Coronary features in septic patients with elevated cardiac troponin

Introduction
Cardiac troponin, which is frequently elevated in septic patients, represents a diagnostic challenge in everyday clinical practice.

Aim
To investigate coronary features in septic patients with elevated cardiac troponin I (cTnI) and mechanisms of myocardial infarction.

Material and methods
A single-center retrospective observational study was conducted in consecutive cTnI-positive septic patients undergoing coronary angiography during index hospitalization.

Results
From January 2012 to December 2022, 74 patients with peak cTnI 16647 ng/l (normal < 40 ng/l), peak C-reactive protein 234 mg/l (normal < 5 mg/l), peak procalcitonin 14 µg/l (normal < 0.20 µg/l), arterial lactate 5.1 mmol/l (normal < 2.0 mmol/l), and positive hemocultures in 39% were enrolled. Obstructive coronary disease (> 70% diameter stenosis) was documented in 65%, with multivessel involvement in 51%. Chronic total occlusion (CTO) was present in 35%, and > 50% unprotected left main (ULM) stenosis in 22%. Definite or possible acute culprit lesions were documented in 9.5% and 6.8%, respectively. The median SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score was 16 (25th and 75th IQR 0–34). Peak cTnI was significantly elevated in patients with a definite acute culprit lesion (67,659 ng/l) compared to a possible (18,422 ng/l; p = 0.030) or no acute culprit lesion (13,410 ng/l; p = 0.021). Only a weak, non-linear correlation between SYNTAX score and peak cTnI was documented (r2 = 0.088; p = 0.006).

Conclusions
Two-thirds of septic patients with elevated cTnI have obstructive coronary disease, with multivessel involvement in around 50%, significant ULM stenosis in 20%, and CTO in 40%. An acute culprit lesion, which is present in up to 10%, is associated with significantly elevated cTnI compared to patients with stable coronary disease.