Elektif koroner girişim sonrası minör miyokardiyal hasar gelişen hastalarda nötrofil lenfosit oranının değerlendirilmesi

Yıl 2019, Cilt: 24 Sayı: 3, 199 - 205, 24.10.2019

Hüseyin Göksülük , İrfan Veysel Düzen

Öz

Amaç: Bu çalışmada elektif perkütan koroner girişim (PKG) geçiren hastalarda nötrofil/lenfosit oranı (NLO) ve minör miyokardiyal hasar (MMH) arasındaki korelasyonu değerlendirmek amaçlanmıştır.

Gereç ve Yöntemler: MMH varlığına göre çalışma popülasyonu iki gruba ayrıldı: MMH (+) grup (n=77) ve MMH (-) grup (n=86). Kardiyak troponin I (cTnI) ve CK-MB prosedürden önce ve işlemden 12 saat sonra ölçüldü. cTnI’nin 0,06 ng/ml’den yüksek olması MMH olarak kabul edildi. Beyaz kan hücresi sayımı ve periferik diferansiyel sayımları işlemden sonra ölçüldü. NLO mutlak nötrofil ve lenfosit sayıları oranlanarak hesaplandı.

Bulgular: Hastalar çoğunlukla erkek (%62) ve ortalama yaş 60 idi. MMH’li hastalarda ortalama NLO’nun daha yüksek olduğu görüldü (MMH’li grupta 5,0 iken MMH’siz grupta 3,6; p=0,003). MMH’li grupta erkek ve hipertansif hasta sayısı daha fazla idi. İşlemden sonra tüm hastalar hesaplanan

NLO tertillerine göre de gruplandırıldı. Daha yüksek tertillerdeki hastalarda MMH daha fazla idi. Çok değişkenli analizde NLO, erkek cinsiyet, tip-C lezyon MMH’nin bağımsız belirleyicileri olarak tespit edildi.

Tartışma ve Sonuç: Çalışmamız NLO’nun elektif PKG sonrası MMH gelişen hastalarda daha yüksek olduğunu göstermektedir.

Anahtar Kelimeler

lenfosit, nötrofil, minör miyokardiyal hasar

An Assessment of the Neutrophil/Lymphocyte Ratio in Patients Developing Minor Myocardial Injury Following Elective Percutaneous Coronary Intervention

Öz

Aim: In this study, we aimed to evaluate the correlation between the neutrophil/lymphocyte ratio (NLR) and minor myocardial injury (MMI) in patients who underwent elective percutaneous coronary intervention (PCI).

Materials and Methods: According to MMI presence, the study population was divided into two groups: the MMI (+) group (n=77) and the MMI (-) group (n=86). Cardiac troponin I (cTnI) and CK-MB were measured before and 12 hours after the procedure. A level of cTnI higher than 0.06 ng/ml was considered MMI. White blood cell counts and peripheral differential counts were measured after the procedure. The NLR was calculated as the ratio between the absolute neutrophil and lymphocyte counts.

Results: Patients were mostly male (62%) with a mean age of 60 years. The patients with MMI were found to have a higher mean NLR (5.0 in the MMI [+] group vs 3.6 in the MMI [-] group, p=0.003). The MMI (+) group included more male and hypertensive patients. After the procedure all patients were also grouped according to the NLR tertiles determined. The higher-tertile patients had a higher MMI prevalence. In the multivariate analysis, NLR, male sex, and type-C lesion were independent predictors of MMI.

Discussion and Conclusion: Our study shows that patients developing MMI following elective PCI exhibit higher NLRs

Anahtar Kelimeler

lymphocyte, minor myocardial injury, neutrophil

Kaynakça

• 1. Califf RM, Abdelmeguid AE, Kuntz RE et al. Myonecrosis after revascularization procedures. J Am Coll Cardiol 1998; 31: 241-51. 2. Klein LW, Kramer BL, Howard E et al. Incidence and clinical significance of transient creatine kinase elevations and the diagnosis of non-Q-wave myocardial infarction associated with coronary angioplasty. J Am Coll Cardiol 1991; 17: 621-626
• 3. Oh JK, Shub C, Ilstrup DM et al. Creatine kinase release after successful percutaneous transluminal coronary angioplasty. Am Heart J 1985; 109: 1225-1231
• 4. Simoons ML, Van den Brand M, Lincoff M et al. Minimal myocardial damage during coronary intervention is associated with impaired outcome. Eur Heart J 1999; 20: 1112–1119.
• 5. Prasad A, Singh M, Lerman A et al. Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term mortality. J Am Coll Cardiol 2006; 48: 1765-1770.
• 6. Nallamothu BK, Chetcuti S, Mukherjee D et al. Prognostic implication of troponin I elevation after percutaneous coronary intervention. Am J Cardiol 2003; 91: 1272-1274.
• 7. Gómez JA, Cequier A, Valero J et al. Minor Myocardial Damage During Percutaneous Coronary Intervention Does Not Affect Long-Term Prognosis. Rev Esp Cardiol 2009; 62: 625-632.
• 8. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999; 340:115–126.
• 9. Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005; 45:1638–1643.
• 10. Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and / or cardiac revascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost 2011;106:591–9.
• 11. Benites-Zapata VA, Hernandez AV, Nagarajan V, et al. Usefulness of neutrophil-to-lymphocyte ratio in risk stratification of patients with advanced heart failure. Am J Cardiol 2015; 115: 57–61.
• 12. Cho KH, Jeong MH, Ahmed K, et al. Value of early risk stratification using hemoglobin level and neutrophil-to-lymphocyte ratio in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2011; 107: 849–56.
• 13. Han YC, Yang TH, Kim DI, et al. Neutrophil to lymphocyte ratio predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circ J 2013; 43: 93–9.
• 14. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395:27e31.
• 15. Cho KI, Ann SH, Singh GB, Her AY, Shin ES. Combined usefulness of the platelet-to-lymphocyte ratio and the neutrophil-to-lymphocyte ratio in predicting the long-term adverse events in patients who have undergone percutaneous coronary intervention with a drug-eluting stent. PLoS One 2015;10:e0133934.
• 16. Kruk M, Przyluski J, Kalinczuk L, Pregowski J, Deptuch T, Kadziela J, Bekta P, Karcz M, Demkow M, Chmielak Z, Witkowski A, Ruzyllo W. Association of non-specific inflammatory activation with early mortality in patients with ST-elevation acute coronary syndrome treated with primary angioplasty. Circ J 2008;72:205e211.
• 17. Bekler A, Erbag G, Sen H, Gazi E, Ozcan S. Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome. Pak J Med Sci 2015; 31: 159–163.
• 18. Yaylak B, Ede H, Baysal E et al. Neutrophil/lymphocyte ratio is associated with right ventricular dysfunction in patients with acute inferior ST-segment elevation myocardial infarction. Cardiol J 2016; 23: 100–106.
• 19. Duffy BK, Gurm HS, Rajagopal V, et al. Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 2006; 97: 993–6.
• 20. Arıkan, R. (2004). Araştırma teknikleri ve rapor hazırlama. Ankara: Asil Yayın
• 21- Sungwook Yua, Hisatomi Arima, Carin Bertmar, Stephen Clarke, Geoffrey Herkes, Martin Krause, Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. Journal of the Neurological Sciences 387 (2018) 115–118
• 22. Kaptoge S, Di Angelantonio E, Pennells L et al. C-reactive protein, fibrinogen, and cardiovascular disease prediction. N Engl J Med 2012; 367: 1310-1320.
• 23. Pearson TA, Mensah GA, Alexander RW et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511.
• 24. Anderson JL, Carlquist JF, Muhlestein JB et al. Evaluation of C-reactive protein, an inflammatory marker, and infectious serology as risk factors for coronary artery disease and myocardial infarction. J Am Coll Cardiol 1998; 32: 35-41.
• 25. Gurm HS, Bhatt DL, Lincoff AM, et al. Impact of preprocedural white blood cell count on long-term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials. Heart 2003;89:1200–4.
• 26. Park JJ, Jang HJ, Oh IY, et al. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013; 111:636–42.
• 27. Pan W, Zhao D, Zhang C, et al. Application of neutrophil/lymphocyte ratio in predicting coronary blood flow and mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. J Cardiol 2015; 66: 9–14.
• 28. Poludasu S, Cavusoglu E, Khan W et al. Neutrophil to lymphocyte ratio as a predictor of long-term mortality in African Americans undergoing percutaneous coronary intervention. Clin Cardiol 2009; 32: E6-E10.
• 29. Mangiacapra F, Barbato E. Clinical implications of platelet-vessel interaction. J Cardiovasc Transl Res 2013;6:310-315.
• 30. Van Tassell BW, Toldo S, Mezzaroma E et al. Targeting interleukin-1 in heart disease. Circulation 2013;128:1910e1923.
• 31. Onsrud M, Thorsby E. Influence of in vivo hydrocortisone on some human blood lymphocyte subpopulations. I. Effect on natural killer cell activity. Scand J Immunol 1981;13:573e579.
• 32. Bressi E, Mangiacapra F, Ricottini E, Cavallari I, Colaiori I, Di Gioia G, Creta A, Di Sciascio G. Relation of Neutrophil to Lymphocyte Ratio With Periprocedural Myocardial Damage in Patients Undergoing Elective Percutaneous Coronary Intervention. Am J Cardiol 2016;118:980-984.