Koroner anjiyografi sırasında saptanan koroner yavaş akım olan sigara içen hastalarda trombosit parametrelerinin araştırılması

Abstract

Amaç: Artmış morbidite ve mortalite ile ilişkili olan koroner yavaş akış (KYA), ateroskleroz ile ilişkilidir ve koroner arter hastalığının (KAH) bir varyantı olarak kabul edilir. KYA sigara içen hastalarda daha yaygındır. KYA'lı sigara içen hastalarda laboratuvar parametrelerini (özellikle trombosit indeksleri) değerlendirmeyi amaçladık.
Yöntemler: Hastalar Ocak 2017 ile Ekim 2019 arasında koroner anjiyografi (KAG) uygulanan hastalardan seçildi. 7287 hastanın KAG kayıtları retrospektif olarak tarandı. Çalışmamız bir vaka kontrol çalışması olarak tasarlandı. Bu prosedürler, klinik endikasyonlara dayanarak iskemik kalp hastalığını tanımlamak için gerçekleştirildi. KAG pozitif invaziv olmayan stres testleri ve/veya aterosklerotik KAH için yüksek klinik şüphesi olan hastalara uygulandı. KYA'lı sigara içen hastalar (n=226) çalışma grubunu oluşturdu ve NKA'lı eşleşen sayıda sigara içen hastalar (n=226) kontrol grubuna dahil edildi. Tüm hastaların demografik özellikleri kaydedildi. Tüm deneklerin hematolojik ve biyokimyasal parametreleri kaydedildi ve değerlendirildi.
Bulgular: KYA'lı sigara içen hastalarda (çalışma grubu) LDL kolesterol, trigliserit, total kolesterol, ALT, CRP, MCV, RDW, Trombosit sayısı, PDW, MPV, PCT ve PLR düzeyleri normal koroner arter hastalarına (kontrol grubu) göre daha yüksek bulundu (sırasıyla P=0,034, P=0,015, P=0,033, P=0,006, P<0,001, P=0,033, P=0,021, P=0,039, P=0,006, P=0,010, P=0,021 ve P=0,008). HDL kolesterol KYA'lı sigara içen hastalarda kontrol grubuna göre daha düşük bulundu. (P=0,007).
Sonuç: Sonuçlarımıza göre, yüksek trombosit parametreleri koroner akım patogenezinde rol oynayabilir. Trombosit parametrelerinin yüksekliği KYA varlığını gösterebilir. Bulgularımız sigara içen KYA hastalarında inflamasyon ve trombosit fonksiyon bozukluğu kanıtlarını desteklemektedir. Bu ilişkiyi göstermek için randomize moleküler düzeyde kapsamlı çalışmalara ihtiyaç vardır.

Keywords

• Koroner yavaş akım,Ortalama trombosit hacmi,Plateletkrit,Trombosit dağılım genişliği,Sigara kullanımı

An investigation of platelet parameters in smoking patients with coronary slow flow detected during coronary angiography

Abstract

Aim: Coronary slow flow (CSF), which is linked to increased morbidity and mortality, is associated with atherosclerosis, and considered a variant of coronary artery disease (CAD). CSF is more common in smoking patients. We aimed to evaluate laboratory parameters, especially platelet indices, in smoking patients with CSF.
Methods: Patients were selected from those who underwent coronary angiography (CAG) between January 2017 and October 2019. CAG records of 7287 patients were screened retrospectively for our case-control study. Procedures were carried out to identify ischemic heart disease based on clinical indications. CAG was performed in patients with positive non-invasive stress tests and/or high clinical suspicion for atherosclerotic CAD. Smoking patients with CSF (n=226) constituted the study group and matched number (n=226) of smoking patients with NCA were included in the control group. The demographic characteristics of all patients were recorded. Hematologic and biochemical parameters of all subjects were recorded and evaluated.
Results: LDL cholesterol, triglyceride, total cholesterol, ALT, CRP, MCV, RDW, platelet count, PDW, MPV, PCT, and PLR levels were higher in smoking patients with CSF (study group) than normal coronary artery patients (control group) (P=0.034, P=0.015, P=0.033, P=0.006, P<0.001, P=0.033, P=0.021, P=0.039, P=0.006, P=0.010, P=0.021 and P=0.008, respectively). HDL cholesterol was found lower in smoking patients with CSF compared to controls (P=0.007).
Conclusion: According to our results, high platelet parameters may play a role in coronary flow pathogenesis. The height of platelet parameters may indicate the presence of CSF. Our findings support the evidence for inflammation and platelet dysfunction in smoking patients with CSF. Extensive studies at a randomized molecular level are needed to demonstrate this relationship.

Keywords

• Coronary slow flow,Mean platelet volume,Plateletcrit,Platelet distribution width,Smoking

References

1. 1. Mukhopadhyay S, Kumar M, Yusuf J, Gupta VK, Tyagi S. Risk factors and angiographic profile of coronary slow flow (CSF) phenomenon in North Indian population: An observational study. Indian Heart J. 2018;70(3):405–9.
2. 2. Wang X, Nie SP. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther. 2011;1(1):37–43.
3. 3. Yılmaz M, Dağlı MN, Uku Ö, Bilen MN, Korkmaz H, Erdem K, et al. Focusing on a complete blood cell parameter: mean platelet volume levels may be a predictor of coronary slow flow. Vasc Health Risk Manag. 2017;7(13):255-61.
4. 4. Amirzadegan A, Motamed A, Davarpasand T, Shahrzad M, Lotfi-Tokaldany M. Clinical characteristics and mid-term outcome of patients with slow coronary flow. Acta Cardiol. 2012;67(5):583–7.
5. 5. Signori LU, Quadros AS, Sbruzzi G, Dipp T, Lopes RD, Schaan BD. Endothelial function in patients with slow coronary flow and normal coronary angiography. Clinics (Sao Paulo). 2012;67(6):677–80.
6. 6. Oylumlu M, Doğan A, Oylumlu M, Yıldız A, Yüksel M, Kayan F, et al. Relationship between platelet-to-lymphocyte ratio and coronary slow flow. Anatol J Cardiol. 2015;15(5):391-5.
7. 7. Herrmann J, Kaski JC, Lerman A. Coronary microvascular dysfunction in the clinical setting: from mystery to reality. Eur Heart J. 2012;33(22):2771-82b.
8. 8. Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J. 2003;146(1):84-90.

9. 9. Koç Ş, Vural A, Aksoy H, Dindar B, Karagöz A, Günaydın ZY, et al. Coronary slow flow accompanying exertional blurred vision and effects of corticosteroids. Am J Case Rep. 2015;26(16):315-8.
10. 10. Kayapinar O, Ozde C, Kaya A. Relationship Between the Reciprocal Change in Inflammation-Related Biomarkers (Fibrinogen-to-Albumin and hsCRP-to-Albumin Ratios) and the Presence and Severity of Coronary Slow Flow. Clin Appl Thromb Hemost. 2019;25:1076029619835383.
11. 11. Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, et al. Vascular endothelial function in patients with slow coronary flow. Coron Artery Dis. 2003;14(2):155-61.
12. 12. Gökçe M, Kaplan S, Tekelioğlu Y, Erdoğan T, Küçükosmanoğlu M. Platelet function disorder in patients with coronary slow flow. Clin Cardiol. 2005;28(3):145-8.
13. 13. Xu Y, Meng HL, Su YM, Chen C, Huang YH, Li XF, et al. Serum YKL-40 is increased in patients with slow coronary flow. Coron Artery Dis. 2015;26(2):121-5.
14. 14. Sığırcı S, Sarıkaya R, Keskin K, Yıldız SS, Pilten Güzel S, Çetinkal G, et al. Biyobelirteçler koroner yavaş akım patogenezini anlamamıza yardımcı olabilir mi? Koroner yavaş akım fenomeninde endokan ve omentin-I [Can biomarkers help us to understand the pathogenesis of coronary slow flow? Endocan and omentin-I in slow coronary flow phenomenon]. Turk Kardiyol Dern Ars. 2019;47(4):251-7.
15. 15. Haybar H, Khodadi E, Zibara K, Saki N. Platelet Activation Polymorphisms in Ischemia. Cardiovasc Hematol Disord Drug Targets. 2018;18(2):153–61.
16. 16. Yaşar AS, Bilen E, Yüksel IO, Arslantaş U, Karakaş F, Kirbaş O, et al. Association between admission mean platelet volume and coronary patency after thrombolytic therapy for acute myocardial infarction. Turk Kardiyol Dern Ars. 2010;38(2):85-9.
17. 17. Wiwanitkit V. Plateletcrit, mean platelet volume, platelet distribution width: its expected values and correlation with parallel red blood cell parameters. Clin Appl Thromb Hemost. 2004;10(2):175–8.
18. 18. Sen T. Coronary Slow Flow Phenomenon Leads to ST Elevation Myocardial Infarction. Korean Circ J. 2013;43(3):196–8.
19. 19. Amasyali B, Turhan H, Kose S, Celik T, Iyisoy A, Kursaklioglu H, et al. Aborted sudden cardiac death in a 20-year-old man with slow coronary flow. Int J Cardiol. 2006;109(3):427-9.
20. 20. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology. 2002;97(4):197-202.
21. 21. Xia S, Deng SB, Wang Y, Xiao J, Du JL, Zhang Y, et al. Clinical analysis of the risk factors of slow coronary flow. Heart Vessels. 2011;26(5):480-6.
22. 22. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52(2):86–105.
23. 23. Luo SH, Jia YJ, Nie SP, Qing P, Guo YL, Liu J, et al. Increased red cell distribution width in patients with slow coronary flow syndrome. Clinics (Sao Paulo). 2013;68(6):732-7.
24. 24. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482–94.
25. 25. Abanoz M. Predictive value of plateletcrit in the diagnosis of lower extremity deep vein thrombosis. J Surg Med. 2020;4(2):148-51.
26. 26. Bekler A, Ozkan MT, Tenekecioglu E, Gazi E, Yener AU, Temiz A, et al. Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome. Angiology. 2015;66(7):638-43.
27. 27. Isik T, Ayhan E, Uyarel H, Ergelen M, Tanboga IH, Kurt M, et al. Increased mean platelet volume associated with extent of slow coronary flow. Cardiol J. 2012;19(4):355-62.
28. 28. Altun I, Akin F, Kose N, Sahin C, Kirli I. Predictors of slow flow in angiographically normal coronary arteries. Int J Clin Exp Med. 2015;8(8):13762–8.
29. 29. 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.
30. 30. Temiz A, Gazi E, Güngör Ö, Barutçu A, Altun B, Bekler A, et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Med Sci Monit. 2014;22(20):660-5.
31. 31. Çetin M, Kiziltunc E, Elalmış ÖU, Çetin ZG, Demirçelik MB, Çiçekçioğlu H, et al. Predictive Value of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio in Patients with Coronary Slow Flow. Acta Cardiol Sin. 2016;32(3):307-12.