Can biomarkers indicate the severity of coronary artery disease?

Year 2021, Volume: 46 Issue: 3, 883 - 888, 30.09.2021

Dilay Karabulut Gülçin Şahingöz Erdal Umut Karabulut Nilgün Işıksaçan Muhammet Hulusi Satılmışoğlu Pinar Kasapoğlu Nihan Turhan

Abstract

Purpose: Biomarkers are useful measures assisting the diagnosis, treatment, and prognosis of cardiovascular diseases. They can predict the severity of cardiovascular diseases, especially in acute myocardial infarction at the emergency department. We aimed to investigate the severity of cardiovascular disease using three biomarkers, namely cardiac troponins, C-reactive protein (CRP), and procalcitonin in patients with ST-elevation myocardial infarction who presented to the emergency department.
Materials and Methods: The study included a total of 166 patients that presented with ST-elevation myocardial infarction (STEMI) in the first three hours of symptom onset and underwent coronary angiography. SYNTAX (SS) scores were calculated, and based on these scores, two groups were formed. High-sensitivity troponin T (Hs-TnT), high-sensitivite CRP (Hs-CRP), and procalcitonin levels were measured at the presentation.
Results: Although the high sensitive troponin, Hs-CRP values were higher in the SYNTAX score>20 groups, there was no statistically significant difference between the two groups. There was no significant difference in the PCT measurements between the two groups
Conclusion: When Hs-TnT and Hs-CRP are evaluated together in patients with STEMI with a high SS, it may be predictive in early determining the severity of coronary artery disease.

Keywords

Biomarker, myocardial infarction, SYNTAX

Biyobelirteçler, koroner arter hastalığının şiddetini gösterebilir mi?

Abstract

Amaç: Biyobelirteçler kardiyovasküler hastalıkların teşhisi, tedavisi ve prognozunu tayin etmede önemlidir. Acil serviste özellikle akut miyokard enfarktüsünde kardiyovasküler hastalıkların ciddiyetini tahmin edebilirler. Bu çalışmada acil servise başvuran ST elevasyonlu miyokard enfarktüsü tanısı olan hastalarda kardiyovasküler hastalıkların şiddetini kardiyak troponinler, C-reaktif protein (CRP) ve prokalsitonin olmak üzere üç biyobelirteç kullanarak araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya ST elevasyonlu miyokard enfarktüsü tanısı alan semptomlarının ilk 3 saati içerisinde başvuran ve koroner anjiografi yapılan 166 hasta alındı. SYNTAX (SS) skoruna göre hastalar iki gruba ayrıldı. Başvuru sırasında ölçülen Hs-troponin T, Hs-CRP ve prokalsitonin düzeyleri ölçüldü.
Bulgular: SYNTAX skoru 20 nin üstünde olan grupta Hs-troponin ve Hs-CRP düzeyleri yüksek olmasına rağmen iki grup arasında istatistiksel olarak anlamlı fark saptanmadı. İki grup arasında prokalsitonin düzeyleri açısından istatistiksel olarak anlamlı fark saptanmadı.
Sonuç: SYNTAX skoru yüksek olan ST elevasyonlu miyokard enfarktüs geçiren hastalarda Hs-troponin T ve Hs-CRP birlikte değerlendirildiğinde, erken dönemde koroner arter hastalığının şiddetini belirlemede öngörücü olabilir.

Keywords

Biyobelirteç, miyokardial enfarktüs, syntax

References

• [1] Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. The global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006; 367: 1747-57.
• [2] Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000; 283: 3223-9.
• [3] Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000; 102: 118-22.
• [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: 242-251.
• [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: 1387-93.
• [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: 1212-7.
• [7] Head SJ, Farooq V, Serruys PW, Kappetein AP. The SYNTAX score and its clinical implications. Heart. 2014; 100: 169-77.
• [8] Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005; 1: 219-27.
• [9] Girasis C, Garg S, Räber L, Sarno G, Morel MA, Garcia-Garcia HM, et al. SYNTAX score and Clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial. Eur Heart J. 2011; 32: 3115-27.
• [10] Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, Mehran R, et al. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. J Am Coll Cardiol. 2011; 57: 2389-97.
• [11] Collinson PO, Boa FG, Gaze DC. Measurement of cardiac troponins. Ann Clin Biochem. 2001; 38: 423-49.
• [12] Twerenbold R, Jaffe A, Reichlin T, Reiter M, Mueller C. High-sensitive troponin T measurements: what do we gain and what are the challenges? Eur Heart J. 2012; 33: 579-86.
• [13] Petrie CJ, Weir RA, Anwar MS, Ali MA, Kerr M, Abed JA. High sensitivity troponin T in acute medicine; more questions than answers? QJM. 2014; 107: 193-200.
• [14] Yamazaki K, Iijima R, Nakamura M, Sugi K. High-sensitivity cardiac troponin T level is associated with angiographic complexity of coronary artery disease: a cross-sectional study. Heart Vessels. 2016; 31: 890-6.
• [15] Bhatt HA, Sanghani DR, Lee D, Julliard KN, Fernaine GA. Predictors of Peak Troponin Level in Acute Coronary Syndromes: Prior Aspirin Use and SYNTAX Score. Int J Angiol. 2016; 25: 54-63.
• [16] Schlett CL, Truong QA, Ahmed W, Blankstein R, Ferencik M, Uthamalingam S et al. High-sensitivity troponin T and C-reactive protein to identify patients without cardiac structural and functional abnormalities as assessed by cardiac CT and SPECT imaging: can biomarkers predict cardiac health? Int J Cardiovasc Imaging. 2013; 29: 865-73.
• [17] Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R et al. Emerging Risk Factors Collaboration; C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010; 375: 132-40.
• [18] 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. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet. 1997; 349: 462-6.
• [19] 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. Fragmin during Instability in Coronary Artery Disease. N Engl J Med. 2000; 343: 1139-47.
• [20] 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.
• [21] Karadeniz M, Duran M, Akyel A, et al. High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome. Int Heart J. 2015; 56: 377-80.
• [22] Babatunde A, Rizvi A, Truong QA. Novel Biomarkers: Utility in Patients with Acute Chest Pain and Relationship to Coronary Artery Disease on Coronary CT Angiography. Curr Cardiovasc Imaging Rep. 2014; 7(7). pii: 9277.
• [23] Morrow DA, Rifai N, Antman EM, 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.
• [24] Visvardis G, Griveas I, Fleva A, et al. Relevance of procalcitonin levels in Comparison to other markers of inflammation in hemodialysis patients. Ren Fail. 2005; 27: 429-34.
• [25] Meisner M. Pathobiochemistry and clinical use of procalcitonin. Clin Chim Acta. 2002; 323: 17-29.
• [26] Kafkas N, Venetsanou K, Patsilinakos S, et al. Procalcitonin in acute myocardial infarction. Acute Card Care. 2008; 10: 30-6.
• [27] Buratti T, Ricevuti G, Pechlaner C, et al. Plasma levels of procalcitonin and interleukin-6 in acute myocardial infarction. Inflammation. 200; 25: 97-100.
• [28] Ertem AG, Efe TH, Yayla Ç, et al. The Association Between Serum Procalcitonin Levels and Severity of Coronary Artery Disease Assessed by SYNTAX Score in Patients With Acute Coronary Syndrome. Angiology. 2017; 68: 40-45.
• [29] Sentürk T, Cordan J, Baran I, et al. Procalcitonin in patients with acute coronary syndrome: correlation with high-sensitive C-reactive protein, prognosis and severity of coronary artery disease. Acta Cardiol. 2007; 62: 135-41.