High-Sensitivity Cardiac Troponin I Levels Below 99th Percentile Upper Reference Limit in Patients Presenting with Suspicion of Acute Coronary Syndrome (ACS) in Emergency Department at a Tertiary Care Hospital in Karachi, Pakistan

Kanani, Fatima; Zubairi, Adnan Mustafa; Zubairy, Maliha; Maqsood, Sidra

doi:10.1007/s40292-022-00532-7

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Studies in the local setting are somewhat preliminary. 6 7 Troponin has also been shown to be an independent predictor of all-cause of hospital mortality but should be measured only in those in whom there is a clinical indication, 8 as there are a number of non-ACS and non-cardiovascular causes of raised troponins. Hs-Troponin I values should be interpreted along with the clinical scenario in outlining management plans to safeguard against unnecessary therapeutic interventions with consequent multi-faceted implications for both the patient and institute.…”

Section: Discussionmentioning

confidence: 99%

Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan

et al. 2023

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Objectives Troponins are classically raised in acute coronary syndrome (ACS) although other cardiovascular and non-cardiovascular causes are recognized. We aimed to see the association of high sensitivity (Hs) Troponin I values exceeding the sex-specific 99th percentile upper reference limit (URL) with diagnoses, emergency department (ED) outcomes, 30-day outcomes of admitted patients and predictors of ACS in both genders. Materials and Methods A retrospective study of all patients presenting to the emergency department from January 2019 to April 2021 with suspicion of ACS and Hs-Troponin I values greater than the sex-specific 99th percentile URL. Statistical Analysis SPSS version 24 was used, Pearson's chi-square tests, Fisher's exact test, Kruskal–Wallis test, Mann–Whitney U test, and odds ratios, including the 95% confidence intervals, for each characteristic were used for analysis. A p-value of < 0.05 was considered significant. Results There were a total of 5,982 patients (3,031 males, 2,951 females), out of which 878 patients were admitted under the cardiology specialty. In patients who were admitted to the ward, mortality was higher in females (8.2%) with less than a 10-fold rise in Hs-Troponin I while similar in both genders (7.6%) in patients with Hs-troponin I greater than 10-fold of sex-specific 99th percentile URL. Raised low-density lipoprotein-cholesterol was a significant factor associated with 2.4 times higher odds of ACS. Conclusion Women with Hs-Troponin values up to 10 times the URL, i.e., 15.6–160 ng/L have higher mortality than their male counterparts. LDL-cholesterol is a significant risk factor for ACS which should be controlled for its prevention.

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Section: Discussionmentioning

confidence: 99%

Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan

et al. 2023

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“…ECG recordings and troponin I were tested for all the patients and a thorough history was obtained concurrently. Troponin I value equivalent to 12.8 ng/L was established as the cut-off level for diagnosing ACS [ 11 ]. For patients with a strong clinical suspicion of myocardial infarction (MI) but normal cardiac biomarkers, troponin I was serially recorded for up to 12 hours post-admission.…”

Section: Methodsmentioning

confidence: 99%

Risk Stratification of Acute-Onset Chest Pain: SVEAT Score Versus HEART and TIMI Scores

Shahid¹,

Malik²,

Kashif³

et al. 2023

Cureus

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IntroductionAcute chest pain is a frequently encountered symptom in the emergency department. Despite the availability of various chest pain risk scores, their effectiveness in identifying low-risk patients suitable for safe and early discharge is inadequate. Moreover, clinical data collected at the initial stage, which has valuable discriminatory ability, is often underutilized. This study aims to assess the effectiveness of the Symptoms, history of Vascular disease, ECG, Age, and Troponin I (SVEAT) score in predicting major adverse cardiovascular events (MACE) in acute-onset chest pain, compared with the pre-existing History, ECG, Age, Risk factors, and Troponin I (HEART) and Thrombolysis In Myocardial Infarction (TIMI) scores. MethodologyThis prospective study utilizing non-probability convenience sampling was conducted in the emergency medicine department of a tertiary care hospital in Rawalpindi, Pakistan, for a period of five months from July 2022 to November 2022. The study included patients aged >45 years who presented primarily with chest pain lasting for at least five minutes but less than 24 hours and with a lack of acute ECG changes indicative of ST-elevation acute coronary syndrome (STE-ACS). Patients who were hemodynamically unstable were excluded. All patients were assessed for the calculation of SVEAT, TIMI, and HEART scores. All patients were followed for a period of 30 days to assess the incidence of MACE. ResultsA total of 60 patients were included. The mean age was 61.5±9.1 years while 31 (51.7%) patients were females. Diabetes was the most prevalent comorbidity (n=32; 53.3%). Regarding MACE, nine (15%) patients developed ACS and underwent percutaneous coronary intervention (PCI). Two patients (3.3%) experienced heart failure. Six (10%) patients also underwent PCI in the absence of ACS while two (3.3%) patients developed sudden cardiac death. Area-under-curve (AUC) values were determined for SVEAT (0.843; 95%CI: 0.74-0.94), TIMI (0.742; 95%CI: 0.62-0.86), and HEART scores (0.840; 95%CI: 0.74-0.94). A cut-off level of 3.5 SVEAT points obtained a sensitivity of 63.2% and specificity of 75.6% in predicting 30-day MACE. ConclusionSVEAT score potentially lacks the appropriate sensitivity level to predict a significant number of major adverse cardiovascular events compared to contemporary risk stratification scores. Therefore, the SVEAT criteria need re-evaluation as a screening tool for risk assessment in acute chest pain.

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“…40 According to Kanani et al, greater hs-Troponin I readings were significantly linked to worse outcomes in the emergency room for both sexes; however, females had a higher inpatient mortality rate. 41…”

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confidence: 99%

Haematological Indices in Acute Coronary Syndrome Patients in Ethiopia: A Comparative Cross-Sectional Study

Tadesse,

Gudina,

Yilma

et al. 2024

JBM

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High-Sensitivity Cardiac Troponin I Levels Below 99th Percentile Upper Reference Limit in Patients Presenting with Suspicion of Acute Coronary Syndrome (ACS) in Emergency Department at a Tertiary Care Hospital in Karachi, Pakistan

Cited by 3 publications

References 22 publications

Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan

Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan

Risk Stratification of Acute-Onset Chest Pain: SVEAT Score Versus HEART and TIMI Scores

Haematological Indices in Acute Coronary Syndrome Patients in Ethiopia: A Comparative Cross-Sectional Study

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