A study of platelet indices in acute coronary syndrome

Background: Current guidelines recommend early invasive intervention in NSTEMI only in the presence of high risk features.ECG has low sensitivity (70%) as around 30% of patients of NSTEMI have acute total occlusion.NSTEMI due to occluded culprit artery is associated with worse mortality than without total occlusion.Hence improved early risk stratification techniques is required for detection of ATO in NSTEMI for early invasive strategy.Previous studies in the non-Asian population have shown that global longitudinal strain, territorial longitudinal strain and territorial circumferential strain has shown to predict acute total occlusion.This study aimed to assess the role of speckle echocardiography in predicting acute total coronary occlusion in a patient presenting with NSTEMI in Indian population.Methods: This was a single-centre case-control study including 47 patients presenting with the first attack of acute NSTEMI.All included patients underwent transthoracic echocardiography including strain imaging followed by invasive coronary angiography.The study population was divided into 24 cases (NSTEMI with acute total coronary occlusion) and 23 controls (NSTEMI without acute total coronary occlusion).Results: Mean age of the patients was 58.7 years.Quantitative troponin, CKMB levels and BNP levels were not significantly different between the two groups.Mean heart rate of the patient, ST depression (atleast 1 mm ST depression in two consecutive leads), mean ST depression and T wave inversion were not different between the two groups.SYNTAX score was significantly higher in cases(median score of 19.5) than in controls(median score of 10) with p ¼ 0.007.Echocardiography showed no difference in ejection fraction and measures of diastolic function between the two groups.LV global longitudinal strain did not differ significantly between the two groups.The lowest mean longitudinal strain of any territory in a given patient was significantly lower in cases group compared to the control(8.1 vs. 11, p ¼ 0.04).The ROC lowest mean 2 longitudinal strain showed an area under the curve(AUC) of 0.74.A cut off value of -10.7 for lowest mean longitudinal strain had a sensitivity of 70.8% and specificity of 70% in detecting ATO.Conclusion: The lowest mean territorial longitudinal strain of -10.7 inpatient presenting with NSTEMI could predict acute total occlusion with a sensitivity of 70.8% and specificity of 70%.Demographic characteristics, ECG changes, biomarkers, left ventricular ejection fraction, global/territorial longitudinal strain or territorial circumferential strain did not help in predicting acute total occlusion.

Abstract licence: CC BY-NC-ND

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.