İnferior ST-Segment Elevasyonlu Miyokard Enfarktüsü Hastalarında Infarkt ile Ilişkili Damarın Öngörülmesinde EKG Kriterleri ve Koroner Arter Baskınlığının EKG Üzerine Etkisi

Year 2020, Volume: 10 Issue: 4, 669 - 676, 15.12.2020

Eser Durmaz , Bilgehan Karadağ , Cansu Ebren Deniz Mutlu Orhan Furkan Karaca Ali Uğur Soysal , Sinem Güral Ünal Hasan Tokdil Zeki Öngen

https://doi.org/10.31832/smj.777121

Abstract

Giriş
Daha önceki çalışmalarda ST-segment yüksekliğinin dağılımının enfarkttan sorumlu damarı öngörebileceği gösterilmiştir. Ancak koroner arter baskınlığının EKG üzerine etkisi yeterince gösterilmemiştir. Bu çalışmada birincil amacımız koroner arter baskınlığının EKG üzerine etkisini araştırdık. İkincil amacımız ise 4. Myokardiyal enfarktüs tanımlaması kılavuzuna göre değişen ST-segment yüksekliği tanımının tanısal değerinin eski tanım ile kıyaslanmasıdır.
Yöntem
Retrospektif olarak primer perkütan girişim ile tedavi edilmiş inferior miyokard enfarktüsü hastaları çalışmaya dahil edildi. Literatür taranarak daha önce tanımlanan şu EKG öngördürücüleri araştırıldı; DIII derivasyonundaki ST-segment elevasyon miktarı DII'den fazla ise infarkttan sorumlu arter sağ koroner arterdir(RCA), aVL veya DI'de ST-segment depresyonu mevcut ise sorumlu arter yine RCA’dır ve DII ST-segment elevasyonu DIII'den fazla ise sorumlu arter Sirkumflex(LCX) arter sorumludur.
Bulgular
Çalışmamızda 192 hasta dahil edildi. 151 hastada sorumlu arter RCA, 41 hastada LCX idi.DIII ST-segment elevasyonunun DII'den fazla olmasının RCA oklüzyonunu göstermede duyarlılığı %84 özgüllüğü %35 olarak saptandı. DII ST-segment elevasyonunun DIII'den fazla olmasının LCX oklüzyonunu göstermede duyarlılığı %48 ve özgüllüğü %65 olarak saptandı. Duyarlılık ve özgüllük açısından en yüksek oran coroner arter baskınlığını öngörmede izlendi; DIII ST-segment elevasyonunun DII'den fazla olmasının koroner arter baskınlığını göstermede duyarlılığı %97 ve özgüllüğü ise %27 olarak saptandı. ST-segment elevasyon miktarının ölçümü için güncel kılavuz önerisi olarak J noktası yerine QRS başlangıcı olarak seçilmesi RCA oklüzyonu olan hastalarda anlamlı değişikliğe neden olmuştur(p: 0.021) ancak LCX oklüzyonu olan hastalarda bu anlamlı değişimin izlenmemiştir(p: 0.212).
Sonuç
Bu çalışmamızda infarkttan sorumlu arteri öngörmek için kullanılan EKG kriterlerinin koroner arter baskınlığına güçlü bir şekilde ilişkili olduğunu gösterdik. Ayrıca yeni EKG kriterleri, RCA oklüzyonu olan hastalarda EKG'nin tanısal doğruluğunu artırdığını ancak LCX oklüzyonu olan hastalarda anlamlı değişiklik yapmadığını gösterdik.
Anahtar sözcükler: inferior STEMI, EKG, Koroner arter baskınlığı

Keywords

inferior STEMI, ekg, koroner arter baskınlığı

ECG Criteria for the Prediction of Infarct-Related Artery and Impact of Coronary Dominance on ECG in Patients with Inferior ST-elevation Myocardial Infarction

Abstract

Background
In-stent restenosis(ISR) is a common angiographic finding in patients with previous stent implantation. Although the mechanism and predictors of ISR has been well-defined, after definition of neoatherosclerosis, a new perspective was emerged and current guidelines recommended a new classification for myocardial infarction due to stent restenosis(Type 4C). In this study, we aimed to investigate the clinical risk factors and predictors of Type 4C myocardial infarction.
Material/method
We reviewed the local angiography database and patients diagnosed with ISR were extracted. Patients’ demographics, clinical characteristics and clinical outcomes were recorded. Type 4C myocardial infarction is defined as myocardial infarction due to stent restenosis.
Results
332 patients were screened and after exclusion 192 patients were included to the final analyses. There were 32 patients with myocardial infarction(group 1). Mean follow-up time was …. months. There was no significant difference between groups with respect to age and gender. Hypertension was significantly more prevalent in group 2. Diabetes mellitus, previous cerebrovascular accident and hyperlipidaemia were comparable between groups, however smoking was significantly more prevalent in group 1. Logistic regression analyses revealed that smoking status and degree of stenosis due to ISR were only independent predictors of type 4C myocardial infarction. Cardiac mortality was significantly increased in patients with myocardial infarction.
Conclusion
Our study demonstrated that type 4C myocardial infarction should not be underestimated during the long-term follow-up of patients who were diagnosed with ISR. Moreover, since cardiac mortality significantly increases in patients with myocardial infarction, future studies for predictors of myocardial infaction is required.

Keywords

inferior STEMI, ECG, Coronary artery dominance

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