Baseline Highly Sensitive Troponin T And Outcome Prediction In Adults With Acute Coronary Syndrome Treated At The Aga Khan University Hospital-Kenya

Abstract

Background: WHO (2017) report indicates that (CVD) is a major concern worldwide and accounts for approximately 10% mortality and 30% morbidity and nearly half of all these deaths are due to ACS. ACS is divided into ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina. The term acute myocardial infarction (AMI) is used in reference to STEMI and NSTEMI and develops when there is an imbalance between demand in oxygen and supply in the heart muscle. Cardiac troponin assays have evolved over the years and is marked with significant improvement in analytical sensitivity that has enabled the measurement of very low concentrations of Troponin as seen in healthy individuals that was previously not possible. Data on the utility of HsTnT assays is scarce from the African continent. The time from onset of symptoms to initial troponin testing impacts on the baseline levels and is an important consideration when interpreting the evolution of troponin levels. Objectives: We wanted to determine if baseline HsTnT is a useful predictor of in-hospital mortality among patients with ACS seen at AKUH-N. We also wanted to determine the relationship between known risk factors for CVD and baseline HsTnT levels. Finally, we wanted to determine the association of time to presentation on baseline hsTnT levels. Methods: A cross sectional study Design looking at clinical and laboratory data for patients diagnosed with ACS at the AKUH-N between January 2012 to December 2013. The data was retrieved from the hospital information system and chart reviews where necessary. Results: 196 patients were in the final analysis. Patients included were 29 - 89 years. 44% had a diagnosis of STEMI, about 40% had NSTEMI diagnoses and 16% diagnosed with unstable xiii ungina (UA). 16.8% had normal baseline troponin T levels while 83.2%had elevated baseline troponin T levels. Duration of symptom onset to presentation in patients with STEMI was 1-3 hrs 66.7% while for NSTEMI/UA majority took more than 24hrs to present 70.1%. 12 (6.1%, 95% CI: 2.8%-9.5%) died while in hospital and 24 (12.2%, 95% CI: 7.7%- 16.8%) died after discharge. Troponin T level was found to have no statistically significant effect (RR=1.00, 95% CI 0.99-1.00) on the risk of mortality among ACS patients at 0.05 level of significance. CVD risk factors as well as baseline hsTnT levels had no statistically significant effect on the risk of mortality among ACS patients. Conclusion : Even though there was no sufficient evidence to conclude that baseline hsTnT was a statistically significant predictor of mortality in this study, previous studies indicates that in patients with ACS, hsTnT levels provides useful prognostic information and permits early identification of patients with increased risk of mortality. (Reichlin, T et al 2009).