BACKGROUND: Guidelines for treatment of acute coronary syndrome (ACS) recommend observing a rise or fall in cardiac troponin (cTn) concentrations for assessing acute injury. It is unknown whether a rising pattern presages a more adverse long-term prognosis than elevations that do not change. The present study assessed whether a rising pattern of cardiac biomarkers was more prognostic than simple elevations. METHODS: We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) (Roche), cTnT (Roche) and cTnI (Beckman Coulter) in 212 ACS patients. These biomarkers were measured in coincident EDTA and heparin plasma samples available from at least 2 different time points, an early first specimen obtained a median of 2 hours after onset of symptoms, interquartile range (IQR) 2-4 hours, and a later second specimen obtained at 9 hours, IQR 9-9 hours. The cTn concentration in the second specimen was used to classify myocardial necrosis (cTnI >0.04 ug/L; cTnT >0.01 ug/L). Outcomes [death, myocardial infarction (MI), heart failure (HF)] were obtained >8 years after the initial presentation. For patients with myocardial necrosis and a cTn concentration ratio (second/first measured concentrations) > or =1.00, the concentration ratios and the absolute concentrations in the second specimen were used to assess prognosis after 4 years. RESULTS: In myocardial necrosis, the relative change (cTn2/cTn1) was greater for cTnI than for cTnT (P <0.01), whereas the relative change in NT-proBNP was the same regardless of which troponin was used to classify necrosis (P = 0.71). The concentration ratio for cTnI, cTnT, and NT-proBNP was not useful for risk stratification (i.e., death/MI/HF; P > or =0.15). CONCLUSIONS: A rise in cardiac troponin or NT-proBNP concentration in ACS patients presenting early after onset of pain is not helpful for long-term prognosis.
BACKGROUND: Guidelines for treatment of acute coronary syndrome (ACS) recommend observing a rise or fall in cardiac troponin (cTn) concentrations for assessing acute injury. It is unknown whether a rising pattern presages a more adverse long-term prognosis than elevations that do not change. The present study assessed whether a rising pattern of cardiac biomarkers was more prognostic than simple elevations. METHODS: We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) (Roche), cTnT (Roche) and cTnI (Beckman Coulter) in 212 ACS patients. These biomarkers were measured in coincident EDTA and heparin plasma samples available from at least 2 different time points, an early first specimen obtained a median of 2 hours after onset of symptoms, interquartile range (IQR) 2-4 hours, and a later second specimen obtained at 9 hours, IQR 9-9 hours. The cTn concentration in the second specimen was used to classify myocardial necrosis (cTnI >0.04 ug/L; cTnT >0.01 ug/L). Outcomes [death, myocardial infarction (MI), heart failure (HF)] were obtained >8 years after the initial presentation. For patients with myocardial necrosis and a cTn concentration ratio (second/first measured concentrations) > or =1.00, the concentration ratios and the absolute concentrations in the second specimen were used to assess prognosis after 4 years. RESULTS: In myocardial necrosis, the relative change (cTn2/cTn1) was greater for cTnI than for cTnT (P <0.01), whereas the relative change in NT-proBNP was the same regardless of which troponin was used to classify necrosis (P = 0.71). The concentration ratio for cTnI, cTnT, and NT-proBNP was not useful for risk stratification (i.e., death/MI/HF; P > or =0.15). CONCLUSIONS: A rise in cardiac troponin or NT-proBNP concentration in ACS patients presenting early after onset of pain is not helpful for long-term prognosis.
Authors: Russell V Luepker; Fred S Apple; Robert H Christenson; Richard S Crow; Stephen P Fortmann; David Goff; Robert J Goldberg; Mary M Hand; Allan S Jaffe; Desmond G Julian; Daniel Levy; Teri Manolio; Shanthi Mendis; George Mensah; Andrzej Pajak; Ronald J Prineas; K Srinath Reddy; Veronique L Roger; Wayne D Rosamond; Eyal Shahar; A Richey Sharrett; Paul Sorlie; Hugh Tunstall-Pedoe Journal: Circulation Date: 2003-11-10 Impact factor: 29.690
Authors: David A Morrow; Christopher P Cannon; Robert L Jesse; L Kristin Newby; Jan Ravkilde; Alan B Storrow; Alan H B Wu; Robert H Christenson; Fred S Apple; Gary Francis; Wilson Tang Journal: Clin Chem Date: 2007-03-23 Impact factor: 8.327
Authors: Peter A Kavsak; Andrew R MacRae; Alice M Newman; Viliam Lustig; Glenn E Palomaki; Dennis T Ko; Jack V Tu; Allan S Jaffe Journal: Clin Chim Acta Date: 2007-01-23 Impact factor: 3.786
Authors: L K Newby; R H Christenson; E M Ohman; P W Armstrong; T D Thompson; K L Lee; C W Hamm; H A Katus; C Cianciolo; C B Granger; E J Topol; R M Califf Journal: Circulation Date: 1998-11-03 Impact factor: 29.690
Authors: Andrew R Macrae; Peter A Kavsak; Viliam Lustig; Rakesh Bhargava; Rudy Vandersluis; Glenn E Palomaki; Marie-Jeanne Yerna; Allan S Jaffe Journal: Clin Chem Date: 2006-03-23 Impact factor: 8.327
Authors: Michael C Kontos; Rakesh Shah; Lucie M Fritz; F Philip Anderson; James L Tatum; Joseph P Ornato; Robert L Jesse Journal: J Am Coll Cardiol Date: 2004-03-17 Impact factor: 24.094
Authors: James L Januzzi; Fabian Bamberg; Hang Lee; Quynh A Truong; John H Nichols; Mahir Karakas; Asim A Mohammed; Christopher L Schlett; John T Nagurney; Udo Hoffmann; Wolfgang Koenig Journal: Circulation Date: 2010-03-01 Impact factor: 29.690