Nötrofil-yüksek yoğunluklu lipoprotein oranı: akut miyokart enfarktüsü hastalarında enfarkt ilişkili arter açıklığının bağımsız bir belirleyicisi

Yıl 2023, Cilt: 4 Sayı: 5, 400 - 405, 27.10.2023

Bekir Demirtaş , Zehra Güven Çetin

https://doi.org/10.47582/jompac.1345407

Öz

Amaç: İnfarkt ilişkili arter (İRA) tanımı, akut miyokard infarktüsü (AMI) sırasında iskemiye neden olan bir trombüs veya aterom tarafından tıkanmış bir koroner arterdir. IRA'nın erken açıklığı, AMI'li hastalarında tedavinin birincil amacıdır. Nötrofil/yüksek yoğunluklu lipoprotein kolesterol (HDL-K) oranı (NHO) yeni bir inflamatuar belirteç olarak kabul edilmiştir. NHO ile işlem öncesi İRA açıklığı arasındaki olası ilişkiyi göstermeyi amaçladık.
Yöntem: 400 hasta tarandı ve 318 dışlama kriterlerinden sonra çalışmaya dahil edildi. Koroner prosedür öncesi İRA akış hızı, daha önce tarif edilen miyokard enfarktüsünde tromboliz sınıflamasına (TIMI) göre belirlendi. TIMI mevcut 0,1 ve 2 hastalar IRA non-patent, TIMI-3 hastalar IRA patent olarak kabul edildi ve iki gruba ayrıldı. IRA açıklığını tahmin etmede olası parametreler için regresyon analizi yapıldı, tek değişkenli analizde değerlendirildi ve p değeri <0,05 olanlar çok değişkenli analizde değerlendirildi.
Bulgular: Ortalama yaş 62,3 ± 11,9 ve %73,4'ü erkekti. Çok değişkenli lojistik regresyon analizinde, yüksek pik troponin (ng/mL) (p<0,001, Odds Ratio (OR): 0,936, %95 Güven Aralıkları (GA): 0,910 - 0,962) ve NHO (p= 0,020, OR: 0,043, %95 GA: 0.003 - 0.603) seviyeleri, patent IRA'nın bağımsız belirleyicileri olarak bulunmuştur.
Sonuç: Çalışmamız, AMİ hastalarında İRA açıklığı ile NHO arasındaki ilişkiyi araştırdık. Araştırmamızın ana bulgusu, yüksek NHR ve pik troponin düzeylerinin, patent olmayan IRA hastalarıyla ilişkili olduğu ve bağımsız belirleyicileri olduğudur.

Anahtar Kelimeler

akut miyokart enfarktüsü, vasküler açıklık, yüksek dansiteli lipoprotein, nötrofil

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Neutrophil-to-high-density lipoprotein ratio: an independent predictor of infarct-related artery patency in patients with acute myocardial infarction

Öz

Aims: The definition of an infarct-related artery (IRA) is a coronary artery occluded by a thrombus or atheroma that causes ischemia during acute myocardial infarction (AMI). Early patency of the IRA is the primary goal of treatment in patients with AMI. The neutrophil/ high-density lipoprotein cholesterol (HDL-C) ratio (NHR) has been recognized as a new inflammatory marker. We aimed to show the possible relationship between NHR and preprocedural IRA patency.
Methods: Four hundred patients were screened, and 318 were included in the study after exclusion criteria. IRA flow rate before the coronary procedure was determined according to the previously described thrombolysis in myocardial infarction (TIMI). TIMI current 0,1 and 2 patients were considered IRA non-patent, and TIMI-3 patients were considered IRA patent and were divided into two groups. Regression analysis was performed for possible parameters in predicting IRA patency, evaluated in univariable analysis, and those with p-value <0.05 were assessed in multivariable analysis.
Results: The mean age was 62.3 ± 11.9 years, and 73.4% were male. In multivariable logistic regression analysis, high peak troponin (ng/mL) (p<0.001, Odds Ratio (OR): 0.936, 95% Confidence Intervals (CIs): 0.910 - 0.962) and NHR (p= 0.020, OR: 0.043, 95% CIs: 0.003 - 0.603) levels were found to be independent predictors of patent IRA.
Conclusion: Our study investigated the relationship between IRA patency and NHR in AMI patients. The main finding of our research is that significantly higher NHR and peak troponin levels were associated with non-patent IRA patients and were independent predictors.

Anahtar Kelimeler

acute myocardial infarction, vascular patency, high-density lipoprotein, neutrophil

Proje Numarası

Yok

Kaynakça

• GBD 2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260-1344.
• Gibson CM. Has my patient achieved adequate myocardial reperfusion?. Circulation. 2003;108(5):504-507.
• Khan AR, Golwala H, Tripathi A, et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J. 2017;38(41):3082-3089.
• Ibánez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol. 2017;70(12):1082.
• Spagnoli LG, Bonanno E, Sangiorgi G, Mauriello A. Role of inflammation in atherosclerosis. J Nucl Med. 2007;48(11):1800-1815.
• Murphy AJ, Woollard KJ, Suhartoyo A, et al. Neutrophil activation is attenuated by high-density lipoprotein and apolipoprotein A-I in in vitro and in vivo models of inflammation. Arterioscler Thromb Vasc Biol. 2011;31(6):1333-1341.
• Hafiane A, Genest J. High density lipoproteins: Measurement techniques and potential biomarkers of cardiovascular risk. BBA Clin. 2015; 3:175-188.
• Chen Y, Jiang D, Tao H, Ge P, Duan Q. Neutrophils to high-density lipoprotein cholesterol ratio as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a retrospective study. BMC Cardiovasc Disord. 2022;22(1):434.
• Gkantzios A, Tsiptsios D, Karapepera V, et al. Monocyte to HDL and neutrophil to HDL ratios as potential ischemic stroke prognostic biomarkers. Neurol Int. 2023;15(1):301-317.
• Kou T, Luo H, Yin L. Relationship between neutrophils to HDL-C ratio and severity of coronary stenosis. BMC Cardiovasc Disord. 2021;21(1):127.
• Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138(20): e618-e651.
• TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312(14):932-936.
• Mehta RH, Harjai KJ, Cox D, et al. Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol. 2003;42(10):1739-1746.
• Doganay B, Okutucu S, Cetin M, et al. Association of serum copeptin levels with patency of infarct-related arteries in patients with ST-segment elevation myocardial infarction. Acta Cardiol Sin. 2019;35(4):360-368.
• Verdoia M, Gioscia R, Viola O, et al. Impact of age on pre-procedural TIMI flow in STEMI patients undergoing primary percutaneous coronary intervention. J Cardiovasc Med. 2023;24(9):631-636.
• Lamas GA, Flaker GC, Mitchell G, et al. Effect of infarct artery patency on prognosis after acute myocardial infarction. The Survival and Ventricular Enlargement Investigators. Circulation. 1995;92(5):1101-1109.
• Stone GW, Cox D, Garcia E, et al. Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation. 2001;104(6):636-641.
• Hashimoto T, Ako J, Nakao K, et al. Pre-procedural thrombolysis in myocardial infarction flow in patients with ST-segment elevation myocardial infarction. Int Heart J. 2018;59(5):920-925.
• Rakowski T, Dudek D, Dziewierz A, et al. Impact of infarct-related artery patency before primary PCI on outcome in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Euro Intervention. 2013;8(11):1307-1314.
• Doğan M, Akyel A, Bilgin M, et al. Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost. 2015;21(2):172-176.
• Maden O, Kacmaz F, Selcuk MT, et al. Relationship of admission haematological indices with infarct-related artery patency in patients with acute ST-segment elevation myocardial infarction treated with primary angioplasty. Coron Artery Dis. 2007;18(8):639-644.
• Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009;54(23):2129-2138.
• Silvestre-Roig C, Braster Q, Ortega-Gomez A, Soehnlein O. Neutrophils as regulators of cardiovascular inflammation. Nat Rev Cardiol. 2020;17(6):327-340.
• Pircher J, Czermak T, Ehrlich A, et al. Cathelicidins prime platelets to mediate arterial thrombosis and tissue inflammation. Nat Commun. 2018;9(1):1523.
• Ganjali S, Momtazi AA, Banach M, Kovanen PT, Stein EA, Sahebkar A. HDL abnormalities in familial hypercholesterolemia: Focus on biological functions. Prog Lipid Res. 2017;67:16-26.
• Ozkan E, Erdogan A, Karagoz A, Tanboğa IH. Comparison of systemic immune-inflammation index and naples prognostic score for prediction coronary artery severity patients undergoing coronary computed tomographic angiography. Angiology. 2023;33197231170979.