cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2023.10.n2586cardio-2586Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESВзаимосвязь системного индекса коагуляции-воспаления с кровотечением при остром коронарном синдромеSystemic Coagulation Inflammation Index Associated With Bleeding in Acute Coronary Syndromehttps://orcid.org/0000-0003-0758-649XЗенгинИ.Zenginİ.

MD,

Бурса

Ismet Zengin - MD,

Bursa

ismetzengin48@hotmail.comhttps://orcid.org/0000-0001-5789-5691СевергунК.SevergünK.

MD,

Бурса

Kübra Severgün - MD,

Bursa

kubradoganay32@yahoo.comГородская больница Бурсы, отделение кардиологии, Университет медицинских наукТурцияBursa City Hospital, Department of Cardiology, Health Sciences UniversityTurkeyУчебно-исследовательская больница Юксек Ихтисас, отделение кардиологии, Университет медицинских наукТурцияBursa Yüksek Ihtisas Training and Research Hospital, Department of Cardiology, Health Sciences UniversityTurkey20230811202363107277Copyright © Kardiomag, 20232023KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2586

Цель. Выраженность воспалительного компонента при остром коронарном синдроме (ОКС) и степень активации коагуляционного каскада может иметь прогностическое значение. Системный индекс коагуляции-воспаления (SCI) оценивает как степень выраженности воспаления, так и систему свертывания крови. Было показано, что данный индекс связан с клиническими исходами. Мы исследовали связь SCI с внутрибольничными клиническими событиями (острое повреждение почек, кардиогенный шок, жизнеугрожающая аритмия, кровотечение) и смертностью у больных с ОКС.Материал и методы. В исследование включено 396 пациентов в возрасте ≥18 лет, госпитализированных с диагнозом ОКС. SCI рассчитывали по формуле: количество тромбоцитов (103/мкл) × фибриноген (г/л) / количество лейкоцитов (WBC) (103/мкл). Пациенты были разделены на две группы в зависимости от величины системного индекса коагуляции-воспаления: SCI >100 или SCI <100. Анализировали наличие взаимосвязи между клиническими и лабораторными характеристиками.Результаты. Средний возраст пациентов составил 61,4±12,2 года; 78,3% (n=310) пациентов были мужского пола. Инфаркт миокарда без подъема сегмента ST (ИМбпST) был диагностирован у 56,1% пациентов (n=222). У 42,4% пациентов (n=168) ответственным сосудом была левая передняя нисходящая артерия (ПНА). Средний балл SCI составил 97,5±47,1. Количество лейкоцитов, нейтрофилов и лимфоцитов было выше в группе SCI <100, тогда как количество фибриногена, С-реактивного белка и тромбоцитов было выше в группе SCI>100. Кровотечение любой причины как госпитальное осложнение было статистически значимо выше у пациентов с SCI >100 (р<0,05). Другие внутрибольничные события не были ассоциированы с величиной SCI (р>0,05).Выводы. Кровотечения у пациентов с ОКС значительно чаще встречались в группе со значениями SCI >100. Таким образом, данный индекс может быть полезным параметром для прогнозирования внутрибольничных кровотечений при ОКС. Вместе с тем, величина SCI не была связана со смертностью и другими внутрибольничными клиническими событиями в исследуемой когорте

Aim. Assessment of the inflammatory component of acute coronary syndrome (ACS) and the degree of activation of the coagulation cascade may provide prognostic information. The systemic coagulation-inflammation index (SCI) assesses both inflammation and the coagulation system, and it has also been found to be associated with clinical outcomes. We investigated the relationship between SCI and in-hospital clinical events (acute kidney injury, cardiogenic shock, life-threatening arrhythmia, bleeding) and mortality.Material and methods. The study included 396 patients aged ≥18 yrs who were hospitalized with a diagnosis of ACS. The SCI was calculated using the formula: platelet count (103 / µl) X fibrinogen (g / l) / white blood cell (WBC) count (103 / µl). Patients were divided into two groups according to whether their SCI score was >100 or <100, and the relationship between clinical and laboratory characteristics was analyzed accordingly.Results. The mean age of the patients was 61.4±12.2 years and 78.3 % (n=310) were male. The type of ACS was NSTEMI in 56.1 % (n=222). The responsible vessel was the left anterior descending artery (LAD) in 42.4 % of the patients (n=168). The mean SCI score was 97.5±47.1. WBC, neutrophil, and lymphocyte counts were higher in the SCI <100 group, whereas fibrinogen, C-reactive protein, and platelet count were higher in the SCI >100 group. Bleeding from any cause as an in-hospital complication was significantly higher in patients with SCI >100 (p<0.05). Other in-hospital events were not significantly associated with SCI (p>0.05).Conclusions. Bleeding in ACS patients was significantly more common in the group with SCI >100. Thus, SCI may be a useful parameter for predicting in-hospital bleeding complications in ACS. On the other hand, SCI was not associated with mortality and other in-hospital clinical events.

системный индекс коагуляции-воспаленияострый коронарный синдроминфаркт миокарда с подъемом сегмента STинфаркт миокарда без подъема сегмента STкровотечениеsystemic coagulation inflammation indexacute coronary syndromeST segment elevated myocardial infarctionnon-ST segment elevated myocardial infarctionbleedingReferencesCenturión OA. Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions. Cardiovascular Revascularization Medicine. 2016;17(2):119–28. DOI: 10.1016/j.carrev.2016.01.005Centurión OA. Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions. Cardiovascular Revascularization Medicine. 2016;17(2):119–28. DOI: 10.1016/j.carrev.2016.01.005Sibbing D, Angiolillo DJ, Huber K. Antithrombotic therapy for acute coronary syndrome: Past, present and future. Thrombosis and Haemostasis. 2017;117(7):1240–8. DOI: 10.1160/TH16-12-0963Sibbing D, Angiolillo DJ, Huber K. Antithrombotic therapy for acute coronary syndrome: Past, present and future. Thrombosis and Haemostasis. 2017;117(7):1240–8. DOI: 10.1160/TH16-12-0963Denegri A, Boriani G. High Sensitivity C-reactive Protein (hsCRP) and its Implications in Cardiovascular Outcomes. Current Pharmaceutical Design. 2021;27(2):263–75. DOI: 10.2174/1381612826666200717090334Denegri A, Boriani G. High Sensitivity C-reactive Protein (hsCRP) and its Implications in Cardiovascular Outcomes. Current Pharmaceutical Design. 2021;27(2):263–75. DOI: 10.2174/1381612826666200717090334Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Review of Cardiovascular Therapy. 2016;14(5):573–7. DOI: 10.1586/14779072.2016.1154788Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Review of Cardiovascular Therapy. 2016;14(5):573–7. DOI: 10.1586/14779072.2016.1154788Kounis NG, Koniari I, Plotas P, Soufras GD, Tsigkas G, Davlouros P et al. Inflammation, Thrombosis, and Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes. Angiology. 2021;72(1):6–8. DOI: 10.1177/0003319720946213Kounis NG, Koniari I, Plotas P, Soufras GD, Tsigkas G, Davlouros P et al. Inflammation, Thrombosis, and Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes. Angiology. 2021;72(1):6–8. DOI: 10.1177/0003319720946213Xia Y, Xia C, Wu L, Li Z, Li H, Zhang J. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. Journal of Clinical Medicine. 2023;12(3):1128. DOI: 10.3390/jcm12031128Xia Y, Xia C, Wu L, Li Z, Li H, Zhang J. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. Journal of Clinical Medicine. 2023;12(3):1128. DOI: 10.3390/jcm12031128Mahmud E, Ramsis M, Behnamfar O, Enright K, Huynh A, Kaushal K et al. Effect of Serum Fibrinogen, Total Stent Length, and Type of Acute Coronary Syndrome on 6-Month Major Adverse Cardiovascular Events and Bleeding After Percutaneous Coronary Intervention. The American Journal of Cardiology. 2016;117(10):1575–81. DOI: 10.1016/j.amjcard.2016.02.032Mahmud E, Ramsis M, Behnamfar O, Enright K, Huynh A, Kaushal K et al. Effect of Serum Fibrinogen, Total Stent Length, and Type of Acute Coronary Syndrome on 6-Month Major Adverse Cardiovascular Events and Bleeding After Percutaneous Coronary Intervention. The American Journal of Cardiology. 2016;117(10):1575–81. DOI: 10.1016/j.amjcard.2016.02.032Liu H, Qian S, Shao Y, Li H, Zhang H. Prognostic Impact of Systemic Coagulation-Inflammation Index in Acute Type A Aortic Dissection Surgery. JACC: Asia. 2022;2(6):763–76. DOI: 10.1016/j.jacasi.2022.06.007Liu H, Qian S, Shao Y, Li H, Zhang H. Prognostic Impact of Systemic Coagulation-Inflammation Index in Acute Type A Aortic Dissection Surgery. JACC: Asia. 2022;2(6):763–76. DOI: 10.1016/j.jacasi.2022.06.007Civeira F, Arca M, Cenarro A, Hegele RA. A mechanism-based operational definition and classification of hypercholesterolemia. Journal of Clinical Lipidology. 2022;16(6):813–21. DOI: 10.1016/j.jacl.2022.09.006Civeira F, Arca M, Cenarro A, Hegele RA. A mechanism-based operational definition and classification of hypercholesterolemia. Journal of Clinical Lipidology. 2022;16(6):813–21. DOI: 10.1016/j.jacl.2022.09.006Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. The Lancet. 2017;389(10075):1238–52. DOI: 10.1016/S0140-6736(16)32064-5Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. The Lancet. 2017;389(10075):1238–52. DOI: 10.1016/S0140-6736(16)32064-5Caiazzo G, Musci RL, Frediani L, Umińska J, Wanha W, Filipiak KJ et al. State of the Art: No-Reflow Phenomenon. Cardiology Clinics. 2020;38(4):563–73. DOI: 10.1016/j.ccl.2020.07.001Caiazzo G, Musci RL, Frediani L, Umińska J, Wanha W, Filipiak KJ et al. State of the Art: No-Reflow Phenomenon. Cardiology Clinics. 2020;38(4):563–73. DOI: 10.1016/j.ccl.2020.07.001Lameire NH, Levin A, Kellum JA, Cheung M, Jadoul M, Winkelmayer WC et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney International. 2021;100(3):516–26. DOI: 10.1016/j.kint.2021.06.028Lameire NH, Levin A, Kellum JA, Cheung M, Jadoul M, Winkelmayer WC et al. Harmonizing acute and chronic kidney disease definition and classification: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney International. 2021;100(3):516–26. DOI: 10.1016/j.kint.2021.06.028Thiele H, De Waha-Thiele S, Freund A, Zeymer U, Desch S, Fitzgerald S. Management of cardiogenic shock. EuroIntervention. 2021;17(6):451– 65. DOI: 10.4244/EIJ-D-20-01296Thiele H, De Waha-Thiele S, Freund A, Zeymer U, Desch S, Fitzgerald S. Management of cardiogenic shock. EuroIntervention. 2021;17(6):451– 65. DOI: 10.4244/EIJ-D-20-01296Alkhalfan F, Nafee T, Yee MK, Chi G, Kalayci A, Plotnikov A et al. Relation of White Blood Cell Count to Bleeding and Ischemic Events in Patients With Acute Coronary Syndrome (from the ATLAS ACS 2-TIMI 51 Trial). The American Journal of Cardiology. 2020;125(5):661–9. DOI: 10.1016/j.amjcard.2019.12.007Alkhalfan F, Nafee T, Yee MK, Chi G, Kalayci A, Plotnikov A et al. Relation of White Blood Cell Count to Bleeding and Ischemic Events in Patients With Acute Coronary Syndrome (from the ATLAS ACS 2-TIMI 51 Trial). The American Journal of Cardiology. 2020;125(5):661–9. DOI: 10.1016/j.amjcard.2019.12.007Bodí V, Llacer A, Sanchis J, Nunez J, Nunez E. Prognostic Value of Leukocytosis in Acute Coronary Syndromes: The Cinderella of the Inflammatory Markers. Current Medicinal Chemistry. 2006;13(18):2113–8. DOI: 10.2174/092986706777935221Bodí V, Llacer A, Sanchis J, Nunez J, Nunez E. Prognostic Value of Leukocytosis in Acute Coronary Syndromes: The Cinderella of the Inflammatory Markers. Current Medicinal Chemistry. 2006;13(18):2113–8. DOI: 10.2174/092986706777935221Eber B, Schumacher M. Fibrinogen: Its Role in the Hemostatic Regulation in Atherosclerosis. Seminars in Thrombosis and Hemostasis. 1993;19(02):104–7. DOI: 10.1055/s-2007-994012Eber B, Schumacher M. Fibrinogen: Its Role in the Hemostatic Regulation in Atherosclerosis. Seminars in Thrombosis and Hemostasis. 1993;19(02):104–7. DOI: 10.1055/s-2007-994012Gil M, Zarębiński M, Adamus J. Plasma fibrinogen and troponin I in acute coronary syndrome and stable angina. International Journal of Cardiology. 2002;83(1):43–6. DOI: 10.1016/S0167-5273(02)00008-6Gil M, Zarębiński M, Adamus J. Plasma fibrinogen and troponin I in acute coronary syndrome and stable angina. International Journal of Cardiology. 2002;83(1):43–6. DOI: 10.1016/S0167-5273(02)00008-6Toss H, Lindahl B, Siegbahn A, Wallentin L. Prognostic Influence of Increased Fibrinogen and C-Reactive Protein Levels in Unstable Coronary Artery Disease. Circulation. 1997;96(12):4204–10. DOI: 10.1161/01.CIR.96.12.4204Toss H, Lindahl B, Siegbahn A, Wallentin L. Prognostic Influence of Increased Fibrinogen and C-Reactive Protein Levels in Unstable Coronary Artery Disease. Circulation. 1997;96(12):4204–10. DOI: 10.1161/01.CIR.96.12.4204Verheggen P, de Maat MP, Cats VM, Haverkate F, Zwinderman AH, Kluft C et al. Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function. European Heart Journal. 1999;20(8):567–74. DOI: 10.1053/euhj.1998.1312Verheggen P, de Maat MP, Cats VM, Haverkate F, Zwinderman AH, Kluft C et al. Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function. European Heart Journal. 1999;20(8):567–74. DOI: 10.1053/euhj.1998.1312Iso H, Folsom AR, Sato S, Wu KK, Shimamoto T, Koike K et al. Plasma fibrinogen and its correlates in Japanese and US population samples. Arteriosclerosis and Thrombosis. 1993;13(6):783–90. DOI: 10.1161/01.ATV.13.6.783Iso H, Folsom AR, Sato S, Wu KK, Shimamoto T, Koike K et al. Plasma fibrinogen and its correlates in Japanese and US population samples. Arteriosclerosis and Thrombosis. 1993;13(6):783–90. DOI: 10.1161/01.ATV.13.6.783Campbell CL, Steinhubl SR, Hooper WC, Jozic J, Smyth SS, Bernstein D et al. Bleeding events are associated with an increase in markers of inflammation in acute coronary syndromes: an ACUITY trial substudy. Journal of Thrombosis and Thrombolysis. 2011;31(2):139–45. DOI: 10.1007/s11239-010-0513-1Campbell CL, Steinhubl SR, Hooper WC, Jozic J, Smyth SS, Bernstein D et al. Bleeding events are associated with an increase in markers of inflammation in acute coronary syndromes: an ACUITY trial substudy. Journal of Thrombosis and Thrombolysis. 2011;31(2):139–45. DOI: 10.1007/s11239-010-0513-1Dumaine R, Gibson CM, Murphy SA, Southard M, Ly HQ, McCabe CH et al. Association of a History of Systemic Hypertension With Mortality, Thrombotic, and Bleeding Complications Following Non‐ST‐Segment Elevation Acute Coronary Syndrome. The Journal of Clinical Hypertension. 2006;8(5):315–22. DOI: 10.1111/j.1524-6175.2006.05384.xDumaine R, Gibson CM, Murphy SA, Southard M, Ly HQ, McCabe CH et al. Association of a History of Systemic Hypertension With Mortality, Thrombotic, and Bleeding Complications Following Non‐ST‐Segment Elevation Acute Coronary Syndrome. The Journal of Clinical Hypertension. 2006;8(5):315–22. DOI: 10.1111/j.1524-6175.2006.05384.xManoukian SV. Predictors and Impact of Bleeding Complications in Percutaneous Coronary Intervention, Acute Coronary Syndromes, and ST-Segment Elevation Myocardial Infarction. The American Journal of Cardiology. 2009;104(5 Suppl):9C-15C. DOI: 10.1016/j.amjcard.2009.06.020Manoukian SV. Predictors and Impact of Bleeding Complications in Percutaneous Coronary Intervention, Acute Coronary Syndromes, and ST-Segment Elevation Myocardial Infarction. The American Journal of Cardiology. 2009;104(5 Suppl):9C-15C. DOI: 10.1016/j.amjcard.2009.06.020Alexander KP, Chen AY, Roe MT, Newby LK, Gibson CM, AllenLaPointe NM et al. Excess Dosing of Antiplatelet and Antithrombin Agents in the Treatment of Non–ST-Segment Elevation Acute Coronary Syndromes. JAMA. 2005;294(24):3108–16. DOI: 10.1001/jama.294.24.3108Alexander KP, Chen AY, Roe MT, Newby LK, Gibson CM, AllenLaPointe NM et al. Excess Dosing of Antiplatelet and Antithrombin Agents in the Treatment of Non–ST-Segment Elevation Acute Coronary Syndromes. JAMA. 2005;294(24):3108–16. DOI: 10.1001/jama.294.24.3108Hamilos M, Petousis S, Xanthopoulou I, Goudevenos J, Kanakakis J, Sitafidis G et al. Antiplatelet treatment in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention: a GReek AntiPlatElet registry substudy. Coronary Artery Disease. 2018;29(1):53–9. DOI: 10.1097/MCA.0000000000000547Hamilos M, Petousis S, Xanthopoulou I, Goudevenos J, Kanakakis J, Sitafidis G et al. Antiplatelet treatment in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention: a GReek AntiPlatElet registry substudy. Coronary Artery Disease. 2018;29(1):53–9. DOI: 10.1097/MCA.0000000000000547

The authors declare that there are no conflicts of interest present.