Published online before print January 19, 2004, doi: 10.1161/01.CIR.0000109696.92474.92
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;109:465-470.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Elevated Troponin T Levels and Lesion Characteristics in Non–ST-Elevation Acute Coronary Syndromes
From the Department of Internal Medicine, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan (K.O., M.T., S.S., F.I., R.U., K.M.); and the First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan (T.T.).
Correspondence to Kyoichi Mizuno, MD, Department of Internal Medicine, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamakari, Inba, Inba, Chiba, Japan 270-1694. E-mail Mizunok{at}nms.ac.jp
Received March 4, 2003; de novo received June 4, 2003; revision received October 24, 2003; accepted October 28, 2003.
Background— Elevated troponin T levels in non–ST-elevation acute coronary syndromes (NSTE-ACS) have been shown to predict an adverse outcome. Furthermore, it has been reported that troponin T could help improve the effectiveness of such new antithrombotic drugs as platelet GPIIb/IIIa antagonists and low-molecular-weight heparins. We hypothesized that such elevated troponin T levels in NSTE-ACS indicate the presence of thrombus at culprit lesions, and this hypothesis was verified through the use of coronary angioscopy.
Methods and Results— We studied 57 consecutive patients with NSTE-ACS who underwent preinterventional angioscopy. Before catheterization, we obtained blood samples to determine troponin positivity, and the patients were then classified as either troponin-positive or troponin-negative groups (diagnostic threshold, 0.1 ng/mL). Using angioscopy at the culprit lesions, we examined the presence of coronary thrombus, yellow plaque, and complex plaque. Moreover, we compared the preinterventional angiographic parameters (thrombus and complexity of the culprit lesion, and TIMI flow) between the two groups. Twenty-two patients were troponin-positive and 35 patients were troponin-negative. Univariate analyses indicated that the TIMI flow and the incidence of coronary thrombus detected with angioscopy correlate with the elevated troponin T levels. A multivariate logistic regression analysis showed the presence of coronary thrombus detected with angioscopy to be the only independent factor associated with elevated troponin T levels in patients with NSTE-ACS (odds ratio, 22.1; 95% CI, 2.59 to 188.42; P=0.0046).
Conclusions— Using angioscopy, the elevated troponin T levels in NSTE-ACS were confirmed to be strongly associated with the presence of coronary thrombus.
Key Words: coronary diseases • thrombus • plaque
This article has been cited by other articles:
 |
|
 |
|
  S. Yokoyama, M. Takano, M. Yamamoto, S. Inami, S. Sakai, K. Okamatsu, S. Okuni, K. Seimiya, D. Murakami, T. Ohba, et al. Extended Follow-Up by Serial Angioscopic Observation for Bare-Metal Stents in Native Coronary Arteries: From Healing Response to Atherosclerotic Transformation of Neointima Circ Cardiovasc Interv, June 1, 2009; 2(3): 205 - 212. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Prasad, C. S. Rihal, R. J. Lennon, M. Singh, A. S. Jaffe, and D. R. Holmes Jr Significance of Periprocedural Myonecrosis on Outcomes After Percutaneous Coronary Intervention: An Analysis of Preintervention and Postintervention Troponin T Levels in 5487 Patients Circ Cardiovasc Interv, August 1, 2008; 1(1): 10 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Takano, M. Yamamoto, Y. Xie, D. Murakami, S. Inami, K. Okamatsu, K. Seimiya, T. Ohba, Y. Seino, and K. Mizuno Serial long-term evaluation of neointimal stent coverage and thrombus after sirolimus-eluting stent implantation by use of coronary angioscopy Heart, December 1, 2007; 93(12): 1533 - 1536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Takano, M. Yamamoto, Y. Xie, D. Murakami, S. Inami, K. Okamatsu, K. Seimiya, T. Ohba, Y. Seino, and K. Mizuno Serial long-term evaluation of neointimal stent coverage and thrombus after sirolimus-eluting stent implantation by use of coronary angioscopy Heart, November 1, 2007; 93(11): 1353 - 1356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Takano, T. Ohba, S. Inami, K. Seimiya, S. Sakai, and K. Mizuno Angioscopic differences in neointimal coverage and in persistence of thrombus between sirolimus-eluting stents and bare metal stents after a 6-month implantation Eur. Heart J., September 2, 2006; 27(18): 2189 - 2195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Kirtane, J. J. Vafai, S. A. Murphy, J. M. Aroesty, M. S. Sabatine, C. P. Cannon, C. M. Gibson, and for the TIMI Study Group Angiographically evident thrombus following fibrinolytic therapy is associated with impaired myocardial perfusion in STEMI: a CLARITY-TIMI 28 substudy Eur. Heart J., September 1, 2006; 27(17): 2040 - 2045. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. L. Miller, K. N. Garratt, M. F. Burritt, R. J. Lennon, G. S. Reeder, and A. S. Jaffe Baseline troponin level: key to understanding the importance of post-PCI troponin elevations Eur. Heart J., May 1, 2006; 27(9): 1061 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Henriksen and N. Boon Cardiological management. BMJ, March 18, 2006; 332(7542): 644 - 645. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Malarstig, T. Tenno, N. Johnston, B. Lagerqvist, T. Axelsson, A.-C. Syvanen, L. Wallentin, and A. Siegbahn Genetic Variations in the Tissue Factor Gene Are Associated With Clinical Outcome in Acute Coronary Syndrome and Expression Levels in Human Monocytes Arterioscler Thromb Vasc Biol, December 1, 2005; 25(12): 2667 - 2672. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Babuin and A. S. Jaffe Troponin: the biomarker of choice for the detection of cardiac injury Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rajappa and A. Sharma Biomarkers of Cardiac Injury: An Update Angiology, November 1, 2005; 56(6): 677 - 691. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Bolognese, G. Falsini, F. Liistro, and P. Angioli Myocardial damage during percutaneous interventions for non-ST-elevation acute coronary syndromes Eur. Heart J. Suppl., October 1, 2005; 7(suppl_K): K15 - K18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Roe, E. D. Peterson, Y. Li, C. V. Pollack Jr, R. H. Christenson, W. F. Peacock, F. M. Fesmire, L. K. Newby, R. L. Jesse, J. W. Hoekstra, et al. Relationship Between Risk Stratification by Cardiac Troponin Level and Adherence to Guidelines for Non-ST-Segment Elevation Acute Coronary Syndromes Arch Intern Med, September 12, 2005; 165(16): 1870 - 1876. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Giugliano and E. Braunwald The Year in Non--ST-Segment Elevation Acute Coronary Syndromes J. Am. Coll. Cardiol., September 6, 2005; 46(5): 906 - 919. [Full Text] [PDF]
|
|
|
|
|
|
H. Yilmaz and I. Basarici Troponin Levels and Acute Coronary Syndrome J. Am. Coll. Cardiol., August 16, 2005; 46(4): 741 - 741. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]
|
|
|
|
|
|
M. Takano, S. Inami, F. Ishibashi, K. Okamatsu, K. Seimiya, T. Ohba, S. Sakai, and K. Mizuno Angioscopic follow-up study of coronary ruptured plaques in nonculprit lesions J. Am. Coll. Cardiol., March 1, 2005; 45(5): 652 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Bolognese, K. Ducci, P. Angioli, G. Falsini, F. Liistro, S. Baldassarre, and A. Burali Elevations in Troponin I After Percutaneous Coronary Interventions Are Associated With Abnormal Tissue-Level Perfusion in High-Risk Patients With Non-ST-Segment-Elevation Acute Coronary Syndromes Circulation, September 21, 2004; 110(12): 1592 - 1597. [Abstract] [Full Text] [PDF]
|
|