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The Sensitivity and Specificity of High Sensitive CRP, D-Dimer and IL-6 in Acute Coronary Syndrome

Year 2011, Volume: 2011 Issue: 4, 429 - 434, 01.04.2011
https://doi.org/10.5152/balkanmedj.2011.010

Abstract

Objective: ACS is the life threatening causes of chest pain. The aim of this study is to detect the sensitivity and specificity of CRP, IL-6 and D-dimer and identify their role in predicting adverse cardiac events. Material and Methods: All patients describing typical chest pain were enrolled in the study. Demographic features and final diagnosis were written and serum specimens were collected. All patients were telephoned after one month to determine if there were any adverse cardiac events. Results: There were 132 patients, (94 male, 38 female). The mean age was 60.92±10.78. 55 patients were diagnosed as AMI (37 STEMI and 18 NSTEMI) 60 patients as unstable angina pectoris, 15 patients as stable angina pectoris and 2 patients as non cardiac chest pain. 6 patients died in the hospital. 15 patients had adverse cardiac events (12 recurrent AMI, 2 sudden cardiac death, 1 stroke). The levels of D-dimer, CRP and IL-6 at the presentation were not predictive for adverse events. Conclusion: D-dimer, CRP and IL-6 levels were high both in ACS and stable angina. Detecting the predictive value for adverse cardiac events requires larger patient numbers and longer follow up times. Turkish Başlık: Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6'nın Duyarlılık ve Seçiciliği Anahtar Kelimeler: Akut koroner sendrom, CRP, D-Dimer, IL-6 Amaç: AKS göğüs ağrısının hayatı tehdit eden nedenlerinden birisidir. Bu çalışmanın amacı tipik göğüs ağrısı nedeni ile acil servise başvuran hastalarda, CRP, IL-6, D-dimer'in duyarlılık ve seçiciliğini ve ilk 1 aylık dönemdeki istenmeyen kardiyak olayları öngörmedeki değerliliğini saptamaktır. Gereç ve Yöntemler: Çalışmaya acil servise başvuran tipik göğüs ağrılı hastalar alındı. Tüm hastaların demografik özellikleri ve sonuç tanıları kaydedildi, kan örnekleri alındı. Hastalar bir ay sonra telefonla aranarak istenmeyen kardiyak olay gelişip gelişmediği öğrenildi. Bulgular: Toplam 132 hastanın 94'ü erkek, 38'i kadın, yaş ortalaması 60.92±10.78 olarak saptandı. Sonuçta, 55 hasta AMI [37'si STEMI, 18'i NSTEMI], 60 hasta USAP, 15 hasta SAP, 2 hasta nonkardiyak göğüs ağrısı tanısı aldı. Hastaların 6'sı hastanede yattığı dönemde öldü. İlk 1 ayda 15 hastada (12'sinde tekrarlayan AMI, 2'sinde ani ölüm ve 1'inde inme) istenmeyen kardiyovasküler olay gelişti. Başvuru anında ölçülen IL-6, D-dimer ve CRP düzeyleri ile komplikasyon gelişimi arasında bir ilişki olmadığı saptandı. Sonuç: CRP, IL-6 ve D-dimer hem AKS hastalarında hem de kararlı anjina hastalarında yükselmektedir. AKS sonrası erken dönem komplikasyon riskini belirlemede CRP, IL-6 ve D-dimer değerlerinin yararlılığının saptanabilmesi için hasta sayısının fazla olması ve daha uzun takip süresi gerekmektedir.

References

  • Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnosis of acute cardiac ischemia in the emergency department. N Engl J Med 2000;342:1163-70. [CrossRef]
  • McCarty BD, Beshansky JR, D’Agostino RB, Sekler HP. Missed diagnosis of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med 1993;22:579-82. [CrossRef]
  • Auer J, Berent R, Lassnig E, Eber B. C-reactive protein and coronary artery disease. Jpn Heart J 2002;43:607-19. [CrossRef]
  • Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. Lancet 1997;349:462-6. [CrossRef]
  • Liuzzo G. Biasucci LM. Gallimore R. Grillo RL. Rebuzzi AG. Pepys MB et al. The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. N Engl J Med 1994;331:417-24. [CrossRef]
  • Ikeda U, Ohkawa F, Seino Y, Yamamoto K, Hidaka Y, Kasahara T, et al. Serum interleukin–6 levels become elevated in acute myocardial infarction. J Mol Cell Cardiol 1992;24:579-84. [CrossRef]
  • Miyao Y, Yasue H, Ogawa H, Misumi I, Masuda T, Sakamoto T, et al. Elevated interleukin–6 levels in patients with acute myocardial infarction. Am Heart J 1993;126:1299-304. [CrossRef]
  • Bayes-Genis A, Mateo J, Santaló M, Oliver A, Guindo J, Badimon L, et al. D-dimer is an early diagnostic marker of coronary ischemia in patients with chest pain. Am Heart J 2000;140:379-84. [CrossRef]
  • Kruskal JB, Commerford PJ, Franks JJ, Kirsch RE. Fibrin and fibrinogen-related antigens in patients with stable and unstable coronary artery disease. N Engl J Med 1987;317:1361-5. [CrossRef]
  • Ridker PM, Hennekens CH, Cerskus A, Stampfer MJ. Plasma concentration of cross-linked fibrin degradation products (D-dimer) and the risk of future myocardial infarction among apparently healthy men. Circulation 1994;90:2236-40.
  • Zebrack JS, Anderson L, Maycock CA, Horne BD, Bair TL, Muhlestein JB. Intermountain Heart Colloborative (IHC) Study Group. Usefulness of high-sensitivity C-reactive protein in predicting long-term risk of death and myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction. Am J Cardiol 2002;89:145-9. [CrossRef]
  • Neumann FJ, Ott I, Gawaz M, Richardt G, Holzapfel H, Jochum M, et al. Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation 1995;92:748-55.
  • Biasucci LM, Vitelli A, Liuzzo G, Altamura S, Caligiuri G, Monaco C, et al. Elevated levels of interleukin–6 in unstable angina. Circulation 1996;94:874-7.
  • Ridker PM, Rifai N, Stampfer MJ, Hennekens CH. Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation 2000;101:1767.
  • Morrow DA. Rifai N. Antman EM, Weiner DL, McCabe CH, Cannon CP, et al. C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. Thrombolysis in myocardial infarction. J Am Coll Cardiol 1998;31:1460-5. [CrossRef]
  • Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE Investigators. J Am Coll Cardiol 2000;35:1535-42. [CrossRef]
  • Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long term mortality in unstable coronary artery disease. FRISC study group. N Eng J Med 2000;343:1139-47. [CrossRef]
  • Mueller C, Buettner HJ, Hodgson JM, Marsch S, Perruchoud AP, Roskamm H, et al. Inflammation and long term mortality after non-ST-elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients. Circulation 2002;105:1412-5. [CrossRef]
  • Speidl WS, Graf S, Hornykewycz S, Nikfardjam M, Niessner A, Zorn G, et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J 2002;144:449-55. [CrossRef]
  • Benamer H. Steg PG. Benessiano J. Vicaut E. Gaultier CJ. Boccara A, et al. Comparison of the prognostic value of C-Reactive protein and troponin I in patients with unstable angina pectoris. Am J Cardiol 1998;82:845-50. [CrossRef]
  • Montalescot G, Philippe F, Ankri A, Vicaut E, Bearez E, Poulard JE, et al. Early increase of von willebrand factor predicts adverse outcome in unstable coronary artery disease: Beneficial effects of enoxaparin. Circulation 1998;98:294-9.
  • Oltrona L, Ardissino D, Merlini PA, Spinola A, Chiodo F, Pezzano A. C-reactive protein elevation and early outcome in patients with unstable angina pectoris. Am J Cardiol 1997;80:1002-6. [CrossRef]
  • Torzewski M, Rist C, Mortensen RF, Zwaka TP, Bienek M, Waltenberger J, et al. C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis. Arterioscler Thromb Vasc Biol 2000;20:2094-9. 433 Balkan Med J 2011; 28: 429-34 Yiğit et al. Akut Koroner Sendrom Tanısında İnflamatuar Belirteçler
  • Torzewski J, Torzewski M, Bowyer DE, Fröhlich M, Koenig W, Waltenberger J, et al. C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol 1998;18:1386-92. [CrossRef]
  • Ikeda U, Shimada K. Interleukin-6 and acute coronary syndrome. Clin Cardiol 2001;24:701-4. [CrossRef]
  • Ottani F, Galvani M. Prognostic role of hemostatic markers in acute coronary syndromes patients. Clinica Chimica Acta 2001;311:33-9. [CrossRef]
  • Lowe GDO, Yarnell JWG, Rumley A, Bainton D, Sweetnam PM. C-reactive protein, fibrin D-dimer and incident ischemic heart disease in the speedwell study. Arterioscler Thromb Vasc Biol. 2001;21:603-10. [CrossRef]
  • Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon III RO, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511. [CrossRef]

Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği

Year 2011, Volume: 2011 Issue: 4, 429 - 434, 01.04.2011
https://doi.org/10.5152/balkanmedj.2011.010

Abstract

Amaç: AKS göğüs ağrısının hayatı tehdit eden nedenlerinden birisidir. Bu
çalışmanın amacı tipik göğüs ağrısı nedeni ile acil servise başvuran hastalarda,
CRP, IL-6, D-dimer’in duyarlılık ve seçiciliğini ve ilk 1 aylık dönemdeki
istenmeyen kardiyak olayları öngörmedeki değerliliğini saptamaktır.
Gereç ve Yöntemler: Çalışmaya acil servise başvuran tipik göğüs ağrı-
lı hastalar alındı. Tüm hastaların demografik özellikleri ve sonuç tanıları
kaydedildi, kan örnekleri alındı. Hastalar bir ay sonra telefonla aranarak
istenmeyen kardiyak olay gelişip gelişmediği öğrenildi.
Bulgular: Toplam 132 hastanın 94’ü erkek, 38’i kadın, yaş ortalaması
60.92±10.78 olarak saptandı. Sonuçta, 55 hasta AMI [37’si STEMI, 18’i
NSTEMI], 60 hasta USAP, 15 hasta SAP, 2 hasta nonkardiyak göğüs ağrısı
tanısı aldı. Hastaların 6’sı hastanede yattığı dönemde öldü. İlk 1 ayda 15
hastada (12’sinde tekrarlayan AMI, 2’sinde ani ölüm ve 1’inde inme) istenmeyen
kardiyovasküler olay gelişti. Başvuru anında ölçülen IL-6, D-dimer
ve CRP düzeyleri ile komplikasyon gelişimi arasında bir ilişki olmadığı saptandı.
Sonuç: CRP, IL-6 ve D-dimer hem AKS hastalarında hem de kararlı anjina
hastalarında yükselmektedir. AKS sonrası erken dönem komplikasyon
riskini belirlemede CRP, IL-6 ve D-dimer değerlerinin yararlılığının saptanabilmesi
için hasta sayısının fazla olması ve daha uzun takip süresi gerekmektedir.

References

  • Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnosis of acute cardiac ischemia in the emergency department. N Engl J Med 2000;342:1163-70. [CrossRef]
  • McCarty BD, Beshansky JR, D’Agostino RB, Sekler HP. Missed diagnosis of acute myocardial infarction in the emergency department: results from a multicenter study. Ann Emerg Med 1993;22:579-82. [CrossRef]
  • Auer J, Berent R, Lassnig E, Eber B. C-reactive protein and coronary artery disease. Jpn Heart J 2002;43:607-19. [CrossRef]
  • Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. Lancet 1997;349:462-6. [CrossRef]
  • Liuzzo G. Biasucci LM. Gallimore R. Grillo RL. Rebuzzi AG. Pepys MB et al. The prognostic value of C-reactive protein and serum amyloid A protein in severe unstable angina. N Engl J Med 1994;331:417-24. [CrossRef]
  • Ikeda U, Ohkawa F, Seino Y, Yamamoto K, Hidaka Y, Kasahara T, et al. Serum interleukin–6 levels become elevated in acute myocardial infarction. J Mol Cell Cardiol 1992;24:579-84. [CrossRef]
  • Miyao Y, Yasue H, Ogawa H, Misumi I, Masuda T, Sakamoto T, et al. Elevated interleukin–6 levels in patients with acute myocardial infarction. Am Heart J 1993;126:1299-304. [CrossRef]
  • Bayes-Genis A, Mateo J, Santaló M, Oliver A, Guindo J, Badimon L, et al. D-dimer is an early diagnostic marker of coronary ischemia in patients with chest pain. Am Heart J 2000;140:379-84. [CrossRef]
  • Kruskal JB, Commerford PJ, Franks JJ, Kirsch RE. Fibrin and fibrinogen-related antigens in patients with stable and unstable coronary artery disease. N Engl J Med 1987;317:1361-5. [CrossRef]
  • Ridker PM, Hennekens CH, Cerskus A, Stampfer MJ. Plasma concentration of cross-linked fibrin degradation products (D-dimer) and the risk of future myocardial infarction among apparently healthy men. Circulation 1994;90:2236-40.
  • Zebrack JS, Anderson L, Maycock CA, Horne BD, Bair TL, Muhlestein JB. Intermountain Heart Colloborative (IHC) Study Group. Usefulness of high-sensitivity C-reactive protein in predicting long-term risk of death and myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction. Am J Cardiol 2002;89:145-9. [CrossRef]
  • Neumann FJ, Ott I, Gawaz M, Richardt G, Holzapfel H, Jochum M, et al. Cardiac release of cytokines and inflammatory responses in acute myocardial infarction. Circulation 1995;92:748-55.
  • Biasucci LM, Vitelli A, Liuzzo G, Altamura S, Caligiuri G, Monaco C, et al. Elevated levels of interleukin–6 in unstable angina. Circulation 1996;94:874-7.
  • Ridker PM, Rifai N, Stampfer MJ, Hennekens CH. Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation 2000;101:1767.
  • Morrow DA. Rifai N. Antman EM, Weiner DL, McCabe CH, Cannon CP, et al. C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. Thrombolysis in myocardial infarction. J Am Coll Cardiol 1998;31:1460-5. [CrossRef]
  • Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE Investigators. J Am Coll Cardiol 2000;35:1535-42. [CrossRef]
  • Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long term mortality in unstable coronary artery disease. FRISC study group. N Eng J Med 2000;343:1139-47. [CrossRef]
  • Mueller C, Buettner HJ, Hodgson JM, Marsch S, Perruchoud AP, Roskamm H, et al. Inflammation and long term mortality after non-ST-elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients. Circulation 2002;105:1412-5. [CrossRef]
  • Speidl WS, Graf S, Hornykewycz S, Nikfardjam M, Niessner A, Zorn G, et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J 2002;144:449-55. [CrossRef]
  • Benamer H. Steg PG. Benessiano J. Vicaut E. Gaultier CJ. Boccara A, et al. Comparison of the prognostic value of C-Reactive protein and troponin I in patients with unstable angina pectoris. Am J Cardiol 1998;82:845-50. [CrossRef]
  • Montalescot G, Philippe F, Ankri A, Vicaut E, Bearez E, Poulard JE, et al. Early increase of von willebrand factor predicts adverse outcome in unstable coronary artery disease: Beneficial effects of enoxaparin. Circulation 1998;98:294-9.
  • Oltrona L, Ardissino D, Merlini PA, Spinola A, Chiodo F, Pezzano A. C-reactive protein elevation and early outcome in patients with unstable angina pectoris. Am J Cardiol 1997;80:1002-6. [CrossRef]
  • Torzewski M, Rist C, Mortensen RF, Zwaka TP, Bienek M, Waltenberger J, et al. C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis. Arterioscler Thromb Vasc Biol 2000;20:2094-9. 433 Balkan Med J 2011; 28: 429-34 Yiğit et al. Akut Koroner Sendrom Tanısında İnflamatuar Belirteçler
  • Torzewski J, Torzewski M, Bowyer DE, Fröhlich M, Koenig W, Waltenberger J, et al. C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Thromb Vasc Biol 1998;18:1386-92. [CrossRef]
  • Ikeda U, Shimada K. Interleukin-6 and acute coronary syndrome. Clin Cardiol 2001;24:701-4. [CrossRef]
  • Ottani F, Galvani M. Prognostic role of hemostatic markers in acute coronary syndromes patients. Clinica Chimica Acta 2001;311:33-9. [CrossRef]
  • Lowe GDO, Yarnell JWG, Rumley A, Bainton D, Sweetnam PM. C-reactive protein, fibrin D-dimer and incident ischemic heart disease in the speedwell study. Arterioscler Thromb Vasc Biol. 2001;21:603-10. [CrossRef]
  • Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon III RO, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511. [CrossRef]
There are 28 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Özlem Yiğit This is me

Yıldıray Cete This is me

Cenker Eken This is me

Erkan Göksu This is me

Publication Date April 1, 2011
Published in Issue Year 2011 Volume: 2011 Issue: 4

Cite

APA Yiğit, Ö., Cete, Y., Eken, C., Göksu, E. (2011). Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği. Balkan Medical Journal, 2011(4), 429-434. https://doi.org/10.5152/balkanmedj.2011.010
AMA Yiğit Ö, Cete Y, Eken C, Göksu E. Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği. Balkan Medical Journal. April 2011;2011(4):429-434. doi:10.5152/balkanmedj.2011.010
Chicago Yiğit, Özlem, Yıldıray Cete, Cenker Eken, and Erkan Göksu. “Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer Ve IL-6’nın Duyarlılık Ve Seçiciliği”. Balkan Medical Journal 2011, no. 4 (April 2011): 429-34. https://doi.org/10.5152/balkanmedj.2011.010.
EndNote Yiğit Ö, Cete Y, Eken C, Göksu E (April 1, 2011) Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği. Balkan Medical Journal 2011 4 429–434.
IEEE Ö. Yiğit, Y. Cete, C. Eken, and E. Göksu, “Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği”, Balkan Medical Journal, vol. 2011, no. 4, pp. 429–434, 2011, doi: 10.5152/balkanmedj.2011.010.
ISNAD Yiğit, Özlem et al. “Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer Ve IL-6’nın Duyarlılık Ve Seçiciliği”. Balkan Medical Journal 2011/4 (April 2011), 429-434. https://doi.org/10.5152/balkanmedj.2011.010.
JAMA Yiğit Ö, Cete Y, Eken C, Göksu E. Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği. Balkan Medical Journal. 2011;2011:429–434.
MLA Yiğit, Özlem et al. “Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer Ve IL-6’nın Duyarlılık Ve Seçiciliği”. Balkan Medical Journal, vol. 2011, no. 4, 2011, pp. 429-34, doi:10.5152/balkanmedj.2011.010.
Vancouver Yiğit Ö, Cete Y, Eken C, Göksu E. Akut Koroner Sendrom Tanısında Yüksek Duyarlılıklı CRP, D-Dimer ve IL-6’nın Duyarlılık ve Seçiciliği. Balkan Medical Journal. 2011;2011(4):429-34.