Intermediate hs-cTnI concentrations were associated with a higher likelihood of CAD compared to low hs-cTnI in patients with excluded myocardial infarction (71.9% vs 43.4%; OR 3.33; 95% CI 1.92-5.78).
Cohort (n=250)
Does intermediate hs-cTnI concentration predict the presence of CAD on CCTA in patients with suspected ACS but excluded MI?
In patients with suspected ACS but excluded MI, intermediate hs-cTnI levels (5 ng/L to 99th percentile) strongly predict the presence of occult CAD on CCTA, suggesting a role for targeted imaging and preventative therapy.
Odds Ratio: 3.33 (95% CI 1.92–5.78)
Absolute Event Rate: 71.9% vs 43.4%
BACKGROUND: Patients with suspected acute coronary syndrome in whom myocardial infarction has been excluded are at risk of future adverse cardiac events. OBJECTIVES: This study evaluated the usefulness of high-sensitivity cardiac troponin I (hs-cTnI) to select patients for further investigation after myocardial infarction has been excluded. METHODS: This is a prospective cohort study of patients presenting to the emergency department with suspected acute coronary syndrome and hs-cTnI concentrations below the sex-specific 99th percentile. Patients were recruited in a 2:1 fashion, stratified by peak hs-cTnI concentration above and below the risk stratification threshold of 5 ng/L. All patients underwent coronary computed tomography angiography (CCTA) after hospital discharge. RESULTS: Overall, 250 patients were recruited (61.4 ± 12.2 years 31% women) in whom 62.4% (156 of 250 patients) had coronary artery disease (CAD). Patients with intermediate hs-cTnI concentrations (between 5 ng/L and the sex-specific 99th percentile) were more likely to have CAD than those with hs-cTnI concentrations <5 ng/L (71.9% 120 of 167 patients vs 43.4% 36 of 83 patients; odds ratio: 3.33; 95% CI: 1.92-5.78). Conversely, there was no association between anginal symptoms and CAD (63.2% 67 of 106 patients vs 61.8% 89 of 144 patients; odds ratio: 0.92; 95% CI: 0.48-1.76). Most patients with CAD did not have a previous diagnosis (53.2%; 83 of 156 patients) and were not on antiplatelet and statin therapies (63.5%; 99 of 156 patients) before they underwent CCTA. CONCLUSIONS: In patients who had myocardial infarction excluded, CAD was 3× more likely in those with intermediate hs-cTnI concentrations compared with low hs-cTnI concentrations. In such patients, CCTA could help to identify those with occult CAD and to target preventative treatments, thereby improving clinical outcomes.
Lee et al. (Mon,) conducted a cohort in Suspected acute coronary syndrome with excluded myocardial infarction (n=250). Intermediate hs-cTnI concentrations (5 ng/L to 99th percentile) vs. Low hs-cTnI concentrations (<5 ng/L) was evaluated on Coronary artery disease (CAD) on CCTA (OR 3.33, 95% CI 1.92-5.78). Intermediate hs-cTnI concentrations were associated with a higher likelihood of CAD compared to low hs-cTnI in patients with excluded myocardial infarction (71.9% vs 43.4%; OR 3.33; 95% CI 1.92-5.78).