Ability of Minor Elevations of Troponins I and T to Predict Benefit From an Early Invasive Strategy in Patients With Unstable Angina and Non-ST Elevation Myocardial Infarction&lt;SUBTITLE&gt;Results From a Randomized Trial&lt;/SUBTITLE&gt;

Morrow, David A.

doi:10.1001/jama.286.19.2405

Cited by 605 publications

(315 citation statements)

References 20 publications

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“…Vasoconstriction secondary to ischaemia may further decrease coronary blood flow 46,47 . The hypothesis that prolonged tachycardia and stress-induced ischaemia underlie the evolution of perioperative MI is furtherly supported by the reduction in cardiac death rates from 34 to 3.4% by prophylactic preoperative bisoprolol treatment in high-risk patients undergoing major vascular surgery 48 . Therefore, the pathophysiology of early perioperative MI seems to be related to a prolonged imbalance between myocardial oxygen supply and demand in the setting of CAD.…”

Section: Pathophysiology Of Perioperative Myocardial Infarctionmentioning

confidence: 98%

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

2006

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Advances in surgical and anaesthetic techniques and an aging patient population have resulted in more complex procedures being performed in greater numbers of aged subjects and in patients with a high likelihood of significant cardiovascular disease. Nearly one fourth of non-cardiac surgical procedures (major intra-abdominal, thoracic, vascular, and orthopaedic procedures) performed in persons older than 65 years have been found to be associated with significant perioperative cardiovascular morbidity and mortality. During previous years the main attempt was to define strategies to accurately estimate perioperative cardiovascular risk based either on the characteristics of surgery and on patient characteristics. More recently preventive medical strategies have been proposed. Therefore, the physician has to be aware of the key elements useful to calculate the perioperative cardiovascular risk, and of the medical preventive treatment or further interventions to adopt in patients candidate to surgery.

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Section: Pathophysiology Of Perioperative Myocardial Infarctionmentioning

confidence: 98%

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

2006

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“…Until recently, cardiac troponins (troponin I and T) have been considered markers of myocardial necrosis, especially in the setting of acute coronary syndromes (ACS)1. Current percutaneous coronary intervention (PCI) guidelines also give a class I recommendation for the measurement of cardiac biomarkers including troponins in ACS patients who underwent PCI.…”

Section: Paradigm Shift Of Cardiac Troponinsmentioning

confidence: 99%

Prognostic impact of cardiac troponin T in patients with stable coronary artery disease and diabetes

Amano

2015

J of Diabetes Invest

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“…Therefore, identification of those who benefit most from a particular therapy has become important. The beneficial effects of antithrombotic treatment with low molecular weight heparins, antiplatelet therapy with glucoprotein IIb/ IIIa receptor inhibitors, and an invasive approach with early revascularization in NSTE-ACS have all been shown to be predominantly present in patients with elevated troponin [47][48][49]. Hence, the cardiac troponin level has been incorporated in the treatment algorithms in recent guidelines [50].…”

Section: Selection Of Therapymentioning

confidence: 99%

Acute coronary syndrome – the present and future role of biomarkers1)

Lindahl¹

2013

Clinical Chemistry and Laboratory Medicine

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Over the past two decades there have been dramatic changes in the diagnosis, treatment and prognosis of acute coronary syndrome (ACS). Several new treatment modalities have been added and the prognosis has improved dramatically. Biomarkers play a crucial role in the management of ACS. At present, cardiac troponin is the biomarker of choice for diagnosis of acute myocardial infarction (AMI). Currently, there are no other biomarkers, which can compete, neither regarding specificity nor regarding early sensitivity. However, there is still a clinical need of a biomarker able to reliably rule-in or rule-out AMI immediately on admission. MicroRNAs seem to be promising new candidates for diagnostic purposes. The optimal combination of biomarkers and new imaging techniques is another important area for research. The list of biomarkers associated with an adverse prognosis in ACS is long. However, for most of them it has been very difficult to prove an added clinical value. Only cardiac troponin, and to some degree also B-type natriuretic peptides, is widely used in clinical practice for risk assessment. Among new markers, growth differentiation factor 15 and the midregional part of the prohormone of adrenomedullin, have shown some promising results. Since the renal function is assessed in clinical routine, also markers of the renal function have gained increasing interest. Cardiac troponin has been proven useful for selection of antithrombotic, antiplatelet and invasive treatment. Besides cardiac troponin, no other markers have consistently been shown to be useful for selection of specific treatments.

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Ability of Minor Elevations of Troponins I and T to Predict Benefit From an Early Invasive Strategy in Patients With Unstable Angina and Non-ST Elevation Myocardial Infarction<SUBTITLE>Results From a Randomized Trial</SUBTITLE>

Abstract: In patients with clinically documented acute coronary syndrome who are treated with glycoprotein IIb/IIIa inhibitors, even small elevations in cTnI and cTnT identify high-risk patients who derive a large clinical benefit from an early invasive strategy.

Cited by 605 publications

References 20 publications

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

Prognostic impact of cardiac troponin T in patients with stable coronary artery disease and diabetes

Acute coronary syndrome – the present and future role of biomarkers1)

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