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Persistent cardiac troponin I elevation in stabilized patients after an episode of acute coronary syndrome predicts long-term mortality
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2007 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 116, no 17, 1907-1914 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND - In patients with non-ST-elevation acute coronary syndrome, any troponin elevation is associated with an increased risk for cardiovascular events. However, the prevalence and prognostic importance of persistent troponin elevation in stabilized patients after an episode of non-ST-elevation acute coronary syndrome are unknown and were therefore assessed in this study. METHODS AND RESULTS - Cardiac troponin I (cTnI) was measured in 1092 stabilized patients at 6 weeks and 3 and 6 months after enrollment in the FRagmin and Fast Revascularization during InStability in Coronary artery disease (FRISC-II) trial. cTnI was analyzed with the Access AccuTnI assay with the application of different prognostic cutoffs. Outcomes were assessed through 5 years. Elevated cTnI levels >0.01 μg/L were found in 48% of the study patients at 6 weeks, in 36% at 6 months, and in 26% at all 3 measurements. cTnI elevation was associated with increased age and other cardiovascular high-risk features. The lowest tested cTnI cutoff (0.01 μg/L) was prognostically most useful and was independently predictive of mortality (hazard ratio, 2.1 [95% confidence interval, 1.3 to 3.3]; P=0.001) on multivariable analysis adjusted for cardiovascular risk factors and randomization to an invasive versus noninvasive treatment strategy, whereas it was related to myocardial infarction only on univariate analysis. CONCLUSIONS - Persistent minor cTnI elevation can be detected frequently in patients stabilized after an episode of non-ST-elevation acute coronary syndrome with the use of a sensitive assay. Elevated cTnI levels >0.01 μg/L predict mortality during long-term follow-up. Our results emphasize the importance of further troponin testing in non-ST-elevation acute coronary syndrome patients after hospital discharge.

Place, publisher, year, edition, pages
2007. Vol. 116, no 17, 1907-1914 p.
Keyword [en]
Coronary disease, Prognosis, Troponin
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-96038DOI: 10.1161/CIRCULATIONAHA.107.708529ISI: 000250517900009PubMedID: 17909103OAI: oai:DiVA.org:uu-96038DiVA: diva2:170454
Available from: 2007-05-30 Created: 2007-05-30 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Cardiac Troponins in Patients with Suspected or Confirmed Acute Coronary Syndrome: New Applications for Biomarkers in Coronary Artery Disease
Open this publication in new window or tab >>Cardiac Troponins in Patients with Suspected or Confirmed Acute Coronary Syndrome: New Applications for Biomarkers in Coronary Artery Disease
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The cardiac troponins are the biochemical markers of choice for the diagnosis of acute myocardial infarction (AMI) and risk prediction in patients with acute coronary syndrome (ACS). In this thesis, the role of early serial cardiac troponin I (cTnI) testing was assessed in fairly unselected patient populations admitted because of chest pain and participating in the FAST II-study (n=197) and the FASTER I-study (n=380). Additionally, the importance of cTnI testing in stable post-ACS patients from the FRISC II-study (n=1092) was studied.

The analyses in chest pain patients demonstrate that cTnI is very useful for early diagnostic and prognostic assessment. cTnI allowed already 2 hours after admission the reliable exclusion of AMI and the identification of low-risk patients when ECG findings and a renal marker such as cystatin C were added as conjuncts. Other biomarkers such as CK-MB, myoglobin, NT-pro BNP or CRP did not provide superior clinical information. However, myoglobin may be valuable in combination with cTnI results for the early prediction of an impending major AMI when used as input variable for an artificial neural network. Such an approach applying cTnI results only may also furthermore improve the early diagnosis of AMI.

Persistent cTnI elevation > 0.01 μg/L was detectable using a high-sensitive assay in 26% of the stable post-ACS patients from the FRISC II-study. NT-pro BNP levels at 6 months were the most important variable independently associated to persistent cTnI elevation besides male gender, indicating a relationship between adverse left ventricular remodeling processes and cTnI leakage. Patients with persistent cTnI elevation had a considerable risk for both mortality and AMI during 5 year follow-up.

These analyses thus, confirm the value of cTnI for early assessment of chest pain patients and provide new and unique evidence regarding the role of cTnI for risk prediction in post-ACS populations.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 269
Keyword
Internal medicine, Ischemic heart disease, Acute myocardial infarction, Troponin, Natriuretic peptide, CRP, Cystatin C, Artificial neural network, Point of care measurements, Risk prediction, Invärtesmedicin
Identifiers
urn:nbn:se:uu:diva-7945 (URN)978-91-554-6924-5 (ISBN)
Public defence
2007-09-14, Robergsalen, Ingång 40, Akademiska Sjukhuset, Uppsala, 09:15
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Available from: 2007-05-30 Created: 2007-05-30 Last updated: 2011-01-19Bibliographically approved

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Eggers, KaiLagerqvist, BoWallentin, LarsLindahl, Bertil

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