ST Segment Yüksekliği Olmayan Miyokard İnfarktüsü Hastalarında Nötrofil/Lenfosit Oranı ile SYNTAX ve SYNTAX II Skorları Arasındaki İlişkinin Değerlendirilmesi

Year 2017, , 117 - 123, 01.08.2017

İbrahim Rencüzoğulları , Yavuz Karabağ Metin Çağdaş Süleyman Karakoyun Mahmut Yesin İnanç Artaç Doğan İliş Bahattin Balcı

https://doi.org/10.5505/kjms.2017.47587

Abstract

Amaç: ST segment yüksekliği olmayan miyokard infarktüsü
(NSTEMİ), koroner arter hastalarının (KAH) en sık prezantasyonlarından
biridir. Syntax II skoru kompleks KAH olan hastaların
mortalitesini predikte etmek için son zamanlarda geliştirilmiş iki
anatomik ve altı klinik değişken içeren bir skorlama sistemidir.
Nötrofil/lenfosit oranı (NLR) temel olarak bazal inflamatuvar cevabı
yansıtan bir parametredir. Bu çalışmada; NSTEMİ hastalarında
NLR ile KAH şiddeti arasındaki ilişkiyi Syntax skoru (SS) ve Syntax
II skorunu (SSII) kullanarak araştırmak amaçlanmıştır.
Materyal ve Metot: Şubat 2015 ile Haziran 2016 tarihleri arasında
Kafkas Üniversitesi Tıp Fakültesi’ne başvuran ve koroner anjiyografi
(KAG) uygulanan ardışık toplam 271 NSTEMİ hastası çalışmaya
dahil edildi. Hastalardan periferik venöz kan alındı ve bu
kanlardan NLR dahil bazı kan parametleri, biyokimyasal parametreler
ile kardiyak biyobelirteçler çalışıldı. SS ile SSII hesaplandı.
Bulgular: Çalışma grubu 194 NSTEMI hastasından (ort. yaş: 65
± 12; %37.6 bayan hasta) oluştu. Daha öncesine ait SSII ile ilgili
sınıflama olmaması nedeni ile hastalar medyan SSII değerine göre
2 gruba bölündü (SS II≤ 31.5 düşük skorlu grup [n = 97] ve >31.5
yüksek skorlu grup [n = 97]). SSII yüksek skorlu grupta NLR, SSII
düşük skorlu gruba göre anlamlı olarak daha yüksekti (3.22 (2,30-
4,86) vs 4.05 (2,83-7,21) p=0,004). NLR ile SS arasında korelasyon
bulunmazken (r=0.023, p=0.759), NLR ile SSII korele olarak
izlendi (r=0.218, p=0.002). NLR’ nin SS ile korelasyonun bulunmayıp
SSII ile korelasyonun bulunması nedeni ile NLR’ nin SSII
bileşenleri ile korelasyon analizi yapıldı. Yapılan analizinde; NLR,
sol ventrikül ejeksiyon fraksiyonu (r=-0.161, p=0.026) ve kreatin
klirensi ile ilişkili olduğu izlendi (r=-0.161, p=0.025). Ancak NLR
SSII’nin diğer parametrik değişkenleri ile ilişkili değildi.
Sonuç: Sonuç olarak çalışmamızda NLR, SS ile ilişkili olmayıp,
SSII ile ilişkilidir. Yüksek NLR, SSII yüksek skorlu hastaları predikte
edebilir ve SSII’yi predikte etmesi anatomik skor sisteminden
ziyade komorbiditeler ile alakalıdır.

Keywords

nötrofil/lenfosit oranı; Syntax II skoru; ST segment yüksekliği olmayan miyokard infarktüsü

Assessment of Relationship Between SYNTAX and SYNTAX II Scores and Neutrophil/Lymphocyte Ratio in Patients with Non-ST Segment Elevation Myocardial Infarction

Abstract

Aim: Non ST segment elevation myocardial infarction (NSTEMI) is
one of the most common presentations of coronary arterial disease
(CAD). Syntax II score (SSII) is a recently developed scoring system
consisting two anatomical and six clinical variables which is used to
predict mortality of patients with complex CAD. Neutrophil/lymphocyte
ratio (NLR) basically shows basal inflammatory response. The
aim of our study was to evaluate the relationship between NLR and
CAD severity using Syntax score (SS) and SSII in NSTEMI patients.
Material and Method: Consecutive 271 NSTEMI patients who referred
to Kafkas University between February 2015 and June 2016
and underwent coronary angiography have been included in this
study. Peripheral venous blood samples were taken from all patients.
Hemogram parameters including NLR, biochemical parameters
and cardiac biomarkers were evaluated. SS and SSII were
calculated from recorded coronary angiograms.
Results: The study population consisted of 194 NSTEMI patients.
Due to the fact that there was no definitive previous classification of
SSII, the patients were divided into 2 groups according to median
SSII value. (SSII<31.5 low score group [n=97] and >31.5 high score
group [n=97]. NLR was significantly higher at SSII high score group
than low score group 3.22 (2.30-4.86) vs 4.05 (2.83-7.21) p=0.004).
While there was no correlation between NLR and SS (r=0.023,
p=0.759), there was a correlation between NLR and SSII (r=0.218,
p=0.002). Therefore correlation analysis was performed between
NLR and SSII components. Our analysis demonstrated that there
was a correlation between NLR and left ventricular ejection fraction
(r=-0.161, p=0.026), as well as between NLR and creatinine clearance
(r=-0.161, p=0.025). However, there was no correlation with
other parametric components of SSII.
Conclusion: Our study demonstrated that there was a correlation between
NLR and SSII, but no correlation between NLR and SS. High
NLR can predict that patients have high SSII scores, and this prediction
is related to comorbidities rather than anatomical score system.

Keywords

neutrophil/lymphocyte ratio; Syntax II score, non-ST segment elevation myocardial infarction

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