Koroner Arter Ektazisinde İnflamasyon Parametrelerinin Obstrüksiyonla İlişkisi

Öz

Amaç: Koroner arter ektazisi (CAE), asemptomatik vakalardan, stabil anjina pectoris ve hatta akut koroner sendroma kadar geniş bir klinik spektrumda karşımıza çıkabilen bir koroner arter hastalığıdır. CAE, tıkayıcı bir lezyon olmaksızın akut koroner sendromla ortaya çıkabilir. İzole CAE’yi normal koroner arterler ve koroner arter hastalığı ile kıyaslayan birçok çalışma olmasına ragmen obstrüktif tipte lezyonu olan CAE hastaları (obstruktif CAE) daha önce hiç değerlendirmeye alınmamıştır. Biz bu çalışmada obstrüktif CAE hastaları ile izole CAE hastalarını çeşitli inflamatuvar parametreler açısından kıyaslamayı amaçladık.
Materyal ve Metod: Çalışmaya 95 obstrüktif CAE hastası ve 95 yaş ve cinsiyet uyumlu izole CAE hastası dahil olmak üzere toplam 190 hasta dahil edildi. Çalışmada tüm katılımcılar acil servise başvuran ve NSTE-AKS tanısı alan hastalardan oluşturuldu. İki grup arasında Platelet/lenfosit oranı (PLR), Nötrofil/lenfosit oranı (NLR), Monosit / HDL oranı, CRP ve sedimantasyon gibi sistemik inflamatuar parametreler karşılaştırıldı.
Bulgular: CRP değeri, obstrüktif CAE'de izole CAE'ye göre anlamlı olarak yüksek bulundu [sırasıyla, 5.5 (3.0-9.0) mg/L, 4.0 (3.0-6.0) mg/L (p=0.003)]. İzole CAE’ye göre obstrüktif CAE'de PLR değeri anlamlı olarak daha yüksek bulundu [sırasıyla, 120±45, 143±76 (p=0.015)]. Çok değişkenli lojistik regresyon analizinde, yalnızca CRP, CAE'deki tıkanıklığın bağımsız bir öngörücüsü olarak saptandı [OR:1.075 (1.011-1.142), p=0.021].
Sonuç: Bildiğimiz kadarıyla bu çalışma, akut koroner sendromla başvuran CAE hastalarında obstruktif tipte lezyonların inflamatuvar parametrelere etkisini değerlendiren ilk çalışmadır. Bu çalışmada CAE hastalarında obstrüktif koroner arter hastalığı varlığında sistemik inflamasyonun arttığını gösterdik.

Anahtar Kelimeler

• koroner arter ektazisi
• miyokard infarktüsü
• inflamasyon
• CRP

The Relationship of Inflammation Parameters with Obstruction in Coronary Artery Ectasia

Abstract

Background: Coronary artery ectasia (CAE) is a coronary artery disease that can progress in a wide clinical spectrum, from asymptomatic cases to stable angina pectoris or acute coronary syndrome. CAE can present with an acute coronary syndrome without an obstructive lesion. Although many studies comparing isolated CAE with normal coronary arteries and coronary artery disease, CAE patients with obstructive type lesions (obstructive CAE) have never been evaluated. In this study, we aimed to compare obstructive CAE patients and isolated CAE patients in terms of various inflammatory parameters.
Materials and Methods: A total of 190 patients were enrolled, including 95 obstructive CAE patients and 95 age and sex-matched isolated CAE patients. All participants were evaluated in the study consisted of patients admitted to the emergency department and diagnosed with NSTE-ACS. Systemic inflammatory parameters such as Platelet/lymphocyte ratio (PLR), Neutrophil/lymphocyte ratio (NLR), Monocyte/HDL ratio, CRP and sedimentation of the patients, were compared between two groups.
Results: CRP value was found significantly higher in obstructive CAE, compared to isolated CAE [5.5 (3.0-9.0) mg/L, 4.0 (3.0-6.0) mg/L (P=0.003) respectively]. PLR value was found significantly higher in obstructive CAE compared to isolated CAE [143±76, 120±45 (p=0.015) respectively]. In multivariable logistic regression analysis, only CRP was an independent predictor of obstruction in CAE [OR:1.075 (1.011-1.142), p=0.021].
Conclusions: To the best of our knowledge, this study is the first to evaluate the effects of obstructive lesions on inflammatory parameters in patients with CAE presenting with acute coronary syndrome. We have shown that systemic inflammation is increased in the presence of obstructive coronary artery disease in CAE patients.

Keywords

• coronary artery ectasia
• myocardial infarction
• inflammation
• CRP

Kaynakça

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