Ali Rıza DEMİR, Gökhan DEMİRCİ, Serkan ASLAN, Begüm UYGUR, Yalçın AVCI, Ali Kemal KALKAN, Mehmet ERTÜRK

İki-Stent Stratejisi ile Revaskülarize Edilen Koroner Bifurkasyon Lezyona Sahip Hastalarda Akut Böbrek Hasarı Prediktörlerinin Belirlenmesi

Giriş: Akut böbrek hasarı (ABH) kardiyak invaziv girişimler sonrası mortalite, morbidite, hastanede kalış süresi ve maliyeti arttıran önemli bir komplikasyondur. İki-stent stratejisi ile revaskülarize edilen koroner bifurkasyon lezyonları sonrası görülme sıklığı ve ABH gelişimini etkileyen faktörler belirsizliğini korumaktadır. Hastalar ve Yöntem: Çalışmada Ocak 2015-Eylül 2020 tarihleri arasında kurumumuzda gerçek koroner arter bifurkasyon lezyonlarına iki-stent stratejisi ile revaskülarizasyon uygulanan ve dışlama kriterlerini karşılamayan 230 ardışık non-ST elevasyonlu miyokart infarktüsü (NSTEMI) hastası retrospektif olarak incelenmiştir. ABH, işlem sonrası ilk 48 saat içinde kreatinin değişikliklerinin ortaya çıkması ile “Acute Kidney Injury Network (AKIN)” grubu kriterlerinin karşılanması olarak tanımlanmıştır. Tüm hastalar için ACEF (yaş, serum kreatinin, sol ventrikül ejeksiyon fraksiyonu) skoru hesaplanmıştır. Bulgular: İşlem sonrası hastaların 28 (%12.2)’inde ABH gelişmiştir. Yapılan çok değişkenli analiz sonucunda hipertansiyon, ACEF skoru ≥ 1.14 ve kontrast volümü ≥ 252 mL ABH için bağımsız prediktörler olarak saptanmıştır. Koroner anatomiye dair faktörlerin ve teknik ile ilişkili faktörlerin ise ABH üzerine herhangi bir etkisi bulunamamıştır. ACEF skoru 1.14 değerinin üstünde %82.1 duyarlılık, %60.9 özgüllük ve %96.1 negatif prediktif değeri ile ABH gelişimini tespit etmiştir. Ayrıca yüksek ACEF skoru olan grupta ABH oranı, düşük ACEF skoru olan gruba göre anlamlı düzeyde daha yüksek bulunmuştur (%22.5’e karşın %3.9, p< 0.001). Sonuç: Basit ve son derece kullanıcı dostu ACEF skoru, iki-stent stratejisi ile revaskülarize edilen koroner bifurkasyon lezyonları sonrası ABH gelişme riskini doğru bir şekilde tanımlayabilir.

Determination of Predictors of Acute Kidney Injury in Patients with Coronary Bifurcation Lesions Revascularized with the Two-Stent Strategy

Introduction: Acute kidney injury (AKI) is an important complication that increases mortality, morbidity, hospitalization and costs after the invasive cardiac procedures. The incidence of AKI and the factors affecting the development of AKI after the revascularization of coronary bifurcation lesions with the two-stent strategy remain unclear. Patients and Methods: We retrospectively evaluated 230 consecutive non-ST elevation myocardial infarction (NSTEMI) patients who underwent revascularization with the two-stent strategy for the true coronary artery bifurcation lesions between January 2015 and September 2020, and did not meet the exclusion criteria. AKI was defined as meeting Acute Kidney Injury Network (AKIN) group criteria with the development of creatinine changes within the first 48 hours after the procedure. ACEF (age, serum creatinine, left ventricular ejection fraction) score was calculated for all patients. Results: AKI developed in 28 (12.2%) patients after the procedure. As a result of the multivariable analysis, hypertension, ACEF score ≥ 1.14 and contrast agent volume ≥ 252 mL were determined as independent predictors for AKI. The coronary anatomical factors and technique related factors had no effect on AKI development. ACEF score ≥ 1.14 had sensitivity of 82.1%, specificity of 60.9% and negative predictive value of 96.1% for detecting AKI development. Moreover, the rate of AKI in the group with high ACEF score was significantly higher than the group with low ACEF score (22.5% vs. 3.9%, p< 0.001). Conclusion: The simple and extremely user-friendly ACEF score can accurately describe the risk of AKI development after the revascularization of coronary bifurcation lesions with the two-stent strategy.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi