Primer perkütan koroner girişim uygulanan ST yükselmeli miyokart enfarktüslü hastalarda sol ventrikül ejeksiyon fraksiyonu ve HAS-BLED skoru kombinasyonunun mortaliteyi öngördürücü değeri

Year 2018, Volume: 9 Issue: 2, 71 - 78, 01.08.2018

Tuncay Kiris , Eyup Avci , Aykan Celik

https://doi.org/10.22312/sdusbed.423517

Abstract

Amaç: HAS-BLED skoru ve sol ventrikül ejeksiyon fraksiyonu (SVEF), akut
koroner sendromlu hastalarda her ikiside klinik sonuçları bağımsız olarak
öngörebilir. Primer percutan koroner girişim (PKG) ile tedavi edilen ST segment
yükselmeli miyokard infarktüsü (STEMI) hastalarında SVEF ve HAS-BLED skoru
kombinasyonlarının  mortaliteyi
öngördürücü değerini araştırdık.

Yöntemler: Primer PKG uygulanan 588 ardışık STEMI hastasını araştırdık. Her hasta
için HAS-BLED skorları hesaplandı ve mortalite için öngörü değeri, eğri
altındaki alan (AUC) kullanılarak analiz edildi. Hastalar HAS-BLED skorlarına
göre dört gruba ayrıldı. Onların HAS-BLED skorları çok düşük risk: 0, düşük
risk: 1, orta risk: 2, yüksek risk: ≥ 3 idi. Birincil son nokta toplam
mortaliteydi.

Bulgular: Çok değişkenli cox regresyon analizi ile HAS-BLED skoru (p
<0.001)  ve SVEF (p <0.001) toplam
mortalitenin bağımsız öngördürücüleriydi. Sadece HAS-BLED skoru için toplam
mortalitede AUC 0.71 (% 95 CI: 0.66-0.76) idi. SVEF eklendikten sonra 0.77'ye
(p <0.001) yükseldi. SVEF ve HAS-BLED skorlarının birleştirilmesinin artan
prediktif değeri, net yeniden sınıflandırma iyileştirmesi (NRI =% 27.2, p
<0.001) ve entegre ayrımcılık iyileştirmesi (IDI = 0.061, p <0.001) ile
de gösterildi.

Sonuçlar: SVEF'nin HAS-BLED skoru ile birleştirilmesi, primer PKG uygulanan STEMI
hastalarında tüm nedenlere bağlı mortalite için öngörüydü.

Keywords

HAS-BLED skoru, Sol ventrikül ejeksiyon fraksiyonu, Mortalite, STEMI

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