TROPONINS, EXCERSISE TESTS AND CORONAROGRAPHY ASSESSMENT OF THE SEVERITY IN ACUTE CORONARY SYNDROME

Dispite the advances in diagnostics and treatment in acute coronary syndrome (ACS), there is still a problem of undesirable events after ACS, which increases the chance of mortality by 10%. Verification of patient who may be candidates for these undesirable events is the basis for the prevention, treatment and decrease in mortality. One of the strategies which gives good results is a combination of monitoring of troponine levels, symptom-limited exercise tests and coronarography. The correlation of cardiac markers values in acute coronary syndrome and severity of coronary disease is estimated by exercise stress tests and coronarography, as well as by impact of the markers on therapy choice. The study enrolled 450 patients. Laboratory analysis involved troponin T and I (TnT, TnI), myoglobin, CK-MB and CK-MB mass. Ergometric and invasive examinations were done at the end of hospitalisation. There is a significant relation in positive exercise stress tests in troponin-positive patients, which is statistically significant. Analysis of exercise stress test showed statistically significant increase of positive findings in troponin-positive ones (p<0.05). Out of 104 coronarographies in the group with two diseased coronary vessels, there were 46,4% of Tn-positive, compared to 29% of troponin-negative patients, which can also be seen in the group with ≥3 diseased coronary vessels (3,2 vs 14,8%). Out of 104 coronarographied patients, 29 (8,1%) underwent PTCA, and 25 (7%) ACBG. Statistically significance occurred in choosing patients for PTCA in comparison to Tn status (p<0.05), which was not the case in the group selected for ACBG. In our research, a good diagnostic and prognostic troponin value was established and confirmed by statistically significant correlation of troponin values and exercise stress tests findings on discharge. They were a reliable indicator of degree and severity of coronarographic finding, as well as a guideline in choosing invasive strategy treatment. Acta Medica Medianae 2012;51(4):5-12.