What question did this study set out to answer?

To assess whether a rising pattern of cardiac troponin or NT-proBNP concentrations predicts long-term adverse clinical outcomes more effectively than stable elevations in early-presenting acute coronary syndrome.

March 28, 2008Clinical ChemistryOpen Access

Is a Pattern of Increasing Biomarker Concentrations Important for Long-Term Risk Stratification in Acute Coronary Syndrome Patients Presenting Early after the Onset of Symptoms?

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome (n=212). Intervention: Rising pattern of cardiac biomarkers (cTnI, cTnT, NT-proBNP) vs. Elevations that do not change. Primary outcome: Death, myocardial infarction (MI), or heart failure (HF) (p=>=0.15).

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Key result

A rising pattern of cardiac troponin or NT-proBNP concentrations in ACS patients presenting early after symptom onset was not useful for long-term risk stratification for death, MI, or HF (P>=0.15).

Why the study?

Does a rising pattern of cardiac biomarkers predict long-term adverse outcomes better than simple elevations in early-presenting ACS patients?

Population

212 acute coronary syndrome patients presenting early after symptom onset

Comparison

Rising pattern of cardiac biomarkers based on… vs Simple elevations

Design

Cohort

Follow-up

>8 years

Authors

PKPeter A. KavsakGeneral Cardiology ANAlice NewmanMerck & Co., Inc., Rahway, NJ, USA (United States)DKDennis T. KoInterventional Cardiology

Discussion

Member takes

Implication

Does not support rising troponin or NT-proBNP patterns for long-term ACS risk stratification; hypothesis-generating and should not yet change practice.

Key Points

To assess whether a rising pattern of cardiac troponin or NT-proBNP concentrations predicts long-term adverse clinical outcomes more effectively than stable elevations in early-presenting acute coronary syndrome.
Analyzed serial plasma samples from 212 acute coronary syndrome patients collected at a median of 2 hours (IQR 2–4) and 9 hours (IQR 9–9) after symptom onset.
Measured cTnI, cTnT, and NT-proBNP, defining myocardial necrosis via the 9-hour specimen (cTnI >0.04 µg/L; cTnT >0.01 µg/L).
Evaluated concentration ratios (second to first sample) against long-term endpoints (death, myocardial infarction, and heart failure) after 4 years and over 8 years of follow-up.
The relative increase between specimens was significantly greater for cTnI than for cTnT in myocardial necrosis (P < 0.01), with identical relative change observed for NT-proBNP (P = 0.71).
Concentration ratios for cTnI, cTnT, and NT-proBNP did not stratify long-term risk for composite death, myocardial infarction, or heart failure (P ≥ 0.15).

Study Design

Type

Cohort (n=212)

Structured PICO

Does a rising pattern of cardiac biomarkers predict long-term adverse outcomes better than simple elevations in early-presenting ACS patients?

Population

212 ACS patients presenting early after symptom onset with serial biomarker measurements, followed for >8 years.

Exposure

Rising pattern of cardiac biomarkers (cTnI, cTnT, NT-proBNP) based on concentration ratio (second/first measured concentrations ≥1.00)

Comparator

Simple elevations (absolute concentrations without a rising pattern)

Outcome

Composite of death, myocardial infarction (MI), or heart failure (HF)composite

Main Result

p-value: p=>=0.15

A rising pattern of cardiac troponin or NT-proBNP in early-presenting ACS patients does not provide additional long-term prognostic value over absolute concentrations.

Cite This Study

Kavsak et al. (2008) conducted a cohort in Acute coronary syndrome (n=212). Rising pattern of cardiac biomarkers (cTnI, cTnT, NT-proBNP) vs. Elevations that do not change was evaluated on Death, myocardial infarction (MI), or heart failure (HF) (p=>=0.15). A rising pattern of cardiac troponin or NT-proBNP concentrations in ACS patients presenting early after symptom onset was not useful for long-term risk stratification for death, MI, or HF (P>=0.15).

synapsesocial.com/papers/6a88329b6304c7fd8e4df7ef https://doi.org/10.1373/clinchem.2007.094664

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Implication

Does not support rising troponin or NT-proBNP patterns for long-term ACS risk stratification; hypothesis-generating and should not yet change practice.

Is a Pattern of Increasing Biomarker Concentrations Important for Long-Term Risk Stratification in Acute Coronary Syndrome Patients Presenting Early after the Onset of Symptoms?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Is a Pattern of Increasing Biomarker Concentrations Important for Long-Term Risk Stratification in Acute Coronary Syndrome Patients Presenting Early after the Onset of Symptoms?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider