Diagnostic and prognostic role of peak troponin T in patients with acute coronary syndromes and non-obstructive coronary arteries. (14th October 2021)

• Record Type: Journal Article
• Authors: Williams, M G L; Liang, K; De Garate, E; Spagnoli, L; Fiori, E; Lawton, C B; Dastidar, A; Johnson, T W; Biglino, G; Bucciarelli-Ducci, C
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA); Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.1494
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Up to 10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood. Purpose: The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA. Methods: Consecutive patients with a working diagnosis of MINOCA from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. Peak troponin T was identified during the index admission and divided into deciles and quartiles for analysis. The primary endpoint was all-cause mortality. Results: Among 796 patients undergoing CMR, 719 met the study criteria and had underwent a diagnostic quality scan. The peak Troponin T threshold for optimal diagnostic sensitivity and specificity was 211 ng/L. Peak troponin T ≥211 ng/L and time to CMR of ≤14 days has a sensitivity of 94%, specificity of 35%, PPV 57% and NPV 94% for the CMR making a diagnosis. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.65% (p<0.001, 95% CI 3.38 – 3.91; R2 0.84; Figure 1). If the troponin is in the lowest decile and the CMR is performed at ≤14 days, the diagnostic yield is still 72%. There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p=0.157), however mortality is significantly lower in the highest two troponin quartiles (6.9% versus 11.9%; p=0.009; Figure 2). Conclusion: Peak troponin T is readily available during the index admission in patients presenting with MINOCA and provides useful diagnostic and prognostic information for the attending cardiologist. Funding Acknowledgement: Type of funding sources: None.