SPC365

High-sensitivity Troponin I peak in MINOCA – a useful tool in the right clinical context?

Session: SESSÃO DE POSTERS 33 - DOENÇAS CARDIOVASCULARES - MINOCA E SÍNDROME DE TAKOTSUBO
Speaker: Catarina Lagoas Pohle

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type: Cartazes
FP Number: ---
Authors: Catarina Lagoas Pohle; Jéni Quintal; Rui Antunes Coelho; Patrícia Bernardes; David Campos; Marco Tomaz; Catarina Sá; Ana Fátima Esteves; Filipe Seixo
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined by a clinical diagnosis of Myocardial Infarction (MI) and exclusion of <span style="color:black">significant epicardial stenosis</span> on coronary angiography. In the presence of clinical suspicion, the decision to perform coronary angiography is based on biomarker levels.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To evaluate if high-sensitivity troponin-I (hsTnI) in patients with myocardial infarction and elevated cardiac biomarkers has a good discriminative power to predict MINOCA.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A retrospective analysis of consecutive AMI patients who underwent coronary angiography admitted to the Cardiology Department from November 2021 to October 2022 was conducted.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We analysed demographic and cardiovascular risk factors, initial and peak hs-TnI, index-hospitalization data and evaluated the presence of significant coronary artery stenosis at coronary angiography. Univariable and multivariable analysis was performed to obtain the Odds Ratio (OR, 95% CI, p-value) for significant coronary artery disease (CAD). ROC curve and area under the curve (AUC) were obtained to determine the discriminative power of peak hsTnI as predictor of a positive coronary angiography. Optimal cut-point value was obtained (Youden index) and patients were divided according to this value.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 375 patients (72.0% males) with a mean age <span style="color:black">of 66.4 &plusmn; 12.3 years </span>were submitted to coronary angiography. MINOCA was present in 18 patients (4.8%). When comparing patients with or without significant CAD at coronary angiography, the groups differed in relation to male sex (p=0.033), regional wall motion abnormalities at admission (p=0.039) and peak hsTnI (p=0.001). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Optimal cut-point value for predicting the presence of significant coronary artery stenosis at coronary angiography was a peak hsTnI of 7010 pg/mL (AUC 0.724, p-value 0.001, 95% CI 0.593-0.855). The characteristics of the two groups are described in Table 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the hsTnI &gt;7010 group, mean age was 65.6 <span style="color:black">&plusmn; 12.9 years and 61% were male; 58% had a diagnosis of hypertension, 55% had dyslipidemia, 55% had type 2 diabetes mellitus and 66% were smokers. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The two groups differed significantly in the presence of dyslipidemia (p= 0.033), type 2 Diabetes mellitus (p=0.033), and presence of regional wall motion abnormalities at admission (p&lt;0.001) (see table).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">After adjustment, peak hsTnI &gt;7010 pg/mL was the only independent predictor of significant CAD (OR 4.732, 95% CI 1.469-15.243, p-value 0.009). </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the right clinical context where there is high suspicion for MINOCA, decision to perform and/or timing of coronary angiography could be based on peak hsTnI values. In this population, patients with hsTnI &lt; 7010 pg/mL without established cardiovascular risk factors, namely dyslipidemia and type 2 diabetes mellitus and without region wall motion abnormalities at admission, are more likely to have MINOCA.</span></span></span></p>