Incremental prognostic value of serum levels of troponin T and C-reactive protein on admission in patients with unstable angina pectoris

Rebuzzi, Antonio Giuseppe; Quaranta, Gaetano; Liuzzo, Giovanna; Caligiuri, Giuseppina; Lanza, Gaetano Antonio; Gallimore, J. Ruth; Grillo, R; Cianflone, Domenico; Biasucci, Luigi M.; Maseri, Attilio

doi:10.1016/s0002-9149(98)00458-5

Cited by 152 publications

(70 citation statements)

References 16 publications

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“…Because CRP is an acute phase reactant and its levels increase after myocardial damage, it is not surprising that CRP levels are elevated in patients with elevated troponin levels. As first shown by Morrow et al 9 and subsequently confirmed by several other studies, 11,19,20,28 not only is the prognostic value of CRP independent from troponin levels, but the association of CRP and troponin levels also gives incremental prognostic information ( Figure 2). In particular, in all of these studies, patients with low CRP (Ͻ10 mg/L) and negative troponin T or I have a mortality rate as low as 0% up to 4 years, whereas troponin-negative but CRP-positive patients have a significantly higher (Ͼ2%) mortality rate.…”

Section: Prognostic Value Of Crp In Relationship To Other Prognostic mentioning

confidence: 58%

CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease

Biasucci¹

2004

Circulation

151

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Abstract-Inflammation is a recognized key component of acute coronary syndromes. Such pathogenetic achievement has led to the use of inflammatory cells and proteins as prognostic markers in these syndromes. A number of markers have been proposed, including proinflammatory cytokines such as interleukin-6, interleukin-1RA, and tumor necrosis factor-␣, adhesion molecules such as intracellular adhesion molecule-1 and vascular adhesion molecule-1 and markers of cell activation. Although all are of scientific interest, the clinical use of these markers is limited by their high cost, low availability, and unfavorable biological profile. Conversely, common markers of inflammation such as C-reactive protein (CRP), the prototypic acute phase protein, and to a lesser extent fibrinogen, have been proven to be reliable and important markers of risk in ischemic heart disease. CRP, in particular, has been found to be associated with short-and long-term prognosis in acute coronary syndromes, including ST-elevation myocardial infarction, and in stable angina, and to predict the risk of restenosis and major events, including death, after revascularization procedures. CRP has been consistently found to be independent from other risk factors and to have an incremental value beyond the common risk factors and biochemical markers of risk, including troponin. Whether CRP also should be used as a guide to therapy is still a matter of discussion that deserves further, properly designed studies. Key Words: AHA Scientific Statements Ⅲ inflammation Ⅲ revascularization Ⅲ angina Ⅲ risk factors S hort-and long-term prediction of risk in patients with acute coronary syndromes (ACS) is a challenging clinical problem. Despite diagnostic and therapeutic advances, the rate of event recurrence is still relatively high (in the range of 14% to 16% at 6 months 1,2 ). The growing evidence that inflammation plays a pivotal role in the pathogenesis of most of the cases of ACS 3 led to the use of inflammatory mediators as markers of risk in these syndromes. 4 As consistent data have been accumulated in this area, risk prediction in ischemic heart disease and in ACS in particular represents the main use of inflammatory markers in cardiovascular medicine. More recently, sparse but intriguing data have been published suggesting that inflammatory markers may represent a marker of risk in other cardiovascular conditions. C-Reactive ProteinA number of inflammatory mediators have been studied as markers of risk in ischemic heart disease. They are discussed separately. Although many of them are of potential clinical interest (discussed below), C-reactive protein (CRP) is the inflammatory marker most extensively assessed in prognostic studies and is an almost perfect marker of inflammation (it has a half-life of 19 hours and is neither consumed nor produced during the reaction). This is the result, in part, of analytical reasons because of the availability of high-sensitivity, relatively low-cost methods for its measurement and in part because of its biological pr...

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Section: Prognostic Value Of Crp In Relationship To Other Prognostic mentioning

confidence: 58%

CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease

Biasucci¹

2004

Circulation

151

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“…[13][14][15][16][17][18] Troponin T in one of the most studied laboratory parameters, and among the data potentially available, serum levels of cardiac troponin T have significantly greater prognostic value than other laboratory parameters in patients with unstable angina pectoris. 13,14,19) Multivariate analysis showed that serum levels of troponin T is an independent factor with high sensitivity and specificity for poor prognosis. 14) QT interval dispersion reflects regional variations in ventricular repolarization and cardiac electrical instability, which is a substrate for ventricular arrhythmia.…”

Section: Discussionmentioning

confidence: 99%

“…10,11) Prior research has demonstrated that troponin T has excellent sensitivity for the diagnosis of acute myocardial infarction and also may be useful for prognostic stratification of patients with unstable angina pectoris. [12][13][14][15] In this prospective study, we investigated the relation between myocardial injury and the value of troponin T and QT interval dispersion in hospitalized unstable angina patients.…”

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confidence: 99%

<b>QT Interval Dispersion</b>

et al. 2000

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SUMMARYPrognostic assessment of unstable angina pectoris is a common clinical problem for physicians. Markers of myocardial cell injury, serial electrocardiographic findings and ST segment monitoring are mainly studied for prognosis.We investigated the relation between myocardial injury and the value of cardiac troponin T and QT interval dispersion in hospitalized unstable angina patients. This is a prospective study that includes adult patients admitted to an emergency department with Braunwald class IIIB unstable angina pectoris. Eighty-six patients were enrolled in the study (mean age of 57 ± 12 years, 63 males and 23 females). Cardiac troponin T was assayed and QT dispersion calculated from surface ECG. Fifty-eight patients with troponin T < 0.1 ng / ml and 28 patients with troponin T levels ≥ 0.1 formed group 1 and group 2, respectively.There were no significant differences in sex, age, history of coronary revascularization or ECG findings such as ST depression and T inversions between the two groups. The QT dispersion was significantly greater in patients with elevated cardiac troponin T levels (77 ± 18 msec vs 38 ± 13 msec; p < 0.014).Because QT interval dispersion exhibited an association with cardiac troponin T levels, it may be used as a non-invasive marker of ischemic injury in patients with unstable angina. (Jpn Heart J 2000; 41: 597-603) Key words: Unstable angina pectoris, QT dispersion, Troponin T IDENTIFICATION of patients with acute chest pain at high risk for cardiovascular complications is a common clinical problem for physicians. Surface ECG has been one of the most studied parameters for this purpose.1-4) QT interval on the surface electrocardiogram (ECG) is a measure of total time of ventricular depolarization and repolarization. Regional differences in ventricular repolarization are reflected as differences in QT intervals in leads corresponding to differents part of the myocardium. This heterogeneity is called QT interval dispersion.

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“…In acute coronary syndromes, hs-CRP predicts recurrent myocardial infarction independent of troponins, which suggests it is not merely a marker for the extent of myocardial damage. [52][53][54] Recent data also suggest that hs-CRP may be a marker for risk of restenosis after PCIs, 55,56 but all studies are not in agreement with these results. 57 Elevated hs-CRP levels also seem to predict prognosis and recurrent events in patients with stroke 58,59 and peripheral arterial disease.…”

Section: B Prediction Of Recurrent Cvd Events and Death: Secondary Pmentioning

confidence: 98%

“…hs-CRP consistently predicts new coronary events in patients with unstable angina and acute myocardial infarction. [42][43][44][45][46][47][48][49][50][51] Most of these studies have been long term, but some in-hospital survivorship studies [52][53][54] have also shown an association.…”

Section: B Prediction Of Recurrent Cvd Events and Death: Secondary Pmentioning

confidence: 99%