Determination of the Risk Factors of Vascular Pathology of Coronary Angiography Patients at Appealing, Vital Signs, Comorbid Diseases, Drugs and ECG Findings

Yıl 2018, Cilt: 1 Sayı: 2, 6 - 12, 28.12.2018

Tanju Taşyürek Sinan Karacabey , Erkman Sanrı , Kerem Ali Kabaroğlu Haldun Akoğlu , Özge Onur , Arzu Denizbaşı

Öz

Aim: Patients who applied to our emergency department and had percutaneous coronary intervention (PCI) at the coronary angiography laboratory of the same hospital with acute coronary syndrome (ACS) diagnose, detected coronary artery pathologies and retrospectivaly vital signs, ECG and physical examination findings and medical history (chronic illnesses, drugs and habits) at the time of appication were investigated whether to find a risk ratio.

Material and Methods: Records of adult patients over 18 years of age who were admitted to the emergency service between 01.01.2015 and 31.01.2016 and who underwent PCI in the coronary angiography laboratory were retrospectively screened. A case- control study was prepared, patient who have ACS structured as case and patients who did not have an ACS diagnosis structured as control group.The obtained data were collected and analyzed in five groups as demographic features, chronic diseases and smoking, drugs being used, vital findings and pain type, ECG findings and type of ACS (STEMI, NSTEMI, unstabil angina).

Results: The study group consisted of 108 male patients (77.7%) and 31 female patients (33.3%) (total 139). Five (3.6%) of the patients were arrest and the mean age of the study population was 61.4 years.The median vital findings at the time of admission showed a tendency to mild hypertension with normal range.The rate of patients with typical and atypical angina was 47.5% and 48.9%, respectively.The most common type of ACS was found to be NSTEMI (80%).This was followed by STEMI.In angio results of patients, the vessel with the least occlusion, in other words less than 20%, was detected as LMCA.LAD were detected 79% the vessel obstructed more than 70%. In RCA and Cx, obstruction were observed in values close to this (72 and 68%, respectively).

Conclusion: While advanced age and male sex were statistically significant, other parameters were not statistically significant in terms of prediction of angiographic absence of vessel occlusion and angiographically complete obstruction risk. In our series, no different findings were found in terms of the risk assessments used.

Anahtar Kelimeler

Emergency department, acute coronary syndrome, coronary angiography, STEMI, NSTEMI

Koroner Anjiyografi Hastalarındaki Damar Patolojlerinin Başvuru Anındaki Vital Bulgularının, Hikayesinin, Ek Hastalıklarının, Kullandığı İlaçların ve EKG Bulgularının Oluşturduğu Risk Oranlarının Tespiti

Öz

Amaç: Acil servisimize başvuran ve akut koroner sendrom (AKS) tanısıyla aynı hastanenin koroner anjiyografi laboratuvarında perkütan koroner girişim (PKG) uygulanan hastalarda tespit edilen koroner damar patolojilerini, geriye doğru bakarak hastaların acil servise başvurdukları zaman tespit edilen vital bulguları, fizik muayene sonuçları, EKG bulguları ve özgeçmiş özellikleri (kronik hastalıklar, kullandığı ilaçlar ve alışkanlıklar) ile karşılaştırılarak, bir risk oranı tespit edilip edilemeyeceği araştırılmıştır.

Gereçler ve Yöntem: Çalışmada 01.01.2015 ile 31.01.2016 tarihleri arasında acil servise başvurup, koroner anjiyo laboratuvarında PKG uygulanan, 18 yaş üstü, erişkin hastaların kayıtlar retrospektif olarak taranmıştır. AKS tanısı alan hastalar vaka, almayanlar ise kontrol grubu olarak yapılandırılarak, bir vaka-kontrol çalışması formatı hazırlanmıştır. Elde edilen veriler demografik özellikler, kronik hastalıklar ve sigara kullanımı, kullanılmakta olan ilaçlar, vital bulgular ve ağrı tipi, EKG bulguları ile AKS tipi (ST Elevasyonlu Miyokard İnfarktüsü (STEMI), Non ST Elevasyonlu Miyokard İnfarktüsü (NSTEMI), anstabil anjina) olarak beş grupta toplanmış ve analiz edilmiştir.

Bulgular: Çalışmamızın hasta grubunu 108’i erkek (%77,7), 31’i kadın (%33,3) olmak üzere toplam 139 hasta oluşturmuştur. Hastalardan 5 (%3,6) tanesi arrest haliyle başvurmuş olup, çalışma popülasyonunun ortalama yaşı 61,4 yıldır (p<0.01). Başvuru anındaki medyan vital bulgular normal sınırlarda olmakla beraber hafif hipertansiyona eğilim gözlenmekteydi. Başvuru belirtisi tipik ve atipik anjina ile uyumlu hasta oranı birbirine denkti (%47,5 ve %48,9). AKS tipi incelendiğinde en sık NSTEMI olduğu görüldü (%80). Bunu ikinci sıklıkta STEMI izledi. Hastaların anjiyo sonuçlarında, en az tıkalı olan, bir diğer ifadeyle %20’den az darlık olan damar sol ana koroner arter olarak tespit edildi. %70’den fazla obtrüksüyon tespit edilen damar %79 ile LAD oldu. RCA ve Cx’de buna yakın değerlerde (sırasıyla %72 ve 68) tıkanıklık saptandı.

Sonuç: İleri yaş, erkek cinsiyet varlığı istatistiksel anlamlılık gösterirken diğer parametrelerin anjiyografik olarak damar tıkanıklığı olmaması ile anjiyografide tam tıkanıklık tespit edilmesi riskini öngörmede istatistiksel bir anlamlılık görülmemiştir. Bizim serimizde mevcut kullanılan risk değerlendirmeleri açısından farklı bir bulguya rastlanılmamıştır.

Anahtar Kelimeler

acil servis, akut koroner sendrom, koroner anjiyografi, STEMI, NSTEMI

Kaynakça

• 1. Ölüm Nedeni İstatistikleri, 2015: Türkiye İstatistik Kurumu Haber Bülteni; [updated 24 Mart 2016. Sayı: 21526]. Available from: http://www.tuik.gov.tr/PreHaberBultenleri.do?id=21526.2. Wilson RF M, White CW. Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. . Circulation. 1987;75(4):723-32. .3. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Journal of the American College of Cardiology. 2011;58(24):e44-122.4. Bradley SM, Maddox TM, Stanislawski MA, O'Donnell CI, Grunwald GK, Tsai TT, et al. Normal coronary rates for elective angiography in the Veterans Affairs Healthcare System: insights from the VA CART program (veterans affairs clinical assessment reporting and tracking). Journal of the American College of Cardiology. 2014;63(5):417-26.5. Nichols M TN, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, Rayner M European Cardiovascular Disease Statistics 2012. European Society of Cardiology, Sophia Antipolis: European Heart Network, Brussels; 2012.6. Summary Health Statistics: National Health Interview Survey, 2014 [Available from:https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2014_SHS_Table_A-1.pdf.7. ThomasM.Maddox M,MSc; MaggieA.Stanislawski; GaryK.Grunwald, PhD; StevenM.Bradley,MD, MPH;P.MichaelHo,MD,PhD;ThomasT.Tsai, MD, MSc; ManeshR.Patel, MD; AmneetSandhu, MD ;JavierValle, MD; DavidJ.Magid,MD, MPH; BenjaminLeon,BS; DeepakL.Bhatt, MD; StephanD.Fihn, MD, MPH; JohnS.Rumsfeld,MD,PhD. Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction. JAMA. 2014;312(17):1754-63.8. Harshida Patel AR, Inger Ekman, . Symptoms in acute coronary syndromes: does sex make a difference? . Am Heart J. 2004;148:27-33.9. Peter J. Kudenchuk CM, Jenny S. Martin, RN, Mark Wirkus, W. Douglas Weaver,. Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women (the Myocardial Infarction Triage and Intervention Registry). The American journal of cardiology. 1996;78:9-14.10. Diercks DB PW, Hiestand BC, Chen AY, Pollack CV Jr, Kirk JD, Smith SC Jr, Gibler WB, Ohman EM, Blomkalns AL, Newby LK, Hochman JS, Peterson ED, Roe MT. . Frequency and consequences of recording an electrocardiogram .10 minutes after arrival in an emergency room in non-ST-segment elevation acute coronary syndromes (from the CRUSADE initiative). . The American journal of cardiology. 2006;97:437–42.11. Mehta LS BT, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK on behalf of the American Heart Association Cardiovascular Disease in Women and Special Populations Committee of the Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research. Acute Myocardial Infarction in Women A Scientific Statement From the American Heart Association. Circulation. 2016;133:XXX–XXX.12. Moo-Sik Lee AJF, Hyun-Soo Kim, Jee-Young Hong, Jing Li, Ryan J. Lennon, Amir Lerman The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry. J Prev Med Public Health 2014; 47(4):216-29.13. D'Agostino RB Sr VR, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. . General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743-53.14. Patel MR PE, Dai D,et al. Low diagnostic yield of elective coronary angiography The New England journal of medicine. 2010;362 (10):886-95.15. Lau J IJ, Balk EM, Milch C, Terrin N, Chew PW, Salem D. . Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies. . Ann Emerg Med. 2001;37:453-60.16. Maddox TM, Stanislawski MA, Grunwald GK, Bradley SM, Ho PM, Tsai TT, et al. Nonobstructive coronary artery disease and risk of myocardial infarction. Jama. 2014;312(17):1754-63.17. Savonitto S AD, Granger CB, Morando G, Prando MD, Mafrici A, Cavallini C, Melandri G, Thompson TD, Vahanian A, Ohman EM, Califf RM, Van de Werf F, Topol EJ. . Prognostic value of the admission electrocardiogram in acute coronary syndromes. Jama. 1999;281:707–13.18. Bugiardini R BMC. Angina with “normal”coronary arteries: a changing philosophy. JAMA. 2005;293(4):477-84.19. Patel MR CA, Peterson ED, et al. . Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable anginapatients Suppress ADverse outcomes with Early implementation of the ACC/AHAGuidelines (CRUSADE) initiative. Am Heart J. 2006;152 (4):641-7.20. Roe MT HR, Prosper DM, et al. . Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease: the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT)Trial Investigators. Circulation. 2000;102(10):1101-6.21. Hung M-J CW-J. Comparison of white blood cell counts in acute myocardial infarction patients with significant versus insignificant coronary artery disease. Am J Cardiol 2003;91 (11):1339-42.22. Agewall S BJ, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. . European heart journal. 2016.23. Lars Wallentin LL, Elisabet Ärnström, Steen Husted, Magnus Janzon, Søren Paaske Johnsen, Frederic Kontny, Tibor Kempf, Lars-Åke Levin, Bertil Lindahl, Mats Stridsberg, Elisabeth Ståhle, Per Venge, Kai C Wollert, Eva Swahn, Bo Lagerqvist, for the FRISC-II study group Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II): 15 year follow-up of a prospective, randomised, multicentre study.