Akut Koroner Sendrom Olgularının COVID-19 Pandemisi Sırasında ve Öncesinde Demografik ve Laboratuvar Parametrelerinin Değerlendirilmesi

Betül Çam; Abuzer Coşkun; Burak Demirci; Hatice Karaçam; Burak Akın

doi:10.4274/BMB.galenos.2023.2022-09-077

Akut Koroner Sendrom Olgularının COVID-19 Pandemisi Sırasında ve Öncesinde Demografik ve Laboratuvar Parametrelerinin Değerlendirilmesi

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Akut Koroner Sendrom Olgularının COVID-19 Pandemisi Sırasında ve Öncesinde Demografik ve Laboratuvar Parametrelerinin Değerlendirilmesi

Bagcilar Med Bull 2023;8(1):33-40 DOI: 10.4274/BMB.galenos.2023.2022-09-077

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İzin

Öz

Amaç:

Hem iskemik kalp hastalıkları hem de Koronavirüs hastalığı-2019 (COVID-19) son dönemlerde acil servislere sıklıkla başvuran iki ana hasta grubunu oluşturmaktadır. Akut koroner sendrom (AKS) olgularında COVID-19 pandemisinin demografik ve klinik süreçlere etkisini değerlendirmeyi amaçladık.

Yöntem:

Bu retrospektif, tek merkezli çalışma, 10 Mart 2019-11 Mart 2021 tarihleri arasında acil servise başvuran AKS hastaları üzerinde yapılmıştır. Hastalar pandemi ve prepandemi dönemi olarak ikiye ayrılırken, pandemi dönemi de COVID (+) ve (-) olarak gruplandırıldı. Hastaların AKS sınıflaması, klinik ve laboratuvar sonuçları değerlendirildi.

Bulgular:

Çalışmaya alınan 1,067 hastanın yaş ortalaması 58,0±19,2 yıl ve 785’i (%73,5) erkekti. Pandemi öncesi dönemdeki 542 olgunun 262’si (%48,3) non-ST elevasyonlu miyokard enfarktüsü (NSTEMI) ve 202’si (%37,3) ST elevesyonlu miyokard enfarktüsü (STEMI) idi. Pandemi grubundaki COVID (+) olgularından 252 hastanın 194’ü (%76,9) NSTEMI ve 34’ü (%13,6) STEMI idi (p=0,001, p=0,013). Pandemi döneminde COVID (-) grubundaki 8 ölümün 7’si (%87,5) STEMI kaynaklıydı. Buna karşılık 26 COVID (+) ölümün 20’si (%77) NSTEMI grubunda izlendi. NSTEMI mortalitesi COVID (+) grubunda önemli ölçüde daha yüksekti (p=0,001).

Sonuç:

Acil serviste AKS olgularının hızlı değerlendirilmesi hasta hasta prognozu üzerinde oldukça etkilidir. COVID-19 hastalığının ciddiyetinin, risk faktörlerinin, laboratuvar bulgularının ve sonuçlarının doğru değerlendirilmesi, şiddetli akut solunum sendromu-koronavirüs-2 enfeksiyonunda AKS indükleyebilecek mekanizmaların tam olarak anlaşılması, tanı ve tedaviyi kolaylaştıracak stratejilerin geliştirilmesi açısından oldukça önemlidir.

Anahtar Kelimeler: Acil servis, akut koroner sendrom, COVID-19, mortalite

Kaynakça

1

Eisen A, Giugliano RP, Braunwald E, Townsend N, Wilson L, Bhatnagar P, et al. Cardiovascular disease in Europe: epidemiological update 2016. JAMA Cardiol 2016;37(6):718-730.

2

Switaj TL, Christensen SR, Brewer DM. Acute Coronary Syndrome: Current Treatment. Am Fam Physician 2017;95(4):232-240.

3

Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol 2019;234(10):16812-16823.

4

Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016;37(42):3232-3245.

5

Zhao M, Wang M, Zhang J, Gu J, Zhang P, Xu Y, et al. Comparison of clinical characteristics and outcomes of patients with coronavirus disease 2019 at different ages. Aging (Albany NY) 2020;12(11):10070-10086.

6

Jee Y. WHO International Health Regulations Emergency Committee for the COVID-19 outbreak. Epidemiol Health 2020;42:e2020013.

7

Hendren NS, Drazner MH, Bozkurt B, Cooper LT Jr. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation 2020;141(23):1903-1914.

8

Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr 2020;14(3):247-250.

9

Ashraf S, Ilyas S, Alraies MC. Acute coronary syndrome in the time of the COVID-19 pandemic. Eur Heart J 2020;41(22):2089-2091.

10

Wańha W, Wybraniec M, Kapłon-Cieślicka A, Kupczyńska K, Dobrowolski P, Michalski B, et al. Myocardial infarction in the shadow of covid-19. Cardiol J 2020;27(5):478-480.

11

Dhakal BP, Sweitzer NK, Indik JH, Acharya D, William P. SARS-CoV-2 Infection and Cardiovascular Disease: COVID-19 Heart. Heart Lung Circ 2020;29(7):973-987.

12

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020;191:9-14.

13

Raad M, Dabbagh M, Gorgis S, Yan J, Chehab O, Dagher C, et al. Cardiac Injury Patterns and Inpatient Outcomes Among Patients Admitted With COVID-19. Am J Cardiol 2020;133:154-161.

14

Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020;253:117723.

15

Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022;145(8):153-639.

16

Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull 2009;92:7-32.

17

GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1084-1150.

18

Kayikcioğlu M, Oto A. Control and Management of Cardiovascular Disease in Turkey. Circulation 2020;141(1):7-9.

19

Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr, Sperling LS, Virani SS, et al. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2019;73(24):3153-3167.

20

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069.

21

Schiavone M, Gobbi C, Biondi-Zoccai G, D’Ascenzo F, Palazzuoli A, Gasperetti A, et al. Acute coronary syndromes and Covid-19: Exploring the uncertainties. J Clin Med 2020;9(6):1683.

22

Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, Farahmandian N, Miresmaeili SM, Bahreini E. A comprehensive review of COVID-19 characteristics. Biol Proced Online 2020;22(1):19.

23

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.

24

Shi S, Qin M, Cai Y, Liu T, Shen B, Yang F, et al. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019. Eur Heart J 2020;41(22):2070-2079.

25

Task Force for the management of COVID-19 of the European Society of Cardiology. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022;118(7):1618-1666.

26

Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2020;9(3):241-247.

27

Kopel J, Perisetti A, Roghani A, Aziz M, Gajendran M, Goyal H. Racial and Gender-Based Differences in COVID-19. Front Public Health 2020;8:418.

28

Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, et al. Laboratory Findings of COVID-19 Infection are Conflicting in Different Age Groups and Pregnant Women: A Literature Review. Arch Med Res 2020;51(7):603-607.

29

Hiteshi AK, Li D, Gao Y, Chen A, Flores F, Mao SS, et al. Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass. Clin Cardiol 2014;37(10):605-609.

30

Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, et al. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J 2020;41(13):1328-1336.

31

Ferreira-González I. The epidemiology of coronary heart disease. Rev Esp Cardiol (Engl Ed) 2014;67(2):139-144.

32

Khan IH, Savarimuthu S, Leung MST, Harky A. The need to manage the risk of thromboembolism in COVID-19 patients. J Vasc Surg 2020;72(3):799-804.

33

Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-Mediated Inflammatory Responses: From Mechanisms to Potential Therapeutic Tools. Virol Sin 2020;35(3):266-271.

34

Tahir F, Bin Arif T, Ahmed J, Malik F, Khalid M. Cardiac Manifestations of Coronavirus Disease 2019 (COVID-19): A Comprehensive Review. Cureus 2020;12(5):e8021.

35

Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA, et al. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic. J Am Coll Cardiol 2020;75(22):2871-2872.

36

Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020;8(3):48.

37

Negreira Caamaño M, Piqueras Flores J, Mateo Gómez C. Impact of COVID-19 pandemic in cardiology admissions. Med Clin (Barc) 2020;155:179-180.

38

Shafeghat M, Aminorroaya A, Rezaei N. How Stable Ischemic Heart Disease Leads to Acute Coronary Syndrome in COVID-19? Acta Biomed 2021;92(5):e2021512.

39

Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-Elevation myocardial infarction in patients with COVID-19: Clinical and angiographic outcomes. Circulation 2020;141(25):2113-2116.

40

Bavishi C, Bonow RO, Trivedi V, Abbott JD, Messerli FH, Bhatt DL. Special Article - Acute myocardial injury in patients hospitalized with COVID-19 infection: A review. Prog Cardiovasc Dis 2020;63(5):682-689.

41

Guedeney P, Collet JP. Diagnosis and Management of Acute Coronary Syndrome: What is New and Why? Insight From the 2020 European Society of Cardiology Guidelines. J Clin Med 2020;9(11):3474.

42

Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021;42(14):1289-1367.

43

Arora S, Stouffer GA, Kucharska-Newton AM, Qamar A, Vaduganathan M, Pandey A, et al. Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction. Circulation 2019;139(8):1047-1056.

44

Han H, Xie L, Liu R, Yang J, Liu F, Wu K, et al. Analysis of heart injury laboratory parameters in 273 COVID-19 patients in one hospital in Wuhan, China. J Med Virol 2020;92(7):819-823.

45

Karimi A, Shobeiri P, Kulasinghe A, Rezaei N. Novel systemic inflammation markers to predict COVID-19 prognosis. Front Immunol 2021;12:741061.

46

Tahto E, Jadric R, Pojskic L, Kicic E. Neutrophil-to-lymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Coronary Syndrome. Med Arch 2017t;71(5):312-315.

47

Wang Q, Chen H, Shi Y, Hughes AC, Liu WJ, Jiang J, et al. Tracing the origins of SARS-CoV-2: lessons learned from the past. Cell Res 2021;31(11):1139-1141.