ABSTRACT
In an attempt to clarify the occurrence of inflammation in acute coronary syndromes, this study was performed on 20 patients with unstable angina [UA] and 20 patients with myocardial infarction [MI]. Twenty healthy volunteers were taken as controls. All studied patients and controls were subjected to full clinical examination and standard 12 lead ECG. Laboratory investigations included serum creatine kinase [CK], CK-MB, Troponin T [TnT], C-reactive protein [CRP], alpha 1-acid glycoprotein [AGP] and sialic acid. Complete Selvester ECG scoring was done for MI patients. Holter monitoring for 24 hours starting immediately after hospital admission was done for UA group. CK, CK-MB and TnT were significantly elevated in MI group [P<0.05], while CRP, AGP and sialic acid were elevated in both UA and MI groups [P<0.05]. ST-episodes were detected in 10 patients with UA [50%]. All of them had CRP above the cut off value of 10 ug/ml while 6 of these patients had measurable TnT above a cut off value of 0.2 ug/ml. In UA group CRP showed the highest sensitivity [70%] followed by AGP [45%] and TnT [30%]. Meanwhile, TnT showed 95% sensitivity, 100% specificity in MI and was positively correlated with QRS score [r = 0.813, P<0.001]. Sialic acid and AGP were positively correlated with ST ischemic changes in UA group [r= 0.75 and 0.574 respectively]. It was observed that the 4 patients with UA who developed cardiac C Vents [20%] showed marked elevation in both CRP and AGP on hospital admission. Meanwhile, they had measurable TnT and showed ST ischemic changes on Holter monitoring. We conclude that acute phase reactants, cardiac specific troponins as well as Holter monitoring are useful prognostic indicators in patients with acute coronary syndrome