Uticaj istovremenog prisustva sistolne disfunkcije leve komore i renalne disfunkcije na 5-godišnji ishod nakon akutnog infarkta miokarda sa elevacijom ST segmenta

  • Lidija Savić Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia
  • Igor Mrdović Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milika Ašanin Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Sanja Stanković Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia
  • Dragan Matić Coronary Care Unit Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia
  • Gordana Krljanac Coronary Care Unit, Cardiology Clinic and Emergence Hospital, Center for Medical Biochemistry, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Ratko Lasica Coronary Care Unit, Emergency Hospital, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/5772
Ključne reči: myocardial infarction||, ||infarkt miokarda, comorbidity||, ||komorbiditet, ventricular dysfunction, left||, ||srce, disfukncija leve komore, angioplasty, baloon||, ||angioplastika, balonska, mortality||, ||mortalitet, prognosis||, ||prognoza,

Sažetak


Uvod/Cilj. Istovremeno prisustvo sistolne disfunkcije leve komore (LVSD) i renalne disfunkcije (RD) je snažan nezavisni prediktor pojave neželjenih događaja u kratkoročnom i srednjoročnom praćenju bolesnika sa akutnim infarktom miokarda sa elevacijom ST segmenta (STEMI) koji su lečeni primarnom perkutanom koronarnom intervencijom (pPCI). Cilj ovog rada bio je da se utvrdi, pre svega, prognostički uticaj istovremenog prisustva LVSD i RD na ukupni 5-godišnji mortalitet kod bolesnika sa STEMI koji su lečeni pPCI, kao i da se utvrdi prognostički uticaj LVSD i RD na pojavu značajnih neželjenih kardiovaskularnih događaja [major adverse cardiovascular events (MACEs): kardiovaskularni mortalitet, reinfarkt, šlog i hitna revaskularizacija zbog ishemije] kod ovih bolesnika. Metode. Analiziran je 951 bolesnik. Bolesnici su bili podeljeni u četiri grupe u zavisnosti od prisustva LVSD (ejekciona frakcija < 40%) i/ili bazalne RD (klirens kreatinina < 60 ml/min): grupa I (bez LVSD, bez RD), grupa II (LVSD, bez RD), grupa III (RD, bez LVSD), grupa IV (LVSD+RD). Rezultati. Dobijeni rezultati pokazuju da je 5-godišnji mortalitet iznosio 2,3%, 17,6%, 11,7% i 38.3%, a 5-godišnja pojava MACE 8,8%, 28,4%, 18,3% i 44, 4% u grupama I, II, III i IV (p < 0.001). Najviši procenat smrtnih ishoda i pojave MACE registrovan je u prvoj godini praćenja u svim grupama. Korišćenjem jednogodišnje landmark analize potvrđeno je da su bolesnici sa istovremenim prisustvom LVSD i RD imali najviši procenat smrtnih ishoda u periodu između jedne i pet godina (p = 0,028). Postojala je snažna tendencija statističke značajnosti za pojavu MACEa između analiziranih grupa u periodu između jedne do pet godina (p = 0.085). U Cox regresionom modelu, istovremeno prisustvo LVSD-RD bilo je snažan nezavisni prediktor mortaliteta i pojave MACE u 5-godišnjem praćenju: mortalitet hazard ratio (HR) 4,5 [95% interval poverenja (CI) 1,9–10,8]; MACE, HR 2,5 (95% CI 1,4–4,5). Zaključak. Snažan negativan, nezavisan prognostički uticaj istovremenog prisustva LVSD-RD održava se u dugoročnom praćenju bolesnika sa STEMI koji su lečeni primarnom PCI.

Reference

Kümler T, Gislason HG, Køber L, Torp Pedersen C. Persistence of the prognostic importance of left ventricular systolic dys-function and heart failure after myocardial infarction: 17 year follow-up of the TRACE register. Eur J Hear Fail 2010; 12: 805−11.

Shiga T, Hagiwara N, Ogawa H, Takagi A, Nagashima M, Yamauchi T, et al. Sudden cardiac death and left ventricular ejection fraction during long-term follow-up after acute my-ocardial infarction in the primary percutaneous coronary in-tervention era: results from the HIJAMI-II registry. Heart 2009; 95(3): 216−20.

Sadeghi H, Stone GW, Grines CL, Mehran R, Dixon SR, Lansky AJ, et al. Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 2003; 108(22): 2769−75.

Gruberg L. Renal insufficiency and prognosis after primary PCI: still bad after all these years. J Invasive Cardiol 2009; 21(10): 499−500.

Smith GL, Masoudi FA, Shlipak MG, Krumholz HM, Parikh CR. Renal impairment predicts long-term mortality risk after acute myocardial infarction. J Am Soc Nephrol 2008; 19(1): 141−50.

Campbell NG, Varagunam M, Sawhney V, Ahuja KR, Salahuddin N, de Palma R, et al. Mild chronic kidney disease is an independent predictor of long-term mortality after emergency angiography and primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. Heart 2012; 98(1): 42−7.

Dohi T, Miyauchi K, Okazaki S, Yokoyama T, Tamura H, Kojima T, et al. Long-term impact of mild chronic kidney disease in patients with acute coronary syndrome undergoing percutane-ous coronary interventions. Nephrol Dial Transplant 2011; 26(9): 2906−11.

Morel O, Muller C, Jesel L, Moulin B, Hannedouche T. Impaired platelet P2Y12 inhibition by thienopyridines in chronic kidney disease: mechanisms, clinical relevance and pharmacological options. Nephrol Dial Transplant 2013; 28(8): 1994−2002.

Verma A, Anavekar NS, Meris A, Thune JJ, Arnold MJO, Ghali JK, Solomon SD. The relationship between renal function and cardiac structure, function, and prognosis after myocardial in-farction: the VALIANT Echo Study. J Am Coll Cardiol 2007; 50(13): 1238−45.

Mrdovic I, Savic L, Krljanac G, Asanin M, Perunicic J, Lasica R, et al. Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention. The RISK-PCI score. Int J Cardiol 2013; 162(3): 220−7.

Metra M, Cotter G, Gheorghiade M, Dei CL, Voors AA. The role of the kidney in heart failure. Eur Heart J 2012; 33(17): 2135−42.

Hamdan A, Kornowski R, Solodky A, Fuchs S, Battler A, Assali AR. Predictors of left ventricular dysfunction in patients with first acute anterior myocardial infarction undergoing primary angioplasty. Isr Med Assoc J 2006; 8(8): 532−5.

Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B. The severe cardiorenal syndrome: 'Guyton revisited'. Eur Heart J 2005; 26(1): 11−7.

Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymp-tomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000; 35(3): 681−9.

Hebert K, Dias A, Delgado MC, Franco E, Tamaritz L, Steen D, et al. Epidemiology and survival of the five stages of chronic kidney disease in a systolic heart failure population. Eur J Heart Fail 2010; 12(8): 861−5.

McAlister FA, Ezekowitz J, Tarantini L, Squire I, Komajda M, Bayes-Genis A, et al. Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new Chronic Kidney Disease-Epidemiology Collaboration Group formula. Circ Heart Fail 2012; 5(3): 309−14.

Schou M, Torp-Pedersen C, Gustafsson F, Abdulla J, Kober L. Wall motion index, estimated glomerular filtration rate and mortality risk in patients with heart failure or myocardial infarction: A pooled analysis of 18,010 patients. Eur J Heart Fail 2008; 10(7): 682−8.

Mathew J, Katz R, Sutton MJ, Dixit S, Gerstenfeld EP, Ghio S, et al. Chronic kidney disease and cardiac remodeling in patients with mild heart failure: results from the REsynchronization reVErses Remodeling in Systolic Left vEntricular Dysfunction (REVERSE) study. Eur J Hear Fail 2012; 14(12): 1420−8.

Palmer SC, Yandle TG, Frampton CM, Troughton RW, Nicholls GM, Richards MA. Renal and cardiac function for long-term (10 year) risk stratification after myocardial infarction. Eur Heart J 2009; 30(12): 1486−94.

Marenzi G, Moltrasio M, Assanelli E, Lauri G, Marana I, Grazi M, et al. Impact of cardiac and renal dysfunction on inhospital morbidity and mortality of patients with acute myocardial in-farction undergoing primary angioplasty. Am Heart J 2007; 153(5): 755−62.

Savic L, Mrdovic I, Perunicic J, Asanin M, Lasica R, Marinkovic J, et al. Impact of the combined left ventricular systolic and renal dysfunction on one-year outcomes after primary percutaneous coronary intervention. J Interven Cardiol 2012; 25(2): 132−9.

Mrdovic I, Savic L, Lasica R, Krljanac G, Asanin M, Brdar N, et al. Efficacy and safety of tirofiban-supported primary percutane-ous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register. Eur Heart J Acute Cardio-vasc Care 2014; 3(1): 56−66.

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es G, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115(17): 2344−51.

Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, diCapua P, et al. Renal impairment and outcomes in heart fail-ure: systematic review and meta-analysis. J Am Coll Cardiol 2006; 47(10): 1987−96.

Hillege HL, van Gilst WH, van Veldhuisen DJ, Navis G, Grobbee DE, de Graeff PA, et al. Accelerated decline and prognostic im-pact of renal function after myocardial infarction and the ben-efits of ACE inhibition: the CATS randomized trial. Eur Heart J 2003; 24(5): 412−20.

Ezekowitz J, McAlister FA, Humphries KH, Norris CM, Tonelli M, Ghali WA, et al. The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease. J Am Coll Cardiol 2004; 44(8): 1587−92.

Kangasniemi OP, Mahar MAA, Rasihalo E, Satomaa A, Tiozzo V, Lepojärvi M, et al. Impact of estimated glomerular filtration rate on the 15-year outcome after coronary artery bypass surgery. Eur J Cardiothorac Surg 2008; 33(2): 198−202.

Zamora E, Lupón J, Vila J, Urrutia A, de Antonio M, Sanz H, et al. Estimated glomerular filtration rate and prognosis in heart failure: value of the Modification of Diet in Renal Disease Study-4, chronic kidney disease epidemiology collaboration, and cockroft-gault formulas. J Am Coll Cardiol 2012; 59(19): 1709−15.

Objavljeno
2015/11/02
Broj časopisa
Vol. 72 Br. 8 (2015)
Rubrika
Originalni članak