ÖZET
Amaç:
Augmented voltage right’daki (aVR) ST-elevasyonu ve depresyonu akut koroner sendrom hastalarında yüksek mortalite ve uzamış koroner arter hastalığıyla ilişkilidir. Hastaların, kardiyak troponin, üç damar hastalığı, serum osmolarite ve mortalite açısından karşılaştırılması amaçlanmıştır.
Yöntemler:
Çalışmaya Ocak 2014-Aralık 2016 tarihleri arasında acil servise göğüs ağrısı nedeniyle başvuran, akut koroner sendrom tanısıyla kardiyoloji kliniğine yatırılan, 372 (162 kadın, yaş ortalaması 64±10 yıl) hastanın dosyası retrospektif olarak taranarak dahil edildi. aVR’de ST-elevasyonu olan hastalar Grup 1 ve ST-depresyonu olan hastalar Grup 2 olarak ayrıldı. Hastaların prognozu, yaş, cinsiyet, lipid profili ve Gensini skoru, osmolarite ve mortalite açısından karşılaştırıldı.
Bulgular:
Grup 1’de osmolarite 295,8±16, Grup 2’de 291,7±8,1 idi (p=0,003). Grup 1’in troponin değerleri Grup 2’den yüksekti. Gensini skoru Grup 1’de 40±2,7, Grup 2’de 28,6±2,3 idi (p=0,001). Grup 1’de unstabil angina 32 (%18,1), ST-elevasyonlu miyokard infarktüsü (MI) 135 (%76,3) ve non-ST-elevasyonlu MI 10 (%5,6) hastada görülürken; Grup 2’de sırasıyla; 62 (%31,8), 106 (%54,4) ve 27(138) hastada görüldü (p=0,001). Üç damar hastalığı Grup 1’de 56 (%31,6), Grup 2’de 29 (%14,9) hastada tespit edildi (p=0,001). Her iki grupta en sık komplikasyon iskemik kalp yetmezliğiydi. Mortalite Grup 1’de 36 (%20,3) ve Grup 2’de 14 (%7,2) hastada görüldü. Osmolarite en düşük unstabil anginada, en yüksek non-ST-elevasyonlu MI’da tespit edildi ve ayrıca üç damar hastalığında, erkeklerde ve mortal seyreden hastalarda yüksek bulundu.
Sonuç:
Akut koroner sendrom hastalarında osmolarite; aVR’de ST-elevasyonu ve depresyonu, üç damar hastalığı ve mortalite açısından öngörücü bir değer olabilir.
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