Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients

Kontos, Michael C.; Shah, Rakesh; Fritz, Lucie M; Anderson, F. Philip; Tatum, James L.; Ornato, Joseph P.; Jesse, Robert L.

doi:10.1016/j.jacc.2003.10.036

Cited by 119 publications

(53 citation statements)

References 40 publications

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“…Our findings are at variance with those of some other studies demonstrating an increasing mortality with higher troponin cutoffs (5,6,24 ). We can not exclude the possibility that a probable beneficial effect by coronary revascularization attenuated the prognostic value of high cTnI cutoffs in patients with more severe cardiac disease, i.e., patient subgroups known to have a higher prevalence of cTnI elevation (7,25,26 ).…”

Section: Discussioncontrasting

confidence: 98%

Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

Bissell¹

2010

Yearbook of Pathology and Laboratory Medicine

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Section: Discussioncontrasting

confidence: 98%

Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

Bissell¹

2010

Yearbook of Pathology and Laboratory Medicine

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“…Troponin elevation also signifies adverse short and long-term prognosis in this patient population (19)(20)(21)(22). Similarly, in our study, we observed that elevated troponin was associated with increased thrombus burden, worse systolic function, higher complexity of the lesions, and worse post intervention TIMI flow.…”

Section: Troponin I and Percutaneous Coronary Artery Interventions Insupporting

confidence: 80%

High-sensitivity troponin i and the risk of flow limiting coronary artery disease in non-ST elevation acute coronary syndrome (NSTE-ACS)

Jabbar¹,

Mufti²,

Altabaqchali³

et al. 2017

Southwest J Pulm Crit Care

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Background: In acute coronary syndrome, elevated troponins are associated with worse clinical outcomes. We examined the relationship between the level of troponin elevation and the presence of a flow-limiting lesion for patients with no history of coronary disease admitted with NSTE-ACS. Methods: From January of 2010 until April of 2013, 561 patients received coronary angiography for new-onset NSTE-ACS. The Mann-Whitney Test, chi-square test, and Spearman correlation were used to examine relationships. Inferences were made at the 0.05 level of significance. The independent samples t test and the chi square test were used to identify predictors of LV systolic dysfunction-LVSD. Results: The 430 patients with a flow-limiting coronary lesions had a higher troponin I level than the 131 patients without obstructive coronary disease (5.69 ng/ml vs. 2.85 ng/ml, p=0.002). Further, within troponin categories, those in the greater than 5.0 ng/ml group were more likely to have angiographically significant CAD than those in the less than 0.5 ng/ml group (p=0.012). Elevated troponins were also associated with increased thrombus burden, worse systolic function, higher complexity of the lesions, and worse post intervention TIMI flow. Cardiac troponin >5ng/ml [odds ratio=2.13 (95%CI=1.22 to 3.70) p=0.008] and DM [odds ratio=1.74 (95%CI=1.02 to 2.97) p=0.042] were independent predictors of LVSD. Advanced LM disease and age were marginally significant. Conclusion:The degree of cardiac troponin I elevation should be incorporated into the risk stratification models of NSTE-ACS to promptly triage high-risk patients to early

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“…It is unclear, however, whether defining an acute etiology on the basis of changing biomarker concentrations enhances the long-term prognostic effect of the detection of cardiac troponin (cTn) concentrations above the 99th percentile, because the mechanisms for these elevations may vary (6,7 ). What is clear is that high cTn concentrations are prognostic for poor outcomes (8,9 ). We conducted the present study to address this issue by investigating the prognostic value over time of the detection of relative increases in biomarkers (e.g., cTnI, cTnT, and NT-proBNP) in patients with myocardial necrosis (cTn Ͼ99th percentile).…”

Section: Discussionmentioning

confidence: 99%

Is a Pattern of Increasing Biomarker Concentrations Important for Long-Term Risk Stratification in Acute Coronary Syndrome Patients Presenting Early after the Onset of Symptoms?

Kavsak

Newman

et al. 2008

Clinical Chemistry

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BACKGROUND:Guidelines for treatment of acute coronary syndrome (ACS) recommend observing a rise or fall in cardiac troponin (cTn) concentrations for assessing acute injury. It is unknown whether a rising pattern presages a more adverse long-term prognosis than elevations that do not change. The present study assessed whether a rising pattern of cardiac biomarkers was more prognostic than simple elevations.

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Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients

Abstract: Increased cTnI values are associated with worse outcomes. Although low cTnI values are associated with adverse events, they do not have the same implication as higher cTnI values, and nonischemic evaluations are frequent.

Cited by 119 publications

References 40 publications

Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

High-sensitivity troponin i and the risk of flow limiting coronary artery disease in non-ST elevation acute coronary syndrome (NSTE-ACS)

Is a Pattern of Increasing Biomarker Concentrations Important for Long-Term Risk Stratification in Acute Coronary Syndrome Patients Presenting Early after the Onset of Symptoms?

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