Akut ST elevasyonlu miyokard enfarktüslü hastalarda aritmiler

Yıl 2019, Cilt: 44 Sayı: 2, 416 - 424, 30.06.2019

İhsan Dursun Mustafa Beğenç Taşcanov

https://doi.org/10.17826/cumj.444433

Cited By: 2

Öz

Amaç: Aritmiler ve iletim bozuklukları akut miyokard enfarktüsünde (AMİ) yaygındır ve hastane öncesi dönemde önemli bir ölüm nedenidirler. Bu çalışmanın amacı, hastane içi dönemde ST yükselmeli AMI (STEMI) hastalarında tüm aritmiler için ortak öngördürücüleri araştırmaktı.

Gereç ve Yöntem: Akut STEMI olan 90 hasta (74 erkek, 55±11 yıl) çalışmaya dahil edildi. Hastaların klinik özellikler kaydedildi ve serum C-reaktif protein (CRP), kreatinin kinaz MB (CKMB) ve potasyum düzeyleri gibi laboratuvar parametreleri ölçüldü. Hastalar aritmilerin gelişip gelişmemesine göre hastalar iki gruba ayrıldı.

Bulgular: Grup 1 (n = 42) hastalar  yeni başlangıçlı aritmi  ve Grup 2 (n = 48) olan hastalar aritmisi olmayan hastalardı. Medyan bazal CRP düzeyleri, özellikle atriyal fibrilasyon ve ventriküler aritmiler olan hastalarda grup 1'de (36.6 (21.8-77) mg/dl'ye karşı 21.8 (24.2-30.7) mg/dl, P = 0.002) anlamlı olarak yüksek bulundu. Lojistik regresyon analizi, başlangıç yüksek CRP düzey (P = 0.018), tepe CKMB düzeyi ve inferior lokalizasyonlu AMI'nin  AMI sonrası aritmi gelişimi ile anlamlı olarak ilişkili olduğunu gösterdi.

Sonuç: CRP ve CKMB düzeyleri ile inferior  lokalizasyonlu infarktüsün, AMI sırasında tüm aritmik olaylar için öngördürücü değere sahip olduğunu bulduk. CRP düzeylerinin hem atriyal hem de ventriküler aritmiler ile ilişkili olduğu bulunmuştur. CRP düzeylerinin değerlendirilmesi, STEMI'den sonra aritmik olaylar için yüksek risk taşıyan hastaları tespit etmek için kullanılabilir.

Anahtar Kelimeler

Miyokard infarktüsü, kardiyak aritmiler

Arrhythmias in patients with acute ST elevation myocardial infarction

Öz

Purpose: Arrhythmias and conduction disturbances are common during acute myocardial infarction (AMI) and a major cause of death in the pre-hospital phase. The aim of this study was to investigate common predictors for all arrhythmias in patients with ST elevation AMI (STEMI) during in-hospital phase. 

Materials and Methods: Ninety patients (74 male, 55 ±11 years) with acute STEMI were included. Clinical charesteristics were recorded and laboratory parameters including serum C- reactive protein (CRP), creatinine kinase MB (CKMB) and potassium levels were measured. The patients were divided into two groups according to development of arrhythmias.

Results: Group 1 (n=42) patients had new onset arrhythmias and Group 2 (n=48) patients had without arrhythmias. Median baseline CRP levels were significantly higher in group 1 (36.6 (21.8-77) mg/dl vs. 21.8 (24.2-30.7) mg/dl), especially in patients with atrial fibrillation and ventricular arrhythmias. Logistic regression analysis showed that baseline higher CRP level, peak CKMB level and inferior localization of AMI were significantly associated with the development of arrhythmia following AMI. 

Conclusion: Levels of CRP and CKMB and inferior infarct localization have predictive values for all the arrhythmic events during AMI. CRP levels were found to be associated with both atrial and ventricular arrhythmias. The assessment of CRP levels can be used to detect patients at high risk for arrhythmic events after STEMI.

Anahtar Kelimeler

Myocardial infarction, cardiac arrhythmias, , inflammation

Kaynakça

• 1 Pedersen OD, Bagger H, Kober L, Torp – Pedersen C. The occurrence and prognostic significance of atrial fibrillation / - flutter following acute myocardial infarction. TRACE study group. TRAndolapril Cardiac Evalution. Eur Heart J 1999;20:748 –754.
• 2 Boateng S, Sanborn T. Acute myocardial infarction. Dis Mon. 2013 Mar;59(3):83-96.
• 3 Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Staszewsky L, Tavazzi L, Tognoni G. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results. Circulation 1993;87:312–322.
• 4 Escosteguy CC, Carvalho Mde A, Medronho Rde A, Abreu LM, Monteiro Filho MY. Bundle branch and atrioventricular block as complications of acute myocardial infarction in the thrombolytic era. Arq Bras Cardiol 2001;76:291 - 296.
• 5 Antman EM, Anbe DT, Armstrong PW,Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr. American College of Cardiology; American Heart Association; Canadian Cardiovascular Society. ACC/AHA guidelines for the management of patients with STelevation myocardial infarction executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Am Coll Cardiol 2004;44:671- 719.
• 6 Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm AJ, Hindricks G, Huber K, Kirchhof P, Kuck KH, Kudaiberdieva G, Lin T, Raviele A, Santini M, Tilz RR, Valgimigli M, Vos MA, Vrints C, Zeymer U, Lip GY, Potpara T, Fauchier L, Sticherling C, Roffi M, Widimsky P, Mehilli J, Lettino M, Schiele F, Sinnaeve P, Boriani G, Lane D, Savelieva I.Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA,ACCA,and EAPCI task force. Europace. 2014 Nov;16(11):1655-73
• 7 Pietilä KO, Harmoinen AP, Jokiniitty J, Pasternack AI. Serum C-reactive protein concentration in acute myocardial infarction and its relation to mortality during 4 months of follow-up in patients under thrombolytic treatment. Eur Heart J 1996;17:1345–1349.
• 8 Anzai T, Yoshikawa T, Shiraki H, Asakura Y, Akaishi M, Mitamura H, Ogawa S. C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation 1997;96:778–784.
• 9 Anzai T, Yoshikawa T, Kaneko H, Maekawa Y, Iwanaga S, Asakura Y, Ogawa S. Association Between Serum C-Reactive Protein Elevation and Left Ventricular Thrombus Formation After First Anterior Myocardial Infarction. Chest 2004;125;384- 389.
• 10 Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006– 3010.
• 11 Boss CJ, Lip GYH. The role of inflammation in atrial fibrillation. Int J Clin Pract 2005;59: 870 - 872.
• 12 Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR. C-Reactive protein elevation in patients with atrial arrhythmias. Inflammatory mechanisms and persistence of atrial fibrillation. Circulation 2001;104:2886- 2891.
• 13 Watanabe T, Takeishi Y, Hirono O, Itoh M, Matsui M, Nakamura K, Tamada Y, Kubota I. C-Reactive protein elevation predicts the occurrence of atrial structural remodeling in patients with paroxysmal atrial fibrillation. Heart Vessels 2005; 20:45–49.
• 14 Gedikli O, Orem C, Baykan M, Karahan C, Kucukosmanoglu M, Sahin S, Korkmaz L, Yilmaz H, Celik S. Association between serum C-reactive protein elevation and atrial fibrillation after first anterior myocardial infarction.Clin Cardiol. 2008 Oct;31(10):482-7.
• 15 Aronson D, Boulos M, Suleiman A, Bidoosi S, Agmon Y, Kapeliovich M, Beyar R, Markiewicz W, Hammerman H, Suleiman M.Relation of C-reactive protein and new-onset atrial fibrillation in patients with acute myocardial infarction. Am J Cardiol. 2007 Sep 1;100(5):753-7.
• 16 Beck OA, Hochrein H: Initial serum potassium level in relation to cardiac arrhythmias in acute myocardial infarction (author’s transl). Z Kardiol 1977;66:187- 190.
• 17 Gettes LS. Electrolyte abnormalities underlying lethal and ventricular arrhythmias. Circulation 1992;85:170- 6
• 18 Gang UJ, Hvelplund A, Pedersen S, Iversen A, Jøns C, Abildstrøm SZ, Haarbo J, Jensen JS, Thomsen PE. High-degree atrioventricular block complicating ST-segment elevation myocardial infarctionin the era of primary percutaneous coronary intervention. Europace. 2012 Nov;14(11):1639-45
• 19 Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I. Recommendations for quantification of the left ventricle by two - dimensional echocardiography. J Am Soc Echo 1989;2:358–367.
• 20 Lehto M, Snapinn S, Dickstein K, Swedberg K, Nieminen MS; OPTIMAAL investigators. Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience. Eur Heart J 2005;26:350–356.
• 21 Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ, Solomon AJ. Acute myocardial infaction complicated by atrial fibrillation in the elderly. Circulation 2000;101:969 - 974.22 Parashar S, Kella D, Reid KJ, Spertus JA, Tang F, Langberg J, Vaccarino V, Kontos MC, Lopes RD, Lloyd MS. New-onset atrial fibrillation after acute myocardial infarction and its relation to admission biomarkers (from the TRIUMPH registry). Am J Cardiol. 2013 Nov 1;112(9):1390-5
• 23 Henkel DM, Witt BJ, Gersh BJ, Jacobsen SJ, Weston SA, Meverden RA, Roger VL. Ventricular arrhythmias after acute myocardial infarction: a 20 - year community study. Am Heart J2006;151:806-812
• 24 Gettes LS. Electrolyte abnormalities underlying lethal and ventricular arrhythmias. Circulation 1992;85:170- 76.
• 25 Juul-Moller S, Lilja B, Johansson BW. Ventricular arrhythmias and left ventricular function: one-year follow-up after myocardial infarction.Eur Heart J 1988;9:1181- 7.
• 26 Heidbuchel H, Tack J, Vanneste L, Ballet A, Ector H, Van de Werf F. Significance of arrhythmias during the first 24 hours of acute myocardial infarction treated with alteplase and effect of early administration of a beta- blocker or a bradycardiac agent on their incidence. Circulation. 1994;89:1051 - 1059.
• 27 Grande P, Pedersen A. Myocardial infarct size: correlation with cardiac arrhythmias and sudden death. Eur Heart J 1984;5:622- 627.
• 28 Khairy P, Thibault B, Talajic M, Dubuc M, Roy D, Guerra PG, Nattel S. Prognostic significance of ventricular arrhythmias post - myocardial infarction. Can J Cardiol 2003;19:1393- 1404.
• 29 Marín F, Pascual DA, Roldán V, Arribas JM, Ahumada M, Tornel PL, Oliver C, Gómez-Plana J, Lip GY, Valdés M. Statins and postoperative risk of atrial fibrillation following coronary artery bypass grafting. Am J Cardiol 2006;97:55- 60.
• 30 Amar D, Zhang H, Heerdt PM, Park B, Fleisher M, Thaler HT. Statin use is associated with a reduction in atrial fibrillation after noncardiac thoracic surgery independent of C-reactive protein. Chest 2005;128:3421 - 3427.
• 31 Vyas AK, Guo H, Moss AJ, Olshansky B, McNitt SA, Hall WJ, Zareba W, Steinberg JS, Fischer A, Ruskin J, Andrews ML; MADIT-II Research Group. Reduction in ventricular tachyarrhythmias with statins in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol 2006 ;47:769 - 773.
• 32 Chiu JH, Abdelhadi RH, Chung MK, Gurm HS, Marrouche NF, Saliba WI, Natale A, Martin DO. Effect of statin therapy on risk of ventricular arrhythmia among patients with coronary artery disease and an implantable cardioverter - defibrillator. Am J Cardiol. 2005;95:490 - 491.
• 33 Nordrehaug JE, Johannessen KA, von der Lippe LG. Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction. Circulation 1985;71:645–649.
• 34 Solomon RJ, Cole AG. Importance of potassium in patients with acute myocardial infarction. Acta Med Scand Suppl 1981;647:87–93.
• 35 Jurkovicova O, Cagan S. Supraventricular arrhythmias and disorders of atrioventricular and intraventricular conduction in patients with acute myocardial infarct. Bratisl Lek Listy 1998;99:172 - 180.
• 36 Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA. 2013; 310:66-74.
• 37 Huelsmann M, Neuhold S, Resl M, et al. PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. J.Am. Coll. Cardiol. 2013; 62:1365-72
• 38 O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2013 Jan 29;61(4):e78-140