PREDIKTIVNI FAKTORI ZA NASTANAK VELIKIH NEŽELJENIH SRČANIH DOGAĐAJA NAKON KAROTIDNE ENDARTEREKTOMIJE
Sažetak
Karotidna endarterektomija (engl. carotid endarterectomy ‒ CEA) predstavlja standardnu hiruršku proceduru u prevenciji moždanog udara kod pacijenata sa stenozom karotidne arterije. Međutim, pri izvođenju ove procedure postoji značajan rizik od nastanka velikih neželjenih kardiovaskularnih događaja (engl. major adverse cardiovascular events ‒ MACE). Cilj ovog rada bio je da unapredi preoperativnu procenu rizika i da doprinese razvoju personalizovanih perioperativnih strategija u ispitivanoj populaciji kod koje postoji visok rizik od nastanka MACE-a. U studiju je u toku 2017. godine prospektivno uključeno ukupno sto deset pacijenata koji su bili podvrgnuti elektivnoj CEA. Prikupljeni su preoperativni klinički podaci, koji su obuhvatili i nivoe suPAR-a (engl. soluble urokinase plasminogen activator receptor), uree i ejekcione frakcije leve komore (engl. left verticular ejection fraction ‒ LVEF). Pojava MACE-a, koji podrazumeva infarkt miokarda, aritmije, srčanu slabost, moždani udar ili kardiovaskularnu smrt, praćena je trideset dana posle operacije. Statistička analiza, zasnovana na univarijantnoj analizi i Koksovoj regresionoj analizi, izvršena je radi procene prediktora MACE-a. U toku trideset dana praćenja nakon CEA, MACE je zabeležen kod deset pacijenata (9,1%). Ovi pacijenti su imali značajno više nivoe suPAR-a (7,04 ± 1,81 naspram 3,15 ± 1,01 ng/mL; p < 0,001), povišene vrednosti uree (7,69 ± 2,25 naspram 6,14 ± 1,89 mmol/L; p = 0,024) i niži LVEF (48,9% ± 5,43% naspram 55,17% ± 7,8%; p = 0,007). Koksova regresiona analiza identifikovala je suPAR kao nezavisan prediktor za pojavu MACE-a u roku od trideset dana (HR = 2,144; p < 0,001). Povišeni preoperativni nivoi suPAR-a, povećana urea i smanjena ejekciona frakcija povezani su sa većim rizikom od pojave MACE-a nakon CEA. Integracija ovih biomarkera u preoperativnu procenu može unaprediti stratifikaciju kardiovaskularnog rizika i pomoći u donošenju odluke o načinu na koji će se tretirati pacijenti kod kojih postoji visok rizik od nastanka MACE-a pre operacije.
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