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SYSTEMIC IMMUNE-INFLAMMATION INDEX IS A PREDICTOR OF LEFT VENTRICULAR THROMBUS FORMATION FOLLOWING ANTERIOR MYOCARDIAL INFARCTION

Year 2023, Volume: 4 Issue: Ek Sayı, 188 - 194, 16.10.2023

Abstract

Introduction: Left ventricular thrombus (LVT) formation following anterior ST-elevation myocardial infarction (STEMI), is a serious complication and is associated with an increased risk of cardiovascular morbidity and mortality. Recently introduced the systemic immune-inflammation index (SII) is a reliable indicator of adverse events in various cardiovascular conditions. Herein, we aimed to explore the role of SII in the prediction of LVT formation in anterior STEMI patients following primary percutaneous coronary intervention (PCI).
Methods: Medical records of 124 anterior STEMI patients who developed LVT following primary PCI and 124 age and sex-matched anterior STEMI patients without formation of LVT following primary PCI were analyzed. For each group, patient demographics, comorbidities, laboratory parameters, ECG and echocardiographic findings were analyzed. The SII was measured using the following formula: SII= total peripheral platelets count x neutrophil/lymphocyte ratio.
Results: According to our study, reduced left ventricular ejection fraction and increased SII were identified as independent predictors of LVT formation following anterior STEMI. To determine the SII index cut-off value for predicting LVT formation, the ROC curve was drawn and the best cut-off value was determined as 676.27 (AUC:0.778, 95% CI:0.699-0.858, p<0.001). Above this cut-off value, LVT formation could be predicted with a sensitivity of 66.1% and a specificity of 74.2%.
Conclusion: SII is may be used as an independent predictor of LVT formation for anterior STEMI patients following primary PCI.

References

  • 1. Solheim S, Seljeflot I, Lunde K, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. Am J Cardiol. 2010;106:1197-200.
  • 2. Gianstefani S, Douiri A, Delithanasis I, et al. Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention. Am J Cardiol. 2014;113:1111-6.
  • 3. Leow AST, Sia CH, Tan BYQ, et al. Characterisation of acute ischemic stroke in patients with left ventricular thrombi after myocardial infarction. J Thromb Thrombolysis. 2019;48:158–66.
  • 4. Robinson AA, Jain A, Gentry M, McNamara RL. Left ventricular thrombi after STEMI in the primary PCI era: a systematic review and meta-analysis. Int J Cardiol. 2016;221:554–59.
  • 5. Garber AM, Mentz RJ, Al-Khalidi HR, et al. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction. J Thromb Thrombolysis. 2016;41:365-73.
  • 6. Driesman A, Hyder O, Lang C, Stockwell P, Poppas A, Abbot JD. Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST-Segment Elevation Myocardial Infarction. Clin Cardiol. 2015;38:590-7.
  • 7. Gokdeniz T, Boyaci F, Hatem E, et al. SYNTAX score predicts the left ventricle thrombus development in patients undergoing primary percutaneous coronary intervention for first anterior myocardial infarction. Clin Appl Thromb Hemost. 2014;20:698-705.
  • 8. Huang J, Zhang Q, Wang R, et al. Systemic immune-inflammatory index predicts clinical outcomes for elderly patients with acute myocardial infarction receiving percutaneous coronary intervention. Med. Sci. Monit. 2019;25:9690–701.
  • 9. Seo M, Yamada T, Morita T, et al. Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. Eur Heart J. 2018;39:ehy564.P589.
  • 10. Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50:e13230.
  • 11. Chen L, Pandey S, Shen R, Xu Y, Zhang Q. Increased Systemic Immune-Inflammation Index Is Associated With Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage Patients. Front Neurol. 2021;12:745175.
  • 12. Gok M, Kurtul A. A novel marker for predicting severity of acute pulmonary embolism: systemic immuneinflammation index. Scand Cardiovasc J. 2021;55:91-6.
  • 13. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-77.
  • 14. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212-22.
  • 15. Saric M, Armour AC, Arnaout MS, et al. Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. J Am Soc Echocardiogr. 2016;29:1-42.
  • 16. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. 2012;98:1743-9.
  • 17. Neumann FJ, Ott I, Gawaz M, Richardt G, Holzapfel H, Jochum M, Schömig A. Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation. 1995;92:748-55.
  • 18. Pöss J, Desch S, Eitel C, de Waha S, Thiele H, Eitel I. Left Ventricular Thrombus Formation After ST-Segment-Elevation Myocardial Infarction: Insights From a Cardiac Magnetic Resonance Multicenter Study. Circ Cardiovasc Imaging. 2015;8:e003417.
  • 19. Phan J, Nguyen T, French J, et al. Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: a serial cardiac MRI study. Int J Cardiol Heart Vasc. 2019;24:100395.
  • 20. Arbel Y, Finkelstein A, Halkin A, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225:456-60.
  • 21. Adamstein NH, MacFadyen JG, Rose LM, et al. The neutrophil-lymphocyte ratio and incident atherosclerotic events: analyses from five contemporary randomized trials. Eur Heart J. 2021;42:896–903.
  • 22. Kurtul A, Murat SN, Yarlioglues M, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol. 2014;114:972-78.
  • 23. Ma X, Han K, Yang L, et al. Adjustment of the GRACE risk score by monocyte to high-density lipoprotein ratio improves prediction of adverse cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Front Cardiovasc Med. 2022;8:755806.
  • 24. Candemir M, Kiziltunc E, Nurkoç S, Sahinarslan A. Relationship Between Systemic Immune-Inflammation Index (SII) and the Severity of Stable Coronary Artery Disease. Angiology. 2021;72:575–81.
  • 25. Tosu AR, Kalyoncuoglu M, Biter HB, et al. Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI. Medicina (Kaunas). 2021;57:588.
  • 26. Han K, Shi D, Yang L, et al. Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Ann Med. 2022;54:1667-77.
  • 27. Siddiqi SA, Nishat S, Kanwar D, et al. Cerebral venous sinus thrombosis: association with primary varicella zoster virus infection. J Stroke Cerebrovasc Dis 2012;21:917.e1–917.e4.
  • 28. İdil Soylu A, Arıkan Cortcu S, Uzunkaya F, et al. The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease. Vascular 2017;25:299–306.
  • 29. Kerr R, Stirling D, Ludlam CA. Interleukin 6 and haemostasis. Br J Haematol. 2001;115:3–12.
  • 30. Anzai T, Yoshikawa T, Asakura Y, et al. Preinfarction angına as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction. J Am Coll Cardiol. 1995;26:319–27.
  • 31. Anzai T, Yoshikawa T, Kaneko H, et al. Association between serum C-reactive protein elevation and left ventricular thrombus formation after first anterior myocardial infarction. Chest. 2004; 125:384-9.
  • 32. Shacham Y, Leshem-Rubinow E, Ben Assa E, et al. Comparison of C-reactive protein and fibrinogen levels in patients having anterior wall ST-Segment elevation myocardial infarction with versus without left ventricular thrombus (from a primary percutaneous coronary intervention cohort). Am J Cardiol. 2013;112:57-60.

SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ

Year 2023, Volume: 4 Issue: Ek Sayı, 188 - 194, 16.10.2023

Abstract

Giriş: Anterior ST yükselmeli miyokard infarktüsünü (STEMI) takiben sol ventrikül trombüsü (SVT) oluşumu ciddi bir komplikasyondur ve artmış kardiyovasküler morbidite ve mortalite riski ile ilişkilidir. Son zamanlarda tanıtılan sistemik immün-enflamasyon indeksi (SII), çeşitli kardiyovasküler durumlardaki olumsuz olayların güvenilir bir göstergesidir. Burada, primer perkütan koroner girişim (PKG) sonrası anterior STEMI hastalarında SII'nin SVT oluşumunu öngörmedeki rolünü araştırmayı amaçladık.
Yöntemler: Primer PKG sonrası SVT gelişen 124 anterior STEMI hastasının ve primer PKG sonrası SVT oluşmayan yaş ve cinsiyet uyumlu 124 anterior STEMI hastasının tıbbi kayıtları analiz edildi. Her grup için hasta demografik özellikleri, komorbiditeler, laboratuvar parametreleri, EKG ve ekokardiyografik bulgular analiz edildi. SII, aşağıdaki formül kullanılarak ölçüldü: SII= toplam periferik trombosit sayısı x nötrofil/lenfosit oranı.
Bulgular: Çalışmamıza göre, azalmış sol ventrikül ejeksiyon fraksiyonu ve artmış SII, anterior STEMI sonrası SVT oluşumunun bağımsız belirteçleri olarak belirlendi. SII indeksi cut-off değerinin SVT oluşumunu öngörmede belirlenmesi için ROC eğrisi çizildi ve en iyi cut- off değeri 676,27 olarak belirlendi (AUC:0,778, 95% CI:0,699-0,858, p<0,001). Bu cut-off değerinin üzerinde %66,1 sensitivite ve %74,2 spesifite ile SVT oluşumu tahmin edilebildi.
Sonuç: SII, primer PKG sonrası anterior STEMI hastalarında SVT oluşumunun bağımsız bir göstergesi olabilir.

References

  • 1. Solheim S, Seljeflot I, Lunde K, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. Am J Cardiol. 2010;106:1197-200.
  • 2. Gianstefani S, Douiri A, Delithanasis I, et al. Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention. Am J Cardiol. 2014;113:1111-6.
  • 3. Leow AST, Sia CH, Tan BYQ, et al. Characterisation of acute ischemic stroke in patients with left ventricular thrombi after myocardial infarction. J Thromb Thrombolysis. 2019;48:158–66.
  • 4. Robinson AA, Jain A, Gentry M, McNamara RL. Left ventricular thrombi after STEMI in the primary PCI era: a systematic review and meta-analysis. Int J Cardiol. 2016;221:554–59.
  • 5. Garber AM, Mentz RJ, Al-Khalidi HR, et al. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction. J Thromb Thrombolysis. 2016;41:365-73.
  • 6. Driesman A, Hyder O, Lang C, Stockwell P, Poppas A, Abbot JD. Incidence and Predictors of Left Ventricular Thrombus After Primary Percutaneous Coronary Intervention for Anterior ST-Segment Elevation Myocardial Infarction. Clin Cardiol. 2015;38:590-7.
  • 7. Gokdeniz T, Boyaci F, Hatem E, et al. SYNTAX score predicts the left ventricle thrombus development in patients undergoing primary percutaneous coronary intervention for first anterior myocardial infarction. Clin Appl Thromb Hemost. 2014;20:698-705.
  • 8. Huang J, Zhang Q, Wang R, et al. Systemic immune-inflammatory index predicts clinical outcomes for elderly patients with acute myocardial infarction receiving percutaneous coronary intervention. Med. Sci. Monit. 2019;25:9690–701.
  • 9. Seo M, Yamada T, Morita T, et al. Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. Eur Heart J. 2018;39:ehy564.P589.
  • 10. Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50:e13230.
  • 11. Chen L, Pandey S, Shen R, Xu Y, Zhang Q. Increased Systemic Immune-Inflammation Index Is Associated With Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage Patients. Front Neurol. 2021;12:745175.
  • 12. Gok M, Kurtul A. A novel marker for predicting severity of acute pulmonary embolism: systemic immuneinflammation index. Scand Cardiovasc J. 2021;55:91-6.
  • 13. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-77.
  • 14. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20:6212-22.
  • 15. Saric M, Armour AC, Arnaout MS, et al. Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. J Am Soc Echocardiogr. 2016;29:1-42.
  • 16. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. 2012;98:1743-9.
  • 17. Neumann FJ, Ott I, Gawaz M, Richardt G, Holzapfel H, Jochum M, Schömig A. Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation. 1995;92:748-55.
  • 18. Pöss J, Desch S, Eitel C, de Waha S, Thiele H, Eitel I. Left Ventricular Thrombus Formation After ST-Segment-Elevation Myocardial Infarction: Insights From a Cardiac Magnetic Resonance Multicenter Study. Circ Cardiovasc Imaging. 2015;8:e003417.
  • 19. Phan J, Nguyen T, French J, et al. Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: a serial cardiac MRI study. Int J Cardiol Heart Vasc. 2019;24:100395.
  • 20. Arbel Y, Finkelstein A, Halkin A, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225:456-60.
  • 21. Adamstein NH, MacFadyen JG, Rose LM, et al. The neutrophil-lymphocyte ratio and incident atherosclerotic events: analyses from five contemporary randomized trials. Eur Heart J. 2021;42:896–903.
  • 22. Kurtul A, Murat SN, Yarlioglues M, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol. 2014;114:972-78.
  • 23. Ma X, Han K, Yang L, et al. Adjustment of the GRACE risk score by monocyte to high-density lipoprotein ratio improves prediction of adverse cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Front Cardiovasc Med. 2022;8:755806.
  • 24. Candemir M, Kiziltunc E, Nurkoç S, Sahinarslan A. Relationship Between Systemic Immune-Inflammation Index (SII) and the Severity of Stable Coronary Artery Disease. Angiology. 2021;72:575–81.
  • 25. Tosu AR, Kalyoncuoglu M, Biter HB, et al. Prognostic Value of Systemic Immune-Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI. Medicina (Kaunas). 2021;57:588.
  • 26. Han K, Shi D, Yang L, et al. Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Ann Med. 2022;54:1667-77.
  • 27. Siddiqi SA, Nishat S, Kanwar D, et al. Cerebral venous sinus thrombosis: association with primary varicella zoster virus infection. J Stroke Cerebrovasc Dis 2012;21:917.e1–917.e4.
  • 28. İdil Soylu A, Arıkan Cortcu S, Uzunkaya F, et al. The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease. Vascular 2017;25:299–306.
  • 29. Kerr R, Stirling D, Ludlam CA. Interleukin 6 and haemostasis. Br J Haematol. 2001;115:3–12.
  • 30. Anzai T, Yoshikawa T, Asakura Y, et al. Preinfarction angına as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction. J Am Coll Cardiol. 1995;26:319–27.
  • 31. Anzai T, Yoshikawa T, Kaneko H, et al. Association between serum C-reactive protein elevation and left ventricular thrombus formation after first anterior myocardial infarction. Chest. 2004; 125:384-9.
  • 32. Shacham Y, Leshem-Rubinow E, Ben Assa E, et al. Comparison of C-reactive protein and fibrinogen levels in patients having anterior wall ST-Segment elevation myocardial infarction with versus without left ventricular thrombus (from a primary percutaneous coronary intervention cohort). Am J Cardiol. 2013;112:57-60.
There are 32 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Ahmet Lütfü Sertdemir 0000-0002-4656-5547

Mustafa Duran 0000-0001-5937-235X

Ahmet Taha Şahin 0000-0002-2928-1059

Abdullah İçli 0000-0002-7047-811X

Mustafa Çelik 0000-0003-4102-1564

Sefa Tatar 0000-0001-8703-5078

Yakup Alsancak 0000-0001-5230-2180

Early Pub Date October 16, 2023
Publication Date October 16, 2023
Published in Issue Year 2023 Volume: 4 Issue: Ek Sayı

Cite

APA Sertdemir, A. L., Duran, M., Şahin, A. T., İçli, A., et al. (2023). SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ. Eskisehir Medical Journal, 4(Ek Sayı), 188-194.
AMA Sertdemir AL, Duran M, Şahin AT, İçli A, Çelik M, Tatar S, Alsancak Y. SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ. Eskisehir Med J. October 2023;4(Ek Sayı):188-194.
Chicago Sertdemir, Ahmet Lütfü, Mustafa Duran, Ahmet Taha Şahin, Abdullah İçli, Mustafa Çelik, Sefa Tatar, and Yakup Alsancak. “SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ”. Eskisehir Medical Journal 4, no. Ek Sayı (October 2023): 188-94.
EndNote Sertdemir AL, Duran M, Şahin AT, İçli A, Çelik M, Tatar S, Alsancak Y (October 1, 2023) SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ. Eskisehir Medical Journal 4 Ek Sayı 188–194.
IEEE A. L. Sertdemir, M. Duran, A. T. Şahin, A. İçli, M. Çelik, S. Tatar, and Y. Alsancak, “SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ”, Eskisehir Med J, vol. 4, no. Ek Sayı, pp. 188–194, 2023.
ISNAD Sertdemir, Ahmet Lütfü et al. “SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ”. Eskisehir Medical Journal 4/Ek Sayı (October 2023), 188-194.
JAMA Sertdemir AL, Duran M, Şahin AT, İçli A, Çelik M, Tatar S, Alsancak Y. SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ. Eskisehir Med J. 2023;4:188–194.
MLA Sertdemir, Ahmet Lütfü et al. “SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ”. Eskisehir Medical Journal, vol. 4, no. Ek Sayı, 2023, pp. 188-94.
Vancouver Sertdemir AL, Duran M, Şahin AT, İçli A, Çelik M, Tatar S, Alsancak Y. SİSTEMİK İMMÜN-ENFLAMASYON İNDEKSİ, ANTERİOR MİYOKARD ENFARKTÜSÜNÜ TAKİBEN SOL VENTRIKÜL TROMBÜS OLUŞUMUNUN BİR GÖSTERGESİ. Eskisehir Med J. 2023;4(Ek Sayı):188-94.