Akut Koroner Sendrom ile Başvuran Hastalarda Modifiye Endotelyal Aktivasyon ve Stres İndeksinin (mEASIX) Uzun Dönem Mortaliteyi Öngörmedeki Değeri

Öz

Endotelyal disfonksiyon, inflamasyon ve mikrovasküler hasar, akut koroner sendromun (AKS) gelişim ve ilerlemesinde rol oynayan temel mekanizmalardır. Endotelyal Aktivasyon ve Stres İndeksi (EASIX) ve türevleri endotelyal stresi yansıtan kolay erişilebilir biyobelirteçlerdir. Ancak, C-reaktif proteini içeren modifiye EASIX'in (m-EASIX) prognostik değeri net değildir. Bu çalışmada, EASIX türevi indekslerin prognostik performansı değerlendirildi ve başvuru anındaki mEASIX düzeyinin AKS ile başvuran hastalarda uzun dönem tüm nedenlere bağlı mortalite ile bağımsız ilişkisi araştırıldı. Ocak 2019 ile Şubat 2020 tarihleri arasında üçüncü basamak bir merkezde AKS tanısıyla başvuran erişkin hastalar retrospektif olarak değerlendirildi. Başvuru laboratuvar verileri kullanılarak EASIX, basitleştirilmiş EASIX (s-EASIX) ve modifiye EASIX (m-EASIX) hesaplandı. İndekslerin prognostik performansı ROC analizi, Kaplan–Meier sağkalım eğrileri ve çok değişkenli Cox orantısal risk regresyon analizi ile değerlendirildi. m-EASIX, taburculuk sonrası tüm nedenlere bağlı mortaliteyi öngörmede sayısal olarak en yüksek AUC değerini gösterdi (AUC: 0,730; %95 GA: 0,617–0,843; p<0,001); bunu EASIX (AUC: 0,715) ve s-EASIX (AUC: 0,629) izledi. Bununla birlikte, eşleştirilmiş DeLong karşılaştırmalarında m-EASIX ile EASIX (p=0,809) veya s-EASIX (p=0,158) arasında anlamlı fark saptanmadı. m-EASIX ≥1,21 olan grupta mortalite oranı, m-EASIX <1,21 olan gruba kıyasla anlamlı olarak daha yüksekti (%53,7’ye karşı %11,5; p<0,001). Yaş, hemoglobin düzeyi ve sol ventrikül ejeksiyon fraksiyonu için düzeltme sonrasında yüksek m-EASIX, taburculuk sonrası tüm nedenlere bağlı mortalite ile bağımsız olarak ilişkiliydi (HR: 2,759; %95 GA: 1,109–6,865; p=0,029). Değerlendirilen indeksler arasında m-EASIX sayısal olarak en yüksek AUC değerini göstermekle birlikte, ayırt edici performansı EASIX veya s-EASIX’ten istatistiksel olarak üstün değildi. Klinik kullanıma geçilmeden önce prospektif çalışmalarda doğrulanması gerekmektedir.

Anahtar Kelimeler

• Akut koroner sendrom
• endotelyal disfonksiyon
• EASIX
• mEASIX
• inflamasyon
• mortalite
• risk sınıflandırması

Destekleyen Kurum

Bu çalışma için herhangi bir finansal destek alınmamıştır.

Etik Beyan

Bu çalışma, Bursa Uludağ Üniversitesi Sağlık Araştırmaları Etik Kurulu tarafından onaylanmıştır (Karar No: 2026/312/11-16, Tarih: 10.06.2026). Çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür.

Teşekkür

Teşekkür bulunmamaktadır.

Modified Endothelial Activation and Stress Index (mEASIX) Predicts Long-Term Mortality in Patients with Acute Coronary Syndromes

Öz

Endothelial dysfunction, inflammation, and microvascular injury are key mechanisms involved in the development and progression of acute coronary syndrome (ACS). The Endothelial Activation and Stress Index (EASIX) and its derivatives have emerged as readily available biomarkers of endothelial stress; however, the prognostic value of modified EASIX (m-EASIX), which incorporates C-reactive protein, remains uncertain. This study evaluated the prognostic performance of EASIX-derived indices and investigated whether high admission m-EASIX was independently associated with long-term post-discharge all-cause mortality in patients with ACS. Adult patients admitted with ACS between January 2019 and February 2020 who survived the index hospitalization and were discharged alive were retrospectively identified from a tertiary referral center. EASIX, simplified EASIX (s-EASIX), and m-EASIX were calculated from admission laboratory measurements, and their prognostic performance was evaluated using receiver operating characteristic analysis, Kaplan–Meier survival curves, and multivariable Cox proportional hazards models. Among 102 patients who survived the index ACS hospitalization, 29 (28.4%) died during a mean post-discharge follow-up of 68.2 ± 28.0 months. m-EASIX showed the numerically highest AUC for post-discharge all-cause mortality (AUC 0.730, 95% CI 0.617–0.843; p<0.001), followed by EASIX (AUC 0.715) and s-EASIX (AUC 0.629). However, paired DeLong comparisons showed no significant difference between m-EASIX and EASIX (p=0.809) or between m-EASIX and s-EASIX (p=0.158). Patients with m-EASIX ≥1.21 had significantly higher mortality than those with lower values (53.7% vs. 11.5%; p<0.001). After adjustment for age, hemoglobin concentration, and left ventricular ejection fraction, high m-EASIX remained independently associated with post-discharge all-cause mortality (HR 2.759, 95% CI 1.109–6.865; p=0.029). Among the evaluated indices, m-EASIX showed the numerically highest AUC, although its discriminatory performance was not statistically superior to that of EASIX or s-EASIX. Further prospective validation is required before clinical implementation.

Anahtar Kelimeler

• Acute coronary syndrome
• endothelial dysfunction
• EASIX
• mEASIX
• inflammation
• mortality
• risk stratification

Destekleyen Kurum

No financial support was received for this study.

Etik Beyan

This study was approved by the Bursa Uludağ University Health Research Ethics Committee (Approval Date: 10 June 2026; Decision No: 2026/312/11-16) and was conducted in accordance with the principles of the Declaration of Helsinki.

Teşekkür

The authors have no acknowledgements.

Kaynakça

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