Elevated troponin T levels and lesion characteristics in non-ST-elevation acute coronary syndromes.
BACKGROUND
Elevated troponin T levels in non-ST-elevation acute coronary syndromes (NSTE-ACS) have been shown to predict an adverse outcome. Furthermore, it has been reported that troponin T could help improve the effectiveness of such new antithrombotic drugs as platelet GPIIb/IIIa antagonists and low-molecular-weight heparins. We hypothesized that such elevated troponin T levels in NSTE-ACS indicate the presence of thrombus at culprit lesions, and this hypothesis was verified through the use of coronary angioscopy.


RESULTS
We studied 57 consecutive patients with NSTE-ACS who underwent preinterventional angioscopy. Before catheterization, we obtained blood samples to determine troponin positivity, and the patients were then classified as either troponin-positive or troponin-negative groups (diagnostic threshold, 0.1 ng/mL). Using angioscopy at the culprit lesions, we examined the presence of coronary thrombus, yellow plaque, and complex plaque. Moreover, we compared the preinterventional angiographic parameters (thrombus and complexity of the culprit lesion, and TIMI flow) between the two groups. Twenty-two patients were troponin-positive and 35 patients were troponin-negative. Univariate analyses indicated that the TIMI flow and the incidence of coronary thrombus detected with angioscopy correlate with the elevated troponin T levels. A multivariate logistic regression analysis showed the presence of coronary thrombus detected with angioscopy to be the only independent factor associated with elevated troponin T levels in patients with NSTE-ACS (odds ratio, 22.1; 95% CI, 2.59 to 188.42; P=0.0046).


CONCLUSIONS
Using angioscopy, the elevated troponin T levels in NSTE-ACS were confirmed to be strongly associated with the presence of coronary thrombus.
Okamatsu
Kentaro
K
Department of Internal Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Inba, Chiba, Japan.
Takano
Masamichi
M
Sakai
Shunta
S
Ishibashi
Fumiyuki
F
Uemura
Ryota
R
Takano
Teruo
T
Mizuno
Kyoichi
K
D000208:Acute Disease; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D017546:Angioscopy; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D013577:Syndrome; D020107:Troponin T / Q000097:blood*
D020107:Troponin T