St-Segment Yükselmeli Miyokart İnfarktüslü Hastalarda Yüksek Dereceli Atriyoventriküler Bloğun No-reflow Fenomenine ve Prognoza Etkisi

Giriş: ST segment yükselmeli miyokart infarktüsü (STEMİ) seyrinde yüksek dereceli atriyoventriküler bloğun (HAVB) mortalite ile ilişkili olduğu tespit edilmiş olsa da AV bloğunun mortaliteye hangi mekanizmalarla neden olduğu, net olarak ortaya konulmamıştır. Bu çalışmada, (i) HAVB ile hem kısa hem de uzun dönem mortalite ile ilişkili olduğu defalarca gösterilen no-reflow arasındaki ilişkiyi (ii) hem HAVB hem de no-reflow’un hastane içi ve uzun dönem mortaliteye etkisini araştırmayı amaçladık. Hastalar ve Yöntem: Primer perkütan koroner girişim (pPCI) yapılan toplam 1217 hasta, HAVB gelişip gelişmemesine, daha sonra da no-reflow gelişip gelişmemesine göre iki gruba ayrıldı. No-reflow’un bağımsız prediktörleri araştırıldı. Son olarak da hastalar, hastane içi ve uzun dönem mortalite açısından karşılaştırıldı. Bulgular: Bu çalışmada, 47 (%3.8) hastada HAVB, 150 (%12.3) hastada no-reflow izlendi. HAVB, no-reflow’un bağımsız bir prediktörü olarak saptandı (OR: 3.127, %95 CI: 1.215-9.056; p= 0.006). Sağkalım analizinde HAVB ve no-reflow’da hastane içi mortalite (sırasıyla %19.1’e karşı %3.2; p< 0.001 ve %10.7’ye karşı %2.9; p< 0.001) ve uzun dönem mortalite (sırasıyla %15.7’ye karşı %6.2; p= 0.037 ve %14.1’e karşı %5.5; p< 0.001) daha yüksek olarak izlendi. Sonuç: Bu çalışmada, STEMİ ile ortaya çıkan HAVB’nin, kısa döneme ek olarak, uzun dönem mortalite ile de ilişkili olduğu tespit edildi. HAVB ile sağkalımla ileri derecede korelasyonu olan reperfüzyon başarısının ilişkisini gösteren bu ilk çalışmada, HAVB’nin no-reflow için bağımsız bir prediktör olduğunu ve no-reflow’u olan hastaların hem kısa hem de uzun dönem izlemlerinde kötü prognoza sahip olduğunu ortaya koyduk.

Anahtar Kelimeler:

Yüksek dereceli atriyoventriküler blok, ST segment yükselmeli miyokart infarktüsü, no-reflow

Impact of High-Degree Atrioventricular Block on No-Reflow Phenomenon and Prognosis in Patients with St-Segment Elevation Myocardial Infarction

Introduction: Although it has been established that high-degree atrioventricular block (HAVB) is associated with mortality in the course of ST segment elevation myocardial infarction (STEMI), the mechanisms by which this AV block cause mortality are not yet fully understood. In this study we aimed: (i) to investigate the relationship between HAVB and no-reflow, which has been repeatedly shown to be associated with both short- and long-term mortality; (ii) to determine the effect of both HAVB and no-reflow on in-hospital and long-term mortality. Patients and Methods: A total of 1.217 patients who underwent primary percutaneous coronary intervention (pPCI) were divided into two groups, according to HAVB development, and were further divided according to no-reflow development. Independent predictors of no-reflow were investigated. Furthermore, patients were compared in terms of in-hospital and long-term mortality. Results: In the present study, 47 patients (3.8%) suffered from HAVB and 150 patients (12.3%) had no-reflow. HAVB was an independent predictor of no-reflow [odds ratio (OR): 3.127, 95% confidence interval (CI): 1.215-9.056; p= 0.006]. In survival analysis, both HAVB and no-reflow were associated with in-hospital (19.1% vs. 3.2%; p< 0.001 and 10.7% vs. 2.9%; p< 0.001, respectively) and long-term (15.7% vs. 6.2%; p= 0.037 and 14.1% vs. 5.5%; p< 0.001, respectively) mortality. Conclusion: To our knowledge, this is the first study in the literature to examine the effect of HAVB on reperfusion success. In this study, we found that HAVB emerged with STEMI is associated with long-term mortality and to short-term mortality. Also HAVB was an independent predictor of no-reflow, and patients who had no-reflow had a worse prognosis both in short- and long-term follow-up.

Keywords:

High grade AV block, ST segment elevation myocardial infarction, no-reflow,

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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