Predictors of Total Occlusion of the Culprit Artery in Low-to-Intermediate Risk NSTEMI-ACS: A Retrospective Study

Abstract

Introduction: In patients with low-to-intermediate risk acute non-ST-elevation myocardial infarction–acute coronary syndrome (NSTEMI-ACS), non-invasive treatments have gained importance. However, these patients may present with a wide spectrum, ranging from microvascular involvement to partial or complete epicardial artery occlusion. Patients with total occlusion of the culprit artery have higher morbidity and mortality rates. Early invasive treatment may reduce these rates. Therefore, early identification of such patients is important. Nonetheless, no specific clinical or laboratory distinguishing factors have been identified. This study aimed to investigate the role of inflammatory markers in identifying patients with total occlusion of the culprit artery among those with low-to-intermediate risk NSTEMI-ACS. Patients and Methods: This retrospective cohort study included patients diagnosed with NSTEMI-ACS who underwent coronary angiography in a tertiary cardiology clinic between January 2018 and December 2019. A total of 276 patients were enrolled, while 32 meeting exclusion criteria were excluded. The remaining patients were classified as those with total occlusion of the culprit artery (n=47) and those without (n=229). Inflammatory markers were compared between groups. Results: Statistically significant differences were found between the groups in terms of neutrophil-to-lymphocyte ratio (NLR) (p=0.01), systemic immune-inflammation index (SII) (p=0.016), and mean platelet volume (MPV) (p=0.028). Conclusion: According to the findings of this study, NLR, SII, and MPV may be useful in determining the presence of total occlusion of the culprit artery in NSTEMI-ACS patients. However, the causal relationship between these parameters and total occlusion remains unclear. Larger, multicenter studies are required to confirm their predictive value and determine the ideal cutoff points.

Keywords

• Non-ST-elevation myocardial infarction
• total occlusion
• neutrophil-to-lymphocyte ratio
• systemic immune-inflammation index
• mean platelet volume

Düşük-orta riskli NSTEMI'de Sorumlu Arterin Total Oklüde Olmasını Belirlemede ki Öngörücüler: Retrospektif Bir Çalışma

Öz

Giriş: Düşük-orta riskli Akut ST-non-elevasyonsuz miyokard infarktüsü-akut koroner sendromlu (NSTEMI-ACS) hastalarda non-invaziv tedaviler önem kazanmaktadır. Ancak düşük-orta riskli NSTEMI-AKS hastaları mikrovasküler tutulumdan parsiyel veya total epikardiyal arter tıkanıklığına kadar değişen bir tablo ile karşımıza çıkabilmektedir. Sorumlu arterinde total obstrüksiyonu olan hastaları artmış morbidite ve mortalite oranlarına sahiptir. Bu hastalarda erken invazif tedavi bu oranların düşürülmesinde etkili olabilir. Dolayısıyla bu hastaların erken dönemde ayırt edilmesi önemli olabilir. Bununla birlikte bu hastaları ayırt edici klinik veya laboratuvar ayırt edici faktör bulunmamaktadır. Bu çalışmada düşük-orta riskli NSTEMI-AKS hastalarda sorumlu arteri total obstrüksiyonu olan hastaları ayırt etmede inflamatuar belirteçlerin rolü araştırıldı. Hastalar ve Yöntem: Retrospektif kohort çalışması olarak tasarlanan çalışmaya Ocak 2018-Aralık 2019 tarihleri arasında üçüncü basamak kardiyoloji kliniğinde NSTEMI-AKS tanısı ile koroner anjiyografi yapılan hastalar dahil edilmiştir. Bu hastaları (n= 276), dışlama kriterleri olan hastalar (n= 32) ekarte edildi. Sonuç olarak sorumlu arteri total oklüzyon olan (n= 47) ve total oklüzyonu olmayan (n= 229) olarak gruplandırılmıştır. İnflamatuvar göstergeler bu gruplar arasında kıyaslanmıştır. Bulgular: Nötrofil lenfosit oranı (NLR) (p= 0.01), sistemik immün inflamasyon indeksi (SII) (p= 0.016) ve ortalama trombosit hacmi (MPV) (p= 0.028) parametleri ile NSTEMI-AKS hastalarında sorumlu arterde total tıkanıklığı olan ve olmayan gruplar arasında istatistiksel olarak fark olduğu saptanmıştır. Sonuç: Bu çalışma sonucunda elde edilen bulgulara göre NLR, SII ve MPV parametrelerinin NSTEMI -AKS hastalarında sorumlu arterin total tıkalı olup olmamasının tespitinde faydalı olabilir. Bu sonucun total tıkanıklık ile neden-sonuç ilişkisi net değildir. Bu parametrelerin öngörücü değerleri ve ideal kesme noktasının tespiti için çok merkezli ve büyük ölçekli araştırmaları gerektirmektedir.

Anahtar Kelimeler

• ST yükselmesiz miyokart infarktüsü
• total oklüzyon
• nötrofil lenfosit oranı
• sistemik immün inflamasyon indeksi
• ortalama trombosit hacmi

Kaynakça

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