Accuracy of delta high-sensitivity troponin I in diagnosing the severity of coronary artery disease with the SYNTAX score as the gold standard
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242913Keywords:
Accuracy, Delta high-sensitivity troponin I, CAD, Coronary artery disease, SYNTAX scoreAbstract
Background: The SYNTAX score is a comprehensive angiographic tool that quantifies the complexity and extent of coronary artery disease (CAD) based on the number, location, and severity of lesions in the coronary arteries. This study aimed to assess the accuracy of delta high-sensitivity troponin I in diagnosing the severity of coronary artery disease with the SYNTAX score as the gold standard.
Methods: This study was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Bangladesh from July 2022 to June 2023. A total of 70 patients with significant delta hs-cTnI were divided into two groups: Group-A (n=36) with a delta hs-cTnI rise between >20 to 49%, and Group-B (n=34) with a delta hs-cTnI rise ≥50%. Coronary angiography was conducted, and the SYNTAX Score was calculated for both groups. Data analysis was performed using SPSS version 25.0.
Results:32.4% of patients with a high-rise of delta cTnI (≥50%) had a SYNTAX score >22, compared to none of the patients with a low-rise of cTnI 20-49% (p<0.001). The delta hs-cTnI showed a significantly moderate linear correlation with the SYNTAX score (p=0.001). The optimal cut-off value for high sensitivity, with minimal compromise in specificity, was 89.0, with an area under the curve of 0.847 (p<0.001), indicating that nearly 85% of severe CAD could be accurately diagnosed with a delta hs-cTnI value of 90.0 or higher in NSTEMI patients.
Conclusion: The study findings suggest that a delta hs-cTnI value of 90.0 or higher in NSTEMI patients can accurately diagnose nearly 85% of severe CAD.
References
Twerenbold R, J Boeddinghaus J, Mueller C, Update on high-sensitivity cardiac troponin in patients with suspected myocardial infarction. Eur Heart J Supp. 2018;20:2-10.
Thygesen K, Alpert JS, Jaffe AS, et al. Writing group on behalf of the joint ESC/ACCF/AHA/WHF task force for the universal definition of myocardial infarction. third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581-98.
Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger C, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med. 10;172(16):1211-8.
Storrow AB, Nowak RM, Diercks DB, Singer AJ, Wu AH, Kulstad E, et al. Absolute and relative changes (delta) in troponin I for early diagnosis of myocardial infarction: Results of a prospective multicenter trial. Clin Biochem. 2015;48(4,5):260-7.
Qadir F, Farooq S, Khan M, Hanif B, Lakhani M. Correlation of cardiac troponin I levels (10 folds upper limit of normal) and extent of coronary artery disease in non-ST elevation myocardial infarction. J Pak Med Assoc. 2010;60(6):423-8.
López-Fernández S, Cequier A, Iràculis E, Gómez JA, Teruel L, Valero J, et al. Elevated troponin I levels in patients with acute coronary syndrome without ST elevation are associated with increased complexity of the culprit lesion. Rev Esp Cardiol. 2004;57(4):291-8.
Benamer H, Steg PG, Benessiano J, Vicaut E, Gaultier CJ, Aubry P, et al. Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit lesion in unstable angina. Am Heart J. 1999;137(5):815-20.
Altun B, Turkon H, Tasolar H, Begg H, Altun M, Temız A, et al. The relationship between high-sensitive troponin T, neutrophil lymphocyte ratio and SYNTAX Score. Scand J Clin Lab Invest. 2014;74(2):108-15.
Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. Euro Intervention. 2005;1(2):219-27.
Sajid S, Abbas K. Severity of coronary artery disease in non-st elevation myocardial infarction (nstemi) patients with high troponin-I level. Pak Heart J. 2021;51(2):114-8.
Bonaca M, Sabatine M, Dalby A, Spinar J, Murphy AS, Jarolil P, et al. Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I. J Am Coll Cardiol. 2010;55(19):2118-24.
Faria RC. Troponina como indicador de gravidade angiográfica em pacientes com síndrome coronariana aguda sem supradesnível de segmento ST. Rev SOCERJ. 2005;18(5):443-4.
Ndrepepa, Gjin, et al. "High-sensitivity troponin T level and angiographic severity of coronary artery disease." Am J Card. 2011;018(5):639-43.
Apple, Michael W. "Democratic education in neoliberal and neoconservative times." Int Stud Socio Edu. 2021;1:21-31.
Samman Tahhan A, Sandesara P, Hayek SS, Hammadah M, Alkhoder A, Kelli HM, et al. High-sensitivity troponin i levels and coronary artery disease severity, progression, and long-term outcomes. J Am Heart Assoc. 2018;7(5):7914.
Akteruzzaman M. “Correlation of troponin-I with angiographic profile in patients of unstable angina.” Chattagram Maa-O-Shishu Hospital Medical College Journal. 2013;12:13-8.
