The Importance of Cardiac Markers in Diagnosis of Acute Myocardial Infarction

Abstract

Each year, approximately 10% of millions of patients who appealed to emergency services with heart attack complaints are diagnosed with heart attacks. The fact that the patient potential is so high causes a serious concentration in the hospitals. Cardiac markers are important for giving specific and rapid results in the identification of acute myocardial infarction (AMI) and non-cardiac cases. In this study; it was aimed importance of cardiac markers in early diagnosis of AMI and investigation of lipid profile effects on AMI. In the study, Serum troponin (TnT), creatine kinase (CK), CK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), triglyceride, total cholesterol (TC), LDL- , and HDL-cholesterol (HDL-c) levels were analyzed by routine biochemical methods in 33 healthy individuals (9 females, 24 males)  and 27 patients (8 females, 19 males) who treated with the diagnosis of AMI in Coronary Intensive Care Unit at Dermlupınar University Evliya Çelebi Training and Research Hospital. In the statistical analysis, the ALT, AST, CK, CK-MB, LDH and TnT parameters of the patient group were found to be very high when compared to controls (p <0.0001). The significances determined statistically in triglyceride, LDL-cholesterol, total cholesterol and HDL-cholesterol levels were (p <0.001), (p <0.05), (p <0.05), (p> 0.1), respectively. It was thought that cardiac marker analysis is a highly specific marker for AMI diagnosis and that it is greatly facilitated in the elimination of non-cardiac cases.

Keywords

• cardiac markers,non-cardiac cases,acute myocardial infarction

Akut Miyokard İnfarktüsü Tanısında Kardiyak Markörlerin Önemi

Öz

Her yıl, kalp krizi şikâyetleriyle acil servislere başvuran milyonlarca hastadan yaklaşık %10’una kalp krizi tanısı konulmaktadır. Hasta potansiyelinin bu denli yüksek olması, hastanelerde ciddi bir yoğunluğa neden olmaktadır. Kardiyak markörler, akut miyokard infarktüsünün (AMİ) tanısında ve non-kardiyak vakalarda spesifik ve hızlı sonuçlar vermesi açısından önemlidir. Bu çalışmada; kardiyak markörlerin AMİ erken tanısındaki önemi ve lipid profilinin AMİ üzerine etkisinin araştırılması amaçlanmıştır. Dumlupınar Üniversitesi Evliya Çelebi Eğitim Araştırma Hastanesi Koroner Yoğun Bakım Ünitesi’nde AMİ teşhisiyle tedavi edilen 27 hasta (8 kadın, 19 erkek) ve 33 sağlık sağlıklı bireylerde (9 kadın, 24 erkek) serum troponin (TnT), kreatin kinaz (CK), CK-MB, alanin aminotransferaz (ALT) , aspartat aminotransferaz (AST), laktat dehidrogenaz (LDH), trigliserid, total kolesterol (TC), LDL-kolesterol (LDL-c), ve HDL-kolesterol (HDL-c) düzeyleri  rutin biyokimyasal metotlarla analiz edildi. İstatistiki analizlerde, hasta grubunun ALT, AST, CK, CK-MB, LDH ve TnT parametreleri kontrol ile karşılaştırıldığında çok yüksek bulunmuştur (p < 0.0001). Trigliserit, LDL-kolesterol, Total Kolesterol ve HDL-kolesterol düzeylerinde istatistiksel olarak tespit edilen anlamlılıklar sırasıyla (p < 0.001), (p < 0.05), (p < 0.05), (p > 0.1) şeklindedir. Kardiyak markör analizinin AMİ teşhisi için oldukça spesifik bir belirleyici olduğu, non-kardiyak vakaların elimine edilmesinde büyük kolaylık sağladığı düşünülmektedir. 

Anahtar Kelimeler

• Kalp krizi,kardiyak markörler,akut miyokard infarktüsü,non-kardiyak vaka

Kaynakça

1. 1. Singh N, Rathore V, Mahat RK, Rastogi P. Glycogen Phosphorylase BB: A more Sensitive and Specific Marker than Other Cardiac Markers for Early Diagnosis of Acute Myocardial Infarction. Indian Journal of Clinical Biochemistry. 2017:1-5.
2. 2. Rathish R, Gunalan G, Sumathi P. Current biomarkers for myocardial infarction. Int J Pharm Biol Sci. 2013;4(1):434-442.
3. 3. Antman E, Bassand J-P, Klein W, et al. Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction: The Joint European Society of Cardiology/American College of Cardiology Committee∗∗ A list of contributors to this ESC/ACC Consensus Document is provided in Appendix B. Journal of the American College of Cardiology. 2000;36(3):959-969.
4. 4. Miyahara Y, Nagaya N, Kataoka M, et al. Monolayered mesenchymal stem cells repair scarred myocardium after myocardial infarction. Nature medicine. 2006;12(4):459-465.
5. 5. Lewandrowski K, Chen A, Januzzi J. Cardiac markers for myocardial infarction: a brief review. Pathology Patterns Reviews. 2002;118(suppl_1):S93-S99.
6. 6. Zahran S, Figueiredo V, Cembrowski G, Graham M, Schulz R, Hwang P. Troponin degradation products: more specific marker for myocardial infarction. The FASEB Journal. 2017;31(1 Supplement):846.841-846.841.
7. 7. Mueller C, Giannitsis E, Möckel M, et al. Rapid rule out of acute myocardial infarction: novel biomarker-based strategies. European Heart Journal: Acute Cardiovascular Care. 2017;6(3):218-222.
8. 8. Brown MS, Goldstein JL. A receptor-mediated pathway for cholesterol homeostasis. Science. 1986;232(4746):34-47.

9. 9. Tyroler HA. Review of lipid-lowering clinical trials in relation to observational epidemiologic studies. Circulation. 1987;76(3):515-522.
10. 10. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. New England Journal of Medicine. 1990;323(19):1289-1298.
11. 11. Stampfer MJ, Krauss RM, Ma J, et al. A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. Jama. 1996;276(11):882-888.
12. 12. Priscilla DH, Prince PSM. Cardioprotective effect of gallic acid on cardiac troponin-T, cardiac marker enzymes, lipid peroxidation products and antioxidants in experimentally induced myocardial infarction in Wistar rats. Chemico-biological interactions. 2009;179(2):118-124.
13. 13. Lott JA, Stang JM. Serum enzymes and isoenzymes in the diagnosis and differential diagnosis of myocardial ischemia and necrosis. Clinical chemistry. 1980;26(9):1241-1250.
14. 14. Pickering JW, Than MP, Cullen L, et al. Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of DetectionA Collaborative Meta-analysisRapid Rule-out of AMI With Cardiac Troponin T Measurement. Annals of Internal Medicine. 2017;166(10):715-724.
15. 15. Gürdal A, Helvacı F, Sümerkan MÇ, Çetin Ş, Kılıçkesmez K. Nadir Görülen Non-Kardiyak Troponin Yüksekliği Nedeni: Akut Kolesistit; Olgu Sunumu.
16. 16. Demarchi MS, Regusci L, Fasolini F. Electrocardiographic changes and false-positive troponin I in a patient with acute cholecystitis. Case reports in gastroenterology. 2012;6(2):410-414.
17. 17. Banerjee S, Linder MW, Singer I. False-positive troponin I in a patient with acute cholecystitis and positive rheumatoid factor assay. Cardiology. 2001;95(3):170-171.
18. 18. Fox DJ, Grimm C, Curzen NP. Raised troponin T in acute cholecystitis. Journal of the Royal Society of Medicine. 2004;97(4):179-179.