Akut koroner sendromlu hastalarda antikardiyolipin antikorları ile tekrarlayan kardiyak olay riski ilişkisi

Association between anticardiolipin antibodies and recurrent cardiac events in patients with acute coronary syndrome

Adalet GÜRLEK,Çağdaş ÖZDOL,Gülgün PAMİR,İrem DİNÇER,Hüseyin TUTKAK,Derviş ORAL,Çetin EROL

Özet

Amaç: Akut koroner sendromlu hastalarda antikardiyolipin (aCL) antikor mevcudiyetinin, hastane içi dönemde ve takipte, tekrarlayan kardiyak olayları predikte edip edemediğini belirlemek Gereç ve Yöntem: Hasta populasyonunu akut koroner sendromu olan 80 hasta oluşturmuştur. Antikardiyolipin (aKL) antikor düzeyleri taburculuk öncesi dönemde alınmıştır. Hastalar aKL IgG düzeyleri $\geq$40 GPL ünitesi (grup I, n=30) ve IgG 0.05). Sol atrial trombüs oranı antikardiyolipin pozitif kişilerde daha sık olmasına karşın (sırasıyla %13 ve %4), istatistiksel olarak anlam tesbit edilmedi. Antikardiyolipin pozitif hastalarda restenoz oranı %40 iken, negatif olan hastalarda %14 saptandı (p<0.01). Reinfarktüs ve antikardiyolipin pozitifliği arasında pozitif bir ilişki saptanmadı. İlk gruptaki hastaların hastane içi mortalitesi II. gruba göre bir miktar daha fazla olsa da, fark anlamlı değildi (sırasıyla %10 ve %4; p: 0.27). Bir yıllık mortalite gruplar arasında benzerdi. Sonuç: Bu bulgulara göre; Antikardiyolipin pozitif hastalarda restenoz daha sık olmaktadır ve mortalite, reinfarktüs ve intrakardiyak trombüs ile antikardiyolipin antikorları arasında ilişki saptanmamıştır.

Abstract

Aim: To determine whether the presence of anticardiolipin (aCL) antibodies in patients with acute coronary syndome is predictive of recurrent cardiac events in hospital stay and follow up. Material and Methots: The study population consisted of 80 patients with acute coronary syndrome. Levels of IgM and IgG aCL levels were determined before hospital discharge. We divided patients into those aCL IgG= or $\geq$40 GPL units ( Group I, n=30) and those aCL IgG <40 GPL units (Group II, n= 50). All patients underwent coronary angiography. Follow up coronary angiography was performed 12 months after PTCA. Patients were observed to determine overall mortality, reinfarction and restenosis. Results: There was no difference between the groups for prevelance of hypertension, diabetes mellitus and cigarette smoking, sex and ejection fraction. Prevelance of left ventricular thrombus was similar between the groups (group I: 16% vs group II: 16.7%, p>0.05). Altough the presence of left atrial thrombus was much more frequent in cardiolipin positive patients (13% vs 4%, respectively), the difference was not statiscally significant (p=0.19). Restenosis was observed in 40% of cardiolipin positive patients and 14% of cardiolipin negative patients (p<0.01). There was no significant association of reinfarction and anticardiolipin positivity during follow up (26% vs 10%, p>0.05). In group I patients, in hospital mortality was somewhat more frequent compared to group II patients (4% vs 10%), but the difference was not statistically significant (p=0.27). 1 year mortality was similar between the groups. Conclusıons: These results suggest that 1) restenosis occurs more frequently in anticardiolipin positive patients 2) no assocition is evident between positive aCL and mortality, reinfarction, and intracardiac thrombus.

Anahtar kelimeler: Koroner hastalık,Antikorlar, antikardiyolipin,Koroner restenoz,Tromboz