Akademik Veri Yönetim Sistemi
8th Eurasian Congress of Emergency Medicine & 18th Emergency Medicine Congress of Turkey & 17th World Interactive Network Focused on Critical Ultrasound Congress, Antalya, Türkiye, 1 - 04 Aralık 2022, ss.215-219
OBJECTIVE: In-hospital mortality rate of cardiogenic shock, which is one of the important complications related to MI and reported
in 6-10% of ST-elevation myocardial infarction (STEMI) patients, is stated as 50%. Following MI, shock develops within 24 hours in
75% of patients. Recognizing shock at an early stage (before it is decompensated) is important to reduce mortality. When shock
develops, body exhibits a reflex mechanism that reduces peripheral perfusion to maintain perfusion of vital organs. In this
compensation process, evaluating peripheral circulation helps predict hemodynamic collapse in the early period. Peripheral perfusion
index (PI) used to evaluate peripheral perfusion is a rapid, bedside and non-invasive method. The aim of this study is to investigate
the relationship of PI with clinical and laboratory markers and its role in predicting prognosis in patients diagnosed with STEMI in the
Emergency Department (ED).
MATERIAL and METHODS: The study was conducted prospectively and observationally in ESOGU Emergency Department (ED)
between 03.06.2021- 14.05.2022. Patients aged 18 years and older, who were diagnosed with STEMI in the ED, underwent emergency
coronary angiography (CAG), and consented to participate in the study, were included in the study. Limb disorders that affect PI
measurement, treatment other than acetylsalicylic acid before measurement, intubation or cardiopulmonary resuscitation and
presence of pregnancy and trauma were accepted as exclusion criteria. The number of patients for the study group was determined
to be at least 154 cases, with α error = 0.05 and power of the study 0.95.
STEMI administration in the ED was performed according to current guidelines in all patients. The presentation PI measurements of
the patients were performed using a fingertip transcutaneous probe. In the study, age, gender, co-morbidities, ED presenting
complaint, pain level, vital signs, PI value, ECG findings, bedside ECHO findings, laboratory values, CAG results, 24th hour and 30th
day survival were evaluated. The optimum cut-off value of PI was determined as 1.2 for mortality and CABG decision evaluation.
RESULT: 167 of 190 cases diagnosed with STEMI met the inclusion criteria. The mean age of the cases was 61.35±12.11 (range 32-95)
and 132 (79%) were male. The characteristic features of the cases were given in Table 1. The mean PI value was 2.75 (range 0.15-
10.80) and the median value was 2.30 (Q1-Q3=1.38-3.60). The PI value of 35 patients (20.9%) was measured as <1.20. Critical stenosis
of coronary arteries was detected with CAG in 135 (80.8%) patients. CABG was decided for 23 cases (13.8%). When survival was
evaluated, it was found that 11 cases (6.6%) had exitus at the 24th hour and 20 cases (11.4%) had exitus at the 30th day. Major risk
factors were determined by binary logistic regression analyses in which shock index (SI), ejection fraction (EF), admission troponin,
proBNP, troponin peak value, PI, age, sex, lactate and base deficit were evaluated for CABG decision with 24th hour and 30th day
mortality (Table 2). ROC curve analyses were performed to predict 24th hour and 30th day mortality and CABG decision. In all three
evaluations, PI was found to be more significant than the other parameters (Figure 1, Figure 2, Figure 3).
CONCLUSION: PI derived from a pulse oximeter can be used with vital signs and shock parameters to diagnose hemodynamic
instability early in STEMI. Likewise, a sudden drop in PI might indicate possible circulatory disorders in a stable patient. Furthermore,
it might be beneficial in triaging these patients to appropriate medical centers.