Prospective Evaluation of the Prognostic Implications of
Improved Assay Performance With a Sensitive Assay for Cardiac
Troponin I

J 2010

Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I

BONACA, Marc; Benjamin SCIRICA; Marc SABATINE; Anthony DALBY; Jindřich ŠPINAR et al.

Základní údaje

Originální název

Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I

Autoři

BONACA, Marc; Benjamin SCIRICA; Marc SABATINE; Anthony DALBY; Jindřich ŠPINAR; Sabina A MURPHY; Peter JAROLIM; Eugene BRAUNWALD a David A MORROW

Vydání

Journal of The American College of Cardiology, USA, Elsevier Science Inc. 2010, 0735-1097

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Impakt faktor

Impact factor: 14.293

Označené pro přenos do RIV

Organizační jednotka

Lékařská fakulta

DOI

https://doi.org/10.1016/j.jacc.2010.01.044

UT WoS

000277303100013

Klíčová slova anglicky

troponin; prognosis; sensitive; acute coronary syndrome; ACS

Příznaky

Mezinárodní význam

Změněno: 22. 4. 2013 17:08, Soňa Böhmová

Anotace

V originále

Objectives The purpose of this study was to investigate the prognostic implications of low-level increases in cardiac troponin I (cTnI) using a current-generation sensitive assay in patients with suspected acute coronary syndrome (ACS). Background Recent enhancements in troponin assays have enabled resolution of the 99th percentile reference limit at progressively lower concentrations. However, the clinical significance of low-level increases with sensitive assays is still debated. Methods We measured cTnI using a sensitive assay (TnI-Ultra, Siemens Healthcare Diagnostics, Deerfield, Illinois) at baseline in 4,513 patients with non-ST-segment elevation ACS randomly assigned to ranolazine or placebo. We applied decision limits at the 99th percentile reference limit (0.04 mu g/l), the cut point of the predecessor assay (0.1 mu g/l), and 1 equivalent to elevation of creatine kinase-myocardial band (1.5 ng/ml). Results Patients with baseline cTnI >= 0.04 mu g/l (n = 2,924) were at higher risk of death/myocardial infarction (MI) at 30 days than were patients with a negative cTnI (6.1% vs. 2.0%, p < 0.001). After adjusting for the TIMI (Thrombolysis In Myocardial Infarction) risk score, cTnI >= 0.04 mu g/l was associated with a 3-fold (95% confidence interval: 2.0 to 4.4, p < 0.001) higher risk of death/MI at 30 days. Moreover, patients with low-level increases (0.04 mu g/l to <0.1 mu g/l), were at significantly higher risk of death/MI at 30 days (5.0% vs. 2.0%, p = 0.001) and death at 12 months (6.4% vs. 2.4%, p = 0.005) than were patients with cTnI <0.04 mu g/l. Conclusions Low-level increases in cTnI using a sensitive assay identify patients at higher risk of death or MI. These findings support current American College of Cardiology/American Heart Association recommendations defining MI, and the incremental value of newer, more sensitive assays in identifying high-risk patients with ACS.

Citovat

BONACA, Marc; Benjamin SCIRICA; Marc SABATINE; Anthony DALBY; Jindřich ŠPINAR; Sabina A MURPHY; Peter JAROLIM; Eugene BRAUNWALD a David A MORROW. Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I. Journal of The American College of Cardiology. USA: Elsevier Science Inc., 2010, roč. 55, č. 19, s. 2118-2124. ISSN 0735-1097. Dostupné z: https://doi.org/10.1016/j.jacc.2010.01.044.

@article{919722,
   author = {Bonaca, Marc and Scirica, Benjamin and Sabatine, Marc and Dalby, Anthony and Špinar, Jindřich and Murphy, Sabina A and Jarolim, Peter and Braunwald, Eugene and Morrow, David A},
   article_location = {USA},
   article_number = {19},
   doi = {https://doi.org/10.1016/j.jacc.2010.01.044},
   keywords = {troponin; prognosis; sensitive; acute coronary syndrome; ACS},
   language = {eng},
   issn = {0735-1097},
   journal = {Journal of The American College of Cardiology},
   title = {Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I},
   volume = {55},
   year = {2010}
}

TY  - JOUR
ID  - 919722
AU  - Bonaca, Marc - Scirica, Benjamin - Sabatine, Marc - Dalby, Anthony - Špinar, Jindřich - Murphy, Sabina A - Jarolim, Peter - Braunwald, Eugene - Morrow, David A
PY  - 2010
TI  - Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I
JF  - Journal of The American College of Cardiology
VL  - 55
IS  - 19
SP  - 2118-2124
EP  - 2118-2124
PB  - Elsevier Science Inc.
SN  - 07351097
KW  - troponin
KW  - prognosis
KW  - sensitive
KW  - acute coronary syndrome
KW  - ACS
N2  - Objectives The purpose of this study was to investigate the prognostic implications of low-level increases in cardiac troponin I (cTnI) using a current-generation sensitive assay in patients with suspected acute coronary syndrome (ACS). Background Recent enhancements in troponin assays have enabled resolution of the 99th percentile reference limit at progressively lower concentrations. However, the clinical significance of low-level increases with sensitive assays is still debated. Methods We measured cTnI using a sensitive assay (TnI-Ultra, Siemens Healthcare Diagnostics, Deerfield, Illinois) at baseline in 4,513 patients with non-ST-segment elevation ACS randomly assigned to ranolazine or placebo. We applied decision limits at the 99th percentile reference limit (0.04 mu g/l), the cut point of the predecessor assay (0.1 mu g/l), and 1 equivalent to elevation of creatine kinase-myocardial band (1.5 ng/ml). Results Patients with baseline cTnI >= 0.04 mu g/l (n = 2,924) were at higher risk of death/myocardial infarction (MI) at 30 days than were patients with a negative cTnI (6.1% vs. 2.0%, p < 0.001). After adjusting for the TIMI (Thrombolysis In Myocardial Infarction) risk score, cTnI >= 0.04 mu g/l was associated with a 3-fold (95% confidence interval: 2.0 to 4.4, p < 0.001) higher risk of death/MI at 30 days. Moreover, patients with low-level increases (0.04 mu g/l to <0.1 mu g/l), were at significantly higher risk of death/MI at 30 days (5.0% vs. 2.0%, p = 0.001) and death at 12 months (6.4% vs. 2.4%, p = 0.005) than were patients with cTnI <0.04 mu g/l. Conclusions Low-level increases in cTnI using a sensitive assay identify patients at higher risk of death or MI. These findings support current American College of Cardiology/American Heart Association recommendations defining MI, and the incremental value of newer, more sensitive assays in identifying high-risk patients with ACS.
ER  -

BONACA, Marc; Benjamin SCIRICA; Marc SABATINE; Anthony DALBY; Jindřich ŠPINAR; Sabina A MURPHY; Peter JAROLIM; Eugene BRAUNWALD a David A MORROW. Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I. \textit{Journal of The American College of Cardiology}. USA: Elsevier Science Inc., 2010, roč.~55, č.~19, s.~2118-2124. ISSN~0735-1097. Dostupné z: https://doi.org/10.1016/j.jacc.2010.01.044.

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