ST Segment Yüksekliği Olmayan Miyokard İnfarktüsü Hastalarında Nötrofil/Lenfosit Oranı ile SYNTAX ve SYNTAX II Skorları Arasındaki İlişkinin Değerlendirilmesi

Öz

Amaç: ST segment yüksekliği olmayan miyokard infarktüsü (NSTEMİ), koroner arter hastalarının (KAH) en sık prezantasyonlarından biridir. Syntax II skoru kompleks KAH olan hastaların mortalitesini predikte etmek için son zamanlarda geliştirilmiş iki anatomik ve altı klinik değişken içeren bir skorlama sistemidir. Nötrofil/lenfosit oranı (NLR) temel olarak bazal inflamatuvar cevabı yansıtan bir parametredir. Bu çalışmada; NSTEMİ hastalarında NLR ile KAH şiddeti arasındaki ilişkiyi Syntax skoru (SS) ve Syntax II skorunu (SSII) kullanarak araştırmak amaçlanmıştır. Materyal ve Metot: Şubat 2015 ile Haziran 2016 tarihleri arasında Kafkas Üniversitesi Tıp Fakültesi’ne başvuran ve koroner anjiyografi (KAG) uygulanan ardışık toplam 271 NSTEMİ hastası çalışmaya dahil edildi. Hastalardan periferik venöz kan alındı ve bu kanlardan NLR dahil bazı kan parametleri, biyokimyasal parametreler ile kardiyak biyobelirteçler çalışıldı. SS ile SSII hesaplandı. Bulgular: Çalışma grubu 194 NSTEMI hastasından (ort. yaş: 65 ± 12; %37.6 bayan hasta) oluştu. Daha öncesine ait SSII ile ilgili sınıflama olmaması nedeni ile hastalar medyan SSII değerine göre 2 gruba bölündü (SS II≤ 31.5 düşük skorlu grup [n = 97] ve >31.5 yüksek skorlu grup [n = 97]). SSII yüksek skorlu grupta NLR, SSII düşük skorlu gruba göre anlamlı olarak daha yüksekti (3.22 (2,30- 4,86) vs 4.05 (2,83-7,21) p=0,004). NLR ile SS arasında korelasyon bulunmazken (r=0.023, p=0.759), NLR ile SSII korele olarak izlendi (r=0.218, p=0.002). NLR’ nin SS ile korelasyonun bulunmayıp SSII ile korelasyonun bulunması nedeni ile NLR’ nin SSII bileşenleri ile korelasyon analizi yapıldı. Yapılan analizinde; NLR, sol ventrikül ejeksiyon fraksiyonu (r=-0.161, p=0.026) ve kreatin klirensi ile ilişkili olduğu izlendi (r=-0.161, p=0.025). Ancak NLR SSII’nin diğer parametrik değişkenleri ile ilişkili değildi. Sonuç: Sonuç olarak çalışmamızda NLR, SS ile ilişkili olmayıp, SSII ile ilişkilidir. Yüksek NLR, SSII yüksek skorlu hastaları predikte edebilir ve SSII’yi predikte etmesi anatomik skor sisteminden ziyade komorbiditeler ile alakalıdır.

Anahtar Kelimeler

• nötrofil/lenfosit oranı; Syntax II skoru; ST segment yüksekliği olmayan miyokard infarktüsü

Assessment of Relationship Between SYNTAX and SYNTAX II Scores and Neutrophil/Lymphocyte Ratio in Patients with Non-ST Segment Elevation Myocardial Infarction

Öz

Aim: Non ST segment elevation myocardial infarction (NSTEMI) is one of the most common presentations of coronary arterial disease (CAD). Syntax II score (SSII) is a recently developed scoring system consisting two anatomical and six clinical variables which is used to predict mortality of patients with complex CAD. Neutrophil/lymphocyte ratio (NLR) basically shows basal inflammatory response. The aim of our study was to evaluate the relationship between NLR and CAD severity using Syntax score (SS) and SSII in NSTEMI patients. Material and Method: Consecutive 271 NSTEMI patients who referred to Kafkas University between February 2015 and June 2016 and underwent coronary angiography have been included in this study. Peripheral venous blood samples were taken from all patients. Hemogram parameters including NLR, biochemical parameters and cardiac biomarkers were evaluated. SS and SSII were calculated from recorded coronary angiograms. Results: The study population consisted of 194 NSTEMI patients. Due to the fact that there was no definitive previous classification of SSII, the patients were divided into 2 groups according to median SSII value. (SSII<31.5 low score group [n=97] and >31.5 high score group [n=97]. NLR was significantly higher at SSII high score group than low score group 3.22 (2.30-4.86) vs 4.05 (2.83-7.21) p=0.004). While there was no correlation between NLR and SS (r=0.023, p=0.759), there was a correlation between NLR and SSII (r=0.218, p=0.002). Therefore correlation analysis was performed between NLR and SSII components. Our analysis demonstrated that there was a correlation between NLR and left ventricular ejection fraction (r=-0.161, p=0.026), as well as between NLR and creatinine clearance (r=-0.161, p=0.025). However, there was no correlation with other parametric components of SSII. Conclusion: Our study demonstrated that there was a correlation between NLR and SSII, but no correlation between NLR and SS. High NLR can predict that patients have high SSII scores, and this prediction is related to comorbidities rather than anatomical score system.

Anahtar Kelimeler

• neutrophil/lymphocyte ratio; Syntax II score,non-ST segment elevation myocardial infarction

Kaynakça

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