Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

Year 2010, Volume: 37 Issue: 3, 276 - 281, 01.09.2010

Ayşe Saatçı Yaşar Nurcan Başar Ahmet Kasapkara İsa Öner Yüksel Göktürk İpek Mehmet Bilge

Abstract

Objectives : It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial in­farction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction. Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received throm­bolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Choles­terol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution. Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syn­drome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of pa­tients without metabolic syndrome (32.9% versus 58.6%, p=0.001). On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolu­tion (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179) Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortal­ity of patients with metabolic syndrome.

Keywords

Metabolic syndrome, acute myocardial in­farction, ST segment resolution

Akut miyokard infarktüslü hastalarda trombolitik tedavi sonrası ST segment gerilemesi üzerine metabolik sendromun etkisi

Abstract

Amaç: Akut miyokard infarktüslü hastalarda, metabolik sendromun kısa dönem sonuçları ve uzun dönem sağ­kalım üzerine olumsuz etkileri gösterilmiştir. Çalışmamız­daki amacımız akut miyokard infarktüsü nedeni ile trom­bolitik alan hastalarda metabolik sendromun ST segment gerilemesi üzerine etkisini incelemektir. Gereç ve yöntemler: Akut miyokard infarktüsü ile başvu­ran ve göğüs ağrısının ilk 12 saati içinde trombolitik teda­vi alan 161 hasta retrospektif olarak incelendi. Metabolik sendrom tanısı Ulusal Kolesterol Eğitim Programı Üçüncü Erişkin Tedavi Paneli kılavuzuna göre konuldu. Tromboli­tik tedavi öncesi ve 90. dakikada çekilen elektrokardiyog­rafiler ST segment gerilemesi açısından değerlendirildi. Komplet ST segment gerilemesi ≥%70 olarak belirlendi. Bulgular: Çalışmaya alınan 161 hastanın 91\'inde (%56.5) metabolik sendrom saptandı. Trombolitik tedavi sonrası komplet ST segment gerilemesi oranı metabolik send­romlu hastalarda metabolik sendromu olmayan hastalara göre daha düşük bulundu (%32.9-% 58.6, p=0.001). Çok değişkenli analizde metabolik sendrom ST segment geri­lemesini öngördüren tek bağımsız faktör olarak bulundu (p=0.01, Odds oranı=2.543, %95 CI:1.248-5.179). Sonuç: Çalışmamızda akut miyokard infarktüs ile başvu­ran hastalardan metabolik sendromu olanlarda trombolitik tedavi sonrası komplet ST segment gerilemesi metabolik sendromu olmayanlara göre daha düşük oranda bulundu. Bu durum bu hastalarda akut miyokard infarktüsündeki artmış morbidite ve mortaliteye katkıda bulunuyor olabi­lir.

Keywords

Metabolik sendrom, akut miyokard infarktüsü, ST segment gerilemesi

References

• Grundy SM. Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol 1999;83:25F-29F.
• Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.
• Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbid- ity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24.683–9.
• Girman CJ, Rhodes T, Mercuri M, et al. 4S Group and the AFCAPS/TexCAPS Research Group. The metabolic syn- drome and risk of major coronary events in the Scandina- vian Simvastatin Survival Study (4S) and the Air Force/ Texas Coronary Atherosclerosis Prevention Study (AF- CAPS/TexCAPS). Am J Cardiol 2004;93:136–41.
• Turhan H, Yasar AS, Basar N, Bicer A, Erbay AR, Yetkin E. High prevalence of metabolic syndrome among young women with premature coronary artery disease. Coronary Artery Dis 2005;16.37–40.
• Malik S, Wong ND, Franklin SS, et al. Impact of the meta- bolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004;110:1245–50.
• Zeller M, Steg PG, Ravisy J, et al. Observatiore des Infarctus de Cote-d’Or Survey working Group. Prevalence and im- pact of metabolic syndrome on hospital outcomes in acute myocardial infarction. Arch Intern Med 2005;165:1192–8.
• Takeno M, Yasuda S, Otsuka Y, et al. Impact of metabolic syndrome on the long-term survival of patients with acute myocardial infarction. Circ J 2008;72.415–9.
• Schroder R. Prognostic impact of early ST-segment resolu- tion in acute ST-elevation myocardial infarction. Circula- tion 2004;110:e506–10.
• Krucoff MW, Johanson P, Baeza R, Crater SW, Dellborg M. Clinical utility of serial and continuous ST-segment recov- ery assessment in patients with acute ST- elevation myo- cardial infarction: assessing the dynamics of epicardial and myocardial reperfusion. Circulation 2004;110:e533–9.
• de Lemos JA, Antman EM, Giugliano RP, et al. for the TIMI 14 Investigators. ST segment resolution and infarct-related artery patency and flow after thromblytic therapy. Am J Cardiol 2000;85.299–304.
• Dissmann R, Schroder R, Busse U, et al. Early assess- ment of outcome by ST-segment analysis after throm- bolytic therapy in acute myocardial infarction. Am Heart J 1994;128:851–7.
• Schroder R, Dissmann R, Bruggemann T, et al. Extent of early ST segment elevation resolution, a simple but strong predictor of outcome in patients with acute myocardial in- farction. J Am Coll Cardiol 1994;24.384–91.
• Schroder R, Wegscheider K, Schroder K, Dissmann R, Meye-Sabellek W. For the INJECT Trial Group. Extent of early ST-segment elevation resolution: A strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens: a substudy of the International Joint Efficacy Compari- son of Thrombolytics (INJECT) Trial. J Am Coll Cardiol 1995;26,1657–64.
• Ito H, Tomooka T, Sakai N, et al. Lack of myocardial perfu- sion immediately after successful thrombolysis. A predic- tor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 1992; 85: 1699–705.
• Yasar AS, Bilen E, Bilge M, Arslantas U, Karakas F. Impact of metabolic syndrome on coronary patency after throm- bolytic therapy for acute myocardial infarction. Coron Ar- tery Dis 2009;20.387–91.
• Schiller NB, Shah PM, Crawford M, et al. Recommenda- tions for quantitation of the left ventricle by two-dimen- sional echocardiography. American Society of Echocar- diography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiog 1989;2:358–67.
• Kozan O, Oguz A, Abaci A, et al. Prevalence of the meta- bolic syndrome among Turkish adults. Eur J Clin Nutr 2007:61:548–53
• Onat A, Sansoy V. Halkımızda koroner hastalığın başsuç- lusu metabolik sendrom: Sıklığı, unsurları, koroner risk ile ilişkisi ve yüksek risk kriterleri. Türk Kardiyol Dern Arş 2002;30:8–15.
• Zeller M, Steg PG, Ravisy J, et al; Observatiore des Infarctus de Cote-d’Or Survey working Group. Prevalence and im- pact of metabolic syndrome on hospital outcomes in acute myocardial infarction. Arch Intern Med 2005;165:1192–8.
• Levantesi G, Macchia A, Marfisi R, et al; GISSI-Preven- zione Investigators. Metabolic syndrome and risk of car- diovascular events after myocardial infarction. J Am Coll Cardiol 2005;46.277–83
• Shah A, Wagner GS, Granger CB, et al. Prognostic implica- tions of TIMI flow grade in the infarct related artery com- pared with continuous 12-lead ST-segment resolution anal- ysis: reexamining the “gold standard” for myocardial reper- fusion assessment. J Am Coll Cardiol 2000;35.666–72.
• Serne EH, de Jongh RT, Eringa EC, IJzerman RG, Stehou- wer CD. Microvascular dysfunction: a potential pathophys- iological role in the metabolic syndrome. Hypertension 2007; 50.204–11.
• Wiernsperger N, Nivoit P, De Aguiar LG, Bouskela E. Mi- crocirculation and the metabolic syndrome. Microcircula- tion 2007;14.403–38.
• Turhan H, Erbay AR, Yasar AS, Bicer A, Sasmaz H, Yet- kin E. Impaired coronary blood flow in patients with meta- bolic syndrome: Documented by Thrombolysis in Myo- cardial Infarction (TIMI) frame count method. Am Heart J 2004:148:789–94.
• Pirat B, Bozbas H, Simsek V, et al. Impaired coronary flow reserve in patients with metabolic syndrome. Atherosclero- sis 2008;201:112–6.