MİYOKARD ENFARKTÜSÜ NEDENLİ KORONER ANJİYOGRAFİYE YÖNLENDİRİLEN COVID-19 HASTALARINDA MORTALİTE PREDİKTÖRLERİ
Öz
Amaç
Miyokard enfarktüsü tablosu ile başvuran COVID-19 hastalarında mortalite ve mortalite verileri hastaların uzun süreli takiplerinin olmaması nedeniyle kısıtlıdır. Bu çalışmada bu hasta grubunun mortalite prediktörlerinin araştırılması amaçlanmıştır.
Araçlar ve Yöntem
COVID-19 enfeksiyonu mevcut olan ve yüksek riskli miyokard enfarktüsü nedeniyle invaziv koroner anjiyografi yapılan 80 hasta çalışmaya dahil edilmiştir. Tüm hastalar ilk başvurudan sonra en az 1 yıl süre ile takip edilmiştir. Hastaların mortalite verileri ve medikal kayıtları hastanenin medikal kayıt programından retrospektif olarak alınmıştır.
Sonuç
Otuz dört hastanın (%42,5) ilk başvurudan sonraki bir yıllık takipte öldüğü izlendi. Bu hastaların 30’u (%88,2) ilk başvurudaki hastane yatışı sonlanmadan öldü. Medyan kapı balon süresi 107,5 dk (17-1278) olarak izlendi. 49 hastaya (%61,25) invaziv koroner anjiyografi sırasında perkütan koroner girişim uygulandı. Yüksek ferritin ve LDH seviyelerinin mortalite ile bağımsız olarak ilişkili olduğu izlendi (OR: 1,006, CI %95: 1,001-1,01, p: 0,011; OR:1,005, CI %95: 1,001-1,009, p:0,025; sırasıyla). Ferritin için kestirim değeri 211 mcg/L (AUC:0.762, sensitivite: 73.5%, spesifite 63%, p:<0.001) ve LDH için kestirim değeri 492 U/L (AUC:0.863, sensitivite: 79.4%, spesifite 80.4%, p:<0.001) olarak hesaplandı.
İnvaziv medikal tedaviye rağmen miyokard enfarktüsü gelişen COVID-19 hastalarında mortalite oranı yüksektir. Çalışmada yalnızca artmış LDH ve ferritin seviyelerinin mortalite prediktörü olduğu izlenmiştir.
Anahtar Kelimeler
Miyokard Enfarktüsü COVID-19 Koroner Anjiyografi Mortalite Myocardial Infarction Coronary Angiography Mortality
Kaynakça
- Singh A, Zaheer S, Kumar N, Singla T, Ranga S. Covid19, beyond just the lungs: A review of multisystemic involvement by Covid19. Pathol Res Pract 2021; 224: 153384.
- Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27:601-15.
- Yang X., Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.
- Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost 2020; 18: 1743-46.
- de Roquetaillade C, Chousterman BG, Tomasoni D, et al. Unusual arterial thrombotic events in Covid-19 patients. Int J Cardiol 2021;323:281-4.
- Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med 2020;8:e46-7.
- Levi F, Lucchini F, Negri E, La Vecchia C. Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 2002;88:119- 24.
- Hands ME, Rutherford JD, Muller JE, et al. The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. The MILIS Study Group. J Am Coll Cardiol 1989;14:40-8.
- 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;42:1289-1367.
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction. Circulation 2018;38:e618-51.
- Saad M, Kennedy KF, Imran H, et al. Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction. JAMA 2021;326:1940-52.
- Aktoz M, Altay H, Aslanger E et al. Turkish Cardiology Association Consensus Report: COVID-19 Pandemic and Cardiovascular Diseases. Turk Kardiyol Dern Ars 2020;48:1-87.
- Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017; 39:119-77.
- Fanaroff AC, Garcia S, Giri J. Myocardial Infarction During the COVID-19 Pandemic. JAMA 2021;326:1916-8.
- Shi C, Wang L, Ye J, et al. Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis. BMC Infect Dis 2021;21:663.
- Solano-López J, Zamorano JL, Pardo Sanz A, et al. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. Rev Esp Cardiol 2020;73:985-93.
- Henry BM, Aggarwal G, Wong J, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. The Am J Emerg Med 2020;38:1722-6.
- Lino K, Guimarães GMC, Alves LS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis 2021;25:101569.
- Montero-Cabezas JM, Córdoba-Soriano JG, Díez-Delhoyo F, et al. Angiographic and Clinical Profile of Patients With COVID-19 Referred for Coronary Angiography During SARS-CoV-2 Outbreak: Results From a Collaborative, European, Multicenter Registry. Angiology 2022;73:112-9.
THE PREDICTORS OF MORTALITY IN PATIENTS WHO WERE REFERRED TO CORONARY ANGIOGRAPHY DUE TO MYOCARDIAL INFARCTION AND HAD COVID-19
Öz
Background and Objective
The mortality and morbidity data are limited because the patients who presented with myocardial infarction and have COVID-19 were not followed for an extended period. This study aimed to investigate mortality predictors in this group.
Method
Eighty patients with COVID-19 infection who performed invasive coronary angiography due to high-risk myocardial infarction were enrolled. All patients were followed at least one year after the first admission. Mortality data and medical records were retrospectively collected using the hospital’s medical record software.
Results
Thirty-four patients (42.5%) died one year after the first admission. Thirty of them (88.2%) were in-hospital mortality. The median door-to-procedure time was 107.5 minutes (17-1278). PCI was performed in 49 patients (61.25%). Higher ferritin and LDH were independent factors related to mortality (OR: 1.006, CI 95%: 1.001-1.01, p: 0.011; OR:1.005, CI 95%: 1.001-1.009, p:0.025; respectively). The cut-off value was estimated at 211 mcg/L for ferritin (AUC:0.762, sensitivity: 73.5%, specificity 63%, p:<0.001), and 492 U/L for LDH (AUC:0.863, sensitivity: 79.4%, specificity 80.4%, p:<0.001).
Conclusion
Despite invasive management, the mortality rate in patients with myocardial infarction and COVID-19 is high. Only increased LDH and ferritin levels were independent predictors for mortality.
Anahtar Kelimeler
Miyokard Enfarktüsü COVID-19 Koroner Anjiyografi Mortalite Myocardial Infarction Coronary Angiography Mortality
Kaynakça
- Singh A, Zaheer S, Kumar N, Singla T, Ranga S. Covid19, beyond just the lungs: A review of multisystemic involvement by Covid19. Pathol Res Pract 2021; 224: 153384.
- Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27:601-15.
- Yang X., Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.
- Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost 2020; 18: 1743-46.
- de Roquetaillade C, Chousterman BG, Tomasoni D, et al. Unusual arterial thrombotic events in Covid-19 patients. Int J Cardiol 2021;323:281-4.
- Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med 2020;8:e46-7.
- Levi F, Lucchini F, Negri E, La Vecchia C. Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 2002;88:119- 24.
- Hands ME, Rutherford JD, Muller JE, et al. The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. The MILIS Study Group. J Am Coll Cardiol 1989;14:40-8.
- 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;42:1289-1367.
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction. Circulation 2018;38:e618-51.
- Saad M, Kennedy KF, Imran H, et al. Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction. JAMA 2021;326:1940-52.
- Aktoz M, Altay H, Aslanger E et al. Turkish Cardiology Association Consensus Report: COVID-19 Pandemic and Cardiovascular Diseases. Turk Kardiyol Dern Ars 2020;48:1-87.
- Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017; 39:119-77.
- Fanaroff AC, Garcia S, Giri J. Myocardial Infarction During the COVID-19 Pandemic. JAMA 2021;326:1916-8.
- Shi C, Wang L, Ye J, et al. Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis. BMC Infect Dis 2021;21:663.
- Solano-López J, Zamorano JL, Pardo Sanz A, et al. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. Rev Esp Cardiol 2020;73:985-93.
- Henry BM, Aggarwal G, Wong J, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. The Am J Emerg Med 2020;38:1722-6.
- Lino K, Guimarães GMC, Alves LS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis 2021;25:101569.
- Montero-Cabezas JM, Córdoba-Soriano JG, Díez-Delhoyo F, et al. Angiographic and Clinical Profile of Patients With COVID-19 Referred for Coronary Angiography During SARS-CoV-2 Outbreak: Results From a Collaborative, European, Multicenter Registry. Angiology 2022;73:112-9.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 28 Temmuz 2023 |
| Yayımlanma Tarihi | 28 Temmuz 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 4 Sayı: 2 |
Kaynak Göster
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