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2018, Number 1

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Rev Mex Patol Clin Med Lab 2018; 65 (1)

Evaluation of thoracic pain and copeptin + troponin T as a biomaker of excluscute ischemic coronary syndromion in ae of the IAM type without elevation of the ST segment (IAM SESST)/angina unestable

Ledesma MVM, Ascencio TRG, Pérez MCA, Camacho CR, Sígala AR, Ascencio TCM, Pérez GHR

Language: Spanish
References: 21
Page: 55-61
PDF size: 324.38 Kb.


ABSTRACT

Introduction: The diagnosis of acute myocardial infarction (AMI) in patients presenting with chest pain is difficult at times. Serum markers play an important role in the diagnosis of AMI when other indicators could be negative or questionable. The markers used in the diagnosis of stroke are: creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), myoglobin and troponin. Copeptin: is the C-terminal pro- vasopressin, a glycopeptide of 39 amino acids, and a novel marker that permits fast and reliable exclusion of AMI portion. Objective: To determine levels copeptin + troponin T in patients with chest pain and suspected AMI, valued at the Emergency Adults in the Old Civil Hospital of Guadalajara «Fray Antonio Alcalde». Material and methods: Study design: Prospective, Traversal, Analytical. For study they included a sample of 50 patients in 2 groups: 1) those with elevated troponin T › 0.05 ng/mL + EKG SE-SST and 2) those without elevated troponin ‹ 0.05 ng/mL + EKG SE-SST in both groups of samples for measurement copeptin patient admission to the emergency department they were taken. Results: Multivariate analysis (ANOVA) correlated to dyslipidemia p = (0.009) and smoking p = (0.0001) as causal factors related to AMI. When copeptin meets values ​​below 10 pmol/L has a better diagnostic performance, showing a sensitivity 23.7% (95% CI 10-37), a specificity of 100%, a positive predictive value of 29% (95% CI 15-43), a negative predictive value of 100% a positive likelihood ratio of 1.31 (95% CI 1.1-1.56) and a negative likelihood ratio of 0. With an AUC of 0.925 (95% CI). If the cutoff to 13 pmol/L was modified to decrease sensitivity and specificity 91.7% to 52.6%. Conclusions: Ischemic heart rate Acute Infarction occupies one of the first places of death in the world. In this study, copeptin ‹ 10 pmol/L achieved its best diagnostic performance shown in (NPV) of 100% and a specificity of 100%, in the study population, unlike the cutoff point that has been considered 6.6 pmol/L by the supplier BRAHMS KRYPTOR. Troponin T + copeptin test performed at the bedside can be an important tool in the stage of decision-making of patients with a high suspicion of ischemic heart disease, which rules SICA (IAM SE-SST/AI) in its initial stages.


REFERENCES

  1. Suasnavar P, Soto MG. Dolor precordial asociado a cardiopatía isquémica en el servicio de urgencias de Medicina Interna del Hospital Roosevelt. Rev Guatem Cardiol. 2013; 23 (2): 47-49.

  2. World Health Organization Expert Commitee. Hypertension and coronary heart disease: classification and criteria for epidemiological studies. Technical report series number 168. Geneva: World Health Organization; 1959, p. 28.

  3. Bodor GS, Porter S, Landt Y, Ladenson JH. Development of monoclonal antibodies specific for troponin-I and preliminary results in suspected cases of myocardial infarction. Clin Chem. 1992; 38 (11): 2203-2214.

  4. Lindahl B, Venge P, Wallentin L. Relation between troponin T and the risk of sub- sequent cardiac events in unstable coronary artery disease. The FRISC study group. Circulation. 1996; 93 (9): 1651-1657.

  5. Troponin T and myocardial damage. Lancet. 1991; 338 (8758): 23-24.

  6. Holwerda DA. A glycopeptide from the posterior lobe of pig pituitaries. I. Isolation and characterization. Eur J Biochem. 1972; 28 (3): 334-339.

  7. Land H, Schütz G, Schmale H, Richter D. Nucleotide sequence of cloned cDNA encoding bovine arginine vasopressin-neurophysin II precursor. Nature. 1982; 295: 299-303,

  8. Morgenthaler NG, Struck J, Alonso C, Bergmann A. Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem. 2006; 52 (1): 112-119.

  9. Christ-Crain M, Opal SM. Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia. Crit Care. 2010; 14 (1): 203-211.

  10. Khan S, Dhillon O, O’Brien R, Struck J, Quinn PA, Morgenthaler NG et al. C-terminal provasopressin (copeptin) as a novel and prognostic marker in acute myocardial infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) study. Circulation. 2007; 115: 2103-2110.

  11. Tang WH, Francis GS, Morrow DA, Newby LK, Cannon CP, Jesse RL et al. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: Clinical utilization of cardiac biomarker testing in heart failure. Circulation. 2007; 116: e99-e109.

  12. Carillo-Esper R, De la Torre-León T. Copeptina. Un novedoso e interesante biomarcador pronóstico. Med Int Mex. 2013; 29 (4): 380-387.

  13. 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. 2009; 54 (1): 60-68.

  14. Chenevier-Gobeaux C, Freund Y, Claessens YE, Guérin S, Bonnet P, Doumenc B et al. Copeptin for rapid rule out of acute myocardial infarction in emergency department. Int J Cardiol. 2013; 166 (1): 198-204.

  15. Maisel A, Mueller C, Neath SX, Christenson RH, Morgenthaler NG, McCord J et al. Copeptin helps in the early detection of patients with acute myocardial infarction. primary results of the CHOPIN Trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol. 2013; 62 (2): 150-160.

  16. Voors AA, von Haehling S, Anker SD, Hillege HL, Struck J, Hartmann O et al. C-terminal provaso- pressin (copeptin) is a strong prognostic marker in patients with heart failure after an acute myocardial infarction: results from the OPTI- MAAL study. Eur Heart J. 2009; 30 (10): 1187-1194.

  17. Kelly D, Squire IB, Khan SQ, Quinn P, Struck J, Morgenthaler NG et al. C-terminal provasopressin (copeptin) is associated with left ventricular dysfunction, remodeling, and clinical heart failure in survivors of myocardial infarction. J Card Fail. 2008; 14 (9): 739-745.

  18. Sebbane M, Lefebvre S, Kuster N, Jreige R, Jacques E, Badiou S 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. Am J Emerg Med. 2013; 31 (9): 1302-1308.

  19. Martinez-Sanchez C, Martinez Reding J, Arias Mendoza A y cols. Epidemiología de los SICA en México Intersistemas 2004, 2008, RENASICA 2005.

  20. Dégano IR, Elosua R, Marrugat J. Epidemiología del síndrome coronario agudo en España: estimación del número de casos y la tendencia de 2005 a 2049. Rev Esp Cardiol. 2013; 66: 472-481.

  21. García-Castillo A, Jerjes-Sánchez C, Martínez-Bermúdez P, Azpiri-López JR, Autrey-Caballero A, Martínez-Sánchez C y cols. Treviño RENASICA II Registro Mexicano de Síndromes Coronarios Agudos. Arch Cardiol Mex. 2005; 75 (Supl. 1): S6-S19.




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