Çetin GEÇMEN, Ekrem GÜLER, Gamze BABUR GÜLER, Ali ELVERAN, Hacı Murat GÜNEŞ, Hicaz ZENCİRKIRAN AGUŞ, Oğuz KARACA, Nurşen KELEŞ, Özlem ESEN, Ali Metin ESEN

ST Yükselmesiz Akut Koroner Sendrom Hastalarında TIMI Risk Skoru ile Hemoglobin Değeri Arasındaki İlişkinin Değerlendirilmesi

Giriş: ST yükselmesiz akut koroner sendrom hastalarının geliş hemoglobin seviyesi ile TIMI risk skoru arasındaki ilişki araştırıldı. Hastalar ve Yöntem: ST yükselmesiz akut koroner sendromlu 286 hasta çalışmaya dahil edildi. Tüm hastaların geliş anında hemoglobin ve biyokimyasal parametreleri çalışıldı. Hastalar TIMI risk skoruna göre düşük, orta ve yüksek risk olarak 3 gruba ayrıldı. Bulgular: Geliş hemoglobin seviyesi (g/dL) düşük, orta ve yüksek TIMI risk grubunda sırasıyla (13.5 ± 1.9, 12.5 ± 1.9, 11.3 ± 1.9, p< 0.001) olarak saptandı. Hemoglobin seviyesi ve TIMI risk skoru arasında orta düzeyde negatif korelasyon bulundu (r: -0.408, p< 0.001). Tek değişkenli regresyon analizinde TIMI risk skoru artışı ile geliş hemoglobin seviyelerinin önemli derecede düşük olduğu saptandı (Estimate; -0.406, p< 0.001, %95 GA[-0.521-(-0.290)]. Sonuç: ST yükselmesiz akut koroner sendrom ile hastaneye yatırılan hastaların risk skoru attıkça geliş hemoglobin seviyelerinin bağlantılı olarak düşük olduğu tespit edildi. Basit ve yaygın bir test olarak kullanılan hemoglobin seviyesi, ST yükselmesiz akut koroner sendrom hastalarının geliş anındaki risk durumunu belirlemede kullanılabilir.

Anahtar Kelimeler:

Miyokart infarktüsü, hemoglobinler, akut koroner sendrom

Evaluation of the Relationship Between Hemoglobin Levels and Thrombolysis in Myocardial Infarction Risk Score in Patients with Non-ST Elevation Acute Coronary Syndrome

Introduction: The relationship between hemoglobin (Hb) levels at admission and the thrombolysis in myocardial infarction (TIMI) risk score in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) was investigated. Patients and Methods: In total, 286 NSTE-ACS patients were included in the study. Hb levels and biochemical parameters were measured at admission. The patients were grouped into the following three groups according to the TIMI risk score: low-intermediate-, and high-risk groups. Results: Hb levels (in g/dL) at admission in low-, intermediate-, and high-risk groups were 13.5 ± 1.9, 12.5 ± 1.9, and 11.3 ± 1.9, respectively (p < 0.001). We found a negative moderate correlation between Hb levels and TIMI risk scores (r= -0.408, p < 0.001). In univariate regression analysis, it was found that with the increase in the TIMI risk score, Hb levels at admission were significantly reduced (estimate= -0.406; p< 0.001; 95% confidence interval; -0.521 to -0.290). Conclusion: We found that as the TIMI risk score of patients admitted to hospital presenting with NSTE-ACS increased, their Hb levels at admission correspondingly decreased. Thus, the simple and commonly measured Hb level can be a useful parameter in stratifying the risks of patients presenting with NSTE-ACS during admission.

Keywords:

Myocardial infarction, hemoglobins, acute coronary syndrome,

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1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25-e146.
2. Tello-Montoliu A, Marín F, Roldán V, Mainar L, López MT, Sogorb F, et al. Multimarker risk stratification approach to non-ST elevation acute coronary syndrome: implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels. J Intern Med 2007;262:651-8.
3. Guler E, Gecmen C, Guler GB, Karaca O, Agus HZ, Gunes HM, et al. Adding lipoprotein (a) levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome. Kardiol Pol 2013;71:695-701.
4. Alexander KP, Chen AY, Wang TY, Rao SV, Newby LK, LaPointe NM, et al. Transfusion practice and outcomes in non–ST-segment elevation acute coronary syndromes. Am Heart J 2008;155:1047-53.
5. Lipsic E, Van Der Horst IC, Voors AA, van der Meer P, Nijsten MW, van Gilst WH, et al. Hemoglobin levels and 30 day mortality in patients after myocardial infarction. Int J Cardiol 2005;100:289-92.
6. Kunadian V, Mehran R, Lincoff AM, Feit F, Manoukian SV, Hamon M, et al. Cox DA. Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial). Am J Cardiol 2014;114:1823-9.
7. Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. 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;333:109.
8. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000;284:835-42.
9. Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005;111:2042-9.
10. Nikolsky E, Aymong ED, Halkin A, Grines CL, Cox DA, Garcia E, et al. Impact of anemia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. J Am Coll Cardiol 2004;44:547-53.
11. Levy PS, Quigley RL, Gould SA. Acute dilutional anemia and critical left anterior descending coronary artery stenois impairs end organ oxygen delivery. J Trauma 1996;41:416-23.
12. Mazzone A, Cusa C, Mazzucchelli I, Vezzoli M, Ottini E, Pacifici R, et al. Increased production of inflammatory cytokines in patients with silent miyocardial ischemia. J Am Coll Cardiol 2001;38:1895-901.
13. Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA 2003;289:853-63.
14. Sharma R, Francis DP, Pitt B, Poole-Wilson PA, Coats AJ, Anker SD. Haemoglobin predicts survival in patients with chronic heart failure: a substudy of the ELITE II trial. Eur Heart J 2004;25:1021-8.
15. Dauerman HL, Goldberg RJ, White K, Gore JM, Sadiq I, Gurfinkel E, et al. GRACE Investigators. Revascularization, stenting and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol 2002;90:838-42.
16. Breddin K, Loew D, Lechner K, Oberla K, Walter E. The German-Austrian aspirin trial: a comparison of acetylsalicylic acid, placebo and phenprocoumon in secondary prevention of myocardial infarction. On behalf of the German-Austrian Study Group. Circulation 1980;62:V63-72.
17. López-Sendón J, Swedberg K, McMurray J, Tamargo J, Maggioni AP, Dargie H, et al. Expert consensus document on angiotensin converting enzyme inhibitors in cardiovascular disease - The Task Force on ACE inhibitors of the European Society of Cardiology. Eur Heart J 2004;25:1454-70.
18. Spencer FA, Moscucci M, Granger CB, Gore JM, Goldberg RJ, Steg PG, et al. GRACE Investigators. Does comorbidity account for the excess mortality in patients with major bleeding in acute myocardial infarction? Circulation 2007;116:2793-801.
19. Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, et al. HORIZONS-AMI Trial Investigators. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 2008;358:2218-30.
20. Bassand JP, Afzal R, Eikelboom J, Wallentin L, Peters R, Budaj A, et al. Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes. Eur Heart J 2010;31:50-5.
21. McKechnie RS, Smith D, Montoye C, Kline-Rogers E, O’Donnell MJ, DeFranco AC, et al. Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Prognostic implication of anemia on in-hospital outcomes after percutaneous coronary intervention. Circulation 2004;110:271-7.
22. Rao SV, Jollis JG, Harrington RA, Granger CB, Newby LK, Armstrong PW, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004;292:1555-62.
23. Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001;345:1230-6.
24. Alexander KP, Chen AY, Wang TY, Rao SV, Newby LK, LaPointe NM, et al. Transfusion practice and outcomes in non-ST-segment elevation acute coronary syndromes. Am Heart J 2008;155:1047-53.

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