High-sensitivity Troponin T as a predictor of coronary anatomic complexity due to SYNTAX score in patients with acute coronary syndrome without ST elevation

Abstract

High-sensitivity troponin T (HsTnT) and SYNTAX score (SS) are significant prognostic tools in patients with coronary heart disease. Knowing the coronary anatomy has an implication in patient management regarding antithrombotic strategy and revascularization. Objective: The aim of the study is to find an association between HsTnT and the severity and complexity of coronary anatomy measured by SS in patients with acute coronary syndrome without ST elevation (NSTEACS). Methods: We conducted an observational, descriptive, retrospective analysis in 1011 patients with diagnosis of NSTEACS between December 2013 and December 2016. Inclusion criteria required patients to have an available coronary angiography report. HsTnT was measured at hospital admission and repeated three hours later; the peak value was taken into account. Results: Of the studied population, the mean SS was 13.3. 86 patients (8.5%) had SS >32. Mean hsTnT at admission in the group with SS <32 was 15 (11-40) and hsTnT at 3 h was 17 (11-89), while in the group with SS>32 was 435 (258-756) and 657 (358-1026), respectively. In 104 patients, we observed left main coronary disease (10.3%) and in 168 multiple vessels disease (16.4%). The AUC of hsTnT as a predictor of complex coronary anatomy was 0.93. An hsTnT value of 280 ng / L was selected as the cut-off point for the prediction of high-risk STX, yielding 85% sensitivity and 86% specificity. In the multivariate analysis, hypertension OR 3.17 (CI 95%, 1.23 – 8.18; P = 0.017), ejection fraction OR 0.95 (CI 95%, 0.92 – 0.97; P = 0.001) and hsTnT OR 1.05 (CI 95%, 1.004 – 1.007; P = 0.001) show association. Conclusion: In patients with NSTEMI, hsTnT demonstrated a satisfactory performance for predicting complexity of the coronary anatomy evaluated by STX.