ST Yükselmeli Miyokart İnfarktüslü Hastalarda C-Reaktif Protein/Albumin Oranı ile Yeni Başlangıçlı Atriyal Fibrilasyon Arasındaki İlişkinin Değerlendirilmesi

Abstract

Giriş: Daha önceden yapılan çalışmalar, inflamatuvar belirteçlerin koroner arter hastalığı olan hastalarda yeni başlayan atriyal fibrilasyon (AF)’un gelişimi ile ilişkili olduğunu göstermiştir. Bununla birlikte, ST yükselmeli miyokart infarktüslü (STEMİ) hastalarda AF gelişimi için serum C-reaktif protein (CRP)’in serum albumin oranı (CAR)’na göre prediktif değeri henüz araştırılmamıştır. Bu nedenle, bu çalışmada, primer perkütan koroner girişim (pPKG) yapılan STEMİ hastalarında AF’ı öngörmedeki değerini değerlendirmeyi amaçladık.

 

Hastalar ve Yöntem: Bu çalışma, pPKG uygulanan 1153 STEMİ hastasına ilişkin verilerin geriye yönelik analiz edilmesi ile yapıldı. CRP düzeyleri immünoturbidimetrik yönteme göre ölçüldü ve serum albumin düzeyleri bromkresol yeşili yöntemiyle analiz edildi. CAR, CRP değerlerinin serum albumin oranı olarak tanımlandı.

 

Bulgular: Hastanede kalış sırasında AF insidansı %5.2 (n= 62 hasta) idi. AF olan hastalar, AF olmayanlara kıyasla yüksek CAR değerlerine sahipti. Çok değişkenli lojistik regresyon analizleri, yüksek CAR değerinin AF’ın bağımsız bir belirleyicisi olduğunu ortaya koydu (OR: 3.280, %95 CI: 1.564-6.878; p= 0.002). Ayrıca, ROC curve eğrilerinin karşılaştırıldığında, CAR’ın öngörücü performansının sırasıyla CRP ve albuminden daha yüksek olduğunu göstermiştir.

 

Sonuç: Bu çalışmada pPKG ile tedavi edilen STEMİ hastalarında yüksek CAR değerlerinin AF gelişimi ile bağımsız olarak ilişkili olduğunu gözlemledik.

Keywords

• C-reaktif protein/albumin oranı,yeni başlayan atriyal fibrilasyon,ST yükselmeli miyokart infarktüsü

Assessment of the Relationship Between C-Reactive Protein to Albumin Ratio and New-Onset Atrial Fibrillation in Patients with ST Elevation Myocardial Infarction

Abstract

Introduction: Previous studies reported that inflammatory markers are associated with the development of new-onset atrial fibrillation (NOAF) in patients with coronary artery disease. However, the predictive value of serum C-reactive protein (CRP) to serum albumin ratio (CAR) for the development of NOAF in patients with ST elevation myocardial infarction (STEMI) has not been investigated yet. Hence, the aim of the present study was to evaluate the potential utility of the CAR in predicting NOAF in patients with STEMI who underwent primary percutaneous coronary intervention (pPCI).

 

Patients and Methods: The present study was a retrospective analysis of the data related to 1153 patients with STEMI who underwent pPCI. CRP levels were measured according to the immunoturbidimetric method, and serum albumin levels were analyzed by the bromocresol green method. The CAR was defined as the serum CRP level divided by the serum albumin level.

 

Results: The incidence of NOAF during in-hospital stay was 5.2% (n= 62 patients). Patients with NOAF had higher CAR values than those without NOAF. Multivariate logistic regression analyses revealed that elevated CAR value was an independent predictor of NOAF (odds ratio 3.280, 95% confidence interval 1.564-6.878; p= 0.002). Furthermore, comparison of receiver operating characteristic curves yielded that the predictive performance of CAR was higher than CRP and albumin alone, respectively.

 

Conclusion: In the present study, we observed that elevated CAR values were independently associated with NOAF development in patients with STEMI treated with pPCI.

Keywords

• C-reactive protein to albumin ratio,new-onset atrial fibrillation,ST elevation myocardial infarction

References

1. 1. Schmitt J, Duray G, Gersh BJ, Hohnloser SH. Atrial fibrillation in acute myocardial infarction: A systematic review of the incidence, clinical features and prognostic implications. Eur Heart J 2009;30:1038-45.
2. 2. Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM. Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1997;30:406-13.
3. 3. Kinjo K, Sato H, Sato H, Ohnishi Y, Hishida E, Nakatani D. Prognostic significance of atrial fibrillation/atrial flutter in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol 2003;92:1150-4.
4. 4. Mrdovic I, Savic L, Krljanac G, Perunicic J, Asanin M, Lasica R, et al. Incidence, predictors, and 30-day outcomes of new-onset atrial fibrillation after primary percutaneous coronary intervention: Insight into the RISK-PCI trial. Coron Artery Dis 2012:23:1-8.
5. 5. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-95.
6. 6. Dernellis J, Panaretou M. Effects of C-reactive protein and the third and fourth components of complement (C3 and C4) on incidence of atrial fibrillation. Am J Cardiol 2006;97:245-8.
7. 7. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006-10.
8. 8. Oduncu V, Erkol A, Karabay CY, Kurt M, Akgün T, Bulut M, et al. The prognostic value of serum albumin levels on admission in patients with acute ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis 2013;24:88-94.

9. 9. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Koseoglu C, et al. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology 2016;67:34-40.
10. 10. Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med 2009;9:30-3.
11. 11. Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Tanaka K, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015;22:803-10.
12. 12. Çağdaş M, Rencüzoğullari I, Karakoyun S, Karabağ Y, Yesin M, Artaç I, et al. Assessment of relationship between C-reactive protein to albumin ratio and coronary artery disease severity in patients with acute coronary syndrome. Angiology 2017:3319717743325.
13. 13. TaskForce on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-619.
14. 14. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-429.
15. 15. Gibson CM, Cannon CP, Murphy SA, Marble SJ, Barron HV, Braunwald E. TIMI Study Group. Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to longterm outcomes after thrombolytic administration in acute myocardial infarction. Circulation 2002;105:1909-13.
16. 16. Kudaiberdieva G, Görenek B. Post PCI atrial fibrillation. Acute Cardiac Care 2007;9:6976.
17. 17. Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation 2000;101:969-74.
18. 18. Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010;105:186-91.
19. 19. Iguchi Y, Kimura K, Kobayashi K, Aoki J, Terasawa Y, Sakai K, et al. Relation of atrial fibrillation to glomerular filtration rate. Am J Cardiol 2008;102:1056-9.
20. 20. 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 echocardiog- raphy’s guidelines and standards committee and the chamber quan- tification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr 2005;18:1440-63.
21. 21. Iwata M, Kuzuya M, Kitagawa Y, Iguchi A. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res 2006;18:307e11.
22. 22. Lo B, Fijnheer R, Nierich AP, Bruins P, Kalkman CJ. C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. Ann Thorac Surg 2005;79:1530-5.
23. 23. Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patients under- going oesophagectomy for oesophageal malignancies? Interact Cardiovasc Thorac Surg 2015;20:107-13.
24. 24. Kim HJ, Lee HW. Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol 2013;19:105-15.
25. 25. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 2010;9:69.
26. 26. Nelson JJ, Liao D, Sharrett AR, Folsom AR, Chambless LE, Shahar E, et al. Serum albumin level as a predictor of incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 2000;151:468-77.