Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Year 2018, Volume: 21 Issue: 2, 98 - 107, 19.08.2018

Tuncay Kırış , Sezgin Vatansever Selçuk Yazıcı Aykan Çelik Eser Varış Mustafa Karaca Mehmet Serdar Bayata Cem Nazlı

Abstract

Introduction:
There
are some studies regarding the prognostic value of coagulation abnormalities
both in heart failure and acute pulmonary embolism patients. However, it is
unclear whether prothrombin time (PT) at presentation will be associated with
long-term mortality in acute coronary syndrome (ACS) patients not on
anticoagulant therapy. Thus, we investigated the prognostic role of initial PT
in such patients.

Patients
and Methods: A total of 1100 consecutive patients with ACS undergoing
percutaneous coronary intervention (PCI) who were not receiving anticoagulant
therapy were included in the study, retrospectively. PT was measured on
admission in these patients before anticoagulation therapy. The study
population was divided into three groups based on the PT values: A high-PT
group (PT ≥ 14 sec, n= 50), intermediate-PT group (12.5 < PT < 14 sec, n=
169), and low-PT group (PT ≤ 12.5 sec, n= 881). The primary end point was
all-cause death during the median follow-up of 30.5 months.

Results: The rate
of the primary end point was 15% in the low-PT group, 27% in the
intermediate-PT group, and 52% in the high-PT group (p< 0.001). For
long-term mortality, a significantly higher mortality risk was observed in
high-PT group (HR: 2.648, 95% CI: 1.590-4.410, p< 0.001) compared with the
others group in multivariate analysis. The addition of PT to a multivariable
model that included the left ventricular ejection fraction, histories of
diabetes mellitus and stroke, age, hemoglobin, creatinine, white blood cell
count, total bilirubin levels and Killip class led to a significant net
reclassification improvement (NRI) of 26.7% (p< 0.001) and an integrated
discrimination improvement of 0.022 (p= 0.001).

Conclusion: Our findings suggest that
prolonged initial PT in the absence of anticoagulant therapy can be associated
with all-cause mortality in ACS patients who were undergoing PCI. In addition,
PT may be used to identify the high-risk patients with ACS.

Keywords

Prothrombin time, anticoagulation, acute coronary syndromes, mortality

Perkütan Koroner Girişim Yapılan Akut Koroner Sendromlu Hastalarda Protrombin Zamanın Prognostik Değeri

Abstract

Giriş: Hem kalp yetersizliği hem de akut pulmoner embolili hastalarda koagülasyon
anormalliklerinin prognostik değeri ile ilgili bazı çalışmalar vardır. Fakat,
antikoagülan tedavi almayan akut koroner sendrom (AKS) hastalarında kabuldeki
protrombin zaman (PZ)'ın uzun dönemde mortaliteyle ilişkili olup olmadığı belli
değildir. Bu yüzden, biz bu hastalarda başlangıç PZ’nin prognostik rolünü
araştırdık.

Hastalar ve
Yöntem: Çalışmaya retrospektif olarak perkütan koroner girişim
(PKG) uygulanan AKS’li ardışık 1.100 hasta alındı. Antikoagülan tedavi
başlanmadan önce hastaların PZ'si ölçüldü. Hastalar PZ’sine göre; yüksek (≥ 14
saniye, n= 50), orta (12.5 < PZ < 14 saniye, n= 169) ve düşük (≤ 12.5
saniye, n= 881) olmak üzere üç gruba ayrıldı. Primer sonlanım noktası ortalama
30.5 aylık takipte tüm nedenlere bağlı ölüm olarak belirlendi.

Bulgular: Uzun dönem total mortalite oranı, düşük, orta ve yüksek PZ gruplarında
sırasıyla: %15, %27 ve %52 idi (p< 0.001). Çok değişkenli analizde yüksek PZ
mortalite ile ilişkili bulundu (HR: 2.648, %95 CI: 1.590-4.410, p< 0.001).
Sol ventrikül ejeksiyon fraksiyonu, diyabet öyküsü, inme, yaş, hemoglobin,
kreatinin, beyaz küre sayısı, total bilirubin seviyeleri ve Killip sınıfını
içeren çok değişkenli bir modele PZ'nin eklenmesi %26.7’lik bir net yeniden
sınıflandırma iyileşmesi (p< 0.001) ve 0.022’lik total bir ayrımcılık
iyileşmesi (p= 0.001) sağladı.

Sonuç: Antikoagülan tedavinin
yokluğunda başlangıç PZ’nin uzaması, AKS hastalarında artmış mortaliteyle
ilişkili olabilir. Ayrıca, PZ yüksek riskli AKS hastaları belirlemek için kullanılabilir.

Keywords

Protrombin zamanı, antikoagülasyon, akut koroner sendromlar, mortalite

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