Troponin T Levels in Patients with Acute Coronary Syndromes, with or without Renal Dysfunction
Ronnier J. Aviles, M.D., Arman T. Askari, M.D., Bertil Lindahl, M.D., Ph.D., Lars Wallentin, M.D., Ph.D., Gang Jia, M.S., E. Magnus Ohman, M.D., Kenneth W. Mahaffey, M.D., L. Kristin Newby, M.D., Robert M. Califf, M.D., Maarten L. Simoons, M.D., Eric J. Topol, M.D., Peter Berger, M.D., and Michael S. Lauer, M.D.
Background Among patients with suspected acute coronary syndromes,cardiac troponin T levels have prognostic value. However, thereis concern that renal dysfunction may impair the prognosticvalue, because cardiac troponin T may be cleared by the kidney.
Methods We analyzed the outcomes in 7033 patients enrolled inthe Global Use of Strategies to Open Occluded Coronary ArteriesIV trial who had complete base-line data on troponin T levelsand creatinine clearance rates. The troponin T level was consideredabnormal if it was 0.1 ng per milliliter or higher, and creatinineclearance was assessed in quartiles. The primary end point wasa composite of death or myocardial infarction within 30 days.
Results Death or myocardial infarction occurred in 581 patients.Among patients with a creatinine clearance above the 25th percentilevalue of 58.4 ml per minute, an abnormally elevated troponinT level was predictive of an increased risk of myocardial infarctionor death (7 percent vs. 5 percent; adjusted odds ratio, 1.7;95 percent confidence interval, 1.3 to 2.2; P<0.001). Amongpatients with a creatinine clearance in the lowest quartile,an elevated troponin T level was similarly predictive of increasedrisk (20 percent vs. 9 percent; adjusted odds ratio, 2.5; 95percent confidence interval, 1.8 to 3.3; P<0.001). When thecreatinine clearance rate was considered as a continuous variableand age, sex, ST-segment depression, heart failure, previousrevascularization, diabetes mellitus, and other confoundershad been accounted for, elevation of the troponin T level wasindependently predictive of risk across the entire spectrumof renal function.
Conclusions Cardiac troponin T levels predict short-term prognosisin patients with acute coronary syndromes regardless of theirlevel of creatinine clearance.
Source Information
From the Department of Cardiology, the Cleveland Clinic Foundation, Cleveland (R.J.A., A.T.A., G.J., E.J.T., M.S.L.); the Department of Cardiology, University of Uppsala, Uppsala, Sweden (B.L., L.W.); the University of North Carolina, Chapel Hill (E.M.O.); the Duke Clinical Research Institute, Durham, N.C. (K.W.M., L.K.N., R.M.C.); and the Department of Cardiology, University Hospital Rotterdam, Rotterdam, the Netherlands (M.L.S.). Peter Berger, M.D., Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn., was also an author.
Address reprint requests to Dr. Lauer at the Department of Cardiology, Desk F25, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44951, or at lauerm{at}ccf.org.
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