Primer Perkütan Koroner Girişim Yapılan Hastalarda Akut Stent Trombozunu Öngörmek İçin R2CHA2DS2-VASc Skoru ile CHA2DS2-VASc Skorlarının Karşılaştırılması

Year 2021, , 150 - 156, 30.08.2021

Çağrı Zorlu , Özge Kurmuş

https://doi.org/10.30565/medalanya.864907

Abstract

Amaç: Akut stent trombozu (AST), özellikle ST segment yükselmesi olan miyokard infarktüsü (STYMI) hastalarında stent yerleştirildikten sonra ani damar tıkanıklığı sonucu oluşan önemli bir komplikasyondur. Primer perkütan koroner girişim sonrası hastaların yaklaşık% 1'inde ortaya çıkar. CHA2DS2-VASc skoru günlük pratikte kolayca uygulanır ve bu skorun bileşenleri AST'nin risk faktörlerine benzer. Kronik böbrek hastalığında pıhtılaşmaya meyilli bir duruma yol açabilir ve bu durum STYMI' da artmış AST riski ile ilişkilidir. CHA2DS2-VASc skoru renal disfonksiyonlu hastalarda yetersiz olduğundan AST'li hastalarda modifiye skor olan R2CHA2DS2-VASc skorunun prognostik önemini araştırmayı amaçladık.

Yöntem: STYMI sonrası 56 AST' li hasta ve AST'siz 1493 hasta retrospektif olarak bu kesitsel çalışmaya dahil edildi. CHA2DS2-VASc skoru ve R2CHA2DS2-VASc skoru iki grup arasında karşılaştırıldı.

Bulgular: Medyan CHA2DS2-VASc skoru ve medyan R2CHA2DS2-VASc skoru AST grubunda anlamlı olarak daha yüksekti (P <0.001, P <0.001). R2CHA2DS2-VASc skoru ≥2 iken %65 duyarlılık ve % 89 özgüllük ile AST' nin bir prediktörü olarak kullanılabilir.

Sonuç: R2CHA2DS2-VASc skoru, AST' yi tahmin edebilen basit, ucuz ve kolay erişilebilir bir skorlamadır.

Keywords

akut stent trombozu, CHA2DS2-VASc skoru, R2CHA2DS2-VASc skoru, ST segment yükselmeli miyokard enfarktüsü

Comparison between R2CHA2DS2-VASc Score and CHA2DS2-VASc Score to Predict Acute Stent Thrombosis in Patients with After Primary Percutaneous Coronary Intervention

Abstract

Aim: Acute stent thrombosis (AST) is an important complication resulting from sudden vascular occlusion after stent implantation, especially in patients with ST-segment elevation myocardial infarction (STEMI). It occurs in about 1% of the patients after primary percutaneous coronary intervention. The CHA2DS2-VASc score is easily applied in daily practice and the components of this score are similar to common risk factors of the AST. Chronic renal disease has a hypercoagulable state and this condition is associated with an increased risk of AST in STEMI. Since the CHA2DS2-VASc score is insufficient to assess the risk of AST in patients with renal dysfunction, we aimed to investigate the prognostic significance of the modified score, R2CHA2DS2-VASc score in patients with AST.

Methods:This cross-sectional study retrospectively included 56 patients withAST and 1493 patients without AST after STEMI. The CHA2DS2-VASc and R2CHA2DS2-VASc scores were compared between the two groups.

Results:The median CHA2DS2-VASc and R2CHA2DS2-VASc scores were significantly higher in the AST group (P <0.001, P <0.001, respectively). The R2CHA2DS2-VASc score ≥2 was used as a predictor of the AST with a sensitivity of 65% and specificity of 89%.

Conclusions: The R2CHA2DS2-VASc score is a simple, cheap, and easily accessible score that can predict AST.

Keywords

Acute stent thrombosis, CHA2DS2-VASc score, R2CHA2DS2-VASc score, ST segment elevation myocardial infarction

References

• 1. Armstrong EJ, Feldman DN, Wang TY, Kaltenbach LA, Yeo KK, Wong SC, et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc Interv. 2012;5(2):131-40. PMID: 22361596.
• 2. Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J. 2015;36(47):3320-31. PMID: 26417060.
• 3. van Werkum JW, Heestermans AA, Zomer AC, Kelder JC, Suttorp MJ, Rensing BJ, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol. 2009;53(16):1399-409. PMID: 19371823.
• 4. Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol. 2005;45(7):995-8. PMID: 15808753.
• 5. Claessen BE, Henriques JP, Jaffer FA, Mehran R, Piek JJ, Dangas GD. Stent thrombosis: a clinical perspective. JACC Cardiovasc Interv. 2014;7(10):1081-92. PMID: 25341705.
• 6. Chan YH, Yiu KH, Lau KK, Yiu YF, Li SW, Lam TH, et al. The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: role of incorporating PR prolongation. Atherosclerosis. 2014;237(2):504-13. PMID: 25463082.
• 7. Chua SK, Lo HM, Chiu CZ, Shyu KG. Use of CHADS₂ and CHA₂DS₂-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014;9(10):e111167. PMID: 25343586.
• 8. Li Y, Wang J, Lv L, Xu C, Liu H. Usefulness of the CHADS2 and R2CHADS2 scores for prognostic stratification in patients with coronary artery disease. Clin Interv Aging. 2018;13:565-71. . PMID: 29670341.
• 9. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909-45. PMID: 19004841.
• 10. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344-51. PMID: 17470709.
• 11. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-429. PMID: 20802247.
• 12. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-70. PMID: 10075613.
• 13. Lohaus R, Michel J, Mayer K, Lahmann AL, Byrne RA, Wolk A, et al. Six Versus Twelve Months Clopidogrel Therapy After Drug-Eluting Stenting in Patients With Acute Coronary Syndrome: An ISAR-SAFE Study Subgroup Analysis. Sci Rep. 2016;6:33054. PMID: 27624287.
• 14. Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293(17):2126-30. PMID: 15870416.
• 15. Stone GW, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, et al. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet. 2013; 382(9892):614-23. PMID: 23890998.
• 16. Dohi T, Maehara A, Witzenbichler B, Rinaldi MJ, Mazzaferri EL Jr, Duffy PL, et al. Etiology, Frequency, and Clinical Outcomes of Myocardial Infarction After Successful Drug-Eluting Stent Implantation: Two-Year Follow-Up From the ADAPT-DES Study. Circ Cardiovasc Interv. 2015;8(12):e002447. PMID: 26643737.
• 17. Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet. 2007;369(9562):667-78. PMID: 17321312.
• 18. El-Menyar A, Hussein H, Al Suwaidi J. Coronary stent thrombosis in patients with chronic renal insufficiency. Angiology. 2010;61(3):297-303. PMID: 19689994.
• 19. Açikgöz SK, Açikgöz E, Çiçek G. Value of CHA2DS2-VASc Score for Prediction and Ruling Out of Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention. Angiology. 2020;71(5):411-16. PMID: 32030991
• 20. Liang J, Wang Z, Shi D, Liu Y, Zhao Y, Han H,et al. High clopidogrel dose in patients with chronic kidney disease having clopidogrel resistance after percutaneous coronary intervention. Angiology. 2015;66(4):319-25. PMID: 24913197.
• 21. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263-72. PMID: 19762550.
• 22. Cha MJ, Lee HS, Kim YD, Nam HS, Heo JH. The association between asymptomatic coronary artery disease and CHADS2 and CHA2 DS2 -VASc scores in patients with stroke. Eur J Neurol. 2013;20(9):1256-63. PMID: 23560528.
• 23. Piccini JP, Stevens SR, Chang Y, Singer DE, Lokhnygina Y, Go AS, et al. Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts. Circulation. 2013; 127(2):224-32. PMID: 23212720.
• 24. Fu S, Zhou S, Luo L, Ye P. R2(GFR)CHADS2 and R2(GFR)CHA2DS2VASc schemes improved the performance of CHADS2 and CHA2DS2VASc scores in death risk stratification of Chinese older patients with atrial fibrillation. Clin Interv Aging. 2017;12:1233-8. PMID: 28848331
• 25. Huang FY, Huang BT, Pu XB, Yang Y, Chen SJ, Xia TL, et al. CHADS2, CHA2DS2-VASc and R2CHADS2 scores predict mortality in patients with coronary artery disease. Intern Emerg Med. 2017;12(4):479-86. PMID: 28161883