Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with refractory unstable angina, and troponin T predicts benefit of treatment with abciximab in combination with PTCA.

Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with refractory unstable angina, and troponin T predicts benefit of treatment with abciximab in combination with PTCA.

MedLine Citation:	PMID: 12559939 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	AIMS: Treatment with the glycoprotein IIb/IIIa receptor antagonist abciximab before and during coronary intervention in refractory unstable angina improves early outcome. We collected 4-year follow-up data to assess whether this benefit is sustained. Additionally, we investigated the predictive value of baseline troponin T and CRP for long-term cardiovascular events. METHODS AND RESULTS: Of 1265 patients enrolled in the CAPTURE trial follow-up was available in 94% of the patients alive after 6 months (median 48 months). Survival was similar in both groups. Both elevated troponin T and CRP were associated with impaired outcome, independently of other established risk factors, but with a different time course. Elevated troponin was associated with increased procedure related risk, and elevated CRP with increased risk for subsequent events. Lower rates of the composite end-point of death or myocardial infarction with abciximab vs. placebo were sustained during long-term follow up: 15.7% vs 17.2% at 4 years (P=ns), particularly in patients with elevated troponin T: 16.9% with abciximab vs 28.4% with placebo: P=0.015. Elevated CRP was not associated with specific benefit of abciximab. CONCLUSION: Troponin T as a marker of thrombosis and CRP as a marker of inflammation are independent predictors of impaired outcome at 4 years follow-up. The initial benefit from abciximab with regard to death and myocardial infarction was preserved at 4 years. No specific benefit with abciximab was observed for patients with elevated CRP, suggesting that a chronic inflammatory process is not affected by abciximab. In contrast the benefit of treatment in patients with elevated troponin T implies that the acute thrombotic process in refractory unstable angina is treated effectively.

Authors:	T Lenderink; E Boersma; C Heeschen; A Vahanian; M-J de Boer; V Umans; M J B M van den Brand; C W Hamm; M L Simoons;
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Publication Detail:	Type: Clinical Trial; Journal Article; Randomized Controlled Trial
Journal Detail:	Title: European heart journal Volume: 24 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2003 Jan
Date Detail:	Created Date: 2003-01-31 Completed Date: 2003-03-10 Revised Date: 2005-11-17
Medline Journal Info:	Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England
Other Details:	Languages: eng Pagination: 77-85 Citation Subset: IM
Affiliation:	Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:	Angina, Unstable / blood, drug therapy, therapy* Angioplasty, Transluminal, Percutaneous Coronary / methods* Antibodies, Monoclonal / therapeutic use* C-Reactive Protein / metabolism* Chronic Disease Combined Modality Therapy / methods Female Follow-Up Studies Humans Immunoglobulin Fab Fragments / therapeutic use* Male Middle Aged Platelet Aggregation Inhibitors / therapeutic use* Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Predictive Value of Tests Survival Analysis Treatment Outcome Troponin T / metabolism*
Chemical
Reg. No./Substance:	0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Troponin T; 143653-53-6/abciximab; 9007-41-4/C-Reactive Protein
Comments/Corrections
Comment In:	Eur Heart J. 2003 Jan;24(2):136-7 [PMID: 12573270 ]

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