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- Troponin I and D-dimer levels as triaging biomarkers to distinguish acute pulmonary thromboembolism from myocardial infarction
- Soo-Jin Kim, Moo Hyun Kim, Kwang Min Lee, Jin Woo Lee, Young Shin Cha, Da Eun Koh, Joo Yeong Hwang, Jong Sung Park
- Kosin Med J. 2023;38(4):252-258. Published online December 20, 2023
- DOI: https://doi.org/10.7180/kmj.23.133
- 591 View
- 15 Download
- 1 Citations
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Abstract
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- Background
Acute pulmonary thromboembolism (APTE) is often confused with myocardial infarction. Previous studies have shown that patients with APTE exhibit lower initial and peak cardiac troponin I (CTI) levels, but higher D-dimer (DD) levels, than patients with myocardial infarction. The present study aimed to reaffirm the tree model algorithm using an entirely new set of data.
Methods
We reviewed retrospective clinical and laboratory data from patients who were diagnosed with APTE or non-ST-elevation myocardial infarction (NSTEMI) between 2015 and 2016. Subjects who were not classified with a diagnosis or did not have their CTI or DD levels assessed were excluded. We categorized patients according to the previous algorithm and compared the outcomes with the previous test dataset.
Results
The analysis involved data from 156 patients with APTE and 363 patients with NSTEMI. In the validation data set, the APTE group showed higher initial DD levels (9.80±10.84 μg/mL) and lower initial CTI levels (0.17±0.54 μg/mL) than the NSTEMI group. The accuracy rate for the test dataset and the validation set were similar. The test set accuracy rate was 91.0%, while the accuracy rate in the validation set improved to 88.6%.
Conclusions
Patients with APTE exhibited lower initial and peak CTI levels, but higher DD levels than NSTEMI patients. The accuracy rate estimates were similar between the test set obtained from the tree model algorithm and the validation set. The study findings demonstrate that the assessment of cardiac biomarkers can be useful for differentiating between APTE and NSTEMI. -
Citations
Citations to this article as recorded by
- The old biomarkers you know are still useful: D-dimer and troponin I
Sanghyun Lee
Kosin Medical Journal.2023; 38(4): 229. CrossRef
- The old biomarkers you know are still useful: D-dimer and troponin I
- Comparison of the radiation dose between dual-acquisition coronary computed tomography angiography and coronary angiography for coronary spasm
- Soo-Jin Kim, Moo Hyun Kim, Eun-Ju Kang
- Kosin Med J. 2022;37(1):46-51. Published online March 16, 2022
- DOI: https://doi.org/10.7180/kmj.21.035
- 2,160 View
- 31 Download
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Abstract
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- Background
Coronary computed tomography angiography (CCTA) is an imaging technique that can be used to evaluate and diagnose coronary artery stenosis. Dual-acquisition CCTA (DA-CCTA) with additional nitrate infusion is a promising alternative noninvasive diagnostic tool, as conventional CCTA has limitations in the diagnosis of variant angina compared to conventional angiographic coronary spasm tests. However, DA-CCTA may pose a potential risk due to radiation exposure. We compared the radiation dose between DA-CCTA and the coronary angiographic spasm provocation test.
Methods
Patients with clinically suspected variant angina at a single hospital between March 2013 and October 2018 were screened and underwent DA-CCTA or a coronary angiographic spasm provocation test. The effective radiation dose required for each approach was compared.
Results
In total, 211 suspected variant angina patients underwent DA-CCTA or the coronary angiographic spasm provocation test. Of these, 49 patients (mean age, 59.8 years; 67.3% men) received DA-CCTA and 162 patients (mean age, 60.5 years; 66.2% men) received a coronary angiographic spasm provocation test. There was a significant difference in the effective radiation dose, with a median dose of 5.1 mSv (interquartile range [IQR], 4.1–9.2 mSv) required for DA-CCTA and a median dose of 10.9 mSv (IQR, 8.4–15.2 mSv) for the coronary angiographic spasm provocation test (p<0.001).
Conclusion
DA-CCTA showed a significantly lower effective radiation dose than the coronary angiographic spasm provocation test required to diagnose variant angina.
- Efficacy of Evolocumab in Patients with Hypercholesterolemia
- Xuan Jin, Moo Hyun Kim, Young-Rak Cho, Jong-Sung Park, Kai Song, Song Lin Yuan
- Kosin Med J. 2020;35(2):125-132. Published online December 31, 2020
- DOI: https://doi.org/10.7180/kmj.2020.35.2.125
- 1,470 View
- 16 Download
- 1 Citations
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Abstract
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Objectives The FOURIER trial reported that inhibition of PCSK9 with evolocumab on a background of statin therapy lowered low-density lipoprotein (LDL) cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. Here, we report data from a single center focusing on the effect of a PCSK9 inhibitor antibody on hyperlipidemia.
Methods We enrolled 29 hypercholesterolemia patients who had LDL cholesterol levels ≥ 70 mg per deciliter or non-HDL cholesterol ≥ 100 mg per deciliter and were divided into two groups (placebo n = 14, evolocumab n = 15), and participated in a 72 – 96 week, randomized, double-blind, placebo-controlled trial with statin therapy. Patients were randomly assigned to receive evolocumab (140 mg every 2 weeks or 420 mg monthly) or matched placebo via subcutaneous injection. Lipid changes during follow-up were analyzed.
Results The median LDL cholesterol level at baseline was 88 mg per deciliter, and the average LDL cholesterol level was 101.8 ± 20.0 mg per deciliter. At 4 weeks, the median LDL cholesterol level was 39 mg per deciliter, and the average LDL cholesterol level was 34.8 ± 51.8 mg per deciliter. Compared to placebo group, the LDL cholesterol levels were significantly reduced after treatment (
P < 0.001), as well as total cholesterol, ApoB, and ApoB/ApoA1 levels. During follow-up, no discomfort was reported at local injection sites, and no cases of abnormal liver function were observed.Conclusions Evolocumab significantly reduced LDL cholesterol levels and was well tolerated.
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Citations
Citations to this article as recorded by- Safety, adherence and efficacy of PCSK9 inhibitors: a retrospective real-world study
Bee Ling Kelly Chng, Wei Min Paul Heng, Yu Ming Soon, Jin Shing Hon, Yee How Lau, Ru San Tan, Jack Wei Chieh Tan
Proceedings of Singapore Healthcare.2022; 31: 201010582211441. CrossRef
- Safety, adherence and efficacy of PCSK9 inhibitors: a retrospective real-world study
- Treatment of Stent Dislodgement Complicated by Coronary Artery Dissection using Parallel Wire Technique and Small Balloon
- Su Young Kim, Seung-Hee Han, Kyung Han Kim, Moo Hyun Kim, Jong Sung Park
- Kosin Med J. 2013;28(1):55-60. Published online January 19, 2013
- DOI: https://doi.org/10.7180/kmj.2013.28.1.55
- 771 View
- 3 Download
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Abstract
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Stent dislodgement is a rare complication of complex percutaneous coronary artery intervention and is often associated with significant morbidity. We report a case of stent dislodgement complicated by coronary artery dissection and acute total occlusion of left circumflex coronary artery. Direct expansion of the dislodged stent was performed using parallel wire technique and small balloon. An overlapping stent was implanted for remained coronary artery dissection. Coronary artery flow was restored and ST segment elevation was normalized after successful intervention.
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