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Predicting a late positive serum troponin in initially troponin-negative patients with non-ST-elevation acute coronary syndrome: clinical predictors and validated risk score results from the TIMI IIIB and GUSTO IIA studies.

Publication ,  Journal Article
Januzzi, JL; Newby, LK; Murphy, SA; Pieper, K; Antman, EM; Morrow, DA; Sabatine, MS; Ohman, EM; Cannon, CP; Braunwald, E
Published in: Am Heart J
February 2006

BACKGROUND: Troponin testing is useful for evaluating patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS); however, a significant percentage of patients are troponin negative at presentation and develop late rise of the marker. METHODS: Patients in the TIMI IIIB study were assessed with respect to their troponin I (TnI) status at presentation and 12 hours. Multivariable analysis identified independent clinical factors associated with TnI rise at 12 hours among subjects initially TnI negative. A score predicting late TnI rise in TIMI IIIB was developed using these factors and validated among patients in the GUSTO IIA study. RESULTS: Of 1342 subjects in TIMI IIIB, 200 (14.9%) were negative at baseline, but developed an elevated TnI (> or = 0.4 ng/mL) at 12 hours. Six independent predictors of late TnI rise were identified: ST-segment deviation (odds ratio [OR] 3.52, 95% CI 2.38-5.23, P < .001), presentation < 8 hours from symptom onset (OR 2.91, 95% CI 1.92-4.40, P < .001), no prior percutaneous coronary intervention (OR 2.88, 95% CI 1.54-5.39, P = .001), no prior beta-blocker use (OR 1.74, 95% CI 1.15-2.63, P = .008), unheralded angina (OR 1.65, 95% CI 1.12-2.42, P = .01), and a history of myocardial infarction (OR 1.59, 95% CI 1.06-2.37, P = .02). ST deviation, presentation < 8 hours from symptoms, and no prior percutaneous coronary intervention were given a score of 2 points, whereas a score of 1 point was assigned to the other factors. Among baseline TnI-negative patients, a rising score was paralleled by an increasing prevalence of late TnI rise from 0% (with a score of 0) to 69% (with a score of 9) (P < .001). In confirmation, the score was able to similarly predict late troponin T rise among 855 patients in the GUSTO IIA study (P < .0001). CONCLUSION: Development of late troponin rise is common in non-ST-segment elevation acute coronary syndromes. Six easily ascertained variables may be used to identify those at higher risk for late rise in troponin levels after an initially negative presentation.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2006

Volume

151

Issue

2

Start / End Page

360 / 366

Location

United States

Related Subject Headings

  • Troponin I
  • Time Factors
  • Syndrome
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Odds Ratio
  • Myocardial Infarction
  • Male
  • Humans
  • Female
 

Citation

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Januzzi, J. L., Newby, L. K., Murphy, S. A., Pieper, K., Antman, E. M., Morrow, D. A., … Braunwald, E. (2006). Predicting a late positive serum troponin in initially troponin-negative patients with non-ST-elevation acute coronary syndrome: clinical predictors and validated risk score results from the TIMI IIIB and GUSTO IIA studies. Am Heart J, 151(2), 360–366. https://doi.org/10.1016/j.ahj.2005.04.021
Januzzi, James L., L Kristin Newby, Sabina A. Murphy, Karen Pieper, Elliot M. Antman, David A. Morrow, Marc S. Sabatine, E Magnus Ohman, Christopher P. Cannon, and Eugene Braunwald. “Predicting a late positive serum troponin in initially troponin-negative patients with non-ST-elevation acute coronary syndrome: clinical predictors and validated risk score results from the TIMI IIIB and GUSTO IIA studies.Am Heart J 151, no. 2 (February 2006): 360–66. https://doi.org/10.1016/j.ahj.2005.04.021.
Januzzi JL, Newby LK, Murphy SA, Pieper K, Antman EM, Morrow DA, Sabatine MS, Ohman EM, Cannon CP, Braunwald E. Predicting a late positive serum troponin in initially troponin-negative patients with non-ST-elevation acute coronary syndrome: clinical predictors and validated risk score results from the TIMI IIIB and GUSTO IIA studies. Am Heart J. 2006 Feb;151(2):360–366.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2006

Volume

151

Issue

2

Start / End Page

360 / 366

Location

United States

Related Subject Headings

  • Troponin I
  • Time Factors
  • Syndrome
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Odds Ratio
  • Myocardial Infarction
  • Male
  • Humans
  • Female