Primer perkütan girişim yapılan akut miyokard infarktüslü hastalarda serotonin düzeyinin no-reflow gelişimine etkisi

Abstract

Amaç: ST segment yükselmeli akut miyokard infaktüslü hastalarda primer perkütankoroner girisim sırasında gelisebilen no-reflow miyokard reperfüzyonunu etkileyenen önemli faktörlerden biridir. No-reflow gelisiminde vasokonstriksiyonla birliktebirçok faktör sorumlu tutulmaktadır. Bu çalısmada amacımız, güçlüvazokonstriksiyon etkisi olan serotoninin no-reflow gelisimine etkisini arastırmaktır.Materyal ve Metod: Çalısmaya; klinigimize gögüs agrısı sikayetiyle ilk 12 saatiçinde basvurup, akut miyokard infarktüsü tanısıyla, primer perkütan koroner girisimuygulanan 40 hasta alındı. Baslangıç akımı TIMI 0 olup islem sonrası normal akımsaglanan grup I'i, anjiyografik olarak TIMI 2 akım saglanan (no-reflow) grup II'yiolusturdu. Serotonin ölçümü için islem öncesi koroner ostiumdan kan numunesialındı. Trombosit içi ve serum serotonin seviyesi ELSA yöntemiyle ölçüldü. Noreflowgelisiminde sorumlu olabilen gelis CRP düzeyi ölçüldü. Reperfüzyonkriterlerinden ST segment rezolüsyonu, gögüs agrısının geçmesi degerlendirildi.Bulgular: Grup I' de 25 hasta (20 erkek, 5 kadın), yas ortalaması 55±12.2, grup II'de 15 hasta (13 erkek, 2 kadın) grup II yas ortalaması 62± 8.5 idi. Gruplar arasındaklinik özellikler ve koroner arter hastalıgı risk faktörleri açıdan fark yoktu. Grup I'de trombosit içi serotonin seviyesi ortalama degeri 476.4±208.9 ng/109 trombosit,grup II'de 542.7±273.4 ng/109 trombosit idi. Fark istatistiksel olarak anlamlıbulunmadı (p=0.39). Serum serotonin düzeyleri karsılastırıldıgında grup I'de 41.4±40.8ng/ml idi,grup II'de 66.7±45.7 ng/ml idi. Grup II'de serum serotinin düzeyidaha yüksek olmakla beraber aradaki fark istatistiksel olarak anlamlı bulunmadı(p=0.07). Reperfüzyonun göstergesi olarak EKG de ST rezolüsyonudegerlendirildiginde grup I'de 20 hastada, grup II'de 4 hastada ST rezolüsyonu vardı(p=0.001). Grup I'de islem sonrası agrı daha erken sonlanmıstı (p=0.035). Basvuruanındaki CRP seviyesi no-reflow grubunda istatistiksel olarak anlamlı sekilde dahayüksek bulundu (p=0.014).Sonuç: No-reflow gelisen hasta grubumuzda serotonin düzeyi daha yüksek olmaklaberaber istatiksel olarak anlamlı degildi. Primer perkütan koroner girisim yapılanhastalarda serotonin düzeyinin no-reflow gelisimine etkisi saptanmadıAnahtar Kelimeler: crp, no-reflow, serotonin, vazokonstriksiyon.

Aim: In patients with acute ST segment elevation myocardial infarction, one of themost important factors affecting myocardial reperfusion is no-reflow that may occurduring primary percutaneous coronary intervention. Vasoconstriction and many otherfactors are responsible for the occurence of no-reflow. In this study, our aim is toinvestigate the effects of serotonin which is a severe vasoconstrictor agent, on theoccurence of no-reflow.Patients and methods: In these study 40 patients, who have admitted to our clinicwith chest pain in the first 12 hours and also to whom primary percutaneous coronaryintervention was applied because of acute myocardial infarction were enrolled. Whenthe basal flow was TIMI 0 and post-procedure flow was normal, the patients wereenrolled in group I; on the other hand when the flow was angiographically TIMI 2,the patients (no-reflow) were enrolled in group II. To measure the serotonin levels,blood samples were collected from the coronary ostium before the procedure. ELISAtechnique was used to measure serotonin levels in platelet and serum. CRP levels,which may be responsible for the occurence of no-reflow were measured inadmission. The reperfusion criteria like ST segment resolution and relief of chestpain were evaluated.Results : In group I there were 25 patients (20 males, 5 females) and the mean agewas 55±12.2; in group II there were 15 patients (13 males, 2 females) and the meanage was 62±8.5. There was no difference between groups about the risk factors ofcoronary artery disease and the clinical characteristics. In group I the mean serotoninlevel in platelet was 476.4±208.9 ng/109 platelet and for group II it was measured as542,7±273,4 ng/109 platelet. The difference was not statistically significant (p=0.39).When we compared the serum serotonin levels it was 41.4 ± 40.8 ng/ml for group I onthe other hand it was measured as 66.7± 45.7 ng/ml for group II. Although the serum serotonin levels were higher in group II, the difference was not statistically significant(p=0.07). When we evaluated the ST resolution in ECG as a sign of reperfusion, theresolution was observed in 20 patients in group I and in 4 patients in group II(p=0.001). In group I, the post-procedure cessation of chest pain was earlier(p=0.035). In no-reflow group, the baseline CRP levels were significantly higher(p=0.014).Conclusion: In no-reflow group although the serotonin levels were higher, thedifference was not statistically significant. There was no effect of serotonin level inthe development of no-reflow, in patients to whom primary coronary percutaneousintervention was appliedKey words:CRP, no-reflow, serotonin, vasoconstriction.