Korean Circ J.  2003 May;33(5):385-392. 10.4070/kcj.2003.33.5.385.

The Clinical Significance of Elevated Troponin in Patients with Acute Coronary Syndrome with Normal Electrocardiogram

• Lim SY
• Jeong MH
• Bae EH
• Shim DS
• Lee SH
• Kim W
• Kim JH
• Park OY
• Park WS
• Ahn YK
• Cho JG
• Park JC
• Suh SP
• Ahn BH
• Kim SH
• Kang JC

• KMID: 2093876
• DOI: http://doi.org/10.4070/kcj.2003.33.5.385

Abstract

BACKGROUND AND OBJECTIVES
The level of cardiac specific troponin (cTn) may be important in patients with acute coronary syndrome (ACS), but with normal electrocardiography (ECG).
SUBJECTS AND METHODS
Three hundred and nineteen patients (61+/-11 years, M:F=212:107), with ACS and normal ECG, who underwent a diagnostic coronary angiogram (CAG), between July 2000 and June 2001, were analyzed according to their cTn level. The clinical characteristics, initial CAG findings and major adverse cardiac events (MACE), during a one-year clinical follow-up, were compared between positive and negative cTn groups.
RESULTS
Of the enrolled patients, 191 had a negative cTn (group A, 61+/-10 years, M:F=131:60), and 128 a positive cTn (group B, 60+/-11 years, M:F=81:47), and 176 (55.2%) were shown to have significant coronary artery stenosis on CAG. There were no significant differences in risk factors between the two groups. The mean left ventricular ejection fraction was 64+/-9%, and was lower in group B than in group A (59+/-10% vs. 67+/-7%, p<0.05). cTn positivity was associated with the percentage of significant coronary artery stenosis present (88% vs. 32%, p<0.05), a smaller minimal luminal diameter (1.09+/-0.44 mm vs. 2.68+/-0.33 mm, p<0.05) and a larger diameter of stenosis (68+/-6% vs. 44+/-6%, p<0.05). A multi-vessel lesion was more common in group B than in group A (58.3% vs. 30.3%, p<0.05). During the one-year follow-up period, 36 patients developed MACE, resulting in 3 deaths, 7 acute myocardial infarctions and 34 patients with restenosis. MACE was observed in 9 patients of group A and in 27 of group B (4.7% vs. 21.1%, p<0.05).
CONCLUSION
The troponin levels are valuable for the early diagnosis, and prediction of the long-term prognosis, in patients with ACS and a normal ECG.

Keyword

Coronary disease; Electrocardiography; Angina, unstable; Myocardial infarction; Coronary stenosis; Troponin; Prognosis

MeSH Terms

Acute Coronary Syndrome*
Angina, Unstable
Constriction, Pathologic
Coronary Disease
Coronary Stenosis
Early Diagnosis
Electrocardiography*
Follow-Up Studies
Humans
Myocardial Infarction
Phenobarbital
Prognosis
Risk Factors
Stroke Volume
Troponin*
Phenobarbital
Troponin