Öz
Amaç: Bu çalışmanın amacı acil serviste akut miyokard infarktüsü (AMİ) nedeni ile değerlendirilen ve koroner anjiografi uygulanan hastaların koroner damar darlığının acilde bakılan kan parametreleri ile saptana bilirliğini değerlendirmek.
Gereç ve yöntem: Tek merkez prospektif gözlemsel çalışmamızda 1 Eylül-31 Ekim 2023 tarihleri arasında acil serviste AMİ tanısı alan ve tek kardiyolog tarafından koroner anjiyografi yapılan hastalar dâhil edildi. Acil servis rutin değerlendirmede uygulanan kan parametreleri kayıt edildi ve anjiografi sonrası damar darlık yüzdelerine göre prediktif etkisi olan parametreler değerlendirildi.
Bulgular: Araştırmamıza çalışma kriterlerini karşılayan toplam 64 hasta (44 erkek, 20 kadın) dâhil edildi. Koroner anjiyografi sonrası herhangi bir koroner arterde en yüksek darlık yüzdesine göre yapılan değerlendirme sonrası hastalar 2 gruba ayrıldı. Grup 1 hafif darlık (darlık <%50) saptanan 15 hasta ve grup 2 ciddi darlık (%70-99 darlık) tespit edilen 49 hastadan oluşmaktadır. Grup 2’de erkek cinsiyet baskınlığı ile Troponin-I (Tn-I) düzeyinin yüksek, lenfosit ve trombosit değerlerinin düşük olduğu görüldü (sırasıyla p=0,010, p=0,004, p=0,042 ve p=0,007).
Sonuç: Erkeklerde koroner darlığa bağlı olarak Tn-I düzeylerinin daha yüksek olduğu görülmüştür. Ateroskleroz ve trombozun yanı sıra, şiddetli darlık vakalarında iltihaplanma, trombosit ve lenfosit sayısının azalmasına katkıda bulunabilir. Bu bulguları doğrulamak için daha büyük örneklem büyüklüğüne sahip, ileriye dönük, randomize kontrollü çalışmalara ihtiyaç vardır.
Anahtar Kelimeler
Akut miyokard infarktüsü kardiyak belirteçler tam kan sayımı koroner darlık koroner anjiografi
Kaynakça
- 1. Yöntem M, Erdoğdu BŞ, Akdoğan M, Kaleli S. The importance of cardiac markers in diagnosis of acute myocardial infarction. OTSBD 2017;2:11-17. https://doi.org/10.26453/otjhs.357230
- 2. Buyukterzi Z, Gurses KM, Erdem S, et al. Mean neutrophil volume is elevated in patients suffering from acute coronary syndrome. Kocaeli Med J 2019;8:74-80. https://doi.org/10.5505/ktd.2019.24471
- 3. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction [published correction appears in J Am Coll Cardiol 2000;36:959-969. https://doi.org/10.1016/s0735-1097(00)00804-4
- 4. Miyahara Y, Nagaya N, Kataoka M, et al. Monolayered mesenchymal stem cells repair scarred myocardium after myocardial infarction. Nature Medicine 2006;12:459-465. https://doi.org/10.1038/nm1391
- 5. Lewandrowski K, Chen A, Januzzi J. Cardiac markers for myocardial infarction: a brief review. Pathology Patterns Reviews 2002;118:93-99. https://doi.org/10.1309/3EK7-YVV9-228C-E1XT
- 6. Makki N, Brennan TM, Girotra S. Acute coronary syndrome. J Intensive Care Med 2015;30:186-200. https://doi.org/10.1177/0885066613503294
- 7. Çiçek ÖF, Zaman S, Ekinfen E, Şeyhanlı ES. Acil servise başvuran akut koroner sendrom hastalarında trombosit kütle indeksinin tanıdaki yeri. Göbeklitepe International J Health Sci 2023;6:64-71. https://doi.org/10.55433/gsbd/213
- 8. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol 2006;47:13-18. https://doi.org/10.1016/j.jacc.2005.10.065
- 9. Domenico T, Rita A, Giacomo S, et al. Salivary biomarkers for diagnosis of acute myocardial infarction: a systematic review. Int J Cardiol 2023;371:54-64. https://doi.org/10.1016/j.ijcard.2022.09.043
- 10. Raskovalova T, Twerenbold R, Collinson PO, et al. Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 2014;3:18-27. https://doi.org/10.1177/2048872613514015
- 11. Balk EM, Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: a meta-analysis. Ann Emerg Med 2001;37:478-494. https://doi.org/10.1067/mem.2001.114905
- 12. Sheikh Beig Goharrizi MA, Ghodsi S, Mokhtari M, Moravveji SS. Non-invasive STEMI-related biomarkers based on meta-analysis and gene prioritization. Comput Biol Med 2023;161:106997 https://doi.org/10.1016/j.compbiomed.2023.106997
- 13. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med 2007;357:2482-2494. https://doi.org/10.1056/NEJMra071014
- 14. Rencüzoğulları İ, Karabağ Y, Çağdaş M, ve ark. ST segment yüksekliği olmayan miyokard infarktüsü hastalarında nötrofil/lenfosit oranı ile SYNTAX ve SYNTAX II skorları arasındaki ilişkinin değerlendirilmesi. Kafkas J Med Sci 2017;7:117-123. https://doi.org/10.5505/kjms.2017.47587
- 15. Major AS, Fazio S, Linton MF. B-lymphocyte deficiency increases atherosclerosis in LDL receptor-null mice. Arterioscler Thromb Vasc Biol 2002;22:1892-1898. https://doi.org/10.1161/01.atv.0000039169.47943.ee
- 16. Núñez J, Sanchis J, Bodí V, et al. Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis 2009;206:251-257. https://doi.org/10.1016/j.atherosclerosis.2009.01.029
- 17. Tangjitgamol S, Udayachalerm W, Wanishsawad C, Kaewwanna W, Ativanichayapong N. Association of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and coronary artery disease among the physicians. J Inflamm Res 2024;17:59-66. . https://doi.org/10.2147/JIR.S447750
- 18. Yüksel M, Yıldız A, Oylumlu M, et al. The association between platelet/lymphocyte ratio and coronary artery disease severity. Anatol J Cardiol 2015;15:640-647. https://doi.org/10.5152/akd.2014.5565
- 19. Liu Y, Ye T, Chen L, et al. Systemic immune-inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. Coron Artery Dis 2021;32:715-720. https://doi.org/10.1097/MCA.0000000000001037
- 20. Yücel H, Amanvermez Şenarslan D. Koroner Arter Baypas Greft (KABG) ameliyatı olan hastalarda aterosklerozun ilerlemesi ile hematolojik parametreler arasındaki ilişki CBU-SBED 2020;7:29-34. https://doi.org/10.34087/cbusbed.696363
- 21. Ayaz G, Karadağ B, Güven B, ve ark. Koroner arter hastalığı şiddeti ve trombosit agregasyonu. Sağlık Bilimlerinde İleri Araştırmalar Dergisi 2021;4:13-19. https://doi.org/10.26650/JARHS2021-843387
Can emergency department blood parameters predict coronary artery occlusion in acute myocardial infarction?
Öz
Purpose: The aim of this study is to assess the detectability of coronary artery stenosis in patients evaluated for acute myocardial infarction (AMI) in the emergency department and undergoing coronary angiography, based on blood parameters examined in the emergency setting.
Materials and methods: In our single-center prospective observational study, patients diagnosed with AMI in the Emergency Department between September 1 and October 31, 2023, and those who underwent coronary angiography by a single cardiologist were included. The blood parameters applied during routine assessment in the Emergency Department were recorded, and parameters with predictive effects based on the percentages of vessel stenosis after angiography were evaluated.
Results: A total of 64 patients (44 males and 20 females) who met the study criteria were included in our research. Following the evaluation based on the highest percentage of stenosis in any coronary artery after coronary angiography, patients were divided into two groups. Group 1 consisted of 15 patients with mild stenosis (stenosis <50%), and Group 2 comprised 49 patients with severe stenosis (70-99% stenosis). Group 2, a predominance of male gender was observed along with elevated Troponin-I (Tn-I) levels, and lower values of lymphocyte and platelet counts (p=0.010, p=0.004, p=0.042, and p=0.007, respectively).
Conclusion: In males, it has been observed that Tn-I levels are higher in association with coronary stenosis. Alongside atherosclerosis and thrombosis, inflammation may contribute to decreased platelet and lymphocyte counts in cases of severe stenosis. Further prospective, randomized controlled studies with larger sample sizes are needed to confirm these findings.
Anahtar Kelimeler
Acute myocardial infarction cardiac markers whole blood count coronary stenosis coronary angiography
Etik Beyan
The study received approval from the XXX University Health Sciences Non-Interventıonal Research Ethıcs Commıttee (ethics committee approval no: 2023-2 Date: 12.01.2023).
Destekleyen Kurum
None
Teşekkür
None
Kaynakça
- 1. Yöntem M, Erdoğdu BŞ, Akdoğan M, Kaleli S. The importance of cardiac markers in diagnosis of acute myocardial infarction. OTSBD 2017;2:11-17. https://doi.org/10.26453/otjhs.357230
- 2. Buyukterzi Z, Gurses KM, Erdem S, et al. Mean neutrophil volume is elevated in patients suffering from acute coronary syndrome. Kocaeli Med J 2019;8:74-80. https://doi.org/10.5505/ktd.2019.24471
- 3. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction [published correction appears in J Am Coll Cardiol 2000;36:959-969. https://doi.org/10.1016/s0735-1097(00)00804-4
- 4. Miyahara Y, Nagaya N, Kataoka M, et al. Monolayered mesenchymal stem cells repair scarred myocardium after myocardial infarction. Nature Medicine 2006;12:459-465. https://doi.org/10.1038/nm1391
- 5. Lewandrowski K, Chen A, Januzzi J. Cardiac markers for myocardial infarction: a brief review. Pathology Patterns Reviews 2002;118:93-99. https://doi.org/10.1309/3EK7-YVV9-228C-E1XT
- 6. Makki N, Brennan TM, Girotra S. Acute coronary syndrome. J Intensive Care Med 2015;30:186-200. https://doi.org/10.1177/0885066613503294
- 7. Çiçek ÖF, Zaman S, Ekinfen E, Şeyhanlı ES. Acil servise başvuran akut koroner sendrom hastalarında trombosit kütle indeksinin tanıdaki yeri. Göbeklitepe International J Health Sci 2023;6:64-71. https://doi.org/10.55433/gsbd/213
- 8. Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol 2006;47:13-18. https://doi.org/10.1016/j.jacc.2005.10.065
- 9. Domenico T, Rita A, Giacomo S, et al. Salivary biomarkers for diagnosis of acute myocardial infarction: a systematic review. Int J Cardiol 2023;371:54-64. https://doi.org/10.1016/j.ijcard.2022.09.043
- 10. Raskovalova T, Twerenbold R, Collinson PO, et al. Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 2014;3:18-27. https://doi.org/10.1177/2048872613514015
- 11. Balk EM, Ioannidis JP, Salem D, Chew PW, Lau J. Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: a meta-analysis. Ann Emerg Med 2001;37:478-494. https://doi.org/10.1067/mem.2001.114905
- 12. Sheikh Beig Goharrizi MA, Ghodsi S, Mokhtari M, Moravveji SS. Non-invasive STEMI-related biomarkers based on meta-analysis and gene prioritization. Comput Biol Med 2023;161:106997 https://doi.org/10.1016/j.compbiomed.2023.106997
- 13. Davì G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med 2007;357:2482-2494. https://doi.org/10.1056/NEJMra071014
- 14. Rencüzoğulları İ, Karabağ Y, Çağdaş M, ve ark. ST segment yüksekliği olmayan miyokard infarktüsü hastalarında nötrofil/lenfosit oranı ile SYNTAX ve SYNTAX II skorları arasındaki ilişkinin değerlendirilmesi. Kafkas J Med Sci 2017;7:117-123. https://doi.org/10.5505/kjms.2017.47587
- 15. Major AS, Fazio S, Linton MF. B-lymphocyte deficiency increases atherosclerosis in LDL receptor-null mice. Arterioscler Thromb Vasc Biol 2002;22:1892-1898. https://doi.org/10.1161/01.atv.0000039169.47943.ee
- 16. Núñez J, Sanchis J, Bodí V, et al. Relationship between low lymphocyte count and major cardiac events in patients with acute chest pain, a non-diagnostic electrocardiogram and normal troponin levels. Atherosclerosis 2009;206:251-257. https://doi.org/10.1016/j.atherosclerosis.2009.01.029
- 17. Tangjitgamol S, Udayachalerm W, Wanishsawad C, Kaewwanna W, Ativanichayapong N. Association of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and coronary artery disease among the physicians. J Inflamm Res 2024;17:59-66. . https://doi.org/10.2147/JIR.S447750
- 18. Yüksel M, Yıldız A, Oylumlu M, et al. The association between platelet/lymphocyte ratio and coronary artery disease severity. Anatol J Cardiol 2015;15:640-647. https://doi.org/10.5152/akd.2014.5565
- 19. Liu Y, Ye T, Chen L, et al. Systemic immune-inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. Coron Artery Dis 2021;32:715-720. https://doi.org/10.1097/MCA.0000000000001037
- 20. Yücel H, Amanvermez Şenarslan D. Koroner Arter Baypas Greft (KABG) ameliyatı olan hastalarda aterosklerozun ilerlemesi ile hematolojik parametreler arasındaki ilişki CBU-SBED 2020;7:29-34. https://doi.org/10.34087/cbusbed.696363
- 21. Ayaz G, Karadağ B, Güven B, ve ark. Koroner arter hastalığı şiddeti ve trombosit agregasyonu. Sağlık Bilimlerinde İleri Araştırmalar Dergisi 2021;4:13-19. https://doi.org/10.26650/JARHS2021-843387
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 20 Mayıs 2024 |
| Yayımlanma Tarihi | |
| Gönderilme Tarihi | 21 Ocak 2024 |
| Kabul Tarihi | 13 Mayıs 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 17 Sayı: 3 |
Kaynak Göster
