Clinical and echocardiographic data predict diagnosis in patients younger than 40 years admitted for chest pain and elevated troponin I levels
(2006) Société Belge de Médecine Interne — Location: Brussels (1.December.2006)
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- Abstract
- Introduction Cardiac specifi c troponin I (TnI) provides useful rapid diagnostic and prognostic information for patients with chest pain presumed to be ischemic in origin. However, elevated TnI levels and ST-segment modifi cation on electrocardiogram can be found in conditions other than acute coronary syndrome (ACS), especially myopericarditis (MP) in young patients. The purpose of the study was to prospectively evaluated simple combined criteria to rule out ACS, in patients younger than 40 years admitted for chest pain and elevated TnI levels, and therefore to avoid unnecessary invasive coronary angiography. Methods Sixty-nine consecutive patients younger than 40 years (62 males), were referred to our department and included in our database. On admission, 35 baseline clinical, biological, electrocardiographic and echocardiographic variables were compared to possibly discriminate ACS from MP. Coronary angiography was performed in 87% of the cases. Results Forty-nine patients with ACS were included and 20 were considered as MP (29%). Patients with ACS were older (38±3 vs 33±5 years, p<0.001), with more risk factors (smoking, hypercholesterolemia, hypertension, and family history). History of a recent fl u like syndrome (68% vs 0%), atypical (80% vs 19%) and breath-infl uenced (45% vs 2%) chest pain were more frequently (all p<0.001) found in the group of MP patients. Troponin and CK levels were not different in the 2 groups, in comparison of CRP levels higher in the group of MP patients (5.2±5.0 vs 1.8±0.7 ng/mL, p=0.03). At echocardiography, no abnormal segment contraction (67% vs 37%, p<0.05) and pericardial effusion (17% vs 0%, p<0.001) were found to be in favour of the diagnosis of MP. Five baseline variables (≤3 coronary risk factors, fl ulike syndrome, breath-infl uenced chest pain, pericardial effusion and no abnormal segment contraction at echocardiography) with the strongest prognostic performance, constituted a simple data score to discriminate ACS from MP. The presence of ≥3 criteria gives 100% specifi city and 59% sensitivity, and the presence of ≥2 criteria gives 86% specifi city and 94% sensitivity. Conclusion Simple data predict diagnosis of ACS in patients younger than 40 years admitted for chest pain and elevated troponin I levels. A fi ve variables score is found to be clinically useful in the triage of such patients and allow avoiding immediate unnecessary transfer for invasive coronary angiography.
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Hôpital de Jolimont
Citations
Kersten, V., Lanthier, N., Descamps, O., Semeria, S., Marcovitch, O., & de Meester, A. (2006). Clinical and echocardiographic data predict diagnosis in patients younger than 40 years admitted for chest pain and elevated troponin I levels. Acta Clinica Belgica, 61(5), 304. https://hdl.handle.net/2078.5/119266 (Original work published 2006)