Severity of coronary artery disease in patients with acute coronary syndrome without ST segment elevation is related to baseline troponin I and ST-segment depression.
BACKGROUND
Risk assessment for patients admitted with acute coronary syndrome (ACS) is usually based on the past medical history, along with several clinical and biochemical criteria. We hypothesised that stratification of patients with ACS according to the presence of ST-segment depression and results of a qualitative troponin I test would identify subjects with more severe disease who may benefit from an earlier, more aggressive strategy.


METHODS
The study group consisted of 115 patients hospitalized for typical chest pain (>5 min) occurring within the last 24 hours, with coronary angiography. Blood was drawn for routine biochemistry and qualitative troponin I testing, and ECG was performed on admission.


RESULTS
Patients were classified according to the presence of ST segment depression (ST) and the troponin I test results (T) into three categories: group A, consisting of 34 patients with ST+/T+; group B, consisting of 84 patients with either ST+/T- or ST-/T+; and group C, consisting of 7 subjects with ST-/T-. This stratification correlated significantly with the extent of coronary artery disease (p=0.0004). Significant coronary artery stenosis was significantly more prevalent in patients from groups A and B than in C (p<0.002). No difference in the patients' medical history, apart from more frequent AMI within the past 10 days in group A (p=0.009) was found between groups.


CONCLUSIONS
Admission assessment of ECG and troponin I tests in patients with ACS may identify subjects with significant coronary artery disease, who are at high risk and could benefit from aggressive therapy.
Gil
Maciej
M
Medical Department, Eli Lilly Polska, Warsaw, Poland.
Zarebiński
Maciej
M
Adamus
Jerzy
J
D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000145:classification / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000097:blood / Q000145:classification / Q000175:diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D019210:Troponin I / Q000097:blood*
D019210:Troponin I