Prognostic Impact of Hyperosmolarity in Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction

Year 2015, , 323 - 330, 01.11.2015

Gökhan Çiçek Sadık Kadri Açıkgöz Servet Altay Mehmet Bozbay Mehmet İleri

https://doi.org/10.5505/abantmedj.2015.97720

Abstract

Objective: Hyperosmolarity hyp is associated with high mortality rates, yet little is known about its predictive value. The relation between hyperosmolarity and long-term outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention is not known. Method: A total of 2.503 consecutive patients with STEMI undergoing primary angioplasty were retrospectively evaluated. Cutoff value for hyperosmolarity was calculated with receiver–operating characteristic ROC curves. If osmolarity was above the threshold, patients were classified as ‘‘high group’’. If osmolarity was under the threshold, patients were classified as ‘’low group’’. Results: There were 1.669 patients in the low-group mean age 55.3±11.6 years and 834 patients in the high-group mean age 59.1± 12.1 years . Serum osmolarity levels were 295,9 ± 6,01 mosm/l in the high-group and 281,6 ± 6,8 mosm/l in the low-group p < 0.001, respectively . The mean follow-up time was 23 1-54 months. In a multivariate analyses, high-hyp group was an independent predictor of major adverse cardiac events during the longterm follow-up odds ratio 1.72, 95% confidence interval 1.07 to 2.77, p 0.02 . Conclusion: In conclusion, independently of sodium, glucose and BUN, hyperosmolarity is an independent predictor of long-term major adverse cardiac outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.

Keywords

ST-segment elevation myocardial infarction, primary angioplasty, hyperosmolarity

ST-Yükselmeli Miyokard İnfarktüsü İçin Primer Anjiyoplasti Uygulanan Hastalarda Hiperosmolaritenin Prognoza Etkisi

Abstract

Amaç: Hiperosmolarite yüksek mortalite ile ilişkilidir, fakat kestirim değeri ile ilgili çok az şey bilinmektedir. Primer perkütan koroner girişim uygulanan ST-yükselmeli miyokart infarktüsü STYMI hastalarında hiperosmolarite ve uzun dönem sonuçlar arasındaki ilişki bilinmemektedir. Yöntem: Ardışık olarak alınan, primer perkütan girişim planlanan STYMI tanılı 2.503 hasta retrospektif olarak değerlendirildi. Hiperosmolarite için kestirim değeri ROC eğrisi ile elde edildi. Osmolarite eşiği kestirim değerinin üzerindeyse “yüksek grup”, altındaysa “düşük grup” olarak sınıflandırıldı. Bulgular: : Düşük grupta 1.669 hasta ort. yaş 55.3±11.6 , yüksek grupta 834 hasta vardı ort.yaş 59.1± 12.1 . Serum osmolarite seviyeleri yüksek grupta 295,9 ± 6,01 mosm/l, düşük grupta 281,6 ± 6,8 mosm p Yüksek grupta hastane içi ve uzun dönem mortalite anlamlı olarak daha yüksekti 62, 2.4% vs 1.5%, P < 0.001,sırasıyla . Ortalama takip süresi 23 1-54 aydı. Uzun dönem takipte çok değişkenli analiz; büyük olumsuz kardiyak olayları, yüksek hiperosmolarite grubunda bağımsız olarak öngördü olasılık oranı 1.72, 95% güven aralığı 1.07 to 2.77, p 0.02 . Sonuç: Uzun dönem takipte, primer perkütan koroner girişim uygulanan ST-yükselmeli miyokart infarktüslü STYMI hastalarda hiperosmolarite; sodyum, kan şekeri ve kan üre azotu BUN ’ dan bağımsız olarak, büyük olumsuz kardiyak olayları bağımsız olarak öngördürdü.

Keywords

ST-yükselmeli miyokart infarktüsü, primer anjioplasti, hiperosmolarite

References

• Funk GC, Lindner G, Druml W, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med 2010; 36:304–11.
• Darmon M, Timsit J-F, Francais A, et al. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant 2010; 25:2510–5.
• Hoorn EJ, Betjes MGH, Weigel J, et al. Hypernatraemia in critically ill patients: too little water and too much salt. Nephrol Dial Transplant 2008; 23:1562–8.
• O’Neil P, Davies I, Wears R, et al. Elderly female patients in continuing care: Why are they hyperosmolar? Gerontology 1989; 35: 205– 209.
• Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Intern Med 1996; 124:197–203.
• Himmelstein DU, Jones AA, Woolhandler S. Hypernatremic dehydration in nursing home patients: An indicator of neglect. J Am Geriatr Soc 1983; 31:466–471.
• Molaschi M, Ponzetto M, Massaia M, et al. Hypernatremic dehydration in the elderly on admission to hospital. J Nutr Health Aging 1997; 1:156–160.
• Warren JL, Bacon WE, Harris T, et al. The burden and outcomes associated with dehydration among US elderly, 1991. Am J Public Health 1994; 84:1265– 1269.
• Sem Briongos Figuero, Manuel Jiménez-Mena, Javier OrtegaMarcos, et al. Dehydration and serum hyperosmolarity as new predictors of mortality after acute coronary syndrome. International Journal of Cardiology 2014; 172: 472–474.
• Wachtel TJ, Silliman RA, Lamberton P. Prognostic factors in the diabetic hyperosmolar state. J Am Geriatr Soc 1987; 35:737–741.
• Bellodi G, Manicardi V, Malavasi V, et al. Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus. Am J Cardiol 1989; 64: 885–888.
• Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355: 773–778.
• Kosiborod M, Rathore SS, Inzucchi SE, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 2005; 111: 3078– 3086.
• Al Suwaidi J, Reddan DN, Williams K, et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 2002; 106: 974–980.
• Gibson CM, Pinto DS, Murphy SA, et al. Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality. J Am Coll Cardiol 2003; 42: 1535–1543.
• Kirtane AJ, Leder DM, Waikar SS, et al. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol 2005; 45: 1781–1786.
• Sem Briongos Figuero, Manuel Jiménez-Mena, Javier OrtegaMarcos, et al. Dehydration and serum hyperosmolarity as new predictors of mortality after acute coronary syndrome. International Journal of Cardiology 2014;172: 472-474.
• Blanc B, Finch CA, Hallberg L, et al. Nutritional anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser 1968; 405:1-40.
• Guyton AC, Hall JE. Textbook of medical physiology 12th edition. Elsevier London 2010.
• Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two- Dimensional Echocardiograms. J Am Soc Echocardiography 1989; 2: 358-67.
• Chesebro JH, Knatterud G, Roberts R, et al. Thrombolysis In Myocardial Infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen streptokinase. Clinical findings through hospital discharge. Circulation 1987; 76: 142–154.
• Gibson CM, Cannon CP, Murphy SA, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation 2000; 101(2): 125-130.
• Grant PJ, Tate GM, Hughes JR, et al. Does hypernatraemia promote thrombosis? Thromb Res 1985; 40: 393–9.
• Terlecki M1, Bednarek A, Kawecka-Jaszcz K, et al. Acute hyperglycaemia and inflammation in patients with ST segment elevation myocardial infarction. Kardiol Pol. 2013; 71(3):260-7.
• Dorwart WV and Chalmers L. Comparison of methods for calculating serum osmolality form chemical concentrations, and the prognostic value of such calculations. Clin Chem 1975; 21: 190–194.
• Gąsior M, Stasik-Pres G, Pres D et al. Relationship between blood glucose on admission and prognosis in patients with acute myocardial infarction treated with percutaneous coronary intervention. Kardiol Pol. 2007; 65: 1031–1038.
• Bhalla A, Sankaralingam S, Dundas R, et al. Influence of raised plasma osmolality on clinical outcome after acute stroke. Stroke 2000; 31: 2043– 2048.
• Li C, Hu D, Shi X, et al. A multicentre prospective evaluation of the impact of renal insufficiency on in- hospital and long-term mortality of patients with acute ST-elevation myocardial infarction. Chin Med J (Engl) 2015 Jan 5; 128(1):1-6.
• Conte G, Dal Canton A, Terribile M, et al. Renal handling of urea in subjects with persistent azotemia and normal renal function. Kidney Int. 1987; 32: 721–727.
• Usberti M, Federico S, Di Minno G, et al. Effects of angiotensin II on plasma ADH, prostaglandin synthesis, and water excretion in normal humans. Am J Physiol 1985; 248:254–259.
• Aronson D, Mittleman MA and Burger AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med 2004; 116: 466–473.
• Dal Canton A, Fuiano G, Conte G, et al. Mechanism of increased plasma urea after diuretic therapy in uraemic patients. Clin Sci 1985; 68: 255– 261.