Measurement of Cardiac Troponin T Is an Effective Method for Predicting Complications Among Emergency Department Patients With Chest Pain

Sayre, Michael R.; Kaufmann, K.; Chen, I. W.; Sperling, Matthew; Sidman, Robert D.; Diercks, Deborah; Liu, Todd J; Gibler, W. Brian

doi:10.1016/s0196-0644(98)70199-4

Cited by 60 publications

(21 citation statements)

References 38 publications

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“…13 However, studies performed in lower risk patient populations found no significant increase in cardiac event rate with minor elevations in troponin compared with the absence of detectable troponin. 8,[14][15][16] Thus, it has been suggested that troponin elevations are, in and of themselves, not equivalent, and it is the pathogenesis behind the elevation that is of prognostic importance. 17 Results of our study provide additional clarity about the discrepancy in the literature in the prognostic association of troponin levels in NSTE ACS.…”

Section: Discussionmentioning

confidence: 99%

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Bagai

Huang

Lokhnygina

et al. 2015

Circ: Cardiovascular Interventions

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Background— In patients with non–ST-segment–elevation acute coronary syndrome (NSTE ACS), elevated troponin levels identify patients at high risk for adverse outcomes; however, it is unknown whether the magnitude of troponin elevation during hospitalization remains predictive of subsequent events in patients undergoing coronary revascularization. Methods and Results— We studied 12 635 patients with NSTE ACS in the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) study with at least 1 troponin measurement during index hospitalization. Cox proportional hazards regression was used to examine the relationship between peak troponin level (standardized as the ratio of peak troponin value measured during hospitalization and local laboratory upper reference limit [URL]) and revascularization on all-cause mortality at 2 years. Revascularization (percutaneous coronary intervention or coronary artery bypass graft) was performed during index hospitalization in 8586 patients (68.0%); revascularized patients had higher peak troponin ratios (median, 23 versus 9.5× URL). Among patients that did not undergo revascularization, the mortality rate at 2 years increased in a curvilinear fashion with increasing levels of peak troponin. In contrast, the mortality rate at 2 years remained constant irrespective of peak troponin levels among revascularized patients ( P for interaction=0.004). This relationship was unchanged after multivariable adjustment. Conclusions— There is a differential relationship between the magnitude of troponin elevation and long-term mortality in ACS patients treated with and without revascularization. Although prognostically important in patients treated without revascularization, the prognostic implications of peak troponin level seem to be minimal in revascularized patients. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00527943.

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Section: Discussionmentioning

confidence: 99%

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Bagai

Huang

Lokhnygina

et al. 2015

Circ: Cardiovascular Interventions

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“…2,3 In recent years, marker proteins, particularly cardiac troponins, have become extremely important in risk stratification of patients with cardiac chest pain. [4][5][6] Measurement of marker proteins at presentation does help to identify high-risk patients, 7 but their usefulness in early decisionmaking is limited because they do not become clearly positive until up to 12 hours after the onset of symptoms. Chest pain units have been established in many centers and, using accelerated diagnostic protocols, including serial marker measurements, dynamic ECG monitoring, and cardiac imaging, can improve risk stratification of patients with suspected cardiac pain.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Artificial Neural Network Models for Prediction of Acute Coronary Syndromes Using Clinical Data From the Time of Presentation

Harrison

Kennedy²

2005

Annals of Emergency Medicine

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“…2,3 Findings of negative serial cardiac markers in addition can identify a population at even lower risk for cardiac events at 30 days (0.3-0.7%) 6,7 and 60 days (0.2-2.8%). [6][7][8] This population, however, re-mains at relatively high risk of subsequent cardiac morbidity within six months (5-23%). 9,10 Recent prospective studies have investigated the prognosis of patients with nondiagnostic or negative diagnostic cardiac studies.…”

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confidence: 99%

Adverse Cardiac Events in Emergency Department Patients with Chest Pain Six Months after a Negative Inpatient Evaluation for Acute Coronary Syndrome

Manini

2002

Academic Emergency Medicine

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Objective: To evaluate the impact of the diagnostic test setting-inpatient versus outpatient-on adverse cardiac events (ACEs) after six months in emergency department (ED) patients with chest pain who were admitted to the hospital and subsequently had a negative evaluation for acute coronary syndrome (ACS). Methods: The authors retrospectively studied a consecutive sample of ED patients with chest pain over a nine-month period. All patients were admitted to the hospital and underwent negative evaluations for ACS, defined as the absence of diagnostic changes on serial electrocardiograms or cardiac markers (creatine kinase-MB and troponin T), and a negative diagnostic cardiac study. Subjects were classified according to cardiac diagnostic study setting-either inpatient or outpatient. Diagnostic testing included exercise treadmill, angiography, stress echocardiography, or stress thallium scans. Acute cardiac events at six months were defined as cardiac death, myocardial infarction, unstable angina, cardiac arrest, or emergent revascularization. Results: The six-month rate of ACEs among 157 subjects was 14%, with 2% cardiac mortality. The outpatient group had higher ACE risk when compared with the inpatient group using multivariate logistic regression, both for the entire cohort (OR 3.5, p < 0.03) and for a subgroup excluding patients with prior coronary artery disease (OR 6.7, p < 0.05). The outpatient group included 19 of 52 (37%) noncompliant subjects who did not receive a diagnostic study. Conclusions: Long-term cardiac morbidity of patients after a negative ACS evaluation may be higher than previously thought. Risk of ACE is significantly higher in subjects scheduled for outpatient diagnostic tests. Inpatient diagnostic testing is justified for subjects at risk for poor compliance. Key words: chest pain; emergency department; coronary disease; myocardial infarction; angina; long-term prognosis. ACADEMIC EMERGENCY MEDICINE 2002; 9: 896-902. In the United States, approximately five million people annually undergo evaluation in the emergency department (ED) for acute chest pain, at a cost of more than $5 billion. 1 In a study of more than 10,000 patients who presented to the ED with acute chest pain, a group with less than 1% probability of major complications could be identified

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Measurement of Cardiac Troponin T Is an Effective Method for Predicting Complications Among Emergency Department Patients With Chest Pain

Cited by 60 publications

References 38 publications

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Magnitude of Troponin Elevation and Long-Term Clinical Outcomes in Acute Coronary Syndrome Patients Treated With and Without Revascularization

Artificial Neural Network Models for Prediction of Acute Coronary Syndromes Using Clinical Data From the Time of Presentation

Adverse Cardiac Events in Emergency Department Patients with Chest Pain Six Months after a Negative Inpatient Evaluation for Acute Coronary Syndrome

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