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Primer perkütan koroner girişim uygulanan ST yükselmeli miyokart enfarktüslü hastalarda sol ventrikül ejeksiyon fraksiyonu ve HAS-BLED skoru kombinasyonunun mortaliteyi öngördürücü değeri

Yıl 2018, Cilt: 9 Sayı: 2, 71 - 78, 01.08.2018
https://doi.org/10.22312/sdusbed.423517

Öz

Amaç: HAS-BLED skoru ve sol ventrikül ejeksiyon fraksiyonu (SVEF), akut
koroner sendromlu hastalarda her ikiside klinik sonuçları bağımsız olarak
öngörebilir. Primer percutan koroner girişim (PKG) ile tedavi edilen ST segment
yükselmeli miyokard infarktüsü (STEMI) hastalarında SVEF ve HAS-BLED skoru
kombinasyonlarının  mortaliteyi
öngördürücü değerini araştırdık.



Yöntemler: Primer PKG uygulanan 588 ardışık STEMI hastasını araştırdık. Her hasta
için HAS-BLED skorları hesaplandı ve mortalite için öngörü değeri, eğri
altındaki alan (AUC) kullanılarak analiz edildi. Hastalar HAS-BLED skorlarına
göre dört gruba ayrıldı. Onların HAS-BLED skorları çok düşük risk: 0, düşük
risk: 1, orta risk: 2, yüksek risk: ≥ 3 idi. Birincil son nokta toplam
mortaliteydi.



Bulgular: Çok değişkenli cox regresyon analizi ile HAS-BLED skoru (p
<0.001)  ve SVEF (p <0.001) toplam
mortalitenin bağımsız öngördürücüleriydi. Sadece HAS-BLED skoru için toplam
mortalitede AUC 0.71 (% 95 CI: 0.66-0.76) idi. SVEF eklendikten sonra 0.77'ye
(p <0.001) yükseldi. SVEF ve HAS-BLED skorlarının birleştirilmesinin artan
prediktif değeri, net yeniden sınıflandırma iyileştirmesi (NRI =% 27.2, p
<0.001) ve entegre ayrımcılık iyileştirmesi (IDI = 0.061, p <0.001) ile
de gösterildi.



Sonuçlar: SVEF'nin HAS-BLED skoru ile birleştirilmesi, primer PKG uygulanan STEMI
hastalarında tüm nedenlere bağlı mortalite için öngörüydü.

Kaynakça

  • 1. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA et al. TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy. Circulation 2000;102(17):2031-2037.
  • 2. Morrow DA, Antman EM, Parsons L, de Lemos JA, Cannon CP, Giugliano RP, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA 2001;286(11):1356-1359.
  • 3. De Luca G, Suryapranata H, van‘t Hof AWJ, de Boer MJ, Hoorntje JC, Dambrink JH, et al. Prognostic assessment of patients with acute myocardial infarction treated with primary angioplasty: implications for early discharge. Circulation 2004;109(22):2737-2743.
  • 4. Addala S, Grines CL, Dixon SR, Stone GW, Boura JA, Ochoa AB, et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score). The American Journal of Cardiology 2004;93(5):629-632.
  • 5. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, Cox DA, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the CADILLAC risk score. J Am Coll Cardiol. 2005;45(9):1397-1405.
  • 6. Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Eagle KA, Cannon CP, et al. Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the Global Registry of Acute Coronary Events. Arch Intern Med. 2003; 163(19):2345-2355.
  • 7. Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol. 2011;57(2):173-180.
  • 8. Puurunen MK, Kiviniemi T, Schlitt A, Rubboli A, Dietrich B, Karjalainen P, et al. CHADS2, CHA2DS2-VASc and HAS-BLED as predictors of outcome in patients with atrial fibrillation undergoing percutaneous coronary intervention. Thromb Res. 2014;133(4):560-566.
  • 9. Capodanno D, Rossini R, Musumeci G, Lettieri C, Senni M, Valsecchi O, et al. Predictive accuracy of CHA2DS2-VASc and HAS-BLED scores in patients without atrial fibrillation undergoing percutaneous coronary intervention and discharged on dual antiplatelet therapy. Int J Cardiol. 2015;199:319-325.
  • 10. Nikolsky E, Aymong ED, Halkin A, Grines CL, Cox DA, Garcia E, Mehran R, et al. Impact of anemia in patients with acute myocardial infarction undergoing pri¬mary percutaneous coronary intervention: analysis from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial. J Am Coll Cardiol. 2004; 44(3):547-553.
  • 11. Richards AM, Nicholls MG, Troughton RW, et al: Antecedent hypertension and heart failure after myocardial infarction. J Am Coll Cardiol. 2002;39:1182-1188.
  • 12. Romelsjö A, Allebeck P, Andréasson S, Leifman A. Alcohol, mortality and cardiovascular events in a 35 year follow-up of a nationwide representative cohort of 50,000 Swedish conscripts up to age 55. Alcohol Alcohol. 2012;47(3):322-327.
  • 13. Cooper HA, Domanski MJ, Rosenberg Y, Norman J, Scott JH, Assmann SF, McKinlay SM, et al, Magnesium in Coronaries Trial Inv stigators. Acute ST-segment elevation myocardial infarction and prior stroke: an analysis from the Magnesium in Coronaries (MAGIC) trial. Am Heart J. 2004;148(6):1012-1019.
  • 14. Sutton NR, Li S, Thomas L, Wang TY, de Lemos JA, Enriquez JR, Shah RU, et al. The association of left ventricular ejection fraction with clinical outcomes after myocardial infarction: Findings from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With the Guidelines (GWTG) Medicare-linked database. Am Heart J. 2016;178:65-73.
  • 15. Liu KL, Lin SM, Chang CH, Chen YC, Chu PH. Plasma angiopoietin-1 level, left ventricular ejection fraction, and multivessel disease predict development of 1-year major adverse cardiovascular events in patients with acute ST elevation myocardial infarction - a pilot study. Int J Cardiol. 2015;182:155-60.
  • 16. Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2012;33(20):2569-2619.
  • 17.Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 1987;76(1):142-154.
  • 18. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. White H. Third universal definition of myocardial infarction. Circulation 2012;126(16):2020-2035.
  • 19. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011;123(23):2736-2747. 20. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1998;44(3):837-845.
  • 21. Pencina MJ, D'Agostino RB Sr, Steyerberg EW. Extensions of net reclassificationimprovement calculations to measure usefulness of new biomarkers. Stat Med. 2011;30(1):11-21.
  • 22. Hsieh MJ, Lee CH, Chen CC, Chang SH, Wang CY, Hsieh IC. Predictive performance of HAS-BLED risk score for long-term survival in patients with non-ST elevated myocardial infarction without atrial fibrillation.J Cardiol. 2017;69(1):136-143.
  • 23. Konishi H, Miyauchi K, Tsuboi S, Ogita M, Naito R, Dohi T, Kasai T, et al. Impact of the HAS-BLED score on long-term outcomes after percutaneous coronary intervention. Am J Cardiol. 2015;116(4):527-531. 24. Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, et al. Acute myocardial infarction and renaldysfunction: a high-risk combination. Ann Intern Med. 2002;137(7):563-570. 25. Abougergi MS, Karagozian R, Grace ND, Saltzman JR, Qamar AA. ST Elevation Myocardial Infarction Mortality Among Patients With Liver Cirrhosis: A Nationwide Analysis Across a Decade. J Clin Gastroenterol. 2015;49(9):778-783.
  • 26. Piccolo R, Franzone A, Koskinas KC, Räber L, Pilgrim T, Valgimigli M, et al. Effect of Diabetes Mellitus on Frequency of Adverse Events in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Am J Cardiol. 2016;118(3):345-352.
  • 27. Pancholy SB, Shantha GP, Patel T, Cheskin LJ. Sex differences in short-term and long-term all-cause mortality among patients with ST-segment elevation myocardial infarction treated by primary percutaneous intervention: a meta-analysis. JAMA Intern Med. 2014;174(11):1822-1830.
  • 28. Ng VG, Lansky AJ, Meller S, Witzenbichler B, Guagliumi G, Peruga JZ, et al. The prognostic importance of left ventricular function in patients with ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Eur Heart J Acute Cardiovasc Care. 2014;3(1):67-77.
  • 29. Halkin A, Stone GW, Dixon SR, Grines CL, Tcheng JE, Cox DA, et al. Impact and determinants of left ventricular function in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction. Am J Cardiol. 2005;96(3):325-31.
  • 30. Kim HK, Jeong MH, Ahn Y, Kim JH, Chae SC, Kim YJ, et al. Other Korea Acute Myocardial Infarction Registry Investigators. Hospital discharge risk score system for the assessment of clinical outcomes in patients with acute myocardial infarction (Korea Acute Myocardial Infarction Registry [KAMIR] score). Am J Cardiol. 2011;107(7):965-971.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Tuncay Kiris

Eyup Avci

Aykan Celik Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2018
Gönderilme Tarihi 14 Mayıs 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 9 Sayı: 2

Kaynak Göster

Vancouver Kiris T, Avci E, Celik A. Primer perkütan koroner girişim uygulanan ST yükselmeli miyokart enfarktüslü hastalarda sol ventrikül ejeksiyon fraksiyonu ve HAS-BLED skoru kombinasyonunun mortaliteyi öngördürücü değeri. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2018;9(2):71-8.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.