Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit lesion in unstable angina.
BACKGROUND
This study assessed the relation between the angiographic appearance of the culprit lesion and cardiac troponin I (cTnI) or C-reactive protein (CRP) elevations within the first 24 hours in unstable angina. Intracoronary thrombus or a complex morphology, is frequently observed on angiography in patients with unstable angina and is associated with a higher rate of spontaneous or coronary angioplasty-related complications. Biochemical parameters related to myocardial injury (eg, cTnI) or to systemic inflammation (eg, CRP) are known prognostic markers for clinical outcome and may help in angiographic risk stratification to provide new adjunctive therapy.


RESULTS
We studied 100 patients admitted for unstable angina with angiographically proven coronary artery disease (with normal creatine kinase [CK] and CK-MB mass). Serum concentrations of cTnI (N < 0.4 ng/mL) and CRP (N < 3 mg/L) were measured at admission and 12 and 24 hours later. Multivariate analysis showed that elevated cTnI (>/=0.4 ng/mL) within 24 hours (35 patients) was an independent predictor of an angiographic appearance of the culprit lesion carrying a high risk of major cardiac events in the outcome and whether angioplasty is attempted (coronary thrombus, occlusion, or type C lesions; odds ratio 4.1, 1. 6 to 10.5). cTnI levels at admission and CRP at 0, 12, and 24 hours were not predictive of high-risk angiographic anatomy.


CONCLUSIONS
In patients with unstable angina and angiographically proven coronary artery disease, increased cTnI within 24 hours of admission but not increased CRP is associated with an angiographic appearance of the culprit lesion carrying a high risk of complication, especially in the event of angioplasty.
Benamer
H
H
Service de Cardiologie and Service de Biochimie A, Hôpital Bichat, Paris Cedex 18, France.
Steg
P G
PG
Benessiano
J
J
Vicaut
E
E
Gaultier
C J
CJ
Aubry
P
P
Boudvillain
O
O
Sarfati
L
L
Brochet
E
E
Feldman
L J
LJ
Himbert
D
D
Juliard
J M
JM
Assayag
P
P
D000789:Angina, Unstable / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I; D002097:C-Reactive Protein