Bilal İLANBEY, Süleyman ERSOY, Alp YILDIRIM

Şüpheli Miyokard Enfarktüsü Hastalarında High Sensitive Troponin I ve Troponin T Değerlerinin Koroner Anjiyografi Sonuçları ile Uyumu

EKG’de ST segment yükselmesi olmayan miyokard enfarktüsü (NSTEMI) hastalarının tanısında high-sensitive troponinler önemlidir. Seri troponin ölçümleri ve belirli cut-off değerlerin kullanıldığı algoritmalar sayesinde miyokard enfarktüsü için dahil etme ya da dışlama yapılabilmektedir. Bazı hastalar dahil etme veya dışlamaya uymamakta ve şüpheli miyokard enfarktüsü düşünülerek gözlem altına alınmaktadır. Gözlem altına alınan ve klinik olarak miyokard enfarktüsü olasılığı yüksek hastalara koroner anjiyografi yapılmaktadır. Amacımız ESC 2020 kılavuzuna göre gözlem altına alınan hastalarda high-sensitive troponin I ve T’nin koroner anjiyografi ile uyumunu değerlendirmekti. 0-1 saat için hs-cTnI 6-50 ng/L arası ve delta 1s değişikliği <15ng/L; hs-cTnT 13-52 ng/L arası ve delta 1s değişikliği <5 ng/L olan ve koroner anjiyografi yapılan 113 hastanın dosyaları ile anjiografi sonuçları retrospektif olarak incelendi. Koroner anjiyografide %50 üzerinde olan darlıklar lezyon olarak kabul edildi. Hastaların %75,2’sinde koroner anjiyografide en az bir lezyon vardı. High-sensitive troponin I grubunda lezyonu olan hastaların oranı, high-sensitive troponin T grubuna göre istatistiksel olarak anlamlı yüksekti. Lojistik regresyon analizinde koroner arter hastalığı risk göstergesi açısından high-sensitive troponin I, high-sensitive troponin T ye göre yaklaşık 3 kat daha üstündü. ESC 2020 klavuzuna göre şüpheli miyokard enfarktüsü tanısını alan hastaların high-sensitive troponin I sonuçları, high-sensitive troponin T sonuçlarına göre anjiyografideki lezyonu öngörmede daha değerlidir.

Anahtar Kelimeler:

: esc 2020 kılavuzu, high sensitive troponin, koroner anjiyografi, şüpheli miyokard enfarktüsü

Compatibility of High-Sensitive Troponin I and Troponin T Values with Coronary Angiography Results in Patients with Suspected Myocardial Infarction

High-sensitive troponins are important in the diagnosis of myocardial infarction patients without ST-segment elevation (NSTEMI) on ECG. Myocardial infarction can be included or excluded using serial troponin assays and algorithms with specific cut-off values. Some patients don’t comply with inclusion or exclusion and are observed for suspected myocardial infarction. Patients who are being monitored and have a high clinical probability of myocardial infarction undergo coronary angiography. We aimed to evaluate the compatibility of high-sensitive troponin I and T with coronary angiography in patients under observation according to the ESC 2020 guideline. According to the 0-1 hour algorithm, those who had coronary angiography had a hs-cTnI value between 6-50 ng/L and a delta 1-hour change <15ng/L; The files and angiography results of 113 patients with a hs-cTnT value between 13-52 ng/L and delta 1-hour change <5 ng/L were analyzed retrospectively. Stenosis greater than 50% on coronary angiography was considered as a lesion. 75.2% of the patients had at least one lesion on coronary angiography. The proportion of patients with lesions in the high-sensitive troponin I group was statistically significantly higher than in the high-sensitive troponin T group. In logistic regression analysis, high-sensitive troponin I was approximately 3 times superior to high-sensitive troponin T in terms of coronary artery disease risk indicator. High-sensitive troponin I results of patients diagnosed with suspected myocardial infarction stated in the ESC 2020 guideline are more valuable in predicting the lesion on angiography than high-sensitive troponin T results.

Keywords:

esc 2020 guideline, high sensitive troponin, coronary angiography, suspected myocardial infarction,

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Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. New England Journal of Medicine, 376(21), 2053-2064.
Boeddinghaus, J., Nestelberger, T., Twerenbold, R., Koechlin, L., Meier, M., Troester, V., Wussler, D., Badertscher, P., Wildi, K., & Puelacher, C. (2019). High-sensitivity cardiac troponin I assay for early diagnosis of acute myocardial infarction. Clinical Chemistry, 65(7), 893-904.
Boeddinghaus, J., Nestelberger, T., Twerenbold, R., Neumann, J. T., Lindahl, B., Giannitsis, E., Sörensen, N. A., Badertscher, P., Jann, J. E., & Wussler, D. (2018). Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. European Heart Journal, 39(42), 3780-3794.
Boeddinghaus, J., Twerenbold, R., Nestelberger, T., Koechlin, L., Wussler, D., Meier, M., Troester, V., Zimmermann, T., Badertscher, P., & Wildi, K. (2019). Clinical use of a new high-sensitivity cardiac troponin I assay in patients with suspected myocardial infarction. Clinical Chemistry, 65(11), 1426-1436.
Collet, J.-P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., & Folliguet, T. (2021). 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 42(14), 1289-1367.
Cullen, L., Parsonage, W. A., Greenslade, J., Lamanna, A., Hammett, C. J., Than, M., Tate, J., Kalinowski, L., Ungerer, J. P., & Chu, K. (2013). Delta troponin for the early diagnosis of AMI in emergency patients with chest pain. International Journal of Cardiology, 168(3), 2602-2608.
Eggers, K. M., Lind, L., Venge, P., & Lindahl, B. (2013). Factors influencing the 99th percentile of cardiac troponin I evaluated in community-dwelling individuals at 70 and 75 years of age. Clinical Chemistry, 59(7), 1068-1073.
Farooq, V., Serruys, P. W., Bourantas, C. V., Zhang, Y., Muramatsu, T., Feldman, T., Holmes, D. R., Mack, M., Morice, M. C., & Ståhle, E. (2013). Quantification of incomplete revascularization and its association with five-year mortality in the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) trial validation of the residual SYNTAX score. Circulation, 128(2), 141-151.
Gore, M. O., Seliger, S. L., Defilippi, C. R., Nambi, V., Christenson, R. H., Hashim, I. A., Hoogeveen, R. C., Ayers, C. R., Sun, W., & McGuire, D. K. (2014). Age-and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. Journal of the American College of Cardiology, 63(14), 1441-1448.
Jousilahti, P., Vartiainen, E., Tuomilehto, J., & Puska, P. (1999). Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14 786 middle-aged men and women in Finland. Circulation, 99(9), 1165-1172.
Kuster, N., Monnier, K., Baptista, G., Dupuy, A.-M., Badiou, S., Bargnoux, A.-S., Jeandel, C., & Cristol, J.-P. (2015). Estimation of age-and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly. Clinical Chemistry and Laboratory Medicine (CCLM), 53(5), 691-698.
Reichlin, T., Hochholzer, W., Bassetti, S., Steuer, S., Stelzig, C., Hartwiger, S., Biedert, S., Schaub, N., Buerge, C., & Potocki, M. (2009). Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. New England Journal of Medicine, 361(9), 858-867.
Rubini Gimenez, M., Twerenbold, R., Reichlin, T., Wildi, K., Haaf, P., Schaefer, M., Zellweger, C., Moehring, B., Stallone, F., & Sou, S. M. (2014). Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction. European Heart Journal, 35(34), 2303-2311.
Serruys, P. W., Morice, M.-C., Kappetein, A. P., Colombo, A., Holmes, D. R., Mack, M. J., Ståhle, E., Feldman, T. E., Van Den Brand, M., & Bass, E. J. (2009). Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. New England Journal of Medicine, 360(10), 961-972.
Sianos, G., Morel, M.-A., Kappetein, A. P., Morice, M.-C., Colombo, A., Dawkins, K., van den Brand, M., Van Dyck, N., Russell, M. E., & Mohr, F. W. (2005). The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention, 1(2), 219-227.
Thygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., White, H. D., Mickley, H., Crea, F., & Van de Werf, F. (2019). Fourth universal definition of myocardial infarction (2018). European Heart Journal, 40(3), 237-269.
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., & Delling, F. N. (2020). Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation, 141(9), e139-e596.
Welsh, P., Preiss, D., Hayward, C., Shah, A. S., McAllister, D., Briggs, A., Boachie, C., McConnachie, A., Padmanabhan, S., & Welsh, C. (2019). Cardiac troponin T and troponin I in the general population: comparing and contrasting their genetic determinants and associations with outcomes. Circulation, 139(24), 2754-2764.
Wu, A. H., Christenson, R. H., Greene, D. N., Jaffe, A. S., Kavsak, P. A., Ordonez-Llanos, J., & Apple, F. S. (2018). Clinical laboratory practice recommendations for the use of cardiac troponin in acute coronary syndrome: expert opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clinical Chemistry, 64(4), 645-655.