TY - JOUR
T1 - Cardiac troponin I levels and clinical outcomes in patients with acute coronary syndromes
T2 - The potential role of early percutaneous revascularization
AU - Fuchs, Shmuel
AU - Kornowski, Ran
AU - Mehran, Roxana
AU - Satler, Lowell F.
AU - Pichard, Augusto D.
AU - Kent, Kenneth M.
AU - Hong, Mun K.
AU - Slack, Steve
AU - Stone, Gregg W.
AU - Leon, Martin B.
PY - 1999/11/15
Y1 - 1999/11/15
N2 - OBJECTIVES: To establish the role of early catheter-based coronary intervention among patients sustaining acute coronary syndromes (ACS) stratified according to admission plasma troponin I (Tn-I) levels. BACKGROUND: The impact of early revascularization strategy on the clinical outcomes in patients with ACS stratified by plasma Tn-I levels has not been established. METHODS: In-hospital complications and long-term outcomes were assessed in 1,321 consecutive patients with non-ST elevation ACS undergoing early (within 72 h) catheter-based coronary interventions. Patients were grouped according to admission Tn-I levels. Group I (n = 1,099) had no elevated plasma Tn-I (<0.15 ng/ml), Group II (n = 95) had Tn-I level between 0.15 to 0.45 ng/ml and Group III (n = 127) had Tn-I > 0.45 ng/ml. In- hospital composite cardiac events (death, Q-wave MI, urgent in- hospital revascularization) and 8 months clinical outcomes (death, MI, repeat revascularization or any cardiac event) were compared between the three groups. RESULTS: The rate of in- hospital composite cardiac events was 6.1% among patients with Tn-I > 0.45 ng/ml, 1.0% in patients with Tn-I between 0.15-0.45 ng/ml and 3.1% in patients without elevated admission Tn-I (p = 0.09 between groups). There was no difference in hospital mortality (p = 0.25). At eight months of follow-up, there was no difference in out-of-hospital death (3.5%, 3.8% and 1.8%, p = 0.17, respectively), MI (2.6%, 3.8% and 2.9%, p = 0.94) or target lesion revascularization (9.0%, 8.3% and 11.5%, p = 0.47), and cardiac event-free survival was also similar between groups (p = 0.66). By multivariate analysis, Tn-I > 0.45 ng/ml was independently associated with in-hospital composite cardiac events [odds ratio (OR) = 2.4, p = 0.04] but not with out-of- hospital clinical events up to eight months. CONCLUSIONS: In patients with ACS, early (within 72 h) catheter-based coronary intervention may attenuate the adverse prognostic impact of admission Tn-I elevation during eight months of follow-up despite a trend towards increased in-hospital composite cardiac events.
AB - OBJECTIVES: To establish the role of early catheter-based coronary intervention among patients sustaining acute coronary syndromes (ACS) stratified according to admission plasma troponin I (Tn-I) levels. BACKGROUND: The impact of early revascularization strategy on the clinical outcomes in patients with ACS stratified by plasma Tn-I levels has not been established. METHODS: In-hospital complications and long-term outcomes were assessed in 1,321 consecutive patients with non-ST elevation ACS undergoing early (within 72 h) catheter-based coronary interventions. Patients were grouped according to admission Tn-I levels. Group I (n = 1,099) had no elevated plasma Tn-I (<0.15 ng/ml), Group II (n = 95) had Tn-I level between 0.15 to 0.45 ng/ml and Group III (n = 127) had Tn-I > 0.45 ng/ml. In- hospital composite cardiac events (death, Q-wave MI, urgent in- hospital revascularization) and 8 months clinical outcomes (death, MI, repeat revascularization or any cardiac event) were compared between the three groups. RESULTS: The rate of in- hospital composite cardiac events was 6.1% among patients with Tn-I > 0.45 ng/ml, 1.0% in patients with Tn-I between 0.15-0.45 ng/ml and 3.1% in patients without elevated admission Tn-I (p = 0.09 between groups). There was no difference in hospital mortality (p = 0.25). At eight months of follow-up, there was no difference in out-of-hospital death (3.5%, 3.8% and 1.8%, p = 0.17, respectively), MI (2.6%, 3.8% and 2.9%, p = 0.94) or target lesion revascularization (9.0%, 8.3% and 11.5%, p = 0.47), and cardiac event-free survival was also similar between groups (p = 0.66). By multivariate analysis, Tn-I > 0.45 ng/ml was independently associated with in-hospital composite cardiac events [odds ratio (OR) = 2.4, p = 0.04] but not with out-of- hospital clinical events up to eight months. CONCLUSIONS: In patients with ACS, early (within 72 h) catheter-based coronary intervention may attenuate the adverse prognostic impact of admission Tn-I elevation during eight months of follow-up despite a trend towards increased in-hospital composite cardiac events.
UR - http://www.scopus.com/inward/record.url?scp=0033571141&partnerID=8YFLogxK
U2 - 10.1016/S0735-1097(99)00434-9
DO - 10.1016/S0735-1097(99)00434-9
M3 - Article
C2 - 10577560
AN - SCOPUS:0033571141
SN - 0735-1097
VL - 34
SP - 1704
EP - 1710
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -