İlker DUMAN, Ayşe ÇOLAK, Halil Lütfi KISACİK

Koroner Bypas Cerrahisi Sonrasında Gelişen Safen Ven Greft Darlıklarına Perkütan Girişim Yapılan Hastalarda Majör Olumsuz Kardiyovasküler Olaylar ile Serum Fibrinojen Düzeyi Arasındaki İlişki

Amaç: Koroner arter bypas greft (KABG) cerrahisi sonrasında gelişen safen ven greft (SVG) hastalığına perkütan girişim ile revaskülarizasyon sağlanan bireylerde uzun dönem kardiyovasküler sonuçlar ve mortaliteyi öngördürmede, aterosklerozun patogenezinde rol oynayan serum fibrinojen seviyesinin değerini aydınlatmak amaçlandı. Gereç ve Yöntemler: Perkütan koroner girişim (PKG) yolu ile safen ven greft darlıklarına müdahale edilen hastalar retrospektif olarak tarandı. Toplamda 115 hasta çalışmaya dahil edildi. Majör olumsuz kardiyovasküler olay (MACE) varlığına göre 56 hasta (+), 59 hasta (-) olarak değerlendirildi. Her iki grubun PKG öncesi fibrinojen düzeyleri belirlenerek MACE ve fibrinojen değerleri arasındaki ilişki incelendi. Bulgular: Ortalama takip süresi 42,5 ay olan çalışmada beyaz küre ve serum fibrinojen değerleri, MACE'nin olduğu grupta diğer gruba oranla istatistiksel olarak anlamlı derecede yüksek bulundu (p=0,001). Fibrinojen yüksekliği ve hipertansiyonun bağımsız olarak MACE oluşumuna neden olduğu saptandı (sırasıyla p=0,001 CI: 1,880-6,142; p=0,005 CI: 0,076-0,632). Fibrinojen değerinin 2,75 gr/L’nin olması, %76,2 sensitivite ve %62,7 spesifite ile bağımsız olarak MACE oranlarının öngördürücüsü olarak bulundu (AUC 0,793 CI:0,710-0,875). Sonuçlar: Serum fibrinojen düzeyinin, safen ven greft darlıklarına yapılacak girişimsel tedavi öncesi değerlendirildiğinde, ölüm ve istenmeyen kardiyak klinik son noktaları öngörmede faydalı olabileceği sonucuna varıldı.

Anahtar Kelimeler:

Fibrinojen, Safen ven hastalığı, Ateroskleroz

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Referans1 Goldman S, Zadina K, Moritz T ve ark. VA Cooperative Study Group #207/297/364. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol. 2004 Dec 7;44(11):2149-56.
Referans2 Ohno T. [Redo Coronary Artery Bypass Grafting]. Kyobu Geka. 2021 Sep;74(10):729-733. Japanese.
Referans3 Dianati Maleki N, Ehteshami Afshar A, Parikh PB. Management of Saphenous Vein Graft Disease in Patients with Prior Coronary Artery Bypass Surgery. Curr Treat Options Cardiovasc Med. 2019 Feb 28;21(2):12.
Referans4 Xenogiannis I, Zenati M, Bhatt DL et al. Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation. 2021 Aug 31;144(9):728-745.
Referans5 Hong YJ, Jeong MH, Ahn Y et al. Intravascular ultrasound findings that are predictive of no reflow after percutaneous coronary intervention for saphenous vein graft disease.Am J Cardiol. 2012; 109:1576–1581.
Referans6 Neumann FJ, Sousa-Uva M, Ahlsson A et al. ESC Scientific Document Group. 2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J. 2019; 40:87–165.
Referans7 Montalescot G, Collet JP, Choussat R, Thomas D. Fibrinogen as a risk factor for coronary heart disease. Eur Heart J 1998; 19 (Suppl H): H11-7
Referans8 Lovely RS, Kazmierczak SC, Massaro JM, D'Agostino RB, Sr, O'Donnell CJ, Farrell DH. γ′ Fibrinogen: evaluation of a new assay for study of associations with cardiovascular disease. Clin Chem 2010;56:781-788.
Referans9 Del Turco S, Basta G, De Caterina AR et al. Different inflammatory profile in young and elderly STEMI patients undergoing primary percutaneous coronary intervention (PPCI): Its influence on no-reflow and mortality. Int J Cardiol. 2019 Sep 1;290:34-39.
Referans10 Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997 Jan;96(1):168-73.
Referans11 Vischer UM. von Willebrand factor, endothelial dysfunction, and cardiovascular disease. J Thromb Haemost. 2006 Jun;4(6):1186-93.
Referans12 Wiman B, Andersson T, Hallqvist J, Reuterwall C, Ahlbom A, deFaire U. Plasma levels of tissue plasminogen activator/plasminogen activator inhibitor-1 complex and von Willebrand factor are significant risk markers for recurrent myocardial infarction in the Stockholm Heart Epidemiology Program (SHEEP) study. Arterioscler Thromb Vasc Biol. 2000 Aug;20(8):2019-23.
Referans13 Kleinegris MC, ten Cate H, ten Cate-Hoek AJ. D-dimer as a marker for cardiovascular and arterial thrombotic events in patients with peripheral arterial disease. A systematic review. Thromb Haemost. 2013 Aug;110(2):233-43.
Referans14 Delanghe JR, Langlois MR, De Bacquer D et al. Discriminative value of serum amyloid A and other acute-phase proteins for coronary heart disease. Atherosclerosis 2002; 160: 471-6.
Referans15 Yusuf s, Hawken S, Ounpuu S et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937-952.
Referans16 Morrow DA, Gersh BJ, Braunwald E. Chronic coronary artery disease. In: Zipes DP, Libby P, Bonow RO, Braunwald E, editors. Braunwald‘s heart disease: a textbook of cardiovascular medicine. 7th ed. Philadelphia: Elsevier Saunders; 2005. p. 1281-1354.
Referans17 Knatterud GL, White C, Geller NL et al. Angiographic changes in saphenous vein grafts are predictors of clinical outcomes. Am Heart J 2003;145 (2):262–9.
Referans18 Sabik JF III, Blackstone EH, Houghtaling PL, Walts PA, Lytle BW. Is reoperation still a risk factor in coronary artery bypass surgery? Ann Thorac Surg 2005;80:1719–1727.
Referans19 Yau TM, Borger MA, Weisel RD, Ivanov J. The changing pat-tern of reoperative coronary surgery: trends in 1230 consecu-tive reoperations. J Thorac Cardiovasc Surg 2000;120:156–163.
Referans20 Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation 2004;109:2290–2295.
Referans21 Alexander JH, Hafley G, Harrington RA et al. PREVENT IV Investigators. Efficacy and safety of edifoligide, an E2F transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial. JAMA 2005;294:2446 –54.
Referans22 Okabe T, Lindsay J, Buch AN et al. Drug-eluting stents versus bare metal stents for narrowing in saphenous vein grafts. Am J Cardiol 2008;102:530–534.
Referans23 Patel NJ, Bavishi C, Atti V et al. Drug-eluting stents versus bare-metal stents in saphenous vein graft intervention.Circ Cardiovasc Interv. 2018; 11:e007045.
Referans24 Peters SA, Woodward M, Rumley A et al. Direct comparisons of three alternative plasma fibrinogen assays with the von Clauss assay in prediction of cardiovascular disease and all-causes mortality: the Scottish Heart Health Extended Cohot. Br J Haematol 2013; 162: 392-9.
Referans25 Ganda OP, Arkin CH. Hyperfibrinogenemia. An important risk factor for vascular compliations in diabetes. Diabetes Care. 1992; 15: 1245-1250.
Referans26 Vanninen E, Laitinen J, Vusstupa M. Physical Activity any Fibrinogen Concentration in Newly Diagnosed NIDDM. Diabetes Care. 1994; 17: 1031-1038.
Referans27 Akinyelure OP, Colantonio LD, Chaudhary NS et al. Inflammation biomarkers and incident coronary heart disease: the Reasons for Geographic And Racial Differences in Stroke Study. Am Heart J. 2022 Jul 8;253:39-47.
Referans28 Swirski FK, Nahrendorf M. Leukocyte behavior in atherosclerosis, myocardial infarction, and heart failure. Science. 2013 Jan 11;339(6116):161-6.
Referans29 Kannel WB. Influence of fibrinogen on cardiovascular disease. Drugs. 1997;54 Suppl 3:32-40.
Referans30 Jun Wang, Lu Jia, Xing Li et al."New Insights into the Association between Fibrinogen and Coronary Atherosclerotic Plaque Vulnerability: An Intravascular Optical Coherence Tomography Study", Cardiovascular Therapeutics, vol. 2019, Article ID 8563717, 12 pages, 2019.