| 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. | |
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MedLine Citation:
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PMID: 20569707 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: American heart journal Volume: 159 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-23 Completed Date: 2010-07-15 Revised Date: 2011-07-28 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 964-971.e1 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 Mosby, Inc. All rights reserved. |
Affiliation:
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TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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U01 HL081341-04/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 0/Troponin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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