Stent Restenozunu Tahmin Etmede Sistemik İmmün İnflamasyon İndeksinin Rolü

Amaç: Koroner arter hastalığı için implante edilen stentlerin restenozu önemli bir sorun olarak karşımıza çıkmaktadır ve hangi hastalarda gelişebileceği net değildir. Aterosklerotik süreçte ve stent içi restenozda inflamasyon önemli bir rol oynamaktadır. Çalışmamızda stent içi restenozu tahmin etmede Sistemik immün inflamasyon indeksinin (SII) kullanılabilirliğinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmada Haziran 2019 ile Haziran 2022 yılları arasında akut koroner sendrom veya stabil anjina pektoris ile hastaneye başvurup başarılı stent implantasyonu uygulanmış ve sonrasında 1 yıl içinde stabil anjina pektoris nedeniyle tekrar koroner anjiografi yapılmış hastalar retrospektif olarak incelenmiştir. Hastaların ikinci yapılan koroner anjiografileri öncesinde alınan rutin hemogram testinden SII değeri (Platelet x Nötrofil) / (Lenfosit) formülü ile hesaplanmıştır. Toplam 213 hasta çalışmaya dahil edilmiştir ve hastalar stent içi restenoz olan (n:58) ve restenoz olmayan (n:155) olarak iki gruba ayrılmıştır. Bulgular: SII ortanca değeri restenoz (+) olan grupta daha yüksek saptandı (920 vs 582, p=0,001). SII değeri ile restenoz arasındaki ilişki ROC eğrisi ile değerlendirildi ve 809 optimal kesme değerinin %60,3 sensitivite ve %64,5 spesifisite ile restenozu tahmin ettiği belirlendi (Eğri altındaki alan: 0,642; %95 GA: 0,559-0,725, p=0,001). Çok değişkenli lojistik regresyon analizinde Diabetes mellitus (OR:2,409, CI %95: 1,228-4,727, p=0,011), hiperlipidemi (OR:2,703, CI %95: 1,335-5,472, p=0,006) ve Log10 SII’nin (OR:3,659, CI %95: 1,360-9,848, p=0,010) stent içi restenozun bağımsız öngördürücüsü olduğu saptandı. Sonuç: Stent içi restenozda diabet, hiperlipidemi ve inflamasyon önemli rol oynamaktadır. Bir inflamasyon belirteci olan ve kolay hesaplanabilen SII’nin stent içi restenozunun bağımsız öngördürücüsü olduğu görülmüştür. Stent içi restenozu tahmin etmede inflamasyon belirteçlerinin katkısı olabileceği düşünülmelidir.

Anahtar Kelimeler:

Sistemik immün inflamasyon indeks, Stent içi restenoz, İnflamasyon, Ateroskleroz

Role of Systemic Immune Inflammation Index in Predicting In-stent Restenosis

Aim: Restenosis of implanted stents for coronary artery disease is an important problem and it is not clear in which patients it may develop. Inflammation plays an important role in the atherosclerotic process and in-stent restenosis. In our study, we aimed to investigate the usability of the Systemic immune inflammation index (SII) in predicting in-stent restenosis. Material and Methods: In the study, patients who were admitted to the hospital with acute coronary syndrome or stable angina pectoris and underwent successful stent implantation between June 2019 and June 2022 and then underwent coronary angiography again within 1 year due to stable angina pectoris were retrospectively analyzed. The SII value was calculated by the formula (Platelet x Neutrophil) / (Lymphocyte) from the routine hemogram test taken before the second coronary angiography of the patients. A total of 213 patients were included in the study, and the patients were divided into two groups as those with in-stent restenosis (n:58) and those without restenosis (n:155). Results: The median level of SII was found to be higher in the group with restenosis (+) (920 vs 582, p=0.001). The relationship between the SII value and restenosis was evaluated with the ROC curve, and the optimal cut-off value of 809 was determined to predict restenosis with 60.3% sensitivity and 64.5% specificity (Area under the curve: 0.642; 95% CI: 0.559-0.725, p=0.001). In multivariate logistic regression analysis, Diabetes mellitus (OR:2.409, CI 95%: 1.228-4.727, p=0.011), hyperlipidemia (OR:2.703, CI 95%: 1.335-5.472, p=0.006) and Log10 SII (OR:3,659, CI 95%: 1.360-9.848, p=0.010) was found to be an independent predictor of in-stent restenosis. Conclusion: Diabetes, hyperlipidemia and inflammation play an important role in in-stent restenosis. SII, which is an inflammation marker and can be calculated easily, was found to be an independent predictor of in-stent restenosis. It should be considered that inflammation markers may contribute to the prediction of in-stent restenosis.

Keywords:

Systemic immune inflammation index, In-Stent restenosis, Inflammation, Atherosclerosis,

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