Correlation of Troponin T Levels in the Cardiac Sudden Death Cases at Hospital Kuala Lumpur

Cardiac deaths accounted for 50% of all deaths in the developed and one fourth in the developing world. Sudden cardiac death due to an acute myocardial infarction (AMI) comprises a significant proportion of autopsy cases. Troponin levels act as a specific and sensitive indicator of myocardial infarction. However, histological evaluation for the diagnosis of AMI remains the gold standard. This retrospective study was based on the total of 154 post-mortem cases and total of 85 emergency cases with Trop T samples sent for laboratory investigation in year 2016 at Hospital Kuala Lumpur. From the post-mortem cases, Trop T values for non-cardiac related death cases (5.322 ng/ml) were higher than cardiac-related death (4.916 ng/ml) with no significant difference between them although Trop T values were highly sensitive to myocardial infarction but the limitation was on the specificity. There was also no correlation between post-mortem Trop T levels to the cardiac-related cause of death using post-mortem cases. The minimum Trop T value amongst the MI post-mortem cases was assumed to be the cut-off value i.e. ≥ 0.390 ng/ml. Although the elevated Trop T values might concur with the diagnosis of acute coronary syndrome causing subsequent death, there were multiple factors that can attribute to an elevated Trop T results after death including post-mortem performing interval and depending on the severity of myocardial damage at the time of death. Eventually 38 emergency cases certified with MI were compared with 8 post-mortem cases certified with MI. The mean for post-mortem (PM) cases (5.065 ± 4.498 ng/ml) was much higher than those ante-mortem (AM) case (1.327 ± 1.918 ng/ml). Hence, there was statistically significant difference between ante-mortem and post-mortem cases presented with myocardial infarction. As such, post-mortem Trop T level could probably not be used to reflect the ante-mortem Trop T level to diagnose myocardial infarction. In addition, the effect of post-mortem performing interval was also statistically significant between interval of < 12 hours and 12 - 48 hours. A prospective study should be conducted by using the same patient diagnosed with myocardial infarction to analyse the ante-mortem and post-mortem Trop T value.