Direct comparison of early elevations of cardiac troponin T and I in patients with clinical unstable angina

Ottani, Filippo; Galvani, Marcello; Ferrini, Donatella; Ladenson, Jack H.; Puggioni, Roberto; Destro, Antonio; D, Baccos; Bosi, Stefano; Ronchi, Annalisa; Rusticali, F; Jaffe, Allan S.

doi:10.1053/hj.1999.v137.92779

Cited by 39 publications

(10 citation statements)

References 24 publications

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“…Serum cTnI was measured on a number of assay platforms; six trials utilised the Stratus II analyzer (Dade Behring, Miami, Fla., USA) [5, 8, 10, 13, 16, 21], five the Opus Magnum (Dade Behring, Westwood, Mass., USA) [7, 9, 12, 14, 18]and one each the ACCESS (Beckman, Chaska, Minn., USA) [15]and the AxSYM (Abbott Diagnostics, Abbott Park, Ill., USA) [6]assay systems. Concordance between values obtained when a given patient sample is assayed on different platforms is low, and results may vary up to 20-fold [26].…”

Section: Methodsmentioning

confidence: 99%

“…The population upper limit of normal is in the case of each assay several standard deviations below the pathologic cut-off point. As regards the trials in our meta-analysis six [5, 8, 10, 12, 14, 21]utilised a cut-off point value approximating the upper limit of normal for the given assay, whereas the remaining 7 trials used the pathologic cut-off point.…”

Section: Methodsmentioning

confidence: 99%

“…Many clinical trials have addressed the role of cTn measurement in acute coronary syndrome without ST elevation (ACS) [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25]. A substantial proportion of these trials have, however, had small numbers of patients at a single centre or a limited number of centres, and sample timing and analytical techniques have varied between centres.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Troponins in Suspected Acute Coronary Syndrome

Fleming

Daly²

2001

Cardiology

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We performed a meta-analysis of published trials to determine the predictive value of cardiac troponin I (cTnI) and T (cTnT) levels for adverse events (death and myocardial infarction) in acute coronary syndrome without ST elevation (ACS). The accumulated odds ratio (OR) for adverse events (30 days) in ACS with elevated cTnI (n = 5,759) and cTnT (n = 5,483) was 4.9 (95% confidence interval, CI, 3.9–6.2) and 4.6 (95% CI 3.8–5.5), respectively. Trials that mandated timed serum sampling (6 or more hours after symptom onset) had an improved predictive value for elevated cTnI (n = 2,807, OR 8.8; 95% CI 5.9–13.2) and cTnT (n = 1,990, OR 8.5; 95% CI 5.9–12.5). In conclusion, cTnI and cTnT provide similar information in ACS. The risk of adverse events is 4-fold higher in patients with suspected ACS and elevated serum cTn. For patients with an elevated timed (6-hour) sample the risk is over 8-fold higher.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac Troponins in Suspected Acute Coronary Syndrome

Fleming

Daly²

2001

Cardiology

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“…Direct comparison of early elevations of troponin T and troponin I in patients with unstable angina indicate that both markers identify myocardial damage in equal numbers of patients [23].…”

Section: Troponins As Markers Of 'High Risk'mentioning

confidence: 99%

Evidence for the Benefits of the Low-Molecular-Weight Heparin Dalteparin in ‘High-Risk’ Patients with Acute Coronary Syndromes

Husted¹,

Ziegler²

2004

Heart Drug

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Acute coronary syndrome (ACS) is a clinical emergency that requires urgent assessment. ACS encompasses a variety of clinical symptoms of varying severity, and risk stratification is essential to enable triage of patients to the optimum level of care and specific therapy. The medical treatment of ACS is directed primarily at the dissolution of developing intracoronary thrombi by antiplatelet (e.g. aspirin and clopidogrel) and anticoagulant [e.g. low-molecular-weight heparin (LMWH) and unfractionated heparin] therapy. Recent data from clinical trials have shown that LMWH is at least as effective and safe as unfractionated heparin. Additionally, elevation of biochemical cardiac markers and ST segment changes provide powerful risk stratification tools. Data from the Fragmin during Instability in Coronary Artery Disease and Fragmin and Fast Revascularisation during Instability in Coronary Artery Disease studies have demonstrated that prolonged treatment with the LMWH dalteparin provides significant benefit in clinical outcome in patients stratified as ‘high risk’ by troponin measurement and ST monitoring. While an early invasive strategy is recommended in ‘high-risk’ patients with ACS, dalteparin treatment is also effective and safe for up to 45 days in patients awaiting revascularization, or in those for whom an early invasive treatment is not possible. This paper is a review of the evidence for the use of dalteparin in ACS.

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“…Laboratory data no longer simply confirm or negate previously obtained clinical data, but are an integral part of patient management. There is a considerable body of evidence demonstrating the important role of clinical laboratories in disease management, the most frequently cited examples being the measurement of glycated hemoglobin in diabetes (10), C-reactive protein in infectious diseases (11), and cardiac troponins in acute coronary syndrome (12,13). It has already been demonstrated that laboratory tests are effective not only in improving medical outcome (the primary goal), but also in reducing hospital stay length and total costs (14,15).…”

Section: Clinical-laboratory Relationshipsmentioning

confidence: 99%

The Changing Face of Clinical Laboratories

Plebani¹

1999

CCLM

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Laboratory medicine has undergone a sea change, and medical laboratories must now adapt to, and meet new, customer-supplier needs springing from shifts in the patterns of disease prevalence, medical practice, and demographics. Managed care and other cost-containment processes have forced those involved in health care to cooperate to develop a full picture of patient care, and this has affected clinical laboratory objectives, the main focus now being on improvement in medical outcomes. More recently, the resource shortages in health care and results of cost/effectiveness analysis have demonstrated that the value of a laboratory test must be ascertained not only on the basis of its chemical or clinical performance characteristics, but also by its impact on patient management, the only true assessment of the quality of testing being quality of patient outcomes. The time is ripe for changing the vision of laboratory medicine, and some of the reasons for this are the availability of results in real-time, the introduction of more specific tests, and the trend to prevent diseases rather than cure them. The information from laboratory tests designed to evaluate biochemical or genetic risk and/or prognostic factors cannot be replaced either by physical examination and/or the assessment of symptoms. Today, the importance of laboratory scientists must be proven in three broad areas: a) guaranteeing the quality of tests, irrespective of where they are performed; b) improving the quality of the service; c) maximizing the impact of laboratory information on patient management.

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Direct comparison of early elevations of cardiac troponin T and I in patients with clinical unstable angina

Cited by 39 publications

References 24 publications

Cardiac Troponins in Suspected Acute Coronary Syndrome

Cardiac Troponins in Suspected Acute Coronary Syndrome

Evidence for the Benefits of the Low-Molecular-Weight Heparin Dalteparin in ‘High-Risk’ Patients with Acute Coronary Syndromes

The Changing Face of Clinical Laboratories

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