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      Prognostic value of troponins in acute coronary syndrome depends upon patient age

      Author(s): , , , , ,
      Publication date Created:
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      Journal: Heart
      Publisher: BMJ

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          Abstract

          This study aims to determine whether the prognostic significance of troponins in acute coronary syndrome in predicting mortality varies by age, and if so, to what extent when other prognostic indicators are considered.

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          Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes.

          E Braunwald, M Schactman, M J Tanasijevic … (1996)
          In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. We studied the prognostic value of cardiac troponin I levels in patients with unstable angina or non-Q-wave myocardial infarction. In a multicenter study, blood specimens from 1404 symptomatic patients were analyzed for cardiac troponin I, a serum marker not detected in the blood of healthy persons. The relation between mortality at 42 days and the level of cardiac troponin I in the specimen obtained on enrollment was determined both before and after adjustment for baseline characteristics. The mortality rate at 42 days was significantly higher in the 573 patients with cardiac troponin I levels of at least 0.4 ng per milliliter (21 deaths, or 3.7 percent) than in the 831 patients with cardiac troponin I levels below 0.4 ng per milliliter (8 deaths, or 1.0 percent; P or = 65 years). In patients with acute coronary syndromes, cardiac troponin I levels provide useful prognostic information and permit the early identification of patients with an increased risk of death.
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            Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators.

            Robert H. Christenson, Neal Kleiman, Bradi B. Granger … (1996)
            The prognosis of patients hospitalized with acute myocardial ischemia is quite variable. We examined the value of serum levels of cardiac troponin T, serum creatine kinase MB (CK-MB) levels, and electrocardiographic abnormalities for risk stratification in patients with acute myocardial ischemia. We studied 855 patients within 12 hours of the onset of symptoms. Cardiac troponin T levels, CK-MB levels, and electrocardiograms were analyzed in a blinded fashion at the core laboratory. We used logistic regression to assess the usefulness of baseline levels of cardiac troponin T and CK-MB and the electrocardiographic category assigned at admission-ST-segment elevation, ST-segment depression, T-wave inversion, or the presence of confounding factors that impair the detection of ischemia (bundle-branch block and paced rhythms)-in predicting outcome. On admission, 289 of 801 patients with base-line serum samples had elevated troponin T levels (> 0.1 ng per milliliter). Mortality within 30 days was significantly higher in these patients than in patients with lower levels of troponin T (11.8 percent vs. 3.9 percent, P < 0.001). The troponin T level was the variable most strongly related to 30-day mortality (chi-square = 21, P < 0.001), followed by the electrocardiographic category (chi-square = 14, P = 0.003) and the CK-MB level (chi-square = 11, P = 0.004). Troponin T levels remained significantly predictive of 30-day mortality in a model that contained the electrocardiographic categories and CK-MB levels (chi-square = 9.2, P = 0.027). The cardiac troponin T level is a powerful, independent risk marker in patients who present with acute myocardial ischemia. It allows further stratification of risk when combined with standard measures such as electrocardiography and the CK-MB level.
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              Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey.

              Annika Rosengren, Lars Wallentin, Maarten L. Simoons … (2006)
              Age is one of the most powerful determinants of prognosis in myocardial infarction, but there is comparatively little recent data across the whole spectrum of acute coronary syndromes (ACS). We examined the impact of increasing age on clinical presentation and hospital outcome in a large sample of patients with ACS. Patients (n = 10 253) from the Euroheart ACS survey in 103 hospitals in 25 countries were investigated. There was a significant inverse association between the age and the likelihood of presenting with ST-elevation. For each decade of life, the odds of presenting with ST-elevation decreased by 0.82 [95% confidence interval (CI) 0.79-0.84]; P or =85 years, with no major differences across different types of admission or discharge diagnoses. Elderly ACS patients were less likely to present with ST-elevation but had substantial in-hospital mortality, yet they were markedly less intensively treated and investigated.
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                Author and article information

                Journal
                Title: Heart
                Abbreviated Title: Heart
                Publisher: BMJ
                ISSN (Print): 1355-6037
                ISSN (Electronic): 1468-201X
                Publication date Created: September 23 2014
                Publication date Created: October 15 2014
                Publication date (Print): October 15 2014
                Publication date (Electronic): June 26 2014
                Volume: 100
                Issue: 20
                Pages: 1583-1590
                Article
                DOI: 10.1136/heartjnl-2014-305533
                PubMed ID: 24968887
                SO-VID: 344c2b57-bd01-4c71-948a-5a8764a8cb93
                Copyright © © 2014
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