Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(03): 409-418
DOI: 10.1055/s-0043-1761940
Original Article

Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan

Fatima Kanani 
1   Section of Chemical Pathology, Indus Hospital & Health Network, Karachi, Pakistan
,
Sidra Maqsood 
2   Indus Hospital Research Centre, Indus Hospital & Health Network, Karachi, Pakistan
,
Vandana Wadhwani 
3   Department of Cardiology, Indus Hospital & Health Network, Karachi, Pakistan
,
Maliha Zubairy
1   Section of Chemical Pathology, Indus Hospital & Health Network, Karachi, Pakistan
,
Imran Iftikhar
3   Department of Cardiology, Indus Hospital & Health Network, Karachi, Pakistan
,
Adnan Mustafa Zubairi
1   Section of Chemical Pathology, Indus Hospital & Health Network, Karachi, Pakistan
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Objectives Troponins are classically raised in acute coronary syndrome (ACS) although other cardiovascular and non-cardiovascular causes are recognized. We aimed to see the association of high sensitivity (Hs) Troponin I values exceeding the sex-specific 99th percentile upper reference limit (URL) with diagnoses, emergency department (ED) outcomes, 30-day outcomes of admitted patients and predictors of ACS in both genders.

Materials and Methods A retrospective study of all patients presenting to the emergency department from January 2019 to April 2021 with suspicion of ACS and Hs-Troponin I values greater than the sex-specific 99th percentile URL.

Statistical Analysis SPSS version 24 was used, Pearson's chi-square tests, Fisher's exact test, Kruskal–Wallis test, Mann–Whitney U test, and odds ratios, including the 95% confidence intervals, for each characteristic were used for analysis. A p-value of < 0.05 was considered significant.

Results There were a total of 5,982 patients (3,031 males, 2,951 females), out of which 878 patients were admitted under the cardiology specialty. In patients who were admitted to the ward, mortality was higher in females (8.2%) with less than a 10-fold rise in Hs-Troponin I while similar in both genders (7.6%) in patients with Hs-troponin I greater than 10-fold of sex-specific 99th percentile URL. Raised low-density lipoprotein-cholesterol was a significant factor associated with 2.4 times higher odds of ACS.

Conclusion Women with Hs-Troponin values up to 10 times the URL, i.e., 15.6–160 ng/L have higher mortality than their male counterparts. LDL-cholesterol is a significant risk factor for ACS which should be controlled for its prevention.

Keywords

acute coronary syndrome - myocardial infarction - non-ST-elevation myocardial infarction (NSTEMI) - cardiac troponin - LDL cholesterol - emergency department

Authors' Contributions

F.K. conceived the idea and designed the study. S.M. and V.W. analyzed and interpreted the patient data. F.K., and A.M.Z. did the initial drafting of the manuscript. I.I. and A.M.Z. revised critically afterward for important intellectual content. All authors read and approved the final manuscript.


IRB Consideration

IRB exemption was given before the start of the study (IRB number: IHHN_IRB_2021_12_017).




Publication History

Article published online:
04 April 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Thygesen K, Alpert JS, Jaffe AS. et al; ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40 (03) 237-269
    CrossrefPubMedGoogle Scholar
  • 2 Chapman AR, Lee KK, McAllister DA. et al. Association of high-sensitivity cardiac troponin I concentration with cardiac outcomes in patients with suspected acute coronary syndrome. JAMA 2017; 318 (19) 1913-1924
    CrossrefPubMedGoogle Scholar
  • 3 Herman DS, Kavsak PA, Greene DN. Variability and error in cardiac troponin testing: an ACLPS critical review. Am J Clin Pathol 2017; 148 (04) 281-295
    CrossrefPubMedGoogle Scholar
  • 4 Wu AHB, Christenson RH, Greene DN. et al. Clinical laboratory practice recommendations for the use of cardiac troponin in acute coronary syndrome: expert opinion from the Academy of the American Association for Clinical Chemistry and the Task Force on Clinical Applications of Cardiac Bio-Markers of the International Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem 2018; 64 (04) 645-655
    CrossrefPubMedGoogle Scholar
  • 5 Mueller C, Giannitsis E, Christ M. et al; TRAPID-AMI Investigators. Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emerg Med 2016; 68 (01) 76-87.e4
    CrossrefPubMedGoogle Scholar
  • 6 Bahadur K, Ijaz A, Salahuddin M, Alam A. Determination of high sensitive cardiac troponin I 99th percentile upper reference limits in a healthy Pakistani population. Pak J Med Sci 2020; 36 (06) 1303-1307
    CrossrefPubMedGoogle Scholar
  • 7 Kanani F, Zubairi AM, Zubairy M, Maqsood S. High-sensitivity cardiac troponin I levels below 99th percentile upper reference limit in patients presenting with suspicion of acute coronary syndrome (ACS) in emergency department at a tertiary care hospital in Karachi, Pakistan. High Blood Press Cardiovasc Prev 2022; 29 (05) 445-450
    CrossrefPubMedGoogle Scholar
  • 8 Docherty AB, Sim M, Oliveira J. et al. Early troponin I in critical illness and its association with hospital mortality: a cohort study. Crit Care 2017; 21 (01) 216
    CrossrefPubMedGoogle Scholar
  • 9 Vidali M, Verzotti E, Cabraz N. et al. “Real life use” of troponin in the emergency department: a survey of over 3000 cases. Biochem Med (Zagreb) 2015; 25 (03) 421-429
    CrossrefPubMedGoogle Scholar
  • 10 Marcusohn E, Epstein D, Roguin A, Zukermann R. Rapid rule out for suspected myocardial infarction: is the algorithm appropriate for all?. Eur Heart J Qual Care Clin Outcomes 2020; 6 (03) 193-198
    CrossrefPubMedGoogle Scholar
  • 11 Neumann JT, Sörensen NA, Ojeda F. et al. Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. PLoS One 2017; 12 (03) e0174288
    CrossrefPubMedGoogle Scholar
  • 12 Wassie M, Lee M-S, Sun BC. et al. Single vs serial measurements of cardiac troponin level in the evaluation of patients in the emergency department with suspected acute myocardial infarction. JAMA Netw Open 2021; 4 (02) e2037930
    CrossrefPubMedGoogle Scholar
  • 13 Thorsteinsdottir I, Aspelund T, Gudmundsson E. et al. High-sensitivity cardiac troponin I is a strong predictor of cardiovascular events and mortality in the AGES-Reykjavik community based cohort of older individuals. Clin Chem 2016; 62 (04) 623-630
    CrossrefPubMedGoogle Scholar
  • 14 Kaura A, Panoulas V, Glampson B. et al. Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres. BMJ 2019; 367: l6055
    CrossrefPubMedGoogle Scholar
  • 15 Lee KK, Noaman A, Vaswani A. et al. Prevalence, determinants, and clinical associations of high-sensitivity cardiac troponin in patients attending emergency departments. Am J Med 2019; 132 (01) 110.e8-110.e21
    CrossrefPubMedGoogle Scholar
  • 16 El-Menyar A, Zubaid M, Shehab A. et al. Prevalence and impact of cardiovascular risk factors among patients presenting with acute coronary syndrome in the middle East. Clin Cardiol 2011; 34 (01) 51-58
    CrossrefPubMedGoogle Scholar
  • 17 Omidi N, Sadeghian S, Salarifar M. et al. Relationship between the severity of coronary artery disease and cardiovascular risk factors in acute coronary syndrome: based on Tehran Heart Center's Data Registry. J Tehran Heart Cent 2020; 15 (04) 165-170
    PubMedGoogle Scholar
  • 18 Puri R, Mehta V, Duell PB. et al. Evidence for intensive LDL-C lowering for acute coronary syndrome: recommendations from the Lipid Association of India. J Clin Lipidol 2022; 16 (03) 261-271
    CrossrefPubMedGoogle Scholar
  • 19 Shah ASV, Griffiths M, Lee KK. et al. High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women: prospective cohort study. BMJ 2015; 350 (19) g7873
    CrossrefPubMedGoogle Scholar
  • 20 Desai S, Munshi A, Munshi D. Gender bias in cardiovascular disease prevention, detection, and management, with specific reference to coronary artery disease. J Midlife Health 2021; 12 (01) 8-15
    PubMedGoogle Scholar
  • 21 El-Menyar AA, Al Suwaidi J. Impact of gender in patients with acute coronary syndrome. Expert Rev Cardiovasc Ther 2009; 7 (04) 411-421
    CrossrefPubMedGoogle Scholar
  • 22 Alabas OA, Gale CP, Hall M. et al. Sex differences in treatments, relative survival, and excess mortality following acute myocardial infarction: national cohort study using the SWEDEHEART registry. J Am Heart Assoc 2017; 6 (12) e007123
    CrossrefPubMedGoogle Scholar