Acute coronary syndrome and cardiac biomarkers

Abstract

Introduction: Diagnosis of acute cardiac event in the early stage of its onset is of utmost important in the treatment process whereas the development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac Troponin I (cTnI) had made it possible. Given the possible complexities in establishing an early and accurate diagnosis of acute coronary syndrome (ACS), it is important for the clinician to use all available information, including the history, physical exam (PE), electrocardiogram (ECG), and cardiac biomarkers to formulate both the diagnosis of Acute coronary syndrome (ACS) and the overall assessment of patient prognosis and risk. Hence, the study was carried out to assess the clinical profiles of acute coronary syndromes and compare it with cardiac biochemical markers in Acute coronary syndrome (ACS) patients.

Methods: Hundred and eight consecutive cases of acute coronary syndrome (ACS), attending the Coronary Care Unit (CCU), of Tribhuvan University Teaching Hospital fulfilling the study criteria were taken for the present study. A record of physical findings was made and cardiovascular examination was done in each case. All the cases were scrutinized to a detail serial 12 lead electrocardiogram (ECG), serial cardiac biochemical markers- Troponin I (cTnI), Lactate dehydrogenase (LDH), aspartate transaminase (Serum Glutamate Oxaloacetate Transaminase, SGOT), and Creatine Kinase Myocardial Band (CK-MB), chest x-ray and laboratory test(e.g. Lipid profile, blood sugar), and echocardiographic study.

Results: Acute coronary syndrome was found to be more common in males (51%) than in females (49%). Ages ranged from 30 to 80 years. The common clinical presentations were chest pain (79%), palpitation (74%), sweating (71%), vomiting (45%), acute pulmonary oedema (6%), cardiac arrest (.9%) and (7%) presented with syncope. CKMB were high in about (64%), whereas troponin positive cases were (60%). (89%) presented with abnormal ECG findings, STEMI was diagnosed in (33%), NSTEMI in (29%), whereas (40%) was found to have UA. Main clinical profiles were diabetes (35%), hypertension (76%), and hyperlipidemia (61%), smoking (78%), alcoholic (47%) and family history of cad (57%), overweight (25%) while obesity (36%) and abnormal WHR (69%) respectively. There was significant correlation between clinical profiles and ECG, Creatine Kinase Myocardial Band (ck_mb), troponin and types of ACS, but a slight negative correlation was detected in profiles for WHR and troponin, and fasting hyperglycemia, education, gender, diabetes, hypertension, smoking, Chest pain, heart rate, WHR, and low HDL profile with types of ACS.

Conclusion: The outcome of this study showed that the majority are male, relatively younger as compared to Western population, have smoking and hypertension followed by diabetes as the major risk factors. USA and STEMI are the dominant types of ACS and the majority of patients are likely to have hypertension, IHD and diabetes in their families. Better control of risk factors and the awareness of preventive strategies are needed.