Acta Medica Medianae
Klinika za kardiovaskularne bolesti Kliničkog centra
18000 Niš, Srbija
Copyright 2007 by Faculty of Medicine, University of Nis
CORRELATION OF SEVERITY OF ELECTROCARDIOGRAPHIC CHANGES AND TROPONIN LEVEL IN ACUTE CORONARY SYNDROME
Snezana Ciric-Zdravkovic, Svetlana Petrovic- Nagorni, Goran Koracevic, Miomir Randjelovic and Lazar Todorovic
Clinic of cardiovascular diseases Clinical Center of Niš
The patients with a wide variation of clinical course and subsequent cardiac events risks are classified within acute coronary syndrome (ACS). In order to select an appro-priate therapeutic approach, there is a need for precise diagnostics and risk evaluation of future cardiac events, so evaluation should be done early, based on available clinical electrocardiographic and sensitive and specific biomarkers.
The aim of the paper was to evaluate cardiac markers values in diagnostics of ACS, especially in the group UAP/NSTEMI, interconnections of ECG markers and cardiac troponin levels as well as their prognostic value.
In the examined population there were 333 patients involved. The total follow-up period was three months. Health control check-ups were performed in the 1st and 3rd month since discharge and they involved clinical examination, ECG, establisment of the course of the illness regarding recurrent angina, reinfarction revascularisation or percute interventions, as well as the results. Laboratory analysis involved troponin T and I (TnT, TnI), myoglobin, CK-MB and CK-MB mass. Most of the examined patients belonged to the group NSTEMI, that is 50%. Total number of male patients was 251 or 2/3, female patients 106 or 1/3. Mean age in male patients was 61,86±11,02 years, and in female patients 64,19±10,14 years. Although women were older about 2,33 years, that difference was not statistically significant (p>0,05).
Frequency and severity analysis of ST depression showed that most of the patients had ST depression (1mm and 2mm, each 21%), while in the subgroups depression was 3 and 4mm, which was present in 10%, and 5mm in 2,63%. There is a significant correlation between ST depression and positive TnT findings. In all the subgroups of patients with ST depression there was high, statistically significant, troponin level. About 40% of patients with T wave is TnT positive, and in Tnl that relation is more expressed and is up to 50% positive. Out of 220 patients with UAP/NSTEMI without Q-wave on admission, 18 or 8,18% patients developed Q-wave during hospitalisation. In 10 (13,51%) patients presented on admission as NSTEMI, new Q-wave was developed in TnI positive, while in the troponin negative group there were no Q-waves, what is statistically significant.
High sensitivity and specificity of troponin for diagnosing acute coronary syndrome, as well as their correlation with the rate of ST depression, changes in T wave and occurence of new Q-wave was proved. In our research troponin values were especially valuable in making the diagnosis of NSTEMI and in risk stratification. Acta Medica Medianae 2007; 46(2):9-15.
Key words: acute coronary syndrome, UAP, NSTEMI, troponin T, troponin I, ECG