Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit lesion in unstable angina

Background This study assessed the relation between the angiographic appear ance of the culprit lesion and cardiac troponin I (cTnI) or C-reactive prot ein (CRP) elevations within the First 24 hours in unstable angina. Intracor onary thrombus or a complex morphology, is frequently observed on angiograp hy in patients with unstable angina and is associated with a higher rate of spontaneous or coronary angioplasty-related complications. Biochemical par ameters related to myocardial injury leg, cTnI) or to systemic inflammation (eg, CRP) are known prognostic markers for clinical outcome and may help i n angiographic risk stratification to provide new adjunctive therapy. Methods and Results We studied 100 patients admitted for unstable angina wi th angiographically proven coronary artery disease (with normal creatine ki nase [CK] and CK-MB mass). Serum concentrations of cTnI (N < 0.4 ng/mL) and CRP (N < 3 mg/L) were measured at admission and 12 and 24 hours later. Mul tivariate analysis showed that elevated cTnI (greater than or equal to 0.4 ng/mL) within 24 hours (35 patients) was an independent predictor of an ang iographic appearance of the culprit lesion carrying a high risk of major ca rdiac events in the outcome and whether angioplasty is attempted (coronary thrombus, occlusion, or type C lesions; odds ratio 4.1, 1.6 to 10.5). cTnI levels at admission and CRP at 0, 12, and 24 hours were not predictive of h igh-risk angiographic anatomy. Conclusions In patients with unstable angina and angiographically proven co ronary artery disease, increased cTnI within 24 hours of admission but not increased CRP is associated with an angiographic appearance of the culprit lesion carrying a high risk of complication, especially in the event of ang ioplasty.