Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction
January 2002
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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.
- Male
- Aged
- Female
- Humans
- Middle aged
- Research Support, Non-U.S. Gov't
- Survival Analysis
- Prognosis
- Biological Markers
- Logistic Models
- Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors
- Troponin T/*metabolism
- Antibodies, Monoclonal/therapeutic use
- Immunoglobulin Fab Fragments/therapeutic use
- Platelet Aggregation Inhibitors/therapeutic use
- Randomized Controlled Trials
- Aspirin/therapeutic use
- Creatinine/metabolism
- Angina Pectoris/complications/drug therapy/metabolism
- Kidney Failure/*complications/*metabolism
- Myocardial Infarction/complications/drug therapy/metabolism
- Myocardial Ischemia/*complications/drug therapy/*metabolism
- troponin
- patient
- creatinine clearance
- creatinine
- clearance
- troponin t level
- level
- troponin t levels
- troponin t
- infarction
- creatinine clearance rate
- percent
- troponin t status
- value
- death
- milliliter
- quartile
- <0.001
- 0.1 ng
- ratio
