ArticleFrontiers in cardiovascular medicine2026
Angiographic prevalence of occlusion myocardial infarction and the limited value of serial troponin in patients with non-ST-segment elevation acute coronary syndrome.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: An estimated 25%-34% of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are diagnosed with an occluded culprit artery during catheterization. Whether early serial troponin kinetics discriminate angiographically defined occlusion myocardial infarction (OMI) in catheterized patients with NSTE-ACS remains uncertain. Methods: We conducted a single-center retrospective cohort study of 481 patients with NSTE-ACS who underwent coronary catheterization between 2017 and 2023. OMI was defined by a purely angiographic criterion: >90% culprit-vessel stenosis with Thrombolysis in Myocardial Infarction flow grade 0, 1, or 2. Seven contemporary sensitivity troponin I metrics (absolute values at 0, 3, and 6 h; deltas; and ratios) were evaluated by receiver operating characteristic analysis. Operating characteristics are reported with 95% confidence intervals (CIs) and likelihood ratios. Results: Ninety-eight patients (20.4%) met the angiographic definition of OMI. These patients were younger (median, 65.5 vs. 70.0 years; Conclusion: Among analyzable patients with NSTE-ACS undergoing catheterization, approximately one in five met the study-defined angiographic criteria for OMI. Early serial troponin kinetics showed only modest discrimination, and upper confidence bounds fell below levels expected of a standalone triage biomarker. Complementary strategies for identifying these patients, including expert ECG interpretation, warrant further study.
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