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Small changes in Troponin T levels are common in patients with non-ST-elevation myocardial infarction and are linked to higher mortality.
MedLine Citation:
PMID:  23933541     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To examine the extent of change in Troponin T levels in patients with non-ST-elevation myocardial infarction (NSTEMI).
BACKGROUND: Changes in cardiac troponin levels are required for the diagnosis of NSTEMI, according to the new universal definition of acute myocardial infarction. A relative change of 20-230 % and an absolute change of 7- 9 ng/L have been suggested as cut-off points.
METHOD: In a clinical setting, where a change in cTnT was not mandatory for the diagnosis of NSTEMI, serial samples of cTnT were measured with a high-sensitive cTnT (hs-cTnT) assay, and 37 clinical parameters were evaluated in 1178 patients with a final diagnosis of NSTEMI presenting <24h after symptom onset.
RESULTS: After six hours of observation, the relative change in the hs-cTnT level remained <20 % in 26 % and the absolute change <9 ng/L in 12 % of the NSTEMI patients. A relative hs-cTnT change <20% was linked to higher long-term mortality across quartiles (p=0.002) and in multivariate analyses (HR 1.61 (1.17-2.21) p=0.004), whereas 30-day mortality was similar across quartiles of relative hs-cTnT change CONCLUSION: Because stable hs-TnT levels are common in patients with a clinical diagnosis of NSTEMI in our hospital, a small hs-cTnT change may not be useful to exclude NSTEMI, particularly as these patients show both short-term and long-term mortality at least as high as patients with large changes in hs-cTnT.
Christian Bjurman; Mårten Larsson; Per Johanson; Max Petzold; Bertil Lindahl; Michael Lx Fu; Ola Hammarsten
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-29
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-8-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, SE-41345 Goteborg, Sweden.
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