ST yükselmesiz miyokard enfarktüslü yaşlı hastalarda hastane içi mortaliteyi öngörmek için yüksek duyarlı modifiye Glasgow prognostik skoru

Yıl 2022, Cilt: 13 Sayı: 1, 35 - 41, 26.03.2022

Lale Dinç Asarcıklı , Habibe Kafes , Burak Açar , Duygu İnan , Duygu Genç , Sennur Unal Dayı

https://doi.org/10.18663/tjcl.1023517

Öz

Amaç: Akut koroner sendromlarda inflamasyon ve malnütrisyon kötü prognostik belirteçlerdir. Bu çalışmada, ST yükselmesiz miyokard enfarktüslü (STYsizME) yaşlı hastalarda C-reaktif protein ve serum albümin düzeylerinden elde edilen yüksek duyarlı modifiye Glasgow prognostik skoru (HS-mGPS) ile hastane içi mortalite arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntemler: Çalışmaya dahil edilen hastalar üç farklı üçüncü basamak sağlık merkezinden alındı. 65 yaş üstü STYsizME tanısı almış 282 uygun hasta geriye dönük olarak kaydedildi. Hastane içi ölüm için GRACE risk skoru ve HS-mGPS her hasta için hesaplandı. Hastalar, inflamasyona dayalı skorlarına göre kategorize edildi (yüksek HS-mGPS grubu (HS-mGPS ≥1, n=124)’ e karşın düşük HS-mGPS grubu (HS-mGPS =0, n=158).
Bulgular: Çalışma grupları arasında hastaneye yatış kan basıncı düzeyleri, koroner anjiyografi bulguları, tedavi modaliteleri ve GRACE skorları arasında fark yoktu. Yüksek HS-mGPS'li hastalar, düşük HS-mGPS grubuna kıyasla daha yüksek başvuru kalp hızına ve daha uzun hastanede kalış süresine sahipti. Hastane içi ölüm oranları yüksek HS-mGPS grubunda, düşük HS-mGPS grubuna kıyasla daha yüksekti (sırasıyla %21,8 (n=27)’ e karşın %3,2 (n=5), P<0.001). GRACE risk skoru (HR:1,037, %95 GA: 1,009-1,065, P=0,008) ve HS-mGPS ≥1 (HR:4,602, %95 GA: 1,581-13,391, P=0,005) hastane içi mortalitenin bağımsız öngörücüleriydi. Bununla beraber Kaplan Meier analizinde HS-mGPS ≥1 grubunda hastane içi mortalite HS-mGPS =0 grubuna göre beirgin olarak daha yüksekti (long rank testinde P<0,001).
Sonuç: Yüksek HS-mGPS, STYsizME' lü yaşlı hastalarda hastane mortalitesi ile bağımsız olarak ilişkilidir. Hesaplaması basit olan bu inflamasyona dayalı skoru kullanmak, yaşlı hastalarda daha kesin risk tahminine yardımcı olabilir.

Anahtar Kelimeler

akut koroner sendrom, albümin, C-reaktif protein, Glasgow Prognostik Skoru, miyokard enfarktüsü, yaşlı hastalar

Destekleyen Kurum

Yok

Proje Numarası

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High sensitive modified Glasgow prognostic score for predicting ın-hospital mortality ın elderly patients with non-st elevation myocardial infarction

Öz

Aim: Inflammation and malnutrition are poor prognostic markers in acute coronary syndromes. In this study, we aimed to investigate the association between high sensitive modified Glasgow prognostic score (HS-mGPS), derived from C-reactive protein and serum albumin levels, and in-hospital mortality of elderly patients with non-ST elevation myocardial infarction (NSTEMI).
Material and Methods: Included subjects were recruited from three different tertiary health centers. Totally, 282 eligible patients aged >65 years with diagnosis of NSTEMI were retrospectively enrolled. Global Registry of Acute Coronary Events (GRACE) risk score for in-hospital mortality and HS-mGPS was calculated for each patient. Subjects were categorized according to their inflammation-based scores ((high HS-mGPS group (HS-mGPS ≥1, n=124) vs. low HS-mGPS group (HS-mGPS =0, n=158)).
Results: Both groups were similar regarding admission blood pressure levels, coronary angiography findings, treatment modalities and GRACE scores. Patients with high HS-mGPS had higher admission heart rate and longer hospitalization duration compared to low HS-mGPS group. In-hospital mortality rates were higher in high HS-mGPS group compared to low HS-mGPS group (21.8% (n=27) vs. 3.2% (n=5), respectively, P<0.001). GRACE risk score (HR:1.037, 95% CI: 1.009-1.065, P=0.008) and HS-mGPS ≥1 (HR:4.602, 95% CI: 1.581-13.391, P=0.005) were independent predictors of in-hospital mortality. Furthermore, in hospital mortality in HS-mGPS group was significantly higher than low HS-mGPS group in the Kaplan–Meier curve analysis (log rank P < 0.001).
Conclusion: High HS-mGPS is independently associated with in-hospital mortality in elderly patients with NSTEMI. Using this inflammation-based simple score could help in more precise risk estimation in elderly patients daily practice.

Anahtar Kelimeler

acute coronary syndrome, albumin, C-reactive protein, elderly patients, Glasgow prognostic score, myocardial infarction

Proje Numarası

-

Kaynakça

• 1. Roger VL, Jacobsen SJ, Weston SA, et al. Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994. Ann Intern Med. 2002; 136: 341-8
• 2. DeGeare VS, Stone GW, Grines L, et al. Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials). Am J Cardiol. 2000; 86: 30-4
• 3. Antman EM. TIMI 11B. Enoxaparin versus unfractionated heparin for unstable angina or non-Q-wave myocardial infarction: a double-blind, placebo-controlled, parallel-group, multicenter trial. Rationale, study design, and methods. Thrombolysis in Myocardial Infarction (TIMI) 11B Trial Investigators. Am Heart J. 1998; 135: 353-60
• 4. Elbarouni B, Goodman SG, Yan RT, et al. Validation of the Global Registry of Acute Coronary Event (GRACE) risk score for in-hospital mortality in patients with acute coronary syndrome in Canada. Am Heart J. 2009; 158: 392-9
• 5. Lawler PR, Bhatt DL, Godoy LC, et al. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J. 2021; 42: 113-31
• 6. Raposeiras-Roubin S, Barreiro Pardal C, Rodino Janeiro B, et al. High-sensitivity C-reactive protein is a predictor of in-hospital cardiac events in acute myocardial infarction independently of GRACE risk score. Angiology. 2012; 63: 30-4
• 7. Wang R, Wen X, Huang C, et al. Association between inflammation-based prognostic scores and in-hospital outcomes in elderly patients with acute myocardial infarction. Clin Interv Aging. 2019; 14: 1199-206
• 8. Cinar T, Cagdas M, Rencuzogullari I, et al. Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction. Scand Cardiovasc J. 2019; 53: 83-90
• 9. Purdon AD, Rao AK. Interaction of albumin, arachidonic acid and prostanoids in platelets. Prostaglandins Leukot Essent Fatty Acids. 1989; 35: 213-8
• 10. Lindenmann J, Fink-Neuboeck N, Avian A, et al. Preoperative Glasgow Prognostic Score as additional independent prognostic parameter for patients with esophageal cancer after curative esophagectomy. Eur J Surg Oncol. 2017; 43: 445-53
• 11. Cho A, Arfsten H, Goliasch G, et al. The inflammation-based modified Glasgow prognostic score is associated with survival in stable heart failure patients. ESC Heart Fail. 2020; 7: 654-62
• 12. Altay S, Gurdogan M, Keskin M, et al. The Inflammation-Based Glasgow Prognostic Score as a Prognostic Factor in Patients with Intensive Cardiovascular Care Unit. Medicina (Kaunas). 2019; 55 .
• 13. Hanai N, Sawabe M, Kimura T, et al. The high-sensitivity modified Glasgow prognostic score is superior to the modified Glasgow prognostic score as a prognostic predictor for head and neck cancer. Oncotarget. 2018; 9: 37008-16
• 14. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37: 267-315
• 15. Stone PH, Thompson B, Anderson HV, et al. Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: The TIMI III registry. JAMA. 1996; 275: 1104-12.
• 16. Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev. 2016; 31: 1-8
• 17. Oduncu V, Erkol A, Karabay CY, et al. The prognostic value of serum albumin levels on admission in patients with acute ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis. 2013; 24: 88-94
• 18. Brunetti ND, Troccoli R, Correale M, et al. C-reactive protein in patients with acute coronary syndrome: correlation with diagnosis, myocardial damage, ejection fraction and angiographic findings. Int J Cardiol. 2006; 109: 248-56 .
• 19. Shitara J, Ogita M, Wada H, et al. Clinical impact of high-sensitivity C-reactive protein during follow-up on long-term adverse clinical outcomes in patients with coronary artery disease treated with percutaneous coronary intervention. J Cardiol. 2019; 73: 45-50 .
• 20. Kennon S, Timmis AD, Whitbourn R, et al. C reactive protein for risk stratification in acute coronary syndromes? Verdict: unproven. Heart. 2003; 89: 1288-90 .
• 21. Joles JA, Willekes-Koolschijn N, Koomans HA. Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine. Kidney Int. 1997; 52: 761-70 .
• 22. Lee SN, Moon D, Moon KW, et al. The Glasgow prognostic score as a significant predictor of clinical outcomes in patients with acute coronary syndrome. J Cardiol. 2019; 74: 130-5 .
• 23. Jia Y, Li D, Cao Y, et al. Inflammation-based Glasgow Prognostic Score in patients with acute ST-segment elevation myocardial infarction: A prospective cohort study. Medicine (Baltimore). 2018; 97: 13615 .
• 24. Gonzalez-Pacheco H, Bojalil R, Amezcua-Guerra LM, et al. Derivation and validation of a simple inflammation-based risk score system for predicting in-hospital mortality in acute coronary syndrome patients. J Cardiol. 2019; 73: 416-24 .
• 25. Gonzalez-Pacheco H, Amezcua-Guerra LM, Sandoval J, et al. Prognostic Implications of Serum Albumin Levels in Patients With Acute Coronary Syndromes. Am J Cardiol. 2017; 119: 951-8 .