(Circulation. 1998;98:1853-1859.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Value of Serial Troponin T Measures for Early and Late Risk Stratification in Patients With Acute Coronary Syndromes
From the Duke Clinical Research Institute, Durham, NC (L.K.N., E.M.O., T.D.T., K.L.L., C.C., C.B.G., R.M.C.); University of Maryland Medical System, Baltimore (R.H.C.); University of Alberta, Edmonton, Alberta, Canada (P.W.A.); University Hospital of Hamburg, Germany (C.W.H.); University of Heidelberg, Germany (H.A.K.); and the Cleveland Clinic Foundation, Cleveland, Ohio (E.J.T.).
Background—The baseline cardiac troponin T (cTnT) level strongly predicts short-term mortality in acute coronary syndromes, but the added value of later measures to predict short- and long-term outcome and in the context of baseline clinical characteristics is unclear.
Methods and Results—Relations between baseline, peak, and 8- and
16-hour (late) cTnT results and outcomes were assessed in 734 patients
in a GUSTO-IIa substudy. Proportional-hazards models assessed the
prognostic information gained from late cTnT when added to a mortality
model containing the baseline cTnT result and clinical factors. At
baseline, 260 patients were cTnT-positive (>0.1 ng/mL), 323 became
positive later, and 151 remained negative (
0.1 ng/mL). Mortality at
30 days was 10% in the baseline-positive group, 5% in late-positive
patients, and 0% in negative patients. After adjustment for baseline
characteristics, any positive cTnT result predicted 30-day mortality
(baseline, 
2=8.96, P=0.0113; 8-hour,
2=6.51, P=0.0107; 16-hour,
2=8.40, P=0.0038). Both the 8- and the
16-hour results added to the strength of the baseline result
(baseline+8-hour, 2=12.04, P=0.0072;
baseline+16-hour, 2=13.52, P=0.0036).
Only age and ST-segment elevation were stronger predictors of 30-day
mortality than baseline cTnT; results were similar for prediction of
1-year mortality. Most of the mortality difference between
cTnT-positive and -negative patients occurred within the first 30
days.
Conclusions—The cTnT level is a strong, independent predictor of short-term outcome in acute coronary syndromes. The addition of later samples to a baseline level is useful to evaluate the risk of serious cardiac events.
Key Words: risk factors • mortality • prognosis • ischemia
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