Akarsu Murat, Atıcı Adem, Yoldemir Şengül, Özcan Mustafa, Yıldırım Özgür, Akarsu Harun, Arman Yücel, Tükek Tufan
Clinic of Internal Medicine, Kanuni Sultan Suleyman Education and Research Hospital.
Department of Cardiology, Medeniyet University.
Acta Cardiol Sin. 2024 May;40(3):281-291. doi: 10.6515/ACS.202405_40(3).20240128A.
The use of high-sensitivity troponin levels increases the sensitivity of the diagnosis of non-ST elevation myocardial infarction (NSTEMI). However, the inclusion of other factors in the differential diagnosis, apart from atherothrombosis causing myocardial injury, decreases the specificity of high-sensitivity troponin. In this study, we compared the efficacy of high-sensitivity troponin with serum oncostatin M in NSTEMI cases with elevated urea and creatinine.
This study was performed with a prospective cross-sectional sample. Ninety participants with coronary angiography performed due to a preliminary diagnosis of NSTEMI were included. High-sensitivity troponin I, creatine kinase-MB, lactate dehydrogenase, serum transaminase and oncostatin M levels were quantitatively measured for the first 4-8 hours from the onset of symptoms. All participants had coronary angiography performed within the first 12 hours after attending the emergency service. Based on coronary angiography data, patients with significant coronary stenosis or occlusion detected during coronary angiography were defined as group A, and patients with no occlusion in the coronary artery and who did not require an additional interventional procedure were defined as group B. The SYNTAX 2 score was used to determine the severity of coronary artery disease.
Patients in both groups A and B had similar age, sex distribution and comorbidities. Group A had higher serum urea, creatinine, oncostatin M and high-sensitivity troponin I values than group B. With 585 pg/ml as the cut-off value, serum oncostatin M had a sensitivity of 88.6% and specificity of 85% for the diagnosis of NSTEMI. Logistic regression multivariate analysis showed that serum oncostatin M and high-sensitivity troponin I values had diagnostic efficacy for NSTEMI. Serum oncostatin M was found to be more effective than high-sensitivity troponin I in patients with elevated urea and creatinine.
Serum oncostatin M had similar sensitivity and specificity for NSTEMI diagnosis as high-sensitivity troponin I. Serum OSM can especially be considered as a complementary diagnostic biomarker for NSTEMI in patients with renal dysfunction.
高敏肌钙蛋白水平的检测提高了非ST段抬高型心肌梗死（NSTEMI）诊断的敏感性。然而，在鉴别诊断中纳入除动脉粥样硬化血栓形成导致心肌损伤之外的其他因素，会降低高敏肌钙蛋白的特异性。在本研究中，我们比较了高敏肌钙蛋白与血清抑瘤素M在尿素和肌酐升高的NSTEMI病例中的诊断效能。
本研究采用前瞻性横断面样本。纳入90例因初步诊断为NSTEMI而接受冠状动脉造影的参与者。在症状发作后的最初4 - 8小时内，对高敏肌钙蛋白I、肌酸激酶同工酶、乳酸脱氢酶、血清转氨酶和抑瘤素M水平进行定量检测。所有参与者在就诊于急诊服务后的12小时内接受冠状动脉造影。根据冠状动脉造影数据，在冠状动脉造影期间检测到显著冠状动脉狭窄或闭塞的患者定义为A组，冠状动脉无闭塞且无需额外介入治疗的患者定义为B组。采用SYNTAX 2评分来确定冠状动脉疾病的严重程度。
A组和B组患者在年龄、性别分布和合并症方面相似。A组的血清尿素、肌酐、抑瘤素M和高敏肌钙蛋白I值高于B组。以585 pg/ml为临界值，血清抑瘤素M诊断NSTEMI的敏感性为88.6%，特异性为85%。逻辑回归多变量分析显示，血清抑瘤素M和高敏肌钙蛋白I值对NSTEMI具有诊断效能。在尿素和肌酐升高的患者中，发现血清抑瘤素M比高敏肌钙蛋白I更有效。
血清抑瘤素M对NSTEMI诊断的敏感性和特异性与高敏肌钙蛋白I相似。血清抑瘤素M尤其可被视为肾功能不全患者NSTEMI的补充诊断生物标志物。
