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Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy.

Publication ,  Journal Article
Newby, LK; Ohman, EM; Christenson, RH; Moliterno, DJ; Harrington, RA; White, HD; Armstrong, PW; Van De Werf, F; Pfisterer, M; Hasselblad, V ...
Published in: Circulation
June 19, 2001

BACKGROUND: Troponin T (TnT) is valuable for short- and long-term risk stratification of patients with acute coronary syndromes (ACS). It also may predict which ACS patients will benefit from glycoprotein (GP) IIb/IIIa blockade. METHODS AND RESULTS: We prospectively studied 1160 patients with non-ST-segment elevation ACS randomized in PARAGON-B to receive lamifiban, an intravenous GP IIb/IIIa antagonist, or placebo. TnT levels were obtained before study treatment began and 24 to 72 hours later; assays were performed by a blinded core laboratory. At baseline, 40.2% of patients were TnT-positive (>/=0.1 ng/mL); these patients were older and more often male or smokers. Patients positive at baseline had a significantly higher rate of the primary end point (composite of death, myocardial [re]infarction, or severe recurrent ischemia at 30 days; odds ratio, 1.5; 95% CI, 1.1 to 2.1) than those who were TnT-negative. Lamifiban was associated with significant reduction in the primary end point (from 19.4% to 11.0%, P=0.01) among TnT-positive patients but not among TnT-negative patients (11.2% for placebo versus 10.8% for lamifiban, P=0.86; P=0.08 for test of interaction between TnT status and treatment assignment). This pattern held for the end points of death alone and death or myocardial (re)infarction at 30 days. Peak TnT level at 48 hours did not differ with lamifiban treatment. CONCLUSIONS: TnT predicts poor short-term outcomes in non-ST-segment elevation ACS. Treatment benefit with lamifiban is limited almost exclusively to TnT-positive patients, reducing 30-day adverse outcomes to a rate nearly identical to that of negative patients.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 19, 2001

Volume

103

Issue

24

Start / End Page

2891 / 2896

Location

United States

Related Subject Headings

  • Tyrosine
  • Troponin T
  • Treatment Outcome
  • Survival Rate
  • Secondary Prevention
  • Prospective Studies
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Odds Ratio
  • Middle Aged
 

Citation

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MLA
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Newby, L. K., Ohman, E. M., Christenson, R. H., Moliterno, D. J., Harrington, R. A., White, H. D., … Topol, E. J. (2001). Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy. Circulation, 103(24), 2891–2896. https://doi.org/10.1161/01.cir.103.24.2891
Newby, L. K., E. M. Ohman, R. H. Christenson, D. J. Moliterno, R. A. Harrington, H. D. White, P. W. Armstrong, et al. “Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy.Circulation 103, no. 24 (June 19, 2001): 2891–96. https://doi.org/10.1161/01.cir.103.24.2891.
Newby LK, Ohman EM, Christenson RH, Moliterno DJ, Harrington RA, White HD, et al. Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy. Circulation. 2001 Jun 19;103(24):2891–6.
Newby, L. K., et al. “Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy.Circulation, vol. 103, no. 24, June 2001, pp. 2891–96. Pubmed, doi:10.1161/01.cir.103.24.2891.
Newby LK, Ohman EM, Christenson RH, Moliterno DJ, Harrington RA, White HD, Armstrong PW, Van De Werf F, Pfisterer M, Hasselblad V, Califf RM, Topol EJ. Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy. Circulation. 2001 Jun 19;103(24):2891–2896.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 19, 2001

Volume

103

Issue

24

Start / End Page

2891 / 2896

Location

United States

Related Subject Headings

  • Tyrosine
  • Troponin T
  • Treatment Outcome
  • Survival Rate
  • Secondary Prevention
  • Prospective Studies
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Odds Ratio
  • Middle Aged