Document Detail


Combination of quantitative ST deviation and troponin elevation provides independent prognostic and therapeutic information in unstable angina and non-ST-elevation myocardial infarction.
MedLine Citation:
PMID:  16368287     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: ST deviation and troponin are indicators of risk in unstable angina/non-ST-elevation myocardial infarction with related but distinct pathophysiology. We hypothesized that a combination of the two would offer complementary information regarding the benefit of an invasive strategy. METHODS AND RESULTS: Electrocardiogram and troponin data were gathered in 1846 patients in TACTICS-TIMI 18. Adjusting for baseline characteristics, the independent odds ratio (OR) (95% CI) for death or myocardial infarction by 6 months was 1.29 (0.78-2.13) for 0.05 to 0.09 mV ST deviation, 1.83 (1.22-2.75) for > or = 0.10 mV ST deviation, 1.69 (0.96-2.97) for troponin T 0.01 to 0.10 ng/mL, and 2.32 (1.52-3.53) for troponin T > 0.10 ng/mL. There was a significant interaction between the magnitude of ST deviation and treatment strategy (P(interaction) = .04). After adjusting for troponin and other baseline characteristics, an early invasive strategy was associated with a 27% greater reduction in the odds of death or myocardial infarction in those with 0.05 to 0.09 mV of ST deviation (OR(interaction) 0.73, 95% CI 0.27-2.02) and a 64% greater reduction in those with > or = 0.10 mV (OR(interaction) 0.36, 95% CI 0.16-0.84) compared with in those without ST deviation. CONCLUSIONS: The magnitude of ST deviation and degree of troponin elevation are graded independent predictors of outcome in unstable angina/non-ST-elevation myocardial infarction. ST deviation complements troponin elevation in selecting patients for early invasive management.
Authors:
Marc S Sabatine; David A Morrow; Carolyn H McCabe; Elliott M Antman; C Michael Gibson; Christopher P Cannon
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  151     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2005-12-21     Completed Date:  2006-03-31     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  25-31     Citation Subset:  AIM; IM    
Affiliation:
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. msabatine@partners.org
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MeSH Terms
Descriptor/Qualifier:
Angina, Unstable / blood*,  mortality,  physiopathology*,  therapy
Electrocardiography*
Humans
Myocardial Infarction / blood*,  mortality,  physiopathology*,  therapy
Prognosis
Treatment Failure
Troponin / blood*
Grant Support
ID/Acronym/Agency:
R01 HL072872/HL/NHLBI NIH HHS; R01 HL072879/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Troponin

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