Troponina I y factores de riesgo como predictores enfermedad ateroesclerótica coronaria en pacientes con IAM sin elevación del ST en Bogotá 2010-2013
Thesis
SummaryIntroduction: Cardiovascular disease is a major cause of morbidity and mortality in both sex worldwide (1). In Colombia, during 2010, ocurred 26.334 deaths by acute myocardial infarction, becoming the first cause of death at national level (2).Objective: To determine risk factors associated with high-sensitivity troponin I as predictors of atherosclerotic coronary artery disease in patients with NSTEMI, with atherosclerotic coronary vascular changes demonstrated by coronoangiography in a population of patients admitted to the coronary care unit of a private clinic level III in Bogotá during 2010 to 2013.Methodology: An analytical observational retrospective study, case-control tipe, was proposed in a population with acute myocardial infarction without ST elevation who consulted the emergency department of a private hospital in Bogotá, in which the investigator wanted to assess the predictability of ultrasensitive troponin I for the diagnosis of atherosclerotic coronary disease determined by coronoangiography, and associated risk factors that may increase this predictability.Results: Of the 918 patients diagnosed with acute myocardial infarction without ST elevation, stratified by presence of atherosclerotic coronary disease ascertained by coronoangiografía. It was found that troponin I presented a sensitivity of 89% and specificity 18% for the diagnosis of coronary artery disease without ST elevation on admission to the emergency in a patient clinically diagnosed with non-ST elevation AMI. On the other hand, positive predictive value was 77 % and the negative predictive value was 35%. In our model, if a patient was elderly, had ultrasensitive troponin I, had history of diabetes mellitus , dyslipidemia , smoking, previous coronary disease, previous arterial occlusive disease, stent prior history, previous PCI and previous revascularization, this patient would present a risk of atheromatous disease of 99.56 %, while if a patient elderly, had ultrasensitive troponin I, had history of diabetes mellitus , dyslipidemia , smoking and previous arterial occlusive disease, this patient would present a risk for coronary artery disease of 92.49%. Additionally, the proposed model has a predicted probability of 0.828 evaluated by ROC curve.Conclusion: The predictability of troponin I to arteriosclerotic heart disease was acceptable. However, this predictability increases when risk factors such as be a man, advanced age, history of diabetes, history of smoking, history of coronary disease, previous arterial occlusive disease, stent prior history, previous PCI and previous revascularization.
