Akut miyokard infarktüslü hastalarda kollateral dolaşımın klinik, elektrokardiyografik ve anjiyografik parametrelerle değerlendirilmesi
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Dosyalar
Tarih
2006
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Akut miyokard infarktüslü (AMİ) hastalarda erken dönem kollateral dolaşım (KD) varlığı araştırıldı ve bunun klinik, elektrokardiyografik ve anjiyografik parametrelerle ilişkisi değerlendirildi. Çalışma planı: Çalışmaya, ilk altı saat içinde başvuran AMİ’li 79 hasta (63 erkek, 16 kadın; ort. yaş 57) alındı. Primer anjiyoplasti öncesinde koroner anjiyografi ile infarktla ilişkili damar, anlamlı darlık (≥%50 darlık) saptanan damar sayısı, sorumlu damarda lezyonun yeri (proksimal, orta ve distal) ve KD varlığı kaydedildi. İnfarktla ilişkili damara KD’nin derecesi Rentrop sınıflamasına göre değerlendirildi. İlk altı saat içinde çekilen EKG’lerde Q dalgası varlığı ve resiprokal ST segment değişiklikleri belirlendi. Bulgular: Otuz bir hastada (%39.2) infarktla ilişkili damara KD görüldü. Sorumlu lezyon 43 hastada (%54.4) sol ön inen (LAD) koroner arter, 11’inde (%13.9) sirkumfleks (Cx) arter, 25’inde (%31.7) sağ koroner arterde (RCA) idi. İlk altı saat içindeki EKG’de, 34 hastada (%43) Q dalgası görülmedi; resiprokal ST segment çökmesine ise 53 hastada (%67.1) rastlandı. Kollateral dolaşım RCA tıkanmalarında, LAD ve Cx tıkanmalarına göre daha fazla görüldü (sırasıyla %60, %32.6 ve %18.2, p=0.012). Kollateral dolaşım varlığı ile hipertansiyon (r=0.226, p=0.045) ve RCA tıkanması (r=0.309, p=0.006) arasında anlamlı ilişki bulundu. Çokdeğişkenli regresyon analizinde, sadece RCA tıkanmasının KD varlığını öngörmede bağımsız belirleyici olduğu görüldü (r=0.377, p<0.001). Sonuç: Kollateral dolaşım, AMİ’nin erken döneminde, hipertansiyon öyküsü ve RCA tıkanması olan hastaların önemli bir kısmında işlevsel hale gelmektedir. Bu bulgular AMİ’de tedavi seçiminde (invaziv/konservatif) yardımcı olabilir.
Objectives: We investigated the presence of collateral circulation (CC) during early period of acute myocardial infarction (AMI) and evaluated its relationship with clinical, electrocardiographic, and angiographic parameters. Study design: In 79 patients (63 men, 16 women; mean age 57 years) who presented within the first six hours of AMI, coronary angiography was performed before primary angioplasty to determine the infarct-related artery (IRA), the number of arteries with significant stenosis (≥50%), localization of stenosis (proximal, middle, or distal), and the presence of CC. The presence of Q waves and reciprocal ST-segment changes were evaluated on initial electrocardiograms. Collateral circulation to the IRA was graded according to the Rentrop scoring system. Results: Collateral circulation to the IRA was detected in 31 patients (39.2%). Infarct-related artery was the left anterior descending (LAD) coronary artery in 43 patients (54.4%), circumflex (Cx) artery in 11 patients (13.9%), and the right coronary artery (RCA) in 25 patients (31.7%). On initial electrocardiograms, Q wave was absent in 34 patients (43%) and reciprocal ST-segment depression was present in 53 patients (67.1%). Collateral circulation was more common in RCA occlusions than those involving the LAD and Cx arteries (60%, 32.6%, and 18.2%, respectively; p=0.012). The presence of CC was significantly correlated with hypertension (r=0.226, p=0.045) and RCA occlusion (r=0.309, p=0.006). In multiple regression analysis, only RCA occlusion was found to be an independent predictor for CC (r=0.377, p<0.01) Conclusion: In the early period of AMI, collateral circulation becomes functional in a considerable number of patients who have hypertension and RCA occlusion. This may be helpful in choosing between conservative and invasive treatments.
Objectives: We investigated the presence of collateral circulation (CC) during early period of acute myocardial infarction (AMI) and evaluated its relationship with clinical, electrocardiographic, and angiographic parameters. Study design: In 79 patients (63 men, 16 women; mean age 57 years) who presented within the first six hours of AMI, coronary angiography was performed before primary angioplasty to determine the infarct-related artery (IRA), the number of arteries with significant stenosis (≥50%), localization of stenosis (proximal, middle, or distal), and the presence of CC. The presence of Q waves and reciprocal ST-segment changes were evaluated on initial electrocardiograms. Collateral circulation to the IRA was graded according to the Rentrop scoring system. Results: Collateral circulation to the IRA was detected in 31 patients (39.2%). Infarct-related artery was the left anterior descending (LAD) coronary artery in 43 patients (54.4%), circumflex (Cx) artery in 11 patients (13.9%), and the right coronary artery (RCA) in 25 patients (31.7%). On initial electrocardiograms, Q wave was absent in 34 patients (43%) and reciprocal ST-segment depression was present in 53 patients (67.1%). Collateral circulation was more common in RCA occlusions than those involving the LAD and Cx arteries (60%, 32.6%, and 18.2%, respectively; p=0.012). The presence of CC was significantly correlated with hypertension (r=0.226, p=0.045) and RCA occlusion (r=0.309, p=0.006). In multiple regression analysis, only RCA occlusion was found to be an independent predictor for CC (r=0.377, p<0.01) Conclusion: In the early period of AMI, collateral circulation becomes functional in a considerable number of patients who have hypertension and RCA occlusion. This may be helpful in choosing between conservative and invasive treatments.
Açıklama
Anahtar Kelimeler
Elektrokardiyografi, Kollateral Dolaşım, Anjiyografi, Koroner Dolaşım, Hipertansiyon, Miyokard İnfaktrüsü, Electrocardiography, Collateral Circulation, Angiography, Coronary Circulation, Hypertension, Myocardial İnfarction
Kaynak
Türk Kardiyoloji Derneği Arşivi
Archives of the Turkish Society of Cardiology
Archives of the Turkish Society of Cardiology
WoS Q Değeri
Scopus Q Değeri
Q4
Cilt
34
Sayı
1
