Troponin: an important prognostic marker and risk-stratification tool in non–ST-segment elevation acute coronary syndromes

Abstract

Over the past decade, there has been a progressive evolution of cardiac marker testing in patients with acute coronary syndromes (ACS). This has not only resulted in a dramatic shift in how we view the diagnosis of myocardial infarction (MI), but it has also extended the role of cardiac marker testing into risk stratification and guidance of treatment decisions. By the year 2000, the development of highly sensitive and cardiac-specific troponin assays had resulted in a consensus change in the definition of MI, placing increased emphasis on cardiac-marker testing with troponins as the new gold standard. Furthermore, and perhaps more importantly, the role of the troponins as superior markers of subsequent cardiac risk in ACS patients became firmly established. Most recently, the supportive role of these markers in identifying patients with ACS who may derive particular benefit from potent anti-thrombotic and anti-platelet therapy or early invasive treatment strategies has been demonstrated. This paper will review the evolution of these important roles of troponin testing for risk stratification in ACS.

Accumulation of Calpain and Caspase-3 Proteolytic Fragments of Brain-Derived αII-Spectrin in Cerebral Spinal Fluid after Middle Cerebral Artery Occlusion in Rats

“…Analysis of specific biochemical markers is a mandatory component of diagnosing dysfunction in a number of organs, including the use of troponin assays in patients with acute coronary syndromes (Newby et al, 2003). Indeed, troponin testing has rapidly evolved from its ini- (280 kDa) protein and calpain-mediated 145 kDa and caspase-3 mediated 120 kDa (II-SBDPs in CSF.…”

The Prequel

“…17 Troponins have been shown to be better for prognosis than CKMB in ACS, and troponins identify patients at higher risk despite CKMB levels being normal. 18 CKMB is now not available in an increasing number of hospitals. With CKMB becoming obsolete, troponin will become the gold standard and CKMB will no longer have a role in defining after PCI injury in clinical practice.…”

Soluble CD40L Levels Are Regulated by the −3459 A>G Polymorphism and Predict Myocardial Infarction and the Efficacy of Antithrombotic Treatment in Non-ST Elevation Acute Coronary Syndrome

“…Thus, echocardiography signs of ischemia and biomarkers such as troponin-T (TnT) and IL-6 have been shown useful for the identification of patients with the largest benefits of early invasive treatment or anticoagulant treatments. [3][4][5][6] To further improve the risk stratification and tailoring of treatment in ACS patients, new markers with predictive power for both short-term and long-term outcomes and that are able to discriminate between the risk of new thrombotic events such as myocardial infarction (MI) and the more unspecific risks of mortality are needed. 7 CD40 is expressed on a variety of immune cells within atherosclerotic lesions including endothelial cells, smooth muscle cells, and monocytes/macrophages, whereas CD40L is largely expressed on CD4ϩ T-cells and activated platelets.…”