Faruk AYDINYILMAZ, Nail Burak ÖZBEYAZ, Engin ALGUL, İlkin GULIYEV, Haluk Furkan ŞAHAN, Ayşenur ÖZKAYA İBİŞ, Kamuran KALKAN, Hamza SUNMAN

BAŞARILI EPİKARDAL AKIM SAĞLANAN AKUT ST ELEVASYONLU MİYOKARDİYAL ENFARKTÜSLÜ HASTALARDA YETERLİ MİYOKARDİYAL PERFÜZYONU ETKİLEYEN FAKTÖRLER

Amaç: Bu çalışmanın amacı, başarılı primer perkütan koroner girişimden (pPKG) sonra akut ST segment yükselmeli miyokard enfarktüslü (STEMI) hastalarda tam ve yetersiz ST segment rezolüsyonlu (STR) hasta grupları arasında çok yönlü parametreleri değerlendirmek ve karşılaştırmak ve STR ile ilişkili ilişkileri belirlemektir. Gereç ve Yöntemler: 888 hasta çalışmaya dahil edildi, hastalar pPKG'den 60-90. Dakikada çekilen elektrokardiyografide STR <%70 ve ≥%70 olmak üzere iki gruba ayrıldı. Kardiyovasküler risk faktörleri ve çeşitli anjiyografik parametreler değerlendirildi ve gruplar arasında karşılaştırıldı. Bulgular: Yetersiz STR'li 346 hasta ve tam STR'li 542 hasta vardı. Çok değişkenli regresyon analizinde sorumlu lezyonun LAD olması (OR=1.768; p=0,048), kapı-tel geçiş süresi (OR=0.993; p=0,033), toplam işlem süresi (OR=0.994; p=<0,001) ve glikoprotein 2b/3a inhibitörü kullanımı (OR=2,135; p=0,013) tam STR için bağımsız risk faktörleri olarak bulundu. Kapı-tel ve toplam işlem süresinin eğri altında kalan alanı 0.668, 0.831, cut-off değeri 58, 52 dakika ve duyarlılık ve özgüllük %63,9, %70,8 ve %63,1, %76,8 olarak belirlendi. Sonuç: pPKG sonunda başarılı akım sağlansa bile işlem süresinin mümkün olduğunca kısa tutulması ve glikoprotein 2b/3a kullanılması miyosit düzeyinde perfüzyonu artırabilen faktörler olarak bulundu.

Anahtar Kelimeler:

ST elevasyonlu miyokard enfarktüsü, TIMI-3 akım, ST elevasyon rezolüsyonu, elektrokardiyografi

FACTORS AFFECTING ADEQUATE MYOCARDIAL PERFUSION IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION WITH SUCCESSFUL EPICARDIAL FLOW

Aim: The aim of this study was to evaluate and compare multifarious parameters between complete and incomplete ST-segment resolution (STR) patients groups and to identify associates of STR in patients with acute ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). Material and Methods: 888 consecutive patients were divided into two groups according to the STR <70% and ≥70% 60-90 min after pPCI. The cardiovascular risk factors and various angiographic parameters were assessed and compared between the groups. Results: There were 346 patients with incomplete STR and 542 patients with complete STR. In multivariable regression analysis, culprit lesion (LAD) (OR=1.768; p=0.048), door-to-wire crossing time (OR=0.993; p=0.033), total procedure time (OR=0.994; p=<0.001) and glycoprotein 2b/3a inhibitor use (OR=2.135; p=0.013) were found to be independent risk factors for complete STR. The AUC of door-to-wiring and total procedure time for STR prediction was 0.668, 0.831, the cut-off value was 58, 52 min, and the sensitivity and specificity were 63.9%, 70.8%, and 63.1%, 76.8%. Conclusion: Even if the successful flow is achieved at the end of pPCI, keeping the procedure time as short as possible and using glycoprotein 2b/3a are the factors that can increase perfusion at the myocyte level.

Keywords:

ST elevasyonlu miyokard enfarktüsü, TIMI-3 akım, ST elevasyon rezolüsyonu, elektrokardiyografi,

PDF

___

1. Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. European heart journal 2006;27(7):779-788.
2. Grines C, Patel A, Zijlstra F, et al. Primary coronary angioplasty compared with intravenous thrombolytic therapy for acute myocardial infarction: six-month follow up and analysis of individual patient data from randomized trials. American heart journal 2003;145(1):47-57.
3. Brener SJ, Dizon JM, Mehran R, et al. Complementary prognostic utility of myocardial blush grade and ST-segment resolution after primary percutaneous coronary intervention: analysis from the HORIZONS-AMI trial. American heart journal 2013;166(4):676-683.
4. Sezer M, Nisanci Y, Umman B, et al. New support for clarifying the relation between ST segment resolution and microvascular function: degree of ST segment resolution correlates with the pressure derived collateral flow index. Heart 2004;90(2):146-150.
5. Park SR, Kang YR, Seo MK, et al. Clinical predictors of incomplete ST-segment resolution in the patients with acute ST segment elevation myocardial infarction. Korean circulation journal 2009;39(8):310-316.
6. Ndrepepa G, Alger P, Kufner S, Mehilli J, Schömig A, Kastrati A. ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Cardiology journal 2012;19(1):61-69.
7. Farkouh ME, Reiffel J, Dressler O, et al. Relationship between ST-segment recovery and clinical outcomes after primary percutaneous coronary intervention: the HORIZONS-AMI ECG substudy report. Circulation: Cardiovascular Interventions 2013;6(3):216-223.
8. Van der Zwaan H, Stoel M, Roos-Hesselink J, Veen G, Boersma E, von Birgelen C. Early versus late ST-segment resolution and clinical outcomes after percutaneous coronary intervention for acute myocardial infarction. Netherlands heart journal 2010;18(9):416-422.
9. Lee A, Sadick N, Ng A, Hsieh C, Ross D. Prognostic implication of ST‐segment resolution following primary percutaneous transluminal coronary angioplasty for ST‐elevation acute myocardial infarction. Internal medicine journal 2004;34(9‐10):551-556.
10. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Journal of the American College of Cardiology 2018;72(18):2231-2264.
11. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal 2018;39(2):119-177.
12. Topol EJ, Califf RM, George BS, et al. A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. New England Journal of Medicine 1987;317(10):581-588.
13. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996;93(5):879-888.
14. Ryan TJ. Guidelines for percutaneous transluminal coronary angioplasty: a report of the American College of Cardiology/American Heart Association Task Force on assessment of diagnostic and therapeutic cardiovascular procedures (subcommittee on percutaneous transluminal coronary angioplasty). Journal of the American College of Cardiology 1988;12(2):529-545.
15. Unikas R, Budrys P. Association between clinical parameters and ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Medicina 2016;52(3):156-162.
16. Wu KC, Zerhouni EA, Judd RM, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998;97(8):765-772.
17. James S, Angiolillo DJ, Cornel JH, et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. European heart journal 2010;31(24):3006-3016.
18. De Luca G, Gibson CM, Bellandi F, et al. Diabetes mellitus is associated with distal embolization, impaired myocardial perfusion, and higher mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty and glycoprotein IIb-IIIa inhibitors. Atherosclerosis 2009;207(1):181-185.
19. De Luca G, Bellandi F, Huber K, et al. Early glycoprotein IIb‐IIIa inhibitors in primary angioplasty‐abciximab long‐term results (EGYPT‐ALT) cooperation: individual patient’s data meta‐analysis. Journal of Thrombosis and Haemostasis 2011;9(12):2361-2370.
20. Zhao X-Q, Théroux P, Snapinn SM, Sax FL. Intracoronary thrombus and platelet glycoprotein IIb/IIIa receptor blockade with tirofiban in unstable angina or non–Q-wave myocardial infarction: angiographic results from the PRISM-PLUS trial (Platelet receptor inhibition for ischemic syndrome management in patients limited by unstable signs and symptoms). Circulation 1999;100(15):1609-1615.
21. Yonetsu T, Lee T, Murai T, et al. Association between prior aspirin use and morphological features of culprit lesions at first presentation of acute coronary syndrome assessed by optical coherence tomography. Circulation Journal 2017;81(4):511-519.
22. Hashimoto T, Ako J, Nakao K, et al. Pre-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with ST-Segment Elevation Myocardial Infarction A J-MINUET Substudy. International heart journal 2018;59(5):920-925.
23. Glaser R, Naidu SS, Selzer F, et al. Factors associated with poorer prognosis for patients undergoing primary percutaneous coronary intervention during off-hours: biology or systems failure? JACC: Cardiovascular Interventions 2008;1(6):681-688.
24. Holmes DR, Kereiakes DJ, Garg S, et al. Stent thrombosis. Journal of the American College of Cardiology 2010;56(17):1357-1365.
25. Serruys PW, Daemen J. Late stent thrombosis: a nuisance in both bare metal and drug-eluting stents. Circulation 2007;115(11):1433-1439.
26. Durmaz E, Karadag B, Ikitimur B, et al. The impact of lesion complexity on no-reflow phenomenon and predictors of reversibility in patients treated with primary percutaneous intervention. Coronary Artery Disease 2020;31(8):678-686.
27. Árnadóttir Á, Pedersen S, Bo Hasselbalch R, et al. Temporal release of high-sensitivity cardiac troponin T and I and copeptin after brief induced coronary artery balloon occlusion in humans. Circulation 2021;143(11):1095-1104.
28. Winter R, Jussila R, Nowak J, Brodin L-A. Speckle tracking echocardiography is a sensitive tool for the detection of myocardial ischemia: a pilot study from the catheterization laboratory during percutaneous coronary intervention. Journal of the American Society of Echocardiography 2007;20(8):974-981.
29. Mehta S, Oliveros E, Alfonso CE, et al. Optimizing door-to-balloon times for STEMI interventions–Results from the SINCERE database. Journal of the Saudi Heart Association 2009;21(4):229-243.