Key result
In patients with suspected acute coronary syndrome and excluded myocardial infarction, intermediate high-sensitivity troponin concentrations were associated with a more than 3-fold higher likelihood of coronary artery disease compared with low concentrations (OR 3.33).
Why the study?
Patients with suspected acute coronary syndrome in whom myocardial infarction is excluded remain at risk for future cardiac events, and the role of hs-cTnI to guide further investigation was evaluated.
Does an intermediate hs-cTnI concentration (5 ng/L to 99th percentile) predict a higher prevalence of coronary artery disease on CCTA in patients with suspected ACS after MI is ruled out compared to low hs-cTnI concentrations?
Cohort (n=250)
No
Does an intermediate hs-cTnI concentration (5 ng/L to 99th percentile) predict a higher prevalence of coronary artery disease on CCTA in patients with suspected ACS after MI is ruled out compared to low hs-cTnI concentrations?
In patients with suspected acute coronary syndrome after myocardial infarction has been ruled out, intermediate high-sensitivity troponin concentrations strongly predict the presence of underlying coronary artery disease on CCTA, representing a potential triage tool for targeting preventative therapies.
Answers are grounded in this paper and cite their sources.
May aid selective CCTA after MI exclusion in suspected ACS; hypothesis-generating for troponin-guided CAD detection.
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.
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Lee et al. (2021) conducted a cohort in Suspected acute coronary syndrome with ruled-out myocardial infarction (n=250). Intermediate high-sensitivity cardiac troponin I concentrations (5 ng/L to 99th percentile) vs. Low high-sensitivity cardiac troponin I concentrations (<5 ng/L) was evaluated on Presence of coronary artery disease (CAD) on coronary computed tomography angiography (OR 3.33, 95% CI 1.92-5.78). In patients with suspected acute coronary syndrome and excluded myocardial infarction, intermediate high-sensitivity troponin concentrations were associated with a more than 3-fold higher likelihood of coronary artery disease compared with low concentrations (OR 3.33).
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