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    
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.
Marc S Sabatine; David A Morrow; Carolyn H McCabe; Elliott M Antman; C Michael Gibson; Christopher P Cannon
Related Documents :
9519317 - Long-term prognosis in unstable angina. the importance of early risk stratification usi...
15526537 - Streptokinase and enoxaparin in the pre-hospital management of the st-segment elevation...
16015437 - Significance of st depression during exercise treadmill stress and adenosine infusion m...
1985377 - Incidence and clinical significance of st segment elevation after electrical cardiovers...
15021287 - Bradycardia and sinus arrest following saline irrigation of the brain during epilepsy s...
14633527 - Intramural left atrial hematoma after aortocoronary artery surgery.
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    
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Angina, Unstable / blood*,  mortality,  physiopathology*,  therapy
Myocardial Infarction / blood*,  mortality,  physiopathology*,  therapy
Treatment Failure
Troponin / blood*
Grant Support
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Elevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with acu...
Next Document:  Outcomes after acute coronary syndrome admission to primary versus tertiary Veterans Affairs medical...