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

Yıl 2020, Cilt: 17 Sayı: 3, 389 - 396, 25.12.2020

Seçkin Dereli , Mustafa Yenerçağ , Ahmet Kaya

https://doi.org/10.35440/hutfd.759438

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

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