SYNOPSIS

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

“Role of Serum Uric Acid, C-reactive protein and troponin T as prognostic indicators in patients of Acute Coronary Syndrome.”

Name of the candidate : Dr. Hiremath Sourab

Guide : Dr (Col) R. Arunachalam

Course and Subject : M.D (General Medicine)

Department of General Medicine,

Father Muller Medical College,

Kankanady, Mangalore – 575002.

September – 2011

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF THE SUBJECT FOR

DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

DR.HIREMATH SOURAB.

P.G. RESIDENT

FR. MULLER MEDICAL COLLEGE,

KANKANADY,

MANGALORE – 575002.

2. NAME OF THE

INSTITUTION

FR. MULLER MEDICAL COLLEGE,

KANKANADY,

MANGALORE – 575002

3. COURSE OF STUDY AND

SUBJECT

M.D. (GENERAL MEDICINE)

4. DATE OF ADMISSION TO

COURSE

30-05-2011

5. TITLE OF THE TOPIC :

“Role of Serum Uric Acid , C-reactive Protein and troponin T as prognostic indicators in patients of Acute Coronary Syndrome”.

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6. Brief Resume of the Intended Work:

6.1. Need for the study:

Cardiovascular disease is responsible for 30% of all deaths in the world. About 80% of the

global burden of cardiovascular disease deaths occur in low and middle income countries. India

carries a significant portion of this cardiovascular disease burden .India suffers one of the highest

cardiovascular disease case fatality rates in the world according to an international registry

(OASIS) comparing the outcome among patients of Acute Coronary Syndrome.1

Until now various bio-markers have been studied in patients of Acute coronary syndrome.

However, no single marker gives definite prognostic information during the course of the disease.

Little information is available about the role of different individual bio markers .Hence a

comparative study is attempted using 3 easily measured ,broadly available bio-markers namely

serum Uric Acid, troponin-T and C reactive protein targeting different risk indicators like purine

metabolism, cardiac myocyte injury and inflammation.

Acute coronary Syndrome encompasses MI(STEMI and NSTEMI) and Unstable Angina .

Diagnostic criteria.2, 3

1. Chest discomfort (with or without radiation to the arms, back , neck jaw or epigastrium)

or anginal equivalents such as shortness of breath, diaphoresis or extreme fatigue.

2. 12 lead ECG with ST segment elevation in STEMI and ST segment depression or

prominent T wave inversion or absence of ST segment Elevation with positive

biomarkers of necrosis(troponin T) for NSTEMI

3. Elevated cardiac bio markers like troponin-T.

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6.2 Review of Literatu6.2 Review of literature

Peter A. Kasak and group measured CRP in 446 emergency department patients with

acute coronary syndromes. All-cause mortality and hospital discharges for acute myocardial

infarction and congestive heart failure were obtained for period of eight years following the event.

Kaplan-Meier analyses indicated that the patients with CRP concentrations above the American

Heart Association scientific statement cut off 10 mg/dl had a higher rate of death and CHF

admissions .Study concluded that patients presenting early with chest pain with elevated CRP

concentrations have a greater long term risk for death and heart failure.4

MY Nadkar and V I Jain studied 100 patients with acute myocardial infarction and 50

controls. Serum uric acid level was measured on day 0,3 and 7 of MI. On all the days serum uric

acid levels were higher in patients who were in higher Killip class. Study concluded that serum

uric acid levels are higher in patients of acute myocardial infarction correlated with Killip

classification.5

S.M.N.A Nadeem K and group studied 255 consecutive patients admitted with diagnosis

of unstable angina and non STEMI . All patients had a baseline troponin T estimation done and

repeated twelve hours later in case of an initial negative result. . Study concluded that positive

troponin T in patients with UA/NSTEMI is a strong , independent risk predictor of future death

and MI.6

6.3 Objective of the study: To assess the role of Serum uric acid, C-reactive protein and troponin

T as best prognostic indicator in hospitalised patients of Acute Coronary syndrome in Father

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Muller Medical College Hospital.

7. Materials and Methods

7.1 Source of data:

The data will be collected from patients admitted in Father Muller Medical College Hospital

with acute coronary syndrome from 1st September 2011 to 1st September 2012.

7.2. Method of collection of data:

STUDY DESIGN

The study will be a descriptive prospective study of the patients admitted in Father Muller

Medical College with Acute coronary syndrome.

The study will include a minimum of 40 patients diagnosed with acute coronary syndrome.

Three bio markers namely troponin-T, serum Uric acid and CRP will be measured on day 0.

Troponin t will be measured by Dry Chemistry (turbidimetric method) and will be repeated after

twelve hours if initially found negative, Uric acid by Uricase method and CRP by turbidimetric

method. Cut off value for troponin-T is <.03mg/dl,CRP is 6mg/dl and Uric Acid 7 mg/dl in males

and females. Anthropometric measurements including height, weight, waist and hip will be taken.

Body mass index and waist to hip ratio will be calculated. Patients will be followed up over a

period of seven days. Death, Heart failure (Killip class I to IV), recurrent ACS and LV ejection

fraction will be taken as end points of the study. All the values will be statistically compared to

determine a single best bio marker predicting the prognosis.

Inclusion Criteria :

1. Age greater than or equal to 18 years.

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2. Patients with first episode of Acute Coronary Syndrome treated by medical line of

management only.

Exclusion Criteria

1. Patients with chronic kidney disease.

2. Gout, haematological malignancy, hypothyroidism, patients on drugs raising uric acid level

like salicylates (>2g/day), diuretics, ethambutol and pyrazinamide.

3. Patient in sepsis.

4. Clinically suspected or a proven case of connective tissue disorder

Data Analysis

Data will be analyzed by frequency, percentage, mean, standard deviation, ANOVA and Chi-

Square .

7.3 Does the study require any investigations or interventions to be conducted on patients or

other humans or animals?

Yes

7.4 Has ethical clearance been obtained from your institution in case of 7.3

Yes

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8. List of References:

1. Lopez A, Mathis D, Ezzati M, Jamesan D, Mcurray C. Global and regional burden of disease

and risk factors. 2001. The Lancet 2006; 367:1747:57.

2. Adams D.C, Antman M.E,Bridges R.C, Califf M.R, Casey E.D, Chavery et Al. ACC/AHA 2007

Guidelines for management of patients with Unstable Angina/Non ST Elevation Myocardial

Infarction-Executive Summary. Journal of American College of cardiology, San Diego:

Elsevier inc.2007; 50:652-726.

3. Armstrong W.P,Bates R.E, Green A.L, Halaismani K.L, Hochman S.J, Krenmholz M.H et al .

2007 focused update of the ACC/AHA 2004 guidelines for management of patient with ST

elevation MI. Journal of American College of Cardiology, San Diego: Elsevier inc. 2007;

51:211-247.

4. Kavasak A.P, McRae R.A, Newman M.A , Lustig V, Palomaki E.G, Ko T et al. Elevated C-

reactive protein in acute coronary presentation is an independent predictor of long term

mortality and heart failure. The Canadian Society Of Clinical Chemists: Elsevier inc,

Toronto.2007; 40:326-29.

5. Nadkar M Y, Jain V I. Serum uric acid in acute myocardial infarction. Journal Association of

Physicians India. Maharashtra. 2008; 56: 759-62.

6. Nadeem S, Basir N and Pathan A. Prognostic significance of troponin T and clinical variation

in acute coronary syndrome. Karachi. Journal Of Pakistan Medical Association 2003; 53: 280.

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9. Signature of candidate

10. Remarks of the guide A useful study to determine the best available prognostic marker in patients with Acute Coronary Syndrome

11. Name and Designation of

11.1 Guide

11.2 Signature

DR. (Col) R. ARUNACHALAM, MD

PROFESSOR DEPARTMENT OF MEDICINE

FATHER MULLER MEDICAL COLLEGE

KANKANADY

MANGALORE

11.3 Head of Department

11.4 Signature

DR.NARASIMHA HEGDE , MD

PROFESSOR AND HOD OF MEDICINE

DEPARTMENT OF GENERAL MEDICINE

FR. MULLER MEDICAL COLLEGE

KANKANADY

MANGALORE

12 12.1 Remarks of Chairman & Principal

12.2 Signature

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