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A rapid troponin I ...
A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes.
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- James, Stefan K. (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Kardiologgruppen, L Wallentin
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- Lindahl, Bertil (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Kardiologgruppen, L Wallentin
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Armstrong, Paul (författare)
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Califf, Robert (författare)
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Simoons, Maarten L. (författare)
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- Venge, Per (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Inflammation
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- Wallentin, Lars (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Kardiologgruppen, L Wallentin
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(creator_code:org_t)
- 2004
- 2004
- Engelska.
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Ingår i: International Journal of Cardiology. - 0167-5273 .- 1874-1754. ; 93:2-3, s. 113-120
- Relaterad länk:
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http://www.ncbi.nlm....
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- BACKGROUND: Troponin is a specific marker of myocardial damage. For early prediction of coronary events in patients with suspicion of acute coronary syndromes the assay also needs to be highly sensitive. METHODS AND RESULTS: A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial. A quantitative troponin T analysis was later performed on blood samples obtained at randomization by a central laboratory. There was an agreement between the rapid troponin I assay and troponin T (< or =/>0.1 microg/l) in 3596 (80.9%) patients. A positive rapid troponin I was identifying any elevation of troponin T (>0.01 microg/l) in 1990 patients (90.4%) whereas a negative rapid troponin I was corresponding to negative troponin T (< or =0.01 microg/l) in only 1217 patients (54.2%). Patients with a positive versus negative rapid troponin I had an increased risk of death or myocardial infarction at 30 days (9.3 vs. 5.9%; odds ratio, O.R. 1.64; 95% confidence interval, 1.31-2.06). Troponin T elevation (>0.1 microg/l) provided a better (10.5 v. 4.9%, O.R. 2.26; C.I. 1.79-2.85) risk stratification. Regardless of a positive or a negative rapid troponin I, the troponin T result (>0.1 vs. < or =0.1 microg/l) stratified the patients into high and low risk of events at 30 days, (10.3 vs. 5.7%, P=0.002) and (11.5 vs. 4.8%, P<0.001), respectively. CONCLUSION: In a population with non-ST elevation acute coronary syndrome a positive rapid troponin I assay is a specific indicator of troponin elevation and a predictor of early outcome. However, a negative rapid troponin I is not a reliable indicator of the absence of myocardial damage and does not indicate a low risk of subsequent cardiac events. A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial and related to a centrally analyzed quantitative troponin T test. A positive rapid troponin I was well corresponding to any elevation of troponin T (>0.01 microg/l) and predicted an unfavorable outcome at 30 days. However, a negative rapid troponin I was corresponding to troponin T < or =0.01 microg/l in only half of the patients. Troponin T >0.1 microg/l vs. < or =0.1 microg/l provided a better risk stratification than the rapid troponin I result. For patients with troponin T elevation (>0.1 microg/l) the 30 day event rate was high regardless of the rapid troponin I result.
Nyckelord
- Acute Disease
- Aged
- Antibodies; Monoclonal/therapeutic use
- Anticoagulants/therapeutic use
- Comparative Study
- Coronary Disease/blood/*diagnosis
- Double-Blind Method
- Female
- Follow-Up Studies
- Humans
- Immunoglobulins; Fab/therapeutic use
- Male
- Middle Aged
- Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
- Predictive Value of Tests
- Research Support; Non-U.S. Gov't
- Risk Assessment
- Sensitivity and Specificity
- Troponin I/*blood
- Troponin T/blood
- MEDICINE
- MEDICIN
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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