St elevasyonlu miyokard enfarktüslü hastalarda enfarktüsle ilişkili arter açıklığı ile primer perkütan koroner girişim öncesi c-reaktif protein/ albümin oranı arasındaki ilişki

Year 2021, , 365 - 371, 22.12.2021

Halil Akın , Önder Bilge , Bernas Altıntaş Rojhat Altındağ , Hüseyin Ede , Mehmet Şahin Adıyaman

https://doi.org/10.18663/tjcl.1005379

Abstract

Amaç: C-reaktif protein ve Albumin gibi inflamatuar markerlar STEM’de daha önce kötü prognoz ile ilşkilendirilmiştir.
Çalışmamızda ST elevasyonlu miyokard enfarktüsü (STEMI) geçiren hastalarda pirmer Perkütan Girişim (p-PKG) öncesi
enfarktüsten sorumlu koroner arter açıklığı ile C-reaktif protein/Albumin oranı (CAR) arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: STEMI nedeni ile p-PKG uygulanmış 822 hasta çalışmaya dahil edildi. Hastalar IRA açıklığına göre TIMI akım
0-1 (n=551) ve TIMI akım 2-3 (n=271) olarak iki gruba ayrıldı. Başvuru sırasında ölçülen CAR oranı, IRA açıklığı ile karşılaştırıldı.
Bulgular: 822 hastanın yaş ortalaması 55±12’ di ve %84,3 (693)’ ü erkekti. Tüm çalışma hastalarının ortalama CAR düzeyi
0.26 (0.08-0.48) olarak tespit edildi. CAR düzeyi TIMI akım 0-1 grubunda TIMI akım 2-3 grubuna göre istatiksel anlamlılıkla
daha yüksek bulundu [0.31 (0.09-0.51) vs 0.23 (0.06-0.42); p<0.001]. Yapılan multivariete lojistik regresyon analizinde CAR
(odds ratio [OR]:1.56, 95% confidence interval [CI]:1.22-1.97, p<0.001) ve nötrofil sayısı (OR:1.72, 95% CI:1.33-2.25, p<0,001)
TIMI 0-1 akım ile arasında anlamlı ilişki saptanmıştır.
Sonuç: Anterior STEMI hastalarında başvuru sırasında ölçülen inflamasyona dayalı bir risk indeksi olan CAR, olumsuz
kardiyovasküler sonuçları tahmin etmek için yararlı bir prognostik araç olduğu bulunmuştur. Bununla birlikte, bu bulgunun
gelecekteki prospektif çalışmalarda doğrulanması gerekmektedir

Keywords

C-reaktif protein/albümin oranı, İnfaktüsten sorumlu koroner arter açıklığı, ST elevasyonlu miyokard infarktüsü

The relationship between infarct-related arteries patency with c-reactive protein/albumin ratio before primary percutaneous coronary intervention in patients with st-segment elevation myocardial infarction

Abstract

Aim: Inflammatory markers such as C-reactive protein and Albumin have previously been associated with poor prognosis
in ST-elevation myocardial infarction (STEMI). The present study aims to investigate the relationship between the
infarct-related arteries (IRA) patency and C-reactive protein/Albumin ratio (CAR) before primary percutaneous coronary
intervention (p-PCI) in patients with STEMI.
Material and Methods: A total of 822 patients who underwent p-PCI for acute STEMI were included in this study. Patients
were divided into two groups according to IRA patency as TIMI flow 0-1 (n = 551) and TIMI flow 2-3 (n = 271). CAR ratio
measured at admission was compared with IRA patency.
Results: The average age of 822 patients was 55±12, and 84.3% (693) of the patients were male. The mean CAR level
of the patients was determined as 0.26 (0.08-0.48). CAR level was statistically significantly higher in TIMI flow 0-1 group
when compared to TIMI flow 2-3 group [0.31 (0.09-0.51) vs 0.23 (0.06-0.42); p<0.001]. In the multivariate logistic regression
analysis a significant relation was found between CAR (odds ratio [OR]:1.56, 95% confidence interval [CI]:1.22-1.97,
p<0.001), and neutrophil count (OR:1.72, 95% CI:1.33-2.25, p<0.001) in patients with TIMI flow 0-1
Conclusion: An inflammation-based risk index, CAR measured at admission in patients with anterior STEMI has been
found to be a useful prognostic tool for predicting adverse cardiovascular outcomes. However, this finding needs to be
confirmed in future prospective studies.

Keywords

C-reactive protein/albumin ratio, infarct-related arteries, ST-elevation myocardial infarction

References

• 1- Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation ac te myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012;33:2569–619.
• 2-Zeymer U, Huber K, Fu Y, et al.; for the ASSENT-4 PCI Investigators. Impact of TIMI 3 patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction on clinical outcome: Results from the ASSENT-4 PCI study. Eur Heart J Acute Cardiovasc Care 2012; 1: 136–142.
• 3-Bisoendial RJ, Boekholdt SM, V rgeer M, et al. C-reactive protein is a mediator of cardiovascular disease. Eur Heart J. 2010;31:2087–91.
• 4-Bisoendial RJ, Kast l in JJP, Peters SLM, et al. Effects of CRP infusion on endothelial function and coagulation in normocholesterolemic and hypercholesterolemic subjects. J Lipid Res. 2007;48:952–60.
• 5-Oduncu V, Erkol A, Karabay CY, 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
• 6-Fairclough E, Cairns E, Hamilton J, et al. 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. Clinical medicine. 2009;9(1):30-33.
• 7-Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Annals of surgical oncology. 2015;22(3):803-810.
• 8-Fairclough E, Cairns E, Hamil on J, et al. 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 (Lond). 2009;9:30–3.
• 9-Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann SurgOncol.2015;22:803–10.
• 10-Nallamothu BK, Normand SL, Wang Y, et al. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study. Lancet 2015;385:1114-22.
• 11- Zeymer U, Huber K, Fu Y, et al.; for the ASSENT-4 PCI Investigators. Impact of TIMI 3 patency before primary percutaneous coronary intervention for ST-elevation myocardial infarction on clinical outcome: Results from the ASSENT-4 PCI study. Eur Heart J Acute Cardiovasc Care 2012; 1: 136–142.
• 12-Rakowski T, Dudek D, Dziewierz A, et al. Impact of infarct-related artery patency before primary PCI on outcome in patients with ST-segment elevation myocardial infarction: The HORIZONS-AMI trial. Eurointervention 2013; 8: 1307–1314.
• 13- O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2013; 82:E1-27
• 14-Fefer P, Hod H, Hammerman H, et al. Relation of clinically defined spontaneous reperfusion to outcome in ST-elevation myocardial infarction. Am J Cardiol 2009;103:149-53.
• 15-Rakowski T, Dudek D, Dziewierz A, et al. Impact of infarct-related artery patency before primary PCI on outcome in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. EuroIntervention 2013;8:1307-14.
• 16- Stefanadis C, Diamantopoulos L, Vlachopoulos C, et al. Thermal heterogeneity within human atherosclerotic coronary arteries detected in vivo: a new method of detection by application of a special thermography catheter. Circulation 1999;99:1965-71.
• 17- Fayad ZA, Fuster V, Fallon JT, et al. Noninvasive in vivo human coronary artery lumen and wall imaging using black-blood magnetic resonance imaging. Circulation 2000;102:506-10.
• 18- Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000;101; 1899-1906
• 19-Biasucci LM, D'Onofrio G, Liuzzo G, et al. Intracellular neutrophil myeloperoxidase is reduced in unstable angina and myocardial infarction, but its reduction is not related to ischemia. J Am Coll Cardiol 1996;27:611-6.
• 20-Buffon A, Biasucci LM, Liuzzo G, et al. Widespread coronary inflammation in unstable angina. N Engl J Med 2002;347: 5-12.
• 21-Christopoulos C, Farag M, Sullivan K, et al. Impaired thrombolytic status predicts adverse cardiac events in patients undergoing primary percutaneous coronary intervention. Thromb. Haemost. 2017;117(3): 457–70.
• 22- Kottoor SJ, Arora RR. The utility of anti-inflammatory agents in cardiovascular disease: a novel perspective on the treatment of atherosclerosis. J Cardiovasc Pharmacol Ther. 2018-107424841877854
• 23. Barrett TO, Hennan JK, Marks RM, et al. C-reactive- protein-associated increase in myocardial infarct size after ischemia/reperfusion. J Pharnıacol Exp Ther2002;303: ı 007-13
• 24. Pietila K, Harnıoinen A, Poyhonen L, et al. Intravenous streptokinase treatment and serum C-reactive protein in patients wiıh acute nıyocardial infarction. Br Hearı J 1987;58:225-9
• 25. Pietila K, Harmoinen A, Hermens W, et al. Serum C-reactive protein and infarct size in myocardial infarct patients wiıh a closed versus an open infarct-related coronary arıery after thrombolytic therapy. Eur Heart J 1993; 14:915-9
• 26-Bisoendial RJ, Boekholdt SM, Vergeer M, et al. C-reactive protein is a mediator of cardiovascular disease. European heart journal. 2010;31(17):2087-2091.
• 27- Kurtul A, Murat SN, Yarlioglues M, 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(1):34-40.
• 28- Celik IE, Yarlioglues M, Kurtul A, et al. Preprocedural albumin levels and risk of in-stent restenosis after coronary stenting with bare-metal stent. Angiology. 2016;67(5):478-483.
• 29- Murat SN, Kurtul A, Yarlioglues M. Impact of serum albumin levels on contrast-induced acute kidney injury in patients with acute coronary syndromes treated with percutaneous coronary intervention. Angiology. 2015;66(8):732- 737.
• 30- Doganay B., Okutucu S., Cetin M. Et al Association of Serum Copeptin Levels with Patency of Infarct-Related Arteries in Patients with ST-Segment Elevation Myocardial Infarction. Acta Cardiol Sin 2019;35:360 368 DOI: 10.6515/ACS.201907_35(4).20181101A
• 31- Jing Li, Ying Zhou, Yaowen Zhang et al Admission homocysteine is an independent predictor of spontaneous reperfusion and early infarct-related artery patency before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. Li et al. BMC Cardiovascular Disorders (2018) 18:125 https://doi.org/10.1186/s12872-018-0868-3
• 32- Fairclough E, Cairns E, Hamilton J, et al. 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. 9(1), 30–33 (2009).
• 33- Wada H, Dohi T, Miyauchi K et al. Independent and combined effects of serum albumin and C-reactive protein on long-term outcomes of patients undergoing percutaneous coronary intervention.Circ.J.81(9),1293–1300 (2017).
• 34-Cınar T. Cagdaş M. Rencüzogulları İ. et al Prognostic Efficacy of C-reactive Protein/Albumin Ratio in ST-Elevation Myocardial Infarction. Scand Cardiovasc J DOI: 10.1080/14017431.2019.1590628. Epub 2019 Apr 3.
• 35-Karabag Y, Cagdas M, Rencuzogullari I, et al. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J. Clin. Lab. Anal. 32(7), e22457 (2018).
• 36- Wang W, Ren D, Wang CS et al Prognostic Efficacy of High-Sensitivity C-reactive Protein to Albumin Ratio in Patients With Acute Coronary Syndrome. Biomark Med. 2019 Jul;13(10):811-820. DOI: 10.2217/bmm-2018-0346. Epub 2019 May 30.
• 37- Karabag Y, Cagdas¸ M, Rencuzogullari I, et al. Usefulness of the C-reactive protein/albumin ratio for predicting no-reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur. J. Clin. Invest. 48(6), e12928 (2018).
• 38-Sianos G, Papafaklis MI, Serruys PW. Angiographic thrombus burden classification in patients with ST-segment elevation myo-cardial infarction treated with percutaneous coronary interven-tion. J Invasive Cardiol. 2010;22(10):6B-14B.
• 39-Singh M, Berger PB, Ting HH, et al. Influence of coronary throm-bus on outcome of percutaneous coronary angioplasty in the cur-rent era (the Mayo Clinic experience). Am J Cardiol. 2001; 88(10):1091-1096.