Primer perkütan koroner girişim uygulanan ST-segment yükseklikli miyokard infarktüslü hastalarda platelet/lenfosit oranı ile no-reflow oluşumu arasındaki ilişki

Year 2021, , 1441 - 1448, 30.12.2021

Çağlar Özmen , Anıl Akray , Abdulkadir İltaş Pınar Özmen Yıldız , İbrahim Yıldız , Halil Aktaş

https://doi.org/10.17826/cumj.977656

Abstract

Amaç: Bu çalışmanın amacı, primer perkütan koroner girişim (PKG) ile tedavi edilen akut ST-segment yükselmeli miyokard infarktüsü (STYMİ) hastalarında başvuru sırasında ölçülen platelet/lenfosit oranının (PLO) ile no-reflow fenomeni oluşumu arasındaki ilişkiyi değerlendirmektir.
Gereç ve Yöntem: Bu çalışmada, primer PKG ile tedavi edilen akut STYMİ'li 126 hasta kapsanmıştırr. Hastaların hastaneye başvuru anındaki hemoglobin, trombosit ve lenfosit düzeyleri dosya verilerinden elde edildi. Hastaların işlem sonrasındaki miyokard infarktüsünde tromboliz (TIMI) akım derecesi, miyokardın boyanma derecesi (MBG) ve TIMI trombüs ölçeği koroner anjiyografi kayıtlarından değerlendirildi.
Bulgular: Hastalar PKG sonrası TIMI akım derecesine göre normal koroner akım (s=66) grubu ve azalmış koroner akım (no-reflow) grubu (s=60) olmak üzere iki gruba ayrıldı. No-reflow grupta normal koroner akım grubu ile kıyaslandığında daha düşük SVEF ve daha yüksek PLO vardı. TIMI akım derecesi ve MBG' si daha düşük olan hastalarda, PLO anlamlı olarak daha yüksekti.
Sonuç: Primer PKG sonrasında no-reflow gelişen STYMİ hastalarında başvuru sırasında ölçülen PLO daha yüksek saptanmıştır. PLO, bu tür hastalarda no-reflow için bir öngörürücü olarak kullanılabilir.

Keywords

lenfosit, miyokard infarktüsü, no-reflow, perkutan koroner girişim

Relationship between platelet/lymphocyte ratio and no-reflow formation in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention

Abstract

Purpose: This study aims to evaluate the relationship between the platelet/lymphocyte ratio (PLR) measured at admission and the occurrence of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
Materials and Methods: This study included 126 patients with acute STEMI treated with primary PCI. Hemoglobin, thrombocyte, and lymphocyte levels of the patients were retrieved from the files at the time of admission. Postprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural myocardial blush grade (MBG), and TIMI thrombus scale were evaluated from the coronary angiography records.
Results: Patients were divided into two groups according to TIMI flow grade after PCI as normal coronary flow (n = 66) and no-reflow groups (n = 60). The no-reflow group had lower LVEF and higher PLR compared to the normal coronary flow group PLR was significantly higher in patients with lower TIMI flow grade and MBG.
Conclusion: PLR measured at admission was found to be higher in STEMI patients who developed no-reflow after primary PCI compared to the normal coronary flow group. PLR can be used as a predictor for no-reflow in such patients.

References

• Referans 1. Ibanez B, James S, Agewall S, Antune s MJ, Bucciar elli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST- segment elevation. European heart journal. 2018;39(2):119- 77.
• Referans 2. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation. 2016;133(11):1135-47.
• Referans 3. 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. J Am Coll Cardiol. 2013;61(4):e78-e140.
• Referans 4. Morishima I, Sone T, Mokuno S, Taga S, Shimauchi A, Oki Y, et al. Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty. Am Heart J. 1995;130(2):239-43.
• Referans 5. Cenko E, Ricci B, Kedev S, Kalpak O, Câlmâc L, Vasiljevic Z, et al. The no-reflow phenomenon in the young and in the elderly. Int J Cardiol. 2016;222:1122-1128.
• Referans 6. Somuncu MU, Akgun T, Cakır MO, Akgul F, Serbest NG, Karakurt H, et al. The Elevated Soluble ST2 Predicts No-Reflow Phenomenon in ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Atheroscler Thromb. 2019;26(11):970-978.
• Referans 7. Niccoli G, D'amario D, Spaziani C, Cosentino N, Marino M, Rigattieri S, et al. Randomized evaluation of intracoronary nitroprusside vs. adenosine after thrombus aspiration during primary percutaneous coronary intervention for the prevention of no-reflow in acute myocardial infarction: the REOPEN-AMI study protocol. J Cardiovasc Med (Hagerstown). 2009;10(7):585-92.
• Referans 8. Davies MJ, Thomas AC. Plaque fissuring–the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J. 1985;53(4):363-373.
• Referans 9. Falk E. Pathogenesis of atherosclerosis. J Am Coll Cardiol. 2006; 47(8 suppl):C7-C12.
• Referans 10. Davı` G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482-2494.
• Referans 11. Nikolsky E, Grines CL, Cox DA, Garcia E, Tcheng JE, Sadeghi M, et al. Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction (from the CADILLAC trial). Am J Cardiol. 2007;99(8):1055-1061.
• Referans 12. Fan Z, Ji H, Li Y, Jian X, Li L, Liu T. Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with stable angina. Biomark Med. 2017;11(11):979-990.
• Referans 13. Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol. 2000;86(4):449-451.
• Referans 14. Cetin MS, Ozcan Cetin EH, Kalender E, Aydin S, Topaloglu S, Kisacik HL, et al. Monocyte to HDL Cholesterol Ratio Predicts Coronary Artery Disease Severity and Future Major Cardiovascular Adverse Events in Acute Coronary Syndrome. Heart Lung Circ. 2016;25(11):1077-1086.
• Referans 15. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1.
• Referans 16. Oylumlu M, Yıldız A, Oylumlu M, Yüksel M, Polat N, Bilik MZ, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anatol J Cardiol. 2015;15(4):277-83.
• Referans 17. Bressi E, Mangiacapra F, Ricottini E, Cavallari I, Colaiori I, Di Gioia G, et al. Impact of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio on 5-Year Clinical Outcomes of Patients with Stable Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention. J Cardiovasc Transl Res. 2018;11(6):517-523.
• Referans 18. Li H, Zhou Y, Ma Y, Han S, Zhou L. The prognostic value of the platelet- to-lymphocyte ratio in acute coronary syndrome: a systematic review and metaanalysis. Kardiologia polska. 2017;75(7):666- 73.
• Referans 19. Thygesen K, Alper t JS, Jaffe AS, Chaitman BR, Bax JJ, Mor row DA, et al. Fourth Universal Definition of Myocardial Infarction. Journal of the American College of Cardiology. 2018;72(18):2231- 64.
• Referans 20. Group TS. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. The New England journal of medicine. 1985;312(14):932-6.
• Referans 21. van't Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation. 1998;97(23):2302-6.
• Referans 22. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001;103(21):2550- 4.
• Referans 23. Caiazzo G, Musci RL, Frediani L, Umińska J, Wanha W, Filipiak KJ, et al. State of the Art: No-Reflow Phenomenon. Cardiol Clin. 2020;38(4):563-573.
• Referans 24. Allencherril J, Jneid H, Atar D, Alam M, Levine G, Kloner RA, et al. Pathophysiology, Diagnosis, and Management of the No-Reflow Phenomenon. Cardiovasc Drugs Ther. 2019;33(5):589-597.
• Referans 25. Durante A. Role of no reflow and microvascular obstruction in the prognostic stratification of STEMI patients. Anatol J Cardiol. 2018;19(5):346-349.
• Referans 26. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.
• Referans 27. Zhou L, Xiao DM, Qin W, Xie BH, Wang TH, Huang H, et al. The clinical value of hematological markers in rheumatoid arthritis patients treated with tocilizumab. J Clin Lab Anal. 2019;33(5):e22862.
• Referans 28. Sun X, Liu X, Liu J, Chen S, Xu D, Li W, et al. Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I-II gastric cancer. Chin J Cancer. 2016;35(1):57.
• Referans 29. Özyurt G, Binici NC. Increased neutrophil-lymphocyte ratios in depressive adolescents is correlated with the severity of depression. Psychiatry Res. 2018;268:426-431.
• Referans 30. Kundi H, Balun A, Cicekcioglu H, Cetin M, Kiziltunc E, Cetin ZG, et al. The relation between platelet-to-lymphocyte ratio and Pulmonary Embolism Severity Index in acute pulmonary embolism. Heart Lung. 2015;44(4):340-3.
• Referans 31. Seaoud E, Mohamed AAHA, Elkot MA. The Role of the Platelet/Lymphocyte Ratio and Neutrophil/Lymphocyte Ratio in Predicting High-Risk Heart Score in Patients Admitted with Non-ST Elevation Acute Coronary Syndrome. Pulse (Basel). 2020;8(1-2):66-74.
• Referans 32. Ndrepepa G, Mehilli J, Tiroch K, Fusaro M, Kufner S, Ellert J, et al. Myocardial perfusion grade, myocardial salvage indices and long-term mortality in patients with acute myocardial infarction and full restoration of epicardial blood flow after primary percutaneous coronary intervention. Rev Esp Cardiol. 2010;63(7):770-8.
• Referans 33. Kurtul A, Yarlioglues M, Murat SN, Ergun G, Duran M, Kasapkara HA, 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. Am J Cardiol. 2014;114(3):342-7.
• Referans 34. Cetin M, Kiziltunc E, Elalmis OU, Cetin ZG, Demircelik MB, Cicekcioglu H, et al. Predictive Value of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Patients with Coronary Slow Flow. Acta Cardiologica Sinica. 2016;32(3):307- 12.
• Referans 35. Akboga MK, Canpolat U, Balci KG, Akyel A, Sen F, Yayla C, et al. Increased Platelet to Lymphocyte Ratio is Related to Slow Coronary Flow. Angiology. 2016;67(1):21- 6.
• Referans 36. Ayca B, Akin F, Okuyan E. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention. Platelets. 2015;26(8):816.
• Referans 37. Maimaiti A, Li Y, Wang YT, Yang X, Li XM, Yang YN, et al. Association of platelet- to- lymphocyte count ratio with myocardial reperfusion and major adverse events in patients with acute myocardial infarction: a two-centre retrospective cohort study. BMJ open. 2019;9(9):e025628.