Cardiac troponin I for stratification of early outcomes and the efficacy of enoxaparin in unstable angina: a TIMI-11B substudy

Morrow, David A.; Antman, EM; Tanasijevic, Milenko J.

doi:10.1016/s1062-1458(01)00230-6

Cited by 56 publications

(81 citation statements)

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“…4,7 Cardiac biomarkers play an important role in the risk stratification and choice of treatment strategies for patients with ACS. Cardiac troponins, sensitive markers of myocardial necrosis, 8 are an important component of risk stratification 9,10 and are useful in the prediction of therapeutic efficacy for pharmacological [11][12][13] and percutaneous interventions (PCI). 14 Brain natriuretic peptide (BNP) is associated with heart failure in patients with shortness of breath 15 and is an indicator of short-and long-term prognosis in patients with ACS.…”

Section: See P 565mentioning

confidence: 99%

Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Wiviott

Cannon²,

Morrow³

et al. 2004

Circulation

160

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Background-Diagnosis of coronary artery disease in women is more difficult because of lower specificity of symptoms and diagnostic accuracy of noninvasive testing. We sought to examine the relationship between gender and cardiac biomarkers in patients with unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI). Methods and Results-In the TACTICS-TIMI 18, OPUS-TIMI 16, and TIMI 11 studies, baseline samples were analyzed in the Thrombolysis In Myocardial Infarction (TIMI) biomarker core laboratory. We examined the relationship between gender and elevated biomarkers. Of 1865 patients from TACTICS-TIMI 18, 34% were women. Fewer women had elevated creatine kinase-MB or troponins, whereas more had elevated high-sensitivity C-reactive protein or brain natriuretic peptide. Presence of ST-segment deviation and TIMI risk scores were not significantly different. This pattern was confirmed in TIMI 11 and OPUS-TIMI 16. The prognostic value of the markers in TACTICS-TIMI 18 was similar in women and men. When a multimarker approach was examined, a greater proportion of high-risk women were identified. Marker-positive patients of both genders had improved outcome with an invasive strategy; however, marker-negative women appeared to have improved outcomes with a conservative strategy. Conclusions-In patients with UA/NSTEMI, there was a different pattern of presenting biomarkers. Men were more likely to have elevated creatine kinase-MB and troponins, whereas women were more likely to have elevated C-reactive protein and brain natriuretic peptide. This suggests that a multimarker approach may aid the initial risk assessment of UA/NSTEMI, especially in women. Further research is necessary to elucidate whether gender-related pathophysiological differences exist in presentation with acute coronary syndromes. (Circulation. 2004;109:580-586.)

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Section: See P 565mentioning

confidence: 99%

Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Wiviott

Cannon²,

Morrow³

et al. 2004

Circulation

160

View full text Add to dashboard Cite

show abstract

“…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).…”

Section: Cardiac Biomarkersmentioning

confidence: 99%

“…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.…”

Section: Cardiac Biomarkersmentioning

confidence: 99%

“…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. 6,16 In contrast, patients with a negative troponin level had no benefit from LMWH or GP IIb/IIIa inhibition as compared with aspirin and heparin.…”

Section: Cardiac Biomarkersmentioning

confidence: 99%

“…6,16 In contrast, patients with a negative troponin level had no benefit from LMWH or GP IIb/IIIa inhibition as compared with aspirin and heparin. 6,13,14,16 Similarly, in the Treat angina with Aggrastat and determine Costs of Therapy with Invasive or Conservative Strategies-Thrombolysis in Myocardial Infarction 18 (TACTICS-TIMI 18) study, an early invasive strategy conferred a 40% reduction in recurrent cardiac events for patients with a positive troponin (troponin T Ͼ0.01 or troponin I Ͼ0.1 ng/mL), whereas no benefit was seen for patients with a negative troponin. 7,15 It should be noted that the oral antiplatelet agents appear to have a different pattern: Both aspirin and clopidogrel benefit patients across the range of risk as predicted by baseline characteristics, including those with positive or negative biomarkers.…”

Section: Cardiac Biomarkersmentioning

confidence: 99%

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