Zeki ŞİMŞEK, Regayip ZEHİR, Elnur ALİZADE, Ender Özgün ÇAKMAK

ST Yükselmeli Miyokart Enfarktüsü Geçiren Hastalarda Enfarkt ile İlişkili Arter Açıklığının Belirlenmesinde CHA2 DS2 -VASc Skorunun Prediktif Doğruluğu

Giriş: Perkütan koroner girişim öncesi enfark ilişkili arter açıklığı, ST yükselmeli miyokart enfarktüsü hastalarında daha iyi klinik sonuçlarla ilişkilidir. Birincil perkütan koroner girişimden önce spontan reperfüzyon meydana gelen hastalarda enfarkt alanı daha küçük olup bu hastalarda sol ventrikül fonksiyonları daha iyi korunur ve bu durum daha az kardiyojenik şok ve belirgin olarak daha düşük mortaliteyle ilişkilidir. CHA2 DS2 -VASc skoru non-valvüler atriyal fibrilasyon hastalarında iskemik inme ve sistemik emboli riskini öngörmek için kullanılan bir araç olmakla beraber son yıllarda atriyal fibrilasyonun varlığına bakılmaksızın çok çeşitli kardiyovasküler hastalıklarda CHA2 DS2 -VASc skorunun prediktif değerine odaklanılmıştır. Bu çalışmanın amacı, ST yükselmeli miyokart enfarktüsü hastalarında enfarkt ilişkili arter açıklığının belirlenmesinde CHA2 DS2 -VASc skorunun prediktif doğruluğunu değerlendirmektir. Hastalar ve Yöntem: Çalışmamızda hastanemize göğüs ağrısıyla başvurup ST yükselmeli miyokart enfarktüsü tanısıyla birincil perkütan koroner girişim uygulanan 723 hastanın retrospektif analizi yapıldı. Tüm hastalar için ayrı ayrı CHA2 DS2 -VASc skoru hesaplandı. Çalışma popülasyonu enfark ilişkili arter tıkalı grup (TIMI 0, 1, 2) ve enfarkt ilişkili arter açık grup (TIMI 3) olmak üzere iki ayrı gruba ayrıldı. CHA2 DS2 -VASc skorunun prediktif değerini belirlemek için multivaryate lojistik regresyon analizi yapıldı. Bulgular: Toplam 568 (%78.6) hastada TIMI 0, 1 veya 2 akım (tıkalı enfarkt ilişkili arter grubu) ve 155 (%21.4) hastada TIMI 3 akım (patent enfarkt ilişkili arter grubu) vardı. Enfarkt ilişkili arter tıkalı gruptaki hastalar, enfarkt ilişkili arter açık grubuna göre daha yüksek CHA2 DS2 -VASc skoruna (2 ± 1’ye karşılık 1 ± 1, p< 0.001) sahipti. Enfarkt ilişkili arter açıklığını tahmin etmek için yapılan “Receiver Operating Characteristic (ROC)” curve analizinin sonucu 0.74 idi ve CHA2 DS2 -VASc skorunun < 2 olmasının enfarkt ilişkili arter açıklığını %70.9 duyarlılık ve %44.5 özgüllükle öngördüğü saptanmıştır (AUC: 0.735, %95 CI: 0.691-0.779, p< 0.001). Sonuç: CHA2 DS2 -VASc skoru, birincil perkütan koroner girişim uygulanan ST yükselmeli miyokart enfarktüsü hastalarında enfarkt ilişkili arter açıklığını tahmin etmek için basit ve güvenilir bir araç olarak kullanılabilir.

Predictive Accuracy of CHA2 DS2 -VASc Score in Determining Infarct-Related Artery Patency in Patients with ST-Elevation Myocardial Infarction

Introduction: Infarct related artery patency before percutaneous coronary intervention is associated with better clinical outcomes in ST elevation myocardial infarction patients. Infarction area is smaller and left ventricular functions are better preserved in patients with spontaneous reperfusion before primary percutaneous coronary intervention, which is associated with less cardiogenic shock and significantly lower mortality. CHA2 DS2 -VASc score is a tool used in predicting the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation, although in recent years the focus has been on predictive value of CHA2 DS2 - VASc score in a wide spectrum of cardiovascular diseases regardless of the presence of atrial fibrillation. The objective of this study was to evaluate the predictive accuracy of CHA2 DS2 -VASc score in determining infarct related artery patency in ST elevation myocardial infarction patients. Patients and Methods: A total of 723 patients who presented to our hospital with chest pain and underwent primary percutaneous coronary intervention with the diagnosis of ST elevation myocardial infarction were retrospectively analyzed. CHA2 DS2 -VASc score was calculated separately for all patients. Study population was divided into two groups as the occluded infarct related artery group (TIMI 0, 1, 2) and patent infarct related artery group (TIMI 3). A multivariate logistic regression analysis was performed in order to determine predictive value of CHA2 DS2 -VASc score. Results: There were TIMI 0, 1 or 2 flow (occluded infarct related artery group) in 568 (78.6%) patients and TIMI 3 flow (patent infarct related artery group) in 155 (21.4%) patients. Patients in the occluded infarct related artery group had a significantly higher CHA2 DS2 -VASc score compared to the patent infarct related artery group (2 ± 1 vs. 1 ± 1, p< 0.001). The result of Receiver Operating Characteristic (ROC) curve analysis carried out to predict infarct related artery patency was 0.74. We found that a CHA2 DS2 -VASc score < 2 predicted infarct related artery patency with a sensitivity of 70.9% and a specificity of 44.5% (AUC: 0.735, 95% CI: 0.691-0.779, p< 0.001). Conclusion: The CHA2 DS2 -VASc score can be used as a simple and reliable tool to predict infarct related artery patency in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

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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