Non-ST eleve akut koroner sendromda platelet/lenfosit oranının akut stent trombozunu öngörmedeki rolü

Amaç: Kardiyovaskuler hastalıklar dünyada önde gelen mortalite nedenidir. Akut stent trombozu (ST) stent implantasyonunun çok ciddi ve mortal bir komplikasyonudur. Yeni bir enflamatuar belirteç olan platelet/lenfosit oranının (PLR) daha önce kalp problemleriyle ilişkili olduğu gösterilmiştir. Bu çalışmada, ST- segment yükselmesiz akut koroner sendromlarda (ST- segment yükselmesiz myokard enfarktüsü ve kararsız angina) PLR ile akut stent trombozunun (ST) ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmamıza Ocak 2013- Aralık 2013 tarihleri arasında stent implantasyonu yapılan, ST- segment yükselmesiz akut koroner sendrom hastası 1300 hasta dahil edildi. Tüm hastaların demografik, klinik, anjiyografik ve laboratuvar parametreleri kaydedildi. Bulgular: ST (+) grupta hipertansiyon, diabetes mellitus oranları daha yüksekti, klopidogrel yükleme süresi daha kısaydı. Ortalama PLR değeri ST (+) grupta ST (-) gruba göre anlamlı olarak daha yüksekti (133.3 ± 75.0'a karşı 110.1 ± 47.0, p = 0.005). Çok değişkenli analizlerde hipertansiyon, diabetes mellitus, kısa klopidogrel yükleme süresi ve PLR'nin akut stent trombozunun bağımsız öngördürücüleri olduğu bulundu.Sonuç: Bulgularımız PLR' nin, ST- segment yükselmesiz akut koroner sendrom hastalarında akut stent trombozunun bağımsız bir öngördürücüsü olduğunu göstermiştir.

Anahtar Kelimeler:

akut stent trombozu, platelet/lenfosit oranı, koroner arter hastalığı, inflamasyon

The association of platelet-to-lymphocyte ratio with in-hospital acute stent thrombosis in non-st elevated acute coronary syndromes

Aim:Cardiovascular diseases are the leading causes of mortality in the world. Interventional methods used in the treatment of coronary artery disease have revolutionized the treatment of the disease. Balloon angioplasty and coronary stenting are two miraculous treatment methods of the disease. Acute stent thrombosis(ST) is a serious and mortal complication of stent thrombosis. Platelet-to-lymphocyte ratio (PLR), a novel inflammatory marker, has previously been shown to be associated with cardiac problems. In this study, we aimed to investigate the association of PLR with in hospital acute stent thrombosis.Material and Methods: 1300 patients without ST elevated myocardial infarction (NSTEMI )who underwent stent implantation between January 2013 and December 2013 in our hospital were included in the study. Demographic, clinical, angiographic and laboratory parameters of all participants were recorded. Results:In the ST+ group hypertension, diabetes mellitus rates were higher, clopidogrel loading time was shorter. The mean PLR value was significantly higher in the ST+ group as compared to ST- group (133.3 ± 75.0 vs 110.1 ± 47.0, p= 0.005). In the multivariate analyses hypertension, diabetes mellitus, shorter clopidogrel loading time and PLR was found to be independent predictors of acute stent thrombosis.Conclusion:Our results demonstrated that PLR is an independent predictor of acute stent thrombosis in Non-ST elevated acute coronary syndrome patients.

Keywords:

acute stent thrombosis, platelet-to-lymphocyte ratio, coronary artery disease, inflammation,

PDF

___

1. Onat A, Şurdumavci G, Şenocak M et al. Survey on Prevalence of Cardiac Disease and its Risk Factors in Adults in Turkey: 3. Prevalence of Heart Diseases. Turk Kardiyol Dern Ars 1991; 19: 26-33.
2. Hurst JW. The first coronary angioplasty as described by Andreas Gruentzig. The American journal of cardiology 1986; 57: 185-6.
3. Puel J, Joffre F, Rousseau H. Endo-prostheses coronariennes auto-expansives dans la prevention des restenoses apres angioplastie transluminale. Arch Mal Coeur 1987; 8: 1311-2.
4. Flores-Ríos X, Abugattás-de Torres JP, Campo-Pérez R et al. Effect of stent thrombosis on the risk-benefit balance of drug-eluting stents and bare metal stents. Revista espanola de cardiologia 2010; 63: 528-35.
5. Grouve E, Kristensen S. Stent thrombosis: definitions, mechanisms and prevention. E-journal of Cardiology Practice 2007; 32.
6. Ly HQ, Kirtane AJ, Murphy SA et al. Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials). The American journal of cardiology 2006; 98: 1-5.
7. Nikolsky E, Grines CL, Cox DA et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). The American journal of cardiology 2007; 99: 1055-61.
8. Horne BD, Anderson JL, John JM et al. Which white blood cell subtypes predict increased cardiovascular risk? Journal of the American College of Cardiology 2005; 45: 1638-43.
9. Nunez J, Minana G, Bodi V et al. Low lymphocyte count and cardiovascular diseases. Current medicinal chemistry 2011; 18: 3226-33.
10. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002; 105: 1135-43.
11. Wang X, Xie Z, Liu X, Huang X et al. Association of Platelet to lymphocyte ratio with non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome: an optical coherence tomography study. BMC cardiovascular disorders 2017; 17: 175.
12. Kurtul A, Yarlioglues M, Murat SN et al. Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. The American journal of cardiology 2014; 114: 342-47.
13. Yayla Ç, Akboga MK, Canpolat U et al. The association of the platelet-to-lymphocyte ratio with mitral annular calcification. Scandinavian Cardiovascular Journal 2015; 49: 351-6.
14. Açar G, Kalkan ME, Avci A et al. The relation of platelet–lymphocyte ratio and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion. Clinical and Applied Thrombosis/Hemostasis 2015; 21: 462-8.
15. Azab B, Shah N, Akerman M, McGinn JT. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. Journal of thrombosis and thrombolysis 2012; 34: 326-34.
16. Del Pace S, Boddi M, Rasoini R et al. Acute infection–inflammation and coronary stent thrombosis: an observational study. Internal and emergency medicine 2010; 5: 121-6.
17. Fuentes Q E, Fuentes Q F, Andrés V, Pello OM, de Mora JF, Palomo G I. Role of platelets as mediators that link inflammation and thrombosis in atherosclerosis. Platelets. 2013; 24: 255-62.
18. Falk E. Pathogenesis of atherosclerosis. Journal of the American College of Cardiology 2006; 47: 7-12.
19. Lindemann S, Krämer B, Seizer P, Gawaz M. Platelets, inflammation and atherosclerosis. Journal of Thrombosis and Haemostasis 2007; 5: 203-11.
20. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. The Journal of clinical investigation 2005; 115: 3378-84.
21. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. American Journal of Cardiology 1997; 79: 812-4.
22. Ommen SR, Hodge DO, Rodeheffer RJ, McGregor CG, Thomson SP, Gibbons RJ. Predictive power of the relative lymphocyte concentration in patients with advanced heart failure. Circulation 1998; 97: 19-22.
23. Thomson SP, McMahon LJ, Nugent CA. Endogenous cortisol: a regulator of the number of lymphocytes in peripheral blood. Clinical immunology and immunopathology 1980; 17: 506-14.
24. Akkaya E, Gul M, Ugur M. Platelet to lymphocyte ratio: a simple and valuable prognostic marker for acute coronary syndrome. International journal of cardiology 2014; 177: 597-8.
25. Yılmaz S, Sen F, Ünal S et al. Usefulness of the platelet-to-lymphocyte ratio in predicting bare-metal stent restenosis. Scandinavian Cardiovascular Journal 2015; 49: 39-44.