Akut Koroner Sendrom ile Başvuran Hastalarda Çoklu Damar Hastalığı Oranlarının Akut Koroner Sendrom Alt Tiplerine Göre Karşılaştırılması

Year 2023, Volume: 20 Issue: 1, 56 - 61, 27.04.2023

Veysel Tosun , Halil Fedai

https://doi.org/10.35440/hutfd.1204384

Abstract

Amaç: Akut koroner sendromlar (AKS), ST elevasyonlu miyokard enfarktüsü (STEMİ), ST elevasyonsuz miyokard enfarktüsü (NSTEMİ) ve unstabil anjina pektoris (USAP)’ ten oluşan akut damar tıkanıklıkları ile seyreden hastalık grubudur. Bu yazımızda koroner anjiyografi yapılan hastalarda AKS türleri ile çoklu damar hastalığı arasındaki ilişkiyi araştırmayı amaçladık.
Materyal ve metod: Temmuz 2019 ile Eylül 2022 tarihleri arasında AKS tanısı ile koroner anjiyografi yapılan 2048 hasta çalışmaya alındı. Hastaların epikrizlerinin yanında demografik özellikleri, lipit profili ve anjiyografi raporları incelendi. STEMİ, NSTEMİ ve USAP şeklinde 3 grup oluşturularak lipit profilleri ile darlık-tıkanıklık olan damar sayıları kaydedildi.
Bulgular: 522(%25.4) STEMİ, 1116(%54.5) NSTEMİ ve 410(%24.1) USAP çalışmaya alındı. STEMİ grubu, NSTEMİ ve USAP grubuna göre daha gençti (sırasıyla p<0.001 ve p:0.043), sigara içme oranı daha yüksekti (sırasıyla p:0.043 ve p:0.027), daha yüksek LDL-K kolesterol değerlerine sahipti (sırasıyla p:0.040 ve p<0.001). Üç ve üzeri damar hastalığı NSTEMİ ve USAP gruplarına kıyasla en yüksek STEMİ grubunda saptandı (hepsi için p<0.001). LDL-K ve HbA1c değeri ile koroner tıkanıklık-darlık olan damar sayısı arasında zayıf ama pozitif anlamlı bir ilişki mevcuttu (sırasıyla r:0.163, p<0.001; r:0.349, p<0.001); HDL-K ile de negatif bir ilişki mevcuttu (r:-0.111, p:0.001).
Sonuç: STEMİ ile gelen AKS hastalarında çoklu damar hastalığının daha fazla olduğu saptandı.

Keywords

akut koroner sendrom, çoklu damar hastalığı, anjiyografi, revaskülarizasyon

Supporting Institution

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Project Number

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Thanks

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Comparison of Multivessel Disease Rates According to Acute Coronary Syndrome Subtypes in Patients Presenting with Acute Coronary Syndrome

Abstract

Background: Acute coronary syndromes (ACS) which is consist of ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP) are a group of diseases with acute vascular occlusion. In this article, we aimed to investigate the relationship between ACS types and multivessel disease in patients who underwent coronary angiography.
Materials and Methods: A total of 2048 patients with ACS who underwent coronary angiography between July 2019 and September 2022 were included in the study. Demographic characteristics, lipid profile and angiography reports of the patients were examined, as well as epicrisis. Lipid profiles and the number of vessels with critical stenosis- were recorded by forming 3 groups as STEMI, NSTEMI and USAP.
Results: 522 (25.4%) STEMI, 1116 (54.5%) NSTEMI and 410 (24.1%) USAP patients were included in the study. The STEMI group was younger than the NSTEMI and USAP group (p<0.001 and p=0.043, respecti-vely), had a higher smoking rate (p=0.043 and p=0.027, respectively), had higher LDL-C values (p=0.040 and p<0.001, respectively). Three or more vessel disease was detected most in the STEMI group com-pared to the NSTEMI and USAP group (p<0.001, for all). There was a weak but positive significant corre-lation between LDL-C and HbA1c values and the number of vessels with coronary occlusion-stenosis (r:0.163, p<0.001; r:0.349, p<0.001, respectively). there was also negative correlation with HDL-C (r:-111, p=0.001).
Conclusions: Multiple vessel disease was found to be more common in ACS patients presenting with STEMI.

Key Words: Acute coronary syndrome, Multiple vessel disease, Angiography, Revascularization

Keywords

akut koroner sendrom, çoklu damar hastalığı, anjiyografi, revaskülarizasyon

Project Number

yok

References

• 1. Faxon DP, Fuster V, Libby P, Beckman JA, Hiatt WR, Thompson RW, et al. Atherosclerotic Vascular Disease Conference: Writing Group III: pathophysiology. Circulation. 2004; 109:2617-25.
• 2. Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, et al. A definition of advanced types of athe-rosclerotic lesions and a histological classification of athe-rosclerosis. A report from the Committee on Vascular Lesi-ons of the Council on Arteriosclerosis, American Heart Asso-ciation. Circulation. 1995; 92:1355-74.
• 3. Steinberg D, Witztum JL. Oxidized low-density lipoprotein and atherosclerosis. Arterioscler Thromb Vasc Biol. 2010; 30:2311-6.
• 4. Dawber TR, Meadors GF, Moore FE Jr. Epidemiological app-roaches to heart disease: the Framingham Study. Am J Pub-lic Health Nations Health. 1951; 41:279-81.
• 5. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364:937-52.
• 6. Frohlich J, Al-Sarraf A. Cardiovascular risk andatherosclerosis prevention. CardiovascPathol. 2013; 22:16-8.
• 7. Mehta SR, Bossard M. Acute Coronary Syndromes and Mul-tivessel Disease: Completing the Evidence. JACC Cardiovasc Interv. 2020; 13:1568-70.
• 8. Roberts WC, Virmani R. Quantification of coronary arterial narrowing in clinically-isolated unstable angina pectoris. An analysis of 22 necropsy patients. Am J Med. 1979; 67:792-9.
• 9. Park DW, Clare RM, Schulte PJ, Pieper KS, Shaw LK, Califf RM, et al. Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. JAMA. 2014; 312:2019-27.
• 10. Hassanin A, Brener SJ, Lansky AJ, Xu K, Stone GW. Prognos-tic impact of multivessel versus culprit vessel only percuta-neous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. EuroIntervention. 2015; 11:293-300.
• 11. Zhang L, Hailati J, Ma X, Liu J, Liu Z, Yang Y, et al. Analysis of risk factors for different subtypes of acute coronary synd-rome. J Int Med Res. 2021; 49:3000605211008326.
• 12. Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of STsegment elevation acute myocardial infarction of the Eu-ropean Society of Cardiology (ESC). Eur Heart J. 2012; 33: 2569-619.
• 13. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, And-reotti F, et al. Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Eleva-tion of the European Society of Cardiology. 2015 ESC Guide-lines for the management of acute coronary syndromes in patients presenting without persistent ST-segment eleva-tion: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37:267-315.
• 14. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18:499-502.
• 15. Beig JR, Shah TR, Hafeez I, Dar MI, Rather HA, Tramboo NA, et al. Clinico-angiographic profile and procedural outcomes in patients undergoing percutaneous coronary interventi-ons: The Srinagar registry. Indian Heart J. 2017; 69:589-96.
• 16. Ahmed S, Khowaja S, Khowaja S, Ashraf T, Aamir K, Batra MK, et al. Differences in Angiographic Profile and Immediate Outcome of Primary Percutaneous Coronary Intervention in Otherwise Risk-Free Young Male Smokers. Cureus. 2020; 12:e8799.
• 17. Badran HM, Elnoamany MF, Khalil TS, Eldin MM. Age-related alteration of risk profile, inflammatory response, and angi-ographic findings in patients with acute coronary syndrome. Clin Med Cardiol. 2009; 3:15-28.
• 18. Shiyovich A, Shlomo N, Cohen T, Iakobishvili Z, Kornowski R, Eisen A. Temporal trends of patients with acute coronary syndrome and multi-vessel coronary artery disease-from the ACSIS registry. International Journal of Cardiology. 2020; 304:8-13.
• 19. Van Minh H, Binh HA, Bao TQ, Hai NTT, Nam LX, Anh TD. Age related differences in acute coronary syndrome: An obser-vation at a central hospital in Vietnam. Journal of Translatio-nal Internal Medicine. 2021; 9:32-7.
• 20. Mohamed Ebrahim ME, Dignan R, Femia G, Kim S, Gregory G, Burgess S, et al. Late clinical outcomes of unselected pati-ents with diabetic mellitus and multi-vessel coronary artery disease. International Journal of Cardiology. 2019; 296:21-5.
• 21. Anh DT, Minh HV, Binh HA, Bao TQ, Hai NTT, Nam LX, et al. Age Related Differences in Acute Coronary Syndrome: an Observation at a Central Hospital in Vietnam. J Transl Int Med. 2021; 9:32-7.
• 22. Hegde SS, Mallesh P, Yeli SM, Gadad VM. Comparitive angi-ographic profile in diabetic and non-diabetic patients with acute coronary syndrome. Journal of clinical and diagnostic research. 2014; 8:7-10.
• 23. Rezende PC, Hlatky MA, Hueb W, Garcia RMR, da Silva Selist-re L, Lima EG, et al. Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Dise-ase. JAMA Netw Open. 2020; 3:e1919666.
• 24. Karadeniz Y, Çakır H, Şimşek B, Can G. TEKHARF 2014 tarama-sı ve coğrafi bölgelere göre ölüm oranı ile koroner hastalık insidansı. Türk Kardiyoloji Derneği Arşivi. 2015; 43:326-32.
• 25. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the manage-ment of dyslipidaemias: lipid modification to reduce cardio-vascular risk. European Heart Journal. 2020; 41:111-88.
• 26. Pathak SR, Gajurel RM, Poudel CM, Shrestha H, Thapa S, Thapa S, et al. Angiographic Severity of Coronary Artery Di-sease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal. Kathmandu Univ Med J (KUMJ). 2021; 19:410-14.
• 27. Ajudani R, Rezaee-Zavareh MS, Karimi-Sari H, Safiabadi M, Dolatimehr F, Okhovatian M, et al. Glycosylated haemoglo-bin and coronary atherosclerosis in non-diabetic patients: is it a prognostic factor? Acta Cardiol. 2017; 72:522-28.