ST SEGMENT YÜKSELMESİZ MİYOKART ENFARKTÜS HASTALARINDA SİSTEMİK İMMÜN ENFLAMASYON İNDEKSİ VE MORTALİTE İLİŞKİSİ

Yıl 2023, Cilt: 30 Sayı: 3, 388 - 395, 23.09.2023

Sercan Çayırlı , Ömer Faruk Rahman , Berk Mutlu , Sevil Gülaştı

https://doi.org/10.17343/sdutfd.1292723

Öz

Amaç
Akut koroner sendrom mortalitesi ve morbiditesi yüksek
bir sendromdur. Yüksek riskli hastaların hastane
yatışı esnasında belirlenmesi ve gerekli durumlarda
erken revaskülarizasyon stratejilerinin uygulanması
hastalarda hayati önem arz etmektedir. Klinik pratikte
bu hastaların hızlıca belirlenmesine yönelik basit, etkili,
maliyeti ucuz bir indeks ihtiyacı olduğu aşikardır.
Tüm bu nedenlerden dolayı bu çalışmada tarafımızca
SII’nın, AKS alt grubu olan NSTEMI geçiren hastalarda
mortaliteyi ön görmedeki yerinin araştırılması
amaçlanmıştır.
Gereç ve Yöntem
01.01.2022-31.12.2022 tarihleri arasından Aydın Adnan
Menderes Üniversitesi Tıp Fakültesi Uygulama
ve Araştırma Hastanesi koroner anjiyografi ünitesinde
koroner anjiyografi işlemi uygulanan hastalar geçmişe
dönük olarak tarandı. St segment yükselmesiz miyokart
enfarktüsü geçiren hastalarda ve normal koroner
arterler saptanan hastalarda SII [(nötrofil x platelet) /
lenfosit] hesaplandı. Bu indeks ile tüm nedenlere bağlı
mortalite gelişimi arasında ilişki olup olmadığı araştırıldı.
Bulgular
Grup 1 olarak değerlendirilen NSTEMI grubu SII indeks
ortancası Grup II’ye göre anlamlı düzeyde yüksek
bulundu (p<0.001). Mortalite gözlenen gruba ait
nötrofil ve SII indeksi değerleri ortalaması, sağkalım
grubuna göre istatistiksel olarak anlamlı derecede
yüksek bulundu (sırasıyla p=0.002 ve p=0.019). Çok
yönlü lojistik regresyon sonucunda, NSTEMI varlığı
yaş (odds ratio [OR]: 9.891; 95% CI: 2.096-46.671,
p<0.001) ve SII indeksinin (odds ratio [OR]: 1.001;
95% CI: 1.000-1001, p=0.039) tüm nedenlere bağlı
mortaliteyi bağımsız olarak öngördüğü saptandı. NSTEMI
grubunda SII indeksi 609.98 değerinden yüksek
olguların sağkalım beklentisi 18 ay için %68.1, SII indeksi
609.98 değerinden düşük olgular için ise %79.3
olarak hesaplandı ancak fark istatistiksel olarak anlamlı
bulunmadı (p=0.426).
Sonuç
SII, NSTEMI hasta grubunda mortaliteyi ön görmede
faydalı bir indeks olmasına rağmen sağ kalımı öngörmede
yeterli değildir.

Anahtar Kelimeler

SII, mortalite, miyokart enfarktüsü

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

YOK

ASSOCIATION BETWEEN SYSTEMIC IMMUNEINFLAMMATION INDEX AND MORTALITY IN PATIENTS WITH NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Öz

Objective
Acute coronary syndrome (ACS) is a disease associated
with high mortality and morbidity. It is essential to
identify high-risk patients during hospitalization and
to implement early revascularization strategies if
necessary. There is a clear need for a simple, effective
and cost-effective index for rapid identification of these
patients in clinical practice. The aim of this study was
to investigate the clinical significance of the systemic
immune inflammation index (SII) in non-ST-segment
elevation myocardial infarction (NSTEMI), a subgroup
of ACS, and to evaluate its association with mortality.
Material and Method
Patients who underwent coronary angiography at the
Coronary Angiography Unit of Aydın Adnan Menderes
University Faculty of Medicine Research and Training
Hospital between January and December 2022 were
retrospectively reviewed. Individuals with a diagnosis
of NSTEMI were included as group I, and individuals
with normal coronary arteries during coronary
angiography were included as group II (control group).
Clinical variables and calculated SII values of the
groups were recorded. The role of SII in predicting
all-cause mortality and its effect on expected survival
were evaluated.
Results
The median value of the SII index was significantly
higher in the NSTEMI group (group I) than in the control
group (group II) (p<0.001). The mean neutrophil and
SII index values of the mortality group were significantly
higher than those of the survival group (p=0.002 and
p=0.019, respectively). Multivariate logistic regression
showed that the presence of NSTEMI (odds ratio [OR]:
9.891; 95% CI: 2.096-46.671, p<0.001) and SII index
(odds ratio [OR]: 1.001; 95% CI: 1.000-1001, p=0.039)
independently predicted all-cause mortality. The cutoff
point for the SII index was 609.98 using ROC
curve analysis. Survival expectancy at 18 months was
68.1% for group I patients with SII >609.98 and 79.3%
for group I patients with SII <609.98, but the difference
was not statistically significant (p=0.426).
Conclusion
The SII score can help predict all-cause mortality in
NSTEMI patients, but it is unsuitable for predicting
survival.

Anahtar Kelimeler

SII, mortality, myocardial infarction

Proje Numarası

yok

Kaynakça

• 1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population Trends in the Incidence and Outcomes of Acute Myocardial Infarction. N. Engl. J. Med. 2010;362: 2155–65.
• 2. Miranda GF, Rossi A, Serra A, Garcia B, Rumoroso JR, Iniguez A, Vaquerizo B, Triano JL, Sierra G, Bruguera J. Angiographic quantification of thrombus in ST- elevation acute myocardial i nfarction presenting with an occluded infarct- related artery and its relationship with results of percutaneous intervention. J. Interv. Cardiol. 2009; 22:207–15.
• 3. Jeremias A, Davies JE, Maehara A, Matsumura M, Schneider J, Tang. Blinded physiological assessment of Residual ischemia after successful angiographic percutaneous coronary intervention: the DEFINE PCI study. JACC Cardiovasc Interv. 2019; 12:1991–1. doi: 10.1016/j.jcin.2019.05.054
• 4. Biswas S, Dinh D, LucasM, Duffy SJ, Brennan AL, Liew D, et al. Incidence and predictors of unplanned hospital readmission after percutaneous coronary intervention. J Clin Med. 2020; 9: 32-2. doi: 10.3390/jcm9103242.
• 5. Petrone AB, Eisenman RD, Steele KN, Mosmiller LT, Urhie O, Zdilla MJ. Temporal dynamics of peripheral neutrophil and lymphocytes following acute ischemicstroke. Neurol Sci. 2019; 40:1877–85. doi: 10.1007/s10072-019-03919
• 6. Ikeda U, Ikeda M, Oohara T, Kano S, Yaginuma T. Mitogenicaction of interleukin-1a on vascular smooth muscle cells mediatedby PDGF. Atherosclerosis. 1990;84: 183–88. doi: 10.1016/0021- 9150(90)90089-2
• 7. Mulholland M, Jakobsson G, Lei Y, Sundius L, Ljungcrantz I, Rattik S, et al. IL-2Rbg signalling in lymphocytes promotes systemic inflammation and reduces plasmacholesterol in atherosclerotic mice. Atherosclerosis. 2021; 326-31. doi: 10.1016/j.atherosclerosis.2021.04.010
• 8. Kumbul YÇ, Yasan H, Tüz M, Okur E, Sivrice ME, Büyükçelik B. Prognostic Evaluation of Systemic Immune Inflammation Index in Sudden Idiopathic Sensorineural Hearing Loss. SDÜ Tıp Fakültesi Dergisi. 2020; 27(4): 455-461.
• 9. Jickling GC, Liu DZ, Ander BP, Stamova B, Zhan X, Sharp FR. Targeting neutrophils in ischemic stroke: translational insights from experimental studies. J Cereb Blood FlowMetab. 2015; 35:888–01. doi: 10.1038/jcbfm.2015.45.
• 10. Liu Y, Ye T, Chen L, Jin T, Sheng Y, Wu G, et al. Systemic immüne inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. CoronArteryDis. 2021; 32:715–20. doi: 10.1097/MCA.0000000000001037
• 11. Xu M, Chen R, Liu L, Liu X, Hou J, et al. Systemic immuneinflammation index and incident cardiovascular diseases among middle- aged and elderly Chinese adults: The Dongfeng-Tongji cohort study. Atherosclerosis 2021; 323: 20–9.
• 12. Zhen Y, Tingyi H, Jin W, Ruoyi X, Xibei L, Mengsi L, Zhen S. Systemic immune- inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and metaanalysis. Journal Frontiers in Cardiovascular Medicine. 2022; 9:913-933. doi: 10.3389/fcvm.2022.933913
• 13. Li J, He D, Yu J, et al. Dynamic Status of SII and SIRI Alters the Risk of Cardiovascular Diseases: Evidence from Kailuan Cohort Study. J. Inflamm. Res. 2022; 15:5945–57.
• 14. Yiyuan X, Chunlei X, Lida W, Zheng L, Huili JZ. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All- Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J. Clin Med. 2023; 12: 11-28.
• 15. Ugur Ö, Muhammet G., Cihan Ö., Melik D., Ömer F.A., Efe Y., Servet A. Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non- ST Acute Coronary Syndrom. Medicina 2022; 58: 143.
• 16. Dziedzic EA, Gasior JS, Tuzimek A, Paleczny J, Junka A, Dabrowski M, Jankowski P. Investigation of the Associations of Novel Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI)-With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence. Int. J. Mol. Sci. 2022; 23: 9553.
• 17. Dziedzic EA, Gąsior JS, Tuzimek A, Kochman W. Blood Count- Derived Inflammatory Markers and Acute Complications of Ischemic Heart Disease in Elderly Women. J. Clin. Med. 2023; 12(4):1369.
• 18. Yang YL, Wu CH, Hsu PF, et al. Systemicimmune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur. J. Clin. Investig. 2020; 50: 1–5.
• 19. Jiabao H, Qing Z, Runchang W, Hongyan J, Yusi C, Xiaoqing Q, Cuntai Z. Systemic Immune-Inflammatory Index Predicts Clinical Outcomes for Elderly Patients with Acute Myocardial Infarction Receiving Percutaneous Cor onary Intervention. MedSciMonit, 2019; 25: 9690-01
• 20. Warnatsch A, Ioannou M, Wang Q, Papayannopoulos V. Inflammation. Neutrophil extracellular traps license macrophages for cytokine production in atherosclerosis. Science. 2015;349(6245):316-20. doi: 10.1126/science. aaa8064.
• 21. Fernández-Ruiz I. Neutrophil-driven SMC death destabilizes atherosclerotic plaques. Nat. Rev. Cardiol. 2019;16:455.
• 22. Sheridan FM, Cole PG, Ramage D. Leukocyte adhesion to the coronary microvasculature during ischemia and reperfusion in an in vivo canine model. Circulation 1996; 93: 1784–87.
• 23. Sezer M, Okcular I, Goren T. Association of haematologica lindices with the degree of microvascular injury in patients with acute anterior all myocardial infarction treated with primary percutaneous coronary intervention. Heart, 2007; 93(3): 313– 18.
• 24. Milan-Mattos J, Anibal F, Perseguini N, et al. Effects of natural aging and gender on pro- inflammatory markers. Braz. J. Med. Biol. Res. 2019; 52(9): 73-3.