Prognostic Influence of Elevated Values of Cardiac Troponin I in Patients With Unstable Angina

Galvani, Marcello; Ottani, Filippo; Ferrini, Donatella; Ladenson, Jack H.; Destro, Antonio; D, Baccos; Rusticali, F; Jaffe, Allan S.

doi:10.1161/01.cir.95.8.2053

Cited by 286 publications

(98 citation statements)

References 37 publications

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“…12,[15][16][17][18] In patients with unstable angina, elevated cTnI levels on admission are associated with a 3-to 5-fold increase in short-term morbidity and mortality. 18 -21 A quantitative relation between cTnI concentration and incidence of cardiac complications guides risk stratification practices, 18 -20,22 and as a screening test, cTnI has been shown to improve triage procedures for patients presenting to emergency rooms with acute chest pain.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients

et al. 2002

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Background-Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury that predicts outcomes in patients with acute coronary syndromes. Cardiovascular complications are the leading cause of morbidity and mortality in patients who have undergone vascular surgery. However, postoperative surveillance with cardiac enzymes is not routinely performed in these patients. We evaluated the association between postoperative cTnI levels and 6-month mortality and perioperative myocardial infarction (MI) after vascular surgery. Methods and Results-Two hundred twenty-nine patients having aortic or infrainguinal vascular surgery or lower extremity amputation were included in this study. Blood samples were analyzed for cTnI immediately after surgery and the mornings of postoperative days 1, 2, and 3. An elevated cTnI was defined as serum concentrations Ͼ1.5 ng/mL in any of the 4 samples. Twenty-eight patients (12%) had postoperative cTnI Ͼ1.5ng/mL, which was associated with a 6-fold increased risk of 6-month mortality (adjusted OR, 5.9; 95% CI, 1.6 to 22.4) and a 27-fold increased risk of MI (OR, 27.1; 95% CI, 5.2 to 142.7). Furthermore, we observed a dose-response relation between cTnI concentration and mortality. Patients with cTnI Ͼ3.0 ng/mL had a significantly greater risk of death compared with patients with levels Յ0.35 ng/mL (OR, 4.9; 95% CI, 1.3 to 19.0). Conclusions-Routine postoperative surveillance for cTnI is useful for identifying patients who have undergone vascular surgery who have an increased risk for short-term mortality and perioperative MI. Further research is needed to determine whether intervention in these patients can improve outcome.

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Section: Discussionmentioning

confidence: 99%

Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients

et al. 2002

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“…The importance of small troponin increases is confirmed by their association with a poor prognosis on follow-up studies. [21][22][23][24][25][26][27] A diagnosis of MI or acute coronary syndrome, driven by more sensitive biomarkers, has the potential to create a spurious rise in ischemic CHD incidence if not recognized and reconciled. It could also further reduce recorded case-fatality rates erroneously as milder cases are detected and survive.…”

Section: Measuring Trends In Ischemic Chdmentioning

confidence: 99%

Case Definitions for Acute Coronary Heart Disease in Epidemiology and Clinical Research Studies

Luepker¹,

Apple²,

Christenson³

et al. 2003

Circulation

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385

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“…1) revealed sinus tachycardia, low voltage in the limb leads, and 1 mm ST-segment depression in leads V 5 to V 6 . A portable chest x-ray (Fig.…”

Section: Case Reportmentioning

confidence: 99%

Cardiac amyloidosis presenting with elevations of cardiac troponin I and angina pectoris

Cantwell

Aviles

Björnsson

et al. 2002

Clinical Cardiology

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Summary:We present the case of a 43-year-old male who was initially evaluated for angina pectoris and dyspnea. His CK, CK-MB, and cTnI were all elevated following a blood transfusion and he underwent coronary arteriography, which demonstrated no luminal obstructions. After several months, he was transferred to Mayo Clinic where diagnoses of fulminant cardiac amyloidosis and systemic multiple myeloma were established. The cTnI remained elevated despite normalization of the CK and CK-MB. Despite aggressive treatment, the patient died. Postmortem analysis demonstrated amyloid cardiac deposition including involvement of the coronary microvasculature. Electron microscopy revealed myocyte compression injury from amyloid infiltration. We believe this is the first report of elevated troponin I in a patient with cardiac amyloidosis. The electron microscopy in our case confirms cardiac damage as the mechanism for cTnI elevation. This observation strengthens our knowledge about the specificity of cTnI for the detection of cardiac injury.

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Prognostic Influence of Elevated Values of Cardiac Troponin I in Patients With Unstable Angina

Abstract: These data indicate that cTnI is an important prognostic variable in patients with unstable angina. Elevations of cTnI predict an adverse short- and long-term prognosis.

Cited by 286 publications

References 37 publications

Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients

Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients

Case Definitions for Acute Coronary Heart Disease in Epidemiology and Clinical Research Studies

Cardiac amyloidosis presenting with elevations of cardiac troponin I and angina pectoris

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