Prognostic Value Of Cardiac Troponin Research Articles

Prognostic value of cardiac troponin I and CRP in patients undergoing percutaneous coronary intervention

Objective,This study was designed to evaluate the predictive value of pre-procedure Cardiac troponin I(cTnI)and CRP levels in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methotis cTnI and CRP were determined on admission in 335 consecutive patients with ACS who underwent primary PCI.Blood samples were obtained within 6-10 h after onset of symptom.The concentration of cTnI was determined by an automated chemiluminescence immunoassay.CRP was measured by immunoassay assay.According to the admission cTnI(＜0.1,0.1-0.5,＞0.5μg/L)and CRP(≤3,＞3 mg/L)divided into different groups.The pre-procedure cTnI and CRP status associated with 30 days cardiac mortality and major adverse cardiac events(MACE.including cardiac death.non-fatal recurrent MI.heart failure.readmission for any reason)were analyzed.The cardiac mortality at follow.uD period of 2 years were analyzed.Results Muhivariate logistic regression analyses revealed preoperative cTnI predicted 30 days cardiac mortality(OR=3.5,95%CI 2.2-5.3,P＜0.01),and recurrent MI rate(OR=1.5,95%CI 1.1-2.6,P＜0.05),independent of other known prognostic factors such as age,gender,hypertension,Hypercholestemlemia,diabetes and smoking.The pre-procedure CRP was independently related to 30 days cardiac mortality(OR=1.6,95%CI 1.1-2.3.P＜0.05),whereas there was no relationship to the MI rate.In ACS,levels of CBP≤3 mg/L,the three different risk groups (cTnI＜0.1,0.1-0.5,＞0.5μL)with corresponding 30 days MACE rates of 4.3%,11.7%,18.8%(X2=4.829,P=0.028),CRP＞3 mg/L,the three groups mth corresponding 30 days MACE mtes of 5.5%,13.2%,21.1%(X2=5.862,P=0.015),respectively.Patients were followed up for 2 years,Kaplan-Meier survival analysis demonstrated a significantly reduced survival at 2 years in patients witll a cTnI ＞0.5μg/L(80.0%versus 89.1%for a cTnI of 0.1-0.5μg/L and versus 92.2%flor cTnI＜0.1μg/L;X2=7.571,P＜0.05 by log-rank).Conclusions The levels of CRP and cTnI in Acs of onset in 6-10 h provide an even better risk stratification after the PCI.and closely correlate with 30 days MACE.Elevated cTnI provides long-term prognostic information regarding cardiac mortality.Therefore.The combination of CRP and cTnI measurement should be taken into consideration for risk stratification to decide about the management strategies in ACS patients. Key words: Cardiac troponin I; C-reactive protein; Peroutaneous coronary intervention

Prevalence and prognostic significance of incidental cardiac troponin T elevation in ambulatory patients with stable coronary artery disease: Data from The Heart and Soul Study

The significance of troponin elevation and clinical utility of troponin testing in ambulatory patients with coronary artery disease (CAD) have not been examined. We sought to investigate the prevalence and prognostic value of cardiac troponin T (cTnT) elevation in a population with stable CAD. We studied 987 patients with stable CAD enrolled in the Heart & Soul study who had plasma cTnT measurements before performing exercise treadmill testing. Of the studied population, 58 patients or 6.2% had detectable cTnT levels, >or=0.01 ng/mL (0.01-0.72 ng/mL). During a mean follow-up period of 4.3 (0.1-6.5) years, 58.6% of participants with detectable cTnT had cardiovascular events compared with 22.5% of those without detectable cTnT (hazard ratio [HR] 3.8, 95% CI 2.6-5.4, P < .001). This association remained strong after adjustment for traditional risk factors and C-reactive protein (HR 2.0, 95% CI 1.3-3.1, P = .002). However, after further adjustment for N-terminal pro-B-type natriuretic peptide and echocardiographic parameters of left ventricular function, cTnT elevation was not an independent predictor of cardiovascular events (HR 1.3, 95% CI, 0.8-2.3, P = .28). In ambulatory patients with stable CAD, the prevalence of cTnT elevation was 6.2%. Cardiac troponin T elevation detected using the conventional troponin assay was associated with increased risk of adverse cardiovascular outcomes, but its prognostic value was not incremental over N-terminal pro-B-type natriuretic peptide and echocardiographic evidence of cardiac abnormalities.

Cardiovascular Disease Surveillance in the Comparative Effectiveness Landscape

As the leading cause of death in the Western world, cardiovascular disease (CVD) constitutes an enormous public health problem.1 The last 4 decades have been characterized chiefly by the postponement of CVD events and CVD related deaths until older age. Thus, the burden of CVD is increasing in parallel with the increase in life expectancy.2 Within this context, identifying persons with CVD, measuring its incidence and outcome and how these vary over time and across populations is essential. A central goal of this monitoring (otherwise termed surveillance) has been to understand the determinants of the trends in CVD and in particular the respective responsibility of primary prevention versus that of the care of established disease in the genesis of the CVD trends. A direct extension of surveillance is its application to assess the effectiveness of care and the response to interventions designed to improve the quality of care. Articles see pp 414, 475, and 508 Over the first year of its existence, the journal Circulation: Cardiovascular Quality and Outcomes published 3 important articles that illustrate the clinical relevance of surveillance and the applicability of trend studies to care improvement. The article by Lewsey et al constitutes a classic example of CVD surveillance.3 The authors present much needed data on recent (1986 to 2005) trends in the epidemiology of stroke indicating that age- and sex-specific incidence rates of fatal and nonfatal hospitalized strokes in Scotland declined in men from 235 (95% CI, 229 to 242) to 149 (144 to 154) and in women from 299 (292 to 306) to 182 (177 to 188). The decline in incidence of hospitalized stroke varied by age, but overall this equated to a relative reduction in the risk of stroke of 31% in men and 42% in women. Declines in the …

Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

Los niveles troponina I cardiaca (cTnI) se consideran una importante herramienta de diagnóstico en los eventos coronarios agudos. Sin embargo, hay controversia sobre su sensibilidad, especificidad y valor pronóstico en la hemodiálisis (HD) de los pacientes. El objetivo de este estudio fue explorar el comportamiento y el valor pronóstico de la troponina I cardiaca en pacientes en HD. Se estudiaron treintaicuatro pacientes asintomáticos sometidos a hemodiálisis a largo plazo. Las muestras de sangre fueron tomadas al inicio del estudio (pre-y post-diálisis en suero), después de tres años (pre-diálisis en suero y plasma, con y sin la adición de anticuerpos heterófilos reactivos de bloqueo (HBR) y después de cinco años (suero pre-diálisis). Se midió la troponina I cardiaca cuantitativa con micro-partículas AxSYM cTnI de la enzima inmuno-ensayo de cTnI y la cualitativa con una prueba de un solo paso de inmuno Troponina Hexagon-cromatografía.No fue posible detectar ninguna asociación significativa entre los niveles de cTnI pre-y post-diálisis. La comparación de los resultados de la heparina de suero y plasma no reveló ninguna diferencia estadísticamente significativa entre el nivel de cTnI y los valores promedio para el plasma y suero con y sin la adición de HBR.Las concentraciones cTnI en las muestras sin HBR añadido fueron más bajas que en aquellas con HBR, pero no se observó diferencia estadísticamente significativa entre la media de cTnI y la media de las muestras con y sin adición de HBR. Durante el estudio, el 35,2% de la población murió. Se observó una asociación positiva entre los valores de cTnI en los pacientes que aún viven y en los pacientes que murieron a causa de la miocardiopatía isquémica (p = 0,039). El crudo riesgo de muerte por enfermedad cardiovascular se ha multiplicado por ocho (el intervalo de 95% de confianza estando entre 1,2 y 51,1) en pacientes con una concentración de cTnI superior a 0,04 ng/ml. Los niveles de cTnI pueden reflejar la isquemia miocárdica oculta e identificar los pacientes en hemodiálisis que se enfrentan a un mayor riesgo de muerte.

Troponin not just a simple cardiac marker: prognostic significance of cardiac troponin

Objective The object of this study was to review the role of cardiac troponin as a prognostic factor in acute coronary syndrome patients of varying circumstances. Data sources The data used in this review were obtained mainly from the studies of cardiac troponin reported in pubmed from 1981 to 2006. Study selection Relevant articles on studies of cardiac troponin were selected. Results Elevated cardiac troponin in patients with ST elevation and non ST elevation myocardial infarction was associated with adverse outcomes, including a higher incidence of congestive heart failure, shock, and death. Patients with elevated cardiac troponin value seemed to benefit more from invasive strategies including a percutaneous coronary intervention and bypass surgery, but elevated cardiac troponin was also correlated with adverse outcomes, including a higher degree of failure, shock, and mortality in patients undergoing percutaneous coronary intervention; a higher degree of perioperative myocardial infarction, low cardiac output syndrome, cardiopulmonary resuscitation, and new-onset ventricular arrhythmia in patients undergoing bypass surgery were also observed. Elevated troponin after a percutaneous coronary intervention seemed to be associated with short-term adverse outcomes rather than long-term adverse outcomes, unless the elevation of the troponin post percutaneous coronary intervention was quite high (about 5 times above normal). On the contrary, elevated cardiac troponin after bypass surgery was more confusing to analyze since it happened in almost all patients. Furthermore, differences in cutoff values and time measurements in some studies add more confusion; thus, further research is warranted. Conclusions The prognostic value of cardiac troponin is demonstrated in almost all acute coronary syndrome patients. In addition to its high sensitivity and specificity, the prognostic value of cardiac troponin is another reason to make it the ““golden cardiac marker” of this time.

Prognostic Value of Troponins in Patients with Non‐ST‐segment Elevation Acute Coronary Syndromes and Chronic Kidney Disease

The prognostic value of cardiac troponins (cTn) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) and chronic kidney disease (CKD) is debated. We tested the performance of cTnI and cTnT for risk stratification in patients with CKD and evaluated the prognostic significance of cTnI and cTnT elevations by their magnitude across the range of CKD severity. We examined correlations among cTn elevation, CKD, and in-hospital mortality in 31,586 high-risk patients with NSTE ACS included in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines initiative (CRUSADE). Cardiac tropinins I and T levels were categorized as ratios of each site's upper limit of normal (ULN) for myocardial necrosis: normal (cTn ratio < or =1 x ULN), mild (cTn ratio > 1-3 x ULN), and major (cTn ratio > 3 x ULN) elevation. Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease equation. Stages of CKD were categorized as normal to mild (eGFR > 60 mL/min), moderate (eGFR 30-60 mL/min), or severe (eGFR < 30 mL/min). Mortality increased more steeply across CKD stages (2.0%-12.9%) than across cTn ratio categories (2.7%-5.4%). In normal or mild CKD, mortality was low regardless of cTn elevations. In moderate CKD, mortality increased incrementally with cTnI (3.3% versus 5.4% versus 7.4%) and cTnT (3.7% versus 5.3% versus 7.3%) elevation. Among severe CKD patients, only major cTn elevations further distinguished risk (cTnI: 10.1% versus 9.7% versus 14.6%; cTnT: 7.0% versus 5.7% versus 14.0%). In patients with CKD, cTnI and cTnT perform equally in differentiating short-term prognosis following NSTE ACS; however, the prognostic impact of cTn is dependent upon the degree of CKD severity.

Elevated serum cardiac troponin I in older patients with hip fracture: incidence and prognostic significance

Dear Editor, We read with interest the article of Fischer et al. on incidence and signiWcance of troponin levels in the course of hip fracture repair [1]. We fully agree with their conclusion when they say that the troponin elevation is correlated with postoperative outcome. Indeed, several studies have shown that troponin release is a reliable marker of myocardial injury in the postoperative setting. Their introduction, however, leaves out a fair amount of data when they say that there is little agreement on the prognostic value of cardiac troponin in persons undergoing non-cardiac surgery [2–12]. Actually, several studies have been published on this issue. Most of them have focused on high risk patients, i.e. patients undergoing vascular surgery in whom the incidence of these events is extremely high. On these patients, serial troponin measurements are now the main diagnostic tool to detect myocardial ischaemia [7, 8]. Moreover, studies have shown a strong correlation between short-term troponin release and either postoperative complications or long-term cardiac complications, including death after vascular surgery [6, 7]. Thereafter, other studies have addressed the issue of the public health burden of myocardial ischaemia in major non-vascular surgery, especially in elderly patients [2, 9–12]. This concern is of great importance, since, even if the incidence of postoperative ischaemia in non-vascular surgery is low, the number of patients involved is extremely high [13]. As clearly said by the authors, hip fracture thoroughly features the issue since, due to the aging of the population, the number of patients will widely increase in years to come. Additionally, there are some data indicating that the incidence of cardiac complications is high in the setting of hip fracture. Rosencher et al. [14] in a cohort of 6860 patients, founded a 14.7%, 6 months mortality after hip fracture repair and cardiovascular disease was the most frequent cause of death (270/ 1006; 26.8%). Matot et al. in a sample of 68 hip fracture patients monitored for cardiac events during their hospital stay, founded 7 (10.3%) preoperative cardiac events and 6 (9.4%) postoperative cardiac events in the 64 patients who survived to the surgery [15]. In a previous study on the incidence of postoperative myocardial ischemia after hip surgery and its correlation with late cardiac outcome [2] we had observed that the incidence of myocardial ischemia, as measured by troponin Ic release, was particularly high in the hip fracture population (22%) as were mortality (22%) and the incidence of major cardiac complications (27%). Thereafter we have completed the study by including data S. Ausset Department of Anesthesiology and Intensive Care, Percy Military Hospital, 92141 Paris, France

Prognostic Value of Cardiac Troponin T Is Independent of Inflammation, Residual Renal Function, and Cardiac Hypertrophy and Dysfunction in Peritoneal Dialysis Patients

We investigated whether cardiac troponin T (cTnT) independently predicted outcome and added prognostic value over other clinical risk predictors in chronic peritoneal dialysis (PD) with end-stage renal disease. Baseline cTnT, echocardiography, indices of dialysis adequacy, and biochemical characteristics were assessed in 238 chronic PD patients who were followed prospectively for 3 years or until death. Using multivariable Cox regression analysis, cTnT remained predictive of all-cause mortality [hazard ratio 4.43, 95% CI 1.87-10.45, P = 0.001], cardiovascular death (4.12, 1.29-13.17, P = 0.017), noncardiovascular death (8.06, 1.86-35.03, P = 0.005), and fatal and nonfatal cardiovascular events (CVEs) (3.59, 1.48-8.70, P = 0.005) independent of background coronary artery disease, inflammation, residual renal function, left ventricular hypertrophy, and systolic dysfunction. cTnT alone had better predictive value than C-reactive protein (CRP) alone for mortality [area under the ROC curve (AUC) 0.774 vs 0.691; P = 0.089] and first CVE (AUC 0.711 vs 0.593; P = 0.009) at 3 years. Survival models including age, sex, and clinical, biochemical, and echocardiographic characteristics yielded AUCs of 0.813 (95% CI, 0.748-0.877), 0.800 (95% CI, 0.726-0.874), and 0.769 (95% CI, 0.708-0.830), respectively, in relation to all-cause mortality, cardiovascular death, and fatal and nonfatal cardiovascular events. After addition of cTnT, AUCs of the above models increased significantly to 0.832 (95% CI, 0.669-0.894; P = 0.0037), 0.810 (95% CI, 0.739-0.883; P = 0.0036), and 0.780 (95% CI, 0.720-0.840; P = 0.0002), respectively; no AUCs increased when CRP was added. cTnT is an independent predictor of long-term mortality, cardiovascular death and events, and noncardiovascular death in PD patients.

The diagnostic and prognostic impact of the redefinition of acute myocardial infarction: Lessons from the Global Registry of Acute Coronary Events (GRACE)

The impact and prognostic value of the redefinition of myocardial infarction (MI) with more sensitive markers have not been evaluated prospectively in a large, less selected population with acute coronary syndrome (ACS). We evaluated the attack and case-fatality rates of MI based on initial and/or peak creatine kinase (CK), creatine kinase-MB (CK-MB), and cardiac troponin (the upper limit of normal [ULN] was defined according to the local hospital's standard) in a prospective observational registry of 26,267 patients with ACS admitted to 106 hospitals in 14 countries. The addition of cardiac troponin-positive status to CK status as a criterion for the diagnosis of MI resulted in as many as 1 in 4 additional patients meeting the redefined criteria. Compared with patients without elevated levels of CK and cardiac troponin, the crude odds for dying during hospitalization were significantly higher for patients with elevated troponin but not CK levels of greater than or equal to the ULN (odds ratio [OR] 2.2, 95% CI 1.6-2.9), those without CK levels >2 times the ULN (OR 2.8, 95% CI 2.2-3.5), and those with nonelevated levels of CK-MB (OR 2.1, 95% CI 1.4-3.2). The addition of cardiac troponin-positive status significantly increased the multivariable-adjusted odds for hospital death in patients with CK < or =2 times the ULN (OR 1.6, 95% CI 1.2-2.1) but not for patients without elevated levels of CK or CK-MB. The prognostic value of cardiac troponin, beyond that supplied by CK status or important baseline characteristics, assists in the identification of patients with ACS who are at increased risk for death.

Coronary artery bypass surgery in acute coronary syndromes: prognostic value of cardiac troponin I on admission in patients with acute STEMI and NSTEMI

Objectives: Coronary artery bypass grafting (CABG) in acute coronary syndromes (ACS) are associated with increased mortality rates. Whether there is a difference in the surgical risk of ACS with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) and risk is likewise predictable with cardiac troponin I (cTnI) on admission is uncertain.

Cardiac Troponins and N-Terminal Pro-Brain Natriuretic Peptide in Acute Ischemic Stroke Do Not Relate to Clinical Prognosis

The prognostic value of cardiac troponins and natriuretic peptide in acute ischemic stroke is uncertain. We measured cardiac troponin T (cTnT), cardiac troponin I (cTnI), and N-terminal pro-brain natriuretic peptide (NT-proBNP) at admission in acute ischemic stroke patients without evident myocardial damage. In 174 consecutive patients with MRI-confirmed ischemic stroke, serial measurements of cTnT, cTnI, and NT-proBNP were performed at 3 different time points in the hyperacute phase (at admission, on days 1 and 2). Relation of laboratory values to risk factors, stroke subtype classification, and clinical outcome after 3 months was analyzed. The highest proportion of raised parameters was found at day 2 for cTnI in 8 of 103 (7.8%), at day 3 for cTnT in 8 of 174 (4.6%), and NT-proBNP in 114 of 174 (65.5%) patients. Proportion of patients with good outcome was significantly reduced in the group with highest NT-proBNP quartile. However, using multivariate regression analysis, no significant relation to morbidity and mortality was found for cTnT, cTnI, or NT-proBNP. Significant impact on the outcome was detected for lesion size, insular involvement, sex, age, and stroke severity. NT-proBNP is raised in nearly two thirds of acute stroke patients, whereas elevated cardiac troponins are found only in a small number of acute ischemic stroke patients. Neither NT-proBNP nor cardiac troponins influence clinical outcome if other risk factors are considered.

Prognostic value of cardiac troponin T in patients with both acute and chronic stable congestive heart failure: comparison with atrial natriuretic peptide, brain natriuretic peptide and plasma norepinephrine

Background The prognostic value of cardiac troponin T (cTn-T) in a mixture of patients with both acute and chronic congestive heart failure (CHF), simultaneously assessed and compared with neurohormonal factors, has not yet been thoroughly evaluated. Thus, we focused on the prognostic value of cTn-T in comparison with atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and plasma norepinephrine (PNE) in this population. Methods Prognostic correlates of elevation of cTn-T, ANP, BNP, PNE were analyzed in 63 acute and chronic CHF patients followed up to record worsening CHF and cardiac death. Results cTn-T (≥0.03 μg/L) was found in 17.4% (11 of 63) of patients. cTn-T correlated with ANP, BNP, PNE. Acute CHF patients were more positive for cTn-T and BNP. In our cohort, neither cTn-T (≥0.03 μg/L) nor PNE were associated with increased mortality and worsening HF in CHF patients. After adjustment, BNP was the only independent predictor of cardiac events (RR, 3.23; p=0.01). Conclusions BNP emerged as the only independent predictor of cardiac events in a mixture of patients with both acute and chronic CHF, suggesting that it is the analyte that best reflects long-term prognosis in a diverse population enrolled to mirror the “real world” situation.

Diagnostic and Prognostic Value of Cardiac Troponin I Assays in Patients Admitted With Symptoms Suggestive of Acute Coronary Syndrome

Abstract Context.—Increasing numbers of patients are presenting to emergency departments with symptoms suggestive of an acute myocardial infarction. Objective.—To demonstrate the comparative performance of the Ortho Vitros Troponin I and Beckman Access AccuTnI assays used to detect myocardial infarction and to develop risk stratification schemes for all-cause death in patients who presented with myocardial ischemia symptoms that were suggestive of acute coronary syndrome (ACS). Design.—The prospective enrollment of patients with ACS and the measurement of serial plasma samples by 2 commercial cardiac troponin I (cTnI) assays. Setting.—A metropolitan medical center that admitted patients with ACS during a 2-month period. Patients.—The study population consisted of 200 consecutively admitted patients who presented with symptoms that were suggestive of ACS. Results.—Correlation scatterplots showed no significant bias between cTnI assays based on 659 specimens across the dynamic range of each assay. Only mino...

Cardiac troponin i in acute pericarditis

ObjectivesThis study was designed to investigate the prognostic value of cardiac troponin I (cTnI) in viral or idiopathic pericarditis. BackgroundIdiopathic acute pericarditis has been recently reported as a possible cause of nonischemic release of cTnI. The prognostic value of this observation remains unknown. MethodsWe enrolled 118 consecutive cases (age 49.2 ± 18.4 years; 61 men) within 24 h of symptoms onset. A highly sensitive enzymoimmunofluorometric method was used to measure cTnI (acute myocardial infarction [AMI] threshold was 1.5 ng/ml). ResultsA cTnI rise was detectable in 38 patients (32.2%). The following characteristics were more frequently associated with a positive cTnI test: younger age (p < 0.001), male gender (p = 0.007), ST-segment elevation (p < 0.001), and pericardial effusion (p = 0.007) at presentation. An increase beyond AMI threshold was present in nine cases (7.6%), with an associated creatine kinase-MB elevation, a release pattern similar to AMI, and echocardiographic diffuse or localized abnormal left ventricular wall motion without detectable coronary artery disease. After a mean follow-up of 24 months a similar rate of complications was found in patients with a positive or a negative cTnI test (recurrent pericarditis: 18.4 vs. 18.8%; constrictive pericarditis: 0 vs. 1.3%, for all p = NS; no cases of cardiac tamponade or residual left ventricular dysfunction were detected). ConclusionsIn viral or idiopathic acute pericarditis cTnI elevation is frequently observed and commonly associated with young age, male gender, ST-segment elevation, and pericardial effusion at presentation. cTnI increase is roughly related to the extent of myocardial inflammatory involvement and, unlike acute coronary syndromes, is not a negative prognostic marker.

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Prognostic value of cardiac Troponin I after cardiac surgery: comparison with two different assays

After adult cardiac surgery, the inhospital prognostic value of cTnI, measured at 20 hours after the end of surgery, has been demonstrated [1]. Various cardiac troponin I (cTnI) assays are available but the lack of standardization renders difficult any comparative study [2]. The aim of this study was therefore to determine cTnI concentration after cardiac surgery using two different assays, and to evaluate their correlation and their respective prognostic values.

Cardiac Troponin I Is an Independent Predictor of In-hospital Death after Adult Cardiac Surgery

Although myocardial injury during cardiac surgery is associated with impaired clinical outcome, little is known about the prognostic value of cardiac troponin I (cTnI), a cardiac-specific biologic marker. The purpose of this prospective study was to evaluate the prognostic value of cTnI concentrations measured 20 h after the end of surgery in adult patients undergoing coronary artery bypass grafting or conventional valve surgery. Baseline and perioperative characteristics of 502 consecutive patients undergoing conventional heart surgery during a 1-yr period were collected. In-hospital death (n = 28) and major clinical outcomes, e.g., low cardiac output, ventricular arrhythmia, and renal failure, were recorded. Multivariate analysis, using a stepwise logistic regression, showed that cTnI concentration was an independent predictor of in-hospital mortality (for cTnI concentration > 13 ng/ml, odds ratio = 6.7 [95% confidence interval, 2.3-19.3]), as were diabetes, altered preoperative cardiac function, emergent surgery, cardiopulmonary bypass duration, postoperative Pao2 level and total chest drainage volume. Further, elevated cTnI concentrations were associated with a cardiac cause of death and with major clinical outcomes. Our results demonstrated that cTnI concentration measured 20 h after the end of surgery is an independent predictor of in-hospital death after cardiac surgery. In addition, elevated concentrations of cTnI are associated with a cardiac cause of death and with major postoperative complications.

Prognostic value of serum cardiac troponin I in ambulatory patients with chronic renal failure undergoing long-term hemodialysis: A two-year outcome analysis

OBJECTIVESWe sought to evaluate the prognostic value of cardiac troponin I (cTnI) in asymptomatic, ambulatory patients with chronic renal failure treated with long-term hemodialysis.BACKGROUNDSmaller, short-term follow-up studies on this subject have given conflicting results.METHODSA total of 126 ambulatory patients with chronic renal failure treated with long-term hemodialysis were followed for two years for all-cause mortality, cardiac mortality, all-cause hospital admissions and cardiac hospital admissions. Serum cTnI was measured before dialysis at the time of study entry.RESULTSOne hundred two patients had normal serum levels of cTnI (≤0.03 ng/ml) and 24 patients had elevated levels (0.015 ± 0.007 vs. 0.053 ± 0.029 ng/ml, p < 0.0001). No significant difference in all-cause mortality (20 vs. 4 deaths), cardiac mortality (4 vs. 1 death), all-cause hospital admissions (1.74 ± 1.72 vs. 1.25 ± 1.19 admissions/patient) or cardiac admissions (0.52 ± 0.89 vs. 0.33 ± 0.76 admissions/patient) was present between the patients with normal cTnI levels and those with elevated cTnI levels. Serum cTnI was not significantly different between patients who died versus those who survived (0.022 ± 0.019 vs. 0.022 ± 0.021 ng/ml). Serum cTnI was not an independent predictor of all-cause mortality, cardiac mortality, all-cause admissions or cardiac admissions. Age (older) and serum albumin (lower) were independent predictors of all-cause mortality, whereas a history of myocardial infarction was an independent predictor of cardiac mortality. Serum sodium (lower) was an independent predictor of all-cause hospital admissions, whereas hypertension and previous myocardial infarction were independent predictors of cardiac admissions. The best predictors of the time to death were age (older) and serum sodium level (lower), irrespective of the serum cTnI levels.CONCLUSIONSCardiac troponin I has a limited role in predicting mortality and hospital admissions in asymptomatic patients with chronic renal failure treated with long-term hemodialysis.

Short- and long-term prognostic value of cardiac troponin I and dobutamine echocardiography in patients with stabilized acute coronary syndromes

Background: This study investigated the short- and long-term prognostic values of cardiac troponin I (cTnI) and dobutamine echocardiography (DE) in patients with acute coronary syndrome (ACS) who stabilized after medical treatment. Methods and results: 171 consecutive patients of ACS accepted blood sampling for cTnI at the emergency department and DE at 4.9±0.6 days after admission. The prognostic values of cTnI, DE, and combined cTnI and DE were separately investigated at follow up periods of 30 days, 1 year and 3 years for hard events (cardiac death and non-fatal myocardial infarction) and all spontaneous events. CTnI was elevated in 55 (32%) patients and DE was positive in 114 (67%) patients. Elevated cTnI with positive DE were found in 44 (26%) patients. Within 30 days, the combination of elevated cTnI and positive DE provided more accurate prognostic information than each test result alone, and was the only independent predictor for both hard ( p=0.014) and all events ( p=0.012). After 1 year, cTnI alone had no prognostic value. The combination of an elevated cTnI level and a positive DE only had a prognostic value for all events ( p=0.015). However, DE was an independent predictor for both hard ( p=0.006) and all events ( p=0.002). Neither cTnI alone nor cTnI combined with DE had a significant 3-year prognostic value. However, DE maintained its prognostic value and was still an independent predictor after 3 years for both hard ( p=0.024) and all events ( p=0.004). Conclusions: For patients with stabilized ACS, the diagnostic finding of elevated cTnI combined with a positive DE has a better short-term prognostic value than each test alone. However, DE alone has a better long-term prognostic value.

Prognostic value of cardiac troponin I re-elevation following percutaneous coronary intervention in high-risk patients with acute coronary syndromes

Troponin I is a predictive marker of short- and intermediate-term adverse cardiac events in patients with acute coronary syndromes (ACS). These high-risk patients may benefit from early percutaneous coronary intervention. However, whether additional myocardial injury, defined as postprocedural troponin I elevation, may be associated with adverse short- and intermediate-term outcomes has not been fully explored. Accordingly, we studied 132 consecutive patients with non–ST-elevation ACS (62% with non–Q-wave myocardial infarction) and elevated troponin I levels at admission (>0.15 ng/ml) who underwent percutaneous coronary intervention ≥48 hours after admission. Troponin I levels were routinely measured at 6 and 18 to 24 hours after intervention and patients were stratified according to the presence or absence of troponin I re-elevation, defined as postprocedural troponin I levels >1 times the admission levels. In-hospital and cumulative 6-month clinical outcomes were compared between groups. Patients with troponin I re-elevation (n = 51) were older (68 ± 13 vs 64 ± 12 years, p = 0.05) and had experienced prior myocardial infarction more frequently (92.5 vs 82.1, p = 0.09), but otherwise had similar baseline clinical characteristics. Patients with troponin I re-elevation had significantly higher in-hospital mortality (9.8% vs 0%, p = 0.016) and a higher 6-month cumulative death rate (24% vs 3.7%, p = 0.001). There was a trend for an increased 6-month myocardial infarction rate in patients with troponin I re-elevation (13.7% vs 3.7%, p = 0.11) and target vessel revascularization was similar between groups (16.7% vs 17.4%, p = 0.92). By multivariate analysis, troponin I re-elevation (odds ratio [OR] 6.2, p = 0.011) and diabetes mellitus (OR 5.7, p = 0.014) were the strongest independent predictors for increased 6-month cumulative mortality, whereas creatine kinase MB-fraction re-elevation had no prognostic value. We conclude that troponin I re-elevation after percutaneous coronary intervention in high-risk patients with ACS is associated with a substantial increase in mortality and reduced event-free survival at 6-month follow-up.