KaydedilenlerDerginizi ekleyin

Dergiler / Anatolian Journal of Emergency Medicine / 2018 / Cilt: 1 Sayı: 2

Perkutanöz Girişim Yapılan STEMI hastalarındaki Kardiyak Biyomarkerların Erken Prognostik Önemi

Early Prognostic Values of Cardiac Biomarkers in STEMI patients that underwent Percutaneous Coronary Intervention

Can Aktaş(KOÇ ÜNİVERSİTESİ, TIP FAKÜLTESİ)
Gökçe Akgül Karadana(KOÇ ÜNİVERSİTESİ, TIP FAKÜLTESİ)
Elif Değirmenci(KOÇ ÜNİVERSİTESİ, TIP FAKÜLTESİ)
Yoldaş Demirtaş(KOÇ ÜNİVERSİTESİ, TIP FAKÜLTESİ)
Şevki Hakan Eren(GAZIANTEP UNIVERSITY, GAZİANTEP HEALTH ACADEMY)
Sayfa
13–17
Yayın Tarihi
2018-12-28
DOI
—
🏛️Bu makalenin bibliyografik verileri ve tam metin bağlantısı DergiPark üzerinden sağlanmıştır.
DergiPark Kaydı ↗
✨

Yapay Zeka Hızlı Bakış & Çıkarımlar

AI Insight
⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Bulgular: BNP (p=0.005) ve hs-Troponin T (p=0.002) artmış mortalite ile ilşkliydi.

📌 3 Maddede Bu Makale

🎯
Amaç & Hipotez:Amaç: ST segment elevasyonlu miyokard infarktüsü olan hastalarda başvuru anındaki kardiyak biyomarkerların (CKMB, hs-Troponin T, BNP) prospektif olarak mortalite, Gensini skoru ve LAD lezyonun varlığını belirleyerek erken prognostik önemini değerlendirmektir.
📊
Temel Bulgular & Veri:Materyal ve Metod: Bu çalışma altı aylık bir periyotta acil servise ilk kez göğüs ağrısı ile başvurup perkutan koroner girişim (PCI) yapılan 70 hastada yapılmıştır.
💡
Sonuç & Katkı:Bulgular: BNP (p=0.005) ve hs-Troponin T (p=0.002) artmış mortalite ile ilşkliydi.
🔬Tür:Klinik Araştırma
📍Kapsam:70 hasta
⚙️Değişkenler:Miyokard İnfarktüsü · Biyomarker · Perkutan koroner girişim

Özet

Amaç: ST segment elevasyonlu miyokard infarktüsü olan hastalarda başvuru anındaki kardiyak biyomarkerların (CKMB, hs-Troponin T, BNP) prospektif olarak mortalite, Gensini skoru ve LAD lezyonun varlığını belirleyerek erken prognostik önemini değerlendirmektir. Materyal ve Metod: Bu çalışma altı aylık bir periyotta acil servise ilk kez göğüs ağrısı ile başvurup perkutan koroner girişim (PCI) yapılan 70 hastada yapılmıştır. Başvuru anında ilk kardiyak biyomarkerlar ölçülmleri, hastaların demografik ve klinik özellikleri ve PCI sonuçlarına göre Gensini skorları hesaplanarak kaydedilmiştir. Her bir kardiyak biyomarker ile ilişkili mortalite varlığı ve LAD tutulumu hesplanmıştır. Biyomarker düzeyleri ile Gensini skoru arasındaki korelasyon Spearman korelasyon analizi ile test edilmiştir. Bulgular: BNP (p=0.005) ve hs-Troponin T (p=0.002) artmış mortalite ile ilşkliydi. Gensini skoru ile mortalite ve ilk başvuru anındaki kardiyak biyomarkerlar arsında herhangi bir ilişki tespit edilmemiştir (p>0.05). Yüksek BNP düzeylerinde yüksek oranda LAD tutulumu tespit edilmiştir (p<0.05) ancak diğer biyomarkerlar (CKMB, hs-Troponin T) ile LAD lezyonu varlığı arasında bir ilişki tespit edilmemiştir (p>0.05). Sonuç: Akut ST segment elevasyonu MI ile başvuran hastalarda yüksek BNP ve hs-Troponin düzeyleri artmış mortalitenin bir göstergesi olabilir bu nedenle daha ciddi bir yaklaşım ve takibe gereksinim vardır. Buna ilaveten yüksek BNP düzeyleri potansiyel olarak LAD tutulumunu gösterebilmekte olup bu da mortalite ile sıkı bir ilişki içerisindedir. Başvuru anındaki BNP ve hs-Troponin T değerleri ST segmen elevasyonu olan MI’ lü hastalarda erken prognostic sonuçları gösterebilmektedir ancak lezyonun ciddiyeti hakkında bir fikir vermemektedir.

Abstract

Aim: To assess the early prognostic values of admission cardiac biomarkers (CKMB, hs-Troponin T, BNP) in patients with STEMI by determining the association of these markers with mortality, Gensini scores and LAD involvement prospectively. Materials and Method: The current study was performed through the six-month period on 70 STEMI patients admitted to ED who had chest pain for the first time in their lives and underwent to percutaneous coronary intervention (PCI). Admission first cardiac biomarker values measured within 6 hours, patient demographics and clinical characteristics (age, gender, PCI results, LAD involvement) and Gensini scores calculated in regards to PCI results were recorded. Association of each cardiac biomarker (CKMB, hs-Troponin T, BNP) with the presence of mortality and LAD involvement was calculated. Correlation between biomarker levels and gensini scores were sought with Spearman correlation coefficients test. Results: BNP (p=0.005) and hs-Troponin T (p=0.002) were associated with increased mortality. There was no association between mortality and the first admission value of cardiac biomarkers (BNP, CK-MB, hs-troponin T) with Gensini score (p>0.05). Higher BNP values indicated higher LAD (+) lesion probability (p<0.05) while no association between LAD(+) lesion and the other biomarkers (CKMB, hs- Troponin T) (p>0.05). Conclusions: Acute STEMI with high BNP and hs-Troponin T levels predict increased mortality and needs more serious treatment and close follow-up. Additionally, higher BNP levels suggest a potential LAD (+) lesion which is closely related with mortality. Admission BNP and hs-Troponin T values indicate early prognostic outcome in STEMI patients, however they don’t point out the severity of the lesions.

🔖

Bu Makaleye Atıf Yap

Aktaş, C., Karadana, G. A., Değirmenci, E., Demirtaş, Y., Eren, Ş. H. (2018). Perkutanöz Girişim Yapılan STEMI hastalarındaki Kardiyak Biyomarkerların Erken Prognostik Önemi. Anatolian Journal of Emergency Medicine, Cilt: 1 Sayı: 2, 13–17. https://ajindex.com/articles/1361509

📄 Tam Metin PDF Okuyucu

📄

PDF görüntüleyici hazırlanıyor...

Kaynakça (24)

  1. Weber M, Dill T, Arnold R, Rau M, Ekinci O, Müller KD et al. N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris, Am Heart J 2004;148:612–20.
  2. 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: 959-969.
  3. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127: e362-e425.
  4. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983; 51: 606.
  5. Mayr A, Mair J, Klug G, Schocke M, Pedarnig K, Trieb T et al. Cardiac Troponin T and Creatine Kinase Predict Mid-term Infarct Size and Left Ventricular Function After Acute Myocardial Infarction: A Cardiac MR Study. Journal of Magnetic Resonance Imaging 2011: 33: 847–854.
  6. Klug G, Mayr A, Mair J, Schocke M, Nocker M, Trieb T et al. Role of biomarkers in assessment of early infarct size after successful p-PCI for STEMI. Clin Res Cardiol 2011: 100: 501–510.
  7. Ohman EM, Armstrong PW, White HD, Granger CB, Wilcox RG, Weawer WD et al. Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction. Gustoiii investigators. Global use of strategies to open occluded coronary arteries. Am J Cardiol 1999: 84: 1281–1286.
  8. James SK, Armstrong P, Barnathan E, Califf R, Lindahl B, Siegbahn A et al. Troponin and C-reactive protein have different relations to subsequent mortality and myocardial infarction after acute coronary syndrome: a Gusto-IV Substudy. J Am Coll Cardiol 2003: 41: 916–924.
  9. Savonitto S, Granger CB, Ardissino D, Gardner L, Cavallini C, Galvani M et al. The prognostic value of creatine kinase elevations extends across the whole spectrum of acute coronary syndromes. J Am Coll Cardiol 2002: 39: 22–29.
  10. Nienhuis MB, Ottervanger JP, de Boer MJ, Dambrink JH, Hoortje JC, Gosselink AT et al. Prognostic importance of creatine kinase and creatine kinase-MB after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am Heart J 2008: 155: 673–679.
  11. De Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet 2003: 362: 316–22.
  12. Morita E, Yasue H, Yoshimura M, OgawaH, Jougasaki M, Matsumura T et al. Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation 1993: 88: 82–91.
  13. Morrow DA, de Lemos JA, Sabatine MS, Murphy SA, Demopoulos LA, DiBattiste PM et al: Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18. J Am Coll Cardiol 2003: 41: 1264-1272.
  14. De Lemos JA, Morrow DA, Bentley JH, Omland T, Sabatine MS, McCabe CH et al. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001: 345: 1014–21.
  15. Arakawa N, Nakamura M, Aoki H, Hiramori K. Plasma brain natriuretic peptide concentrations predict survival after acute myocardial infarction. J Am Coll Cardiol 1996: 27: 1656–61.
  16. James SK, Lindahl B, Siegbahn A, Stridsberg M, Venge P, Armsrong P et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: Global Utilization of Strategies to Open occluded arteries (GUSTO)-IV substudy. Circulation 2003: 108: 275–81.
  17. Schnabel R, Lubos E, Rupprecht HJ, Espinola-Klein C, Bickel C, Lackner KJ et al. B-Type Natriuretic Peptide and the risk of cardiovascular events and death in patients with stable angina. Results from the AtheroGene Study. J Am Coll Cardiol 2006: 47: 552-8.
  18. Jeong YH, Lee SW, Lee CW, Hong MK, Kim JJ, Park SW et al. Biomarkers on Admission for the Prediction of Cardiovascular Events After Primary Stenting in Patients with ST-Elevation Myocardial Infarction. Clin. Cardiol. 2008: 31, 12, 572–579.
  19. Velders MA, Wallentin L, Becker RC, Van Bowen AJ, Himmelmann A, Husted S et al. Biomarkers for risk stratification of patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: Insights from the Platelet Inhibition and Patient Outcomes trial. Am Heart J 2015: 169: 879-889.
  20. Jernberg T, Stridsberg M, Venge P, Lindahl B. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation. J Am Coll Cardiol 2002: 40: 437–45.
  21. Omland T, Aakvaag A, Bonarjee VV, Caidahl K, Lie RT, Nilsen DW. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction: comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation 1996; 93: 1963–1969.
  22. Neeland IJ, Patel RS, Eshtehardi P, Dhawan S, McDaniel MC, Rab ST. Coronary angiographic scoring systems: an evaluation of their equivalence and validity. Am Heart J. 2012; 164: 547-552.
  23. Peppes V, Rammos G, Manios E, Koroboki E, Rokas S, Zakopoulos N. Correlation between myocardial enzyme serum levels and markers of inflammation with severity of coronary artery disease and Gensini score: A hospital-based, prospective study in Greek patients. Clinical Interventions in Aging 2008; 3: 699–710.
  24. Goyal BM, Sharma SM, Walia M. B-Type natriuretic peptide levels predict extent and severity of coronary artery disease in non-ST elevation acute coronary syndrome and normal left ventricular function. Indian Heart J. 2014; 66: 183-187.