Prognostic Impact of Hyperosmolarity in Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction

Yıl 2015, Cilt: 4 Sayı: 4, 323 - 330, 01.11.2015

Gökhan Çiçek Sadık Kadri Açıkgöz Servet Altay Mehmet Bozbay Mehmet İleri

https://doi.org/10.5505/abantmedj.2015.97720

Öz

Objective: Hyperosmolarity hyp is associated with high mortality rates, yet little is known about its predictive value. The relation between hyperosmolarity and long-term outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention is not known. Method: A total of 2.503 consecutive patients with STEMI undergoing primary angioplasty were retrospectively evaluated. Cutoff value for hyperosmolarity was calculated with receiver–operating characteristic ROC curves. If osmolarity was above the threshold, patients were classified as ‘‘high group’’. If osmolarity was under the threshold, patients were classified as ‘’low group’’. Results: There were 1.669 patients in the low-group mean age 55.3±11.6 years and 834 patients in the high-group mean age 59.1± 12.1 years . Serum osmolarity levels were 295,9 ± 6,01 mosm/l in the high-group and 281,6 ± 6,8 mosm/l in the low-group p < 0.001, respectively . The mean follow-up time was 23 1-54 months. In a multivariate analyses, high-hyp group was an independent predictor of major adverse cardiac events during the longterm follow-up odds ratio 1.72, 95% confidence interval 1.07 to 2.77, p 0.02 . Conclusion: In conclusion, independently of sodium, glucose and BUN, hyperosmolarity is an independent predictor of long-term major adverse cardiac outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.

Anahtar Kelimeler

ST-segment elevation myocardial infarction, primary angioplasty, hyperosmolarity

ST-Yükselmeli Miyokard İnfarktüsü İçin Primer Anjiyoplasti Uygulanan Hastalarda Hiperosmolaritenin Prognoza Etkisi

Öz

Amaç: Hiperosmolarite yüksek mortalite ile ilişkilidir, fakat kestirim değeri ile ilgili çok az şey bilinmektedir. Primer perkütan koroner girişim uygulanan ST-yükselmeli miyokart infarktüsü STYMI hastalarında hiperosmolarite ve uzun dönem sonuçlar arasındaki ilişki bilinmemektedir. Yöntem: Ardışık olarak alınan, primer perkütan girişim planlanan STYMI tanılı 2.503 hasta retrospektif olarak değerlendirildi. Hiperosmolarite için kestirim değeri ROC eğrisi ile elde edildi. Osmolarite eşiği kestirim değerinin üzerindeyse “yüksek grup”, altındaysa “düşük grup” olarak sınıflandırıldı. Bulgular: : Düşük grupta 1.669 hasta ort. yaş 55.3±11.6 , yüksek grupta 834 hasta vardı ort.yaş 59.1± 12.1 . Serum osmolarite seviyeleri yüksek grupta 295,9 ± 6,01 mosm/l, düşük grupta 281,6 ± 6,8 mosm p Yüksek grupta hastane içi ve uzun dönem mortalite anlamlı olarak daha yüksekti 62, 2.4% vs 1.5%, P < 0.001,sırasıyla . Ortalama takip süresi 23 1-54 aydı. Uzun dönem takipte çok değişkenli analiz; büyük olumsuz kardiyak olayları, yüksek hiperosmolarite grubunda bağımsız olarak öngördü olasılık oranı 1.72, 95% güven aralığı 1.07 to 2.77, p 0.02 . Sonuç: Uzun dönem takipte, primer perkütan koroner girişim uygulanan ST-yükselmeli miyokart infarktüslü STYMI hastalarda hiperosmolarite; sodyum, kan şekeri ve kan üre azotu BUN ’ dan bağımsız olarak, büyük olumsuz kardiyak olayları bağımsız olarak öngördürdü.

Anahtar Kelimeler

ST-yükselmeli miyokart infarktüsü, primer anjioplasti, hiperosmolarite

Kaynakça

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