Perkütan Koroner İşlem Sonrası Zayıf TIMI Akımı Olan ST Elevasyonlu Miyokart İnfarktüsü Hastalarında Soluble ST2 ve N Terminal-Pro Brain Natriüretik Peptid Kombinasyonunun Kısa Dönem Mortaliteyi Öngördürebilirlik Değeri

Yıl 2019, Cilt: 22 Sayı: 3, 168 - 176, 24.12.2019

Mustafa Somuncu , Tunahan Akgün Belma Kalaycı Nail Serbest Hüseyin Karakurt Murat Can Ahmet Avcı

Öz

Giriş: ST elevasyonlu miyokart infarktüsü (STEMİ)’nde, soluble ST2 (sST2) ve N Terminal-Pro Brain Natriüretik Peptid (NT-proBNP) seviyelerindeki yükselme net olarak ortaya konmakla birlikte, STEMİ hastalarında, özellikle de başarısız perkütan koroner işlem (PKİ) uygulananlarda, sST2 ve NT-proBNP’nin kombinasyonunun prognostik değerine ait veriler kısıtlıdır. Bu çalışmada, işlem sonrası TIMI akımı düşük olan STEMİ hastalarında sST2 ve NT-proBNP kombinasyonunun kısa dönem mortaliteyi öngördürmesi açısından klinik önemini değerlendirmeyi amaçladık.

Hastalar ve Yöntem: İşlem sonrası düşük TIMI akımı olan 104 hasta çalışmaya dahil edildi. TIMI 3 akım sağlanamaması, işlem sonrası düşük TIMI akım olarak kabul edildi. Çalışma popülasyonu sST2 ve NT-proBNP seviyelerine göre gruplara ayrıldı. Kısa dönem mortalitenin bağımsız prediktörleri araştırıldı.

Bulgular: Otuz günlük mortalite 15 (%14.4) hastada gerçekleşti. Mortalite gerçekleşen hastalarda sST2 (46.9 ± 23.8 ng/mL vs. 32.5 ± 12.0 ng/mL, p= 0.001) ve NT-proBNP (2387.2 ± 2255.5 pg/mL vs. 1217.1 ± 1588.8 pg/mL, p= 0.015) seviyeleri daha yüksekti. Multivaryant regresyon analizi, yüksek serum sST2’nin (odds oranı 5,024, %95 CI 1.132-22.308, p= 0.034) kısa dönem mortaliteyi bağımsız olarak predikte edebildiğini, fakat aynı durumun NT-proBNP için geçerli olmadığını gösterdi (odds oranı 4.059, %95 CI 0.894-18.427, p= 0.070). Buna ek olarak, yüksek sST2 seviyeleri, yüksek NT-proBNP ile kombine edildiğinde 30 günlük mortalite için en yüksek odds oranına ulaşıldı (13.02, %95 CI 5.41-31.23, p< 0.001).

Sonuç: Bu sonuçlar, sST2 ve NT-proBNP kombinasyonunun, işlem sonrası düşük TIMI akım olan STEMİ hastalarında kısa dönem mortalitenin önemli bir
prediktörü olduğunu ortaya koymaktadır.

Anahtar Kelimeler

Beyin natriüretik peptid, no-reflov fenomeni, mortalite, perkütan koroner girişim

The Predictive Value of the Combination of Soluble ST2 and N Terminal-Pro Brain Natriuretic Peptide for Short-Term Mortality in ST-Elevation Myocardial Infarction Patients with Poor PostProcedural TIMI Flow

Öz

Introduction: The increase in soluble ST2 (sST2) and N Terminal-Pro Brain Natriuretic Peptide (NT-proBNP) in ST-elevation myocardial infarction (STEMI) is well established, however, the existing data regarding the combination of sST2 and NT-proBNP values as prognostic markers after STEMI are limited, particularly in the case of those with failed percutaneous coronary intervention (PCI). This study aimed to assess the clinical significance of the sST2 and NT-proBNP combination in predicting short-term mortality in STEMI patients with post-procedural poor thrombolysis in myocardial infarction (TIMI) flow.

Patients and Methods: A total of 104 patients with post-procedural poor TIMI flow were included in the study. Failure to provide a 3 flow grade was accepted as post-procedural poor TIMI flow. The study population was grouped according to the sST2 and NT-proBNP levels. Independent predictors of short-term mortality were investigated.

Results: A 30 day mortality was observed in 15 (14.4%) patients. sST2 (46.9 ± 23.8 ng/mL vs. 32.5 ± 12.0 ng/ mL, p= 0.001) and NT-proBNP (2387.2 ± 2255.5 pg/mL vs. 1217.1 ± 1588.8 pg/mL, p= 0.015) levels were higher in patients with mortality. Multivariate regression analysis concluded that high serum sST2 (OR: 5.024, 95% CI 1.132-22.308, p= 0.034) independently predicted short-term mortality, while NT-proBNP did not (OR: 4.059, 95% CI 0.894-18.427, p= 0.070). Furthermore, when a high sST2 level was combined with a high NT-proBNP level, the odds ratio of the 30-day mortality was found to be the highest (13.02, 95% CI 5.41-31.23, p< 0.001).

Conclusion: These results suggest that the combined sST2 and NT-proBNP level are essential predictors of short-term mortality in STEMI patients with post-procedural poor TIMI flow.

Anahtar Kelimeler

Brain natriuretic peptide, no-reflow phenomenon, mortality, percutaneous coronary intervention

Kaynakça

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