Use of CHA2DS2-VASc score in patients with stable angina pectoris with slow flow detected in coronary angiography
Öz
Purpose: Coronary slow flow (CSF) phenomenon is the slow movement of contrast to distal vascular structures during coronary angiography. Eventhough It has a high morbidity due to recurrent chest pain and different ischemic presentations, it is linked to coronary artery diseases (myocardial ischemia symptoms, life-threatening arrhythmias, recurrent acute coronary syndromes and sudden cardiac death). CHA2DS2-VASc score is a total of several risk factors for thromboembolism. Impaired renal function was shown to be a predictor of stroke and systemic embolism. We aimed to evaluate the CHA2DS2-VASc score to predict coronary slow flow.
Materials and Methods: Of the 3772 patients who applied to Tokat State Hospital with the diagnosis of stable angina pectoris (SAP) were screened retrospectively. A total of 71 patients with angiographically proven CSF and to meet the age characteristics of the CSF group, 84 patients who were completely normal coronary arteries (NCA) in the control group (n = 84) were screened and total of 155 patients were included in the study.
Results: Patients were classified into two groups: the CSF group (n=71) and the NCA group (n=84). When the characteristics of the CSF and control groups were compared, age, body mass index, systolic blood pressure, diastolic blood pressure, gender were similar. According to the results of the multivariate regression analysis, CHA2DS2-VASc score was an independent predictor (odds ratio: 1.872, 95 % CI: 0.849-1.981, p<0.001)
Conclusion: CHA2DS2-VASc score can be very useful in this regard as an easily applicable instrument. CHA2DS2-VASc score is independent indicators of CSF and can be used to predict CSF risk.
Anahtar Kelimeler
stabile angina pectoris coronary slow flow coronary angiography
Kaynakça
- Referans 1 Sanati H, Kiani R, Shakerian F, Firouzi A, Zahedmehr A, Peighambari M, et al.Coronary Slow Flow Phenomenon Clinical Findings and Predictors. Res Cardiovasc Med. 2016 Jan 2;5(1):e30296. doi: 10.5812/cardiovascmed.30296. eCollection 2016 Feb. Referans 2 Chaudhry MA, Smith M, Hanna EB, Lazzara R. Diverse Spectrum of Presentation of Coronary Slow Flow Phenomenon: A Concise Review of the Literature. Cardiol Res Pract. 2012; 2012: 1–6. https://doi. org/10.1155/2012/383181 PMID: 22645695 Referans 3 Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow--prevalence and clinical correlations. Circ J. 2012;76(4):936–42. Referans 4 Beltrame JF, Limaye SB, Horowitz JD. The Coronary Slow Flow Phenomenon–A New Coronary Microvascular Disorder. Cardiology. 2002; 97: 197–202. https://doi.org/10.1159/000063121 PMID: 12145474 Referans 5 Wang X, Nie S-P. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther. 2011; 1: 37–43. https://doi.org/10.3978/j.issn.2223-3652.2011.10.01 PMID: 24282683 Referans 6 Horjeti B, Goda A. Acute ischemia manifestation in a patient with coronary slow flow phenomenon.J Electrocardiol. 2012; 45: 277–279. https://doi.org/10.1016/j.jelectrocard.2011.07.003 PMID: 21840534 Referans 7 Coppola A. A case of stable microvascular angina with normal coronary arteries: certainties and doubts. Clin Ter. 2015;166(1):26-31. doi: 10.7417/CT.2015.1798. Referans 8 Wożakowska-Kapłon B, Niedziela J, Krzyżak P, Stec S. Clinical manifestations of slow coronary flow from acute coronary syndrome to serious arrhythmias. Cardiol J 2009; 16: 462-8 Referans 9 Cakmak HA, Aslan S, Gul M, et al. Assessment of the relationship between a narrow fragmented QRS complex and coronary slow flow. Cardiol J 2015; 22: 428-36. Referans 10 Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation. Chest. 2010;137(2): 263-272. Referans 11 Parodi G, Scudiero F, Citro R, Silverio A, Bellandi B, Zito C, et al. Risk Stratification Using the CHA2DS2-VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network. J Am Heart Assoc. 2017;6:e006065. DOI: 10.1161/JAHA.117.006065. Referans 12 Glotzer TV, Hellkamp AS, Lee KL, Lamas GA. CHA2DS2-VAS(C) and CHADS2 Scores Predict Adverse Clinical Events in Patients With Pacemakers and Sinus Node Dysfunction Independent of Atrial Fibrillation. Can J Cardiol. 2015 Aug;31(8):1004-11. doi: 10.1016/j.cjca.2015.02.020. Epub 2015 Feb 20. Referans 13 Piotr Ponikowsk, Adriaan A. Voors, , Stefan D. Anker, He´ctor Bueno, John G. F. Cleland, Andrew J. S. Coats, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal (2016) 37, 2129–2200 doi:10.1093/eurheartj/ehw128 Referans 14 Koç S, Ozin B, Altın C, Altan Yaycıoğlu R, Aydınalp A, Müderrisoglu H. Evaluation of circulation disorder in coronary slow flow by fundus fluorescein angiography. Am J Cardiol. 2013;111:1552-1556. doi: 10.1016/j. amjcard.2013.01.324 Referans 15 Wang X, Geng LL, Nie SP. Coronary slow flow phenomenon: A local or systemic disease? Med hypotheses. 2010;75:334- 337. doi: 10.1016/j.mehy.2010.03.016. Referans 16 Goel PK, Gupta SK, Agarwal A, Kapoor A. Slow coronary flow: a distinct angiographic subgroup in syndrome X. Angiology 2001; 52: 507-14. Referans 17 Ayhan E, Uyarel H, Isık T, Ergelen M, Cicek G, Altay S, et al (2012) Slow coronary flow in patients undergoing urgentcoronary angiography for ST elevationmyocardial infarction. Int JCardiol 156(1):106–108. Referans 18 Sen T (2013) Coronary slow flow phenomenon leads to ST elevation myocardial infarction. Korean Circ J43(3):196–198. Referans 19 Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-2747. Referans 20 Kim J, Cha MJ, Lee DH, Lee HS, Nam CM, Nam HS, et al. The association between cerebral atherosclerosis and arterial stiffness in acute ischemic stroke. Atherosclerosis. 2011;219(2):887-891. Referans 21 Park S, Kang HJ, Jeon JH, Kim MJ, Lee IK. Recent advances in the pathogenesis of microvascular complications in diabetes. Arch Pharm Res. 2019 Mar;42(3):252-262. doi: 10.1007/s12272-019-01130-3. Epub 2019 Feb 15. Review. Referans 22 Jin Joo Park, Sun-Hwa Kim, Myung-A Kim, In-Ho Chae, Dong-Ju Choi, Chang-Hwan Yoon. Effect of Hyperglycemia on Myocardial Perfusion in Diabetic Porcine Models and Humans. J Korean Med Sci. 2019 Jul 29; 34(29): e202. Referans 23 Dean J, Dela Cruz S, Mehta PK, Merz CNB. Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy. Nat Rev Cardiol. 2015;12(7):406-414. Referans 24 Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J. 2014;35(17):1101-1111 Referans 25 Chua S-K, Lo H-M, Chiu C-Z, Shyu K-G. Use of CHADS2 and CHA2DS2-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014;9(10):e111167. Referans 26 Cetin M, Cakici M, Zencir C, Tasolar H, Baysal E, Balli M, et al. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. Am J Cardiol. 2014; 113(6):950-956. Referans 27 Chan YH, Yiu KH, Lau KK, Yiu YF, Li SW, Lam TH, et al. The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patientswithout atrial fibrillation: Role of incorporating PR prolongation. Atherosclerosis. 2014;237(2):504-513.
Koroner anjiyografide yavaş akım tespit edilen kararlı anjina pektorisli hastalarda CHA2DS2-VASc skorunun kullanımı
Öz
Amaç: Koroner anjiyografi sırasında kontrast maddenin distal vasküler yapılarının yavaş hareketine koroner yavaş akım (KYA) fenomeni denir. Tekrarlayan göğüs ağrısı ve farklı iskemik sunumlar nedeniyle yüksek morbiditeye sahip olmasına rağmen, koroner arter hastalığı (miyokardiyal iskemi semptomları, hayatı tehdit eden aritmiler, tekrarlayan akut koroner sendromlar ve ani kardiyak ölüm) ile ilişkilidir. CHA2DS2-VASc skoru, tromboembolizm için çeşitli risk faktörlerinden oluşan bir skorlama sistemidir. KYA' yı tahmin etmek için CHA2DS2-VASc skorunu değerlendirmeyi amaçladık.
Gereç ve Yöntem: Tokat Devlet Hastanesi'ne stabil angina pektoris (SAP) tanısı ile başvuran 3772 hasta geriye dönük olarak tarandı. Anjiyografik olarak kanıtlanmış KYA' sı olan 71 hasta ve kontrol grubu olarak da tamamen normal koroner anjiyografisi olan 84 hasta olmak üzere toplam 155 hasta çalışmaya dahil edildi.
Bulgular: Hastalar KYA grubu (n = 71) ve normal koroner arter grubu (n = 84) olmak üzere iki gruba ayrıldı. KYA ve kontrol gruplarının özellikleri karşılaştırıldığında yaş, vücut kitle indeksi, sistolik kan basıncı, diyastolik kan basıncı ve cinsiyet açısından aralarında istatiksel olarak anlamlı bir fark yok idi. Çok değişkenli regresyon analizi sonuçlarına göre, CHA2DS2-VASc skoru bağımsız bir belirleyiciydi (olasılık oranı [OR]: 1,872, % 95 CI: 0,849-1,981, p<0,001)
Sonuç: CHA2DS2-VASc skoru, kolay uygulanabilir bir araç olarak bu konuda çok yararlı olabilir. CHA2DS2-VASc skoru KYA' nın bağımsız göstergelerinden biri olabilir ve KYA riskini tahmin etmek için kullanılabilir.
Anahtar Kelimeler
Koroner yavaş akım CHA2DS2-VASc skoru stabil koroner arter hastalığı
Kaynakça
- Referans 1 Sanati H, Kiani R, Shakerian F, Firouzi A, Zahedmehr A, Peighambari M, et al.Coronary Slow Flow Phenomenon Clinical Findings and Predictors. Res Cardiovasc Med. 2016 Jan 2;5(1):e30296. doi: 10.5812/cardiovascmed.30296. eCollection 2016 Feb. Referans 2 Chaudhry MA, Smith M, Hanna EB, Lazzara R. Diverse Spectrum of Presentation of Coronary Slow Flow Phenomenon: A Concise Review of the Literature. Cardiol Res Pract. 2012; 2012: 1–6. https://doi. org/10.1155/2012/383181 PMID: 22645695 Referans 3 Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow--prevalence and clinical correlations. Circ J. 2012;76(4):936–42. Referans 4 Beltrame JF, Limaye SB, Horowitz JD. The Coronary Slow Flow Phenomenon–A New Coronary Microvascular Disorder. Cardiology. 2002; 97: 197–202. https://doi.org/10.1159/000063121 PMID: 12145474 Referans 5 Wang X, Nie S-P. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovasc Diagn Ther. 2011; 1: 37–43. https://doi.org/10.3978/j.issn.2223-3652.2011.10.01 PMID: 24282683 Referans 6 Horjeti B, Goda A. Acute ischemia manifestation in a patient with coronary slow flow phenomenon.J Electrocardiol. 2012; 45: 277–279. https://doi.org/10.1016/j.jelectrocard.2011.07.003 PMID: 21840534 Referans 7 Coppola A. A case of stable microvascular angina with normal coronary arteries: certainties and doubts. Clin Ter. 2015;166(1):26-31. doi: 10.7417/CT.2015.1798. Referans 8 Wożakowska-Kapłon B, Niedziela J, Krzyżak P, Stec S. Clinical manifestations of slow coronary flow from acute coronary syndrome to serious arrhythmias. Cardiol J 2009; 16: 462-8 Referans 9 Cakmak HA, Aslan S, Gul M, et al. Assessment of the relationship between a narrow fragmented QRS complex and coronary slow flow. Cardiol J 2015; 22: 428-36. Referans 10 Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation. Chest. 2010;137(2): 263-272. Referans 11 Parodi G, Scudiero F, Citro R, Silverio A, Bellandi B, Zito C, et al. Risk Stratification Using the CHA2DS2-VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network. J Am Heart Assoc. 2017;6:e006065. DOI: 10.1161/JAHA.117.006065. Referans 12 Glotzer TV, Hellkamp AS, Lee KL, Lamas GA. CHA2DS2-VAS(C) and CHADS2 Scores Predict Adverse Clinical Events in Patients With Pacemakers and Sinus Node Dysfunction Independent of Atrial Fibrillation. Can J Cardiol. 2015 Aug;31(8):1004-11. doi: 10.1016/j.cjca.2015.02.020. Epub 2015 Feb 20. Referans 13 Piotr Ponikowsk, Adriaan A. Voors, , Stefan D. Anker, He´ctor Bueno, John G. F. Cleland, Andrew J. S. Coats, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal (2016) 37, 2129–2200 doi:10.1093/eurheartj/ehw128 Referans 14 Koç S, Ozin B, Altın C, Altan Yaycıoğlu R, Aydınalp A, Müderrisoglu H. Evaluation of circulation disorder in coronary slow flow by fundus fluorescein angiography. Am J Cardiol. 2013;111:1552-1556. doi: 10.1016/j. amjcard.2013.01.324 Referans 15 Wang X, Geng LL, Nie SP. Coronary slow flow phenomenon: A local or systemic disease? Med hypotheses. 2010;75:334- 337. doi: 10.1016/j.mehy.2010.03.016. Referans 16 Goel PK, Gupta SK, Agarwal A, Kapoor A. Slow coronary flow: a distinct angiographic subgroup in syndrome X. Angiology 2001; 52: 507-14. Referans 17 Ayhan E, Uyarel H, Isık T, Ergelen M, Cicek G, Altay S, et al (2012) Slow coronary flow in patients undergoing urgentcoronary angiography for ST elevationmyocardial infarction. Int JCardiol 156(1):106–108. Referans 18 Sen T (2013) Coronary slow flow phenomenon leads to ST elevation myocardial infarction. Korean Circ J43(3):196–198. Referans 19 Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-2747. Referans 20 Kim J, Cha MJ, Lee DH, Lee HS, Nam CM, Nam HS, et al. The association between cerebral atherosclerosis and arterial stiffness in acute ischemic stroke. Atherosclerosis. 2011;219(2):887-891. Referans 21 Park S, Kang HJ, Jeon JH, Kim MJ, Lee IK. Recent advances in the pathogenesis of microvascular complications in diabetes. Arch Pharm Res. 2019 Mar;42(3):252-262. doi: 10.1007/s12272-019-01130-3. Epub 2019 Feb 15. Review. Referans 22 Jin Joo Park, Sun-Hwa Kim, Myung-A Kim, In-Ho Chae, Dong-Ju Choi, Chang-Hwan Yoon. Effect of Hyperglycemia on Myocardial Perfusion in Diabetic Porcine Models and Humans. J Korean Med Sci. 2019 Jul 29; 34(29): e202. Referans 23 Dean J, Dela Cruz S, Mehta PK, Merz CNB. Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy. Nat Rev Cardiol. 2015;12(7):406-414. Referans 24 Crea F, Camici PG, Bairey Merz CN. Coronary microvascular dysfunction: an update. Eur Heart J. 2014;35(17):1101-1111 Referans 25 Chua S-K, Lo H-M, Chiu C-Z, Shyu K-G. Use of CHADS2 and CHA2DS2-VASc scores to predict subsequent myocardial infarction, stroke, and death in patients with acute coronary syndrome: data from taiwan acute coronary syndrome full spectrum registry. PLoS One. 2014;9(10):e111167. Referans 26 Cetin M, Cakici M, Zencir C, Tasolar H, Baysal E, Balli M, et al. Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score. Am J Cardiol. 2014; 113(6):950-956. Referans 27 Chan YH, Yiu KH, Lau KK, Yiu YF, Li SW, Lam TH, et al. The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patientswithout atrial fibrillation: Role of incorporating PR prolongation. Atherosclerosis. 2014;237(2):504-513.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kalp ve Damar Cerrahisi |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2020 |
| Kabul Tarihi | 28 Nisan 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 45 Sayı: 3 |
