Primer Perkütan Koroner Girişim Yapılan ST-Segment Elevasyonlu Miyokard Enfarktüsünde MELD-Albumin Skorunun Prediktif Rolü

Öz

Amaç: Uluslararası normalleştirilmiş oranı (INR) hariç tutan modifiye Model for End-stage Liver Disease (MELD) skoru olan MELD-XI ile INR yerine albumin kullanan yine bir modifiye MELD skoru olan MELD-Albumin skorları karaciğer ve böbrek fonksiyonlarını yansıtır ve mortalitenin belirleyicileridir. Her ne kadar ST segment elevasyonlu miyokard enfarktüsü (STEMI) olan hastalarda MELD skoru çalışılmış olsa da, bu hasta grubunda MELD-XI ve MELD-Albumin skorlarının prediktif değerleri bugüne kadar çalışılmamıştır. Amacımız STEMI hastalarında MELD-XI ve MELD-Albumin skorlarının mortalite üzerine prediktif değerini saptamaktı.
Materyal ve metod: Acil servise başvuran ve primer perkütan koroner girişim (pPKG) uygulanan 1506 ardışık STEMI hastası retrospektif olarak değerlendirildi. Prognoz için değerlendirilen parametreler başta hastane içi ve 12 aylık takipte mortalite ve diğer majör kardiyak olaylar (MACE) kabul edidi. Hastalar MELD-Albumin skoruna göre 5 gruba ayrıldı.
Bulgular: MELD-Albumin ve MELD-XI skorları yüksek olan hastalarda hastane içi ve 12 aylık mortalite anlamlı derecede yüksekti. Çoklu lojistik regresyon analizi ile MELD-XI ve MELD-Albumin skorlarının hastane içi ve 12 aylık mortalitenin öngördürücüleri olduğu tespit edildi. Receiver operating karakteristik analizi ile hem hastane içi hem de 12 aylık mortaliteyi öngördürmede modifiye MELD skorunun eğri altında kalan alanlarının (Area Under The Curve, AUC) MELD-Albumin skorunun AUC’sine göre daha yüksek olduğu saptandı.
Sonuç: MELD-Albumin skoru kolay hesaplanabilen, güvenilir ve pratik bir risk değerlendirme aracıdır. Bu skor, STEMI hastalarında hastane içi ve 12 aylık mortalitenin bağımsız bir ön gördürücüsüdür.

Anahtar Kelimeler: ST segment elevasyonlu miyokard enfarktüsü; Ölüm; Majör istenmeyen kardiyak olaylar; MELD-XI skor; MELD-Albumin skor;

Anahtar Kelimeler

• ST segment elevasyonlu miyokard enfarktüsü
• ölüm
• ; majör istenmeyen kardiyak olaylar
• MELD-XI skor
• MELD-Albumin skor

The Predictive Role of MELD-Albumin Score in ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Öz

Abstract

Background: The Model for End-stage Liver Disease excluding the international normalised ratio (INR, MELD-XI) and modified MELD, which uses albumin in place of the INR (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. Although MELD score has been studied in patients with ST-segment elevation myocardial infarction (STEMI), prognostic value of MELD-XI and MELD-Albumin scores has not been studied in those patients. Our aim was to determine the predictive value of MELD-XI and MELD-Albumin scores on mortality in patients with STEMI.
Materials and Methods: 1506 consecutive STEMI patients who applied to the emergency department and underwent primary percutaneous coronary intervention (PPCI) were evaluated retrospectively. The parameters evaluated for prognosis were primarily mortality and other major cardiac events (MACE) at in-hospital and 12-month follow-up. Patients were stratified into 5 groups according to MELD-Albumin score.
Results: The patients with higher MELD-Albumin and MELD-XI scores had significantly higher in-hospital and long-term mortality. The multiple logistic regression analysis identified the MELD-XI and MELD-Albumin scores as the independent predictors of in-hospital and 12-month mortality. ROC curve analysis showed that area under curve (AUC)s of MELD-Albumin were higher than than MELD-XI AUCs for predicting mortality both in-hospital and at 12-month follow-up.
Conclusions: The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool. This score may be used as an independent predictor of in-hospital and long-term mortality in patients with STEMI.


Key words: ST-elevation myocardial infarction; Mortality; Major adverse cardiac events; MELD-XI score; MELD-Albumin score

Anahtar Kelimeler

• ST-elevation myocardial infarction
• mortality
• ; major adverse cardiac events
• MELD-XI score
• MELD-Albumin score

Kaynakça

1. 1. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe: epidemiological update. Eur Heart J 2013; 34(39): 3028-34.
2. 2. Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, et al. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 2012; 308(10): 998-1006.
3. 3. Steg PG, James SK, Gersh BJ. 2012 ESC STEMI guidelines and reperfusion therapy: Evidence-based recommendations, ensuring optimal patient management. Heart 2013; 99(16): 1156-57.
4. 4. Brkovic V, Dobric M, Beleslin B, Giga V, Vukcevic V, Stojkovic S, et al. Additive prognostic value of the SYNTAX score over GRACE, TIMI, ZWOLLE, CADILLAC and PAMI risk scores in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. The international journal of cardiovascular imaging 2013; 29(6): 1215-28.
5. 5. Chiostri M, Valente S, Crudeli E, Giglioli C, Gensini GF. A new post-PCI scoring system for in-hospital mortality in STEMI patients. J Cardiovasc Med 2010; 11(10): 733-38.
6. 6. Keskin M, Güvenç TS, Hayıroğlu Mİ, Kaya A, Tatlısu MA, Avşar Ş, et al. A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index. J Crit Care 2017; 41: 183-90.
7. 7. Deo SV, Al-Kindi SG, Altarabsheh SE, Hang D, Kumar S, Ginwalla MB, et al. Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score predicts heart transplant outcomes: evidence from the registry of the United Network for Organ Sharing. The Journal of Heart and Lung Transplantation 2016; 35(2): 222-27.
8. 8. Srikureja W, Kyulo NL, Runyon BA, Hu K-Q. MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis. J Hepatol 2005; 42(5): 700-06.

9. 9. Abe S, Yoshihisa A, Takiguchi M, Shimizu T, Nakamura Y, Yamauchi H, et al. Liver dysfunction assessed by model for end-stage liver disease excluding INR (MELD-XI) scoring system predicts adverse prognosis in heart failure. PloS one 2014; 9(6): e100618.
10. 10. Inohara T, Kohsaka S, Shiraishi Y, Goda A, Sawano M, Yagawa M, et al. Prognostic impact of renal and hepatic dysfunction based on the MELD-XI score in patients with acute heart failure. Int J Cardiol 2014; 176(3): 571-73.
11. 11. MORAES ACOd, FONSECA-NETO OCLd. The use of MELD score (Model for end-stage liver disease) and derivatives in cardiac transplantation. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 2018; 31(2).
12. 12. Grimm JC, Magruder JT, Do N, Spinner JA, Dungan SP, Kilic A, et al. Modified model for end-stage liver disease excluding INR (MELD-XI) score predicts early death after pediatric heart transplantation. The Annals of Thoracic Surgery 2016; 101(2): 730-35.
13. 13. Bax JJ, Baumgartner H, Ceconi C, Dean V, Fagard R, Funck-Brentano C, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60(16): 1581-98.
14. 14. Habib S, Berk B, Chang CCH, Demetris AJ, Fontes P, Dvorchik I, et al. MELD and prediction of post–liver transplantation survival. Liver Transpl 2006; 12(3): 440-47.
15. 15. Chokshi A, Cheema FH, Schaefle KJ, Jiang J, Collado E, Shahzad K, et al. Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction. The Journal of Heart and Lung Transplantation 2012; 31(6): 591-600.
16. 16. Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, et al. Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction. Journal of the American College of Cardiology 2013; 61(22): 2253-61.
17. 17. Arai T, Yashima F, Yanagisawa R, Tanaka M, Shimizu H, Fukuda K, et al. Prognostic value of liver dysfunction assessed by MELD-XI scoring system in patients undergoing transcatheter aortic valve implantation. Int J Cardiol 2017; 228: 648-53.
18. 18. Chen Y, Liu YX, Seto WK, Wu MZ, Yu YJ, Lam YM, et al. Prognostic value of hepatorenal function by modified model for end‐stage liver disease (MELD) score in patients undergoing tricuspid annuloplasty. Journal of the American Heart Association 2018; 7(14): e009020.
19. 19. Shibahara S. The heme oxygenase dilemma in cellular homeostasis: new insights for the feedback regulation of heme catabolism. The Tohoku journal of experimental medicine 2003; 200(4): 167-86.
20. 20. Vítek L. The role of bilirubin in diabetes, metabolic syndrome, and cardiovascular diseases. Front Pharmacol 2012; 3: 55.
21. 21. Kim K-M, Kim B-T, Park S-B, Cho D-Y, Je SH, Kim K-N. Serum total bilirubin concentration is inversely correlated with Framingham risk score in Koreans. Arch Med Res 2012; 43(4): 288-93.
22. 22. Şahin Ö, Akpek M, Karadavut S, Coşgun MS, Savaş G, Şarlı B, et al. Relation between Serum Total Bilirubin Levels and Severity of Coronary Artery Disease in Patients with Non ST Elevation Myocardial Infarction. J Am Coll Cardiol 2013; 62(18 Supplement 2): C217-C18.
23. 23. De Caterina R, Husted S, Wallentin L, Agnelli G, Bachmann F, Baigent C, et al. Anticoagulants in heart disease: current status and perspectives. European heart journal 2007; 28(7): 880-913.
24. 24. Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J, Masyuk M, et al. Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance. PloS one 2017; 12(2): e0170987.
25. 25. Biegus J, Zymliński R, Sokolski M, Siwołowski P, Gajewski P, Nawrocka‐Millward S, et al. Impaired hepato‐renal function defined by the MELD XI score as prognosticator in acute heart failure. European journal of heart failure 2016; 18(12): 1518-21.
26. 26. Kırıs T, Avcı E, Çelik A. Combined value of left ventricular ejection fraction and the Model for End-Stage Liver Disease (MELD) score for predicting mortality in patients with acute coronary syndrome who were undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2018; 18(1): 44.
27. 27. Omer FC, Ahmet OA, Ahmet SY, Sinan Ş, Ali RA. Association Between C-Reactive Protein to Albumin Ratio and Left Ventricular Thrombus Formation Following Acute Anterior Myocardial Infarction. Angiology: 3319720933431.
28. 28. Jia Y, Gao Y, Li D, Cao Y, Cheng Y, Li F, et al. Geriatric Nutritional Risk Index Score Predicts Clinical Outcome in Patients With Acute ST-Segment Elevation Myocardial Infarction. The Journal of Cardiovascular Nursing 2020.
29. 29. Killip III T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients. Am J Card 1967; 20(4): 457-64.
30. 30. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, et al. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000; 102(17): 2031-37.