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Systemic immune-inflammation index and high-sensitivity cardiac troponin T in acute coronary syndromes

Year 2021, Volume: 5 Issue: 3, 218 - 225, 31.12.2021
https://doi.org/10.30565/medalanya.936506

Abstract

Aim: Acute coronary syndromes (ACSs) are classified as ST-segment elevated myocardial infarction (STEMI), non-ST-segment elevated myocardial infarction (NSTEMI) and unstable angina pectoris (USAP). Cardiac troponins constitute the cornerstone biomarkers for the laboratory diagnosis of ACS. In this study, we aimed to investigate whether systemic immune-inflammation index (SII) is associated with peak cardiac troponin T (TnT) levels in ACS.

Methods: Consecutive patients with ACS whose coronary angiography was performed were included in the present study (n=397). Admission SII was determined as platelet count x neutrophil count/lymphocyte count. Serum levels of cardiac enzymes, including high-sensitivity TnT and creatine kinase-myocardial band (CK-MB), were measured at the time of admission and repeated daily during patients’ hospital stay.

Results: Patients were categorized as namely STEMI (n=92) and NSTEMI/USAP (n=141). The findings obtained in this study showed that the median of SII levels was higher in STEMI than NSTEMI/USAP at a significant level. Correlation analysis of SII with various clinical and laboratory parameters demonstrated a significant correlation with C-reactive protein, peak CK-MB (r=0.52, p<0.001), peak TnT (r=0.49, p<0.001) and left ventricular ejection fraction (r= -0.48, p<0.001). Multivariate linear regression analysis identified age and log-SII (Beta Coefficient: 1.29, 95% Confidence Interval: 0.93-1.66, p<0.001) as independent predictors of peak TnT levels.

Conclusion: SII is an independent predictor of peak TnT levels and significantly correlates with peak CK-MB levels in patients with ACS. SII significantly and inversely correlates with left ventricular systolic functions.

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References

  • 1. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc. 2009;84(10):917-38. doi: 10.1016/S0025-6196(11)60674-5.
  • 2. Mair J, Lindahl B, Hammarsten O, Muller C, Giannitsis E, Huber K, et al. How is cardiac troponin released from injured myocardium? Eur Heart J Acute Cardiovasc Care. 2018;7(6):553-60. doi: 10.1177/2048872617748553.
  • 3. Hallen J. Troponin for the estimation of infarct size: what have we learned? Cardiology. 2012;121(3):204-12. doi: 10.1159/000337113.
  • 4. Tricoci P, Leonardi S, White J, White HD, Armstrong PW, Montalescot G, et al. Cardiac troponin after percutaneous coronary intervention and 1-year mortality in non-ST-segment elevation acute coronary syndrome using systematic evaluation of biomarker trends. J Am Coll Cardiol. 2013;62(3):242-51. doi: 10.1016/j.jacc.2013.04.043.
  • 5. Boden H, Ahmed TA, Velders MA, van der Hoeven BL, Hoogslag GE, Bootsma M, et al. Peak and fixed-time high-sensitive troponin for prediction of infarct size, impaired left ventricular function, and adverse outcomes in patients with first ST-segment elevation myocardial infarction receiving percutaneous coronary intervention. Am J Cardiol. 2013;111(10):1387-93. doi: 10.1016/j.amjcard.2013.01.284.
  • 6. Byrne RA, Ndrepepa G, Braun S, Tiroch K, Mehilli J, Schulz S, et al. Peak cardiac troponin-T level, scintigraphic myocardial infarct size and one-year prognosis in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2010;106(9):1212-7. doi: 10.1016/j.amjcard.2010.06.050.
  • 7. Cimmino G, Loffredo FS, Morello A, D'Elia S, De Palma R, Cirillo P, et al. Immune-Inflammatory Activation in Acute Coronary Syndromes: A Look into the Heart of Unstable Coronary Plaque. Curr Cardiol Rev. 2017;13(2):110-7. doi: 10.2174/1573403X12666161014093812.
  • 8. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230. doi: 10.1111/eci.13230.
  • 9. Erdogan M, Erdol MA, Ozturk S, Durmaz T. Systemic immune-inflammation index is a novel marker to predict functionally significant coronary artery stenosis. Biomark Med. 2020;14(16):1553-61. doi: 10.2217/bmm-2020-0274.
  • 10. Erdogan M, Ozturk S, Kardesler B, Yigitbasi M, Kasapkara HA, Bastug S, et al. The relationship between calcific severe aortic stenosis and systemic immune-inflammation index. Echocardiography. 2021;38(5):737-44. doi: 10.1111/echo.15044.
  • 11. Kelesoglu S, Yilmaz Y, Elcik D, Cetinkaya Z, Inanc MT, Dogan A, et al. Systemic Immune Inflammation Index: A Novel Predictor of Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction. Angiology. 2021;72(9):889-95. doi: 10.1177/00033197211007738.
  • 12. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: 10.1093/eurheartj/ehx393.
  • 13. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi: 10.1093/eurheartj/ehv320.
  • 14. Mohammad MA, Koul S, Smith JG, Noc M, Lang I, Holzer M, et al. Predictive Value of High-Sensitivity Troponin T for Systolic Dysfunction and Infarct Size (Six Months) After ST-Elevation Myocardial Infarction. Am J Cardiol. 2018;122(5):735-43. doi: 10.1016/j.amjcard.2018.05.005.
  • 15. Sanchis J, Bodi V, Llacer A, Facila L, Martinez-Brotons A, Insa L, et al. Relationship of C-reactive protein levels with angiographic findings and markers of necrosis in non-ST-segment elevation acute coronary syndrome. Rev Esp Cardiol. 2004;57(5):382-7. doi: 10.1157/13061115.
  • 16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005.
  • 17. Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio. Clin Appl Thromb Hemost. 2016;22(5):405-11. doi: 10.1177/1076029615569568.
  • 18. Nunez J, Minana G, Bodi V, Nunez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Curr Med Chem. 2011;18(21):3226-33. doi: 10.2174/092986711796391633.
  • 19. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol. 1997;79(6):812-4. doi: 10.1016/s0002-9149(96)00878-8.
  • 20. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115(12):3378-84. doi: 10.1172/JCI27196.
  • 21. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther. 2016;14(5):573-7. doi: 10.1586/14779072.2016.1154788.
  • 22. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1. doi: 10.3109/09537104.2014.979340.
  • 23. Cankurt T, Celik IE, Ozturk S, Maden O. Inflammatory Conditions in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention of Saphenous Vein Graft. Int J Angiol. 2020;29(4):237-44. doi: 10.1055/s-0040-1714751.
  • 24. Geng Y, Shao Y, Zhu D, Zheng X, Zhou Q, Zhou W, et al. Systemic Immune-Inflammation Index Predicts Prognosis of Patients with Esophageal Squamous Cell Carcinoma: A Propensity Score-matched Analysis. Sci Rep. 2016;6:39482. doi: 10.1038/srep39482.
  • 25. Gao Y, Guo W, Cai S, Zhang F, Shao F, Zhang G, et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected esophageal squamous cell carcinoma. J Cancer. 2019;10(14):3188-96. doi: 10.7150/jca.30281.
  • 26. Chia S, Senatore F, Raffel OC, Lee H, Wackers FJ, Jang IK. Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2008;1(4):415-23. doi: 10.1016/j.jcin.2008.04.010.
  • 27. Dogan I, Karaman K, Sonmez B, Celik S, Turker O. Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction. Nucl Med Commun. 2009;30(10):797-801. doi: 10.1097/MNM.0b013e32832e3a16.
  • 28. Chen C, Cong BL, Wang M, Abdullah M, Wang XL, Zhang YH, et al. Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients. Integr Med Res. 2018;7(2):192-9. doi: 10.1016/j.imr.2018.02.006.
  • 29. Bekler A, Erbag G, Sen H, Gazi E, Ozcan S. Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome. Pak J Med Sci. 2015;31(1):159-63. doi: 10.12669/pjms.311.5967.
  • 30. Nienhuis MB, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje 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(4):673-9. doi: 10.1016/j.ahj.2007.11.004.

Akut koroner sendromlarda sistemik immün-inflamasyon indeksi ve yüksek duyarlılıklı kardiyak troponin T

Year 2021, Volume: 5 Issue: 3, 218 - 225, 31.12.2021
https://doi.org/10.30565/medalanya.936506

Abstract

Amaç: Akut koroner sendromlar (AKS), ST-segment yükselmeli miyokard enfarktüsü (STEMI), non-ST-segment yükselmeli miyokard enfarktüsü (NSTEMI) ve kararsız angina pektoris (USAP) olarak sınıflandırılır. Kardiyak troponinler AKS laboratuvar tanısı için temel biyolojik belirteçleri oluşturur. Biz bu çalışmada sistemik immün-inflamasyon indeksinin (SII) AKS' de zirve kardiyak troponin T (TnT) seviyeleri ile ilişkisini araştırmayı amaçladık.

Yöntem: Koroner anjiyografi yapılan AKS hastaları ardışık olarak çalışmaya dahil edildi (n=397). Başvuru anındaki SII değeri, trombosit sayısı x nötrofil sayısı / lenfosit sayısı olarak belirlendi. Yüksek duyarlılıklı TnT ve kreatin kinaz-miyokardiyal bandı (CK-MB) içeren serum kardiyak enzim seviyeleri başvuru sırasında ölçüldü ve ölçümler hastaların hastanede kaldıkları süre boyunca günlük olarak tekrarlandı.

Bulgular: Hastalar STEMI (n = 92) ve NSTEMI/USAP (n = 141) olarak kategorize edildi. SII ortanca değerleri STEMI grubunda NSTEMI/USAP grubundan anlamlı düzeyde daha yüksekti. SII' nin çeşitli klinik ve laboratuvar parametreleriyle yapılan korelasyon analizinde C-reaktif protein, zirve CK-MB (r = 0.52, p <0.001), zirve TnT (r = 0.49, p <0.001) ve sol ventrikül ejeksiyon fraksiyonu (r =-0.48, p <0.001) ile anlamlı bir korelasyon gösterdiği tespit edildi. Çok değişkenli doğrusal regresyon analizi yaş ve log transforme-SII' yi (Beta Katsayısı:1.29, % 95 Güven Aralığı:0.93-1.66, p<0.001) zirve TnT seviyelerinin bağımsız prediktörleri olarak tanımladı.

Sonuç: SII zirve TnT seviyelerinin bağımsız bir öngörücüsüdür ve AKS hastalarında zirve CK-MB seviyeleriyle anlamlı seviyede korelasyon göstermektedir. Ayrıca, SII sol ventrikül sistolik fonksiyonlarıyla anlamlı seviyede ters korelasyon göstermektedir.

Project Number

N/A

References

  • 1. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc. 2009;84(10):917-38. doi: 10.1016/S0025-6196(11)60674-5.
  • 2. Mair J, Lindahl B, Hammarsten O, Muller C, Giannitsis E, Huber K, et al. How is cardiac troponin released from injured myocardium? Eur Heart J Acute Cardiovasc Care. 2018;7(6):553-60. doi: 10.1177/2048872617748553.
  • 3. Hallen J. Troponin for the estimation of infarct size: what have we learned? Cardiology. 2012;121(3):204-12. doi: 10.1159/000337113.
  • 4. Tricoci P, Leonardi S, White J, White HD, Armstrong PW, Montalescot G, et al. Cardiac troponin after percutaneous coronary intervention and 1-year mortality in non-ST-segment elevation acute coronary syndrome using systematic evaluation of biomarker trends. J Am Coll Cardiol. 2013;62(3):242-51. doi: 10.1016/j.jacc.2013.04.043.
  • 5. Boden H, Ahmed TA, Velders MA, van der Hoeven BL, Hoogslag GE, Bootsma M, et al. Peak and fixed-time high-sensitive troponin for prediction of infarct size, impaired left ventricular function, and adverse outcomes in patients with first ST-segment elevation myocardial infarction receiving percutaneous coronary intervention. Am J Cardiol. 2013;111(10):1387-93. doi: 10.1016/j.amjcard.2013.01.284.
  • 6. Byrne RA, Ndrepepa G, Braun S, Tiroch K, Mehilli J, Schulz S, et al. Peak cardiac troponin-T level, scintigraphic myocardial infarct size and one-year prognosis in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2010;106(9):1212-7. doi: 10.1016/j.amjcard.2010.06.050.
  • 7. Cimmino G, Loffredo FS, Morello A, D'Elia S, De Palma R, Cirillo P, et al. Immune-Inflammatory Activation in Acute Coronary Syndromes: A Look into the Heart of Unstable Coronary Plaque. Curr Cardiol Rev. 2017;13(2):110-7. doi: 10.2174/1573403X12666161014093812.
  • 8. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230. doi: 10.1111/eci.13230.
  • 9. Erdogan M, Erdol MA, Ozturk S, Durmaz T. Systemic immune-inflammation index is a novel marker to predict functionally significant coronary artery stenosis. Biomark Med. 2020;14(16):1553-61. doi: 10.2217/bmm-2020-0274.
  • 10. Erdogan M, Ozturk S, Kardesler B, Yigitbasi M, Kasapkara HA, Bastug S, et al. The relationship between calcific severe aortic stenosis and systemic immune-inflammation index. Echocardiography. 2021;38(5):737-44. doi: 10.1111/echo.15044.
  • 11. Kelesoglu S, Yilmaz Y, Elcik D, Cetinkaya Z, Inanc MT, Dogan A, et al. Systemic Immune Inflammation Index: A Novel Predictor of Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction. Angiology. 2021;72(9):889-95. doi: 10.1177/00033197211007738.
  • 12. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi: 10.1093/eurheartj/ehx393.
  • 13. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi: 10.1093/eurheartj/ehv320.
  • 14. Mohammad MA, Koul S, Smith JG, Noc M, Lang I, Holzer M, et al. Predictive Value of High-Sensitivity Troponin T for Systolic Dysfunction and Infarct Size (Six Months) After ST-Elevation Myocardial Infarction. Am J Cardiol. 2018;122(5):735-43. doi: 10.1016/j.amjcard.2018.05.005.
  • 15. Sanchis J, Bodi V, Llacer A, Facila L, Martinez-Brotons A, Insa L, et al. Relationship of C-reactive protein levels with angiographic findings and markers of necrosis in non-ST-segment elevation acute coronary syndrome. Rev Esp Cardiol. 2004;57(5):382-7. doi: 10.1157/13061115.
  • 16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005.
  • 17. Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, et al. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio. Clin Appl Thromb Hemost. 2016;22(5):405-11. doi: 10.1177/1076029615569568.
  • 18. Nunez J, Minana G, Bodi V, Nunez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Curr Med Chem. 2011;18(21):3226-33. doi: 10.2174/092986711796391633.
  • 19. Ommen SR, Gibbons RJ, Hodge DO, Thomson SP. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease. Am J Cardiol. 1997;79(6):812-4. doi: 10.1016/s0002-9149(96)00878-8.
  • 20. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115(12):3378-84. doi: 10.1172/JCI27196.
  • 21. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Ther. 2016;14(5):573-7. doi: 10.1586/14779072.2016.1154788.
  • 22. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26(7):680-1. doi: 10.3109/09537104.2014.979340.
  • 23. Cankurt T, Celik IE, Ozturk S, Maden O. Inflammatory Conditions in Acute Coronary Syndrome Patients Treated with Percutaneous Coronary Intervention of Saphenous Vein Graft. Int J Angiol. 2020;29(4):237-44. doi: 10.1055/s-0040-1714751.
  • 24. Geng Y, Shao Y, Zhu D, Zheng X, Zhou Q, Zhou W, et al. Systemic Immune-Inflammation Index Predicts Prognosis of Patients with Esophageal Squamous Cell Carcinoma: A Propensity Score-matched Analysis. Sci Rep. 2016;6:39482. doi: 10.1038/srep39482.
  • 25. Gao Y, Guo W, Cai S, Zhang F, Shao F, Zhang G, et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients with surgically resected esophageal squamous cell carcinoma. J Cancer. 2019;10(14):3188-96. doi: 10.7150/jca.30281.
  • 26. Chia S, Senatore F, Raffel OC, Lee H, Wackers FJ, Jang IK. Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2008;1(4):415-23. doi: 10.1016/j.jcin.2008.04.010.
  • 27. Dogan I, Karaman K, Sonmez B, Celik S, Turker O. Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction. Nucl Med Commun. 2009;30(10):797-801. doi: 10.1097/MNM.0b013e32832e3a16.
  • 28. Chen C, Cong BL, Wang M, Abdullah M, Wang XL, Zhang YH, et al. Neutrophil to lymphocyte ratio as a predictor of myocardial damage and cardiac dysfunction in acute coronary syndrome patients. Integr Med Res. 2018;7(2):192-9. doi: 10.1016/j.imr.2018.02.006.
  • 29. Bekler A, Erbag G, Sen H, Gazi E, Ozcan S. Predictive value of elevated neutrophil-lymphocyte ratio for left ventricular systolic dysfunction in patients with non ST-elevated acute coronary syndrome. Pak J Med Sci. 2015;31(1):159-63. doi: 10.12669/pjms.311.5967.
  • 30. Nienhuis MB, Ottervanger JP, de Boer MJ, Dambrink JH, Hoorntje 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(4):673-9. doi: 10.1016/j.ahj.2007.11.004.
There are 30 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Selcuk Ozturk 0000-0002-3426-1212

Mehmet Erdoğan 0000-0002-2747-3823

Yasar Turan 0000-0002-2796-899X

Project Number N/A
Publication Date December 31, 2021
Submission Date May 12, 2021
Acceptance Date July 26, 2021
Published in Issue Year 2021 Volume: 5 Issue: 3

Cite

Vancouver Ozturk S, Erdoğan M, Turan Y. Systemic immune-inflammation index and high-sensitivity cardiac troponin T in acute coronary syndromes. Acta Med. Alanya. 2021;5(3):218-25.

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