AKUT KORONER SENDROMDA SERUM FİBRİNOJEN DÜZEYİ İLE STENT RESTENOZU ARASINDAKİ İLİŞKİ

Yıl 2020, Cilt: 22 Sayı: 1, 71 - 78, 30.04.2020

Muhammed Karadeniz Taner Sarak

https://doi.org/10.24938/kutfd.659050

Öz

Amaç: İn-stent restenoz, koroner arterlere stent implantasyonu sonrası stentli bölgenin aşamalı olarak yeniden daralmasıdır. İlaç salınımlı stentlerin kullanılmaya başlanmasıyla restenoz oranları azalmış olsa da hala majör problem olmaya devam etmektedir. Bu çalışmada akut koroner sendrom nedeniyle koroner anjiyografi yapılan hastalarda in-stent restenozu ile fibrinojen düzeyi arasındaki ilişkiyi araştırmayı amaçladık.

Gereç ve Yöntemler: İki grup arasında yaş, hipertansiyon, diyabetes mellitus, sigara içimi ve sol ventrikül ejeksiyon fraksiyonu açısından fark yoktu (p>0.005, hepsi için). İSR grubunda erkek cinsiyet ve hiperlipidemi oranı İSR olmayan gruba göre daha yüksekti (sırasıyla, p=0.04; 0.007). Biyokimyasal parametrelerden homosistein ve fibrinojen dışında iki grup arasında fark izlenmedi. Serum homosistein ve fibrinojen seviyesi İSR olan grupta İSR olmayan gruba göre istatistiksel olarak anlamlı derecede yüksek saptandı (sırasıyla, p=0.009; 0.032). Dislipidemi, homosistein ve fibrinojen İSR'nin bağımsız prediktörleri olarak saptandı.

Bulgular: Tedavi sonrası WOMAC ağrı, WOMAC tutukluk, WOMAC fonksiyonel durum ve WOMAC toplam skorlarında tedavi öncesi değerlere göre her iki grupta da istatistiksel olarak anlamlı gelişme saptandı (p<0.001). Ancak tedavi sonuçları arasında gruplar arası istatistiki olarak anlamlı fark saptanmadı.

Sonuç: Koroner arter hastalığı nedeniyle çıplak metal stent implante edilmiş hastalarda plazma fibrinojen düzeyi İSR riskini öngörmede yardımcı olabilecek önemli bir biyokimyasal parametre olabilir.

Anahtar Kelimeler

koroner arter hastalığı, stent içi restenoz, fibrinojen

The Relationship Between Serum Fibrinogen Level and Stent Restenosis in Patients with Acute Coronary Syndrome

Öz

Objective: In-stent restenosis (ISR) is a gradual re-constriction of the stented area after stent implantation in the coronary arteries. Although the rate of re-stenosis was decreased after using drug-induced stents, it still remains as a major problem. In this study, we aimed to investigate the relationship between ISR and fibrinogen levels in patients undergoing coronary angiography for acute coronary syndrome.

Material and Methods: We enrolled 321 patients with a history of coronary angioplasty who underwent coronary angiography between December 2014 and June 2019. The patients were grouped in two as patients with and without stent restenosis and their biochemical data were analyzed.

Results: There was no difference between the groups in terms of age, hypertension, diabetes mellitus, smoking and left ventricular ejection fraction (p>0.005, for all). Male gender and hyperlipidemia rate were higher in ISR group than non-ISR group (p=0.04; 0.007 respectively). Biochemical parameters were not different between the groups except for homocysteine and fibrinogen. Serum homocysteine and fibrinogen levels were significantly higher in the ISR group than in the non-ISR group (p=0.009; 0.032 respectively). Dyslipidemia, homocysteine and fibrinogen were identified as independent predictors of ISR.

Conclusion: Plasma fibrinogen levels may be an important biochemical parameter in predicting the risk of restenosis in patients with bare metal stents implanted for coronary artery disease.

Anahtar Kelimeler

Coronary artery disease, in-stent restenosis, fibrinogen

Kaynakça

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