Relation between admission troponin -T level and angiographic severity of coronary artery lesion in patients with non-ST segment elevation acute coronary syndrome

ABSTRACT

Cardiac troponin T and I are sensitive marker for myocardial injury. Elevation of these markers in patients with ST segment elevation acute ischemic syndrome is associated with more severe coronary artery disease and poor prognosis. In the case of non-ST segment elevation acute ischemic syndrome the condition is not so clear to find out the role of admission troponin T on the prediction of the severity of coronary artery lesion in patients with non-STE acute coronary syndrome. This study is a case-controlled clinical trial that was conducted in the National Heart Institute in order to find out the diagnostic utility of elevated troponin T for prediction of the severity of coronary artery disease in patients with non-ST segment elevation acute coronary syndrome. Forty patients admitted in the ICU of the National Heart Institute with chest pain and non-ST segment elevation acute coronary syndrome were included in the study. Coronary angiography was done to 33 patients [2 patients died and 5 patients refused coronary angiography]. They were divided into 2 groups according to troponin T level Group I 15 patients with troponin T +ve and group II 18 patients with troponin -ve. All Patient Included in the Study Were Subjected To Full history Taking, full general and local examination, resting twelve-leads ECG, routine laboratory investigation, Troponin testing on admission and coronary angiography before discharge. Male sex was significantly more in the group I than group II patients. Also, patients with group I were significantly older [P < 0.05]. There was no significant difference between the two groups regarding the risk factors for coronary artery disease or the ECG diagnosis of ischemic changes [P > 0.05]. The incidence of in-hospital adverse events were significantly higher among the group I than group II patients [P < 0.05]. The degree of stenosis was significantly more in group I than group II. [87% +/- 10.8 and 76% +/- 9.5 respectively, P < 0.05]. The incidence of multivessel disease was significantly higher in group I than that of group II [P < 0.05]. There was significant difference between the two groups regarding the TIMI flow [P < 0.05]. Angiographic evidence of thrmobus was present in 3 patients [20%] of group I, while it was present in 1 patients [5.6%] of group II. The difference between the two groups was significant [P < 0.05]. Troponin T elevation on admission is associated with a significantly severe form of coronary artery disease, more complex lesion, higher incidence of multivessel disease and visible thrombus in patients with non-ST segment elevation acute ischemic syndrome