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Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators.

Publication ,  Journal Article
Ohman, EM; Armstrong, PW; Christenson, RH; Granger, CB; Katus, HA; Hamm, CW; O'Hanesian, MA; Wagner, GS; Kleiman, NS; Harrell, FE; Califf, RM ...
Published in: N Engl J Med
October 31, 1996

BACKGROUND: The prognosis of patients hospitalized with acute myocardial ischemia is quite variable. We examined the value of serum levels of cardiac troponin T, serum creatine kinase MB (CK-MB) levels, and electrocardiographic abnormalities for risk stratification in patients with acute myocardial ischemia. METHODS: We studied 855 patients within 12 hours of the onset of symptoms. Cardiac troponin T levels, CK-MB levels, and electrocardiograms were analyzed in a blinded fashion at the core laboratory. We used logistic regression to assess the usefulness of baseline levels of cardiac troponin T and CK-MB and the electrocardiographic category assigned at admission-ST-segment elevation, ST-segment depression, T-wave inversion, or the presence of confounding factors that impair the detection of ischemia (bundle-branch block and paced rhythms)-in predicting outcome. RESULTS: On admission, 289 of 801 patients with base-line serum samples had elevated troponin T levels (> 0.1 ng per milliliter). Mortality within 30 days was significantly higher in these patients than in patients with lower levels of troponin T (11.8 percent vs. 3.9 percent, P < 0.001). The troponin T level was the variable most strongly related to 30-day mortality (chi-square = 21, P < 0.001), followed by the electrocardiographic category (chi-square = 14, P = 0.003) and the CK-MB level (chi-square = 11, P = 0.004). Troponin T levels remained significantly predictive of 30-day mortality in a model that contained the electrocardiographic categories and CK-MB levels (chi-square = 9.2, P = 0.027). CONCLUSIONS: The cardiac troponin T level is a powerful, independent risk marker in patients who present with acute myocardial ischemia. It allows further stratification of risk when combined with standard measures such as electrocardiography and the CK-MB level.

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Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

October 31, 1996

Volume

335

Issue

18

Start / End Page

1333 / 1341

Location

United States

Related Subject Headings

  • Troponin T
  • Troponin
  • Statistics, Nonparametric
  • Risk
  • Recurrence
  • Prospective Studies
  • Prognosis
  • Myocardial Ischemia
  • Middle Aged
  • Male
 

Citation

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Chicago
ICMJE
MLA
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Ohman, E. M., Armstrong, P. W., Christenson, R. H., Granger, C. B., Katus, H. A., Hamm, C. W., … Topol, E. J. (1996). Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med, 335(18), 1333–1341. https://doi.org/10.1056/NEJM199610313351801
Ohman, E. M., P. W. Armstrong, R. H. Christenson, C. B. Granger, H. A. Katus, C. W. Hamm, M. A. O’Hanesian, et al. “Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators.N Engl J Med 335, no. 18 (October 31, 1996): 1333–41. https://doi.org/10.1056/NEJM199610313351801.
Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, et al. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med. 1996 Oct 31;335(18):1333–41.
Ohman, E. M., et al. “Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators.N Engl J Med, vol. 335, no. 18, Oct. 1996, pp. 1333–41. Pubmed, doi:10.1056/NEJM199610313351801.
Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, O’Hanesian MA, Wagner GS, Kleiman NS, Harrell FE, Califf RM, Topol EJ. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med. 1996 Oct 31;335(18):1333–1341.
Journal cover image

Published In

N Engl J Med

DOI

ISSN

0028-4793

Publication Date

October 31, 1996

Volume

335

Issue

18

Start / End Page

1333 / 1341

Location

United States

Related Subject Headings

  • Troponin T
  • Troponin
  • Statistics, Nonparametric
  • Risk
  • Recurrence
  • Prospective Studies
  • Prognosis
  • Myocardial Ischemia
  • Middle Aged
  • Male