Abstract
Background: The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). The current cutoff point for Hs-troponin is highly sensitive but not specific for obstructive coronary artery disease (CAD). This study aims to determine the best cutoff point for diagnosing CAD in patients presented with NSTEMI. Methods: Our study included all patients admitted as NSTEMI that underwent coronary angiography (CAG). They were grouped into two groups: A and B. Group A has obstructive CAD of 70% or more stenosis and group B with non-obstructive CAD. Patients were assessed for their demographics, clinical history, laboratory and imaging results. Using SPSS version 22, the pooled cohort of patients were analyzed at significant level 0.05 and the data were tested for significant correlations between two predetermined groups. Results: Group A comprised 87.6% of the patients and both groups had a median age of 53 years. In Group A, 91% were males, 54% diabetics, 54% hypertensives, and median Hs-troponin was 145 ng/L. While in group B, 88% were males, 39% diabetics, 60% hypertensives, and median Hs-troponin was 54 ng/L. There was significant correlation between the two groups in the percentage of diabetes and median troponin level (p Conclusion: Hs-troponin is sensitive but less specific for obstructive CAD. However, increasing its cutoff value will improve its specificity.
Highlights
The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin)
This study aims to determine the best cutoff point for diagnosing coronary artery disease (CAD) in patients presented with NSTEMI
The receiver operating characteristic curve (ROC) analysis showed an Area Under the Curve (AUC) of 0.634 (0.51 - 0.751) with a p value of 0.03 at confidence interval of 95%
Summary
The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). Acute coronary syndrome with normal or near normal coronary arteries, commonly known as Myocardial Infarction/Injury with Non-obstructive Coronary Arteries (MINOCA), can be caused by many etiologies like coronary disorders, myocardial disorders, or non-cardiac disorders [1] [2] [3] These etiologies include: coronary spasm, microvascular dysfunction, myocarditis, hypertensive heart disease, stroke, sepsis, and pulmonary embolism [1] [4]. All these conditions result in rise of cardiac enzymes; the challenge arises in making a decision whether the patient is suffering myocardial injury, ischemic infarction requiring further cardiac intervention [1]. Research has shown that two third of patients with MINOCA present as NSTEMI [1] [3]
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