Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes

Filippo Ottani, Marcello Galvani, Francesca Antonia Nicolini, Donatella Ferrini, Andrea Pozzati, Giuseppe Di Pasquale, Allan S Jaffe

Research output: Contribution to journalArticle

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Abstract

Background: Elevations of cardiac troponin T or I are predictive of adverse outcomes in patients with acute coronary syndromes. However, odds ratios (ORs) vary substantially between studies. This investigation refines these values by means of a meta-analysis. Methods: Twenty-one studies were suitable. ORs were calculated for short-term (30 days) and long-term (5 months to 3 years) follow-up in patients with ST-segment elevation (ST↑), in those without ST-segment elevation (no ST↑), and in patients with unstable angina. The primary end point was a composite of death or nonfatal myocardial infarction. Results: A total of 18,982 patients were included. At 30 days, the OR for death or myocardial infarction was 3.44 (95% confidence interval [Cl], 2.94-4.03; P< .00001) for patients with positive troponin. In the ST↑ group, troponin elevations carried a 2.86-fold (95% Cl, 2.35-3.47; P < .0001) higher risk during short-term follow-up, which was maintained long term. The no-ST↑ patients with troponin elevations manifested a 4.93-fold (95% Cl, 3.77-6.45; P < .0001) increase of adverse outcomes. The OR for patients with unstable angina and positive troponin was 9.39 (95% Cl, 6.46-13.67; P < .0001). For cardiac death alone, the results were similar. Conclusions: Patients with acute coronary syndromes who have troponin elevations show a substantial increase in risk during short and long-term follow-up.

Original languageEnglish (US)
Pages (from-to)917-927
Number of pages11
JournalAmerican Heart Journal
Volume140
Issue number6
DOIs
StatePublished - 2000

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Troponin
Acute Coronary Syndrome
Odds Ratio
Unstable Angina
Myocardial Infarction
Troponin T
Troponin I
Meta-Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes. / Ottani, Filippo; Galvani, Marcello; Nicolini, Francesca Antonia; Ferrini, Donatella; Pozzati, Andrea; Di Pasquale, Giuseppe; Jaffe, Allan S.

In: American Heart Journal, Vol. 140, No. 6, 2000, p. 917-927.

Research output: Contribution to journalArticle

Ottani, Filippo ; Galvani, Marcello ; Nicolini, Francesca Antonia ; Ferrini, Donatella ; Pozzati, Andrea ; Di Pasquale, Giuseppe ; Jaffe, Allan S. / Elevated cardiac troponin levels predict the risk of adverse outcome in patients with acute coronary syndromes. In: American Heart Journal. 2000 ; Vol. 140, No. 6. pp. 917-927.
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abstract = "Background: Elevations of cardiac troponin T or I are predictive of adverse outcomes in patients with acute coronary syndromes. However, odds ratios (ORs) vary substantially between studies. This investigation refines these values by means of a meta-analysis. Methods: Twenty-one studies were suitable. ORs were calculated for short-term (30 days) and long-term (5 months to 3 years) follow-up in patients with ST-segment elevation (ST↑), in those without ST-segment elevation (no ST↑), and in patients with unstable angina. The primary end point was a composite of death or nonfatal myocardial infarction. Results: A total of 18,982 patients were included. At 30 days, the OR for death or myocardial infarction was 3.44 (95{\%} confidence interval [Cl], 2.94-4.03; P< .00001) for patients with positive troponin. In the ST↑ group, troponin elevations carried a 2.86-fold (95{\%} Cl, 2.35-3.47; P < .0001) higher risk during short-term follow-up, which was maintained long term. The no-ST↑ patients with troponin elevations manifested a 4.93-fold (95{\%} Cl, 3.77-6.45; P < .0001) increase of adverse outcomes. The OR for patients with unstable angina and positive troponin was 9.39 (95{\%} Cl, 6.46-13.67; P < .0001). For cardiac death alone, the results were similar. Conclusions: Patients with acute coronary syndromes who have troponin elevations show a substantial increase in risk during short and long-term follow-up.",
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AU - Ottani, Filippo

AU - Galvani, Marcello

AU - Nicolini, Francesca Antonia

AU - Ferrini, Donatella

AU - Pozzati, Andrea

AU - Di Pasquale, Giuseppe

AU - Jaffe, Allan S

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N2 - Background: Elevations of cardiac troponin T or I are predictive of adverse outcomes in patients with acute coronary syndromes. However, odds ratios (ORs) vary substantially between studies. This investigation refines these values by means of a meta-analysis. Methods: Twenty-one studies were suitable. ORs were calculated for short-term (30 days) and long-term (5 months to 3 years) follow-up in patients with ST-segment elevation (ST↑), in those without ST-segment elevation (no ST↑), and in patients with unstable angina. The primary end point was a composite of death or nonfatal myocardial infarction. Results: A total of 18,982 patients were included. At 30 days, the OR for death or myocardial infarction was 3.44 (95% confidence interval [Cl], 2.94-4.03; P< .00001) for patients with positive troponin. In the ST↑ group, troponin elevations carried a 2.86-fold (95% Cl, 2.35-3.47; P < .0001) higher risk during short-term follow-up, which was maintained long term. The no-ST↑ patients with troponin elevations manifested a 4.93-fold (95% Cl, 3.77-6.45; P < .0001) increase of adverse outcomes. The OR for patients with unstable angina and positive troponin was 9.39 (95% Cl, 6.46-13.67; P < .0001). For cardiac death alone, the results were similar. Conclusions: Patients with acute coronary syndromes who have troponin elevations show a substantial increase in risk during short and long-term follow-up.

AB - Background: Elevations of cardiac troponin T or I are predictive of adverse outcomes in patients with acute coronary syndromes. However, odds ratios (ORs) vary substantially between studies. This investigation refines these values by means of a meta-analysis. Methods: Twenty-one studies were suitable. ORs were calculated for short-term (30 days) and long-term (5 months to 3 years) follow-up in patients with ST-segment elevation (ST↑), in those without ST-segment elevation (no ST↑), and in patients with unstable angina. The primary end point was a composite of death or nonfatal myocardial infarction. Results: A total of 18,982 patients were included. At 30 days, the OR for death or myocardial infarction was 3.44 (95% confidence interval [Cl], 2.94-4.03; P< .00001) for patients with positive troponin. In the ST↑ group, troponin elevations carried a 2.86-fold (95% Cl, 2.35-3.47; P < .0001) higher risk during short-term follow-up, which was maintained long term. The no-ST↑ patients with troponin elevations manifested a 4.93-fold (95% Cl, 3.77-6.45; P < .0001) increase of adverse outcomes. The OR for patients with unstable angina and positive troponin was 9.39 (95% Cl, 6.46-13.67; P < .0001). For cardiac death alone, the results were similar. Conclusions: Patients with acute coronary syndromes who have troponin elevations show a substantial increase in risk during short and long-term follow-up.

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