| Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I. | |
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MedLine Citation:
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PMID: 20447535 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to investigate the prognostic implications of low-level increases in cardiac troponin I (cTnI) using a current-generation sensitive assay in patients with suspected acute coronary syndrome (ACS). BACKGROUND: Recent enhancements in troponin assays have enabled resolution of the 99th percentile reference limit at progressively lower concentrations. However, the clinical significance of low-level increases with sensitive assays is still debated. METHODS: We measured cTnI using a sensitive assay (TnI-Ultra, Siemens Healthcare Diagnostics, Deerfield, Illinois) at baseline in 4,513 patients with non-ST-segment elevation ACS randomly assigned to ranolazine or placebo. We applied decision limits at the 99th percentile reference limit (0.04 microg/l), the cut point of the predecessor assay (0.1 microg/l), and 1 equivalent to elevation of creatine kinase-myocardial band (1.5 ng/ml). RESULTS: Patients with baseline cTnI > or =0.04 microg/l (n = 2,924) were at higher risk of death/myocardial infarction (MI) at 30 days than were patients with a negative cTnI (6.1% vs. 2.0%, p < 0.001). After adjusting for the TIMI (Thrombolysis In Myocardial Infarction) risk score, cTnI > or =0.04 microg/l was associated with a 3-fold (95% confidence interval: 2.0 to 4.4, p < 0.001) higher risk of death/MI at 30 days. Moreover, patients with low-level increases (0.04 microg/l to <0.1 microg/l), were at significantly higher risk of death/MI at 30 days (5.0% vs. 2.0%, p = 0.001) and death at 12 months (6.4% vs. 2.4%, p = 0.005) than were patients with cTnI <0.04 microg/l. CONCLUSIONS: Low-level increases in cTnI using a sensitive assay identify patients at higher risk of death or MI. These findings support current American College of Cardiology/American Heart Association recommendations defining MI, and the incremental value of newer, more sensitive assays in identifying high-risk patients with ACS. |
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Authors:
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Marc Bonaca; Benjamin Scirica; Marc Sabatine; Anthony Dalby; Jindrich Spinar; Sabina A Murphy; Peter Jarolim; Eugene Braunwald; David A Morrow |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 55 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-07 Completed Date: 2010-06-10 Revised Date: 2010-08-02 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 2118-24 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mbonaca@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetanilides
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therapeutic use Acute Coronary Syndrome / blood*, diagnosis*, mortality Aged Biological Markers / blood Enzyme Inhibitors / therapeutic use Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / blood, diagnosis, epidemiology Piperazines / therapeutic use Predictive Value of Tests Prognosis Prospective Studies Risk Factors Troponin I / blood* |
| Chemical | |
Reg. No./Substance:
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0/Acetanilides; 0/Biological Markers; 0/Enzyme Inhibitors; 0/Piperazines; 0/Troponin I; 110445-25-5/ranolazine |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2010 May 11;55(19):2125-8
[PMID:
20447536
]
Nat Rev Cardiol. 2010 Aug;7(8):416 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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