygulanan STEMİ hastalarında KMN gelişimi için potansiyel belirleyicisi olarak değerlendirilemez.

Anahtar Kelimeler:

Kontrast nefropatisi, primer perkütan koroner girişim, ST-segment yükselmeli miyokart infarktüsü, monosit/yüksek dansiteli lipoprotein oranı

Predictive Value of Monocyte to High-Density Lipoprotein Cholesterol Ratio for Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention

Introduction: Contrast-induced nephropathy (CIN) is a serious complication in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (p-PCI). The monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) has recently been defined as an inflammation and oxidative stress marker. The aim of this study was to evaluate the predictive value of MHR for risk of CIN in patients with ST who underwent p-PCI. Patients and Methods: Data of a 2120 patients who were hospitalised with the diagnosis of STEMI and underwent p-PCI were retrospectively evaluated. A relative increase in serum creatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from the baseline within 72 h of contrast exposure was defined as CIN. MHR was calculated on emergency admission. The risk of CIN was evaluated across MHR values. Results: The incidence of CIN was 6.6% (n= 139). Age (p= 0.001), baseline creatinine levels (p< 0.001), DM (p< 0.001), HT (p< 0.001) and anaemia (p= 0.001) were higher in patients with CIN. The patients were divided into 2 groups based on the development of CIN. Peripheral monocyte count, HDL levels and MHR did not differ between the groups. After correction for all baseline confounders, neither peripheral monocyte count nor MHR were found to be independent predictors of CIN development in our multivariate logistic regression analyses. Conclusion: Because MHR does not differ much from that in stable patients at the early phase of infarction, it cannot be a potential predictor of CIN development in patients with STEMI who underwent p-PCI.

Keywords:

Contrast-induced nephropathy, primary percutaneous coronary intervention, ST segment elevation myocardial infarction, monocyte to high-density lipoprotein cholesterol ratio,

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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