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Kardiyoloji Dışı Kliniklerden Akut Koroner Sendrom İle Konsülte Edilen Hastalarda Hastane İçi Mortalite Öngördürücüleri: Tıbbi Tedavi Ve Perkütan Koroner Girişim Arasında Bir Karşılaştırma

Yıl 2025, Cilt: 12 Sayı: 1, 34 - 41, 30.04.2025

Gizem Çabuk , Özgür Kuş

https://doi.org/10.47572/muskutd.1490410

Öz

Akut koroner sendrom hastalarının, acil servise veya koroner yoğun bakım ünitesine doğrudan kabul edilenlere kıyasla, kardiyoloji dışı kliniklerde tedavi yönetimi daha zorlu olabilmektedir. Bu çalışmanın amacı, kardiyoloji dışı kliniklerde yatan akut koroner sendrom hastalarındaki hastane içi mortalite öngördürücülerini araştırmak ve sadece tıbbi tedavi ile veya ek olarak perkütan koroner girişim ile yönetilen hastalar arasındaki sonuçları karşılaştırmaktı. Bu retrospektif bir çalışmaydı. Ocak 2018 - Aralık 2023 arasında kardiyoloji dışı kliniklerden akut koroner sendrom olarak konsülte edilen hastalar (ST elevasyonlu miyokart enfarktüslü hastalar hariç) çalışmaya dahil edildi. Hastalar, tedavi yönetimine göre iki gruba ayrıldı: yalnızca tıbbi tedavi alanlar ve medikal tedaviye ek olarak koroner anjiyografi yapılanlar. Hastane içi mortalite açısından bağımsız öngördürücüler, ikili lojistik regresyon analizi kullanılarak belirlendi. Çalışmaya toplam 241 hasta dahil edildi. 112 hasta (%46.4) yalnızca tıbbi tedavi aldı (Grup 1), 129 hastaya (%53.6) koroner anjiyografi yapıldı (Grup 2) ve Grup 2'deki 69 hastaya perkütan koroner girişim uygulandı. Alt grup analizi, başlangıçtan itibaren medikal tedavi alan hastaların, perkütan koroner girişim uygulanan hastalara göre daha yüksek hastanede ölüm oranına sahip olduğunu gösterdi; medikal tedavi alan 172 hastadan 32'si (%18.6), perkütan koroner girişim uygulanan 69 hastadan 10'unda (%14.4) mortalite gelişti (p=0.040). İleri yaş, düşük serum albumin, yüksek bilirubin, üre ve kardiyak troponin seviyeleri ile COVID-19 enfeksiyonu artmış hastane içi mortalite ile ilişkili bulunurken, kardiyoloji dışı kliniklerden konsülte edilen akut koroner sendrom hastalarında perkütan koroner girişim, tek başına azalmış hastane içi mortalite ile ilişkiliydi.

Anahtar Kelimeler

Akut Koroner Sendrom Mortalite Perkütan Koroner Girişim

Kaynakça

  • Thygesen K, Alpert JS, Jaffe AS, et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. Circulation. 2018;138(20):e618-e651.
  • Boulanger M, Béjot Y, Rothwell PM, et al. Long-term risk of myocardial infarction compared to recurrent stroke after transient ischemic attack and ischemic stroke: systematic review and meta-analysis. J Am Heart Assoc. 2018;7(2):e007267.
  • Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-367.
  • Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: Prospective multinational observational study (GRACE). Br. Med. J. 2006;333(7578):1091–4.
  • Bavry AA, Kumbhani DJ, Rassi AN, et al. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006;48(7):1319-25.
  • Zhu L, Chen M, Lin X. Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis. Biosci Rep. 2020;40(1):BSR20190881.
  • Kurtul A, Murat SN, Yarlioglues M, et al. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology. 2016;67(1):34-40.
  • González-Pacheco H, Amezcua-Guerra LM, Sandoval J, et al. Prognostic Implications of Serum Albumin Levels in Patients With Acute Coronary Syndromes. Am J Cardiol. 2017;119(7):951-8.
  • Plakht Y, Gilutz H, Shiyovich A. Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20-4.
  • Das UN. Albumin infusion for the critically ill–is it beneficial and, if so, why and how? Crit Care. 2015;19(1):156.
  • Kirtane AJ, Leder DM, Waikar SS, et al. TIMI Study Group. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol. 2005;45(11):1781-6.
  • Usberti M, Federico S, Di Minno G, et al. Effects of angiotensin II on plasma ADH, prostaglandin synthesis, and water excretion in normal humans. Am J Physiol. 1985;248(2):254-9.
  • Adam AM, Nasir SAR, Merchant AZ, et al. Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome. Indian Heart J. 2018;70(3):353-9.
  • Shen H, Zeng C, Wu X, et al. Prognostic value of total bilirubin in patients with acute myocardial infarction: A meta-analysis. Medicine (Baltimore). 2019;98(3):e13920.
  • Okuhara K, Kisaka T, Ozono R, et al. Change in bilirubin level following acute myocardial infarction is an index for heme oxygenase activation. South Med J. 2010;103(9):876-81.
  • Sakai S, Tara S, Yamamoto T, et al. Gastrointestinal bleeding increases the risk of subsequent cardiovascular events in patients with acute cardiovascular diseases requiring intensive care. Heart Vessels. 2021;36(9):1327-35.
  • Zeus T, Ketterer U, Leuf D, et al. Safety of percutaneous coronary intervention in patients with acute ischemic stroke/transient ischemic attack and acute coronary syndrome. Clin Res Cardiol. 2016;105(4):356-63.
  • Sacco A, Montalto C, Bravi F, et al. Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy. Minerva Cardiol Angiol. 2023;71(1):44-50.
  • Patel B, Carson P, Shah M, et al. Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis. Clin Cardiol. 2017;40(12):1303-8.
  • Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
  • Lala A, Johnson KW, Januzzi JL, et al. Mount Sinai COVID Informatics Center. Prevalence and Impact of Myocardial Injury in Patients Hospitalized with COVID-19 Infection. J Am Coll Cardiol. 2020;76(5):533-46.
  • Santoso A, Pranata R, Wibowo A, et al. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis. Am J Emerg Med. 2021;44:352-7.
  • Rashid M, Wu J, Timmis A, et al. Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med. 2021;290(1):88-100.
  • Chilazi M, Duffy EY, Thakkar A, et al. COVID and Cardiovascular Disease: What We Know in 2021. Curratheroscler Rep. 2021;23(7):37.

Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention

Yıl 2025, Cilt: 12 Sayı: 1, 34 - 41, 30.04.2025

Gizem Çabuk , Özgür Kuş

https://doi.org/10.47572/muskutd.1490410

Öz

The management of patients with acute coronary syndrome who are hospitalized in non-cardiology clinics can be more challenging compared to those admitted directly to the emergency department or coronary intensive care unit. The aim of this study was to investigate the predictors of in-hospital mortality in patients with acute coronary syndrome who were initially hospitalized in non-cardiology clinics, and to compare outcomes between those managed with medical therapy alone versus those who also underwent percutaneous coronary intervention. This was a retrospective study. We enrolled patients who were referred as acute coronary syndrome from non-cardiology clinics (excluding patients with ST elevation myocardial infarction) between January 2018 and December 2023. Patients were divided into two groups based on their management approach: those who received medical therapy only and those who also underwent coronary angiography. Independent predictors of in-hospital mortality were identified using binary logistic regression analysis. A total of 241 patients were included in this study. While 112 patients (46.4%) received medical therapy only (Group 1), 129 patients (53.6%) underwent coronary angiography (Group 2), and 69 of 129 patients underwent percutaneous coronary intervention. The subgroup analysis showed that patients receiving medical therapy from the onset after coronary angiography (CAG) had a higher in-hospital mortality rate (32 of 172 patients, 18.6%) than those undergoing percutaneous coronary intervention (PCI) (10 of 69 patients, 14.4%), with a p-value of 0.040. We found that while advanced age, low serum albumin, elevated bilirubin, blood urea nitrogen, and cardiac troponin levels, as well as COVID-19 infection were associated with increased in-hospital mortality; percutaneous coronary intervention was associated with reduced in-hospital mortality in patients with acute coronary syndrome who were referred from non-cardiology clinics.

Anahtar Kelimeler

Acute Coronary Syndrome Mortality Percutaneous Coronary Intervention

Kaynakça

  • Thygesen K, Alpert JS, Jaffe AS, et al. Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. Circulation. 2018;138(20):e618-e651.
  • Boulanger M, Béjot Y, Rothwell PM, et al. Long-term risk of myocardial infarction compared to recurrent stroke after transient ischemic attack and ischemic stroke: systematic review and meta-analysis. J Am Heart Assoc. 2018;7(2):e007267.
  • Collet JP, Thiele H, Barbato E, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-367.
  • Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: Prospective multinational observational study (GRACE). Br. Med. J. 2006;333(7578):1091–4.
  • Bavry AA, Kumbhani DJ, Rassi AN, et al. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol. 2006;48(7):1319-25.
  • Zhu L, Chen M, Lin X. Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis. Biosci Rep. 2020;40(1):BSR20190881.
  • Kurtul A, Murat SN, Yarlioglues M, et al. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology. 2016;67(1):34-40.
  • González-Pacheco H, Amezcua-Guerra LM, Sandoval J, et al. Prognostic Implications of Serum Albumin Levels in Patients With Acute Coronary Syndromes. Am J Cardiol. 2017;119(7):951-8.
  • Plakht Y, Gilutz H, Shiyovich A. Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20-4.
  • Das UN. Albumin infusion for the critically ill–is it beneficial and, if so, why and how? Crit Care. 2015;19(1):156.
  • Kirtane AJ, Leder DM, Waikar SS, et al. TIMI Study Group. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates. J Am Coll Cardiol. 2005;45(11):1781-6.
  • Usberti M, Federico S, Di Minno G, et al. Effects of angiotensin II on plasma ADH, prostaglandin synthesis, and water excretion in normal humans. Am J Physiol. 1985;248(2):254-9.
  • Adam AM, Nasir SAR, Merchant AZ, et al. Efficacy of serum blood urea nitrogen, creatinine and electrolytes in the diagnosis and mortality risk assessment of patients with acute coronary syndrome. Indian Heart J. 2018;70(3):353-9.
  • Shen H, Zeng C, Wu X, et al. Prognostic value of total bilirubin in patients with acute myocardial infarction: A meta-analysis. Medicine (Baltimore). 2019;98(3):e13920.
  • Okuhara K, Kisaka T, Ozono R, et al. Change in bilirubin level following acute myocardial infarction is an index for heme oxygenase activation. South Med J. 2010;103(9):876-81.
  • Sakai S, Tara S, Yamamoto T, et al. Gastrointestinal bleeding increases the risk of subsequent cardiovascular events in patients with acute cardiovascular diseases requiring intensive care. Heart Vessels. 2021;36(9):1327-35.
  • Zeus T, Ketterer U, Leuf D, et al. Safety of percutaneous coronary intervention in patients with acute ischemic stroke/transient ischemic attack and acute coronary syndrome. Clin Res Cardiol. 2016;105(4):356-63.
  • Sacco A, Montalto C, Bravi F, et al. Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy. Minerva Cardiol Angiol. 2023;71(1):44-50.
  • Patel B, Carson P, Shah M, et al. Acute kidney injury requiring dialysis and in-hospital mortality in patients with chronic kidney disease and non-ST-segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis. Clin Cardiol. 2017;40(12):1303-8.
  • Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
  • Lala A, Johnson KW, Januzzi JL, et al. Mount Sinai COVID Informatics Center. Prevalence and Impact of Myocardial Injury in Patients Hospitalized with COVID-19 Infection. J Am Coll Cardiol. 2020;76(5):533-46.
  • Santoso A, Pranata R, Wibowo A, et al. Cardiac injury is associated with mortality and critically ill pneumonia in COVID-19: A meta-analysis. Am J Emerg Med. 2021;44:352-7.
  • Rashid M, Wu J, Timmis A, et al. Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med. 2021;290(1):88-100.
  • Chilazi M, Duffy EY, Thakkar A, et al. COVID and Cardiovascular Disease: What We Know in 2021. Curratheroscler Rep. 2021;23(7):37.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri (Diğer)
Bölüm Araştırma Makalesi
Yazarlar

Gizem Çabuk 0000-0002-3478-4611

Özgür Kuş 0000-0001-8109-662X

Yayımlanma Tarihi 30 Nisan 2025
Gönderilme Tarihi 28 Mayıs 2024
Kabul Tarihi 27 Mart 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 12 Sayı: 1

Kaynak Göster

APA Çabuk, G., & Kuş, Ö. (2025). Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 12(1), 34-41. https://doi.org/10.47572/muskutd.1490410
AMA Çabuk G, Kuş Ö. Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention. MMJ. Nisan 2025;12(1):34-41. doi:10.47572/muskutd.1490410
Chicago Çabuk, Gizem, ve Özgür Kuş. “Predictors of In-Hospital Mortality in Patients With Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12, sy. 1 (Nisan 2025): 34-41. https://doi.org/10.47572/muskutd.1490410.
EndNote Çabuk G, Kuş Ö (01 Nisan 2025) Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12 1 34–41.
IEEE G. Çabuk ve Ö. Kuş, “Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention”, MMJ, c. 12, sy. 1, ss. 34–41, 2025, doi: 10.47572/muskutd.1490410.
ISNAD Çabuk, Gizem - Kuş, Özgür. “Predictors of In-Hospital Mortality in Patients With Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 12/1 (Nisan 2025), 34-41. https://doi.org/10.47572/muskutd.1490410.
JAMA Çabuk G, Kuş Ö. Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention. MMJ. 2025;12:34–41.
MLA Çabuk, Gizem ve Özgür Kuş. “Predictors of In-Hospital Mortality in Patients With Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, c. 12, sy. 1, 2025, ss. 34-41, doi:10.47572/muskutd.1490410.
Vancouver Çabuk G, Kuş Ö. Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome Referred from Non-Cardiology Clinics: A Comparison Between Medical Therapy and Percutaneous Coronary Intervention. MMJ. 2025;12(1):34-41.
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