Monocyte count to high-density lipoprotein ratio predicts occlusion of the infarct-related artery in STEMI

Öz

 Aim: Patency of infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (pPCI) is associated with better clinical outcomes. However, there were limited data regarding the predictors of IRA patency before pPCI in the setting of STEMI. We intended to evaluate the association of monocyte count to high-density lipoprotein ratio (MHR) with IRA patency in STEMI.

Material and Methods: A total of 726 patients were recruited. IRA patency was determined by the thrombolysis in myocardial infarction (TIMI) flow grade. According TIMI flow grade in the IRA before PCI, the study population was divided into two groups as TIMI 0,1 or 2 group (occluded IRA, n=624) and TIMI 3 group (patent IRA, n=102). Blood samples were collected on admission to calculate MHR. Of all patients, 92 (20.4%) patients revealed pre-pPCI TIMI 3 flow in IRA.

Results: The MHR was significantly higher in occluded IRA group (22.4 ± 5.4 vs 17.8 ± 6.9, P < 0.001). Glucose, troponin I, and platelet to lymphocyte ratio (PLR) levels were also higher in occluded IRA group (P < 0.05). Multivariate regression analysis demonstrated the MHR on admission (odds ratio [OR]: 1.191; 95% confidence interval [CI]: 1.116-1.272, P < 0.001) and pre-hospital use of prasugrel or ticagrelor (OR: 7.045; CI: 1.687-29.414, P = 0.007) as independent predictors of IRA patency.

Conclusion: IRA patency is more frequently found in patients having received fast acting

antiplatelet therapy before pPCI and a higher MHR value independently predicts it.

Anahtar Kelimeler

• monocyte count to high-density lipoprotein ratio,ST-segment elevation myocardial infarction,infarct-related artery patency

Monosit sayısı /yüksek yoğunluklu lipoprotein oranı, STEMI'de enfarktla ilişkili arterin oklüzyonunu öngörür

Öz

Amaç: ST segment yükselmeli miyokard enfarktüsü (STEMI) olan hastalarda, primer perkütan koroner girişim (pPKI) öncesi enfarktüs ilişkili arter acıklığı daha iyi klinik sonuçlar ile ilişkilidir. Bununla birlikte, STEMI ortamında pPKI öncesinde IRA açıklığının öngördürücüleri ile ilgili sınırlı veri vardır. STEMI'de monosit sayısı /yüksek yoğunluklu lipoprotein oranı (MHR) ile enfarktla ilişkili arterin acıklığı arasındaki ilişkiyi değerlendirmek istedik.

Gereç ve Yöntemler: Toplam 726 hasta çalışmaya alındı. IRA açıklığı, miyokard enfarktüsünde tromboliz (TIMI)  akım sınıflaması ile belirlendi. PKI öncesi IRA'da TIMI akım derecesine göre çalışma popülasyonu, TIMI 0,1 veya 2 grup (tıkalı IRA, n=624) ve TIMI 3 grubu (patent IRA, n=102) olmak üzere iki gruba ayrıldı. MHR hesaplamak için basvuruda kan örnekleri toplandı. Tüm hastaların 92'sinde (%20,4) IRA'da pre-pPKI TIMI 3 akımı vardı.

Bulgular: MHR, tıkanan IRA grubunda anlamlı derecede yüksekti (22,4 ± 5,4'e karşılık 17,8 ± 6,9, P < ,001). Tıkalı IRA grubunda, glikoz, troponin İ ve trombosit/lenfosit oranı (PLR) düzeyleri de yüksekti (P < 0.05). Çok değişkenli regresyon analizinde, başvuru sırasındaki MHR değeri (odds oranı [1,391]; %95 güven aralığı [CI]: 1,116-1,272, P < 0,001) ve prasugrel veya tikagrelorun hastane öncesi kullanımı (OR: 7,045; CI:1,687-29,414, P = 0,007) IRA açıklığının bağımsız öngördürücüleri olarak bulundu.

Sonuçlar: IRA açıklığı, pPKI öncesi hızlı etkili antitrombosit tedavi  alan hastalarda daha sık görülmektedir ve daha düşük bir MHR değeri IRA açıklığını bağımsız bir şekilde tahmin eder.

Anahtar Kelimeler

• monosit sayısı / yüksek yoğunluklu lipoprotein oranı,ST segment yükselmesi miyokard enfarktüsü,infarkla ilişkili arter açıklığı

Kaynakça

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