Predictors of Peak Troponin Level in Acute Coronary Syndromes: Prior Aspirin Use and SYNTAX Score
Hemal A Bhatt1, Dharmesh R Sanghani1, David Lee1
1Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York.
Insights
Predictors of peak troponin in acute coronary syndrome (ACS) include ST-elevation myocardial infarction and coronary artery disease complexity. Daily aspirin use was linked to lower peak troponin levels in ACS patients.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Peak troponin levels are established predictors of cardiovascular mortality and adverse events.
- The relationship between peak troponin and cardiovascular risk factors, as well as coronary artery disease (CAD) severity and complexity, requires further elucidation.
Purpose of the Study:
- To identify predictors of peak troponin levels in patients diagnosed with acute coronary syndrome (ACS).
Main Methods:
- Retrospective review of cardiac catheterization reports and electronic medical records from 219 patients with ACS (2010-2013).
- Inclusion of major cardiovascular risk factors, comorbidities, laboratory data, cardiac catheterization indications, and coronary lesion characteristics.
- Application of univariate and multivariate regression analyses to assess associations.
Main Results:
- Multivariate analysis revealed ST-elevation myocardial infarction (p=0.001) and higher Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (p=0.002) as significant predictors of elevated peak troponin.
- A significant positive correlation was observed between SYNTAX score and peak troponin (r=0.257, p=0.001).
- Daily aspirin use was associated with lower peak troponin levels (p=0.002), while prior statin use and the presence of cardiovascular risk factors were not significantly associated.
Conclusions:
- Coronary artery disease severity and complexity, urgency of cardiac catheterization, and prior aspirin use are key determinants of peak troponin levels in ACS.
- These findings can aid in predicting ACS patient populations at higher risk for adverse cardiovascular outcomes associated with elevated peak troponin.
Abstract:
The peak troponin level has been associated with cardiovascular (CV) mortality and adverse CV events. The association of peak troponin with CV risk factors and severity and complexity of coronary artery disease remains unknown. We assessed the predictors of peak troponin in patients with acute coronary syndrome (ACS). This study aims to determine the predictors of peak troponin in ACS. Cardiac catheterization (CC) reports and electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 219 patients were eligible for the study. All major CV risk factors, comorbidities, laboratory data, CC indications, and coronary lesion characteristics were included. Univariate and multivariate regression analyses were done. On multivariate linear regression analysis, ST-elevation myocardial infarction (p = 0.001, β = 65.16) and increasing synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (p = 0.002, β = 1.15) were associated with higher peak troponin. The Pearson correlation between SYNTAX score and peak troponin was r = 0.257, p = 0.001. History of daily aspirin use was associated with lower peak troponin (p = 0.002, β = -24.32). Prior statin use (p = 0.321, β = -8.98) and the presence of CV risk factors were not associated with peak troponin. Coronary artery disease severity and complexity, urgency of CC, and prior aspirin use are associated with peak troponin levels in ACS. Our findings may help predict patient population with ACS who would be at a greater risk for short- and long-term CV morbidity and mortality due to elevated peak troponin.
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