Akut Anterior Miyokard İnfarktüsü Geçiren ve Primer Perkütan Koroner Girişim Uygulanan Hastalarda Sol Ventrikül Apikal Trombüs Oluşumunun Öngördürücüleri: SYNTAX Skorunun Önemi

Yıl 2021, Cilt: 16 Sayı: 3, 316 - 321, 01.11.2021

Mahmut Yılmaz Mehmet Ballı Mustafa Gür

https://doi.org/10.17517/ksutfd.823196

Öz

Amaç: Sol Ventrikül (SV) apikal trombüs oluşumu Anterior Miyokard İnfarktüs (AMİ) geçiren hastalarda SV apikal anevrizma ve sistolik disfonksiyonun eşlik ettiği önemli bir istenmeyen olaydır. SYNTAX skoru koroner arter hastalarında kardiyovasküler mortalite ve morbiditenin önemli bir belirtecidir. Çalışmamızda AMİ geçiren hastalarda SV apikal trombus oluşumu ile SYNTAX skoru ve diğer risk faktörleri arasındaki ilişkiyi araştırdık. Yöntem: AMİ geçiren ve primer perkütan koroner girişim uygulanan ardışık 205 hasta çalışmamıza dahil edildi (Kadın:35/Erkek:170, ortalama yaş: 55.8 ± 9.6 yıl) . Koroner arter hastalığının ciddiyeti SYNTAX skoru ile değerlendirildi. Hastalar apikal trombüs varlığı (n=19) veya yokluğuna (n=186) göre iki gruba ayrıldı.
Sonuç: Apikal trombüs olan grupta sistolik ve diyastolik kan basıncı daha düşük olarak bulundu(p<0.001 her ikisi için). Apikal trombüs saptanan hastalarda SYNTAX skoru daha yüksek Sol Ventriküler Atım Oranı (SVAO)daha düşük olarak saptandı(p<0.001 her ikisi için). Çok değişkenli analizde SYNTAX skoru (p=0.003), düşük sistolik kan basıncı varlığı(p=0.006) ve düşük SVAO(p=0.001)’ın SV apikal trombüs oluşumunu bağımsız olarak öngördürdüğünü saptadık.
Tartışma: Çalışmamızda azalmış SVAO, düşük sistolik kan basıncı ve yüksek SYNTAX skorunun (>18.25) perkütan koroner girişim uygulanan AMİ hastalarında SV trombüs oluşumu açısından bu hasta grubunun yakın takip edilmesi akılcı bir yaklaşım olabilir.

Anahtar Kelimeler

Sol Ventrikül,, Trombüs,, SYNTAX skoru

Predictors Of Left Ventricular Apical Thrombus Formation in Patients With Acute Anterior Myocardial Infarction and Treated Primary Percutaneous Coronary Intervention: Importance of Syntax Score

Öz

Aim: Left ventricular (LV) apical thrombus development is one of the important advers event patients with anterior ST elevation myocardial infarction (STEMI) and accompanies with LV apical aneurysm and systolic dysfunction. SYNTAX score is an important determinant of cardiovascular morbidity and mortality in patients with coronary artery disease. We aimed that the relationship between LV apical thrombus and SYNTAX score and other clinical risk factors patients with anterior STEMI

Methods: A total of 205 consecutive anterior STEMI patients undergoing primary PCI (35 female/ 170 male mean age: 55.8 ± 9.6 years) were included in our study. We assessed the severity and complexity of coronary artery disease by using SYNTAX score. The patients were divided into two groups; patients with apical thrombus (n=19) and patients without apical thrombus(n=186).

Results: We found that systolic and diastolic blood pressure were lower patients with apical thrombus groups. (p<0.001 for both). Syntax score was higher and LV ejection fraction (LVEF) is lower in patients with apical thrombus (p<0.001 for both). We also showed that LV apical thrombus formation was independently associated with lower systolic blood pressure (p=0.006), SYNYAX score (p=0.003), and depressed LVEF (p=0.001).

Conclusion: In this study, impaired LVEF, lower systolic blood pressure and SYNTAX score have been found to be predictors of LV thrombus generation. Patients presenting with anterior myocardial infarction who have high SYNTAX scores (> 18.25) at PPCI should be followed up closely.

Anahtar Kelimeler

Left Ventricul, Thrombus, SYNTAX score

Kaynakça

• 1. Ellen C Keeley , Judith A Boura, Cindy L Grines. Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet. 2006 Feb 18;367(9510):579-88. doi: 10.1016/S0140-6736(06)68148-8.
• 2. Franz-Josef Neumann, Miguel Sousa-Uva, Anders Ahlsson, Fernando Alfonso, Adrian P Banning, Umberto Benedetto, et al. ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, Volume 40, Issue 2, 07 January 2019, Pages 87–165, https://doi.org/10.1093/eurheartj/ehy394
• 3. Duk-Woo Park, Robert M Clare, Phillip J Schulte, Karen S Pieper, Linda K Shaw, Robert M Califf,, et al. Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. JAMA. 2014 Nov 19;312(19):2019-27. doi: 10.1001/jama.2014.15095.
• 4. Yoshihiro Seo, Hiroshi Maeda, Tomoko Ishizu, Toshiyuki Ishimitsu, Shigeyuki Watanabe, Kazutaka Aonuma et al. Peak c-reactive protein concentration correlates with left ventricular thrombus formation diagnosed by contrast echocardiographic left ventricular opacification in patients with a first anterior acute myocardial infarction. Circ J. 2006;70:1290-1296.
• 5. C M O'Connor, R M Califf, E W Massey, D B Mark, D J Kereiakes, R J Candela, et al. Stroke and acute myocardial infarction in the thrombolytic era: Clinical correlates and long-term prognosis. J Am Coll Cardiol. 1990;16:533-540
• 6. F Chiarella, E Santoro, S Domenicucci, A Maggioni, C Vecchio. Predischarge Two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial infarction in the gissi-3 study. The American journal of cardiology. 1998;81:822-827.
• 7. Svein Solheim , Ingebjørg Seljeflot, Ketil Lunde, Reidar Bjørnerheim, Svend Aakhus, Kolbjørn Forfang, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. The American Journal of Cardiology. 2010;106:1197-1200
• 8. Tullio Palmerini, Adriano Caixeta, Philippe Genereux, Ecaterina Cristea, Alexandra Lansky, Roxana Mehran,, et al. Comparison of clinical and angiographic prognostic risk scores in patients with acute coronary syndromes: Analysis from the acute catheterization and urgent intervention triage strategy (acuity) trial. Am Heart J. 2012;163:383-391, 391 e381-385.
• 9.  Gabriel Steg, Stefan K James, Dan Atar, Luigi P Badano, Carina Blömstrom-Lundqvist, Michael A Borger, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC);  ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619.
• 10. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). J Am Med Assoc 2001;285:2486–97
• 11. Craig T January, L Samuel Wann, Joseph S Alpert, Hugh Calkins, Joaquin E Cigarroa, Joseph C Cleveland Jr, et al.   2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:e1–76. doi: 10.1016/j.jacc.2014.03.022. Epub 2014 Mar 28.
• 12. A S Pearlman, J M Gardin, R P Martin, A F Parisi, R L Popp, M A Quinones, et al. Guidelines for optimal physician training in echocardiography. Recommendations of the american society of echocardiography committee for physician training in echocardiography. The American journal of cardiology. 1987;60:158-163
• 13. Georgios Sianos, Marie-Angèle Morel, Arie Pieter Kappetein, Marie-Claude Morice, Antonio Colombo, Keith Dawkins, et al. The syntax score: An angiographic tool grading the complexity of coronary artery disease. Euro Intervention: journal of Euro PCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2005;1:219-227.
• 14. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart. 2012;98:1743-1749.
• 15. R W Asinger, F L Mikell, J Elsperger, M Hodges. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. The New England journal of medicine. 1981;305:297-302
• 16. Azriel B Osherov, Michal Borovik-Raz, Doron Aronson, Yoram Agmon, Michael Kapeliovich, Arthur Kerner,  et al. Incidence of early left ventricular thrombus after acute anterior wall myocardial infarction in the primary coronary intervention era. American heart journal. 2009;157:1074-1080.
• 17. Onat A Kİ, Çetinkaya A, et al. 10 yıllık tek harf çalışması verilerine göre Türk erişkinlerde koroner kökenli ölüm ve olayların prevalansı yüksek türk kardiyoloji Türk Kardiyoloji Dern. Arş. 2001:8-19.
• 18. Scherff F, Vassalli G, Surder D, et al. The syntax score predicts early mortality risk in the elderly with acute coronary syndrome having primary pci. The Journal of invasive cardiology. 2011;23:505-510.
• 19. LeRoy Elazar Rabbani, Carol Waksmonski, Sohah N Iqbal, Jennifer Stant, Robert Sciacca, Mark Apfelbaum,  et al. Determinants of left ventricular thrombus formation after primary percutaneous coronary intervention for anterior wall myocardial infarction. Journal of thrombosis and thrombolysis. 2008;25:141-145.
• 20. C M Gibson, K A Ryan, S A Murphy, R Mesley, S J Marble, R P Giugliano, et al. Impaired coronary blood flow in nonculprit arteries in the setting of acute myocardial infarction. The timi study group. Thrombolysis in myocardial infarction. Journal of the American College of Cardiology. 1999;34:974-982.
• 21. C Vecchio 1, F Chiarella, G Lupi, P Bellotti, S Domenicucci. Left ventricular thrombus in anterior acute myocardial infarction after thrombolysis. A gissi-2 connected study. Circulation 1991;84:512-519.
• 22. R W Asinger, F L Mikell, J Elsperger, M Hodges. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. The New England journal of medicine. 1981;305:297-302
• 23. Nico R Mollet, Steven Dymarkowski, Wim Volders, Jurgen Wathiong, Lieven Herbots, Frank E Rademakers, et al. Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease. Circulation. 2002;106:2873-2876
• 24.Jonathan W Weinsaft , Han W Kim, Anna Lisa Crowley, Igor Klem, Chetan Shenoy, Lowie Van Assche, , et al. Lv thrombus detection by routine echocardiography: Insights into performance characteristics using delayed enhancement cmr. JACC. Cardiovascular imaging. 2011;4:702-712
• 25.Ronak Delewi , Robin Nijveldt, Alexander Hirsch, Constantin B Marcu, Lourens Robbers, Marriela E C J Hassell et al. Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging. European journal of radiology. 2012;81:3900-3904.