scholarly journals Elevated Troponin I Levels in Diabetic Ketoacidosis Without Obstructive Coronary Artery Disease

2018 ◽  
Vol 2 (9) ◽  
pp. 1020-1023 ◽  
Author(s):  
Ajaydas T Manikkan
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Ketoacidosis ◽  
Troponin I ◽  
Wide Spectrum ◽  
Present Report ◽  
Prognostic Significance ◽  
Elevated Troponin ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Elevated troponin levels have been observed in a wide spectrum of patients who do not have ischemic heart disease, including nonacute coronary syndrome and cardiovascular and noncardiovascular conditions. The cases of two patients with diabetic ketoacidosis who had elevated troponin levels in the absence of coronary artery disease are presented. This clinical scenario can pose a diagnostic dilemma for the physician. The objective of the present report is to highlight the mechanism of troponin elevation in patients with diabetic ketoacidosis, in addition to the clinical and prognostic significance of this finding.

scholarly journals Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

2009 ◽  
Vol 55 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Kai M Eggers ◽  
Allan S Jaffe ◽  
Lars Lind ◽  
Per Venge ◽  
Bertil Lindahl
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Reference Population ◽  
Cardiac Troponin I ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background: The aim of this study was to evaluate factors influencing the 99th percentile for cardiac troponin I (cTnI) when this cutoff value is established on a highly sensitive assay, and to compare the value of this cutoff to that of lower cutoffs in the prognostic assessment of patients with coronary artery disease. Methods: We used the recently refined Access AccuTnI assay (Beckman-Coulter) to assess the distribution of cTnI results in a community population of elderly individuals [PIVUS (Prospective Study of the Vasculature in Uppsala Seniors) study; n = 1005]. The utility of predefined cTnI cutoffs for risk stratification was then evaluated in 952 patients from the FRISC II (FRagmin and Fast Revascularization during InStability in Coronary artery disease) study at 6 months after these patients had suffered acute coronary syndrome. Results: Selection of assay results from a subcohort of PIVUS participants without cardiovascular disease resulted in a decrease of the 99th percentile from 0.044 μg/L to 0.028 μg/L. Men had higher rates of cTnI elevation with respect to the tested thresholds. Whereas the 99th percentile cutoff was not found to be a useful prognostic indicator for 5-year mortality, both the 90th percentile (hazard ratio 3.1; 95% CI 1.9–5.1) and the 75th percentile (hazard ratio 2.8; 95% CI 1.7–4.7) provided useful prognostic information. Sex-specific cutoffs did not improve risk prediction. Conclusions: The 99th percentile of cTnI depends highly on the characteristics of the reference population from which it is determined. This dependence on the reference population may affect the appropriateness of clinical conclusions based on this threshold. However, cTnI cutoffs below the 99th percentile seem to provide better prognostic discrimination in stabilized acute coronary syndrome patients and therefore may be preferable for risk stratification.

scholarly journals Difference in the Mortality Between Weekend and Non-Weekend Coronary Artery Disease Admissions

2017 ◽  
Vol 02 (01) ◽  
pp. 036-041
Author(s):  
M. Sandeep ◽  
K. Satish
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Risk Score ◽  
Wide Spectrum ◽  
P Value ◽  
Coronary Artery Diseases ◽  
Coronary Syndrome ◽  
Artery Disease

AbstractBackground: Acute coronary syndrome requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week. So, we sought to examine the effects of admission on clinical outcomes in patients with wide spectrum coronary artery diseases.Methods: A retrospective analysis of ICCU Inpatient sample database of 17 months from 2015 to 2016 used to compare differences in in-hospital mortality between patients admitted on a non-weekday versus weekend for wide spectrum ACS which include STEMI, NSTEMI and unstable angina and patients with cardiogenic shock. Out of these 75% had higher TIMI risk score (5-7).Results: Total 2700 patients with ACS were included in the present study with wide spectrum coronary artery diseases. Out of that 20 % (n=541) were admitted in weekends and 79.9% (n=2159) were admitted in non-weekends. Total 804 females admitted on non-weekend had a mean age of 61.05±12 years and 162 females admitted on weekend had mean age 58.5±13.3 years (p value=0.025). Out of 2159 admitted on non-weekend, 1355 were males with mean age of 57.65±15.55 years and 379 were males admitted on weekend out of 541 patients with mean age of 56.85±13.1 years (p value =0.314). In-hospital mortality rate of these patients admitted on non-weekends was 9.4% (n=204) and those admitted on weekends was 5.9% (n=32) with statistically significant difference (95% CI; p= 0.003). The mortality rate of ACS without STEMI in non-weekend group was 8.6% (n=170) which was statistically significant (p = 0.006) with mortality of weekend group 5.3% (n=26).Conclusion: Our study shows that there is no added mortality in patients with coronary artery disease on weekend days compared with non-weekend days. As the patients admitted during non-weekend were elder and sicker than the weekend admissions (having the high risk score), the in-hospital mortality is higher on non-weekends. Efforts to improve health care system should ensure comparable outcomes for patients irrespective of time of hospital admission.

scholarly journals Elevated Troponin I in the Absence of Coronary Artery Disease: A Case Report With Review of Literature

2015 ◽  
Vol 7 (10) ◽  
pp. 820-824 ◽  
Author(s):  
Sabrina Arshed ◽  
Hong Xiu Luo ◽  
Shoaib Zafar ◽  
Kalyani Regeti ◽  
Nilma Malik ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Case Report ◽  
Coronary Artery ◽  
Troponin I ◽  
Review Of Literature ◽  
Elevated Troponin ◽  
Artery Disease

Abstract 157: Use of a Novel Risk Score in the Emergency Department Discriminates Acute Coronary Syndrome Among Chest Pain Patients with Known Coronary Artery Disease

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Matthew T Crim ◽  
Frederick K Korley ◽  
Scott A Berkowitz ◽  
Mustapha Saheed ◽  
Jason Miller ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Chest Pain ◽  
Risk Score ◽  
Troponin I ◽  
Elevated Troponin ◽  
Ecg Changes ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Background: Patients with known coronary artery disease (CAD) presenting to the Emergency Department (ED) with chest pain thought to be of ischemic origin are often admitted to the hospital, yet less than half are eventually diagnosed with acute coronary syndrome (ACS). We assessed whether the use of a novel risk score in the ED could discriminate which of these high-risk patients actually do or do not have ACS. Methods and Results: Chart review was performed on a prospectively defined cohort of 142 patients with known CAD presenting to the ED with chest pain thought to be of ischemic origin, all of whom were admitted to the hospital from December 2012 to April 2013. Known CAD was defined as history of myocardial infarction, PCI, CABG, angiographic coronary stenosis >50%, or a positive stress test. Troponin I was measured using the Beckman Coulter assay. Variables were assessed with logistic regression for their association with ACS as determined by the inpatient attending physician at hospital discharge. The cohort included 59 women (42%) and 90 African American individuals (63%). One-hundred sixteen patients (82%) had a history of revascularization (104 PCI, 53 CABG, 41 both). ACS was eventually diagnosed in 43 (30%) of the patients. Non-ACS patients had a 2.8 day average length of stay and $9,908 average inpatient (post-ED) hospital charges (not including physician fees), which is $980,926 for the 99 (70%) non-ACS patients. A novel risk score, including (1) elevated troponin I (>0.05 ng/mL) in the ED, (2) dynamic ECG changes in the ED, (3) body mass index (BMI), (4) home aspirin use, (5) age older than 65, (6) history of chronic kidney disease (CKD), and (7) associated illness at presentation to the ED (anemia, arrhythmia, hypertension, infection, COPD exacerbation, diabetic ketoacidosis or hyperosmolar hyperglycemic state), discriminated ACS and non-ACS with an area under ROC curve (AUC) of 0.829. In the multi-variable regression, troponin I elevation was the most predictive of ACS (OR 7.22, p <0.001), followed by home aspirin use (OR 6.07, p 0.036), age older than 65 (OR 4.06, p 0.012), dynamic ECG changes (OR 2.68, p 0.046), and BMI (OR 1.09, p 0.008). The presence of an associated illness was associated with decreased likelihood of ACS (OR 0.24, p 0.013), as was CKD (OR 0.17, p 0.008). Conclusions: A novel risk score including elevated troponin I in the ED, dynamic ECG changes in the ED, body mass index, home aspirin use, age older than 65, history of chronic kidney disease, and associated illness at presentation to the ED, is a valuable tool for discriminating between ACS and non-ACS among patients with known CAD presenting to the ED with chest pain. This preliminary analysis provides a foundation for larger and prospective studies for validation. Application of this risk score, along with other clinical factors, may reduce the number of potentially avoidable admissions and associated costs.

scholarly journals Case report of a 66-year-old woman with atypical takotsubo syndrome and concomitant coronary artery disease

2020 ◽  
Vol 13 (2) ◽  
pp. e230164 ◽  
Author(s):  
David Niederseer ◽  
Jelena Rima Ghadri ◽  
Robert Manka ◽  
Christian Templin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Takotsubo Syndrome ◽  
Elevated Troponin ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Concomitant Coronary Artery Disease

Takotsubo syndrome is increasingly recognised worldwide. As both, takotsubo syndrome and acute myocardial infarction can present with similar findings, including chest pain, elevated troponin and creatine kinase, it is often difficult to differentiate these conditions. Here, we present a challenging case that illustrates (1) difficulties to diagnose takotsubo syndrome in the presence of a significant coronary artery stenosis; (2) how takotsubo syndrome could be misdiagnosed as acute coronary syndrome if diagnostic workup does not include echocardiography or left ventriculography; (3) the importance of cardiac MRI which can contribute to the diagnosis of takotsubo syndrome.

Coronary artery spasm in a 15-year-old male in diabetic ketoacidosis

2021 ◽  
pp. 1-3
Author(s):  
Danielle Strah ◽  
Michael Seckeler ◽  
Jenny Mendelson
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Diabetic Ketoacidosis ◽  
Coronary Artery Spasm ◽  
Elevated Troponin ◽  
St Segment ◽  
Artery Disease

Abstract Coronary artery disease and myocardial infarction are known complications of long-standing diabetes mellitus in adults, but coronary artery spasm is far more rare and has not been reported in children. We present a 15-year-old male in diabetic ketoacidosis who developed diffuse ST segment elevations and elevated troponin with normal coronary arteries on coronary angiography and no signs of pericarditis that was due to coronary artery spasm.

scholarly journals The Management of Coronary Artery Disease in Ethiopia: Emphasis on Revascularization

2021 ◽  
Vol 31 (2) ◽  
Author(s):  
Bekele Alemayehu Shashu
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiovascular Diseases ◽  
Angina Pectoris ◽  
Troponin I ◽  
Obstructive Coronary Artery Disease ◽  
Pathological Process ◽  
Coronary Syndrome ◽  
Artery Disease

Cardiovascular diseases are number one cause of death worldwide. Over half of the cardiovascular diseases, 51%, are due to coronary artery disease. Coronary artery disease is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial coronary arteries. Rupture of the fibrous cap of the plaque causes the majority of the deaths due to myocardial infarction. Angina pectoris is a discomfort in the chest or adjacent areas caused by myocardial ischemia usually precipitated by exertion. In acute coronary syndrome, the chest discomfort is either of low threshold or appears at rest and when it evolves on the background of established angina pectoris, the discomfort becomes more frequent and prolonged. Exercise electrocardiography which has been the most frequently used non-invasive test to diagnose obstructive coronary artery disease is currently shown to have inferior diagnostic performance compared with diagnostic imaging tests. The pivotal tests in patients presenting with clinical features of acute coronary syndrome are electrocardiography and determination of serum troponin I and/or T. Revascularization is the mainstay of treatment in patients with acute coronary syndrome. In chronic coronary syndrome, on top of optimal medical treatment, revascularization reduces mortality in:- 1) left main stenosis, 2) three-vessel coronary artery disease, particularly with ejection fraction of less than 40%, 3) two vessel disease with more than 75% stenosis of the proximal left anterior descending coronary artery disease.

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