Research Article
Koroner yoğun bakım ünitesindeki hastalarda akut miyokard infaktüsü ve anstabil angina pektoris ayrımında kardiyak belirteçlerin rolü
Abstract
Amaç: Kardiyak belirteçler; kardiyak ve nonkardiyak hastaların doğru triajında fizik muayene bulguları, Elektrokardiyografi (EKG) ve Ekokardiyografi (ECHO)’ya ek olarak önemini korumaktadır. Bu çalışmada, koroner yoğun bakım ünitesindeki Akut Miyokard İnfarktüsü (AMI) ve Anstabil Angina Pektoris (ASAP) olan hastaların kardiyak troponin ve Kreatin Kinaz MB (CKMB) test sonuçlarını ve klinik verilerini değerlendirerek kabul edilebilir bir strateji geliştirmeyi amaçladık.
Gereç ve Yöntem: Koroner yoğun bakım ünitesinde yatan 208 hastanın (yaş:61±12) klinik ve laboratuvar verileri retrospektif olarak incelendi. Hastalar tanılarına göre üç gruba ayrıldı. Grup 1, AMİ olan 132 hastadan oluştu; Grup 2, AMİ olmayan ASAP'lı 28 hastadan oluştu; Grup 3, nonkardiyak hastalığı olan 48 hastadan (kronik kalp yetmezliği, böbrek yetmezliği, sepsis, vb.) oluştu. CKMB seviyeleri Dimension Xpand Plus (Dade Behring Inc, Newark, ABD) marka biyokimya otoanalizöründe immünoinhibisyon yöntemiyle ölçüldü. CTnT (Kardiyak Troponin T) ölçümü için Cardiac T Quantitative Rapid Assay (Roche Diagnostics GmbH, Mannheim, Almanya) hasta başı cihazı kullanıldı.
Bulgular: Grupları değerlendirmede biyolojik belirteçler CKMB ve
cTnT için ROC analizi yapıldı. AMI grubu için; CKMB'nin Eğri Altındaki Alan
(EAA):0.724 (SE=0.041, p<0.001), cTnT'nin EAA:0.741 (SE=0.038, p<0.001); ASAP
grubu için; CKMB'nin EAA:0.536 (SE=0.067, p=0.601), cTnT'nin EAA:0.637 (SE=0.067,
p=0.047) olarak tespit edildi.
Sonuç:
ROC analizi sonuçları ve EAA değerlendirmeleri
AMI ve ASAP hastalarının ayrımında kardiyak belirteçler CKMB ve cTnT’nin
tanısal gücünü ortaya koydu. Bu kardiyak belirteçlerin birlikte kullanılması
tanısal gücü artırmaktadır. Nonkardiyak hasta grupları için büyük örneklemli çalışmalarda
ROC analizi faydalı olabilir.
References
- 1. Adams JE, Abendschein DR, Jaffe AS. Biochemical markers of myocardial injury: is MB creatine kinase the choice for the 1990s? Circulation. 1993;88:750-63. 2. Çelebi ÖÖ, Diker E, Aydogdu S. Kardiyak troponinlerin klinik önemi. Türk Kardiyoloji Dern Arş. 2008;36:269-77. 3. Roger VL, Killian JM, Weston SA, Jaffe AS, Kors J, Santrach PJ, et al. Redefinition of myocardial infarction: prospective evaluation in the community. Circulation 2006;114:790-7 4. Cross E, How S, Goodacre S. Development of acute chest pain services in the UK. Emerg Med J. 2007;24:100-2. 5. Hjortshøj S, Otterstad JE, Lindahl B, Danielsen R, Pulkki K, Ravkilde J. Biochemical diagnosis of myocardial infarction evolves towards ESC/ACC consensus: experiences from the Nordic countries. Scand Cardiovasc J. 2005;39:159-66. 6. Deveci F, Turgut T, Tuğ T, Kırkıl G, Türkoğlu S, Muz MH. KOAH’lı Olgularda Kardiyak Troponin Düzeyleri.Toraks Dergisi.2006;7:95-100 7. Perna ER, Macin SM, Canella JP, Augier N, Stival JL,Cialzeta JR, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation 2004;110:2376-82 8. Ishii J, Cui W, Kitagawa F, Kuno T, Nakamura Y, Naruse H, et al. Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure. Clin Chem 2003;49:2020-6 9. La Vecchia L, Mezzena G, Ometto R, Finocchi G, Bedogni F, Soffiati G, et al. Detectable serum troponin I in patients with heart failure of nonmyocardial ischemic origin. Am J Cardiol 1997;80:88-90. 10. Del Carlo CH, Pereira-Barretto AC, Cassaro-Strunz C, Latorre Mdo R, Ramires JA. Serial measure of cardiac troponin T levels for prediction of clinical events in decompensated heart failure. J Card Fail 2004;10:43-8 11. Spies C, Haude V, Fitzner R, Schroder K, Overbeck M, Runkel N, et al. Serum cardiac troponin T as a prognostic marker in early sepsis. Chest 1998;113:1055-63. 12. McLaurin MD, Apple FS, Voss EM, Herzog CA, Sharkey SW. Cardiac troponin I, cardiac troponin T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin T expression in skeletal muscle. Clin Chem 1997;43:976-82. 13. Wallace TW, Abdullah SM, Drazner MH, Das SR, Khera A, McGuire DK, et al. Prevalence and determinants of troponin T elevation in the general population. Circulation 2006;113:1958-65. 14. Chapelle JP. Cardiac troponin I and troponin T: recent players in the field of myocardial markers. Clin Chem Lab Med 1999;37:11-20.
The role of cardiac markers in acute myocardial ınfarction and unstable angina pectoris discrimination in patients with coronary intensive care unit
Abstract
Aim:
Cardiac markers have been keeping on their importance
in correct triage of cardiac and noncardiac patients, in addition to physical
examination finding, electrocardiography (ECG) and echocardiography (ECHO). In this study, we aimed to develop an
acceptable strategy by evaluating the cardiac troponin and creatine kinase MB
(CKMB) test results and clinical data of patients with acute myocardial infarction
(AMI) and unstable angina pectoris (USAP) in coronary intensive care unit.
Material and method: Clinical and laboratory data of 208 patients (age: 61±12) in coronary intensive care unit were retrospectively reviewed. Patients were divided into three groups according to their diagnosis. Group 1 consisted from 132 patients with AMI; Group 2 consisted from 28 patients with ASAP without AMI; Group 3 consisted from 48 patients with Noncardiac disease (chronic heart failure, renal failure, sepsis, etc.). CKMB levels were measured by the immunoinhibition method in Dimension Xpand Plus (Dade Behring Inc, Newark, USA) chemistry autoanalyzer. The Cardiac T Quantitative Rapid Assay point of care testing analyzer (Roche Diagnostics GmbH, Mannheim, Germany) was used for cTnT(Cardiac Troponin T) measurement.
Result:
ROC analysis was performed
for biomarkers CKMB and cTnT in evaluating the groups. For the AMI group; Area under the curve of CKMB (AUC):
0.724 (SE=0.041, p<0.001), AUC of cTnT: 0.741 (SE=0.038, p<0.001); for
the ASAP group; AUC of CKMB:0.536 (SE=0.067, p=0.601) and AUC of cTnT: 0.637
(SE=0.067, p=0.047) were detected.
Conclusion: The ROC analysis results and the AUC evaluations revealed the diagnostic power of cardiac markers CKMB and cTnT in the discrimination between AMI and ASAP patients. The combined use of these cardiac markers increases the diagnostic power. ROC analysis may be useful in large sample studies for noncardiac patient groups.
References
- 1. Adams JE, Abendschein DR, Jaffe AS. Biochemical markers of myocardial injury: is MB creatine kinase the choice for the 1990s? Circulation. 1993;88:750-63. 2. Çelebi ÖÖ, Diker E, Aydogdu S. Kardiyak troponinlerin klinik önemi. Türk Kardiyoloji Dern Arş. 2008;36:269-77. 3. Roger VL, Killian JM, Weston SA, Jaffe AS, Kors J, Santrach PJ, et al. Redefinition of myocardial infarction: prospective evaluation in the community. Circulation 2006;114:790-7 4. Cross E, How S, Goodacre S. Development of acute chest pain services in the UK. Emerg Med J. 2007;24:100-2. 5. Hjortshøj S, Otterstad JE, Lindahl B, Danielsen R, Pulkki K, Ravkilde J. Biochemical diagnosis of myocardial infarction evolves towards ESC/ACC consensus: experiences from the Nordic countries. Scand Cardiovasc J. 2005;39:159-66. 6. Deveci F, Turgut T, Tuğ T, Kırkıl G, Türkoğlu S, Muz MH. KOAH’lı Olgularda Kardiyak Troponin Düzeyleri.Toraks Dergisi.2006;7:95-100 7. Perna ER, Macin SM, Canella JP, Augier N, Stival JL,Cialzeta JR, et al. Ongoing myocardial injury in stable severe heart failure: value of cardiac troponin T monitoring for high-risk patient identification. Circulation 2004;110:2376-82 8. Ishii J, Cui W, Kitagawa F, Kuno T, Nakamura Y, Naruse H, et al. Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure. Clin Chem 2003;49:2020-6 9. La Vecchia L, Mezzena G, Ometto R, Finocchi G, Bedogni F, Soffiati G, et al. Detectable serum troponin I in patients with heart failure of nonmyocardial ischemic origin. Am J Cardiol 1997;80:88-90. 10. Del Carlo CH, Pereira-Barretto AC, Cassaro-Strunz C, Latorre Mdo R, Ramires JA. Serial measure of cardiac troponin T levels for prediction of clinical events in decompensated heart failure. J Card Fail 2004;10:43-8 11. Spies C, Haude V, Fitzner R, Schroder K, Overbeck M, Runkel N, et al. Serum cardiac troponin T as a prognostic marker in early sepsis. Chest 1998;113:1055-63. 12. McLaurin MD, Apple FS, Voss EM, Herzog CA, Sharkey SW. Cardiac troponin I, cardiac troponin T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin T expression in skeletal muscle. Clin Chem 1997;43:976-82. 13. Wallace TW, Abdullah SM, Drazner MH, Das SR, Khera A, McGuire DK, et al. Prevalence and determinants of troponin T elevation in the general population. Circulation 2006;113:1958-65. 14. Chapelle JP. Cardiac troponin I and troponin T: recent players in the field of myocardial markers. Clin Chem Lab Med 1999;37:11-20.
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Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Original article |
| Authors | |
| Publication Date | June 1, 2018 |
| Published in Issue | Year 2018 Volume: 10 Issue: 2 |
e-ISSN: 2548-0251
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