Akut Miyokardiyal İnfarktüs Sonrası Primer Anjiyoplasti Uygulanan Hastalarda Kontrastla İlişkili Nefropatinin Bir Prediktörü: Kontrast Madde Hacminin Glomerüler Filtrasyon Hızına Oranı

Amaç Akut miyokard infarktüsü nedeni ile perkütan koroner girişim yapılan hastalarda, kontrast madde hacminin glomerüler filtrasyon hızına oranının (KV/GFH) kontrast ilişkili nefropatiyi (KİN) öngördürmedeki etkisini belirlemek ve KİN gelişiminden sakınmak amacı ile güvenli bir KV/GFH eşik değeri tanımlamak. Gereç ve Yöntemler Akut myokard infarktüsü nedeni ile perkütan koroner girişim yapılan 108 hasta değerlendirildi. Hastalar perkütan koroner girişimden 48 saat sonra bakılan serum kreatinin değerlerindeki değişime göre, KİN gelişen ve KİN gelişmeyen olarak iki gruba ayrıldı. Ardından KİN ile ilişkili olan risk faktörlerinin analizi yapıldı. Receiver operating characteristic (ROC) eğrisi kullanılarak KİN gelişimini belirlemek amacıyla KV/GFH için optimal bir eşik değer belirlendi ve lojistik regresyon kullanılarak KİN’i öngördüren bağımsız değişkenler tanımlandı. Bulgular Hastalar içinde KİN gelişim oranı %24 olarak saptandı. KV/GFH anlamlı olarak KIN gelişen grupta daha yüksek bulundu. ROC eğrisi analizi ile elde edilen KV/GFH>2.68 değeri, KİN gelişimini öngörmede %92 sensitivite ve %89 spesifisiteye sahipti. KV/GFH dışında, yaş ve HDL-K da KİN için bağımsız risk faktörleri olarak saptandı. Sonuç Akut myokard infarktüsü nedeni ile perkütan koroner girişim yapılan hastalarda, KV/GFH>2.68 değeri KİN’i öngördürmede anlamlı bağımsız bir değişkendir. Bu değer PKG yapılacak hastalarda kontrast madde kullanımını yönetmek açısından kullanışlı olabilir.

Anahtar Kelimeler:

Kontrast ilişkili nefropati, kontrast madde hacmi, akut miyokardiyal infarktüs, perkütan koroner girişim, yüksek dansiteli lipoprotein

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