Portal de Periódicos da CAPES

Value of Serial Troponin T Measures for Early and Late Risk Stratification in Patients With Acute Coronary Syndromes

1998; Lippincott Williams & Wilkins; Volume: 98; Issue: 18 Linguagem: Inglês

10.1161/01.cir.98.18.1853

1524-4539

L. Kristin Newby, Robert H. Christenson, E. Magnus Ohman, Paul W. Armstrong, Trevor Thompson, Kerry L. Lee, Christian W. Hamm, Hugo A. Katus, Cresha Cianciolo, Christopher B. Granger, Eric J. Topol, Robert M. Califf,

Coronary Interventions and Diagnostics

Background —The baseline cardiac troponin T (cTnT) level strongly predicts short-term mortality in acute coronary syndromes, but the added value of later measures to predict short- and long-term outcome and in the context of baseline clinical characteristics is unclear. Methods and Results —Relations between baseline, peak, and 8- and 16-hour (late) cTnT results and outcomes were assessed in 734 patients in a GUSTO-IIa substudy. Proportional-hazards models assessed the prognostic information gained from late cTnT when added to a mortality model containing the baseline cTnT result and clinical factors. At baseline, 260 patients were cTnT-positive (>0.1 ng/mL), 323 became positive later, and 151 remained negative (≤0.1 ng/mL). Mortality at 30 days was 10% in the baseline-positive group, 5% in late-positive patients, and 0% in negative patients. After adjustment for baseline characteristics, any positive cTnT result predicted 30-day mortality (baseline, χ 2 =8.96, P =0.0113; 8-hour, χ 2 =6.51, P =0.0107; 16-hour, χ 2 =8.40, P =0.0038). Both the 8- and the 16-hour results added to the strength of the baseline result (baseline+8-hour, χ 2 =12.04, P =0.0072; baseline+16-hour, χ 2 =13.52, P =0.0036). Only age and ST-segment elevation were stronger predictors of 30-day mortality than baseline cTnT; results were similar for prediction of 1-year mortality. Most of the mortality difference between cTnT-positive and -negative patients occurred within the first 30 days. Conclusions —The cTnT level is a strong, independent predictor of short-term outcome in acute coronary syndromes. The addition of later samples to a baseline level is useful to evaluate the risk of serious cardiac events.