Age-sex distribution of patients with high-sensitivity troponin T levels below the 99th percentile.

BACKGROUND: Recently, very low concentrations of high-sensitivity cardiac troponin T (hs-cTnT), below the 99th percentile, have been used to immediately exclude acute myocardial infarction in certain patients without taking their age and sex into consideration. RESULTS: The hs-cTnT values below the 99th percentile (≤ 14 ng/L) were higher in men (p = 0.000) and significantly increased with age (p = 0.000) among both men and women. In addition, hs-cTnT was positively associated with age (r = 0.459, p = 0.000), myoglobin (r = 0.392, p = 0.000), and creatine kinase-MB (r = 0.133, p = 0.000). Moreover, males were younger (p = 0.001) and had higher myoglobin (p = 0.000) and creatine kinase-MB (p = 0.000) concentrations than females. MATERIALS AND METHODS: A total of 5585 consecutive subjects who presented with non-traumatic chest pain/discomfort to the inpatient, outpatient, or emergency department and who underwent high-sensitivity troponin T, myoglobin and creatine kinase-MB testing at presentation, with hs-cTnT below the 99thpercentile (≤ 14 ng/L), were eligible for enrollment. CONCLUSIONS: We suggest that patients' age, sex and levels of myocardial injury biomarkers should be taken into consideration when ruling out acute myocardial infarction and/or adverse prognostic implications in patients who have very low hs-cTnT concentrations.

Relationship between true fasting plasma insulin level and angiographic characteristics of coronary atherosclerosis.

BACKGROUND: Reports about the relationships between specific insulin concentration and coronary heart disease risk are controversial. HYPOTHESIS: The objective of this study was to examine the association between insulin level and the severity of coronary atherosclerosis. METHODS: The study population consisted of 507 consecutive patients (376 men and 131 women) who underwent coronary angiography for suspected or known coronary atherosclerosis. The patients' habits of smoking and drinking were investigated, and anthropometric measurements including body mass index, systolic and diastolic blood pressures, as well as plasma measurements including lipids and blood glucose were taken. The true insulin level was measured using a highly sensitive two-site sandwich ELISA. The severity of coronary atherosclerosis was defined by the Gensini score system. The statistical methods including Kruskal-Wallis test, chi-square analysis, Spearman correlation analysis, and multivariate stepwise linear regression analysis were employed to explore the relationship between specific insulin level and coronary atherosclerosis. RESULTS: When the Gensini score was examined as a categorical variable classified by tertile values, subjects with a high Gensini score had significantly higher values of fasting plasma specific insulin level (p = 0.022). The Spearman correlation analysis suggest that the Gensini score correlated significantly with true insulin (mIU/l) (r = 0.095, p = 0.033). However, the results from the multivariate stepwise linear regression analysis show that the association between specific insulin level and severity of coronary atherosclerosis lost its significance. CONCLUSIONS: The level of plasma fasting specific insulin was associated significantly with the severity of coronary atherosclerosis, as measured by Gensini score, but hyperinsulinemia showed no association with the severity of coronary atherosclerosis in multivariate analyses.

Relationship between leukocyte count and angiographical characteristics of coronary atherosclerosis.

AIM: To explore the relationship between differential leucocyte count and coronary atherosclerosis. METHODS: The study population consisted of 507 consecutive patients (376 male and 131 female) who underwent coronary angiography for suspected or known coronary atherosclerosis. The patients' smoking and drinking habits were investigated, and anthropometric measurements, serum measurements, and hematological measurements were conducted for every patient. The severity of coronary atherosclerosis was defined by using Gensini's score system. One-way ANOVA, Spearman's correlation analysis, and multivariate stepwise linear regression analysis were employed to explore the relationship between differential leucocyte count and coronary atherosclerosis. RESULTS: One-way ANOVA indicated that the diastolic blood pressure, glucose, urea, creatinine, leukocyte count, neutrophil count, monocyte count, hemoglobin, and platelet count differed among the groups according to Gensini's score, the tertile values of which were used as cutoff points. Spearman's correlation analysis suggested that Gensini's score was significantly correlated with age, diastolic blood pressure, glucose, urea, creatinine, leukocyte count, neutrophil count, monocyte count, hemoglobin, and erythrocyte count, respectively. Multivariate stepwise linear regression analysis show that neutrophil count (beta=0.247, P=0.000), age (beta=0.141, P=0.001), glucose (beta=0.173, P=0.000), creatinine (beta=0.088, P=0.063), hemoglobin (beta=-0.168, P=0.013) and sex (men were coded as 1 and women were coded as 2; beta=-0.121, P=0.012) were significantly independently associated with the Gensini's score. CONCLUSION: The independent association of neutrophil count with the angiographical characteristics of coronary atherosclerosis, as estimated by Gensini's score, strongly suggests that granulocytosis may play a role in the development of coronary atherosclerosis.