Document Detail


Early dynamic risk stratification with baseline troponin levels and 90-minute ST-segment resolution to predict 30-day cardiovascular mortality in ST-segment elevation myocardial infarction: analysis from CLopidogrel as Adjunctive ReperfusIon TherapY (CLARITY)-Thrombolysis in Myocardial Infarction (TIMI) 28.
MedLine Citation:
PMID:  20569707     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Troponin is the preferred biomarker for risk stratification in non-ST elevation ACS. The incremental prognostic use of the initial magnitude of troponin elevation and its value in conjunction with ST-segment resolution (STRes) in ST elevation myocardial infarction (STEMI) is less well defined.
METHODS: Troponin T (TnT) was measured in 1,250 patients at presentation undergoing fibrinolysis for STEMI in CLARITY-TIMI 28. ST-segment resolution was measured at 90 minutes. Multivariable logistic regression was used to examine the independent association between TnT levels, STRes, and 30-day cardiovascular (CV) mortality.
RESULTS: Patients were classified into undetectable TnT at baseline (n = 594), detectable but below the median of 0.12 ng/mL (n = 330), and above the median (n = 326). Rates of 30-day CV death were 1.5%, 4.5%, and 9.5%, respectively (P < .0001). Compared with those with undetectable levels and adjusting for baseline factors, the odds ratios for 30-day CV death were 4.56 (1.72-12.08, P = .002) and 5.81 (2.29-14.73, P = .0002) for those below and above the median, respectively. When combined with STRes, there was a significant gradient of risk, and in a multivariable model both baseline TnT (P = .004) and STRes (P = .003) were significant predictors of 30-day CV death. The addition of TnT and STRes to clinical risk factors significantly improved the C-statistic (from 0.86 to 0.90, P = .02) and the integrated discriminative improvement (7.1% increase) (P = .0009).
CONCLUSIONS: Baseline TnT and 90-minute STRes are independent predictors of 30-day CV death in patients with STEMI. Use of these 2 simple, readily available tools can aid clinicians in early risk stratification.
Authors:
Matthew W Sherwood; David A Morrow; Benjamin M Scirica; Songtao Jiang; Christoph Bode; Nader Rifai; Robert E Gerszten; C Michael Gibson; Christopher P Cannon; Eugene Braunwald; Marc S Sabatine
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  159     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-23     Completed Date:  2010-07-15     Revised Date:  2014-09-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  964-971.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Mosby, Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Dose-Response Relationship, Drug
Electrocardiography*
Female
Follow-Up Studies
Humans
Immunoassay
Male
Middle Aged
Myocardial Infarction / blood,  drug therapy*,  mortality
Platelet Aggregation Inhibitors / administration & dosage,  therapeutic use*
Prognosis
Risk Factors
Survival Rate
Thrombolytic Therapy / methods*
Ticlopidine / administration & dosage,  analogs & derivatives*,  therapeutic use
Time Factors
Treatment Outcome
Troponin / blood*
Grant Support
ID/Acronym/Agency:
U01 HL081341/HL/NHLBI NIH HHS; U01 HL081341-04/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Troponin; A74586SNO7/clopidogrel; OM90ZUW7M1/Ticlopidine
Comments/Corrections

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


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