Akut miyokard infarktüsü nedeniyle perkütan koroner girişim uygulanan hastalarda infarkt ilişkili arterin tam tıkalı olup olmamasının kontrast nefropati gelişimine etkisi
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Date
2022
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Hatay Mustafa Kemal Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Amaç: Bu çalışmada akut miyokard infarktüsü (AMI) nedeniyle perkütan koroner girişim (PKG) uygulanan hastalarda başlangıçtaki infarkt ile ilişkili arterin TIMI Trombüs Grade sınıfının kontrast madde nefropatisi (KMN) gelişimi üzerindeki etkisinin araştırılması amaçlandı. Gereç ve Yöntem: Çalışmamız tek merkezli prospektif olarak planlanmıştır. Çalışmaya Mayıs 2019 ile Nisan 2022 tarihleri arasında kurumumuzda AMI tanısı ile acil PKG yapılan 389 hasta dahil edildi. Hastaların demografik ve klinik özellikleri kaydedildi. Serum kreatinin düzeyleri işlem öncesi ve işlemden 48-72 saat sonra çalışıldı. Hastalar kreatinin düzeylerindeki artışa göre KMN gelişen ve KMN gelişmeyen olmak üzere iki gruba ayrıldı ve KMN gelişimine neden olabilecek risk faktörleri değerlendirildi. HastalarTIMI trombüs grade skoruna göreTIMI (0-4) ve TIMI (5) olmak üzere iki gruba ayrıldı. TIMI trombüs grade skorlarına göre ayrılan grupların klinik, demografik ve laboratuvar özellikleri karşılaştırıldı. Bulgular: Hastaların 59'unda (%15,2) KMN geliştiği saptandı. Acil PKG uygulanan AMI hastalarında KMN gelişimi açısından; hastanın yaşı (p<0,001), daha öncesinde ACE inhibitörü (p=0,018) ve betabloker kullanımı (p=0,017), işlem öncesi bazal GFH düşüklüğü (p<0,001), hemoglobin düşüklüğü (p=0,001) ve kontrast madde miktarı (p=0,005) anlamlı bulundu. İşlem öncesi bazal GFH (p=0,005) ve kullanılan kontrast madde miktarının (p=0,007) KMN gelişiminde bağımsız etkili faktörler olduğu bulundu. PKG uygulanan hastaların %31,9'unun infarktla ilişkili arterinin tromboz ile tam tıkalı olduğu bulundu. İnfarktla ilişkili arterin tam tıkalı olması ile KMN arasında istatistiksel olarak anlamlı bir ilişki bulunmadı (p=0,203). İnfarktla ilişkili arterin tam tıkalı olmasını öngören parametreler platelet sayısı, AST ve ALT yüksekliği olarak saptandı (sırasıyla p=0,019, p=0,002, p=0,001). Sonuç: AMI nedeniyle PKG yapılan hastaların %31,9'unun infarktla ilişkili arterinin tromboz ile tam tıkalı olduğu bulundu. İnfarktla ilişkili arterin tam tıkalı olması ile KMN gelişme riski arasında anlamlı ilişki bulunamadı. İnfarktla ilişkili arterin tam tıkalı olması açısından; platelet, AST ve ALT yüksekliği anlamlı bulundu.
Aims: The aim of our study is toinvestigated the effect of the TIMI Thrombus Grade class of the initial infarct-related artery on the development of contrast media nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Materials and Methods: Our study was planned as a single-center, prospective study. The study included 389 patients who underwent emergency PCI with the diagnosis of AMI in our institution between May 2019 and April 2022. Demographic and clinical characteristics of the patients were recorded. Serum creatinine levels were examined preoperatively and 48-72 h postoperatively. According to the increase in creatinine levels, the patients were divided into two groups as developing and not developing CIN.Risk factors that may cause the development of CIN were evaluated. According to the TIMI thrombus grade score, the patients were divided into two groups as TIMI (0-4) and TIMI (5). Clinical, demographic and laboratory characteristics were compared according to TIMI thrombus grade scores. Results: CIN was detected in 59 (15,2%) patients.In terms of development of CIN in AMI patients who underwent emergency PCI; patient's age (p<0,001), previous use of ACE inhibitor (p=0,018) and beta-blocker (p=0,017), low baseline GFR before the procedure (p<0,001), low hemoglobin (p=0,001) and contrast material amount (p=0,005) were found significant. It was found that the baseline GFR before the procedure (p=0,005) and the amount of contrast material used (p=0,007) were independent factors in the development of CIN. It was found that 31,9% of the patients who underwent PCI had totally occlusion of the infarct-related artery with thrombosis. There was no statistically significant correlation between totally occlusion of the infarct-related artery and CIN (p=0,203). In terms of predicting totally occluded infarct-related artery; platelet, AST and ALT levels were detected significantly (p=0,019, p=0,002, p=0,001, respectively). Conclusion: It was found that 31,9% of the patients who underwent PCI for AMI had complete occlusion of the infarct-related artery with thrombosis. No significant correlation was found between complete occlusion of the infarct-related artery and the risk of developing CIN. In terms of complete occlusion of the infarct-related artery; platelet, AST and ALT elevations were significant. Key words: Acute myocardial infarction, percutaneous coronary intervention, contrast induced nephropathy, thrombus burden, TIMI thrombus grade
Aims: The aim of our study is toinvestigated the effect of the TIMI Thrombus Grade class of the initial infarct-related artery on the development of contrast media nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Materials and Methods: Our study was planned as a single-center, prospective study. The study included 389 patients who underwent emergency PCI with the diagnosis of AMI in our institution between May 2019 and April 2022. Demographic and clinical characteristics of the patients were recorded. Serum creatinine levels were examined preoperatively and 48-72 h postoperatively. According to the increase in creatinine levels, the patients were divided into two groups as developing and not developing CIN.Risk factors that may cause the development of CIN were evaluated. According to the TIMI thrombus grade score, the patients were divided into two groups as TIMI (0-4) and TIMI (5). Clinical, demographic and laboratory characteristics were compared according to TIMI thrombus grade scores. Results: CIN was detected in 59 (15,2%) patients.In terms of development of CIN in AMI patients who underwent emergency PCI; patient's age (p<0,001), previous use of ACE inhibitor (p=0,018) and beta-blocker (p=0,017), low baseline GFR before the procedure (p<0,001), low hemoglobin (p=0,001) and contrast material amount (p=0,005) were found significant. It was found that the baseline GFR before the procedure (p=0,005) and the amount of contrast material used (p=0,007) were independent factors in the development of CIN. It was found that 31,9% of the patients who underwent PCI had totally occlusion of the infarct-related artery with thrombosis. There was no statistically significant correlation between totally occlusion of the infarct-related artery and CIN (p=0,203). In terms of predicting totally occluded infarct-related artery; platelet, AST and ALT levels were detected significantly (p=0,019, p=0,002, p=0,001, respectively). Conclusion: It was found that 31,9% of the patients who underwent PCI for AMI had complete occlusion of the infarct-related artery with thrombosis. No significant correlation was found between complete occlusion of the infarct-related artery and the risk of developing CIN. In terms of complete occlusion of the infarct-related artery; platelet, AST and ALT elevations were significant. Key words: Acute myocardial infarction, percutaneous coronary intervention, contrast induced nephropathy, thrombus burden, TIMI thrombus grade
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Keywords
Kardiyoloji, Cardiology, Akut miyokard infarktüsü, perkütan koroner girişim, kontrast madde nefropatisi, trombos yükü, TIMI trombüs derecesi
