Akut Koroner Sendrom Şüpheli Hastalarda Mortalitenin Belirlenmesinde Ultra Duyarlı Troponin-I'in Değeri
Öz
özet:
Amaç: Bu çalışmada, günlük pratikte kullanılan ultra-duyarlı troponin kitlerinin referans değerinin mortaliteyi belirlemedeki rolünü araştırıldı.
Gereç-yöntem: Bu çalışma 1 Ocak 2018-30 Haziran 2019 tarihleri arasında Akdeniz Üniversitesi Hastanesi acil servisinde (AS) yapılmıştır. Acil servise on sekiz ay içinde başvuran ve sonucu olan tüm hastalar 0.06-0.1 ng/mL aralığındaki ultra-duyarlı troponin düzeyi çalışmaya dahil edildi. Hastaların acil servise tekrarlayan başvuruları dahil edildi ve hastaların sadece ilk troponin değerleri çalışma için referans olarak alındı.
Bulgular: Başlangıç troponin I değeri 0.06-0.1 ng/mL aralığında olan 591 hastanın 1029 troponin değerinin ölçüldüğü belirlendi. Bu hastalardan 332'sinin acil servisten taburcu edildiği, diğerlerinin ise hastaneye kaldırıldığı öğrenildi. Hastaların 168'inin (%28,43) öldüğü belirlendi. Ölen hastaların cinsiyet dağılımına bakıldığında 101 (%60,11) hastanın erkek, 67 (%39,89) hastanın kadın olduğu görüldü. Ölen hastaların yaşları (ortalama 71.38±12.25) ile yaşayan hastaların yaşları (ortalama 61.78±15.89) arasında istatistiksel olarak anlamlı fark bulundu (p<0.019). Tek değişkenli analizde pozitif troponin değerine ek olarak DM (p<0.022) ve hiperlipidemi (p<0.018) istatistiksel olarak anlamlı bulundu.
Sonuç: Acil serviste çalışılan yüksek duyarlı troponin için 0.06 ng/mL'lik üst değer etkin bir şekilde mortaliteyi belirler.
Anahtar Kelimeler
Destekleyen Kurum
The authors declare no conflict of interest or any financial support.
Teşekkür
tüm akdeniz universitesi acil servis kliniği ekibine teşekkürler.
Kaynakça
- 1. Bingisser R, Cairns C, Christ M, et al. Cardiac troponin: a critical review of the case for point-of-care testing in the ED. Am J Emerg Med 2012; 30(8): 1639-49.
- 2. Christ M, Popp S, Pohlmann H, et al. Implementation of High Sensitivity Cardiac Troponin T Measurement in the Emergency Department. Am J Med 2010; 123(12): 1134-42.
- 3. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. N Engl J Med 2000; 342(16): 1163-70.
- 4. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined -- a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36(3): 959-69.
- 5. Apple FS, Collinson PO. Analytical Characteristics of High-Sensitivity Cardiac Troponin Assays. Clin Chem 2012; 58(1): 54-61.
- 6. Reichlin T, Hochholzer W, Bassetti S, et al. Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays. N Engl J Med 2009; 361(9): 858-67.
- 7. Kavasoglu ME, Eken C, Eray O, Serinken M, Gülen B. Value of High-Sensitive Cardiac Troponin in Predicting Mortality in the Emergency Department. Clin Lab 2016; 62: 1483-9.
- 8. Lippi G, Sanchis-Gomar F . " Ultra-sensitive " cardiac troponins : Requirements for effective implementation in clinical practice . Biochem Med ( Zagreb ) 2018 ; 28 : 030501.
- 9. Nowak RM, Christenson RH, Jacobsen G, McCord J, Apple FS, Singer AJ, Limkakeng A Jr, Peacock WF, deFilippi CR. Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study. Ann Emerg Med. 2020 Jul;76(1):1-13.
- 10. Reaney PDW, Elliott HI, Noman A, Cooper JG. Risk stratifying chest pain patients in the emergency department using HEART, GRACE and TIMI scores, with a single contemporary troponin result, to predict major adverse cardiac events. Emerg Med J 2018; 1-8.
- 11. Amsterdam EA, Wenger NK, Brindis RG, et al., ACC/AHA Task Force Members, Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130(25): 2354-94.
- 12. Poldervaart, JM, Langedijk M, Backus BE, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol 2017; 227: 656-61.
- 13. Huang D, Refaat M, Mohammedi K, Jayyousi A. Macrovascular Complications in Patients with Diabetes and Prediabetes. J of Biomedic and Biotechnol 2017; 9.
- 14. Chapman AR, Hesse K, Andrews J, et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Circulation 2018; 138(16): 1654-65.
The Value Of Ultra-Sensitive Troponin-I In Determining Mortality In Patients With Suspected Acute Coronary Syndrome
Öz
Abstract:
Objective: This study investigated the role of the reference value of ultra-sensitive troponin kits used in daily practice in determining mortality.
Material-methods: This study was conducted in the emergency department (ED) of Akdeniz University Hospital between January 1, 2018, and June 30, 2019. All patients admitted to the emergency department within a period of eighteen months and who had the result of the ultra-sensitive troponin level in the range of 0.06-0.1 ng/mL were included in the study. The recurrent admissions of the patients to the ED were included, and only the first troponin values of the patients were taken as s reference for the study.
Result: It was determined that 1029 troponin values of 591 patients with initial troponin I value in the range 0.06-0.1 ng/mL were measured. It was found that 332 of these patients were discharged from the emergency department, and the others were hospitalized. It was found that 168 (28.43%) of the patients died. Considering the gender distribution of the patients who died, it was observed that 101 (60.11%) patients were male, and 67 (39.89%) patients were female. A statistically significant difference was found between the ages of the patients who died (mean 71.38±12.25) and the age of patients alive (mean 61.78 ± 15.89) (p <0.019). In univariate analysis, in addition to the positive troponin value, DM (p<0.022) and hyperlipidemia (p<0.018) were found to be statistically significant.
Conclusion: For high-sensitive troponin worked in the ED, the upper value of 0.06 ng/mL effectively determines mortality
Anahtar Kelimeler
Ultra-Sensitive Troponin-I mortality acute coronary syndrome
Kaynakça
- 1. Bingisser R, Cairns C, Christ M, et al. Cardiac troponin: a critical review of the case for point-of-care testing in the ED. Am J Emerg Med 2012; 30(8): 1639-49.
- 2. Christ M, Popp S, Pohlmann H, et al. Implementation of High Sensitivity Cardiac Troponin T Measurement in the Emergency Department. Am J Med 2010; 123(12): 1134-42.
- 3. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. N Engl J Med 2000; 342(16): 1163-70.
- 4. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined -- a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000; 36(3): 959-69.
- 5. Apple FS, Collinson PO. Analytical Characteristics of High-Sensitivity Cardiac Troponin Assays. Clin Chem 2012; 58(1): 54-61.
- 6. Reichlin T, Hochholzer W, Bassetti S, et al. Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays. N Engl J Med 2009; 361(9): 858-67.
- 7. Kavasoglu ME, Eken C, Eray O, Serinken M, Gülen B. Value of High-Sensitive Cardiac Troponin in Predicting Mortality in the Emergency Department. Clin Lab 2016; 62: 1483-9.
- 8. Lippi G, Sanchis-Gomar F . " Ultra-sensitive " cardiac troponins : Requirements for effective implementation in clinical practice . Biochem Med ( Zagreb ) 2018 ; 28 : 030501.
- 9. Nowak RM, Christenson RH, Jacobsen G, McCord J, Apple FS, Singer AJ, Limkakeng A Jr, Peacock WF, deFilippi CR. Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study. Ann Emerg Med. 2020 Jul;76(1):1-13.
- 10. Reaney PDW, Elliott HI, Noman A, Cooper JG. Risk stratifying chest pain patients in the emergency department using HEART, GRACE and TIMI scores, with a single contemporary troponin result, to predict major adverse cardiac events. Emerg Med J 2018; 1-8.
- 11. Amsterdam EA, Wenger NK, Brindis RG, et al., ACC/AHA Task Force Members, Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130(25): 2354-94.
- 12. Poldervaart, JM, Langedijk M, Backus BE, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol 2017; 227: 656-61.
- 13. Huang D, Refaat M, Mohammedi K, Jayyousi A. Macrovascular Complications in Patients with Diabetes and Prediabetes. J of Biomedic and Biotechnol 2017; 9.
- 14. Chapman AR, Hesse K, Andrews J, et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Circulation 2018; 138(16): 1654-65.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 30 Ağustos 2023 |
| Yayımlanma Tarihi | 1 Eylül 2023 |
| Gönderilme Tarihi | 3 Aralık 2021 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 9 Sayı: 3 |
