Comparing the value of pregnancy associated Plasma Protein A (PAPP-A) and ischemia modified albumin in the patients with chest pain

Yıl 2017, Cilt: 8 Sayı: 3, 113 - 123, 01.06.2017

Özgür Tatlı , Yunus Karaca , İsmet Durmuş Sinan Şahin Ahmet Menteşe , Suha Türkmen Abdulkadir Gündüz , Süleyman Türedi

https://doi.org/10.18663/tjcl.292392

Öz

Aim: To evaluate the diagnostic value of
PAPP-A and CK-MB in early diagnosis of ACS.

Material and Methods: It is a single-center, prospective,
clinical study. There were totally 152 cases. At the end of the study the
levels of troponin-T, CK-MB, PAPP-A and IMA in the different groups were
compared.

Results: There were 13 patients
with STEMI, 53 patients with NSTEMI/UAP and 80 patients with non-specific ECG
findings. When we consider the definitive diagnosis; there were 8 patients with
STEMI, 36 patients with NSTEMI, 23 patients with UAP, 17 patients with SAP and
68 patients with non-coroner chest pain. In our study, the most specific
parameter at the highest sensitivity for the patients with the chest pain
within the first hours (0-2 hour, 2-4 hour) was IMA. (Sensitivity/specificity;
100/30.7, 93.7/52.3 respectively).

Conclusion: According to our
results, PAPP-A and IMA cannot be used as an diagnostic tool like troponin-T
and CK-MB in ACS. Also IMA cannot be used as an ideal screening test in the
diagnosis of ACS during the early period of chest pain.  Still, IMA is more useful diagnostic
biochemical marker than troponin-T, CK-MB and PAPP-A as a screening test in
detecting ACS during the first hours. 

Anahtar Kelimeler

PAPP-A, IMA, chest pain, acute coronary syndrome

Göğüs ağrısı olan hastalarda gebelikle ilişkili Plazma Protein A (PAPP-A) ve iskemi modifiye albümin değerinin karşılaştırılması

Öz

Amaç: AKS’un erken tanısında PAPP-A ve CK-MB’nin tanısal değerinin
belirlenmesidir.

Gereç
ve Yöntemler: Tek merkezli, prospektif, klinik bir çalışma 152 vaka
incelendi. Çalışmanın sonunda troponin-T, CK-MB, PAPP-A ve IMA’nın farklı
gruplardaki düzeyleri kıyaslandı.

Bulgular: 13 hastada STEMI tanısı kondu, 53 hastada NSTEMI/UAP ve 80
hastada non spesifik EKG bulguları mevcuttu. Kesin tanısına göre 8 hastada
STEMI, 36 hastada NSTEMI, 23 hastada UAP ( unstabil njina pektoris), 17 hastada
SAP (stabil anjina pektoris) 68 hastada non koroner göğüs ağrısı mevcuttu.
Göğüs ağrısının ilk saatlerinde (0-2 saat, 2-4 saat) en yüksek sensitivitedeki
en spesifik parametre IMA idi. (Sensitivite/spesifite; 100/30.7, 93.7/52.3).

Sonuçlar: Sonuçlarımıza
göre, PAPP-A ve IMA, AKS'de troponin-T ve CK-MB gibi bir tanı aracı olarak
kullanılamaz. Sonuçlarımız, duyarlılık ve özgüllük özellikleriyle ilgili olarak
IMA, göğüs ağrısı erken döneminde AKS tanısında ideal bir tarama testi olarak
kullanılamaz. Yine de, IMA, ilk saatler boyunca AKS'yi saptamada bir tarama
testi olarak troponin-T, CK-MB ve PAPP-A'ya kıyasla daha yararlı diagnostik biyokimyasal
belirteçtir. Çalışma sonuçlarımız literatürde benzer bir çok araştırmanın
aksine bir sonuç sergilemektedir ve bulguları daha kapsamlı bir dizi çalışma
ile değerlendirilmelidir.

 

Anahtar Kelimeler

PAPP-A, IMA, gögüs ağrısı, akut koroner sendrom

Kaynakça

• 1. Solinas L, Raucci R, Terrazzino S, et al. Prevalence, clinical characteristics, resource utilization and outcome of patients with acute chest pain in the emergency department. A multicenter, prospective, observational study in north-eastern Italy. Italian heart journal: official journal of the Italian Federation of Cardiology 2003; 4: 318-324.
• 2. Neumann J. T, Sörensen N. A, Schwemer T, et al. Diagnosis of myocardial infarction using a high-sensitivity troponin I 1-hour algorithm. Jama cardiology 2016; 1: 397-404.
• 3. Sebbane M, Lefebvre S, Kuster N, et al. Early rule out of acute myocardial infarction in ED patients: value of combined high-sensitivity cardiac troponin T and ultrasensitive copeptin assays at admission. The American journal of emergency medicine 2013; 31: 1302-1308.
• 4. Iversen K, Teisner A, Dalager S,et al. Pregnancy associated plasma protein-A (PAPP-A) is not a marker of the vulnerable atherosclerotic plaque. Clinical biochemistry 2011; 44: 312-318.
• 5. Iversen K. K, Dalsgaard M, Teisner A. S, et al. Pregnancy-associated plasma protein-A, a marker for outcome in patients suspected for acute coronary syndrome. Clinical biochemistry 2010; 43: 851-857.
• 6. Apple F. S, Wu A. H, Mair J, et al. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Clinical Chemistry 2015; 51: 810-824.
• 7. Bhagavan N. V, Lai E. M, Rios P. A, et al. Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction. Clinical Chemistry 2003; 49: 581-585.
• 8. Christenson R. H, Duh S. H, Sanhai W. R, et al. Characteristics of an albumin cobalt binding test for assessment of acute coronary syndrome patients: a multicenter study. Clinical Chemistry 2001;47: 464-470.
• 9. Çevik E, Yılmaz B. K, Acar Y. A, Haklıgör A, Çinar O. Bazı Erken Kardiyak Belirteçlerin (Miyoglobin, İMA ve Copeptin) Tanısal Performansının STYME Hastalarında Değerlendirilmesi. Turkish Journal of Emergency Medicine 2013; 13127-132.
• 10. Anderson J. L, Adams C. D, Antman E. M, Bridges C. R, Califf R. M, Casey D. E. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and .... Journal of the American College of Cardiology 2007; 50.7: e1-e157.
• 11. Bar–Or D, Lau E, Winkler J. V. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia—a preliminary report. The Journal of emergency medicine 2000; 19: 311-315.
• 12. Lılly, Leonard S. Braunwald's heart disease: a textbook of cardiovascular medicine. Elsevier Health Sciences, 2012.
• 13. Hamm C. W, Goldmann B. U, Heeschen C, Kreymann G, Berger J, Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. New England Journal of Medicine 1997; 337: 1648-1653.
• 14. Puleo P. R, Meyer D, Wathen C et al. Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction. New England Journal of Medicine 1994; 331 :561-566.
• 15. Lippi G, Montagnana M, Guidi G. C. Albumin cobalt binding and ischemia modified albumin generation: an endogenous response to ischemia? International journal of cardiology 2006; 108: 410-411.
• 16. Turedi S, Gunduz A, Mentese A et al. Value of ischemia-modified albumin in the diagnosis of pulmonary embolism. The American journal of emergency medicine 2007; 25: 770-773.
• 17. Gunduz A, Turedi S, Mentese A, et al. Ischemia-modified albumin levels in cerebrovascular accidents. The American journal of emergency medicine 2008; 26: 874-878.
• 18. Gunduz A, Turedi S, Mentese A, et al. Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study. The American journal of emergency medicine 2008; 26: 202-205.
• 19. Balta S, Aparci M, Demir M, Ozturk C, Celik T. Ischemia-modified albumin in patients with seizure. The American journal of emergency medicine 2014; 32: 1282.
• 20. Keating L, Benger J. R, Beetham R, et al. The PRIMA study: presentation ischaemia-modified albumin in the emergency department. Emergency Medicine Journal, 2006; 23: 764-768.
• 21. Sinha M. K, Roy D, Gaze D. C, et al. Role of “Ischemia modified albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emergency Medicine Journal 2004; 21: 29-34.
• 22. Peacock F, Morris D. L, Anwaruddin S, et al. W. Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. American heart journal, 2006; 152: 253-262.
• 23. Roy D, Quiles J, Aldama G, et al. Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. International journal of cardiology 2004; 97: 297-301.
• 24. Wudkowska A, Goch J, Goch A. Ischemia-modified albumin in differential diagnosis of acute coronary syndrome without ST elevation and unstable angina pectoris. Kardiol Pol 2010; 68: 431-437.
• 25. Dawie J, Chawla R, Worku Y, Azazh A. Diagnosis of ischemic heart disease using CK-MB, troponin-I and ischemia modified albumin. Ethiopian medical journal 2011; 49: 25-33.
• 26. Kim J. S, Hwang H. J, Ko Y. G, Choi D, Ha J. W, Hong M. K, Jang Y. Ischemia-modified albumin: is it a reliable diagnostic and prognostic marker for myocardial ischemia in real clinical practice?. Cardiology, 2010; 116: 123-129.
• 27. Worster A, Devereaux P. J, Heels-Ansdell et al. Capability of ischemia-modified albumin to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome. Canadian Medical Association Journal 2005; 172: 1685-1690.
• 28. Bayes-Genis, A., Conover, C. A., Overgaard, M et al. Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. New England Journal of Medicine 2001; 345:1022-1029.
• 29. Lund J, Qin Q. P, Ilva T et al. Pregnancy‐associated plasma protein A: A biomarker in acute ST‐elevation myocardial infarction (STEMI). Annals of medicine 2006; 38:221-228.
• 30. Dominguez-Rodriguez A, Abreu-Gonzalez P, Garcia-Gonzalez M, Ferrer J. Vargas M. Circulating pregnancy-associated plasma protein A is not an early marker of acute myocardial infarction. Clinical biochemistry 2005; 38:180-182.
• 31. McCann C. J, Glover B. M, Menown I, et al. Investigation of a multimarker approach to the initial assessment of patients with acute chest pain. Advances in therapy 2009; 26: 531-534.