Correlation between Complexity of Coronary Lesions and Significant Delta High-Sensitivity Troponin I Levels in Patients with Non-ST Elevation Myocardial Infarction

Abstract

Introduction: The role of high-sensitive cardiac troponin (hs-cTn) assays has higher analytical precision at lower concentrations to detect myocardial injury. The changes in troponin concentration between two assays conducted within a specified time interval refers to “Delta troponin”. This study aimed to assess the correlation between the complexity of coronary lesions and significant delta high-sensitivity troponin I levels in patients with non-ST elevation myocardial infarction. Methods: This cross-sectional study was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from July 2022 to June 2023. A total of 70 patients with significant delta hs-cTnI were included and divided into two groups: Group-A (n = 36) with a delta hs-cTnI rise between >20% to 49%, and Group-B (n = 34) with a delta hs-cTnI rise ≥ 50%. Coronary angiography was performed and the SYNTAX Score was calculated for both groups. Data were collected using SPSS version 25.0. Result: Patients with a high-rise delta cTnI (≥50%) showed a significantly higher proportion of lesions in major coronary arteries LCx and LAD compared to those with a low-rise of cTnI (20% - 49%) (p = 0.007 and 0.004, respectively). The presence of triple vessel diseases was higher in the former group than in the latter (p < 0.001). The SYNTAX score was significantly higher in the high-rise delta hs-cTnI group (p < 0.001). Furthermore, 32.4% of patients with a high-rise delta cTnI had a SYNTAX score > 22, compared to none in the low-rise group (p < 0.001). There was a moderately significant linear correlation between delta hs-cTnI and SYNTAX score (p = 0.001). Conclusion: A high rise in delta hs-cTnI is linked to higher SYNTAX scores, signifying complex coronary lesions in NSTEMI patients, with a significant linear correlation between them. Patients with a high rise in delta cTnI may exhibit more significant coronary artery lesions and triple vessel diseases compared to those with a low rise in cTnI.