Cardiac Troponin T Levels for Risk Stratification in Acute Myocardial Ischemia
Why the study?
Does elevated baseline cardiac troponin T predict 30-day mortality in patients presenting with acute myocardial ischemia?
Population
855 patients hospitalized with acute myocardial ischemia within 12 hours of the onset of symptoms
Comparison
Elevated baseline cardiac troponin T levels vs Lower levels of cardiac troponin T
Design
Cohort, Biomarkers and electrocardiograms were analyzed in a blinded fashion…
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Elevated troponin T may aid risk stratification in acute myocardial ischemia; leaves open impact on management decisions.
Key Points
- To determine the prognostic utility of serum cardiac troponin T, CK-MB levels, and admission electrocardiographic abnormalities for risk stratification in acute myocardial ischemia.
- Evaluated 855 patients presenting within 12 hours of acute myocardial ischemia symptom onset.
- Blinded core laboratory assessment of baseline cardiac troponin T, CK-MB, and admission electrocardiographic categories (ST elevation, ST depression, T-wave inversion, or confounding features).
- Multivariable logistic regression was utilized to assess predictors of 30-day mortality.
- Baseline troponin T was elevated (>0.1 ng/mL) in 289 of 801 patients, resulting in significantly higher 30-day mortality than in patients with lower levels (11.8% vs. 3.9%, P < 0.001).
- Troponin T was the strongest predictor of 30-day mortality (chi-square = 21, P < 0.001), followed by electrocardiographic category (chi-square = 14, P = 0.003) and CK-MB level (chi-square = 11, P = 0.004).
- Troponin T remained an independent predictor of 30-day mortality in multivariable modeling adjusted for electrocardiographic category and CK-MB level (chi-square = 9.2, P = 0.027).
Structured PICO
Does elevated baseline cardiac troponin T predict 30-day mortality in patients presenting with acute myocardial ischemia?
P
Population
855 patients hospitalized with acute myocardial ischemia within 12 hours of the onset of symptoms
I
Intervention
Elevated baseline cardiac troponin T levels (> 0.1 ng/mL)
C
Comparator
Lower levels of cardiac troponin T
O
Outcome
Mortality within 30 dayshard clinical
Cardiac troponin T is a powerful, independent predictor of 30-day mortality in patients with acute myocardial ischemia, providing incremental prognostic value over ECG and CK-MB.
Cite This Study
Ohman et al. (1996) studied this question.