بررسی عوامل خطر سنتی مرتبط با ویژگی‌های بالینی بیماران انفارکتوس میوکارد با بالارونده قطعه ST

نوع مقاله : Original Article(s)

نویسندگان

1 استادیار، مرکز تحقیقات اقدامات تهاجمی قلب، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، مرکز تحقیقات نارسایی قلب، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 مرکز تحقیقات بازتوانی قلبی، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 دانشیار، مرکز تحقیقات نارسایی قلب، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

5 مرکز تحقیقات پرفشاری خون، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

6 مرکز تحقیقات قلب و عروق اصفهان، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

7 استاد، مرکز تحقیقات بازتوانی قلبی، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقاله پژوهشی




مقدمه: سکته‌ی حاد قلبی یا انفارکتوس حاد میوکارد (Acute myocardial infarction) AMI یکی از عوامل اصلی ابتلا و مرگ و میر در سراسر جهان است. هدف از مطالعه‌ی حاضر، بررسی ارتباط هر یک از عوامل خطر با ویژگی‌های AMI بود.
روش‌ها: در این گزارش مقطعی که در بیمارستان چمران و خورشید و فیض اصفهان انجام شد، ارتباط مشخصات دموگرافیک بیماران (سن، جنسیت، شاخص توده‌ی بدنی، سیگار کشیدن فعلی، دیابت، فشارخون بالا و هیپرکلسترولمی) با پارامترهای بالینی و پاراکلینیکی AMI، از جمله وسعت AMI، شدت (درگیری) شریان‌‌های کرونر، شریان کرونر اپیکاردیال درگیر و میزان موفقیت (Percutaneous coronary intervention) PCI بر اساس امتیاز ترومبولیز در انفارکتوس میوکارد (درجه‌بندی TIMI) ارزیابی شد.
یافته‌ها: در مطالعه‌ی حاضر، 478 بیمار انفارکتوس همراه با قطعه‌ی ST بالا رونده (STEMI) با میانگین سنی 12/79±60/41 سال و تعداد 396 بیمار (82/8 درصد) مرد در مطالعه وارد شدند. مصرف سیگار با رخداد MI قدامی ارتباط معنی‌داری داشت، به طوری که بیماران سیگاری، 84 درصد بیشتر از بیماران غیرسیگاری دچار سکته از نوع قدامی شدند (0/012 = P). درگیری شریان‌های نزولی قدامی چپ/دیاگونال با سیگار کشیدن ارتباط معنی‌داری داشت به طوری که افراد سیگاری 2/34 برابر بیشتر دچار این درگیری شدند (0/033 = P). همچنین، هیپرکلسترولمی با موفقیت PCI ارتباط معکوس داشت (0/006 = P). بیماران با سن پایین‌تر موفقیت PCI آن‌ها بیشتر بوده است (0/002 = P). در بیماران با درگیری دو رگ،  TIMIقبل، با شاخص توده‌ی بدنی ارتباط معنی‌داری داشت (0/024 = P)
نتیجه‌گیری: بر اساس مطالعه‌ی حاضر، مصرف سیگار، پیش‌بینی‌کننده‌ی قطع خون‌رسانی دیواره‌ی قدامی میوکارد و انفارکتوس دیواره‌ی قدامی بود و هیپرکلسترولمی، ارتباط معکوس با دستیابی به جریان TIMI درجه 3 پس از PCI داشت. علاوه بر این، حضور همزمان سه یا چند بیماری با افزایش شدت CAD همراه بود.

تازه های تحقیق

  1. Guidelines ECfP, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, et al. Third universal definition of myocardial infarction. Journal of the American College of Cardiology 2012; 60(16): 1581-98.
  2. Pryds K, Hjortbak MV, Schmidt MR. Influence of cardiovascular risk factors, comorbidities, medication use and procedural variables on remote ischemic conditioning efficacy in patients with ST-segment elevation myocardial infarction. Int J Mol Sci 2019; 20(13): 3246.
  3. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011; 124(1): 40-7.
  4. Crea F, Lanza GA, Camici PG. Coronary microvascular dysfunction. Berlin, Germany: Springer; 2016.
  5. Symons R, Masci PG, Francone M, Claus P, Barison A, Carbone I, et al. Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker's paradox revisited. Eur Heart J 2016; 37(36): 2756-64.
  6. O’gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127(4): e362-425.
  7. Forman MB, Jackson EK. Importance of tissue perfusion in ST segment elevation myocardial infarction patients undergoing reperfusion strategies: role of adenosine. Clin Cardiol 2007; 30(11): 583-5.
  8. Soylu K, Yuksel S, Gulel O, Erbay AR, Meric M, Zengin H, et al. The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. J Thorac Dis 2013; 5(3): 258-64.
  9. Mendis S, Thygesen K, Kuulasmaa K, Giampaoli S, Mähönen M, Ngu Blackett K, et al. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol 2011; 40(1): 139-46.
  10. Hajar R. Risk factors for coronary artery disease: historical perspectives. Heart views 2017; 18(3): 109-14.
  11. Nakamura K, Nakagawa H, Sakurai M, Murakami Y, Irie F, Fujiyoshi A, et al. Influence of smoking combined with another risk factor on the risk of mortality from coronary heart disease and stroke: pooled analysis of 10 Japanese cohort studies. Cerebrovasc Dis 2012; 33(5): 480-91.
  12. Yunyun W, Tong L, Yingwu L, Bojiang L, Yu W, Xiaomin H, et al. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord 2014; 14: 179.
  13. Alemu R, Fuller EE, Harper JF, Feldman M. Influence of smoking on the location of acute myocardial infarctions. ISRN Cardiol 2011; 174358.
  14. Grines CL, Topol EJ, O’Neill WW, George BS, Kereiakes D, Phillips HR, et al. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation 1995; 91(2): 298-303.
  15. Barbash GI, Reiner J, White HD, Wilcox RG, Armstrong PW, Sadowsi Z, et al. Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: mechanism of the “smoker's paradox” from the GUSTO-I trial, with angiographic insights.
    J Am Coll Cardiol 1995; 26(5): 1222-9.
  16. Attard R, Dingli P, Doggen CJ, Cassar K, Farrugia R, Wettinger SB. The impact of passive and active smoking on inflammation, lipid profile and the risk of myocardial infarction. Open Heart 2017; 4(2): e000620.
  17. Abela GS, Kalavakunta JK, Janoudi A, Leffler D, Dhar G, Salehi N, et al. Frequency of cholesterol crystals in culprit coronary artery aspirate during acute myocardial infarction and their relation to inflammation and myocardial injury. Am J Cardiol 2017; 120(10): 1699-707.
  18. Edwards MS, Corriere MA, Craven TE, Pan XM, Rapp JH, Pearce JD, et al. Atheroembolism during percutaneous renal artery revascularization. J Vasc Surg 2007; 46(1): 55-61.
  19. Niccoli G, Scalone G, Lerman A, Crea F. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J 2016; 37(13): 1024-33.
  20. Pervaiz MH, Durga S, Janoudi A, Berger K, Abela GS. PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction. J Nucl Cardiol 2018; 25(2): 433-40.
  21. Gadeela N, Rubinstein J, Tamhane U, Huang R, Pathak DR, Hosein H-A, et al. The impact of circulating cholesterol crystals on vasomotor function: implications for no-reflow phenomenon. JACC: JACC Cardiovasc Interv 2011; 4(5): 521-9.
  22. Murray M, Thalmann I, Mossialos E, Zeiher A. Comorbidities of coronary heart disease and the impact on healthcare usage and productivity loss in a nationally-based study. Epidemiology (Sunnyvale). 2018; 8(3): 2-7.
  23. Ariyanti R, Besral B. Dyslipidemia associated with hypertension increases the risks for coronary heart disease: a case-control study in Harapan Kita hospital, National Cardiovascular Center, Jakarta.
    J Lipids 2019; 2517013.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Analysis of Traditional Risk Factors on ST-Segment Elevation Myocardial Infarction Characteristics

نویسندگان [English]

  • Seyed Mohammad Kermani-Alghoraishi 1
  • Javad Shahabi 2
  • Foad Ghobadi 3
  • Azam Soleimani 4
  • Marjan Jamalian 5
  • Amir Behfar 3
  • Ali Safaei 6
  • Masoumeh Sadeghi 7
1 Assistant Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Heart failure research center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associated Professor, Heart failure research center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
6 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
7 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Acute myocardial infarction (AMI) is one of the major attributes of mortality and morbidity worldwide. The current study aims to assess the association of each risk factor with the characteristics of AMI.
Methods: In this cross-sectional report that was conducted in Chamran, Khurshid, and Faiz hospitals in Isfahan, the relationship between demographic characteristics of patients (age, gender, body mass index, current smoking, diabetes, high blood pressure, and hypercholesterolemia) with clinical and paraclinical parameters of AMI, from Including the extent of AMI, the severity (involvement) of coronary arteries, that involved epicardial coronary artery, and the success rate of PCI were evaluated based on TIMI grading.
Findings: In this study, 478 STEMI patients with a mean age of 60.41 ± 12.79 years and 396 males (82.8%) were included in the study. Smoking is significantly associated with the occurrence of anterior MI; 84% more smoking patients experienced anterior MI compared to non-smoking patients (P = 0.012). The involvement of the left anterior descending (LAD)/diagonal arteries was significantly related to smoking so smokers were 2.34 times more likely to have (P = 0.033). In addition, hypercholesterolemia was inversely related to PCI success (P = 0.006). Patients with a younger age had more PCI success (P = 0.002). Previous TIMI patients with two-vessel involvement have a significant relationship with body mass index (P = 0.024).
Conclusion: According to this study, smoking was an independent predictor for anterior myocardial wall blood supply interruption and anterior wall infarctions. Hypercholesterolemia was inversely associated with post-PCI TIMI flow grade III achievement. Besides, the concurrent presence of three or more comorbidities was associated with the severity of CAD.

کلیدواژه‌ها [English]

  • Coronary artery disease
  • Percutaneous coronary intervention
  • Myocardial reperfusion
  • Risk factors

مراجع

  1. Guidelines ECfP, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, et al. Third universal definition of myocardial infarction. Journal of the American College of Cardiology 2012; 60(16): 1581-98.
  2. Pryds K, Hjortbak MV, Schmidt MR. Influence of cardiovascular risk factors, comorbidities, medication use and procedural variables on remote ischemic conditioning efficacy in patients with ST-segment elevation myocardial infarction. Int J Mol Sci 2019; 20(13): 3246.
  3. McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011; 124(1): 40-7.
  4. Crea F, Lanza GA, Camici PG. Coronary microvascular dysfunction. Berlin, Germany: Springer; 2016.
  5. Symons R, Masci PG, Francone M, Claus P, Barison A, Carbone I, et al. Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker's paradox revisited. Eur Heart J 2016; 37(36): 2756-64.
  6. O’gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127(4): e362-425.
  7. Forman MB, Jackson EK. Importance of tissue perfusion in ST segment elevation myocardial infarction patients undergoing reperfusion strategies: role of adenosine. Clin Cardiol 2007; 30(11): 583-5.
  8. Soylu K, Yuksel S, Gulel O, Erbay AR, Meric M, Zengin H, et al. The relationship of coronary flow to neutrophil/lymphocyte ratio in patients undergoing primary percutaneous coronary intervention. J Thorac Dis 2013; 5(3): 258-64.
  9. Mendis S, Thygesen K, Kuulasmaa K, Giampaoli S, Mähönen M, Ngu Blackett K, et al. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol 2011; 40(1): 139-46.
  10. Hajar R. Risk factors for coronary artery disease: historical perspectives. Heart views 2017; 18(3): 109-14.
  11. Nakamura K, Nakagawa H, Sakurai M, Murakami Y, Irie F, Fujiyoshi A, et al. Influence of smoking combined with another risk factor on the risk of mortality from coronary heart disease and stroke: pooled analysis of 10 Japanese cohort studies. Cerebrovasc Dis 2012; 33(5): 480-91.
  12. Yunyun W, Tong L, Yingwu L, Bojiang L, Yu W, Xiaomin H, et al. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord 2014; 14: 179.
  13. Alemu R, Fuller EE, Harper JF, Feldman M. Influence of smoking on the location of acute myocardial infarctions. ISRN Cardiol 2011; 174358.
  14. Grines CL, Topol EJ, O’Neill WW, George BS, Kereiakes D, Phillips HR, et al. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation 1995; 91(2): 298-303.
  15. Barbash GI, Reiner J, White HD, Wilcox RG, Armstrong PW, Sadowsi Z, et al. Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: mechanism of the “smoker's paradox” from the GUSTO-I trial, with angiographic insights.
    J Am Coll Cardiol 1995; 26(5): 1222-9.
  16. Attard R, Dingli P, Doggen CJ, Cassar K, Farrugia R, Wettinger SB. The impact of passive and active smoking on inflammation, lipid profile and the risk of myocardial infarction. Open Heart 2017; 4(2): e000620.
  17. Abela GS, Kalavakunta JK, Janoudi A, Leffler D, Dhar G, Salehi N, et al. Frequency of cholesterol crystals in culprit coronary artery aspirate during acute myocardial infarction and their relation to inflammation and myocardial injury. Am J Cardiol 2017; 120(10): 1699-707.
  18. Edwards MS, Corriere MA, Craven TE, Pan XM, Rapp JH, Pearce JD, et al. Atheroembolism during percutaneous renal artery revascularization. J Vasc Surg 2007; 46(1): 55-61.
  19. Niccoli G, Scalone G, Lerman A, Crea F. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J 2016; 37(13): 1024-33.
  20. Pervaiz MH, Durga S, Janoudi A, Berger K, Abela GS. PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction. J Nucl Cardiol 2018; 25(2): 433-40.
  21. Gadeela N, Rubinstein J, Tamhane U, Huang R, Pathak DR, Hosein H-A, et al. The impact of circulating cholesterol crystals on vasomotor function: implications for no-reflow phenomenon. JACC: JACC Cardiovasc Interv 2011; 4(5): 521-9.
  22. Murray M, Thalmann I, Mossialos E, Zeiher A. Comorbidities of coronary heart disease and the impact on healthcare usage and productivity loss in a nationally-based study. Epidemiology (Sunnyvale). 2018; 8(3): 2-7.
  23. Ariyanti R, Besral B. Dyslipidemia associated with hypertension increases the risks for coronary heart disease: a case-control study in Harapan Kita hospital, National Cardiovascular Center, Jakarta.
    J Lipids 2019; 2517013.
مجله دانشکده پزشکی اصفهان
دوره 42، شماره 776
هفته 4، شهریور
مرداد و شهریور 1403
صفحه 624-632

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  • تاریخ دریافت: 14 اسفند 1401
  • تاریخ بازنگری: 23 خرداد 1403
  • تاریخ پذیرش: 01 مهر 1403

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