Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction
BACKGROUND: Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin T may be cleared by the kidney. METHODS: We analyzed the outcomes in 7033 patients enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries IV trial who had complete base-line data on troponin T levels and creatinine clearance rates. The troponin T level was considered abnormal if it was 0.1 ng per milliliter or higher, and creatinine clearance was assessed in quartiles. The primary end point was a composite of death or myocardial infarction within 30 days. RESULTS: Death or myocardial infarction occurred in 581 patients. Among patients with a creatinine clearance above the 25th percentile value of 58.4 ml per minute, an abnormally elevated troponin T level was predictive of an increased risk of myocardial infarction or death (7 percent vs. 5 percent; adjusted odds ratio, 1.7; 95 percent confidence interval, 1.3 to 2.2; P<0.001). Among patients with a creatinine clearance in the lowest quartile, an elevated troponin T level was similarly predictive of increased risk (20 percent vs. 9 percent; adjusted odds ratio, 2.5; 95 percent confidence interval, 1.8 to 3.3; P<0.001). When the creatinine clearance rate was considered as a continuous variable and age, sex, ST-segment depression, heart failure, previous revascularization, diabetes mellitus, and other confounders had been accounted for, elevation of the troponin T level was independently predictive of risk across the entire spectrum of renal function. CONCLUSIONS: Cardiac troponin T levels predict short-term prognosis in patients with acute coronary syndromes regardless of their level of creatinine clearance.
|Keywords||Aged, Angina Pectoris/complications/drug therapy/metabolism, Antibodies, Monoclonal/therapeutic use, Aspirin/therapeutic use, Biological Markers, Creatinine/metabolism, Female, Humans, Immunoglobulin Fab Fragments/therapeutic use, Kidney Failure/*complications/*metabolism, Logistic Models, Male, Middle aged, Myocardial Infarction/complications/drug therapy/metabolism, Myocardial Ischemia/*complications/drug therapy/*metabolism, Platelet Aggregation Inhibitors/therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors, Prognosis, Randomized Controlled Trials, Research Support, Non-U.S. Gov't, Survival Analysis, Troponin T/*metabolism|
Aviles, R.J., Newby, L.K., Califf, R.M., Lauer, M.S., Simoons, M.L., Berger, P., … Mahaffey, K.W.. (2002). Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. New England Journal of Medicine, 346(26), 2047–2052. Retrieved from http://hdl.handle.net/1765/8453