ACİL SERVİSE GÖĞÜS AĞRISI İLE BAŞVURAN KRONİK BÖBREK YETMEZLİĞİ HASTALARINDA TROPONİN T YÜKSEKLİĞİNİN AKUT KORONER SENDROM TANISINDA VE MORTALİTEYİ BELİRLEMEDE BAŞARISININ DEĞERLENDİRİLMESİ

Giriş: Kardiyak troponinler, genel popülasyonda akut miyokard infarktüsü tanısında önemli bir biyobelirteçtir. Bunun yanında kronik böbrek yetmezliği olan hastalarda yüksek troponin düzeyleri sıklıkla görülen bir durumdur ve bu durum tanısal doğruluğu azaltmaktadır. Çalışmamızda kronik böbrek yetmezliği (KBY) olan göğüs ağrılı hastalarda troponin T’nin akut miyokard infarktüslü hastaların tanısındaki başarısını tespit etmektedir. Gereç ve Yöntem: Çalışmamız retrospektif gözlemsel olarak 3. basamak bir hastanede yapıldı. Çalışma için hastanemiz acil servisine 1 Ocak 2019 ile 1 Ocak 2020 tarihleri arasında göğüs ağrısı ile başvuran hastalardan çalışma kriterlerini taşıyan hastalar dahil edildi. Hastaların geliş ve 4. saat troponin düzeyleri kaydedildi. Olgular KBY varlığına göre iki kategori şeklinde incelendi. Bulgular: 3309 hastanın %62,9’u erkek ve yaş ortanca değeri 57,5 yıldı. Hastaların 506’sında kronik böbrek yetmezlik mevcuttu. Başvurudaki troponin T için ROC eğrisi altında kalan alan, KBY’li olgularda 0,836 (%95 CI; 0,561-0,832) ve KBY olmayan olgularda 0,675 (%95 Confident Interval (CI); 0,613-0,737) aralığındaydı. Yine 4. saat kontrol troponin T düzeyindeki dinamik değişim incelendiğinde; ROC eğrisi altında kalan KBY’li hastalarda 0,796 (%95 CI; 0,718-0,953) ve KBY olmayan olgularda 0,780 (%95 CI; 0,613-0,737) aralık arasındaydı ve KBY’li olgularda hem başlangıç hem 4. saat troponin düzeyleri KBY öyküsü olmayan olgulara göre yüksekti. Kronik böbrek yetmezliği olan olgularda mortalite anlamlı olarak fazlaydı. Koroner anjiografi (KAG) yapılan KBY’li olgularda en fazla çoklu damar lezyonu çıkmış olsa bu durum istatistiksel anlamlı değildi. Sonuç: KBY’li hastalarda, yüksek troponin T düzeyi görülmektedir. Bu nedenle, akut miyokard infarktüsü şüpheli hastalarda tanısı için bireysel referans aralıkları belirlenmelidir. Ayrıca kontrol troponin T düzeylerinden öte, dinamik troponin T değişikliği akut miyokard infarktüsü tanısında fayda sağlayacaktır. KBY olgularında Troponin T düzeyindeki artışın mortalite ile ilişkili olduğunu düşündük.

EVALUATION OF THE SUCCESS OF TROPONIN T HIGHER IN DIAGNOSIS OF ACUTE CORONARY SYNDROME AND DETERMINATION OF MORTALITY IN CHRONIC RENAL FAILURE PATIENTS APPLIED TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN

Introduction: Cardiac troponins are an important biomarker in the diagnosis of acute myocardial infarction in the general population. In addition, high troponin levels are frequently seen in patients with chronic renal failure, which reduces the diagnostic accuracy. Our study determines the success of troponin T in the diagnosis of patients with acute myocardial infarction in patients with chest pain with chronic renal failure (CFR) Material and Methods: Our study was carried out retrospectively and observationally in a tertiary hospital. For the study, patients who met the study criteria from the patients who applied to the emergency department of our hospital between January 1, 2019 and January 1, 2020 with chest pain were included. The troponin levels of the patients at admission and at the 4th hour were recorded. The cases were analyzed in two categories according to the presence of chronic renal failure. Results: Of 3309 patients, 62.9% were male and the median age was 57.5 years. 506 of the patients had chronic renal failure. The area under the ROC curve for troponin T at admission was 0.836 (95% CI; 0.561-0.832) in subjects with CRF and 0.675 (95% CI; 0.613-0.737) in subjects without CRF. Again, when the dynamic change in the 4th hour control troponin T level is examined; Under the ROC curve, the range was between 0.796 (95% CI; 0.718- 0.953) in patients with CRF and 0.780 (95% CI; 0.613-0.737) in patients without CRF, and both baseline and 4th hour troponin levels in patients with CRF without a history of CRF higher than the cases. Mortality was significantly higher in patients with chronic renal failure. Although the most multiple vascular lesions were observed in CRF patients who underwent coronary angiography (CAG), this situation was not statistically significant. Conclusions: High troponin T levels are observed in patients with CRF. Therefore, individual reference intervals should be determined for the diagnosis of patients with suspected acute myocardial infarction. In addition, dynamic troponin T changes, beyond control troponin T levels, will be beneficial in the diagnosis of acute myocardial infarction. We thought that the increase in Troponin T levels in CRF cases was associated with mortality.

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