AKUT İNFERİOR MİYOKARD ENFARKTÜSLÜ HASTALARDA LEAD III >LEAD II ST-ELEVASYONUNUN SAĞ VENTRİKÜL ENFARKTÜSÜNÜ VE HASTANE İÇİ MORTALİTEYİ ÖNGÖRDÜRÜCÜ DEĞERİ Predictive Value of Lead III >Lead II ST Elevation for Ventricular Infarction and Hospital Mortality Rate in Patients with Acute Inferior Myocardial Infarction

Year 2016, Volume: 6 Issue: 2, 1 - 9, 19.12.2016

Barış Yaylak Erkan Baysal Bernas Altıntaş

Abstract

Amaç: Bu çalışmanın amacı akut inferior miyokard enfarktüsü ile başvuran primer perkütanöz koroner

girişim yapılan hastalarda lead III ‘deki ST- Elevasyonun lead II’deki ST-elevasyonundan fazla

olmasının sağ ventrikül miyokard enfarktüsü ve hastaneiçi mortalite yi öngördürmedeki değerini

araştırdık.

Yöntem: Çalışmaya sağ koroner arterden kaynaklanan ve primer perkütanöz koroner girişime giden

180 akut inferior miyokard enfarktüsü hasta alındı. Sağ ventrikül miyokard enfarktüsü sağ taraflı

çekilen EKG’de V4R’daki ST-elevasyonu olması ile tanımlandı. V4R’daki ST-elevasyonu olmayan

hastalar sağ ventrikül miyokard enfarktüsü olmayan akut inferior miyokard enfarktüsü, V4R’da STelevasyonu

olan hastalar sağ ventrikül miyokard enfarktüsü olan akut inferior miyokard enfarktüsü

hastalar olarak iki gruba ayrıldı. lead III ‘deki ST- elevasyonun lead II’deki ST-elevasyonundan yüksek

olmasının sağ ventrikül enfarktüsü belirlemesi ve hastaneiçi mortaliteyi öngörmesine bakıldı.

Bulgu: Lead III>II ST-elevasyonu sağ ventrikül miyokard enfarktüsü olan hastalarda oranı daha yüksek

izlendi (p<0.001). Yapılan multivariate regresyon analizinde, lead III>II ST-elevasyonunun sağ

ventrikül miyokard enfarktüsü bağımsız öngördürücü olduğu izlendi ( odds ratio :2.8,95% CI 1.55-

5.25; p=0.008). Ancak, hastaneiçi mortalite üzerindeki öngördürücülüğü izlenmedi.

Sonuç: Sağ koroner arterden kaynaklanan akut inferior miyokard enfarktüslü primer perkütanöz

koroner girişime giden hastalarda Lead III>II ST-elevasyonu sağ ventrikül miyokard enfarktüsünün

bağımsız öngördürücüsüdür. Ancak hastaneiçi mortalite üzerine bir öngördücülüğü yoktur.

ABSTRACT

Objectives: The aim of this study was to evaluate ST-elevation in lead III more than II (III>II) findings

in predicting right ventricular infarction (RVI) and in-hospital mortality in patients with acute

inferior myocardial infarction (AIMI) undergoing primary percutaneous coronary intervention

(pPCI).

Methods: A total of 180 AIMI patients undergoing pPCI and right coronary artery (RCA) as infarctrelated

artery were included in the study. The presence of RVI was determined by ST-elevation in

right side lead (V4R). Patients were divided into 2 groups: patients without ST-elevation in lead

V4R (AIMI without RVI), and patients with ST-elevation in lead V4R (AIMI with RVI). We assessed

the diagnostic accuracy of ST-elevation in lead III more than II to identify RVI and predicting inhospital

mortality.

Results: A large proportion of ST-elevation in lead III>II (p=0.001) were observed in patients with

RVI. In a multivariate regression analysis, ST-elevation in lead III>II remained an independent

predictor of RVI (odds ratio :2.8,95% CI 1.55-5.25; p=0.008). However , this predictive effect was

not observed in-hospital mortality.

Conclusion: ST-elevation in lead III>II was an independent predictor of RVI in patients with RCA

related inferior myocardial infarction undergoing pPCI. However, ST-elevation in lead III>II was

not predictor of in-hospital mortality.

Keywords

Sağ ventriküler miyokard enfarktüsü; ST-elevasyon; Perkütanöz koroner girişim

References

• 1. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI). Lancet. 1986;1(8478):397-402.
• 2. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2(8607):349-60.
• 3. Cohn JN, Guiha NH, Broder MI, Limas CJ. Right ventricular infarction. Clinical and hemodynamic features. Am J Cardiol. 1974;33(2):209-14.
• 4. Isner JM, Roberts WC. Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease. Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol. 1978;42(6):885-94.
• 5. Mehta SR, Eikelboom JW, Natarajan MK, Diaz R, Yi C, Gibbons RJ, et al. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol. 2001;37(1):37-43.
• 6. Zehender M, Kasper W, Kauder E, Schonthaler M, Geibel A, Olschewski M, et al. Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993;328(14):981-8.
• 7. Zornoff LA, Skali H, Pfeffer MA, St John Sutton M, Rouleau JL, Lamas GA, et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol. 2002;39(9):1450-5.
• 8. Assali AR, Teplitsky I, Ben-Dor I, Solodky A, Brosh D, Battler A, et al. Prognostic importance of right ventricular infarction in an acute myocardial infarction cohort referred for contemporary percutaneous reperfusion therapy. Am Heart J. 2007;153(2):231-7.
• 9. Menown IB, Allen J, Anderson JM, Adgey AA. Early diagnosis of right ventricular or posterior infarction associated with inferior wall left ventricular acute myocardial infarction. Am J Cardiol. 2000;85(8):934-8.
• 10. Kinch JW, Ryan TJ. Right ventricular infarction. N Engl J Med. 1994;330(17):1211-7.