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      Elevated Cardiac Troponin Levels Do Not Predict Adverse Outcomes in Hospitalized Patients without Clinical Manifestations of Acute Coronary Syndromes


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          The prognostic significance of elevated cardiac troponin levels (CTL) in hospitalized patients with no other evidence of myocardial ischemia or injury is largely unknown. Fifty patients (mean age 61 ± 15 years, 15 women) out of 580 consecutive hospitalized patients were selected based on normal CK-MB and at least 3-fold increase of CTL. The medical charts of these patients were reviewed and a 1-year follow-up was performed. The most frequent admission diagnoses were exacerbation of congestive heart failure (22%), stroke (20%) followed by respiratory failure (6%), cirrhosis (6%), gastrointestinal bleeding (6%), end-stage renal disease (4%), atrial fibrillation (4%) and metastatic malignancies (4%). Abnormal CTL prompted a cardiology consult in 48% of patients, an echocardiogram in 44%, myocardial perfusion study in 10% and coronary angiography in 1 patient. Of 21 deaths, only 1 was related to an acute coronary event. The measurement of CTL in patients without definite clinical or electrocardiographic evidence of myocardial ischemia and with a wide spectrum of clinical diagnoses does not predict in-hospital and at 1 year cardiovascular complications and/or cardiac death.

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

          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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            Troponin T Identifies Patients With Unstable Coronary Artery Disease Who Benefit From Long-Term Antithrombotic Protection fn1fn1This study was supported by grants from the Swedish Heart and Lung Foundation, Stockholm, Sweden; the Selander’s Foundation, Uppsala, Sweden; the Uppsala County Association Against Heart and Lung Diseases, Uppsala, Sweden; Pharmacia Biosensor AB, Uppsala, Sweden; and Pharmacia AB, Stockholm, Sweden. Boehringer Mannheim Scandinavia AB, Bomma, Sweden provided the troponin T kits.

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              New Serum Markers for Acute Myocardial Infarction


                Author and article information

                S. Karger AG
                June 2000
                04 July 2000
                : 93
                : 1-2
                : 1-6
                aUniversity of Texas, Houston Medical School, bHermann Hospital and cBaylor College of Medicine, Houston, Tex., USA
                6994 Cardiology 2000;93:1–6
                © 2000 S. Karger AG, Basel

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                Page count
                Tables: 5, References: 43, Pages: 6
                General Cardiology


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