Benefit of Abciximab in Patients with Refractory Unstable Angina in Relation to Serum Troponin T Levels

Abstract

The serum troponin T level, which is considered to be a surrogate marker for thrombus formation, identifies a high-risk subgroup of patients with refractory unstable angina suitable for coronary angioplasty who will particularly benefit from antiplatelet treatment with abciximab.

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

“…[12][13][14][15][16][17][18][19][20][21][22][23] The majority of these included elevated cardiac markers and ECG changes as independent predictors of adverse outcomes. Unfortunately, there are limited data on risk assessment of "subacute" patients with ACS after initial presentation.…”

Unstable Angina and Non–ST-Elevation Myocardial Infarction

“…Multiple studies have shown that patients with an elevated troponin level are at increased risk. 1,[5][6][7] There appears to be a direct relationship between the degree of troponin elevation and mortality. 5 Interestingly, recurrent MI appears to be very high among patients with low levels of troponin elevation, and thus the rate of death or MI appears to be equally high in patients with either low or high troponin values.…”

“…7 The European Society of Cardiology (ESC)/ACC consensus document on MI, as well as multiple trials in UA/NSTEMI, supports a very low cut-point for troponin elevation as a biomarker of adverse outcome in patients presenting with a clear history of ischemic symptoms. 1,[5][6][7][8] It should be noted however, that in patients without a clear history, troponin elevations in the absence of ischemia have been reported 9,10 and can be caused by congestive heart failure, 11 pulmonary embolism, 12 or technical problems with the assay. 10 Thus, in patients with an unclear history, small troponin elevations may not be diagnostic of acute coronary syndromes (ACS).…”

“…In contrast, among patients with a clinical history suggestive of myocardial ischemia, troponin elevations have very strong prognostic implications of adverse outcomes. 1,[5][6][7][13][14][15] Multiple studies show that troponin can be used to guide antithrombotic and interventional therapies. 6,7,[13][14][15] This was seen in trials with low molecular weight heparin (LMWH).…”

“…1,[5][6][7][13][14][15] Multiple studies show that troponin can be used to guide antithrombotic and interventional therapies. 6,7,[13][14][15] This was seen in trials with low molecular weight heparin (LMWH). 13,14 In 4 trials of glycoprotein (GP) IIb/IIIa inhibitors, there was a 50% to 70% reduction in death or MI in troponinpositive patients receiving GP IIb/IIIa inhibitors compared with those receiving aspirin and heparin alone.…”