(Circulation. 1996;94:1291-1297.)
© 1996 American Heart Association, Inc.
Articles |
Prognostic Significance of Admission Troponin T Concentrations in Patients With Myocardial Infarction
Charing Cross Hospital (P.S., M.N.), Mayday University Hospital (P.C.), and West Middlesex University Hospital (D.M., T.G.), London, UK.
Correspondence to Dr Peter John Stubbs, Academic Unit of Cardiovascular Medicine, Charing Cross and Westminster Medical School, Fifth Floor South Wing, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK.
Background New, highly specific cardiac structural proteins can now be measured. The early presence of one of these proteins, troponin T, has been found to have important prognostic significance in patients with unstable angina pectoris. The prognostic significance of its presence on admission was assessed in patients with myocardial infarction.
Methods and Results Two hundred forty patients admitted with myocardial infarction were studied and followed prospectively for a median of 3 years. The prognostic significance of an admission troponin T concentration 
0.2 ng/mL for subsequent cardiac death and/or reinfarction was assessed and compared with other variables in a regression model. Any detectable troponin T on admission was associated with a worse prognosis on follow-up. An admission concentration of 0.2 ng/mL was associated with a higher risk of subsequent cardiac death (
2, 13.3; P=.0002) and death or nonfatal reinfarction (2, 16; P=.00006). The excess risk was seen primarily in patients with admission ECG ST-segment elevation (cardiac death 2, 9.7; P=.001; death or nonfatal reinfarction 2, 10.3; P=.001). In a stepwise regression model for cardiac death or nonfatal reinfarction, troponin T was superior to most of the other variables entered in both myocardial infarction subgroups.
Conclusions The presence of admission troponin T in patients with myocardial infarction defines a subgroup, particularly those with ST-segment elevation, at increased risk of subsequent cardiac events and identifies a group that may benefit from alternative early management strategies.
Key Words: myocardial infarction • prognosis • troponin T • risk factors
This article has been cited by other articles:
 |
|
 |
|
  J. S Alpert, K. Thygesen, A. Jaffe, and H. D White The universal definition of myocardial infarction: a consensus document Heart, October 1, 2008; 94(10): 1335 - 1341. [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Chew Cardiac Troponin T in Acute Coronary Syndrome with Renal Insufficiency Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 284 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. O Collinson, G. H Gaynor, and D. C Gaze Cardiac troponin I measurement using the ACS:180 to predict four-year cardiac event rate Ann Clin Biochem, March 1, 2008; 45(2): 184 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kempf, E. Bjorklund, S. Olofsson, B. Lindahl, T. Allhoff, T. Peter, J. Tongers, K. C. Wollert, and L. Wallentin Growth-differentiation factor-15 improves risk stratification in ST-segment elevation myocardial infarction Eur. Heart J., December 1, 2007; 28(23): 2858 - 2865. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S G Foussas, M N Zairis, S S Makrygiannis, S J Manousakis, F A Anastassiadis, C S Apostolatos, N G Patsourakos, M P Glyptis, J K Papadopoulos, D C Xenos, et al. The significance of circulating levels of both cardiac troponin I and high-sensitivity C reactive protein for the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction Heart, August 1, 2007; 93(8): 952 - 956. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. P Gale, C. Kashinath, and P. Brooksby The association between hyperglycaemia and elevated troponin levels on mortality in acute coronary syndromes Diabetes and Vascular Disease Research, September 1, 2006; 3(2): 80 - 83. [Abstract] [PDF]
|
|
|
|
 |
|
 A. S. Jaffe, L. Babuin, and F. S. Apple Biomarkers in Acute Cardiac Disease: The Present and the Future J. Am. Coll. Cardiol., July 4, 2006; 48(1): 1 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F Jishi, P R Hudson, C P Williams, R P Jones, G K Davies, Z R Yousef, R J Trent, and R P W Cowell Troponin I, laboratory issues, and clinical outcomes in a district general hospital: crossover study with "traditional" markers of myocardial infarction in a total of 1990 patients J. Clin. Pathol., October 1, 2004; 57(10): 1027 - 1032. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B L Norgaard, K Andersen, K Thygesen, J Ravkilde, P Abrahamsson, L Grip, and M Dellborg Long term risk stratification of patients with acute coronary syndromes: characteristics of troponin T testing and continuous ST segment monitoring Heart, July 1, 2004; 90(7): 739 - 744. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Galvani, D. Ferrini, and F. Ottani Natriuretic peptides for risk stratification of patients with acute coronary syndromes Eur J Heart Fail, March 15, 2004; 6(3): 327 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bjorklund, B. Lindahl, P. Johanson, T. Jernberg, A.-M. Svensson, P. Venge, L. Wallentin, M. Dellborg, and the ASSENT-2 and ASSENT-PLUS study groups Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction Eur. Heart J., January 2, 2004; 25(2): 113 - 120. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P O Collinson, P J Stubbs, and A-C Kessler Multicentre evaluation of the diagnostic value of cardiac troponin T, CK-MB mass, and myoglobin for assessing patients with suspected acute coronary syndromes in routine clinical practice Heart, March 1, 2003; 89(3): 280 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Panteghini Acute Coronary Syndrome: Biochemical Strategies in the Troponin Era Chest, October 1, 2002; 122(4): 1428 - 1435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. de Lemos and E. Braunwald ST segment resolution as a tool for assessing the efficacy of reperfusion therapy J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1283 - 1294. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Giannitsis, M. Muller-Bardorff, S. Lehrke, U. Wiegand, R. Tolg, B. Weidtmann, F. Hartmann, G. Richardt, and H. A. Katus Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction Circulation, August 7, 2001; 104(6): 630 - 635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Berton, R Cordiano, R Palmieri, F Cucchini, R de Toni, and P Palatini Microalbuminuria during acute myocardial infarction; a strong predictor for 1-year mortality Eur. Heart J., August 2, 2001; 22(16): 1466 - 1475. [Abstract] [PDF]
|
|
|
|
|
|
E. Giannitsis, S. Lehrke, U. K. H. Wiegand, V. Kurowski, M. Muller-Bardorff, B. Weidtmann, G. Richardt, and H. A. Katus Risk Stratification in Patients With Inferior Acute Myocardial Infarction Treated by Percutaneous Coronary Interventions : The Role of Admission Troponin T Circulation, October 24, 2000; 102(17): 2038 - 2044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Matetzky, T. Sharir, M. Domingo, M. Noc, K.-Y. Chyu, S. Kaul, N. Eigler, P. K. Shah, and B. Cercek Elevated Troponin I Level on Admission Is Associated With Adverse Outcome of Primary Angioplasty in Acute Myocardial Infarction Circulation, October 3, 2000; 102(14): 1611 - 1616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Al-Obaidi, P. J. Stubbs, P. Collinson, R. Conroy, I. Graham, and M. I. M. Noble Elevated homocysteine levels are associated with increased ischemic myocardial injury in acute coronary syndromes J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1217 - 1222. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. S. Apple, F. P. Anderson, P. Collinson, R. L. Jesse, M. C. Kontos, M. A. Levitt, E. A. Miller, and M. M. Murakami Clinical Evaluation of the First Medical Whole Blood, Point-of-Care Testing Device for Detection of Myocardial Infarction Clin. Chem., October 1, 2000; 46(10): 1604 - 1609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Jaffe, J. Ravkilde, R. Roberts, U. Naslund, F. S. Apple, M. Galvani, and H. Katus It's Time for a Change to a Troponin Standard Circulation, September 12, 2000; 102(11): 1216 - 1220. [Full Text] [PDF]
|
|
|
|
|
|
B. Jurlander, P. Clemmensen, G. S. Wagner, and P. Grande Very early diagnosis and risk stratification of patients admitted with suspected acute myocardial infarction by the combined evaluation of a single serum value of cardiac troponin-T, myoglobin, and creatine kinase MBmass Eur. Heart J., March 1, 2000; 21(5): 382 - 389. [Abstract] [PDF]
|
|
|
|
|
|
G S Hillis, N Zhao, P Taggart, W C Dalsey, and A Mangione Utility of cardiac troponin I, creatine kinase-MBmass, myosin light chain 1, and myoglobin in the early in-hospital triage of "high risk" patients with chest pain Heart, November 1, 1999; 82(5): 614 - 620. [Abstract] [Full Text]
|
|
|
|
 |
|
 C. W. Hamm, C. Heeschen, B. Goldmann, A. Vahanian, J. Adgey, C. M. Miguel, W. Rutsch, J. Berger, J. Kootstra, M. L. Simoons, et al. Benefit of Abciximab in Patients with Refractory Unstable Angina in Relation to Serum Troponin T Levels N. Engl. J. Med., May 27, 1999; 340(21): 1623 - 1629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. L. Norgaard, K. Andersen, M. Dellborg, P. Abrahamsson, J. Ravkilde, K. Thygesen, and for the TRIM study group Admission risk assessment by cardiac troponin T in unstable coronary artery disease: additional prognostic information from continuous ST segment monitoring J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1519 - 1527. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J de Winter, R. Bholasingh, J. G Lijmer, R. W Koster, J. P.M.C Gorgels, Y. Schouten, F. J Hoek, and G. T Sanders Independent prognostic value of C-reactive protein and troponin I in patients with unstable angina or non-Q-wave myocardial infarction Cardiovasc Res, April 1, 1999; 42(1): 240 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Savonitto, D. Ardissino, C. B. Granger, G. Morando, M. D. Prando, A. Mafrici, C. Cavallini, G. Melandri, T. D. Thompson, A. Vahanian, et al. Prognostic Value of the Admission Electrocardiogram in Acute Coronary Syndromes JAMA, February 24, 1999; 281(8): 707 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. S. Apple, R. H. Christenson, R. Valdes Jr., A. J. Andriak, A. Berg, S.-H. Duh, Y.-J. Feng, S. A. Jortani, N. A. Johnson, B. Koplen, et al. Simultaneous Rapid Measurement of Whole Blood Myoglobin, Creatine Kinase MB, and Cardiac Troponin I by the Triage Cardiac Panel for Detection of Myocardial Infarction Clin. Chem., February 1, 1999; 45(2): 199 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Zaacks, P. R. Liebson, J. E. Calvin, J. E. Parrillo, and L. W. Klein Unstable angina and non-Q wave myocardial infarction: does the clinical diagnosis have therapeutic implications? J. Am. Coll. Cardiol., January 1, 1999; 33(1): 107 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Holmvang, M. S. Luscher, P. Clemmensen, K. Thygesen, and P. Grande Very Early Risk Stratification Using Combined ECG and Biochemical Assessment in Patients With Unstable Coronary Artery Disease (A Thrombin Inhibition in Myocardial Ischemia [TRIM] Substudy) Circulation, November 10, 1998; 98(19): 2004 - 2009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Newby, R. H. Christenson, E. M. Ohman, P. W. Armstrong, T. D. Thompson, K. L. Lee, C. W. Hamm, H. A. Katus, C. Cianciolo, C. B. Granger, et al. Value of Serial Troponin T Measures for Early and Late Risk Stratification in Patients With Acute Coronary Syndromes Circulation, November 3, 1998; 98(18): 1853 - 1859. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Christenson, S.-H. Duh, L. K. Newby, E. M. Ohman, R. M. Califf, C. B. Granger, S. Peck, K. S. Pieper, P. W. Armstrong, H. A. Katus, et al. Cardiac troponin T and cardiac troponin I: relative values in short-term risk stratification of patients with acute coronary syndromes Clin. Chem., March 1, 1998; 44(3): 494 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. I. Haft, S. A. Saadeh, P. Stubbs, P. Collinson, G. X. Brogan, J. E. Hollander, H. Thode, E. V. Carbajal, E. M. Ohman, R. M. Califf, et al. Cardiac Troponins in Acute Coronary Syndromes N. Engl. J. Med., April 24, 1997; 336(17): 1257 - 1259. [Full Text]
|
|
|
|
|
|
P. O. Collinson To T or Not to T, That Is the Question Clin. Chem., March 1, 1997; 43(3): 421 - 423. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Stubbs, M. Noble, P. Collinson, D. Moseley, and T. Greenwood Authors' reply BMJ, November 23, 1996; 313(7068): 1330c - 1331. [Full Text]
|
|
|
|
 |
|
 TROPONIN T PREDICTS PROGNOSIS IN PATIENTS WITH MI Journal Watch (General), September 27, 1996; 1996(927): 5 - 5. [Full Text]
|
|