The Prognostic Value of Serum Troponin T in Unstable Angina

Hamm, Christian W.; Ravkilde, Jan; Gerhardt, W.; Jørgensen, Poul J.; Peheim, E.; Ljungdahl, Lars G.; Goldmann, Britta; Katus, Hugo A.

doi:10.1056/nejm199207163270302

Cited by 917 publications

(353 citation statements)

References 35 publications

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“…Moreover, cardiac biomarkers are more likely to be elevated in HD patients than in those with renal failure not on dialysis and their value should hence be interpreted with caution (7). Although cardiac troponin T (cTnT) is a sensitive and specific marker of myocardial injury in the general population (8), this is less ascertained in patients undergoing chronic HD, who have frequently elevated baseline values of cTnT without any evidence of acute myocardial injury (9). Although controversy remains on the clinical usefulness of measuring troponins for the diagnosis of acute ischemic cardiac events in these subjects (10), the levels of both cardiac troponin I (cTnI) and cTnT are inversely related to renal function predialysis (11) and several clinical investigations have demonstrated that cTnT is an independent predictor of mortality in end-stage renal disease (ESRD) patients starting dialysis (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Effect of hemodialysis on traditional and innovative cardiac markers

Montagnana

Lippi

Tessitore

et al. 2008

Clinical Laboratory Analysis

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The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD), and results were adjusted for hemoconcentration. The pre-HD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMAo85 K units/L; cTnT o0.03 ng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0 K units/L, Po0.0001) and variable (138%; 95% confidence interval [CI], 12-65%) increase of serum IMA was observed post-HD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044 ng/mL, P 5 0.016; CK-MB:2.33 vs.2.50 mg/L, Po 0.0001; myoglobin: 128.1 vs. 148.7 mg/L, Po0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the long-term risk of these patients, but not for diagnosing an ACS during or immediately post-HD.

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Section: Introductionmentioning

confidence: 99%

Effect of hemodialysis on traditional and innovative cardiac markers

Montagnana

Lippi

Tessitore

et al. 2008

Clinical Laboratory Analysis

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“…Several biomarkers, on admission for ACS, provide clinically important information on risk for cardiovascular morbidity and mortality, including NT‐proBNP (myocardial dysfunction),9, 10 cardiac troponins (myocardial necrosis),29 and cystatin C (kidney function) 7, 11. Circulating osteoprotegerin has been reported to be associated with cardiovascular outcomes, including mortality, MI, and incident heart failure, in several ACS cohorts 16, 17, 18, 19.…”

Section: Discussionmentioning

confidence: 99%

Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial

Ueland

Åkerblom

Ghukasyan

et al. 2018

JAHA

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BackgroundElevated levels of osteoprotegerin, a secreted tumor necrosis factor–related molecule, might be associated with adverse outcomes in patients with coronary artery disease. We measured plasma osteoprotegerin concentrations on hospital admission, at discharge, and at 1 and 6 months after discharge in a predefined subset (n=5135) of patients with acute coronary syndromes in the PLATO (Platelet Inhibition and Patient Outcomes) trial.Methods and ResultsThe associations between osteoprotegerin and the composite end point of cardiovascular death, nonprocedural spontaneous myocardial infarction or stroke, and non–coronary artery bypass grafting major bleeding during 1 year of follow‐up were assessed by Cox proportional hazards models. Event rates of the composite end point per increasing quartile groups at baseline were 5.2%, 7.5%, 9.2%, and 11.9%. A 50% increase in osteoprotegerin level was associated with a hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.21–1.42) for the composite end point but was not significant in adjusted analysis (ie, clinical characteristics and levels of C‐reactive protein, troponin T, NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide], and growth differentiation factor‐15). The corresponding rates of non–coronary artery bypass grafting major bleeding were 2.4%, 2.2%, 3.8%, and 7.2%, with an unadjusted HR of 1.52 (95% CI, 1.36–1.69), and a fully adjusted HR of 1.26 (95% CI, 1.09–1.46). The multivariable association between the osteoprotegerin concentrations and the primary end point after 1 month resulted in an HR of 1.09 (95% CI, 0.89–1.33); for major bleeding after 1 month, the HR was 1.33 (95% CI, 0.91–1.96).ConclusionsIn patients with acute coronary syndrome treated with dual antiplatelet therapy, osteoprotegerin was an independent marker of major bleeding but not of ischemic cardiovascular events. Thus, high osteoprotegerin levels may be useful in increasing awareness of increased bleeding risk in patients with acute coronary syndrome receiving antithrombotic therapy.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

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“…10,11 On the other hand, WBC or neutrophil count have not been thoroughly evaluated as prognostic indicators in this patient population. In this study, we demonstrated that patients with a NSTE ACS who did not experience a major in-hospital event had significant lower serum levels of TnI compared to those who did.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical studies have demonstrated that neutrophils are activated in patients with unstable angina and AMI. 10,11 Since there is substantial evidence that neutrophils are involved in the pathophysiology of ACS, a more thorough understanding of their role is desirable. A full blood count is routinely measured in every patient on admission and neutrophil count could be a convenient risk stratification marker in patients admitted for ACS.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil Count on Admission Predicts Major In‐hospital Events in Patients with a Non‐ST‐Segment Elevation Acute Coronary Syndrome

Karabinos

Koulouris

Kranidis

et al. 2009

Clinical Cardiology

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Background: Inflammation plays a key role in the pathogenesis of acute coronary syndromes (ACS). In this context we assessed neutrophil count as a predictor of major in-hospital events in patients admitted for a non-ST-segment elevation (NSTE) ACS. Methods: We measured neutrophils on admission in 160 patients with a NSTE ACS and we correlated their count with the incidence of a combined in-hospital end point including: cardiac death, acute heart failure, ST-segment elevation myocardial infarction, and recurrent myocardial ischemia. Results: Patients who had a major in-hospital event also had a higher neutrophil count (P = 0.02) and higher serum levels of troponin I (P = 0.04). In the univariate logistic regression analysis, in-hospital major events could be predicted by troponin I >0.07 ng/mL (odds ratio [OR]: 5.65, 95% confidence interval [CI]: 1.26-25.32, P = 0.02), white blood cell count >8650 cells/µL (OR: 2.68, 95% CI: 1.03-6.95, P = 0.04), neutrophil count >6700 cells/µL (OR: 7.74, 95% CI: 2.79-21.47, P < 0.001), and C-reactive protein >0.97 mg/dL (OR: 3.56, 95% CI: 1.13-11.19, P = 0.02). However, in multivariate regression, neutrophil count >6700 cells/µL (OR: 6.52, 95% CI: 1.56-27.22, P = 0.01) was the only independent in-hospital prognostic factor. Conclusions: In patients with a NSTE ACS of moderate or high risk, neutrophil count on admission may identify those who are at risk of having an adverse in-hospital outcome.

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The Prognostic Value of Serum Troponin T in Unstable Angina

Abstract: Cardiac troponin T in serum appears to be a more sensitive indicator of myocardial-cell injury than serum creatine kinase MB activity, and its detection in the circulation may be a useful prognostic indicator in patients with unstable angina.

Cited by 917 publications

References 35 publications

Effect of hemodialysis on traditional and innovative cardiac markers

Effect of hemodialysis on traditional and innovative cardiac markers

Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial

Neutrophil Count on Admission Predicts Major In‐hospital Events in Patients with a Non‐ST‐Segment Elevation Acute Coronary Syndrome

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