Atherogenic Indices in Patients Aged ≤45 Years With NSTEMI or Myocarditis: A Retrospective Comparative Study
DOI:
https://doi.org/10.66288/actamedi.2026.144Keywords:
Troponin T; NSTEMI; myocarditis; atherogenic index; Castelli risk index; young adults.Abstract
Aim: To compare lipid-related atherogenic indices between patients aged ≤45 years with elevated cardiac troponin T (cTnT) who were diagnosed with non-ST-elevation myocardial infarction (NSTEMI) or myocarditis, and to explore their association with diagnostic classification.
Methodology: This single-centre retrospective observational study included 329 patients aged ≤45 years with elevated cTnT, a final diagnosis of NSTEMI or myocarditis, and coronary angiography during the index evaluation. Of these, 288 patients had NSTEMI and 41 had myocarditis. Castelli Risk Index I (CRI-1), Castelli Risk Index II (CRI-2), atherogenic index of plasma (AIP), triglyceride–glucose (TyG) index, and remnant cholesterol (RC) were calculated from routinely available laboratory measurements. Between-group comparisons, logistic regression analyses, correlation analysis, and receiver operating characteristic (ROC) analysis were performed.
Results: The NSTEMI group had higher CRI-1, CRI-2, AIP, TyG index, and RC levels than the myocarditis group. Patients with myocarditis were younger and had higher cTnT concentrations, whereas diabetes mellitus, hypertension, and smoking were more common among patients with NSTEMI. Because the evaluated indices were strongly correlated, only CRI-2 was included as the representative index in the final multivariable model. Age and CRI-2 remained associated with diagnostic group classification after adjustment. CRI-2 showed modest discriminatory performance, with an area under the ROC curve of 0.6796. At a cutoff of 2.143, sensitivity was 40.54% and specificity was 88.42%.
Conclusion: Among patients aged ≤45 years with elevated cTnT, atherogenic and metabolic indices differed between those with NSTEMI and those with myocarditis. However, the modest discriminatory performance of CRI-2 indicates that these indices should be considered complementary, hypothesis-generating markers rather than stand-alone diagnostic tools. Prospective multicentre studies using standardised diagnostic criteria and cardiac magnetic resonance-based adjudication are needed.
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