The Role of Relative Troponin Change in Predicting Clinical Outcome and Critical Stenosis in Patients with Chest Pain

Abstract

Aim:Dynamic changes in troponin levels have been shown to be effective indicators of acute injury and useful for distinguishing acute injuries from chronic injuries. This study investigates the role of the change in troponin I (TnI) values in the prediction of acute myocardial infarction (AMI) and its relationship with the findings of percutaneous coronary angiographies.Materials and Methods:The patients included here were divided into two groups: a group of patients with AMI and a group of patients without AMI. The patients diagnosed with AMI were subsequently divided into two subgroups as those with and without critical stenosis. The relative troponin change in these patients was calculated as the percentage of the difference between the first and second troponin measurements; the second measurement was taken two hours later after admission.Results:The receiver operating curve analysis revealed that increases of more than 83.18% in ΔTnI were significant predictors of AMI and critical stenosis [sensitivity 45.24%, specificity 89.67%, area under the curve (AUC)=0.698 (95% confidence interval (CI): 0.639-0.752, p=0.001), sensitivity 56.00%, specificity 87.92%, AUC value of 0.681 (95% CI: 0.620-0.738, p<0.001), respectively].Conclusion:The ΔTnI value is a useful marker with high negative and positive predictive values for detecting AMI in patients admitted with chest pain. It can be beneficial as an adjunctive tool to predict the critical lesion, in conjunction with percutaneous angiography.

Keywords

• troponin
• acute myocardial infarction
• chest pain
• coronary stenosis
• outcome