Çok Damarlı ST Yükselmesiz Miyokard İnfarktüsü Hastalarında Tek Aşamalı ve Çok Aşamalı Koroner Revaskülarizasyonun Mortalite Sonuçları

Abstract

Amaç: Bu çalışmanın amacı, çok damar hastalığı olan ST segment yükselmesiz miyokard enfarktüsü (non-ST segment elevation myocardial infarction, NSTEMI) tanısı aşan hastalarda tek aşamalı perkütan koroner girişim (single-stage percutaneous coronary intervention, SS-PCI) ile çok aşamalı perkütan koroner girişim (multi-stage percutaneous coronary intervention, MS-PCI) stratejilerinin kısa dönem ve uzun dönem mortalite sonuçlarının karşılaştırılmasıdır. Gereç ve Yöntemler: Bu çalışmaya çok damar hastalığı olan NSTEMI tanısı alan (SS-PCI grubunda 71 (%23,8) hasta ve MS-PCI grubunda 227 (%76,2) hasta olmak üzere) ardışık toplam 298 hasta dahil edildi. Mortalite ile ilgili veriler, enstitümüzün sağlık bilgi sisteminden ve ulusal sağlık sicilinden alındı. Bulgular: Hastane içi mortalite oranları tek değişkenli analizde SS-PCI grubunda MS-PCI grubuna göre anlamlı olarak daha yüksek saptamasına rağmen (%14,1 (n=10)’e karşı %4,0 (n=9); p=0,005), çoklu modelde bağımsız olarak genel mortalite ile ilişkili saptanmadı. Mortalite ile ilişkili olarak belirlenen parametreler içerisinde, hemoglobin düşüklüğü (odds raito (OR)=0,485; %95 güven aralığı (GA)=0,332-0,708; p=0,002), No-reflow gelişimi (OR=6,194; %95 GA=1,310-29,300; p=0,021) ,post dilatasyon kullanılmaması (OR=0,287; %95 GA=0,085-0,970; p=0,045) genel mortalitenin bağımsız ön gördürücüleri olarak saptandı. Sonuç: SS-PCI ve MS-PCI stratejileri ile tam koroner revaskülarizasyon uygulanan çok damar hastalığı olan NSTEMI hastalarında total mortalite açısından iki grup arasında anlamlı bir fark saptanmamasına rağmen düşük hemoglobin, No-reflow gelişimi ve post-dilatasyon kullanılmaması mortalitenin bağımsız ön gördürücüleri olarak bulundu.

Keywords

• Çok damarlı koroner arter hastalığı
• sorumlu olmayan lezyon
• ST segment yükselmesiz miyokard enfarktüsü

Mortality Outcomes of Single-staged versus Multi-staged Complete Coronary Revascularization in Multivessel Non-ST Elevation Myocardial Infarction Patients

Abstract

Aim: The aim of this study was to compare the short-term and long-term mortality results of single-stage percutaneous coronary intervention (SS-PCI) and multi-stage percutaneous coronary intervention (MS-PCI) strategies in patients diagnosed with non-ST segment elevation myocardial infarction (NSTEMI) with multivessel disease. Material and Methods: A total of 298 consecutive patients diagnosed with multivessel NSTEMI (71 (23.8%) patients in the SS-PCI group and 227 (76.2%) patients in the MS-PCI group) were included in this study. Data regarding mortality were obtained from the health information system of our institute and national health registry. Results: Although in-hospital mortality rates were found to be significantly higher in univariate analysis in the SS-PCI group compared to the MS-PCI group (14.1% (n=10) vs 4.0% (n=9); p=0.005), it was not independently associated with total mortality in multiple model. Among the parameters predicted mortality determinants, low hemoglobin (odds ratio (OR)=0.485, 95% confidence interval (CI)=0.332-0.708; p=0.002), No-reflow occurrence (OR=6.194, 95% CI=1.310-29.300, p=0.021), not using post dilatation (OR=0.287, 95% CI=0.085-0.970, p=0.045) were independently associated with total mortality. Conclusion: There was no statistical difference in overall mortality between the two study groups in multivessel NSTEMI patients who underwent complete coronary revascularization with the SS-PCI and MS-PCI strategy, while low hemoglobin, No-reflow phenomenon, and not using post-dilatation were found as independent predictors of mortality.

Keywords

• Multivessel coronary artery disease
• non-culprit lesion
• non-ST segment elevation myocardial infarction

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