Akut Koroner Sendrom ile Başvuran Hastalarda Daha Önceden Düzenli Asetilsalisilik Asit Kullanımının TIMI Akımı ve Miyokardiyal Hasar Üzerine Etkileri

Year 2022, Volume: 13 Issue: 45, 54 - 61, 07.04.2022

Halil Aktaş

https://doi.org/10.17944/mkutfd.975838

Abstract

Amaç: Kardiyovasküler hastalıklar, dünya çapında önde gelen en önemli ölüm nedenidir. Kardiyovasküler hastalıkların sekonder korumasında antiagregan tedaviler önemli bir yer tutmaktadır. Bu çalışma ile; akut koroner sendrom ile başvuran hastalarda, daha önceden düzenli asetilsalisilik asit kullanımının TIMI akımı ve miyokardiyal hasar üzerine olan etkileri araştırılacaktır.
Yöntem: Çalışmaya retrospektif olarak akut koroner sendrom kliniği ile başvurmuş ve koroner anjiyografi yapılmış hastalar alındı. Hastalar daha önceden düzenli asetilsalisilik asit kullanan (grup 1) ve hiç asetilsalisilik asit kullanmayanlar olarak (grup 2) iki gruba ayrıldı. Gruplar arasında demografik veriler, laboratuvar verileri, TIMI akımları ve miyokardial hasar belirteci olarak troponin I değerleri karşılaştırıldı.
Bulgular: Çalışmaya 440 hasta alındı. Grup 1’de 122 hasta (yaş ortalaması 64.9±1 yıl; 25 (%20.5) kadın) ve grup 2’de 318 hasta (yaş ortalaması 61±0.7 yıl; 83 (%26.1) kadın) yer aldı. Grup 1’de ileri yaş, hipertansiyon, diyabetes mellitus, hiperlipidemi ve koroner arter hastalığı öyküsü daha yüksek oranda gözlendi. Grup 1’deki hastalarda TIMI-0 akım grup 2’ye göre anlamlı olarak daha düşük oranda gözlendi (%30.3’e karşın, %47.8; p=0.004). Bunun yanı sıra; grup 1’deki hastaların maksimum ölçülen troponin I değerleri grup 2’deki hastalara göre anlamlı olarak daha düşük düzeyde bulundu (median 5486 pg/ml’ye karşın 15740 pg/ml; p <0.001).
Sonuç: Akut koroner sendrom kliniği ile başvurmuş ve daha önceden düzenli asetilsalisilik asit kullanan hastalarda TIMI akım dereceleri daha yüksek ve enzimatik miyokardiyal hasar miktarı daha az bulunmuştur. Böylelikle sekonder korumanın önemi bu çalışmayla bir kez daha vurgulanmıştır.

Keywords

Asetilsalisilik asit, akut koroner sendrom, TIMI akım derecesi, miyokardiyal hasar

Supporting Institution

yok

The Effects of Previous Regular Use of Acetylsalicylic Acid on TIMI Flow Grade and Myocardial Damage in Patients Presenting with Acute Coronary Syndrome

Abstract

Objective: Cardiovascular diseases are the leading cause of death worldwide. Antiaggregant therapies have an important place in the secondary prevention of cardiovascular diseases. In this study, the effects of regular use of acetylsalicylic acid on TIMI flow grade and myocardial damage will be investigated in patients presenting with acute coronary syndrome.
Methods: The patients who admitted with the clinic of acute coronary syndrome and underwent coronary angiography were included in the study, retrospectively. The patients were divided into two groups as those who used acetylsalicylic acid regularly (group 1) and those who never used acetylsalicylic acid (group 2). Demographic data, laboratory data, TIMI flow grade and troponin-I values as a marker of myocardial damage were compared between the groups.
Results: 440 patients were included in the study. There were 122 patients in group 1(mean age 64.9±1.0 years; 25(20.5%) women) and 318 patients in group 2(mean age 61.0±0.7 years; 83(26.1%) women). Advanced age, hypertension, diabetes mellitus, hyperlipidemia and history of coronary artery disease were observed at a higher rate in group 1. TIMI-0 flow was observed at a significantly lower rate in patients in group 1(30.3% vs. 47.8%; p=0.004). Additionally, the maximum measured troponin values of the patients in group 1 were found significantly lower (median 5486 pg/ml vs. 15740 pg/ml; p<0.001).
Conclusion: TIMI flow grades were higher and the amount of enzymatic myocardial damage was found less in patients who admitted with the clinic of acute coronary syndrome and used previously regular acetylsalicylic acid. Thus, the importance of secondary protection was emphasized once again in this study.

Keywords

Acetylsalicylic acid, acute coronary syndrome, TIMI flow grade, myocardial damage

References

• Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101:1206–18. https://doi.org/10.1161/01.CIR.101.10.1206
• Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–88. http://doi.org/10.1016/S0140-6736(18)32203-7
• Łabuz-Roszak B, Horyniecki M, Beata Łącka-Gaździk B. Acetylsalicylic acid in the prevention and treatment of cardiovascular diseases. Wiad Lek 2018;71(8):1608-14.
• De Luca G , Ernst N, Zijlstra F, van 't Hof AWJ, Hoorntje JCA, Dambrink JHE, et al. Preprocedural TIMI Flow and Mortality in Patients With Acute Myocardial Infarction Treated by Primary Angioplasty. J Am Coll Cardiol. 2004 Apr 21;43(8):1363-7. https://doi.org/10.1016/j.jacc.2003.11.042
• Gupta S, de Lemos JA. Use and misuse of cardiac troponins in clinical practice. Prog Cardiovasc Dis 2007;50:151–65. https://doi.org/10.1016/j.pcad.2007.01.002
• Ibanez B,James S,Agewall S,Antunes MJ,Bucciarelli-Ducci C,Bueno H, et al. 2017 ESC Guidelinesforthemanagement of acutemyocardialinfarction in patientspresentingwith ST-segmentelevation: TheTask Force forthemanagement of acutemyocardialinfarction in patientspresentingwith ST-segmentelevation of theEuropeanSociety of Cardiology (ESC). EurHeart J. 2018; 39 (2): 119–177. https://doi.org/10.1093/eurheartj/ehx393
• Collet JP,Thiele H,Barbato E,Barthélémy O,Bauersachs J,Bhatt DL, et al. 2020 ESC Guidelinesforthemanagement of acutecoronarysyndromes in patientspresentingwithoutpersistent ST-segmentelevation: TheTask Force forthemanagement of acutecoronarysyndromes in patientspresentingwithoutpersistent ST-segmentelevation of theEuropeanSociety of Cardiology (ESC). EurHeart J. 2021; 42(14): 1289–1367. https://doi.org/10.1093/eurheartj/ehaa575.
• Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI framecount: a quantitativemethod of assessingcoronaryarteryflow. Circulation. 1996; 93: 879-88. https://doi.org/10.1161/01.CIR.93.5.879.
• Rezkalla SH, Kloner RA. Coronaryno-reflowphenomenon: fromtheexperimentallaboratorytothecardiaccatheterizationlaboratory.CatheterCardiovascInterv.2008;72 (7): 950-7. https://doi.org/10.1002/ccd.21715.
• Hennekens CH. Update on aspirin in the treatment and prevention of cardiovascular disease. Am J Manag Care 2002; 8: 691-700.
• Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal (2018) 39, 3021–3104. https://doi.org/10.1093/eurheartj/ehy339
• Cosentino F,Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Victoria Delgado V,et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). European Heart Journal (2020) 41, 255-323. https://doi.org/10.1093/eurheartj/ehz486
• Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, Peter M Di Battiste PM, et al. Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis in Myocardial Infarction 18 trial)substudy. J Am Coll Cardiol. 2002 Nov 20;40(10):1761-8. https://doi.org/10.1016/S0735-1097(02)02484-1
• Pan J, Yuan M, Yu M, Gao Y,Shen C, Wang Y, et al. Myocardial Blood Flow Quantified by Low-Dose Dynamic CT Myocardial Perfusion Imaging Is Associated with Peak Troponin Level and Impaired Left Ventricle Function in Patients with ST-Elevated Myocardial Infarction. Korean J Radiol. 2019 May; 20(5): 709–18. https://doi.org/10.3348/kjr.2018.0729
• Ndrepepa G,Kufner S,Hoyos M, Harada Y, Xhepa E, Hieber J, et al. High-sensitivity cardiac troponin T and prognosis in patients with ST-segment elevation myocardial infarction. Journal of Cardiology 72 (2018) 220–6. https://doi.org/10.1016/j.jjcc.2018.02.014
• Anis A, Shakhnoza K, Shoira K. Role of the acetylsalicylic acid in the treatment of coronary artery disease. Biomedical Research 2020; 31 (4): 82-5.
• Jimenez AH, Stubbs ME, Tofler GH, Winther K, Williams GH, Muller JE. Rapidity and duration of platelet suppression by enteric-coated aspirin in healthy young men. Am J Cardiol.1992; 69:258–62. https://doi.org/10.1016/0002-9149(92)91316-V
• Burch JW, Stanford N, Majerus PW. Inhibition of platelet prostaglandin synthase by oral aspirin. J Clin Invest.1979; 61:314–9. https://doi.org/10.1172/JCI108941
• Schaaf MJ, Mewton N, Rioufol G, Angoulvant D, Cayla G, Delarche N, et al. Pre-PCI angiographic TIMI flow in the culprit coronary artery influences infarct size and microvascular obstruction in STEMI patients. Journal of Cardiology 67 (2016) 248–53. https://dx.doi.org/10.1016/j.jjcc.2015.05.008
• Nammas W, Pietilä M, Romppanen H, Sia J, DeBelder A, Karjalainen PP. Outcome of poorinitial TIMI flow in patientspresentingwithacutecoronarysyndrome, ScandCardiovas J. 2017; 51:5; 248-254. https://doi.org/10.1080/14017431.2017.1346278.
• Akay OM, Canturk Z, Akin E, Bal C, Gulbas Z. Aspirin-resistance frequency: a prospective study in 280 healthy Turkish volunteers. Clin Appl Thromb Hemost. 2009 Feb;15(1):98-102. https://doi.org/10.1177/1076029607306806