Abstract:
When the initial ECG of patients suffering from acute chest pain is nondiagnostic,
it is difficult to arrive at a clinical diagnosis. Diagnosing NSTEMI and
differentiation from unstable angina (UA) requires serial electrocardiograms
(ECGs) and serial marker testing. Admitting all the patients diagnosing NSTEMI
and differentiation from UA of acute chest pain for serial investigations create a
high economic burden and risk of exceeding hospital capacity and limited
healthcare resources. Failure to make an early diagnosis can cause significant
morbidity and mortality. Cardiac troponins are cardiac-specific proteins detected
in high levels even in microscopic areas of myocardial necrosis. Cardiac Troponin
I is highly specific for myocardial tissues. In this study, we assessed the levels of
cardiac Troponin I as a marker for NSTEMI when an initial ECG is nondiagnostic.
We also assessed the potential of the cardiac troponin-I levels to
accurately exclude acute coronary syndrome (ACS) when an initial ECG is nondiagnostic.
ACS includes STEMI, NSTEMI, and UA. STEMI is diagnosed based
on ECG criteria. Descriptive analysis carried out by statistical methodology was
adopted for the study. Data were collected from 42 patients of which 36 were used
for analysis based on descriptive sampling. With informed consent, data from 36
patients were used for statistical analysis (SPSS). 22.2% were diagnosed with
NSTEMI from a single Troponin I result. HEART score was used to assess the
risk for Major Adverse Cardiac Event (MACE) for the next six weeks. If MACE
was more than 4%, further testing including repeat Troponin I, 2D-ECHO
cardiogram, exercise ECG, and cardiologist referral were recommended. Some of
them could still be NSTEMI on repeat testing few hours later depending on the
time of onset of chest pain). 61.1% were diagnosed with UA or non-cardiac chest
pain based on a combination of clinical evaluation, ECG, and single Troponin I
result. NSTEMI cannot be excluded on a single troponin I result which requires
clinical assessment and repeat troponin I. Therefore, troponin I levels can be used
to diagnose NSTEMI in patients with acute chest pain when the initial ECG is
non-diagnostic.
