Diyabetik olmayan akut koroner sendromlarda erken dönem yeni bir risk önbelirleyicisi olarak: 'geliş insülin rezistans indeksi (GİRİ)'
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Tarih
2002
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
İnsülin rezistansı, birçok kardiyovasküler hastalık için bir risk göstergesidir ancak bazılarının etyoloji ve prognozu üzerinde etkisi tam olarak açığa kavuşmamıştır. Bu çalışmamızda, insülin rezistansının pratik olarak belirlenmesinde yeni sunulmuş olan "Geliş İnsülin Rezistans İndeksi (GİRİ)'nin", diyabetik olmayan akut koroner sendromlarda erken dönem yeni bir risk önbelirleyicisi olup olmadığını araştırmayı amaçladık. Yöntem Çalışmamıza akut miyokard infarktüsü (AMİ) (Grup I, yaş ortalaması 58±12 olan 72 hasta) ve kararsız angina pektoris (KAP), (Grup II, yaş ortalaması 58±10 olan 88 hasta) tamlarıyla koroner yoğun bakım ünitesine yatırılan ve koroner anjiyografı (KAG) yapılan 160 diyabetik olmayan hasta dahil edildi. Tüm hastalarda geliş insülin ve glukoz değerlerinin çarpımının, normal glukoz düzeyi (5mmol/L) ve insülin düzeyinin (5mU/L) çarpımına bölünmesiyle GİRİ hesaplandı. Hastaların ekokardiyografık olarak sol ventrikül ejeksiyon fraksiyonu (SVEF), duvar hareket skor indeksi (SVDHSİ) ve KAG'lerinden Gensini skor indeksi belirlenerek, 30 gün boyunca, major kardiyak olaylar (kalp yetersizliği, atriyal fıbrilasyon, reinfarktüs, ciddi ventriküler aritmiler, AV blok, revaskülarizasyon gereksinimi ve mortalite) bakımından takip edildi. Bulgular Grup I'de GİRİ daha yüksek bulundu.(7.2±5.3'e karşın, 5.2±4.4, p=0.01). Grup I'de GİRİ ile Gensini skoru ve SVDHSİ arasında pozitif (sıra ile; r=0.41, p=0.01; r=0.48, pO.001), SVEF arasında ise negatif korelasyon (ı=-0.37, pO.001) saptandı. Ayrıca Grup I'de çok değişkenli regresyon analizinde, GİRİ ile Gensini skor indeksi (r=0.23, p=0.01) ve SVDHSİ (r=0.43, p<0.0001) arasındaki pozitif korelasyonun devam ettiği görüldü. Yine Grup I'de kalp yetersizliği (r=0.42,60 p<0.0001), atriyal fıbrilasyon (r=0.35, p=0,002) ve reinfarktüs (r=0.23, p=0.04) arasında anlamlı korelasyon saptanırken, çok değişkenli regresyon analizinde de, kalp yetersizliği (r=0.21, p=0.007), atriyal fıbrilasyon (r=0.18, p=0.01) ve reinfarktüs (r=0.18, p=0.01) ile anlamlı pozitif korelasyonun devam ettiği görüldü. Buna karşın KAP grubunda, GİRİ ile bu parametreler arasında anlamlı bir ilişki saptanmadı. Sonuç GİRİ, AMİ ile gelen, diyabetik olmayan hastalarda, erken dönem bir risk prediktörü olarak yüksek riskli alt grupların erken belirlenmesinde kullanılabilir. Aynı zamanda GİRİ, AMİ'lü hastalarda sol ventrikül disfonksiyonunun ve koroner arter hastalığının yaygınlığım belirleyen bağımsız bir risk faktörü olarak, alternatif tedavi stratejilerden yararlanabilecek hastaların belirlenmesinde de yol gösterici olabilir.Anahtar kelimeler: Akut miyokard infarktüsü; kararsız angina pektoris; insülin rezistansı
Insulin resistance is a risk predictor for many cardiovascular diseases, but its effect on etiology and prognosis diseases has not been clearly identified. In this study, we aimed to investigate if AIRI (admission index of insulin resistance), recently and practically presented for determination of insulin resistance, is a new risk predictor of early prognosis in nondiabetic acute coronary syndromes or not. Method One hundred and sixty nondiabetic patients admitted to the intensive coronary care unit and undergoing coronary angiography with the diagnoses of acute myocardial infarction (AMI) (Group I;72 patients; mean age 58 + 12) and unstabil angina pectoris (UAP) (Group II; 88 patients; mean age 58 ± 10) were included in the study. In all patients blood glucose and insulin levels were measured on admission and AIRI was calculated by the formula of admission glucose level x insulin level / normal blood glucose level (5mmol / L) x normal insulin level (5 mU / L) for each patient. After determining the left ventricular ejection fraction (LVEF) and wall motion score index (LVWMSI) echocardiographically and calculating the Gensini score index from coronary angiography, the patients were followed for major cardiac events (heart failure, atrial fibrillation, reinfarction, life-threatening ventricular arrhythmias, atrio-ventricular block, need for revascularisation and mortality )for 30 days. Results AIRI was found higher in group I (7.2 ± 5.3 versus 5.2 ± 4.4, p = 0.01) AIRI was positively correlated with Gensini score and LVWMSI (r = 0.41, p = 0.01; r = 0.48, p < 0.001, respectively) and negatively correlated with LVEF (r= - 0.37, p = 0.001) in group I. In addition, it was seen that positive correlation of AIRI with Gensini score (r= 0.23, p=0.01) and LVWMSI (r=0.43, p<0.0001) in group I persisted on multivariate regression analysis. (Again, AIRI was significantly correlated with heart failure (r= 0.42, p < 0.0001) atrial fibrillation (i= 0.35, p=0.002)62 and reinfarction (r= 0.23, p= 0.04) in group I. Along with this, in multivariate regression analysis, it was correlated with heart failure (r= 0.21, p < 0.007), atrial fibrillation (r= 0.18, p=0.01) and reinfarction (r= 0.18, p= 0.01). On the other hand, there was no significant correlation between AIRI and these parameters in group II. Conclusion AIRI can be used as in early stage, risk predictor to determine high risk subgroups of nondiabetic patients applying with AMI. Also AIRI, as an independent risk factor detecting the wideness of coronary artery disease and left ventricular dysfunction in patients with AMI, is a parameter which can be practically calculated and easily used. Also AIRI may guide for determination of the patients in whom alternative treatment strategies may be useful in patients with AMI.Key words: Myocardial infarction; unstable angina; insulin resistance
Insulin resistance is a risk predictor for many cardiovascular diseases, but its effect on etiology and prognosis diseases has not been clearly identified. In this study, we aimed to investigate if AIRI (admission index of insulin resistance), recently and practically presented for determination of insulin resistance, is a new risk predictor of early prognosis in nondiabetic acute coronary syndromes or not. Method One hundred and sixty nondiabetic patients admitted to the intensive coronary care unit and undergoing coronary angiography with the diagnoses of acute myocardial infarction (AMI) (Group I;72 patients; mean age 58 + 12) and unstabil angina pectoris (UAP) (Group II; 88 patients; mean age 58 ± 10) were included in the study. In all patients blood glucose and insulin levels were measured on admission and AIRI was calculated by the formula of admission glucose level x insulin level / normal blood glucose level (5mmol / L) x normal insulin level (5 mU / L) for each patient. After determining the left ventricular ejection fraction (LVEF) and wall motion score index (LVWMSI) echocardiographically and calculating the Gensini score index from coronary angiography, the patients were followed for major cardiac events (heart failure, atrial fibrillation, reinfarction, life-threatening ventricular arrhythmias, atrio-ventricular block, need for revascularisation and mortality )for 30 days. Results AIRI was found higher in group I (7.2 ± 5.3 versus 5.2 ± 4.4, p = 0.01) AIRI was positively correlated with Gensini score and LVWMSI (r = 0.41, p = 0.01; r = 0.48, p < 0.001, respectively) and negatively correlated with LVEF (r= - 0.37, p = 0.001) in group I. In addition, it was seen that positive correlation of AIRI with Gensini score (r= 0.23, p=0.01) and LVWMSI (r=0.43, p<0.0001) in group I persisted on multivariate regression analysis. (Again, AIRI was significantly correlated with heart failure (r= 0.42, p < 0.0001) atrial fibrillation (i= 0.35, p=0.002)62 and reinfarction (r= 0.23, p= 0.04) in group I. Along with this, in multivariate regression analysis, it was correlated with heart failure (r= 0.21, p < 0.007), atrial fibrillation (r= 0.18, p=0.01) and reinfarction (r= 0.18, p= 0.01). On the other hand, there was no significant correlation between AIRI and these parameters in group II. Conclusion AIRI can be used as in early stage, risk predictor to determine high risk subgroups of nondiabetic patients applying with AMI. Also AIRI, as an independent risk factor detecting the wideness of coronary artery disease and left ventricular dysfunction in patients with AMI, is a parameter which can be practically calculated and easily used. Also AIRI may guide for determination of the patients in whom alternative treatment strategies may be useful in patients with AMI.Key words: Myocardial infarction; unstable angina; insulin resistance
Açıklama
Anahtar Kelimeler
Diyabetik, Diabetic, akut koroner sendrom, acute coronary syndrome, geliş insülin rezistans indeksi, arrival insulin resistance index
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Scopus Q Değeri
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Künye
İçli, A. (2002). Diyabetik olmayan akut koroner sendromlarda erken dönem yeni bir risk önbelirleyicisi olarak: 'geliş insülin rezistans indeksi (GİRİ)'. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Kardiyoloji Anabilim Dalı, Konya.
