KORONER BT ANJİYOGRAFİDE SAPTANAN KORONER ATEROSKLEROZ DÜZEYİ İLE PROGNOSTİK BESLENME İNDEKSİ ARASINDAKİ İLİŞKİ

Öz

AMAÇ: Koroner kalp hastalığı şüphesi olan kişilerde majör olumsuz kardiyovasküler olayın erken risk tahmini, majör olumsuz olayı önlemeye yardımcı olabilir. Koroner bilgisayarlı tomografi anjiyografi (BTA), koroner aterosklerozu tanımlama yeteneği, plağın morfolojisi ve majör olumsuz kardiyovasküler olay (MACE) risk tahmini değerlendirilmesi için oldukça önemli bir tetkiktir. Lenfosit sayısı ve serum albümin düzeyi parametrelerini kullananarak elde edilen Prognostik beslenme indeksi (PNİ) serum albümin ve lenfosit değerlerine dayalı olarak bireyin hem immünolojik hem de inflamatuar durumunu yansıtan bir belirteçtir. Bu çalışmada, Koroner BTA ile saptanan koroner arter hastalığının derecesi ve prognostik nütrisyon indeksi (PNİ) ile MACE riskinin öngörülmesinde arasındaki ilişkiyi araştırdık. GEREÇ VE YÖNTEM: Koroner BTA tetkiki yapılan 484 hastanın tüm verileri retrospektif olarak incelenmiştir. Koroner arter darlık derecesi %50’den az, %50-%70 darlık ve %70 üzeri olmak üzere sınıflandırıldı. Çalışmaya dahil edilen hastaların kan analizleri incelenerek PNİ = 10 x serum albümini (g/dL) + 0,005 x toplam lenfosit sayısı (mm3 başına) formülü kullanılarak hesaplandı. Çalışmamızda BTA tetkiki yapıldıktan sonraki 1 yıl içinde mortalite gelişmiş olan, SVO veya MI geçiren hastalar MACE gelişip gelişmemesi göre iki gruba ayrıldı. MACE gelişimi ile BTA koroner arter darlık derecesi, albümin seviyesi ve PNI ile karşılaştırılması yapıldı. BULGULAR: MACE gelişimine göre Koroner BTA koroner arter darlık derecesi ve biyobelirteçlerin karşılaştırılması sonucu anlamlı farklılık gösteren parametreler yaş, albumin, PNI düzeyleri idi. Çalışmamız PNI’nın MACE gelişimi ile negatif yönde anlamlı bir ilişki olduğunu göstermiş olup PNI’daki her bir birimlik artışın MACE gelişme riskini yaklaşık %10,5 oranında azalttığını göstermektedir. Koroner BTA'de özellikle LAD’de tüm darlık derecelerinde 1 yıllık MACE gelişimi ile anlamlı ilişki bulunmuş olup %50 ve üzeri darlıklarda MACE gelişimiyle ilişki daha da belirgindi. SONUÇ: Koroner BTA, hedef popülasyonun prognozunu iyileştirmek için erken tanı ve önleyici müdahaleyi sağlamak için MACE’nin risk tahminine önemli bir katkı sağlamaktadır. BTA bulguları ve biyokimyasal belirteçler MACE riskinin öngörülmesinde birlikte değerlendirilmeli; özellikle beslenme durumu, risk yönetiminde göz ardı edilmemelidir. Elde edilen bulgular, MACE riskinin potansiyel tahmininin bütüncül bir yaklaşımla ele alınması gerektiğini vurgulamaktadır.

Anahtar Kelimeler

• Koroner Bilgisayarlı Tomografi Anjiyografi
• Prognostik Nutrisyon İndex
• Major olumsuz kardiyovasküler olay.

RELATIONSHIP BETWEEN CORONARY ATHEROSCLEROSIS LEVEL DETECTED IN CORONARY CT ANGIOGRAPHY AND PROGNOSTIC NUTRITION INDEX

Öz

OBJECTIVE: Early risk prediction of major adverse cardiovascular events in individuals with suspected coronary heart disease may help prevent major adverse events. Coronary computed tomography angiography (CTA) is a crucial examination for its ability to identify coronary atherosclerosis, assess plaque morphology, and predict the risk of major adverse cardiovascular events (MACE). The Prognostic Nutrition Index (PNI), derived from lymphocyte count and serum albumin levels, is a marker reflecting both the immunological and inflammatory status of an individual based on serum albumin and lymphocyte values. In this study, we investigated the relationship between the degree of coronary artery disease detected by coronary CTA and the Prognostic Nutrition Index in predicting the risk of MACE. MATERIAL AND METHODS: All data from 484 patients who underwent coronary CTA were retrospectively analyzed. The degree of coronary artery stenosis was classified as less than 50%, 50%-70% stenosis, and greater than 70%. Blood analyses of the patients included in the study were reviewed, and PNI was calculated using the formula = 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm3). In our study, patients who had mortality within 1 year of CTA and who had a CVA or MI was divided into two groups based on whether they developed MACE. The development of MACE was compared with the degree of coronary artery stenosis on CTA, albumin levels, and PNI. RESULTS: The parameters that showed significant differences in the development of MACE were age, albumin, and PNI levels when comparing the degree of coronary artery stenosis and biomarkers on CTA. Our study demonstrated a significant negative correlation between PNI and the development of MACE, indicating that each unit increase in PNI reduces the risk of MACE by approximately 10.5%. Coronary CTA found a significant association with the development of MACE at 1 year for all degrees of stenosis, particularly in the left anterior desending artery (LAD) . The association was even more pronounced for stenoses of 50% or greater. CONCLUSIONS: Coronary CTA provides a significant contribution to the risk estimation of MACE, enabling early diagnosis and preventive intervention to improve the prognosis of the target population. CTA findings and biochemical markers should be evaluated together in predicting the risk of MACE; nutritional status, in particular, should not be overlooked in risk management. The findings emphasize the need for a holistic approach to estimating the potential risk of MACE.

Anahtar Kelimeler

• Coronary Computed Tomography Angiography
• Prognostic Nutrition Index
• Major Adverse Cardiovascular Event

Kaynakça

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