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Peak Versus Area Under the Curve of Cardiac Troponin I Values for Estimation of Infarct Size
Session:
Painel 6 - Doença Coronária 10
Speaker:
Pedro Teixeira Carvalho
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Pedro Teixeira Carvalho; Diana Vale Carvalho; Lisa Maria Ferraz; José Luís Costa Martins; Manuela Vieira; Mesquita Bastos; Ana Maria Briosa Neves; Vera Afreixo; Juliana Reis
Abstract
<p><strong>Background:</strong> Left ventricular ejection fraction (LVEF) is one of the most important variables to predict functional class and prognosis after myocardial infarction (MI) and relates to infarct size. Peak cardiac troponin I (cTnI) levels are frequently used in clinical practise as a prognostic marker after MI. However, it is affected by infarct type - ST/Non-ST elevation MI (STEMI/NSTEMI) - and whether angioplasty (PCI) was performed.</p> <p><strong>Objectives: </strong>The authors hypothesised that an estimate of total cTnI release during MI hospitalization, assessed by the area under the curve (AUC), would provide a better estimate than peak cTnI for infarct size, evaluated through LVEF at discharge.</p> <p><strong>Methods: </strong>We collected data regarding demographics, cTnI measurements and LVEF at discharge of consecutive MI patients admitted at our hospital. We excluded patients with severe wall motion abnormalities unrelated to the culprit vessel, prior LVEF<50% or history of previous MI causing wall motion abnormalities. Statistical analysis was performed in SPSS<sup>®</sup>, using Spearman’s rank correlation coefficient and ROC curves to assess which of the following better predicted LVEF: AUC of cTnI estimated by the trapezoid equation or peak cTnI. </p> <p><strong>Results: </strong>We included 42 STEMI and 72 NSTEMI consecutive patients. Median age was 64,5 years (IQ 56-75). 20,2% developed heart failure during hospitalization, median peak cTnI was 27 ng/mL (IQ 10-58) and median cTnI AUC was 1057 (IQ 398-2600). PCI was performed on 67% of patients (88% for STEMI and 52% for NSTEMI). Median LVEF at discharge was 58% (IQ 50-64%).</p> <p>There was a strong, negative correlation between AUC of cTnI and LVEF, which was statistically significant (r<sub>s</sub>=-.600, p=0,000). Peak cTnI had slightly weaker negative correlation, but also statistically significant (r<sub>s</sub>=-.544, p=0,000). ROC curves showed good accuracy of both AUC of cTnI (AUC: 0,869; CI: 0,774-0,964; p=0,000 – image 1) and peak TnI (AUC: 0,816; CI 0,714-0,918; p=0,000 – image 2) for prediction of LVEF<50%.</p> <p>However, when we analysed only patients who performed PCI, AUC troponin had a statistically significant negative correlation (r<sub>s</sub>=-0,599 ; p= 0,000) but peak cTnI did not (r<sub>s</sub>=-.227, p=0,197).</p> <p><strong>Conclusions:</strong></p> <p>Both peak cTnI and AUC cTnI give a good estimation of infarct size, evaluated through LVEF at discharge. However, AUC cTnI has a better performance for patients who had PCI, since these patients have higher peak values, which doesn’t always translate to reduced LVEF. Perhaps peak cTnI is too simple to evaluate infarct size in all MI patients. For instance, in the setting of primary PCI, there are other premises to account. AUC cTnI could be a useful clue in this setting.</p>
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