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Volume 335:1333-1342 October 31, 1996 Number 18 Next

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ABSTRACT

Background The prognosis of patients hospitalized with acute myocardial ischemia is quite variable. We examined the value of serum levels of cardiac troponin T, serum creatine kinase MB (CK-MB) levels, and electrocardiographic abnormalities for risk stratification in patients with acute myocardial ischemia.

Methods We studied 855 patients within 12 hours of the onset of symptoms. Cardiac troponin T levels, CK-MB levels, and electrocardiograms were analyzed in a blinded fashion at the core laboratory. We used logistic regression to assess the usefulness of base-line levels of cardiac troponin T and CK-MB and the electrocardiographic category assigned at admission — ST-segment elevation, ST-segment depression, T-wave inversion, or the presence of confounding factors that impair the detection of ischemia (bundle-branch block and paced rhythms) — in predicting outcome.

Results On admission, 289 of 801 patients with base-line serum samples had elevated troponin T levels (>0.1 ng per milliliter). Mortality within 30 days was significantly higher in these patients than in patients with lower levels of troponin T (11.8 percent vs. 3.9 percent, P<0.001). The troponin T level was the variable most strongly related to 30-day mortality (chi-square = 21, P<0.001), followed by the electrocardiographic category (chi-square = 14, P = 0.003) and the CK-MB level (chi-square = 11, P = 0.004). Troponin T levels remained significantly predictive of 30-day mortality in a model that contained the electrocardiographic categories and CK-MB levels (chi-square = 9.2, P = 0.027).

Conclusions The cardiac troponin T level is a powerful, independent risk marker in patients who present with acute myocardial ischemia. It allows further stratification of risk when combined with standard measures such as electrocardiography and the CK-MB level.

Source Information

From the Division of Cardiology, Department of Medicine (E.M.O., C.B.G., M.A.O., G.S.W., R.M.C.), and the Division of Biometry, Department of Community and Family Medicine (F.E.H.), Duke University, Durham, N.C.; the Department of Medicine, University of Edmonton, Edmonton, Alta., Canada (P.W.A.); the Department of Pathology, University of Maryland Medical System, Baltimore (R.H.C.); Innere Medizin III, University of Heidelberg, Heidelberg, Germany (H.A.K.); the Department of Cardiology, Medical Clinic, University Hospital of Hamburg, Hamburg, Germany (C.W.H.); Methodist Hospital–Baylor College of Medicine, Houston (N.S.K.); and the Cleveland Clinic Foundation, Cleveland (E.J.T.). Kerry L. Lee, Ph.D. (Duke University, Durham, N.C.), was also an author of the study.

Address reprint requests to Dr. Ohman at Box 3151, Duke University Medical Center, Durham, NC 27710.

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Cardiac Troponins in Acute Coronary Syndromes
Haft J. I., Saadeh S. A., Stubbs P., Collinson P., Brogan G. X., Hollander J. E., Thode H., Carbajal E. V., Ohman E. M., Califf R. M., Topol E. J., Antman E. M., Tanasijevic M. J., Cannon C. P., Van de Werf F.
Extract | Full Text  
N Engl J Med 1997; 336:1257-1259, Apr 24, 1997. Correspondence

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