High-sensitive troponin I serum levels, CAD pre-test score and coronary artery disease severity in NSTEMI patients

Introduction: High-sensitivity cardiac troponin I (hsTnI) has a determining role in diagnosing acute myocardial infarction due to its increased sensitivity in detecting myocardial injury and/or necrosis. However, hsTnI leves are influenced by comorbidities and the-re isn’t a clear correlation between hsTnI plasma levels and the extent of coronary artery involvement.

Objective: We analyzed NSTEMI patients with the goal of identifying a possible correlation between hsTnI, co-ronary artery disease score (CAD Consortium) and the extent of coronary artery lesions present in these pati-ents (evaluated through coronary catheterization).

Methods: Our study group consists of 52 NSTEMI patients hospitalized in Bagdasar-Arseni Emergency Hospital’s Cardiology ward that underwent coronary catheterization, over a 3 month period. We analyzed demographic data (age,sex), cardiovascular risk factors (diabetes, hypertension, smoking history and obesity), chest pain type, various biological markers (hsTnI and CK/CK-MB enzymes, creatinine serum levels), echocardiographical data (LVEF and the presence of val-vulopathies) and coronary artery lesions –quantified through coronary catheterization. The patients were divided into 3 groups based on hsTnI plasma levels – group I 0-500 ng/dL, group II -500-1500 ng/dL, and group III – hsTnI plasma levels greater than 1500 ng/ dL. We also calculated the coronary artery disease pre-test score (CAD Consortium) – a score used to predict the presence of coronary artery lesions using only cli-nical data.

Results: Age was not significantly different between the 3 groups. Female patients register a greater percentage of atypical chest pain on presentation compared to men (45% vs. 27%). The mean number of cardiovascular risk factors was greater in the second group than in the other 2 (2 vs. 4 vs. 3). Serum creatinine levels and the clinical pre-test CAD score did not vary significantly between the 3 study groups. There was a negative cor-relation between serum hsTnI and LVEF. Patients from the 3rd study group had a greater percentage of signifi-cant coronary artery lesions compared to the 1st study group (93% vs. 67%), however patients in the 1st group had a greater level of lesions affecting all 3 coronary ar-teries.

Conclusions: Our study confirms the utility of deter-mining serum hsTnI levels in ACS patients and reite-rates the correlation between higher serum levels and a poorer LVEF. However a correlation between hsTnI serum levels and the degree of coronary artery disease was not present in our study group. However, we did observe a greater number of atypical chest pain pre-sentations among female patients. Also, greater hsTnI serum levels were not associated with a greater pre-test CAD score. Further studies are required to fully eva-luate and predict medium to long term outcomes in NSTEMI patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)