ST segment yükselmesiz miyokard enfarktüsü olan hastalarda CHA2DS2 -VASc skorunun koroner arter hastalığının ciddiyet ve karmaşıklığı ile ilişkisi
Öz
Amaç: Bu çalışmada ST segment yükselmesiz miyokard enfarktüsü (NSTEMI) olan hastalarda CHA2DS2 -VASc skorunun koroner arter hastalığının ciddiyet ve karmaşıklığını predikte eden SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) skoru ile korelasyonunun belirlenmesi amaçlandı.
Yöntem: Bu retrospektif kesitsel çalışma bir üçüncü basamak sağlık merkezinde yürütüldü. Acil serviste NSTEMI tanısı alan ve perkütan koroner girişim uygulanan hastalar dahil edildi. Hastaların demografik, klinik ve anjiyografik özellikleri hastanenin elektronik veri sisteminden elde edildi. Ekokardiyografi ve anjiyografi görüntüleri hastaların klinik özelliklerine kör, deneyimli bir girişimsel kardiyolog tarafından değerlendirildi. CHA2DS2-VASc ve SYNTAX skorları hesaplandı. Çalışmanın primer sonlanımı CHA2DS2-VASc ve SYNTAX skorları arasındaki korelasyondu.
Bulgular: Çalışmaya toplam 216 hasta dahil edildi. Ortalama CHA2DS2-VASc ve SYNTAX skorları sırasıyla 2,9±1,7 ve 16,6±7,9 olarak belirlendi. SYNTAX skoruna göre risk gruplarına ayrılan hastaların CHA2DS2-VASc skorları arasında düşük ve orta risk arasında (sırasıyla 2,8±1,7 ve 3,4±1,7, p<0,001), düşük ve yüksek risk arasında (sırasıyla, 2,8±1,7 ve 3,7±1,8, p<0.001) anlamlı fark izlendi. CHA2DS2-VASc ve SYNTAX skorları arasında yapılan korelasyon analizinde anlamlı pozitif korelasyon belirlendi (Spearman’s rho= 0,454, p=0,02).
Sonuç: Bu çalışmada CHA2DS2-VASc ve SYNTAX skorları arasında kabul edilebilir bir pozitif korelasyon olduğu gösterilmiştir. Acil serviste NSTEMI tanısı alan hastalarda koroner arter hastalığının ciddiyeti ve karmaşıklığını ön görmede CHA2DS2-VASc skorunun kullanılması fayda sağlayabilir.
Anahtar Kelimeler
ST segment yükselmesiz miyokard enfarktüsü koroner arter hastalığı CHA2DS2-VASc skoru SYNTAX skoru
Kaynakça
- Ralapanawa U, Sivakanesan R. Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review. J Epidemiol Glob Health. 2021;11(2):169-177. doi:10.2991/jegh.k.201217.001
- Collet JP, Thiele H, Barbato E, 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. doi:10.1093/eurheartj/ehaa575
- Head SJ, Farooq V, Serruys PW, Kappetein AP. The SYNTAX score and its clinical implications. Heart. 2014;100(2):169-177. doi:10.1136/heartjnl-2012-302482
- Akboğa MK, Yılmaz S, Yalçın R. Prognostic value of CHA2DS2-VASc score in predicting high syntax score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation. Anatol J Cardiol. 2021;25(11):789-795. doi:10.5152/AnatolJCardiol.2021.03982
- Hatamnejad MR, Heydari AA, Salimi M, Jahangiri S, Bazrafshan M, Bazrafshan H. The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina. BMC Cardiovasc Disord. 2022;22(1):1-11. doi:10.1186/s12872-022-02455-6
- Maleki M, Tajlil A, Separham A, et al. Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-Segment elevation acute coronary syndrome (NSTE-ACS). J Cardiovasc Thorac Res. 2021;13(3):216-221. doi:10.34172/jcvtr.2021.40
- Bedel C, Korkut M, Aksoy F, Kuş G. Usefulness of Immature Granulocytes to Predict High Coronary SYNTAX Score in Acute Coronary Syndrome; a Cross-sectional Study. Arch Acad Emerg Med. 2020;8(1):e73.
- Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
- Kurtul A, Acikgoz SK. Validation of the CHA2DS2-VASc Score in Predicting Coronary Atherosclerotic Burden and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Am J Cardiol. 2017;120(1):8-14. doi:10.1016/j.amjcard.2017.03.266
- Taşolar H, Çetin M, Ballı M, et al. CHA2DS2-VASc-HS score in non-ST elevation acute coronary syndrome patients: Assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events. Anatol J Cardiol. 2016;16(10):742-748. doi:10.14744/AnatolJCardiol.2015.6593
- Alyeşil C, Yilmaz S, Özturan İU, Pekdemir M, Yaka E, Doğan NÖ. Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome. Clin Exp Emerg Med. 2020;7(4):275-280. doi:10.15441/ceem.19.088
- Duyan M, Ünal AY, Özturan İU, Günsoy E. Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure. Turkish J Emerg Med. 2020;20(3):105-110. doi:10.4103/2452-2473.290065
- Rahmani R, Majidi B, Ariannejad H, Shafiee A. The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction. Cardiovasc Revascularization Med. 2020;21(4):514-517. doi:10.1016/j.carrev.2019.07.023
- Friberg L, Rosenqvist M, Lip GYH. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33(12):1500-1510. doi:10.1093/eurheartj/ehr488
- Fauchier L, Lecoq C, Ancedy Y, et al. Evaluation of 5 Prognostic Scores for Prediction of Stroke, Thromboembolic and Coronary Events, All-Cause Mortality, and Major Adverse Cardiac Events in Patients With Atrial Fibrillation and Coronary Stenting. Am J Cardiol. 2016;118(5):700-707. doi:10.1016/j.amjcard.2016.06.018
- Ma X, Shao Q, Dong L, et al. Prognostic value of CHADS2 and CHA2DS2-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Medicine (Baltimore). 2020;99(30):e21321. doi:10.1097/MD.0000000000021321
Relation of CHA2DS2 -VASc score with severity and complexity of coronary artery disease in patients with non-ST segment elevation myocardial infarction
Öz
Objectives: This study aimed to determine the correlation between CHA2DS2 -VASc score and the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) scoring system for predicting severity and complexity of coronary artery disease in patients with non-ST segment elevation myocardial infarction (NSTEMI).
Methods: This is a retrospective cross-sectional study conducted in a tertiary care center. The patients admitted to the emergency department (ED) with NSTEMI and who underwent the PCI were included. The patients’ demographic, clinical and angiographic characteristics were gathered from the hospital electronic medical records. Echocardiography and angiography images were evaluated by an experienced interventional cardiologist blinded to the patients' clinical information. The CHA2DS2-VASc and SYNTAX scores were calculated. The primary outcome of this study was the correlation between the CHA2DS2-VASc and SYNTAX scores.
Results: A total of 216 patients were included. The mean CHA2DS2-VASc and SYNTAX scores were 2.9±1.7 and 16.6±7.9, respectively. There were significant differences in the mean CHA2DS2-VASc scores between the low and moderate (2.8±1.7 and 3.4±1.7, respectively, p<0.001), and low and high-risk groups (2.8±1.7 and 3.7±1.8, respectively, p<0.001) according to the SYNTAX score risk classification. The rank correlation analysis showed a significant positive correlation between the CHA2DS2-VASc and SYNTAX scores (Spearman’s rho= 0.454, p=0.02).
Conclusion: This study showed a fair, positive correlation between the CHA2DS2-VASc and SYNTAX scores. The use CHA2DS2-VASc score might be practical to predict the severity and complexity of coronary artery disease in patients admitted to the ED with NSTEMI.
Anahtar Kelimeler
non-ST elevation acute coronary syndrome coronary artery disease CHA2DS2-VASc score SYNTAX score
Kaynakça
- Ralapanawa U, Sivakanesan R. Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review. J Epidemiol Glob Health. 2021;11(2):169-177. doi:10.2991/jegh.k.201217.001
- Collet JP, Thiele H, Barbato E, 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. doi:10.1093/eurheartj/ehaa575
- Head SJ, Farooq V, Serruys PW, Kappetein AP. The SYNTAX score and its clinical implications. Heart. 2014;100(2):169-177. doi:10.1136/heartjnl-2012-302482
- Akboğa MK, Yılmaz S, Yalçın R. Prognostic value of CHA2DS2-VASc score in predicting high syntax score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation. Anatol J Cardiol. 2021;25(11):789-795. doi:10.5152/AnatolJCardiol.2021.03982
- Hatamnejad MR, Heydari AA, Salimi M, Jahangiri S, Bazrafshan M, Bazrafshan H. The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina. BMC Cardiovasc Disord. 2022;22(1):1-11. doi:10.1186/s12872-022-02455-6
- Maleki M, Tajlil A, Separham A, et al. Association of neutrophil to lymphocyte ratio (NLR) with angiographic SYNTAX score in patients with non-ST-Segment elevation acute coronary syndrome (NSTE-ACS). J Cardiovasc Thorac Res. 2021;13(3):216-221. doi:10.34172/jcvtr.2021.40
- Bedel C, Korkut M, Aksoy F, Kuş G. Usefulness of Immature Granulocytes to Predict High Coronary SYNTAX Score in Acute Coronary Syndrome; a Cross-sectional Study. Arch Acad Emerg Med. 2020;8(1):e73.
- Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
- Kurtul A, Acikgoz SK. Validation of the CHA2DS2-VASc Score in Predicting Coronary Atherosclerotic Burden and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Am J Cardiol. 2017;120(1):8-14. doi:10.1016/j.amjcard.2017.03.266
- Taşolar H, Çetin M, Ballı M, et al. CHA2DS2-VASc-HS score in non-ST elevation acute coronary syndrome patients: Assessment of coronary artery disease severity and complexity and comparison to other scoring systems in the prediction of in-hospital major adverse cardiovascular events. Anatol J Cardiol. 2016;16(10):742-748. doi:10.14744/AnatolJCardiol.2015.6593
- Alyeşil C, Yilmaz S, Özturan İU, Pekdemir M, Yaka E, Doğan NÖ. Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome. Clin Exp Emerg Med. 2020;7(4):275-280. doi:10.15441/ceem.19.088
- Duyan M, Ünal AY, Özturan İU, Günsoy E. Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure. Turkish J Emerg Med. 2020;20(3):105-110. doi:10.4103/2452-2473.290065
- Rahmani R, Majidi B, Ariannejad H, Shafiee A. The Value of the GRACE Score for Predicting the SYNTAX Score in Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction. Cardiovasc Revascularization Med. 2020;21(4):514-517. doi:10.1016/j.carrev.2019.07.023
- Friberg L, Rosenqvist M, Lip GYH. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33(12):1500-1510. doi:10.1093/eurheartj/ehr488
- Fauchier L, Lecoq C, Ancedy Y, et al. Evaluation of 5 Prognostic Scores for Prediction of Stroke, Thromboembolic and Coronary Events, All-Cause Mortality, and Major Adverse Cardiac Events in Patients With Atrial Fibrillation and Coronary Stenting. Am J Cardiol. 2016;118(5):700-707. doi:10.1016/j.amjcard.2016.06.018
- Ma X, Shao Q, Dong L, et al. Prognostic value of CHADS2 and CHA2DS2-VASc scores for post-discharge outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Medicine (Baltimore). 2020;99(30):e21321. doi:10.1097/MD.0000000000021321
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 15 Ekim 2022 |
| Gönderilme Tarihi | 1 Ağustos 2022 |
| Kabul Tarihi | 19 Eylül 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 5 Sayı: 3 |
Cited By
Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants
Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine
https://doi.org/10.1097/HPC.0000000000000336
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