Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit lesion in unstable angina

Benamer, Hakim; Steg, Philippe Gabriel; Bénessiano, Joëlle; Vicaut, Éric; Gaultier, C; Aubry, P; Boudvillain, Olivier; Sarfati, Laurent; Brochet, Éric; Feldman, Laurent J.; Himbert, Dominique; Juliard, Jean‐Michel; Assayag, Patrick

doi:10.1016/s0002-8703(99)70404-7

Cited by 86 publications

(57 citation statements)

References 31 publications

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“…Furthermore, the risk for subsequent death appears to be related to the degree of troponin elevation: There is a statistically significant increase in mortality with increasing levels of troponin, and the relative risk for death is 7.8 in the group with the highest troponin levels (6). While the presence of thrombus and impaired epicardial blood flow are both associated with troponin elevation (7,8), impaired myocardial perfusion is a more robust and independent predictor of troponin elevation among patients with acute coronary syndromes (9).…”

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confidence: 99%

Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded

2005

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Current guidelines for the diagnosis of non-ST-segment elevation myocardial infarction are largely based on an elevated troponin level. While this rapid and sensitive blood test is certainly valuable in the appropriate setting, its widespread use in a variety of clinical scenarios may lead to the detection of troponin elevation in the absence of thrombotic acute coronary syndromes. Many diseases, such as sepsis, hypovolemia, atrial fibrillation, congestive heart failure, pulmonary embolism, myocarditis, myocardial contusion, and renal failure, can be associated with an increase in troponin level. These elevations may arise from various causes other than thrombotic coronary artery occlusion. Given the lack of any supportive data at present, patients with nonthrombotic troponin elevation should not be treated with antithrombotic and antiplatelet agents. Rather, the underlying cause of the troponin elevation should be targeted. However, troponin elevation in the absence of thrombotic acute coronary syndromes still retains prognostic value. Thus, cardiac troponin elevations are common in numerous disease states and do not necessarily indicate the presence of a thrombotic acute coronary syndrome. While troponin is a sensitive biomarker to "rule out" non-ST-segment elevation myocardial infarction, it is less useful to "rule in" this event because it may lack specificity for acute coronary syndromes. Ann Intern Med. 2005;142:786-791. www.annals.org For author affiliations, see end of text.

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Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded

2005

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“…The presence of circulating cardiac troponin (cTn) 4 is indicative of myocardial injury (1)(2)(3). Increased concentrations of cTn are associated with more frequent thrombus, impaired myocardial tissue perfusion, and higher probability of adverse outcomes following coronary intervention (4)(5)(6).…”

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confidence: 99%

“…Increased concentrations of cTn are associated with more frequent thrombus, impaired myocardial tissue perfusion, and higher probability of adverse outcomes following coronary intervention (4)(5)(6). In addition, the evidencebased literature shows a consistently strong direct relationship between increased cTn concentration and the risk of both short-and long-term cardiac events and mortality in patients who present with symptoms of acute coronary syndrome (ACS) (2,7 ).…”

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Use of the Centaur TnI-Ultra Assay for Detection of Myocardial Infarction and Adverse Events in Patients Presenting With Symptoms Suggestive of Acute Coronary Syndrome

Apple¹,

et al. 2008

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“…Increased cardiac troponin concentrations have been associated with more frequent thrombi, impaired myocardial tissue perfusion, and a higher probability of adverse outcomes following coronary intervention (5)(6)(7). In addition, the risk of both short-and long-term cardiac events and mortality is related strongly and directly to increased cardiac troponin concentrations in patients who present with symptoms of acute coronary syndrome (ACS) (2,8,9 ).…”

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Assessment of the Multiple-Biomarker Approach for Diagnosis of Myocardial Infarction in Patients Presenting with Symptoms Suggestive of Acute Coronary Syndrome

Apple¹,

Smith

Pearce

et al. 2009

Clinical Chemistry

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Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit lesion in unstable angina

Cited by 86 publications

References 31 publications

Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded

Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded

Use of the Centaur TnI-Ultra Assay for Detection of Myocardial Infarction and Adverse Events in Patients Presenting With Symptoms Suggestive of Acute Coronary Syndrome

Assessment of the Multiple-Biomarker Approach for Diagnosis of Myocardial Infarction in Patients Presenting with Symptoms Suggestive of Acute Coronary Syndrome

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