Cardiac-Specific Troponin I Levels to Predict the Risk of Mortality in Patients with Acute Coronary Syndromes

SummaryBackground: Cardiac troponins are the biochemical markers of choice for the evaluation of acute coronary syndromes (ACS). Using the first-generation test, most studies related adverse outcome to > 0.20 or 0.10 µg/l cardiac troponin T (cTnT) levels. With the highly sensitive and specific second-and third-generation assays, cTnT is undetectable in most healthy individuals.Hypothesis: We evaluated whether a lower cTnT level, within 24 h of admission, could indicate an increased risk of future complications.Methods: During 1998-1999, clinical data were collected in 260 patients with ACS. Cardiac troponin T was measured at arrival, and 4, 8, and 12-24 h thereafter. The maximum cTnT value was then used to assess, over a 15-month follow-up period, the cumulative risk of death or myocardial infarction (MI), as well as rates of events according to quartiles of cTnT values.Results: Patients with ≤ 0.03 µg/l cTnT levels had the lowest rate of adverse events and the best Kaplan-Meier event-free survival curve. Increasing cTnT levels were associated with stepwise increases in mortality rates and with a constant 10-fold increase in MI rates during follow-up.Conclusions: A low threshold cTnT elevation is recommended to assess the risk of ACS. All cTnT elevations > 0.03 µg/l predict a higher risk of MI during follow-up, whereas increasing values predict mortality in relation to the amount of elevation.

Section: Evolution Of Cardiac Troponin T Test and Its Use In Risk Strsupporting

confidence: 91%

Classification and risk stratification of patients with acute chest pain using a low discriminatory level of cardiac troponin T

Solymoss

Bourassa

Černáček

et al. 2004

“…1 artery stenosis, visible thrombus, plaque rupture, and multivessel CAD. 8,9 Moreover, in the setting of acute coronary syndrome, patients with baseline elevations of troponin T have a higher risk of death or recurrent MI early after presentation, 10,11 after PCI 12 and during long-term follow up. 13 It has also been demonstrated that elevation of troponin T is relatively common among patients with stable CAD undergoing PCI and is an independent prognostic indicator of ischemic complications.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Cardiac Troponin T Elevation in Patients with Stable Coronary Artery Disease After Elective Coronary Drug‐Eluting Stent Implantation

Chen

Qian

et al. 2011

Background: Cardiac troponin T elevation after coronary intervention has been demonstrated to be associated with the prognosis of coronary artery disease (CAD). However, there were few studies about comprehensive risk factors analysis of troponin T elevation after elective drug-eluting stent (DES) implantation. Hypothesis: The prognosis of CAD after coronary interventions was associated with clinical and procedural risk factors of CAD, such as age, hypertension, severity extent of CAD and so on. Methods: From March to December in 2010, patients with stable CAD were admitted for elective coronary intervention in our hospital. They were divided into an elevated troponin T group and a normal troponin T group by postprocedural troponin T. Clinical factors, laboratory-test factors, and angiographic factors (such as gender, age, cholesterol, Gensini score, and others) were analyzed. Results: A total of 209 patients with an average age of 64.0 ± 9.9 years were enrolled in the study: 70 patients with elevated troponin T (≥0.03 ng/mL) after DES implantation and 139 patients with normal troponin T (<0.03 ng/mL). After univariate analysis, we found that age, hypertension, total cholesterol, low density lipoprotein-cholesterol (LDL-C), Gensini score, number of stenosed vessels, and total implanted stents were associated with postprocedural troponin T elevation. According to the results of multivariate analysis, we found that age, total cholesterol, number of stenosed vessels, and number of implanted stents were independent risk factors of postprocedural troponin T elevation. Conclusions: Age, serum total cholesterol, number of stenosed vessels, and number of implanted stents could be independent risk factors of troponin T elevation after elective DES implantation.

“…[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.…”

Section: Timing Of Heart Rate Assessmentmentioning

confidence: 99%

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

Kovar

Cannon

Bentley

et al. 2004

Self Cite

Background: Lower admission heart rate (HR) is known to predict favorable outcome in ST‐elevation acute myocardial infarction. However, there are limited short‐term and no long‐term data available regarding the prediction value of the initial HR in patients with the full spectrum of acute coronary syndromes (ACS). In addition, it is unknown whether the HR obtained later during hospitalization for ACS (i.e., Day 2 or 3) remains prognostically valuable. Hypothesis: The aim of this study was to investigate the utility of the initial and delayed HR in predicting outcome in patients with ACS. Methods: We examined mortality at 30 days and 10 months in 10,267 patients with ACS enrolled in the oral glycoprotein IIb/IIIa inhibition with Orofiban in Patients with Unstable coronary Syndromes‐Thrombolysis In Myocardial Infarction (OPUS‐TIMI) 16 trial. Patients were stratified by HR and day from onset of ACS into the following groups: (1) HR < 60 beats/min, (2) HR 60‐80 beats/min, (3) HR 80‐100 beats/min, (4) HR > 100 beats/min; and HR obtained on (1) Day 1, (2) Day 2, and (3) Day 3. Results: By univariate analysis, mortality at 30 days and at 10 months increased progressively with higher HR strata (1.4 vs. 1.6 vs. 2.3 vs. 5.6%, p < 0.001, and 2.6 vs. 4.2 vs. 6.5 vs. 11.8%, p < 0.001, respectively). Elevated HR remained associated with mortality irrespective of time from onset of ACS. Conclusions: Higher initial and delayed HR is highly predictive of higher short‐ and long‐term mortality in patients with ACS. This is a simple marker that could be easily used in risk assessment.