Anstabil Anjina Pektoris Tanılı Hastalarda Serum Copeptin Düzeylerinin ve HEART Skoru Değerinin Kısa Dönem Prognozda Etkinliğinin Araştırılması

Year 2023, Volume: 6 Issue: 2, 81 - 88, 30.06.2023

Kenan Yılmaz , Ozlem Koksal , Arzu Yılmaztepe Oral , Vahide Aslıhan Durak , Murat Çetin

https://doi.org/10.54996/anatolianjem.1163597

Abstract

Amaç: Bu çalışmanın amacı Acil Serviste Anstabil Anjina Pektoris tanısı olan hastalarda, Copeptin düzeyi ve HEART skorlama sisteminin birlikte kullanılmasının klinik özellikleri öngörmedeki değerliliğinin saptanmasıdır.

Gereç ve Yöntemler: Bu çalışmaya, bir üniversite hastanesi Acil Servisi’ne Eylül 2020 – Mart 2021 tarihleri arasında kardiyak tipte göğüs ağrısı ile başvuran ve Anstabil Anjina Pektoris düşünülen erişkin hastalar (n=65) ve hastane çalışanlarından oluşan sağlıklı kontroller (n=45) dâhil edilmiştir. Hastaların kısa dönem prognoz açısından sonlanmaları, Copeptin düzeyleri, kardiyak enzimleri (CK-MB, Troponin) ve HEART risk skor değerleri kaydedilmiştir.

Bulgular: Kontrol grubu ile karşılaştırıldığında ve Anstabil Anjina Pektoris grubunda erkek cinsiyet sıklığı, yaş ve başvuruda kaydedilen troponin değerleri istatistiksel olarak anlamlı düzeyde daha fazlayken, başvuruda kaydedilen Copeptin düzeyi anlamlı düzeyde daha düşük bulunmuştur (p<0.001). Başvuru Copeptin düzeyinin sağlam olguları belirleme açısından 3.86 pmol/L kesim noktasında %57,8 sensitif, %95,4 spesifik olduğu, Troponin düzeyinin ise Anstabil Anjina Pektoris olgularını belirleme açısından 1.1 ng/mL kesim noktasında %64,6 sensitif, %80,0 spesifik olduğu belirlenmiştir (p<0.001). Başvuru anında kaydedilen Troponin ve Copeptin düzeyleri arasında istatistiksel olarak anlamlı düzeyde negatif yönde (r=-0.288, p = 0.020), HEART skoru ile başvuru troponin düzeyi arasında pozitif yönde zayıf düzeyde korelasyon ilişkisi saptanmıştır (r= 0.396, p= 0.001).

Sonuç: Copeptin düzeyi ile nihai sonuç ve HEART skoru arasında anlamlı ilişki saptanmamıştır. Anstabil Anjina Pektoris olgularında sadece Copeptin düzeyinin nihai sonucu öngörmede yeterli olmadığı, HEART skorunun ise bu açıdan klinik pratikte daha etkili olabileceği belirlenmiştir.

Keywords

Anstabil angina pektoris, copeptin, HEART skoru

Investigation of the Efficacy of Serum Copeptin Levels and HEART Scores in Short Term Prognosis in Patients Diagnosed with Unstable Angina Pectoris

Abstract

Aim: The aim of this study was to determine the value of the combined use of Copeptin levels and HEART scoring system in predicting clinical features in patients who were thought to have Unstable Angina Pectoris in the emergency department.

Material and methods: Adult patients who admitted to the emergency department of an university hospital with cardiac chest pain between September 2020 and March 2021 were included as Unstable Angina Pectoris group (n=65); and healthy control group (n = 45) which consisted of the hospital staff. The patients' short-term outcome in terms of prognosis, Copeptin levels, cardiac enzymes (CK-MB, Troponin) and HEART risk score values were recorded.

Results: Compared to the control group, the frequency of male gender, age, and troponin values recorded at admission were statistically significantly higher in the Unstable Angina Pectoris group, while copeptin levels at admission were significantly lower (p<0.001). Copeptin level at admission was 57.8% sensitive and 95.4% specific at the cut-off point of 3.86 pmol/L in terms of identifying healthy cases, whereas the troponin level was 64.6% sensitive and 80.0% specific at the cut-off point of 1.1 ng/mL for detecting Unstable Angina Pectoris cases (p<0.001). There was a weak negative correlation between troponin and copeptin levels recorded at admission (r= -0.288, p = 0.020), and a weak positive correlation between HEART score and troponin level at admission (r= 0.396, p= 0.001).

Conclusion: No significant correlation was found between the levels of Copeptin and the final result and HEART score. It was determined that the use of Copeptin level alone in USAP cases were not sufficient to predict the final result and the HEART score could be more effective in clinical practice in this respect.

Keywords

Unstable Angina Pectoris, copeptin, HEART score

References

• Germany GH, Germany AK, Lenzen MJ, Denmark EP, Vranckx P. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST -segment elevation. 2018;119–77.
• Goyal A, Zeltser R. Unstable Angina. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442000.
• Gök H. Klinik kardiyoloji. 3. baskı, İstanbul: Nobel Tıp Kitabevi; 2003. s.399-425.
• Akcakoyun M, Akcay A, Demir D, et al. Braunwald’s classification of unstable angina pectoris and C-reactive protein. Heart. 2002;87(5): A21-A21.
• Schrier RW. Abraham WT: hormones and hemodynamics in heart failure. N Engl J Med 1999;341:577–85.
• Dunser MW, Wenzel V, Mayr AJ et al. Management of vasodilatory shock: defining the role of arginine vasopressin. Drugs 63:237–56.
• Gu YL, Voors AA, Zijlstra F, Hillege HL, Struck J, Masson S. Comparison of the temporal release pattern of copeptin with conventional biomarkers in acute myocardial infarction. Clin Res Cardiol [Internet]. 2011 Dec 16;100(12):1069–76. Available from: http://link.springer.com/10.1007/s00392-011-0343-y
• Ray P, Charpentier S, Chenevier-Gobeaux C, Reichlin T, Twerenbold R, Claessens Y-E, et al. Combined copeptin and troponin to rule out myocardial infarction in patients with chest pain and a history of coronary artery disease. Am J Emerg Med [Internet]. 2012 Mar;30(3):440–8. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0735675711005729
• von Haehling S, Papassotiriou J, Morgenthaler NG, Hartmann O, Doehner W, Stellos K, et al. Copeptin as a prognostic factor for major adverse cardiovascular events in patients with coronary artery disease. Int J Cardiol [Internet]. 2012 Dec;162(1):27–32.
• Reichlin T, Hochholzer W, Stelzig C, Laule K, Freidank H, Morgenthaler NG, et al. Incremental Value of Copeptin for Rapid Rule Out of Acute Myocardial Infarction. J Am Coll Cardiol [Internet]. 2009 Jun;54(1):60–8.
• Meune C, Zuily S, Wahbi K, Claessens Y-E, Weber S, Chenevier-Gobeaux C. Combination of copeptin and high-sensitivity cardiac troponin T assay in unstable angina and non-ST-segment elevation myocardial infarction: A pilot study. Arch Cardiovasc Dis [Internet]. 2011 Jan;104(1):4–10.
• Lotze U, Lemm, Heyer, Mueller. Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital. Vasc Health Risk Manag [Internet]. 2011 Aug;509.
• Keller T, Tzikas S, Zeller T, Czyz E, Lillpopp L, Ojeda FM, et al. Copeptin Improves Early Diagnosis of Acute Myocardial Infarction. J Am Coll Cardiol [Internet]. 2010 May;55(19):2096–106.
• Six A.J., Backus B.E., Kelder J.C. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16:191–196.
• Mohsen M, Shawky A. The diagnostic utility of High-Sensitivity Cardiac Troponin T in acute coronary syndrome. EHJ. 2016;68:1–9.
• 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 Cardiovascular Care. 2014;3:1.
• Balmelli C, Meune C, Twerenbold R, et al. Comparison of the performances of cardiac troponins, including sensitive assays, and copeptin in the diagnosis of acute myocardial infarction and long-term prognosis between women and men. Am Heart J. 2013;166:30.
• Shin H, Jang BH. Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis. PLoS One. 2018; 13(7): e0200379.
• Lu J, Wang S, He G, Wang Y. Prognostic value of copeptin in patients with acute coronary syndrome: A systematic review and meta-analysis. Plos one. 2020;15(8):e0238288.
• Fesmire FM, Martin EJ, Cao Y, et al. Improving risk stratification in patients with chest pain: the erlanger HEARTS3 score. Am J Emerg Med 2012; 30(9): 1829–1837.
• Aydin H, Ozpinar Y, Karaogu U, et al. Comparison of the HEART and HEARTS3 scores to predict major adverse cardiac events in chest pain patients at the emergency department. Hong Kong Journal of Emergency Medicine. 2020;1024907920944070.
• Six AJ, Backus BE, Kelder JC. Chestpain in the emergency room: value of the HEART score. Neth Heart J 2008; 16: 191–196.
• Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013; 168: 2153–2158.
• Leite L, Baptista R, Leitão J, et al. Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. BMC Cardiovasc Disord 2015; 11: 15–48.
• Lotze U, Lemm H, Heyer A, Müller K. Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction. Vasc Health Risk Manage. 2011;7:509–515.
• Ay MO, Erenler AK, Dogan T, Yetim M. Diagnostic value of copeptin in acute myocardial infarction. European Review for Medical and Pharmacological Sciences. 2017; 21: 1576-1582.
• Piyanuttapull S. Correlation of plasma copeptin levels and early diagnosis of acute myocardial infarction compared with troponin-T. Chotmaihet Thangphaet. 2013;96(1):13-19.
• Tentzeris I, Jarai R, Farhan S, et al. Complementary role of copeptin and high-sensitivity troponin in predicting outcome in patients with stable chronic heart failure. European Journal of Heart Failure. 2014;13(7):726-733.