ST Segment Yükselmesiz Myokard İnfarktüsünde Gensini Skoru İle Elektrokardiyografik Frontal QRS-T Açısı Arasındaki İlişki

Öz

Amaç: Gensini skoruna dayalı risk sınıflandırması, ST Segment Yükselmesiz Myokard İnfarktüsü (NSTEMI) hastalarında erken revaskülarizasyon ihtiyacını belirlemek için önemli bir rol oynamaktadır. Frontal QRS-T açısının [f(QRS-T)] koroner arter hastalığının aterosklerotik yükünü öngörmedeki prediktif rolü, NSTEMI hastalarında STEMI hastalarıyla kıyaslandığında daha belirsizdir. Bu çalışmada NSTEMI hastalarında f(QRS-T) açısı ve Gensini skoru arasındaki ilişkiyi araştırmayı amaçladık. Materyal ve metot: Çalışmaya NSTEMI tanısıyla koroner yoğun bakımda takip edilen 248 hasta dahil edildi. f(QRS-T) açısı, EKG cihazının otomatik analizine göre frontal düzlemde QRS ve T dalgalarının eksenleri arasındaki farkın mutlak değeri olarak hesaplandı. Gensini skoru, birbirinden bağımsız olarak iki kardiyolog tarafından bir Gensini skor hesaplayıcısı kullanılarak hesaplandı. Çalışmaya dahil edilen hastalar düşük Gensini skorlu (≤45) ve yüksek Gensini skorlu (> 45) olmak üzere iki gruba ayrıldı. Bulgular: Sol ventrikül ejeksiyon fraksiyonu (LVEF) Gensini skoru yüksek olan grupta anlamlı derecede düşük saptandı (46,1±8 vs. 53,±7; p<0,001). Hastaların anjiyografik görüntüleri incelendiğinde sorumlu lezyonun en sık LAD'de (P<0.001) olduğu, revaskülarizasyon stratejileri kıyaslandığında ise en sık LAD’ye (P<0.001) yönelik revaskülarizasyon yapıldığı tespit edildi. Çalışmanın primer sonlanım noktası olan f(QRS-T) açısı, Gensini skoru yüksek olan grupta anlamlı derecede daha yüksek saptandı (54±47 vs. 84±54; p<0,001). Tek değişkenli ve çok değişkenli lojistik regresyon analizi sonucuna göre f(QRS-T) açısının yüksek Gensini skoru için bağımsız bir gösterge olduğunu tespit ettik. Receiver-operating characteristic (ROC) analizine göre, NSTEMI hastalarında f(QRS-T) açısının 61,5° üzerinde olması, yüksek Gensini skorlu (>45) hastaları %70 sensitivite ve % 61 spesifite ile öngörmektedir (Şekil 1). Sonuç: NSTEMI hastalarında f (QRS-T) açısının, Gensini skorunu öngörerek erken invaziv girişim ihtiyacını değerlendirmek için yararlı bir yöntem olabileceği bulunmuştur.

Anahtar Kelimeler

• Frontal QRS-T açısı
• Gensini skoru
• NSTEMI

The relationship between Electrocardiographic Frontal QRS-T angle and Gencini score in Non- ST segment elevated Myocardial İnfarction

Öz

Aim: Early risk stratification based on Gensini score plays a crucial role to identify the need for early invasive strategy in patients with NSTEMI. The predictive role of frontal QRS-T angle [f(QRS-T)] on the atherosclerotic burden of coronary artery disease is less clear in NSTEMI patients compared to STEMI patients. In this study, we aimed to investigate the relationship between f(QRS-T) and Gensini score in NSTEMI patients. Material and method: Total of 248 patients with the diagnosis of NSTEMI transferred to coronary care unit were included in the study. f(QRS-T) was calculated as the absolute value of the difference between the frontal plane QRS and T axes based on automatic report of ECG machine. Gensini score was computed using an Gensini score calculator by well-experienced two cardiologists.The study population was divided into two groups based on the low (≤45), and high Gensini score (>45). Results: Left ventricular ejection fraction was significantly lower in the group with high Gensini score (46.1 ± 8 vs. 53,3 ± 7; p <0.001). When the angiographic views was examined and revascularization strategies were compared, it was detected that responsible lesion was seen in LAD most frequently (p<0.001) and revascularization was performed most frequently for LAD (P <0.001). The f(QRS-T) angle, the primary endpoint of the study, were significantly higher in the group with high Gensini score ( 54±47 vs. 84±54; p<0,001). We determined that f(QRS-T) angle is an independent indicator for high Gensini score, based on the univariate and multivariate logistic regression analysis. Based on Receiver-operating characteristic (ROC) analysis, finding f(QRS-T) angle higher than 61.5° in NSTEMI patients predicts patients with high Gensini score (>45) with %70 sensitivity and % 61 specificity. Conclusion: In NSTEMI patients, f(QRS-T) has been found to be a useful decision-making tool to predict Gensini score to assess early invasive strategy.

Anahtar Kelimeler

• Frontal QRS angle
• Gensini score
• NSTEMI

Kaynakça

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