ST-segment Yükselmeli Miyokart Enfarktüsünde Kronik Total Oklüzyonu Öngörmede Nötrofil/Lenfosit ve Trombosit/Lenfosit Oranı

Yıl 2022, , 277 - 283, 28.08.2022

Faruk Boyacı Murat Akçay , Teyyar Gökdeniz

https://doi.org/10.35440/hutfd.1070075

Cited By: 2

Öz

Amaç: Nötrofil/lenfosit oranı (NLR) ve trombosit/lenfosit oranı (PLR), yeni sistemik inflamasyon belirteçleri ve olumsuz kardiyovasküler sonuçların öngörücüleridir. Primer perkütan koroner girişim (PCI), akut ST-segment yükselmeli miyokart enfarktüsü (STYME) olan hastalarda etkili bir tedavi stratejisidir. Enfarktla ilişkili olmayan arterde kronik total okluzyon (KTO), bu hastaların %10'unda mevcuttur ve kısa ve uzun dönem morbidite ve mortalite ile ilişkilidir. Biz burada, ST segment yükselmeli miyokard enfarktüslü (STYME) hastalarda NLO ve PLR' nin eşzamanlı kronik total okluzyon (KTO) ile ilişkisini araştırmayı amaçladık.
Materyal ve Metod: STYME ile başvuran ve eşzamanlı başka damarda CTO'su olan ve olmayan toplam yüz doksan hasta alındı. İnflamatuvar belirteçler ve eşzamanlı CTO arasındaki ilişki analiz edildi.
Bulgular: STYME’lü hastalarda eşzamanlı KTO'su olan hastalarda, KTO'su olmayan hastalara kıyasla NLR, PLR, C-reaktif protein (CRP) ve troponin artarken, glomerüler filtrasyon hızı (eGFR), sol ventrikül ejeksiyon fraksiyonu (LVEF) azaldı. Çok değişkenli analizde NLR (p=0,002), PLR (p=0,042), CRP (p=0,002), HT (p<0,001), HL (p=0,002) ve LVEF (p=0,012) parametreleri eşzamanlı CTO için bağımsız öngörücüler olarak bulundu. ROC eğrisi analizinde eşzamanlı CTO’yu sırasıyla NLR ve PLR için (>5.6) ve (> 164) kestirim değerleri saptandı.
Sonuç: Basit ve kolay hesaplanan laboratuvar parametreleri olan PLR ve NLR, STYME'lü hastalarda eşzamanlı CTO'nun öngörülmesine yardımcı olabilmektedir.

Anahtar Kelimeler

STYME, Enfarkt dışı arter kronik total oklüzyonu, Nötrofil/lenfosit oranı (NLR), Trombosit/lenfosit oranı (PLR)

Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Predicting Chronic Total Occlusion in ST-Segment Elevation Myocardial Infarction

Öz

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are new systemic inflammation markers and predictor of adverse cardiovascular outcomes. Approximately 10% of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) have chronic total occlusion (CTO) of the non-infarct-related artery. The presence of concurrent CTO is associated with short- and long-term morbidity and mortality. Here, we aimed to investi-gate the relationship of NLR and PLO with coexistent CTO in STEMI patients.
Materials and Methods: Ninety consecutive STEMI patients with concurrent CTO were included in the study group and 100 STEMI patients without CTO were included in the control group retrospectively. The relationship between inflammatory markers and concurrent CTO in STEMI was analyzed.
Results: STEMI patients with concurrent CTO had increased NLR, PLR, C-reaktive protein and troponin while decreased glomerular filtration rate, left ventricular ejection fraction (LVEF) in comparison with patients without CTO. In multivariate analysis, NLR (p=0.002), PLR (p=0.042), CRP (p=0.002), hypertension (p<0.001), Hyperlipidemia (p=0.002) and LVEF (p=0.012) were found to be the independent predictors for the presence of concurrent CTO. In the ROC (Receiver Operating Characteristic) curve analysis, ≥ 5.6 and ≥ 164 cut-off values were determined for NLR and PLR in detecting concurrent CTO in STEMI.
Conclusions: PLR and NLR, simple and easily calculated laboratory parameters, may permit prediction of concurrent CTO in patients with STEMI.

Key Words: 

Anahtar Kelimeler

STEMI, Non-infarct artery chronic total occlusion, Neutrophil/lymphocyte ratio (NLR), Plate-let/lymphocyte ratio (PLR)

Kaynakça

• Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet. 2003; 361: 13–20.
• Simoons M. L, Clinical Perspectives. Selection of reperfusion therapy for individual patients with evolving myocardial infarction. Eur Heart J. 1997; 18: 1371–81.
• Claessen BE, van der Schaaf RJ, Verouden NJ, Stegenga NK, Engstrom AE, Sjauw KD, et al. Evaluation of the effect of a concurrent chronic total occlusion on long-term mortality and left ventricular function in patients after primary percutaneous coronary intervention. JACC Cardiovasc Interv. 2009; 2: 1128–34.
• van der Schaaf RJ, Vis MM, Sjauw KD, Koch KT, Baan J Jr, Tijssen JGP, et al. Impact of multivessel coronary disease on long-term mortality in patients with ST-elevation myocardial infarction is due to the presence of a chronic total occlusion. Am J Cardiol. 2006; 98: 1165–69.
• Lexis CP, van der Horst IC, Rahel BM, Lexis MAS, Kampinga MA, Gu YL, et al. Impact of chronic total occlusions on markers of reperfusion, infarct size, and longterm mortality: A substudy from the TAPAS-trial. Catheter Cardiovasc Interv. 2011; 77: 484–91.
• Tajstra M, Gasior M, Gierlotka M, Pres D, Hawranek M, Trzeciak P, et al. Comparison of five-year outcomes of patients with and without chronic total occlusion of noninfarct coronary artery after primary coronary intervention for ST-segment elevation acute myocardial infarction. Am J Cardiol. 2012; 109:208–13.
• Claessen BE, Dangas GD, Weisz G, Witzenbichler B, Guagliumi G, Möckel M, et al. Prognostic impact of a chronic total occlusion in a non-infarct-related artery in patients with ST-segment elevation myocardial infarction: 3-year results from the HORIZONS- AMI trial. Eur Heart J. 2012; 33: 768–75.
• Van der Schaaf RJ, Claessen BE, Vis MM, Hoebers LP, Koch KT, Baan J Jr, et al. Effect of multivessel coronary disease with or without concurrent chronic total occlusion on one-year mortality in patients treated with primary percutaneous coronary intervention for cardiogenic shock. Am J Cardiol. 2010; 105: 955-59.
• Bataille Y, Déry JP, Larose E, Déry U, Costerousse O, Rodés-Cabau J, et al. Prevalence, predictors and clinical impact of unique and multiple chronic total occlusion in non-infarct-related artery in patients presenting with ST-elevation myocardial infarction. Heart. 2012; 98: 1732- 37.
• Tamhane UU, Aneja S, Montgomery D, Rogers E-K, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008; 102: 653–57.
• Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005; 115: 3378–84.
• Lindemann S, Kramer B, Seizer P, Gawaz M. Platelets, inflammation and atherosclerosis. Journal of thrombosis and haemostasis. 2007; 5 (Suppl 1): 203– 11.
• Huo Y, Schober A, Forlow SB, Smith DF, Hyman MC, Jung S, et al. Circulating activated platelets exacerbate atherosclerosis in mice deficient in apolipoprotein E. Nat Med. 2003; 9: 61–7.
• Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, et al. American Society of Echocardiography. American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr. 2004; 17: 1086- 119.
• Stone GW, Kandzari DE, Mehran R, Colombo A, Schwartz RS, Bailey S, et al. Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I. Circulation. 2005; 112 (15); 2364-72.
• Botev R, Mallié JP, Couchoud C, Schück O, Fauvel JP, Wetzels JFM, et al. Estimating glomerular filtration rate: Cockcroft-Gault and Modification of Diet in Renal Disease formulas compared to renal inulin clearance. Clin J Am Soc Nephrol. 2009; 4: 899–906.
• Rentrop KP, Thornton JC, Feit F, Van Buskirk M. Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model. Am J Cardiol. 1988; 61: 677–84.
• Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000; 342: 836–43.
• Hatmi ZN, Saeid AK, Broumand MA, Khoshkar SN, Danesh ZF. Multiple inflammatory prognostic factors in acute coronary syndromes: a prospective inception cohort study. Acta Med Iran. 2010; 48: 51–57.
• Oda E, Kawai R, Aizawa Y. Lymphocyte count was significantly associated with hyper-LDL cholesterolemia independently of high-sensitivity C-reactive protein in apparently healthy Japanese Heart Vessels. 2012;27: 377–83.
• Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003; 348: 138–50.
• Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005; 45: 1638–43.
• Azab B, Shah N, Akerman M, T McGinn Jr J. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis. 2012; 34: 326–34.
• Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet to lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012; 23: 265–73.
• Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002; 105: 1135–43.
• Claessen BE, Hoebers LP, van der Schaaf RJ, Kikkert WJ, Engstrom AE, M Vis M, et al. Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction. Heart. 2010; 96: 1968–72.
• Lee HY, Kim JH, Kim BO, Kang YJ, Ahn HS, Hwang MW, et al. Effect of aspiration thrombectomy on microvascular dysfunction in ST-segment elevation myocardial infarction with an elevated neutrophil count. Korean Circ J. 2011; 41: 68–75.
• Buyukkaya E, Karakas MF, Karakas E, Akçay AB, Tanboga IH, Kurt M, et al. Correlation of Neutrophil to Lymphocyte Ratio With the Presence and Severity of Metabolic Syndrome. Clin Appl Thromb Hemost. 2014; 20 (2): 159-63.
• Tasoglu I, Sert D, Colak N, Uzun A, Songur M, Ecevit A. Neutrophil-Lymphocyte Ratio and the Platelet-Lymphocyte Ratio Predict the Limb Survival in Critical Limb Ischemia. Clin Appl Thromb Hemost. 2014; 20 (6): 645-50.
• Totani L, Evangelista V. Platelet-leukocyte interactions in cardiovascular disease and beyond. Arterioscler Thromb Vasc Biol. 2010; 30: 2357–61.
• Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi H-J, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012; 17: 216–22.
• Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013; 17: 391–96.
• Çiçek G, Açıkgoz SK, Bozbay M, Altay S, Uğur M, Uluganyan M, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio combination can predict prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 2015; 66 (5): 441-7.