BAŞARILI EPİKARDAL AKIM SAĞLANAN AKUT ST ELEVASYONLU MİYOKARDİYAL ENFARKTÜSLÜ HASTALARDA YETERLİ MİYOKARDİYAL PERFÜZYONU ETKİLEYEN FAKTÖRLER

Abstract

Amaç: Bu çalışmanın amacı, başarılı primer perkütan koroner girişimden (pPKG) sonra akut ST segment yükselmeli miyokard enfarktüslü (STEMI) hastalarda tam ve yetersiz ST segment rezolüsyonlu (STR) hasta grupları arasında çok yönlü parametreleri değerlendirmek ve karşılaştırmak ve STR ile ilişkili ilişkileri belirlemektir. Gereç ve Yöntemler: 888 hasta çalışmaya dahil edildi, hastalar pPKG'den 60-90. Dakikada çekilen elektrokardiyografide STR <%70 ve ≥%70 olmak üzere iki gruba ayrıldı. Kardiyovasküler risk faktörleri ve çeşitli anjiyografik parametreler değerlendirildi ve gruplar arasında karşılaştırıldı. Bulgular: Yetersiz STR'li 346 hasta ve tam STR'li 542 hasta vardı. Çok değişkenli regresyon analizinde sorumlu lezyonun LAD olması (OR=1.768; p=0,048), kapı-tel geçiş süresi (OR=0.993; p=0,033), toplam işlem süresi (OR=0.994; p=<0,001) ve glikoprotein 2b/3a inhibitörü kullanımı (OR=2,135; p=0,013) tam STR için bağımsız risk faktörleri olarak bulundu. Kapı-tel ve toplam işlem süresinin eğri altında kalan alanı 0.668, 0.831, cut-off değeri 58, 52 dakika ve duyarlılık ve özgüllük %63,9, %70,8 ve %63,1, %76,8 olarak belirlendi. Sonuç: pPKG sonunda başarılı akım sağlansa bile işlem süresinin mümkün olduğunca kısa tutulması ve glikoprotein 2b/3a kullanılması miyosit düzeyinde perfüzyonu artırabilen faktörler olarak bulundu.

Keywords

• ST elevasyonlu miyokard enfarktüsü
• TIMI-3 akım
• ST elevasyon rezolüsyonu
• elektrokardiyografi

FACTORS AFFECTING ADEQUATE MYOCARDIAL PERFUSION IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION WITH SUCCESSFUL EPICARDIAL FLOW

Abstract

Aim: The aim of this study was to evaluate and compare multifarious parameters between complete and incomplete ST-segment resolution (STR) patients groups and to identify associates of STR in patients with acute ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). Material and Methods: 888 consecutive patients were divided into two groups according to the STR <70% and ≥70% 60-90 min after pPCI. The cardiovascular risk factors and various angiographic parameters were assessed and compared between the groups. Results: There were 346 patients with incomplete STR and 542 patients with complete STR. In multivariable regression analysis, culprit lesion (LAD) (OR=1.768; p=0.048), door-to-wire crossing time (OR=0.993; p=0.033), total procedure time (OR=0.994; p=<0.001) and glycoprotein 2b/3a inhibitor use (OR=2.135; p=0.013) were found to be independent risk factors for complete STR. The AUC of door-to-wiring and total procedure time for STR prediction was 0.668, 0.831, the cut-off value was 58, 52 min, and the sensitivity and specificity were 63.9%, 70.8%, and 63.1%, 76.8%. Conclusion: Even if the successful flow is achieved at the end of pPCI, keeping the procedure time as short as possible and using glycoprotein 2b/3a are the factors that can increase perfusion at the myocyte level.

Keywords

• ST elevasyonlu miyokard enfarktüsü
• TIMI-3 akım
• ST elevasyon rezolüsyonu
• elektrokardiyografi

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