ÖZET

Amaç:

Koroner anjiyografide (KAG) mekanik tıkanıklık olmamasına ve sorumlu koroner arterde yeterli açıklık sağlanmasına rağmen ilgili myokard segmentinde perfüzyonun sağlanamamasına no-reflow (akımsızlık) fenomeni denir. No-reflow fenomeninin akut myokard infarktüsü (MI) hastalarında daha sık olduğu ve tekrarlayan MI, hastane içi istenmeyen kardiyak olaylar, sol ventrikül yeniden yapılanması, malign ventriküler aritmi ve uzun dönemde kalp yetersizliği gelişimi ile ilişkili olduğu son yapılan çalışmalarda gösterilmiştir. No-reflow fenomenini öngördürücü faktörler net olarak tanımlanamamıştır. Biz bu çalışmamızda, kliniğimize ST segment yükselmeli MI (STSYMI) ile başvuran hastalarda no-reflow gelişimi ile ilgili öngördürücü faktörleri tanımlamayı amaçladık.

Yöntem:

Kliniğimize 2017-2021 tarihleri arasında STYMI tanısı ile primer perkütan koroner girişim (PPKG) uygulanan hastalar geriye dönük dahil edildi. Demografik, klinik ve laboratuvar bulguları hastane veri tabanı taranarak elde edildi. KAG’de sorumlu epikardiyal koroner arterde yeterli açıklık sağlanmasına ve spazm, diseksiyon olmamasına rağmen TIMI ≤2 akım olan hastalar no-reflow gelişen gruba dahil edildi. No-reflow fenomeni gelişimini öngördürebilecek demografik, klinik, laboratuvar ve anjiyografik parametrelerin tanımlanması planlandı.

Bulgular:

Çalışmamıza toplam 689 hasta dahil edildi. Yaş ortalaması 55,9±8,7 olup hastaların %71,8’i erkekti. No-reflow gelişimine göre 2 grup oluşturulduğunda 107 hastada (%15,5) no-reflow geliştiği gözlendi. Lojistik regresyon analizinde sol ventrikül ejeksiyon fraksiyonu, troponin, açlık kan şekeri, TIMI trombüs yükü ve TIMI trombüs yükünün derecesi no-reflow gelişiminin bağımsız öngördürücüleri olarak saptandı.

Sonuç:

Hastane içi istenmeyen kardiyak olaylar, sol ventrikül yeniden şekillenmesi, malign ventriküler aritmi ve kalp yetmezliği sıklığının no-reflow fenomeni gelişen hastalarda fazla olduğu göz önünde bulundurulduğunda, no-reflow riskinin öngördürücü faktörlerinin belirlenmesi uzun vadeli sonucu iyileştirmek için önleyici tedbirler alınmasına yardımcı olabilir.

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Birincil Perkütan Koroner Girişim Uygulanan ST Segment Yükselmeli Miyokart İnfarktüsü Hastalarında Akımsızlık Fenomeni Gelişimi Öngördürücüleri

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References