Muhammad Atif Raza, Abdul Rehman Abid, Nadeem Hayat Mallick.
Coronary artery disease in non-ST-elevation myocardial infarction: angiographic findings at raised troponin T levels.
J Cardiovascular Dis Jan ;8(3):91-5.

Objective: To determine the frequency of stenosis of various coronary arteries in patients with raised troponin-T levels in non-ST-elevation myocardial infarction. Patients and methods: This cross-sectional survey was conducted at Department of Cardiology, Punjab Institute of Cardiology Lahore from March 2009 to September 2009. Two hundred and fifty consecutive patients presenting with non-ST-elevation myocardial infarction admitted to the Punjab Institute of Cardiology Lahore were studied. Coronary angiography was performed in these patients before discharge. Any stenosis ≥50% was considered significant for coronary artery disease. Results: There were194(77.6%) males and 56(22.4%) females. Minimum age was 25 years, maximum was 75 years with mean age of 52.76±10 years. There were 87(34.8%) smoker, 74(29.6%) diabetics, 136(54.4%) hypertensives and 69(27.6%) patients were hyperlipidemics. The study population was divided into two groups, Group I, 111 (44.4%) patients with trop-T level 0.11-0.49ng/ml and Group II, 139(55.6%) patients with trop-T level ≥0.5ng/ml. There were 85(76.6%) males and 26(23.4%) females in Group I and among 139 patients in Group II, 109(78.8%) were males and 30(21.6%) females. Thiry four (30.6%) patients in Group I and 53(38.1%) in group II were smoker, 28 (25.2%) in Group I and 46(32.4%) in Group II were diabetic. Hypertension was the most common risk factor which was present in 63(56.8%) patients in Group I and 73(52.5%) in Group II where as hyperlipidemia was detected among 25(22.5%) patients in Group I and 44(31.7%) in group II. Left main-stem narrowing was detected in 3(2.7%) patients of Group I and 8(5.8%) of Group II. Left anterior descending artery disease was observed in 68(61.3%) patients in Group I and 114(82%) patients of Group II and it was most commonly involved artery. Left circumflex artery disease was present in 31(27.9%) and 96 (69.1%) patients in Group I and II respectively. Right coronary artery was second most commonly diseased vessel in 29(26.1%) patients in Group I and 95(68.3%) patients in Group II. Ramus-intermedius narrowing was observed in only 2(1.8%) and 6(4.3%) patients in Group I and II respectively. Where as 27(34.3%) patients in Group I and 117(84.2%) patients in Group II had multi-vessel coronary artery disease i.e. ≥50% stenosis of more than one artery. Conclusion: Patients with higher trop-T level have more number of coronary arteries involved on angiography i.e. more severe disease therefore patients with raised trop-T should be treated aggressively and be referred for invasive strategy earlier especially if trop-T levels are markedly elevated. Key words: Trop-T; Coronary angiography; Coronary artery disease; Non ST elevation MI; Multi-vessel disease.

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