Kararsız Angina Pektorisli Hastalarda Ciddiyetin Yeni Bir Belirteci Olarak Trombosit Lenfosit Oranı: Randomize Kontrollü Çift Kör Çalışma

Yıl 2021, Cilt: 11 Sayı: 3, 398 - 403, 01.12.2021

Mustafa Bolatkale Ahmet Çağdaş Acara

Öz

Amaç: Akut Koroner Sendrom (AKS), ST segment yükselmeli miyokard enfarktüsünden kararsız angina pektorise (UAP) kadar geniş bir klinik durum yelpazesini kapsar. UAP, Acil Servis kliniğinde herhangi bir biyobelirteçle tespit edilemez. Trombosit lenfosit oranı (PLR), kardiyak bozukluklarda aşırı trombotik aktiviteyi ve enflamasyonu belirlemek için potansiyel bir işaret olarak gösterilmiştir. Syntax skoru (SXscore), sadece lezyon şiddetini ve kompleksitesini ölçmekle kalmayan, aynı zamanda AKS’li hastalarda mortalite dahil olmak üzere agır kardiyovasküler sonuçları öngören koroner anjiyografiye dayalı anatomik bir skorlama sistemidir. Bu çalışmanın amacı, UAP’lı hastalarda trombosit lenfosit oranı ile SXscore karşılaştırılarak bu hastalarda PLR’nin prediktif değerini ortaya koymaktır.
Materyal ve Metot: Çalışma grubu, acil servise başvuran UAP tanısı alan hastalar ve acil servise’de UAP tanıs alan yetişkin hastalardan oluşturuldu. Kontrol grubu, kronik hastalığı olmayan sağlıklı yetişkinlerden oluşmuştur. Çalışma grubunda AKS şüphesi olan hastalara koroner anjiografi uyguladık ve her hasta için Syntax Skoru hesaplandı. Çalışma ve kontrol grubu arasında PLR seviyeleri karşılaştırıldı ve çalışma grubunun PLR seviyeleri ile Syntax skorları karşılaştırıldı.
Bulgular: Ortalama PLR düzeyleri UAP grubunda 122,89±52,44 ve kontrol grubunda 104,21±22,85 idi (p: 0,005). PLR düzeyi 113,98 olduğunda %55,8 duyarlılığa, %66,7 özgülüğe sahip olarak bulundu ve SXscore ile negatif korelasyon gösterdiği görülüldü (r=- 0,325; p: 0,004).
Sonuç: UAP ile başvuran hastalarda PLR seviyelerinin önemli ölçüde arttığı görüldü. PLR, UAP’ın ciddiyetinin tahmininde yeni bir belirteç olarak düşünülebilir. Ancak koroner vasküler hasarın değerlendirilmesinde etkisiz olduğu görülmüştür.

Anahtar Kelimeler

syntax score;, platelet-lymphocyte oranı;, unstable angina pektoris

Kaynakça

• 1. Finegold JA, Asaria P, Francis DP. Mortality from ischemic heart disease by country, region, and age: statistics from world health organization and united nations. Int J Cardiol 2013;168:934–45.
• 2. Poldervaart JM, Langedijk M, Backus BE. Comparison of the GRACE, HEART and TIMI scores predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol 2017;15:656–61.
• 3. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33:2551–67.
• 4. Leite L, Baptista R, Leitão J, Cochicho J, Breda F, Elvas L, et al. Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. BMC Cardiovasc Disord 2015;15:48–54.
• 5. Mehta RH, Eagle KA. Missed diagnoses of acute coronary syndromes in the emergency room-continuing challenges. N Engl J Med 2000;342:1207–10.
• 6. Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation 2010;122:1756–76.
• 7. Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, et al. For the ROMICAT-II Investigators, Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 2012;4:299–308.
• 8. Kappetein AP, Dawkins KD, Mohr FW, Morice MC, Mack MJ, Russell ME, et al. Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the syntax runin phase. Eur J Cardiothorac Surg 2006;29:486–91.
• 9. Capodanno D, Di Salvo ME, Cincotta G, Miano M, Tamburino C, Tamburino C. Usefulness of the Syntax score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circulation Cardiovasc Intv 2009;2:302–8.
• 10. Capodanno D. Syntax score: reaching optimal revascularisation for complex coronary artery disease. ESC Council for Cardiology Practice 2009;8: N°5.
• 11. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes. J Am Coll Cardiol 2014;64: e139-e228.
• 12. Toprak C, Tabakci MM, Simsek Z, Arslantas U, Durmus HI, Ocal L, et al. Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and longterm adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Postepy Kardiol Interwencyjnej 2015;11:288–97.
• 13. Croce K, Libby P. Intertwining of thrombosis and inflammation in atherosclerosis. Curr Opin Hematol 2007;14:55–61.
• 14. Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J 2013;34:719–28.
• 15. Azab B, Shah N, Akerman M, McGinn Jr JT. Value of platelet/ lymphocyte ratio as a predictor of all-cause mortality after non- STelevation myocardial infarction. J Thromb Thrombolysis 2012;34:326–34.
• 16. Sun XP, Li J, Zhu WW, Li DB, Chen H, Li HW, et al. Impact of platelet-tolymphocyte ratio on clinical outcomes in patients with STsegment elevation myocardial infarction. Angiology 2017;68:346–53.
• 17. Jan Budzianowski, Konrad Pieszko, Paweł Burchardt, Janusz Rzeźniczak, Jarosław Hiczkiewicz. The Role of Hematological Indices in Patients with Acute Coronary Syndrome. Dis Markers 2017;2017:3041565.
• 18. Poldervaart JM, Langedijk M, Backus BE. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol 2017;15:656–61.
• 19. Ataoğlu HE, Yilmaz F, Uzunhasan I, Cetin F, Temiz L, Döventaş YE, et al. Procalcitonin: a novel cardiac marker with prognostic value in acute coronary syndrome. J Int Med Res 2010;38:52–61.
• 20. McCord J, Cabrera R, Lindahl B, Giannitsis E, Evans K, Nowak R, et al. Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department. Circ Cardiovasc Qual Outcomes 2017;10: pii: e003101.
• 21. Birim O, van Gameren M, Bogers AJ, Serruys PW, Mohr FW, Kappetein AP. vasculature predicts outcome of surgery for left main disease. Ann Thorac Surg 2009;87:1097–104.
• 22. Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The relation between atherosclerosis and the neutrophillymphocyte ratio. Clin Appl Thromb Hemost 2016;22:405–11.
• 23. Dutta P, Courties G, Wei Y, Leuschner F, Gorbatov R, Robbins C, et al. Myocardial infarction accelerates atherosclerosis. Nature 2012;487:325–9.
• 24. Gürsoy OM, Karakoyun S, Kalçık M, Gökdeniz T, Yesin M, Gündüz S, et al. Usefulness of novel hematologic inflammatory parameters to predict prosthetic mitral valve. Am J Cardiol 2014;113:860–4.
• 25. Açar G, Kalkan ME, Avci A, Alizade E, Tabakci MM, Toprak C, et al. The relation of platelet-lymphocyte ratio and coronary collateral circulation in patients with stable angina pectoris and chronic total occlusion. Clin Appl Thromb Hemost 2015;21:462–8.
• 26. Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, Mehran R, et al. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol 2011;57:2389–97.
• 27. Kurtul A, Yarlioglues M, Murat SN, Ergun G, Duran M, Kasapkara HA, et al. Usefulness of the platelet-tolymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Am J Cardiol 2014;114:342–7.
• 28. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ergun G, Acikgoz SK, et al. Association of Platelet-to-Lymphocyte Ratio With Severity and Complexity of Coronary Artery Disease in Patients With Acute Coronary Syndromes. Am J Cardiol 2014;114:972–8.
• 29. Bolatkale M, Acara Ahmet Ç. A Novel Index for Prompt Prediction of Severity in Patients with Unstable Angina Pectoris. Emergency Medicine International Volume 2020, Article ID 7651610, 7 pages. https://doi.org/10.1155/2020/7651610
• 30. Acara Ahmet Ç, Bolatkale M. Endothelial Nitric Oxide Level as a Predictor of Coronary Complexity in Patients With Unstable Angina Pectoris. Am J Med Sci 2019;357(6):453−460.