Assessment of the prevalence of coronary artery disease in patients managed for supraventricular tachycardia with elevated troponinemia

Introduction

Supraventricular tachycardia (SVT) are frequently associated with elevation of blood troponin, but its clinical significance to determine possible coronary artery disease remains unclear. The aim of this study was to assess the prevalence of significant coronary artery disease (CAD) in patients admitted for SVT with troponin elevation.

Objective

The aim of this study was to assess the prevalence of significant coronary artery disease (CAD) in patients admitted for SVT with troponin elevation.

Method

This bicentric observational historical-prospective study, conducted at the Montpellier and Nîmes university hospital centers, included patients with SVT and anormal troponin and for whom coronary angiography was performed within one-month follow-up. The primary endpoint was the presence of significant CAD (CAD+) defined by coronary lesion more than 70% or 50% in case of positive FFR or more than 50% for the left main. The predictive value of troponin in favor of significant CAD was assessed using multivariate analysis. Procedural, hospital and clinical complications were assessed up to 6 months.

Results

The study included 131 patients. Of these, 57 patients were in the CAD+ group while 74 patients did not have significant CAD (CAD−). Patients with significant CAD had higher mean troponin levels than those in the CAD− group (495.56 ng/L vs. 167.54 ng/L). Among CAD+ patients, only 3 had an unstable coronary lesion with a peak troponin levels systematically above 1000 ng/L.

Predictive factors for significant CAD were troponin above 232, repolarization disorders on electrocardiogram, male gender and previous CAD before hospitalization. Significantly more complications were observed in patients with significant CAD (26.32% vs. 8.11%; p = 0.005). At 6-month follow-up, there was no difference in term of hospitalization for cardiac cause in the two groups (27.0% and 31.6% in CAD− and CAD+ groups respectively, p = 0.598) with only one stroke and one myocardial infarction in the CAD+ group.

Conclusion

In patients admitted for SVT, a significant coronary artery disease was more frequently observed in case of increased troponin with a higher predictive value of troponin above 232. An individualized approach, including patient history, chest pain and repolarization changes, is nevertheless necessary, particularly in cases of moderately elevated troponin levels.