Association of Inflammatory and Hemostatic Parameters With Values of High Sensitive Troponin in Patients With Acute Coronary Syndrome

Abstract

Background: Acute coronary syndrome (ACS) includes a group of different clinical conditions resulting from acute ischemia and/or myocardial necrosis and may manifest as: unstable angina pectoris, acute myocardial infarction without and with ST-segment elevation on electrocardiography (ECG), or as sudden cardiac death. Their mutual differentiation is based, with clinical findings and ECG characteristics, on laboratory confirmation or exclusion of myocardial necrosis on the basis of obtained values of highly sensitive and specific cardiac troponins T or I. Troponin I is a widespread marker in clinical use that possesses almost 100% specificity for myocardial tissue and is used as a highly sensitive marker even in the case of microscopically small lesions of cardiac tissue necrosis.

Objective: To investigate the association of inflammatory and hemostatic parameters with values of high sensitive troponin I (hsTnI) in patients with acute coronary syndrome.

Methods: The prospective study included 82 patients with a clinical condition of acute coronary heart disease (stable angina pectoris 23, acute coronary syndrome 59, of which 35 had non-STEMI elevation infarction and 24 had ST-segment elevation infarction (STEMI). The values of hsTnI had been measured in all patients and correlated with values of inflammatory (c reactive protein-CRP, leukocytes, neutrophils, lymphocytes, neutrophil/lymphocyte ratio) and hemostatic (platelet counts, mean platelet volume-MPV) parameters.

Results: Patients with acute coronary syndrome had significantly higher values of hsTnI, and inflammatory parameters: CRP, leukocytes and neutrophils (absolute number and percentage) as well as the neutrophil /lymphocyte ratio compared to patients with stable angina pectoris. In patients with ACS, hsTnI has significantly correlated with CRP (r=0.5; p=0.00), leukocytes (r=0.3; p=0.020) and absolute neutrophil count (r=0.27; p=0.039). In patients with non-STEMI, a significant correlation was found between hsTnI and MPV (r=0.359; p=0.034), while in the STEMI group a significant correlation existed between hsTnI and CRP (r=0.422; p=0.40), and neutrophil /lymphocyte ratio (r =0.511; p=0.011).

Conclusion: Markers of inflammation may help in early risk stratification in patients with acute coronary syndrome.

Keywords: CRP; MPV; leukocytes; myocardial infarction; platelets.