The Value of High-Sensitivity Troponin in Assessing the Extent of Benefit Provided by Ticagrelor versus Clopidogrel in Non-ST-Segment Elevation Acute Coronary Syndromes
There is considerable evidence supporting an aggressive approach to the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS). This includes intensive medical therapy and an early invasive strategy. These tactics, alone or in combination, can reduce the rate of subsequent ischemic events though increase bleeding events. The challenge for clinicians is to efficiently identify those patients (from among the very large number of patients presenting to the hospital with chest pain) who will receive the greatest net benefit from an aggressive approach. Numerous methods for risk stratification of NSTE-ACS patients have emerged. Clinical risk assessments such as the TIMI risk score have been shown to predict adverse outcomes and, perhaps more importantly, identify patients most likely to benefit from an early invasive strategy or intensive antithrombotics.1-2 Elevated levels of serum troponin have been found separately to predict adverse events and identify patients likely to benefit from intensive antiplatelet therapy.3 Other biomarkers, such as B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) predict adverse outcomes in the setting of NSTE-ACS, but have not consistently been shown to predict a response to a specific treatment regimen.4 In this issue of Circulation, Wallentin et al5 report their analysis of baseline levels of high-sensitivity troponin T (hs-TnT), NT-proBNP, and growth-differentiation factor-15 (GDF-15) in NSTE-ACS patients enrolled in the Platelet Inhibition and Patient Outcomes (PLATO) trial.6
- Received October 1, 2013.
- Accepted October 4, 2013.